肿瘤学-培训课件
肿瘤学-培训课件,肿瘤,培训,课件
Cervical CancerQianqianLiu,MDDept.ofGynecologicalOncology,CancerHospitalofGuangzhouMedicalUniversityE-mail:2016-09-19CervicalcancerEtiology(病因)(病因):HPVDiagnosis(诊断)断):biopsy,stageTheraphy(治(治疗):surgeryandradiationPrevention(预防)防)CERVICALCANCER.The most common malignancy(恶性肿瘤)in gynecological oncologyIncidence(发病率):7.8/100,000(我国每年新发11万例)Mortality(死亡率):2.7/100,000Usually occurs between 3539 and 6064.The average age at diagnosis of patients with cervical cancer is 52.2 years old.NormalcervixAcutecervicitisCervicalpolypErosionofcervix Cervical cancerCERVICALCANCER.Howcanitoccur?etiology(病因)(病因)Howcanwemakeadiagnosis(诊断)断)?Howcanweevaluate(评估)估)thepatient?Howcanwemanage(治(治疗)thepatient?Howshouldweexplaintothepatient?Canweprevent(预防)防)cervicalcancer?HumanPapillomavirus(HPV)人乳头瘤病毒人乳头瘤病毒Long known to cause warts(疣)Over 200 types identifiedMost benign,but 15-20 can cause cancersVery common20,000,000 curr ent cases in US6,200,000 new cases annually80%of women have HPV by age 5050%of college students are infectedHPV&CervicalCancerHPV recognized as the underlying cause(潜在原因)of cervical cancer since 1996 NIH Consensus Conference on Cervical Cancer,1996World Health Organization/European Research Organization on Genital Infection and Neoplasia,1996德国人哈拉尔德楚尔豪森 因发现人乳头状瘤病毒()是导致宫颈癌的病原体,获得2008年诺贝尔生理学或医学奖CommonHPVTypesandtheireffectsHPVTypesLeadto:Low-RiskHigh-RiskHPV6,11,40,42,43,44,54,61,70,72,81HPV16,18,31,33,35,39,45,51,52,56,58,59,68,73,82BenigncervicalchangesGenitalwartsPrecancercervicalchangesCervicalcancerAnalandothercancersHPVInfections:SummaryMost people are infected by HPV at some timeImmune system usually clears HPV,but not to all infectorPersistent low-risk HPV can lead to genital wartsPersistent high-risk HPV can lead to pre-cancerHPVLong persistence of HPV can lead to cancerHowcanwemakeadiagnosis?SYMPTOMS(症状)(症状)Abnormalvaginalbleeding:postcoitalbleeding*(同房后阴道流血)、(同房后阴道流血)、contactbleeding(接触性出血)(接触性出血)Abnormalvaginaldischarge(异常阴道分泌物)(异常阴道分泌物)SYMPTOMSpain referred to the flank or legbladder or rectal invasion:dysuria(排尿困(排尿困难),hematuria(血尿)(血尿),rectal bleeding(直(直肠出血)出血),obstipation(顽固性便秘)固性便秘)lymphatic and venous blockage:persistent edema(水(水肿)Howcanwemakeadiagnosis?SIGNS(体征)(体征)Vulva(外阴)(外阴)Vagina(阴道)(阴道):mucous(粘液),fornix(穹窿)Cervix(宫颈)(宫颈):erosion(糜烂)、growth(增生)、ulceration(溃疡)、barrel-shaped(桶状)Uterus(宫体)(宫体):size(大小),mobility(活动性)Parametrium(宫旁组织)(宫旁组织):thickening(增厚)Four types:(a).exogenous cancer:the most common type(外生型)(b).endogenous cancer(内生型)(c).ulcer type cancer(溃疡型)(d).anabrotic type cancer(糜烂型)Grossappearance(大体观)(大体观)宫颈癌类型外生型溃疡型糜烂型内生型 宫颈鳞癌外生型(菜花型)宫颈鳞癌溃疡型(空洞型)Howcanwemakeadiagnosis?CLINICALTESTS:Thin-prep cytologic test(液基薄层细胞学检测,TCT)Colposcopy and target biopsy(阴道镜及镜下活检)Endocervical curettage(颈管骚刮术,ECC)Cone biopsy(锥切)Biopsy(活检)组织病理学是病理学是诊断的金断的金标准!