1. Malignant tumor of the respiratory system Nasopharygeal carcinoma Lung cancer

2. Pulmonary Carcinoma

3. Introduction No doubt it is the leading cause of cancer-related deaths. The incidence is increasing at a fast rate for both male and female. So it is the commonest cancer in the world.

4. Etiology: 1. Smoking and atmospheric pollution 2. Oncogenes and suppressor genes over express or/and mutation 3. Others: virus infection, asbestosis, radioactive substances inhalation et, al.

5. Pathology Gross types: 1. Central type (hilar type):

8. 2. Peripheral type (nodular type): single or multiple nodules arise in one of the small bronchi or bronchioles. 3. Diffuse type: rare

9. Peripheral type

13. Carcinoma in situ in bronchial mucosa or only invade the wall of bronchi, mass<2cm, no LN metastasis. Early lung cancer:

14. Occult lung cancer Exam of sputum(+) Clinical feature (-) X-ray exam (-) Pathology: carcinoma in situ or early invasive carcinoma

15. Histologic types: 1. Squamous cell carcinoma: The commonest type and most closely associated with cigarette smoking. Well- differentiated Poorly-differentiated Undifferentiated

19. 2. Adenocarcinoma Usually shown as peripheral type, grow rapidly; hematogenous metastasis may happen early and widely spread. Special types: Bronchiolo-alveolar carcinoma Colloid carcinoma Scar cancer

22. Bronchiolo-alveolar carcinoma

23. 3. Small cell (or oat cell) carcinoma: * Probably derived from neuroscretory cells (a kind of APUD cells) of bronchial mucosa. * Highly malignancy; * Growth rapidly; * Metastasis early and widely; * Radiosensitive.

27. 4. Large cell carcinoma 5. Adeno-squamous carcinoma

28. Large cell lung cancer

31. Patterns of spread and complications: 1. Direct extention (1). Obstruction of airway (2). Pleurisy with effusion, often hemorrhagic in nature.

32. (3). Extension of apical lung cancers may involve the lower cords of bronchial plexus and cervical sympathetic plexus ( Horner’s Syndrome: ptosis, miosis, anhydrosis)

33. 2. Lymphatic metastasis 3. Hematogenous metastasis

34. Clinical manifestation: Methods for lung cancer diagnosis: 1. Sputum cytology, pleural effusion cytology 2. Fiberbronchoscope examination and biopsy 3. X-ray examination and CT 4. Fine-needle aspiration biopsy

35. NASOPHARYNGEAL CARCINOMA

36. Introduction Etiology: The major risk factors are follows: 1. Smoking 2. Food with high carcinogen contents 3. Virus infection: EB Virus 4. Genetic and family history

37. Pathology Location: Nasopharyngeal roof, lateral wall and pharyngeal recess

38. Gross type: Nodular type Cauliflower type Submucosa type Ulcerative type Unclassified type.

41. Histologic type: 1. Keratinizing squamous cell carcinoma 2. Non-keratinizing carcinoma Differentiated carcinoma Undifferentiated carcinoma Vesicular nuclear cell carcinoma 3. Adenocarcinoma

44. 1. Direct extension Upward to base of skull Laterally to auditory tube and middle ear Forward to nasal cavity, orbit Spread and metastasis:

45. 2. Lymphatic metastasis: Retropharyngeal LN Upper deep LN Internal jugular vein LN Superior cervical LN Important: Cervical LN enlargement may be the first scene of NPC 3. Hematogenous metastasis