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2008年NCCN关于遗传性非息肉病性结肠癌的筛查指南要点解读
遗传性非息肉病性结肠癌(hereditary nonpolyposis colon cancer,HNPCC),也称Lynch综合征,占结直肠癌发病总数的2%~3%[1].其发病机制主要是由于DNA错配修复基因(主要是MLH1,MSH2,MSH6,PMS2)突变导致,携带一个HNPCC突变基因的个体终生结直肠癌的危险度为80%[2].HNPCC的主要临床特点为肿瘤发病年龄早,通常在50岁前发生结肠癌,好发于近端结肠(盲肠、升结肠和横结肠),有同时或异时原发性结肠癌,且常见肠外恶性肿瘤,肠外恶性肿瘤常见的部位是子宫内膜,其次是胃、小肠、肝胆系统、上泌尿道和卵巢等.HNPCC的主要危险是以常染色体显性遗传方式传给子代,尤其是一级或二级亲属好发结肠癌.HNPCC临床预后较好,早期发现、早期治疗将极大改善患者的预后.对HNPCC患者及其亲属必须进行密切的监测,NCCN指南[3]对HNPCC的筛查包括分子诊断、遗传检测、随访监测及手术治疗等.
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慢性结肠炎发生及癌变的分子机制研究进展
结肠癌是常见的恶性肿瘤之一,其发病率和病死率在中国乃至世界范围内均很高[1-2],其中一部分结肠癌是由慢性结肠炎引起的,称之为结肠炎相关的结肠癌( colitis-associated colon cancer )。大量的流行病学、实验病理学和临床研究表明炎症性肠病( inflammatory bowel disease ),特别是慢性溃疡性结肠炎( chronic ulcerative colitis)和克罗恩病( Crohn disease)的长期存在可以恶性转化为结肠癌,甚至促进结肠癌的进展和早期转移[3-4]。本文主要论述慢性结肠炎的发生及其恶变的分子机制研究进展。
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光动力疗法治疗结肠癌肝转移的研究进展
结肠癌是消化道常见肿瘤,在欧美国家的肿瘤患者死亡原因中列第 3位,在我国也逐渐呈高发趋势.约 2/3的结肠癌患者死亡时发生肝转移,而能进行肝切除治疗的病例不到 10%,大量患者只能依靠其它非手术疗法,但迄今为止并未找到一种理想的方法 [1].光动力疗法( photodynamic therapy,PDT)问世 20余年来以其独特的优点在肿瘤防治科学中显示出较强的生命力,近年来 PDT技术的快速发展突破了 PDT仅能应用于表浅及管腔肿瘤治疗的传统概念,已有大量实验研究表明 PDT可以用于治疗深部肿瘤如结肠癌肝脏转移肿瘤,作者就其当前研究近况作一综述.
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结肠癌患者术后肠内营养治疗
目的采用肠内营养对结肠癌患者术后进行营养治疗.方法71例住院结肠癌患者,平均年龄52.53±13.94岁,随机分为肠内营养治疗组(EN)和静脉营养治疗组(PN).每天基础热能按125kJ(30Kcal)/kg体重,蛋白质1.25g/kg(0.2g氮/kg),热氮比值为非蛋白热能150Kcal:1g氮.结果EN组未见有恶心、呕吐、腹胀、腹泻等胃肠反应.全部患者的外部切口均Ⅰ期愈合.术前EN组47.06%,PN组48.47%的患者存在营养不良.体重、握力、MAC、MAMC、TSF、淋巴细胞总数、Hb、TP、A、BUN、CR、Na、K、Cl、血糖、Tch、TG等指标均在正常范围内.两组均为负氮平衡,术后第3d与第9d相比,差异均有显著性(P<0.05).EN组血清谷氨酰胺和谷氨酸高于PN组,差异有显著性(P<0.05),其余氨基酸无差异.PN组尿L/M值升高,与EN组相比,差异有显著性(P<0.05).结论结肠癌患者术后用肠内营养治疗有明显的效果并能维护肠屏障功能.
