原發(fā)性支氣管肺癌

Primarybronchogeniccarcinoma呼吸內(nèi)科RespiratoryDepartment熊維寧Xiong,Weining1精選課件定義

Definition原發(fā)性支氣管肺癌簡(jiǎn)稱肺癌，是起源于支氣管粘膜或腺體的腫瘤。Primarybronchogeniccarcinomaisabbreviatedtolungcancer,itderivesfrombronchimucosaorgland.2精選課件EpidemiologyLungCancerWorldwide:mostcommoncancer2,000,000casesperyearChina:firstleadingcauseofcancerdeathinurbanarea<15%5-yearsurvival3精選課件病因和發(fā)病機(jī)制

Etiologyandpathogenesis1吸煙1Smoking4精選課件LungCancer:SmokingFactsTobaccouseistheleadingcauseoflungcancer87%oflungcancersarerelatedtosmokingRiskrelatedto:AmountsmokedAgeofsmokingonsetProductsmoked(tar/nicotinecontent,filters)DepthofinhalationGenderRiskgoesdownafter>5yrscessationAt15years,80-90%riskreductionNevergetsto“neversmoker”risk5精選課件20YearLag6精選課件

Ifwhathappenedonyourinsidehappenedonyouroutside,wouldyoustillsmoke?7精選課件2職業(yè)致癌因子2Occupationcarcinogenicfactor:Asbestos,Radon3空氣污染3Airpollution（1）室外大環(huán)境污染（1）Outdoorenvironmentpollution（2）室內(nèi)小環(huán)境污染（2）Indoorenvironmentpollution4電離輻射4Ionizingradiation8精選課件5飲食與營(yíng)養(yǎng)5DietandnutritionVITAMINA???????????????????9精選課件6其他因素6Otherfactors

7遺傳因素7HereditaryfactorTumorsuppressorgenes *p53Dominantoncogenes *Kras *Her-2/neu10精選課件病理和分類

Pathologyandclassification11精選課件解剖學(xué)分類

Anatomyclassification1中央型肺癌1Centrallungcancer12精選課件2周圍型肺癌2Peripherallungcancer13精選課件組織學(xué)分類

Histologyclassification1小細(xì)胞肺癌1Smallcelllungcancer,SCLC（1）燕麥細(xì)胞型（1）oatcelltype（2）中間細(xì)胞型（2）intermediatecelltype（3）混合型（3）mixedtype14精選課件SmallcellcarcinomaRareinnon-smokersLargehilarmass70%presentwithovertmetastasisVerychemo-responsive…Worstprognosis15精選課件Smallcellcarcinoma16精選課件2非小細(xì)胞肺癌2Non-smallcelllungcancer,NSCLC（1）鱗狀細(xì)胞癌（鱗癌）（1）Squamouscellcarcinoma,SCC（2）腺癌和支氣管肺泡癌（2）Adenocarcinoma，AC，andbronchoalveolarcarcinoma（3）大細(xì)胞癌（3）Largecellcarcinoma（4）鱗腺癌（4）Adeno-squamouscarcinoma17精選課件SquamouscellcarcinomaNow2ndmostcommon(1stinChina)Stronglylinkedwithsmoking60-80%intheproximalairways(centraltype)CavitationTendencytospreadlocally/regionallyPrognosisslightlybetterthanAdenocarcinoma18精選課件SquamousCellCarcinoma19精選課件SquamousCellCarcinoma20精選課件鱗癌21精選課件LungCancerPathologyAdenocarcinomaMostcommonpathology(2ndinChina)“Non-smoker’slungcancer”WomenPeripheral(75%)Aggressivemetastases22精選課件AdenocarcicomaLeftLowerLobe23精選課件Adenocarcinoma24精選課件Adenocarcinoma25精選課件BronchoalveolarCellCarcinomaBACAerogenousandlymphaticspreadLeastassociatedwithcigarettesmokingUsuallyperipheralLocalized,multi-nodularordiffuseSlowmetabolismPrognosisLocalizedvs.other26精選課件支氣管肺泡癌27精選課件LargecellcarcinomaLargeperipheralmasswithnecrosisMalignantepithelialneoplasmPoorly-differentiatedAggressivemets“It’sacancer…it’snotsmallcell…but…”28精選課件Largecellcarcinoma29精選課件Largecellcarcinoma30精選課件10100d25～30187d惡性度最高最常見發(fā)病率(%)倍增時(shí)間不明顯有關(guān)密切吸煙女性較輕老年男性好發(fā)年齡性別20～2533d30～35100d大細(xì)胞癌腺癌小細(xì)胞癌鱗癌31精選課件鱗癌小細(xì)胞癌腺癌大細(xì)胞癌解剖分類中央型中央型周圍周圍生長(zhǎng)方式管腔內(nèi)管腔外管腔外轉(zhuǎn)移晚早較早手術(shù)機(jī)會(huì)多少支氣管肺泡癌瘢痕癌較大放化療敏感32精選課件臨床表現(xiàn)

