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1、lung cancer2021/6/161What is Lung Cancer?Begins when cells in the lung grow out of control and form a tumor2021/6/162Etiology and pathogenesisCigarette smokingOther factors include air pollutions Nowadays It is reported that tuberculosis is associated with the incidence of lung cancer 2021/6/163Clas
2、sificationsAccording to anatomy: (1)Central lung (2) peripheral lung cancer2021/6/1642021/6/165According to histologic classification: Small cell lung cancer(SCLC) and Non-small cell lung cancer(NSCLC). NSCLC includes Squamous cell carcinoma, large cell carcinoma, adenocarcinoma, adenosquamous carci
3、noma.2021/6/166Small cell lung cancer(SCLC)Oat-cell carcinoma SCLC grows very rapidly and is very aggressive. Soon after the original cell becomes cancerous, it quickly multiplies to form a tumor. These cells swiftly spread to distant sites in the bodySCLC belongs in a group of tumors derived from n
4、euroendocrine cells that are responsible for the production and secretion of specific peptide product.they may related to paraneoplastic syndrome.2021/6/167Cells are oval or vaguely spindle-shaped ,have scant cytoplasm2021/6/1682021/6/169 Squamous cell carcinomathe most frequent form of the tumor(30
5、-50 percent of all casesbronchial epithelium and growth in situIt is related to cigarette smokingCavitation can occure in the distal to the obstructing massCentral location2021/6/1610Intercellular bridges and cellular pleomorphism2021/6/16112021/6/1612squamous cell carcinoma usually occurs near the
6、bronchi, the tumor can cause cough (sometimes a cough that is tinged with blood), shortness of breath, wheezing, and pneumonia in the area between the tumor and the edge of the lungit causes symptoms early in the disease 2021/6/1613adenocarcinomaareas of scarring is associated with the occurrence of
7、 adenocarcinoma.Peripheral adenocarcinomas are usually well-circumscribed, grey-white masses that rarely cavitate.It arises from the submucosal glands,located in peripheral airways and alveoliFemale 2021/6/16142021/6/16152021/6/1616large cell carcinoma2021/6/1617large nuclei,prominent nucleoli,abund
8、ant cytoplsma2021/6/1618usually located peripherallycan be quite large and not infrequently cavitate2021/6/1619the Symptoms of Lung CancerF Fa at ti ig gu ue e ( (t ti ir re ed dn ne es ss s) ) C Co ou ug gh h S Sh ho or rt tn ne es ss s o of f b br re ea at th h C Ch he es st t p pa ai in n L Lo os
9、 ss s o of f a ap pp pe et ti it te e C Co ou ug gh hi in ng g u up p p ph hl le eg gmm H He emmo op pt ty ys si is s ( (c co ou ug gh hi in ng g u up p b bl lo oo od d) )I If f c ca an nc ce er r h ha as s s sp pr re ea ad d, , s sy ymmp pt to omms s i in nc cl lu ud de e b bo on ne e p pa ai in n,
10、 , d di if ff fi ic cu ul lt ty y b br re ea at th hi in ng g, , a ab bd do ommi in na al l p pa ai in n, , h he ea ad da ac ch he e, , w we ea ak kn ne es ss s, , a an nd d c co on nf fu us si io on n2021/6/1620Due to primary lesions: cough, dyspnea, hemoptysis, sputum, wheezing, weight loss, fever
11、, pneumoniaDue to local extension: chest pain,hoarseness,superior vena cava syndrome, horners syndrome, dysphagia, pericardial effusion,pleural effusion, diaphragm paralysisOnly 5-15 percent of patients are asymptomatic when discovered to have bronchogenic carcinoma.2021/6/1621 Regionnal spread to h
12、ilar and mediastinal nodes may cause dysphagia due to esophageal compression horseness due to recurrent laryngeal nerve compression horners syndrome due to sympathetic nerve involvement elevation of the hemidiaphragm from phrenic nerve compression.2021/6/1622Superior sulcus, or pancoasts tumor may i
13、nvolve the brachial plexus, resulting in a c7-t2 neuropathy with pain, numbness, and weakness of the arm.Cardiac involvement is seen in About 20-25 percent of patients 2021/6/1623Extrapulmonary manifestations. Including metastasis to other organs, such as brain, central nervous system, skeleton syst
