肺癌的化疗夏黎明课件VIP

1、肺癌的化疗夏黎明1 Lung Cancer Chemotherapy Liming xia the first affiliated hospital of Anhui College of Traditional Chinese Medicine 肺癌的化疗夏黎明2 Also called: Bronchogenic carcinoma Lung cancer is one of the most common cancers in the world. It is a leading cause of cancer death in men and women in the world.

2、Cigarette smoking causes most lung cancers. Risk factors: cigarettes , high levels of pollution, radiation and asbestos exposure ,etc. 肺癌的化疗夏黎明3 Your lungs are two spongy organs in your chest that are divided into sections (lobes). Every time you inhale, air is carried through the windpipe to your l

3、ungs in two major airways (bronchi). Inside your lungs, the bronchi subdivide into a million smaller airways (bronchioles), which finally end in clusters of tiny air sacs (alveoli). Within the air sacs, oxygen is absorbed into your bloodstream and carbon dioxide is released. 肺癌的化疗夏黎明4 Types of lung

4、cancer Small cell lung cancer. Small cell lung cancer, sometimes called oat cell carcinoma, occurs almost exclusively in heavy smokers and is less common than non-small cell lung cancer. Non-small cell lung cancer. Non-small cell lung cancer is an umbrella term for several types of lung cancers that

5、 behave in a similar way. Non- small cell lung cancers include squamous cell carcinoma, adenocarcinoma and large cell carcinoma. 肺癌的化疗夏黎明5 How Is Lung Cancer Diagnosed? Symptoms and syndromes Pulmonary symptoms Symptoms in other organs Symptoms linked to tumor metabolism Blood (hematologic) syndrome

6、s Vein and artery (vascular) syndromes Skin (cutaneous) syndromes Musculoskeletal syndromes Nervous system (neurologic) syndromes Hormonal (endocrine) syndromes Miscellaneous syndromes 肺癌的化疗夏黎明6 Tests and diagnosis Screening Diagnosis Imaging tests Sputum cytology Tissue samples (biopsy) bronchoscop

7、y mediastinoscopy needle biopsy 肺癌的化疗夏黎明7 (Left) Conventional CT scan without contrast showing possible tumor in the liver. (Right) Conventional CT scan of the same patient using contrast. Images courtesy of Dr. Peter Choyke, Department of Radiology, Clinical Center, National Institutes of Health. 肺

8、癌的化疗夏黎明8 Bronchoscopy 肺癌的化疗夏黎明9 Small Cell Lung Carcinoma (above) accounts for about 15 percent of all lung cancer cases. Normal lung cells (above). 肺癌的化疗夏黎明10 Stage I. Cancer at this stage has invaded the underlying lung tissue but hasnt spread to the lymph nodes. Stage II. This stage cancer has sp

9、read to neighboring lymph nodes or invaded the chest wall. Stage IIIA. At this stage, cancer has spread from the lung to lymph nodes in the center of the chest. Stage IIIB. The cancer has spread locally to areas such as the heart, blood vessels, trachea and esophagus all within the chest or to lymph

10、 nodes in the area of the collarbone or to the tissue that surrounds the lungs within the rib cage (pleura). Stage IV. The cancer has spread to other parts of the body, such as the liver, bones or brain. Stages of non-small cell lung cancer Staging 肺癌的化疗夏黎明11 Limited. Cancer is confined to one lung

11、and to its neighboring lymph nodes. Extensive. Cancer has spread beyond one lung and nearby lymph nodes, and may have invaded both lungs, more remote lymph nodes or other organs. Stages of small cell lung cancer 肺癌的化疗夏黎明12 Surgery Chemotherapy Radiation therapy Targeted drug therapy Bevacizumab (Ava

12、stin) Erlotinib (Tarceva). Clinical trials Supportive (palliative) care Coping and support Learn all you can about lung cancer Take an active role in your treatment Build a strong support system Set reasonable goals Take time for yourself Stay active Alternative medicine AcupunctureHypnosis Massage

13、Meditation Yoga Treatments 肺癌的化疗夏黎明13 Lung cancer surgery 肺癌的化疗夏黎明14 Stage Common options Treatment options for non-small cell lung cancers I Surgery II Surgery, chemotherapy, radiation IIIA Combined chemotherapy and radiation, sometimes surgery based on results of treatment IIIB Chemotherapy, somet

