Brief introduction of GBZ 94-20 17 occupational tumor diagnosis

Directory 1 Pinyin 2 English Reference 3 Basic Information 4 Preface 5 Standard Text 5.1/Scope 5.2 2 Normative Reference 5.3 3 Terminology and Definition 5.4 4 Diagnostic Principles 5.5 5 Diagnostic Basis 5.5.1asbestos-induced lung cancer and mesothelioma 5.5./ Kloc-0/ Lung Cancer 5.5 Lung Cancer Caused by Dichloromethyl Ether 5.5.5 Lung Cancer and Skin Cancer Caused by Arsenic and Its Compounds 5.5.5.15.5./Lung Cancer 5.5.5.2 5.5.2 Skin Cancer 5.5.6 Hepatic Angiosarcoma 5.5.7 Lung Cancer 5.5. Lung cancer and pleural mesothelioma 5.5.9. 1 5.9. 1 lung cancer 5.5.9.2 5.9.2 pleural mesothelioma 5.5. 10 5. 10 skin cancer caused by coal tar, coal tar pitch and petroleum pitch 5.5./kloc-. Kloc-0/β- naphthylamine Bladder Cancer 5.6 6 6 Treatment Principles 5. 1A. 1 Diagnostic Principles Related Notes 6. 1.2A.2 Diagnostic Rules Related Notes 6. 1 .2.1A.2./kl 2.2A.2 Leukemia Caused by Benzene 6 A.2.3 Lung Cancer Caused by Chloromethyl Ether and Dichloromethyl Ether 6. 1.2.4A.2.4 Lung

2 English reference diagnosis of occupational tumors

3 basic information ICS 13. 100

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People's Republic of China (PRC)'s national occupational health standard GBZ 94-20 17 replaced GBZ 94-20 14 "Diagnosis of Occupational Tumors", which was issued by People's Republic of China (PRC) National Health and Family Planning Commission on May 8, 2065438.

4 Foreword Chapter 6 of this standard is recommended, and the rest are mandatory.

This standard is formulated according to the Law of People's Republic of China (PRC) on the Prevention and Control of Occupational Diseases. This standard was drafted according to GB/T1.1-2009.

This standard replaces GBZ 94-2014 Diagnosis of Occupational Tumors. Compared with GBZ 94-2014, this standard is mainly modified as follows:

-Three diagnostic criteria for occupational tumors have been added.

This standard was drafted by School of Public Health, Fudan University.

This standard was drafted by Shanghai Yangpu District Center for Disease Control and Prevention, Shanghai Yangpu District Central Hospital and Shanghai pulmonary hospital. The main drafters of this standard are:, Dai, Huang Li,, Zhang Xunmiao.

The previous editions replaced by this standard are as follows:

——GBZ 94—2002:

——GBZ 94—20 14 .

5 standard text of occupational tumor diagnosis

5. 1 1 scope This standard specifies the principles of diagnosis and treatment of occupational tumors.

This standard is applicable to the diagnosis and treatment of occupational tumors (excluding tumors caused by occupational radioactive factors) listed in the Classification and Catalogue of Occupational Diseases.

5.2 2 Normative reference documents The following documents are very important for the application of this document. For dated reference documents, only dated version is applicable to this document. For undated reference documents, the latest version (including all revisions) is applicable to this document.

GB/T 16 180 labor ability appraisal: the level of disability caused by work-related injuries and occupational diseases.

Diagnosis of occupational benzene poisoning in GBZ 68

Diagnosis of occupational arsenic poisoning in GBZ 83

GBZ/T 157 occupational disease diagnosis terminology

GBZ/T 224 occupational health terminology

5.3 3 Terms and definitions The terms and definitions defined in GBZ/T 157 and GBZ/T 224 and the following terms and definitions are applicable to this document. For the convenience of use, some terms and definitions in GBZ/T 224 are listed repeatedly below.

3. 1

occupational cancer

A specific tumor exposed to carcinogens for a long time in the working environment.

