还剩9页未读,继续阅读
本资源只提供10页预览,全部文档请下载后查看!喜欢就下载吧,查找使用更方便
文本内容:
Text of the speechPrinciplesof oncologyI.INTRODUCTIONNeoplasia literallymeaning“new growthis theuncontrolled proliferationof transformedcells.Theterm tumor,which wasoriginally used to describe the swellingcaused byinflammation,is nowusedinterchangeably withneoplasm.Tumor is an abnormalgrown oftissure resultingfrom uncontrolled5progressive multiplicationofcells.Tumors may be benignor malignant.Malignant tumors usually arecalled cancer.As Ahumandisease,cancer wasdescribed asearly as1600B.C in ancient Egyptianwritings.Hippocrates,the ancientGreek physician,recognized thedifference betweenbenign andmalignantand namedmalignant tumorscarcinos\The Latinword of cancer meanscrab\Malignant tumorsconsist of undifferentiatedor unspecialized,cells thatshow anatypical cellStructure anddo not9function likethe normal cells of the organfrom which they derive.Malignant tumorsalsometastasize fromtne primary sites wherethey developto otherdistant sitesin body.Cancer iscurrently thesecond-leading cause of death in developedcountries and among thethreemost common causes ofdeathin developing countries.The othersare diabetesand Cardio-celebralvascular diseases.Current theoryof carcinogenesisconsiders that cancer resultsfrom mutationsof certaingenes thatallowthe cells to begin their uncontrolledgrowth.Traditionally,cancer has been treatedbysurgery,chemotherapy,and radiation therapy.In recentyears,with theadvances inbasic researchandbiotechnology,Biological therapies3ncluding immunotherapy,hormonal therpyhave beenaddedto thatlist.New drugsand techniquesare constantlybeing investigatedand developed,suchas antiangiogenicagentse.g.,angiostatin andendstatin,genetically engineeredoncolytic viruses,And vaccineagents.Understanding theprinciples ofmolecular oncologywill helpcliniciansappropriately interpretnew contributionsand incorporatethem intopractice.II.EPIDEMIOLOGYEpidemiologic studiesaim tomonitor cancer incidence andmortality ofcertain population.Thediscovery of association betweenthe incidenceand prevalenceof putativecausative factorshelp ustounderstand the etiology of cancer•Incidence is the numberof newcases withina specifiedtime frameand is usually expressedas casesper100,000people peryear.Prevalence is the numberof patients with the disease in the population.Apersons riskof contractingor dyingof cancer is usuallyexpressed interms oflifetime riskrisk over thecourse ofa lifetimeor,when describingthe relationshipof specificrisk factorswith a particular cancer,as relativerisk incomparison tothose withor withouta certainexposure ortrait.Global Burdenof CancerWorldwide,cancer isresponsible forone ineight deaths.By2020,70%of allcancer-relatedincrease markedlyin size.Theirdeaths will occur indeveloping countries,where survivalratestissue weightmay causedistortion ofregional softtissue,and underlyingbones may be enlargedbecauseof theirvascularity.The termpachydermatocele”comes fromthe thick,corrugated appearancemotunlike that of the skin ofan elephant.Surgical excision,in stagesif thetumor islarge,is advised.Thetumor may be extremelyvascular because of looseareolar tissue and abundantlarge vascularsinuses.These sinuseshave nocontractility,as donormal blood vessels,and controlof hemorrhagemay bedifficult.D.HemangiomasThree types of hemangiomas are generallyrecognized,including capillaryhemangiomas9cavernous hemangiomas,and windinghemangiomas.Capillary hemangiomas are soft,compressible popularlesions withsharp borderslocated mostlymostly on the shoulder,face,andscalp.They can be excisedor cryotherapy by liquidnitrogen.They maybe treatedby phosphoruscompression,radiation,and prednisone.Cavernous hemangiomasconsist ofvenules andfat tissue.They arebright redor purple,and have a spongyconsistency.They should be excisedearly.Winding hemangiomasconsistofbig windingblocs vessels.They arisein subcutaneoustissue andmuscleand mayeven invadebones.They appearas amass underthe skin and manyextend tomore than onelimb.Hemangiomas resectionisthechoice of treatment.Before operation,thorough angiography,complete operativeplan andmassive bloodtransfusion preparationshould be done.h・Melanoma andnon-melanoma skin cancerBasal cell,squamous cellcarcinomas andmelanoma are the mostcommon skin malignancies.Increased exposure to ultravioletradiation is associated with an increaseddevelopment ofall threeof them.
