肿瘤诊治及中西医疗法新进展【精品-ppt】

Department of Genetics and Pathology, Uppsala University, Sweden 任志平 Zhi-Ping Ren MD PhD,Sanjiu Medical & Wellness Center Toronto (416) 497-6339,Research Institute,Program of Genetics and Genomic Biology TMDT Building 101 College St. East Tower 15th Floor Toronto, Ontario M5J 1L7 Canada,New Progress of Cancer Diagnosis and Treatment in Western Medicine and Traditional Chinese Medicine (TCM),腫瘤診治及中西醫療法新進展,What is cancer? How to treat cancer? Can cancer be prevented?,甚麼是腫瘤? 如何診治? 中西醫療法 腫瘤能預防嗎?,The accurrence of cancer is a very complicated process,腫瘤的發生是一個非常複雜的過程,Cancer is a disease of abnormal DNA Cancer is a somatic cell genetic disease,Any single step goes wrong, problems will come,Multiple steps carcinogenesis,A series of events, initiation, promotion and progression, that leads to the development of an invasive cancer,腫瘤發生的多步驟學說,Normal,Dysplasia,Carcinoma in situ,Cancer,Metastasis,正常細胞,異常增生,原位癌,癌,轉移癌,Oncogenes,Oncogenes,Tumor suppressor genes,Other factors,Each different cancer has its own pathway from benign to malignant,Inherited cancer (internal cause) Sporadic cancer (external cause),每種不同的腫瘤都有自己的惡變途徑 包括先天及後天因素,Incidence, mortality and cure rates of the most commonly diagnosed cancers,Risk factors,Contact carcinogens: smoking, aflatoxin, nitrite, nitrisamine, radiation, UV light, etc.,危險因素: 接觸致癌物, 吸煙, 黃曲霉毒素, 亞硝酸鹽, 亞硝酸胺, 放射線, 紫外線, 等.,The most important thing in cancer management is early detection,Axiom: Early detection of cancer leads to cure,早期監測在腫瘤治療中最重要,Techniques used in molecular pathology,DNA level Mutation analysis Comparative genomic hybridisation (CGH) Fluorescence in situ hybridisation (FISH) Mutation screening with arrays RNA level Gene expression-transcription cDNA and oligonucleotide arrays Serial analysis of gene expression (SAGE) Detecting mutations and polymorphisms with arrays Differential display and representational difference analysis,Protein level Gene expression: translation-proteomics and mass spectrometry Tissue arrays; functional genomics Other techniques used in molecular pathology Microdissection Knockout and transgenic organisms Quantitative and real-time PCR Bioinformatics and data mining Diagnostics, biomarkers and drug development ,Microdissection,Microdissection History,Laser capture microdissection. Emmert-Buck MR, Bonner RF, Smith PD, Chuaqui RF, Zhuang Z, Goldstein SR, Weiss RA, Liotta LA. Science. 1996 Nov 8;274(5289):998-1001 Sequence-based analysis of the human p53 gene based on microdissection of tumor biopsy samples. Hedrum A, Pontn F, Ren Z-P, Lundeberg J, Pontn J, Uhln M. Biotechniques. 1994 Jul;17(1):118-9, 122-4, 126-9.,Western ways to treat cancer,Slash (operation) burn (radiation) poison (chemotherapy),西醫治癌方法: 手術, 放療, 化療.,New development in the treatment of cancer,New technologies used for operation: Accurate positioning of tumor (MRI, CT, PET) Lymph node tracking method (radiation blue dye injection and find sentinel lymph node) Surgeon controls camera and robotic instruments through remote computer console ,Other new techniques used,Computer assisted imagining, functional imaging analysis, nanotechnology, bioinformatics ,Radiation: new imaging system precisely positioning and aiming target cells, different radiation dosage and therapy Chemotherapy (including hormonal therapy): new drug development, more specific and less toxic (find the specific pathways and blocking it specifically),New methods in cancer treatment:,Anti-angiogenesis, Vascular Endothelial Growth Factor (VEGF) inhibitor Immunotherapy: recognize cancer cell as foreign cell, attack the cancer cell Interferon-alfa, interleukin-2 DNA vaccines Hormonal therapy,腫瘤治療新方法: 阻斷血管生成, 免疫療法, 干擾素, DNA 疫苗, 激素療法,Knowledge is strength Knowledge is power Knowledge saves life,知識就是力量, 知識拯救生命!,You are the best doctor of yourself Your knowledge will save your life,Website: (people live with cancer) (American Society of Clinical Oncology) /aboutherbs (Memorial Sloan-Kettering Cancer Center) ,Colon cancer 結腸癌,1 in 17 men and women, 95% get it over the age of 50 About 75% are sporadic; the rest together is about 25% Long nature history: from polyps to adenoma to carcinoma takes 20 years in average Colorectal cancer can be prevented: Life style (good diet-more vegetables, fruits; exercises-strongest correlation to prevent colorectal cancer); screening (polypectomy-clonoscope, sigmoidoscopy- prevents cancer-best kept secret) Risk factor: obesity, eating meat, smoking, alcohol. 5-FU, inhibit Vascular Endothelial Growth Factor (VEGF),Breast cancer 乳腺癌,1 in 8 women affected 212,600 cases diagnosed and 40,200 die of the disease in 2003 Screening: 1. BRCA testing. 