肺癌（英文版）课件

LungCancerBronchialcarcinomaAdvancedLungCancer：

morethan80%BronchialcarcinomaEarlystage

LungCancer:lessthan20%

Why?PatientBronchialcarcinomaDoctorSociety/governmentEpidemiologyBronchialcarcinomaEpidemiologyBronchialcarcinomaNo1：LungcancerIncidence/MortalityEtiologyBronchialcarcinomaThecauseisnotyetclear,butagreethattheincidenceoflungcancerisrelatedtothefollowingfactor:

Bronchialcarcinoma

1、smoking

Smokingindexmorethan400Danger!!BronchialcarcinomaMale85%Female47%

Lungcancer!!

2、airpollutionBronchialcarcinoma

2、airpollutionBronchialcarcinoma

2、airpollutionBronchialcarcinoma

3、occupationalexposure

Asbestos,

Arsenic,Uranium,TinBronchialcarcinoma

4、Drivergene

EGFRALKRasCmetROS-1

BronchialcarcinomaPathologyBronchialcarcinomaGeneralclassification

(1).CentralLungCancer?(2).PeripheralLungCancer?BronchialcarcinomaHistologicClassifcation:

(1)SmallCellLungCancer(2)Non-SmallCellLungCancerBronchialcarcinomaNon-SmallCellLungCancer:

(1)Adenocarcinoma:35-40%

(2)SquamousCellCarcinoma:30-35%

(3)LargeCellCarcinoma:10%(4)AdenosquamousCellCarcinomaBronchialcarcinoma(5)Smallcelllungcancer:

a.Accountforapproximately15%b.Oftenlocatedinproximalsegmentalbronchi.c.Highmalignancy,easytodistantspreadd.PoorprognosisBronchialcarcinomaClinicalmanifestationBronchialcarcinomaThesignsandsymptomsoflungcancerdependonthe

site

,size,theextentofinvasion

and

metastasesBronchialcarcinoma1.Whensmalltumor/peripheralzoneNosymptomsBronchialcarcinoma2.Whenlargertumor/centralzonemanysymptomsBronchialcarcinoma3.Wheninvasion/metastasesBronchialcarcinoma1.Problemscausedbythetumoritself?Cough--Mostcommon,thebronchusinvolvedbytumorBronchialcarcinomaHemoptysis--BronchialmucosalvascularbeinvolvedWheezing/dyspnea--Obstructivepneumonia,atelectasis,PleuraleffusionChestpain--TumorInvadedthechestwallFever--causedbypneumonitisorbonemetastasisOthers--Lossofappetite,Weightloss,Weakness,CachexiaProblemscausedbythetumoritself?CoughHemoptysisWheezing/dyspneaChestpainFeverOthersBronchialcarcinoma2.Problemscausedbythetumorinvasionormetastasis?(1).Recurrentlaryngealnerveparalysis--tumororlymphnodeinvadeRLG(2).Horner’syndrome--eighthcervicalandfirstthoracicsympatheticnerve(Stellateganglion)BronchialcarcinomaProblemscausedbythetumorinvasionormetastasis?(3).Superiorvenacavasyndrome--tumororlymphnodeinvadeorpresssuperiorvenacava,causevascularobstructionBronchialcarcinomaProblemscausedbythetumorinvasionormetastasis?(4).Pancoast’ssyndrome--Horner’syndrome,tumorinvadefirstandsecondribs,Brachialplexus,causingSeverepainBronchialcarcinomaProblemscausedbythetumorinvasionormetastasis?(5).Brainmetastsis--headache,Vomiting,paralysis(6).Bonemetastsis--causingsevere,persistentpainBronchialcarcinomaProblemscausedbythetumorinvasionormetastasis?(7).Adrenalmetastasis--(8).Livermetastases--Bronchialcarcinoma3.paraneoplasticsyndromes?(1).hypertrophicpulmonaryoseoarthropathy--occursinADpatientsandismanifestedasboneandjointpain(2).Cassidy’ssyndrome–

ofteninSCLCpatients,asdiarrhea,FacialflushingorasthmaBronchialcarcinomaparaneoplasticsyndromes?(3).Gynecomastia–OfteninSCLCpatients(4).Electrolyteimbalance–OfteninSCLCpatientsBronchialcarcinomaDiagnosisBronchialcarcinomaFirststep:

Adetailedhistory---smokinghistory,occupationalandenvironmentalexposure,andfamilyhistory.BronchialcarcinomaSecondstep:

Physicalexaminationhead,neck,chest,abdomen,limbSupraclavicularlymphnodesBronchialcarcinomathirdstep:

1.ChestX-ray:Chestradiographcanrevealperipheralnodulesbutcentraltumoriseasilymissed,obscuredbyhilarstructureBronchialcarcinomathirdstep:

