4 外科肿瘤学中文简.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * T stage are defined by depth of penetration into the gastrci wall, T1:Tumor invades lamina propria or submucosa, T2:Tumor invades muscularis propria or subserosa,T3: Tumor penetrates serosa (visceral peritoneum) without invasion of adjacent structures; T4: Tumor invades adjacent structures. * * * * * * * * * * * * * * * * * * * * 肿瘤治疗方案制订的基础Treatment Principles of Cancer Treatment are Based Upon ● 肿瘤生物学特性 ● 治疗手段的并发症发生率和死亡率 ● 治疗手段的效果 ● 病人生活质量 肿瘤治疗方案制订的基础Treatment Principles of Cancer Treatment are Based Upon ● with localized cancers are curable ● presenting with positive Lymph Nodes tend to bad outcome ● with distant metastases are rarely curable ● the most commonly parameter to measure survival and benefit of treatment --5-yr survival rates 肿瘤治疗新手段New Approaches to Cancer ● Immunology ● Biological response modifiers ● Interferons and interleukins ● Adoptive immunotherapy ● Monoclonal antibodies ● Tumor vaccines ● Gene therapy 本课重点(key points) 肿瘤的分类与命名 肿瘤的病理: 发生发展过程, 肿瘤细胞的分化 生长方式, 转移方式 肿瘤的临床表现: 局部表现 肿瘤的主要诊断方法 肿瘤的三级预防 肿瘤的治疗手段 外科治疗的原则 药物分类二 1)细胞毒素类药物； 2)抗代谢类药； 3)抗生素类； 4)生物碱类； 5)激素类； 6)其他 增殖周期 M G1 G0 G2 S 静止期 药物分类一 1、细胞周期特异性 2、细胞周期非特异性 3。细胞周期时相特异性 化 疗 细胞毒药物: 依赖肿瘤细胞与正常细胞生长、修复、死亡的动力学间的差异来杀伤肿瘤细胞，选择性差。 靶向治疗：具有针对致癌机制，直接攻击致癌 病因，选择性强 Antisense DNA Cytoplasm mRNA DNA protein S G2 M G1 G0 细胞周期与抗癌药物 The Cell Cycle Anticancer Drugs 抗代谢药物 抗细胞分裂药 长春碱类 泰素 化疗药物的分类Classification of Chemotherapeutic Drugs Classes Examples Alkalating agents Cisplatin Antimetabolites 5-FU, MTX Mitotic inhibitors VP-16,Taxoids Natural products MMC, Bleomycin Others Hydroxyurea 肿瘤负荷越大 ● 治疗周期越多 ● 耐药克隆越多 ● 生长指数越小 ● 转移可能越大 肿瘤化疗耐药性Resistance to Chemotherapy ● Decreased drug-activating enzymes ● Increased drug-inactivating enzymes ● Increased DNA repair ● Mutations in drug targets ● Excretion of drug out of the cells 化疗药物的不良反应Chemotherapy-induced Toxicities