小細(xì)胞肺癌診療治療進(jìn)展專(zhuān)家講座

SmallCellLungCancer(SCLC):

Diagnosis,TreatmentandNaturalHistoryGaryL.WeinsteinM.D.小細(xì)胞肺癌診療治療進(jìn)展第1頁(yè)SCLCLungcancerepidemiologySCLCPathologyTumormarkersGeneticsClinicalcourseStagingTreatment小細(xì)胞肺癌診療治療進(jìn)展第2頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第3頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第4頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第5頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第6頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第7頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第8頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第9頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第10頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第11頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第12頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第13頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第14頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第15頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第16頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第17頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第18頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第19頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第20頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第21頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第22頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第23頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第24頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第25頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第26頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第27頁(yè)SCLC,factoids15–25%ofalllungcancersAlmostexclusivelyinsmokersDistinguishedfromNSCLCby:RapiddoublingtimeHighgrowthfractionEarlydevelopmentofwide-spreadmets小細(xì)胞肺癌診療治療進(jìn)展第28頁(yè)SCLC,factoids(cont’d)Consideredhighlyresponsiveto“chemsandbeams”BUT…usuallyrelapseswithin2yearsdespitetreatmentOverall,only3–8%ofallpatientssurvivemorethan5yearsMostcommonmalignancyassociatedwithNeurologicparaneoplasticsyndromes小細(xì)胞肺癌診療治療進(jìn)展第29頁(yè)SCLC,pathologyMostrecent(1999)WHOclassificationClassicalsmallcellcarcinomaLargecellneuroendocrinecancerCombinedsmallcellcarcinomawithsomeNSCLCCellsareapprox.2X’sthesizeofnormallymphocytes小細(xì)胞肺癌診療治療進(jìn)展第30頁(yè)SCLC,pathology

小細(xì)胞肺癌診療治療進(jìn)展第31頁(yè)SCLC,pathology

小細(xì)胞肺癌診療治療進(jìn)展第32頁(yè)SCLC,clinicalpresentationTypicallyarisecentrallyMostcommonpresentationisalargehilarmasswithbulkymediastinalLANCommonsymptomscough,SOB,wtlossApprox.70%withovertmetsatpresentationCommonlyspreadtoliver,adrenals,boneandbrainCanpresentwithparaneoplasticsyndome小細(xì)胞肺癌診療治療進(jìn)展第33頁(yè)SCLC,tumormarkers3maingroups:Neural,Epithelial,NeuroendocrineEpithelial:virtuallyallSCLCsareimmunoreactiveforKeratinandEpithelialMembraneAntigen1ormoremarkersofNeural/Neuroendocrinedifferentiationfoundinapprox.75%ofSCLCs小細(xì)胞肺癌診療治療進(jìn)展第34頁(yè)SCLC,tumormarkersLeadstoexpressionofdopadecarboxylase,calcitonin,neuron-specificenolase,chromograninA,CD-56(aneuralcelladhesionmolecule)gastrinreleasingpeptideandinsulin-likegrowthhormoneOccasionallypatientsproduceantibodiesthatcross-reactwithboththeSCLCcellsandtheCNScerebellardegenerationsyndromesSCLCcellscanproduceanumberofpolypeptidehormonesincludingACTHandVasopressin

小細(xì)胞肺癌診療治療進(jìn)展第35頁(yè)NeurologicParaneoplasticSyndromes

小細(xì)胞肺癌診療治療進(jìn)展第36頁(yè)Lungcancer,ParaneoplasticSyndromes

小細(xì)胞肺癌診療治療進(jìn)展第37頁(yè)SCLC,geneticsDevelopmentoflungcancersoccurthroughstimulationofproliferationandmutagenesis,occurringoverYEARSandresultingfromexposuretotobaccoandothercarcinogens小細(xì)胞肺癌診療治療進(jìn)展第38頁(yè)SCLC,geneticsThemostcommongeneticsofSCLCare:P53mutationispresentin75-90%Lossofheterozygosityofc-somes9pand10qinthemajorityDeletionof3pinactivationofasmanyas3tumorsuppressorgenesLossoftheretinoblastomagenefunctionisnearlyubiquitousActivationoftelomeraseinapprox.90%(allowscellstodivideforever)小細(xì)胞肺癌診療治療進(jìn)展第39頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第40頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第41頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第42頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第43頁(yè)小細(xì)胞肺癌診療治療進(jìn)展第44頁(yè)小細(xì)胞肺癌診療治療進(jìn)