腫瘤學(xué)-緒論和介紹

IntroductionandDiagnosis

緒論與診斷

FabienneMueller

ResidentMedicalOncology

SectionofDiagnosticImagingandRadio-OncologyVetsuisseFaculty,UniversityofZurich

Overview

綜述

Introduction:

介紹Gettingadiagnosis

如何診斷

1.Generalhealthstatus 全身健康狀況

2.Tissuesample

組織取樣

3.Localization

定位

=>Prognosisandtherapy 預(yù)后與治療

Introduction:Whyworryaboutcancerinpets??為什么擔(dān)心寵物患癌癥？Majorcauseofdeathinpets

寵物的主要死因45%ofdogs>10yearsdieofcancer 45%的、10歲以上的老齡狗死于癌癥23%ofdogsandcats(ofallagegroups)presentedfornecropsydiedofcancer 23%的狗貓（各年齡段）尸檢時發(fā)現(xiàn)死于癌癥Prevalenzincreasing

越來越多的影響因素Human-animalbond

人畜共用Improveddiagnostics

先進的診斷技術(shù)Betterpreventiveandtherapeuticmedicalpractices 較好的預(yù)防與治療實踐->Animalsgetolder

動物老齡化Breeding品種->Predispositions遺傳因素Environmentalinfluences環(huán)境影響IntroductionVeterinariansshouldbeprepared...

獸醫(yī)應(yīng)當(dāng)具備的...Ownersareinformedandhavehighexpectations 主人的見多識廣和對醫(yī)生的高期望值：

Exposurethroughtv,press,internetetc

平時通過電視、報紙雜志、網(wǎng)絡(luò)等了解一些Ownersfearsaboutcancer

主人對癌癥的恐懼

Manyownerhavepersonalexperiencewithcancer

許多主人有患癌癥的經(jīng)歷

Veterinarianshouldbepositive,compassionate,andknowledgeable 獸醫(yī)應(yīng)當(dāng)以積極的態(tài)度去面對，富有同情心而且學(xué)識淵博Rewardingexperienceforveterinarians

獸醫(yī)的回報

Ownersaredevoted,compassionate,and

thankful

主人對寵物看病舍得花錢，富同情心，并對看病的醫(yī)生心存感激IntroductionDiagnosingcancer....癌癥診斷…

Generalhealthstatus 全身健康狀況

PhysicalExam

體檢Completepatient!

全身體檢

Palpatealllymphnodes 觸診所有的淋巴結(jié)Bodycharts

體表定位MEASURE!!

檢測-Lymphnodes

淋巴結(jié)-Masses

腫塊

GeneralHealthBodycharts

體表定位GeneralHealthBloodwork

血液檢查Basisfortherapy

治療基礎(chǔ)：-

CanIgivechemo/othermedications?

是否給予化學(xué)的和/或其它的治療藥物？-

CanIanesthetizetheanimal? 是否實施麻醉？

...

Identificationofotherhealthproblems 有關(guān)其它健康問題的鑒定Paraneoplasticsyndromes 瘤外綜合癥

GeneralHealth2.TissueSample組織取樣FineNeedleAspiration

細針抽吸Simpleandnoninvasive 簡單且損傷小Minimalmorbidity

最低發(fā)病率Almostanybodyarea 幾乎可用于身體上任何部位

-Bodycavities(fluid)體腔（液體）-Lymphnodes淋巴結(jié)-Masses腫塊-Intraabdominalorgans腹腔器官...Neoplasiavsinflammation 瘤形成與炎癥的比較TissueSampleTechniques

技術(shù)?needle-on“進針?needle-off“出針TissueSample?Needle-On“vs?Needle-Off“

進針與出針Nosignificantdifference 沒有明顯的差別?Needle-on“ 進針

Idealfortissuesthatdonotexfoliatewell

對于不易剝離的組織較理想?Needle-off“

出針

Fortissuethateasilyexfoliates

組織較易剝離

owerriskofbloodcontamination

減少血液污染

Goodtactilecontrol

便于接觸調(diào)節(jié)TissueSampleSlidePreparationandStaining

壓片準備與染色TissueSampleCytology

細胞學(xué)檢查TissueSampleSubmittingtheSlides

壓片提交Stainoneslidebeforesubmitting-Representativesample?-Improveyourskills...Multipleslides(eachmassornode)Label(withpencil)AlwayssubmitAppropriatecontainers-Notinformalin-PlasticorstyrofoamCommunicationwithpathologist

TissueSample在提交前先作單面染色，是否有代表性樣品，提高你的技術(shù)…多個壓片（每一腫塊或結(jié)節(jié)）貼標簽（可用鉛筆）經(jīng)常制作合適的容器，不要用福爾馬林，要用塑料或泡沫聚苯乙烯與病理專家聯(lián)系Biopsy

組織活檢Moreexactdiagnosis更加精確的診斷Grade(prognosis)評級（預(yù)后）Preoperativeoderexcisionalbiopsy?

