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1、lung cancer1;.What is Lung Cancer?What is Lung Cancer?Begins when cells in the lung grow out of control and form a tumor2Etiology and pathogenesisCigarette smokingOther factors include air pollutions Nowadays It is reported that tuberculosis is associated with the incidence of lung cancer 3Classific
2、ationsAccording to anatomy: (1)Central lung (2) peripheral lung cancer45According 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 carcinoma.6Small cell lung c
3、ancer(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 neuroendocrine cells that are res
4、ponsible for the production and secretion of specific peptide product.they may related to paraneoplastic syndrome.7Cells are oval or vaguely spindle-shaped ,have scant cytoplasm89 Squamous cell carcinomathe most frequent form of the tumor(30-50 percent of all casesbronchial epithelium and growth in
5、situIt is related to cigarette smokingCavitation can occure in the distal to the obstructing massCentral location10Intercellular bridges and cellular pleomorphism1112squamous cell carcinoma usually occurs near the bronchi, the tumor can cause cough (sometimes a cough that is tinged with blood), shor
6、tness of breath, wheezing, and pneumonia in the area between the tumor and the edge of the lungit causes symptoms early in the disease 13adenocarcinomaareas of scarring is associated with the occurrence of adenocarcinoma.Peripheral adenocarcinomas are usually well-circumscribed, grey-white masses th
7、at rarely cavitate.It arises from the submucosal glands,located in peripheral airways and alveoliFemale 141516large cell carcinoma17large nuclei,prominent nucleoli,abundant cytoplsma18usually located peripherallycan be quite large and not infrequently cavitate19the Symptoms of Lung Cancerthe Symptom
8、s of Lung Cancer Fatigue (tiredness) Fatigue (tiredness) CoughCough Shortness of breath Shortness of breath Chest pain Chest pain Loss of appetite Loss of appetite Coughing up phlegm Coughing up phlegm Hemoptysis (coughing up blood)Hemoptysis (coughing up blood) If cancer has spread, symptoms includ
9、e bone pain, difficulty breathing, abdominal pain, If cancer has spread, symptoms include bone pain, difficulty breathing, abdominal pain, headache, weakness, and confusionheadache, weakness, and confusion20Due to primary lesions: cough, dyspnea, hemoptysis, sputum, wheezing, weight loss, fever, pne
10、umoniaDue 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.21 Regionnal spread to hilar and media
11、stinal 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.22Superior sulcus, or pancoasts tumor may involve the brachial ple
12、xus, 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 23Extrapulmonary manifestations. Including metastasis to other organs, such as brain, central nervous system, skeleton system, liver,adrenal glands and lym
13、ph 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.24Physical examinationsUsually in e
14、arly 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(unilaterally constricted pupil, enophthalmos,n
15、arrowed palpebral fissure and loss of sweating on the same side of the face.25Physical examinationsEndobronchial obstruction may result in a localized wheezeLobar collapse may result in an area of decreased breath sounds and dullness to percussion.26How is Lung Cancer Evaluated?How is Lung Cancer Ev
16、aluated? Because almost all patients will have a tumor in the lung, a chest x-ray or CT scan of the Because almost all patients will have a tumor in the lung, a chest x-ray or CT scan of the chest is performed chest is performed The diagnosis must be confirmed with a biopsyThe diagnosis must be conf
17、irmed with a biopsy The location(s) of all sites of cancer is determined by additional CT scans, PET The location(s) of all sites of cancer is determined by additional CT scans, PET (positron emission tomography) scans, and MRI (magnetic resonance imaging)(positron emission tomography) scans, and MR
18、I (magnetic resonance imaging) It is important to find out if cancer started in the lung or somewhere else in the body. It is important to find out if cancer started in the lung or somewhere else in the body. Cancer arising in other parts of the body can spread to the lung as well Cancer arising in
19、other parts of the body can spread to the lung as well 27Chest X-ray It is the most important method to find lung cancerThe most frequent finding is a mass in the lung field282930On chest X-ray, secondary manifestations include lobar collapse, pleural effusion, pneumonitis, elevation of the hemidiap
20、hragm, hilar and mediastinal adenopathy, and erosion of ribs or vertebrae due to metastases.313233Obstructive atelectasis34Lung cancer on CT CT is the most useful in evaluating patients with pulmonary and mediastinal masses.It is also useful for detecting multiple metastases.CT can show a mass to be
