大肠直肠癌的形成过程.ppt

勞工大腸癌採樣及防治講習 怡仁綜合醫院 胃腸科 黃文豪 結腸癌發生人數按年齡及性別分類 結腸癌發生人數按臨床、病理分類 直腸癌發生人數按年齡及性別分類 直腸癌發生人數按臨床、病理分類 Factors that may influence carcinogenesis in the colon and rectum Probably causative High-fat and low-fiber diet (adjusted for energy intake) Red meat consumption Possibly causative Beer and alc. Consumpion( esp. for rectal ca.) Cigarette smoking Diabetes mellitus Enviromental carcinogens and mutagens Heterocyclic amines ( from charbroiled and fried meat and fish) Low dietary selenium Propably protective Aspirin, NSAID, and cyclooxygenase-2 inhibitors Calcium Hormone replacement therapy (estrogen) Low body mass Physical activity Possible protective Carotene-rich foods High-fiber diet Vitamins C and E Vitamin D Yellow-green cruciferous vegetable Risk factors for colorectal cancer Age≧ 50 years High-fat, low-fiber diet Personal history of Colorectal adenomas (synchronous or metachronous) Colorectal carcinoma Family history of a polyposis syndrome: Familial adenomatous polyposis Turcost’s syndrome Muir-Torre syndrome Peutz-Jeghers syndrome Familial huvenile polyposis Hereditary nonpolyposis colorectal cancer First-degree relative with colorectal cancer Inflammatory disease Ulcerative colitis Chrohn’s disease 大腸直腸癌的形成過程 Colon polyps Two-thirds of polyps are adenomas (dysplasia) Adenoma prevalence 25% at age 50 and 50% by age 70 Risk of cancer increases with polyp size, number, and histology The polyp examined is representative of the individual’s propensity to form polyps and cancer Non-invasive testing for Colorectal carcinoma Stool test: Fecal occult blood test (FOBT) Chemical (guaiac-based FOBT) Immunochemical (iFOBT) Stool DNA test Serum test Tumor marker (CEA)?? Proteomics: analyze global pattern of protein expression (not available) 化學法 1.自西元1965年Okamoto等學者報告以來已有近50年的歷史 2.主要是利用紅血球中的過氧化酵素產生氧化還原反應，改變試劑顏色來判別。 3.臨床上常用的試劑依不同化學性質可分為兩種，一種是具有致癌性的O-Toluidine或 B e n z i d i n e ； 另一種是不具致癌性的 Guaiaconic acid(零陵香)。 4.每日糞便中血液若超過6-2