1、lung cancerWhat is Lung Cancer?Begins when cells in the lung grow out of control and form a tumorEtiology and pathogenesisCigarette smokingOther factors include air pollutions Nowadays It is reported that tuberculosis is associated with the incidence of lung cancer ClassificationsAccording to anatom
2、y:(1)Central lung (2)peripheral lung cancerAccording to histologic classification:Small cell lung cancer(SCLC)and Non-small cell lung cancer(NSCLC).NSCLC includes Squamous cell carcinoma,large cell carcinoma,adenocarcinoma,adenosquamous carcinoma.Small cell lung cancer(SCLC)Oat-cell carcinoma SCLC g
3、rows very rapidly and is very aggressive.Soon after the original cell becomes cancerous,it quickly multiplies to form a tumor.These cells swiftly spread to distant sites in the bodySCLC belongs in a group of tumors derived from neuroendocrine cells that are responsible for the production and secreti
4、on of specific peptide product.they may related to paraneoplastic syndrome.Cells are oval or vaguely spindle-shaped,have scant cytoplasm Squamous cell carcinomathe most frequent form of the tumor(30-50 percent of all casesbronchial epithelium and growth in situIt is related to cigarette smokingCavit
5、ation can occure in the distal to the obstructing massCentral locationIntercellular bridges and cellular pleomorphismsquamous cell carcinoma usually occurs near the bronchi,the tumor can cause cough(sometimes a cough that is tinged with blood),shortness of breath,wheezing,and pneumonia in the area b
6、etween the tumor and the edge of the lungit causes symptoms early in the disease adenocarcinomaareas of scarring is associated with the occurrence of adenocarcinoma.Peripheral adenocarcinomas are usually well-circumscribed,grey-white masses that rarely cavitate.It arises from the submucosal glands,l
7、ocated in peripheral airways and alveoliFemale large cell carcinomalarge nuclei,prominent nucleoli,abundant cytoplsmausually located peripherallycan be quite large and not infrequently cavitatethe Symptoms of Lung CancerF Fa at ti ig gu ue e (t ti ir re ed dn ne es ss s)C Co ou ug gh h S Sh ho or rt
8、 tn ne es ss s o of f b br re ea at th h C Ch he es st t p pa ai in n L Lo os ss s o of f a ap pp pe et ti it te e C Co ou ug gh hi in ng g u up p p ph hl le eg gmm H He emmo op pt ty ys si is s (c co ou ug gh hi in ng g u up p b bl lo oo od d)I If f c ca an nc ce er r h ha as s s sp pr re ea ad d,s
9、 sy ymmp pt to omms s i in nc cl lu ud de e b bo on ne e p pa ai in n,d di if ff fi ic cu ul lt ty y b br re ea at th hi in ng g,a ab bd do ommi in na al l p pa ai in n,h he ea ad da ac ch he e,w we ea ak kn ne es ss s,a an nd d c co on nf fu us si io on nDue to primary lesions:cough,dyspnea,hemopty
10、sis,sputum,wheezing,weight loss,fever,pneumoniaDue to local extension:chest pain,hoarseness,superior vena cava syndrome,horners syndrome,dysphagia,pericardial effusion,pleural effusion,diaphragm paralysisOnly 5-15 percent of patients are asymptomatic when discovered to have bronchogenic carcinoma.Re
11、gionnal spread to hilar and mediastinal nodes may cause dysphagia due to esophageal compression horseness due to recurrent laryngeal nerve compression horners syndrome due to sympathetic nerve involvement elevation of the hemidiaphragm from phrenic nerve compression.Superior sulcus,or pancoasts tumo
12、r may involve the brachial plexus,resulting in a c7-t2 neuropathy with pain,numbness,and weakness of the arm.Cardiac involvement is seen in About 20-25 percent of patients Extrapulmonary manifestations.Including metastasis to other organs,such as brain,central nervous system,skeleton system,liver,ad
