外科学-总论英文课件：Tumor

1、Tumor,附属仁济医院,PART I History and Epidemiology,附属仁济医院,The first curative excision of an ovarian tumor was achieved by Ephraim McDowell in 1809 Father of Ovariotomy（卵巢切除术） Founder of Abdominal Surgery,Haeger K . The Illustrated History of Surgery . London : Harold Starke , 1988 : 223 45 .,Theodor Billr

2、oth is frequently credited with performing the first gastrectomy（胃切除术） for cancer which he performed in Vienna on 29 January 1881,History of Surgical Oncology,Ephraim McDowell Nov 11th,1771 Jun 25th,1830,Theodor Billroth Apr 26th,1829-Feb 6th, 1894,PART I,History of surgical oncology,Resected stomac

3、h and autopsy material of Therese Heller, Vienna,PART I,Epidemiology,PART I,404,996 new cases of stomach cancer were estimated to have occurred, age-standardized incidence rate was 22.7 (per 100,000). 325,166 cases of death occurred in China, age-standardized mortality rate was 17.9 (per 100,000). D

4、ata quality:C4,31,269 new cases of stomach cancer were estimated to have occurred, age-standardized incidence rate was 41.8 (per 100,000). 10,746 cases of death occurred in Korea, age-standardized mortality rate was 13 (per 100,000). Data quality:A2,107,898 new cases of stomach cancer were estimated

5、 to have occurred, age-standardized incidence rate was 29.9 (per 100,000). 52,326 cases of death occurred in Japan, age-standardized mortality rate was 12.4 (per 100,000). Data quality:B1,http:/globocan.iarc.fr,Due to the huge population, China has the largest number of GC patient in the world. ASR

6、in Korea was highest between 3 countries because of the high quality national data and medium quality vital registration. While in China, coverage of registration was lower than 10% and vital registration was incomplete.,Stomach Cancer,Epidemiology,PART I,Epidemiology,PART I,http:/globocan.iarc.fr,L

7、ung cancer was the most common malignancy and the 1st leading cause of cancer death in China in 2012.,Lung Liver Stomach Esophagus Colorectum,Mortality rate,Age-standardized incidence rate,http:/globocan.iarc.fr,PART I,Epidemiology of major cancers in China,2012 China Cancer Registry Annual Report,I

8、ncidence(1/105),Incidence(1/105),Mortality(1/105),Mortality(1/105),There is an average of 3.12 million new cancer patients in China every year, and for every minute in China, there are 6 people diagnosed as cancer, and 5 died of cancer.,PART I,Epidemiology of major cancers in China,Distribution of M

9、ortality Rates for Gastric Cancer in China,Chen WQ, et al. China Cancer, 2011,20(3): 162-169.(Chinese),Countryside,City,vs,In urban areas, the cancer spectrum is similar to the characteristics of developed countries, while cancer in rural areas still retains the patterns of developing countries. Ove

10、rall, cancer incidence in urban areas is higher and mortality is lower than those in rural areas.,PART I,Epidemiology of major cancers in China,PART II Classification and Staging,附属仁济医院,Classification,Neoplasia, neoplasm (new growth ) uncontrolled proliferation of transformed cells Tumor Benign, mal

11、ignant Cancer Carcinoma Sarcoma,PART II,Benign and Malignant,PART II,Adenocarcinoma of Sigmoid Colon,Lipoma in Small Intestine,Shape and histological characters Biological behavior（metastasis，转移） Borderline tumor（交界性肿瘤）,Carcinoma and Sarcoma,PART II,Retroperitoneal Liposarcoma Originated from mesenc

12、hymal tissue,Gastric Carcinoma Originated from epithelial tissue,TNM staging system,PART II,New TNM staging system of gastric cancer,PART II,PART III Tumor Biology and carcigenesis,附属仁济医院,Multistep process of tumorigenesis,PART III,Successive genetic changes each confer a growth advantage, leading t

13、o the progressive conversion of normal cells into cancer cells,Cell-signal pathway in tumorigenesis,PART III,The signal transduction pathways which regulate normal cellular functions has revealed that key components of these networks are commonly altered in cancer cells by mutation, amplification/de

14、letion, chromosomal translocation, overexpression, or epigenetic silencing,MAPK signaling pathway,PI3K/mTOR signaling pathway,Oncogenes and tumor suppressor genes,PART III,PART III,Devices used in detection,PCR,Western Blot,Immuno-histo device,flow cytometry,Genetic model for colorectal tumorigenesi

15、s,Fearon ER: Agenetic model for colorectal tumorigenesis. Cell 61:759767, 1990,A multistep model for colorectal tumorigenesis has been described Many of these alterations occur at the genetic level, involving the gain of function by oncogenes （癌基因）or the loss of function by tumor suppressor genes （抑

16、癌基因）,PART III,PART IV Surgery in neoplasm,附属仁济医院,Principle of Surgery,PART IV,Core principle: Total removal of neoplastic tissue En bloc resection（整块切除） A complete margin of normal tissue around the primary lesion Frozen sections （快速冰冻病理检查）used to evaluate tissue margins in instances of doubt Comple

17、te removal of involved regional lymph nodes（淋巴结清扫） Resection of an involved adjacent organ Non - contact separation techniques（非接触原则）,Standard procedure of Gastric Cancer in Japan,PART IV,Standard gastrectomy is the principal surgical procedure performed with curative intent. It involves resection o

