Gastric cancer

Size: px

Start display at page:

Download "Gastric cancer"

全虢乐
5 years ago
Views:

1 Gastric Cancer 胃癌 2011 Paul Zhang, M.D., Ph.D. Assistant Professor of Medicine Baylor College of Medicine 9/17/2011

2 The Situation 现状 In 2009, an estimated 21,500 adults (13,190 men and 8,310 women) in the United States will be diagnosed with stomach cancer. It is estimated that 10,880 deaths (6,450 men and 4,430 women) from this disease will occur this year. Most people diagnosed with stomach cancer are in their 60s and 70s. The five-year relative survival rate (percentage of patients who survive at least five years after the cancer is detected, excluding those who die from other diseases) of patients with stomach cancer is about 24%. If stomach cancer is found before it has spread, the five-year relative survival rate is about 61% 年, 在美国估计有 21,500 成年人 (13,190 男性和 8,310 名女性 ) 将被诊断为胃癌据估计, 这一年有 10,880 人将死于这种疾病 (6,450 男性和 4,430 名女性 ) 大多数确诊为胃癌的人年龄是 60 多岁和 70 多岁胃癌患者的五年相对存活率 ( 病人癌症发现之后生存五年以上的百分比, 不包括那些死于其他疾病的人 ) 约为 24% 如果胃癌发现时还没扩散, 五年相对存活率约为 61%

3 Gastric Cancer: Asian Countries 胃癌 : 亚洲国家 Japan, China, Russia, Korea, Costa Rica Chile Brazil

5 Gastric Cancer: Regions 胃癌 : 地区

6 Causes and Risk 病因及风险 Age. over age 55. Gender. Men have twice the risk Family history. a first-degree relative Genetic mutations Hereditary diffuse gastric cancer, hereditary non-polyposis colorectal cancer (HNPCC or Lynch syndrome) and familial adenomatous polyposis (FAP) Race. Black people and Asians Diet. Eating foods preserved by drying, smoking, salting, or pickling. Bacteria. Helicobacter pylori Previous surgery or health conditions. pernicious Occupational exposure. Exposure to certain dusts and fumes may increase the risk of developing stomach cancer. Tobacco and alcohol Obesity.

7 Causes and Risk 病因及风险年龄 : 55 岁以上性别 : 男性有双倍的风险家族史 : 直系亲属基因突变 - 遗传性弥漫性胃癌, - 遗传性非息肉性大肠癌 (HNPCC 或 Lynch 综合症 ) 和 - 家族 (FAP) 的腺瘤性息肉病种族 : 黑人和亚洲人饮食 : 吃熏制和腌制的食品细菌 : 幽门螺旋杆菌以前的手术或健康状况职业暴露 : 接触某些粉尘和烟雾可能会增加患胃癌的风险烟草和酒精肥胖

8 Genetic factors 遗传因素 The majority of gastric tumor are sporadic in nature 大部分胃癌肿瘤 - Rare inherited gastric cancer predisposition traits 罕见的遗传性胃癌 - p53 (Li-Fraumeni syndrome) E-cadherin (CDH1) alterations

Clinical Manifestation 临床表现 Signs and Symptoms 症状 Early Gastric Cancer 早期胃癌 Asymptomatic or silent 无症状 80% Peptic ulcer symptoms 消化性溃疡症状 10% Nausea or

9 Clinical Manifestation 临床表现 Signs and Symptoms 症状 Early Gastric Cancer 早期胃癌 Asymptomatic or silent 无症状 80% Peptic ulcer symptoms 消化性溃疡症状 10% Nausea or vomiting 恶心或呕吐 8% Anorexia 厌食症 8% Early satiety 早饱 5% Abdominal pain 腹痛 2% Gastrointestinal blood loss 胃肠道出血 <2% Weight loss 体重减轻 <2% Dysphagia 吞咽困难 <1%

10 Signs and Symptoms 症状 Weight loss 体重减轻 60% Abdominal pain 腹痛 50% Nausea or vomiting 恶心或呕吐 30% Anorexia 厌食症 30% Dysphagia 吞咽困难 25% Gastrointestinal blood loss 胃肠道出血 20% Early satiety 早饱 20% Peptic ulcer symptoms 消化性溃疡症状 20% Abdominal mass or fullness 腹部包块或饱胀感 5% Asymptomatic or silent 无症状 <5%

