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1、1,原发性支气管肺癌 Primary bronchogenic carcinoma,呼吸内科 Respiratory Department 熊维宁 Xiong, Weining,2,定义 Definition,原发性支气管肺癌简称肺癌，是起源于支气管粘膜或腺体的肿瘤。 Primary bronchogenic carcinoma is abbreviated to lung cancer, it derives from bronchi mucosa or gland.,3,Epidemiology,Lung Cancer Worldwide: most common cancer 2,000
2、,000 cases per year China : first leading cause of cancer death in urban area 15% 5-year survival,4,病因和发病机制 Etiology and pathogenesis,1 吸烟 1 Smoking,5,Lung Cancer: Smoking Facts,Tobacco use is the leading cause of lung cancer 87% of lung cancers are related to smoking Risk related to: Amount smoked
3、Age of smoking onset Product smoked (tar/nicotine content, filters) Depth of inhalation Gender Risk goes down after 5 yrs cessation At 15 years, 80-90% risk reduction Never gets to “never smoker” risk,6,20 Year Lag,7,If what happened on your inside happened on your outside, would you still smoke?,8,
4、2 职业致癌因子 2 Occupation carcinogenic factor: Asbestos, Radon 3 空气污染 3 Air pollution （1）室外大环境污染 （1）Outdoor environment pollution （2）室内小环境污染 （2）Indoor environment pollution 4 电离辐射 4 Ionizing radiation,9,5 饮食与营养 5 Diet and nutrition VITAMIN A,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,?,10,6 其他因素 6 Other factor
5、s 7 遗传因素 7 Hereditary factor Tumor suppressor genes *p53 Dominant oncogenes *Kras *Her-2/neu,11,病理和分类,Pathology and classification,12,解剖学分类 Anatomy classification,1 中央型肺癌 1 Central lung cancer,13,2 周围型肺癌 2 Peripheral lung cancer,14,组织学分类 Histology classification,1 小细胞肺癌 1 Small cell lung cancer, SCL
6、C （1）燕麦细胞型 （1）oat cell type （2）中间细胞型 （2）intermediate cell type （3）混合型 （3）mixed type,15,Small cell carcinoma Rare in non-smokers Large hilar mass 70% present with overt metastasis Very chemo-responsive Worst prognosis,16,Small cell carcinoma,17,2 非小细胞肺癌 2 Non-small cell lung cancer, NSCLC （1）鳞状细胞癌（鳞癌
7、） （1）Squamous cell carcinoma, SCC （2）腺癌和支气管肺泡癌 （2）Adenocarcinoma，AC，and bronchoalveolar carcinoma （3）大细胞癌 （3）Large cell carcinoma （4）鳞腺癌 （4）Adeno-squamous carcinoma,18,Squamous cell carcinoma Now 2nd most common ( 1st in China) Strongly linked with smoking 60-80% in the proximal airways (central typ
8、e) Cavitation Tendency to spread locally/regionally Prognosis slightly better than Adenocarcinoma,19,Squamous Cell Carcinoma,20,Squamous Cell Carcinoma,21,鳞癌,22,Lung Cancer Pathology,Adenocarcinoma Most common pathology(2nd in China) “Non-smokers lung cancer” Women Peripheral (75%) Aggressive metast
9、ases,23,Adenocarcicoma Left Lower Lobe,24,Adenocarcinoma,25,Adenocarcinoma,26,Bronchoalveolar Cell Carcinoma,BAC Aerogenous and lymphatic spread Least associated with cigarette smoking Usually peripheral Localized, multi-nodular or diffuse Slow metabolism Prognosis Localized vs. other,27,支气管肺泡癌,28,L
10、arge cell carcinoma Large peripheral mass with necrosis Malignant epithelial neoplasm Poorly-differentiated Aggressive mets “Its a cancerits not small cellbut”,29,Large cell carcinoma,30,Large cell carcinoma,31,32,33,临床表现,Clinical manifestation,34,原发肿瘤引起的症状和体征 Symptoms and physical signs due to prim
11、ary tumor,1 咳嗽 1 Cough 2 咯血 2 Hemoptysis 3 喘鸣 3 Wheeze 4 气急 4 Breath lessness 5 发热 5 Fever 6 其他 6 Others,35,肿瘤局部扩展引起的症状和体征 Symptoms and physical signs due to tumor local expanding,1 胸痛 1 Chest pain 2 呼吸困难 2 Dyspnea 3 吞咽困难 3 Dysphagia: esophageal compression 4 声音嘶哑 4 Hoarse voice: laryngeal nerve par
