肺癌lung cancer 课件

Lung Cancer Overview Lung Cancer: What is it? nUncontrolled growth of malignant cells in one or both lungs and tracheo-bronchial tree nArises from protective or ciliated cells in the bronchial epithelium nBegins as a result of repeated carcinogenic irritation causing increased rates of cell replication nProliferation of abnormal cells leads to hyperplasia, dysplasia or carcinoma in situ Lung Cancer: Incidence in US n173,770 new cases yearly (2004 statistics) n160,440 deaths yearly (2004 statistics) nMore deaths from lung cancer than prostate, breast and colorectal cancers combined nClosely correlated with smoking patterns nDecreasing incidence and deaths in men; continued increase in women nIncidence and mortality rates higher for African Americans than white Americans Lung Cancer: What Causes It? nSmoking nRadiation Exposure nEnvironmental/ Occupational Exposure nAsbestos nRadon nPassive smoke Lung Cancer: Smoking Facts nTobacco use is the leading cause of lung cancer n87% of lung cancers are related to smoking nRisk related to: namount smoked (pack years- # cigs/day x # yrs) nage of smoking onset nproduct smoked (tar/nicotine content, filters) ndepth of inhalation ngender Lung Cancer: Screening nNo proven effective screening tool nChest X-ray commonly used nClinical trials: nLow dose spiral chest CT scan nSputum analysis nChest X-ray Lung Cancer: Clinical Presentation Local Symptoms ncough ndyspnea nhemoptysis nrecurrent infections nchest pain Lung Cancer: Clinical Presentation Syndromes/Symptoms secondary to regional metastases: nEsophageal compression dysphagia nLaryngeal nerve paralysis hoarseness nSymptomatic nerve paralysis Horners syndrome nCervical/thoracic nerve invasion Pancoast syndrome nLymphatic obstruction pleural effusion nVascular obstruction SVC syndrome nPericardial/cardiac extension effusion, tamponade Lung Cancer: Clinical Presentation nSymptoms secondary to distant metastases npain norgan-related nGeneral Symptoms nweight loss nfatigue Lung Cancer: Metastatic Sites nLymph nodes nBrain nBones nLiver nLung/pleura nAdrenal gland Lung Cancer: Paraneoplastic Syndromes nNon Small Cell Lung Cancer nhypercalcemia nskeletal-connective tissue syndromes nSmall Cell Lung Cancer ninappropriate secretion of ADH nectopic ACTH secretion nneurologic/myopathic syndromes Lung Cancer: Diagnosis nHistory and Physical exam nDiagnostic tests nChest x-ray nBiopsy (bronchoscopy, needle biopsy, surgery) nStaging tests nCT chest/abdomen nBone scan nBone marrow aspiration nPET scan Lung Cancer: Prognostic Factors nStage at diagnosis nPerformance status Lung Cancer: Cell Types Non Small Cell Lung Cancer (NSCLC) Small Cell Lung Cancer (SCLC) Non Small Cell Lung Cancer (NSCLC) n80% of all lung cancers nBetter survival rates when found in early stages NSCLC: Histologic Cell Types nAdenocarcinoma nSquamous Cell Carcinoma nLarge Cell Carcinoma NSCLC: TNM Staging Stage Ia T1 N0M0 Ib T2N0M0 IIa T1N1M0 IIb T2N1M0 T3N0-1M0 IIIa T1-3 N1M0 IIIb Any T4any N3M0 IV Any M1 NSCLC: Treatment nSurgery nMediastinoscopy nVideo-assisted Thoracoscopy (VAT) nThoracotomy: Lobectomy. Pneumonectomy nRadiation nExternal Beam nBrachytherapy NSCLC: Treatment nChemotherapy nStandard nCisplatin, Carboplatin nNewer agents: Gemcitabine, Paclitaxel, Docetaxel, Vinorelbine, Irinotecan used alone and in combination NSCLC: Treatment by Stage StageDescriptionTreatment Options Stage I a/b Tumor of any size is found only in the lung Surgery Stage II a/b Tumor has spread to lymph nodes associated with the lung Surgery Stage III a Tumor has spread to the lymph nodes in the tracheal area, including chest wall and diaphragm Chemotherapy followed by radiation or surgery Stage III b Tumor has spread to the lymph nodes on the opposite lung or in the neck Combination of chemotherapy and radiation Stage IV Tumor has spread beyond the chest Chemotherapy and/or palliative (maintenance) care Adjuvant Chemotherapy NSCLC: Treatment Outcomes Stage I II IIIa IIIb IV 5-Year Survival 60-80% 40-50% 25-30% 5-10% 1% Small Cell Lung Cancer (SCLC) nMost aggressive lung cancer nResponsive to chemotherapy and radiation but recurrence rate is high even in early stage SCLC: Cell Types nOat Cell nIntermediate nCombined SCLC: Staging nLimited Stage Defined as tumor involvement of one lung, the mediastinum and ipsilateral and/or contralateral supraclavicular lymph nodes or disease that can be encompassed in a single radiotherapy port. nExtensive Stage Defined as tumor that has spread beyond one lung, mediastinum, and supraclavicular lymph nodes. Common distant sites of metastases are the adrenals, bone, liver, bone marrow, and brain. SCLC: Treatment nLimited Disease nChemotherapy nConcomitant Radiation nProphylactic Cranial Irradiation nExtensive Disease nChemotherapy nPalliative radiation SCLC: Treatment nChemotherapy: nMost commonly used initial regimen: Cisplatin or Carboplatin plus Etoposide x 4-6 cycles nNewer agents under evaluation: Topotecan, Paclitaxel, Docetaxel, Irinotecan, Gemcitabine SCLC: Treatment Outcomes nLimited Disease nmedian survival18 - 20 months n5-year survival10% nExtensive Disease nmedian survival10 - 12 months n5-year survival1 - 2% Advanced Lung Cancer: Supportive Care nTreatment Modalities for Palliation nChemotherapy nRadiation nSymptom Management nDyspnea nFatigue nPain Lung Cancer: Conclusions nSmoking cessation is essential