支气管癌肺癌英文课件.ppt
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支气管肺癌版PPT讲稿
病因和发病机制
多因素参与、多步骤组成的复杂过程
外因
内因
吸烟
环境污染
职业因素
家族遗传
既往病史
发病原因
• 吸烟：饭后一支烟，快乐似神仙
已在香烟中分离到69种致癌物质，如 二甲基亚硝胺、二乙基亚硝胺、苯丙芘等。 全球每年因吸烟导致死亡人数高达600万人。
吸烟是诱发肺癌的首要危险因素，吸烟
量越越
大、吸烟
• 遗传和基因改变：癌基因活化、抑癌基因
失活
发病原因
• 饮食与营养（维生素A、β胡萝卜素缺乏；
补充富含这VitA、B胡萝卜素的食物对抽 烟者有明显保护作用）
• 其他因素：
1.慢性肺部疾病：COPD、支扩、肺结 核
2.病毒感染、真菌感染（黄曲霉等）
3.宿主因素：免疫功能低下、内分泌 失调、营 养状况
支气管肺癌版课件
定义
• 肺癌（lung cancer），又称“支气
管肺癌”，是起源于呼吸上皮细胞（支 气管、细支气管、肺泡）的恶性肿瘤
• 世界上严重威胁人类健康与生命的恶性
肿瘤
• 在多数国家发病率呈明显升高趋势 • 居于恶性肿瘤发病率和死亡率的第一位
流行病学
• 肺癌是第一大癌
全球第一大癌。我国肿瘤发病和死亡情况逐年增高，肺癌成为 恶性肿瘤发病的第一位。
症状时已远处转移。易转移至肝、脑和骨，更易累及胸膜 而引起胸腔积液。
腺癌
癌巢呈腺管样结构， 癌细胞呈柱状、高度 异形性，核大浓染， 常有核仁。沿肺泡间 隔增殖。
大细胞癌
• 未分化细胞癌，缺乏小细胞癌、腺
癌、鳞癌分化的细胞和结构特点。
• 可发生肺门或肺边缘支气管。 • 转移较小细胞未分化癌晚，手术切
肺癌英文PPT演示幻灯片
Bronchogenic Carcinoma (Lung Cancer)
Respiratory department
1
Definition
Bronchogenic carcinoma refers to the malignant tumor which grows in the bronchus. Originating from mucus or gland of bronchus.
2
Incidence and mortality
Bronchogenic carcinoma has increased remarkable in incidence and mortality during half of the century and has become the most frequent visceral malignant diseases of men.The mortality of lung cancer hold the first place among all kinds carcinomas.
2.Symptoms caused by the near organs or tissue involved by tumor.
(1).Dysphagia. (2).Hoarseness. (3).Pleural effusion due to invasion of the
pleura.
8
Clinical features
There are no symptoms of early lung cancer in some patients.
Symptoms caused by lung cancer are nonspecific:perhaps an audible wheeze or a slight cough,symptoms of infection (fever ,purulent sputum) , of obstruction (wheezing,dyspnea), or ulceration of bronchial mucosa (hemoptysis).
Respiratory department
1
Definition
Bronchogenic carcinoma refers to the malignant tumor which grows in the bronchus. Originating from mucus or gland of bronchus.
2
Incidence and mortality
Bronchogenic carcinoma has increased remarkable in incidence and mortality during half of the century and has become the most frequent visceral malignant diseases of men.The mortality of lung cancer hold the first place among all kinds carcinomas.
2.Symptoms caused by the near organs or tissue involved by tumor.
(1).Dysphagia. (2).Hoarseness. (3).Pleural effusion due to invasion of the
pleura.
8
Clinical features
There are no symptoms of early lung cancer in some patients.
Symptoms caused by lung cancer are nonspecific:perhaps an audible wheeze or a slight cough,symptoms of infection (fever ,purulent sputum) , of obstruction (wheezing,dyspnea), or ulceration of bronchial mucosa (hemoptysis).
支气管癌英文课件.ppt
Incidence and mortality
Bronchogenic carcinoma has increased remarkable in incidence and mortality during half of the century and has become the most frequent visceral malignant diseases of men.The mortality of lung cancer hold the first place among all kinds carcinomas.
Passive smoking is also a carcinogen factor.
