1、1原发性支气管肺癌原发性支气管肺癌 Primary bronchogenic carcinoma呼吸内科呼吸内科Respiratory Department熊维宁熊维宁Xiong,Weining2定义定义Definition原发性支气管肺癌简称肺癌，是起源于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。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.3EpidemiologyLung CancerWorld
2、wide:most common cancer2,000,000 cases per yearChina:first leading cause of cancer death in urban area 5 yrs cessationAt 15 years,80-90%risk reductionNever gets to“never smoker”risk620 Year Lag7 If what happened on your inside happened on your outside,would you still smoke?82 职业致癌因子职业致癌因子2 Occupatio
3、n carcinogenic factor:Asbestos,Radon 3 空气污染空气污染3 Air pollution（1）室外大环境污染）室外大环境污染（1）Outdoor environment pollution（2）室内小环境污染）室内小环境污染（2）Indoor environment pollution4 电离辐射电离辐射4 Ionizing radiation95 饮食与营养饮食与营养5 Diet and nutritionVITAMIN A?106 其他因素其他因素6 Other factors 7 遗传因素遗传因素7 Hereditary factorTumor sup
4、pressor genes*p53Dominant oncogenes*Kras*Her-2/neu11病理和分类病理和分类Pathology and classification12解剖学分类解剖学分类Anatomy classification1 中央型肺癌中央型肺癌1 Central lung cancer132 周围型肺癌周围型肺癌2 Peripheral lung cancer14组织学分类组织学分类Histology classification1 小细胞肺癌小细胞肺癌1 Small cell lung cancer,SCLC（1）燕麦细胞型）燕麦细胞型（1）oat cell ty
5、pe（2）中间细胞型）中间细胞型（2）intermediate cell type（3）混合型）混合型（3）mixed type15Small cell carcinomaRare in non-smokersLarge hilar mass 70%present with overt metastasisVery chemo-responsiveWorst prognosis16Small cell carcinoma172 非小细胞肺癌非小细胞肺癌2 Non-small cell lung cancer,NSCLC（1）鳞状细胞癌（鳞癌）鳞状细胞癌（鳞癌）（1）Squamous cell
6、carcinoma,SCC（2）腺癌和支气管肺泡癌）腺癌和支气管肺泡癌（2）Adenocarcinoma，AC，and bronchoalveolar carcinoma（3）大细胞癌）大细胞癌（3）Large cell carcinoma（4）鳞腺癌）鳞腺癌（4）Adeno-squamous carcinoma18Squamous cell carcinomaNow 2nd most common(1st in China)Strongly linked with smoking60-80%in the proximal airways(central type)CavitationTend
7、ency to spread locally/regionallyPrognosis slightly better than Adenocarcinoma19Squamous Cell Carcinoma20Squamous Cell Carcinoma21鳞癌鳞癌22Lung Cancer PathologyAdenocarcinomaMost common pathology(2nd in China)“Non-smokers lung cancer”WomenPeripheral(75%)Aggressive metastases23Adenocarcicoma Left Lower
8、Lobe24Adenocarcinoma25Adenocarcinoma26Bronchoalveolar Cell CarcinomaBACAerogenous and lymphatic spreadLeast associated with cigarette smokingUsually peripheralLocalized,multi-nodular or diffuseSlow metabolismPrognosisLocalized vs.other27支气管肺泡癌支气管肺泡癌28Large cell carcinomaLarge peripheral mass with ne
9、crosisMalignant epithelial neoplasmPoorly-differentiatedAggressive mets“Its a cancerits not small cellbut”29Large cell carcinoma30Large cell carcinoma3110100d2530187d恶性度最高最常见发病率(%)倍增时间不明显有关密切吸烟女性较轻老年男性好发年龄性别202533d3035100d大细胞癌腺癌小细胞癌鳞癌32鳞癌小细胞癌腺癌大细胞癌解剖分类中央型中央型周围周围生长方式管腔内管腔外管腔外转移晚早较早手术机会多少支气管肺泡癌瘢痕癌较大放化
10、疗敏感33临床表现临床表现Clinical manifestation34原发肿瘤引起的症状和体征原发肿瘤引起的症状和体征Symptoms and physical signs due to primary tumor1 咳嗽咳嗽1 Cough2 咯血咯血2 Hemoptysis3 喘鸣喘鸣3 Wheeze4 气急气急4 Breath lessness5 发热发热5 Fever6 其他其他6 Others35肿瘤局部扩展引起的症状和体征肿瘤局部扩展引起的症状和体征Symptoms and physical signs due to tumor local expanding1 胸痛胸痛1 Ch
