肺癌的化療夏黎明ppt課件

1、Lung Cancer Chemotherapy,Liming xia the first affiliated hospital of Anhui College of Traditional Chinese Medicine,Also called: Bronchogenic carcinoma Lung cancer is one of the most common cancers in the world. It is a leading cause of cancer death in men and women in the world. Cigarette smoking ca

2、uses most lung cancers. Risk factors: cigarettes , high levels of pollution, radiation and asbestos exposure ,etc,Your lungs are two spongy organs in your chest that are divided into sections (lobes). Every time you inhale, air is carried through the windpipe to your lungs in two major airways (bron

3、chi). Inside your lungs, the bronchi subdivide into a million smaller airways (bronchioles), which finally end in clusters of tiny air sacs (alveoli). Within the air sacs, oxygen is absorbed into your bloodstream and carbon dioxide is released,Types of lung cancer,Small cell lung cancer. Small cell

4、lung cancer, sometimes called oat cell carcinoma, occurs almost exclusively in heavy smokers and is less common than non-small cell lung cancer. Non-small cell lung cancer. Non-small cell lung cancer is an umbrella term for several types of lung cancers that behave in a similar way. Non-small cell l

5、ung cancers include squamous cell carcinoma, adenocarcinoma and large cell carcinoma,How Is Lung Cancer Diagnosed,Symptoms and syndromes Pulmonary symptoms Symptoms in other organs Symptoms linked to tumor metabolism Blood (hematologic) syndromes Vein and artery (vascular) syndromes Skin (cutaneous)

6、 syndromes Musculoskeletal syndromes Nervous system (neurologic) syndromes Hormonal (endocrine) syndromes Miscellaneous syndromes,Tests and diagnosis Screening Diagnosis Imaging tests Sputum cytology Tissue samples (biopsy) bronchoscopy mediastinoscopy needle biopsy,Left) Conventional CT scan withou

7、t contrast showing possible tumor in the liver. (Right) Conventional CT scan of the same patient using contrast. Images courtesy of Dr. Peter Choyke, Department of Radiology, Clinical Center, National Institutes of Health,Bronchoscopy,Small Cell Lung Carcinoma (above) accounts for about 15 percent o

8、f all lung cancer cases,Normal lung cells (above,Stage I. Cancer at this stage has invaded the underlying lung tissue but hasnt spread to the lymph nodes. Stage II. This stage cancer has spread to neighboring lymph nodes or invaded the chest wall. Stage IIIA. At this stage, cancer has spread from th

9、e lung to lymph nodes in the center of the chest. Stage IIIB. The cancer has spread locally to areas such as the heart, blood vessels, trachea and esophagus all within the chest or to lymph nodes in the area of the collarbone or to the tissue that surrounds the lungs within the rib cage (pleura). St

10、age IV. The cancer has spread to other parts of the body, such as the liver, bones or brain,Stages of non-small cell lung cancer,Staging,Limited. Cancer is confined to one lung and to its neighboring lymph nodes. Extensive. Cancer has spread beyond one lung and nearby lymph nodes, and may have invad

11、ed both lungs, more remote lymph nodes or other organs,Stages of small cell lung cancer,Surgery Chemotherapy Radiation therapy Targeted drug therapy Bevacizumab (Avastin) Erlotinib (Tarceva). Clinical trials Supportive (palliative) care Coping and support Learn all you can about lung cancer Take an

12、active role in your treatment Build a strong support system Set reasonable goals Take time for yourself Stay active Alternative medicine AcupunctureHypnosis Massage Meditation Yoga,Treatments,Lung cancer surgery,Stage Common options,Treatment options for non-small cell lung cancers,Stage Common opti

13、ons,Treatment options for small cell lung cancers,Chemotherapy,Chemotherapy uses drugs to kill cancer cells. One or more chemotherapy drugs may be administered through a vein in your arm (intravenously) or taken orally. A combination of drugs usually is given in a series of treatments over a period

14、of weeks or months, with breaks in between so that your body can recover. Chemotherapy can be used as a first line treatment for lung cancer or as additional treatment after surgery. In some cases, chemotherapy can be used to lessen side effects of your cancer,Chemotherapy is usually the main treatm

15、ent for SCLC,Chemotherapy for SCLC generally uses a combination of 2 drugs. The drug combinations most often used for initial chemotherapy for SCLC are: cisplatin and etoposide carboplatin and etoposide cisplatin and irinotecan carboplatin and irinotecan cyclophosphamide, doxorubicin (Adriamycin), a

16、nd vincristine,If the cancer progresses during treatment or returns after treatment is finished, different chemotherapy drugs may be tried. The choice of drugs depends to some extent on how soon the cancer begins to grow again. (The longer it takes for the cancer to return, the more likely it is to

17、respond to further treatment.,Chemotherapy for SCLC,If the cancer progresses during treatment or relapses within 2 to 3 months of finishing treatment, drugs such as topotecan, ifosfamide, paclitaxel, docetaxel, irinotecan, or gemcitabine may be tried. If the relapse occurs from 2 to 3 months to 6 mo

18、nths after treatment, topotecan is often the drug of choice. Other drugs that may be tried include irinotecan, cyclophosphamide/doxorubicin/vincristine (known as the CAV regimen), gemcitabine, paclitaxel, docetaxel, oral etoposide, or vinorelbine. For relapses 6 or more months after treatment, the o

19、riginal chemotherapy regimen may still be effective and can often be tried again,Chemotherapy for SCLC,Chemotherapy is treatment with anti-cancer drugs injected into a vein or taken by mouth. These drugs enter the bloodstream and go throughout the body, making this treatment useful for cancer that h

20、as spread (metastasized) to distant organs. Depending on the type and stage of lung cancer, chemotherapy may be given as the main (primary) treatment or as an addition (adjuvant) to surgery or radiation therapy. Doctors give chemotherapy in cycles, with each period of treatment followed by a rest pe

21、riod to allow the body time to recover. Chemotherapy cycles generally last about 3 to 4 weeks, and initial treatment typically involves 4 to 6 cycles. Chemotherapy is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemotherapy,NSCLC Chemothe

22、rapy,Most often, initial treatment for advanced lung cancer uses a combination of 2 chemotherapy drugs. Studies have shown that adding a third chemotherapy drug doesnt add much benefit and is likely to cause more side effects. The drugs most frequently used for initial chemotherapy for NSCLC are: ci

23、splatin carboplatin paclitaxel docetaxel gemcitabine vinorelbine irinotecan etoposide vinblastine pemetrexed,NSCLC Chemotherapy,The most common combinations include either cisplatin or carboplatin plus one other drug, although some studies have found that using combinations with less severe side eff

24、ects, such as gemcitabine with vinorelbine or paclitaxel, may be just as effective for many patients. For people whose cancers meet certain criteria, targeted therapy drugs such as bevacizumab (Avastin) or cetuximab (Erbitux) may be added to initial treatment as well (see Targeted therapies section,

25、NSCLC Chemotherapy,Single-drug chemotherapy is sometimes used for people who might not tolerate combination chemotherapy well, such as those in poor overall health. If the initial chemotherapy treatment is no longer working, second-line treatment usually consists of a single drug such as docetaxel o

26、r pemetrexed. Another option may be the targeted therapy erlotinib (Tarceva) Again, advanced age is no barrier to receiving these drugs as long as the person is in good general health,NSCLC Chemotherapy,Possible side effects,Chemotherapy drugs work by attacking cells that are dividing quickly, which

27、 is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects. The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are taken. These sid