3.2

Cumulative total years of occupational exposure

The total number of years workers have been exposed to occupational carcinogens in their occupational activities.

3.3

Latency period

Time interval between exposure to certain carcinogens and diagnosis of occupational tumors caused by carcinogens.

5.4 4 Diagnostic principle: there is a clear long-term history of occupational exposure to carcinogens, and primary tumor lesions appear. Combined with laboratory test indexes and field occupational hygiene investigation, after comprehensive analysis, the occurrence of primary tumor should meet the requirements of cumulative exposure years of carcinogens in the workplace, and the location of tumor should be consistent with the specific target organs exposed to carcinogens and meet the requirements of the incubation period of occupational tumor occurrence and development before diagnosis can be made.

5.5 5 The diagnosis basis is 5.5. 1.5. 1 asbestos-induced lung cancer and mesothelioma 5.5.1.1lung cancer 5.1. Asbestosis complicated with lung cancer should be diagnosed as lung cancer caused by asbestos.

5. 1. 1.2 lung cancer patients without asbestosis should meet the following three conditions at the same time:

The diagnosis of primary lung cancer is clear;

1 1. It has a clear history of occupational exposure to asbestos dust, and the cumulative exposure period exceeds 1 year (including 1 year);

1 1. The hiding period is greater than 15 years (inclusive).

5.5. 1.2 5. 1.2 mesothelioma 5. 1.2. 1? Asbestosis complicated with mesothelioma should be diagnosed as mesothelioma caused by asbestos.

5. 1.2.2 Patients with mesothelioma without asbestosis should meet the following three conditions at the same time in diagnosis:

The diagnosis of mesothelioma is definite;

1 1. It has a clear history of occupational exposure to asbestos dust, and the cumulative exposure period exceeds 1 year (including 1 year);

1 1. The hiding period is greater than 15 years (inclusive).

5.5.2 5.2 The diagnosis of bladder cancer caused by benzidine should meet the following three conditions at the same time:

The diagnosis of primary bladder cancer is clear;

1 1. has a clear history of occupational exposure to benzidine, and the cumulative exposure period exceeds 1 year (inclusive);

1 1. The hiding period is greater than 10 year (inclusive).

5.5.3 5.3 Leukemia caused by benzene 5.3. 1? Leukemia caused by chronic benzene poisoning (see GBZ 68) should be diagnosed as benzene-induced leukemia. 5.3.2 Leukemia patients with no history of chronic benzene poisoning should meet the following three conditions at the same time when making diagnosis:

The diagnosis of leukemia is clear;

1 1. has a clear history of occupational exposure to excessive benzene, and the cumulative exposure time is more than 6 months (including 6 months);

1 1. The incubation period is over 2 years (including 2 years).

5.5.4 5.4 The diagnosis of lung cancer caused by chloromethyl ether and dichloromethyl ether should meet the following three conditions at the same time:

The diagnosis of primary lung cancer is clear;

1 1. It has a clear history of occupational exposure to chloromethyl ether or dichloromethyl ether, and the cumulative exposure period exceeds 1 year (including 1 year);

1 1. The incubation period is over 4 years (including 4 years).

5.5.5 Lung cancer and skin cancer caused by arsenic and its compounds 5.5.5. 1 5.5. 1 lung cancer The diagnosis of lung cancer caused by arsenic and its compounds should meet the following three conditions:

The diagnosis of primary lung cancer is clear;

1 1. It has a clear history of occupational exposure to arsenic and its compounds, and the cumulative exposure time is more than 3 years (including 3 years);

1 1. The incubation period is over 6 years (including 6 years).

5.5.5.2 skin cancer 5. 5. 2+0? Skin cancer in patients with chronic arsenic poisoning (see GBZ 83) should be diagnosed as arsenic-induced skin cancer. In 5.5.2.2, the diagnosis of skin cancer for people without a history of chronic arsenic poisoning should meet the following three conditions:

The diagnosis of primary skin cancer is clear;

1 1. It has a clear history of occupational exposure to arsenic and its compounds, and the cumulative exposure time is over 5 years (including 5 years);

1 1. The incubation period is over 5 years (including 5 years).