Etiology
2.Atmospheric pollution.It was found that carcinogenic factor is benzpyrene .
3.Occupational factors. 4Radioactivity in the atmosphere . 5.Diets and Nutrition. 6.Chronic irritation. 7.Genetic factors.
Pathology And Classification
1. According to the position of tumor arising from ,it can be divided into two types .
Central type:Tumor arises from main bronchus, lobar and segmental bronchus . Peripheral type : Tumor arises beyond segmental bronchus .
支气管肺癌PPT参考课件
3
病因学
• 吸烟 约80-90%的肺癌与吸烟相关，小细胞肺癌约95%归因于吸烟 • 大气污染 特别是工业废气 • 室内微小环境的污染 室内燃煤空气污染 • 职业危害(石棉、氡、甲基乙醚、铬、镍、砷） • 慢性肺部疾病、结核继发肺部疤痕者 • 营养状况 • 遗传因素
4
肺癌相关的遗传学异常
遗传学异常
Mx M0 M1 M1a
M1b
远处转移不能评价
没有远处转移
有远处转移 对侧肺叶内出现散在的多个或多 个肿瘤结节；胸膜结节或恶性胸 腔（心包）积液。 远处转移。
绝大多数的肺癌患者的胸腔积液（心包积液）经多次 细胞学检查未能找到肿瘤细胞，而积液又是非血性或 非渗出性，临床判断积液与肿瘤无关，积液不影响分 期，应定义为M0
咳嗽
40
呼吸困难
30
胸痛
25
咯血
15
肺炎
15
体重减轻
40
全身虚弱
35
缺乏食欲
35
发热
15
贫血
15
发生频率(%)
22
1.肺癌的肺外表现：是肺癌发生过程中一些少见症状或体征，该表现不是肿瘤直 接作用或转移引起的，它可出现于肺癌发现前、后，或同时发生这类症状和体征 表现于胸部以外的脏器 2.贺纳综合征(Horner’s syndrome) 位于肺尖部的 肺癌称肺上沟癌(Pancost 癌)，可压迫颈部交感神经，引起病侧眼睑下垂，瞳孔缩小，眼球内陷，同侧额部 与胸壁无汗或少汗。 3。潘寇综合征(Pancoast’s syndrome) 在贺纳综合征的基础上肿瘤进一步破坏 第1，2肋骨和臂丛神经，造成以腋下为主，向上肢内侧放射的烧灼样疼痛，在夜 间尤甚。
锁骨上、颈部等淋巴结肿大，中枢神经系统，脊髓束受压 迫，肝转移(35%)，骨转移（30-40%）,肾上腺（10-35%）
病因学
• 吸烟 约80-90%的肺癌与吸烟相关，小细胞肺癌约95%归因于吸烟 • 大气污染 特别是工业废气 • 室内微小环境的污染 室内燃煤空气污染 • 职业危害(石棉、氡、甲基乙醚、铬、镍、砷） • 慢性肺部疾病、结核继发肺部疤痕者 • 营养状况 • 遗传因素
4
肺癌相关的遗传学异常
遗传学异常
Mx M0 M1 M1a
M1b
远处转移不能评价
没有远处转移
有远处转移 对侧肺叶内出现散在的多个或多 个肿瘤结节；胸膜结节或恶性胸 腔（心包）积液。 远处转移。
绝大多数的肺癌患者的胸腔积液（心包积液）经多次 细胞学检查未能找到肿瘤细胞，而积液又是非血性或 非渗出性，临床判断积液与肿瘤无关，积液不影响分 期，应定义为M0
咳嗽
40
呼吸困难
30
胸痛
25
咯血
15
肺炎
15
体重减轻
40
全身虚弱
35
缺乏食欲
35
发热
15
贫血
15
发生频率(%)
22
1.肺癌的肺外表现：是肺癌发生过程中一些少见症状或体征，该表现不是肿瘤直 接作用或转移引起的，它可出现于肺癌发现前、后，或同时发生这类症状和体征 表现于胸部以外的脏器 2.贺纳综合征(Horner’s syndrome) 位于肺尖部的 肺癌称肺上沟癌(Pancost 癌)，可压迫颈部交感神经，引起病侧眼睑下垂，瞳孔缩小，眼球内陷，同侧额部 与胸壁无汗或少汗。 3。潘寇综合征(Pancoast’s syndrome) 在贺纳综合征的基础上肿瘤进一步破坏 第1，2肋骨和臂丛神经，造成以腋下为主，向上肢内侧放射的烧灼样疼痛，在夜 间尤甚。
锁骨上、颈部等淋巴结肿大，中枢神经系统，脊髓束受压 迫，肝转移(35%)，骨转移（30-40%）,肾上腺（10-35%）
关于支气管肺癌版课件
临床症状
较多
较少
痰细胞学阳性率
较高
较低
手术难度
较高
较低
中央型
周围型
非小细胞肺癌
• 只要能较早诊断，可以获得较好的存活率 – I期患者5年存活率约为60-80% – IV期患者<1%
• 非小细胞肺癌的组织类型主要有 – 腺癌(~50%)：原位腺癌、微浸润腺癌、浸润性腺癌、浸润性腺
癌变异型。
– 鳞癌(~35%) ：角化型、非角化型、基底细胞样型。 – 大细胞癌 (~10%)：未分化的非小细胞癌，较为少见.
