1、Neoplasms of Genitourinary System 泌尿系肿瘤,Adenocarcinoma of the Kidney,（ Renal Cell Carcinoma, RCC, 肾细胞癌）,RCC,In US(1999), 30,000 new cases diagnosed, 11,900 deaths from this disease RCC accounts for 3% of adult cancers, 85% of all primary malignant renal tumors RCC occurs most commonly in 5th6th deca
2、de, male-female ratio 2:1,Etiology,Cause: unknownRisk Factors: cigarette smoking, exposure to asbestos （石棉）and tanning（鞣革）products,Etiology,RCC occurs in 2 forms: -inherited（遗传）：chromosome translocation, Von Hippel-Lindau disease -sporadic（散发）,Pathology,RCC originates from the proximal renal tubular
3、 epithelium. Types:Clear cell typeGranular cell typeMixed cell typeRCC is most often a mixed adenocarcinoma（腺癌）.,Tumor Staging (Robson System),I: Tumor is confined within the kidney parenchyma. II: Tumor involves the perinephric fat but confined within Gerotas fascia (including the adrenal). IIIA: T
4、umor involves the main renal vein/inferior vena cava.,Tumor Staging (Robson System),IIIB: Tumor involves regional LN. IIIC: Tumor involves both local vessels and LN. IVA: Tumor involves adjacent organs other than the adrenal. IVB: Distant metastases.,Clinical Findings,Symptoms & Signs A. Classical t
5、riadgross hematuria, flank pain, palpable mass (only in 1015% advanced cases)Symptoms secondary to metastatic disease: dysnea & cough, seizure & headache, bone painRenal tumors are increasingly detected incidentally by CT or ultrasound,Clinical Findings,B. Paraneoplastic Syndromes:erythrocytosis（红细胞
6、增多症）, hypercalcemia（高钙血症）, hypertension C. Lab Findings: anemia, hematuria(60%), ESR,Clinical Findings,D. X-ray Findings:*Ultrasonography*Intravenous Urography (IVU): 75% accurate (used alone), calcification*CT scanning: more sensitive, mass +renal hilum, perinephric space and vena cava, adrenals, r
7、egional LN and adjacent organs *Renal Angiography,IVU of right RCC,CT scan of right RCC,CT scan of left RCC,RCC invading renal vein,Left cystic RCC,Left cystic RCC,Differential Diagnosis,Benign renal tumors:Angiomyolipoma （血管平滑肌脂肪瘤, 错构瘤),Treatment,1. Localized disease:Surgical removal-only potential
8、ly curative therapyRadical Nephrectomy (en bloc removal of the kidney and Gerotas fascia including ipsilateral adrenal, proximal ureter, regional lymphadenectomy (淋巴结清扫),Treatment,2.Disseminated disease:nephrectomy- reducing tumor burdenradiation- radioresistant tumor, metastases 2/3 effectivechemot
9、herapy- 10% effectiveimmunotherapy- IL-2/interferon-alpha, 30% response rate,Prognosis,Stage 5-year survival rate I 88100%II 60%III 1520%IV 020%,Renal Pelvic Cancer,肾盂癌,Incidence: rare, 3% of all urothelial cancersPathology:transitional cell 90%squamous cell 10%,Clinical Findings,A. Symptoms & Signs
10、gross hematuria 7090%flank pain 850%B. Lab Findings:hematuria, cytology (40% positive), tumor markers (BTA, NMP22),Clinical Findings,C. ImagingIVU-intraluminal filling defect, unilateral nonvisualization of the collecting system, hydronephrosisUS, CT & MRIUreteropyeloscopy (肾盂输尿管镜),IVU of right pelv
11、ic Ca,CT scan of right pelvic Ca,CT of right pelvic Ca,Treatment,Standard therapy-nephroureterectomy (肾输尿管全长切除)removal of the entire distal ureter with a small cuff of bladder,Bladder Carcinoma,膀胱癌,Bladder Ca,The second most common cancer of the genitourinary system, male-female ratio 2.7:1 Initiato
12、rs/Promoters:cigarette smokingoccupational exposuregenetic events,Staging: TNM System,Histopathology（组织病理学）,Transitional cell carcinoma（移行细胞癌）90% Nontransitional cell carcinoma: adenocarcinoma, squamous cell Ca, undifferentiated Ca,Clinical Findings,A. Symptoms:hematuria 8590%irritative voiding symp
13、tomsB. Signs:Majority of patients have no pertinent physical signs.,Clinical Findings,C. Lab tests:urine testhematuriaurinary cytologydepend on grade and volume of the tumorother markers: BTA, NMP22, telomerase（端粒酶）,Clinical Findings,D. Imaging:UltrasonographyscreenIVUevaluation of upper urinary tra
14、ctCT/MRIassessment of the depth of infiltration and pelvic LN enlargementE. Cystoscopy（膀胱镜）,Ultrasonography of Bladder Ca,IVU of Bladder Tumor,CT scan of bladder Ca,Bladder Ca under cystoscopy,Treatment,1. SurgeryTUR (Trans-Urethral Resection)Partial Cystectomy （膀胱部分切除）Radical Cystectomy（根治性膀胱全切除）2.