11 Diagnosis 诊断 Endoscopy(EGD) 胃镜 Endoscopic ultrasound 胃镜超声 X-ray:Barium swallow 钡餐透视 Computed tomography (CT) scan 电脑断层扫描 Positron emission tomography(pet) 正子发射断层扫描 H Pylori 幽门螺旋杆菌 Biopsy 活检

12 Gastric Cancer: Endoscopy 胃镜

13 Endoscopic mucosal resection 胃镜下黏膜切除术 Gastric cancer lesion confined to mucosa layer 胃癌病变局限于黏膜层 Endoscopic ultrasound (EUS) is helpful in staging GC 胃镜超声 ( EUS) 对胃癌分期有帮助

14 Stomach Cancer: Sites 部位

15 Pathology and Biopsy 病理和活检 Most (85%) cases of gastric cancer are adenocarcinomas 大部分胃癌 (85%) 是腺癌

16 Stages TNM 分期

17 TNM Classification 分类 0 Tis N 0 M 0 III A T 2 N 2 M 0 I A T 1 N 0 M 0 T 3 N 1 M 0 I B T 1 N 1 M 0 T 4 N 0 M 0 T 2 N 0 M 0 III B T 3 N 2 M 0 II T 1 N 2 M 0 IV T 4 N 2 M 0 T 2 N 1 M 0 T 1~3 N 3 M 0 T 3 N 0 M 0 any T any N M 1

Chemotherapy 先手术再化疗 Post-op 后手术 : for any patients

18 Gastric Cancer Surgery 胃癌手术 Very Early Stages 非常早期 : T1, Surgery alone 单纯手术 or EMR Any T2 or N +: Pre-op Chemotherapy 先手术再化疗 Post-op 后手术 : for any patients with T2 or above T2 或以上, chemotherapy or chemoradiation 化疗或放化疗

19 Endoscopic Mucosal Resection 胃镜下黏膜切除术

20 Gastric Cancer Radiotherapy 胃癌放射治疗 Dose 剂量 : 45-50cGy, 1.8cGy/day, 25 days Often given together with chemotherapy 常常与化疗同做

Chemotherapy 化疗 Adjuvant chemotherapy: for

21 Chemotherapy 化疗 Adjuvant chemotherapy: for any T2 or above or N+ patients: increase 5 years survival rates 辅助化疗 : 对于 T2 或以上或 N+ 患者 : 提高 5 年生存率 Combination chemotherapy are recommended 建议综合化疗 DCF: Docetaxel, Cisplatin, 5FU ECF: Epirubicin, Cisplatin, 5FU

22 Gastric Cancer: Post-op CRT

23 Gastric Cancer: Chemotherapy 胃癌 : 化疗

resection gastric ulcer Management of dietary risk

24 Prevention 预防 Eradication of H. Pylori infection in those high risk family history of gastric cancer chronic gastritis with apparent abnormality (atrophy, IM) post early gastric cancer resection gastric ulcer Management of dietary risk factor intake adequate amount of fruits, vegetables minimize their intake of salty/smoked foods

25 Prevention 预防高风险者要根除幽门螺旋杆菌感染胃癌家族史慢性胃炎伴明显异常 ( 萎缩,IM) 早期胃癌切除后胃溃疡膳食危险因素的管理摄入足够量的水果, 蔬菜尽量减少腌和熏制的食品的摄入量

26 EPIC Study EJC21/10/2010 For gastric cancer risk was inversely associated with high plasma vitamin C, some carotenoids, retinol and α- tocopherol, high intakes of cereal fibre and high adhesion to Mediterranean diet; 胃癌的风险与下列因素成反比 : 高血浆维生素 C, 某些胡萝卜素, 相关的维生素 A 和 α- 维生素 E, 高谷物纤维, 高地中海饮食摄入量 ; while red and processed meat was associated with an increased risk. 而红肉和加工肉类会增加风险

光鹽社 (Light and Salt Association) 用心用愛關懷社區光鹽社是政府註冊的 501 (c) (3) 非營利組織, 其宗旨是結合休士頓華人社區的人力與資源, 關懷並照顧休士頓地區

光鹽社 (Light and Salt Association) 用心用愛關懷社區光鹽社是政府註冊的 501 (c) (3) 非營利組織, 其宗旨是結合休士頓華人社區的人力與資源, 關懷並照顧休士頓地區光鹽社 (Light and Salt Association) 用心用愛關懷社區光鹽社是政府註冊的 501 (c) (3) 非營利組織, 其宗旨是結合休士頓華人社區的人力與資源, 關懷並照顧休士頓地區需要幫助的人自 1997 年成立以來, 光鹽社推動的活動有 :