原發(fā)性支氣管肺癌中英文對照課件

1、.1原發(fā)性支氣管肺癌原發(fā)性支氣管肺癌 Primary bronchogenic carcinoma呼吸內(nèi)科呼吸內(nèi)科Respiratory Department熊維寧熊維寧Xiong, Weining.2定義定義Definition 原發(fā)性支氣管肺癌簡稱肺癌，是起源于原發(fā)性支氣管肺癌簡稱肺癌，是起源于支氣管粘膜或腺體的腫瘤。支氣管粘膜或腺體的腫瘤。 Primary bronchogenic carcinoma is abbreviated to lung cancer, it derives from bronchi mucosa or gland.3Epidemiology Lung Canc

2、er Worldwide: most common cancer 2,000,000 cases per year China : first leading cause of cancer death in urban area 5 yrs cessation At 15 years, 80-90% risk reduction Never gets to “never smoker” risk.620 Year Lag.7 If what happened on your inside happened on your outside, would you still smoke?.8 2

3、 職業(yè)致癌因子職業(yè)致癌因子 2 Occupation carcinogenic factor: Asbestos, Radon 3 空氣污染空氣污染 3 Air pollution （1）室外大環(huán)境污染）室外大環(huán)境污染 （1）Outdoor environment pollution （2）室內(nèi)小環(huán)境污染）室內(nèi)小環(huán)境污染 （2）Indoor environment pollution 4 電離輻射電離輻射 4 Ionizing radiation.9 5 飲食與營養(yǎng)飲食與營養(yǎng) 5 Diet and nutritionVITAMIN A?.10 6 其他因素其他因素 6 Other factor

4、s 7 遺傳因素遺傳因素 7 Hereditary factor Tumor suppressor genes*p53 Dominant oncogenes*Kras*Her-2/neu.11病理和分類病理和分類Pathology and classification.12解剖學(xué)分類解剖學(xué)分類Anatomy classification 1 中央型肺癌中央型肺癌 1 Central lung cancer.13 2 周圍型肺癌周圍型肺癌 2 Peripheral lung cancer.14組織學(xué)分類組織學(xué)分類Histology classification 1 小細(xì)胞肺癌小細(xì)胞肺癌 1 Sm

5、all cell lung cancer, SCLC （1）燕麥細(xì)胞型）燕麥細(xì)胞型 （1）oat cell type （2）中間細(xì)胞型）中間細(xì)胞型 （2）intermediate cell type （3）混合型）混合型 （3）mixed type.15 Small cell carcinoma Rare in non-smokers Large hilar mass 70% present with overt metastasis Very chemo-responsive Worst prognosis.16Small cell carcinoma.17 2 非小細(xì)胞肺癌非小細(xì)胞肺癌 2

6、 Non-small cell lung cancer, NSCLC （1）鱗狀細(xì)胞癌（鱗癌）鱗狀細(xì)胞癌（鱗癌） （1）Squamous cell carcinoma, SCC （2）腺癌和支氣管肺泡癌）腺癌和支氣管肺泡癌 （2）Adenocarcinoma，AC，and bronchoalveolar carcinoma （3）大細(xì)胞癌）大細(xì)胞癌 （3）Large cell carcinoma （4）鱗腺癌）鱗腺癌 （4）Adeno-squamous carcinoma.18 Squamous cell carcinoma Now 2nd most common ( 1st in China

7、) Strongly linked with smoking 60-80% in the proximal airways (central type) Cavitation Tendency to spread locally/regionally Prognosis slightly better than Adenocarcinoma.19Squamous Cell Carcinoma.20Squamous Cell Carcinoma.21鱗癌鱗癌.22Lung Cancer Pathology Adenocarcinoma Most common pathology(2nd in C

8、hina) “Non-smokers lung cancer” Women Peripheral (75%) Aggressive metastases.23Adenocarcicoma Left Lower Lobe.24Adenocarcinoma.25Adenocarcinoma.26Bronchoalveolar Cell Carcinoma BAC Aerogenous and lymphatic spread Least associated with cigarette smoking Usually peripheral Localized, multi-nodular or

