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1、原发性支气管肺癌 Primary bronchogenic carcinoma,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.,Epidemiology,Lung Cancer Worldwide: most common cancer 2,000,000 cases per year China : first leading cause of ca
2、ncer death in urban area 15% 5-year survival,病因和发病机制 Etiology and pathogenesis,1 吸烟 1 Smoking,Lung Cancer: Smoking Facts,Tobacco use is the leading cause of lung cancer 87% of lung cancers are related to smoking Risk related to: Amount smoked Age of smoking onset Product smoked (tar/nicotine content
3、, filters) Depth of inhalation Gender Risk goes down after 5 yrs cessation At 15 years, 80-90% risk reduction Never gets to “never smoker” risk,20 Year Lag,If what happened on your inside happened on your outside, would you still smoke?,2 职业致癌因子 2 Occupation carcinogenic factor: Asbestos, Radon 3 空气
4、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 pollution Chinese women, many of whom are nonsmokers, have very high lung cancer rates. This phenomenon has been associated with exposure to cooking oil vapors and other forms of air pollution (such as pa
5、ssive smoking) in the indoor environments of China. 4 电离辐射 4 Ionizing radiation,5 饮食与营养 5 Diet and nutrition VITAMIN A,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,6 其他因素 6 Other factors 7 遗传因素 7 Hereditary factor Tumor suppressor genes *p53 Dominant oncogenes *Kras *Her-2/neu,病理和分类,Pathology and classific
6、ation,解剖学分类 Anatomy classification,According to the position of tumor arising from, it can be divided into two types: 1 中央型肺癌 1 Central lung cancer: tumor arises from main bronchus, lobar and segmental bronchus .,2 周围型肺癌 2 Peripheral lung cancer tumor arises beyond segmental bronchus.,组织学分类 Histolog
7、y classification,小细胞肺癌 Small cell lung cancer, SCLC 非小细胞肺癌 Non-small cell lung cancer, NSCLC The histologic distinction between SCLC and NSCLC is extremely important. There are substantial differences between the two groups in both treatment and prognosis.,1 小细胞肺癌 1 Small cell lung cancer, SCLC （1）燕
8、麦细胞型 （1）oat cell type （2）中间细胞型 （2）intermediate cell type （3）混合型 （3）mixed type,SCLC Rare in non-smokers Large hilar mass 70% present with overt metastasis Very chemo-responsive Worst prognosis,SCLC,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
9、（2）Adenocarcinoma，AC，and bronchoalveolar carcinoma （3）大细胞癌 （3）Large cell carcinoma （4）鳞腺癌 （4）Adeno-squamous carcinoma,Squamous cell carcinoma Now 2nd most common ( 1st in China) Strongly linked with smoking 60-80% in the proximal airways (central type) Cavitation Tendency to spread locally/regionall
10、y Prognosis slightly better than Adenocarcinoma,个别细胞角化,Squamous Cell Carcinoma,Squamous Cell Carcinoma,鳞癌,Adenocarcinoma Most common pathology(2nd in China) “Non-smokers lung cancer” Women Peripheral (75%) Aggressive metastases,Adenocarcicoma Left Lower Lobe,Adenocarcinoma,腺癌的脏层胸膜内陷,Adenocarcinoma,B
11、ronchoalveolar Cell Carcinoma,BAC Aerogenous and lymphatic spread Least associated with cigarette smoking Usually peripheral Localized, multi-nodular or diffuse Slow metabolism Prognosis Localized vs. other,支气管肺泡癌,Large cell carcinoma Large peripheral mass with necrosis Poorly-differentiated,Large c
12、ell carcinoma,Large cell carcinoma,临床表现,Clinical manifestation,Symptoms,There are no symptoms of early lung cancer in some patients. Symptoms caused by lung cancer are non-specific. People often decide to visit the doctor only after they have been bothered by certain complaints over a period of time
13、. Individuals who have lung cancer frequently experience symptoms such as:,原发肿瘤引起的症状和体征 Symptoms and physical signs due to primary tumor,1 咳嗽 1 Cough 2 咯血 2 Hemoptysis 3 喘鸣 3 Wheeze 4 气急 4 Breath lessness 5 发热 5 Fever 6 其他 6 Others,肿瘤局部扩展引起的症状和体征 Symptoms and physical signs due to tumor local expand
14、ing,1 胸痛 1 Chest pain 2 呼吸困难 2 Dyspnea 3 吞咽困难 3 Dysphagia: esophageal compression 4 声音嘶哑 4 Hoarseness: laryngeal nerve paralysis 5 上腔静脉阻塞综合征 5 Superior vena cava obstruction syndrome: due to obstruction of the superior vena cava, the patient may have noticed that his collar is tight, the neck is enl
15、arged and the jugular vein and the veins of anterior chest wall are distension and edema of the face.,6 Horner综合征，肺上沟瘤 6 Horners syndrome, Pancoasts tumor: it is caused by invading the cervical sympathetic ganglia on the involved side, the pupils small ptosis of the up eyelids, retraction of the eye
16、ball and no sweat of the face. 7 臂丛神经压迫征 7 Brachial plexus compression syndrome,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,2 肝转移 2 Metastasize to liver 3 骨转移 3 Metastasize to bone 4 皮下转移性结节 4 Subcutaneouly metastatic nodus 5 颈部或锁骨上淋巴结转移 5 Cervical or supraclavicular lymph node metastasis,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 e
