1. Thoracic surgery Thoracic Surgery Department Regional Hospital for Lung Diseases Szczecin Zdunowo, Poland

2. Long time ago

3. Much later

4. Main carcinogenic factors • Chemicals • Asbestos • Benzidine • methyl eter • Vinyl chloride • Aromatic hydrocarbons CIGARETTE SMOKING • Occupational exposure • Coal gasification • Hematite and uranium mining • Contact with arsene, nickel, beryl, chrome

5. So called early lung cancer symptoms • Cough • Hemoptysis • Intrathoracic pain • Recurrent pneumonias • Are those symptoms really early?

6. Paraneoplasmatic symptoms • Cushing syndrome • Hipercalcemia • Gynaecomastia • Polymyosistis • Peripheral neuropathy • Myasthenia • Proliferatic osteoarthropathy • Lupus erythematosus • Acanthosis nigricans • Anaemia, leucopenia • Thrombocytopaenia • Thrombophlebitis migrans • Aseptic endocarditis

7. Histology

8. Diagnosis • Radiology: X-ray, CT, NMR, USG, scintigraphy • Pathology: sputum cytology, endoscopy, FNAB mediastinoscopy, VATS, explorative thoracotomy • Genetics: p53, k-ras, CEA, cyfra 21-1, myc

11. Contraindications for surgery • Dissemination • Horner`s syndrome • Vena cava syndrome • Vocal cord paresis • Pancoast syndrome • WHO>2

12. Surgical approach • Antero- and anterolateral • Posterolateral • Sternotomy • Clamshell • Paulson • Mixed

13. Anterior thoracotomy

14. Posterolateral thoracotomy

15. Sternotomy

16. Clamshell

17. Paulson

18. Mixed

19. Types of surgery • Pneumonectomy • Lobectomy (incl. sleeve) • Segmentectomy • Wedge or marginal resection • VATS

24. Long term survival rates

25. Combined treatment

26. Pneumothorax • Close • Open • Tension

28. Treatment • Bed rest • Drainage • Pleurectomy

29. Drainage