食管癌的新分期JG学案.ppt

国产替吉奥 慎用！ 谢 谢！ * 肿瘤在食管中的部位与周围毗邻结构相比，其周围毗邻的结构更为重要。第六版：Siewert has proposed classifying EG junction cancers into types I, II, and III, depending on the relative extent of involvement of either the esophagus or the stomach. A tumour the epicenter of which is within 5 cm of the esophagogastric junction and also extends into the oesophagus is classified and staged according to the oesophageal scheme All other tumours with an epicenter in the stomach greater than 5 cm from the oesophagogastric junction or those within 5 cm of the EGJ without extension into the oesophagus are staged using the gastric carcinoma scheme * T1 分为T1A 和T1B，T4分为T4A和T4B，pleura-peritoneum, pericardium, and diaphragm. T4BAorta, carotid vessels, azygos vein, trachea, left main bronchus, and vertebral body * T4b 侵犯气管、椎体、大血管等 * Number must be recorded for total number of regional nodes sampled and total number of reported nodes with metastasis. * * The data demonstrate that the number of regional lymph nodes containing metastases (positive nodes) is the most important prognostic factor. In classifying N, the data support convenient coarse groupings of the number of positive nodes (0, 1–2, 3–6, 7 or more). pT1, approximately ten nodes must be resected to maximize survival; for pT2, 20 nodes and for pT3 or pT4, 30 nodes or more. M分期 M1a和M1b 在新分期中不再使用 UICC分期第七版 病理学命名原则 GX在分期中归入 G1 ； G4在分期中归入鳞状细胞癌G3分级； 分期中记录最高级别组织病理学分级 如果病理为混合癌或其它类型肿瘤，分期归入鳞状细胞癌中； AJCC分期——鳞状细胞癌 AJCC分期——腺癌 正常食管扩张时在CT影像学上食管壁厚约3 mm，任何情况下，食管壁厚度5 mm被认为异常。 食管壁非对称性增厚是食管癌主要的但不是特异的CT影像学表现。 CT检查 CT判断气管、支气管受侵 3点受侵的标准 (1)食管气管间脂肪组织消失； (2)气管、支气管变形、移位； (3)肿瘤突向气管腔内。 正确率为93％，敏感性为97％，特异性为88％。 CT判断主动脉受侵 两项标准： (1)主动脉夹角法：肿瘤与主动脉接触弧度45度为主动脉无受侵；肿瘤与主动脉接触弧度90度为主动脉受侵；肿瘤与主动脉接触弧度45一90度。为可疑受侵。 (2)三角法：在食管、胸主动脉和椎体之间有一三角形脂肪间隙，若此脂肪间隙消失则为主动脉受侵。 ＞90度 食管癌CT分期 1989年 Tio 分期 T1 食管壁厚 5 -10 mm , 无明显纵隔侵犯 T2 食管壁厚＞10 mm T3 食管壁厚＞15 mm T4 明显侵犯纵隔和邻近结构: 主动脉、气管 食管癌CT分期 T分期的准确率为42.9 - 68.8 % T1-T2