1.Basal cellcarcinomasBasal cellcarcinomas containcells thatresemble thebasal celland showinfiltrative growth.Theyhave lowmalignancy,slow growthand rareblood and lymph metastasis.Its focusulcerates afterlittleinjury.The lesionedge isirregular.It hasbad smell,and is apt tohemorrhage.Cancer cellofbasal cellcancer mayinvade subcutis,and seldominto thedeep tissue.Resection orcryotherapy byliquidnitrogen hasgood result.
2.Squamous cellcancerIt comesfrom squamouscell,is nothighly malignant.At beginning,there isflat prominencewithrough surface.It isapt to be ulcer,in whichthere are high edgeand irregularbottom.It maybelike cauliflowerthe transformationfrom abenign lesionto asquamous cancermay detectedas aslightthickening or a smalnodule.Ulceration occursand isfrequently followedby developmentofa crustyovergrowth whichat samemay burrowinto thedeeper tissues.Pain isnot prpminentuntillate stage.Good treatmentis earlyradical resection.After operation,radiation therapyshould bedone.If onthe face,cryotherapybynitrogen maybe used.
3.MelanomaMelanoma ismalignant tumorderived frommelanocytes.Melanoma accountsfor4%-5%of allskincancer butcauses the majority ofdeath fromskinmalignancies.Melanoma canoccurs atanyage from birth to advanced age.The medianage ofdiagnosis isin therange of45-55years.It iswellestablished thatexposuretosunlight ultraviletrays increasesthe riskof developingmelanoma.Melanoma commonlypsesents asa changingpigmented skinlesion.Patient typicallydescribe aflatlesion thatspread overthe surface of the skin andlater becomeselevated.If thelesion isallowedto progress,itching,bleeding andulceration willfollow.In someinstance,melanomas ariseinpreexisting nevi;however,themajorityarise denovo.Melanoma maypresent asa nodalordistant metastasisas thefirst evidence of thedisease.Fewew than10%melanoma arisein areasasthe eyes,mucosal sufaces,and unknownprimarysites.Any suspectedmelanoma should be removedby excisional biopsy.If thebiopsy specimenrevealmelanoma,a formalexcision withadequate marginsis requied.Traditionally,excision ofamelanoma calledfor5-cm margins.The currentstandard forlesion lessthan1mm indepth isexcisionwith1-cm margins.Melanoma between1mm and4mm should be excisedwitha2-to3-cm marginand mayrequire theresection ofunderlying fascia.Melanoma has been demostratedto have anorderly progressionof nodalmetastatic disease.The sentinellymph nodebiopy hasbecomethe standardof carein thestaging andtreatment of melanoma.Traditional chemotherapyregiments haveproved largelyineffective in the treatmentofmelanoma;however,cytokine interferon a-2b hasbeen shown to impronedisease-free andoveralsurvival inhigh-risk patientswith noevidenceofsystemic metastases.The durationof therapyislong12months andtoxicities areuniversal andsubstantial,but evenso,interferona-2b remainsthe best hopefor thechemotherapeutic treatmentof high-risk patientshas showngreat promise,but suchtherapies arestill in the experimentalstage.There issome evidencethat radiationtherapymay improvelocal andregional controlofmelanomawhen combinedwith surgery.*Verruca Vulgarisverruca juvenilisThecommon wartistheresult ofinvasion of the epithelialcells by a specificvirus.Warts occurinchildhood throughadolescence and early adultlife and affect chieflythe fingersand hands.The wartsoccurin cropsbecause ofautoinoculation.Although the condition maybe painfuland troublesomeowingto cracks,fissures,and bleeding,and psychologictrauma maybe severe,theconditionis self-limited andthe lesions willeventually disappearwithout anyresidual scarring.Excision isof doubtfulvalue.Dermatologic assistanceby electrodesiccationor freezingwith liquidnitrogen maybe helpful.