04-7238595 3161 - cch.org.t¬¬七期.pdf · 9 hyperplasia dyspla-sia barrett's esophagus...
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04-7238595 3161
04-7238595 4352
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FLASH
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C o n t e n t s2011 6
http://www.cch.org.tw
4
1995
50%
10 14 6
1/5
13% 50% 60%
60%
7 8
;
4
1.5cm
97
5
6
-18
-18
60
30 -
18
6
T c -
99m MDP
-99m
3 4
20 30
4%
19%
36% 78%
-99m
-18
7
CT
CT
CT
...
Takagi
65% 35%
25% 75%
CT
CT
MRI
CT
CTMoss TNM
CT
T N
M
CT
6
celiac axis
CT
CT
CT
MPR
8
2.49%
3.74%
7 24
9
18
10%
20%
0.74%
5.08%
16.98%
63.45%
2010
Narrow Band Image, NBI
a
b
2010
Endoscopic submu-
cosal dissection, ESD
9
hyperplasia dyspla-
sia
Barrett's esophagus
goblet cel
30
90%
15% 45%
40%
5%
AJCC
2010 AJCC
grade
,
8.3
6.5
moderately dif-ferentiated poorly differentiated
1. WHO Classification of Tumour of the Digesive System. 20092. Sternbuerg's Diagnostic Surgical Pathology, Volume II, fifth edi-
tion.3. AJCC Cancer Stagin Manual, seventh edition.
1
2
90% 5%
97
2.49%
3.74%
7 24
9 18
97
1,989
1,537
10
11
1.
2.
a.
b.
c.
3.
32%-57%
50%
12
25
X
50
13
60%
14
90%
6%
Barret t 's
esophagus related 50%
5% 10%
10% 20%
65% 35%
25% 75%
1980 EORTC
5-FU MMC 5-FU CDDP
24%
30% 1990
Forastiere
5-FU Vinblastine CDDP
24% 29
34%
60% RTOG
NCCN Guideline T1
neoadjuvant therapy
primary treatment
15
1. 2 3
2.
3.
4.
5.
240c.c. 1 2
100 1 1 1
2
1.
2.
3.
50 50 1 70
8
1 100
120 2
1
240c.c.
2
2000 80
16
95BMI 25 30
BMI 1.5
17
2010
5.9%
80%
600
Krukenberg tumor
D'Elia Eur Radiol.
2000;10 12 :1877-85
1 2 3
18
2007
2474
Helicobacter pylori
1
2
3
Borrmann Borrmann classi-
fication
4
type 0-I protruded);type 0-II
superficial ; type 0-III:
excavated type 0-II
type 0-IIa type 0-IIb type 0-IIc
type 0-II
19
Borrmann Borrmann
classif icat ion
5 type 1 polypoid
type 2 fungating type 3
ulcerated type 4
infiltrative
: tubular papil-
lary mucinous
mixed Lauren Lauren
classification
diffuse
intestinal mixed
indeterminate 6
7
T N
M TNM
TNM staging system
mucosa layer
muscularis mucosa submucosa
layer muscularis propria
serosa
1
Kumar:
Robbins and Cotran Pathologic
Basis of Disease, Professional
Edition , 8th ed.
2
Kumar: Robbins and CotranPathologic Basis of Disease,Professional Edition , 8th ed.
3
Feldman: Sleisenger
and Fordtran's Gastrointestinal and
Liver Disease, 9th ed.
20
N
N0
N1 1-2
N2 3-6
N3 N3a N3b
N3a 7-15
N3b 16
M
M0
M1
8 9 T
N M
T
T0
Tis
T1 T1a T1b
T1a
T1b
T2
T3 subserosal connective tissue
visceral peritoneum
T4 T4a T4b
T4a
T4b
60% 80%
50% 1-6
46% 7-15
30%
1. Kumar: Robbins and Cotran PathologicBasis of Disease, Professional Edition ,8th ed.
2. Feldman: Sleisenger and Fordtran'sGastrointestinal and Liver Disease, 9thed.
3. WHO Classification of Tumors of theDigestive System
4. AJCC Cancer Staging Manual, 7th ed.
21
4t y p e 0 - I protrudedtype 0 - I I superficial
type0-IIa, type0-IIb, type0-IIctype 0-III excavated
6
signet ring cellKumar: Robbins and Cotran
Pathologic Basis of Disease, Professional Edition, 8th ed.
8) T1,T2,T3AJCC Cancer Staging Manual, 7th ed.
9) T4 AJCCCancer Staging Manual, 7th ed.
7 : Kumar: Robbins and Cotran
Pathologic Basis of Disease, Professional Edition, 8th ed.
5 Borrmann Borrmannclassificationtype 1 polypoidtype 2 fungatingtype 3 ulceratedtype 4 infiltrative
WHO Classification of Tumors of theDigestive System
Type 0-I
Type 0-IIaType 0-IIbType 0-IIc
Type 0-III
22
90
1.
2 3
2.
2 8
3.
4.
5.
C
1962
3%
20%
90%
7 70%
23
X
95%
1.
2.
a.
1 2
b.
Glycerol,
3.
4.
5.
24
Billroth
Y
98%
~~
25
1991
1994
75%
10
10
2
26
3 4
6
35
5726
3
Avastin
Erbitux
HER-2/neu
5 FU Cisplatin
Anthracycline Oxaliplatin
1 . 5 5
FU/Cisplatin/Anthracycline
80 90%
HER-2/neu
herceptin
HER-2/neu
27
90
90
D1
D2
D2
D1
D2
D2
TS-1 5-FU
5-FU
D2
TS-1 D2 TS-
1 50% 60%
TS-1
TS-1
TS-1
28
4.
IMRT
IGRT
1 5
2009 7
6D Axesse
BodyFix 6D
4
1.
2.
INT0116
36
27
3.
29
1982
50%
83% 96% 57%
83%
92.2% 73.8%
96.0% 78.8%
83.3% 57.4%
90.7% 82.9%
30
31
1.
12-15
2. 14
3. 30
4.
5.
1. 2 5 3 2. 2
1. 1
2. 1 5 3 1
32
B12
1.
10 15
20 30
2.
!
250
3 750
100%
3.
B12
33
260
20 40%
50 90%
65%
1.
2.
3.
4.
5.
6.
7.
8.
-
34
64
70
70
95
96
A-3
97
)
35
10
36
~~~
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09:00 17:10 09:00 23:25 11:30
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10:20 18:30 10:20 16:20
11:00 19:00 11:00 16:40
11:30 19:40 11:30 23:25
12:10 23:25 12:00 00:20
13:30 00:20 12:20 00:40
14:00 00:40 12:40
14:30
1.
2. 5
07:10 14:40 07:10 15:10 07:10
07:30 15:10 07:30 15:30 07:30
07:48 15:30 07:48 16:00 08:40
08:20 16:00 08:20 16:30 09:40
08:40 16:30 08:40 16:50 10:40
09:10 16:50 09:10 23:30 11:40
09:40 17:20 09:40 15:10
10:00 17:50 10:00 15:30
10:30 18:10 10:30 16:30
11:10 18:40 11:10 16:50
11:40 19:10 11:40 23:30
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