肿瘤学总论ppt课件

1、恶性肿瘤真的很要命恶性肿瘤真的很要命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恶性肿瘤白皮书恶性肿瘤白皮书命名规律命名规律组织及器官组织及器官+分化程度分化程度+细胞形态细胞形态+来源性质来源性质如： 右肺下叶低分化鳞状细胞癌，左胫骨骨肉

5、瘤等1. 1. 化学因素化学因素 30-40 10 3-5 癌前期原位癌浸润癌肿瘤血行转移锁骨上淋巴结检查的意义！概念：肿瘤细胞所具有的，或受肿瘤刺激的宿主细胞产生的，可反映肿瘤发生、发展，能检测肿瘤治疗反应的一类物质。 肿瘤标志物检查鼻咽低分化鳞癌鼻咽低分化鳞癌 胰腺癌胰腺癌 CT示右肺结节，18F-FDG PET示肺结节高代谢，提示肺部恶性肿瘤脑星状细胞瘤诊断治疗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东汉、华佗切除体表肿瘤东汉、华佗切除体表肿瘤1809年年Mcdowell行卵巢肿瘤切除术行卵巢肿瘤切除术1946年年Gilman及及Philips首次应用氮芥治疗恶性肿瘤首次应

12、用氮芥治疗恶性肿瘤,开创了开创了肿瘤化疗的历史先河肿瘤化疗的历史先河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、线。线。.X线治疗机和各类加速器产生的不同能量线治疗机和各类加速器产生的不同能量的的X线。线。. 各类加速器产生的电子束、中子束、质各类加速器产生的电子束、中子束、质子束、负子束、负介子束以及其它重粒子束。介子束以及其它重粒子束。 M期特异性药物 S期特异性药物 G2期特异

13、性药物 长春花碱 健择 博来霉素 长春新碱 5-氟脲嘧啶 平阳霉素 长春花碱酰胺 6-巯基嘌呤 G1期特异性药物 去甲长春花碱 氨甲蝶呤 左旋门冬酰胺酶 紫杉醇 阿糖胞苷 肾上腺皮质类固醇 泰索帝 强的松 足叶乙甙嘌呤核苷酸嘧啶6巯基嘌呤硫鸟嘌呤脱氧核苷酸DNA RNA（tRNA、mRNA、核蛋白体） 蛋白质微管酶类抑制嘌呤合成抑制核苷酸转变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功能博莱霉素损伤DNA阻碍修复烷化剂、顺铂、丝裂霉素与DNA交叉联接三尖杉酯碱抑制蛋白质合成L门冬酰胺酶VP16、HCPT、ADM抑制TOPO酶或放线菌素D抑制RNA合成嵌入DNA长春碱类促使微管解聚紫杉类促使微管聚合羟基脲、脱氧胞苷抑制核苷酸还原酶作用机理作用机理细胞毒性药物作用于DNA化学结构的药物：烷化剂、铂类、丝裂霉素影响核酸合成的药物：抗嘌呤、嘧啶合成药，阿糖胞苷作用于核酸转录的药物：放线菌素D、蒽环类