肺癌的化疗夏黎明ppt课件.ppt

LungCancerChemotherapy LimingxiathefirstaffiliatedhospitalofAnhuiCollegeofTraditionalChineseMedicine Alsocalled BronchogeniccarcinomaLungcancerisoneofthemostcommoncancersintheworld Itisaleadingcauseofcancerdeathinmenandwomenintheworld Cigarettesmokingcausesmostlungcancers Riskfactors cigarettes highlevelsofpollution radiationandasbestosexposure etc Yourlungsaretwospongyorgansinyourchestthataredividedintosections lobes Everytimeyouinhale airiscarriedthroughthewindpipetoyourlungsintwomajorairways bronchi Insideyourlungs thebronchisubdivideintoamillionsmallerairways bronchioles whichfinallyendinclustersoftinyairsacs alveoli Withintheairsacs oxygenisabsorbedintoyourbloodstreamandcarbondioxideisreleased Typesoflungcancer Smallcelllungcancer Smallcelllungcancer sometimescalledoatcellcarcinoma occursalmostexclusivelyinheavysmokersandislesscommonthannon smallcelllungcancer Non smallcelllungcancer Non smallcelllungcancerisanumbrellatermforseveraltypesoflungcancersthatbehaveinasimilarway Non smallcelllungcancersincludesquamouscellcarcinoma adenocarcinomaandlargecellcarcinoma HowIsLungCancerDiagnosed SymptomsandsyndromesPulmonarysymptomsSymptomsinotherorgansSymptomslinkedtotumormetabolismBlood hematologic syndromesVeinandartery vascular syndromesSkin cutaneous syndromesMusculoskeletalsyndromesNervoussystem neurologic syndromesHormonal endocrine syndromesMiscellaneoussyndromes TestsanddiagnosisScreeningDiagnosisImagingtestsSputumcytologyTissuesamples biopsy bronchoscopymediastinoscopyneedlebiopsy Left ConventionalCTscanwithoutcontrastshowingpossibletumorintheliver Right ConventionalCTscanofthesamepatientusingcontrast ImagescourtesyofDr PeterChoyke DepartmentofRadiology ClinicalCenter NationalInstitutesofHealth Bronchoscopy SmallCellLungCarcinoma above accountsforabout15percentofalllungcancercases Normallungcells above StageI Canceratthisstagehasinvadedtheunderlyinglungtissuebuthasn tspreadtothelymphnodes StageII Thisstagecancerhasspreadtoneighboringlymphnodesorinvadedthechestwall StageIIIA Atthisstage cancerhasspreadfromthelungtolymphnodesinthecenterofthechest StageIIIB Thecancerhasspreadlocallytoareassuchastheheart bloodvessels tracheaandesophagus allwithinthechest ortolymphnodesintheareaofthecollarboneortothetissuethatsurroundsthelungswithintheribcage pleura StageIV Thecancerhasspreadtootherpartsofthebody suchastheliver bonesorbrain Stagesofnon smallcelllungcancer Staging Limited Cancerisconfinedtoonelungandtoitsneighboringlymphnodes Extensive Cancerhasspreadbeyondonelungandnearbylymphnodes andmayhaveinvadedbothlungs moreremotelymphnodesorotherorgans Stagesofsmallcelllungcancer SurgeryChemotherapyRadiationtherapyTargeteddrugtherapyBevacizumab Avastin Erlotinib Tarceva ClinicaltrialsSupportive palliative careCopingandsupportLearnallyoucanaboutlungcancerTakeanactiveroleinyourtreatmentBuildastrongsupportsystemSetreasonablegoalsTaketimeforyourselfStayactiveAlternativemedicineAcupunctureHypnosisMassageMeditationYoga Treatments Lungcancersurgery StageCommonoptions Treatmentoptionsfornon smallcelllungcancers StageCommonoptions Treatmentoptionsforsmallcelllungcancers Chemotherapy Chemotherapyusesdrugstokillcancercells Oneormorechemotherapydrugsmaybeadministeredthroughaveininyourarm intravenously ortakenorally Acombinationofdrugsusuallyisgiveninaseriesoftreatmentsoveraperiodofweeksormonths withbreaksinbetweensothatyourbodycanrecover Chemotherapycanbeusedasafirstlinetreatmentforlungcancerorasadditionaltreatmentaftersurgery Insomecases chemotherapycanbeusedtolessensideeffectsofyourcancer ChemotherapyisusuallythemaintreatmentforSCLC ChemotherapyforSCLCgenerallyusesacombinationof2drugs ThedrugcombinationsmostoftenusedforinitialchemotherapyforSCLCare cisplatinandetoposidecarboplatinandetoposidecisplatinandirinotecancarboplatinandirinotecancyclophosphamide doxorubicin Adriamycin andvincristine