医学报告参赛-课件-新颖-完整.ppt

1、 优质参赛课件 参赛选手：*LUNG CANCER MANAGEMENTMETHODS AND PHILOSOPHY DR.D.R.JOSHIDR.D.R.JOSHIB.J.MEDICAL COLLEGE,PUNEB.J.MEDICAL COLLEGE,PUNE =SYMPTOMATIC&PHYSICAL ASSESSMENT,=RADIOLOGICAL ASSESSMENT,*PLAIN CHEST FILMS,*C.T.SCANS *RADIONUCL.BONE SCANS =Thcentesis,Bscopy,Medscopy =And.U S G ABDOMEN.FOR NEW PAT

2、IENTS-High index of suspicion Try to define anatomic extent Find cell-type of lesion Patients GC for aggressive Rx Plan for the Rx.STAGING&5-Yrs SURVIVAFOR NSCLC (1986)I T1_2 no mo 60-80%IIT1_2 N1 mo 25-50%IIIaT3 N0-mo 25-40%T1-3 N2 mo 10-30%IIIbAny T4/N3 mo.5%IVAny M1 5%AJCC RECOMMENDED STAGING#Cli

3、nical diagnostic#Post-surgical pathologic stage#Re-treatment stage#Autopsy stage PERFORMANCE INDEX .*KARNOFSKY SCALE*ECOG(Zubrod)SCALE v Record At Diagnosis stagev Correlate with apparent stage of the Disease.PRE-OP EVALUATION -CARDIOPULM STATUS HIGH RISKHIGH RISK:Recent MI,Arrhythmias Congestive Ca

4、rdiac Failure,Systemic Hypertension Pulmonary Hypertension,FEV1 35 YRS SIZE 3 CMS LACK OF CALCIFICATION H/O PREVIOUS OR CURRENT MALIGNANCY GROWTH OF LESION CHEST SYMPTOMS ASSOCIATED PNEUMONIA,COLLAPSE,ADENOPATHY.EXTENT OF RESECTION.DEPENDS ON EXTENT OF LESION *Wedge resection *Segmentectomy *Lobecto

5、my *Sleeve resection *Pneumonectomy#PALLIATIVE RESECTION-NO ROLE NSCLC:CONTRAINDICATIONS FOR CURATIVE SURGERY STAGE IIIb-N3 disease STAGE IV Recurrent Lary /Phrenic N palsy Vena cava /Lt Atrium involvement SVC Obstruction T3 Disease Card.tamponade,Malignant Effusion.Cardiac arrythmias MVV 40%,FEV11.

6、5L Split PFT by V/Q scan 50 *No CO2 retention CHEMOTHERAPY IN NSCLC MAXIMUM BENEFIT WHEN *CHEMOTH added to RADIOTH.Locally advanced IIIb&few IIIa *Neo-adjuvant Chemo Pre-operative Rx for STAGE IIIa some new drugs -Docetaxel,Paclitaxel Gemcitabine,Topotecan Tirapazamine,etc CHEMOTHERAPY IN SCLC WIDEL

7、Y USED:CISPL,ETOP.Every 3 weeks*oral/single/old pt OROR poor performance pt:ETOP.*Single agent chemo:ETOPOSIDE TENOPOSIDE*Salvage:ETOP+CISPL (EP)Cycloph+Adria+Vincrist (CAV)NOW:intensive initial OR re-induction Rx with autologous bone marrow infusion NEO-ADJUVANT CHEMOTHERAPY Assess drug sensitivity

8、 of cells Render unresectable resectable Better tolerated before surgery Slows growth after primary Tumour is removed Preserve blood supply good drug delivery Increase survival in N2 than surgery alone RELATIVE CONTRAINDICATIONS FOR RADIOTHERAPY.#Prior HIGH-DOSE RADIATION#Connective Tissue Disorders

9、#FEV1 40%Normal Lung and 50%Heart vol.RADIATION-THERAPY I.Neoadjuvant Pancoast *N2 4500 II.Adjuvant N+T3 Incom.resection 5000 III.Palliative Stage III Stage IV 2-5000 (local symptoms)IV.Definitive T1-2N0-1 No/refuse Surg 6000 V.SCLC(+chemo)Ltd stage 5000 ADVANCES IN RADIOTHERAPY.#BIOLOGIC *Hyper-fra

10、ctionation *Accelerated Therapy#TECHNICAL *3-Dimensional Conf.Radiation Therapyv RESPONSE TO PALLIATIVE RADIATION.Haemoptysis.75-85%SVC obstruction 60-80%Pain 50-75%Cough .35-65%Dyspnoea .35-50%Wt.loss/anorexia.30-50%Atelectasis 20%V.Cord palsy .5%OVERALL RELIEF =60-70%SUPPORTIVE CARE#Encourage to S

11、TOP SMOKING#During CHEMOTHERAPY -*ANTI EMETICS,*BLOOD COUNTS&CHEMISTRY *MONITOR FOR INFECTION AND BLEEDING *ROUTINE BOLUS/FLUIDS WITH CISPLATINPSYCHOLOGICAL SUPPORT.#FEAR,ANXIETY,DEPRESSION#COMPROMISED SELF IMAGE#CANCER SURVIVORS#PHYSICAL HANDICAPS -REAL -PERCEIVEDv FEAR OF RELAPSEDEALING WITH DEATH

12、.#THREE PHASES OF UNSUCCESSFUL CANCER Rx _ -OPTIMISM AT HOPE OF CURE -ACKNOWLEDGEMET OF INCURABLE DISEASE AT RECURRENCE -DENIAL,ISOLATION,ANGER,DEPRESSION,BARGAINING,AT DISCLOSURE OF IMMINENT DEATH .contd .#SPEAK FRANKLY REGARDING LIKELY COURSE OF DISEASE#RE-ASSURE PATIENT&FAMILY#SURROGATE DECISION#LEGAL DOCUMENTS#DNR ORDERSAny suggestions/feedback is welcome And may please be communicated to 再见！