[理学]第十讲 肿瘤基因组和基因芯片.pptVIP

肿瘤基因组学与基因芯片 第十讲 肿瘤的研究 美国1971年颁布国家癌症条例开始抗癌大战 使癌症成为“慢性病” Concept of Neoplasm（瘤） “… is an abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues, and persists in the same excessive manner after cessation of the stimuli which evoked the change” Basic Biologic Features of Neoplasms Neoplasms Evolve in Multiple Steps Initiation: presumably occurs through irreversible or stable damage to DNA Promotion: an process bringing about a clonal expansion of initiated cells Progression: results when genetic instability leads to further mutagenic and epigenetic changes 肿瘤的发生（Initiation） Tumor initiation：Cooperative DNA lesions as common final pathway Precancerous and incipient（初始 的） lesions Molecular targets：Oncogenes, tumor suppressor genes DNA repair genes 肿瘤的促进（promotion） Expansion of initiated cells Repetitive process Initiation Promotion 致癌剂 肿瘤促进剂 低黄曲霉素B1Aflaloxin B1，高杀草强Amitrole，砷和其化合物Arsenic compounds，高三氧化二砷Arsenic trioxide，高三硫化砷Arsenic trisulfide，高石棉Asbestos 癌基因（如myc 、ras） 需要反复刺激 Initiation Promotion Initiation PromotionTarget Genes 肿瘤的发展（progression） 肿瘤组织浸润相邻组织 淋巴结转移和血道转移 远端转移 Apoptosis and Tumorigenesis 小 结 肿瘤发生发展的三个阶段 基于基因表达谱的分子分型 为什么提倡利用分子水平进行肿瘤的分型？ 肿瘤的一般临床学知识 肿瘤的诊断 肿瘤的临床分期（stage） 肿瘤的临床分级（grade） 肿瘤的治疗 放疗 化疗 辅助治疗 靶点治疗 肿瘤的临床分期(stage) TNM分期 肿瘤的大小(T, tumor size) 肿瘤是否发生临近的淋巴结转移(N, node) 肿瘤是否有远处转移(M, metastasis) 乳腺癌 分 期 Tis Carcinoma in site T1 Tumor ≤ 2.0 cm in greatest dimension T2 Tumor 2.0 cm –5.0 cm in greatest dimension T3 Tumor 5.0 cm in greatest dimension T4 Tumor of any size with direct extension to chest wall or skin N0 No regional lymph nodes metastasis N1 Metastasis to moveable ipsilateral axillary node(s)(同侧腋下淋巴结) N2 Metastasis to ipsilateral axillary node(s) fixed to one another or other structures N3 Metastasis to ipsilateral internal mammary node(s) M0 No distant metastasis M1 Distant metastasis (includes metastasis to ipsilateral supraclavicular（锁骨） lymph node(s) 肿瘤的临床分级(grade)