Brief message about tuberculosis and lung cancer. Cancer and pulmonary tuberculosis (Transition of tuberculosis to cancer). Independents include

Tuberculosis and lung cancer often develop simultaneously. They can easily be confused, because the diseases have similar symptoms.

What is tuberculosis

This disease is chronic infection, caused a separate species bacteria (Koch's bacillus). The respiratory organs are most often affected, but the disease can also affect other areas of the body:

• genitals;
• eyes;
• bones and joints;
• lymph nodes.

Treatment of the disease takes a lot of time. Therapy includes a complex of antibiotics, and in some cases surgery is required. In most cases, infection occurs through airborne droplets after contact with an infected person. Less commonly, the disease is transmitted through contact or due to poor personal hygiene. A patient who has this disease in its open form spreads the infection by coughing (along with sputum). A patient can infect more than 10 people in 1 year.

Pathogens are resistant to exposure environment. They may live outside for a while human body. Sunlight and ultraviolet rays are harmful to them.

What is lung cancer

The disease is the presence of a malignant tumor developing in the respiratory organs (bronchi or lungs). According to statistics, this form of oncology most often ends in death (in 85% of cases).

The undifferentiated type of the disease develops quite rapidly and is accompanied by extensive metastases. Differentiated is characterized by slow development. The small cell type is considered the most dangerous.

It is characterized by rapid development, mild symptoms, and early appearance of metastases.

The tumor most often forms in the upper part of the lung. This is due to stronger air exchange, as well as anatomical structure bronchial tree. All harmful substances that enter the body along with the air remain for a long time in the upper lobes of the lungs, causing the development of diseases.

The spread of metastases occurs in 3 ways:

1. Lymphogenic. The lymph nodes of the respiratory system are the first to be affected. The disease then spreads to everyone else.
2. Hematogenous. The tumor grows into a blood vessel. As a result, infected cells spread throughout almost the entire body.
3. Implantation. Spread occurs through the pleura.

Causes of the disease include smoking, air pollution and radiation.

Similarities

Oncological damage to the lungs and tuberculosis can be confused, because their symptoms are largely similar, these are:

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• shortness of breath (in both cases the respiratory organs are affected);
• nausea, loss of appetite, weight loss;
• cough (it cannot be treated, is present constantly or intermittently);
• hemoptysis (occurs due to damage to blood vessels in the respiratory system);
• indifference, increased fatigue;
• painful sensations in the sternum area;
• increased erythrocyte sedimentation rate;
• anemia;
• visual similarity in the picture (x-ray).

The reasons for their occurrence are also common:

• decreased protective functions of the body;
• harmful conditions labor;
• environmental (air) pollution;
• smoking (with many years of experience);
• presence of chronic lung diseases.

If you have the listed symptoms, you should not put off visiting a doctor, since both diseases are life-threatening.

What is the difference

Difference between tuberculosis and lung cancer:

1. Causes of the onset of the disease. The infection is transmitted by airborne droplets. Infection most often occurs in childhood or adolescence. A tumor is formed as a result of pathological changes occurring in cells. Among the patients, the majority are middle-aged and elderly people.
2. The nature of the disease. In the first case, the pathology occurs in 2 stages. The first stage lasts a long time, and if you have good immunity, the disease stops spreading. In the case of oncology, the disease develops rapidly and is accompanied by irreversible consequences.
3. Forecast. With adequate therapy and a timely diagnosis, the life expectancy of tuberculosis patients is much higher.

One disease differs from another in terms of treatment methods. In the first case, chemotherapy is used, aimed at destroying the causative agent of the disease. If a tumor is present, the affected area of ​​tissue is surgically removed, followed by treatment with chemotherapy.

How to distinguish

What disease the patient has - tuberculosis or lung cancer - can be distinguished if you know the signs of each of them. Symptoms of an infectious disease that are not typical for oncology:

1. Tachycardia, increased sweating, loss of appetite. If a tumor is present, such symptoms appear at a late stage.
2. The cough is worse in the morning and during sleep.
3. In the absence of proper therapy, insomnia, headaches, nausea and problems with stool appear.
4. Mycobacteria destroy bone tissue. The pathology is accompanied painful sensations in the joints, especially during physical work.
5. In rare cases, the kidneys and reproductive organs are affected. As a result, problems with urination occur and there is a possibility of infertility.
6. Are affected skin. Infiltrates appear under the epidermis.

