Kliniczne aspekty chorób układu oddechowego: część 1 i 2 | Clinical Aspects of Respiratory System Diseases: part 1 and 2

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“Environmental triggers”: “Czynniki środowiskowe wyzwalające”, “Allergic factors”: “Czynniki alergiczne”, “Airway inflammation”: “Zapalenie dróg oddechowych”, “Asthma Phenotypes”: “Fenotypy astmy”, “Allergic Asthma”: “Astma alergiczna”, “Atopic Asthma”: “Astma atopowa”, “Non-Allergic Asthma”: “Astma niealergiczna”, “Exercise-Induced Asthma”: “Astma wysiłkowa”, “Occupational Asthma”: “Astma zawodowa”, “Causes and Triggers”: “Przyczyny i czynniki wyzwalające”, “Allergens”: “Alergeny”, “Pollen”: “Pyłki roślin”, “Dust mites”: “Roztocza kurzu domowego”, “Pet dander”: “Naskórek i sierść zwierząt”, “Mold”: “Pleśnie”, “Irritants”: “Substancje drażniące”, “Tobacco smoke”: “Dym tytoniowy”, “Air pollution”: “Zanieczyszczenie powietrza”, “Respiratory infections”: “Infekcje układu oddechowego”, “Clinical Manifestations”: “Objawy kliniczne”, “Wheezing”: “Świszczący oddech”, “Shortness of breath”: “Duszność”, “Coughing”: “Kaszel”, “Chest tightness”: “Ucisk w klatce piersiowej”, “Mild intermittent asthma”: “Łagodna, przerywana astma”, “Inhaled corticosteroids (ICS)”: “Wziewne glikokortykosteroidy (ICS)”, “Long-acting beta-agonists (LABAs)”: “Długo działające beta2-mimetyki (LABA)”, “Leukotriene modifiers”: “Modulatory receptorów leukotrienowych”, “Quick-relief medications”: “Leki szybko działające”, “Short-acting beta-agonists (SABAs)”: “Krótko działające beta2-mimetyki (SABA)”, “Biologic therapies”: “Terapie biologiczne”, “Status Asthmaticus”: “Stan astmatyczny”, “Airway remodeling”: “Przebudowa dróg oddechowych”, “Chronic Obstructive Pulmonary Disease (COPD)”: “Przewlekła obturacyjna choroba płuc (POChP)”, “Progressive disease”: “Choroba postępująca”, “Chronic bronchitis”: “Przewlekłe zapalenie oskrzeli”, “Emphysema”: “Rozedma płuc”, “Persistent airflow obstruction”: “Utrwalona obturacja dróg oddechowych”, “Alpha-1 antitrypsin deficiency”: “Niedobór alfa-1-antytrypsyny”, “Chronic cough”: “Przewlekły kaszel”, “Dyspnea”: “Duszność”, “Barrel chest”: “Klatka piersiowa beczkowata”, “Spirometry”: “Spirometria”, “FEV1/FVC ratio”: “Stosunek FEV1/FVC”, “Pulmonary rehabilitation”: “Rehabilitacja oddechowa”, “Oxygen therapy”: “Tlenoterapia”, “Long-term oxygen therapy (LTOT)”: “Długotrwała tlenoterapia (LTOT)”, “Smoking cessation”: “Zaprzestanie palenia tytoniu”, “Pulmonary Hypertension”: “Nadciśnienie płucne”, “Cor Pulmonale”: “Serce płucne”, “Respiratory Failure”: “Niewydolność oddechowa”, “Influenza (Flu)”: “Grypa”, “Acute respiratory infection”: “Ostra infekcja układu oddechowego”, “Influenza viruses”: “Wirusy grypy”, “Fever”: “Gorączka”, “Myalgia”: “Bóle mięśniowe”, “Rapid influenza diagnostic tests (RIDTs)”: “Szybkie testy diagnostyczne na grypę (RIDT)”, “Polymerase chain reaction (PCR) testing”: “Test PCR”, “Vaccination”: “Szczepienie”, “Antiviral medications”: “Leki przeciwwirusowe”, “Oseltamivir”: “Oseltamiwir”, “Zanamivir”: “Zanamivir”, “Acute Respiratory Distress Syndrome (ARDS)”: “Zespół ostrej niewydolności oddechowej (ARDS)”, “Myocarditis”: “Zapalenie mięśnia sercowego”, “Encephalitis”: “Zapalenie mózgu”, “Lung Cancer”: “Rak płuc”, “Non-Small Cell Lung Cancer (NSCLC)”: “Rak niedrobnokomórkowy płuca (NSCLC)”, “Small Cell Lung Cancer (SCLC)”: “Rak drobnokomórkowy płuca (SCLC)”, “Secondhand smoke exposure”: “Ekspozycja na bierne palenie”, “Asbestos exposure”: “Ekspozycja na azbest”, “Radon gas”: “Gaz radonowy”, “Environmental exposure”: “Ekspozycja środowiskowa”, “Adenocarcinoma”: “Gruczolakorak”, “Squamous Cell Carcinoma”: “Rak