肺癌（英）课件

Bronchogenic Carcinoma (Lung Cancer) Respiratory department Definition lBronchogenic carcinoma refers to the malignant tumor which grows in the bronchus. Originating from mucus or gland of bronchus. Incidence and mortality lBronchogenic carcinoma has increased remarkable in incidence and mortality during half of the century and has become the most frequent visceral malignant diseases of men.The mortality of lung cancer hold the first place among all kinds carcinomas. Etiology 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). lPassive smoking is also a carcinogen factor. Etiology 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. Pathology And Classification l1. According to the position of tumor arising from ,it can be divided into two types . lCentral type:Tumor arises from main bronchus, lobar and segmental bronchus . Peripheral type : Tumor arises beyond segmental bronchus . Pathology And Classification l2.According to cytology,it is convenient to classify into four kinds of types. l(1).Squamous cell carcinoma. l(2).Small cell anaplastic carcinoma. l(3).Large cell anaplastic carcinoma. l(4).Adenocarcinoma(including alveolar cell carcinoma). Pathology And Classification lAccording to the different principles of management,it is divided into two types. lSCLC:small cell lung carcinoma. lNSCLC:non small cell lung carcinoma. Clinical features lThere are no symptoms of early lung cancer in some patients. 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). Clinical features l1.Respiratory symptoms. l(1).Cough: l (2).Hemoptysis: l(3).Dyspnea.: l(4).Wheeze or stridor: l(5).Chest pain : l(6).Fever: Clinical features 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. Clinical Features l(4).Horners syndrome.It is caused by invading the cervical sympathetic ganglia on the involved side the pupil is small ptosis of the up eyelids,retraction of the eyeball and no sweat of the face. l(5)Cardiac effusion Clinical fetures l(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 anterior chest wall are distension and edema of the face. l3.Symptoms caused by metastasis.liver, skeleton,brain, supra clavicle lymph nodes. Clinical fetures l4.Paraneoplastic syndrome.Because tumor cell can secrete ectopic hormone，antigen or enzyme the patients with Lung Cancer sometimes may have some paraneoplastic syndrome Including: l (1) Collagen tissue disorder such as finger clubbing , hypertrophic pulmonray osteoarthropathy 。 Clinical features l(2)Endocrine disorders including Cushings syndrome ,syndrome of inappropriate antiduretic hormone secretion(SIADHS), l(3) Neuropathic or myopathic disorders including polyneuritis ,cerebellar degeneration,mental abnormalitis etc l (4) others. Radiographic Findings 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 which is often eccentric irregular in the inner wall owing to the necrosis of the neoplasm. Radiographic Findings l2 Central type l (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 lobal or segmental; obstractive atalectasis (collapse) lobe or segment. Advantage of CT: 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,Right upper lobe Fig3 Mass With Fuzzy,Right Upper LObe Fig4 Mass In right Lobe,Lateral portion Fig5 Cavitating Bronchial Carcinoma Examination of sputum lCytologic examination of 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) Bronchoscope lBronchoscope may verify the existence of tumor , of Central type, and cytologic diagnosis of lung cancer should be obtained though FBC l.Blind biopsy may be help to the diagnosis of the tumor beyond the range of bronchoscope vision Fig 1 Normal Trachea Fig 2 Normal Carina Fig 3 Squamous Cell Carcinoma, Trachea Fig 4 Adenocarcinoma Left Lingular Bronchus Fig 5 Adenocarcinoma Right Truncal Intermedus Fig 6 Extrinsic Pressure Trachea Lung Biopsy l1.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. Diagnosis l1.Symptom -free: General investigation of high risk group (male,morn than 40 years old,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. Diagnosis lDiagnosis 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. Diagnosis lDiagnosis procedure: l3. X-ray film(-) and sputum for cytology (+) ruling out the tumor of upper respiratory tract first FBC. l4 X-ray film(+) and sputum for cytology (-) FBC(-) lung biopsy. Differential diagnosis l1.Solitary nodule: Tuberculoma, Benign Tumor l2.Cavitation:Lung Abscess, Tuberculosis, l3. Enlargement of hilar shadow: Hamartoma l4.Others: Pleural Effusion,Widening