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講課肺癌英文演示文稿當(dāng)前第1頁\共有62頁\編于星期三\15點WhatisLungCancer?Beginswhencellsinthelunggrowoutofcontrolandformatumor當(dāng)前第2頁\共有62頁\編于星期三\15點EtiologyandpathogenesisCigarettesmokingOtherfactorsincludeairpollutionsNowadaysItisreportedthattuberculosisisassociatedwiththeincidenceoflungcancer
當(dāng)前第3頁\共有62頁\編于星期三\15點ClassificationsAccordingtoanatomy:(1)Centrallung(2)peripherallungcancer當(dāng)前第4頁\共有62頁\編于星期三\15點當(dāng)前第5頁\共有62頁\編于星期三\15點Accordingtohistologicclassification:Smallcelllungcancer(SCLC)andNon-smallcelllungcancer(NSCLC).NSCLCincludesSquamouscellcarcinoma,largecellcarcinoma,adenocarcinoma,adenosquamouscarcinoma.當(dāng)前第6頁\共有62頁\編于星期三\15點Smallcelllungcancer(SCLC)
Oat-cellcarcinoma
SCLCgrowsveryrapidlyandisveryaggressive.Soonaftertheoriginalcellbecomescancerous,itquicklymultipliestoformatumor.ThesecellsswiftlyspreadtodistantsitesinthebodySCLCbelongsinagroupoftumorsderivedfromneuroendocrinecellsthatareresponsiblefortheproductionandsecretionofspecificpeptideproduct.theymayrelatedtoparaneoplasticsyndrome.當(dāng)前第7頁\共有62頁\編于星期三\15點Cellsareovalorvaguelyspindle-shaped,havescantcytoplasm當(dāng)前第8頁\共有62頁\編于星期三\15點當(dāng)前第9頁\共有62頁\編于星期三\15點
Squamouscellcarcinomathemostfrequentformofthetumor(30-50percentofallcasesbronchialepitheliumandgrowthinsituItisrelatedtocigarettesmokingCavitationcanoccureinthedistaltotheobstructingmassCentrallocation當(dāng)前第10頁\共有62頁\編于星期三\15點Intercellularbridgesandcellularpleomorphism當(dāng)前第11頁\共有62頁\編于星期三\15點當(dāng)前第12頁\共有62頁\編于星期三\15點squamouscellcarcinomausuallyoccursnearthebronchi,thetumorcancausecough(sometimesacoughthatistingedwithblood),shortnessofbreath,wheezing,andpneumoniaintheareabetweenthetumorandtheedgeofthelungitcausessymptomsearlyinthedisease
當(dāng)前第13頁\共有62頁\編于星期三\15點adenocarcinomaareasofscarringisassociatedwiththeoccurrenceofadenocarcinoma.Peripheraladenocarcinomasareusuallywell-circumscribed,grey-whitemassesthatrarelycavitate.Itarisesfromthesubmucosalglands,locatedinperipheralairwaysandalveoliFemale當(dāng)前第14頁\共有62頁\編于星期三\15點當(dāng)前第15頁\共有62頁\編于星期三\15點當(dāng)前第16頁\共有62頁\編于星期三\15點largecellcarcinoma當(dāng)前第17頁\共有62頁\編于星期三\15點largenuclei,prominentnucleoli,abundantcytoplsma當(dāng)前第18頁\共有62頁\編于星期三\15點usuallylocatedperipherallycanbequitelargeandnotinfrequentlycavitate當(dāng)前第19頁\共有62頁\編于星期三\15點theSymptomsofLungCancerFatigue(tiredness)Cough
ShortnessofbreathChestpainLossofappetiteCoughingupphlegmHemoptysis(coughingupblood)Ifcancerhasspread,symptomsincludebonepain,difficultybreathing,abdominalpain,headache,weakness,andconfusion當(dāng)前第20頁\共有62頁\編于星期三\15點Duetoprimarylesions:cough,dyspnea,hemoptysis,sputum,wheezing,weightloss,fever,pneumoniaDuetolocalextension:chestpain,hoarseness,superiorvenacavasyndrome,horner’ssyndrome,dysphagia,pericardialeffusion,pleuraleffusion,diaphragmparalysisOnly5-15percentofpatientsareasymptomaticwhendiscoveredtohavebronchogeniccarcinoma.