9317019 9317035.. 1
2
85 3
4
5
TX, Tis (carcinoma in situ) T1 (1) 3 (2) (visceral pleura) (3) (main bronchus) T2 (1) > 3 (2) (visceral pleura) (3), (carina) 2 (4) (atelectasis) (obstructive pneumonitis) (hilar region) 6
T3 T4 (1) ( superior sulcus tumor) (mediastinal pleura)(parietal pericardium) (2), (carina) 2, (3) (atelectasis) (obstructive pneumonitis) (1) (vertebral body) (2) (carina) (3) (4) 7
Stage Groupings Stage IA T1 N0 M0 Stage IB T2 N0 M0 Stage IIA T1 N1 M0 Stage IIB T2 N1 M0 T3 N0 M0 Stage IIIA T1-T3 N2 M0 T3 N1 M0 Stage IIIB Any T N3 M0 T4 Any N M0 Stage IV Any T Any N M1 Limited stage (1) (2) Extensive stage (1) (2) 70% 8
9
(Brinkman Index) > 400 60 (ex ) 10
CBC/DC LDH Albumin Alk-p Ca 酶 : CEA SCC Chest x-rays X CT (Computed Tomography scans) PET (Positron Emission Tomography) MRI (Magnetic Resonance Imaging) Tumor marker Fiberoptic Bronchoscopy Percutaneous Needle Biopsy Open-Lung Biopsy 11
Normal Posterior to Anterior (PA) Chest X-ray 12
CT guide 1 X X 13
14
15
16
PET 17
18
Sputum cytology Chest x-rays X CT (Computed Tomography scans) PET (Positron Emission Tomography) MRI (Magnetic Resonance Imaging) Tumor marker Fiberoptic Bronchoscopy Percutaneous Needle Biopsy Open-Lung Biopsy 0.2 2 75% /, 25% / 19
20
74-96% 21
Open lung biopsy is a test in which a small piece of the lung tissue is removed through a surgical incision in the chest. The sample is then examined for cancer, infection, or lung diseases. 22
23
CEA CEA ( ) CEA CEA CEA(normal range is <2.5 ng/ml in an adult non-smoker and <5.0 ng/ml in a smoker.) (Neuroblastoma) NSE (glycolytic enzyme enolase) NSE 24
NSE NSE < 15.2 ng/ml 1. 0.5 ml 2. NSE 3. 30 25
26
27
1 yr 6.5 ng/ml 1-15 yr 0.5-15 ng/ml 15 yr 5 ng/ml (Somatotropic hormone SH Somatotropin) 188 21500 28
29
platinum-based( ) taxane paclitaxel (Taxol) docetaxel (Taxotere) HER1/FGFR 酶 (tyrosine kinase) Erlotinib HER1/EGFR 酶 (EGFR HER1 c-erbb-1) EGF ( TGF-α) EGFR Erlotinib EGFR 酶 (EGFR-associated kinases) 酶 (matrix metalloproteinase) (VEGF) 30
酶.. 31
32