It is vitally important to distinguish one disease from another, but in both cases you cannot do without medical care.

Can tuberculosis turn into cancer?

Combination of tuberculosis and lung cancer occurs quite often, because the first disease creates the prerequisites for the development of the second. Most of the processes characteristic of infectious disease, are favorable factors for the appearance of tumors.

Conditions for the development of oncology:

1. Inflammatory processes that constantly occur in the body.
2. Weakening of the body's protective functions. The immune system actively fights infection. The body does not have enough strength to resist the development of a new disease.
3. The affected tissue does not have time to regenerate, causing the cells to become malignant.

Even after recovery for 2 years, the risk of tumors remains. There is also inverse relationship: People with cancer are at risk of developing tuberculosis due to weakened immunity.

Differences in diagnosis

Differential diagnosis determines the signs of the disease with maximum accuracy. Methods for detailed study of pathologies used in medical institutions:

1. X-ray. When affected by mycobacteria, the lungs contain one or more homogeneous structures with clearly visible voids. In case of cancer, an expansion of the pulmonary root is observed on the radiograph.
2. Fiberglass bronchoscopy. The procedure helps to analyze bronchial secretions and find out the extent of damage to the mucous membranes and walls of the respiratory organs. The presented method allows you to take tissue for analysis and determine the presence of neoplasms. A biopsy is performed to help diagnose the disease and its stage.
3. Videothoracoscopy. It is a surgical procedure performed under general anesthesia. The obtained material allows us to make a diagnosis with great accuracy.

Tuberculosis and lung cancer are severe and also very dangerous diseases. To increase the chances of a full recovery, it is important to recognize the disease in time and carry out the appropriate course of treatment. Although pulmonary tuberculosis and cancer are considered different diseases, there are many similarities in the characteristics of their course and the symptoms they exhibit, so an incorrect diagnosis may be made in the first stages. That is why it is important to pay attention to the general symptoms and find out the difference between these ailments.

Similar symptoms

At first glance, there is nothing in common between tuberculosis and cancer. But if you thoroughly study each pathology, it will become obvious that not everything is as simple as it might seem.

Signs that indicate tuberculosis or lung cancer are very similar:

• Development of shortness of breath
• Sudden weight loss
• Availability chronic cough with the release of bloody sputum.

Sometimes even specialists find it difficult to distinguish the symptoms of cancer from an infectious disease caused by Koch's bacillus. In some cases, diagnosing the disease and making a diagnosis will take longer than expected. But it is better to detect the disease later than to start ineffective treatment. A serious assessment of the patient’s condition and carrying out appropriate tests will help identify the disease.

Symptoms of lung cancer

A specialist can predict the development of oncology based on the following signs:

• Severe fatigue
• Apathetic state
• Loss of vitality
• Fever and slight increase in body temperature, as with ARVI, flu or a cold
• An infrequent cough that became chronic
• Sputum production with blood (in the last stages of lung cancer)
• Pain in the area chest(at stages 3 or 4, analgesics do not relieve pronounced pain)
• Shortness of breath along with abnormal heart rhythm (observed in advanced cancer)
• Swelling of the upper body (face and neck).

With advanced processes, cyanosis of the mucous membranes, as well as acrocyonosis, is diagnosed. A change in the terminal phalanges may be observed (the presence of so-called “drumsticks”).

Diagnosis of lung cancer in a patient with tuberculosis or residual effects after treatment is quite a difficult task. Most effective method X-ray examination and tomography are considered. But along with this, the results of a cytological examination after taking a biopsy of the lung and lymph nodes from the patient are of main importance.

Invasive diagnostic methods (endobronchial examination or transthoracic puncture) should be carried out only if there are serious indications, when the observed symptoms and x-rays indicate the development of cancer.

