癌症病理、诊断与相关分期系统简单介绍.pptVIP

TNM分期系統的目的 幫助臨床醫師規劃治療 提供預後指標 協助治療結果的評估 便利治療中心間的資料交流 貢獻於人類癌症的持續研究 TNM系統 TNM系統描述疾病範圍是基於評估三種構成要素: T: 原發腫瘤(tumor)的範圍, (T0, T1, T2, T3, T4) N: 局部淋巴結(node)有否轉移以及轉移範圍, (N0, N1, N2, N3) M: 有否遠處轉移(metastasis), (M0, M1) 兩種分期類別: 臨床分期(治療前的臨床分期): 以TNM (或cTNM)表示 病理分期(手術後病理組織分期) 以pTNM表示 定妥T,N,M 和/或pT, pN, pM的類別後, 再將它們組合成期別(stage) TNM分期 T-原發腫瘤: TX: 原發腫瘤無法評估 T0: 無原發腫瘤 Tis: 原位癌 T1, T2, T3, T4: 原發腫瘤增大或局部侵犯更多 N-局部淋巴結: NX: 局部淋巴結無法評估 N0: 無局部淋巴結轉移 N1, N2, N3: 局部淋巴結轉移增加 M-遠處轉移 MX: 有否遠處轉移無法評估 M0: 無遠處轉移 M1: 有遠處轉移 癌症之病理分化 G-組織病理分化 (histopathological grading) GX: 分化無法評估 G1: 分化良好 (well differentiated) G2: 中度分化 (moderately differentiated) G3: 分化不良 (poorly differentiated) G4: 未分化 (undifferentiated) (Grades 3 和 4 在某些情形下可以合併成 “G3-4 分化不良或未分化”) TNM Classification of Lung Tumors T- Primary Tumor TX: Primary tumor cannot be assessed, or tumor proven by the presence of malignant cells in sputum or bronchial washings, but not visualized by imaging or bronchoscopy T0: No evidence of primary tumor Tis: Carcinoma in situ T1: Tumor 3 cm or less in greastest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus) TNM Classification of Lung Tumors T2: Tumor with any of the following features of size or extent: More than 3 cm in greatest dimension Involve main bronchus, 2 cm or more distal to the carina Invades visceral pleura Associated with atelectasis or obstructive pneumonitis that extends to the hilar region, but does not involve the entire lung TNM Classification of Lung Tumors T3: Tumor of any size that directly invades any of the following: chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium; or tumor in the main bronchus less than 2 cm distal to the carina, but without involvement of the carina; or associated atelectasis or obstructive pneumonitis of the entire lung T4: Tumor of any size that invades any of t