准!TCT is the most common and effective screening method.Normal Cervicitis Squamous Cell Carcinoma(鳞状细胞癌)TCT resultsTCT results ASCUSASCUSASCUSASCUS:atypical squamous cells of undetermined :atypical squamous cells of undetermined :atypical squamous cells of undetermined :atypical squamous cells of undetermined significance significance significance significance(意义不明确的非典型鳞状细胞)(意义不明确的非典型鳞状细胞)(意义不明确的非典型鳞状细胞)(意义不明确的非典型鳞状细胞)LSIL/HSIL:LSIL/HSIL:LSIL/HSIL:LSIL/HSIL:low-grade/High-grade squamous low-grade/High-grade squamous low-grade/High-grade squamous low-grade/High-grade squamous intraepithelial lesionintraepithelial lesionintraepithelial lesionintraepithelial lesion(低度(低度(低度(低度/高度鳞状上皮内病变)高度鳞状上皮内病变)高度鳞状上皮内病变)高度鳞状上皮内病变)AGUS:AGUS:AGUS:AGUS:atypical glandular cell of undetermined atypical glandular cell of undetermined atypical glandular cell of undetermined atypical glandular cell of undetermined significance significance significance significance (意义不明确的非典型腺细胞)(意义不明确的非典型腺细胞)(意义不明确的非典型腺细胞)(意义不明确的非典型腺细胞).SCC SCC SCC SCC:Squamous Cell CarcinomaSquamous Cell CarcinomaSquamous Cell CarcinomaSquamous Cell CarcinomaColposcopy ExaminationTCT is only a screening test.A definitive diagnosis requires inspection(视诊)of a well-visualized(直观)cervix with a colposcope.Colposcopyanddirectedbiopsy The cervix is painted with 3%acetic acid solution(醋酸溶液)(醋酸溶液)to enhance surface alterations and vascular changes.The colposcope evaluation is considered adequate or satisfactory if the complete T zone and full extent of the lesions is visualized(直(直观的)的).Areas of abnormality(white epithelium(白色上皮)(白色上皮),mosaicism(嵌合体)(嵌合体),and punctation(斑点)(斑点)are selectively punch biopsied(打孔活(打孔活检).ConebiopsyIndicationsforconebiopsy 1.The lesion cannot be fully visualized.2.The ECC is positive.3.There is significant discrepancy(偏差)between the TCT and biopsy.4.A biopsy reveals microinvasive squamous cell carcinoma(微小鳞状上皮细胞癌)5.A biopsy reveals adenocarcinoma in situ(原位癌)Squamous cell carcinoma鳞癌Adenocarcinoma腺癌Howcanwemakeadiagnosis?TCT is only a screening test!Definitive diagnosis of cervical cancer requires a BIOPSY!Howcanweevaluatethepatient?宫颈(?)癌()癌(?)期)期HistologictypeStagegeneralconditionHowcanweevaluatethepatient?Histologictype(组织类型)型):Squmouscellcarcinoma(鳞癌,癌,SCC)80%Adenocacinoma(腺癌)(腺癌)15%-20%Others(其他)(其他)5%-10%Metastaticpath(转移途径)移途径)i.direct spreading直接蔓延:the most common way,exogenic type,cervical canal type ii.lymphatic metastasis淋 巴 转 移:tumor embolus(癌栓)in lymphatic space iii.blood metastasis血道转移:extremely lessobturatorlymphnodesinternaliliaclymphnodesexternaliliaclymphnodescommoniliaclymphnodesHowcanweevaluatethepatient?Stage(FIGO):Pelvicexamination骨盆骨盆检查,Rectovaginalexamination直直肠阴道阴道检查,Intravenouspyelography(IVP),ultrasonographyorCTStagingisclinical,butcanuseIVPandCTCervicalcanceristheonlygynecologicmalignancythatisnotsurgicallystaged宫颈癌是癌是妇科科恶性性肿瘤中唯一不采用手瘤中唯一不采用手术分期而是分期而是临床分期的疾病床分期的疾病!2014FIGO分期分期ClinicalStagingforCervicalCarcinomaStage I Invasion is strictly confined to the cervixIA:Invasive cancer identified only microscopically.IA1:Minimal microscopically evident stromal invasion=3mm in depth and no wider than 7mm.IA2:Microscopic invasion=5mm in depth and no wider than 7mmStage IStage IIA IA1 IA2 ClinicalStagingforCervicalCarcinomaStage I Invasion is strictly confined to the cervixIB:All others preclinical lesions and clinical lesions confined to the cervix.IB1:Clinical lisions no greater than 4 cm.IB2:Clinical lisions greater than 4 cm.Stage IbStage IbIB1 IB2 IB1 lisionsnogreaterthan4cmIB2 lesionsgreaterthan4cm.ClinicalStagingforCervicalCarcinomaStage IIInvasion is beyond the cervix but not to the pelvic wall or lower third of the vaginaIIA Parametria(宫旁)is not involved,involving vagina but not