醫(yī)學資料 Lung cancer 肺癌英文

GoodMorning!LungCancerProf.WenjianhuDept.CardiothoracicSurgeryClinicalCollege,FirstAffiliatedHospitalChongqingUniversityofMedicalSciences

LungcancerContentsAnatomyIntroductionEtiologyPathologyClinicalPresentationDiagnosisStagingDifferentialDiagnosisTreatmentPrognosisSummaryDept.CardiothoracicsurgeryLungcancerAnatomyDept.CardiothoracicsurgeryLungcancerDept.CardiothoracicsurgeryLungcancerRight:3lobes,10segments

Left:2lobes,10segments

Themainfunctionofthelungsisgasexchange.

IntroductionDept.CardiothoracicsurgeryLungcancerDept.CardiothoracicsurgeryLungcancerDefinition:Lungcancerisamalignancyofthelung.Itischaracterizedbyunregulatedreplicationofcellscreatingtumors.Today,wearegoingtostudyprimarylungcancer.Synonyms:Cancerofthelungs;Carcinomaofthelungs;BronchogeniccarcinomaEpidemiologyLungCancerWorldwide:mostcommoncancer2,000,000casesperyearChina:Leadingcauseofcancerdeathestimated500,000deaths2002EtiologyDept.CardiothoracicsurgeryLungcancerWhatcauseslungcancer?Multipleexposuretocarcinogens(cancer-causingagents)resultsindamagetoDNAinthecellsofthelung.Dept.CardiothoracicsurgeryLungcancerCigarettesmokingisbyfarthebiggestcarcinogen

forthedevelopmentoflungcancer.responsiblefor85percentofalllungcancers.

Dept.CardiothoracicsurgeryLungcancerOtherriskfactorsincludethefollowing:FamilyhistoryEnvironmentalandoccupationalexposuretocertainsubstancesExposuretoexcessiveradiationPreviousLungdiseasesPoordietDept.CardiothoracicsurgeryLungcancerPathologyDept.CardiothoracicsurgeryLungcancerDept.CardiothoracicsurgeryLungcancerLungCancerPathologicClassification

SMALLCELL～18%(15～25%)

(SCLC)NON-SMALLCELL

～82%(NSCLC)squamouscell～40%adenocarcinoma～30%largecell～12%(5～15%)Dept.CardiothoracicsurgeryLungcancerSquamouscellcarcinomacommonlystartsinthebronchiandmaynotspreadasrapidlyasotherlungcancers.

Dept.CardiothoracicsurgeryLungcancer

Adenocarcinomausuallydevelopsontheperipheryofthelungsandismorecommonlyfoundinwomenthaninmen.

Dept.CardiothoracicsurgeryLungcancerAdenocarcinomaThisisaperipheraladenocarcinomaofthelung.Adenocarcinomastendtooccurmoreperipherallyinlung.Dept.CardiothoracicsurgeryLungcancerLargecellcarcinomaisanylungtumorthatcannotbeclassified,usuallyoccursintheperipheryofthelung.LargecellcarcinomaLargecellcarcinomaisusuallyaperipherallung,sphericaltumorwithwell-definedborders,fleshy,homogenousgrayish-whitecutsurface;frequentlyinvolveschestwall.Dept.CardiothoracicsurgeryLungcancerSmallcellcarcinoma,alsocalledoatcellcarcinoma,cancreateitsownhormones,whichalterbodychemistry.Smallcelllungcancergrowsmorequicklyandismorelikelytospreadtootherorgansinthebody.

Dept.CardiothoracicsurgeryLungcancerSmallcellcarcinoma

Asmallcell(oatcell)carcinomaisarisingcentrallyinthis

lungandspreadingextensively.ClinicalmanifestationDept.CardiothoracicsurgeryLungcancerWhatarethesymptomsoflungcancer?Initsearlystages,lungcancerusuallycausesnosymptoms.Dept.CardiothoracicsurgeryLungcancerAtthetimeofdiagnosis,commonsymptomsoflungcanceraresimilartothoseofsomeotherrespiratorydiseases.Dept.CardiothoracicsurgeryLungcancerLatesymptomsoflungcancergenerallyresultfromspreadtootherpartsofthebody(metastasis).Dept.CardiothoracicsurgeryLungcancersignsandsymptomscough

Dept.CardiothoracicsurgeryLungcancersignsandsymptomsHemoptysisDept.CardiothoracicsurgeryLungcancersignsandsymptomsChestpainor

shoulderpain

Dept.CardiothoracicsurgeryLungcancersignsandsymptomsShortnessofbreath,wheezingDept.CardiothoracicsurgeryLungcancersignsandsymptomsRepeatedpneumoniaorbronchitisDept.CardiothoracicsurgeryLungcancersignsandsymptomsSwellingandeffusionDept.CardiothoracicsurgeryLungcancersignsandsymptomsLossofappetiteorweightloss

