1、讲课肺癌英文2 Begins when cells in the lung grow out of control and form a tumor3Etiology and pathogenesisCigarette smokingOther factors include air pollutions Nowadays It is reported that tuberculosis is associated with the incidence of lung cancer 4Classifications According to anatomy: (1)Central lung (
2、2) peripheral lung cancer56 According to histologic classification: Small cell lung cancer(SCLC) and Non-small cell lung cancer(NSCLC). NSCLC includes Squamous cell carcinoma, large cell carcinoma, adenocarcinoma, adenosquamous carcinoma.7Small cell lung cancer(SCLC)Oat-cell carcinoma SCLC grows ver
3、y rapidly and is very aggressive. Soon after the original cell becomes cancerous, it quickly multiplies to form a tumor. These cells swiftly spread to distant sites in the body SCLC belongs in a group of tumors derived from neuroendocrine cells that are responsible for the production and secretion o
4、f specific peptide product.they may related to paraneoplastic syndrome.8 Cells are oval or vaguely spindle-shaped ,have scant cytoplasm91011 Squamous cell carcinoma the most frequent form of the tumor(30-50 percent of all cases bronchial epithelium and growth in situ It is related to cigarette smoki
5、ng Cavitation can occure in the distal to the obstructing mass Central location12 Intercellular bridges and cellular pleomorphism1314 squamous cell carcinoma usually occurs near the bronchi, the tumor can cause cough (sometimes a cough that is tinged with blood), shortness of breath, wheezing, and p
6、neumonia in the area between the tumor and the edge of the lung it causes symptoms early in the disease 15adenocarcinoma areas of scarring is associated with the occurrence of adenocarcinoma. Peripheral adenocarcinomas are usually well-circumscribed, grey-white masses that rarely cavitate. It arises
7、 from the submucosal glands,located in peripheral airways and alveoli Female 161718large cell carcinoma19 large nuclei,prominent nucleoli,abundant cytoplsma20 usually located peripherally can be quite large and not infrequently cavitate21gh Shortness of breath Chest pain Loss of appetite Coughing up
8、 phlegm Hemoptysis (coughing up blood) If cancer has spread, symptoms include bone pain, difficulty breathing, abdominal pain, headache, weakness, and confusion22 Due to primary lesions: cough, dyspnea, hemoptysis, sputum, wheezing, weight loss, fever, pneumonia Due to local extension: chest pain,ho
9、arseness,superior vena cava syndrome, horners syndrome, dysphagia, pericardial effusion,pleural effusion, diaphragm paralysis Only 5-15 percent of patients are asymptomatic when discovered to have bronchogenic carcinoma.23 Regionnal spread to hilar and mediastinal nodes may cause dysphagia due to es
10、ophageal compression horseness due to recurrent laryngeal nerve compression horners syndrome due to sympathetic nerve involvement elevation of the hemidiaphragm from phrenic nerve compression.24 Superior sulcus, or pancoasts tumor may involve the brachial plexus, resulting in a c7-t2 neuropathy with
11、 pain, numbness, and weakness of the arm. Cardiac involvement is seen in About 20-25 percent of patients 25 Extrapulmonary manifestations. Including metastasis to other organs, such as brain, central nervous system, skeleton system, liver,adrenal glands and lymph nodes ects. Paraneoplastic syndromes
12、 are remote effects of tumor. They lead to metabolic and neuromuscular disturbances unrelated to the primary tumor, metastases, or treatment. They may be the first sign of the tumor.They do not indicate that a tumor has spread.26Physical examinations Usually in early stage, most of the patients with
13、 lung cancer have no positive physical findings. General findings include abnormal percussion, breath sounds changes, moist rales (when pneumonia happens) Digital clubbing, superior vena cava syndrome, horners syndrome(unilaterally constricted pupil, enophthalmos,narrowed palpebral fissure and loss
14、of sweating on the same side of the face.27Physical examinations Endobronchial obstruction may result in a localized wheeze Lobar collapse may result in an area of decreased breath sounds and dullness to percussion.28ll have a tumor in the lung, a chest x-ray or CT scan of the chest is performed The
15、 diagnosis must be confirmed with a biopsyThe location(s) of all sites of cancer is determined by additional CT scans, PET (positron emission tomography) scans, and MRI (magnetic resonance imaging)It is important to find out if cancer started in the lung or somewhere else in the body. Cancer arising
16、 in other parts of the body can spread to the lung as well 29Chest X-ray It is the most important method to find lung cancerThe most frequent finding is a mass in the lung field303132On chest X-ray, secondary manifestations include lobar collapse, pleural effusion, pneumonitis, elevation of the hemi
17、diaphragm, hilar and mediastinal adenopathy, and erosion of ribs or vertebrae due to metastases.333435Obstructive atelectasis36Lung cancer on CT CT is the most useful in evaluating patients with pulmonary and mediastinal masses.It is also useful for detecting multiple metastases.CT can show a mass t
18、o be located in which lobe of lung field and the size of the mass. It also shows the nodule in the mediastinum.Sometimes,when a mass locate behind the heart, chest X-ray cant detect it .CT can detect some secret sites of lung cancer. 3738Bronchoscopy39 Rigid and flexible scope Biopsy and selective w
19、ashings Larger samples than flexible scope Exact location Lobectomy Pneumonectomy Unresectable Sleeve4041Transthoracic lung biopsy It may be utilized when tumor located in peripheral airway. Transthoracic needle with guidance by CT can be used to detect lesions located near the chest wall 4243Video
20、Assisted Thoracic Surgery Diagnosis of pleural disease Wedge resection 4445Mediasteinoscopy & Mediasteinotomy4647 Diagnoses unresectable disease Eliminate N2 disease from surgical resection48ThoracotomyIf the methods mentioned above are not useful for detecting the cell type of lung cancer,thoracoto
21、my may be used49Staging of lung cancer 5051 52 5354Small cell lung cancer has often metastasized at the time of diagnosis.TNM staging is not suited to small cell lung cancer. 55TreatmentIncluding: A:Surgery B:Chemotherapy C:Radiation therapy D:Some other therapy immunologic therapy, Chinese traditio
22、nal therapy56SurgeryNon-small cell lung cancer: patients with stage I and II are considered candidates for surgical resection, with stage III cancer may be candidates for surgery with postoperative radiation of the mediastinum. 5758SurgeryWe must measure pulmonary function before surgical therapy.Fo
23、rced vital capacity greater than 2 liters and a forced expiratory volume in the first second (FEV1)of greater than 50 percent of the forced vital capacity predict that a patient can tolerate the consequences of pneumonectomy. 596061ChemotherapyNon-small cell lung cancerMVP:MMC 6-8mg/m2 (1), VDS 3mg/
24、m2NP:VP-16 (d1,d8). DDP 100mg/m2 (d1)GP Small-cell lung cancer it is highly responsive to chemotherapy.EP regimen VP-16 100mg/m2 d1d3. DDP 100mg/m2 d1. GP62ChemotherapyAggressive chemotherapy produces complications and symptoms in all patients. All experience anemia,leukepenia and opportunistic infection other complications include nausea,vomiting possible cadiotoxicity, hemorrhagic cystitis and peripheral neuropathy. 63Radiation therapyIt is of proven benefit in controlling bone pain,spinal cord compression, superior vena cava syndrome and bronchial obstruction.