Find out more about lung cancer

Signs of tuberculosis

With the development of this disease, the following symptoms may be observed:

• Lethargy
• Deterioration general condition
• Low-grade fever (body temperature – 37-38C)
• Enlarged lymph nodes
• Development of anemia
• Chronic cough accompanied by sputum
• Presence of wheezing in the lungs
• Rhinitis
• Difficulty breathing (quite rare), as well as pain in the chest.

Thus, we can conclude that pulmonary tuberculosis differs from cancer in the nature of the pathological processes (infectious or oncological), contagiousness, as well as partial symptoms.

Detailed information about tuberculosis prevention can be found here.

The relationship between two pathologies

The problem with the occurrence of the ailments in question lies in the fact that tuberculosis can gradually develop into lung cancer. This is why cancer is often diagnosed after tuberculosis has been completely cured.

Recent studies have shown that the risk of lung cancer in the presence of tuberculosis increases significantly, which is explained by the structural changes that occur within the lung tissue.

The age factor also plays a big role in this. In patients over 45 years of age with tuberculosis, the risk of developing cancer is almost 7 times higher than in younger people. This is due to a slowdown in metabolic processes, as well as a decrease in the body’s immune defense.

When tuberculosis degenerates into oncology, central and peripheral localization is observed pathological process. At the moment, there are 3 stages of lung cancer that arises against the background of tuberculosis:

• Asymptomatic period
• Obvious manifestation of symptoms
• The occurrence of metastases.

Thanks to a thorough analysis of the observed x-ray changes in the presence of a number of signs that are not characteristic of tuberculosis, it will be possible to identify oncology in a timely manner and carry out the necessary treatment.

Pulmonary tuberculosis is the 2 most life-threatening pathology of the respiratory system. Despite the fact that the development of diseases is promoted by different reasons, they have some similarities. It is not surprising that people who are far from medicine often confuse tuberculosis and lung cancer, which is considered incorrect. These diseases must be able to be distinguished from each other in the early stages, when the patient has every chance of recovery. That is why, despite the similarity of symptoms, completely different schemes are used in the treatment of these pathologies.

How is tuberculosis different from cancer?

These diseases have completely different causes and mechanisms of development.. Malignant tumors develop when the structure of cells changes, caused by genetic mutations. Cancer is not a contagious disease and cannot be transmitted from a sick person to a healthy one. Tuberculosis is caused by pathogenic microorganisms and is a highly contagious infection.

A detailed study of these pathologies reveals that they have different pathogenesis. Difficulties in diagnosis may arise due to the similarity of clinical pictures, however, here you can find some distinctive features. Why is it so important to distinguish one disease from another? early stage.

Treatment of these pathologies is carried out different ways, early initiation of therapy gives the patient a chance of survival. When treating tuberculosis, drugs are used that are aimed at destroying the infectious agent. Surgical methods are used extremely rarely. For cancer lung surgery considered the most effective way treatment. Chemotherapy helps reduce the rate of division of malignant cells, it is considered additional method treatment.

Most experts believe that tuberculosis can cause malignant degeneration of cells. Lung cancer can develop even several years after treatment is completed. For a long time, people believed that if you had tuberculosis malignant neoplasms cannot develop, however latest research showed that lung cancer often occurs against the background infectious diseases. The appearance of atypical cells is facilitated by structural changes bronchial and pulmonary tissues.

In people who have had tuberculosis, tumors are found 10 times more often than in people who have never had it.

The risk of developing cancer increases as the body ages. Thus, in people over 45 years of age, lung cancer due to tuberculosis occurs 7 times more often than in young people. Tumors can develop in any part of the lungs. Cancer developing against the background of tuberculosis occurs in 3 stages:

• asymptomatic phase;
• period of onset of severe symptoms;
• the appearance of metastases.

The clinical pictures of the diseases have much in common, which makes diagnosis difficult. It is almost impossible to make an accurate diagnosis based on the symptoms present in patients. In both tuberculosis and cancer, the following symptoms are observed:

• respiratory failure;
• hemoptysis;
• painful cough;
• weight loss;
• allocation large quantity sputum.