5.5.6 The diagnosis of hepatic angiosarcoma caused by vinyl chloride should meet the following three conditions at the same time:

The diagnosis of primary hepatic angiosarcoma is definite.

1 1. It has a clear history of occupational exposure to vinyl chloride monomer, and the cumulative exposure period exceeds 1 year (including 1 year);

1 1. The hiding period is greater than 1 year (inclusive).

5.5.7 5.7 Diagnosis of lung cancer caused by coke oven emissions should meet the following three conditions at the same time:

The clinical diagnosis of primary lung cancer is clear;

1 1. It has a clear history of occupational exposure to coke oven emissions, and the cumulative exposure period exceeds 1 year (inclusive);

1 1. The hiding period is greater than 10 year (inclusive).

5.5.8 5.8 When diagnosing lung cancer caused by hexavalent chromium compounds, the following three conditions should be met at the same time:

The clinical diagnosis of primary lung cancer is clear;

1 1. Has a clear history of occupational exposure to hexavalent chromium compounds, and the cumulative exposure time exceeds 1 year (inclusive);

1 1. The incubation period is over 4 years (including 4 years).

5.5.9 5.9 Diagnosis of lung cancer and pleural mesothelioma caused by 5.9. 1 lung cancer should meet the following three conditions at the same time:

The diagnosis of primary lung cancer is clear;

(1 1) has a clear history of occupational exposure to mordenite dust, and the cumulative exposure period exceeds 1 year (including 1 year);

1 1. The hiding period is greater than 10 year (inclusive).

5.9.2 The diagnosis of pleural mesothelioma should meet the following three conditions:

The diagnosis of pleural mesothelioma is clear;

(1 1) has a clear history of occupational exposure to mordenite dust, and the cumulative exposure period exceeds 1 year (including 1 year);

1 1. The hiding period is greater than 10 year (inclusive).

5.5. 10 5. 10 The diagnosis of skin cancer caused by coal tar, coal tar pitch and petroleum pitch shall meet the following three conditions at the same time:

The diagnosis of primary skin cancer is clear;

1 1. It has a clear occupational contact history with coal tar, coal tar pitch and petroleum pitch, and the cumulative contact time is more than 6 months (including 6 months); 1 1. The hiding period is greater than 15 years (inclusive).

5.5.115.11β naphthylamine in the diagnosis of bladder cancer should meet the following three conditions at the same time:

The diagnosis of primary bladder cancer is clear;

1 1. It has a clear history of occupational exposure to β-naphthylamine, and the cumulative exposure time exceeds 1 year (inclusive);

1 1. The hiding period is greater than 10 year (inclusive).

5.6 6 Treatment principle 6. 1 Stay away from carcinogens.

6.2 according to the principle of malignant tumor treatment, active treatment and regular review; 6.3 If it is necessary to conduct labor ability appraisal, it shall be handled in accordance with GB/T 16 180.

5.7 7 For instructions on the correct use of this standard, see Appendix A..

6 Appendix 6. 1 Appendix A (informative appendix) Explanation of correct use of this standard 6. 1. 1 Diagnostic principles The relevant explanation should refer to the patient's previous occupational exposure to carcinogens (monitoring records, or records of raw materials, products and processes of enterprises, or monitoring data of similar enterprises in the same period, etc. ) to make clinical diagnosis and exclude other possible non-occupational exposure routes of carcinogens.

The confirmation of workers' occupational exposure history of carcinogens can be comprehensively evaluated according to the relevant records of workers' occupational history, or through the air sampling measurement results of workplace environmental conditions, or some biological monitoring data, or the monitoring data of excessive exposure.

