肺癌英文课件

,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Bronchogenic Carcinoma(Lung Cancer),Respiratory department,1,Bronchogenic Carcinoma(Lung,Definition,Bronchogenic carcinoma refers to the malignant tumor which grows in the bronchus. Originating from mucus or gland of bronchus.,2,DefinitionBronchogenic carcino,Incidence and mortality,Bronchogenic carcinoma,has increased remarkable,in incidence and mortality during half of the century and has become the,most frequent,visceral malignant diseases of men.The mortality of lung cancer,hold the first place,among all kinds carcinomas.,3,Incidence and mortalityBroncho,Etiology,The cause of lung cancer is unknown.It is believed that there are following related factors.,1.,Excessive cigarette smoking,:Smoking index(Brinkman Index) is equal to cigarettes per day,smoking time(years).,Passive smoking,is also a carcinogen factor.,4,EtiologyThe cause of lung canc,Etiology,2,.,Atmospheric pollution,.It was found that carcinogenic factor is benzpyrene .,3,.,Occupational factors,.,4Radioactivity in the atmosphere .,5.Diets and Nutrition,.,6,.,Chronic irritation,.,7.Genetic factors.,5,Etiology2.Atmospheric pollutio,Pathology And Classification,1. According to,the position,of tumor arising from ,it can be divided into two types .,Central type,:Tumor arises from main bronchus, lobar and segmental bronchus .,Peripheral type,: Tumor arises beyond segmental bronchus .,6,Pathology And Classification1.,Pathology And Classification,2.According to,cytology,it is convenient to classify into four kinds of types.,(1).Squamous cell carcinoma.,(2).Small cell anaplastic carcinoma.,(3).Large cell anaplastic carcinoma.,(4).Adenocarcinoma,(including alveolar cell carcinoma).,7,Pathology And Classification2.,Pathology And Classification,According to the different,principles of management,it is divided into two types.,SCLC,:small cell lung carcinoma.,NSCLC,:non small cell lung carcinoma.,8,Pathology And ClassificationAc,Clinical features,There are,no symptoms,of early lung cancer in some patients.,Symptoms caused by lung cancer are,non-specific,:,perhaps an audible wheeze or a slight cough,symptoms of infection (fever ,purulent sputum) , of obstruction (wheezing,dyspnea), or ulceration of bronchial mucosa (hemoptysis).,9,Clinical featuresThere are no,Clinical features,1.Respiratory symptoms,.,(1,).,Cough,:,(2).,Hemoptysis,:,(3,).,Dyspnea,.:,(4).,Wheeze or stridor:,(5,).,Chest pain,:,(6).,Fever:,10,Clinical features1.Respiratory,Clinical features,2.Symptoms caused by the near organs or tissue involved by tumor,.,(1,).Dysphagia,.,(2).,Hoarseness,.,(3).,Pleural effusion,due to invasion of the pleura.,11,Clinical features2.Symptoms ca,Clinical Features,(4,).,Horners syndrome,.It is caused by invading the cervical sympathetic ganglia on the involved side the pupil is small ptosis of the up eyelids,retraction of the eyeball and no sweat of the face.,(5),Cardiac effusion,12,Clinical Features(4).Horners,Clinical fetures,(6).,Superior vena caval syndrome,. Due to obstruction of the superior vena caval,the patient may have noticed that his collar is tight, the neck is enlarged and the jugular vein and the veins of anterior chest wall are distension and edema of the face.,3.Symptoms caused by metastasis.,liver, skeleton,brain, supra clavicle lymph nodes.,13,Clinical fetures(6).Superior v,Clinical fetures,4.,Paraneoplastic syndrome,.,Because tumor cell can secrete ectopic hormone,，,antigen or enzyme the patients with Lung Cancer sometimes may have some paraneoplastic syndrome Including:,(1),Collagen tissue disorder such as finger clubbing , hypertrophic pulmonray osteoarthropathy,。