肺癌英文版#荟萃知识

1、Bronchogenic Carcinoma(Lung Cancer),Respiratory department,1,专业知识,Definition,Bronchogenic carcinoma refers to the malignant tumor which grows in the bronchus. Originating from mucus or gland of bronchus.,2,专业知识,Incidence and mortality,Bronchogenic carcinoma has increased remarkable in incidence and

2、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.,3,专业知识,Etiology,The cause of lung cancer is unknown.It is believed that there are following related factors. 1. Exces

3、sive cigarette smoking:Smoking index(Brinkman Index) is equal to cigarettes per day smoking time(years). Passive smoking is also a carcinogen factor.,4,专业知识,Etiology,2.Atmospheric pollution.It was found that carcinogenic factor is benzpyrene . 3.Occupational factors. 4Radioactivity in the atmosphere

4、 . 5.Diets and Nutrition. 6.Chronic irritation. 7.Genetic factors.,5,专业知识,Pathology And Classification,1. According to the position of tumor arising from ,it can be divided into two types . Central type:Tumor arises from main bronchus, lobar and segmental bronchus . Peripheral type : Tumor arises be

5、yond segmental bronchus .,6,专业知识,Pathology And Classification,2.According to cytology,it is convenient to classify into four kinds of types. (1).Squamous cell carcinoma. (2).Small cell anaplastic carcinoma. (3).Large cell anaplastic carcinoma. (4).Adenocarcinoma(including alveolar cell carcinoma).,7

6、,专业知识,Pathology And Classification,According to the different principles of management,it is divided into two types. SCLC:small cell lung carcinoma. NSCLC:non small cell lung carcinoma.,8,专业知识,Clinical features,There are no symptoms of early lung cancer in some patients. Symptoms caused by lung canc

7、er 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).,9,专业知识,Clinical features,1.Respiratory symptoms. (1).Cough: (2).Hemoptysis: (3).Dyspnea.: (4).Wheeze or

8、stridor: (5).Chest pain : (6).Fever:,10,专业知识,Clinical features,2.Symptoms caused by the near organs or tissue involved by tumor. (1).Dysphagia. (2).Hoarseness. (3).Pleural effusion due to invasion of the pleura.,11,专业知识,Clinical Features,(4).Horners syndrome.It is caused by invading the cervical sym

9、pathetic ganglia on the involved side the pupil is small ptosis of the up eyelids,retraction of the eyeball and no sweat of the face. (5)Cardiac effusion,12,专业知识,Clinical fetures,(6).Superior vena caval syndrome. Due to obstruction of the superior vena caval,the patient may have noticed that his col

10、lar is tight, the neck is enlarged and the jugular vein and the veins of anterior chest wall are distension and edema of the face. 3.Symptoms caused by metastasis.liver, skeleton,brain, supra clavicle lymph nodes.,13,专业知识,Clinical fetures,4.Paraneoplastic syndrome.Because tumor cell can secrete ecto

11、pic hormone，antigen or enzyme the patients with Lung Cancer sometimes may have some paraneoplastic syndrome Including: (1) Collagen tissue disorder such as finger clubbing , hypertrophic pulmonray osteoarthropathy 。,14,专业知识,Clinical features,(2)Endocrine disorders including Cushings syndrome ,syndro

12、me of inappropriate antiduretic hormone secretion(SIADHS), (3) Neuropathic or myopathic disorders including polyneuritis ,cerebellar degeneration,mental abnormalitis etc (4) others.,15,专业知识,Radiographic Findings,The appearance on the x-ray film depends on the position ,size and stage of the tumor 1.

13、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.,16,专业知识,Radiographic Findings,2 Central

14、type (1) Direct appearance :Unilateral enlargement of the hilar shadow due to the tumor itself or enlarged lymph nodes. (2) Indirect appearance :Including local emphysema;obstructive pneumonia either lobal or segmental; obstractive atalectasis (collapse) lobe or segment.,17,专业知识,Advantage of CT:,(1)

15、 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. (2) Lymph nodes along hilar or mediastina can be found by CT.,18,专业知识,Fig1 Atelectasis,Right upper lobe,19,专业知识,Fig3 Mass With Fuzzy,Right Upper

16、 LObe,20,专业知识,Fig4 Mass In right Lobe,Lateral portion,21,专业知识,Fig5 Cavitating Bronchial Carcinoma,22,专业知识,Examination of sputum,Cytologic examination of bronchial secretions(or sputum)may reveal exfoliated malignant cells recognizable to the pathologist who is specially trained for such work.The spu

17、tum must to be fresh, send on time, repeat(4-6 times).,23,专业知识,Bronchoscope,Bronchoscope may verify the existence of tumor , of Central type, and cytologic diagnosis of lung cancer should be obtained though FBC .Blind biopsy may be help to the diagnosis of the tumor beyond the range of bronchoscope

18、vision,24,专业知识,Fig 1 Normal Trachea,Fig 2 Normal Carina,25,专业知识,Fig 3 Squamous Cell Carcinoma, Trachea,Fig 4 Adenocarcinoma Left Lingular Bronchus,26,专业知识,Fig 5 Adenocarcinoma Right Truncal Intermedus,Fig 6 Extrinsic Pressure Trachea,27,专业知识,Lung Biopsy,1.Biopsy with fiberoptic bronchoscope; 2.Trans

19、thoracic neddle biopsy with CT directed or B type ultrasonic; 3.Biopsy with thoracoscopy ; 4.Biopsy with medistinoscopy; 5.Exploratory thoracotomy.,28,专业知识,Diagnosis,1.Symptom -free: General investigation of high risk group (male,morn than 40 years old,cigarette consumption 20/per day). Taking a x-r

20、ay film and examining sputum for cancer cell every half year Early 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.,29,专业知识,Diagnosis,Diagnosis procedure: 1. X-ray

21、 film(-) and sputum for cytology (-) FBC(-) follow up once a month /year. 2. X-ray film(+) and sputum for cytology (+) FBC to identify the cancer cell type CT , MRI therapy.,30,专业知识,Diagnosis,Diagnosis procedure: 3. X-ray film(-) and sputum for cytology (+) ruling out the tumor of upper respiratory tract first FBC. 4 X-ray film(+) and sputum for cytology (-) FBC(-) lung biopsy.,31,专业知识,Differential diagnosis,1.Solitary nodule: Tuberculoma, Benign Tumor 2.Cavitation:Lung Abscess, Tuberculosis, 3. Enlargement of hilar shadow: Hamartoma 4.Others: Pleural Effusion,Widening Of Mediat