9、diffuse Slow metabolism Prognosis Localized vs. other.27支氣管肺泡癌支氣管肺泡癌.28 Large cell carcinoma Large peripheral mass with necrosis Malignant epithelial neoplasm Poorly-differentiated Aggressive mets “Its a cancerits not small cellbut”.29Large cell carcinoma.30Large cell carcinoma.3110100d2530187d惡性度最高

10、最常見發(fā)病率(%)倍增時間不明顯有關(guān)密切吸煙女性較輕老年男性好發(fā)年齡性別202533d3035100d大細(xì)胞癌腺癌小細(xì)胞癌鱗癌.32鱗癌小細(xì)胞癌腺癌大細(xì)胞癌解剖分類中央型中央型周圍周圍生長方式管腔內(nèi)管腔外管腔外轉(zhuǎn)移晚早較早手術(shù)機(jī)會多少支氣管肺泡癌瘢痕癌較大放化療敏感.33臨床表現(xiàn)臨床表現(xiàn)Clinical manifestation.34原發(fā)腫瘤引起的癥狀和體征原發(fā)腫瘤引起的癥狀和體征Symptoms and physical signs due to primary tumor 1 咳嗽咳嗽 1 Cough 2 咯血咯血 2 Hemoptysis 3 喘鳴喘鳴 3 Wheeze 4 氣急氣急

11、4 Breath lessness 5 發(fā)熱發(fā)熱 5 Fever 6 其他其他 6 Others.35腫瘤局部擴(kuò)展引起的癥狀和體征腫瘤局部擴(kuò)展引起的癥狀和體征Symptoms and physical signs due to tumor local expanding1 胸痛胸痛1 Chest pain2 呼吸困難呼吸困難2 Dyspnea3 吞咽困難吞咽困難3 Dysphagia: esophageal compression4 聲音嘶啞聲音嘶啞4 Hoarse voice: laryngeal nerve paralysis 5 上腔靜脈阻塞綜合征上腔靜脈阻塞綜合征5 Superior

12、vena cava obstruction syndrome6 Horner綜合征，肺上溝瘤綜合征，肺上溝瘤6 Horners syndrome, Pancoasts tumor: Cervical/thoracic nerve invasion 7 臂叢神經(jīng)壓迫征臂叢神經(jīng)壓迫征7 Brachial plexus compression syndrome.36腫瘤遠(yuǎn)處轉(zhuǎn)移引起的癥狀和體征腫瘤遠(yuǎn)處轉(zhuǎn)移引起的癥狀和體征Symptoms and physical signs due to tumor distant metastasis 1 腦、中樞神經(jīng)系統(tǒng)轉(zhuǎn)移腦、中樞神經(jīng)系統(tǒng)轉(zhuǎn)移 1 Metast

13、asize to brain, central nervous system.37 2 肝轉(zhuǎn)移肝轉(zhuǎn)移 2 Metastasize to liver 3 骨轉(zhuǎn)移骨轉(zhuǎn)移 3 Metastasize to bone 4 皮下轉(zhuǎn)移性結(jié)節(jié)皮下轉(zhuǎn)移性結(jié)節(jié) 4 Subcutaneouly metastatic nodus 5 頸部或鎖骨上淋巴結(jié)轉(zhuǎn)移頸部或鎖骨上淋巴結(jié)轉(zhuǎn)移 5 Cervical or supraclavicular lymph node metastasis.38肺癌作用于其他系統(tǒng)引起的肺外表現(xiàn)肺癌作用于其他系統(tǒng)引起的肺外表現(xiàn)Manifestation out of lung due to o

14、ther systems affected by lung cancer 1 異位內(nèi)分泌綜合征異位內(nèi)分泌綜合征 1 Ectopic endocrine syndrome, EES （1） 抗利尿激素分泌異常綜合征抗利尿激素分泌異常綜合征 （1） Syndrome of inapprpriate antidiuretic hormone(SIADH) secretion （2） 異位異位ACTH綜合征綜合征 （2） Ectopic ACTH syndrome （3） 神經(jīng)肌肉綜合征神經(jīng)肌肉綜合征 （3） Neuromyopathic syndrome （4） 高鈣血癥高鈣血癥 （4） Hyper

