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1、1,原发性支气管肺癌 Primary bronchogenic carcinoma,呼吸内科Respiratory Department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。Primary bronchogenic carcinoma is abbreviated to lung cancer,it derives from bronchi mucosa or gland.,3,Epidemiology,Lung CancerWorldwide:most common cancer2,000,000 cases
2、 per yearChina:first leading cause of cancer death in urban area15%5-year survival,4,病因和发病机制Etiology and pathogenesis,1 吸烟1 Smoking,5,Lung Cancer:Smoking Facts,Tobacco use is the leading cause of lung cancer87%of lung cancers are related to smokingRisk related to:Amount smoked Age of smoking onsetPr
3、oduct smoked(tar/nicotine content,filters)Depth of inhalationGenderRisk goes down after 5 yrs cessationAt 15 years,80-90%risk reductionNever gets to“never smoker”risk,6,20 Year Lag,7,If what happened on your inside happened on your outside,would you still smoke?,8,2 职业致癌因子2 Occupation carcinogenic f
4、actor:Asbestos,Radon 3 空气污染3 Air pollution（1）室外大环境污染（1）Outdoor environment pollution（2）室内小环境污染（2）Indoor environment pollution4 电离辐射4 Ionizing radiation,9,5 饮食与营养5 Diet and nutritionVITAMIN A,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,10,6 其他因素6 Other factors 7 遗传因素7 Hereditary factorTumor suppressor gene
5、s*p53Dominant oncogenes*Kras*Her-2/neu,11,病理和分类,Pathology and classification,12,解剖学分类Anatomy classification,1 中央型肺癌1 Central lung cancer,13,2 周围型肺癌2 Peripheral lung cancer,14,组织学分类Histology classification,1 小细胞肺癌1 Small cell lung cancer,SCLC（1）燕麦细胞型（1）oat cell type（2）中间细胞型（2）intermediate cell type（3
6、）混合型（3）mixed type,15,Small cell carcinomaRare in non-smokersLarge hilar mass 70%present with overt metastasisVery chemo-responsiveWorst prognosis,16,Small cell carcinoma,17,2 非小细胞肺癌2 Non-small cell lung cancer,NSCLC（1）鳞状细胞癌（鳞癌）（1）Squamous cell carcinoma,SCC（2）腺癌和支气管肺泡癌（2）Adenocarcinoma，AC，and bronch
7、oalveolar carcinoma（3）大细胞癌（3）Large cell carcinoma（4）鳞腺癌（4）Adeno-squamous carcinoma,18,Squamous cell carcinomaNow 2nd most common(1st in China)Strongly linked with smoking60-80%in the proximal airways(central type)CavitationTendency to spread locally/regionallyPrognosis slightly better than Adenocarc
8、inoma,19,Squamous Cell Carcinoma,20,Squamous Cell Carcinoma,21,鳞癌,22,Lung Cancer Pathology,AdenocarcinomaMost common pathology(2nd in China)“Non-smokers lung cancer”WomenPeripheral(75%)Aggressive metastases,23,Adenocarcicoma Left Lower Lobe,24,Adenocarcinoma,25,Adenocarcinoma,26,Bronchoalveolar Cell
9、 Carcinoma,BACAerogenous and lymphatic spreadLeast associated with cigarette smokingUsually peripheralLocalized,multi-nodular or diffuseSlow metabolismPrognosisLocalized vs.other,27,支气管肺泡癌,28,Large cell carcinomaLarge peripheral mass with necrosisMalignant epithelial neoplasmPoorly-differentiatedAgg
10、ressive mets“Its a cancerits not small cellbut”,29,Large cell carcinoma,30,Large cell carcinoma,31,32,33,临床表现,Clinical manifestation,34,原发肿瘤引起的症状和体征Symptoms and physical signs due to primary tumor,1 咳嗽1 Cough2 咯血2 Hemoptysis3 喘鸣3 Wheeze4 气急4 Breath lessness5 发热5 Fever6 其他6 Others,35,肿瘤局部扩展引起的症状和体征Sy
