Lung cancer prevention
¨ç smoking cessatioon
¨è chemoprevention
H/N cancerȯÀÚ´Â Æó¾ÏÀÇ À§ÇèÀÌ ³ô´Ù.
À̶§ 13-cis retinoic acid¸¦ Åõ¿©ÇÔÀ¸·Î½á 2nd cancer risk¸¦ ³·ÃßÁö¸¸ significant toxicity
°¡ ÀÖ´Ù. vit E, ¥â-carotene´Â Æó¾ÏÀÇ À§ÇèÀ» Áõ°¡½ÃŲ´Ù.
±×·¯¹Ç·Î, ÇöÀç lung cancer¿¡ ´ëÇÑ chemoprevention¿øÄ¢Àº ¾ø´Ù.
Benign lung neoplasm : primary lung tumorÁß <5%
´ëºÎºÐ(90%)ÀÌ Bronchial adenoma & hamartoma
very uncommon : chondroma, fibroma, lipoma, hemangioma, leiomyoma, teratoma,
pseudolymphoma, endometriosis
1. Bronchial adenoma(80% - central)
slowly growing endobronchial lesion
¸ðµç benign pul. neoplasmÀÇ 50%
15-60¼¼¿¡ ¹ßÇö(Æò±Õ 45¼¼)
Áõ»ó¹ßÇö½Ã±îÁö ¼ö³âÀÌ °É¸²
: chronic cough, recurrent hemoptysis, atelectasis, pneumonitis, abscess formation
i) carcinoid(80-90%)
ii) adenocystic tumor(or cylindromas)(10-15%)
iii) mucoepidermoid tumor(2-3%)
1) Bronchial carcinoids - benign course
neuroendocrine phenotype(Kulchitsky cell°ú À¯»ç)
APUD(amine precursor uptake & decarboxylation) systemÀÇ ÀϺÎ
hormoneºÐºñ(ACTH or AVP)ÇÏ¿© paraneoplastic syndromeÀ» À¯¹ßÇÔ.
: tumor resection½Ã ¾ø¾îÁü.
- bronchial carcinoid metastasis(ÁÖ·Î liver) -> carcinoid syndromeÀ¯¹ß
: cutaneous flush, bronchoconstriction, diarrhea, cardiac valvular lesions
- µå¹°°Ô aggressive histologic app(atypical carcinoid)¸¦ º¸ÀÌ´Â °æ¿ì°¡ ÀÖ´Ù.
: 70%°¡ regional LN, liver, obneÀ¸·Î metastasis
cf. typical carcinoid = 5%
- hypervascularÇϹǷΠbiopsy½Ã ÁÖÀÇ
- potentially malignant -> Á¦°ÅÇØ¾ß ÇÔ
( sx relief¸ñÀû ¹× local invasion & metastasis°¡´ÉÇϹǷÎ)
- Ä¡·á = surgical resection
5YSR = 95%
regional LN(+) = 70%
2. Hamartoma
peak incidence : 60¼¼(M>F)
normal pul. tissue component(smooth m. collagen)ÀÌ disorganized fashionÀ¸·Î ±¸¼º
peripheral, clinically silent benign
popcorn calcification°ú °°Àº pathognomonic radiographic findingsÀÌ ¾ø´Ù¸é Áø´ÜÀ» À§ÇØ
ÀýÁ¦ÇØ¾ß ÇÑ´Ù(ƯÈ÷ smokerÀÎ °æ¿ì¿¡).
VATS·Î Op Cx¸¦ ÃÖ¼ÒÈÇÒ¼ö ÀÖ´Ù.
Metastatic pulmonary tumors
1) SPN + known extrathoracic tumorÀÎ °æ¿ì
SPNÀº primary lung canceró·³ approachÇÑ´Ù.
Áï 35¼¼ ÀÌ»ó, smokerÀÎ °æ¿ì, other site acitive cancer(-) -> ¼ö¼úÀû ÀýÁ¦
2) Multiple lung metastasis
pul. metastasis¸¦ ¼º°øÀûÀ¸·Î ÀýÁ¦ÇÒ¼ö ÀÖ´Â primary tumor
: colon, rectum, cervix, corpus tumor, H/N, breast, testis, salivary gland cancer,
melanoma, bladder, kidney cancer
carefully selected patient¿¡¼ 5YSR = 20-30%
* osteogenic sarcoma¿¡¼± dramatic result
=> pul. metastatic resectionÀÌ standard curative treatment
* ÆóÀüÀ̽à ÀýÁ¦ ÀûÀÀÁõ
¨ç ¿¹»óµÈ pul. resection¿¡ tolerableÇØ¾ß ÇÑ´Ù.
¨è primary tumor°¡ ¼º°øÀûÀ¸·Î Ä¡·áµÉ¼ö ÀÖ¾î¾ß ÇÑ´Ù.
¨é all known metastatic disease°¡ ÀýÁ¦ ¹üÀ§¿¡ Æ÷ÇԵǾî¾ß ÇÑ´Ù.