小细胞肺癌诊断治疗进展r.pptVIP

Small Cell Lung Cancer (SCLC):Diagnosis, Treatment and Natural HistoryGary L.Weinstein M.D. SCLCLung cancer epidemiologySCLCPathologyTumor markersGeneticsClinical courseStagingTreatment SCLC, factoids15 – 25 % of all lung cancersAlmost exclusively in smokersDistinguished from NSCLC by:Rapid doubling timeHigh growth fractionEarly development of wide-spread mets SCLC, factoids (cont’d)Considered highly responsive to “chems and beams”BUT…usually relapses within 2 years despite treatmentOverall, only 3 –8 % of all patients survive more than 5 yearsMost common malignancy associated with Neurologic paraneoplastic syndromes SCLC, pathologyMost recent (1999) WHO classificationClassical small cell carcinomaLarge cell neuroendocrine cancerCombined small cell carcinoma with some NSCLCCells are approx. 2 X’s the size of normal lymphocytes SCLC, pathology ????????????????????????????????????????????????????????????????????????????????????????????????????????? SCLC, pathology ????????????????????????????????????????????????????????????????????????????????????????????????????????????? SCLC, clinical presentationTypically arise centrallyMost common presentation is a large hilar mass with bulky mediastinal LANCommon symptoms cough, SOB, wt lossApprox. 70 % with overt mets at presentationCommonly spread to liver, adrenals, bone and brainCan present with paraneoplastic syndome SCLC, tumor markers3 main groups: Neural, Epithelial, NeuroendocrineEpithelial: virtually all SCLCs are immunoreactive for Keratin and Epithelial Membrane Antigen1 or more markers of Neural/Neuroendocrine differentiation found in approx. 75 % of SCLCs SCLC, tumor markersLeads to expression of dopa decarboxylase, calcitonin, neuron-specific enolase, chromogranin A, CD-56 (a neural cell adhesion molecule) gastrin releasing peptide and insulin-like growth hormoneOccasionally patients produce antibodies that cross-react with both the SCLC cells and the CNS ? cerebellar degeneration syndromesSCLC cells can produce