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BronchogenicCarcinoma

(LungCancer)Respiratorydepartment1BronchogenicCarcinoma

(LungDefinitionBronchogeniccarcinomareferstothemalignanttumorwhichgrowsinthebronchus.Originatingfrommucusorglandofbronchus.2DefinitionBronchogeniccarcinoIncidenceandmortalityBronchogeniccarcinomahasincreasedremarkableinincidenceandmortalityduringhalfofthecenturyandhasbecomethemostfrequentvisceralmalignantdiseasesofmen.Themortalityoflungcancerholdthefirstplaceamongallkindscarcinomas.3IncidenceandmortalityBronchoEtiologyThecauseoflungcancerisunknown.Itisbelievedthattherearefollowingrelatedfactors.1.Excessivecigarettesmoking:Smokingindex(BrinkmanIndex)isequaltocigarettesperdaysmokingtime(years).Passivesmokingisalsoacarcinogenfactor.4EtiologyThecauseoflungcancEtiology2.Atmosphericpollution.Itwasfoundthatcarcinogenicfactorisbenzpyrene.3.Occupationalfactors.4Radioactivityintheatmosphere.5.DietsandNutrition.6.Chronicirritation.7.Geneticfactors.5Etiology2.AtmosphericpollutioPathologyAndClassification1.Accordingtothepositionoftumorarisingfrom,itcanbedividedintotwotypes.Centraltype:Tumorarisesfrommainbronchus,lobarandsegmentalbronchus.Peripheraltype:Tumorarisesbeyondsegmentalbronchus.6PathologyAndClassification1.PathologyAndClassification2.Accordingtocytology,itisconvenienttoclassifyintofourkindsoftypes.(1).Squamouscellcarcinoma.(2).Smallcellanaplasticcarcinoma.(3).Largecellanaplasticcarcinoma.(4).Adenocarcinoma(includingalveolarcellcarcinoma).7PathologyAndClassification2.PathologyAndClassificationAccordingtothedifferentprinciplesofmanagement,itisdividedintotwotypes.SCLC:smallcelllungcarcinoma.NSCLC:nonsmallcelllungcarcinoma.8PathologyAndClassificationAcClinicalfeaturesTherearenosymptomsofearlylungcancerinsomepatients.Symptomscausedbylungcancerarenon-specific:perhapsanaudiblewheezeoraslightcough,symptomsofinfection(fever,purulentsputum),ofobstruction(wheezing,dyspnea),orulcerationofbronchialmucosa(hemoptysis).9ClinicalfeaturesTherearenoClinicalfeatures1.Respiratorysymptoms.(1).Cough:(2).Hemoptysis:(3).Dyspnea.:(4).Wheezeorstridor:(5).Chestpain:(6).Fever:10Clinicalfeatures1.RespiratoryClinicalfeatures2.Symptomscausedbythenearorgansortissueinvolvedbytumor.(1).Dysphagia.(2).Hoarseness.(3).Pleuraleffusion

duetoinvasionofthepleura.11Clinicalfeatures2.SymptomscaClinicalFeatures(4).Horner’ssyndrome.Itiscausedbyinvadingthecervicalsympatheticgangliaontheinvolvedsidethepupilissmallptosisoftheupeyelids,retractionoftheeyeballandnosweatoftheface.(5)Cardiaceffusion12ClinicalFeatures(4).Horner’sClinicalfetures(6).Superiorvenacavalsyndrome.Duetoobstructionofthesuperiorvenacaval,thepatientmayhavenoticedthathiscollaristight,theneckisenlargedandthejugularveinandtheveinsofanteriorchestwallaredistensionandedemaoftheface.3.Symptomscausedbymetastasis.liver,skeleton,brain,supraclaviclelymphnodes.13Clinicalfetures(6).SuperiorvClinicalfetures4.Paraneoplasticsyndrome.Becausetumorcellcansecreteectopichormone，antigenorenzymethepatientswithLungCancersometimesmayhavesomeparaneoplasticsyndromeIncluding:

(1)Collagentissuedisordersuchasfingerclubbing,hypertrophicpulmonrayosteoarthropathy。14Clinicalfetures4.ParaneoplastClinicalfeatures(2)EndocrinedisordersincludingCushing’ssyndrome,syndromeofinappropriateantiduretichormonesecretion(SIADHS),(3)Neuropathicormyopathicdisordersincludingpolyneuritis,cerebellardegeneration,mentalabnormalitisetc

