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1、Bronchogenic Carcinoma(Lung Cancer)Respiratory department为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益DefinitionlBronchogenic carcinoma refers to the malignant tumor which grows in the bronchus.Originating from mucus or gland of bronchus.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单
2、位和职工的合法权益Incidence and mortalitylBronchogenic 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.为了规范事业单位聘用关系，建立和完善适应
3、社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益EtiologylThe cause of lung cancer is unknown.It is believed that there are following related factors.l1.Excessive cigarette smoking:Smoking index(Brinkman Index)is equal to cigarettes per day smoking time(years).lPassive smoking is also a carcinogen factor.为了规范事
4、业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Etiologyl2.Atmospheric pollution.It was found that carcinogenic factor is benzpyrene.l3.Occupational factors.l4Radioactivity in the atmosphere.l5.Diets and Nutrition.l6.Chronic irritation.l7.Genetic factors.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘
5、用制度，保障用人单位和职工的合法权益Pathology And Classificationl1.According to the position of tumor arising from,it can be divided into two types.lCentral type:Tumor arises from main bronchus,lobar and segmental bronchus.Peripheral type:Tumor arises beyond segmental bronchus.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘
6、用制度，保障用人单位和职工的合法权益Pathology And Classificationl2.According to cytology,it is convenient to classify into four kinds of types.l(1).Squamous cell carcinoma.l(2).Small cell anaplastic carcinoma.l(3).Large cell anaplastic carcinoma.l(4).Adenocarcinoma(including alveolar cell carcinoma).为了规范事业单位聘用关系，建立和完
7、善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Pathology And ClassificationlAccording to the different principles of management,it is divided into two types.lSCLC:small cell lung carcinoma.lNSCLC:non small cell lung carcinoma.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Clinical featureslTher
8、e are no symptoms of early lung cancer in some patients.lSymptoms caused by lung cancer are non-specific:perhaps an audible wheeze or a slight cough,symptoms of infection(fever,purulent sputum),of obstruction(wheezing,dyspnea),or ulceration of bronchial mucosa(hemoptysis).为了规范事业单位聘用关系，建立和完善适应社会主义市场经
9、济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Clinical featuresl1.Respiratory symptoms.l(1).Cough:l(2).Hemoptysis:l(3).Dyspnea.:l(4).Wheeze or stridor:l(5).Chest pain:l(6).Fever:为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Clinical featuresl2.Symptoms caused by the near organs or tissue involved by tu
10、mor.l(1).Dysphagia.l(2).Hoarseness.l(3).Pleural effusion due to invasion of the pleura.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Clinical Featuresl(4).Horners syndrome.It is caused by invading the cervical sympathetic ganglia on the involved side the pupil is small ptosis of the up e
11、yelids,retraction of the eyeball and no sweat of the face.l(5)Cardiac effusion为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Clinical feturesl(6).Superior vena caval syndrome.Due to obstruction of the superior vena caval,the patient may have noticed that his collar is tight,the neck is en
12、larged and the jugular vein and the veins of anterior chest wall are distension and edema of the face.l3.Symptoms caused by metastasis.liver,skeleton,brain,supra clavicle lymph nodes.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Clinical feturesl4.Paraneoplastic syndrome.Because tumor ce
13、ll can secrete ectopic hormone，antigen or enzyme the patients with Lung Cancer sometimes may have some paraneoplastic syndrome Including:l(1)Collagen tissue disorder such as finger clubbing,hypertrophic pulmonray osteoarthropathy。为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Clinical fea
14、turesl(2)Endocrine disorders including Cushings syndrome,syndrome of inappropriate antiduretic hormone secretion(SIADHS),l(3)Neuropathic or myopathic disorders including polyneuritis,cerebellar degeneration,mental abnormalitis etc l(4)others.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益
15、Radiographic FindingslThe appearance on the x-ray film depends on the position,size and stage of the tumor 1.Peripheral type:It may be various such as infiltrative or nodular,lobulated or umbilicus sign,liner protrusions from the shadow into the surrounding lung,cavitation which is often eccentric i
