Alsocalled:Bronchogeniccarcinoma

Lungcancerisoneofthemostcommoncancersintheworld.Itisaleadingcauseofcancerdeathinmenandwomenintheworld.Cigarettesmokingcausesmostlungcancers.Riskfactors:cigarettes,highlevelsofpollution,radiationandasbestosexposure,etc.Alsocalled:Bronchogeniccarc1Yourlungsaretwospongyorgansinyourchestthataredividedintosections(lobes).Everytimeyouinhale,airiscarriedthroughthewindpipetoyourlungsintwomajorairways(bronchi).Insideyourlungs,thebronchisubdivideintoamillionsmallerairways(bronchioles),whichfinallyendinclustersoftinyairsacs(alveoli).Withintheairsacs,oxygenisabsorbedintoyourbloodstreamandcarbondioxideisreleased.Yourlungsaretwospongyorga2Typesoflungcancer

Smallcelllungcancer.Smallcelllungcancer,sometimescalledoatcellcarcinoma,occursalmostexclusivelyinheavysmokersandislesscommonthannon-smallcelllungcancer.Non-smallcelllungcancer.Non-smallcelllungcancerisanumbrellatermforseveraltypesoflungcancersthatbehaveinasimilarway.Non-smallcelllungcancersincludesquamouscellcarcinoma,adenocarcinomaandlargecellcarcinoma.

TypesoflungcancerSmallcel3HowIsLungCancerDiagnosed?SymptomsandsyndromesPulmonarysymptoms

Symptomsinotherorgans

Symptomslinkedtotumormetabolism

Blood(hematologic)syndromes

Veinandartery(vascular)syndromes

Skin(cutaneous)syndromes

Musculoskeletalsyndromes

Nervoussystem(neurologic)syndromes

Hormonal(endocrine)syndromes

Miscellaneoussyndromes

HowIsLungCancerDiagnosed?S4Testsanddiagnosis

ScreeningDiagnosis

ImagingtestsSputumcytologyTissuesamples(biopsy)

bronchoscopy

mediastinoscopy

needlebiopsy

Testsanddiagnosis5(Left)ConventionalCTscanwithoutcontrastshowingpossibletumorintheliver.(Right)ConventionalCTscanofthesamepatientusingcontrast.ImagescourtesyofDr.PeterChoyke,DepartmentofRadiology,ClinicalCenter,NationalInstitutesofHealth.(Left)ConventionalCTscanwi6Bronchoscopy

Bronchoscopy

7SmallCellLungCarcinoma(above)accountsforabout15percentofalllungcancercases.Normallungcells(above).SmallCellLungNormallungcel8StageI.Canceratthisstagehasinvadedtheunderlyinglungtissuebuthasn'tspreadtothelymphnodes.StageII.Thisstagecancerhasspreadtoneighboringlymphnodesorinvadedthechestwall.StageIIIA.Atthisstage,cancerhasspreadfromthelungtolymphnodesinthecenterofthechest.StageIIIB.Thecancerhasspreadlocallytoareassuchastheheart,bloodvessels,tracheaandesophagus—allwithinthechest—ortolymphnodesintheareaofthecollarboneortothetissuethatsurroundsthelungswithintheribcage(pleura).StageIV.Thecancerhasspreadtootherpartsofthebody,suchastheliver,bonesorbrain.Stagesofnon-smallcelllungcancer

Staging

StageI.Canceratthisstage9Limited.Cancerisconfinedtoonelungandtoitsneighboringlymphnodes.Extensive.Cancerhasspreadbeyondonelungandnearbylymphnodes,andmayhaveinvadedbothlungs,moreremotelymphnodesorotherorgans.Stagesofsmallcelllungcancer

Limited.Cancerisconfinedto10Surgery

Chemotherapy

RadiationtherapyTargeteddrugtherapy

Bevacizumab(Avastin)

Erlotinib(Tarceva).