2. mammography screening (false negative up to 20%) Surgical prevention of breast cancer: Prophylactic mastectomy Tamoxifen, raloxifene, herceptin (Trastuzumab),Lung cancer 肺癌,85% to 90% caused by cigarette smoking 164,000 new cases in the U.S. M:F=1.2:1; Deaths 156,900 (96%) in 2000 CT screening is not sensitive enough No demonstration of decreased mortality in screened population Best treatment so far: surgery. Unresectable stage: chemotherapy is worth the effort “Trial and Error” No good testing methods,Prostate cancer 前列腺癌,Most common cancer in American men 320,000 new cases diagnosed 2005, 1/10 death anticipated in the U.S. We do not have specific genetic testing in prostate cancer. PSA test is not specific. Treatment options: watchful waiting, radical prostatectomy Hormonal therapy + chemotherapy Prevention? Beta-carotene 7 years clinical trial FDA not proved,Cervical cancer 宮頸癌,500,000 women worldwide die of cervical cancer annually 12,200 new diagnosed, 4,100 deaths in the US per year Screening test: Pap smear test (collect cells) reducing mortality 70% Sexually transmitted Known causes HPV DNA found in 99.8% cervical cancer Can be prevented by screening and follow-up Can nearly always be cured if detected early Cryotherapy, laser vaporization, conization, trahelectomy HPV vaccine,Ovarian cancer 卵巢癌,1 in 57 women 25,580 diagnosed; 16,090 die in 2004 in the US Risk factors: nulliparity: 30-60% increased; breast feeding decreased; oral contraceptives 30-60% decreased Difficult detect, symptom is non-specific,Skin cancer 皮膚癌,Melanoma, Non-melanoma 1 in 53 USA will get melanoma Self observing, pay attention to your every parts of your body leads to early detection Sun light, hair dye, ,Head and neck cancer 头頸部癌,53,000 men and women diagnosed, 5% of all cancer in the US but ranks 6th for worldwide cancer diagnosis Risk factor: Tobacco + alcohol = 90% exposed; poor or low amount of fruit and vegetable Tobacco: contain over 40 different carcinogens Persistent oral sore, screening leads to early detection,Brain tumor 腦腫瘤,Etiology is basically unknown 17,000 new primary brain diagnosed per year in the US (100,000 matastatic) More than 100 types of brain tumor Each has separate pathologic features Distinct biology Different treatment and outcomes No good treatment methods No good detection methods. No role for screening as in breast cancer Early detection DO NOT leads to cure,Western medicine,Based on scientific evidence focuses on find out the etiology, pathology and the external cause of the disease and seek to treat it accordingly,Western Medicine is clearly not the only way to treat cancer,Tumor can not be resection Metastatic tumors Do not response to chemotherapy or radiotherapy Too weak to be treated ,Side effects and toxicity of western treatment,Nausea, fatigue, diarrhea, acneiform rash, etc, etc Many patients can not complete their treatment Prophylactic ectomy is hard to accept ,Western Medicine and Traditional Chinese Medicine are completely different both in theory and in practice, but both serve the same object the patient,Traditional Chinese Medicine (TCM),Absorbed Chinese philosophy, culture and science, and summarized the experience of the Chinese people in fighting against disease. Based on observations and experiences accumulated over several thousands of years Focuses on the patient and try to cultivate and activate the patients internal repair power (increasing immune response against the disease).,Western Medicine treat disease TCM treat patient Western Medicine and TCM will not interfere with each other In many aspects, they help and support each other,Can TCM alone cure cancer?,Not scientifically approved, but TCM can prevent it. TCM play a very important complementary role in cancer treatment,Cultivate and activate the patients internal repair power is extremely important,For example: Likelihood of getting HPV infection has been estimated to be 75% or more in life time In younger women, the bodys immune system fights off the virus with no ill effects Cervical cancer occur most often in women 30 years of age or older,State of Dynamic Equilibrium,動態平衡: 損傷, 修復, 健康.,“正氣存內邪不可干” “邪之所湊其氣必虛” 黃帝內經,“with sufficient healthy qi inside the body, pathogenic factors will have no way to invade the body” “if pathogenic factors invade the body, qi in the body must be deficient” Haungdi Neijing,如果我們體內免疫及修復能力完好, 我們就不會患腫瘤,If our immune system and repair ability is intact, we will not suffer from tumor,“上工醫未病不醫已病” “Good doctor treat disease, best doctor prevent it”,Characteristics of Traditional Chinese Medicine,Holism The Body, an Organic Whole Unification of Human and Nature World Treatment Based upon Syndrome Differentiation 整體觀念, 天人和一, 辨証施治.,中醫治則:治病求本, 扶正袪邪, 調整陰陽, 因人制宜,Therapeutic principles of TCM Concentrating treatment on the root cause Strenthening healthy qi and eliminating pathogenic factors Regulation of yin and yang Abidance by individuality, locality and seasons,Prevention Principles of TCM,Preven