gastrointestinal cancer.ppt

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1 Tumer marker gastrointestinal cancer Introdution Gastro- Intestinal m a r k e r 1

2 10 2

3 (glandular epithlium cells) (squamous cell) (stricture) metaplasia () (N.R. Barrett) a 1/5 b12 3

4 ( 90%) ( ) I. II. IIa IIb IIIc III. 4

5 I. II. III. IV. PS: Krukenberg's tumor ) (Linitis Plastica ) (30 50 ) % 4. 5

6 (Linitis Plastica ) E-cadherin 酶 (Linitis Plastica ) 6

7 (Linitis Plastica ) 酶.. 7

8 x GroES (Urea Breath Test) Tumor Mark??? 8

9 90% 50%15% 90% 30% 9

10 Gardner s (Crohn's ) ras c-myc DCC p53 5q21 MCC FAP 10

11 FCC APC Hypomehtylation Miscellaneous ( K- ras) DCC p53 nm23 () (95%) 45% 25%5% 16% 9% Carcinoid tumors Gastrointestinal stromal tumors Lymphomas: cancers ) 11

12 70-80% (GIST) 0.1~3% (non-epithelial neoplasms) (leiomyoma) (leiomyosarcoma) KIT gain of function mutation(point mutaion) 12

13 (GIST) (GIST) KIT CD117 KIT 13

14 (GIST) Heinrich(Scienc e 2003) KIT PDGFRA (ramification) KIT PDGFRA (GIST) KIT ( "") (noncomplex or even normal karyotype)14 (deletion) 14 (loss)1p 9p 11p22q 8q 17q (amplification) El-Rifai(Cancer Res 2000) 14

15 (GIST) 90% a) (R0 resection) b) (extensive lymph node sampling) (GIST) (MDR gene) Glivec(imatinib mesylate) ( ) 15

16 Glivec(imatinib mesylate) 1. Glivec(imatinib mesylate, STI-571)Novartis Pharmaceuticals 酶 (tyrosine kinase)abl ABL-2(ABL-related gene) Kit PDGF-R() chimeric BCR-ABL Imatinib mesylate 酶 (tyrosine kinase) 酶 ATP (substrate) imatinib mesylate KIT 酶 2. GlivecBCR-ABL c-kit PDGF-R (multitargeting agent) Glivec(imatinib mesylate) Heinrich(JCO 2003) 127 KIT PDGFRA112KIT (88.2%) 6PDGFRA(4.7%) 9 (7.1%)KIT PDGFRA KITexon 9 exon exon % 23 exon % (P =.0006) KIT PDGFRA 0% (P <.0001) PDGFRA PDGFRA KIT imatinib mesylatekit PDGFRA 16

BCR-ABL Imatinib mesylate 酶 (tyrosine kinase) 酶 ATP (substrate) imatinib mesylate KIT 酶 2.

17 X X Tumor marker??? 17

18 Tumor marker CA72-4 CA19-9 CEA 18

19 Tumor marker CA72-4 CA19-9 CEA % 11.4% % 17.9% 50% 16.3% % 32.3% 9.1% 35.7% 8.3% 24.2% Stage A Stage B Stage C Stage D CA 72-4 > 6 u/ml 3.2% 30.55% 53.3% 70% 43% 9% 22% 41.7% 78% 43% CEA > 5ng/ml Tumor marker 19

2% Stage A Stage B Stage C Stage D 31 59 60 50 200 CA 72-4 >

20 CA72-4 CA72-4 TAG-72 (tumor associated antigen) CA72-4 CA19-9 CA19-9 (70%~100%) (22~51%) (42%) (20%) CA U/ml 20

21 CEA 1965 Gold Freedman 180-kd 30 CEA 40-70% CEA 21

22 Fas Circulating Soluble Fas Ligand in Patients with Gastric Carcinoma Cancer, Vol89, No12(December 15), 2000:pp Tsutsumi S, Kuwano H, Shimura T, Morinaga N, Mochiki E, and Asao T Fas Fas(Fas ligand, FasL) FasL T Fas, T;, FasL, FasL(soluble Fas ligand, sfasl), FasL, 22

23 43sFasL 0.1ng/mL 166sFasL 0.04 ng/ml, (P = 0.738) sfasl, sfasl ( 0,, ) (P<0.001), sfasl,, sfasl(0.08 ng/ml), sfaslsfasl, sfasl(p<0.001) sfasl(p = 0.041) The end & thank your attention & Happy new year 23

24 24

天主教永年高級中學綜合高中課程手冊目錄

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