Clinicaltrials

Supportive(palliative)care

CopingandsupportLearnallyoucanaboutlungcancer

Takeanactiveroleinyourtreatment

Buildastrongsupportsystem

Setreasonablegoals

Taketimeforyourself

Stayactive

AlternativemedicineAcupunctureHypnosisMassage

Meditation

Yoga

TreatmentsSurgeryTreatments11LungcancersurgeryLungcancersurgery12Stage

Commonoptions

Treatmentoptionsfornon-smallcelllungcancers

ISurgeryIISurgery,chemotherapy,radiationIIIACombinedchemotherapyandradiation,sometimessurgerybasedonresultsoftreatmentIIIBChemotherapy,sometimesradiationIVChemotherapy,targeteddrugtherapy,clinicaltrials,supportivecareStageCommonoptio13Stage

Commonoptions

TreatmentoptionsforsmallcelllungcancersLimitedCombinedchemotherapyandradiation,sometimessurgeryExtensiveChemotherapy,clinicaltrials,supportivecareStageCommonoptio14Chemotherapy

Chemotherapyusesdrugstokillcancercells.Oneormorechemotherapydrugsmaybeadministeredthroughaveininyourarm(intravenously)ortakenorally.Acombinationofdrugsusuallyisgiveninaseriesoftreatmentsoveraperiodofweeksormonths,withbreaksinbetweensothatyourbodycan

recover.Chemotherapycanbeusedasafirstlinetreatmentforlungcancerorasadditionaltreatmentaftersurgery.Insomecases,chemotherapycanbeusedtolessensideeffectsofyourcancer.Chemotherapy

Chemotherapyuse15ChemotherapyisusuallythemaintreatmentforSCLC

ChemotherapyforSCLCgenerallyusesacombinationof2drugs.ThedrugcombinationsmostoftenusedforinitialchemotherapyforSCLCare:

cisplatinandetoposidecarboplatinandetoposidecisplatinandirinotecancarboplatinandirinotecancyclophosphamide,doxorubicin(Adriamycin),andvincristineChemotherapyisusuallythema16Ifthecancerprogressesduringtreatmentorreturnsaftertreatmentisfinished,differentchemotherapydrugsmaybetried.Thechoiceofdrugsdependstosomeextentonhowsoonthecancerbeginstogrowagain.(Thelongerittakesforthecancertoreturn,themorelikelyitistorespondtofurthertreatment.)ChemotherapyforSCLC

Ifthecancerprogressesdurin17Ifthecancerprogressesduringtreatmentorrelapseswithin2to3monthsoffinishingtreatment,drugssuchastopotecan,ifosfamide,paclitaxel,docetaxel,irinotecan,orgemcitabinemaybetried.Iftherelapseoccursfrom2to3monthsto6monthsaftertreatment,topotecanisoftenthedrugofchoice.Otherdrugsthatmaybetriedincludeirinotecan,cyclophosphamide/doxorubicin/vincristine(knownastheCAVregimen),gemcitabine,paclitaxel,docetaxel,oraletoposide,orvinorelbine.Forrelapses6ormoremonthsaftertreatment,theoriginalchemotherapyregimenmaystillbeeffectiveandcanoftenbetriedagain.ChemotherapyforSCLC

ChemotherapyforSCLC18肺癌的化療課件19Chemotherapyistreatmentwithanti-cancerdrugsinjectedintoaveinortakenbymouth.Thesedrugsenterthebloodstreamandgothroughoutthebody,makingthistreatmentusefulforcancerthathasspread(metastasized)todistantorgans.Dependingonthetypeandstageoflungcancer,chemotherapymaybegivenasthemain(primary)treatmentorasanaddition(adjuvant)tosurgeryorradiationtherapy.Doctorsgivechemotherapyincycles,witheachperiodoftreatmentfollowedbyarestperiodtoallowthebodytimetorecover.Chemotherapycyclesgenerallylastabout3to4weeks,andinitialtreatmenttypicallyinvolves4to6cycles.Chemotherapyisoftennotrecommendedforpatientsinpoorhealth,butadvancedagebyitselfisnotabarriertogettingchemotherapy.NSCLCChemotherapyChemotherapyistreatmentwith20Mostoften,initialtreatmentforadvancedlungcancerusesacombinationof2chemotherapydrugs.Studieshaveshownthataddingathirdchemotherapydrugdoesn'taddmuchbenefitandislikelytocausemoresideeffects.ThedrugsmostfrequentlyusedforinitialchemotherapyforNSCLCare:cisplatincarboplatinpaclitaxeldocetaxelgemcitabinevinorelbineirinotecanetoposidevinblastinepemetrexedNSCLCChemotherapyMostoften,initialtreatment21Themostcommoncombinationsincludeeithercisplatinorcarboplatinplusoneotherdrug,althoughsomestudieshavefoundthatusingcombinationswithlessseveresideeffects,suchasgemcitabinewithvinorelbineorpaclitaxel,maybejustaseffectiveformanypatients.Forpeoplewhosecancersmeetcertaincriteria,targetedtherapydrugssuchasbevacizumab(Avastin)orcetuximab(Erbitux)maybeaddedtoinitialtreatmentaswell(see"Targetedtherapies"section).NSCLCChemotherapyNSCLCChemotherapy22Single-drugchemotherapyissometimesusedforpeoplewhomightnottoleratecombinationchemotherapywell,suchasthoseinpooroverallhealth.Iftheinitialchemotherapytreatmentisnolongerworking,second-linetreatmentusuallyconsistsofasingledrugsuchasdocetaxelorpemetrexed.Anotheroptionmaybethetargetedtherapyerlotinib(Tarceva)Again,advancedageisnobarriertoreceivingthesedrugsaslongasthepersonisingoodgeneralhealth.NSCLCChemotherapySingle-drugchemotherapyisso23肺癌的化療課件24Possiblesideeffects

