Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

종양 환자의 접근 (서울의대강의)

medical-oncology
by

Dae Heo

on 17 April 2013

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of 종양 환자의 접근 (서울의대강의)

61/m
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:
ADVANCED GASTRIC CARCINOMA

- 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
(metastatectomy)

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
(Breast)
D. Possibly cured with high-dose chemotherapy
with stem cell support (relapsed leukemia)
E. Responsive with useful palliation, but not cure
(AGC)
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
Radiotherapy

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