(4)others.15Clinicalfeatures(2)EndocrineRadiographicFindingsTheappearanceonthex-rayfilmdependsontheposition,sizeandstageofthetumor1.Peripheraltype:Itmaybevarioussuchasinfiltrativeornodular,

lobulatedorumbilicussign,linerprotrusionsfromtheshadowintothesurroundinglung,cavitationwhichisofteneccentricirregularintheinnerwallowingtothenecrosisoftheneoplasm.16RadiographicFindingsTheappeaRadiographicFindings2

Centraltype(1)Directappearance:Unilateralenlargementofthehilarshadowduetothetumoritselforenlargedlymphnodes.(2)Indirectappearance:Includinglocalemphysema;obstructivepneumoniaeitherlobalorsegmental;obstractiveatalectasis(collapse)lobeorsegment.17RadiographicFindings2CentralAdvantageofCT:(1)Somesmalllesion,lesionbehindofcardiacorbloodvessel,andpathologylocatedinapicaloflungcanbefoundbyCTwhichcan’tbefoundbychestx-ray.(2)LymphnodesalonghilarormediastinacanbefoundbyCT.18AdvantageofCT:(1)Somesmall

Fig1Atelectasis,Rightupperlobe19Fig1Atelectasis,Rightupper

Fig3MassWithFuzzy,RightUpperLObe20Fig3MassWithFuzzy,Rig

Fig4MassInrightLobe,Lateralportion21Fig4MassInrightLobe,Late

Fig5CavitatingBronchialCarcinoma22Fig5CavitatingBronchialExaminationofsputum

Cytologicexaminationofbronchialsecretions(orsputum)mayrevealexfoliatedmalignantcellsrecognizabletothepathologistwhoisspeciallytrainedforsuchwork.Thesputummusttobefresh,sendontime,repeat(4-6times)..23ExaminationofsputumCytologiBronchoscopeBronchoscopemayverifytheexistenceoftumor,ofCentraltype,andcytologicdiagnosisoflungcancershouldbeobtainedthoughFBC.Blindbiopsymaybehelptothediagnosisofthetumorbeyondtherangeofbronchoscopevision24BronchoscopeBronchoscopemayvFig1NormalTracheaFig2NormalCarina25Fig1NormalTracheaFig2NoFig3SquamousCellCarcinoma,TracheaFig4AdenocarcinomaLeftLingularBronchus26Fig3SquamousCellFig4AdenFig5AdenocarcinomaRightTruncalIntermedusFig6ExtrinsicPressureTrachea27Fig5AdenocarcinomaFig6ExtLungBiopsy1.Biopsywithfiberopticbronchoscope;2.TransthoracicneddlebiopsywithCTdirectedorBtypeultrasonic;3.Biopsywiththoracoscopy;4.Biopsywithmedistinoscopy;5.Exploratorythoracotomy.28LungBiopsy1.BiopsywithfiberDiagnosis1.Symptom-free:Generalinvestigationofhighriskgroup(male,mornthan40yearsold,cigaretteconsumption20/perday).Takingax-rayfilmandexaminingsputumforcancercelleveryhalfyearEarlystageofthebronchogeniccarcinomaReferstothetumorisstilllocatedatthebronchus,noinvadethehilarlymphnodes,pleuraaswellasdistantmetastases,itsdiameterisoften<3cm.29Diagnosis1.Symptom-free:GeneDiagnosisDiagnosisprocedure:1.X-rayfilm(-)andsputumforcytology(-)FBC(-)followuponceamonth/year.2.X-rayfilm(+)andsputumforcytology(+)FBCtoidentifythecancercelltypeCT,MRItherapy.30DiagnosisDiagnosisprocedure:DiagnosisDiagnosisprocedure:3.X-rayfilm(-)andsputumforcytology(+)rulingoutthetumorofupperrespiratorytractfirstFBC.4X-rayfilm(+)andsputumforcytology(-)FBC(-)lungbiopsy.31DiagnosisDiagnosisprocedure:Differentialdiagnosis1.Solitarynodule:Tuberculoma,BenignTumor2.Cavitation:LungAbscess,Tuberculosis,3.Enlargementofhilarshadow:Hamartoma4.Others:PleuralEffusion,WideningOfMediatinal.32Differentialdiagnosis1.SolitaTreatment1.Rresectionbyoperation;2.Radiotherapy;3.Chemotherapy;4.Immunotherapy;5.TraditionalChinesemedicinetherapyetc.Thetherapeuticprincipleoflungcanceriscomprehensive:rescectthetumorasfaraspossiblethencombinewithothertreatments;othertreatmentsfirstthenoperationdependingonthecytologictype,position,sizeandstageofthetumor.33Treatment1.RresectionbyoperaTreatmentSCLC:ⅠChemotherapy,operation.ⅡChemotherapy,radiotherapy.NSCLC:

ⅠOperation.ⅡMost:operation→chemotherapySmallparts:radiotherapy.34TreatmentSCLC:34TreatmentⅢ:Operation+chemotherapy;radiotherapy+chemotherapy.Ⅳ:chemotherapy+radiotherapy(relievesomesymptoms,suchaspain,dyspnea,obstructionetc).35TreatmentⅢ:Operation+chemotThankYOU36ThankYOU36BronchogenicCarcinoma

(LungCancer)Respiratorydepartment37BronchogenicCarcinoma

(LungDefinitionBronchogeniccarcinomareferstothemalignanttumorwhichgrowsinthebronchus.Originatingfrommucusorglandofbronchus.38DefinitionBronchogeniccarcinoIncidenceandmortalityBronchogeniccarcinomahasincreasedremarkableinincidenceandmortalityduringhalfofthecenturyandhasbecomethemostfrequentvisceralmalignantdiseasesofmen.Themortalityoflungcancerholdthefirstplaceamongallkindscarcinomas.39IncidenceandmortalityBronchoEtiologyThecauseoflungcancerisunknown.Itisbelievedthattherearefollowingrelatedfactors.1.Excessivecigarettesmoking:Smokingindex(BrinkmanIndex)isequaltocigarettesperdaysmokingtime(years).Passivesmokingisalsoacarcinogenfactor.40EtiologyThecauseoflungcancEtiology2.Atmosphericpollution.Itwasfoundthatcarcinogenicfactorisbenzpyrene.3.Occupationalfactors.4Radioactivityintheatmosphere.5.DietsandNutrition.6.Chronicirritation.7.Geneticfactors.41Etiology2.AtmosphericpollutioPathologyAndClassification1.Accordingtothepositionoftumorarisingfrom,itcanbedividedintotwotypes.Centraltype:Tumorarisesfrommainbronchus,lobarandsegmentalbronchus.Peripheraltype:Tumorarisesbeyondsegmentalbronchus.42PathologyAndClassification1.PathologyAndClassification2.Accordingtocytology,itisconvenienttoclassifyintofourkindsoftypes.(1).Squamouscellcarcinoma.(2).Smallcellanaplasticcarcinoma.(3).Largecellanaplasticcarcinoma.(4).Adenocarcinoma(includingalveolarcellcarcinoma).43PathologyAndClassification2.PathologyAndClassificationAccordingtothedifferentprinciplesofmanagement,itisdividedintotwotypes.SCLC:smallcelllungcarcinoma.NSCLC:nonsmallcelllungcarcinoma.44PathologyAndClassificationAcClinicalfeaturesTherearenosymptomsofearlylungcancerinsomepatients.Symptomscausedbylungcancerarenon-specific:perhapsanaudiblewheezeoraslightcough,symptomsofinfection(fever,purulentsputum),ofobstruction(wheezing,dyspnea),orulcerationofbronchialmucosa(hemoptysis).45ClinicalfeaturesTherearenoClinicalfeatures1.Respiratorysymptoms.(1).Cough:(2).Hemoptysis:(3).Dyspnea.:(4).Wheezeorstridor:(5).Chestpain:(6).Fever:46Clinicalfeatures1.RespiratoryClinicalfeatures2.Symptomscausedbythenearorgansortissueinvolvedbytumor.(1).Dysphagia.(2).Hoarseness.(3).Pleuraleffusion

duetoinvasionofthepleura.47Clinicalfeatures2.SymptomscaClinicalFeatures(4).Horner’ssyndrome.Itiscausedbyinvadingthecervicalsympatheticgangliaontheinvolvedsidethepupilissmallptosisoftheupeyelids,retractionoftheeyeballandnosweatoftheface.(5)Cardiaceffusion48ClinicalFeatures(4).Horner’sClinicalfetures(6).Superiorvenacavalsyndrome.Duetoobstructionofthesuperiorvenacaval,thepatientmayhavenoticedthathiscollaristight,theneckisenlargedandthejugularveinandtheveinsofanteriorchestwallaredistensionandedemaoftheface.3.Symptomscausedbymetastasis.liver,skeleton,brain,supraclaviclelymphnodes.49Clinicalfetures(6).SuperiorvClinicalfetures4.Paraneoplasticsyndrome.Becausetumorcellcansecreteectopichormone，antigenorenzymethepatientswithLungCancersometimesmayhavesomeparaneoplasticsyndromeIncluding:

(1)Collagentissuedisordersuchasfingerclubbing,hypertrophicpulmonrayosteoarthropathy。50Clinicalfetures4.ParaneoplastClinicalfeatures(2)EndocrinedisordersincludingCushing’ssyndrome,syndromeofinappropriateantiduretichormonesecretion(SIADHS),(3)Neuropathicormyopathicdisordersincludingpolyneuritis,cerebellardegeneration,mentalabnormalitisetc

(4)others.51Clinicalfeatures(2)EndocrineRadiographicFindingsTheappearanceonthex-rayfilmdependsontheposition,sizeandstageofthetumor1.Peripheraltype:Itmaybevarioussuchasinfiltrativeornodular,

lobulatedorumbilicussign,linerprotrusionsfromtheshadowintothesurroundinglung,cavitationwhichisofteneccentricirregularintheinnerwallowingtothenecrosisoftheneoplasm.52RadiographicFindingsTheappeaRadiographicFindings2

Centraltype(1)Directappearance:Unilateralenlargementofthehilarshadowduetothetumoritselforenlargedlymphnodes.(2)Indirectappearance:Includinglocalemphysema;obstructivepneumoniaeitherlobalorsegmental;obstractiveatalectasis(collapse)lobeorsegment.53RadiographicFindings2CentralAdvantageofCT:(1)Somesmalllesion,lesionbehindofcardiacorbloodvessel,andpathologylocatedinapicaloflungcanbefoundbyCTwhichcan’tbefoundbychestx-ray.(2)LymphnodesalonghilarormediastinacanbefoundbyCT.54AdvantageofCT:(1)Somesmall

Fig1Atelectasis,Rightupperlobe55Fig1Atelectasis,Rightupper

Fig3MassWithFuzzy,RightUpperLObe56Fig3MassWithFuzzy,Rig

Fig4MassInrightLobe,Lateralportion57Fig4MassInrightLobe,Late

Fig5CavitatingBronchialCarcinoma58Fig5CavitatingBronchialExaminationofsputum

Cytologicexaminationofbronchialsecretions(orsputum)mayrevealexfoliatedmalignantcellsrecognizabletothepathologistwhoisspeciallytrainedforsuchwork.Thesputummusttobefresh,sendontime,repeat(4-6times)..59ExaminationofsputumCytologiBronchoscopeBronchoscopemayverifytheexistenceoftumor,ofCentraltype,andcytologicdiagnosisoflungcancershouldbeobtainedthoughFBC.Blindbiopsymaybehelptothediagnosisofthetumorbeyondtherangeofbronchoscopevision60BronchoscopeBronchoscopemayvFig1NormalTracheaFig2NormalCarina61Fig1NormalTracheaFig2NoFig3SquamousCellCarcinoma,TracheaFig4AdenocarcinomaLeftLingularBronchus62Fig3SquamousCellFig4AdenFig5AdenocarcinomaRightTruncalIntermedusFig6ExtrinsicPressureTrachea63Fig5AdenocarcinomaFig6ExtLungBiopsy1.Biopsywithfiberopticbronchoscope;2.TransthoracicneddlebiopsywithCTdirectedorBtypeultrasonic;3.Biopsywiththoracoscopy;4.Biopsywithmedistinoscopy;5.Exploratorythoracotomy.64LungBiopsy1.BiopsywithfiberDiagnosis1.Symptom-free:Generalinvestigationofhighriskgroup(male,mornthan40yearsold,cigaretteconsumption20/perday).Takingax-rayfilmandexaminingsputumforcancercelleveryhalfyearEarlystageofthebronchogeniccarcinomaReferstothetumorisstilllocatedatthebronchus,noinvadethehilarlymphnodes,pl

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