Dept.CardiothoracicsurgeryLungcancersignsandsymptomsboneandjointpainDept.CardiothoracicsurgeryLungcancersignsandsymptomsHoarsenessDept.CardiothoracicsurgeryLungcancerDept.CardiothoracicsurgeryLungcancerSVCSyndromePancoastTumorDept.CardiothoracicsurgeryLungcancerDept.CardiothoracicsurgeryLungcancerClubbingfingerDiagnosisDept.CardiothoracicsurgeryLungcancerChestX-RayfilmsComputedtomography(CT)Bronchoscopy(FOB)Cytologyexamination(sputum,pleuraleffusion)Transthoracicneedleaspiration(TTNA)Magneticresonanceimaging(MRI)Positronemissiontomography(PET)Isotopescan(lung,bone)Ultrasoundscan(liver,kidney)MediastinoscopyThoracoscopy(VATS)DiagnosticTechniques1.ChestX-RayfilmsDept.CardiothoracicsurgeryLungcancerDept.CardiothoracicsurgeryLungcancer2.ComputerizedTomography(CT)Dept.CardiothoracicsurgeryLungcancerCTImages3.Bronchoscopy(FOB)

Dept.CardiothoracicsurgeryLungcancerBronchoscopy4.Cytology

examination(sputum,pleuraleffusion)

Dept.CardiothoracicsurgeryLungcancerSquamouscellAdenocarcinomaLargecellcarcinomaSmallcellcarcinoma5.Transthoracicneedleaspiration(TTNA)

Sensitivity90%needlebiopsyDept.CardiothoracicsurgeryLungcancer6.Magneticresonanceimaging(MRI)

MRIImagesDept.CardiothoracicsurgeryLungcancerDept.CardiothoracicsurgeryLungcancer7.PositronEmissionTomography(PET)Dept.CardiothoracicsurgeryLungcancerPETImagesDept.CardiothoracicsurgeryLungcancer8.Isotopescan(lung,bone)

Dept.CardiothoracicsurgeryLungcancer9.UltrasoundscanAbdominalultrasoundisascanningtechniqueusedtoimagetheinterioroftheabdomenDept.CardiothoracicsurgeryLungcancerUltrasoundscan(Adrenalmetastasis)Sonogramshowsa6-cmrightadrenalmetastasisoflungcancer.Dept.CardiothoracicsurgeryLungcancer10.Mediastinoscopy

Dept.CardiothoracicsurgeryLungcancer11.Thoracoscopy(VATS)Dept.CardiothoracicsurgeryLungcancerThoracoscopy(VATS)StagingoflungcancerDept.CardiothoracicsurgeryLungcancerTheserecommendationsforclassifyinglungcanceraccordingtoTNMprinciplesandstagegroupingoftheTNMsubsetswerebasedonstudiesofthesurvivalexperienceofpatientstreatedforprimarylungcancerinacontemporarytimeframe.Dept.CardiothoracicsurgeryLungcancerTNMDEFINITIONST-PrimaryTumor:TXT0TIST1T2T3T4N-NodalInvolvement:N0N1N2N3M-DistantMetastasis:M0M1Dept.CardiothoracicsurgeryLungcancerTX,T0,andTISTXTumorprovenbythepresenceofmalignantcellsT0Noevidenceofprimarytumor

TISCarcinomainsituDept.CardiothoracicsurgeryLungcancerT1Atumorthatis(a)3cm.orless

(b)noevidenceofinvasionproximaltoalobarbronchusatbronchoscopy.Dept.CardiothoracicsurgeryLungcancerT2(a)morethan3cm.

(b)invadesthevisceralpleura;

