¼±Åà - È­»ìǥŰ/¿£ÅÍŰ ´Ý±â - ESC

 

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.