講課肺癌英文-課件

講課肺癌英文講課肺癌英文1WhatisLungCancer?Beginswhencellsinthelunggrowoutofcontrolandformatumor2WhatisLungCancer?BeginswheEtiologyandpathogenesisCigarettesmokingOtherfactorsincludeairpollutionsNowadaysItisreportedthattuberculosisisassociatedwiththeincidenceoflungcancer

3EtiologyandpathogenesisCigarClassificationsAccordingtoanatomy:(1)Centrallung(2)peripherallungcancer4ClassificationsAccordingtoan55Accordingtohistologicclassification:Smallcelllungcancer(SCLC)andNon-smallcelllungcancer(NSCLC).NSCLCincludesSquamouscellcarcinoma,largecellcarcinoma,adenocarcinoma,adenosquamouscarcinoma.6AccordingtohistologicclassiSmallcelllungcancer(SCLC)

Oat-cellcarcinoma

SCLCgrowsveryrapidlyandisveryaggressive.Soonaftertheoriginalcellbecomescancerous,itquicklymultipliestoformatumor.ThesecellsswiftlyspreadtodistantsitesinthebodySCLCbelongsinagroupoftumorsderivedfromneuroendocrinecellsthatareresponsiblefortheproductionandsecretionofspecificpeptideproduct.theymayrelatedtoparaneoplasticsyndrome.7Smallcelllungcancer(SCLC)

OCellsareovalorvaguelyspindle-shaped,havescantcytoplasm8Cellsareovalorvaguelyspin大家學(xué)習(xí)辛苦了，還是要堅(jiān)持繼續(xù)保持安靜9大家學(xué)習(xí)辛苦了，還是要堅(jiān)持繼續(xù)保持安靜91010

Squamouscellcarcinomathemostfrequentformofthetumor(30-50percentofallcasesbronchialepitheliumandgrowthinsituItisrelatedtocigarettesmokingCavitationcanoccureinthedistaltotheobstructingmassCentrallocation11SquamouscellcarcinomathemIntercellularbridgesandcellularpleomorphism12Intercellularbridgesandcell1313squamouscellcarcinomausuallyoccursnearthebronchi,thetumorcancausecough(sometimesacoughthatistingedwithblood),shortnessofbreath,wheezing,andpneumoniaintheareabetweenthetumorandtheedgeofthelungitcausessymptomsearlyinthedisease

14squamouscellcarcinomausualladenocarcinomaareasofscarringisassociatedwiththeoccurrenceofadenocarcinoma.Peripheraladenocarcinomasareusuallywell-circumscribed,grey-whitemassesthatrarelycavitate.Itarisesfromthesubmucosalglands,locatedinperipheralairwaysandalveoliFemale15adenocarcinomaareasofscarrin16161717largecellcarcinoma18largecellcarcinoma18largenuclei,prominentnucleoli,abundantcytoplsma19largenuclei,prominentnucleolusuallylocatedperipherallycanbequitelargeandnotinfrequentlycavitate20usuallylocatedperipherally20theSymptomsofLungCancerFatigue(tiredness)CoughShortnessofbreathChestpainLossofappetiteCoughingupphlegmHemoptysis(coughingupblood)Ifcancerhasspread,symptomsincludebonepain,difficultybreathing,abdominalpain,headache,weakness,andconfusion21theSymptomsofLungCancerFatDuetoprimarylesions:cough,dyspnea,hemoptysis,sputum,wheezing,weightloss,fever,pneumoniaDuetolocalextension:chestpain,hoarseness,superiorvenacavasyndrome,horner’ssyndrome,dysphagia,pericardialeffusion,pleuraleffusion,diaphragmparalysisOnly5-15percentofpatientsareasymptomaticwhendiscoveredtohavebronchogeniccarcinoma.22Duetoprimarylesions:22Regionnalspreadtohilarandmediastinalnodesmaycausedysphagiaduetoesophagealcompressionhorsenessduetorecurrentlaryngealnervecompressionhorner’ssyndromeduetosympatheticnerveinvolvementelevationofthehemidiaphragmfromphrenicnervecompression.23RegionnalspreadtohilarandSuperiorsulcus,orpancoast’stumormayinvolvethebrachialplexus,resultinginac7-t2neuropathywithpain,numbness,andweaknessofthearm.CardiacinvolvementisseeninAbout20-25percentofpatients

24Superiorsulcus,orpancoastExtrapulmonarymanifestations.Includingmetastasistootherorgans,suchasbrain,centralnervoussystem,skeletonsystem,liver,adrenalglandsandlymphnodesects.Paraneoplasticsyndromesareremoteeffectsoftumor.Theyleadtometabolicandneuromusculardisturbancesunrelatedtotheprimarytumor,metastases,ortreatment.Theymaybethefirstsignofthetumor.Theydonotindicatethatatumorhasspread.25Extrapulmonarymanifestations.PhysicalexaminationsUsuallyinearlystage,mostofthepatientswithlungcancerhavenopositivephysicalfindings.Generalfindingsincludeabnormalpercussion,breathsoundschanges,moistrales(whenpneumoniahappens)Digitalclubbing,superiorvenacavasyndrome,horner’ssyndrome(unilaterallyconstrictedpupil,enophthalmos,narrowedpalpebralfissureandlossofsweatingonthesamesideoftheface.26PhysicalexaminationsUsuallyiPhysicalexaminationsEndobronchialobstructionmayresultinalocalizedwheezeLobarcollapsemayresultinanareaofdecreasedbreathsoundsanddullnesstopercussion.27PhysicalexaminationsEndobroncHowisLungCancerEvaluated?Becausealmostallpatientswillhaveatumorinthelung,achestx-rayorCTscanofthechestisperformedThediagnosismustbeconfirmedwithabiopsyThelocation(s)ofallsitesofcancerisdeterminedbyadditionalCTscans,PET(positronemissiontomography)scans,andMRI(magneticresonanceimaging)Itisimportanttofindoutifcancerstartedinthelungorsomewhereelseinthebody.Cancerarisinginotherpartsofthebodycanspreadtothelungaswell28HowisLungCancerEvaluated?BChestX-ray