21、 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 sites of lung cancer. 3536Bronchoscopy37Rigid and flexible scopeBiopsy and selective washing
22、sLarger samples than flexible scopeExact locationLobectomyPneumonectomyUnresectableSleeve3839Transthoracic lung biopsy It may be utilized when tumor located in peripheral airway. Transthoracic needle with guidance by CT can be used to detect lesions located near the chest wall 4041Video Assisted Tho
23、racic SurgeryDiagnosis of pleural diseaseWedge resection 4243Mediasteinoscopy & Mediasteinotomy4445Diagnoses unresectable diseaseEliminate N2 disease from surgical resection46ThoracotomyIf the methods mentioned above are not useful for detecting the cell type of lung cancer,thoracotomy may be used47
24、Staging of lung cancerStaging is a way of describing a cancer, such as the size of the tumor and where it has Staging is a way of describing a cancer, such as the size of the tumor and where it has spread spread Staging is the most important tool doctors have to determine a patients prognosisStaging
25、 is the most important tool doctors have to determine a patients prognosis The type of treatment a person receives depends on the stage of the cancerThe type of treatment a person receives depends on the stage of the cancerStaging is different for non-small cell lung cancer and small cell lung cance
26、rStaging is different for non-small cell lung cancer and small cell lung cancer 48Stage I Non-Small Cell Lung CancerStage I Non-Small Cell Lung Cancer Cancer is found only in the lung Cancer is found only in the lung Surgical removal recommendedSurgical removal recommended Radiation therapy and/or R
27、adiation therapy and/or chemotherapy may also be usedchemotherapy may also be used49Stage II Non-Small Cell Lung CancerStage II Non-Small Cell Lung Cancer The cancer has spread to lymph nodes in the lung The cancer has spread to lymph nodes in the lung Treatment is surgery to remove the tumor and Tr
28、eatment is surgery to remove the tumor and nearby lymph nodesnearby lymph nodes Chemotherapy recommended; radiation therapy Chemotherapy recommended; radiation therapy sometimes given after chemotherapysometimes given after chemotherapy 50Stage III Non-Small Cell Lung CancerStage III Non-Small Cell
29、Lung Cancer The cancer has spread to the lymph nodes The cancer has spread to the lymph nodes located in the center of the chest, outside located in the center of the chest, outside the lung the lung Stage IIIA cancer has spread to lymph Stage IIIA cancer has spread to lymph nodes in the chest, on t
30、he same side where nodes in the chest, on the same side where the cancer originatedthe cancer originated Stage IIIB cancer has spread to lymph Stage IIIB cancer has spread to lymph nodes on the opposite side of the chest, nodes on the opposite side of the chest, under the collarbone, or the pleura (
31、lining under the collarbone, or the pleura (lining of the chest cavity) of the chest cavity) Surgery or radiation therapy with Surgery or radiation therapy with chemotherapy recommended for stage IIIA chemotherapy recommended for stage IIIA Chemotherapy and sometimes radiation Chemotherapy and somet
32、imes radiation therapy recommended for stage IIIBtherapy recommended for stage IIIB 51Stage IV Non-Small Cell Lung CancerStage IV Non-Small Cell Lung Cancer The cancer has spread to different lobes The cancer has spread to different lobes of the lung or to other organs, such as of the lung or to oth
33、er organs, such as the brain, bones, and liverthe brain, bones, and liver Stage IV non-small cell lung cancer is Stage IV non-small cell lung cancer is treated with chemotherapytreated with chemotherapy52Small cell lung cancer has often metastasized at the time of diagnosis.TNM staging is not suited
34、 to small cell lung cancer. 53TreatmentIncluding: A:Surgery B:Chemotherapy C:Radiation therapy D:Some other therapy immunologic therapy, Chinese traditional therapy54SurgeryNon-small cell lung cancer: patients with stage I and II are considered candidates for surgical resection, with stage III cance
35、r may be candidates for surgery with postoperative radiation of the mediastinum. 5556SurgeryWe must measure pulmonary function before surgical therapy.Forced 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 c
36、apacity predict that a patient can tolerate the consequences of pneumonectomy. 575859ChemotherapyNon-small cell lung cancerMVP: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
37、 d1. GP60ChemotherapyAggressive chemotherapy produces complications and symptoms in all patients. All experience anemia,leukepenia and opportunistic infection other complications include nausea,vomiting possible cadiotoxicity, hemorrhagic cystitis and peripheral neuropathy. 61Radiation therapyIt is of proven benefit in controlling bone pain,spinal cord compression, superior vena cava syndrome and bronchial obstruction. 6263
