胃十二指肠肿瘤(英文版)课件

1、Gastric CancerGastric CancerEpidemiologyJemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin 2011; 61:69.EpidemiologyJemal A, Bray F, CEpidemiologyJemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin 2011; 61:69.EpidemiologyJemal A, Bray F, CRisk Fac

2、tors1. NutritionLow fat or protein consumption Salted meat or fish High nitrate consumption High complex-carbohydrate consumption2. Environment Poor food preparation (smoked, salted) Lack of refrigeration Poor drinking water (well water) Smoking Risk Factors1. Nutrition2. Env3.SocialLow socioeconomi

3、c status (except in Japan)Risk Factors4.MedicalPrior gastric surgeryHelicobacter pylori infectionGastric atrophy and gastritisAdenomatous polypsPernicious anemiaMale gender3.SocialRisk Factors4.MedicalEtiological Factors (Risk Factors)Etiological FactorsPathology 1.Early gastric cancer (EGC)Gastric

4、cancer confined to the mucosa or submucosa, regardless of the presence or absence of lymph node metastasis2. Advanced gastric cancer (AGC) Cancer cells infiltrate the proprial muscle layer or serosa Pathology 1.Early gastric cancEGCPathology I: protrudedIIa: superficially elevatedIIc: superficially

5、depressedIIb: superficially flatIII: excavatedEGCPathology I: protrudedIIa: EGC: Endoscopic imagesType IType IIType IIIEGC: Endoscopic imagesType ITyPathology Borrmanns classification of gastric cancer based on gross appearanceAGC: Borrmanns classificationLinitis plasticaPathology Borrmanns classifi

6、cT stage are defined by depth of penetration into the gastric wallLamina propriaT1aT1bT4aT4bT3Subserosal connective tissueT1bT1aT4aT4bT stage T stage are defined by depth oGrouping of Regional Lymph Nodes (Groups 1-3) by Location of Primary Tumor According to the Japanese Classification of Gastric C

7、arcinomaN stage Grouping of Regional Lymph NodMetastesisDirect invasionLyphmatic metastesisHematogenous metastasisSeeding metastasis MetastesisDirect invasion胃十二指肠肿瘤(英文版)课件胃十二指肠肿瘤(英文版)课件Clinical Presentation1. Vague epigastric discomfort2. Epigastric pain3.Weight loss, anorexia, fatigue, or vomiting

8、4. Hematemesis, anemicClinical Presentation1. Vague Physical signs 1. A palpable abdominal mass2. A palpable supraclavicular lymph node3. A palpable mass by rectal examination4. A palpable ovarian mass (Krukenbergs tumor)Physical signs 1. A palpable aExaminationEndoscopyM-SCT (multiple detector-row

9、spiral CT)MRIBUS & EUSDouble-contrast radiography DL (diagnostic laparoscopy ) PET-CTExaminationEndoscopyClinicpathological StagingEUSLaprascopyBUSCTPET-CTCT is the mainly procedureMRIClinicpathological StagingEUSLEndoscopy Carcinoma in situAdvanced carcinomaEndoscopy Carcinoma in situAdvNicheDouble

10、-Contrast Barium Upper GI RadiographyNicheDouble-Contrast Barium UpEUSEUSEUSTTNEUSTTNCT scan CT scan ABCTNM1T4N2M1CT scan ABCTNM1T4N2M1CT scan MRIMRIPET-CT: T3N2PET-CT: T3N2BUSLiver metastasisKrukenbergs tumorleftrightBUSLiver metastasisKrukenbergTTLaparoscopyAbdominal metastasisTTLaparoscopyAbdomin

11、al metastaTreatment for Gastric CancerSurgery Endoscopic mucosal resection (EMR) Endoscopic submucosal dissection (ESD) Laparoscopic Surgery Open SurgeryChemotherapyChemoradiotherapyTarget therapyTreatment for Gastric CancerSuEMR for Earlier gastric cancer (EGC )EMR for Earlier gastric cancerCriteri

12、a for EMRNCCN 2013 V2:1.Tis or T1a 2. Well or moderately differentiated histology3.Tumors less than 15mm in size,4.Absence of ulceration and no evidence of invasive findingCriteria for EMRNCCN 2013 V2:Criteria for EMRAbsolute indication (EMR/ESD):Differentiated adenocarcinomaT1adiameter is 2 cmwitho