15、calcinemia （5） 其他：類癌綜合征其他：類癌綜合征 （5） Others: Carcinoid syndrome.39 2 其他肺外表現(xiàn)其他肺外表現(xiàn) 2 Other manifestation out of lung （1）多發(fā)性周圍神經(jīng)炎）多發(fā)性周圍神經(jīng)炎 （1）Multiple peripheral neuritis （2）肌無力樣綜合征）肌無力樣綜合征 （2）Eaton-Lambert syndrome.40 （3）肥大性肺性骨關(guān)節(jié)?。┓蚀笮苑涡怨顷P(guān)節(jié)病 （3）Hypertrophic pulmonary osteoarthropathy, HPO病人病人正常人正常人.41實

16、驗室和輔助檢查實驗室和輔助檢查Laboratory and auxiliary examination.42胸部胸部X線檢查線檢查 Chest radiograph 1 中央型肺癌中央型肺癌 1 Central lung cancer.43.44 2 周圍型肺癌周圍型肺癌 2 Peripheral lung cancer.45.46.47.48電子計算機(jī)體層掃描電子計算機(jī)體層掃描CT.49Posterior basal segment of left lower lobe, AC .50左上葉肺癌并左上葉不張Left upper lobe cancer combining atelectasi

17、s.51Left lower lobe cancer combining obstructive pneumonia.52.53磁共振磁共振MRI.54.55痰脫落細(xì)胞學(xué)檢查痰脫落細(xì)胞學(xué)檢查Sputum exfoliative cytology testSCCACSCLC.56纖維支氣管鏡檢查纖維支氣管鏡檢查Bronchofiberscopy.57.58.59SCCSCLCACLCC.60核素閃爍顯像核素閃爍顯像Nuclide scintigraphy 1 骨骨閃爍顯像閃爍顯像 1 Bone scintigraphy 2 正電子發(fā)射斷層顯像正電子發(fā)射斷層顯像 2 Positron emissi

18、on tomography (PET).61.62 病理學(xué)檢查病理學(xué)檢查 Pathology 癌標(biāo)志物的檢測癌標(biāo)志物的檢測 Cancer mark test 基因診斷基因診斷 Gene diagnosis 手術(shù)探查手術(shù)探查 Operations research.63診斷和鑒別診斷診斷和鑒別診斷Diagnosis and differential diagnosis.64診斷診斷Diagnosis 早期診斷早期診斷 Early diagnosis 癥狀癥狀 Symptom 體征體征 Physical sign 檢查檢查 Examination.65鑒別診斷鑒別診斷Differential di

19、agnosis 1 肺結(jié)核肺結(jié)核 1 Pulmonary tuberculosis.66TuberculosisLung cancer.67 肺真菌病肺真菌病 Pulmonary mycosis.68 2 肺炎肺炎 2 Pneumonia 抗菌藥物治療有效，病灶吸收快而完全抗菌藥物治療有效，病灶吸收快而完全 Usually, antibacterial drug therapy is effective, and focus is absorbed quickly and completely.69 3 肺膿腫肺膿腫 3 Lung abscess.70 4 結(jié)核性滲出性胸膜炎結(jié)核性滲出性胸膜炎

20、 4 Tuberculous exudative pleurisy.71臨床分期臨床分期Clinical stage IA: T1N0 IB: T2 N0 IIA: T1 N1 IIB: T2 N1, T3 N0 IIIA: T3 N1, and T1-3 N2 IIIB: any T4, any N3 IV: any metastases.72治治 療療Treatment.73手術(shù)治療手術(shù)治療Operation treatment 1 NSCLC 2 SCLC.74化學(xué)藥物治療化學(xué)藥物治療Chemotherapy 1 SCLC 2 NSCLC.75放射治療放射治療Radiotherapy 根治性根治性 Radical cure 姑息性姑息性 Palliative cure.76介入性治療介入性治療Interventional therapy 1 支氣管動脈灌注支氣管動脈灌注 1 Bronchial artery infusion, BAI 2