原發(fā)性支氣管肺癌

Primarybronchogeniccarcinoma呼吸內科RespiratoryDepartment熊維寧Xiong,Weining1精選課件定義

Definition原發(fā)性支氣管肺癌簡稱肺癌，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）室內小環(huán)境污染（2）Indoorenvironmentpollution4電離輻射4Ionizingradiation8精選課件5飲食與營養(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精選課件組織學分類

Histologyclassification1小細胞肺癌1Smallcelllungcancer,SCLC（1）燕麥細胞型（1）oatcelltype（2）中間細胞型（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非小細胞肺癌2Non-smallcelllungcancer,NSCLC（1）鱗狀細胞癌（鱗癌）（1）Squamouscellcarcinoma,SCC（2）腺癌和支氣管肺泡癌（2）Adenocarcinoma，AC，andbronchoalveolarcarcinoma（3）大細胞癌（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(%)倍增時間不明顯有關密切吸煙女性較輕老年男性好發(fā)年齡性別20～2533d30～35100d大細胞癌腺癌小細胞癌鱗癌31精選課件鱗癌小細胞癌腺癌大細胞癌解剖分類中央型中央型周圍周圍生長方式管腔內管腔外管腔外轉移晚早較早手術機會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臂叢神經壓迫征7Brachialplexuscompressionsyndrome35精選課件腫瘤遠處轉移引起的癥狀和體征

Symptomsandphysicalsignsduetotumordistantmetastasis1腦、中樞神經系統(tǒng)轉移1Metastasizetobrain,centralnervoussystem36精選課件2肝轉移2Metastasizetoliver3骨轉移3Metastasizetobone4皮下轉移性結節(jié)4Subcutaneoulymetastaticnodus5頸部或鎖骨上淋巴結轉移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）肥大性肺性骨關節(jié)?。?）Hypertrophicpulmonaryosteoarthropathy,HPO病人正常人40精選課件實驗室和輔助檢查Laboratoryandauxiliaryexamination41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精選課件電子計算機體層掃描

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精選課件痰脫落細胞學檢查

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精選課件病理學檢查Pathology癌標志物的檢測Cancermarktest基因診斷Genediagnosis手術探查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精選課件手術治療

Operationtreatment1NSCLC2SCLC73精選課件化學藥物治療

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