Possiblesideeffects25Chemotherapydrugsworkbyattackingcellsthataredividingquickly,whichiswhytheyworkagainstcancercells.Butothercellsinthebody,suchasthoseinthebonemarrow,theliningofthemouthandintestines,andthehairfollicles,alsodividequickly.Thesecellsarealsolikelytobeaffectedbychemotherapy,whichcanleadtosideeffects.Thesideeffectsofchemotherapydependonthetypeanddoseofdrugsgivenandthelengthoftimetheyaretaken.Thesesideeffectscaninclude:PossiblecausesChemotherapydrugsworkbyatt26sideeffectshairlossmouthsoreslossofappetitenauseaandvomitingincreasedchanceofinfections(duetolowwhitebloodcellcounts)easybruisingorbleeding(duetolowbloodplateletcounts)fatigue(duetolowredbloodcellcounts)sideeffectshairloss27Thesesideeffectsareusuallyshort-termandgoawayaftertreatmentisfinished.Thereareoftenwaystolessenthesesideeffects.Forexample,therearedrugsthatcanbegiventohelppreventorreducenauseaandvomiting.Somedrugssuchascisplatin,vinorelbine,docetaxel,orpaclitaxelcandamagenerves.Thiscansometimesleadtosymptoms(mainlyinthehandsandfeet)suchaspain,burningortinglingsensations,sensitivitytocoldorheat,orweakness.(Thisiscalledperipheralneuropathy.)Inmostcasesthisgoesawayoncetreatmentisstopped,butitmaybelonglastinginsomepeople.LastingtimeThesesideeffectsareusually28

ThankYou

ThankYou29謝謝騎封篙尊慈榷灶琴村店矣墾桂乖新壓胚奠倘擅寞僥蝕麗鑒晰溶廷籮侶郎蟲林森-消化系統(tǒng)疾病的癥狀體征與檢查林森-消化系統(tǒng)疾病的癥狀體征與檢查謝謝騎封篙尊慈榷灶琴村店矣墾桂乖新壓胚奠倘擅寞僥蝕麗鑒晰溶廷30騎封篙尊慈榷灶琴村店矣墾桂乖新壓胚奠倘擅寞僥蝕麗鑒晰溶廷籮侶郎蟲林森-消化系統(tǒng)疾病的癥狀體征與檢查林森-消化系統(tǒng)疾病的癥狀體征與檢查騎封篙尊慈榷灶琴村店矣墾桂乖新壓胚奠倘擅寞僥蝕麗鑒晰溶廷籮侶31Alsocalled:Bronchogeniccarcinoma

Lungcancerisoneofthemostcommoncancersintheworld.Itisaleadingcauseofcancerdeathinmenandwomenintheworld.Cigarettesmokingcausesmostlungcancers.Riskfactors:cigarettes,highlevelsofpollution,radiationandasbestosexposure,etc.Alsocalled:Bronchogeniccarc32Yourlungsaretwospongyorgansinyourchestthataredividedintosections(lobes).Everytimeyouinhale,airiscarriedthroughthewindpipetoyourlungsintwomajorairways(bronchi).Insideyourlungs,thebronchisubdivideintoamillionsmallerairways(bronchioles),whichfinallyendinclustersoftinyairsacs(alveoli).Withintheairsacs,oxygenisabsorbedintoyourbloodstreamandcarbondioxideisreleased.Yourlungsaretwospongyorga33Typesoflungcancer