14、em, liver,adrenal glands and lymph nodes ects.Paraneoplastic syndromes are remote effects of tumor. They lead to metabolic and neuromuscular disturbances unrelated to the primary tumor, metastases, or treatment. They may be the first sign of the tumor.They do not indicate that a tumor has spread.202
15、1/6/1624Physical examinationsUsually in early stage, most of the patients with lung cancer have no positive physical findings.General findings include abnormal percussion, breath sounds changes, moist rales (when pneumonia happens)Digital clubbing, superior vena cava syndrome, horners syndrome(unila
16、terally constricted pupil, enophthalmos,narrowed palpebral fissure and loss of sweating on the same side of the face.2021/6/1625Physical examinationsEndobronchial obstruction may result in a localized wheezeLobar collapse may result in an area of decreased breath sounds and dullness to percussion.20
17、21/6/1626How is Lung Cancer Evaluated? B Be ec ca au us se e a al lmmo os st t a al ll l p pa at ti ie en nt ts s w wi il ll l h ha av ve e a a t tu ummo or r i in n t th he e l lu un ng g, , a a c ch he es st t x x- -r ra ay y o or r C CT T s sc ca an n o of f t th he e c ch he es st t i is s p pe
18、er rf fo or rmme ed d T Th he e d di ia ag gn no os si is s mmu us st t b be e c co on nf fi ir rmme ed d w wi it th h a a b bi io op ps sy y T Th he e l lo oc ca at ti io on n( (s s) ) o of f a al ll l s si it te es s o of f c ca an nc ce er r i is s d de et te er rmmi in ne ed d b by y a ad dd di
19、it ti io on na al l C CT T s sc ca an ns s, , P PE ET T ( (p po os si it tr ro on n e emmi is ss si io on n t to ommo og gr ra ap ph hy y) ) s sc ca an ns s, , a an nd d MMR RI I ( (mma ag gn ne et ti ic c r re es so on na an nc ce e i imma ag gi in ng g) ) I It t i is s i immp po or rt ta an nt t t
20、 to o f fi in nd d o ou ut t i if f c ca an nc ce er r s st ta ar rt te ed d i in n t th he e l lu un ng g o or r s so omme ew wh he er re e e el ls se e i in n t th he e b bo od dy y. . C Ca an nc ce er r a ar ri is si in ng g i in n o ot th he er r p pa ar rt ts s o of f t th he e b bo od dy y c c
21、a an n s sp pr re ea ad d t to o t th he e l lu un ng g a as s w we el ll l 2021/6/1627Chest X-ray It is the most important method to find lung cancerThe most frequent finding is a mass in the lung field2021/6/16282021/6/16292021/6/1630On chest X-ray, secondary manifestations include lobar collapse,
22、 pleural effusion, pneumonitis, elevation of the hemidiaphragm, hilar and mediastinal adenopathy, and erosion of ribs or vertebrae due to metastases.2021/6/16312021/6/16322021/6/1633Obstructive atelectasis2021/6/1634Lung cancer on CT CT is the most useful in evaluating patients with pulmonary and me
23、diastinal masses.It is also useful for detecting multiple metastases.CT can show a mass to be located in which lobe of lung field and the size of the mass. It also shows the nodule in the mediastinum.Sometimes,when a mass locate behind the heart, chest X-ray cant detect it .CT can detect some secret
24、 sites of lung cancer. 2021/6/16352021/6/1636Bronchoscopy2021/6/1637Rigid and flexible scopeBiopsy and selective washingsLarger samples than flexible scopeExact locationLobectomyPneumonectomyUnresectableSleeve2021/6/16382021/6/1639Transthoracic lung biopsy It may be utilized when tumor located in pe
25、ripheral airway. Transthoracic needle with guidance by CT can be used to detect lesions located near the chest wall 2021/6/16402021/6/1641Video Assisted Thoracic SurgeryDiagnosis of pleural diseaseWedge resection 2021/6/16422021/6/1643Mediasteinoscopy & Mediasteinotomy2021/6/16442021/6/1645Diagnoses
26、 unresectable diseaseEliminate N2 disease from surgical resection2021/6/1646ThoracotomyIf the methods mentioned above are not useful for detecting the cell type of lung cancer,thoracotomy may be used2021/6/1647Staging of lung cancerStaging is a way of describing a cancer, such as the size Staging is
27、 a way of describing a cancer, such as the size of the tumor and where it has spread of the tumor and where it has spread Staging is the most important tool doctors have to Staging is the most important tool doctors have to determine a patients prognosisdetermine a patients prognosis The type of tre