當(dāng)前第21頁\共有62頁\編于星期三\15點Regionnalspreadtohilarandmediastinalnodesmaycausedysphagiaduetoesophagealcompressionhorsenessduetorecurrentlaryngealnervecompressionhorner’ssyndromeduetosympatheticnerveinvolvementelevationofthehemidiaphragmfromphrenicnervecompression.當(dāng)前第22頁\共有62頁\編于星期三\15點Superiorsulcus,orpancoast’stumormayinvolvethebrachialplexus,resultinginac7-t2neuropathywithpain,numbness,andweaknessofthearm.CardiacinvolvementisseeninAbout20-25percentofpatients
當(dāng)前第23頁\共有62頁\編于星期三\15點Extrapulmonarymanifestations.Includingmetastasistootherorgans,suchasbrain,centralnervoussystem,skeletonsystem,liver,adrenalglandsandlymphnodesects.Paraneoplasticsyndromesareremoteeffectsoftumor.Theyleadtometabolicandneuromusculardisturbancesunrelatedtotheprimarytumor,metastases,ortreatment.Theymaybethefirstsignofthetumor.Theydonotindicatethatatumorhasspread.當(dāng)前第24頁\共有62頁\編于星期三\15點PhysicalexaminationsUsuallyinearlystage,mostofthepatientswithlungcancerhavenopositivephysicalfindings.Generalfindingsincludeabnormalpercussion,breathsoundschanges,moistrales(whenpneumoniahappens)Digitalclubbing,superiorvenacavasyndrome,horner’ssyndrome(unilaterallyconstrictedpupil,enophthalmos,narrowedpalpebralfissureandlossofsweatingonthesamesideoftheface.當(dāng)前第25頁\共有62頁\編于星期三\15點PhysicalexaminationsEndobronchialobstructionmayresultinalocalizedwheezeLobarcollapsemayresultinanareaofdecreasedbreathsoundsanddullnesstopercussion.當(dāng)前第26頁\共有62頁\編于星期三\15點HowisLungCancerEvaluated?Becausealmostallpatientswillhaveatumorinthelung,achestx-rayorCTscanofthechestisperformedThediagnosismustbeconfirmedwithabiopsyThelocation(s)ofallsitesofcancerisdeterminedbyadditionalCTscans,PET(positronemissiontomography)scans,andMRI(magneticresonanceimaging)Itisimportanttofindoutifcancerstartedinthelungorsomewhereelseinthebody.Cancerarisinginotherpartsofthebodycanspreadtothelungaswell當(dāng)前第27頁\共有62頁\編于星期三\15點ChestX-ray
ItisthemostimportantmethodtofindlungcancerThemostfrequentfindingisamassinthelungfield當(dāng)前第28頁\共有62頁\編于星期三\15點當(dāng)前第29頁\共有62頁\編于星期三\15點當(dāng)前第30頁\共有62頁\編于星期三\15點OnchestX-ray,secondarymanifestationsincludelobarcollapse,pleuraleffusion,pneumonitis,elevationofthehemidiaphragm,hilarandmediastinaladenopathy,anderosionofribsorvertebraeduetometastases.當(dāng)前第31頁\共有62頁\編于星期三\15點當(dāng)前第32頁\共有62頁\編于星期三\15點當(dāng)前第33頁\共有62頁\編于星期三\15點Obstructiveatelectasis當(dāng)前第34頁\共有62頁\編于星期三\15點LungcanceronCT
CTisthemostusefulinevaluatingpatientswithpulmonaryandmediastinalmasses.Itisalsousefulfordetectingmultiplemetastases.CTcanshowamasstobelocatedinwhichlobeoflungfieldandthesizeofthemass.Italsoshowsthenoduleinthemediastinum.Sometimes,whenamasslocatebehindtheheart,chestX-raycan`tdetectit.CTcandetectsomesecretsitesoflungcancer.
