Lung cancer, bronchogenic carcinoma

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• Lung cancer, bronchogenic carcinoma
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Squamous cell Ca

• 30-40,generally central (70 hilar or perihilar
  in subsegmental or larger bronchi)
• strong association with cigarette smoking
• about 15 bronchogenic carcinomas are cavitary,
  and of these, nearly 60 are squamous cell
  lesions, wall typically thick and nodular

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• intralumenal growth pattern- often resulting in
  distal atelectasis or post-obstructive
  pneumonitis (a non-infectious process).
• the lowest frequency of distant metastases,
  spreads to involve local nodes by direct
  extension
• the most favorable prognosis
• Hypertrophic osteoarthropathy

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adenocarcinoma

• as common as squamous cell carcinoma (30-40).
• generally peripheral (75)
• uncommonly cavitate
• commonly metastasizes early to lymph nodes, the
  pleura, adrenal glands, CNS, and bone.

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Small cell Ca

• 15-20 of primary lung malignancies
• the strongest association with cigarette smoking
• the most likely to produce ectopic hormones- most
  commonly resulting in Cushings syndrome (ACTH) or
  syndrome of inappropriate antidiuretic hormone
  (SIADH)

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• generally central (85-90 within a lobar or
  mainstem bronchi) and has a tendency to invade
  longitudinally along the bronchial wall, in a
  submucosal and intramural fashion
• Internal necrosis is common, but cavitation is
  extremely rare
• the worst prognosis, despite typically good
  response to initial chemotherapy

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Large Cell Ca

• only 5-10
• strongly associated with cigarette smoking
• typically peripheral and generally large (over 4
  to 6 cm), with rapid growth, early metastases,
  and a poor prognosis

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Pancoast tumor

• apical density (superior pulmonary sulcus)
• destruction or adjacent rib or vertebra
• Horner's syndrome
• pain in arm
• usually bronchogenic Ca (squamous type)
• also mets, malignant neurogenic tumor

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• ??????,TNM??
• ??X????CT?MRI?PET?

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T1 A tumor less than or equal to 3 cm in
greatest dimension, surrounded by lung or
visceral pleura, without bronchoscopic evidence
of invasion more proximal than the lobar bronchus
(i.e., not in the main bronchus).
TUMOR
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T2 A tumor with any of the following
features i) Larger than 3 cm in largest dimension
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ii) Associated with atelectasis or
post-obstructive pneumonitis that extends to the
hilar region, but does not involve the entire lung
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iii) Invades the visceral pleura
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T3 A tumor of any size that directly invades any
of the following the chest wall (including
superior sulcus tumors), diaphragm, mediastinal
pleura, parietal pericardium or tumor in the
main bronchus less than 2 cm distal to the carina
(but without involvement of the carina) or tumor
associated with atelectasis or obstructive
pneumonitis of the entire lung.
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T4 A tumor of any size that invades any of the
following mediastinum, heart, great vessels,
trachea, esophagus, vertebral body, carina or
any tumor with a malignant pleural or pericardial
effusion or with satellite tumor nodules within
the ipsilateral primary-tumor lobe of the lung.
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Regional Lymph Node Status (N)
N1 Ipsilateral peribronchial or hilar nodal
metastases or intrapulmonary nodes involved by
direct extension of the primary tumor. All N1
nodes lie distal to the mediastinal pleural
reflection.
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N2 Ipsilateral mediastinal and subcarinal lymph
nodal metastases. Midline pre-vascular and
retrotracheal nodes are considered ipsilateral
5, while nodes to the contralateral side of
midline are considered N3
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N3 Contralateral mediastinal or contralateral
hilar nodal metastases also includes ipsilateral
or contralateral scalene or supraclavicular
nodes. Other cervical nodes are classified M1
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Distant Metastasis (M) M0 No distant metastasis
M1 Distant metastasis present or separate
tumor nodules in the ipsilateral nonprimary-tumor
lobes of the lung. Separate tumor nodules in the
contralateral lung are considered M1 if they are
of the same histologic cell type as the primary
lesion. A contralateral lung tumor with a
different cell type is considered a synchronous
primary lesion and should be staged independently

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???????? tuberculosis of bronchial lymph nodes
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?????? infiltration and proliferation
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2?TB??????????? infiltrative pulmonary
tuberculosis with cavity
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??? tuberculoma
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??? tomography
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?????TB Miliary TB
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