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BronchogenicCarcinoma(LungCancer),Respiratorydepartment,Definition,Bronchogeniccarcinomareferstothemalignanttumorwhichgrowsinthebronchus.Originatingfrommucusorglandofbronchus.,Incidenceandmortality,Bronchogeniccarcinomahasincreasedremarkableinincidenceandmortalityduringhalfofthecenturyandhasbecomethemostfrequentvisceralmalignantdiseasesofmen.Themortalityoflungcancerholdthefirstplaceamongallkindscarcinomas.,Etiology,Thecauseoflungcancerisunknown.Itisbelievedthattherearefollowingrelatedfactors.1.Excessivecigarettesmoking:Smokingindex(BrinkmanIndex)isequaltocigarettesperdaysmokingtime(years).Passivesmokingisalsoacarcinogenfactor.,Etiology,2.Atmosphericpollution.Itwasfoundthatcarcinogenicfactorisbenzpyrene.3.Occupationalfactors.4Radioactivityintheatmosphere.5.DietsandNutrition.6.Chronicirritation.7.Geneticfactors.,PathologyAndClassification,1.Accordingtothepositionoftumorarisingfrom,itcanbedividedintotwotypes.Centraltype:Tumorarisesfrommainbronchus,lobarandsegmentalbronchus.Peripheraltype:Tumorarisesbeyondsegmentalbronchus.,PathologyAndClassification,2.Accordingtocytology,itisconvenienttoclassifyintofourkindsoftypes.(1).Squamouscellcarcinoma.(2).Smallcellanaplasticcarcinoma.(3).Largecellanaplasticcarcinoma.(4).Adenocarcinoma(includingalveolarcellcarcinoma).,PathologyAndClassification,Accordingtothedifferentprinciplesofmanagement,itisdividedintotwotypes.SCLC:smallcelllungcarcinoma.NSCLC:nonsmallcelllungcarcinoma.,Clinicalfeatures,Therearenosymptomsofearlylungcancerinsomepatients.Symptomscausedbylungcancerarenon-specific:perhapsanaudiblewheezeoraslightcough,symptomsofinfection(fever,purulentsputum),ofobstruction(wheezing,dyspnea),orulcerationofbronchialmucosa(hemoptysis).,Clinicalfeatures,1.Respiratorysymptoms.(1).Cough:(2).Hemoptysis:(3).Dyspnea.:(4).Wheezeorstridor:(5).Chestpain:(6).Fever:,Clinicalfeatures,2.Symptomscausedbythenearorgansortissueinvolvedbytumor.(1).Dysphagia.(2).Hoarseness.(3).Pleuraleffusionduetoinvasionofthepleura.,ClinicalFeatures,(4).Hornerssyndrome.Itiscausedbyinvadingthecervicalsympatheticgangliaontheinvolvedsidethepupilissmallptosisoftheupeyelids,retractionoftheeyeballandnosweatoftheface.(5)Cardiaceffusion,Clinicalfetures,(6).Superiorvenacavalsyndrome.Duetoobstructionofthesuperiorvenacaval,thepatientmayhavenoticedthathiscollaristight,theneckisenlargedandthejugularveinandtheveinsofanteriorchestwallaredistensionandedemaoftheface.3.Symptomscausedbymetastasis.liver,skeleton,brain,supraclaviclelymphnodes.,Clinicalfetures,4.Paraneoplasticsyndrome.Becausetumorcellcansecreteectopichormone，antigenorenzymethepatientswithLungCancersometimesmayhavesomeparaneoplasticsyndromeIncluding:(1)Collagentissuedisordersuchasfingerclubbing,hypertrophicpulmonrayosteoarthropathy。,Clinicalfeatures,(2)EndocrinedisordersincludingCushingssyndrome,syndromeofinappropriateantiduretichormonesecretion(SIADHS),(3)Neuropathicormyopathicdisordersincludingpolyneuritis,cerebellardegeneration,mentalabnormalitisetc(4)others.,RadiographicFindings,Theappearanceonthex-rayfilmdependsontheposition,sizeandstageofthetumor1.Peripheraltype:Itmaybevarioussuchasinfiltrativeornodular,lobulatedorumbilicussign,linerprotrusionsfromtheshadowintothesurroundinglung,cavitationwhichisofteneccentricirregularintheinnerwallowingtothenecrosisoftheneoplasm.,RadiographicFindings,2Centraltype(1)Directappearance:Unilateralenlargementofthehilarshadowduetothetumoritselforenlargedlymphnodes.