是否需要術(shù)前活檢？TissueSamplePreoperativeBiopsy

術(shù)前活檢

Whenhistologicfeaturesdetermine... 當(dāng)組織學(xué)特征確定以后…-Treatmentmodality

治療方式

(surgeryvsradiotherapyvschemotherapy) （比較手術(shù)法與放射療法與化療法 -Extendoftreatment

進一步的治療

(conservative/palliativevsaggressive/curative)

（比較保守或延期治療與冒失或藥物治療）-Owner`swillingnesstotreat

主人對治療的意愿

(prognosis)

（預(yù)后）

TissueSampleBiopsyGuidelines

活檢原則General:

一般原則-Multiplepieces–atleast3

多取樣品－至少取三小塊；-Avoidaresofinflammation

避開炎癥區(qū)域；-Handlesamplesaslittleaspossible

盡可能少的觸摸樣品;SkinBiopsy:皮膚活檢-Leaveuninvolvedtissueplanesundisturbed

遠離無關(guān)組織->Avoiddrains

不要引流->Mediculoushemostasis

及時止血-Keepfuturetreatmentoptionsinmind(minimaltract) 想好進一步的治療方法（小孔道）。-Differenttechniques(punch,tru-cut,incisional......) 使用不同的方法（鉆孔、環(huán)切、切開…）TissueSampleBiopsyGuidelines

活檢原則Bonebiopsy

骨組織活檢-Fromcenteroflesion

從受損的中心開始-Radiographafterbiopsytoconfirmthatboneis

notfractured

取樣后拍片檢查是否骨折Nasalbiopsy

鼻組織的活檢

-Radiographs/CTbeforebiopsy(bleedingcloudsimage) 活檢前先拍片或做CT（顯示出血斑的影像）；-Hemorrhageisconsiderable應(yīng)考慮出血問題

->Positionwithnosedownandcottonpackingintheendofthenose 鼻子朝下并將棉球塞進鼻孔->Coldpacksafterbiopsy

活檢后冷敷

TissueSample：：Grading

評級

=Differentiationofthecells細胞分化

?Howmuchdothetumorcellsresemblenormalcellsofthesametissuetype?“ 腫瘤細胞與同類組織的正常細胞多么地相似呀？Grade1=welldifferentiated分化良好Grade2=moderatelydifferentiated中等分化程度Grade3=poorlydifferentiated分化不良Predictiveofbiologicbehavior生物學(xué)反應(yīng)的預(yù)測MCT甲狀腺髓樣癌Lymphoma淋巴瘤Softtissuea...軟組織肉瘤TissueSampleExcisionalBiopsy:SurgicalMargins

摘除組織的活檢：手術(shù)切口緣

TissueSample3.Location

定位PrimarytumorLymphnodeDistantmetastasis腫瘤原發(fā)灶周圍淋巴結(jié)遠處轉(zhuǎn)移灶Staging

腫瘤分類=Anatomicalextendofthetumor 腫瘤擴散的解剖基礎(chǔ)?Howfarhasthetumorspreadinthebody?“

“腫瘤在體內(nèi)能擴散多遠?”Primarytumor 腫瘤原發(fā)灶Regionallymphnodes 局部淋巴結(jié)Distantmetastasis 遠端轉(zhuǎn)移灶

LocationPrimarytumor

腫瘤原發(fā)灶PhysicalExam

體檢Measure!!

測量Bodychart

體表定位DiagnosticImaging影像學(xué)診斷

RadiographsUltrasoundCT/MRIEndoscopy

Tumorextend

腫瘤擴散度Tumorconsistency

密度腫瘤Guidanceforbiopsy

為活檢作指導(dǎo)LocationX線檢查、超聲檢查、計算機斷層成像技術(shù)或磁共振成像技術(shù)、內(nèi)窺鏡檢查觀察、DiagnosticImaging–Radiog