肺癌英文PPT课件.ppt

1、Respiratory departmentlBronchogenic carcinoma refers to the malignant tumor which grows in the bronchus. Originating from mucus or gland of bronchus.lBronchogenic carcinoma has increased remarkable in incidence and mortality during half of the century and has become the most frequent visceral malign

2、ant diseases of men.The mortality of lung cancer hold the first place among all kinds carcinomas.lThe cause of lung cancer is unknown.It is believed that there are following related factors.l1. Excessive cigarette smoking:Smoking index(Brinkman Index) is equal to cigarettes per day smoking time(year

3、s). lPassive smoking is also a carcinogen factor.l2.Atmospheric pollution.It was found that carcinogenic factor is benzpyrene .l3.Occupational factors. l4Radioactivity in the atmosphere .l5.Diets and Nutrition.l6.Chronic irritation.l7.Genetic factors.l1. According to the position of tumor arising fr

4、om ,it can be divided into two types .lCentral type:Tumor arises from main bronchus, lobar and segmental bronchus . Peripheral type : Tumor arises beyond segmental bronchus .l2.According to cytology,it is convenient to classify into four kinds of types.l(1).Squamous cell carcinoma.l(2).Small cell an

5、aplastic carcinoma.l(3).Large cell anaplastic carcinoma.l(4).Adenocarcinoma(including alveolar cell carcinoma). lAccording to the different principles of management,it is divided into two types.lSCLC:small cell lung carcinoma.lNSCLC:non small cell lung carcinoma.lThere are no symptoms of early lung

6、cancer in some patients.lSymptoms caused by lung cancer 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).l1.Respiratory symptoms.l(1).Cough:l (2).Hemoptysis:

7、l(3).Dyspnea.:l(4).Wheeze or stridor:l(5).Chest pain :l(6).Fever:l2.Symptoms caused by the near organs or tissue involved by tumor.l(1).Dysphagia.l(2).Hoarseness.l(3).Pleural effusion due to invasion of the pleura.l(4).Horners syndrome.It is caused by invading the cervical sympathetic ganglia on the

8、 involved side the pupil is small ptosis of the up eyelids,retraction of the eyeball and no sweat of the face.l(5)Cardiac effusionl(6).Superior vena caval syndrome. Due to obstruction of the superior vena caval,the patient may have noticed that his collar is tight, the neck is enlarged and the jugul

9、ar vein and the veins of anterior chest wall are distension and edema of the face.l3.Symptoms caused by metastasis.liver, skeleton,brain, supra clavicle lymph nodes. l4.Paraneoplastic syndrome.Because tumor cell can secrete ectopic hormone，antigen or enzyme the patients with Lung Cancer sometimes ma

10、y have some paraneoplastic syndrome Including:l (1) Collagen tissue disorder such as finger clubbing , hypertrophic pulmonray osteoarthropathy 。l(2)Endocrine disorders including Cushings syndrome ,syndrome of inappropriate antiduretic hormone secretion(SIADHS),l(3) Neuropathic or myopathic disorders

11、 including polyneuritis ,cerebellar degeneration,mental abnormalitis etc l (4) others.lThe appearance on the x-ray film depends on the position ,size and stage of the tumor 1.Peripheral type :It may be various such as infiltrative or nodular, lobulated or umbilicus sign,liner protrusions from the sh

12、adow into the surrounding lung, cavitation which is often eccentric irregular in the inner wall owing to the necrosis of the neoplasm.l2 Central typel (1) Direct appearance :Unilateral enlargement of the hilar shadow due to the tumor itself or enlarged lymph nodes.l(2) Indirect appearance :Including

13、 local emphysema;obstructive pneumonia either lobal or segmental; obstractive atalectasis (collapse) lobe or segment.l(1) 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.l (2) Lymph nodes along

14、hilar or mediastina can be found by CT.Fig1 Atelectasis,Right upper lobeFig1 Atelectasis,Right upper lobe Fig3 Mass With Fuzzy,Right Upper LObeFig3 Mass With Fuzzy,Right Upper LObe Fig4 Mass In right Fig4 Mass In right Lobe,Lateral portionLobe,Lateral portion Fig5 Cavitating Bronchial Carcinoma Fig5

15、 Cavitating Bronchial Carcinoma lCytologic examination of bronchial secretions(or sputum)may reveal exfoliated malignant cells recognizable to the pathologist who is specially trained for such work.The sputum must to be fresh, send on time, repeat(4-6 times).lBronchoscope may verify the existence of

16、 tumor , of Central type, and cytologic diagnosis of lung cancer should be obtained though FBCl.Blind biopsy may be help to the diagnosis of the tumor beyond the range of bronchoscope visionFig 1 Normal TracheaFig 2 Normal CarinaFig 3 Squamous Cell Carcinoma, TracheaFig 4 AdenocarcinomaLeft Lingular

17、 BronchusFig 5 AdenocarcinomaRight Truncal IntermedusFig 6 Extrinsic Pressure Tracheal1.Biopsy with fiberoptic bronchoscope; 2.Transthoracic neddle biopsy with CT directed or B type ultrasonic;l3.Biopsy with thoracoscopy ;l4.Biopsy with medistinoscopy;l5.Exploratory thoracotomy.l1.Symptom -free: Gen

18、eral investigation of high risk group (male,morn than 40 years old,cigarette consumption 20/per day). Taking a x-ray film and examining sputum for cancer cell every half year lEarly stage of the bronchogenic carcinoma Refers to the tumor is still located at the bronchus ,no invade the hilar lymph no

19、des,pleura as well as distant metastases,its diameter is often 3cm.lDiagnosis procedure: l1. X-ray film(-) and sputum for cytology (-) FBC(-) follow up once a month /year.l2. X-ray film(+) and sputum for cytology (+) FBC to identify the cancer cell type CT , MRI therapy.lDiagnosis procedure: l3. X-r

20、ay film(-) and sputum for cytology (+) ruling out the tumor of upper respiratory tract first FBC.l4 X-ray film(+) and sputum for cytology (-) FBC(-) lung biopsy.l1.Solitary nodule: Tuberculoma, Benign Tumorl2.Cavitation:Lung Abscess, Tuberculosis,l3. Enlargement of hilar shadow: Hamartomal4.Others:

21、Pleural Effusion,Widening Of Mediatinal.l1.Rresection by operation ;l2.Radiotherapy ;l3.Chemotherapy;l4.Immunotherapy ;l5.Traditional Chinese medicine therapy etc.lThe therapeutic principle of lung cancer is comprehensive: rescect the tumor as far as possible then combine with other treatments ; oth

22、er treatments first then operation depending on the cytologic type, position,size and stage of the tumor.lSCLC:l Chemotherapy , operation.l Chemotherapy,radiotherapy.lNSCLC: l Operation.l Most :operationchemotherapyl Small parts: radiotherapy.l: Operation + chemotherapy;l radiotherapy +chemotherapy.l: chemotherapy+ radiotherapy(relieve some symptoms,such as pain, dyspnea, obstruction etc).