1、lRespiratory departmentlBronchogenic carcinoma refers to the malignant tumor which grows in the bronchus.Originating from mucus or gland of bronchus.lBronchogenic carcinoma has increased remarkable in incidence and mortality during half of the century and has become the most frequent visceral malign
2、ant diseases of men.The mortality of lung cancer hold the first place among all kinds carcinomas.lThe cause of lung cancer is unknown.It is believed that there are following related factors.l1.Excessive cigarette smoking:Smoking index(Brinkman Index)is equal to cigarettes per day smoking time(years)
3、.lPassive smoking is also a carcinogen factor.l2.Atmospheric pollution.It was found that carcinogenic factor is benzpyrene.l3.Occupational factors.l4Radioactivity in the atmosphere.l5.Diets and Nutrition.l6.Chronic irritation.l7.Genetic factors.l1.According to the position of tumor arising from,it c
4、an be divided into two types.lCentral type:Tumor arises from main bronchus,lobar and segmental bronchus.Peripheral type:Tumor arises beyond segmental bronchus.l2.According to cytology,it is convenient to classify into four kinds of types.l(1).Squamous cell carcinoma.l(2).Small cell anaplastic carcin
5、oma.l(3).Large cell anaplastic carcinoma.l(4).Adenocarcinoma(including alveolar cell carcinoma).lAccording to the different principles of management,it is divided into two types.lSCLC:small cell lung carcinoma.lNSCLC:non small cell lung carcinoma.lThere are no symptoms of early lung cancer in some p
6、atients.lSymptoms 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).l1.Respiratory symptoms.l(1).Cough:l(2).Hemoptysis:l(3).Dyspnea.:l(4).Wheez
7、e or stridor:l(5).Chest pain:l(6).Fever:l2.Symptoms caused by the near organs or tissue involved by tumor.l(1).Dysphagia.l(2).Hoarseness.l(3).Pleural effusion due to invasion of the pleura.l(4).Horners syndrome.It is caused by invading the cervical sympathetic ganglia on the involved side the pupil
8、is small ptosis of the up eyelids,retraction of the eyeball and no sweat of the face.l(5)Cardiac effusionl(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 an
9、terior chest wall are distension and edema of the face.l3.Symptoms caused by metastasis.liver,skeleton,brain,supra clavicle lymph nodes.l4.Paraneoplastic syndrome.Because tumor cell can secrete ectopic hormone，antigen or enzyme the patients with Lung Cancer sometimes may have some paraneoplastic syn
10、drome Including:l(1)Collagen tissue disorder such as finger clubbing,hypertrophic pulmonray osteoarthropathy。l(2)Endocrine disorders including Cushings syndrome,syndrome of inappropriate antiduretic hormone secretion(SIADHS),l(3)Neuropathic or myopathic disorders including polyneuritis,cerebellar de
11、generation,mental abnormalitis etc l(4)others.lThe 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 w
12、hich is often eccentric irregular in the inner wall owing to the necrosis of the neoplasm.l2 Central typel(1)Direct appearance:Unilateral enlargement of the hilar shadow due to the tumor itself or enlarged lymph nodes.l(2)Indirect appearance:Including local emphysema;obstructive pneumonia either lob
13、al or segmental;obstractive atalectasis(collapse)lobe or segment.l(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.l(2)Lymph nodes along hilar or mediastina can be found by CT.Fig1 Atelectasis,
14、Right upper lobeFig1 Atelectasis,Right upper lobe Fig3 Mass With Fuzzy,Right Upper LObeFig3 Mass With Fuzzy,Right Upper LObe Fig4 Mass In right Fig4 Mass In right Lobe,Lateral portionLobe,Lateral portion Fig5 Cavitating Bronchial Carcinoma Fig5 Cavitating Bronchial Carcinoma lCytologic examination o
15、f 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).lBronchoscope may verify the existence of tumor,of Central type,and cytologic diagnosis of lung can
16、cer should be obtained though FBCl.Blind biopsy may be help to the diagnosis of the tumor beyond the range of bronchoscope visionFig 1 Normal TracheaFig 2 Normal CarinaFig 3 Squamous Cell Carcinoma,TracheaFig 4 AdenocarcinomaLeft Lingular BronchusFig 5 AdenocarcinomaRight Truncal IntermedusFig 6 Ext
17、rinsic Pressure Tracheal1.Biopsy with fiberoptic bronchoscope;2.Transthoracic neddle biopsy with CT directed or B type ultrasonic;l3.Biopsy with thoracoscopy;l4.Biopsy with medistinoscopy;l5.Exploratory thoracotomy.l1.Symptom-free:General investigation of high risk group(male,morn than 40 years old,
18、cigarette consumption 20/per day).Taking a x-ray film and examining sputum for cancer cell every half year lEarly 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.lD
19、iagnosis procedure:l1.X-ray film(-)and sputum for cytology(-)FBC(-)follow up once a month/year.l2.X-ray film(+)and sputum for cytology(+)FBC to identify the cancer cell type CT,MRI therapy.lDiagnosis procedure:l3.X-ray film(-)and sputum for cytology(+)ruling out the tumor of upper respiratory tract
20、first FBC.l4 X-ray film(+)and sputum for cytology(-)FBC(-)lung biopsy.l1.Solitary nodule:Tuberculoma,Benign Tumorl2.Cavitation:Lung Abscess,Tuberculosis,l3.Enlargement of hilar shadow:Hamartomal4.Others:Pleural Effusion,Widening Of Mediatinal.l1.Rresection by operation;l2.Radiotherapy;l3.Chemotherap
21、y;l4.Immunotherapy;l5.Traditional Chinese medicine therapy etc.lThe 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.lSCLC:l Chemotherapy ,operation.l Chemotherapy,radiotherapy.lNSCLC:l Operation.l Most:operationchemotherapyl Small parts:radiotherapy.l:Operation+chemotherapy;l radiotherapy+chemotherapy.l:chemotherapy+radiotherapy(relieve some symptoms,such as pain,dyspnea,obstruction etc).