,14,Clinical fetures4.Paraneoplast,Clinical features,(2),Endocrine disorders including Cushings syndrome ,syndrome of inappropriate antiduretic hormone secretion(SIADHS),(3),Neuropathic or myopathic disorders including polyneuritis ,cerebellar degeneration,mental abnormalitis etc,(4),others.,15,Clinical features(2)Endocrine,Radiographic Findings,The appearance on the x-ray film,depends on the position ,size and stage of the tumor,1,.Peripheral type,:It may be various such as,infiltrative,or,nodular,lobulated,or,umbilicus sign,liner protrusions,from the shadow into the surrounding lung,cavitation,which is often eccentric irregular in the inner wall owing to the necrosis of the neoplasm.,16,Radiographic FindingsThe appea,Radiographic Findings,2,Central type,(1),Direct appearance,:Unilateral enlargement of the hilar shadow due to the tumor itself or enlarged lymph nodes.,(2),Indirect appearance,:Including local emphysema;obstructive pneumonia either lobal or segmental; obstractive atalectasis (collapse) lobe or segment.,17,Radiographic Findings2 Central,Advantage of CT,:,(1) Some small lesion, lesion behind of cardiac or blood vessel,and pathology located in apical of lung can be found by CT which cant be found by chest x-ray.,(2) Lymph nodes along hilar or mediastina can be found by CT.,18,Advantage of CT:(1) Some small,Fig1 Atelectasis,Right upper lobe,19,Fig1 Atelectasis,Right upper,Fig3 Mass With Fuzzy,Right Upper LObe,20,Fig3 Mass With Fuzzy,Rig,Fig4 Mass In right Lobe,Lateral portion,21,Fig4 Mass In right Lobe,Late,Fig5 Cavitating Bronchial Carcinoma,22,Fig5 Cavitating Bronchial,Examination of sputum,Cytologic examination of bronchial secretions(or sputum)may reveal exfoliated malignant cells recognizable to the pathologist who is specially trained for such work.The sputum must to be,fresh, send on time,repeat,(4-6 times).,23,Examination of sputum Cytologi,Bronchoscope,Bronchoscope may verify the existence of tumor , of Central type, and cytologic diagnosis of lung cancer should be obtained though FBC,.Blind biopsy may be help to the diagnosis of the tumor beyond the range of bronchoscope vision,24,BronchoscopeBronchoscope may v,Fig 1 Normal Trachea,Fig 2 Normal Carina,25,Fig 1 Normal TracheaFig 2 No,Fig 3 Squamous Cell,Carcinoma, Trachea,Fig 4 Adenocarcinoma,Left Lingular Bronchus,26,Fig 3 Squamous Cell Fig 4 Aden,Fig 5 Adenocarcinoma,Right Truncal Intermedus,Fig 6 Extrinsic Pressure,Trachea,27,Fig 5 AdenocarcinomaFig 6 Ext,Lung Biopsy,1.Biopsy with,fiberoptic bronchoscope,; 2.Transthoracic,neddle biopsy,with CT directed or B type ultrasonic;,3.Biopsy with,thoracoscopy,;,4.,Biopsy with,medistinoscopy,;,5,.Exploratory thoracotomy.,28,Lung Biopsy1.Biopsy with fiber,Diagnosis,1.Symptom -free: General investigation of,high risk group,(male,morn than 40 years old,cigarette consumption 20/per day). Taking a x-ray film and examining sputum for cancer cell every half year,Early stage of the bronchogenic carcinoma,Refers to the tumor is still located at the bronchus ,no invade the hilar lymph nodes,pleura as well as distant metastases,its diameter is often 3cm,.,29,Diagnosis1.Symptom -free: Gene,Diagnosis,Diagnosis procedure,:,1. X-ray film(-) and sputum for cytology (-),FBC(-),follow up once a month /year.,2. X-ray film(+) and sputum for cytology (+),FBC to identify the cancer cell type,CT , MRI,therapy.,30,DiagnosisDiagnosis procedure:,Diagnosis,Diagnosis procedure,:,3. X-ray film(-) and sputum for cytology (+),ruling out the tumor of upper respiratory tract first,FBC.,4 X-ray film(+) and sputum for cytology (-),FBC(-),lung biopsy.,31,DiagnosisDiagnosis procedure:,Differential diagnosis,1.Solitary nodule:,Tuberculoma, Benign Tumor,2,.Cavitation,:Lung Abscess, Tuberculosis,3.,Enlargement of hilar shadow:,Hamartoma,4,.Others:,Pleural Effusion,Widening Of Mediatinal.,32,Differential diagnosis1.Solita,Treatment,1.Rresection by operation ;,2.Radiotherapy ;,3.Chemotherapy;,4.Immunotherapy ;,5.Traditional Chinese medicine therapy etc.,The therapeutic principle of lung cancer is,comprehensive,: rescect the tumor as far as possible then combine with other treatments ; other treatments first then operation depending on the cytologic type, position,size and stage of the tumor.,33,Treatment1.Rresection by opera,Treatment,SCLC,:, Chemotherapy , operation., Chemotherapy,radiotherapy.,NSCLC:, Operation., Most :operationchemotherapy,Small parts: radiotherapy,.,34,TreatmentSCLC:34,Treatment,: Operation + chemotherapy;,radiotherapy +chemotherapy.,: chemotherapy+ radiotherapy(relieve some symptoms,such as pain, dyspnea, obstruction etc).,35,Treatment: Operation + chemot,Thank YOU,36,Thank YOU36,