płaskonabłonkowy”, “Large Cell Carcinoma”: “Rak wielkokomórkowy”, “Growth rate”: “Tempo wzrostu”, “Metastasis”: “Przerzuty”, “Stage IV cancer”: “Rak w IV stadium zaawansowania”, “Chemotherapy”: “Chemioterapia”, “Radiation therapy”: “Radioterapia”, “Targeted therapy”: “Terapia celowana”, “Immunotherapy”: “Immunoterapia”, “Persistent Cough”: “Przewlekły kaszel”, “Hemoptysis”: “Krwioplucie”, “Unexplained weight loss”: “Niewyjaśniona utrata masy ciała”, “Recurrent lung infections”: “Nawracające infekcje płuc”, “Bronchoscopy”: “Bronchoskopia”, “Biopsy”: “Biopsja”, “PET Scan”: “Pozytonowa tomografia emisyjna (PET)”, “Lobectomy”: “Lobektomia”, “Segmentectomy”: “Segmentektomia”, “Pneumonectomy”: “Pneumonektomia”, “Superior Vena Cava Syndrome”: “Zespół żyły głównej górnej”, “Paraneoplastic Syndromes”: “Zespoły paranowotworowe”, “Hypercalcemia”: “Hiperkalcemia”, “Hyponatremia”: “Hiponatremia”, “Cushing’s Syndrome”: “Zespół Cushinga”, “EGFR mutations”: “Mutacje EGFR”, “ALK mutations”: “Mutacje ALK”, “Respiratory failure”: “Niewydolność oddechowa”, “Airway obstruction”: “Zablokowanie dróg oddechowych”, “Eczema”: “Egzema”, “Allergic rhinitis”: “Alergiczny nieżyt nosa”, “Triggered”: “Wywołany”, “Frequent Hospitalizations”: “Częste hospitalizacje”, “Exacerbations”: “Zaostrzenia”, “Progressive”: “Postępujący”, “Irreversible”: “Nieodwracalny”, “Ciliated epithelium”: “Nabłonek migawkowy”, “Chronic inflammation”: “Przewlekłe zapalenie”, “Bullae”: “Pęcherze “, “Emphysematous changes”: “Zmiany rozedmowe”, “Bronchial wall thickening”: “Pogrubienie ściany oskrzeli”, “Bronchodilators”: “Leki rozszerzające oskrzela”, “Hypoxemia”: “Hipoksemia”, “Mortality rates”: “Wskaźniki śmiertelności”, “Deterioration”: “Pogorszenie”, “Antibiotics”: “Antybiotyki”, “Corticosteroids”: “Kortykosteroidy”, “Bronchodilator”: “Lek rozszerzający oskrzela”, “Contagious”: “Zakaźny”, “Cough”: “Kaszel”, “Dry”: “Suchy”, “Productive”: “Produktywny”, “Sore throat”: “Ból gardła”, “Nasal congestion”: “Zatkany nos”, “Muscle aches”: “Bóle mięśni”, “Fatigue”: “Zmęczenie”, “Chronic diseases”: “Choroby przewlekłe”, “COPD”: “Przewlekła obturacyjna choroba płuc (POChP)”, “Pneumonia”: “Zapalenie płuc”, “ARDS”: “Zespół ostrej niewydolności oddechowej (ARDS)”, “Flu season”: “Sezon grypowy”, “Polymerase chain reaction”: “Reakcja łańcuchowa polimerazy (PCR)”, “Antipyretics”: “Leki przeciwgorączkowe”, “Alleviate symptoms”: “Łagodzenie objawów”, “Elderly”: “Osoby starsze”, “Radon”: “Radon”, “Asbestos”: “Azbest”, “Secondhand smoke”: “Dym tytoniowy z otoczenia”, “Pollutants”: “Zanieczyszczenia”, “Uncomplicated Influenza”: “Nieskomplikowana grypa”, “High-Risk Populations”: “Populacje wysokiego ryzyka”, “Prolonged exposure”: “Długotrwała ekspozycja”, “Staging”: “Stadia zaawansowania nowotworów”, “Metastatic disease”: “Choroba przerzutowa”, “Chest Pain”: “Ból w klatce piersiowej”, “Dull ache”: “Tępy ból”, “Sharp pain”: “Ostry ból”, “Confined to one lung”: “Ograniczony do jednego płuca”, “Limited-stage”: “Stadium ograniczone”, “Extensive-stage”: “Stadium rozsiane”, “Spread beyond the lung”: “Rozprzestrzenienie poza płuco”, “Surgery”: “Operacja”, “NSCLC”: “Niedrobnokomórkowy rak płuca (NSCLC)”, “SCLC”: “Drobnokomórkowy rak płuca (SCLC)”, “Pleural Effusion”: “Wysięk opłucnowy”, “Pleural cavity”: “Jama opłucnej”, “Facial swelling”: “Obrzęk twarzy” }; // Normalize keys in the dictionary const normalizedWordsToTooltip = {}; for (const [key, value] of Object.entries(wordsToTooltip)) { const cleanedKey = key.replace(/(.*?)/g, 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Szacowany czas lekcji: 48 minut
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Asthma