16、rregular in the inner wall owing to the necrosis of the neoplasm.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Radiographic Findingsl2 Central typel(1)Direct appearance:Unilateral enlargement of the hilar shadow due to the tumor itself or enlarged lymph nodes.l(2)Indirect appearance:Incl
17、uding local emphysema;obstructive pneumonia either lobal or segmental;obstractive atalectasis(collapse)lobe or segment.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Advantage of CT:l(1)Some small lesion,lesion behind of cardiac or blood vessel,and pathology located in apical of lung can
18、be found by CT which cant be found by chest x-ray.l(2)Lymph nodes along hilar or mediastina can be found by CT.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益 Fig1 Atelectasis,Right upper lobeFig1 Atelectasis,Right upper lobe为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益 Fig3
19、Mass With Fuzzy,Right Upper LObeFig3 Mass With Fuzzy,Right Upper LObe为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益 Fig4 Mass In right Fig4 Mass In right Lobe,Lateral portionLobe,Lateral portion为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益 Fig5 Cavitating Bronchial Carcinoma
20、 Fig5 Cavitating Bronchial Carcinoma 为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Examination of sputum lCytologic examination of bronchial secretions(or sputum)may reveal exfoliated malignant cells recognizable to the pathologist who is specially trained for such work.The sputum must t
21、o be fresh,send on time,repeat(4-6 times).为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益BronchoscopelBronchoscope may verify the existence of tumor,of Central type,and cytologic diagnosis of lung cancer should be obtained though FBCl.Blind biopsy may be help to the diagnosis of the tumor
22、 beyond the range of bronchoscope vision为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Fig 1 Normal TracheaFig 2 Normal Carina为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Fig 3 Squamous Cell Carcinoma,TracheaFig 4 AdenocarcinomaLeft Lingular Bronchus为了规范事业单位聘用关系，建立和完善适应社会主义市场
23、经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Fig 5 AdenocarcinomaRight Truncal IntermedusFig 6 Extrinsic Pressure Trachea为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Lung Biopsyl1.Biopsy with fiberoptic bronchoscope;2.Transthoracic neddle biopsy with CT directed or B type ultrasonic;l3.Biopsy with t
24、horacoscopy;l4.Biopsy with medistinoscopy;l5.Exploratory thoracotomy.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Diagnosisl1.Symptom-free:General investigation of high risk group(male,morn than 40 years old,cigarette consumption 20/per day).Taking a x-ray film and examining sputum for
25、cancer cell every half year lEarly stage of the bronchogenic carcinoma Refers to the tumor is still located at the bronchus,no invade the hilar lymph nodes,pleura as well as distant metastases,its diameter is often 3cm.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益DiagnosislDiagnosis pro
26、cedure:l1.X-ray film(-)and sputum for cytology(-)FBC(-)follow up once a month/year.l2.X-ray film(+)and sputum for cytology(+)FBC to identify the cancer cell type CT,MRI therapy.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益DiagnosislDiagnosis procedure:l3.X-ray film(-)and sputum for cyto
27、logy(+)ruling out the tumor of upper respiratory tract first FBC.l4 X-ray film(+)and sputum for cytology(-)FBC(-)lung biopsy.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Differential diagnosisl1.Solitary nodule:Tuberculoma,Benign Tumorl2.Cavitation:Lung Abscess,Tuberculosis,l3.Enlargeme
28、nt of hilar shadow:Hamartomal4.Others:Pleural Effusion,Widening Of Mediatinal.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Treatmentl1.Rresection by operation;l2.Radiotherapy;l3.Chemotherapy;l4.Immunotherapy;l5.Traditional Chinese medicine therapy etc.lThe therapeutic principle of lung
29、cancer is comprehensive:rescect the tumor as far as possible then combine with other treatments;other treatments first then operation depending on the cytologic type,position,size and stage of the tumor.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益TreatmentlSCLC:l Chemotherapy ,operatio
30、n.l Chemotherapy,radiotherapy.lNSCLC:l Operation.l Most:operationchemotherapyl Small parts:radiotherapy.为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益Treatmentl:Operation+chemotherapy;l radiotherapy+chemotherapy.l:chemotherapy+radiotherapy(relieve some symptoms,such as pain,dyspnea,obstruction etc).为了规范事业单位聘用关系，建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度，保障用人单位和职工的合法权益