5年生存率低于20%。
肺癌早期无任何症状 就诊时早期仅占12％ 肺癌总5年生存率仅13％ 早期肺癌5年生存率 80％
为什么 生存率低？
为什么肺癌会成为中国第一大癌？
• 烟草的使用 • 人口基数大 • 发病率不断上升 • 早期诊断的困难性
全球范围内的寿命损失年 在中国，肺癌的影响攀升非常 快，由于吸烟人数快速上升。
•作为室内PM2.5的主要来源二手烟对身体健康造成巨大伤 害。吸入二手烟，发生肺癌的 风险是无被动吸烟者的 1.7-2.52倍。
发病原因
❖ 空气污染 ❖ 室外大环境污染：除了烟草，尾气、雾霾天、工
业污染等恶劣的环境因素，拉近人们与肺癌间的 距离。雾霾天使肺癌风险增5成。 工业废气、汽车尾气(苯并芘)、 装饰材料(甲醛、 氡气) 。 ❖ 室内小环境污染：室内被动吸烟、燃料燃烧和烹 调过程中产生致癌物。室内接触不完全燃烧物为 肺癌的危险因素，特别对女性腺癌；烹调时加热 释放的油烟也不能忽视。
病因和发病机制
多因素参与、多步骤组成的复杂过程
外因
内因
吸烟
环境污染
职业因素
家族遗传
支气管肺癌PPT课件
38.4%
男
女
总
Yang et al, 2005
中国肺癌死亡率
70年代~90年代上升111.85%
癌症中的死因由第四位攀升第一位
肺癌的病因
吸烟 大气污染
室内微小环境的污染
职业危害(石棉、氡、甲基乙醚、铬、镍、砷） 慢性肺部疾病
营养状况
遗传因素
吸 烟
肺癌病人中3/4有重度吸烟 吸烟者比不吸烟者发病高10～13倍 19岁以下开始吸烟，死于肺癌机会更大 吸烟与肺鳞癌、 小细胞肺癌(SCLC) 关系密切
发病率指每 100,000中的发病人数。
温带南美 男/女 55.1/7.6
Parkin DM, et al. CA Cancer J Clin. 1999;49:33-64.
肺癌的5年生存率
西欧/北欧
东欧 日本 澳洲 中国 中东/北非 中非/南非
7% 12% 21% 13%
8%
8% 10% 20%
肺癌的诊断
可疑肺癌的诊断 X光胸片 CT 扫描 ？PET 周围型肿瘤 中央型肿刺 支气管镜 电视辅助的胸腔镜 (楔形切除或针穿) 开胸手术
备选方案 痰细胞学检查 支气管镜 经皮细针穿刺 开胸手术
Adapted from DeVita VT, et al. Cancer: Principles & Practice of Oncology. 7th ed. 2005;753-845.
