,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Treatment of,Lung Cancer,01Feb,201,5,Treatment of Lung Cancer01Feb2,1,Content,I,ntroduction,Chemotherapy,Radiotherapy,Immunotherapy,Targetted therapy,Symptoms and Signs,Surgery,ContentIntroductionChemotherap,2,2024/11/19,Introduction,肺癌目前是全世界癌症死因的第一名。,1995,年全世界有,60,万人死于肺癌，而且每年人数都在上升，,2003,年世界卫生组织（,WHO,）公布的死亡率是,110,万,/,年，发病率是,120,万,/,年。,男女患病率为,2.3:1,。另外种族、家属史与吸烟对肺癌的发病均有影响。,2023/8/4Introduction肺癌目前是全世界癌症,3,2024/11/19,Introduction,The main types of lung cancer are,small-cell lung carcinoma(SCLC),and,non-small-cell lung carcinoma(NSCLC).,The most common cause of lung cancer is long-term exposure to,tobacco smoke,which causes 8090%of lung cancers,The mean age at diagnosis of lung cancer is,60,it is unusual under the age of 40.After the diagnosis of lung cancer is made,approximately,40%of patients survive 1 year,the combined 5-year survival rate for all stages of lung cancer is now approximately 15%.,2023/8/4IntroductionThe main t,4,2024/11/19,Introduction,基本类型,小细胞肺癌：小细胞肺癌（SCLC）近20%的肺癌患者属于这种类型，对放化疗敏感，故小细胞肺癌的治疗应以全身化疗为主，,非小细胞肺癌：非小细胞肺癌（NSCLC）类，约80%的肺癌患者属于这种类型。,非小细胞肺癌是一种恶性程度较高，易复发、转移的恶性肿瘤，超过半数以上的患者在确诊时已属相对晚期，治疗必须采用针对全身兼顾局部的多学科治疗方法（包括手术、放疗、化疗、免疫治疗及靶向治疗）。,2023/8/4Introduction基本类型,5,Treatment of Lung Cancer(肺癌的治疗方法)_课件,6,Treatment of Lung Cancer(肺癌的治疗方法)_课件,7,2024/11/19,Symptoms and Signs,Anorexia,weight loss,or asthenia,(,无力,),occurs in 5588%of patients presenting with a new diagnosis of lung cancer.,Up to 60%of patients have a new cough or a change in a chronic cough,6%31%have hemoptysis 咳血,25%40%complain of pain,sometimes nonspecific chest pain but often referable to bony merastases to the vertebrae脊椎,ribs肋骨,or pelvis骨盆,2023/8/4Symptoms and SignsAnor,8,2024/11/19,Treatment,肺癌的治疗方法,手术 41%,化疗 23%,放疗 11%,手术+化疗 4%,手术+化疗 3%,放化疗 12%,此外还有靶向治疗,免疫治疗,中药治疗等,2023/8/4Treatment肺癌的治疗方法,9,2024/11/19,Treatment-Surgery,外科治疗的重要性,外科治疗是肺癌首选的，主要的治疗措施,外科治疗能在最大范围内切除病灶及引流的淋巴结和受侵犯的临近组织，能实现根治，是所有治疗中效果比较显著的。,2023/8/4Treatment-Surgery外科治疗的,10,2024/11/19,Treatment-Surgery,适合外科手术的患者,非小细胞肺癌IIIIA期,如无手术禁忌，以手术为首选疗法,手术也参与一些中晚期治疗的综合治疗,小细胞肺癌,除了少部分I期外，均应先行化疗，然后根据情况决定是否手术,2023/8/4Treatment-Surgery适合外科手,11,2024/11/19,Treatment-Surgery,不适合做手术的患者,对侧肺门，淋巴结转移,胸外（锁骨上，腋下）淋巴结转移,肝脑肾等远处存在转移,很差的全身健康状况,2023/8/4Treatment-Surgery不适合做手,12,2024/11/19,Treatment-Surgery,手术的原则,彻底切除原发灶和胸腔内有可能转移分淋巴结，且尽可能保留正常的肺组织,手术,局部切除术,肺叶切除术,全肺切除术,2023/8/4Treatment-Surgery手术的原则,13,2024/11/19,Treatment-Radiotherapy,放疗应作为综合治疗的一部分和化疗，手术等方法联合,适宜人群,体力状态较好,肺功能不太差,病变位于胸腔内,2023/8/4Treatment-Radiotherapy,14,2024/11/19,Treatment-Radiotherapy,放疗的不良反应,放射性皮炎,照射区皮肤常有触痛，瘙痒，重者可出现渗液，结痂等。,放射性肺炎,放射性肺炎有急性期，一般几个月多数患者都能有所恢复,放射性食管炎,放疗2周可出现进食疼痛，应进松软，温稀，无刺激的食物,2023/8/4Treatment-Radiotherapy,15,2024/11/19,Treatment-Chemotherapy,用化学药物杀死肿瘤细胞的一种方法,不分好坏，一律杀死,全身治疗中目前应用最广泛和成熟的治疗方法,2023/8/4Treatment-Chemotherapy,16,2024/11/19,Treatment-联合化疗,目的,通过应用多种作用机制不同的化疗药物以增加对肿瘤细胞的杀伤力,目前联合化疗是非小细胞肺癌或小细胞肺癌的常用方案,非小细胞肺癌的常用化疗方案,铂类（顺铂Cisplatin，卡铂Carboplatin）+以下方案之一,吉西他滨Gemcitabine，紫杉醇Paclitaxel，多西他赛Docetaxel，长春瑞滨Vinorelbine，培美曲塞pemetrexed等,2023/8/4Treatment-联合化疗目的,17,2024/11/19,Treatment-联合化疗,小细胞肺癌的常用化疗方案,铂类（顺铂Cisplatin，卡铂Carboplatin）+以下方案之一,依托泊苷，异环磷酰胺，紫杉醇Paclitaxel，多西他赛Docetaxel，吉西他滨，多柔比星等,2023/8/4Treatment-联合化疗小细胞肺癌的常用,18,2024/11/19,Treatment-化疗,化疗方案的指定,患者所患癌症的病例类型及病情分期,癌症发生部位,患者的全身体能状态,癌症对患者正常身体功能的影响,询证医学的证据,患者的经济状况和个人意愿,2023/8/4Treatment-化疗化疗方案的指定,19,2024/11/19,Treatment-化疗,化疗的不良反应,药物对血管内膜的刺激可引起静脉炎,骨髓抑制：最主要且最常见的不良反应，发生在化疗后814天，主要表现为白细胞，红细胞，血小板降低,胃肠道反应：恶心，呕吐，腹泻，便秘，食欲减退,其他,肾功能损害，脱发，心肌损害，神经毒性等,2023/8/4Treatmen