1.ChestX-ray:Chestradiographcanrevealperipheralnodulesbutcentraltumoriseasilymissed,obscuredbyhilarstructureBronchialcarcinoma2.CT:

CTscanofthechestisthestandardofcareforanypatientsuspectedofhavingaprimarylungcancer.Bronchialcarcinoma3.PET-CT

PET-CTiscurrentlybeingusedforevaluationofpatientswithsuspectedmalignant,PET-CTappearalsoparticularlyusefulforthedetectionofmediastinallymphnodemetastasesaswellasvisceralandbonymetastasesinlungcancerBronchialcarcinoma3.PET-CT

Bronchialcarcinoma4.MRI:MRIscansaresuperiortoCTforthedetectionofbrainmetastasesBronchialcarcinomaMethodstogetthetumortissuefordiagnosis:

1.SputumcytologyItisarapid,cheapmeanstoestablishatissuediagnosis.ButthesensitivityislowBronchialcarcinoma2.Fiberopticbronchocopy

Itenablesvisualizationofthetracheobronchialtreethesecondorthirdsegmentaldivision,histologicspecimenscanbeobtainedfromidentifiedlesionBronchialcarcinomaBronchialcarcinoma3.Percutaneousfine-needleaspiration:

ThiscanbeperformedusingCT-guidedtechniques.thepositiveyieldexceeds95%.BronchialcarcinomaBronchialcarcinoma4.Thoracentesis

Typically,abloodypleuraleffusionismalignant.Ingeneral,thoracentesiscanyieldadiagnosisofcancerin70%ofmalignanteffusion.Bronchialcarcinoma5.Thoracoscopy

VATShasbeenwidelyusedinthediagnosis,staging,andresectionoflungcancer.Peripheralnodulescanbeexcisedusingthoracoscopy,mediastinallymphnodescanbesampled,thistechniqueisalsovaluableforsuspectedpleuraldisease.Bronchialcarcinoma6.metastaticlymphnodebiopsy7.Mediastinoscopy/EBUSBronchialcarcinoma8.Thoracotomy

Morethan95%oftumorsshouldbeaccuratelydiagnosedandstagedbeforethoracotomy.Whentheabovemethodsdoesnotwork,thediagnosisoflungcancerisonlymdeatthoracotomy.BronchialcarcinomaBloodBronchialcarcinomaCEA,NSE,SCC,CYFRAStagingBronchialcarcinomaTNMstagingsystemT

meansprimarytumor,itissubdividedintofourcategories(T1toT4)dependingonsize,site,andlocalinvolvementBronchialcarcinomaN

meanslymphnode.N1:bronchopulmonaryN2:ipsilateralmediastinalN3:contralateral

orsupraclavicularlymphnodeBronchialcarcinomaMmeansmetastasis

Metastasesareabsent(M0)orpresent(M1).

Bronchialcarcinoma

TheTNMsystemincludesclinicalaswellaspathologiccriteria

ClinicalTNM---CTNMPathologicTNM---PTNMⅠa、Ⅰb、Ⅱa、Ⅱb、Ⅲa、Ⅲb、Ⅳa、Ⅳbdifferentstagesareassociatedwithsignificantdifferencesin5-yearsurvival.BronchialcarcinomaTreatmentBronchialcarcinomaSurgery

Preoperativeevaluation:(1)Resectability---tumorcanbetotallyencompassedbyexcisionincludingstageI,Ⅱ,andⅢa(2)Cardiopulmonaryfuncation----pulmonaryresectioncanbeperformedwithacceptableperioperativerisk.BronchialcarcinomaSurgicalprocedures(1)Pneumonectomy(2)Lobectomy—currentstandard(3)SegmentectomyBronchialcarcinomaSurgicalprocedures(1)OpenBronchialcarcinomaSurgicalprocedures(2)HybridBronchialcarcinomaSurgicalprocedures(3)VATSBronchialcarcinomaSurgicalprocedures(4)robot--DaVinciBronchialcarcinomaRadiotherapy:RadiotherapycanbeusedinNSCLCofanystage.(1)Earlylungcancer---thepatientcannottoleratetheoperationBronchialcarcinoma(2)Resectabledisease---asanadjuvanttreatmenttoimprovelocalcontrolorpreoperativetreatmenttoimproveradicalresection(3)Advancedandmetastaticlungcancer---aspalliativetreatmenttorelievepainBronchialcarcinomaChemotherapy:Palliativechemotherapy

---usedinlatelungcancer---mayimprovesurvivalforpatientswithstageⅣandimproveoutcomeforpatientswithlocoregionaldisease.Bronchialcarcinoma(2)Adjuvantchemotherapy

---usedaftersurgicalresectionorradiotherapymayimprovesurvivalofpatientsundergoingresectionorradiotherapyofNSCLCBronchialcarcinoma(3)

Neoadjuvantchemotherapy

---inwhichseveralcyclesofchemotherapyisadministered