UNG TH PHIThs. V PHM MINH TH

nh nghaL s tng trng khng kim sot ca cc t bo c tnh mt hay hai phi v cy kh ph qun. L hu qu ca s tip xc lu di vi cc cht gy ung thS pht trin ca cc t bo bt thng dn n s tng sn, lon sn hoc xm ln ti ch

Dch tJemal et al. Ca Statistics, 2007

Phn loi theo m bnh hc

Cc phn loi khc

V trPht trinTrung tmNgoi binLan taTrong lngNgoi thnh ph qunXuyn thnhPh iThm nhim

Pht trin trung tm

Ph i

Pht trin thm nhim

Yu t nguy cTip xc tia xHt thuc lTip xc c cht/ngh nghip Mi trng

Yu t ngh nghip chng minhNghi ngArsenicAsbestosBischloromethyl etherChromiumMustard gasNickelPolycyclic aromatic hydrocarbonsIonizing radiationAcrylonitrileBerylliumVinyl chlorideSilicaIron oreWood dust

Triu chng lm sng

Nhm triu chng lin quan n s pht trin ca khi u trong lng ngc.

Nhm cc triu chng c lin quan n di cn xa

Nhm cc triu chng ton thn v triu chng lin quan n hi chng cn u

Triu chng lin quan n s pht trin khi u trong lng ngc

Ho Ho ra muau ngcKh thKhn ting

Triu chng di cn vngChn p thc qun Nut kh Lit thn kinh qut ngc thanh qun Khn tingTn thng thn kinh giao cm Hi chng HornerXm ln thn kinh c/ngc Hi chngPancoastTc nghn hch bch huyt Trn dch mng phiTc nghn mch mu Hi chng chn p tnh mch ch trnXm ln mng tim, tim Trn dch, chn p tim

Hi chng Pancoast

Hi chng Horner

Hi chng cn u-Hi chng ph i xng khp trong bnh l phi Hi chng ch tit khng ph hp cc hormon chng bi niuHi chng tng nng ni tit v thng thnHi chng cn u lm tng calci mu Hi chng thn kinh c

Chn on: Ni soi ph qun ng mmQuan st trc tip tn thng cc ph qun ln (ung th loi t bo gai). Xc nh chnh xc v tr ca khi u v nh gi mc lan rng ca khi u.Sinh thit trc tip tn thngChi nim mc b mt vng tn thng Ra ht dch ph qun chn on t bo.

Chn on: Cc k thut khcChc ht xuyn thnh ngc di hng dn ca xquang thng qui hay CT ngc i vi cc khi st thnh ngc M lng ngc thm st chn on. Sinh thit mng phi nu c trn dch, Sinh thit hch ngoi vi nu c di cn hch.Ni soi lng ngc v ni soi trung tht lm gim nhiu cc ch nh m lng ngc thm st v tng kh nng chn on nh giai on trong ung th.

Hnh nh hc:X quangCTscan ngc3 dng tn thng:Trung tmNgoi binLan ta

Dng 1: Tn thng trung tmDu hiu trc tipKhi rn phi: ln rn phi 1 bn, tng m , hch rn phi Bt thng ph qun: khi ni lng, dy thnh, hp khng u, tc hon tonDu hiu gin tip: tc nghn ph qunKh ph thng (2%)Xp phi: ph binVim phi (ng c)

Tc nghn hon ton

Xp phi

Du hiu ch S ngc

Ung th t bo gai phi tri

Tc nghnKhi rn phi

Xp phiVim phi tc nghn

Dng 2: Tn thng ngoi viGiai on sm: D 2cmNt n c phiTn thng thm nhim nhin hnh: Khi phi

c im khi u c tnh phiV tr: bt kKch thc: thng > 4cmThi gian nhn i th tch: 120 ngyHnh dng: cu, oval, chia thy, n lm (notch)B: r/khng r, c gai (spiculated infiltrating)m : ng nht, calci ha (him), ph qun hi, to hang vi lng khng u, khng ng tm Xung quanh: du hiu ui mng phi

nocthedAir bronchogramspuclatedPleural tail sign

Tn thng thm nhim nh

air bronchiologram

Tn thng chia thy, du n lm

Tn thng to hang, lng trong khng u

Tua gai3D CT

Pancoast tumors (apical)

Du hiu ui mng phi

Dng 3: Tn thng lan taBronchiolo-alveolar carcinoma1. Nt m lan ta mt thy hoc nhiu thy 2 phi.c im: nhiu thy (di), tng hoc gim sng (ng c), hnh nh ph qun hi 2. ng vch lin thy, tiu thy: Kerley A, B3. Trn dch mng phi4. Rn phi v trung tht: ph i hch lympho

Nt lan taHnh nh knh m

Phn loi: 2 loi t bo ung th phiUng th khng t bo nh (Non Small Cell Lung Cancer-NSCLC)Adenocarcinoma

Squamous Cell Carcinoma

Large Cell Carcinoma

Ung th t bo nh (Small Cell Lung Cancer-SCLC)

Oat Cell

Intermediate

Combined

*