(2)Indirectappearance:Includinglocalemphysema;obstructivepneumoniaeitherlobalorsegmental;obstractiveatalectasis(collapse)lobeorsegment.,AdvantageofCT:,(1)Somesmalllesion,lesionbehindofcardiacorbloodvessel,andpathologylocatedinapicaloflungcanbefoundbyCTwhichcantbefoundbychestx-ray.(2)LymphnodesalonghilarormediastinacanbefoundbyCT.,Fig1Atelectasis,Rightupperlobe,Fig3MassWithFuzzy,RightUpperLObe,Fig4MassInrightLobe,Lateralportion,Fig5CavitatingBronchialCarcinoma,Examinationofsputum,Cytologicexaminationofbronchialsecretions(orsputum)mayrevealexfoliatedmalignantcellsrecognizabletothepathologistwhoisspeciallytrainedforsuchwork.Thesputummusttobefresh,sendontime,repeat(4-6times).,Bronchoscope,Bronchoscopemayverifytheexistenceoftumor,ofCentraltype,andcytologicdiagnosisoflungcancershouldbeobtainedthoughFBC.Blindbiopsymaybehelptothediagnosisofthetumorbeyondtherangeofbronchoscopevision,Fig1NormalTrachea,Fig2NormalCarina,Fig3SquamousCellCarcinoma,Trachea,Fig4AdenocarcinomaLeftLingularBronchus,Fig5AdenocarcinomaRightTruncalIntermedus,Fig6ExtrinsicPressureTrachea,LungBiopsy,1.Biopsywithfiberopticbronchoscope;2.TransthoracicneddlebiopsywithCTdirectedorBtypeultrasonic;3.Biopsywiththoracoscopy;4.Biopsywithmedistinoscopy;5.Exploratorythoracotomy.,Diagnosis,1.Symptom-free:Generalinvestigationofhighriskgroup(male,mornthan40yearsold,cigaretteconsumption20/perday).Takingax-rayfilmandexaminingsputumforcancercelleveryhalfyearEarlystageofthebronchogeniccarcinomaReferstothetumorisstilllocatedatthebronchus,noinvadethehilarlymphnodes,pleuraaswellasdistantmetastases,itsdiameterisoften3cm.,Diagnosis,Diagnosisprocedure:1.X-rayfilm(-)andsputumforcytology(-)FBC(-)followuponceamonth/year.2.X-rayfilm(+)andsputumforcytology(+)FBCtoidentifythecancercelltypeCT,MRItherapy.,Diagnosis,Diagnosisprocedure:3.X-rayfilm(-)andsputumforcytology(+)rulingoutthetumorofupperrespiratorytractfirstFBC.4X-rayfilm(+)andsputumforcytology(-)FBC(-)lungbiopsy.,Differentialdiagnosis,1.Solitarynodule:Tuberculoma,BenignTumor2.Cavitation:LungAbscess,Tuberculosis,3.Enlargementofhilarshadow:Hamartoma4.Others:PleuralEffusion,WideningOfMediatinal.,Treatment,1.Rresectionbyoperation;2.Radiotherapy;3.Chemotherapy;4.Immunotherapy;5.TraditionalChinesemedicinetherapyetc.Thetherapeuticprincipleoflungcanceriscomprehensive:rescectthetumorasfaraspossiblethencombinewithothertreatments;othertreatmentsfirstthenoperationdependingonthecytologictype,position,sizeandstageofthetumor.,Treatment,SCLC:Chemotherapy,operation.Chemotherapy,radiotherapy.NSCLC:Operation.Most:operationchemotherapySmallparts:radiotherapy.,Treatment,:Operation+chemotherapy;radiotherapy+chemotherapy.:chemotherapy+radiotherapy(relievesomesymptoms,suchaspain,dyspnea,obstructionetc).,ThankYOU,
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