*Verruca plantarisplantar wartVerrucaplantaris isthe mosttroublesome ofall warts.Located onthe soleof thefoot,overthemetatarsalheads or the oscalcis,the wartisusuallycovered bya thickened,cornified epihelium.Compression bythepressure of the weightof the body instanding isvery painful.Corrective shoesand orthopedicappliancesmay behelpful.If thecondition persists,excision andeither theuseofa split-thickness graftor therotationofacontiguous flapmaybenecessary.Plantar wartmust notbe20%-30%are barelyhalf thatof developedcountries.Indeed,80%to90%of peoplein whomcancer is diagnosedindevelopingcountries areinitially foundto havelate-stage,terminalcancer.It cantherefore beseen that the vastmajority of cancer deathswilloccurin theIthasbeenestimated thatmorethanllmollioncountries leastequipped tohandle theburden.people arediagnesed withcancer everyday worldwide.Lung,colorectal andgastric cancers areamong thefive mostcommon cancerin the world forboth menand women.For women,the mostcommoncancersarebreat andcervical cancer.There areapproximately2million newcancercases and
1.5million peopledie of cancer everyyear inCnina.The incidence of canceris variablebygeography.This isdue inpart togenetic differences,part todifferencesin environmentalanddietary exposures.In manycases,the highIncidenceof aspecificcancerinaparticularregion islinked toa specificcausative agent.Lungcancer isthe leadingcancer worldwide.The incidencerates oflung cancerarehighin EasterEuropeand Chinafor menand inNorth Americanfor women,which mayreflect cigarettesmokingpatters of20-30years earlier.The incidence of gastric cancer variessignicantly amongdifferentregions of theworld.The age-adjusted incidenceis highestin Japanbut muchlower inNorthAmerica,eastern andnorthern Africa,and SoutheastAsia.Gastric canceris alsothe mostcommonmalignancy in the ruralarea ofChina.The differenceis presumed to bedue todifferencesin dietaryfactors andin theincidenceofinfection withHelicobacter pylori,which isknown toplaya majorrole ingastriccancerdevelopment.The incidenceof colon and rectal cancerishigher indevelopedcountries thandeveloping countriesTheincidenceofhepatocellular carcinomais highinparts ofAfrica andAsia andpresumedtobe associated with thefrequency ofhepatitis Binfectionin theseregions.Comparison of cancer incidencerates iscritical toimproving ourunderstanding of theetiologyofcancer.Analysis oftrends incancer andmotality allowsus tomonitor theeffects ofdifferentpreventive andscreening measures,as wellas theevolution of therapies forspecific cancers.IV.CLASSIFICATIONTumors aregenerally classedinto twogroups.Benign tumorsare noncancerous;malignanttumors arecancerous andhence lifethreatening.Benign andmalignant growthsdiffer inseveral ways.Malignant neoplasmsgrow rapidly;benignneoplasm,ontheother hand,grow slowslowly and the numberof cell divisions mitosesis farlessin comparisonwith malignantneoplasms.Benign neoplasmsare encapsulatedand anddo notdomuchdamage tosurrounding tissue.Malignant growths,however,invasivespreading tosurrounding tissue.Not onlydo malignantneoplasms destrysurroundingtissue,but theyalsoinfiltrate bloodand lymphvessels from whichtheyspread toother areas of the body.Thismigration toother areasof the body iscalled metastasis.Cancer cellsshow ahigh degreeof