腫瘤學(xué)總論ppt課件

1、惡性腫瘤真的很要命惡性腫瘤真的很要命Heart DiseasesCancerCerebrovascular DiseasesChronic Obstructive Lung DiseasesAccidentsPneumonia & InfluenzaDiabetes MellitusSuicideHomicideHIV InfectionAdapted from Greenlee RT, et al. CA Cancer J Clin. 2000:50;22.Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000;50:16.Me

2、lanoma of skinOral cavity & pharynxLung & bronchusPancreasKidney & renal pelvisColon & rectumProstateUrinary bladderLeukemiaNon-Hodgkins lymphomaAll others4%3%14%2%3%10%29%6%3%5%19%EsophagusLung & bronchusPancreasLiver & intrahepatic bile ductStomachColon & rectumProstate

3、Urinary bladderLeukemiaNon-Hodgkins lymphomaAll others3%31%5%3%3%10%11%3%4%5%22%Oncology EpidemiologyAdapted from Greenlee RT, et al. CA Cancer J Clin. 2000;50:16.2%15%25%5%2%11%5%2%5%4%2%21%Melanoma of skinThyroidBreastLung & bronchusPancreasColon & rectumOvaryUterine corpusUrinary bladderN

4、on-Hodgkins lymphomaAll others3%2%30%12%2%11%4%6%2%4%22%Brain & other nervous systemBreastLung & bronchusPancreasStomachColon & rectumOvaryUterine corpusNon-Hodgkins lymphomaLeukemiaMultiple myelomaAll others惡性腫瘤白皮書惡性腫瘤白皮書命名規(guī)律命名規(guī)律組織及器官組織及器官+分化程度分化程度+細(xì)胞形態(tài)細(xì)胞形態(tài)+來(lái)源性質(zhì)來(lái)源性質(zhì)如： 右肺下葉低分化鱗狀細(xì)胞癌，左脛骨骨肉

5、瘤等1. 1. 化學(xué)因素化學(xué)因素 30-40 10 3-5 癌前期原位癌浸潤(rùn)癌腫瘤血行轉(zhuǎn)移鎖骨上淋巴結(jié)檢查的意義！概念：腫瘤細(xì)胞所具有的，或受腫瘤刺激的宿主細(xì)胞產(chǎn)生的，可反映腫瘤發(fā)生、發(fā)展，能檢測(cè)腫瘤治療反應(yīng)的一類物質(zhì)。 腫瘤標(biāo)志物檢查鼻咽低分化鱗癌鼻咽低分化鱗癌 胰腺癌胰腺癌 CT示右肺結(jié)節(jié)，18F-FDG PET示肺結(jié)節(jié)高代謝，提示肺部惡性腫瘤腦星狀細(xì)胞瘤診斷治療Which one is The Best ?T1 - The tumour is no more than 2 centimetres (cm) across T2 - The tumour is more than 2 cen

6、timetres, but no more than 5 centimetres across T3 - The tumour is bigger than 5 centimetres across T4 is divided into 4 groupsT4a - The tumour has spread into the chest wallT4b - The tumour has spread into the skinT4c - The tumour is fixed to both the skin and the chest wallT4d - Inflammatory carci

7、nomaN0: Cancer has not spread to nearby lymph nodes. N1: Cancer has spread to 1 to 3 axillary (underarm) lymph node(s), and/or tiny amounts of cancer are found in internal mammary lymph nodes (those near the breast bone) on sentinel lymph node biopsy. N2: Cancer has spread to 4 to 9 lymph nodes unde

8、r the arm, or cancer has enlarged the internal mammary lymph nodes. N3: One of the following applies: Cancer has spread to 10 or more axillary lymph nodes. Cancer has spread to the lymph nodes under the clavicle (collar bone). Cancer has spread to the lymph nodes above the clavicle. Cancer involves

9、axillary lymph nodes and has enlarged the internal mammary lymph nodes. Cancer involves 4 or more axillary lymph nodes, and tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy. N1 = metastasis to movable ipsilateral axillary lymph node(s)M0 = no distant met

10、astasisBreast cancerIIaN1 = metastasis to movable ipsilateral axillary lymph node(s) (p) N1a, N1bM0 = no distant metastasisBreast cancerIIbN3 = metastasis to ipsilateral internal mammary lymph node(s)M0 = no distant metastasisTumor of any sizewith direct extensionto chest wall or skinT4d = inflammat

11、orycarcinomaBreast cancerIIIbM1 = distant metastasis (including metastases to ipsilateral supraclavicular, cervical, or contralateral internal mammary lymph nodes)Breast cancerIVDistal metasteses of Breast cancer東漢、華佗切除體表腫瘤東漢、華佗切除體表腫瘤1809年年Mcdowell行卵巢腫瘤切除術(shù)行卵巢腫瘤切除術(shù)1946年年Gilman及及Philips首次應(yīng)用氮芥治療惡性腫瘤首次應(yīng)

12、用氮芥治療惡性腫瘤,開(kāi)創(chuàng)了開(kāi)創(chuàng)了腫瘤化療的歷史先河腫瘤化療的歷史先河1895: First therapeutic attempt to treat a local relapse of breast carcinoma by Emil Grubbe (Chicago）放射源放射源1. 放射性同位素放出的放射性同位素放出的、線。線。.X線治療機(jī)和各類加速器產(chǎn)生的不同能量線治療機(jī)和各類加速器產(chǎn)生的不同能量的的X線。線。. 各類加速器產(chǎn)生的電子束、中子束、質(zhì)各類加速器產(chǎn)生的電子束、中子束、質(zhì)子束、負(fù)子束、負(fù)介子束以及其它重粒子束。介子束以及其它重粒子束。 M期特異性藥物 S期特異性藥物 G2期特異

13、性藥物 長(zhǎng)春花堿 健擇 博來(lái)霉素 長(zhǎng)春新堿 5-氟脲嘧啶 平陽(yáng)霉素 長(zhǎng)春花堿酰胺 6-巰基嘌呤 G1期特異性藥物 去甲長(zhǎng)春花堿 氨甲蝶呤 左旋門冬酰胺酶 紫杉醇 阿糖胞苷 腎上腺皮質(zhì)類固醇 泰索帝 強(qiáng)的松 足葉乙甙嘌呤核苷酸嘧啶6巰基嘌呤硫鳥嘌呤脫氧核苷酸DNA RNA（tRNA、mRNA、核蛋白體） 蛋白質(zhì)微管酶類抑制嘌呤合成抑制核苷酸轉(zhuǎn)變氨甲喋呤抑制嘌呤合成抑制dTMP合成氟尿嘧啶阿糖胞苷抑制DNA聚合酶抑制RNA功能博萊霉素?fù)p傷DNA阻礙修復(fù)烷化劑、順鉑、絲裂霉素與DNA交叉聯(lián)接三尖杉酯堿抑制蛋白質(zhì)合成L門冬酰胺酶VP16、HCPT、ADM抑制TOPO酶或放線菌素D抑制RNA合成嵌入DNA長(zhǎng)春堿類促使微管解聚紫杉類促使微管聚合羥基脲、脫氧胞苷抑制核苷酸還原酶作用機(jī)理作用機(jī)理細(xì)胞毒性藥物作用于DNA化學(xué)結(jié)構(gòu)的藥物：烷化劑、鉑類、絲裂霉素影響核酸合成的藥物：抗嘌呤、嘧啶合成藥，阿糖胞苷作用于核酸轉(zhuǎn)錄的藥物：放線菌素D、蒽環(huán)類