Thousands

1
????????

• ???????
• ???

2
????

• ???????? ?,????,????2?3??
• ???30????? ?,??????????
• ?????????38.08???16.16
• ???????????????????
• ????????????,??2025??????????????90?,?????????

3
15?????????????????( 2000?)
Males
Females
?
Breast
Colon/rectum
Stomach
Liver
Prostate
Cervix uteri
Oesophagus
Bladder
Non-Hodgkins lymphoma
Oral cavity
Leukaemia
Pancreas
Ovary
Kidney
1200
1000
800
600
400
200
Thousands
Parkin et al 2001
4
Environmental factors

• 90????????
• ????
• ????
• asbestos
• arsenic
• ?
• ?
• ?
• ???????????

5
Smoking the cause of nearly 90 of lung cancers

• Lung cancer incidence mainly influenced by
  tobacco consumption
• Several smoking-related factors influence the
  risk of lung cancer
• age at start
• average consumption
• duration of habit
• time since quitting
• tobacco product used
• inhalation pattern

Stewart BW Kliehues P (eds.) World Cancer
Report (IARC Press, Lyon) 2003
6
Cigarette consumption and duration of habit
increase lung cancer risk
Rylander R, et al. Lung Cancer 199614 (Suppl.
1)S7583
7
Stopping smoking benefits survival
Continued smoking
Stopped age 50
Stopped age 30
Never smoked
Cumulative risk at UK male 1990 rates
Peto R, et al. BMJ 20003213239
8
Risk of lung cancer from a smoking spouse
Duration of exposure
Cigarette consumption by spouse
5 4 3 2 1
5 4 3 2 1
Relative risk (log scale)
Relative risk (log scale)
0
119
1019
gt20
0
119
1019
gt20
Years living with spouse who smokes
No. of cigarettes smoked daily by spouse
Hackshaw AK, et al. BMJ 1997315980988
9
Smoking overview

• ???????????
• ?????????? 2030
• ?????????????1020

10
??????

• ???
• ??
• ???
• ???

• ?10??

11
? ?

• ????????NO????
• ??????????
• ????
• ???????
• ????
• ???????????

12
Molecular abnormalities in lung cancer
????? ????
????
??????
????????????????? ??????? ?????? ?????? ???? ???
????
Tobaccocarcinogen
????
??
???
???????
?????
13
?????

• ????
• ?????????,?3/4
• ?????????????
• ???????????,?1/4

14
Histological types of lung cancer

• ????? (95)
• ?????? 7580
• ?? (40)
• ?? (25)
• ???? (10)
• ????? 20

Rozengurt E. Curr Opin Oncol 19991111622
15
?????Squamous carcinoma

• ??????(50)?
• ??????,?????????
• ??????,???????
• ???????,?????
• ?????????
• ???????
• ??????????????,5??????

16
Non-small-cell lung cancer squamous-cell
carcinoma
WHO Classification of Tumours of the Lung,
Pleura, Thymus and Heart. (IARC Press, Lyon) 2004
17
??Adenocarcinoma

• ??????
• ????,?????
• ??????
• ????????,??X???(????)?
• ??????
• ?????,??????
• ??????????

18
Non-small-cell lung cancer adenocarcinoma
WHO Classification of Tumours of the Lung,
Pleura, Thymus and Heart. (IARC Press, Lyon) 2004
19
?????Alveolar cell carcinoma

• ????????,????
• ????????????????
• ?????????????,????,?????????
• ??????
• ?? ???????????
• ????????????

20
Non-small-cell lung cancer bronchioloalveolar
carcinoma
WHO Classification of Tumours of the Lung,
Pleura, Thymus and Heart. (IARC Press, Lyon) 2004
21
????Large cell carcinoma

• ???
• ?????????,?????????????,???????,??????
• ?????
• ????????????

22
????Small cell lung cancer

• ???15-20?
• ????,40???
• ???,??????
• ???????
• ?????,????????????????
• ??????????
• ?????

23
Small-cell lung cancer
WHO Classification of Tumours of the Lung,
Pleura, Thymus and Heart. (IARC Press, Lyon) 2004
24
Trends in histological diagnosis
40 35 30 25 20 15 10 5 0
Male adenocarcinoma Female adenocarcinoma Male
squamous cell Female squamous cell Male
small-cell Female small-cell
Patients ()
198286
198791
199296
19972001
25
?????????????

• ???? 44,?? 25
• ?? ?? 28,?? 42
• ?????????????, ???? ???
• ?????,AC ?? (6172)
• BAC??????????????

26
??(METASTASIS)

• ????
• ????
• ????

27
????Direct spread

• ?????????????????????????
• ???????????????????????
• ??????????????????

28
????

• ???---????????????????????????????????????????
  ???
• ????????????????(?????)
• ?????????
• a ?????b ????????

29
????

• ????????,??????
• ??,????????????????
• ????V???????(????????????)?

30
Types of lung cancer non-small-cell lung cancer
(NSCLC)

• ?? (30)
• ?????
• ??????? (?????)
• ??????
• ??????
• ????????????????

• ?? (30-50)
• ???????????
• ?????
• ???????????
• ????????????????
• K-ras????
• CEA??

31
?????

• ? 20
• ??
• ????
• ?????
• ???
• ??????
• ??????
• ??????
• ?????,?????
• ???????---?????

32

• ??????
• Clinical Presentations

33

• ???????????????????????????????????,??X????????
  ???????,??????

34
1.?? Cough

• (?????)????????,????????,???????????
• ??????????????????????

35
2.?? Hemoptysis

• ??????????????,????????
• ???????

36
3.?? Chest pain

• ???????
• ????????????
• ?????????

