胰腺癌及其最最新进展课件

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1、胰腺癌PancreaticCarcinoma2006EstimatedUSCancerCases*MenWomen720,280679,510Prostate33%31%BreastLung&bronchus13%12%Lung&bronchus11%Colon&rectumColon&rectum10%6%UterinecorpusUrinarybladder6%4%Non-HodgkinMelanomaofskin5%lymphomaNon-Hodgkin4%4%Melanomaofskinlymphoma3%ThyroidKidney3

2、%3%OvaryOralcavity3%2%Urinarybladder2%PancreasLeukemia3%22%AllOtherSitesPancreas2%AllOtherSites18%*Excludesbasalandsquamouscellskincancersandinsitucarcinomasexcepturinarybladder.Source:AmericanCancerSociety,2006.2006EstimatedUSCancerDeaths*MenWomenLung&bronchus31%291,270273

3、,56026%Lung&bronchusColon&rectum10%15%BreastProstate9%10%Colon&rectumPancreas6%6%PancreasLeukemia4%6%OvaryLiver&intrahepatic4%4%Leukemiabileduct3%Non-HodgkinlymphomaEsophagus4%3%UterinecorpusNon-Hodgkin3%lymphoma2%Multiplemyeloma2%Brain/ONSUrinarybladder3%23%AllothersitesKi

4、dney3%Allothersites23%ONS=Othernervoussystem.Source:AmericanCancerSociety,2006.流行病学l占全部恶性肿瘤的1-2%l死亡率/发病率=0.99l近年我国城市发病率大幅度上升，死亡率上升到第5位。l多发生在50岁以上，2/3患者>65岁，近年年轻患者明显增加趋势l男女比1.6-1.9：1Five-yearRelativeSurvival(%)*duringThreeTimePeriodsByCancerSiteSite1974-19761983-19851995-200

5、1lAllsites505365lBreast(female)757888lColon505864lLeukemia344148lLungandbronchus121415lMelanoma808592lNon-Hodgkinlymphoma475460lOvary374145†lPancreas335lProstate6775100lRectum495565lUrinarybladder737882*5-yearrelativesurvivalratesbasedonfollowupofpatientsthrough2002.†Recent

6、changesinclassificationofovariancancerhaveaffected1995-2001survivalrates.Source:Surveillance,Epidemiology,andEndResultsProgram,1975-2002,DivisionofCancerControlandPopulationSciences,NationalCancerInstitute,2005.病因学l吸烟机制：烟草有害成分经胆管排泌，刺激胰管上皮，最终导致癌变。烟草中致癌物入血后经胰腺排泌，烟草中尼古丁促进体内儿茶酚

7、胺释放，导致血液中胆固醇水平明显升高。l饮酒因素：酒精>持续刺激胰腺细胞分泌活性>胰腺慢性炎症>>胰腺损害酒精致癌物质（亚硝胺）致癌l慢性胰腺炎、既往胃部手术、放射线照射、以及糖尿病l饮食因素：低纤维、高肉类、高脂肪l遗传病理TumorsofthePancreas–UsuallyExocrine胰腺导管腺癌：最常见的胰腺肿瘤，占60-70%5-10%10-15%胰腺肿瘤的95％以上HeadNeck/BodyTail胰头癌：侵及胆总管、主胰管，导致两个导20%管系统的近端扩张；进一步可以侵及Vater壶Diffusetumorsinvolvin

8、gentiregland腹、十二指肠壁，造成肠壁溃疡胰体/尾癌：可阻塞主胰管，不会累及胆总管胰腺癌的临床表现肿瘤扩散途径l局部侵润：胰头癌中，肿瘤对胰周的侵犯通常通