1、lung cancer Begins when cells in the lung grow out of control and form a tumorEtiology and pathogenesisEtiology and pathogenesisCigarette smokingCigarette smokingOther factors include Other factors include air pollutions air pollutions Nowadays It is reported Nowadays It is reported that tuberculosi
2、s is that tuberculosis is associated with the associated with the incidence of lung incidence of lung cancercancer ClassificationsClassifications According to anatomy:According to anatomy:(1)Central lung (1)Central lung (2)peripheral lung cancer (2)peripheral lung cancer According to histologic clas
3、sification:According to histologic classification:Small cell lung cancer(SCLC)and Non-Small cell lung cancer(SCLC)and Non-small cell lung cancer(NSCLC).small cell lung cancer(NSCLC).NSCLC includes Squamous cell carcinoma,NSCLC includes Squamous cell carcinoma,large cell carcinoma,adenocarcinoma,larg
4、e cell carcinoma,adenocarcinoma,adenosquamous carcinoma.adenosquamous carcinoma.Small cell lung cancer(SCLC)Small cell lung cancer(SCLC)Oat-cell carcinomaOat-cell carcinoma SCLC grows very rapidly and is very aggressive.Soon after the original cell becomes cancerous,it quickly multiplies to form a t
5、umor.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 of specific peptide product.they may related to paraneoplastic syndrome.Cells are oval or vaguely spindle-shaped,have
6、 scant cytoplasm Squamous cell carcinomaSquamous cell carcinoma the most frequent form of the tumor(30-the most frequent form of the tumor(30-50 percent of all cases50 percent of all cases bronchial epithelium and growth in situbronchial epithelium and growth in situ It is related to cigarette smoki
7、ngIt is related to cigarette smoking Cavitation can occure in the distal to Cavitation can occure in the distal to the obstructing massthe obstructing mass Central locationCentral location Intercellular bridges and cellular pleomorphism squamous cell carcinoma usually occurs near the bronchi,the tum
8、or can cause cough(sometimes a cough that is tinged with blood),shortness of breath,wheezing,and pneumonia in the area between the tumor and the edge of the lung it causes symptoms early in the disease adenocarcinomaadenocarcinoma areas of scarring is associated with the areas of scarring is associa
9、ted with the occurrence of adenocarcinoma.occurrence of adenocarcinoma.Peripheral adenocarcinomas are usually well-Peripheral adenocarcinomas are usually well-circumscribed,grey-white masses that rarely circumscribed,grey-white masses that rarely cavitate.cavitate.It arises from the submucosal gland
10、s,located in It arises from the submucosal glands,located in peripheral airways and alveoliperipheral airways and alveoli Female Female large cell carcinomalarge cell carcinoma large nuclei,prominent large nuclei,prominent nucleoli,abundant nucleoli,abundant cytoplsmacytoplsma usually located periph
11、erallyusually located peripherally can be quite large and not infrequently can be quite large and not infrequently cavitatecavitate Due to primary lesions:Due to primary lesions:cough,dyspnea,hemoptysis,sputum,wheezing,cough,dyspnea,hemoptysis,sputum,wheezing,weight loss,fever,pneumonia weight loss,
12、fever,pneumonia Due to local extension:Due to local extension:chest pain,hoarseness,superior vena cava chest pain,hoarseness,superior vena cava syndrome,horners syndrome,dysphagia,syndrome,horners syndrome,dysphagia,pericardial effusion,pleural effusion,pericardial effusion,pleural effusion,diaphrag
13、m paralysis diaphragm paralysis Only 5-15 percent of patients are asymptomatic when Only 5-15 percent of patients are asymptomatic when discovered to have bronchogenic carcinoma.discovered to have bronchogenic carcinoma.Regionnal spread to hilar and mediastinal nodes Regionnal spread to hilar and me
14、diastinal nodes may cause dysphagia due to esophageal may cause dysphagia due to esophageal compressioncompression horseness due to recurrent laryngeal nerve horseness due to recurrent laryngeal nerve compressioncompression horners syndrome due to sympathetic nerve horners syndrome due to sympatheti
