肺癌英文ppt课件

.,BronchogenicCarcinoma(LungCancer),Respiratorydepartment,.,Definition,Bronchogeniccarcinomareferstothemalignanttumorwhichgrowsinthebronchus.Originatingfrommucusorglandofbronchus.,.,Incidenceandmortality,Bronchogeniccarcinomahasincreasedremarkableinincidenceandmortalityduringhalfofthecenturyandhasbecomethemostfrequentvisceralmalignantdiseasesofmen.Themortalityoflungcancerholdthefirstplaceamongallkindscarcinomas.,.,Etiology,Thecauseoflungcancerisunknown.Itisbelievedthattherearefollowingrelatedfactors.1.Excessivecigarettesmoking:Smokingindex(BrinkmanIndex)isequaltocigarettesperdaysmokingtime(years).Passivesmokingisalsoacarcinogenfactor.,.,Etiology,2.Atmosphericpollution.Itwasfoundthatcarcinogenicfactorisbenzpyrene.3.Occupationalfactors.4Radioactivityintheatmosphere.5.DietsandNutrition.6.Chronicirritation.7.Geneticfactors.,.,PathologyAndClassification,1.Accordingtothepositionoftumorarisingfrom,itcanbedividedintotwotypes.Centraltype:Tumorarisesfrommainbronchus,lobarandsegmentalbronchus.Peripheraltype:Tumorarisesbeyondsegmentalbronchus.,.,PathologyAndClassification,2.Accordingtocytology,itisconvenienttoclassifyintofourkindsoftypes.(1).Squamouscellcarcinoma.(2).Smallcellanaplasticcarcinoma.(3).Largecellanaplasticcarcinoma.(4).Adenocarcinoma(includingalveolarcellcarcinoma).,.,PathologyAndClassification,Accordingtothedifferentprinciplesofmanagement,itisdividedintotwotypes.SCLC:smallcelllungcarcinoma.NSCLC:nonsmallcelllungcarcinoma.,.,Clinicalfeatures,Therearenosymptomsofearlylungcancerinsomepatients.Symptomscausedbylungcancerarenon-specific:perhapsanaudiblewheezeoraslightcough,symptomsofinfection(fever,purulentsputum),ofobstruction(wheezing,dyspnea),orulcerationofbronchialmucosa(hemoptysis).,.,Clinicalfeatures,1.Respiratorysymptoms.(1).Cough:(2).Hemoptysis:(3).Dyspnea.:(4).Wheezeorstridor:(5).Chestpain:(6).Fever:,.,Clinicalfeatures,2.Symptomscausedbythenearorgansortissueinvolvedbytumor.(1).Dysphagia.(2).Hoarseness.(3).Pleuraleffusionduetoinvasionofthepleura.,.,ClinicalFeatures,(4).Hornerssyndrome.Itiscausedbyinvadingthecervicalsympatheticgangliaontheinvolvedsidethepupilissmallptosisoftheupeyelids,retractionoftheeyeballandnosweatoftheface.(5)Cardiaceffusion,.,Clinicalfetures,(6).Superiorvenacavalsyndrome.Duetoobstructionofthesuperiorvenacaval,thepatientmayhavenoticedthathiscollaristight,theneckisenlargedandthejugularveinandtheveinsofanteriorchestwallaredistensionandedemaoftheface.3.Symptomscausedbymetastasis.liver,skeleton,brain,supraclaviclelymphnodes.,.,Clinicalfetures,4.Paraneoplasticsyndrome.Becausetumorcellcansecreteectopichormone，antigenorenzymethepatientswithLungCancersometimesmayhavesomeparaneoplasticsyndromeIncluding:(1)Collagentissuedisordersuchasfingerclubbing,hypertrophicpulmonrayosteoarthropathy。,.,Clinicalfeatures,(2)EndocrinedisordersincludingCushingssyndrome,syndromeofinappropriateantiduretichormonesecretion(SIADHS),(3)Neuropathicormyopathicdisordersincludingpolyneuritis,cerebellardegeneration,mentalabnormalitisetc(4)others.,.,RadiographicFindings,Theappearanceonthex-rayfilmdependsontheposition,sizeandstageofthetumor1.Peripheraltype:Itmaybevarioussuchasinfiltrativeornodular,lobulatedorumbilicussign,linerprotrusionsfromtheshadowintothesurroundinglung,cavitationwhichisofteneccentricirregularintheinnerwallowingtothenecrosisoftheneoplasm.,.,RadiographicFindings,2Centraltype(1)Directappearance:Unilateralenlargementofthehilarshadowduetothetumoritselforenlargedlymphnodes.(2)Indirectappearance:Includinglocalemphysema;obstructivepneumoniaeitherlobalorsegmental;obstractiveatalectasis(collapse)lobeorsegment.,.,AdvantageofCT:,(1)Somesmalllesion,lesionbehindofcardiacorbloodvessel,andpathologylocatedinapicaloflungcanbefoundbyCTwhichcantbefoundbychestx-ray.(2)LymphnodesalonghilarormediastinacanbefoundbyCT.,.,Fig1Atelectasis,Rightupperlobe,.,Fig3MassWithFuzzy,RightUpperLObe,.,Fig4MassInrightLobe,Lateralportion,.,Fig5CavitatingBronchialCarcinoma,.,Examinationofsputum,Cytologicexaminationofbronchialsecretions(orsputum)mayrevealexfoliatedmalignantcellsrecognizabletothepathologistwhoisspeciallytrainedforsuchwork.Thesputummusttobefresh,sendontime,repeat(4-6times).,.,Bronchoscope,Bronchoscopemayverifytheexistenceoftumor,ofCentraltype,andcytologicdiagnosisoflungcancershouldbeobtainedthoughFBC.Blindbiopsymaybehelptothediagnosisofthetumorbeyondtherangeofbronchoscopevision,.,Fig1NormalTrachea,Fig2NormalCarina,.,Fig3SquamousCellCarcinoma,Trachea,Fig4AdenocarcinomaLeftLingularBronchus,.,Fig5AdenocarcinomaRightTruncalIntermedus,Fig6ExtrinsicPressureTrachea,.,LungBiopsy,1.Biopsywithfiberopticbronchoscope;2.TransthoracicneddlebiopsywithCTdirectedorBtypeultrasonic;3.Biopsywiththoracoscopy;4.Biopsywithmedistinoscopy;5.Exploratorythoracotomy.,.,Diagnosis,1.Symptom-free:Generalinvestigationofhighriskgroup(male,mornthan40yearsold,cigaretteconsumption20/perday).Takingax-rayfilmandexaminingsputumforcancercelleveryhalfyearEarlystageofthebronchogeniccarcinomaReferstothetumorisstilllocatedatthebronchus,noinvadethehilarlymphnodes,pleuraaswellasdistantmetastases,itsdiameterisoften3cm.,.,Diagnosis,Diagnosisprocedure:1.X-rayfilm(-)andsputumforcytology(-)FBC(-)followuponceamonth/year.2.X-rayfilm(+)andsputumforcytology(+)FBCtoidentifythecancercelltypeCT,MRItherapy.,.,Diagnosis,Diagnosisprocedure:3.X-rayfilm(-)andsputumforcytology(+)rulingoutthetumorofupperrespiratorytractfirstFBC.4X-rayfilm(+)andsputumforcytology(-)FBC(-)lungbiopsy.,.,Differentialdiagnosis,1.Solitarynodule:Tuberculoma,BenignTumor2.Cavitation:LungAbscess,Tuberculosis,3.Enlargementofhilarshadow:Hamartoma4.Others:PleuralEffusion,WideningOfMediatina