28、atment a person receives depends on the The type of treatment a person receives depends on the stage of the cancerstage of the cancerStaging is different for non-small cell lung cancer and Staging is different for non-small cell lung cancer and small cell lung cancersmall cell lung cancer 2021/6/164
29、8Stage I Non-Small Cell Lung CancerCancer is found only Cancer is found only in the lung in the lung Surgical removal Surgical removal recommendedrecommendedRadiation therapy Radiation therapy and/or chemotherapy and/or chemotherapy may also be usedmay also be used2021/6/1649Stage II Non-Small Cell
30、Lung CancerThe cancer has spread to The cancer has spread to lymph nodes in the lung lymph nodes in the lung Treatment is surgery to Treatment is surgery to remove the tumor and nearby remove the tumor and nearby lymph nodeslymph nodesChemotherapy Chemotherapy recommended; radiation recommended; rad
31、iation therapy sometimes given therapy sometimes given after chemotherapyafter chemotherapy 2021/6/1650Stage III Non-Small Cell Lung Cancer The cancer has spread to the lymph The cancer has spread to the lymph nodes located in the center of the nodes located in the center of the chest, outside the l
32、ung chest, outside the lung Stage IIIA cancer has spread to lymph Stage IIIA cancer has spread to lymph nodes in the chest, on the same side nodes in the chest, on the same side where the cancer originatedwhere the cancer originated Stage IIIB cancer has spread to lymph Stage IIIB cancer has spread
33、to lymph nodes on the opposite side of the nodes on the opposite side of the chest, under the collarbone, or the chest, under the collarbone, or the pleura (lining of the chest cavity) pleura (lining of the chest cavity) Surgery or radiation therapy with Surgery or radiation therapy with chemotherap
34、y recommended for stage chemotherapy recommended for stage IIIA IIIA Chemotherapy and sometimes Chemotherapy and sometimes radiation therapy recommended for radiation therapy recommended for stage IIIBstage IIIB 2021/6/1651Stage IV Non-Small Cell Lung Cancer The cancer has spread to The cancer has s
35、pread to different lobes of the lung different lobes of the lung or to other organs, such as or to other organs, such as the brain, bones, and liverthe brain, bones, and liver Stage IV non-small cell Stage IV non-small cell lung cancer is treated with lung cancer is treated with chemotherapychemothe
36、rapy2021/6/1652Small cell lung cancer has often metastasized at the time of diagnosis.TNM staging is not suited to small cell lung cancer. 2021/6/1653TreatmentIncluding: A:Surgery B:Chemotherapy C:Radiation therapy D:Some other therapy immunologic therapy, Chinese traditional therapy2021/6/1654Surge
37、ryNon-small cell lung cancer: patients with stage I and II are considered candidates for surgical resection, with stage III cancer may be candidates for surgery with postoperative radiation of the mediastinum. 2021/6/16552021/6/1656SurgeryWe must measure pulmonary function before surgical therapy.Fo
38、rced vital capacity greater than 2 liters and a forced expiratory volume in the first second (FEV1)of greater than 50 percent of the forced vital capacity predict that a patient can tolerate the consequences of pneumonectomy. 2021/6/16572021/6/16582021/6/1659ChemotherapyNon-small cell lung cancerMVP
39、:MMC 6-8mg/m2 (1), VDS 3mg/m2NP:VP-16 (d1,d8). DDP 100mg/m2 (d1)GP Small-cell lung cancer it is highly responsive to chemotherapy.EP regimen VP-16 100mg/m2 d1d3. DDP 100mg/m2 d1. GP2021/6/1660ChemotherapyAggressive chemotherapy produces complications and symptoms in all patients. All experience anem
40、ia,leukepenia and opportunistic infection other complications include nausea,vomiting possible cadiotoxicity, hemorrhagic cystitis and peripheral neuropathy. 2021/6/1661Radiation therapyIt is of proven benefit in controlling bone pain,spinal cord compression, superior vena cava syndrome and bronchial obstruction. 2021/6/16622021/6/1663 结束语结束语若有不当之处，请指正，谢谢！若有不当之处，请指正，谢谢！