15、c nerve involvementinvolvement elevation of the hemidiaphragm from phrenic elevation of the hemidiaphragm from phrenic nerve compression.nerve compression.Superior sulcus,or pancoasts tumor may Superior sulcus,or pancoasts tumor may involve the brachial plexus,resulting in a c7-involve the brachial
16、plexus,resulting in a c7-t2 neuropathy with pain,numbness,and weakness t2 neuropathy with pain,numbness,and weakness of the arm.of the arm.Cardiac involvement is seen in About 20-25 Cardiac involvement is seen in About 20-25 percent of patientspercent of patients Extrapulmonary manifestations.Includ
17、ing Extrapulmonary manifestations.Including metastasis to other organs,such as brain,metastasis to other organs,such as brain,central nervous system,skeleton system,central nervous system,skeleton system,liver,adrenal glands and lymph nodes ects.liver,adrenal glands and lymph nodes ects.Paraneoplast
18、ic syndromes are remote effectsParaneoplastic syndromes are remote effects of tumor.They lead to metabolic and of tumor.They lead to metabolic and neuromuscular disturbances unrelated to the neuromuscular disturbances unrelated to the primary tumor,metastases,or treatment.They primary tumor,metastas
19、es,or treatment.They may be the first sign of the tumor.They do not may be the first sign of the tumor.They do not indicate that a tumor has spread.indicate that a tumor has spread.Physical examinationsPhysical examinations Usually in early stage,most of the patients Usually in early stage,most of t
20、he patients with lung cancer have no positive physical with lung cancer have no positive physical findings.findings.General findings include abnormal percussion,General findings include abnormal percussion,breath sounds changes,moist rales(when breath sounds changes,moist rales(when pneumonia happen
21、s)pneumonia happens)Digital clubbing,superior vena cava syndrome,Digital clubbing,superior vena cava syndrome,horners syndrome(unilaterally constricted horners syndrome(unilaterally constricted pupil,enophthalmos,narrowed palpebral fissure pupil,enophthalmos,narrowed palpebral fissure and loss of sw
22、eating on the same side of the and loss of sweating on the same side of the face.face.Physical examinationsPhysical examinations Endobronchial obstruction may result in a Endobronchial obstruction may result in a localized wheezelocalized wheeze Lobar collapse may result in an area of Lobar collapse
23、 may result in an area of decreased breath sounds and dullness to decreased breath sounds and dullness to percussion.percussion.Chest X-rayChest X-ray It is the most important method to find lung cancerIt is the most important method to find lung cancerThe most frequent finding is a mass in the lung
24、 The most frequent finding is a mass in the lung fieldfieldOn chest X-ray,secondary manifestations On chest X-ray,secondary manifestations include lobar collapse,pleural effusion,include lobar collapse,pleural effusion,pneumonitis,elevation of the hemidiaphragm,pneumonitis,elevation of the hemidiaph
25、ragm,hilar and mediastinal adenopathy,and hilar and mediastinal adenopathy,and erosion of ribs or vertebrae due to erosion of ribs or vertebrae due to metastases.metastases.Obstructive atelectasisLung cancer on CTLung cancer on CT CT is the most useful in evaluating CT is the most useful in evaluati
26、ng patients with pulmonary and patients with pulmonary and mediastinal masses.mediastinal masses.It is also useful for detecting It is also useful for detecting multiple metastases.multiple metastases.CT can show a mass to be located in CT can show a mass to be located in which lobe of lung field an
27、d the size which lobe of lung field and the size of the mass.It also shows the nodule of the mass.It also shows the nodule in the mediastinum.in the mediastinum.Sometimes,when a mass locate behind Sometimes,when a mass locate behind the heart,chest X-ray cant detect the heart,chest X-ray cant detect