anaplasiareversiontoamore primitiveform.Theseanaplastic cellsresemble primitive,fetal-like cells.They growrapidlyhyperplasia anddo notdifferentiate-that is,function likenormal cellsand joinwith othercellsto form normaltisssue.Themicroscopic evaluationof tumorcells iscalled grading.Grading isconcerned with the degreeofanaplasia of the malignantcells.Grade Icells aremuch likenormalcellsin theirdegree ofdifferentiation.With eachsucceeding grade,differenciation isreduced andanaplasiabecomes moreprominent.All tumorsare namedaccording to the type of tissuefromwhichthey develop.Noncanceroustumors havethe suffix-oma addedto thetissue type.For example,an adenomaisabenign tumororiginatingin theglandular epithelium.The suffixes-carcinoma and-sarcoma indicatemalignanttumors.Carcinomas arethe mostcommon formof cancer.They canarise fromboth externalandinternal epithelialtissue.They readilyinfiltrate surroundingtissue and quickly metastasize.Theword adenocarcinomaindicates cancer of theglandular epithlium.Sarcomas aremalignant tumorsdevelopingfrom mesenchymaltissue bone,fat,musle,blood,etc,Lymphosacoma,for instance,iscancer oflymphatic tissue.A thirdtype of cancerous tumorfrom embryonalconnective tissue,Origin BenignForm MalignantFormSquamous epitheliumPapilloma SquamouscarcinomaBlood vesselsHemangioma HemangiosarcomaSmoothmuscle LeiomyomaLeiomyosarcomaStriated muscleRhabdomyoma RhabdomyosarcomaBoneOsteoma OsteosarcomaCartilageChondromaChondrosarcomaWilms tumor,which occurs in children,for example.More example:V.ETIOLOGYThe originof canceris stillunder investigation.Currently canceris presumedasagenetic diseasethat arises from accumulation ofmutations withincells underthe stressof carcinogen.Environmental carcinogenincludes chemical,physical andbiological agents.These carcinogensresult in genetic changes ofcells.However,carcinogenesis isa multiplestep processand alsoaffectedby manyhost factors,including geneticdispositions andimmunological conditions.
1.Chemical Agentsenviromental factorsand jobrelated carcinogena.Alkylating agentb.Aromatic aminesand amidesSuchagents asb-naphthylamine,produce papillomasand bladdercancer Workersin dyeandpesticide plantscan inhaleor absorbthese substances.c.Policyclic aromatichydrocarbons PAHBesidesjob-related carcinogens.The hydrocarbonsproduced byautomobiles andcigarettesmoke cancauseof theskin,bladder,respiratiry tract and organs.d.Carcinogenic mycotoxine.Inorganic chemical,such asarsenic,cadmium,and nickelChromiumand nickelproduce cancer of thenasal cavity,sinus,and bronchus in workersminingand refiningthese substances.f.Petroleum products,waxes,tars,and similaritems causeskincancerin thoseworking ininsuch industriesas refineriesand asphaltcompanies.g.Coal derivativessuch ascoal tar,pitch,and creosote,produce skincancer andcancer of thelarynx andbronchusincoke ovenworkers,coal tardistillers,and thoseworking incertainareasof the lumberand chemicalindustries.h.Food additives,such asnitrates inbacon and other meats,have beenlinked togastrointestinalcancer.Chemical likevinyl chlorideare widelyused inhomes andnow consideredcarcinogenic.i.The hydrocarbonsproduced byautomobiles andcigarette smokecause cancer of theskin,bladder,and respiratorytract andorgans.
2.Physical Agentsa.Ultraviolet lightOverexposure tosunlight isthe mostcommoncauseof skincancer.b.Ionizing radiationRadiationisapotent carcinoge.Radiologists andothers workingnear radiationhave ahighincidence ofleukemia andskinandbone cancer.