Cumulative exposure years refer to the cumulative exposure time of workers exposed to carcinogens in the workplace. Overtime of workers exposed to carcinogens in the workplace can be converted into corresponding cumulative exposure time. Based on working 8 hours a day, the working hours over 8 hours can be accumulated, that is, the accumulated time over 8 hours can be counted as 1d, and the accumulated days of 250d days are 1 year.

6. 1.2A.2 Description of diagnostic rules 6. 1.2. 1. Bladder cancer caused by A.2. 1 benzidine contact with ureteropelvic transitional cell carcinoma can refer to this standard.

6. 1.2.2a.2 The main histological type of occupational benzene poisoning leukemia is acute myeloid leukemia, which can be used as a reference for differential diagnosis of occupational benzene poisoning leukemia.

6. 1.2.3A.2.3 Chloromethyl ether and dichloromethyl ether can also be found in workplaces where formaldehyde, hydrochloric acid and water vapor are stored.

Since the common tissue type of occupational chloromethyl ether-induced lung cancer is small cell lung cancer, this tissue type can be used as a reference for differential diagnosis of occupational chloromethyl ether-induced lung cancer.

6. 1.2.4A.2.4 Lung cancer and skin cancer caused by arsenic and its compounds. Lung cancer caused by occupational exposure to arsenic and its compounds is not only common in arsenic-containing mining and smelting industries, but also in workers exposed to pesticide arsenic. Therefore, the diagnosis of occupational lung cancer in workers exposed to pesticide arsenic can refer to this standard. Studies have shown that the risk of adenocarcinoma is higher than other lung cancer tissue types, and oat cell carcinoma has also increased. Therefore, this tissue type can be used as a reference for differential diagnosis of occupational arsenic poisoning lung cancer.

The skin of occupational contacts with arsenic and its compounds shows hyperkeratosis and skin ulcers, which are precancerous lesions and can eventually develop into skin cancer after long-term treatment.

6. 1.2.5A.2.5 Lung cancer and pleural mesothelioma caused by pilose antler zeolite At present, the occupational exposure of pilose antler zeolite mostly exists in the production and use of other zeolites. Similar to asbestos, pilose zeolite fiber can cause diffuse pulmonary interstitial fibrosis (zeolite lung), pleural calcification and pleural plaque, and form iron bodies, which are similar to typical asbestos bodies.

The presence of pilose zeolite fibers can be detected in the core of iron corpuscles. In previous studies, pilose zeolite fibers can also be found in bronchoalveolar lavage fluid of pilose zeolite contacts. In addition, compared with asbestos, the condition of pleural mesothelioma caused by pilosity progresses faster, and the median survival time is 10 months.

6. 1.2.6a.2.6 Skin cancer caused by coal tar, coal tar pitch and petroleum pitch Most of the skin cancer tissues caused by occupational exposure to coal tar, coal tar pitch and petroleum pitch are squamous cell carcinoma, usually accompanied by chronic dermatitis, melanosis, keratosis of hair follicle, tumor with ulcer and even distant metastasis. The histological type of this squamous cell carcinoma can be used as a reference for diagnosis.

6. 1.3A.3 The naming and writing format of occupational tumor diagnosis is:

a)？ Occupational tumor [asbestos-induced lung cancer (or mesothelioma)];

b)？ Occupational tumor (bladder cancer caused by benzidine);

c)？ Occupational tumor (benzene-induced leukemia);

d)？ Occupational tumor [lung cancer caused by chloromethyl ether (or dichloromethyl ether)];

e)？ Occupational tumor [lung cancer (or skin cancer) caused by arsenic and its compounds];

f)？ Occupational tumor (hepatic angiosarcoma caused by vinyl chloride);

g)？ Occupational tumor (lung cancer caused by coke oven emissions);

h)？ Occupational tumor (lung cancer caused by hexavalent chromium compound);

Me)? Occupational tumor [lung cancer (or pleural mesothelioma) caused by pilose zeolite];

j)？ Occupational tumor (skin cancer caused by coal tar, coal tar pitch and petroleum pitch);

k)？ Occupational tumor (bladder cancer caused by β-naphthylamine).

7 standard full text