Clinicalmanifestation33精選課件原發(fā)腫瘤引起的癥狀和體征

Symptomsandphysicalsignsduetoprimarytumor1咳嗽1Cough2咯血2Hemoptysis3喘鳴3Wheeze4氣急4Breathlessness5發(fā)熱5Fever6其他6Others34精選課件腫瘤局部擴(kuò)展引起的癥狀和體征

Symptomsandphysicalsignsduetotumorlocalexpanding1胸痛1Chestpain2呼吸困難2Dyspnea3吞咽困難3Dysphagia:esophagealcompression4聲音嘶啞4Hoarsevoice:laryngealnerveparalysis5上腔靜脈阻塞綜合征5Superiorvenacavaobstructionsyndrome6Horner綜合征，肺上溝瘤6Horner’ssyndrome,Pancoast’stumor:Cervical/thoracicnerveinvasion7臂叢神經(jīng)壓迫征7Brachialplexuscompressionsyndrome35精選課件腫瘤遠(yuǎn)處轉(zhuǎn)移引起的癥狀和體征

Symptomsandphysicalsignsduetotumordistantmetastasis1腦、中樞神經(jīng)系統(tǒng)轉(zhuǎn)移1Metastasizetobrain,centralnervoussystem36精選課件2肝轉(zhuǎn)移2Metastasizetoliver3骨轉(zhuǎn)移3Metastasizetobone4皮下轉(zhuǎn)移性結(jié)節(jié)4Subcutaneoulymetastaticnodus5頸部或鎖骨上淋巴結(jié)轉(zhuǎn)移5Cervicalorsupraclavicularlymphnodemetastasis37精選課件肺癌作用于其他系統(tǒng)引起的肺外表現(xiàn)Manifestationoutoflungduetoothersystemsaffectedbylungcancer1異位內(nèi)分泌綜合征1Ectopicendocrinesyndrome,EES（1）抗利尿激素分泌異常綜合征（1）Syndromeofinapprpriateantidiuretichormone(SIADH)secretion（2）異位ACTH綜合征（2）EctopicACTHsyndrome（3）神經(jīng)肌肉綜合征（3）Neuromyopathicsyndrome（4）高鈣血癥（4）Hypercalcinemia（5）其他：類癌綜合征（5）Others:Carcinoidsyndrome38精選課件2其他肺外表現(xiàn)2Othermanifestationoutoflung（1）多發(fā)性周圍神經(jīng)炎（1）Multipleperipheralneuritis（2）肌無力樣綜合征（2）Eaton-Lambertsyndrome39精選課件（3）肥大性肺性骨關(guān)節(jié)?。?）Hypertrophicpulmonaryosteoarthropathy,HPO病人正常人40精選課件實(shí)驗(yàn)室和輔助檢查L(zhǎng)aboratoryandauxiliaryexamination41精選課件胸部X線檢查

Chestradiograph1中央型肺癌1Centrallungcancer42精選課件43精選課件2周圍型肺癌2Peripherallungcancer44精選課件45精選課件46精選課件47精選課件電子計(jì)算機(jī)體層掃描

CT48精選課件Posteriorbasalsegmentofleftlowerlobe,AC49精選課件左上葉肺癌并左上葉不張Leftupperlobecancercombiningatelectasis50精選課件Leftlowerlobecancercombiningobstructivepneumonia51精選課件52精選課件磁共振

MRI53精選課件54精選課件痰脫落細(xì)胞學(xué)檢查

SputumexfoliativecytologytestSCCACSCLC55精選課件纖維支氣管鏡檢查

Bronchofiberscopy56精選課件57精選課件58精選課件SCCSCLCACLCC59精選課件核素閃爍顯像Nuclidescintigraphy1骨γ閃爍顯像

1Boneγscintigraphy2正電子發(fā)射斷層顯像

2Positronemissiontomography(PET)60精選課件61精選課件病理學(xué)檢查Pathology癌標(biāo)志物的檢測(cè)Cancermarktest基因診斷Genediagnosis手術(shù)探查Operationsresearch62精選課件診斷和鑒別診斷

Diagnosisanddifferentialdiagnosis63精選課件診斷

Diagnosis早期診斷Earlydiagnosis癥狀Symptom體征Physicalsign檢查Examination64精選課件鑒別診斷

Differentialdiagnosis1肺結(jié)核1Pulmonarytuberculosis65精選課件TuberculosisLungcancer66精選課件肺真菌病Pulmonarymycosis67精選課件2肺炎2Pneumonia

抗菌藥物治療有效，病灶吸收快而完全Usually,antibacterialdrugtherapyiseffective,andfocusisabsorbedquicklyandcompletely.68精選課件3肺膿腫3Lungabscess69精選課件4結(jié)核性滲出性胸膜炎4Tuberculousexudativepleurisy70精選課件臨床分期

ClinicalstageIA:T1N0IB:T2N0IIA:T1N1IIB:T2N1,T3N0IIIA:T3N1,andT1-3N2IIIB:anyT4,anyN3IV:anymetastases71精選課件治療

Treatment72精選課件手術(shù)治療

Operationtreatment1NSCLC2SCLC73精選課件化學(xué)藥物治療

Chemotherapy1SCLC2NSCLC74精選課件放射治療

Radiotherapy根治性Radicalcure姑息性Palliativecure75精選課件介入性治療

Interventionalther