Asthma is a chronic inflammatory disease of the airways, characterized by reversible airway obstruction, hyperresponsiveness, and bronchoconstriction. This disease affects people of all ages and is often triggered by environmental and allergic factors. Asthma’s pathology is rooted in airway inflammation, leading to episodic exacerbations and varying levels of severity.

Asthma Phenotypes

Asthma can manifest in different phenotypes, each with distinct clinical characteristics.

Asthma PhenotypeClinical Characteristics
Allergic (Atopic) AsthmaTriggered by allergens like pollen, dust mites, and pet dander. Often linked to a personal or family history of allergic conditions such as eczema or allergic rhinitis.
Non-Allergic AsthmaTriggered by non-allergenic factors such as stress, infections, weather changes, or irritants like smoke.
Exercise-Induced AsthmaPhysical activity, particularly in cold or dry air, triggers symptoms. Common in athletes or those engaging in physical exertion in specific environments.
Occupational AsthmaTriggered or worsened by exposure to specific irritants or chemicals in the workplace (e.g., paint fumes, dust, cleaning agents). Avoidance of these triggers is essential.

Causes and Triggers

Asthma is influenced by a combination of genetic and environmental factors, including:

  • Allergens: Pollen, dust mites, pet dander, and mold can provoke airway inflammation.
  • Irritants: Tobacco smoke, strong odors, and air pollution exacerbate airway reactivity.
  • Infections: Viral respiratory infections, especially in childhood, can contribute to asthma onset or exacerbations.
  • Exercise: Cold or dry air during physical activity can trigger bronchoconstriction.
  • Occupational Exposures: Certain chemicals or irritants in the workplace may lead to occupational asthma.

Clinical Manifestations

Asthma symptoms vary in intensity and frequency, often occurring episodically, and include:

  • Wheezing: A high-pitched whistling sound during exhalation.
  • Shortness of breath: Difficulty breathing, often felt as chest tightness.
  • Coughing: Persistent, particularly at night or early in the morning.
  • Chest tightness: A feeling of pressure or constriction in the chest.

Note: Patients with mild intermittent asthma may experience symptoms less than twice a week and have normal lung function between episodes.

Treatment

Management of asthma focuses on reducing airway inflammation, preventing exacerbations, and relieving acute symptoms:

  • Inhaled corticosteroids (ICS): First-line anti-inflammatory medications that control chronic airway inflammation.
  • Long-acting beta-agonists (LABAs): Used in combination with ICS for long-term control of moderate to severe asthma.
  • Leukotriene modifiers: Oral medications that reduce inflammation by blocking the effects of leukotrienes.
  • Quick-relief medications: Short-acting beta-agonists (SABAs) provide immediate relief by relaxing bronchial smooth muscles during asthma attacks.
  • Biologic therapies: Target specific pathways in the immune response and are used in severe asthma cases unresponsive to standard treatment.

