外科英文何卫阳肿瘤Word下载.docx
《外科英文何卫阳肿瘤Word下载.docx》由会员分享，可在线阅读，更多相关《外科英文何卫阳肿瘤Word下载.docx（24页珍藏版）》请在冰豆网上搜索。
教
学
目
的
要
求
1使学生通过本课的学习，初步掌握泌尿男肿瘤的病因、发病机制和病理变化，对泌尿男生殖系肿瘤有一个初步的了解。
2掌握泌尿男生殖系肿瘤的临床症状和表现，以及诊断标准。
3掌握泌尿男生殖系肿瘤的治疗方法。
难
点
1针对外国留学生的全英语教学，对授课教师的专业英语和口语水平有较高的要求。
2泌尿男生殖系肿瘤的病理及临床分期极易混淆，学生不容易掌握。
3泌尿男生殖系肿瘤的临床表现既有典型性，又有多样性，尤其其诊断和鉴别诊断的理解有一定难度。
4泌尿生殖系肿瘤治疗方法的选择不易掌握。
重
1膀胱肿瘤的病因、发病机制、临床及病理分期、临床表现及治疗方法，必须阐述清楚。
2肾癌的临床表现、诊断及治疗。
外语要求
全英语教学（FullEnglishTeaching）
教学方法手段
多媒体教学和传统板书、挂图相结合
参考资料
Smith’sUrology第15版
Campbell’sUrology第7版
外科学第6版
教研室意见
教学组长：
教研室主任：
年月日
（讲稿）
教学内容
辅助手段
时间分配
BladderTumor
一、Overview
1、Mostcommonurologicmalignancy
inmen,thefourthmostcommoncancer；
accountingfor6.2%ofallcancercases；
inwomen,theeighthmostcommoncancer；
accountingfor2.5%ofallcancers；
men:
womenina4:
1ratio；
80%ofcasesoccurinpatientsover50yearsofage
2、80%ofbladdercancersaresuperficial.
3、15-20%ofbladdercancersareinvasive.
二、Etiology
Aswithmostcancers,nodefinitivecauseofbladdercancerisknown.However,thereisstrongcircumstantialevidencethatenvironmentalexposuretocarcinogensplaysamajorrole.
•occupationalexposures
dye
textile
rubber
cable
printing
andplasticsindustries
•nonoccupationalexposures
cigarettesmoking
dietarynitrosamines
Schistosomahaematobiumofthebladder
caffeine
saccharin
andcyclamates
三、Pathology
1、Tumortype
Transitionalcellcarcinoma（TCC）accountsfor90%
ofthesecases
squamouscellcarcinomaabout8%
adenocarcinoma2%
2、Patternsoftumorgrowth
Bladdercancermanifestsinavarietyofpatternsoftumorgrowthpapillary,sessile,infiltrating,nodular,mixed,andflatintraepithelialgrowth（carcinoma-in-situ）Thesetumorsusuallygrowinapapillaryfashionandareoftenmulticentric
3、Tumorgrade
Anestimationofhowaggressivethetumorwillbehave
Tumorgradereferstothehistologicmorphologyasdeterminedbycellularatypia,nuclearabnormalities,andthenumberaswellasthelocationofmitoticfigures.
•GradeIwelldifferentiated（~10%invasive）
•GradeIImoderatelydifferentiated（~50%invasive）
•GradeIIIpoorlydifferentiated（>
80%invasive）
TumorStaging
Thedepthofinvasionintothebladderwallisthebasisofthehistologicstageandclinicalstage.Thetumorstageisthesinglemostimportantprognosticfactor.TNMclassificationiscommonlyusednow.
TisCarcinoma-in-situ
TaNoninvasivepapillarycarcinoma
T1Tumorinvadessubmucosa/laminapropria
T2Tumorinvadessuperficialmuscle
T3aTumorinvadesdeepmuscle
T3bTumorinvadesperivesicalfat
T4Tumorinvadesadjacentorgans
4、PatternsofSpread
Directextension
Thisistheprocessoftumorinvasion,inwhichmalignanttransitionalepithelialcellsextendbeneaththebasallaminaintotheconnectivetissueofthelaminapropriaand,subsequently,intomuscularispropriaandperivesicalfat.