當(dāng)前第35頁\共有62頁\編于星期三\15點當(dāng)前第36頁\共有62頁\編于星期三\15點Bronchoscopy當(dāng)前第37頁\共有62頁\編于星期三\15點RigidandflexiblescopeBiopsyandselectivewashingsLargersamplesthanflexiblescopeExactlocationLobectomyPneumonectomyUnresectableSleeve當(dāng)前第38頁\共有62頁\編于星期三\15點當(dāng)前第39頁\共有62頁\編于星期三\15點TransthoraciclungbiopsyItmaybeutilizedwhentumorlocatedinperipheralairway.TransthoracicneedlewithguidancebyCTcanbeusedtodetectlesionslocatednearthechestwall當(dāng)前第40頁\共有62頁\編于星期三\15點當(dāng)前第41頁\共有62頁\編于星期三\15點VideoAssistedThoracicSurgeryDiagnosisofpleuraldiseaseWedgeresection當(dāng)前第42頁\共有62頁\編于星期三\15點當(dāng)前第43頁\共有62頁\編于星期三\15點Mediasteinoscopy&Mediasteinotomy當(dāng)前第44頁\共有62頁\編于星期三\15點當(dāng)前第45頁\共有62頁\編于星期三\15點DiagnosesunresectablediseaseEliminateN2diseasefromsurgicalresection當(dāng)前第46頁\共有62頁\編于星期三\15點ThoracotomyIfthemethodsmentionedabovearenotusefulfordetectingthecelltypeoflungcancer,thoracotomymaybeused當(dāng)前第47頁\共有62頁\編于星期三\15點StagingoflungcancerStagingisawayofdescribingacancer,suchasthesizeofthetumorandwhereithasspreadStagingisthemostimportanttooldoctorshavetodetermineapatient’sprognosis
ThetypeoftreatmentapersonreceivesdependsonthestageofthecancerStagingisdifferentfornon-smallcelllungcancerandsmallcelllungcancer
當(dāng)前第48頁\共有62頁\編于星期三\15點StageINon-SmallCellLungCancerCancerisfoundonlyinthelungSurgicalremovalrecommendedRadiationtherapyand/orchemotherapymayalsobeused當(dāng)前第49頁\共有62頁\編于星期三\15點StageIINon-SmallCellLungCancerThecancerhasspreadtolymphnodesinthelungTreatmentissurgerytoremovethetumorandnearbylymphnodesChemotherapyrecommended;radiationtherapysometimesgivenafterchemotherapy
當(dāng)前第50頁\共有62頁\編于星期三\15點StageIIINon-SmallCellLungCancerThecancerhasspreadtothelymphnodeslocatedinthecenterofthechest,outsidethelungStageIIIAcancerhasspreadtolymphnodesinthechest,onthesamesidewherethecanceroriginatedStageIIIBcancerhasspreadtolymphnodesontheoppositesideofthechest,underthecollarbone,orthepleura(liningofthechestcavity)SurgeryorradiationtherapywithchemotherapyrecommendedforstageIIIAChemotherapyandsometimesradiationtherapyrecommendedforstageIIIB
當(dāng)前第51頁\共有62頁\編于星期三\15點StageIVNon-SmallCellLungCancerThecancerhasspreadtodifferentlobesofthelungortootherorgans,suchasthebrain,bones,andliverStageIVnon-smallcelllungcanceristreatedwithchemotherapy當(dāng)前第52頁\共有62頁\編于星期三\15點Smallcelllungcancerhasoftenmetastasizedatthetimeofdiagnosis.TNMstagingisnotsuitedtosmallcelllungcancer.當(dāng)前第53頁\共有62頁\編于星期三\15點TreatmentIncluding:A:SurgeryB:ChemotherapyC:RadiationtherapyD:Someothertherapyimmunologictherapy,Chinesetraditionaltherapy當(dāng)前第54頁\共有62頁\編于星期三\15點SurgeryNon-smallcelllungcancer:patientswithstageIandIIareconsideredcandidatesforsurgicalresection,withstageIIIcancermaybecandidatesforsurgerywithpostoperativeradiationofthemediastinum.當(dāng)前第55頁\共有62頁\編于星期三\15點當(dāng)前第56頁\共有62頁\編于星期三\15點SurgeryWemustmeasurepulmona
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