(c)theproximalextentofthetumormustbewithinalobarbronchusoratleast2cm.distaltothecarina.Dept.CardiothoracicsurgeryLungcancerT3Atumorofanysizewithdirectextensionintothe(a)chestwall(b)superiorsulcustumors,orthediaphragm,mediastinalpleuraorpericardium,oratumorinthemainbronchuswithin2cmofthecarinawithoutinvolvingthecarina.Dept.CardiothoracicsurgeryLungcancerT4Extrathoracictumorextensioninvolvingmediastinalstructuresorthevertebralbodyandbrachialplexus,asshownintheexampleofPancoast'stumor.Dept.CardiothoracicsurgeryLungcancerN1Metastasistolymphnodesintheperibronchialortheipsilateralhilarregionorboth,includingdirectextension,isclassifiedN1.Dept.CardiothoracicsurgeryLungcancerN2Enlargedipsilateralmediastinallymphnodes(>1cm.)indicateandareclassifiedclinicallyasN2.Dept.CardiothoracicsurgeryLungcancerN3Metastasistocontralateralmediastinallymphnodes,contralateralhilarlymphnodes,ipsilateralorcontralateralscaleneorsupraclavicularlymphnodes.Dept.CardiothoracicsurgeryLungcancerM1Dept.CardiothoracicsurgeryLungcancerM1Dept.CardiothoracicsurgeryLungcancerStageIADept.CardiothoracicsurgeryLungcancerT1N0M0StageIBT2N0M0Dept.CardiothoracicsurgeryLungcancerStageIIAT1N1M0Dept.CardiothoracicsurgeryLungcancerStageIIBDept.CardiothoracicsurgeryLungcancerT2N1M0T3N0M0StageIIIAT3N1M0T1N2M0T2N2M0T3N2M0Dept.CardiothoracicsurgeryLungcancerStageIIIBT4AnyNM0AnyTN3M0Dept.CardiothoracicsurgeryLungcancerSTAGEIVThestageIVcategoryincludesonlypatientswithevidenceofdistantmetastasis,M1disease.Dept.CardiothoracicsurgeryLungcancerStage0carcinomainsitu.StageIAT1N0M0.StageIBT2N0M0.StageIIAT1N1M0.StageIIBT2N1M0;T3N0M0.StageIIIAT3N1M0;T1N2M0;T2N2M0;T3N2M0.StageIIIBT4AnyNM0;AnyTN3M0.StageIVanyT,anyN,M1.Dept.CardiothoracicsurgeryLungcancerSTAGEGROUPINGOF

THETNMSUBSETSDifferentialDiagnosisDept.CardiothoracicsurgeryLungcancerDept.CardiothoracicsurgeryLungcancer1.pulmonarytuberculosis2.pulmonaryinflammatorylesion3.benigntumor4.mediastinallymphomaDifferentialDiagnosisTreatmentDept.CardiothoracicsurgeryLungcancerTreatmentforlungcancerisbasedonthetypeandstageoftumor,possibilityforremovingthetumor,andthepatient'sabilitytosurvivesurgery.Optionsincludesurgery,radiation,chemotherapy,oracombinationofthesetreatments.Dept.CardiothoracicsurgeryLungcancerTreatmentPlanDept.CardiothoracicsurgeryLungcancerNon-small-celllungcancer:NSCLCinitsearlieststagesarecandidatesforsurgicalresectionwitharealistichopeofcuringthedisease.Radiationtherapyandchemotherapyalsomaybeusedtoslowtumorgrowthandrelievesymptoms.Dept.CardiothoracicsurgeryLungcancerSmall-celllungcancer:ChemotherapyisthemostcommontreatmentforSCLC,butradiationtherapymaybeaddedtoeithersurgeryorchemotherapy,orapatientmayreceiveallthreetreatments.WhilesurgeryisseldomusedtotreatpatientswithSCLC.Dept.CardiothoracicsurgeryLungcancerSurgeryDept.CardiothoracicsurgeryLungcancerThestandardtreatmentofpatientswithstageIorIIdiseaseissurgicalresection.AsubsetofpatientswithstageIIIdiseaseshasimprovedoutcomewithlungresection.SurgicalmanagementofNSCLCDept.CardiothoracicsurgeryLungcancerSurgicaltreatment’sprincipleiscompleteresectionandpreservingthemaximumamountoffunctionallungtissue.WedgeresectionSegmentectomyLobectomySleeveresectionPneumonectomyDept.CardiothoracicsurgeryLungcancerSurgerycantakeseveralforms:PulmonaryresectionDept.CardiothoracicsurgeryLungcancerrightlowerlobectomyDept.CardiothoracicsurgeryLungcancerSleeveresectionDept.CardiothoracicsurgeryLungcancerDept.CardiothoracicsurgeryLungcancerRadiotherapyLinearacceleratorDept.CardiothoracicsurgeryLungcancerRadiationcandestroycancercellswithoutsurgery.Radiationissometimesgivenbeforeoraftersurgery.Radiationtreatmentsmaybedonebefore,during,orafterchemotherapy.Dept.CardiothoracicsurgeryLungcancerChemotherapyDept.CardiothoracicsurgeryLungcancerDept.CardiothoracicsurgeryLungcancerStandardchemotherapyforlungcancerWell-knowndrugpairingsincombinationtherapyinclude:

paclitaxelpluscarboplatincisplatinplusvinorelbinetartratecisplatinplusVP-16,andcarboplatinplusVP-16.Dept.CardiothoracicsurgeryLungcancerInthisprocedure,chemotherapyisadministeredfirst,toreducethesizeoftheprimary