Both diseases lead to decreased immunity and deterioration of the general condition of the body. The following factors contribute to the development of the pathological process in both cases:

• smoking;
• infectious diseases of the respiratory system;
• living in regions with unfavorable environmental conditions;
• work in hazardous conditions.

A thorough analysis of tuberculosis allows us to find several differences. Thus, in oncopathology there are observed chronic fatigue, apathy, slight increase in temperature, general weakness. Cough in the early stages of the disease is short-term. At stages 3-4 it becomes chronic, characterized by the appearance of prolonged attacks. Hemoptysis and severe pain behind the sternum appear only at stage 3 of cancer. Pain syndrome cannot be eliminated with standard painkillers.

As the malignant tumor grows, swelling of the face and neck, signs of acute heart failure, and cyanosis of the mucous membranes and skin appear.

With pulmonary tuberculosis, the following clinical picture is observed:

1. Increased fatigue is combined with increased sweating.
2. Low-grade fever persists constantly.
3. Lymph nodes enlarge and anemia develops.
4. A severe cough with large amounts of sputum appears in the early stages of the disease. It is accompanied by a chronic runny nose.
5. Hemoptysis appears as the pathology develops.
6. Pain sensations are localized in the lung area.

Differential diagnosis is carried out using laboratory research- cytological analysis of affected lung tissues and lymph nodes. With lung cancer, the number of lymphocytes and leukocytes in the blood increases. In tuberculosis, pronounced lymphocytosis is observed. The development of malignant tumors leads to a decrease in albumin levels and an increase in globulin content. In case of infectious lesions of the lungs, the protein composition of the blood remains unchanged.

Main diagnostic method is the injection of tuberculin under the skin. In patients with tuberculosis, the amount of albumin decreases and the level of globulin compounds increases. For cancer, test results do not change after tuberculin administration.

Tuberculosis and lung cancer are completely different pathologies, which in some cases can be combined with each other. How is treatment carried out in such cases and how pathologies develop.

Treatment of lung cancer that frolicked against the background of tuberculosis

Pulmonary tuberculosis is treated with standard chemotherapy drugs, selected depending on the form of the pathology. A malignant tumor promotes the activation of pathogenic microorganisms. If there are post-tuberculosis changes in the lung tissues, tuberculostatic agents are used. Preparing the patient for surgical intervention consists of radiation and chemotherapy.

During the operation it is deleted as malignant tumor, and foci of tuberculosis lesions.

When examining patients at risk, it is mandatory to use radiological methods, for example, fluorography. It is necessary to visit a doctor even if there are no symptoms of the disease. Constant observation by a TB specialist is recommended for people who have chronic diseases respiratory organs working in hazardous conditions who have had tuberculosis and live in unfavorable conditions.

According to WHO statistics, the incidence of lung cancer in the population increases annually by 5-7%, while the epidemiological indicators of tuberculosis are steadily decreasing.

The average life expectancy of patients with tuberculosis has increased and is 55-60 years. Under these conditions, the preconditions are created for an increase in the incidence of lung cancer among them. According to various authors, the frequency of combined diseases of tuberculosis and lung cancer varies widely - from 6.8 to 40%. According to the observations of A.E. Rabukhin, when comparing intensive indicators, it was established that in 1967-1969. Lung cancer was observed among patients with respiratory tuberculosis 4-4.5 times more often than among the corresponding age group of the population, and in 1973, in persons 40-49 years old, primary lung cancer was observed 4.9 times more often, and at the age of 60 years and older - 6.6 times. According to S. D. Poletaev et al. (1982), frequency of fluorographic detection primary cancer lung in combination with tuberculous changes in the respiratory organs increased by last years compared with persons sick only with tuberculosis, 2.1 times. During the period from 1947 to 1983, according to autopsy materials, the proportion of bronchogenic cancer among patients with tuberculosis increased from 1.8 to 8.2%.

There are different points of view regarding the pathogenetic relationship between tuberculosis and lung cancer. Supporters of some points of view exclude the possibility of such a connection and emphasize the antagonism between these diseases, while supporters of others not only admit the possibility of their coexistence, but also emphasize the certain role of tuberculosis in the development of the tumor process.