3.Biological FactorsThevirus causesinfectious mononucleosis,for example,is alsothe causeof Burkittslymphoma,a malignanttumor of the jaw.Mycotoxins producedby moldsare alsopotentCarcinogens.Food contaminatedwith moldhasbeenlinked toliver cancer.
4.Genetic FactorsHeredityA definitepatter ofinherited cancershas notbeen establishedfor mostcancers;because somefamilieshave ahigher incidenceofcancerthan others,however,the likelihoodof inheritingaprediposition tocancerisincreased.Retinoblastoma,cancer ofeye occurringin Childhood,adenomas ofthe thyroidand parathyroids,and colonicpolyposis are considered inheritableneoplasm.
5.Immunological Factors
6.Precancerous disordersSeveralnonneoplastic disordershave beenlinked tocancer.The increasedand extensivecellulargrowth causedby thesedisorders maypredispose themtoformneoplasms.Someexamples ofprecancerous disordersare listedbelow.Precancerous DisorderCancerLeukoplakia Squamouscancer ofthe mouthCirrhosisoftheliver Hepaticcell adenocarcinomaChroniculcerative colitisColonic adenocarcinomaChroniccervicitis Squamouscancer ofthe cervixChronicbalanitis Squamouscancer ofthe penisPagefs diseaseofthebone OsteosarcomaAplasticanemia AcuteleukemiaCarcinogenesisCarcinogenesis inhumans isa multistepprocess.The cancer cell differsfrom itsnormalCounterpart inthatofthe deregulatedcelldivision,differentiation andapoptosis.Current theorypresumethatasuccession ofgeneticchanges,each conferringone oranother type of growthadvantage,leads tothe progressiveconversion ofnormal humancells intocancer cells.Thesegenetic changesresultinseveral essentialalterations incell physiologytht collectivelydictate tomalignanttransformation andtumour progression.Cancer cellsare self-sufficient ingrowth signal.Many ofthe knownoncogenes mimicnormalgrowth signalingin oneway oranother,such asHer2/neu andras,stimulating cancercellproliferation.Cancer cellsare insensitiveto antigrowthsignals.It should be keepin mindthat malignanttransformation andtumor progressionare exceedinglycomplexprocesses,and theirgenetic andbiochemical determinantsremain incompletelyunderstood.VI.CLINICAL MANIFESTATIONTheclinical presentationofcancerdependent onthe natureofthespecific tumor,the locationaswell as the progressionofthedisease.Cancer usuallyappears asan asymptomaticlesion toosmalltobe seenwithout specialexaminations inearly stages.With theProgression ofthedisease,some commonsigns andsymptoms mayappears:
1.Local symptomsThelocal symptomsof neoplasminclude mass,pain,ulceration,hemorrhage,obstruction,invasion andmetastasis.When theneoplasm iseither onor nearthesurfaceofthebody,it maypresent simplyasavisible orpalpable mass.For visceralneoplasm,the massmay notbe palpable.In thegastrointestinal,biliary^respiratory,and urinaltracts,signs arefrequently related to obstruction.Examples arevomiting,jaundice,cough andurinaryretention.The expansile growth ofcentral nervesystem neoplasmmay causepain,paralysis or,sensory loss.When tumorinfiltrates orstimulates nervesdue toexpansile growth,necrosis,or infection,pain appears.Examples arelumbosacral plexuspain incancerofthecervix andrectum,dorsal andlumbar spinepain incancerofthe pancreas,and theshoulder andarmpain andpalsy whencarcinoma ofthe lunginfiltrates thebrachial plexus.Ulcer usuallydevelopedin skinand gastrointestinalcancer asa resultof rapidexpansilegrowth,insufficientblood supply,and subsequentnecrosis orinfection.Hemorrhage isrelatively commonin malignanttumors.Hematemesis andmelena mayindicatethe lesionlocate in the upperalimentary tract,whereas rectalbleeding maybetheSign ofloweralimentary tractneoplasm.However,acute gastrointestinalbleeding issomewhat unusual,butchronic occult blood lossis commonand manifestas irondeficiency anemiaand heme-positivestool.Malignant tumorsinvade surroundingtissue andspread throughblood orlu\ymphaticvessels.Lymph metastasiscan resultin palpableenlarged regionalnodes.The mostfrequentsites ofmetastatic neoplasmsarethecervical andsupraclavicular lymphnodes,lungs,liver,bones andbrains.
