制定化疗方案的重要参考

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看懂术后病理，浸润肠壁程度、周边侵犯程度、淋巴结转移数量是肿瘤内科医生制定化疗方案的重要参考

  •  肠癌术后病理报告一般记载的项目内容大概如下；

术后病理是患者做完手术切除出来的身体组织做病理检测，得出各种对患者病情有指导意义的各种病理检测结果，是肿瘤内科医生做化疗方案的重要依据。根据6年群解答经验和研究超过1000张以上的术后病理报告，结合病理报告出来之后各省的专业肿瘤医院内科医生，针对各种病理结果而制定的化疗方案大体如下；

一、送检材料：如：直肠及肿物、吻合口近端切缘、吻合口远端切缘。

二、肉眼所见：

术后病理通常会描述肉眼所见的送检肠管；切除的肠管管长、肠管的周径或直径、距离肿瘤的上切缘和下切缘、肿瘤的大小、肿瘤是隆起型还是溃疡型、

  • 图像和镜下所见；如；癌组织有管状、腺泡状、或筛状结构组成，细胞异常明显，浸润生长等信息。
  • 病理诊断；

如直（结）肠癌根治标本；

  1. （直肠或结肠）早期癌或中期癌等；
  2. 组织学类型；管状腺癌、或粘液腺癌等；
  3. 分化程度；中低分化或中高分化等；
  4. 浸润深度：粘膜下层、浅肌层、深肌层、侵犯全层等；
  5. 脉管内癌栓：有或无；
  6. 神经侵犯；有或无；
  7. 切缘；送检的近端和远端切缘、环周切缘是否阳性；
  8. 淋巴结见转移癌如（1/15）表示切除15个淋巴结，其中一个阳性。

经验上各大专业肿瘤医院肿瘤内科医生注重的病理诊断项目的重要性排序大概如下：

1、肿瘤侵犯浸润深度；通常分为侵犯粘膜层、侵犯浅肌层、侵犯深肌层、侵犯浆膜层下脂肪、侵犯肠壁全层、侵犯浆膜层、侵犯浆膜层外脂肪。

  • 清除淋巴结阳性数目和清除淋巴结总数目，有些专业医院会分清除淋巴结总数目中来自于肠周第一站淋巴结数目和阳性数目，来自于肠系膜第二站淋巴结的数目和阳性淋巴结数目，来自于第三站淋巴结数目和阳性淋巴结数目。
  • 肠外癌结节数量多少枚和癌结节大小
  • 肿瘤属于那种性质的肿瘤，属于几级、分化程度属于高、中、低分化程度。
  • 检查脉管内是否有癌栓，神经束是否侵犯，这两个因素是否阳性指南列为高危因素；
  • 肠外血管是否被侵犯。

7、两端切缘和环周切缘一般都属于阴性，虽然是重要参考，但是阳性个案不多。

  • 经验上各大肿瘤医院肿瘤内科医生做化疗方案的依据因素大概如下：

经验上各大肿瘤医院的肿瘤内科医生一般见到下列几种因素的病情，通常会做肠癌一线药奥沙利铂＋卡倍他滨片常规化疗方案中，最高的8个三周期疗程、或者12个两周期疗程。

  1. 肿瘤浸润深度达到1mm以上；接近浆膜层附近的；部分突破浆膜层、侵犯周边脂肪的；
  2. 肠周脂肪有癌结节的；
  3. 有淋巴结转移的；轻重分1-3个和3个以上；
  4. 属于粘液腺癌或者印戒淋巴癌的；
  5. 有神经侵犯或者脉管癌栓的；
  6. 淋巴结没有按照指南规定清除12个淋巴结的；
  7. 肿瘤比较大的；

经验上各大肿瘤医院的肿瘤内科医生一般见到下列几种因素的病情，通常会做肠癌一线药常规化疗中奥沙利铂＋卡倍他滨片次高的6个三周期疗程。

  1. 肿瘤浸润深度达到深肌层的，一般在1mm以内的；
  2. 淋巴结没有转移或1个转移的；
  3. 肠外脂肪没有癌结节的；
  4. 属于一般腺癌的；
  5. 脉管癌栓和神经侵犯有一种侵犯的；
  6. 淋巴结没有按照指南规定清除12个淋巴结的；
  7. 肿瘤相对比较大的；

经验上各大肿瘤医院的肿瘤内科医生一般见到下列几种因素的病情，通常会做肠癌一线药常规化疗中的奥沙利铂＋卡倍他滨片比较轻的4个三周期疗程或口服8个卡倍他滨片疗程。

  1. 肿瘤浸润深度达到浅肌层以下的；

2. 淋巴结没有转移的；

3. 肠外脂肪没有癌结节的；

4. 属于一般腺癌的；

5. 脉管内没癌栓和神经没有被侵犯的；

6. 淋巴结按照指南规定清除12个淋巴结的；

7. 肿瘤相对比较小的；

声明：

以上各种术后病理结果和肿瘤内科化疗医生制定的大致化疗方案的关系因素，纯粹是我根据6年来观察各大专业肿瘤医院肿瘤内科医生，制定的化疗方案轻重大概率跟上列因素相关的概率很高，结合自己的术后病理因素及化疗方案，和询问化疗医生时化疗医生的讲解综合得出，一个肿瘤内科医生大概制定化疗方案的依据因素。

任何化疗方案都要以专业医院肿瘤内科医生做出的化疗方案为主，上述经验之谈粗分类化疗方案种类，只作为患者或家属初步读懂病理内容，对肿瘤内科医生制定化疗方案的理解和跟医生的对话基础，和作为一般化疗科普知识的罗列，没有任何的专业研究依据，不可以作为任何患者化疗方案的制定依据。

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