The possible role in this regard of foci in the lungs and intrathoracic lymph nodes with calcified inclusions and scars on the bronchial mucosa is indicated. However, it is noted that cancer can be localized outside the area of ​​a specific process in the lungs. Despite the contradictory nature of the above points of view, it is currently generally accepted that tuberculosis and lung cancer occur independently of each other; More often, with this combined disease, tuberculosis is the first and cancer is added to it, but it is possible for a patient with lung cancer to develop active tuberculosis. The combination of these diseases is more common in men over 50 years of age with focal pulmonary tuberculosis in the inactive phase, but is often found in fibrous-cavernous and cirrhotic forms that occur chronically, with a predominance of the productive type of reaction, pronounced sclerotic changes in the lung tissue and bronchi. Such individuals constitute a risk group for lung cancer. It is believed that tuberculosis does not significantly affect the course of lung cancer, but lung cancer can affect the state of the tuberculosis process, contributing to its exacerbation and progression.

Diagnosis of lung cancer in patients with tuberculosis is difficult due to the low-symptomatic initial manifestations, the commonality of many clinical signs disease, the absence of characteristic pathological signs of early stage cancer, the duration of the asymptomatic period. In order to early diagnosis You should be aware of cancer masks. The combination of cancer with tuberculosis greatly increases the uniqueness clinical picture diseases. The most common masks for the combination of cancer and tuberculosis are pneumonia, exudative pleurisy, especially hemorrhagic. Their development in these patients should alert us to the presence of a tumor process.

When solving differential diagnostic problems, one should take into account a number of patterns characteristic of each disease, in particular, indications in the anamnesis of contact with bacterial excretors, previous pleurisy, adenopathy in tuberculosis, and in case of cancer - family history, chronic inflammatory processes in the lungs.

Patients with tuberculosis are characterized by moderate cough with sputum, shortness of breath and adynamia, while with lung cancer - a painful cough, chest pain, pronounced adynamia, shortness of breath, inadequate to x-ray changes in the lungs. Only some forms of cancer can remain asymptomatic for a long time.

Stetoacoustically (due to more intense tissue compaction), the dullness of percussion sound in cancer is more pronounced. A special place in the differential diagnosis of both diseases is occupied by the x-ray method. It has been established that cancerous changes are more often localized in the middle and lower parts of the lungs, closer to the root; the number and size of foci increase towards the basal parts of the lung. A blastomatous node is characterized by tuberosity and uneven contours, and the absence of areas of calcification. Unlike tuberculous infiltrate, central cancer is accompanied by atelectasis of the lobe or lung segment, para-cancrosis pneumonia, enlarged intrathoracic lymph nodes. While in tuberculosis the X-ray image is characterized by polymorphism, the presence of bronchogenic seedings and adhesions, emphysema with chronic forms, with lung cancer, a single rounded shadow with sharp but uneven boundaries, unilateral expansion of the root, often with symptoms of hypoventilation, are more often observed. The main types of radiological manifestations of combined lung disease with tuberculosis and cancer were determined by A. E. Rabukhin. M. A. Myskin et al. The earliest sign of central lung cancer is the appearance, in close connection with the elements of the root, of a round, medium-intensity, homogeneous, ill-defined shadow measuring 3-5 mm against the background of a preserved root structure. An early sign of peripheral cancer is the appearance in the intact area of ​​the lung of a group of nodular shadows measuring 3-5 mm. The intravital diagnosis of a cancerous tumor that has developed from the wall of the cavity is described, based on the appearance in patients of anemia, persistent hemoptysis and an additional shadow with a polycyclic contour identified on the inner surface of the cavity wall.