Complications

  • Status Asthmaticus: A life-threatening exacerbation requiring immediate medical intervention.
  • Frequent Hospitalizations: Due to poorly controlled asthma or recurrent exacerbations.
  • Airway Remodeling: Chronic inflammation may lead to irreversible changes in the airway structure, resulting in fixed airflow obstruction.

Prognosis

  • Mild to Moderate Asthma: Patients can generally manage symptoms well with regular use of controller medications and lifestyle modifications. With adherence to treatment, the risk of severe exacerbations is minimized, and many individuals lead normal, active lives.
  • Severe Asthma: Prognosis varies; while some may respond to advanced therapies like biologics, others experience persistent symptoms and frequent exacerbations, increasing the risk of complications such as airway remodeling and reduced lung function over time.

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a progressive and irreversible disease that includes chronic bronchitis and emphysema, leading to persistent airflow obstruction. It primarily affects older adults with a history of smoking or significant environmental exposures.

Causes and Risk Factors

  • Tobacco smoke: The leading cause of COPD, responsible for damaging the ciliated epithelium of the airways, resulting in chronic inflammation.
  • Environmental exposures: Prolonged exposure to air pollutants, dust, or workplace chemicals.
  • Alpha-1 antitrypsin deficiency: A rare genetic condition that predisposes individuals to COPD.

Clinical Manifestations

COPD presents with a slow progression of respiratory symptoms, including:

  • Chronic cough: Often productive of mucus (especially in chronic bronchitis).
  • Dyspnea: Worsening shortness of breath, particularly on exertion.
  • Wheezing: Audible during both inspiration and expiration due to airway obstruction.
  • Chest tightness: Persistent and worsened by physical activity.
  • Barrel chest: An increased anteroposterior diameter of the chest due to air trapping (seen in emphysema).

Diagnosis

  • Spirometry: The gold standard for diagnosing COPD, showing a decreased FEV1/FVC ratio (<70%).
  • Chest X-ray: Hyperinflated lungs and a flattened diaphragm are typical findings in emphysema.
  • CT scan: Can reveal the presence of bullae, emphysematous changes, and bronchial wall thickening.

Treatment

While there is no cure for COPD, several treatments aim to manage symptoms, slow the progression of the disease, and improve patients’ quality of life. Key components of COPD management include:

  • Bronchodilators: These medications, available in both short-acting and long-acting forms (beta-agonists or anticholinergics), help relax the airway muscles, improving airflow and reducing symptoms like shortness of breath.
  • Inhaled corticosteroids: Particularly useful in patients with frequent exacerbations, inhaled corticosteroids help reduce airway inflammation, thereby lowering the frequency of exacerbations and improving lung function.
  • Pulmonary rehabilitation: This multidisciplinary program involves exercise training, education, and psychological support, all aimed at improving the patient’s physical fitness and emotional well-being. It also provides patients with strategies for managing their symptoms and enhancing daily living activities.
  • Oxygen therapy: For patients with significant hypoxemia (low blood oxygen levels), long-term oxygen therapy (LTOT) improves both survival and quality of life. Oxygen is often prescribed when oxygen saturation consistently drops below 88%, especially during advanced stages of COPD.

Note: The single most important step in slowing the progression of COPD is smoking cessation. Quitting smoking significantly reduces the decline in lung function, lowers the frequency of exacerbations, and decreases mortality rates.

Complications

  • Acute Exacerbations: Often triggered by infections, leading to rapid deterioration requiring antibiotics, corticosteroids, and bronchodilators.
  • Pulmonary Hypertension and Cor Pulmonale: Chronic hypoxemia can lead to right-sided heart failure.
  • Respiratory Failure: Occurs in advanced COPD, requiring long-term oxygen therapy or mechanical ventilation.