13、renal glands and lymph nodes ects.Paraneoplastic syndromes are remote effects of tumor.They lead to metabolic and neuromuscular disturbances unrelated to the primary tumor,metastases,or treatment.They may be the first sign of the tumor.They do not indicate that a tumor has spread.Physical examinatio
14、nsUsually in early stage,most of the patients with lung cancer have no positive physical findings.General findings include abnormal percussion,breath sounds changes,moist rales(when pneumonia happens)Digital clubbing,superior vena cava syndrome,horners syndrome(unilaterally constricted pupil,enophth
15、almos,narrowed palpebral fissure and loss of sweating on the same side of the face.Physical examinationsEndobronchial obstruction may result in a localized wheezeLobar collapse may result in an area of decreased breath sounds and dullness to percussion.How is Lung Cancer Evaluated?B Be ec ca au us s
16、e e a al lmmo os st t a al ll l p pa at ti ie en nt ts s w wi il ll l h ha av ve e a a t tu ummo or r i in n t th he e l lu un ng g,a a c ch he es st t x x-r ra ay y o or r C CT T s sc ca an n o of f t th he e c ch he es st t i is s p pe er rf fo or rmme ed d T Th he e d di ia ag gn no os si is s mm
17、u us st t b be e c co on nf fi ir rmme ed d w wi it th h a a b bi io op ps sy y T Th he e l lo oc ca at ti io on n(s s)o of f a al ll l s si it te es s o of f c ca an nc ce er r i is s d de et te er rmmi in ne ed d b by y a ad dd di it ti io on na al l C CT T s sc ca an ns s,P PE ET T (p po os si it
18、 tr ro on n e emmi is ss si io on n t to ommo og gr ra ap ph hy y)s sc ca an ns s,a an nd d MMR RI I (mma ag gn ne et ti ic c r re es so on na an nc ce e i imma ag gi in ng g)I It t i is s i immp po or rt ta an nt t t to o f fi in nd d o ou ut t i if f c ca an nc ce er r s st ta ar rt te ed d i in n
19、 t th he e l lu un ng g o or r s so omme ew wh he er re e e el ls se e i in n t th he e b bo od dy y.C Ca an nc ce er r a ar ri is si in ng g i in n o ot th he er r p pa ar rt ts s o of f t th he e b bo od dy y c ca an n s sp pr re ea ad d t to o t th he e l lu un ng g a as s w we el ll l Chest X-ra
20、y It is the most important method to find lung cancerThe most frequent finding is a mass in the lung fieldOn chest X-ray,secondary manifestations include lobar collapse,pleural effusion,pneumonitis,elevation of the hemidiaphragm,hilar and mediastinal adenopathy,and erosion of ribs or vertebrae due t
21、o metastases.Obstructive atelectasisLung cancer on CT CT is the most useful in evaluating patients with pulmonary and mediastinal masses.It is also useful for detecting multiple metastases.CT can show a mass to be located in which lobe of lung field and the size of the mass.It also shows the nodule
22、in the mediastinum.Sometimes,when a mass locate behind the heart,chest X-ray cant detect it.CT can detect some secret sites of lung cancer.BronchoscopyRigid and flexible scopeBiopsy and selective washingsLarger samples than flexible scopeExact locationLobectomyPneumonectomyUnresectableSleeveTranstho
23、racic lung biopsy It may be utilized when tumor located in peripheral airway.Transthoracic needle with guidance by CT can be used to detect lesions located near the chest wall Video Assisted Thoracic SurgeryDiagnosis of pleural diseaseWedge resection Mediasteinoscopy&MediasteinotomyDiagnoses unresec
24、table diseaseEliminate N2 disease from surgical resectionThoracotomyIf the methods mentioned above are not useful for detecting the cell type of lung cancer,thoracotomy may be usedStaging of lung cancerStaging is a way of describing a cancer,such as the size Staging is a way of describing a cancer,s
25、uch as the size of the tumor and where it has spread of the tumor and where it has spread Staging is the most important tool doctors have to Staging is the most important tool doctors have to determine a patients prognosisdetermine a patients prognosis The type of treatment a person receives depends
