1 / 94

Surgical Oncology

Surgical Oncology. Definition of Neoplasia. a disorder of cell growth in which there is a permanent and inherited change in cells resulting in a pathological proliferation of tissue. The Etiology of Cancer. Viruses(papilloma, Epstein-Barr, Hepatitis B, retroviruses,HIV) Radiation exposure

doli
Download Presentation

Surgical Oncology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Surgical Oncology

  2. Definition of Neoplasia • a disorder of cell growth in which there is a permanent and inherited change in cells resulting in a pathological proliferation of tissue.

  3. The Etiology of Cancer • Viruses(papilloma, Epstein-Barr, • Hepatitis B, retroviruses,HIV) • Radiation exposure • Environmental industrial carcinogens • Tobacco and alcohol consumption • Genetic susceptibility syndromes

  4. Historical Observation of Chemical Carcinogens • Date Observation Carcinogen • 1761 Excessive use of Nitrosamines • snuff lead to nasal polyps • 1775 Scrotal cancer in soot chimney sweeps • 1860s bladder cancer Aromatic amines • 1915 Rabbit ears painted Benzpyrene • with tar developed • papillomas

  5. Cancer Mortality & Behavior/environmental Factors • Factor Percentage of cancer deaths • Smoking 30 • Diet 30 • Infectious agents 5 • Alcohol 3 • Sedentary lifestyle 3 • Ultraviolet 2 • Air pollution 2

  6. Smoking-related cancers • Lung cancer • Oropharyngeal cancer • Stomach cancer • Cervical cancer • Pancreatic cancer • Renal cancer • Bladder cancer • Liver cancer • Leukemia

  7. Viruses Associated with Cancer • Virus Cancer • Hepatitis B, C Hepatocellular Cancer • HIV Kaposi’s sarcoma • Epstein-Barr virus Nasopharyngeal cancer • Burkitt’s lymphoma • Human Papilloma virus Cervical cancer

  8. Internal causes • Hereditary susceptibility • Endocrine factors • Immune factors

  9. Prevention • First step • etiology • Second step • early detection and treatment • Third step • improve quality of life

  10. Major Genes in Development of Cancer • Oncogenes • Tumor suppressor genes • DNA repair genes

  11. Oncogenes • Growth factors EGF, TGF-α • Growth factor receptors EGFR, PTK • Intracellular transducers cAMP • Transcription factors c-myc

  12. Inactivationof DNA repairgenes Inactivationof Tumor suppressor genes Activationof Oncogenes Tumor Cell

  13. Multi-step nature of Colon Cancer Inactivation of APC TSG • Normal epithelium • Hyperproliferation DNA hypomethylation • Early adenoma Activation of K-ras oncogene • Intermediate adenoma Inactivation of DCC TSG • Late adenoma Inactivation of P53 TSG • Carcinoma

  14. Modern Viewpoint of Cancer as a Long-term Process • Precancerous phase Up to 10~30 years • In-site phase 3~10 years • Invasion phase 1~5 years 1~5 years • Dissemination phase

  15. The classification and nomination of tumors

  16. Nomenclature of Malignant Tumor • Names of tumor Tissue of origin Examples • Carcinoma Epithelium Adenocarcinomas • Sarcoma Mesenchymal Liposarcoma • Malig. lymphoma Lymphocytes Lymphoma • Malig. melanoma Melanocytes Malignant melanoma • Malig. Mesothelioma Mesothelium Pleural malig. Mesothelioma • Teratoma Germ Cells Testicular teratoma • Choriocarcinoma Trophoblast Uterine choriocarcinoma

  17. Benign Tumors • a limited growth potential • the neoplastic cells closely resemble those of the parent tissue ( well diff.) • growing slowly by expansion • a well-encapsulated lesion • do not usually produce serious effect

  18. Malignant Tumors • proliferate rapidly • more poorly differentiated cells • progressive growth and invasion of the surrounding tissues • metastases by lymphatic & blood vessels • if not treated early, eventually cause death

  19. The Degree of Differentiation • Well differentiated • Moderately differentiated • Poorly differentiated

  20. The Objectives of Cancer Staging & Histological Classification • to aid the clinician in planning of treatment • to give some indication of prognosis • to evaluate the efficiency of treatment • to facilitate exchange of information • to assist in continuing clinical studies of cancer