Smallcelllungcancer.Smallcelllungcancer,sometimescalledoatcellcarcinoma,occursalmostexclusivelyinheavysmokersandislesscommonthannon-smallcelllungcancer.Non-smallcelllungcancer.Non-smallcelllungcancerisanumbrellatermforseveraltypesoflungcancersthatbehaveinasimilarway.Non-smallcelllungcancersincludesquamouscellcarcinoma,adenocarcinomaandlargecellcarcinoma.

TypesoflungcancerSmallcel34HowIsLungCancerDiagnosed?SymptomsandsyndromesPulmonarysymptoms

Symptomsinotherorgans

Symptomslinkedtotumormetabolism

Blood(hematologic)syndromes

Veinandartery(vascular)syndromes

Skin(cutaneous)syndromes

Musculoskeletalsyndromes

Nervoussystem(neurologic)syndromes

Hormonal(endocrine)syndromes

Miscellaneoussyndromes

HowIsLungCancerDiagnosed?S35Testsanddiagnosis

ScreeningDiagnosis

ImagingtestsSputumcytologyTissuesamples(biopsy)

bronchoscopy

mediastinoscopy

needlebiopsy

Testsanddiagnosis36(Left)ConventionalCTscanwithoutcontrastshowingpossibletumorintheliver.(Right)ConventionalCTscanofthesamepatientusingcontrast.ImagescourtesyofDr.PeterChoyke,DepartmentofRadiology,ClinicalCenter,NationalInstitutesofHealth.(Left)ConventionalCTscanwi37Bronchoscopy

Bronchoscopy

38SmallCellLungCarcinoma(above)accountsforabout15percentofalllungcancercases.Normallungcells(above).SmallCellLungNormallungcel39StageI.Canceratthisstagehasinvadedtheunderlyinglungtissuebuthasn'tspreadtothelymphnodes.StageII.Thisstagecancerhasspreadtoneighboringlymphnodesorinvadedthechestwall.StageIIIA.Atthisstage,cancerhasspreadfromthelungtolymphnodesinthecenterofthechest.StageIIIB.Thecancerhasspreadlocallytoareassuchastheheart,bloodvessels,tracheaandesophagus—allwithinthechest—ortolymphnodesintheareaofthecollarboneortothetissuethatsurroundsthelungswithintheribcage(pleura).StageIV.Thecancerhasspreadtootherpartsofthebody,suchastheliver,bonesorbrain.Stagesofnon-smallcelllungcancer

Staging

StageI.Canceratthisstage40Limited.Cancerisconfinedtoonelungandtoitsneighboringlymphnodes.Extensive.Cancerhasspreadbeyondonelungandnearbylymphnodes,andmayhaveinvadedbothlungs,moreremotelymphnodesorotherorgans.Stagesofsmallcelllungcancer

Limited.Cancerisconfinedto41Surgery

Chemotherapy

RadiationtherapyTargeteddrugtherapy

Bevacizumab(Avastin)

Erlotinib(Tarceva).

Clinicaltrials

Supportive(palliative)care

CopingandsupportLearnallyoucanaboutlungcancer

Takeanactiveroleinyourtreatment

Buildastrongsupportsystem

Setreasonablegoals

Taketimeforyourself

Stayactive

AlternativemedicineAcupunctureHypnosisMassage

Meditation

Yoga

TreatmentsSurgeryTreatments42LungcancersurgeryLungcancersurgery43Stage

Commonoptions

Treatmentoptionsfornon-smallcelllungcancers

ISurgeryIISurgery,chemotherapy,radiationIIIACombinedchemotherapyandradiation,sometimessurgerybasedonresultsoftreatmentIIIBChemotherapy,sometimesradiationIVChemotherapy,targeteddrugtherapy,clinicaltrials,supportivecareStageCommonoptio44Stage