reach lower third of the vaginaIIA1:Clinical lisions no greater than 4 cm.IIA2:Clinical lisions greater than 4 cmIIB Parametria is involvedStage IIStage IIInvasion is beyond the cervix but not to the pelvic wall or lower third of the vaginaIIAParametria is not involvedIIBParametria is involvedII IIA AII IIB BClinicalStagingforCervicalCarcinomaStage IIIInvasion is to the pelvic wall or lower third of vaginaIIIAPelvic wall is not involved,spread to vagina and reach low 1/3IIIBPelvic wall is involved;hydronephrosis(肾积水)or nonfunctioning of the kidney(无功能肾)may occur because of tumorStage IIIStage IIIInvasion is to the pelvic wall or lower third of vaginaIIIA APelvic wall is not involvedIIIB BPelvic wall is involvedIIIIIIA AIIIIIIB BClinicalStagingforCervicalCarcinomaStage IVInvasion is beyond to the true pelvis or to the mucosa(粘膜)of the bladder(膀胱)or rectum(直肠).IVASpread is to adjacent organs(临近器官)IVBSpread is to distant organs(远处器官)Stage IVStage IVIVIVA AIVIVB BSpread is to adjacent organsSpread is to distant organsHowcanweevaluatethepatient?Generalcondition:age,marriage,reproductivehistory,familyhistory,pastmedicalhistoryaccessoryexamination pulmonary(Chest-x-ray),cardiac function(ECG),liver function,renal function,blood rootineHowcanwemanagethepatient?Managementofpremalignantlesions:makedefinitivediagnosisselectionofanappropriatemodeoftherapy 1.Conebiopsy:coldknifeconization、LEEP(loopelectrodiathermyexcisionprocedure).Itiswidelyusedandeffective,firstchoseforyoungerwomen.2.Hysterectomy子子宫切除切除术3.othermethods:cryotherapy冷冷冻疗法法;electrocautery电烙法烙法;Howcanwemanagethepatient?For invasive cancer(手术、放疗):1 Simple hysterectomy(Ia1)单纯子宫切除术 2 Modified radical hysterectomy(Ia2)改良子宫根治切除术3 Radical hysterectomy and bilateral adnexectomy and bilateral pelvic lymphadeneotomy(Ib-IIa)根治性子宫切除术+双侧附件切除术+双侧盆腔淋巴结清扫术4 Radiotherapy(any stage,IIb III IV)放疗:同期、新辅助、术后辅助Howcanwemanagethepatient?For invasive cancer(手术、放疗):5 Chemotherapy 化疗:late stage or recurrent cervical cancer6 neoadjuvant chemotherapy,neoadjuvant radiation(新辅助放化疗)7 Goal of treatment:cure(治愈),except stage 4b Howcanwemanagethepatient?Complication(并(并发症)症)Surgery:尿潴留,淋巴囊肿,感染,出血,副损伤等Radiation:放射性膀胱炎,放射性结直肠炎,放射性皮炎,放射性阴道炎Chemotherapy:过敏、骨髓抑制、肝肾功能损伤、胃肠道反应、脱发等Radical hysterectomy根治性子宫切除术Radiotherapy by accelerator(使用加速器的放疗)后装放疗后装放疗Followup The first follow up is in 1 month after discharge,then once a time every 23 month within 1 year.In the second year once a time every 36 month.During 35 years after discharge once a time each year.The contents of the follow up include clinical examination,regular chest X-ray and blood RT,tumor marker test.Prognosis55%five-year survival (all stage combined)stage I 85%stage II 60%stage III 30%stage IV 10%Howcanwepreventcervicalcancer?Risk factorsEducationScreening program(筛查)Treatment of premalignant lesionsVaccinum(疫苗)CervicalCancerScreeningGuidelinesFirst screen 3 years after first intercourse(初次性生活)or by age 21Screen annually with regular Pap smear or every 3 years with liquid-based testsAfter three normal tests,can go to every three yearsStop at 65-70 years with history of negative testsStill need annual check-upsCervical Cytology Screening.ACOG Practice Bulletin No.45.2003;102:417-27.Howcanweexplaintothepatient?What is cervical cancer?How many treatment modes for cervical cancer?Why we choose surgery or RT for the patient?What is the side-effect of the treatment?What is the prognosis and survival rate?Case病例:患者,女,40岁,不规则阴道流血三个月,检查:宫颈下唇菜花样肿物,触之易出血,子宫大小正常,活动良,宫旁无明显增厚。