外科肿瘤学(中文简)课件.ppt
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1、外科肿瘤学Surgical Oncology,肿瘤的定义Definition of Tumor,肿瘤是机体中正常细胞,在不同的始动与促进因素长期作用下所产生的增生与异常分化所形成的新生物 Tumors are characterized by cells that have lost their normal control mechanisms and thus have unregulated growth,The top 10 cancer incidence and mortality in China,2011,incidence,mortality,Age-standardized
2、 incidence rate(1/105),-Chen WQ,et al.Chin Cancer 2015;24(1):1-10,The top 10 cancer incidence and mortality in China,2011,(Male),%,%,incidence,Age-standardized incidence rate(1/105),-Chen WQ,et al.Chin Cancer 2015;24(1):1-10,mortality,%,The top 10 cancer incidence and mortality in China,2011(Female)
3、,%,%,Age-standardized incidence rate(1/105),-Chen WQ,et al.Chin Cancer 2015;24(1):1-10,mortality,incidence,肿瘤病因学The Etiology of Cancer,病毒 Viruses(papilloma,Epstein-Barr,Hepatitis B,retroviruses,HIV)射线 Radiation exposure 环境、工业因素Environmental industrial carcinogens 吸烟/饮酒 Tobacco and alcohol consumptio
4、n 基因易感性 Genetic susceptibility syndromes,肿瘤相关病毒Viruses Associated with Cancer,VirusCancerHepatitis B,CHepatocellular CancerHIVKaposis sarcomaEpstein-Barr virus Nasopharyngeal cancerBurkitts lymphomaHuman Papilloma virusCervical cancer,肿瘤发病率与生活/环境因素Cancer Mortality&Behavior/environmental Factors,Fact
5、orPercentage of cancer deathsSmoking30Diet30Infectious agents 5Alcohol 3Sedentary lifestyle 3Ultraviolet 2Air pollution 2,人体内在因素(Inherent Factors),1.遗传因素:遗传易感性(hereditary susceptibility)2.内分泌因素:某些激素代谢紊乱可诱发或促进 肿瘤生长3.免疫因素:机体免疫功能降低,肿瘤发病率升高4.其它因素:精神,营养(微量元素缺乏)等,吸烟相关肿瘤Smoking-related cancers,Lung cancer
6、Oropharyngeal cancer Stomach cancer Cervical cancer Pancreatic cancer Renal cancer Bladder cancer Liver cancer Leukemia,与肿瘤发生相关的基因(Major Genes in Development of Cancer),癌基因Oncogenes 抑癌基因Tumor suppressor genes DNA修复基因 DNA repair genes,癌基因Oncogenes,Growth factors 生长因子EGF,TGF-Growth factor receptors 生长
7、因子受体EGFR,PTK Intracellular transducers 细胞内传导素cAMP Transcription factors 转录因子c-myc,DNA修复基因失活,抑癌基因失活,癌基因激活,癌细胞,肿瘤的发生和发展,恶性肿瘤病因和发病机制模式图,结直肠肿瘤发生的遗传模型肿瘤的发生经历了一系列遗传学上的变化,如数个癌基因的激活和/或抑癌基因的失活,及其他基因变化。,Modern Viewpoint of Cancer as a Long-term Process,癌前期,广泛播散期,侵袭期,原位癌期,Up to 1030 years,310 years,15 years,15
8、 years,肿瘤病理学The Pathology of Cancer,恶性肿瘤的命名 Nomenclature of Malignant Tumor,Names of tumorTissue of origin ExamplesCarcinomaEpithelium AdenocarcinomasSarcomaMesenchymal LiposarcomaMalig.lymphomaLymphocytes LymphomaMalig.melanomaMelanocytes Malignant melanomaMalig.Mesothelioma Mesothelium Pleural mal
9、ig.MesotheliomaTeratomaGerm Cells Testicular teratomaChoriocarcinomaTrophoblast Uterine choriocarcinoma,良性肿瘤Benign Tumors,A limited growth potential the neoplastic cells closely resemble those of the parent tissue(well diff.)growth slowly by expansion a well-encapsulated lesion do not usually produc