18、f at least two-thirds of the stomach with a D2 lymph node dissection.,Standard procedure of Gastric Cancer in China,PART IV,Regional LN group according to Location of tumor,3rd lumbar vein,Lymphadenectomy in Gastric Cancer Para-aortic LN Dissection, Lower Area,PART IV,Aorta,L Renal Vein,Superior Ven

19、a Cava,Non - contact separation techniques,PART IV,Wound protection Using gauze or swab（纱布）to cover the tumor,To monitor the quality process in cancer surgery cyclic thinking is needed. This process is often described in four steps: plan, do, check; and act The initial phase of planning or redesigni

20、ng a process or activity the procedure will be executed. After this phase it is essential that outcome should be measured and consequently action taken to improve the process. After this the cycle starts again.,PART IV,Cyclic Monitoring in cancer surgery,Prevention Surgery,PART IV,Prevention high ri

21、sk for the development of cancers Breast Ca and Throid Ca No Evidence-based support Patients strong desire,AngelinaJolie,PART V Radiotherapy and Chemotherapy,附属仁济医院,Radiotherapy,PART V,AIM: To deliver a precise dose of radiation to a defined tumor volume with minimal damage to surrounding normal tis

22、sues Radical or curative radiotherapy Adjuvant radiotherapy Palliative radiotherapy,Radiotherapy,PART V,Radical radiotherapy,Single modality radical management with radiotherapy is used to treat a number of early stage laryngeal and skin cancers Advantages: Organ preservation The scope for subsequen

23、t surgical salvage in the event of local disease recurrence,PART V,Adjuvant (Neo-adjuvant) radiotherapy,Usually planned within a radical management setting and delivered after the primary modality (usually surgery) has been completed Advantages: Downsize the primary tumor, thereby making some inoper

24、able tumors operable Reduce local disease recurrences,PART V,Head and neck cancer: An increased survival with a decrease in locoregional recurrence observed with postoperative radiotherapy compared with preoperative radiotherapy Rectal cancer: There is strong evidence that preoperative radiotherapy

25、is more effective than postoperative radiotherapy and improves survival Soft tissue sarcoma: Increased survival observed with preoperative radiotherapy is also associated with an increase in wound complications,Preoperative VS postoperative radiotherapy,PART V,Preoperative radiotherapy in Rectal Can

26、cer,PART V,Rectal cancer: preoperative radiotherapy can preserve the function of anus to avoid the colostomy（结肠造瘘）,To control of symptoms such as pain, cough, or hemoptysis, for prevention of symptoms such as impending paralysis, or for temporary arrest of tumor growth Palliative radiotherapy does n

27、ot aim to improve survival,Palliative radiotherapy,PART V,Radiotherapy,PART V,Chemotherapy options have expanded from cell cycle-specific and cell cycle non-specific drugs to biological therapies and small molecule targeted agents Chemotherapy may be given with curative or palliative Intent,Chemothe

28、rapy,PART V,PART V,Commonly used chemotherapy drugs,PART V,Commonly used chemotherapy regimens,Given before surgical resection, with the goals being downsizing and possible downstaging of the tumor The use of neoadjuvant chemotherapy can also help guide therapy after surgery,Neoadjuvant chemotherapy

29、,PART V,Refers to chemotherapy given after surgery to try to prevent the cancer from recurring Its goal is to treat any micrometastatic disease that may have been left behind at the time of surgery,Adjuvant chemotherapy,PART V,Evaluation of Adjuvant Chemotherapy ACTS-GC trial：S-1,Sakuramoto S, et al

30、. NEJM, 2007, 357: 1810-1820,Criteria,ACTS-GC study JCOG,S-1 Oral drug S-1 80-120 mg/d 4week-2weeks，12 months,Only Surgery,PART V,Sakuramoto S, et al. NEJM, 2007, 357: 1810-1820,1004 cases (stage II/III ，D2,3 years follow up,S-1辅助化疗使胃癌术后患者的3年总生存及3年无复发生存得到了有效改善,PART V,ACTS-GC trial：S-1,Conclusions: A

31、djuvant chemotherapy with S-1 for gastric cancer is feasible and effective. This regimen can be the standard treatment for stage II/III gastric cancer pts after curative D2 dissection.,PART V,ACTS-GC trial：S-1,online article and related content current as of October 5, 2010.,Benefit of Adjuvant Chem

32、otherapy for Resectable Gastric Cancer: A Meta-analysis,The GASTRIC(Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group,JAMA. 2010;303(17):1729-1737(doi:10.100/jama.2010.534) /cgi/content/full/303/17/1729,5 年总生存率 单纯手术 49.6% 辅助化疗 55.3% 差异 5.7%,onl

33、ine article and related content current as of October 5, 2010.,Benefit of Adjuvant Chemotherapy for Resectable Gastric Cancer: A Meta-analysis,The GASTRIC(Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group,JAMA. 2010;303(17):1729-1737(doi:10.100/jama.2010.534) http:/j

34、/cgi/content/full/303/17/1729,PART VI Screening and Prevention,附属仁济医院,Data Source: Korean National Cancer Screening Survey, 20042011,In 2011, stomach cancer had the highest cancer screening rate (64.6%) in Korea. 90% of the funds for gastric cancer screenings are supported by the National Health Institute, and 10% is paid by the participants.,National Canc