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沉默MACC1基因表达对顺铂耐药的卵巢上皮性癌细胞顺铂敏感性的影响
结肠癌转移相关基因1(metastasis-associated in colon cancer 1,MACC1)异常表达于结肠癌、胃癌、肝癌、卵巢上皮性癌(卵巢癌)等多种恶性肿瘤中,可能与上述恶性肿瘤的发生、发展密切相关[1-5]。有研究显示,在前列腺癌细胞中采用小分子干扰RNA(siRNA)抑制MACC1基因的表达,可增加前列腺癌细胞对吉西他滨的敏感性,其作用可能与抑制Ras/细胞外信号调节激酶(ERK)信号通路的活性有关[6]。本研究利用短发夹状RNA(shRNA)沉默MACC1基因表达后,观察顺铂耐药的卵巢癌细胞系A2780/DDP、COC1/DDP细胞对顺铂敏感性的变化,探讨MACC1基因与卵巢癌细胞顺铂耐药的关系及其可能的分子机制。
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To investigate the expression of Fas ligand in human colon carcinoma cell lines. Methods: A total of six human colon cancer cell lines were examined for the expression of Fas ligand mRNA and cell surface protein by using RT-PCR and flow cytometry respectively. Results: The results showed that Fas ligand mRNA was expressed in all of the six cancer cell lines and Fas ligand cell surface protein was expressed in part of them. Conclusion: These data suggest that Fas ligand was expressed, at least in part, in human colon cancer cell lines and might facilitate to escape from immune surveillance of the host.
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Objective: To screen LKB1 mutation in sporadic colon and ovarian tumors. Methods: Using PCR-SSCP analysis, 72 colon cancer, 45 ovarian cancer, 14 granulosa cell tumor were screened for LKB1 mutation. Results: no mutation was in sporadic colon and ovarian adenocarcinomas. Two mutations were detected in one of the granulosa cell tumors: a mis-sense mutation affecting the putative start codon (ATG?ACG, MIT); and a silent change in erxon 7 (CTT?CTA, leucine). Conclusion: LKB1 mutations in sporadic colon and ovarian cancers are rare event and LKB1 is not the target gene lost on chromosome 19p13.3 in ovarian cancers.
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应进一步加强我国结肠癌的基础研究
结肠癌是临床常见的恶性肿瘤之一.2003年美国结肠癌新发病例数和死亡病例数均居美国癌症发病数和死亡数的第3位,居40~79岁男性死亡率的第2位,结肠癌的5年生存率为62%[1].结肠癌是加拿大第2位癌症死亡原因,结肠癌治疗的费用高达520亿加元[2].在我国,结肠癌是第4位常见的癌症和致死因素,且其发生率呈上升趋势.国内结直肠癌较为多见,青年人结肠癌较多见.另外,由于结肠癌早期没有特异性症状,临床诊断时已多属进展期,造成的损失可能更严重.为进一步提高结肠癌的诊治水平,对结肠癌的基础研究不容忽视.
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结肠癌急性梗阻急诊手术20例治疗体会
1临床资料1.1一般资料:男12例,女8例,年龄30~78岁,平均54岁,病程1~4天.全部病例均有间断性便血史,就诊时中毒性休克5例.
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1例结肠癌病人行射波刀治疗的护理
射波刀(Cyberknife)是一种全身肿瘤立体定向放射外科治疗的新技术,它综合了实时影像引导系统、呼吸运动同步追踪系统以及脊柱定位系统等多项先进技术.相对于传统的外科手术来说,射波刀-放射外科治疗系统是一个无创或微创治疗的选择,能提供合适剂量的局部定位治疗[1].对于不能手术切除或用传统手术方式难以操作的病灶,射波刀是一个极佳的选择,普通手术后的残余或复发病灶也可给予治疗,它是传统放疗以及手术治疗失败后仍能选用的治疗工具[2].我院于2009年6月收治1例结肠癌复发病例,现将护理介绍如下.
