上海交大外科肿瘤学课件03外科肿瘤学的基本原则.pptVIP

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 * * * * * * * * * * * * * The Principles of Cancer Surgery 外科肿瘤学的基本原则 Principles of Cancer Surgery No involvement of surgical stump Sufficient lymphatic dissection (DnNn) No distant metastases Removal of involved adjacent organs and structures by combined en bloc resection 肿瘤外科治疗的关键问题Key Points of Cancer Surgery ● Combined treatment modalities ( Multiple disciplinary team, MDT) ● Preoperative chemotherapy ● Postoperative chemotherapy ● Preoperative radiotherapy ● Postoperative radiotherapy ● Perioperative chemotherapy 辅助治疗 Adjuvant therapy Administration of systemic therapy after optimal loco-regional therapy (surgery/ radiotherapy) 新辅助治疗 Neo-adjuvant therapy Chemotherapy/Radiotherapy is administered prior to loco-regional therapy to reduce the tumor cell burden Surgery 根据肿瘤位置局部LN组的清扫情况 D1 4d 4d 4d 6 5 3 D2 11p 12a 14v 1 9 9 8a 9 7 LD/L Surgical treatment for gastric cancer Gastric resection should include the regional lymphatic -- perigastric lymph nodes (D1) and those along the named vessels of the celiac axis (D2), with a goal of examining 15 or greater lymph nodes. 腹腔镜结肠癌手术 腹腔镜结肠吻合技术 胃癌手术标本整块切除 （en bloc resection) 肿瘤治疗原则 良性肿瘤及交界性肿瘤: 以手术切除为主。尤其交界性肿瘤必须切除，否则极易复发或恶性变。 恶性肿瘤: 拟定综合治疗方案，在控制原发病灶后，进行转移灶的治疗。恶性肿瘤第一次治疗的正确与否对预后有密切关系。 I期：手术为主。 II期：局部治疗为主，原发肿瘤切除或放疗，并必须包括转移灶的治疗，辅以有效的全身化疗。 III期：采取综合治疗，手术前、后及术中放疗或化疗。 IV期：有全身治疗为主，辅以局部对症治疗。 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 ● presenti