Prognosis

  • Mild to Moderate COPD: The disease progression can be slowed significantly with smoking cessation, regular use of bronchodilators, and pulmonary rehabilitation. Many patients maintain reasonable quality of life for years.
  • Severe COPD: Prognosis worsens with advanced stages, particularly with frequent exacerbations or the need for long-term oxygen therapy. The 5-year survival rate for severe COPD ranges from 20-50%, depending on comorbid conditions and adherence to treatment.

Influenza (Flu)

Influenza is an acute respiratory infection caused by influenza viruses (primarily types A and B), leading to seasonal epidemics. It is highly contagious and spreads through respiratory droplets.

Clinical Manifestations

  • Fever: Often high and sudden in onset.
  • Cough: Usually dry but can become productive.
  • Sore throat: Common along with nasal congestion.
  • Myalgia: Generalized muscle aches and body pains.
  • Fatigue: Often profound, lasting for weeks after other symptoms resolve.

At-Risk Populations

  • Elderly and those with chronic diseases (e.g., COPD, asthma, heart failure) are at higher risk of severe complications, including pneumonia and acute respiratory distress syndrome (ARDS).
  • Pregnant women and immunocompromised individuals are also at increased risk of complications.

Diagnosis

  • Clinical evaluation based on symptoms during flu season.
  • Rapid influenza diagnostic tests (RIDTs): Quick results but lower sensitivity.
  • Polymerase chain reaction (PCR) testing: More sensitive and specific, used in hospitals to confirm diagnosis.

Treatment

  • Vaccination: Annual influenza vaccination is the most effective preventive measure, recommended for everyone over 6 months of age.
  • Antiviral medications: Drugs like oseltamivir and zanamivir can reduce symptom severity and duration if administered within 48 hours of symptom onset.
  • Supportive care: Rest, hydration, and antipyretics help alleviate symptoms, particularly for mild cases.

Complications

  • Pneumonia: A severe complication often caused by secondary bacterial infections.
  • Acute Respiratory Distress Syndrome (ARDS): A life-threatening complication requiring intensive care.
  • Myocarditis and Encephalitis: In rare cases, the virus can lead to heart or brain inflammation, requiring specialized treatment.

Prognosis

  • Uncomplicated Influenza: Most healthy individuals recover within 1-2 weeks with supportive care, although fatigue may linger longer.
  • High-Risk Populations: The elderly, young children, pregnant women, and those with chronic illnesses may experience severe complications, such as pneumonia or respiratory failure. Influenza-related mortality is highest in these groups, particularly during severe flu seasons.

Lung Cancer

Lung cancer is one of the most common and deadly cancers worldwide. It arises from the uncontrolled growth of abnormal cells in the lung tissue, leading to tumor formation. Lung cancer is broadly divided into two main types based on its cellular characteristics: Non-Small Cell Lung Cancer (NSCLC) and Small Cell Lung Cancer (SCLC). NSCLC accounts for approximately 85% of lung cancers, while SCLC, a more aggressive type, makes up about 15%.

Risk Factors

The primary cause of lung cancer is exposure to carcinogens, especially tobacco smoke. Other risk factors include:

  • Smoking: The leading cause of lung cancer, responsible for the majority of cases.
  • Secondhand Smoke Exposure: Individuals exposed to smoke from others are also at risk.
  • Asbestos Exposure: Occupational exposure increases the risk of developing lung cancer.
  • Radon Gas: A naturally occurring radioactive gas found in homes and buildings.
  • Environmental and Occupational Exposure: Prolonged exposure to certain chemicals (e.g., arsenic, chromium, or nickel) can increase lung cancer risk.
  • Family History: A genetic predisposition may increase susceptibility to lung cancer.

Types of Lung Cancer

CharacteristicsNon-Small Cell Lung Cancer (NSCLC)Small Cell Lung Cancer (SCLC)
SubtypesAdenocarcinoma, Squamous Cell Carcinoma, Large Cell CarcinomaLimited subtypes, primarily characterized by small, round cells
Growth RateSlower growth and spreadFast-growing, tends to spread quickly
Stage at DiagnosisOften diagnosed at earlier stagesFrequently presents in advanced stages
Common Risk FactorsSmoking, exposure to radon, asbestos, secondhand smoke, and occupational hazards (e.g., chemicals, pollutants)Strongly associated with smoking; rare in non-smokers
Treatment ApproachesSurgery, radiation therapy, chemotherapy, targeted therapy (e.g., for mutations like EGFR or ALK), and immunotherapyPrimarily chemotherapy and radiation; surgery is rarely an option due to the aggressive nature of the disease
PrognosisGenerally better prognosis, especially in early-stage diagnosesPoorer prognosis due to rapid progression and late-stage diagnosis
MetastasisSlower to metastasize, but can spread to bones, liver, and brain in advanced stagesCommonly metastasizes early to brain, liver, bones, and adrenal glands
StagingStaged from I to IV, with Stage IV indicating metastatic diseaseStaged as limited (confined to one lung) or extensive (spread beyond the lung)

