上交大外科学课件14外科肿瘤学

外科肿瘤学外科肿瘤学Surgical OncologyDepartment of Surgery Rui Jin Hospital School of MedicineShanghai Jiao Tong University肿瘤的定义Definition of Tumor 肿瘤是机体中正常细胞,在不同的始动与促进因素长期作用下所产生的增生与异常分化所形成的新生物 Tumors are characterized by cells that have lost their normal control mechanisms and thus have unregulated growth The top 10 cancer incidence and mortality in China,2011incidencemortalityAge-standardized incidence rate(1/105)-Chen WQ,et al.Chin Cancer 2015;24(1):1-10 The top 10 cancer incidence and mortality in China,2011(Male)%incidenceAge-standardized incidence rate(1/105)-Chen WQ,et al.Chin Cancer 2015;24(1):1-10 mortality%The top 10 cancer incidence and mortality in China,2011 (Female)%Age-standardized incidence rate(1/105)-Chen WQ,et al.Chin Cancer 2015;24(1):1-10 mortalityincidence 肿瘤病因学肿瘤病因学The Etiology of Cancer 病毒 Viruses (papilloma,Epstein-Barr,Hepatitis B,retroviruses,HIV)射线 Radiation exposure 环境、工业因素Environmental industrial carcinogens 吸烟/饮酒 Tobacco and alcohol consumption 基因易感性 Genetic susceptibility syndromes肿瘤相关病毒肿瘤相关病毒Viruses Associated with CancerVirusCancerHepatitis B,CHepatocellular CancerHIVKaposis sarcomaEpstein-Barr virus Nasopharyngeal cancerBurkitts lymphomaHuman Papilloma virusCervical cancer 肿瘤发病率与生活肿瘤发病率与生活/环境因素环境因素Cancer Mortality&Behavior/environmental FactorsFactorPercentage of cancer deathsSmoking30Diet30Infectious agents 5Alcohol 3Sedentary lifestyle 3Ultraviolet 2Air pollution 2人体内在因素(Inherent Factors)1.遗传因素:遗传易感性(hereditary susceptibility)2.内分泌因素:某些激素代谢紊乱可诱发或促进 肿瘤生长3.免疫因素:机体免疫功能降低,肿瘤发病率升高4.其它因素:精神,营养(微量元素缺乏)等吸烟相关肿瘤吸烟相关肿瘤Smoking-related cancers Lung cancer Oropharyngeal cancer Stomach cancer Cervical cancer Pancreatic cancer Renal cancer Bladder cancer Liver cancer Leukemia 与肿瘤发生相关的基因与肿瘤发生相关的基因 （Major Genes in Development of Cancer）癌基因Oncogenes 抑癌基因Tumor suppressor genes DNA修复基因 DNA repair genes癌基因癌基因Oncogenes Growth factors 生长因子EGF,TGF-Growth factor receptors 生长因子受体EGFR,PTK Intracellular transducers 细胞内传导素cAMP Transcription factors 转录因子c-mycDNA修复基因失活修复基因失活抑癌基因失活抑癌基因失活癌基因激活癌基因激活癌细胞癌细胞肿瘤的发生和发展恶性肿瘤病因和发病机制模式图 结直肠肿瘤发生的遗传模型肿瘤的发生经历了一系列遗传学上的变化，如数个癌基因的激活和/或抑癌基因的失活，及其他基因变化。Modern Viewpoint of Cancer as a Long-term Process癌前期癌前期广泛播散期广泛播散期侵袭期侵袭期原位癌期原位癌期Up to 1030 years310 years15 years15 years肿瘤病理学肿瘤病理学The Pathology of Cancer 恶性肿瘤的命名恶性肿瘤的命名 Nomenclature of Malignant TumorNames of tumorTissue of origin ExamplesCarcinomaEpithelium AdenocarcinomasSarcomaMesenchymal LiposarcomaMalig.lymphomaLymphocytes LymphomaMalig.melanomaMelanocytes Malignant melanomaMalig.Mesothelioma Mesothelium Pleural malig.MesotheliomaTeratomaGerm Cells Testicular teratomaChoriocarcinomaTrophoblast Uterine choriocarcinoma良性肿瘤良性肿瘤Benign Tumors A limited growth potential the neoplastic cells closely resemble those of the parent tissue(well diff.)growth slowly by expansion a well-encapsulated lesion do not usually produce serious effect恶性肿瘤恶性肿瘤Malignant Tumors proliferate rapidly more poorly differentiated cells progressive growth and invasion of the surrounding tissues metastases by lymphatic&blood vessels if not treated early,eventually cause death Peritoneal carcinomatosis of gastric cancer癌肿分期和组织学分类的目的癌肿分期和组织学分类的目的 有助于制订治疗方案 有助于判定预后 有助于评判疗效 有助于资源共享和学术交流 有助于癌肿临床研究的开展组织病理学分期与分类组织病理学分期与分类Histopathological Staging&Classification Adenocarcinomas Squamous carcinomas Small cell carcinomas Large cell carcinomas Sarcomas Lymphomas Leukemias Gliomas Seminomas Teratomas恶性肿瘤特性恶性肿瘤特性The Hallmark of Malignancy 局部破坏性浸润Local destructive invasion 远处转移Distant metastasis-the cardinal behavior to distinguish benign&malignant tumor恶性肿瘤病理特征恶性肿瘤病理特征Pathological Features of Malignancy an infiltrative uncapsulated margin invasion of baseline membrane or surrounding structure evidence of invasion of blood vessels or lymphatics or metastases tumor necrosis architecture abnormalities e.g.increased gland/stroma ratio cytological abnormalities e.g.increased nuclear/cytoplasm ratio numerous mitotic figures&abnormal mitoses恶性肿瘤病理特征恶性肿瘤病理特征Pathological Features of Malignancy 癌的大体分型癌的大体分型Gross Types of CarcinomaPapillaryNodularUlcerativeCysticMultipleDiffuseStrictureBorrmanns ClassificationI 型型 II型型III型型型型左肺上叶中央型肺癌胃癌肝转移Three Important Terms Metaplasia -the replacement of one fully differentiated tissue by another Carcinoma in situ -the histological abnormalities are sufficiently severe to suggest carcinoma,but in the absence of basement membrane invasion Border tumor -A tumor with biologic behavior between benign and malignant 分化程度分化程度The Degree of Differentiation 高度分化(I级)Well differentiated 中度分化(II级)Moderately differentiated 低度分化(III级)Poorly differentiated恶性肿瘤的后果恶性肿瘤的后果Effects of Malignancy Tumor arising within a hollow viscus梗阻 obstruction tumor arising from surface of organ溃疡/出血ulceration and bleeding恶性肿瘤的波散恶性肿瘤的波散Spread of Malignant Tumors直接浸润(direct invasion)-rectal cancer 区域淋巴结转移(lymphatic spread)-breast carcinoma,gastric cancer 血行播散至远处(metastasis by bloodstream)-liver,lung&brain 体腔内种植(cavity implantation)-ovarian carcinoma(Krukenbergs tumor)TNM Staging of GCT