临床表现
远处转移 锁骨上、颈部等淋巴结肿大 中枢神经系统 脊髓束受压迫 肝转移
局部和远处扩散
脑 (10-50%)
引流淋巴结 心包 肺 胸膜 肝脏 (~35%) 肾上腺 (1035%) 皮肤 骨骼 (30-40%)
支气管肺癌PPT课件(文库推荐)
2009NSCLC的分期
• UICC/IASLC 于2009 年公布的第7 版肺癌 分期较第6 版肺癌TNM分期有较大的变动， 主要是根据81 015 例肺癌随访的结果对T 分期和M分期进行了重新修订，新分期更能 与肺癌的生存曲线相一致。
T、M分期更新要点
• ①根据肿瘤大小，将 T1分为 2 个亚组，T1a( 肿 瘤最大径≤2 cm) 和 Tlb( 2 cm ＜肿瘤最大径 ≤3 cm) ;T2分为2 个亚组，T2a(3 cm＜肿瘤最大 径≤5 cm) 和 T2b(5 cm ＜肿瘤最大径≤7 cm) ; 肿瘤最大径＞7cm 由原来的 T2归为 T3;
鳞癌
常见30—35%，老年男性 吸烟密切 中央型多见→管腔内生长→支气管狭窄→
肺不张→阻塞性肺炎 易液化坏死、空洞、癌性脓肿 倍增时间100天，生长慢、转移晚、手术机
会多 放疗、化疗敏感但低于小细胞
腺癌
女性多见，与吸烟关系不大 多生长于肺边缘小支气管的粘液腺 周围型常见，占1/4，倾向于管外生长。在
原发性支气管肺癌
Primary bronchogenic carcinoma
广州军区广州总医院 李伟峰
定义
肿瘤细胞源于支气管粘膜或腺体，常有区 域性淋巴结和血行转移，早期常有刺激性 咳嗽、痰中带血等呼吸道症状，病情进展 速度与细胞的生物特性有关。
流行病学
WHO报告——97年居恶性肿瘤死因第一位。 发达国家肺癌居男性恶性肿瘤首位，女性
隐性癌 0期 Ⅰa期 Ⅰb期 Ⅱa期 Ⅱb期
肺癌的TNM分期
TX,N0,M0 Tis,原位癌 T1,N0,M0 T2,N0,M0 T1,N1,M0 T2,N1,M0 T3,N0,M0
Ⅲa期
Ⅲb期 Ⅳ期
肺癌英文(课堂PPT)
5
Pathology And Classification
1. According to the position of tumor arising from ,it can be divided into two types .
Central type:Tumor arises from main bronchus, lobar and segmental bronchus . Peripheral type : Tumor arises beyond segmental breatures
(4).Horner’s syndrome.It is caused by invading the cervical sympathetic ganglia on the involved side the pupil is small ptosis of the up eyelids,retraction of the eyeball and no sweat of the face.
9
Clinical features
1.Respiratory symptoms.
(1).Cough: (2).Hemoptysis: (3).Dyspnea.: (4).Wheeze or stridor: (5).Chest pain : (6).Fever:
10
Clinical features
cell carcinoma).
7
Pathology And Classification
According to the different principles of management,it is divided into two types.
SCLC:small cell lung carcinoma. NSCLC:non small cell lung carcinoma.
Pathology And Classification
1. According to the position of tumor arising from ,it can be divided into two types .
Central type:Tumor arises from main bronchus, lobar and segmental bronchus . Peripheral type : Tumor arises beyond segmental breatures
(4).Horner’s syndrome.It is caused by invading the cervical sympathetic ganglia on the involved side the pupil is small ptosis of the up eyelids,retraction of the eyeball and no sweat of the face.
9
Clinical features
1.Respiratory symptoms.
(1).Cough: (2).Hemoptysis: (3).Dyspnea.: (4).Wheeze or stridor: (5).Chest pain : (6).Fever:
10
Clinical features
cell carcinoma).
7
Pathology And Classification
According to the different principles of management,it is divided into two types.
SCLC:small cell lung carcinoma. NSCLC:non small cell lung carcinoma.
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2.Symptoms caused by the near organs or tissue involved by tumor.
(1).Dysphagia. (2).Hoarseness. (3).Pleural effusion due to invasion of the
pleura.
(5)Cardiac effusion
Clinical fetures
Passive smoking is also a carcinogen factor.
Etiology
2.Atmospheric pollutir is benzpyrene .
3.Occupational factors. 4Radioactivity in the atmosphere . 5.Diets and Nutrition. 6.Chronic irritation. 7.Genetic factors.
Bronchogenic Carcinoma (Lung Cancer)
Respiratory department
Definition
Bronchogenic carcinoma refers to the malignant tumor which grows in the bronchus. Originating from mucus or gland of bronchus.
