原发性支气管肺癌中英文对照课件

原发性支气管肺癌

Primarybronchogeniccarcinoma呼吸内科RespiratoryDepartment熊维宁Xiong,Weining1精选课件定义

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。Primarybronchogeniccarcinomaisabbreviatedtolungcancer,itderivesfrombronchimucosaorgland.2精选课件EpidemiologyLungCancerWorldwide:mostcommoncancer2,000,000casesperyearChina:firstleadingcauseofcancerdeathinurbanarea<15%5-yearsurvival3精选课件病因和发病机制

Etiologyandpathogenesis1吸烟1Smoking4精选课件LungCancer:SmokingFactsTobaccouseistheleadingcauseoflungcancer87%oflungcancersarerelatedtosmokingRiskrelatedto:AmountsmokedAgeofsmokingonsetProductsmoked(tar/nicotinecontent,filters)DepthofinhalationGenderRiskgoesdownafter>5yrscessationAt15years,80-90%riskreductionNevergetsto“neversmoker”risk5精选课件20YearLag6精选课件

Ifwhathappenedonyourinsidehappenedonyouroutside,wouldyoustillsmoke?7精选课件2职业致癌因子2Occupationcarcinogenicfactor:Asbestos,Radon3空气污染3Airpollution（1）室外大环境污染（1）Outdoorenvironmentpollution（2）室内小环境污染（2）Indoorenvironmentpollution4电离辐射4Ionizingradiation8精选课件5饮食与营养5DietandnutritionVITAMINA???????????????????9精选课件6其他因素6Otherfactors

7遗传因素7HereditaryfactorTumorsuppressorgenes *p53Dominantoncogenes *Kras *Her-2/neu10精选课件病理和分类

Pathologyandclassification11精选课件解剖学分类

Anatomyclassification1中央型肺癌1Centrallungcancer12精选课件2周围型肺癌2Peripherallungcancer13精选课件组织学分类

Histologyclassification1小细胞肺癌1Smallcelllungcancer,SCLC（1）燕麦细胞型（1）oatcelltype（2）中间细胞型（2）intermediatecelltype（3）混合型（3）mixedtype14精选课件SmallcellcarcinomaRareinnon-smokersLargehilarmass70%presentwithovertmetastasisVerychemo-responsive…Worstprognosis15精选课件Smallcellcarcinoma16精选课件2非小细胞肺癌2Non-smallcelllungcancer,NSCLC（1）鳞状细胞癌（鳞癌）（1）Squamouscellcarcinoma,SCC（2）腺癌和支气管肺泡癌（2）Adenocarcinoma，AC，andbronchoalveolarcarcinoma（3）大细胞癌（3）Largecellcarcinoma（4）鳞腺癌（4）Adeno-squamouscarcinoma17精选课件SquamouscellcarcinomaNow2ndmostcommon(1stinChina)Stronglylinkedwithsmoking60-80%intheproximalairways(centraltype)CavitationTendencytospreadlocally/regionallyPrognosisslightlybetterthanAdenocarcinoma18精选课件SquamousCellCarcinoma19精选课件SquamousCellCarcinoma20精选课件鳞癌21精选课件LungCancerPathologyAdenocarcinomaMostcommonpathology(2ndinChina)“Non-smoker’slungcancer”WomenPeripheral(75%)Aggressivemetastases22精选课件AdenocarcicomaLeftLowerLobe23精选课件Adenocarcinoma24精选课件Adenocarcinoma25精选课件BronchoalveolarCellCarcinomaBACAerogenousandlymphaticspreadLeastassociatedwithcigarettesmokingUsuallyperipheralLocalized,multi-nodularordiffuseSlowmetabolismPrognosisLocalizedvs.other26精选课件支气管肺泡癌27精选课件LargecellcarcinomaLargeperipheralmasswithnecrosisMalignantepithelialneoplasmPoorly-differentiatedAggressivemets“It’sacancer…it’snotsmallcell…but…”28精选课件Largecellcarcinoma29精选课件Largecellcarcinoma30精选课件10100d25～30187d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20～2533d30～35100d大细胞癌腺癌小细胞癌鳞癌31精选课件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疗敏感32精选课件临床表现

Clinicalmanifestation33精选课件原发肿瘤引起的症状和体征

Symptomsandphysicalsignsduetoprimarytumor1咳嗽1Cough2咯血2Hemoptysis3喘鸣3Wheeze4气急4Breathlessness5发热5Fever6其他6Others34精选课件肿瘤局部扩展引起的症状和体征