2.Systemic symptomsMostbenign tumoursand earlystage malignanttumor do not present systemic syptoms.Withthe developmentofthedisease,no specificsymptoms,such asanemia,persistent fatigue,unintentional weightloss andfever,maybepresented.Fatigue andweakness maybethe onlysymptoms incancerofthe stomachor rightcolon,because thetumour ulcerationandbleeding have resulted inanemia.DiagnosisEarly diagnosisand earlytreatment contributemostly tothe improvedsurvival ofcancer patientsinlast quartercentury.Careful inquiryof ilnesshistory,thorough physicalexamination mayhelpphysicians tofind signsofcancer.Then avariety oftests areusedtoconfirm oreliminate ofthepresence ofdisease,monitor thedisease progress,and evaluatethe effectiveness oftreatment.Diagnostic proceduresofcancermay includeincluding laboratorytest,imaging,endoscopicexamination andbiopsy.The earlierthe diagnosis,the morepositive theprognosis.
1.History ofIlnessMost benignandearlystage malignancydonotpresentsystemicsymptoms.So,every individualshould be awareofthewarning signsofcancer:A.Unusual bleedingor discharge•For example,rectalcancer--haerrhoidB.A lump.With fever,not disappear.C.A soreulcerthat doesnot heal.Like acraterD.A changein bowelor bladderhabits.Urgency withmucus orblood.E.A coughor hoarsenessthat persists.F.Difficulty inswallowing orin digestion.G.Any changeinawart ormole.H.Weight lossfor noapparent reason.Different kindsof tumorshave differentage distribution.For example,leukemia usuallyoccursin children,sarcoma oftenoccurs inadolescence andcancer usuallyoccursinmiddle-aged orelderlypatient.Benign tumorshavealong course,whereas malignanttumours haveshort coure.Personal history,including habitof alcoholicdrinking,smoking orsome specialoccupationscontacting carcinogenicsubstances maybe noticed.Some tumorshave familyhistory and arehereditary.
2.Physical ExaminationPhysicalexamination includesa thoroughsearch ofthe entireskin surfacefor squamouscell andbasalcarcinomas,indurative lesions,ulcers,suspicious orirritated nevi,nodules,andothersigns ofmalignantdisease.Lymph nodesshould bepalpated forenlargement.Breasts shouldbe carefullyexamined.Rectal examinationshould includeproctoscopic examinationof patientswho havehemorrhoidsor rectalsymptoms.Indirect laryngoscopyshouldbeperformed ifpatients ishoarse,has aneck mass,or issuspected ofhaving anintrathoracic neoplasmor cancerofthethyroid gland.
