肺癌

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　　肺癌的临床表现与癌肿的部位，大小，是否压迫，侵及邻近器官以及有无转移等情况有密切关系，癌肿在较大的支气管内生长,常出现刺激性咳嗽，癌肿增大影响支气管引流,继发肺部感染时可以有脓痰，另一个常见的症状是血痰,通常为痰中带血点，血丝或间断少量咯血有些病人即使出现一两次血痰对诊断也具有重要参考价值，有的病人由于肿瘤造成较大支气管阻塞,可以出现胸闷，气短，发热和胸痛等症状，晚期肺癌压迫邻近器官，组织或发生远处转移时,可以产生：
　　①压迫或侵犯膈神经,引起同侧膈肌麻痹，
　　②压迫或侵犯喉返神经,引起声带麻痹声音嘶哑，
　　③压迫上腔静脉引起面部，颈部，上肢和上胸部静脉怒张，皮下组织水肿，上肢静脉压升高，
　　④侵犯胸膜,可以引起胸腔积液,多为血性，
　　⑤癌肿侵入纵隔,压迫食管,可引起吞咽困难，
　　⑥上叶顶部肺癌,亦称Pancoast肿瘤或肺上沟瘤,可以侵入和压迫位于胸廓上口的器官或组织,如第一肋骨，锁骨上动脉和静脉，臂丛神经，颈交感神经等,产生胸痛，颈静脉或上肢静脉怒张，水肿，臂痛和上肢运动障碍,同侧上眼睑下垂,瞳孔缩小,眼球内陷,面部无汗等颈交感神经综合征，少数肺癌,由于癌肿产生内分泌物质,临床上呈现非转移性的全身症状：如骨关节综合征(杵状指，关节痛，骨膜增生等)，Cushing综合征，重症肌无力，男性乳腺增大，多发性肌肉神经痛等肺外症状，这些症状在切除肺癌后可能消失。

　　肺癌起源于支气管粘膜上皮，局限于基底膜内者称为原位癌，癌肿可向支气管腔内或/和临近的肺组织生长，并可通过淋巴，血行或经支气管转移扩散，癌瘤生长速度和转移扩散的情况与癌瘤的组织学类型，分化程度等生物学特性有一定关系，肺癌的分布情况，右肺多于左肺，上叶多于下叶，从主支气管到细支气管均可发生癌肿，起源于主支气管，肺叶支气管的肺癌，位置靠近肺门者，称为中央型肺癌起源于肺段支气管以下的肺癌，位置在肺的周围部分者，称为周围性肺癌，

　　肺癌的分类，临床上一般将肺癌分为下列四种类型
　　1.鳞形细胞癌(又称鳞癌)：在各种类型肺癌中最为常见，约占50%，患病年龄大多在50岁以上，男性占多数，大多起源于较大的支气管，常为中央型肺癌，虽然鳞癌的分化程度有所不同，但一般生长发展速度比较缓慢，病程较长，对放射和化学疗法较敏感，首先经淋巴转移，血行转移发生较晚，
　　2.未分化癌：发病率仅次于鳞癌，多见于男性，发病年龄较轻，一般起源于较大支气管，居中央型肺癌，根据组织细胞形态又可分为燕麦细胞，小圆细胞和大细胞等几种类型，其中以燕麦细胞最为常见，未分化癌恶性度高，生长快，而且较早地出现淋巴和血行广泛转移，对放射和化学疗法较敏感，在各型肺癌中预后最差，
　　3.腺癌：起源于支气管粘膜上皮，少数起源于大支气管的粘液腺，发病率比鳞癌和未分化癌低，发病年龄较小，女性相对多见，多数腺癌起源于较小的支气管，为周围型肺癌，早期一般没有明显的临床症状，往往在胸部x线检查时被发现，表现为圆形或椭圆形肿块，一般生长较慢但有时早期即发生血行转移，淋巴转移则发生较晚，
　　4.肺泡细胞癌：起源于支气管粘膜上皮，又称为细支气管肺泡细胞癌或细支气管腺癌，部位在肺野周围，在各型肺癌中，发病率最低，女性比较多见，一般分化程度较高，生长较慢，癌细胞沿细支气管，肺泡管和肺泡壁生长，而不侵犯肺泡间隔，淋巴和血行转移发生较晚，但可经支气管播散到其他肺叶或侵犯胸膜，肺泡细胞癌在形态上有结节型和弥漫型两类，前者可以是单个结节或多个结节后者形态类似肺炎，病变范围局限的结节型，手术切除疗效较好。