Bronchological examination data are important for the differential diagnosis of cancer and pulmonary tuberculosis. While in tuberculosis changes in the bronchi are in the nature of wall infiltration, erosion, proliferation of granulation tissue, scar changes, in bronchogenic cancer a tumor is detected that narrows or obstructs the bronchial lumen. Studies of biopsied material, especially by catheterization biopsy, or sputum for atypical cells help clarify the diagnosis; upon bronchography, they reveal a narrowing or “amputation” of the bronchus, the latter is rare, but can also occur with tuberculosis. From data laboratory methods studies should take into account leukocytosis, accelerated ESR, lymphopenia, characteristic of cancer patients, hypochromic anemia, high level serum α 2 - and γ-globulins.

Concerning tuberculin tests, then with tuberculosis, especially with tuberculomas, sensitivity to tuberculin is high, in patients with cancer it is often negative or weakly positive. Bronchogenic cancer developing against the background of tuberculosis often entails the extinction of tuberculosis allergy.

For the purposes of differential diagnosis, serological and immunological reactions have been successfully used in recent years.

The clinical picture of the combined disease - tuberculosis and lung cancer - is varied and depends on the stage, form of bronchogenic cancer (central or peripheral, endo-, exo- or peribronchial growth), localization, as well as the form and phase of the tuberculosis process.

A detailed study of these features allowed D. D. Yablokov and A. I. Galibina to identify 3 periods during this combined disease: the period of asymptomatic or low-symptomatic course of the tumor, the period of pronounced symptoms of the disease, and the period of complications and metastasis.

Treatment of patients with tuberculosis and lung cancer should be comprehensive using combined antibacterial therapy and when indicated - surgical methods treatment. The issue of radiation therapy and chemotherapy with anticancer drugs. In the presence of a limited tuberculosis process, it can be carried out surgery lung cancer. In this case, both in the pre- and postoperative period, long-term therapy with anti-tuberculosis drugs is necessary.

The prognosis of this combined disease largely depends on timely detection.

Many researchers and practitioners point to data that 65 - 90 patients out of a hundred suffering from lung cancer, especially in the first stages, are subject to illiterate treatment for common colds, pneumonia, asthma, pulmonary fibrosis, tuberculosis and other pathologies with similar symptoms .

Primary signs resemble manifestations of ordinary inflammation, which are often ignored, and the time for a complete cure of oncology is lost. Even obvious symptoms of stage 3–4 cancer, when the drainage function bronchi, the walls of the lung collapse, and inflammation becomes aggressive, confused with manifestations of pulmonary fibrosis.

Therefore, accurate differential diagnosis for lung cancer is key to early treatment.

Basic diagnostic methods

If cancerous changes in the lung tissue are suspected, a mandatory standard complex is carried out:

Physical examination and analysis of all, even mild, signs indicating pulmonary pathology;
Cytological examination of a sputum sample. Tumor cells are usually detected in central cancer (in peripheral oncology they are detected only through multiple tests).

• X-ray of the chest in two projections, targeted radiography.
• Large-frame fluorography.
• NSCT - low-dose computed spiral tomography.
• Magnetic resonance examination (MRI tomography)
• PET or positron emission tomography (performed when deciding on surgery).
• Bronchoscopy (direct visual examination of the mucous membrane and bronchi using a bronchofibroscope or endoscope).
• Biopsy (morphological examination under a microscope of a fragment of bronchial tissue). Used to confirm the diagnosis. Prescribed after X-ray and CT scanning.
• Transthoracic pleural puncture.
• Blood test for specific tumor markers.
• Study of cells in washings after bronchoalveolar lavage. Its diagnostic value is equal to that of a biopsy.

Differences between lung tumors and other diseases

Tuberculosis and cancer

How does tuberculosis differ from cancer and how to recognize the disease by external signs?

Tuberculosis and lung cancer are completely different pathologies, although external manifestations these diseases are very similar. Malignant formation occurs due to cellular mutations and is not contagious, while tuberculosis is caused by mycobacterium (Koch bacillus) and is extremely contagious.

Symptoms characteristic of both pathologies:

• pronounced weight loss;
• severe muscle weakness, general fatigue;
• cough of varying degrees of intensity, shortness of breath;
• the presence of bloody inclusions in the sputum;
• chest pain;
• disturbance of the frequency and rhythm of the heartbeat.

How to distinguish tuberculosis from pulmonary oncology? There is a certain difference in symptoms that an experienced doctor notices.

