支气管癌（肺癌）-英文课件

BronchogenicCarcinoma(LungCancer)RespiratorydepartmentDefinitionBronchogeniccarcinomareferstothemalignanttumorwhichgrowsinthebronchus.Originatingfrommucusorglandofbronchus.IncidenceandmortalityBronchogeniccarcinomahasincreasedremarkableinincidenceandmortalityduringhalfofthecenturyandhasbecomethemostfrequentvisceralmalignantdiseasesofmen.Themortalityoflungcancerholdthefirstplaceamongallkindscarcinomas.EtiologyThecauseoflungcancerisunknown.Itisbelievedthattherearefollowingrelatedfactors.1.Excessivecigarettesmoking:Smokingindex(BrinkmanIndex)isequaltocigarettesperdaysmokingtime(years).Passivesmokingisalsoacarcinogenfactor.Etiology2.Atmosphericpollution.Itwasfoundthatcarcinogenicfactorisbenzpyrene.3.Occupationalfactors.4Radioactivityintheatmosphere.5.DietsandNutrition.6.Chronicirritation.7.Geneticfactors.PathologyAndClassification1.Accordingtothepositionoftumorarisingfrom,itcanbedividedintotwotypes.Centraltype:Tumorarisesfrommainbronchus,lobarandsegmentalbronchus.Peripheraltype:Tumorarisesbeyondsegmentalbronchus.PathologyAndClassification2.Accordingtocytology,itisconvenienttoclassifyintofourkindsoftypes.(1).Squamouscellcarcinoma.(2).Smallcellanaplasticcarcinoma.(3).Largecellanaplasticcarcinoma.(4).Adenocarcinoma(includingalveolarcellcarcinoma).PathologyAndClassificationAccordingtothedifferentprinciplesofmanagement,itisdividedintotwotypes.SCLC:smallcelllungcarcinoma.NSCLC:nonsmallcelllungcarcinoma.ClinicalfeaturesTherearenosymptomsofearlylungcancerinsomepatients.Symptomscausedbylungcancerarenon-specific:perhapsanaudiblewheezeoraslightcough,symptomsofinfection(fever,purulentsputum),ofobstruction(wheezing,dyspnea),orulcerationofbronchialmucosa(hemoptysis).Clinicalfeatures1.Respiratorysymptoms.(1).Cough:(2).Hemoptysis:(3).Dyspnea.:(4).Wheezeorstridor:(5).Chestpain:(6).Fever:Clinicalfeatures2.Symptomscausedbythenearorgansortissueinvolvedbytumor.(1).Dysphagia.(2).Hoarseness.(3).Pleuraleffusionduetoinvasionofthepleura.ClinicalFeatures(4).Horner’ssyndrome.Itiscausedbyinvadingthecervicalsympatheticgangliaontheinvolvedsidethepupilissmallptosisoftheupeyelids,retractionoftheeyeballandnosweatoftheface.(5)CardiaceffusionClinicalfetures(6).Superiorvenacavalsyndrome.Duetoobstructionofthesuperiorvenacaval,thepatientmayhavenoticedthathiscollaristight,theneckisenlargedandthejugularveinandtheveinsofanteriorchestwallaredistensionandedemaoftheface.3.Symptomscausedbymetastasis.liver,skeleton,brain,supraclaviclelymphnodes.Clinicalfetures4.Paraneoplasticsyndrome.Becausetumorcellcansecreteectopichormone，antigenorenzymethepatientswithLungCancersometimesmayhavesomeparaneoplasticsyndromeIncluding:(1)Collagentissuedisordersuchasfingerclubbing,hypertrophicpulmonrayosteoarthropathy。