Ifthecancerprogressesduringtreatmentorreturnsaftertreatmentisfinished differentchemotherapydrugsmaybetried Thechoiceofdrugsdependstosomeextentonhowsoonthecancerbeginstogrowagain Thelongerittakesforthecancertoreturn themorelikelyitistorespondtofurthertreatment ChemotherapyforSCLC Ifthecancerprogressesduringtreatmentorrelapseswithin2to3monthsoffinishingtreatment drugssuchastopotecan ifosfamide paclitaxel docetaxel irinotecan orgemcitabinemaybetried Iftherelapseoccursfrom2to3monthsto6monthsaftertreatment topotecanisoftenthedrugofchoice Otherdrugsthatmaybetriedincludeirinotecan cyclophosphamide doxorubicin vincristine knownastheCAVregimen gemcitabine paclitaxel docetaxel oraletoposide orvinorelbine Forrelapses6ormoremonthsaftertreatment theoriginalchemotherapyregimenmaystillbeeffectiveandcanoftenbetriedagain ChemotherapyforSCLC Chemotherapyistreatmentwithanti cancerdrugsinjectedintoaveinortakenbymouth Thesedrugsenterthebloodstreamandgothroughoutthebody makingthistreatmentusefulforcancerthathasspread metastasized todistantorgans Dependingonthetypeandstageoflungcancer chemotherapymaybegivenasthemain primary treatmentorasanaddition adjuvant tosurgeryorradiationtherapy Doctorsgivechemotherapyincycles witheachperiodoftreatmentfollowedbyarestperiodtoallowthebodytimetorecover Chemotherapycyclesgenerallylastabout3to4weeks andinitialtreatmenttypicallyinvolves4to6cycles Chemotherapyisoftennotrecommendedforpatientsinpoorhealth butadvancedagebyitselfisnotabarriertogettingchemotherapy NSCLCChemotherapy Mostoften initialtreatmentforadvancedlungcancerusesacombinationof2chemotherapydrugs Studieshaveshownthataddingathirdchemotherapydrugdoesn taddmuchbenefitandislikelytocausemoresideeffects ThedrugsmostfrequentlyusedforinitialchemotherapyforNSCLCare cisplatincarboplatinpaclitaxeldocetaxelgemcitabinevinorelbineirinotecanetoposidevinblastinepemetrexed NSCLCChemotherapy Themostcommoncombinationsincludeeithercisplatinorcarboplatinplusoneotherdrug althoughsomestudieshavefoundthatusingcombinationswithlessseveresideeffects suchasgemcitabinewithvinorelbineorpaclitaxel maybejustaseffectiveformanypatients Forpeoplewhosecancersmeetcertaincriteria targetedtherapydrugssuchasbevacizumab Avastin orcetuximab Erbitux maybeaddedtoinitialtreatmentaswell see Targetedtherapies section NSCLCChemotherapy Single drugchemotherapyissometimesusedforpeoplewhomightnottoleratecombinationchemotherapywell suchasthoseinpooroverallhealth Iftheinitialchemotherapytreatmentisnolongerworking second linetreatmentusuallyconsistsofasingledrugsuchasdocetaxelorpemetrexed Anotheroptionmaybethetargetedtherapyerlotinib Tarceva Again advancedageisnobarriertoreceivingthesedrugsaslongasthepersonisingoodgeneralhealth NSCLCChemotherapy Possiblesideeffects Chemotherapydrugsworkbyattackingcellsthataredividingquickly whichiswhytheyworkagainstcancercells Butothercellsinthebody suchasthoseinthebonemarrow theliningofthemouthandintestines andthehairfollicles alsodividequickly Thesecellsarealsolikelytobeaffectedbychemotherapy whichcanleadtosideeffects Thesideeffectsofchemotherapydependonthetypeanddoseofdrugsgivenandthelengthoftimetheyaretaken Thesesideeffectscaninclude Possiblecauses sideeffects hairlossmouthsoreslossofappetitenauseaandvomitingincreasedchanceofinfections duetolowwhitebloodcellcounts easybruisingorbleeding duetolowbloodplateletcounts fatigue duetolowredbloodcellcounts Thesesideeffectsareusuallyshort termandgoawayaftertreatmentisfinished Thereareoftenwaystolessenthesesideeffects Forexample therearedrugsthatcanbegiventohelppreventorreducenauseaandvomiting Somedrugssuchascisplatin vinorelbine docetaxel orpaclitaxelcandamagenerves Thiscansometimesleadtosymptoms mainlyinthehandsandfeet suchaspain burningortinglingsensations sensitivitytocoldorheat orweakness Thisiscalledperipheralneuropathy Inmostcasesthisgoesawayoncetreatmentisstopped butitmaybelonglastinginsomepeople Lastingtime ThankYou