10、e serious effect,恶性肿瘤Malignant Tumors,proliferate rapidly more poorly differentiated cells progressive growth and invasion of the surrounding tissues metastases by lymphatic&blood vessels if not treated early,eventually cause death,Peritoneal carcinomatosis of gastric cancer,癌肿分期和组织学分类的目的,有助于制订治疗方案
11、有助于判定预后 有助于评判疗效 有助于资源共享和学术交流 有助于癌肿临床研究的开展,组织病理学分期与分类Histopathological Staging&Classification,Adenocarcinomas Squamous carcinomas Small cell carcinomas Large cell carcinomas Sarcomas Lymphomas Leukemias Gliomas Seminomas Teratomas,恶性肿瘤特性The Hallmark of Malignancy,局部破坏性浸润Local destructive invasion 远处转
12、移Distant metastasis-the cardinal behavior to distinguish benign&malignant tumor,恶性肿瘤病理特征Pathological Features of Malignancy,an infiltrative uncapsulated margin invasion of baseline membrane or surrounding structure evidence of invasion of blood vessels or lymphatics or metastases tumor necrosis,arch
13、itecture abnormalities e.g.increased gland/stroma ratio cytological abnormalities e.g.increased nuclear/cytoplasm ratio numerous mitotic figures&abnormal mitoses,恶性肿瘤病理特征Pathological Features of Malignancy,癌的大体分型Gross Types of Carcinoma,Papillary,Nodular,Ulcerative,Cystic,Multiple,Diffuse,Stricture,
14、Borrmanns Classification,I 型,II型,III型,型,左肺上叶中央型肺癌,胃癌肝转移,Three Important Terms,Metaplasia-the replacement of one fully differentiated tissue by another Carcinoma in situ-the histological abnormalities are sufficiently severe to suggest carcinoma,but in the absence of basement membrane invasion Border
15、 tumor-A tumor with biologic behavior between benign and malignant,分化程度The Degree of Differentiation,高度分化(I级)Well differentiated 中度分化(II级)Moderately differentiated 低度分化(III级)Poorly differentiated,恶性肿瘤的后果Effects of Malignancy,Tumor arising within a hollow viscus梗阻 obstruction tumor arising from surfa
16、ce of organ溃疡/出血ulceration and bleeding,恶性肿瘤的波散Spread of Malignant Tumors,直接浸润(direct invasion)-rectal cancer 区域淋巴结转移(lymphatic spread)-breast carcinoma,gastric cancer 血行播散至远处(metastasis by bloodstream)-liver,lung&brain 体腔内种植(cavity implantation)-ovarian carcinoma(Krukenbergs tumor),TNM Staging of G
17、C,T stage,Lymphatic Spread of Gastric Cancer,淋巴结内单个癌细胞转移灶(CAM 5.2100),淋巴结内数个癌细胞形成的转移簇(CAM 5.2100),肿瘤分期,国际癌症联盟(UICC)TNM分期T(tumor):1,2,3,4,xN(lymph node):1,2,3M(metastasis):0,1临床分期(CTNM)术后的临床病理分期(PTNM)各种肿瘤的TNM分期标准是由各专业会议协定的,分期目的:制定合理治疗方案 正确评价治疗效果 判断预后 有利于交流,TNM 分期,T-原发肿瘤 primary tumorN-区域淋巴结regional l
18、ymph nodeM-远处转移metastases,癌症的诊断步骤The Diagnostic Procedures of Cancer,病史 History Family history Individual habits Social history Occupation Marital&Sex history Past history,体检 Physical Examination 系统体检 局部体检 TumorMetastatic foci,癌症的诊断步骤The Diagnostic Procedures of Cancer,特殊检查 Special Procedures Diagno
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