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1、Bronchogenic Carcinoma(Lung Cancer)Respiratory departmentDefinitionlBronchogenic carcinoma refers to the malignant tumor which grows in the bronchus. Originating from mucus or gland of bronchus.Incidence and mortalitylBronchogenic carcinoma has increased remarkable in incidence and mortality during
2、half of the century and has become the most frequent visceral malignant diseases of men.The mortality of lung cancer hold the first place among all kinds carcinomas.EtiologylThe cause of lung cancer is unknown.It is believed that there are following related factors.l1. Excessive cigarette smoking:Sm
3、oking index(Brinkman Index) is equal to cigarettes per day smoking time(years). lPassive smoking is also a carcinogen factor.Etiologyl2.Atmospheric pollution.It was found that carcinogenic factor is benzpyrene .l3.Occupational factors. l4Radioactivity in the atmosphere .l5.Diets and Nutrition.l6.Chr
4、onic irritation.l7.Genetic factors.Pathology And Classificationl1. According to the position of tumor arising from ,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 .Pathology And
5、Classificationl2.According to cytology,it is convenient to classify into four kinds of types.l(1).Squamous cell carcinoma.l(2).Small cell anaplastic carcinoma.l(3).Large cell anaplastic carcinoma.l(4).Adenocarcinoma(including alveolar cell carcinoma). Pathology And ClassificationlAccording to the di
6、fferent principles of management,it is divided into two types.lSCLC:small cell lung carcinoma.lNSCLC:non small cell lung carcinoma.Clinical featureslThere are no symptoms of early lung cancer in some patients.lSymptoms caused by lung cancer are non-specific:perhaps an audible wheeze or a slight coug
7、h,symptoms of infection (fever ,purulent sputum) , of obstruction (wheezing,dyspnea), or ulceration of bronchial mucosa (hemoptysis).Clinical featuresl1.Respiratory symptoms.l(1).Cough:l (2).Hemoptysis:l(3).Dyspnea.:l(4).Wheeze or stridor:l(5).Chest pain :l(6).Fever:Clinical featuresl2.Symptoms caus
8、ed 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.Clinical Featuresl(4).Horners syndrome.It is caused by invading the cervical sympathetic ganglia on the involved side the pupil is small ptosis of the up eyelids,retra
9、ction of the eyeball and no sweat of the face.l(5)Cardiac effusionClinical feturesl(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 jugular vein and the veins of anterior chest wall are
10、 distension and edema of the face.l3.Symptoms caused by metastasis.liver, skeleton,brain, supra clavicle lymph nodes. Clinical feturesl4.Paraneoplastic syndrome.Because tumor cell can secrete ectopic hormone，antigen or enzyme the patients with Lung Cancer sometimes may have some paraneoplastic syndr
11、ome Including:l (1) Collagen tissue disorder such as finger clubbing , hypertrophic pulmonray osteoarthropathy 。Clinical featuresl(2)Endocrine disorders including Cushings syndrome ,syndrome of inappropriate antiduretic hormone secretion(SIADHS),l(3) Neuropathic or myopathic disorders including poly
12、neuritis ,cerebellar degeneration,mental abnormalitis etc l (4) others.Radiographic FindingslThe 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
13、the shadow into the surrounding lung, cavitation which is often eccentric irregular in the inner wall owing to the necrosis of the neoplasm.Radiographic Findingsl2 Central typel (1) Direct appearance :Unilateral enlargement of the hilar shadow due to the tumor itself or enlarged lymph nodes.l(2) Ind
14、irect appearance :Including local emphysema;obstructive pneumonia either lobal or segmental; obstractive atalectasis (collapse) lobe or segment.Advantage of CT: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 fo
15、und by chest x-ray.l (2) Lymph nodes along hilar or mediastina can be found by CT. Fig1 Fig1 Atelectasis,RightAtelectasis,Right upper lobe upper lobe Fig3 Mass With Fuzzy,Right Upper Fig3 Mass With Fuzzy,Right Upper LObeLObe Fig4 Mass In right Fig4 Mass In right Lobe,Lateral portionLobe,Lateral port
16、ion Fig5 Fig5 CavitatingCavitating Bronchial Carcinoma Bronchial Carcinoma Examination of sputum 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
17、time, repeat(4-6 times).BronchoscopelBronchoscope may verify the existence of 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
18、CarinaFig 3 Squamous Cell Carcinoma, TracheaFig 4 AdenocarcinomaLeft Lingular BronchusFig 5 AdenocarcinomaRight Truncal IntermedusFig 6 Extrinsic Pressure TracheaLung Biopsyl1.Biopsy with fiberoptic bronchoscope; 2.Transthoracic neddle biopsy with CT directed or B type ultrasonic;l3.Biopsy with thor
19、acoscopy ;l4.Biopsy with medistinoscopy;l5.Exploratory thoracotomy.Diagnosisl1.Symptom -free: General 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 bronchog
20、enic carcinoma Refers to the tumor is still located at the bronchus ,no invade the hilar lymph nodes,pleura as well as distant metastases,its diameter is often 3cm.DiagnosislDiagnosis procedure: l1. X-ray film(-) and sputum for cytology (-) FBC(-) follow up once a month /year.l2. X-ray film(+) and s
21、putum for cytology (+) FBC to identify the cancer cell type CT , MRI therapy.DiagnosislDiagnosis procedure: l3. X-ray 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.Differential diagnosisl1
22、.Solitary nodule: Tuberculoma, Benign Tumorl2.Cavitation:Lung Abscess, Tuberculosis,l3. Enlargement of hilar shadow: Hamartomal4.Others: Pleural Effusion,Widening Of Mediatinal.Treatmentl1.Rresection by operation ;l2.Radiotherapy ;l3.Chemotherapy;l4.Immunotherapy ;l5.Traditional Chinese medicine the
23、rapy etc.lThe therapeutic principle of lung cancer is comprehensive: rescect the tumor as far as possible then combine with other treatments ; other treatments first then operation depending on the cytologic type, position,size and stage of the tumor.TreatmentlSCLC:l Chemotherapy , operation.l Chemotherapy,radiotherapy.lNSCLC: l Operation.l Most :operationchemotherapyl Small parts: radiotherapy.Treatmentl: Operation + chemotherapy;l radiotherapy +chemotherapy.l: chemotherapy+ radiotherapy(relieve some symptoms,such as pain, dyspnea, obstruction etc).