37
4.?????

• ??????????
• ???????????????
• ??????????????

38
5.?? Fever

• ????????,???????????
• ????????????????????

39
6.?? Wheeze

• ???????????
• ???????,??????
• ?????

40
7.?????? Emaciation and Cachexia

• ???????????????????
• ?????

41
8.??????????????

• ?????????????
• ?????????????????
• ????????????????V??,??????
• ?????????????????????

42
8.??????????????

• ??????????????
• ????(Pancoast?)
• a????????????,????,????,????horners syndrome
• b ???????????,????????????

43
9.????Extrapulmonary symptom

• ???????????
• ????????(????????)
• ???????(????????)

44
????

• ?????????????????????

45
(No Transcript)
46
???????

• ?????????????????????????,??????
• ?????????????????
• ?????????

47
????????(1)

• a??????????????
• ?????cushings syndrome
• b???????????????
• ?????????????????
• ??

48
???????? (2)

• c?????????????,?????????
• d ???????????????????????????????????

49
?????? ? ???
50
???????

• ?????????????????????????
• ??????????????,?????????????

51
???? (?)????

• ??
• ??
• ??
• ??
• ??

52
(?)????

• ??
• ????
• ????
• ??
• ??????? ????
• ?????????
• ?? ?? ???? ??????
• Horners???
• ???? ???? ???? ???? ???? ????

53
Major presenting symptoms of lung cancer
Patients()
100
80
60
40
20
0
Haemoptysis
Loss of appetite
Pain
Cough
Dyspnoea
Baseline major presenting symptoms
54
????X??????

• ?????
• ????????,????,??,???,?????,????????S??
• ????
• ??????
• ?????
• ???
• ??????

55
(No Transcript)
56
X???(?)

• ?????
• ???????????????????????-----??,???????????,???
• ???????

57
(No Transcript)
58
X???(?)

• ?????
• ???????????????

59
CT(?????????)

• 1). ???X??????, ??
• ??,???, ?????
• 2). ???, ????????
• ?,?????,??????
• 3). ????????????
• ??

60
???(MRI)

• ?????
• ?????

61
???????

• ??????---80,????????
• ????????

62
??????BRONCHOSCOPY

• ??
• 1.???????????,
• 2.???????
• 3.?????????
• 4.???????
• TBLB,?????

63
??????BRONCHOSCOPY(2)
64
LIFE bronchoscopy
White-light bronchoscopy image
LIFE bronchoscopy image
65
?????

• ???????
• ???
• ???
• ???

66
????

• ???
• PET

67
?????????

• ?????

68
Earlier diagnosis

• ???
• ??????
• ????
• ??????
• ?????CT
• PET
• ?????????? (LIFE)

Edell 1997 Hirsch 2001
69
????

• ?????
• ??????? ??? ???????? ???????

70
????????????
??? ?????
???? ??,??? ???????
?? ????????? ??,???
???? lt3cm,???? gt5cm
?? ?????,???? ????,????
?? ??,???,?? ?????,???
?? ??,??,???? ????,??,??
??? ?? ??BAC
???? ??(78-91) ??
71
2.??---?????

• ???????
• ??????
• ?????
• ????
• ????

72
3.???---???

• ????
• X?????,???????
• ?????????????

73
4.??????---????

• ????
• ????
• ??????

74
??????????

• ?????2-3?????
• ????????
• ????
• ??????????
• ????????,????????
• ??????????,????
• ??????,?????
• ?????????,?????
• ??????,??????????
• ????????????????????

75
????-----????????

• ??CT??CT
• ??CT?B???ECT
• ?????-----?????
• ???,??????????PET?
• ???

76
NSCLC stages
Lymph nodes
Invasion of chest wall
Metastasis to distant organs
Main bronchus
Contralateral lymph node
77
?????

• ???TNM?? CTNM, PTNM
• T ???? (TX, T0) T1, T2, T3, T4
• N ????? N0, N1, N2, N3
• M ???? M0, M1

78
???TNM?? CTNM, PTNM
79
???????
??? ???????? ??????
??? ??????????/??????????
PDQ Guidelines 2000
80
?????????

• ???????????????????????????????(PS,QOL)???????????
  ????,????????????????????????????????
• ??,??,??,??,????,?????

81
??????????? IIIb-IV? I-III? ???
I-III????? PS 0-1 ????
??? PS 2
??/??
?? ?? ???? ????

???? ???? ????
82
???????? vs. ????

• ??????,????2?
• ??10 1????

83
Big Lung Trial ?????????????????NSCLC???(??????)
?? ?? ???
Pts 364 361
Stage ? 93 93
?? 12 9
MST(?) 7.7 5.7
1???? 28 19
2???? 8 4
QOL?? 135 138
????????????QOL ????????????QOL ????????????QOL
84
IV? NSCLC??????
1-Yr Survival
????
DDP/CBP ??
CDDP-?? 1995??
BSC
85
??NSCLC????????????????,??????,??????

• ????
• ?????
• ???????
• CPT-11??

86
?????????

• ???
• ????
• ??
• ??????
• ????
• ?????? ???
• ??
• ???,???????
• Topo?I???,????????
• ???
• ???? /-??????
• ?? ????

87
????????????

• ??????
• DDP/VP-16 (PE)
• CTX/ADM/VCR (CAV)
• CTX/ADM/VP-16 (CAE)
• CAV alternating with PE
• PE ???????????
• CBP/VP-16???,?????

88
(No Transcript)
89
??

• ?????????,????
• ???????---???
• ???????
• ??,??,??????????
• ?????????????
• ??????????
• ????????????????
• X???
• ????????