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==== 汉译英 ====

The clinical manifestations of lung cancer and cancer of the location, size, whether the oppression, invasion, and adjacent organs, as well as whether the transfer case is closely related to cancer in a larger endobronchial growth, often appear irritating cough, increased cancer effects bronchial drainage, secondary pulmonary infection can Nong Tan, another common symptom is blood sputum, usually bloody sputum point, bloodshot, or intermittent small amount of hemoptysis some patients even if there is one or two blood sputum in the diagnosis also has important reference value Some patients with the tumor can cause greater bronchial obstruction can occur chest tightness, shortness of breath, fever and chest pain and other symptoms of advanced lung cancer oppression adjacent organs, tissues or distant metastasis occurs, it can produce:
① oppression or violation of the phrenic nerve, causing ipsilateral diaphragm paralysis,
② oppression or violation of the recurrent laryngeal nerve, vocal cord paralysis caused by a hoarse voice,
③ oppression of the superior vena cava caused by the face, neck, upper and upper chest, venous engorgement, subcutaneous tissue, edema, upper extremity venous pressure is increased,
④ violation of the pleura, can cause pleural effusion, mostly bloody,
⑤ cancer mediastinal invasion, oppression, esophagus, can cause difficulty in swallowing,
⑥ the top of the upper lobe of lung cancer, also known as Pancoast tumors or Pancoast tumor, can invade and oppression in the thoracic outlet of the organ or tissue, such as the first rib, the subclavian artery and vein, brachial plexus, cervical sympathetic, etc. produce chest pain, neck vein or upper extremity venous engorgement, edema, arm pain and upper limb movement disorder, ipsilateral upper eyelid ptosis, miosis, enophthalmos, facial sweat-free and other cervical sympathetic syndrome, a small number of lung cancer, because cancer produce endocrine substances, the clinical present non-metastatic systemic symptoms: such as bone and joint syndrome (clubbed fingers, arthralgia, periosteal proliferation, etc.), Cushing syndrome, myasthenia gravis, male breast increase, multiple muscle neuralgia, etc. extrapulmonary symptoms, these symptoms may disappear after the removal of lung cancer.

Lung cancer originated in the bronchial mucosa epithelium, confined within the basement membrane are known as carcinoma in situ, cancer can bronchial cavity or / and adjacent lung tissue growth, and through lymphatic and blood-line or through the transfer of the proliferation of bronchus, carcinoid tumor growth speed and the transfer of the proliferation of carcinoma of the situation and the histological type, differentiation degree of biological characteristics of a certain relationship between the distribution of lung cancer, right lung than the left lung, upper lobe rather than under the leaves, from the main bronchi to the bronchioles were cancer can occur, originated in the main bronchus, lobar bronchus of lung cancer, the location close to the hilum are known as the central type of lung cancer originated in the lung following segmental bronchus of lung cancer, the location around the part of those in the lung, known as peripheral lung cancer,

The classification of lung cancer clinical practice will generally be divided into the following four types of lung cancer
1. Squamous cell carcinoma (also known as squamous cell carcinoma): In the most common types of lung cancer, accounting for about 50%, they will suffer most in the 50 years of age, male-dominated, mostly originated in the larger bronchi, and often central-type lung cancer, although the degree of differentiation of squamous cell carcinoma be different, but relatively slow rate of growth and development in general, longer course of radiation and chemotherapy, more sensitive, first of all through the lymph node metastasis, hematogenous metastasis occurs late,
2. Undifferentiated carcinoma: incidence rate second only to squamous cell carcinoma, more common in men, younger onset, generally originated in the larger bronchi, ranking the central type lung cancer, according to tissue morphology can be divided into oat cell, small round cells and several types of large-cell, etc., of which the most common oat cell undifferentiated carcinoma of high grade, fast growth, and the earlier appearance of a broad line of lymphatic and blood transfer, radiation and chemotherapy, more sensitive, in all types of lung cancer prognosis of the most poor
3. Adenocarcinoma: originated in the bronchial mucosa, a small number originated in the large bronchial mucous glands, the incidence rates of squamous cell carcinoma and undifferentiated carcinoma than in the low age of onset of a smaller, female is relatively more common, the majority originated in the smaller bronchial adenocarcinoma , for peripheral lung cancer, early in general there is no obvious clinical symptoms, often in the chest x-ray examination was found, showing round or oval lumps, usually slow growing but sometimes it occurs early stage of hematogenous metastasis, lymphatic metastasis occurred more night
4. Alveolar cell carcinoma: originated in the bronchial mucosa, also known as bronchioloalveolar cell carcinoma or bronchioloalveolar adenocarcinoma, located in the lung field around the various types of lung cancer incidence rate for the lowest, females are more prevalent, the general degree of differentiation higher, slower growth, cancer cells along the bronchioles, alveolar duct and alveolar wall growth, without encroaching upon the alveolar septum, lymphatic and hematogenous metastasis occurs late, but can spread to another lobe bronchial or violation of the pleura, alveolar cell carcinoma In the form there are two types of nodular type and diffuse type, the former can be a single nodule or multiple nodules, which form similar to pneumonia, nodular lesions limited the scope of surgical resection better