原发性支气管肺癌中对照.ppt

1,原发性支气管肺癌Primarybronchogeniccarcinoma,呼吸内科RespiratoryDepartment熊维宁Xiong,Weining,2,定义Definition,原发性支气管肺癌简称肺癌，是起源于支气管粘膜或腺体的肿瘤。Primarybronchogeniccarcinomaisabbreviatedtolungcancer,itderivesfrombronchimucosaorgland.,3,Epidemiology,LungCancerWorldwide:mostcommoncancer2,000,000casesperyearChina:firstleadingcauseofcancerdeathinurbanarea5yrscessationAt15years,80-90%riskreductionNevergetsto“neversmoker”risk,6,20YearLag,7,Ifwhathappenedonyourinsidehappenedonyouroutside,wouldyoustillsmoke?,8,2职业致癌因子2Occupationcarcinogenicfactor:Asbestos,Radon3空气污染3Airpollution（1）室外大环境污染（1）Outdoorenvironmentpollution（2）室内小环境污染（2）Indoorenvironmentpollution4电离辐射4Ionizingradiation,9,5饮食与营养5DietandnutritionVITAMINA,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,10,6其他因素6Otherfactors7遗传因素7HereditaryfactorTumorsuppressorgenes*p53Dominantoncogenes*Kras*Her-2/neu,11,病理和分类,Pathologyandclassification,12,解剖学分类Anatomyclassification,1中央型肺癌1Centrallungcancer,13,2周围型肺癌2Peripherallungcancer,14,组织学分类Histologyclassification,1小细胞肺癌1Smallcelllungcancer,SCLC（1）燕麦细胞型（1）oatcelltype（2）中间细胞型（2）intermediatecelltype（3）混合型（3）mixedtype,15,SmallcellcarcinomaRareinnon-smokersLargehilarmass70%presentwithovertmetastasisVerychemo-responsiveWorstprognosis,16,Smallcellcarcinoma,17,2非小细胞肺癌2Non-smallcelllungcancer,NSCLC（1）鳞状细胞癌（鳞癌）（1）Squamouscellcarcinoma,SCC（2）腺癌和支气管肺泡癌（2）Adenocarcinoma，AC，andbronchoalveolarcarcinoma（3）大细胞癌（3）Largecellcarcinoma（4）鳞腺癌（4）Adeno-squamouscarcinoma,18,SquamouscellcarcinomaNow2ndmostcommon(1stinChina)Stronglylinkedwithsmoking60-80%intheproximalairways(centraltype)CavitationTendencytospreadlocally/regionallyPrognosisslightlybetterthanAdenocarcinoma,19,SquamousCellCarcinoma,20,SquamousCellCarcinoma,21,鳞癌,22,LungCancerPathology,AdenocarcinomaMostcommonpathology(2ndinChina)“Non-smokerslungcancer”WomenPeripheral(75%)Aggressivemetastases,23,AdenocarcicomaLeftLowerLobe,24,Adenocarcinoma,25,Adenocarcinoma,26,BronchoalveolarCellCarcinoma,BACAerogenousandlymphaticspreadLeastassociatedwithcigarettesmokingUsuallyperipheralLocalized,multi-nodularordiffuseSlowmetabolismPrognosisLocalizedvs.other,27,支气管肺泡癌,28,LargecellcarcinomaLargeperipheralmasswithnecrosisMalignantepithelialneoplasmPoorly-differentiatedAggressivemets“Itsacanceritsnotsmallcellbut”,29,Largecellcarcinoma,30,Largecellcarcinoma,31,32,33,临床表现,Clinicalmanifestation,34,原发肿瘤引起的症状和体征Symptomsandphysicalsignsduetoprimarytumor,1咳嗽1Cough2咯血2Hemoptysis3喘鸣3Wheeze4气急4Breathlessness5发热5Fever6其他6Others,35,肿瘤局部扩展引起的症状和体征Symptomsandphysicalsignsduetotumorlocalexpanding,1胸痛1Chestpain2呼吸困难2Dyspnea3吞咽困难3Dysphagia:esophagealcompression4声音嘶哑4Hoarsevoice:laryngealnerveparalysis5上腔静脉阻塞综合征5Superiorvenacavaobstructionsyndrome6Horner综合征，肺上沟瘤6Hornerssyndrome,Pancoaststumor:Cervical/thoracicnerveinvasion7臂丛神经压迫征7Brachialplexuscompressionsyndrome,36,肿瘤远处转移引起的症状和体征Symptomsandphysicalsignsduetotumordistantmetastasis,1脑、中枢神经系统转移1Metastasizetobrain,centralnervoussystem,37,2肝转移2Metastasizetoliver3骨转移3Metastasizetobone4皮下转移性结节4Subcutaneoulymetastaticnodus5颈部或锁骨上淋巴结转移5Cervicalorsupraclavicularlymphnodemetastasis,38,肺癌作用于其他系统引起的肺外表现Manifestationoutoflungduetoothersystemsaffectedbylungcancer,1异位内分泌综合征1Ectopicendocrinesyndrome,EES（1）抗利尿激素分泌异常综合征（1）Syndromeofinapprpriateantidiuretichormone(SIADH)secretion（2）异位ACTH综合征（2）EctopicACTHsyndrome（3）神经肌肉综合征（3）Neuromyopathicsyndrome（4）高钙血症（4）Hypercalcinemia（5）其他：类癌综合征（5）Others:Carcinoidsyndrome,39,2其他肺外表现2Othermanifestationoutoflung（1）多发性周围神经炎（1）Multipleperipheralneuritis（2）肌无力样综合征（2）Eaton-Lambertsyndrome,40,（3）肥大性肺性骨关节病（3）Hypertrophicpulmonaryosteoarthropathy,HPO,41,实验室和辅助检查,Laboratoryandauxiliaryexamination,42,胸部X线检查Chestradiograph,1中央型肺癌1Centrallungcancer,43,44,2周围型肺癌2Peripherallungcancer,45,46,47,48,电子计算机体层扫描CT,49,Posteriorbasalsegmentofleftlowerlobe,AC,50,左上叶肺癌并左上叶不张,Leftupperlobecancercombiningatelectasis,51,Leftlowerlobecancercombiningobstructivepneumonia,52,53,磁共振MRI,54,55,痰脱落细胞学检查Sputumexfoliativecytologytest,SCC,AC,SCLC,56,纤维支气管镜检查Bronchofiberscopy,57,58,59,SCC,SCLC,AC,LCC,60,核素闪烁显像Nuclidescintigraphy1骨闪烁显像1Bonescintigraphy2正电子发射断层显像2Positronemissiontomography(PET),61,62,病理学检查Pathology癌标志物的检测Cancermarktest基因诊断Genediagnosis手术探查Operationsresearch,63,诊断和鉴别诊断,Diagnosisanddifferentialdiagnosis,64,诊断Diagnosis,早期诊断Earlydiagnosis症状Symptom体征Physicalsign检查Examination,65,鉴别诊断Differentialdiagnosis,1肺结核1Pulmonarytuberculosis,66,Tuberculosis,Lungcancer,67,肺真菌病Pulmonarymycosis,68,2肺炎2Pneumonia抗菌药物治疗有效，病灶吸收快而完全Usually,antibacterialdrugtherapyiseffective,andfocusisabsorbedquicklyandcompletely.,69,3肺脓肿3Lungabscess,70,4结核性渗出性胸膜炎4Tuberculousexudativepleurisy,71,临床分期Clinicalstage,IA:T1N0IB:T2N0IIA:T1N1IIB:T2N1,T3N0IIIA:T3N1,andT1-3N2IIIB:anyT4,anyN3IV:anymetastases,72,治疗,Treatment,73,手术治疗Operationtreatment,1NSCLC2SCLC,74,化学药物治疗Chemotherapy,1SCLC2NSCLC,75,放射治疗Radiotherapy,根治性Radicalcure姑息性Palliativecure,76,介入性治疗Interventionaltherapy,1支气管动脉灌注1Bronchialarteryinfusion,BAI2经纤支镜2Throughbronchofiberscopy,77,生物反应调节剂和生物靶向治疗Biologicalresponsemodifiers(BRM)andbiologicaltargetedtherapy中医药Chinesemedicine,78,预后和预防,Prognosisandprevention,79,预后Prognosis,Theoverallprognosisinbronchialcarcinomaisverypoor;Witharound80%ofpatientsdyingwithinayearofdiagnosisandlessthan6%of