肺癌的早期诊断教学课件.ppt

1、肺癌的早期诊断Cancer profiles in China1970sData Source:National death survey.Ministry of Health.19801/100,000Cancer profiles in China1990sData Source:National death survey.Ministry of Health.19971/100,000Cancer profiles in ChinaData Source:National death survey.Ministry of Health.201120051/100,0002006年中国肿瘤

2、发病率排行男性：1.肺癌（42.4/10万，2002）2.胃癌（41.4/10万，2002）3.肝癌(37.9/10万，2002)4.结直肠癌(30/10万左右)5.食管癌(27.4/10万，2002)6.膀胱癌7.胰腺癌8.白血病9.淋巴瘤10.脑肿瘤女性:1.乳腺癌(18.4/10万，2002)2.肺癌(19/10万，2002)3.结直肠癌(20/10万左右)4.胃癌(19.2/10万，2002)5.肝癌(14.2/10万，2002)6.卵巢癌(3.2/10万，2002)7.胰腺癌8.食管癌(12/10万，2002)9.子宫内膜癌10.脑肿瘤2007 CSCO Global cancer

3、statistics 2002,CA Cancer J Clin 2005;55;74-108Cause of increase肺癌的临床表现和诊断方法肺癌易感因素吸烟人群：80%-90%的肺癌患者吸烟二手烟环境遗传因素环境因素：氡、石棉和其他化学物质吸烟美国、英国、加拿大等国100万以上人群的大规模调查发现，吸烟者肺癌的发病率是不吸烟者的10.8倍。美国癌症协会调查证实，吸烟者患肺癌是不吸烟者的8倍12倍。吸烟量越大，得肺癌的危险性越高。每天吸1支9支者，他们的危险性是不吸烟者的3倍15倍;每天吸40支以上者则是不吸烟者的19倍30倍。从肺癌的年死亡率来看，吸烟者比不吸烟者高18.4倍。肺癌

4、的早期危险信号不明原因的刺激性干咳感冒后咳嗽持久不愈突发痰中带血或鲜血丝固定部位反复发生肺炎肺癌常见的临床症状Pulmonary manifestationscough 咳嗽 hemoptysis 咯血wheezing 喘鸣 dyspnea 呼吸困难pneumoic symptoms 肺炎症状atelectasis 肺不张pneumonia 肺炎lung abscess 肺脓疡Nonpulmonary thoracic menifestationsdyspnea 呼吸困难phrenic nerve paralysispleural/pericardial effusionpneumothora

5、xchest pain 胸痛SVC syndrome 上腔静脉阻塞Pancoast syndrome voice change 声音嘶哑dysphagia 吞咽困难back pain 背部疼痛诊断方法诊断内容：部位诊断+病理诊断+分期诊断 例如：右肺上叶（外周型）中分化腺癌（pIb,T2N0M0）诊断方法 影像学 胸片，CT，MRI 同位素骨扫描，PET/CT 超声影像 病理学 确诊肺癌的金标准胸片PET/CT 扫描气管镜检查和活检CT引导下肿物穿刺活检纵隔镜范例女性，61岁可采用CT引导下穿刺活检男性，52岁，可采用纤维支气管镜活检EBUS-TBNA资料Regional lymph node

6、s mapping by EBUSRegional lymph nodes mapping by EBUS#2L#2R#1#4R#4L#7#12R#12L#11L#11R#10R#10L EBUS-TBNA is superior to TBNA EBUS increases yield in all stations other than#7 Compare with TBNACompare with CT and PET EBUS-TBNA should be considered early in the staging process of lung cancerCompare wit

7、h CT and PET EBUS-TBNA may be considered pre-operation in CT&PET negative patientsCompare with mediastinoscopy EBUS-TBNA and mediastinoscopy achieved similar results in the mediastinal stagingChoose EUS or EBUS?EUS-FNA might give a additional diagnostic gainCombined use of EBUS and EUSCombined use o

8、f EBUS and EUSCombined endoscopic approach could provide excellent diagnostic performance Complications of EBUSInfectious Tumor bed,Mediastinum,PericardiumBleeding(theoretically)Rare!EBUS-TBNA in NCCN guidelineEBUS/EUS changed from a category 2B to 2A in pretreatment evaluationIn non-cancer useSafe&effective in sarcoidosis&TBIL小结80%-90%的肺癌患者吸烟肺癌的早期症状：刺激性干咳，痰中带血或咯血，发热，胸痛等肺癌的诊断内容：部位诊断+病理诊断+分期诊断