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硫酸吗啡控释片治疗重度癌痛剂量个体化的疗效观察
Morphine is classical analgesic with strong effect. Nowadays, controlled- release morphine tablets(MS Contin) are the most advanced among all morphine forms, which has been widely used clinically. Thirty advanced cancerous patients with severe pain were treated with MS Contin from March 1995 to December 1997. The following is the report of clinical observation. 1 Subjects and methods 1.1 Subjects Thirty patients of advanced stage (M,18, F,12 ;age:52± 13years) except primary hepatocarcinomas had pathological or cellular proof . There were 7 cases with hepatocarcinoma, 6 cases with lung cancer, 4 cases with breast cancer , 3 cases with gastric carcinoma, 2 cases with mutiple myeloma, 2 cases with colon cancer and 1 case with pancreatic carcinoma. These patients did not take adrenocortical hormones, sedative, soporific, antidepressants, antihistamines and were not treated with chemotherapy and radiotherapy . 1.2 Methods The grades of pain use VRS. 0 grade: Patients feel no pain.1st grade: Patients feel light pain and can live normally. Their sleep is not disturbed. 2nd grade: Patients feel obvious pain and cannot bear and require taking analgesic. Their sleep is disturbed. 3rd grade: Patients feel severe pain and cannot bear and need to take analgesic. Their sleep is seriously disturbed. All cases were treated with MS Contin tablets(30mg,q12h,po).If there were no obvious effect, doses of 30 mg were added every time. The maximum dose per time was 120 mg .When the doses could make them achieve obvious effect, the patients were treated for over 3 days. All tablets were swallowed and were not chewed.
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MACC1与C-met在食管癌组织中的表达及其临床意义
我国食管癌的发病率和死亡率分别占全球食管癌发病和死亡人数的53.86%和49.26%[1],早期诊断、治疗对于延长患者的生存期、提高生活质量有着重要的意义。肠癌转移相关基因1(Metastasis-as-sociated in colon cancer 1,MACCl)是近年发现的与结肠癌浸润转移密切相关的基因,在结肠癌组织中表达明显的升高[2]。研究表明,MACCl 与结肠癌、卵巢癌以及肺腺癌等多种肿瘤的生长、转移以及复发的关系较为密切[3,4]。MACCl 是肝细胞生长因子/肝细胞生长因子受体(HGF/C-met)信号转导通路的调节因子,能够独立预测结肠癌形成、转移。本研究检测了食管癌组织及癌旁组织中 C-met 与MACC1的表达,并探讨其表达的临床意义,现报告如下。
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社区因症就诊检出大肠癌患者的随访干预研究
上海市区恶性肿瘤发病趋势分析显示,近30年期间男女性大肠癌发病率上升幅度均达到100%以上[1].社区大肠癌因症就诊早发现技术是一项可能提高大肠癌早期检出率,并且易于在基层医院推行的大肠癌二级预防的适宜技术[2].要进一步提高大肠癌的疗效,除了提高大肠癌的早期发现率和推行严格规范的大肠肿瘤切除技术外,加强大肠癌患者术后的随访和康复指导可能也是一个重要环节.近10年间,上海市卢湾区一、二级医院的医技人员,在区卫生行政部门的领导下,开展全区大肠癌因症就诊早发现工作[2],并对检出的大肠癌患者进行定期追踪随访,现将随访干预情况报道如下.
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大肠癌的基因治疗研究
大肠癌是常见癌症之一,其发病率与死亡率有逐年上升的趋势,传统治疗仍以手术为主,放疗、化疗为辅.虽然近年来在大肠癌的预防、诊断和治疗上取得了一些新进展,但疗效仍不尽人意.
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以深静脉血栓为首发症状的结肠癌1例报告
l病例资料患者,女性,81岁.因左下肢突发肿胀1d来院就诊.查体:患者贫血貌,左下肢大腿中段以下非凹陷性水肿,轻度压痛,皮肤温度、色泽尚可,足背动脉可扪及搏动.多普勒超声提示:左下肢股静脉、胭静脉内可见血栓,血流中断,考虑左下肢急性深静脉血栓形成,予以收治入院治疗.患者平时生活自理,行动自如,无长期卧床史,既往亦无深静脉血栓或下肢静脉曲张病史.患者诉近1个月来间歇性排暗红色粪便,故予纤维肠镜检查,结果示升结肠癌.