15、 Radiotherapy,TUR of Bladder Tumor (TURBT),After TUR,Treatment,3. Intravesical Chemotherapy（膀胱内化疗）molecular responseweight rate Mitomycin C 329 3978% Thiotepa 189 up to 55% Doxorubicin 580 mean 38% BCG 3671%,Carcinoma of the Prostate CaP,前列腺癌,CaP,The most common cancer in American men Increases rapi
16、dly with age 95% are adenocarcinoma,Clinical Findings,A. Symptomsearly stage: asymptomatic（无症状）locally advanced/metastatic diseaseobstructive or irritative voiding complaints, bone pain, paresthesias（感觉异常）and weakness of lower extremitiesB. Signs: DREinduration（硬结）,Clinical Findings,C. Tumor markers
17、 PSA（前列腺特异抗原） Prostate Specific Antigen20 ng/ml highly suspect of PCa,Clinical Findings,D. Prostate biopsy（活检）golden standardE. ImagingTRUS, MRI, Bone scan,Treatment,1. Localized disease(optimal form in great debating)Watchful waitingRadical prostatectomy（根治性前列腺切除）Radiationexternal beam,Treatment,2.
18、 Locally advanced/metastatic diseasesEndocrine therapycomplete androgen blockade : orchiectomy睾丸切除+antiandrogen agent (flutamide, 氟他胺) or LHRH agonist（类似物）Radiation,Thanks for your attention!,） “和而不同”，多元发展。近年来，中医药在防治非典、禽流感和艾滋病方面发挥的独特作用也证实了二者的有机结合，具有肯定的临床疗效。 编辑本段东西方医学交融（df高血压958心脏病983u6糖尿病87fr）不管是中医学
19、还是西医学，从二者现有的思维方式的发展趋势来看，均是走向现代系统论思维，中医药学理论与现代科学体系（45传染病q566丙肝964jo乙肝28jgsx甲肝gh）之间具有系统同型性，属于本质相同而描述表达方式不同的两种科学形式。可望在现代系统论思维上实现交融或统一，成为中西医在新的发展水平上实现交融慢性胃炎分类慢性胃炎的命名很不统一。依据不同的诊断方法而有慢性浅表性胃炎、慢性糜烂性胃炎、慢性萎缩性胃炎、慢性胆汁返流性胃炎、慢性疣性胃炎、药物性胃炎、乙醇性胃炎等等。 慢性胃炎大体可分为三种类型：慢性肥厚性胃炎、慢性浅表性胃炎以及慢性萎缩性胃炎。慢性肥厚性胃炎在临床上较为少见，一般也不会发生癌变。慢性
20、浅表性胃炎主要是指胃粘膜的浅表性炎症，这类炎症主要表现为胃粘膜的固有膜宽度增大并伴有水肿，被炎症细胞浸润，但胃腺体多属正常这类胃炎在临床上较多见，一般也不会发生癌变。只要经过恰当治疗之后，炎症可消退，但如治疗不当，往往可发展成萎缩性慢性胃炎慢性萎缩性胃炎是指胃粘膜除有浅表性胃炎病变外，胃腺体明显减少，脉管间隙扩大，胃粘膜层有全层性细胞浸润，常伴有肠上皮化生，即胃型上皮变为肠型上皮这种性质的慢性胃炎与胃癌的关系密切，特别是有肠上皮化生者更是如此或统一的支撑点，希冀籍此能给（df高血压958心脏病983u6糖尿病87fr）中医学以至生命科学带来良好的发展机遇，进而对医学理论带来新的革命。 在胃镜问
21、世以前，胃炎的主要诊断依据是依靠临床症状和上消化道钡餐检查。随着纤维胃镜的临床应用，特别是经胃镜对胃粘膜的活组织检查，对越来越多的胃炎有了较明确的认识。1982年，国内胃炎会议上根据国内外经验，将慢性胃炎分为浅表性和萎缩性两大类。而在浅表性胃炎的命名上，又常常使用病理、部位、形态等含义的词，如“慢性疣状胃炎”、“慢性出血性胃炎”、“慢性糜烂性胃炎”、 “慢性胆汁反流性胃炎”等等。1990年8月，在澳大利亚悉尼召开的第九届世界胃肠病学大会上，又提出了新的胃炎分类法，它由组织学和内镜两部分组成，组织学以病变部位为核心，确定3种基本诊断：急性胃炎；慢性胃炎；特殊类型胃炎。加上前缀病因学诊断和后缀形态
22、学描述，并对炎症、活动度、萎缩、肠化、幽门螺杆菌感染分别给予程度分级。内镜部分以肉眼所见描述为主，分别区分病变程度。 1慢性糜烂性胃炎 内镜下常表现为多发性点状或阿弗他溃疡。慢性非糜烂性胃炎可为特发性，也可由药物(特别是阿司匹林和非甾体类消炎药，参见消化性溃疡的治疗部分)，克罗恩病或病毒感染所引起。幽门螺杆菌可能在此不发挥重要作用。 症状多为非特异性的，可包括恶心，呕吐和上腹部不适。内镜下显示在增厚的皱襞隆起边缘有点状糜烂，中央有白斑或凹陷。组织学变化多样。尚无某种方法具有广泛疗效或可治愈。 治疗多为对症治疗，药物包括制酸剂，H2拮抗剂和质子泵。 2慢性胃炎的癌变 对于胃溃疡发生癌变，人们比较容易理解，但对于有些类型的慢性胃炎也会发生癌变，许多人会感到不可思议然而，慢性萎缩性胃炎发生癌变却是事实 编辑本段现代中医史（df4肺炎88gdg青霉素d25f肝炎df6）轴心时代中、西医学的峰巅之作。雅斯贝而斯曾说：“如果历史有一个轴心，那么我们就必须将这轴心作为一系列对全部人类都有意义的事件，发生于公元前800至200年间的这种精神历程似乎构成了这样一个轴心。,医学健康系列精品课件,本文档下载后可以修改编辑，欢迎下载收藏。,