Commonoptions

TreatmentoptionsforsmallcelllungcancersLimitedCombinedchemotherapyandradiation,sometimessurgeryExtensiveChemotherapy,clinicaltrials,supportivecareStageCommonoptio45Chemotherapy

Chemotherapyusesdrugstokillcancercells.Oneormorechemotherapydrugsmaybeadministeredthroughaveininyourarm(intravenously)ortakenorally.Acombinationofdrugsusuallyisgiveninaseriesoftreatmentsoveraperiodofweeksormonths,withbreaksinbetweensothatyourbodycan

recover.Chemotherapycanbeusedasafirstlinetreatmentforlungcancerorasadditionaltreatmentaftersurgery.Insomecases,chemotherapycanbeusedtolessensideeffectsofyourcancer.Chemotherapy

Chemotherapyuse46ChemotherapyisusuallythemaintreatmentforSCLC

ChemotherapyforSCLCgenerallyusesacombinationof2drugs.ThedrugcombinationsmostoftenusedforinitialchemotherapyforSCLCare:

cisplatinandetoposidecarboplatinandetoposidecisplatinandirinotecancarboplatinandirinotecancyclophosphamide,doxorubicin(Adriamycin),andvincristineChemotherapyisusuallythema47Ifthecancerprogressesduringtreatmentorreturnsaftertreatmentisfinished,differentchemotherapydrugsmaybetried.Thechoiceofdrugsdependstosomeextentonhowsoonthecancerbeginstogrowagain.(Thelongerittakesforthecancertoreturn,themorelikelyitistorespondtofurthertreatment.)ChemotherapyforSCLC

Ifthecancerprogressesdurin48Ifthecancerprogressesduringtreatmentorrelapseswithin2to3monthsoffinishingtreatment,drugssuchastopotecan,ifosfamide,paclitaxel,docetaxel,irinotecan,orgemcitabinemaybetried.Iftherelapseoccursfrom2to3monthsto6monthsaftertreatment,topotecanisoftenthedrugofchoice.Otherdrugsthatmaybetriedincludeirinotecan,cyclophosphamide/doxorubicin/vincristine(knownastheCAVregimen),gemcitabine,paclitaxel,docetaxel,oraletoposide,orvinorelbine.Forrelapses6ormoremonthsaftertreatment,theoriginalchemotherapyregimenmaystillbeeffectiveandcanoftenbetriedagain.ChemotherapyforSCLC

ChemotherapyforSCLC49肺癌的化療課件50Chemotherapyistreatmentwithanti-cancerdrugsinjectedintoaveinortakenbymouth.Thesedrugsenterthebloodstreamandgothroughoutthebody,makingthistreatmentusefulforcancerthathasspread(metastasized)todistantorgans.Dependingonthetypeandstageoflungcancer,chemotherapymaybegivenasthemain(primary)treatmentorasanaddition(adjuvant)tosurgeryorradiationtherapy.Doctorsgivechemotherapyincycles,witheachperiodoftreatmentfollowedbyarestperiodtoallowthebodytimetorecover.Chemotherapycyclesgenerallylastabout3to4weeks,andinitialtreatmenttypicallyinvolves4to6cycles.Chemotherapyisoftennotrecommendedforpatientsinpoorhealth,butadvancedagebyitselfisnotabarriertogettingchemotherapy.NSCLCChemotherapyChemotherapyistreatmentwith51Mostoften,initialtreatmentforadvancedlungcancerusesacombinationof2chemotherapydrugs.Studieshaveshownthataddingathirdchemotherapydrugdoesn'taddmuchbenefitandislikelytocausemoresideeffects.ThedrugsmostfrequentlyusedforinitialchemotherapyforNSCLCare:cisplatincarboplatinpaclitaxeldocetaxelgemcitabinevinorelbineirinotecanetoposidevinblastinepemetrexedNSCLCChemotherapyMostoften,initialtreatment52Themostcommoncombinationsincludeeithercisplatinorcarboplatinplusoneotherdrug,althoughsomestudieshavefoundthatusingcombinationswithlessseveresideeffects,suchasgemcitabinewithvinorelbineorpaclitaxel,maybejustaseffectiveformanypatients.Forpeoplewhosecancersmeetcertaincriteria,targetedtherapydrugssuchasbevacizumab(Avastin)orcetuximab(Erbitux)maybeaddedtoinitialtre