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结肠癌早期诊断的策略
结肠癌的早期诊断包含两方面,一方面是有症状患者的早期诊断,另一方面是无症状早期结肠癌患者的诊断.因为早期结肠癌通过积极治疗可以治愈,所以后者的意义更为重要.当临床症状和体征如贫血、便血、腹痛、体重下降或大便习惯改变等提示可能存在结肠癌时,应立即进行结肠镜和钡剂灌肠检查.尽可能缩短确诊时间,时间越短,预后越好.而发现早期结肠癌的有效方法则是结肠癌的筛查,具体包括以下几方面:①筛查人群的选择,包括一般人群和高危人群;②筛查的方案;③筛查的方法.几年前美国癌症协会、美国内科医师协会和国家癌症学会推荐40~50岁以上的人群每年进行粪便隐血试验.高危人群包括:①溃疡性结肠炎及克罗恩病;②家族腺瘤性息肉病(Gardner综合征和Jurlot综合征)、幼年性息肉病及遗传性非息肉性大肠癌;③大肠癌或大肠腺瘤患者的一级亲属;④有结肠癌病史者.
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结肠癌分子治疗的靶:DNA甲基化和组蛋白乙酰化
DNA甲基化和组蛋白乙酰化是哺乳类动物重要的两种基因表达的后生调节方式.甲基化主要是指位于胞嘧啶-鸟嘌呤二核苷(CpG)中的胞嘧啶为甲基基团所修饰.基因组中CpG积聚的区域谓之"CpG岛".生理情况下,多数基因的CpG岛是非甲基化的,而孤立的CpG则多半处于甲基化状态.基因的5′端(启动子区等)含有丰富的CpG岛,其甲基化则基因表达受抑制.甲基化是由甲基化酶(DNA methyltransferase,DNMT)1、3a和3b催化形成的.DNA和组蛋白共同构成染色质.组蛋白主要有H3、H4、H2A和H2B等.其乙酰化状态由组蛋白乙酰化酶(histone acetvlases,HATs)和去乙酰化酶(histone deacetylases,HDACs)调控.一些转录因子如p300等具有HAT活性;同时丁酸盐和Trichostatin(TSA)等具HDAC的拮抗作用.两类物质都可使乙酰化水平上调,使染色质处于开放状态,便于DNA中的基因转录与表达.通常,甲基化的基因伴同相应的组蛋白去乙酰化;反之亦然.
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1 SummaryThe 5-year-survival rates of surgically treated patients are varying and depend on UICC stages/substages with remarkable variations in between published reports, surgical hospital units, individual surgeons, and continents. These variations may be due to surgical techniques, training status, hospital and individual case volume, but also on referral patterns, and statistical evaluation methods. Survival time and cure rates are significantly improved by modern adjuvant chemotherapy in colon cancers UICC Ⅲ and in substages of UICC Ⅱ (e.g. UICC Ⅱ B) by 5%-16%, and adjuvant radiochemotherapy in rectal cancer by 10%-14% when compared to surgical controls. In three modern colon cancer trials standard adjuvant chemotherapy was further improved by increasing the survival rates, e.g. from 59% to 71% in stage Ⅲ and IIB patients. In rectal cancer neoadjuvant radio(chemo)therapy decreases local relapse rates vs. postoperative adjuvant radio(chemo)therapy. Since surgery in rectal cancer has also been significantly improved by total mesorectal excision (TME) and better surgical training, the indications and methods for multimodal therapy have changed from UICC Ⅱ+Ⅲ to more individual criteria. Molecular and genetic factors, such as thymidylate synthase (TS), microsatellite instability (MSI) or loss of chromosome 18q/DCC might have an independent impact on prognosis in the spontaneous course, but could also help to individually select colon and rectal cancer patients and treatment protocols for multimodal therapy. Thus, surgery and multimodal therapy has become very complex, needs regularly be updated in competent reviews, and should be conducted in specialized centers of multi-and interdisciplinary excellence.
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大肠癌出血228例分析
大肠癌是引起下消化道出血较常见的疾病之一[1],我院1989年6月至2003年6月,经外科手术治疗的大肠癌368例,其中以血便为首发症状者228 例,占61.96%,现就其出血原因及诊治总结分析如下.
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In 2013, at the congress of the European CanCer Organization and the European Society for Medical Oncology, colorectal cancer was the subject of various oral presentations and posters. In this article, we have selected the most innovative studies that are likely to change our daily practice.