医药健康neoplasms of genitourinary system 泌尿系肿瘤课件

Neoplasms of Genitourinary System 泌尿系肿瘤 Adenocarcinoma of the Kidney （ Renal Cell Carcinoma, RCC, 肾 细胞癌） RCC In US(1999), 30,000 new cases diagnosed, 11,900 deaths from this disease RCC accounts for 3% of adult cancers, 85% of all primary malignant renal tumors RCC occurs most commonly in 5th6th decade, male-female ratio 2:1 Etiology Cause: unknown Risk Factors: cigarette smoking, exposure to asbestos （石棉）and tanning（鞣革）products Etiology RCC occurs in 2 forms: -inherited（遗传）：chromosome translocation, Von Hippel-Lindau disease -sporadic（散发） Pathology RCC originates from the proximal renal tubular epithelium. Types: Clear cell type Granular cell type Mixed cell type RCC is most often a mixed adenocarcinoma（腺 癌）. Tumor Staging (Robson System) I: Tumor is confined within the kidney parenchyma. II: Tumor involves the perinephric fat but confined within Gerotas fascia (including the adrenal). IIIA: Tumor involves the main renal vein/inferior vena cava. Tumor Staging (Robson System) IIIB: Tumor involves regional LN. IIIC: Tumor involves both local vessels and LN. IVA: Tumor involves adjacent organs other than the adrenal. IVB: Distant metastases. Clinical Findings Symptoms & Signs A. Classical triadgross hematuria, flank pain, palpable mass (only in 1015% advanced cases) Symptoms secondary to metastatic disease: dysnea & cough, seizure & headache, bone pain Renal tumors are increasingly detected incidentally by CT or ultrasound Clinical Findings B. Paraneoplastic Syndromes: erythrocytosis（红细胞增多症）, hypercalcemia（高钙血症）, hypertension C. Lab Findings: anemia, hematuria(60%), ESR, Clinical Findings D. X-ray Findings: *Ultrasonography *Intravenous Urography (IVU): 75% accurate (used alone), calcification *CT scanning: more sensitive, mass +renal hilum, perinephric space and vena cava, adrenals, regional LN and adjacent organs *Renal Angiography IVU of right RCC CT scan of right RCC CT scan of left RCC RCC invading renal vein Left cystic RCC Left cystic RCC Differential Diagnosis Benign renal tumors: Angiomyolipoma （血管平滑肌脂 肪瘤, 错构瘤) Treatment 1. Localized disease: Surgical removal-only potentially curative therapy Radical Nephrectomy (en bloc removal of the kidney and Gerotas fascia including ipsilateral adrenal, proximal ureter, regional lymphadenectomy (淋巴结清扫) Treatment 2.Disseminated disease: nephrectomy- reducing tumor burden radiation- radioresistant tumor, metastases 2/3 effective chemotherapy- 20 ng/ml highly suspect of PCa Clinical Findings D. Prostate biopsy（活检） golden standard E. Imaging TRUS, MRI, Bone scan Treatment 1. Localized disease (optimal form in great debating) Watchful waiting Radical prostatectomy（根治性前列腺 切除） Radiationexternal beam Treatment 2. Locally advanced/metastatic diseases Endocrine therapycomplete androgen blockade : orchiectomy睾丸切除 +antiandrogen agent (flutamide, 氟他胺) or LHRH agonist（类似物） Radiation Thanks for your attention! ） “和而不同”，多元发展。近年来，中医药在防治非典、禽流感和艾滋病方面发挥的独特作用也证实了二者的有机结合，具有肯定的临床疗效。 编辑本段东西方医学交融（df高血压958心脏病983u6 糖尿病87fr） 不管是中医学还是西医学，从二者现有的思维方式的发展趋势来看，均是走向现代系统论思维，中医药学理论与现代科学体系（45传染病q566 丙肝964jo乙肝28jgsx甲肝gh）之间具有系统同型性，属于本质相同而描述表达方式不同的两种科学形式。可望在现代系统论思维上实现交融或统一，成为中西医在新的发展水平上实现交融慢性胃炎分类 慢性胃炎的命名很不统一。依据不同的诊断方法而有慢性浅表性胃炎、慢性糜烂性胃炎、慢性萎缩性胃炎、慢性胆汁返流性胃炎、慢性疣性胃炎、药物性胃炎、乙醇性胃炎等等。 慢性胃炎大体可分为三种类型：慢性肥厚性胃炎、慢性浅表性胃炎以及慢性萎缩性胃炎。慢性肥厚性胃炎在临床上较为少见，一般也不会发生癌变。慢性浅表性胃炎主要是指胃粘膜的浅表性炎症，这类炎症主要表现为胃粘膜的固有膜宽度增大并伴有水肿，被炎症细胞浸润，但胃腺体多属正常这类胃炎在临床上较多见，一般也不会发生癌变。只要经过恰当治疗之后，炎症可消退，但如治疗不当，往往可发展成萎缩性慢性胃炎慢性萎缩性胃炎是指胃粘膜除有浅表性胃炎病变外，胃腺体明显减少，脉管间隙扩大，胃粘膜层有全层性细胞浸润，常伴有肠上皮化生，即胃型上皮变为肠型上皮这种性质的慢性胃炎与胃癌的关系密切，特别是有肠上皮化生者更是如此或统一的支撑点，希冀籍此能给（df高血压958心脏病983u6 糖尿病87fr）中医学以至生命科学带来良好的发展机遇，进而对医学理论带来新的革命。 在胃镜问世以前，胃炎的主要诊断依据是依靠临床症状和上消化道钡餐检查。随着纤维胃镜的临床应用，特别是经胃镜对胃粘膜的活组织检查，对越来越多的胃炎有了较明确的认识。1982 年，国内胃炎会议上根据国内外经验，将慢性胃炎分为浅表性和萎缩性两大类。而在浅表性胃炎的命名上，又常常使用病理、部位、形态等含义的词，如“慢性疣状胃炎”、“慢性出血性胃炎”、“慢性糜烂性胃炎”、 “慢性胆汁反流性胃炎”等等。1990 年8月，在澳大利亚悉尼召开的第九届世界胃肠病学大会上，又提出了新的胃炎分类法，它由组织学和内镜两部分组成，组织学以病变部位为核心，确定3种基本诊断：急性胃炎；慢性胃炎；特殊类型胃炎。加上前缀病因学诊断和后缀形态学描述，并对炎症、活动度、萎缩、肠化、幽门螺杆菌感染分别给予程度分级。内镜部分以肉眼所见描述为主，分别区分病变程度。 1慢性糜烂性胃炎 内镜下常表现为多发性点状或阿弗他溃疡。慢性非糜烂性胃炎可为特发性，也可由药物(特别是阿司匹林和非甾体类消炎药，参见消化性溃疡的治疗部分)，克罗恩病或病毒感染所引起。幽门螺杆菌可能在此不发挥重要作用。 症状多为非特异性的，可包括恶心，呕吐和上腹部不适。内镜下显示在增厚的皱襞隆起边缘有点状糜烂，中央有白斑或凹陷。组织学变化多样。尚无某种方法具有广泛疗效或可治愈。 治疗多为对症治疗，药物包括制酸剂，H2拮抗剂和质子泵。 2慢性胃炎的癌变