12、alysis 5 上腔静脉阻塞综合征 5 Superior vena cava obstruction syndrome 6 Horner综合征，肺上沟瘤 6 Horners syndrome, Pancoasts tumor: Cervical/thoracic nerve invasion 7 臂丛神经压迫征 7 Brachial plexus compression syndrome,36,肿瘤远处转移引起的症状和体征 Symptoms and physical signs due to tumor distant metastasis,1 脑、中枢神经系统转移 1 Metastasiz
13、e to brain, central nervous system,37,2 肝转移 2 Metastasize to liver 3 骨转移 3 Metastasize to bone 4 皮下转移性结节 4 Subcutaneouly metastatic nodus 5 颈部或锁骨上淋巴结转移 5 Cervical or supraclavicular lymph node metastasis,38,肺癌作用于其他系统引起的肺外表现Manifestation out of lung due to other systems affected by lung cancer,1 异位内分
14、泌综合征 1 Ectopic endocrine syndrome, EES （1） 抗利尿激素分泌异常综合征 （1） Syndrome of inapprpriate antidiuretic hormone(SIADH) secretion （2） 异位ACTH综合征 （2） Ectopic ACTH syndrome （3） 神经肌肉综合征 （3） Neuromyopathic syndrome （4） 高钙血症 （4） Hypercalcinemia （5） 其他：类癌综合征 （5） Others: Carcinoid syndrome,39,2 其他肺外表现 2 Other mani
15、festation out of lung （1）多发性周围神经炎 （1）Multiple peripheral neuritis （2）肌无力样综合征 （2）Eaton-Lambert syndrome,40,（3）肥大性肺性骨关节病 （3）Hypertrophic pulmonary osteoarthropathy, HPO,41,实验室和辅助检查,Laboratory and auxiliary examination,42,胸部X线检查 Chest radiograph,1 中央型肺癌 1 Central lung cancer,43,44,2 周围型肺癌 2 Peripheral
16、lung cancer,45,46,47,48,电子计算机体层扫描 CT,49,Posterior basal segment of left lower lobe, AC,50,左上叶肺癌并左上叶不张,Left upper lobe cancer combining atelectasis,51,Left lower lobe cancer combining obstructive pneumonia,52,53,磁共振 MRI,54,55,痰脱落细胞学检查 Sputum exfoliative cytology test,SCC,AC,SCLC,56,纤维支气管镜检查 Bronchofi
17、berscopy,57,58,59,SCC,SCLC,AC,LCC,60,核素闪烁显像 Nuclide scintigraphy 1 骨闪烁显像 1 Bone scintigraphy 2 正电子发射断层显像 2 Positron emission tomography (PET),61,62,病理学检查 Pathology 癌标志物的检测 Cancer mark test 基因诊断 Gene diagnosis 手术探查 Operations research,63,诊断和鉴别诊断,Diagnosis and differential diagnosis,64,诊断 Diagnosis,早期
18、诊断 Early diagnosis 症状 Symptom 体征 Physical sign 检查 Examination,65,鉴别诊断 Differential diagnosis,1 肺结核 1 Pulmonary tuberculosis,66,Tuberculosis,Lung cancer,67,肺真菌病 Pulmonary mycosis,68,2 肺炎 2 Pneumonia 抗菌药物治疗有效，病灶吸收快而完全 Usually, antibacterial drug therapy is effective, and focus is absorbed quickly and
19、completely.,69,3 肺脓肿 3 Lung abscess,70,4 结核性渗出性胸膜炎 4 Tuberculous exudative pleurisy,71,临床分期 Clinical stage,IA: T1N0 IB: T2 N0 IIA: T1 N1 IIB: T2 N1, T3 N0 IIIA: T3 N1, and T1-3 N2 IIIB: any T4, any N3 IV: any metastases,72,治 疗,Treatment,73,手术治疗 Operation treatment,1 NSCLC 2 SCLC,74,化学药物治疗 Chemothera
20、py,1 SCLC 2 NSCLC,75,放射治疗 Radiotherapy,根治性 Radical cure 姑息性 Palliative cure,76,介入性治疗 Interventional therapy,1 支气管动脉灌注 1 Bronchial artery infusion, BAI 2 经纤支镜 2 Through bronchofiberscopy,77,生物反应调节剂和生物靶向治疗 Biological response modifiers (BRM) and biological targeted therapy 中医药 Chinese medicine,78,预后和预
21、防,Prognosis and prevention,79,预后 Prognosis,The overall prognosis in bronchial carcinoma is very poor; With around 80% of patients dying within a year of diagnosis and less than 6% of patients surviving 5 years after diagnosis; The best prognosis is well-differentiated squamous cell tumors which have not metastasized and are amenable to surgical treatment.,80,预防 Prevention,1 戒烟 1 Stop smoking 2 加强劳动保护 2 Enhance labor protection 3 早期发现 3 Early discovery 4 化学预防 4 Chemical prophylaxis,81,Thanks!,