Clinical Manifestations

Lung cancer symptoms often appear in the later stages of the disease and can vary depending on the tumor’s location and spread.

  • Persistent Cough: A new cough that doesn’t go away or worsens.
  • Hemoptysis: Coughing up blood or rust-colored sputum.
  • Shortness of Breath: Due to airway obstruction or fluid accumulation in the lungs.
  • Chest Pain: A persistent, dull ache or sharp pain in the chest.
  • Hoarseness: Due to pressure on the vocal cords.
  • Unexplained Weight Loss and Fatigue: Common in advanced stages of cancer.
  • Bone Pain: May indicate metastasis to bones.
  • Recurrent Lung Infections: Such as bronchitis or pneumonia, due to tumor obstruction of the airway.

Diagnosis

Diagnosis often involves a combination of imaging studies, laboratory tests, and biopsies:

  • Chest X-ray: The first imaging test often used to detect abnormalities.
  • CT Scan: Provides detailed images to assess the size and location of the tumor and detect metastasis.
  • Bronchoscopy: A procedure to visualize the airways and collect tissue samples.
  • Biopsy: Tissue samples are taken from the lung or other areas where the cancer may have spread to confirm the diagnosis.
  • PET Scan: Used to detect metastatic disease by evaluating the metabolic activity of cells.

Staging

Lung cancer is staged based on the size of the tumor and the extent of spread. NSCLC is staged from I to IV, with Stage IV indicating metastatic disease, while SCLC is typically divided into limited-stage (confined to one lung) and extensive-stage (spread beyond the lung).

Treatment

Treatment for lung cancer depends on the type and stage of cancer, as well as the patient’s overall health:

  • Surgery: Often used in early-stage NSCLC to remove the tumor or part of the lung (lobectomy, segmentectomy, or pneumonectomy).
  • Radiation Therapy: High-energy rays are used to kill or shrink cancer cells, often in combination with surgery or chemotherapy.
  • Chemotherapy: Drugs are used to kill cancer cells. It’s the main treatment for SCLC and can also be used for advanced NSCLC.
  • Targeted Therapy: Medications designed to target specific genetic mutations in cancer cells (e.g., EGFR, ALK mutations) in NSCLC.
  • Immunotherapy: Helps the body’s immune system fight cancer, often used in advanced or metastatic cases.

Complications

  • Metastasis: Lung cancer frequently spreads to other organs, including the brain, liver, bones, and adrenal glands, leading to severe complications.
  • Pleural Effusion: Accumulation of fluid in the pleural cavity, causing difficulty breathing and requiring drainage.
  • Superior Vena Cava Syndrome: Tumor compression of the superior vena cava, leading to facial swelling and difficulty breathing.
  • Paraneoplastic Syndromes: Some lung cancers produce hormones or hormone-like substances, causing symptoms like hypercalcemia, hyponatremia, or Cushing’s syndrome.
  • Respiratory Failure: As the tumor grows or spreads, it may obstruct airways or lead to severe infections, resulting in respiratory failure.

Prognosis

  • Non-Small Cell Lung Cancer (NSCLC): The 5-year survival rate varies widely by stage: about 60-70% for Stage I, 30-50% for Stage II, 10-25% for Stage III, and less than 5% for Stage IV. Early detection significantly improves outcomes, and targeted therapies have enhanced survival in specific genetic subtypes.
  • Small Cell Lung Cancer (SCLC): This type has a poorer prognosis, with a 5-year survival rate of less than 10% overall. Limited-stage SCLC has a 15-30% 5-year survival rate with aggressive treatment, while extensive-stage disease drops to 2-5%. Relapse rates are high.