13、ut ulcer finding (UL-)Japanese Gastric Cancer AssociationExpanded indication (ESD):Tumors clinically diagnosed as T1a and:(a) Differentiated, UL( - ), but 2 cm(b) Differentiated-type, UL(+), and 3 cm (c) Undifferentiated-type, UL(-), and 2cmCriteria for EMRAbsolute indicEMREMREMREMREMREMR1.Difficult

14、 to resect large than 20mm tumor in size2. Difficult to resect ulcerative lesions Limitation of EMR techniquesESD was developed1.Difficult to resect large thESD for Earlier gastric cancer (EGC )ESD for Earlier gastric cancerESDOita Digestive Organs Hospital ESDOita Digestive Organs HospiESDOita Dige

15、stive Organs Hospital ESDOita Digestive Organs HospiPrinciples of radical operation for gastric cancer1. Negative margin (R0 resection, adequate margins 4 cm )2. D2 lymph node dissection for advance gastric cancer3. Subtotal gastrectomy for distal gastric cancer 4.Total or proximal gastrectomy for p

16、roixmal gastric cancerSurgical Treatment for Gastric CancerPrinciples of radical operatioLaparoscopic Resection1. A suitable procedure for ECG (Our experience)2. The efficacy and safety of this approach for advanc gastric carcinoma requires further investigationLaparoscopic Resection1. A suiOpen Sur

17、gery for Advanced Gastric Cancer1. A suitable procedure for ACG2. R0 resection3. R1 resection4. R2 resection Open Surgery for Advanced GastPrinciples of advanced gastric cancer surgery Gastrectomy with regional lymphatics: perigastric lymph nodes(D1) and those along the named vessels of the celiac a

18、xis (D2), with a goal of examining 15 or greater lymph nodesGastrectomy with D2 lymphadenectomy is the standard treatment for curable gastric cancer in eastern Asia Principles of advanced gastricGastrectomy and D2 lymphadenectomy for advanced gastric carcinomaGastrectomyGastrectomy and D2 lymphadene

19、cLymphadenectomyLymphadenectomyRoux-en-Y anastomosis Billroth II anastomosisAnastomosisSubtotal gastrectomyRoux-en-Y anastomosis BillrothTotal gastrectomyTotal gastrectomyLeft gastric AHepatic ASplenic ANo.11 LNLeft gastric AHepatic ASplenicPortal VeinPortal VeinSpleenStomachGreater omentumSpleenSto

20、machGreater omentum胃十二指肠肿瘤(英文版)课件胃十二指肠肿瘤(英文版)课件Adjuvant Therapy ChemotherapyRadiation TherapyTargeted TherapyAdjuvant Therapy ChemotherapyECF: Epirubicin , Cisplatin, 5-FuFOLFOX: Oxaliplatin, 5-Fu, CFSOX: S-1, OxaliplatinXELOX: Capecitabin, OxaliplatinDCF: Docetaxel, Cisplatin, 5-FuChemotherapyPreop

21、erative Chemotherapy Postoperative ChemotherapyECF: Epirubicin , Cisplatin, 5Ulcerative mass at antrum of stomach，about 4*5cm in sizeThe lesion is about 2.0*1.0cm in sizeAfter 3 courses of FOLFOXBefore the neoadjvant chemotherapyOur experiencePreoperative chemotherapyUlcerative mass at antrum of sAf

22、ter 3 courses of preoperative chemotherapyPreoperative chemotherapyAfter 3 courses of preoperativOur experienceLymphadectomy of group 7,8,9Our experienceLymphadectomy ofLiver after ChemotherapyOur experienceLiver after ChemotherapyOur exfoam cells in lamina propria(4010)Our experiencefoam cells in l

23、amina propria(4Targeted TherapyHerccptin Herb-2 receptor inhibitorIressa EGFR inhibitor Avastin VEGFR inhibitor Targeted TherapyHerccptin Other Molecular Medicine Interventions of Gastric Cancer1.Oncogene activation and targeted therapy2.Tumor-suppressor-gene inactivation and related therapy3. Apoptosis targeted therapy4. Anti-metastasis therapy5. Telomerase inhi