LymphaticSpread
Themostcommonsitesofmetastasesinbladdercancerarethepelviclymphnodes
Lymphaticmetastasesoccurearlierandindependentofhematogenousmetastasesinsomepatients.
VascularSpread
Thecommonsitesofvascularmetastasesare
liver,38%;
lung,36%;
bone,27%;
adrenalglands,21%;
andintestine,13%
Anyotherorganmaybeinvolved
Despiteadvancesintreatmentofsystemicurothelialcancer,fewpatientswithdistantmetastasessurvive5years
Implantation
Bladdercanceralsospreadsbyimplantationinabdominalwounds,denudedurothelium,resectedprostaticfossa,ortraumatizedurethra
Implantationoccursmostcommonlywithhigh-gradetumors
四、SignsandSymptoms
Themostcommonpresentingsymptomofbladdercancerispainlesshematuria（grossormicroscopic）
Mostbladdertumorshavenoothersymptomsunlesstheybecomeinvasiveorthereisanassociatedconditioncalledcarcinoma-in-situ（CIS）
•urinaryfrequency
•Urgency
•dysuria
五、Diagnosis
1History
Painlesshematuriaisthehallmarkofbladdercancer
eitheraloneorassociatedwithirritativesymptoms.
2、PhysicalExam
Thephysicalexamisusuallyunremarkableexceptin
faradvanceddisease.
palpabletumorindicatesthatatleastthemuscular
wallisinvolved.
3、Labtests
Urinalysisandculturearemandatorytoconfirmhematuriaandtolookforevidenceofinfection.Evenifinfectionisdemonstratedandhematuriaclearsaftertreatmentwithantibiotics,furtherinvestigationshouldbeundertakeninhighriskindividuals（age,sex,industrialexposure,smoker）.
4、ConventionalMicroscopicCytologyMalignanturothelialcellscanbeobservedonmicroscopicexaminationoftheurinarysedimentorbladderwashings
Microscopiccytologyismoresensitiveinpatientswithhigh-gradetumorsorcarcinoma-in-situ
Eveninpatientswithhigh-gradetumors,however,urinarycytologymaybefalselynegativein20%.
5、FlowCytometry（FCM）
Ingeneral,flowcytometryhasnotbeenfoundtobemoreclinicallyvaluablethanconventionalcytology.
6、X-rays
Excretoryurographyisindicatedinallpatientswithsignsandsymptomssuggestiveofbladdercancer.Intravenousurography（IVU）isnotasensitivemeansofdetectingbladdertumors,particularlysmallones.
However,
1.IVUisusefulinexaminingtheupperurinarytractsforassociatedurothelialtumors.
2.Largetumorsmayappearasfillingdefects.
3.Ureteralobstructioncausedbyabladdertumorisusuallyasignofmuscle-invasivecancer.
4.urographycanassessotheruppertractabnormalitiesthatmayaffectmanagementdecisions.
7.Cystoscopy
Allpatientssuspectedofhavingbladdercancershouldhavecarefulcystoscopy.Abnormalareasshouldbebiopsied.Randomorselected-sitemucosalbiopsyspecimensmayalsobeobtained
8Biopsies
Thisapproachusuallyenablescompleteremovalofthetumorandprovidesvaluablediagnosticinformationaboutthegradeanddepthofinfiltrationofthetumor.
Selected-sitemucosalbiopsiesfromareasadjacenttothetumoraswellasfromtheoppositebladderwall,bladderdome,trigone,andprostaticurethrahavebeenrecommendedattimeofresectionoftheprimarytumor.
StagingTests
ComputedTomographyScan（CT）Inadditiontoassessingtheextentoftheprimarytumor,CTscanningalsoprovidesinformationaboutthepresenceofpelvicandpara-aorticlymphadenopathyandvisceralmetastases.
