胸腔外科.ppt

CANCER PATIENT MANAGEMENT The diagnosis of cancer requires a histological proof of malignancy The treatment is mostly based on the extension of the disease and on the histology. Performance status, age and history are also critical factors for establishing the treatment strategy. TUMOR EXTENT STAGING The extent of the disease is one of the key parameters for treatment orientation. In case of localized disease the resectability of the tumor and the operability of the patient are also pivotal. TNM CLASSIFICATION The U.I.C.C (Union Internationale Contre le Cancer) has set up on international classification based on tumor size (T), lymph node involvement (N) and the presence (or not) of distant metastasis (M). The prognosis is better if the tumor id small and if there is no lymph node involvement and no distant metastasis. TUMOR MARKERS/EXAMPLES In some tumors, the evolution of tumor markers over time should allow the assessment of treatment efficacy and the early detection of relapse. PERFORMANCE STATUS SCALES There are several performance status scales. The Karnofsky goes from 100 (normal) to 0 (dead). The E.C.O.G. from 0 (normal) to 5 (dead). These scales evaluate the degree of autonomy for current activities. RADIATION THERAPY / DEFINITION OF VOLUME The target volume encompasses the tumor volume plus a margin to take into account the possibility of microscopic extension. The treatment volume encompasses the target volume plus a security margin. TYPES OF IONIZING RADIATIONS Gamma Rays (=photons, =X rays) are the most penetrating rays. The maximum dose of these rays is delivered 0.5 cm beneath the skin surface. B particules are electrons. The dose of radiation delivered by electrons diminishes rapidly with tissue depth. A particules are helium nuclei. They deliver their radiation dose at a defined tissue depth. CANCER RADIATION SENSITIVITY The tumors are classified in different categories based on their sensitivity to radiation. The goal of radiotherapy is to del