3.Laboratory EaminationLaboratoryeamination shouldinclude acomplete bloodcell count,urinalysis,and examinationofstool foroccultblood.Other testsshouldbeordered whereindicated bysymptoms.Beforeoperating ona patientfor cureor palliation,a metastaticwork-up shoulbedone,directed bysymptomsand the most likelysite ofmetastases,to determinewhether theneoplasmis stilllocalized.Laboratory testsinclude:a SerologicaltestSerum markersare underactive investigationas theymaybeused asprognostic orpredictivemakers toallow earlydiagnosis ormonitor recurrence.Unfortunately manyofthetumor markersproposedso fardo havehad sensitivitiesand specificities.Tumor markerscan be elevated inbenign conditions.Many tumorsare notspecific fora certaintypeofcancer andcan beelevatedwith morethan onetypeof tumor.In spiteof thesemany clinicallimitation,several serum markersare inclinical use.Samples are:Prostate-specific antigenPSAis potentiallythebestserummarkernow avaailable.PSA levelsmaybeelevatedintheblood ofmen withbenignconditionssuch asprostatitis andbenign prostatichyperplasia,as wellas inmen withprostate cancer.PSA levels have beenshowntobe usufulinmonitoring theeffectivenessofprostate cancertreatment andfor recurrenceafter therapy.Carcinoembryonic antigen{CEA}isa glycoprotein foundintheembryonic endodermalepitheliumElevated CEAlevelshavebeen detectedin patientswith primarycolorectal cancer,aswell aspatientswithbreast,lung ovarian,prostate,liver,or pancreatic cancer.CEA ismostcommonly usedfor themanagement ofcolorectal cancer.Alpha-fetoproteinAFP isaglycoproteinnormal producedbyadeveloping fetus.An elevatedlevelssuggests thepresence ofeither primaryliver canceroragerm celltumor ofthe ovaryortesticle.Benign conditionsthat cancause elevationsof AFPinclude cirrhosis,hepatic necrosis,acute hepatitis,chronic activehepatitis,ataxia-telangiectasia,Wiskott-Aldrich syndrome,andpregnancy.b ImagingTechniquesthat maybe usefulin localizingtumor lesioninclude bariumexaminations ofthegastrointestinal tract;selective arteriographyof majorvessels supplyinginternal organs;radioisotopes andradiopaque dyethat concentrateinthe organs such astheliver,gallbladder,kidney,andlymphnodes;and ultrasonographyand abdominalcomputer assistedtomographyCT,which israpidly becomingthe mostuseful investigativetechnique forintraabdominaltumors.Sometimesmdyes areinjectted intobloodvesselsor substancesareswallowed sothat anyobstruction i.e.,a tumor tothepaths leftby thesesubstances appearon thexray.The operabilityof primary tumors isbest determinedbefore surgerywith appropriateimagingstudies thatcan definethe extentof local-regional disease.For example,a preoperativethin-sectionCT scanis obtainedto determineresectability forpancreaticcancer,which isbased onthe absenceofextrapancreatic disease,the absenceoftumorextension tothe superiormesenteric arteryandceliac axis,andapatent superiormesenteric vein-portal veinconfluence.Disease involvingmultipledistant metastasesis deemedinoperable sinceit isusually otcurable withsurgery ofthe primarytumoncEndoscopic ExaminationLesionsof esophagus,stomach,duodenum,colonandrectum can be examinedby endoscope.Tissue fromthelesionscanberemoved forpathological examination.The colonoscopeallows thephysician to seethe liningof cavitywall.Procedures likeendoscopic RetrogradecholangiopancreatographyERCPallows thephysiciantodiagnose andtreat problemsin upperalimentarytractandpancreas.Laparoscopic examinationis oftenrequired toconfirm thediagnosisand obtainbiopsy.d TumorbiopsyDefinitive diagnosisof solidtumorsusuallyrelies ona biopsyofthelesion.When alesion isnearthe bodysurface orinvolves oneoftheorifices ofthebodythatcanbe examinedwith appropriatevisualinstruments,such asa bronchoscope,colonoscope,or cystoscope.A sampleofthelesion canbeobtained witha needleor withan openincisional orexcisionalbiopsy.Deep-seated lesionscanbe localizedwith CTscan orultrasound guidancefor biops.In aneedle biopsya needdieis injectedinto thesuspected areaandatissue sampleis removedformicroscopic evaluation.A frozensection takenwhen alump issurgically removed.A thinportionofthetumor issliced,dyed,andquicklyfrozen.Next,it isexamined Microscopicallyby apathologistto determinewhether itis benignor malignant.e ExfoliativecytologyCells arescrapped offthebodysurface orinternal liningand examinedmicroscopically Fortumorcells.The Papsmear isan exampleof exfoliation.The earlierthe diagnosis,the morepositive theprognosis.StagingVIL TREATMENTCancercanbetreated withsurgery,radiotheraoy,chemotherapy andbiological approachessuchas immunotherapy.A multimodalitymultidisciplinaryapproach withsystemic therapyisnecessary for most typesofcancer.It isimportant forsurgeons toknow notonly howto performacancer operationbut alsothe alternativesto surgery.
