肺癌英文PPT课件.ppt

BronchogenicCarcinoma LungCancer Respiratorydepartment 1 Definition Bronchogeniccarcinomareferstothemalignanttumorwhichgrowsinthebronchus Originatingfrommucusorglandofbronchus 2 Incidenceandmortality Bronchogeniccarcinomahasincreasedremarkableinincidenceandmortalityduringhalfofthecenturyandhasbecomethemostfrequentvisceralmalignantdiseasesofmen Themortalityoflungcancerholdthefirstplaceamongallkindscarcinomas 3 Etiology Thecauseoflungcancerisunknown Itisbelievedthattherearefollowingrelatedfactors 1 Excessivecigarettesmoking Smokingindex BrinkmanIndex isequaltocigarettesperday smokingtime years Passivesmokingisalsoacarcinogenfactor 4 Etiology 2 Atmosphericpollution Itwasfoundthatcarcinogenicfactorisbenzpyrene 3 Occupationalfactors 4Radioactivityintheatmosphere 5 DietsandNutrition 6 Chronicirritation 7 Geneticfactors 5 PathologyAndClassification 1 Accordingtothepositionoftumorarisingfrom itcanbedividedintotwotypes Centraltype Tumorarisesfrommainbronchus lobarandsegmentalbronchus Peripheraltype Tumorarisesbeyondsegmentalbronchus 6 PathologyAndClassification 2 Accordingtocytology itisconvenienttoclassifyintofourkindsoftypes 1 Squamouscellcarcinoma 2 Smallcellanaplasticcarcinoma 3 Largecellanaplasticcarcinoma 4 Adenocarcinoma includingalveolarcellcarcinoma 7 PathologyAndClassification Accordingtothedifferentprinciplesofmanagement itisdividedintotwotypes SCLC smallcelllungcarcinoma NSCLC nonsmallcelllungcarcinoma 8 Clinicalfeatures Therearenosymptomsofearlylungcancerinsomepatients Symptomscausedbylungcancerarenon specific perhapsanaudiblewheezeoraslightcough symptomsofinfection fever purulentsputum ofobstruction wheezing dyspnea orulcerationofbronchialmucosa hemoptysis 9 Clinicalfeatures 1 Respiratorysymptoms 1 Cough 2 Hemoptysis 3 Dyspnea 4 Wheezeorstridor 5 Chestpain 6 Fever 10 Clinicalfeatures 2 Symptomscausedbythenearorgansortissueinvolvedbytumor 1 Dysphagia 2 Hoarseness 3 Pleuraleffusionduetoinvasionofthepleura 11 ClinicalFeatures 4 Horner ssyndrome Itiscausedbyinvadingthecervicalsympatheticgangliaontheinvolvedsidethepupilissmallptosisoftheupeyelids retractionoftheeyeballandnosweatoftheface 5 Cardiaceffusion 12 Clinicalfetures 6 Superiorvenacavalsyndrome Duetoobstructionofthesuperiorvenacaval thepatientmayhavenoticedthathiscollaristight theneckisenlargedandthejugularveinandtheveinsofanteriorchestwallaredistensionandedemaoftheface 3 Symptomscausedbymetastasis liver skeleton brain supraclaviclelymphnodes 13 Clinicalfetures 4 Paraneoplasticsyndrome Becausetumorcellcansecreteectopichormone antigenorenzymethepatientswithLungCancersometimesmayhavesomeparaneoplasticsyndromeIncluding 1 Collagentissuedisordersuchasfingerclubbing hypertrophicpulmonrayosteoarthropathy 14 Clinicalfeatures 2 EndocrinedisordersincludingCushing ssyndrome syndromeofinappropriateantiduretichormonesecretion SIADHS 3 Neuropathicormyopathicdisordersincludingpolyneuritis cerebellardegeneration mentalabnormalitisetc 4 others 15 RadiographicFindings Theappearanceonthex rayfilmdependsontheposition sizeandstageofthetumor1 Peripheraltype Itmaybevarioussuchasinfiltrativeornodular lobulatedorumbilicussign linerprotrusionsfromtheshadowintothesurroundinglung cavitationwhichisofteneccentricirregularintheinnerwallowingtothenecrosisoftheneoplasm 16 RadiographicFindings 2Centraltype 1 Directappearance Unilateralenlargementofthehilarshadowduetothetumoritselforenlargedlymphnodes 2 Indirectappearance Includinglocalemphysema obstructivepneumoniaeitherlobalorsegmental obstractiveatalectasis collapse lobeorsegment 17 AdvantageofCT 1 Somesmalllesion lesionbehindofcardiacorbloodvessel andpathologylocatedinapicaloflungcanbefoundbyCTwhichcan tbefoundbychestx ray 2 LymphnodesalonghilarormediastinacanbefoundbyCT 18 Fig1Atelectasis Rightupperlobe 19 Fig3MassWithFuzzy RightUpperLObe 20 Fig4MassInrightLobe Lateralportion 21 Fig5CavitatingBronchialCarcinoma 22 Examinationofsputum Cytologicexaminationofbronchialsecretions orsputum mayrevealexfoliatedmalignantcellsrecognizabletothepathologistwhoisspeciallytrainedforsuchwork Thesputummusttobefresh sendontime repeat 4 6times 23 Bronchoscope Bronchoscopemayverifytheexistenceoftumor ofCentraltype andcytologicdiagnosisoflungcancershouldbeobtainedthoughFBC Blindbiopsymaybehelptothediagnosisofthetumorbeyondtherangeofbronchoscopevision 24 Fig1NormalTrachea Fig2NormalCarina 25 Fig3SquamousCellCarcinoma Trachea Fig4AdenocarcinomaLeftLingularBronchus 26 Fig5AdenocarcinomaRightTruncalIntermedus Fig6ExtrinsicPressureTrachea 27 LungBiopsy 1 Biopsywithfiberopticbronchoscope 2 TransthoracicneddlebiopsywithCTdirectedorBtypeultrasonic 3 Biopsywiththoracoscopy 4 Biopsywithmedistinoscopy 5 Exploratorythoracotomy 28 Diagnosis 1 Symptom free Generalinvestigationofhighriskgroup male mornthan40yearsold cigaretteconsumption20 perday Takingax rayfilmandexaminingsputumforcancercelleveryhalfyearEarlystageofthebronchogeniccarcinomaReferstothetumorisstilllocatedatthebronchus noinvadethehilarlymphnodes pleuraaswellasdistantmetastases itsdiameterisoften 3cm 29 Diagnosis Diagnosisprocedure 1 X rayfilm andsputumforcytology FBC followuponceamonth year 2 X rayfilm andsputumforcytology FBCtoidentifythecancercelltype CT MRI therapy 30 Diagnosis Diagnosisprocedure 3 X rayfilm andsputumforcytology rulingoutthetumorofupperrespiratorytractfirst FBC 4X rayfilm andsputumforcytology FBC lungbiopsy 31 Differentialdiagnosis 1 Solitarynodule Tuberculoma BenignTumor2 Cavitation LungAbscess Tuberculosis 3 Enlargementofhilarshadow Hamartoma4 Others PleuralEffusion WideningOfMediatinal 32 T