《胃癌进展》ppt课件

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1、温州医科大学附属第一医院胃癌的综合治疗进展(GastricCancer)EpidemiologyKOREAJapanChina我国以进展期胃癌为主What’sthecauseofgastriccancer?Theexactcauseofgastriccancerisunknown.ThefollowingaresuggestedasriskfactorssomegastricbenignlesionsHelicobacterpyloriinfectionpreviousstomachsurgerysomediets“Pre-ma

2、lignantdiseases”（癌前疾病）Gastricpolyps,particularlyifanadenomatouspolypis>2cmindiameter（胃息肉）Gastriculcer（胃溃疡）AtrophicGastritis（萎缩性胃炎)Thestumpsaftersubtotalorpartialgastrectomyfor5—20years,20-25Yrs.mostly,particularlyinBillorth-Ⅱmanner（残胃）“Pre-malignantlesions”（癌前病变）癌前病变

3、是指容易发生癌变的胃粘膜病理组织学改变。轻度异型增生中度异型增生重度异型增生2.Pathology2.1macroscopicclassificationEarlygastriccancer(EGC)早期胃癌Advancedgastriccancer(AGC)(进展期胃癌)隆起型表浅型凹陷型BorrmannⅠ——polypoidcarcinomaBorrmannⅡ——ulceratingcarcinomaBorrmannIII——ulceratingandinfiltratingcarcinomaBorrmannⅣ——diffu

4、selyinfiltratingcarcinomaBorrmannclassificationMorethan95%ofGCareadenocarcinomaHistologicalclassificationofWHO：papillary（乳头状）tubular（管状）mucinous（黏液性）undifferentiated（未分化）signet-ringcell（印戒细胞）specialtype（特殊类型）2.2Histologicalclassification3.StagingTNMStagingT-categoryP

5、rimarytumor,N-categoryNodalinvolvementM-categoryDistantmetastases,UICCTNMstaging(2010)TEmphasizethedepthofinfiltrationT1limitedtomucosaorsubmucosaT2tumorinvadesmuscularlayerT3tumorinvadessubserosaT4atumorinvadesserosaT4btumorinvadesadjacenttissueand/ororgansStagingNE

6、mphasizethedistancefromprimarytumourmargintopositivenodesN0nonodalinvolvementN11~2positiveLNsN23~6positiveLNsN3≥7positiveLNsMDistantmetastasesM0nodistantmetastasesM1distantmetastasesThePTNMstagingofGC:Ⅰ－ⅣN0N1N2N3T1ⅠaⅠbⅡaⅡbT2ⅠbⅡaⅡbIIIaT3ⅡaⅡbIIIaIIIbT4aⅡbIIIaIIIbIIIcT4

7、bIIIbIIIbIIIcIIIcM1IVTNMIaT+N=1IbT+N=2IIaT+N=3IIbT+N=4IIIaT+N=5IIIbT+N=6IIIcT+N=7T4b+N0/N1=IIIbT4b+N2/N3=IIIC4.Clinicmanifestation5Diagnosis1：胃镜2：增强CT3：超声内镜4：肿瘤指标术前分期确定超声胃镜检查：推荐用于术前分期，有助于评价浸润深度和判断胃周淋巴结转移状况行内镜粘膜切除（EMR）、内镜粘膜下层切除（ESD）CT：术前分期的常规方法建议在胃腔呈良好充盈状态下进行增强CT扫描PET

8、-CT：对判断腹膜转移的价值有待进一步明确目前不推荐常规使用腹腔镜：怀疑腹膜转移或腹腔内播散者，可考虑腹腔镜检查ref：卫生部胃癌诊疗规范早期胃癌的治疗进展期胃癌的治疗晚期治疗6.Treatment近年来胃癌治疗最大的进展是通过胃癌围手术期治疗和辅助放化疗的综合