11、est pain2 呼吸困难呼吸困难2 Dyspnea3 吞咽困难吞咽困难3 Dysphagia:esophageal compression4 声音嘶哑声音嘶哑4 Hoarse voice:laryngeal nerve paralysis 5 上腔静脉阻塞综合征上腔静脉阻塞综合征5 Superior vena cava obstruction syndrome6 Horner综合征，肺上沟瘤综合征，肺上沟瘤6 Horners syndrome,Pancoasts tumor:Cervical/thoracic nerve invasion 7 臂丛神经压迫征臂丛神经压迫征7 Brachia
12、l plexus compression syndrome36肿瘤远处转移引起的症状和体征肿瘤远处转移引起的症状和体征Symptoms and physical signs due to tumor distant metastasis1 脑、中枢神经系统转移脑、中枢神经系统转移1 Metastasize to brain,central nervous system372 肝转移肝转移2 Metastasize to liver3 骨转移骨转移3 Metastasize to bone4 皮下转移性结节皮下转移性结节4 Subcutaneouly metastatic nodus5 颈部或锁
13、骨上淋巴结转移颈部或锁骨上淋巴结转移5 Cervical or supraclavicular lymph node metastasis38肺癌作用于其他系统引起的肺外表现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 异位内分泌综合征异位内分泌综合征1 Ectopic endocrine syndrome,EES（1）抗利尿激素分泌异常综合征抗利尿激素分泌异常综合征（1）Syndrome of inapprpriate antidiuretic hormone(
14、SIADH)secretion（2）异位异位ACTH综合征综合征（2）Ectopic ACTH syndrome（3）神经肌肉综合征神经肌肉综合征（3）Neuromyopathic syndrome（4）高钙血症高钙血症（4）Hypercalcinemia（5）其他：类癌综合征其他：类癌综合征（5）Others:Carcinoid syndrome392 其他肺外表现其他肺外表现2 Other manifestation out of lung（1）多发性周围神经炎）多发性周围神经炎（1）Multiple peripheral neuritis（2）肌无力样综合征）肌无力样综合征（2）Eato
15、n-Lambert syndrome40（3）肥大性肺性骨关节病）肥大性肺性骨关节病（3）Hypertrophic pulmonary osteoarthropathy,HPO病人病人正常人正常人41实验室和辅助检查实验室和辅助检查Laboratory and auxiliary examination42胸部胸部X线检查线检查 Chest radiograph1 中央型肺癌中央型肺癌1 Central lung cancer43442 周围型肺癌周围型肺癌2 Peripheral lung cancer45464748电子计算机体层扫描电子计算机体层扫描CT49Posterior basal
16、 segment of left lower lobe,AC 50左上叶肺癌并左上叶不张Left upper lobe cancer combining atelectasis51Left lower lobe cancer combining obstructive pneumonia5253磁共振磁共振MRI5455痰脱落细胞学检查痰脱落细胞学检查Sputum exfoliative cytology testSCCACSCLC56纤维支气管镜检查纤维支气管镜检查Bronchofiberscopy575859SCCSCLCACLCC60核素闪烁显像核素闪烁显像Nuclide scintig
17、raphy 1 骨骨闪烁显像闪烁显像 1 Bone scintigraphy 2 正电子发射断层显像正电子发射断层显像 2 Positron emission tomography(PET)6162病理学检查病理学检查Pathology癌标志物的检测癌标志物的检测Cancer mark test基因诊断基因诊断Gene diagnosis手术探查手术探查Operations research63诊断和鉴别诊断诊断和鉴别诊断Diagnosis and differential diagnosis64诊断诊断Diagnosis早期诊断早期诊断Early diagnosis症状症状Symptom体征
18、体征Physical sign检查检查Examination65鉴别诊断鉴别诊断Differential diagnosis1 肺结核肺结核1 Pulmonary tuberculosis66TuberculosisLung cancer67肺真菌病肺真菌病Pulmonary mycosis682 肺炎肺炎2 Pneumonia 抗菌药物治疗有效，病灶吸收快而完全抗菌药物治疗有效，病灶吸收快而完全Usually,antibacterial drug therapy is effective,and focus is absorbed quickly and completely.693 肺脓肿
19、肺脓肿3 Lung abscess704 结核性渗出性胸膜炎结核性渗出性胸膜炎4 Tuberculous exudative pleurisy71临床分期临床分期Clinical stageIA:T1N0 IB:T2 N0 IIA:T1 N1IIB:T2 N1,T3 N0IIIA:T3 N1,and T1-3 N2IIIB:any T4,any N3IV:any metastases72治治 疗疗Treatment73手术治疗手术治疗Operation treatment1 NSCLC2 SCLC74化学药物治疗化学药物治疗Chemotherapy1 SCLC2 NSCLC75放射治疗放射治疗
20、Radiotherapy根治性根治性Radical cure姑息性姑息性Palliative cure76介入性治疗介入性治疗Interventional therapy1 支气管动脉灌注支气管动脉灌注1 Bronchial artery infusion,BAI2 经纤支镜经纤支镜2 Through bronchofiberscopy77生物反应调节剂和生物靶向治疗生物反应调节剂和生物靶向治疗Biological response modifiers(BRM)and biological targeted therapy中医药中医药Chinese medicine78预后和预防预后和预防Pr
21、ognosis and prevention79预后预后PrognosisThe 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预防预防Prevention1 戒烟戒烟1 Stop smoking2 加强劳动保护加强劳动保护2 Enhance labor protection3 早期发现早期发现3 Early discovery4 化学预防化学预防4 Chemical prophylaxis81Thanks!
免费区 