26、 on the The type of treatment a person receives depends on the stage of the cancerstage of the cancerStaging is different for non-small cell lung cancer and Staging is different for non-small cell lung cancer and small cell lung cancersmall cell lung cancer Stage I Non-Small Cell Lung CancerCancer i
27、s found only Cancer is found only in the lung in the lung Surgical removal Surgical removal recommendedrecommendedRadiation therapy Radiation therapy and/or chemotherapy and/or chemotherapy may also be usedmay also be usedStage II Non-Small Cell Lung CancerThe cancer has spread to The cancer has spr
28、ead to lymph nodes in the lung lymph nodes in the lung Treatment is surgery to Treatment is surgery to remove the tumor and nearby remove the tumor and nearby lymph nodeslymph nodesChemotherapy Chemotherapy recommended;radiation recommended;radiation therapy sometimes given therapy sometimes given a
29、fter chemotherapyafter chemotherapy Stage III Non-Small Cell Lung Cancer The cancer has spread to the lymph The cancer has spread to the lymph nodes located in the center of the nodes located in the center of the chest,outside the lung chest,outside the lung Stage IIIA cancer has spread to lymph Sta
30、ge IIIA cancer has spread to lymph nodes in the chest,on the same side nodes in the chest,on the same side where the cancer originatedwhere the cancer originated Stage IIIB cancer has spread to lymph Stage IIIB cancer has spread to lymph nodes on the opposite side of the nodes on the opposite side o
31、f the chest,under the collarbone,or the chest,under the collarbone,or the pleura(lining of the chest cavity)pleura(lining of the chest cavity)Surgery or radiation therapy with Surgery or radiation therapy with chemotherapy recommended for stage chemotherapy recommended for stage IIIA IIIA Chemothera
32、py and sometimes Chemotherapy and sometimes radiation therapy recommended for radiation therapy recommended for stage IIIBstage IIIB Stage IV Non-Small Cell Lung Cancer The cancer has spread to The cancer has spread to different lobes of the lung different lobes of the lung or to other organs,such a
33、s or to other organs,such as the brain,bones,and liverthe brain,bones,and liver Stage IV non-small cell Stage IV non-small cell lung cancer is treated with lung cancer is treated with chemotherapychemotherapySmall cell lung cancer has often metastasized at the time of diagnosis.TNM staging is not su
34、ited to small cell lung cancer.TreatmentIncluding:A:Surgery B:Chemotherapy C:Radiation therapy D:Some other therapy immunologic therapy,Chinese traditional therapySurgeryNon-small cell lung cancer:patients with stage I and II are considered candidates for surgical resection,with stage III cancer may
35、 be candidates for surgery with postoperative radiation of the mediastinum.SurgeryWe must measure pulmonary function before surgical therapy.Forced vital capacity greater than 2 liters and a forced expiratory volume in the first second(FEV1)of greater than 50 percent of the forced vital capacity pre
36、dict that a patient can tolerate the consequences of pneumonectomy.ChemotherapyNon-small cell lung cancerMVP:MMC 6-8mg/m2(1),VDS 3mg/m2NP:VP-16(d1,d8).DDP 100mg/m2(d1)GP Small-cell lung cancer it is highly responsive to chemotherapy.EP regimen VP-16 100mg/m2 d1d3.DDP 100mg/m2 d1.GPChemotherapyAggres
37、sive chemotherapy produces complications and symptoms in all patients.All experience anemia,leukepenia and opportunistic infection other complications include nausea,vomiting possible cadiotoxicity,hemorrhagic cystitis and peripheral neuropathy.Radiation therapyIt is of proven benefit in controlling bone pain,spinal cord compression,superior vena cava syndrome and bronchial obstruction.
