膀胱癌诊疗指南非肌层浸润性课件.pptxVIP

膀胱癌诊疗指南非肌层浸润性 非肌层浸润性 膀胱癌 方 就 以 断 治 疗 拍 用 ( 2 0 1 4 2 2008年世界膀胱癌年龄标准化发病/死亡 死亡率 CA Cancer J Clin,2011,61:69-90. 发病率 率 17960,25% Males Females 54610,75% 2013年美国膀胱癌新发/死亡病例数 新发病例数 死亡病例数 4390,29% 10820,71% CA Cancer J Clin,2013,63:11-30. 4 Males Females 发病率 死亡率 癌症进展，2013,1. 2009年我国膀胱癌发病/死亡率 5 发病率 死亡率 癌症进展，2013,1. 2 1.5 1.5 1 0.5 0 农村人口 2009年我国膀胱癌发病/死亡率对比 7 6 4 3 2 1 0 (1/10万 9 3 城市人口 城市人口 (1/10万) 2.5 各 6 发病率随年龄增长而增加 250 200 150 100 50 0 (1/10M)Males 65岁以下 65岁以上 Femal S 229.4 54.3 7 膀胱癌的危险因素 多吸烟 30%-50% 多职业因素 20% 多其他因素 ●慢性感染 ●环磷酰胺、非那西丁 ●放疗暴露 ●不良饮食、遗传因素 8 其他：小细胞癌、混合型癌、癌肉瘤及转移癌等 膀胱癌的组织学类型 ■鳞状细胞癌 ■腺细胞癌 ■其他 9 Malignancy Grading of Bladder Carcinoma: Old and New Systems Modified Bergkvist 1987 Papilloma grade 0 Papilloma with atypia grade 1 Urothelial carcinoma grade 2A Urothelial carcinoma grade 2B Urothelial carcinoma grade 3 WHO 1973 WHO/ISUP 1998 Consensus WHO,2004 Papilloma Papilloma TCC grade 1 Papillary urothelial neoplasm of low malignant potential TCC grade 3 Urothelial carcinoma, high-grade From Droller MJ: Bladder Cancer, Current Diagnosis and Treatment. Totowa, NJ, 2001.With kind permission of Springer Science + Business Media, LLC. PRINCIPLES OF PATHOLOGY MANAGEMENT ·Tumors in many cases that would have been classified as grade 2 by the WHO 1973 grading system are now classified as high-grade using the WHO 2004 and the ISUP/WHO 1998 systems. · The pathology report on biopsy/TURBT specimens should specify: If muscularis propria (detrusor muscle) is present and, if present, whether this structure is invaded by tumor Presence or absence of lymphovascular space invas ion Presence or absence of subjacent carcinoma in situ TCC grade 1 TCC grade 2 Urothelial carcinoma, low-grade Urothelial carcinoma, low-grade or high-grade NCCN Guidelines Index Bladder Cancer TOC Discussion NCCN Clinical Practice G