问题:如何处理,可否手术?CervicalcancerCervical cancer is the most common gynecologic malignancy.HPV is the most important factor.The most common tumor type is squamous cell carcinoma(80%)TCT is only a screening test!Definitive diagnosis of cervical cancer requires a tumor biopsy!Radiation and operation are both effective treament.Goal of the treatment:cure,except stage 4bReference http:/ Thank you!BraintumorDongdongLuoMD.AssociateChiefNeurosurgeonNeurosurgicalDepartment.QQ:865656249Tel:13560163786Whatisbraintumor?IntracranialtumorCraniocerebraltumorBraintumorsarethe:leadingcauseofcancer-relateddeathsinmalesages20-39.fifthleadingcauseofcancer-relateddeathsinwomenages20-39.TeachingGoalContenttomaster:1.Commonclinicalcharateristicsofcerebraltumor;2.DiagnosisandtherapeuticprincipleContenttobefamiliarwith:1.Classificationofcerebraltumor;2.Mainclinicalmanifestationsofvariousbraintumors3.EtiologyandepidemiologyClassificationofcraniocerebraltumors1.Scalptumors(less,angioma,melanama,neurofibroma,basaloma)2.Skulltumors(less,osteoma,multiplemyeloma,fibrosarcoma,dermoidandepidermoid)braintissuemeningesprimarycranialnerve3.IntracranialtumorsintracranialvesselembryonictissueMetastaticfromotherorgansPrimarybraintumors1.Neuroepithelialtumors(gliomas)(神经上皮肿瘤、胶质瘤)Astrocytomas(星形细胞瘤)Oligodendroglioma(少突胶质细胞瘤)Medulloblastoma(髓母细胞瘤)Ependymoma(室管膜瘤)2.Meningioma(脑膜瘤)3.Neurofibroma(神经纤维瘤)3.Primarycerebrallymphoma(原发性脑淋巴瘤)4.Pituitaryadenoma(垂体腺瘤)5.TumorsofothertissuesBloodvessels:haemangioblastoma(血管母细胞瘤)Germcells:germinoma(生殖细胞瘤teratoma(畸胎瘤).Tumoursofmaldevelopmentalorigin:Craniopharyngioma(颅咽管瘤),epidermoid(表皮样囊肿)/dermoidcyst(皮样囊肿)Epidemiology1.Annualincidence:about8.2per1000002.Accountingforabout5%ofallneoplasmsinthebody3.Makeupapproximately50%ofallchildhoodmalignancies.4.DifferentprimarytumortypesandtheiranatomicallocationvarieswithageAdults:gliomas,meningiomas.80-85%supratentorialcompartment.15-20%infratentorialcompartment.Children:medulloblastomas,cerebellarastrocytomas40%supratentorialcompartment.60%infratentorialcompartment.5.Incidencedistributionofprimarybraintumors6.IncidenceofdistributionofallgliomasbyhistologysubtypeEtiologyWhatfactorscancausebraintumors?1.Geneticfactors2.Physicalfactors3.Chemicalfactors4.Biologicalfactorsclinicalmanifestationsdependonthesiteofthetumorsandthespeedofgrowth1.Featuresofincreasedintracranialpressure1)headache2)Vomiting3)Papilloedema2.Focalsymptomsandsignsdependsontheanatomicalsitewhetherthetumoreffectisirritativeordestructive.1)Benign:slowgrowing,mildedema2)Malignant:fastgrowing,aggressive,severveedema3.clinicalmanifestationsoflesionsinthecerebralhemisphereEpilepsyMentalsymptomsMotordisorderSensorydisturbanceAphasiaVisualfielddefectsEpilepsypartialseizuressimplepartialseizurecomplexpartialseizuregeneralizedseizureParalysisMusclestrengthgradingscale0/5Nocontraction1/5Visible/palpablemusclecontractionbutnomovement2/5Movementwithgravityeliminated3/5Movementagainstgravityonly4/5Movementagainstgravitywithsomeresistance5/5Movementagainstgravitywithfullresistance(normal)AphasiaagraphiamotoraphasiaBrocasareaWernickesareaalexiasensoryaphasia4.ClinicalmanifestationsoflesionsinthesellarregionDecreasedvisionVisualfielddefectsEndocrinologicalsymptomshypopituitarismHyperprolactinemiaAcromegaly/gigantismCushing,ssyndromeThyrotoxicosis5.ClinicalmanifestationsoflesionsinthepinealbodyObstructivehydrocephalusVerticalgazeparalysisParinaudsyndromepinealpinealbodybodyprecociouspuberty(性早熟性早熟)Dysfuncitonofmidbrain,cerebellumandhypothalamus6.ClinicalmanifestationsoflesionsintheposteriorcranialfossaCerebellarhemisphere:ataxiaintheipsilaterallimbCerebellarvermis:equilibriumdisorderCerebellopontineanglearea:damagetheipsilateralcranialnerveV-andcerebellarhemisphere.Clinicalcharacteristicsofdifferenttypesofintracranialtumors1.Astrocytomas(星形星形细细胞瘤胞瘤)thecommonestprimarybraintumors.occuratanyage,thecommonestintheagesof40-60years.Male/femaleincidenceis2:1.occurwithequalincidencethroughoutthefrontal,temporalandparietallobes,butareuncommonintheoccipitalFourpathologicalgrades(KernohanI-IV):gradesIandII:Low-monlyseeninchildren/youngadults.gradeIII:Anaplasticastrocytoma.gradeIV:GlioblastomamultiformisMalignantastrocytomasarefarmorecommonthanbenignones.pilocyticastrocytoma(gradeI)F,14-year-oldpreoperationpostoperationpreoperationpostoperationastrocytoma(gradeII)F,40-year-oldPreoperationPostoperationBrainstemastrocytoma(WHOIII)10-year-oldboypreoperationpostoperationGlioblastomamultiformis(gradeIV)M,50-year-old2.Oligodendrogliomaslow-growing/lowmalignancy.youngerage-group(30-50years).commoninfrontallobe.Imagingrevealsawell-demarcatedtumor,frequentlywithareasofcalcification.(少突胶质细胞瘤)(少突胶质细胞瘤)3.Medulloblastoma(髓母(髓母细细胞瘤)胞瘤)themostcommonmalignanttumorofchildhood(4-8years).arisesfromembryonictissueinthecerebellarvermis.mayseedthroughtheCSFpathwaystootherpartsofthecraniumorthespinalcord.4.Ependymoma(室管膜瘤)(室管膜瘤)thesecondmostcommontumorofchildhood.occursintheventricularsystemorthespinalcanal;commoninthefourthventricleandinthecaudalpartofthespinalcord.EpendymomaInlateralventricleInfourthventricleInmedullarycone5.Meningioma(脑脑膜瘤膜瘤)AbenigntumorarisingfromthearachnoidCompressesratherthaninvadestheneuraltissues.Maximumincidenceoccursin40-60yearsofageImagingrevealsawellcircumscribedlesionwithoccasionalcalcification.Commonin:sylvianregion,parasagittalsurfaceolfactorygrooves,lesserwingsofthesphenoid,tuberculumsellae,cerebellopontineangle,thoracicspinalcord6.Neurofibroma(神神经纤维经纤维瘤瘤)abenign,slow-growingtumor.developsonthevestibulardivisionofcranialnerveVIIIcommonly(misleadinglycalledanacousticneuroma).sensorineuraldeafnesstinnitusandvertigo.Itmayappearaspartoftheneurofibromatosissyndrome(type2),whenothertumours(particularlycontralateralacousticneuromas)shouldbesought.neurofibromatosissyndrome7.Primarycerebrallymphomaaggressivetumoursaccountforupto10%ofcentralnervoussystemcomplicationsinAIDSpatients.oftenperiventricular,andmaybemultiple.8.Pituitaryadenoma(垂体腺瘤)(垂体腺瘤)abenigntumorpresentswithneurologicalorendocrinologicalsymptomsSomesmallertumorspresentwithhyperprolactinemiaoracromegaly/gigantism,Cushing,ssyndromeorthyrotoxicosisLargepituitaryadenomausuallypresentswithheadache,bitemporalhemianopia(fromupwardpressureontheopticchiasm),andoccasionallyhypopituitarism.CongenitalbenigntumorStemfromcranialpharynxtuberesidualtissueinthepituitarystalkinembryonicperiodCommoninchildhoodMostlycysticManypostoperativecomplications9.Craniopharyngioma(颅颅咽管瘤)咽管瘤)10.Haemangioblastoma(血管母(血管母细细胞瘤)胞瘤)BenigntumorLocatedinthecerebellarhemisphereHaveageneticpredispositionMostlycysticwitharichbloodsupplyofnodules11.Germcelltumor(生殖(生殖细细胞胞肿肿瘤)瘤)Avarietyofpathologicaltype:germinoma,teratoma,endodermalsinustumor,embryonalcarnioma,chorionicepithelioma,mixedgermcelltumorCommonlyLocatedinpinealregionandsellarregion70%haveoccurredinages10-24SpreadeasilywithCSFSensitivetochemotherapyandradiotherapy12.Metastaticbraintumors(脑转脑转移瘤)移瘤)Metastaticbraintumoursarearound8timescommonerthanprimaryones.About20%ofpatientsdyingwithothertumorswillhaveintracranialmetastases.Theprimarytumorsare:44%bronchus10%breast7%genitourinary.6%bowel3%skin(melanoma)30%others.DiagnosisLocalizationdiagnosisQualitativediagnosis1.Clinicaldiagnosis:intracranialhypertension,seizure2.Imagediagnosis:CT,MRI,DSA,PET,SPECT3.Electrophysiologicalexamination:EEG,cerebralevokedpotential4.laboratoryexamination:anteriorpituitaryhormone,HCG,AFPnormalglioma1.magneticresonancespectroscopy(MRS)2.functionalmagneticresonanceimaging(fMRI)Showrelationshipbetweentumorandimportantareaofbrain3.magneticresonancediffusiontensorimaging(DTI)ShowstherelationshipbetweentumorsandthevitalnervefiberbundledirectlyTreatment1.Symptomatictherapydehydrationmedicine,steroids(toreducecerebraledema),anticonvulsants.2.Benigntumor:Surgery3.Malignanttumor:multimodaltreatment(surgery+radiotherapy+chemotherapy)Routinecraniotomy常规开颅术Routinecraniotomy常规开颅术externalventriculardrainageventriculo-peritonealshuntoperationAdvancedtechniqueMicroneurosurgeryEndoscopictechniqueEndoscopicresectionofpituitaryadenomaEndoscopicthirdventriculostomyNeuralnavigationneurosurgeryIntraoperative awaken and cortical electrical stimulation technologyThepatientremainsawakeduringoperationandacceptsthecortexstimulation,whichiseasilyforneurosurgontojudgethefunctionalregionofbrain.Thetechnologycanreducethedamageofbrainfunctionasmuchaspossible.Intra-operativeMRIIntraoperativeneurophysiologicalmonitoringRadiotherapy1.Highlysensitivetoradiotherapymedulloblastoma,germinoma,lymphoma2.Maglinantglioma1)Stronglyrecommendregularfractionatedirradiationasthestandardtherapyforpostoperativeglioma2)Xorrknifeisnotrecommendedthepreferredtreatmentforglioma3)Recommendstartingradiationtherapyassoonaspossiple2-4weeksaftersurgery.ChemotherapyAtpresentthemostcommonlyuseddrugis:temozolomide(TMZ)替莫替莫唑唑胺胺Moleculartargetingtreatment1)AntiangiogenesisinhibitorsVascularendothelialgrowthfactor(VEGF)monoclonalantibody(AVASTIN)阿瓦斯汀2)epidermalgrowthfactorreceptor(EGFR)inhibitors(GEFITINIB)吉非替尼Prognosisofgliomasin19732002KeyPointCommonclinicalcharateristicsanddiagnosisoftumorincerebralhemisphere,sellarregion,pinealregionandposteriorcrainalfossaCasereportFemale,39yHeadachefor10yearsandvomitingfor3days.CranialCT:LesionofrightfrontallobewithedemaPrimarydiagnosis:LesionofrightfrontallobePre-operativeMRIPre-operativeMRIPre-operativeMRITumorLateralLateralventricleventricleTumorPostoperativepathologicexmainationTumortissue4*6*8cmAnaplasticoligodendroglioma-astrocytomapostoperativeMRIPostoperativetherapy1.Secondweekaftersurgery:radiationtherapy(2.0Gypertime,5timesperweek,60Gyin6weeks)+TMZ2.Afterradiationtherapy:TMZchemotherapyforabout6monthes.Thankyou
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