Tuberculosis - I. T. Pyatnochka 2005

Pulmonary tuberculosis combined with other diseases and pregnancy
Tuberculosis and cancer

The challenges of pulmonary oncology are closely intertwined with phthisiology, particularly when considering the significant increase in the concurrent presence of tuberculosis and Lung Cancer. Furthermore, the growth rate of this combined pathology outpaces the overall rise in lung cancer incidence.

The concurrence of these diseases is most frequently observed in men over the age of 50 with inactive Focal Pulmonary Tuberculosis, as well as chronic fibro-cavernous and cirrhotic forms. These cases are characterized by a predominant productive tissue reaction, along with pronounced sclerotic Changes in the lung parenchyma and Bronchi. Typically, cancer develops secondary to the tuberculosis process. In 78% of cases, the onset of tuberculosis precedes The Development of lung cancer by 5 to 20 years or more. Meanwhile, lung cancer in tuberculosis patients and individuals with post-tuberculosis pulmonary sequelae is often diagnosed with a significant delay—most commonly at stages III-IV—despite these patients having been under long-term dispensary observation for tuberculosis. Overall, lung cancer occurs 3 to 6 times more frequently in tuberculosis patients than in the general population.

Pathogenesis and Pathomorphology. Currently, there is no consensus regarding the exact interrelationship between tuberculosis and lung cancer; however, most authors acknowledge a pathogenetic link between the two. This connection manifests through tuberculosis—acting as any chronic pulmonary inflammation—promoting metaplasia and atypical growth of the bronchial epithelium, impairing bronchial drainage, and facilitating the accumulation of exogenous carcinogens in the presence of relevant adverse factors, which can ultimately trigger malignant transformation. Cancer arising against the Background of tuberculosis is most frequently localized in the upper lobe, though it may also develop in other lobes and segments. A malignant tumor may also originate directly at the site of a tubercular scar or within the wall of a pulmonary cavity.

Clinical presentation. The Emergence of lung cancer against the backdrop of tuberculosis leads to a general deterioration of the patient's condition, characterized by progressive weakness during tuberculostatic therapy, disproportionate severity of the pulmonary process, dyspnea, persistent cough, hemoptysis, chronic chest pain, adynamia, and fever. The patient's condition worsens significantly when endobronchial tumor growth is complicated by Atelectasis. Percussion reveals a dull note over the affected area, accompanied by diminished breath sounds and dry stenotic rales. Blood tests consistently show an elevated ESR, lymphopenia, progressive hypochromic anemia, decreased tuberculin sensitivity, and frequently negative tuberculin Skin tests. Radiologically, central cancer presents as a widened lung ROOT, enlarged regional Lymph Nodes, pulmonary hypoventilation, and bronchial obstruction resulting in atelectasis. The appearance of a solitary focus within an area of dense lesions or fibrosis suggests the potential development of lung cancer. While tumor necrosis and cavitation can occur, this is a late manifestation.

Diagnosis of lung cancer in patients with pulmonary tuberculosis relies primarily on radiological, bronchological, and Cytological examination Methods. The most informative diagnostic approach is a comprehensive bronchological evaluation. Diagnostic thoracotomy, involving the resection of the affected lung segment, serves as both a diagnostic and therapeutic Procedure.

The management of patients with co-occurring pathologies must be strictly individualized, taking into account the clinical form and phase of pulmonary tuberculosis, as well as the Morphology and extent of the malignancy. Anti-tuberculosis therapy can be administered according to standard regimens or as courses of Chemoprophylaxis. Treatment for lung cancer involves The Use of cytostatic agents, radiotherapy, surgical intervention, or a combination thereof. Consequently, the therapeutic approach for patients suffering from both tuberculosis and lung cancer must be combined, involving the simultaneous administration of anti-cancer and anti-tuberculosis treatments.