ItisthemostimportantmethodtofindlungcancerThemostfrequentfindingisamassinthelungfield29ChestX-rayItisthemostimp30303131OnchestX-ray,secondarymanifestationsincludelobarcollapse,pleuraleffusion,pneumonitis,elevationofthehemidiaphragm,hilarandmediastinaladenopathy,anderosionofribsorvertebraeduetometastases.32OnchestX-ray,secondarymani33333434Obstructiveatelectasis35Obstructiveatelectasis35LungcanceronCT

CTisthemostusefulinevaluatingpatientswithpulmonaryandmediastinalmasses.Itisalsousefulfordetectingmultiplemetastases.CTcanshowamasstobelocatedinwhichlobeoflungfieldandthesizeofthemass.Italsoshowsthenoduleinthemediastinum.Sometimes,whenamasslocatebehindtheheart,chestX-raycan`tdetectit.CTcandetectsomesecretsitesoflungcancer.

36LungcanceronCTCTisthemo3737Bronchoscopy38Bronchoscopy38RigidandflexiblescopeBiopsyandselectivewashingsLargersamplesthanflexiblescopeExactlocationLobectomyPneumonectomyUnresectableSleeve39Rigidandflexiblescope394040TransthoraciclungbiopsyItmaybeutilizedwhentumorlocatedinperipheralairway.TransthoracicneedlewithguidancebyCTcanbeusedtodetectlesionslocatednearthechestwall41TransthoraciclungbiopsyIt4242VideoAssistedThoracicSurgeryDiagnosisofpleuraldiseaseWedgeresection43VideoAssistedThoracicSurger4444Mediasteinoscopy&Mediasteinotomy45Mediasteinoscopy&Mediasteino4646DiagnosesunresectablediseaseEliminateN2diseasefromsurgicalresection47DiagnosesunresectablediseaseThoracotomyIfthemethodsmentionedabovearenotusefulfordetectingthecelltypeoflungcancer,thoracotomymaybeused48ThoracotomyIfthemethodsmentStagingoflungcancerStagingisawayofdescribingacancer,suchasthesizeofthetumorandwhereithasspreadStagingisthemostimportanttooldoctorshavetodetermineapatient’sprognosis

ThetypeoftreatmentapersonreceivesdependsonthestageofthecancerStagingisdifferentfornon-smallcelllungcancerandsmallcelllungcancer

49StagingoflungcancerStagingStageINon-SmallCellLungCancerCancerisfoundonlyinthelungSurgicalremovalrecommendedRadiationtherapyand/orchemotherapymayalsobeused50StageINon-SmallCellLungCaStageIINon-SmallCellLungCancerThecancerhasspreadtolymphnodesinthelungTreatmentissurgerytoremovethetumorandnearbylymphnodesChemotherapyrecommended;radiationtherapysometimesgivenafterchemotherapy

51StageIINon-SmallCellLungCStageIIINon-SmallCellLungCancerThecancerhasspreadtothelymphnodeslocatedinthecenterofthechest,outsidethelungStageIIIAcancerhasspreadtolymphnodesinthechest,onthesamesidewherethecanceroriginatedStageIIIBcancerhasspreadtolymphnodesontheoppositesideofthechest,underthecollarbone,orthepleura(liningofthechestcavity)SurgeryorradiationtherapywithchemotherapyrecommendedforstageIIIAChemotherapyandsometimesradiationtherapyrecommendedforstageIIIB

52StageIIINon-SmallCellLungStageIVNon-SmallCellLungCancerThecancerhasspreadtodifferentlobesofthelungortootherorgans,suchasthebrain,bones,andliverStageIVnon-smallcelllungcanceristreatedwithchemotherapy53StageIVNon-SmallCellLungCSmallcelllungcancerhasoftenmetastasizedatthetimeofdiagnosis.TNMstagingisnotsuitedtosmallcelllungcancer.54SmallcelllungcancerhasoftTreatmentIncluding:A:SurgeryB:ChemotherapyC:RadiationtherapyD:Someothertherapyimmunologictherapy,Chinesetraditionaltherapy55TreatmentIncluding:55SurgeryNon-smallcelllungcancer:patientswithstageIandIIareconsideredcandidatesforsurgicalresection,withstageIIIcancermaybecandidatesforsurgerywithpostoperativeradiationofthemediastinum.56SurgeryNon-smallcelllungcan5757SurgeryWemustmeasure