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오염된 공기로부터 까맣게 싹트는 폐암


 

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폐암이란 폐에 생긴 악성 종양을 통틀어 말한다. 분류를 하자면, 기관지나 폐포에서 처음 암세포가 발생한 원발성 폐암과 그 외 다른 기관에서 암세포가 발생, 혈관이나 림
프관을 타고 폐로 이동해 발생한 전이성 폐암이 있다.

일반적으로 폐암이라 칭하는 것은 원발성 폐암을 말하는데, 이 원발성 폐암은 다시 암세포의 형태에 따라 비소세포성 폐암과 소세포성 폐암으로 나뉜다. 이와 같이 비소세포성 폐암과 소세포성 폐암을 구분하는 이유는 각 경우마다 임상적 경과와 치료 방법에 차이가 많이 나기 때문이다. 비소세포성 폐암은 조기에 진단할 시 수술 치료로 완치를 기대할 수 있으나 소세포 폐암은 진단 당시, 수술이 불가능한 경우가 많으며 암세포가 급속히 성장하나 항암화학요법이나 방사선 치료에 잘 반응하는 편이다.

통상적으로 폐암이라고 하면 폐암의 약 80~85%를 차지하는 비소세포성 폐암을 일컬으며, 이런 비소세포성 폐암은 다시 편평상피암, 선암, 대세포암 등으로 세분화할 수 있다.


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폐암의 발생과 관련성이 잘 밝혀져 있는 것은 연령과 흡연력이다. 나이와 폐암에는 상관관계가 매우 높아, 폐암 발병률은 50세 미만의 연령에서는 많지 않으며 60세 이상의 연령에서 급격히 증가하는 것으로 알려져 있다.

이러한 폐암의 발병률은 비흡연자 여성에게서는 가장 낮은 10만 명당 10명 전후의 발생률을 보이며, 흡연자이며 남자인 경우 그 발생률이 급격히 높아져 10만 명당 약 100명을 상회하는 것으로 보고되고 있다.

폐암의 발병률은 구미 선진국의 자료에 의하면 담배의 판매량과 상당히 일치하는 것으로 알려져 있다. 미국의 자료에 의하면 담배의 제조와 판매가 정점에 도달하였던 1940년대부터 약 20~25년 뒤인 1960년대에 폐암의 발생률과 사망률이 최고조에 도달하였으며 이후 폐암의 발생률과 사망률은 점차 하향되어 가고 있는 상황이다.

우리나라의 상황도 이와 비슷할 것으로 추정되며 국내의 담배 생산량과 판매량이 최고조였던 적이 1996~1998년 사이였으므로 2020년대 전후에 폐암 발생률이 최고조에 도달 할 것으로 추정되고 있다.

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담배에서 발견되는 유해 물질은 약 4,000종 가량 되는 것으로 알려져 있다. 이 중에서 직접적인 발암 물질로 알려진 것은 60종 이상이다. 흡연과 폐암의 발생 비율은 담배를 피우는 양이 많을수록, 일찍 흡연을 시작할수록, 흡연 기간이 길수록 증가한다.

흡연자와 같이 생활하면서 담배연기를 흡입하는 간접흡연은, 타고 있는 담배의 끝에서 나오는 부류연과 흡연자가 흡입한 후 내뿜는 주류연으로 나눌 수 있는데, 간접 흡연
자는 주류연보다 부류연에 많이 노출된다.

그런데 부류연은 주류연보다 더 많은 독성 물질을 포함하고 있어, 직접 흡연과 다름없는 폐암의 주된 위험 요인이 된다.
자연계에 존재하는 것과 인위적으로 생성된 방사성 동위원소 모두 폐암의 발암원이 될 수 있는데, 특히 일반인의 경우에는 라돈을 통한 동위원소에 대한 노출이 폐암의 주요 위험 요인이 된다. 라돈은 우라늄의 부산물로서 지하수 또는 지표면을 통하여
밀폐된 건물 내부로 들어가며, 환기시키지 않을 경우 농도가 높아지게 되는데, 폐암의 발생 원인으로 흡연 다음 순위로 추정되고 있으나, 이에 대한 국내외의 연구 결과는 많지 않다.

또한 장기간의 항공 여행 등에서 노출되는 방사선이나 통상적인 엑스선 검사(X-ray)나 전산화단층촬영(CT) 등의 방사선학적 검사에 쓰이는 방사선량은 미미하여, 폐암의 발생 원인으로 여기고 있지는 않는다.

한편 자동차의 배기가스에서 발생하는 발암 물질에는 벤즈피린, 방사선물질, 비산화물질, 크롬 및 니켈혼합물, 비연소성 지방족 탄화수소 등이 있으며, 이 물질은 도시의 공기 속에 포함되어 폐암을 발생시키는 주요 위험 요인으로 작용한다.

특히 흡연과 환경 오염원은 폐암 발병을 부추긴다는 보고가 있으며, 지구의 온난화와도 많은 관계가 있어 전 세계적인 노력으로 화석 연료의 사용을 줄여야 한다.
특정 직업 또는 지역에 노출되면서 폐암의 발생률을 높이는 위험 물질로는 과거 저밀도 단열제, 건축 자재 등에 사용되었던 석면이 있으며 이외에 도비소, 석면, 크롬, 니켈, 다환 방향족 탄화수소, 염화 비닐 등과 같은 위험 물질에 노출되면 폐암의 위험
이 증가할 수 있다.

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강남세브란스병원의 호흡기 내과 및 흉부외과의 폐암 전문 클리닉에서는 폐암을 조기에 진단하고자 최신의 64-채널의 저선량 흉부 전산화 단층촬영(CT scan)을 이용한 조기 폐암 검진 프로그램을 운영하고 있다.

저선량 흉부 전산화 단층촬영은 기존의 흉부 X-선, 객담 세포진 검사보다 매우 정확하고 민감한 검사법이며 조영제를 사용하지 않고 최소한의 방사선량으로서 인체에 미치는 유해 영향을 극소화하였다. 아울러 식사 여부와 관련 없이 검사가 가능하고 검사 시간은 5분 정도로, 간편한 검사이다.

또한 강남세브란스병원에서는 저선량 흉부 전산화 단층촬영에서 폐결절(폐암을 의심하는 소견)이 발견되는 경우 양전자 방출 단층촬영(PET)을 실시하여 병의 정확한 성격과 전신의 상태를 다시 정확하게 확인하게 된다. 아울러 전산화 단층촬영과 양전자 방출 단층촬영을 융합한 PET-CT 장비는 전신적인암 검사에 유용하게 이용되고 있다.

한편 강남세브란스병원에서는 호흡기내과, 흉부외과, 영상의학과, 종양내과, 진단병리과 및 방사선종양학과의 의료진이 폐암의 조기 진단 및 치료 과정에 함께 참여하고 있다.

강남세브란스 암전문병원 폐암 클리닉 바로가기

강남세브란스병원 페이스북 바로가기



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2012/03/23 15:51 2012/03/23 15:51

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