To differentiate pulmonary tuberculosis and cancer, pay attention to the following features:

• cancerous changes in cells cytological examination a fragment of tissue from the lesion and lymph nodes;
• in oncology, a noticeable decrease in the concentration of lymphocytes is observed, in tuberculosis, on the contrary, there is an increased content of lymphocytes;
• during a malignant process, the amount of albumin in the serum significantly decreases and the level of globulin proteins increases;
• diagnosis of tuberculosis also involves examining at least three sputum samples under a Ziehl-Neelsen microscope;
• for tuberculosis, the Mantoux test gives a bright positive reaction, while there is a decrease in albumin fractions and an increase in globulins; in cancer, the reaction to tuberculin is negative or weakly positive, and there are no changes in the composition of protein fractions.

Pneumonia and lung cancer

Experts say that often, as a result of an incorrect diagnosis of pneumonia, a patient with the initial stage of pulmonary oncology is prescribed physiotherapy with deep heating. Such fatal mistakes greatly increase the tumor's aggression.

Usually, to clarify the diagnosis, treatment with antibacterial agents is started, changing the antibiotic after 3 to 5 days. It is believed that if no significant improvement is detected within 10–14 days, then there are grounds for an oncological diagnosis.

Based on the results of treatment and examination, pneumonia is confirmed by such factors as:

1. acute onset;
2. pronounced signs of inflammatory phenomena (may also be present in oncology);
3. listening to moist rales;
4. higher levels of leukocytes and ESR, which decrease during the treatment of pneumonia;
   rapid therapeutic effect against the background of antibacterial therapy (but in initial stage of the cancer process in 25–40 patients out of a hundred, antibiotics also give a false positive result);
5. positive changes on the radiograph after 10–14 days during treatment with antibiotics.

The last factor has the greatest diagnostic significance in the differentiation of oncological pathology. The signs of cancer and pneumonia on radiography are very similar; darkening for both diagnoses can be homogeneous or heterogeneous.

But when analyzing the features of the x-ray, it is noted:

• the shadows of a cancerous tumor in the first stages have clear outlines, sometimes a complex shape;
• the shadow of the root node is noticeably expressed;
• as it progresses, the darkening contour blurs, and a so-called “corolla” becomes noticeable around the tumor, having short or long “radiant shadows” (spikes, processes), the formation of which is due to the active spread of cancer cells along the walls of blood vessels and bronchi;
• the size of the tumor node does not decrease after antibiotic therapy.

Fibrosis and cancer

Pulmonary fibrosis is an abnormal process in the lungs in which their walls collapse (shrink), and connective tissue is formed instead of normal functioning tissue. The more aggressively it grows, the more pronounced the development of fibroatelectasis is - the rapprochement of the walls of the organ, the replacement of collapsed tissue with fibrous tissue and disruption of respiratory function up to suffocation, as in asthma.

The external symptoms of oncology and pulmonary fibrosis are almost the same, and many believe that pulmonary fibrosis is cancer, although the pathologies are of a different nature.

Although the basic symptoms in the first stages of both diseases are similar, however, with the progression of pulmonary fibrosis and large-scale tissue damage, the following is observed:

• cyanosis of the mucous membranes is stronger than in oncology;
• watery cough;
• intense increase in heart failure: pulsation, swelling of the veins in the neck, tachycardia;
• changes in the terminal phalanges of the fingers like “drum sticks”, and nails like “watch glasses”.

Symptoms of changes in fingers like “drumsticks” and nails like “watch glasses”

However, these signs are not specific. Bronchoscopy in the case of fibrosis is also not considered as an indicative diagnostic study.

To accurately determine that it is pulmonary fibrosis and not cancer, studies include:

1. X-ray, in which changes in fibrosis are detected on both sides, more often in the lower segments.
2. Computed tomography (as the second significant method).
3. Pulmonary angiography, which allows to detect the expansion of the central branches in the pulmonary vessels and the narrowing of the peripheral ones.
4. Biopsy. This method, used to differentiate cancer from pulmonary fibrosis, is considered the most reliable.