  21. Histopathological Staging & Classification • Adenocarcinomas • Squamous carcinomas • Small cell carcinomas • Large cell carcinomas • Sarcomas Lymphomas • Leukemias Gliomas • Seminomas Teratomas

  22. The Hallmark of Malignancy • Local Destructive Invasion • Distant Metastasis • ------ the cardinal behavior to distinguish benign & malignant tumor

  23. Pathological Features of Malignancy • ● an infiltrative uncapsulated margin • ● invasion of baseline membrane or surrounding structure • ● evidence of invasion of blood vessels or lymphatics or metastases • ● tumor necrosis

  24. Pathological Features of Malignancy • ● architecture abnormalities • e.g. increased gland/stroma ratio • ● cytological abnormalities • e.g. increased nuclear/cytoplasm ratio • ● numerous mitotic figures & abnormal mitoses

  25. Gross Types of Carcinoma Papillary Nodular Ulcerative Stricture Cystic Diffuse Multiple

  26. Two Terms • Metaplasia ---- the replacement of one fully differentiated tissue by another • Carcinoma in situ the histological abnormalities are sufficiently severe to suggest carcinoma , but in the absence of basement membrane invasion

  27. Effects of Malignancy • Tumor arising within a hollow viscus • obstruction • Tumor arising from surface of organ • ulceration and bleeding

  28. Spread of Malignant Tumors • Direct invasion--- Rectal cancer • Lymphatic system to local lymph nodes • -- Breast carcinoma, Gastric cancer • Bloodstream to distant organs • -- Liver, lung & brain • Across body cavities • -- Ovarian carcinoma

  29. Lymphatic Spread of Gastric Cancer

  30. Diagnosis • History • Physical Examination • Laboratory Tests • Specific Procedures

  31. Symptomsor Signs of Cancer • Alteration in eating habit • Loss of appetite • Problems in swallowing • Change in bowel habit • The presence of a lump at any site

  32. Symptomsor Signs of Cancer • The appearance of bleeding • Unexplained recurrent pain • Recurrent fevers • Unexplained weight loss • Repeated infections which do not clear with treatment

  33. Breast Cancer

  34. Para-neoplastic Syndrome • Small cell carcinomas secret ACTH • Cushing’s syndrome Renal carcinomas secret erythropoitin • polycythaemia • Mucin-secreting adenomas increasing the coagulability • thromboembolism

  35. The Diagnostic Procedures of Cancer • History • Family History Individual Habits • Social History Occupation • Marital & Sex History Past History

  36. The Diagnostic Procedures of Cancer • Physical Examination • Systemic • Local • Tumor • Metastatic foci

  37. The Diagnostic Procedures of Cancer • Special Procedures • ● Diagnostic Radiology • Chest X-rays • Barium enema radiography • Gastro-intestinal series radiography • Arteriography • Computerized tomography(CT) • Radioisotope scanning techniques • Mammography • Positron emission tomography(PET)

  38. The Diagnostic Procedures of Cancer • Special Procedures • Ultrasonic examination • Endoscopy • Cytology • Biopsy bone-marrow biopsy • needle biopsy • endoscopic biopsy • Magnetic resonance imagine(MRI)

  39. The Diagnostic Procedures of Cancer • Lab Test • ● Routine test: blood, urine, stool • ● Serum test: enzyme, hormone • glycoprotein, tumor markers • ● Immunology test: AFP, CEA, • tumor-related antigens • ● Flow-cytometry(FCM): DNA ploidy • DNA index • ● Gene Test: Oncogenes, DNA repair gens • Tumor suppressor genes

  40. Tools For Early Clinical Detection • ● Complete physical examination • ● Regular mammography and breast self exam • ● Haemoccult for occult blood in feces • ● Urine analysis and blood count • ● A complete clinical history • ● An in-depth family medical history

  41. Cachexia

  42. Tumor Markers • Tumor marker Examples • Tumor antigens AFP, CEA • Enzymes PSA • Hormones β-HCG • Oncogenes Ras, c-myc,P53 • Tumor associated antigens • CA 19-9,CA-242

  43. MSCT Metastatic LN

  44. Endoscopic Ultrasonography

  45. TNM staging • T--- primary tumor • N--- regional lymph node • M--- metastases

  46. The Principles of Cancer Surgery

More Related