Symptomsandphysicalsignsduetotumorlocalexpanding1胸痛1Chestpain2呼吸困难2Dyspnea3吞咽困难3Dysphagia:esophagealcompression4声音嘶哑4Hoarsevoice:laryngealnerveparalysis5上腔静脉阻塞综合征5Superiorvenacavaobstructionsyndrome6Horner综合征，肺上沟瘤6Horner’ssyndrome,Pancoast’stumor:Cervical/thoracicnerveinvasion7臂丛神经压迫征7Brachialplexuscompressionsyndrome35精选课件肿瘤远处转移引起的症状和体征

Symptomsandphysicalsignsduetotumordistantmetastasis1脑、中枢神经系统转移1Metastasizetobrain,centralnervoussystem36精选课件2肝转移2Metastasizetoliver3骨转移3Metastasizetobone4皮下转移性结节4Subcutaneoulymetastaticnodus5颈部或锁骨上淋巴结转移5Cervicalorsupraclavicularlymphnodemetastasis37精选课件肺癌作用于其他系统引起的肺外表现Manifestationoutoflungduetoothersystemsaffectedbylungcancer1异位内分泌综合征1Ectopicendocrinesyndrome,EES（1）抗利尿激素分泌异常综合征（1）Syndromeofinapprpriateantidiuretichormone(SIADH)secretion（2）异位ACTH综合征（2）EctopicACTHsyndrome（3）神经肌肉综合征（3）Neuromyopathicsyndrome（4）高钙血症（4）Hypercalcinemia（5）其他：类癌综合征（5）Others:Carcinoidsyndrome38精选课件2其他肺外表现2Othermanifestationoutoflung（1）多发性周围神经炎（1）Multipleperipheralneuritis（2）肌无力样综合征（2）Eaton-Lambertsyndrome39精选课件（3）肥大性肺性骨关节病（3）Hypertrophicpulmonaryosteoarthropathy,HPO病人正常人40精选课件实验室和辅助检查Laboratoryandauxiliaryexamination41精选课件胸部X线检查

Chestradiograph1中央型肺癌1Centrallungcancer42精选课件43精选课件2周围型肺癌2Peripherallungcancer44精选课件45精选课件46精选课件47精选课件电子计算机体层扫描

CT48精选课件Posteriorbasalsegmentofleftlowerlobe,AC49精选课件左上叶肺癌并左上叶不张Leftupperlobecancercombiningatelectasis50精选课件Leftlowerlobecancercombiningobstructivepneumonia51精选课件52精选课件磁共振

MRI53精选课件54精选课件痰脱落细胞学检查

SputumexfoliativecytologytestSCCACSCLC55精选课件纤维支气管镜检查

Bronchofiberscopy56精选课件57精选课件58精选课件SCCSCLCACLCC59精选课件核素闪烁显像Nuclidescintigraphy1骨γ闪烁显像

1Boneγscintigraphy2正电子发射断层显像

2Positronemissiontomography(PET)60精选课件61精选课件病理学检查Pathology癌标志物的检测Cancermarktest基因诊断Genediagnosis手术探查Operationsresearch62精选课件诊断和鉴别诊断

Diagnosisanddifferentialdiagnosis63精选课件诊断

Diagnosis早期诊断Earlydiagnosis症状Symptom体征Physicalsign检查Examination64精选课件鉴别诊断

Differentialdiagnosis1肺结核1Pulmonarytuberculosis65精选课件TuberculosisLungcancer66精选课件肺真菌病Pulmonarymycosis67精选课件2肺炎2Pneumonia

抗菌药物治疗有效，病灶吸收快而完全Usually,antibacterialdrugtherapyiseffective,andfocusisabsorbedquicklyandcompletely.68精选课件3肺脓肿3Lungabscess69精选课件4结核性渗出性胸膜炎4Tuberculousexudativepleurisy70精选课件临床分期

ClinicalstageIA:T1N0IB:T2N0IIA:T1N1IIB:T2N1,T3N0IIIA:T3N1,andT1-3N2IIIB:anyT4,anyN3IV:anymetastases71精选课件治疗

Treatment72精选课件手术治疗

Operationtreatment1NSCLC2SCLC73精选课件化学药物治疗

Chemotherapy1SCLC2NSCLC74精选课件放射治疗

Radiotherapy根治性Radicalcure姑息性Palliativecure75精选课件介入性治疗

Interventionalther