Clinicalfeatures(2)EndocrinedisordersincludingCushing’ssyndrome,syndromeofinappropriateantiduretichormonesecretion(SIADHS),(3)Neuropathicormyopathicdisordersincludingpolyneuritis,cerebellardegeneration,mentalabnormalitisetc(4)others.RadiographicFindingsTheappearanceonthex-rayfilmdependsontheposition,sizeandstageofthetumor1.Peripheraltype:Itmaybevarioussuchasinfiltrativeornodular,lobulatedorumbilicussign,linerprotrusionsfromtheshadowintothesurroundinglung,cavitationwhichisofteneccentricirregularintheinnerwallowingtothenecrosisoftheneoplasm.RadiographicFindings2Centraltype(1)Directappearance:Unilateralenlargementofthehilarshadowduetothetumoritselforenlargedlymphnodes.(2)Indirectappearance:Includinglocalemphysema;obstructivepneumoniaeitherlobalorsegmental;obstractiveatalectasis(collapse)lobeorsegment.AdvantageofCT:(1)Somesmalllesion,lesionbehindofcardiacorbloodvessel,andpathologylocatedinapicaloflungcanbefoundbyCTwhichcan’tbefoundbychestx-ray.(2)LymphnodesalonghilarormediastinacanbefoundbyCT.Fig1Atelectasis,RightupperlobeFig3MassWithFuzzy,RightUpperLObeFig4MassInrightLobe,LateralportionFig5CavitatingBronchialCarcinomaExaminationofsputumCytologicexaminationofbronchialsecretions(orsputum)mayrevealexfoliatedmalignantcellsrecognizabletothepathologistwhoisspeciallytrainedforsuchwork.Thesputummusttobefresh,sendontime,repeat(4-6times)..BronchoscopeBronchoscopemayverifytheexistenceoftumor,ofCentraltype,andcytologicdiagnosisoflungcancershouldbeobtainedthoughFBC.BlindbiopsymaybehelptothediagnosisofthetumorbeyondtherangeofbronchoscopevisionFig1NormalTracheaFig2NormalCarinaFig3SquamousCellCarcinoma,TracheaFig4AdenocarcinomaLeftLingularBronchusFig5AdenocarcinomaRightTruncalIntermedusFig6ExtrinsicPressureTracheaLungBiopsy1.Biopsywithfiberopticbronchoscope;2.TransthoracicneddlebiopsywithCTdirectedorBtypeultrasonic;3.Biopsywiththoracoscopy;4.Biopsywithmedistinoscopy;5.Exploratorythoracotomy.Diagnosis1.Symptom-free:Generalinvestigationofhighriskgroup(male,mornthan40yearsold,cigaretteconsumption20/perday).Takingax-rayfilmandexaminingsputumforcancercelleveryhalfyearEarlystageofthebronchogeniccarcinomaReferstothetumorisstilllocatedatthebronchus,noinvadethehilarlymphnodes,pleuraaswellasdistantmetastases,itsdiameterisoften<3cm.DiagnosisDiagnosisprocedure:1.X-rayfilm(-)andsputumforcytology(-)FBC(-)followuponceamonth/year.2.X-rayfilm(+)andsputumforcytology(+)FBCtoidentifythecancercelltypeCT,MRItherapy.DiagnosisDiagnosisprocedure:3.X-rayfilm(-)andsputumforcytology(+)rulingoutthetumorofupperrespiratorytractfirstFBC.4X-rayfilm(+)andsputumforcytology(-)FBC(-)lungbiopsy.Differentialdiagnosis1.Solitarynodule:Tuberculoma,BenignTumor2.Cavitation:LungAbscess,Tuberculosis,3.Enlargementofhilarshadow:Hamartoma4.Others:PleuralEffusion,WideningOfMediatinal.Treatment1.Rresectionbyoperation;2.Radiotherapy;3.Chemotherapy;4.Immunotherapy;5.TraditionalChinesemedicinetherapyetc.Thetherapeuticprincipleoflungcanceriscomprehensive:rescectthetumorasfaraspossiblethencombinewithothertreatments;othertreatmentsfirstthenoperationdependingonthecytologictype,position,sizeandstageofthetumor.TreatmentSCLC:ⅠChemotherapy,operation.ⅡChemotherapy,radiotherapy.NSCLC:ⅠOperation.ⅡMost:operation→chemotherapySmallparts:radiotherapy.TreatmentⅢ:Operation+chemotherapy;radiotherapy+chemotherapy.Ⅳ:chemotherapy+radiotherapy(relievesomesymptoms,suchaspain,dyspnea,obstructionetc).