1.Surgical treatmentSurgeryremains aprimary treatmentformosttypesofcancer.The goal of surgicaltherapy forcanceris toachieve oncologiccure.A curativeoperation presupposesthatthetumor isconfined totheorgan oforigin,or totheorganandthereginal lymphnode basin.Patients inwhom theprimary tumor isnot resectablwith negativesurgical marginsareconsideredtohaveinoperabledisease.On occasion,primary tumaorsof patientswith distantmetastasis areresected inthesepatients forpalliative reasons,suchasimproving thequality oflife byalleviating pain,infection,orbleeding.Patients withlimited metastasesfromaprimarytumoron occasionare consideredsurgicalcandidates ifthe naturalhistory ofisolated distantmetastases forthat cancertype isfavorable,orthepotential complicationsassociatedwithleaving the primarytumorintact aresigniHcant.Surgical proceduresare designedto removetheprimaryneoplasm andthe contiguousroutes ofspreadlymphatics andregional lymphnodes,withthegoalofremoving everycancercellservingas asource ofmetastasis,to curethe patientortocontrol thedisease locallyeven whenprobabilityof cureis low.Advances insurgical techniques,anesthesia,and supportivecarebloodtransfusions,antibiotics,and fluidand electrolytemanagementhave permittedthe developmentofmore radicaland extensiveoperative procedures.These advanceshaveresultedin significantimprovementsinthelocal controlrates forcertain humanneoplasms.
2.Chemotherapy
3.Radiotherapy
4.Immunotherapy
5.Traditional ChinesedrugsVIII.CUTANEOUS ANDSUBCUTANEOUS TUMORSSuffix-oma meansswelling,tumor.A.LipomaLipomas arebenign tumorsderived fromfat tissueand couldpresent assingle ormultiple softlesions.They arethemostcommon subcutaneousneoplasm.Lipomas couldbe round,ovoid,orlobulated withdefined border.They occurmost frequentlyontheupper backand shoulders.Single lipomashouldberemoved.Multiple lipomasshouldbeignored,sometimes subsideorselfconfined spontaneously.B.FibromasFibromas consistof welldifferentiated connectivetissueandare situatedin subcutaneoustissue.They aresmall andslow ingrowth.The skinof theirsurface isnormal.They arefirm,smooth andmovable.Their treatmentis simpleexcision.Fibromas inthe breastusually combinewith glandtissueand formfibroadenomas andshouldbe excised.Dermoid Fibromasare foundin abdominalwall.They growinthemuscular layerandaremorecommonly inwomen.They aregenerally consideredtoberelatedtothe injuryof abdominalmuscleduring labor.Dermoid Fibromasalso occurin skeletalmuscle inother placeand growwithinHltration andmay becomesarcoma,therefore shouldbeexcisedradically.C.NeurofibromasNeurofibromas usuallyarise fromnerve trunkinthearmpit,internal sideoftheelbow,cheekand retroperitonealregion.Majority ofthem aresolitary withsmooth surfacewith noadhesion tosurroundingtissue.They arediscrete nodulesthat maybe locallypainful orradiate alongthedistrbution ofthe nerve.If theneurofibromas come from sympatheticnerve,ganglion andchain,they areignored during operation.If theycomefrombranchial plexusor ulnarnerve,nervetrunk shouldbe preservedduringoperation.Pachydermatocele isa typeof pendantfibroma oftheskinand subcutaneoustissue thatoccurs inassociationwith vonRecklinghausens disease.The lesionsare presentfrombirthbut may。