临床医学大肠癌ppt课件.ppt

CARCINOMA OF COLON AND RECTUM大肠癌;大肠癌是指发生于回盲至肛门的恶性肿瘤，是常见的恶性肿瘤之一。 占我国常见恶性肿瘤的第4-6位，约占全部恶性肿瘤死亡的5.29%。 临床表现主要为便血、大肠梗阻，治疗以手术为主。;EPIDEMIOLOGY;1990~1992年我国抽样地区62种肿瘤的粗死亡率（1/10万）与死亡构成（%）节选;;;ETIOLOGY;TOPOGRAPHIC ANATOMY;;;Figure 29.9-1Division of the rectum into upper, middle, and lower thirds;;血供;直肠、肛管的淋巴引流;;大肠和结肠壁的淋巴引流;Patterns of spread and posttreatment recurrence of rectal cancer after surgery ;PATHOLOGY;大肠癌的部位分布;组织学类型;影响大肠癌预后的病理因素;大肠癌播散途径; 2．种植播散 (1)腹膜面种植插散：大肠癌浸透肠壁浆膜层时，癌细胞即可脱落入游离腹腔而发生种植播散，可散布于大网膜、肠系膜、内脏等腹膜面上。膀胱直肠陷凹是种植播散的好发部位。腹膜转移灶有时可刺激腹膜引起渗出，常可出现癌性腹水。 (2)肠腔内的种植播散：肿瘤上的癌细胞可以脱落进入肠腔，如脱落在正常粘膜上不会形成种植。如肠粘膜有破损，癌细胞可以存活而形成一个种植转移灶。 (3)医源性的种植播散：医务人员在进行诊断、治疗时造成的肿瘤播散，称为“医源性播散”。 ;3．淋巴道转移 4．血道转移 血道转移相当常见。;TNM Classification of Malignant Tumours, Sixth Edition ;Regional Lymph Nodes;T – Primary Tumour ;;;;;;;N – Regional Lymph Nodes NX. Regional lymph nodes cannot be assessed N0. No regional lymph node metastasis N1. Metastasis in 1 to 3 regional lymph nodes N2. Metastasis in 4 or more regional lymph nodes M – Distant Metastasis MX. Distant metastasis cannot be assessed M0. No distant metastasis M1. Distant metastasis ;;;End Notes ;Summary：Colon and Rectum ;;CLINICAL PRESENTATION;右半结肠癌的临床表现;左半结肠癌的临床表现;直肠癌临床表现;直肠癌临床表现;肛管癌临床表现;DIAGNOSTIC WORK-UP;辅助检查;;鉴别诊断;GENERAL TREATMENT;直肠癌;;;不可切除转移;RADIOTHERAPY;术前放疗 ;术前放疗方法;术后放疗;2. Miles 或 Dixon 根治术后放射治疗适应症 ? ?? 肿瘤位于真骨盆内?????? T3-4N0-2?????? Any T, N + ;术后放疗方法;局部晚期（ T4NanyM0 ??直肠癌的放射治疗 ;局部晚期（ T4NanyM0 ）直肠癌的放疗方法 ;RADIATION THERAPY TECHNIQUES放射治疗技术 ;常规三野等中心照射 ;;;Typical radiation fields for the preoperative treatment of a low-lying rectal cancer. The fields laterally extend to the pelvic sidewall, proximally a short margin above the sacral promontory ;Typical radiation fields for the preoperative treatment of a low-lying rectal cancer. The fields laterally extend to the pelvic sidewall, proximally a short margin above the sacral promontory and distally to the proximal portion of the anal canal, which is marked wi