14、imes radiation IV Chemotherapy, targeted drug therapy, clinical trials, supportive care 肺癌的化疗夏黎明15 Stage Common options Treatment options for small cell lung cancers Limited Combined chemotherapy and radiation, sometimes surgery Extensive Chemotherapy, clinical trials, supportive care 肺癌的化疗夏黎明16 Che

15、motherapy Chemotherapy uses drugs to kill cancer cells. One or more chemotherapy drugs may be administered through a vein in your arm (intravenously) or taken orally. A combination of drugs usually is given in a series of treatments over a period of weeks or months, with breaks in between so that yo

16、ur body can recover. Chemotherapy can be used as a first line treatment for lung cancer or as additional treatment after surgery. In some cases, chemotherapy can be used to lessen side effects of your cancer. 肺癌的化疗夏黎明17 Chemotherapy is usually the main treatment for SCLC Chemotherapy for SCLC genera

17、lly uses a combination of 2 drugs. The drug combinations most often used for initial chemotherapy for SCLC are: cisplatin and etoposide carboplatin and etoposide cisplatin and irinotecan carboplatin and irinotecan cyclophosphamide, doxorubicin (Adriamycin), and vincristine 肺癌的化疗夏黎明18 If the cancer p

18、rogresses during treatment or returns after treatment is finished, different chemotherapy drugs may be tried. The choice of drugs depends to some extent on how soon the cancer begins to grow again. (The longer it takes for the cancer to return, the more likely it is to respond to further treatment.)

19、 Chemotherapy for SCLC 肺癌的化疗夏黎明19 If the cancer progresses during treatment or relapses within 2 to 3 months of finishing treatment, drugs such as topotecan, ifosfamide, paclitaxel, docetaxel, irinotecan, or gemcitabine may be tried. If the relapse occurs from 2 to 3 months to 6 months after treatme

20、nt, topotecan is often the drug of choice. Other drugs that may be tried include irinotecan, cyclophosphamide/doxorubicin/vincristine (known as the CAV regimen), gemcitabine, paclitaxel, docetaxel, oral etoposide, or vinorelbine. For relapses 6 or more months after treatment, the original chemothera

21、py regimen may still be effective and can often be tried again. Chemotherapy for SCLC 肺癌的化疗夏黎明20 肺癌的化疗夏黎明21 Chemotherapy is treatment with anti-cancer drugs injected into a vein or taken by mouth. These drugs enter the bloodstream and go throughout the body, making this treatment useful for cancer t

22、hat has spread (metastasized) to distant organs. Depending on the type and stage of lung cancer, chemotherapy may be given as the main (primary) treatment or as an addition (adjuvant) to surgery or radiation therapy. Doctors give chemotherapy in cycles, with each period of treatment followed by a re

23、st period to allow the body time to recover. Chemotherapy cycles generally last about 3 to 4 weeks, and initial treatment typically involves 4 to 6 cycles. Chemotherapy is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemotherapy. 肺癌的化疗夏黎明

24、22 Most often, initial treatment for advanced lung cancer uses a combination of 2 chemotherapy drugs. Studies have shown that adding a third chemotherapy drug doesnt add much benefit and is likely to cause more side effects. The drugs most frequently used for initial chemotherapy for NSCLC are: cisp

25、latin carboplatin paclitaxel docetaxel gemcitabine vinorelbine irinotecan etoposide vinblastine pemetrexed 肺癌的化疗夏黎明23 The most common combinations include either cisplatin or carboplatin plus one other drug, although some studies have found that using combinations with less severe side effects, such

26、 as gemcitabine with vinorelbine or paclitaxel, may be just as effective for many patients. For people whose cancers meet certain criteria, targeted therapy drugs such as bevacizumab (Avastin) or cetuximab (Erbitux) may be added to initial treatment as well (see Targeted therapies section). 肺癌的化疗夏黎明

27、24 Single-drug chemotherapy is sometimes used for people who might not tolerate combination chemotherapy well, such as those in poor overall health. If the initial chemotherapy treatment is no longer working, second-line treatment usually consists of a single drug such as docetaxel or pemetrexed. An

28、other option may be the targeted therapy erlotinib (Tarceva) Again, advanced age is no barrier to receiving these drugs as long as the person is in good general health. 肺癌的化疗夏黎明25 肺癌的化疗夏黎明26 Possible side effects 肺癌的化疗夏黎明27 Chemotherapy drugs work by attacking cells that are dividing quickly, which

29、is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects. The side effects of chemotherapy depend on the type and dose of drugs given and the length