28、 it.CT can detect some secret sites it.CT can detect some secret sites of lung cancer.of lung cancer.Bronchoscopy Rigid and flexible scope Biopsy and selective washings Larger samples than flexible scope Exact locationLobectomyPneumonectomyUnresectableSleeveTransthoracic lung biopsyTransthoracic lun
29、g biopsy It may be utilized when tumor It may be utilized when tumor located located in peripheral airway.in peripheral airway.Transthoracic needle with Transthoracic needle with guidance guidance by CT can be used to detect by CT can be used to detect lesions lesions located near the chest wall loc
30、ated near the chest wall Video Assisted Thoracic Surgery Diagnosis of pleural disease Wedge resection Mediasteinoscopy&Mediasteinotomy Diagnoses unresectable disease Eliminate N2 disease from surgical resectionThoracotomyThoracotomyIf the methods mentioned above are not If the methods mentioned abov
31、e are not useful for detecting the cell type of useful for detecting the cell type of lung cancer,thoracotomy may be usedlung cancer,thoracotomy may be usedStaging of lung cancerStaging of lung cancer Small cell lung cancer has often Small cell lung cancer has often metastasized at the time of diagn
32、osis.metastasized at the time of diagnosis.TNM staging is not suited to small cell TNM staging is not suited to small cell lung cancer.lung cancer.TreatmentTreatmentIncluding:Including:A:Surgery A:Surgery B:Chemotherapy B:Chemotherapy C:Radiation therapy C:Radiation therapy D:Some other therapy D:So
33、me other therapy immunologic therapy,immunologic therapy,Chinese traditional therapy Chinese traditional therapySurgerySurgeryNon-small cell lung cancer:Non-small cell lung cancer:patients with stage I and II are patients with stage I and II are considered candidates for surgical considered candidat
34、es for surgical resection,with stage III cancer may resection,with stage III cancer may be candidates for surgery with be candidates for surgery with postoperative radiation of the postoperative radiation of the mediastinum.mediastinum.SurgeryWe must measure pulmonary function We must measure pulmon
35、ary function before surgical therapy.before surgical therapy.Forced vital capacity greater than 2 Forced vital capacity greater than 2 liters and a forced expiratory volume in liters and a forced expiratory volume in the first second(FEV1)of greater than the first second(FEV1)of greater than 50 perc
36、ent of the forced vital capacity 50 percent of the forced vital capacity predict that a patient can tolerate the predict that a patient can tolerate the consequences of pneumonectomy.consequences of pneumonectomy.ChemotherapyChemotherapyNon-small cell lung cancerNon-small cell lung cancerMVP:MMC 6-8
37、mg/m2(1),VDS 3mg/m2MVP:MMC 6-8mg/m2(1),VDS 3mg/m2NP:VP-16(d1,d8).DDP 100mg/m2(d1)NP:VP-16(d1,d8).DDP 100mg/m2(d1)GP GP Small-cell lung cancer it is highly Small-cell lung cancer it is highly responsive to chemotherapy.responsive to chemotherapy.EP regimen VP-16 100mg/m2 d1d3.EP regimen VP-16 100mg/m
38、2 d1d3.DDP 100mg/m2 d1.GP DDP 100mg/m2 d1.GPChemotherapyChemotherapyAggressive chemotherapy produces Aggressive chemotherapy produces complications and symptoms in all complications and symptoms in all patients.All experience patients.All experience anemia,leukepenia and opportunistic anemia,leukepe
39、nia and opportunistic infection other complications include infection other complications include nausea,vomiting possible cadiotoxicity,nausea,vomiting possible cadiotoxicity,hemorrhagic cystitis and peripheral hemorrhagic cystitis and peripheral neuropathy.neuropathy.Radiation therapyRadiation therapyIt is of proven benefit in It is of proven benefit in controlling bone pain,spinal controlling bone pain,spinal cord compression,superior vena cord compression,superior vena cava syndrome and bronchial cava syndrome and bronchial obstruction.obstruction.