MagneticResonanceImagingScan（MRI）scanningisnotmuchmorehelpfulthanCTscanning.
六、Treatment
Thefollowingisageneralguidelinetothemanagement
ofbladdercancer
Treatmentoptionsmustbecarefullyindividualized
Majorprognosticfactorsincludestage,grade,size,
numberoflesions,recurrence,andthepresenceofCIS
Superficialbladdercancer
ThetermsuperficialbladdercancerreferstoTa,T1,andTislesionsofanygrade
Theprincipaltechniqueforthediagnosisandtreatmentofsuperficialbladderlesionsremainsendoscopicmanagement
•cystoscopy
•TURbt（transurethralresectionofthebladder
tumor）
•Carcinoma-in-situ（Tis）
RadicalcystectomyisthetherapyofchoiceuntilrecentstudiesdemonstratefavorableresponseratesusingintravesicalBCGormitomycinCchemotherapy.
•Ta-T1
TURbtiscurativeinmostcases.
Intravesicalchemotherapy
•Agents
BacillusCalmette-Guerin（BCG）70%
MitomycinC50%
•Indications
1.
rapidtumorrecurrence
2.
multicentricity
3.
highergradeorinvasionofthelaminapropria
4.
presenceofCIS
Follow-up
Allpatientswithsuperficialtumorsshouldbecloselyfollowedwithlocalcystoscopyandcytologiesevery3monthsfor2years
Ifnotumorrecurrencesarenotedafter2years,thescheduleforfollow-upcystoscopymaybedecreasedtotwiceyearly
Muscleinvasivebladdercancer
Thetermmuscle-invasivebladdercancerrefersto
T2,T3andT4lesionsofanygrade
thestandardtreatmentformuscleinvasivebladder
cancerisaradicalcystectomy
Differenttypesofurinarydiversion
•ilealconduit
•continenturinarydiversion
•orthotopicneobladder
AdvancedBladderCancer
Whenbladdercancerisfoundtoinvolveeitherthe
pelviclymphnodesordistantorgans,removalofthe
primarytumorisunlikelytocurethepatient
Therapeuticstrategy
•chemotherapyand/or
•radiationtherapy
3分钟
10分钟
多幅图片说明
板书说明
7分钟
多幅图片及影像学图片加以说明
多幅膀胱镜下图片说明
图片说明
板书及绘简图说明
RenalCellCarcinoma
1、Definition
•Renalcellcarcinomaisatypeofkidneycancer.
•Thecancerouscellsarefoundintheliningofverysmalltubes（tubules）inthekidney.
•Itisthemostcommontypeofkidneycancerinadults.
2、AlternativeNames
•Renalcancer.
•Kidneycancer.
•Hypernephroma.
•Adenocarcinomaofrenalcells.
•Cancer-kidney
3、Pathology
•MostRCCsareroundtoovoidandcircumscribedbyapseudocapsule.Tumorsizecanvaryfromafewmillimeterstolargeenoughtofilltheentireabdomen,mostfrom5to8cm.
•Cysticdegenerationisfoundin10%to25%,andCalcificationisin10%to20%ofRCCs.
•Approximately12%ofpatientshaveproducedocclusivetumorthrombiintherenalveinandtheinferiorvenacava.
•Thetumormetastasizescommonlytothelungs（30%）,adjacentrenalhilarlymphnodes（25%）.ipsilateraldrenal（12%）,oppositekidney（2%）andbones.
TNMstagingclassification
stage
T
N
M
Ⅰ.Tumorconfinedbyrenalcapsule
T1（<
7.5cm）
T2（>
N0（nodesnegative）
M0（lackofdistantmetastases）
Ⅱ.TumorextensiontoperirenalfatoripsilateraladenalbutconfinedbyGerotasfascia
T3a
N0
M0
Ⅲa.Renalveinorinferiorvenacavainvolvement
T3b（renalvein）
T3c（cavalbelowthe
升级会员 