胃癌概述(英文)课件

TheProfilesof

GastricCancerHematologyandOncology

GraduatestudentWanJiangweiGASTRICCANCER

Worldwideincidence**Incidenceper100,000population.ParkinDM,etal.CACancerJClin.1999;49:33-64.Male 16.4Female 8.2Male 36.3Female 16.9Male 77.9Female 33.3Male 10.8Female 4.9Male 43.6Female 19.0Male 5.9Female 2.6Male 11.5Female 4.3Male 18.6Female 13.3Male 8.4Female 4.0EasternEuropeJapanAustralia/NewZealandChinaNorthernAfricaSouthernAfricaCentralAmericaWesternEuropeNorthAmerica2ndmostcommoncancerintheworld,558400newcasesand405200deaths.Almost40%ofcasesoccurinChina.PazdurRetal.Cancermanagement:Amultidisciplinaryapproach.6thedition,2002

EtiologyandpathogenesisEnvironmentalanddietaryfactors;Helicobacterpylori;Precancerouslesions;Geneticsandgene.EnvironmentalanddietaryfactorsLong-termconsumptionofsmokedgrilled,pickledfood;Foodlackinginfreshvegetablesandfruit;Smoking(Smokershaveatwiceriskofgastriccancerthannonsmokers).Helicobacterpylori

Chronicinflammation

Acceleratetheexcessiveproliferationandthedistortionofthemucosalepithelium.ToxicproductsDirectlytopromotecancer.Promotethesynthesisofn-nitrosocompounds.

PrecancerouslesionsGastricpolyps;Chronicatrophicgastritis;Gastricremnantaftersubtotalgastrectomy.

※Precancerouslesions:Thebenigndiseasesandpathologicalchangesthatcanelevatetheriskofstomachcancer.GeneticsandgeneTheriskofgastriccancerwhohasafamilyhistoryis4timeshigherthanthecontrolgroup.LossandmutationsoftumorsuppressorgenessuchasP53,K-ras,APC,DDC.Cancer-pronepositionsGastricantrum(50%)FundusofstomachCardiaBodyofstomachClinicalmanifestationsEarlygastriccancer

●About70%patientshavenoobvioussymptoms,orhavesomenon-typicalsymptoms;

●Themostcommonprimarysymptom:Mildupperabdominaldiscomfort;

●likeDyspepsiaorGastritis.NCNNGuidelinesTheworkuppermitsclassificationofpatientsinto1of2groups:(1)patientswithapparentlocoregionalcarcinoma(stagesItoIIIorM0),and(2)thosewithobviousmetastaticcarcinoma(stageIVorM1).Patientswithapparentlocoregionaldiseasecanbefurtherclassified:(1)thosewhoaremedicallyfitandwhosecancerisresectable,(2)thosewhoaremedicallyfitbutwhosecancerisunresectable,and(3)thosewhoareinoperable(medicallyunfit).GlobalConsensusGoodlocalcontrolisessentialtocuregastriccarcinoma;Theonlypotentiallycurativetreatmentforlocalizedgastriccancerissurgery.SurgicaltreatmentIndications●Noobviousdistantmetastasis,thevitalorganswithoutseriousorganicdisease;●Alreadyhave

distantmetastases,buttherearecomplicationsofobstruction,perforation,bleeding.Mostgastriccancersarediagnosedatanadvancedstage.The5-yearsurvivalrateafter“curativeresection”forgastriccancerisonlybetween30%and40%.Theefficacyofchemotherapywithpalliativeintentisnowwidelyaccepted.ChemotherapyofGastricCancerChemotherapyofGastricCancerFluorouracil(5-FU)isoneofthemosteffectiveandwidelyuseddrugsinthetreatmentofadvancedgastriccancer(AGC),producingaresponserateofapproximately20%,withmanageabletoxicity.

Overallsurvivalofbetween5and7monthshasbeenreportedfor5-FUmonotherapyinphaseIIIrandomizedstudies.ChemotherapyofGastricCancer5-FU,doxorubicin,andmitomycin(FAM);5-FU,doxorubicin,andhigh-dosemethotrexate(FAMTX);etoposide,doxorubicin,andcisplatin(EAP);etoposide,leucovorin,and5-FU(ELF);epirubicin,cisplatin,and5-FUcontinuousinfusion(ECF);cisplatin,epirubicin,leucovorin,and5-FU(PELF);cisplatinand5-FU.OurStudyDesign

Cycleswererepeatedevery21days.Treatmentwascontinuedforatleast3cyclesexceptintheeventofdiseaseprogression,unacceptabletoxicity,patientrefusal.Efficacyandsafetywereevaluatedevery3cyclesandresponseswerere-confirmed4weekslater.Antiemetictreatment(Ondansetron/GranisetronwithorwithoutDexamethasone)wasalwaysadministeredbeforetheoxaliplatininfusion.PatientPopulation---eligiblecriteria

agedbetween18and75years;alifeexpectancy>=12weeks;adequatehepatic,renal,andbonemarrowfunction.notreceivedchemotherapyorradiotherapyinrecent4weeks;signedinformedconsentwasobtainedfromallpatients.Targetedtherapy

1.EGFR(Epidermalgrowthfactorreceptor)inh