Pathology And Classification
1. According to the position of tumor arising from ,it can be divided into two types .
Central type:Tumor arises from main bronchus, lobar and segmental bronchus . Peripheral type : Tumor arises beyond segmental bronchus .
Clinical features
1.Respiratory symptoms.
(1).Cough: (2).Hemoptysis: (3).Dyspnea.: (4).Wheeze or stridor: (5).Chest pain : (6).Fever:
Clinical features
Etiology
The cause of lung cancer is unknown.It is believed that there are following related factors.
1. Excessive cigarette smoking:Smoking index(Brinkman Index) is equal to cigarettes per day smoking time(years).
Clinical Features
(4).Horner’s syndrome.It is caused by invading the cervical sympathetic ganglia on the involved side the pupil is small ptosis of the up eyelids,retraction of the eyeball and no sweat of the face.
Incidence and mortality
Bronchogenic carcinoma has increased remarkable in incidence and mortality during half of the century and has become the most frequent visceral malignant diseases of men.The mortality of lung cancer hold the first place among all kinds carcinomas.
cell carcinoma).
Pathology And Classification
According to the different principles of management,it is divided into two types.
SCLC:small cell lung carcinoma. NSCLC:non small cell lung carcinoma.
Pathology And Classification
2.According to cytology,it is convenient to classify into four kinds of types.
(1).Squamous cell carcinoma. (2).Small cell anaplastic carcinoma. (3).Large cell anaplastic carcinoma. (4).Adenocarcinoma(including alveolar
Clinical features
There are no symptoms of early lung cancer in some patients.
Symptoms caused by lung cancer are nonspecific:perhaps an audible wheeze or a slight cough,symptoms of infection (fever ,purulent sputum) , of obstruction (wheezing,dyspnea), or ulceration of bronchial mucosa (hemoptysis).
(1).Dysphagia. (2).Hoarseness. (3).Pleural effusion due to invasion of the
pleura.
(5)Cardiac effusion
Clinical fetures
Passive smoking is also a carcinogen factor.
Etiology
2.Atmospheric pollutir is benzpyrene .
3.Occupational factors. 4Radioactivity in the atmosphere . 5.Diets and Nutrition. 6.Chronic irritation. 7.Genetic factors.
Bronchogenic Carcinoma (Lung Cancer)
Respiratory department
Definition
Bronchogenic carcinoma refers to the malignant tumor which grows in the bronchus. Originating from mucus or gland of bronchus.
Pathology And Classification
1. According to the position of tumor arising from ,it can be divided into two types .
Central type:Tumor arises from main bronchus, lobar and segmental bronchus . Peripheral type : Tumor arises beyond segmental bronchus .
Clinical features
1.Respiratory symptoms.
(1).Cough: (2).Hemoptysis: (3).Dyspnea.: (4).Wheeze or stridor: (5).Chest pain : (6).Fever:
Clinical features
Etiology
The cause of lung cancer is unknown.It is believed that there are following related factors.
1. Excessive cigarette smoking:Smoking index(Brinkman Index) is equal to cigarettes per day smoking time(years).
Clinical Features
(4).Horner’s syndrome.It is caused by invading the cervical sympathetic ganglia on the involved side the pupil is small ptosis of the up eyelids,retraction of the eyeball and no sweat of the face.
Incidence and mortality
Bronchogenic carcinoma has increased remarkable in incidence and mortality during half of the century and has become the most frequent visceral malignant diseases of men.The mortality of lung cancer hold the first place among all kinds carcinomas.
cell carcinoma).
Pathology And Classification
According to the different principles of management,it is divided into two types.
SCLC:small cell lung carcinoma. NSCLC:non small cell lung carcinoma.
Pathology And Classification
2.According to cytology,it is convenient to classify into four kinds of types.
(1).Squamous cell carcinoma. (2).Small cell anaplastic carcinoma. (3).Large cell anaplastic carcinoma. (4).Adenocarcinoma(including alveolar
Clinical features
There are no symptoms of early lung cancer in some patients.
Symptoms caused by lung cancer are nonspecific:perhaps an audible wheeze or a slight cough,symptoms of infection (fever ,purulent sputum) , of obstruction (wheezing,dyspnea), or ulceration of bronchial mucosa (hemoptysis).