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종양 환자의 접근 (서울의대강의)


Dae Heo

on 17 April 2013

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Transcript of 종양 환자의 접근 (서울의대강의)

CC: abdominal pain
onset: 1 month ago Ulcerative lesion

- 위궤양?
- 위암? Adenocarcinoma of stomach

위선암 (위암) 종양 환자의 진료

1. Pathology

2. ? Stomach, subtotal gastrectomy:

- Depth of invasion: invades serosa (visceral peritoneum) (pT4)

- Lymph node metastasis:
metastasis in seven out of 23 regional lymph nodes (pN3a)

Pathologic Stage: T4N3M0 (stage IIIc) Ulceroinfiltrative lesion with transmural enhancement and subtle retraction at serosal side in lesser curvature side of prepyloric antrum of the stomach.

- no definite perigastric infiltration or regional lymphadenopathy.

--> DDx : AGC, Borrmann type III> EGC with ulcer related change.

Clinical Stage IB or IIA (T2N0M0 or T3N0M0) 종양 환자의 진료

1. Pathology

2. Staging (extent of disease)

3. Functional status
- performance
- nutrition
- age 치료?

- Surgery
- Radiotherapy
- Chemotherapy
- Hormonal therapy
- Immunotherapy Confinement 말기? 주치료 + 보조치료

1) 위암: 수술 + chemo
2) NSCLC: 수술/RT + chemo
3)Lymphoma: chemo + RT (예외1)

전신 질환 ===> 국소치료

colon cancer + liver meta
osteosarcoma + lung meta (예외 2)

국소질환 ==> 전신치료
(neoadjuvant chemotherapy)

H&N cancer, locally advanced Targeted
therapy 종양 환자의 진료

1. Pathology

2. Staging (extent of disease)

3. ?
En-bloc resection Curability of cancers with chemotherapy (Harrison's)

A. Advanced cancers with possible cure (ALL)
B. Possibly cured by chemotherapy & radiation (H&N)
C. Possibly cured with chemotherapy as adjuvant to surgery
D. Possibly cured with high-dose chemotherapy
with stem cell support (relapsed leukemia)
E. Responsive with useful palliation, but not cure
F. Poorly responsive to chemotherapy (Pancreatic) Organ Preservation

1> Laryngeal cancer (voice box)
chemo + RT > laryngectomy
2> Breast cancer
lumpectomy + RT > radical mastectomy
3> Osteosarcoma
chemo + limb salvage op > amputation
4> Gastric lymphoma
chemo >> gastrectomy 항생제 vs. 항암제

1> 선택성
항생제: self vs non-self
항암제: self vs self (transformed)

2> 원인적치료 vs 현상학적 치료

3> therapeutic index (therapeutic/toxic) Loco-regional------> Surgery

Systemic ------------> Chemotherapy
Hormonal therapy
Immunotherapy Loco-regional -- stage I, II, III

Systemic --------- stage IV 종양 환자의 진료

Introduction to
Clinical Oncology

Dae Seog Heo, M.D.
Department of Internal Medicine
Seoul National Universtiy Hospital 42/male
CC: left neck mass (for 4 mons) 2012-2-10 ER
CC: neck pain & left arm weakness
for 3-4 days 2011-10-31
mass resection
+ LN dissection 2011-10-11 Fractional kill hypothesis
Full transcript