肺癌

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　　肺尖癌，顾名思义就是发生在肺尖部的原发性支气管肺癌，临床少见，约占肺癌总数的5％。由于肺尖癌常常向肺外生长，并易侵犯胸壁、臂丛神经、交感神经、锁骨下血管、肋骨、颈胸椎骨等脏器而引起各种症状，很容易被病人和医师们漏、误诊。因此，获得早期诊断对提高手术切除率和延长病人的生存时间十分重要。
　　肺尖癌有哪些表现因为人的胸廓好像一个圆锥形，胸廓出口相对狭小，各种血管神经等重要脏器由此通过，加之肺尖癌位于肺的周边，呼吸道的症状，如咳嗽咳痰早期并不常见，有的病人可有咯血。大多病人像王老太太一样，主要表现为颈肩部的疼痛，有的可波及肘部和手指引起肌肉萎缩和无力。当肿瘤侵犯肋间神经时可表现有上胸部无法忍受的疼痛，还有的病人可出现眼睑下垂、面部无汗、视物不清等症状。
　　哪些检查可以确诊 一般可先做胸部X线正侧位片和胸部CT扫描，了解肿瘤的部位、大小，周围骨受累与否。必要时行胸部核磁共振检查，以便更好地显示肿瘤与血管及神经的关系，了解肿瘤对周围骨侵犯范围。还可以做正电子发射断层显像（简称PET）、纵隔镜和胸腔镜检查，以减少不必要的开胸探查。另外，肺癌诊断的金标准是病理学，因此，可以行纤维支气管镜检查、经皮穿刺肺活检等，获取病理组织明确诊断。
　　如何治疗一旦明确诊断，肿瘤专科医生应将病人的检查资料进行综合分析，对肺尖癌进行准确分期，对不是早期的肺尖癌病人可先行术前新辅助治疗，因为单纯的外科手术或单纯的放疗结果尚不能令人满意，有些只能减轻症状。而新辅助治疗（放疗和化疗联合治疗）能缩小肿瘤，提高外科切除率，延长生存时间。因此，通过新辅助治疗，病人的临床症状和病变范围可发生较大改善，为手术创造更有利的条件。近年来，由于外科手术技能的不断提高，肺尖癌肿侵犯邻近的锁骨下血管，单个椎体或椎板已不再是手术的禁忌。如果肿瘤已经侵犯椎管，甚至表现有脊髓压迫症状者、臂丛受侵者，脑部、腹部等远处转移者则不宜手术。
　　肺尖癌的治疗与其他任何恶性肿瘤的治疗一样，其目的在于力求达到局部控制和转移控制，最佳的治疗方案还是多种手段的综合治疗和规范化治疗。手术、放疗、化疗是肺尖癌的三大支柱性治疗。应该强调的是外科手术仍然是肺尖癌的重要治疗手段。在病人接受新辅助治疗后，外科医生可根据病变范围，切除包括部分胸壁、邻近受侵组织和肺叶。
　　如何早期发现肺尖癌：由于肺尖癌缺乏特异性症状和体征，特别是在早期可以无症状，很易漏诊。因此，应注意以下几个问题：一是男性，50岁以上，吸烟量400支／年以上者，应定期做胸部X线片或胸部CT检查，一旦发现可疑病变，应采取有效手段尽快确诊；二是不明原因的颈肩部疼痛，经检查排除颈椎病者；三是顽固性胸痛，或上肢疼痛，对症治疗疼痛不能缓解者；四是原有的慢性咳嗽进行性加重或出现咯血、气急、声嘶等症状者；五是中青年肺癌有大量报道，切不可放松警惕，年轻人顽固的颈肩痛、关节痛应仔细寻找原因。

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==== 汉译英 ====
Apex cancer is, by definition that occurred in the Department of Primary Apical bronchial lung cancer, clinical rare, accounting for 5% of the total number of lung cancer. As the apex to the lung cancer is often outside the growth, and easy to violations of chest wall, brachial plexus, sympathetic nerve, subclavian vessels, ribs, neck bones and other organs caused by thoracic variety of symptoms, can easily be missed patients and physicians, misdiagnosis . Thus, access to early diagnosis of surgical resection rate and prolong the survival time of patients is very important.
Apex What are the performance of cancer because people like a conical thorax, thoracic outlet is relatively small, all kinds of vessels and nerves through this and other important organs, combined with apical lung cancer in the peripheral, respiratory symptoms, such as cough sputum early not common, some patients may have hemoptysis. Mrs. Wang, the same as the majority of the patients, mainly manifested as the shoulder and neck pain, and some can be spread to the elbow and fingers cause muscle atrophy and weakness. When the intercostal nerve tumor invasion may have on the performance of intolerable chest pain, as well as patients, there may be ptosis, facial sweat-free, depending on the material unclear symptoms.
What checks can be diagnosed generally do first is lateral chest X ray films and chest CT scans to understand the tumor site, size, surrounded by bone involvement or not. Chest MRI when necessary, in order to better show the tumor and the relationship between blood vessels and nerves to understand the scope of violations of tumor on the surrounding bone. Can be done positron emission tomography (referred to as PET), mediastinoscopy and thoracoscopy in order to reduce unnecessary exploratory thoracotomy. In addition, the gold standard for diagnosis of lung cancer is a pathology, therefore, you can fiberoptic bronchoscopy, percutaneous lung biopsy to obtain histopathological diagnosis.
How to treat once diagnosed, cancer specialists examine the patient's data should be a comprehensive analysis of the apical accurate cancer staging of cancer is not early apex may first preoperative neoadjuvant therapy, surgery or because of simple The results of radiotherapy alone is still not satisfactory, and some can only alleviate the symptoms. The new adjuvant therapy (radiotherapy and chemotherapy combination therapy) can shrink tumors, improve the surgical resection rate and prolong survival time. Therefore, the adoption of new adjuvant therapy, the patient's clinical symptoms and extent of the lesion may occur greatly improved, in order to create more favorable conditions for surgery. In recent years, due to the continuous improvement of surgical skills, apex cancer violation of the adjacent subclavian vessels, a single vertebral body or lamina is no longer a contraindication for surgery. If the tumor has already violated the spinal canal, or even manifestations of symptoms of spinal cord compression, brachial plexus invasion persons, brain, abdomen and other distant metastases were not operative.
Apex cancer treatment and the treatment of cancer, like any other with the aim of striving to achieve local control and transfer of control, the best treatment options, or various means of integrated treatment and standard treatment. Surgery, radiotherapy and chemotherapy are the three pillars of apical cancer treatment. It should be emphasized that surgery is still an important apical cancer treatment. In the patients receiving neoadjuvant treatment, the surgeon according to extent of the lesion, excision, including part of the chest wall, close to invasion organizations and lung.
How to apical early detection of cancer because of the lack of apical cancer-specific symptoms and signs, especially in the early stage may be asymptomatic, it is easily missed. Therefore, should pay attention to the following questions: First, male, over 50 years of age, smoking 400 / year or more should be done on a regular basis chest X-ray film or chest CT examination, if suspicious lesions should be diagnosed as soon as possible to take effective measures ; second, of unknown causes neck and shoulder pain, cervical spondylosis were excluded after inspection; third, refractory chest pain, or upper limb pain, symptomatic treatment can relieve pain and persons; four are the original progressive chronic cough aggravated or there hemoptysis, shortness of breath , hoarseness and other symptoms; five young of lung cancer is a large number of reports must not relax our vigilance, young stubborn neck and shoulder pain, joint pain should be carefully find the reason.