11、mptoms and physical signs due to tumor local expanding,1 胸痛1 Chest pain2 呼吸困难2 Dyspnea3 吞咽困难3 Dysphagia:esophageal compression4 声音嘶哑4 Hoarse voice:laryngeal nerve paralysis 5 上腔静脉阻塞综合征5 Superior vena cava obstruction syndrome6 Horner综合征，肺上沟瘤6 Horners syndrome,Pancoasts tumor:Cervical/thoracic nerve
12、invasion 7 臂丛神经压迫征7 Brachial plexus compression syndrome,36,肿瘤远处转移引起的症状和体征Symptoms and physical signs due to tumor distant metastasis,1 脑、中枢神经系统转移1 Metastasize to brain,central nervous system,37,2 肝转移2 Metastasize to liver3 骨转移3 Metastasize to bone4 皮下转移性结节4 Subcutaneouly metastatic nodus5 颈部或锁骨上淋巴结
13、转移5 Cervical or supraclavicular lymph node metastasis,38,肺癌作用于其他系统引起的肺外表现Manifestation out of lung due to other systems affected by lung cancer,1 异位内分泌综合征1 Ectopic endocrine syndrome,EES（1）抗利尿激素分泌异常综合征（1）Syndrome of inapprpriate antidiuretic hormone(SIADH)secretion（2）异位ACTH综合征（2）Ectopic ACTH syndrom
14、e（3）神经肌肉综合征（3）Neuromyopathic syndrome（4）高钙血症（4）Hypercalcinemia（5）其他：类癌综合征（5）Others:Carcinoid syndrome,39,2 其他肺外表现2 Other manifestation out of lung（1）多发性周围神经炎（1）Multiple peripheral neuritis（2）肌无力样综合征（2）Eaton-Lambert syndrome,40,（3）肥大性肺性骨关节病（3）Hypertrophic pulmonary osteoarthropathy,HPO,41,实验室和辅助检查,La
15、boratory and auxiliary examination,42,胸部X线检查 Chest radiograph,1 中央型肺癌1 Central lung cancer,43,44,2 周围型肺癌2 Peripheral lung cancer,45,46,47,48,电子计算机体层扫描CT,49,Posterior basal segment of left lower lobe,AC,50,左上叶肺癌并左上叶不张,Left upper lobe cancer combining atelectasis,51,Left lower lobe cancer combining ob
16、structive pneumonia,52,53,磁共振MRI,54,55,痰脱落细胞学检查Sputum exfoliative cytology test,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Nuclide scintigraphy 1 骨闪烁显像 1 Bone scintigraphy 2 正电子发射断层显像 2 Positron emission tomography(PET),61,62,病理学检查Pathology癌标志物的检测Cancer mark test基因诊断G
17、ene diagnosis手术探查Operations research,63,诊断和鉴别诊断,Diagnosis and differential diagnosis,64,诊断Diagnosis,早期诊断Early diagnosis症状Symptom体征Physical sign检查Examination,65,鉴别诊断Differential diagnosis,1 肺结核1 Pulmonary tuberculosis,66,Tuberculosis,Lung cancer,67,肺真菌病Pulmonary mycosis,68,2 肺炎2 Pneumonia 抗菌药物治疗有效，病灶
18、吸收快而完全Usually,antibacterial drug therapy is effective,and focus is absorbed quickly and completely.,69,3 肺脓肿3 Lung abscess,70,4 结核性渗出性胸膜炎4 Tuberculous exudative pleurisy,71,临床分期Clinical stage,IA:T1N0 IB:T2 N0 IIA:T1 N1IIB:T2 N1,T3 N0IIIA:T3 N1,and T1-3 N2IIIB:any T4,any N3IV:any metastases,72,治 疗,Tr
19、eatment,73,手术治疗Operation treatment,1 NSCLC2 SCLC,74,化学药物治疗Chemotherapy,1 SCLC2 NSCLC,75,放射治疗Radiotherapy,根治性Radical cure姑息性Palliative cure,76,介入性治疗Interventional therapy,1 支气管动脉灌注1 Bronchial artery infusion,BAI2 经纤支镜2 Through bronchofiberscopy,77,生物反应调节剂和生物靶向治疗Biological response modifiers(BRM)and b
20、iological targeted therapy中医药Chinese medicine,78,预后和预防,Prognosis and prevention,79,预后Prognosis,The overall prognosis in bronchial carcinoma is very poor;With around 80%of patients dying within a year of diagnosis and less than 6%of patients surviving 5 years after diagnosis;The best prognosis is well-differentiated squamous cell tumors which have not metastasized and are amenable to surgical treatment.,80,预防Prevention,1 戒烟1 Stop smoking2 加强劳动保护2 Enhance labor protection3 早期发现3 Early discovery4 化学预防4 Chemical prophylaxis,81,Thanks!,
