医学汉语(四)癌症疗法

                      Medical Chinese(IV) Cancer Therapies

 

 

 

癌症极为凶险也极为狡猾,然而癌症的治疗方法和手段也越来越多、越来越有效。所以,治疗癌症必须在众多的治疗方法和手段中进行选择,从而制订最佳、最全面、最有效的治疗方案。杨老师根据自己的经验认为,癌症患者是否可以获得生的希望,关键仍在于对于信息的掌握。

 

Cancer is extremely dangerous and cunning, but we have increasing number of ways of cancer treatment, which are more and more effective. Therefore, for the treatment of cancer we must choose among the various therapies, in order to formulate the best, most comprehensive and most effective treatment plan. Based on my own experience, JYang holds the idea that the key to cancer patients' hopes for life lies in sufficient information.

 

杨老师现在就尝试盘点一下癌症治疗的各种方法和手段。

JYang will now try to list the various cancer therapies.

一.化疗 Chemotherapy

自从紫衫类及铂类的出现,化疗至今仍作为很多癌症的首选之一。化疗可以很快控制某些癌症,然而副作用太大,给患者带来很大痛苦,同时也降低了免疫系统抵抗癌症的能力。80%的患者仍会发生耐药或再次复发。

 

Since paclitaxel and platinum was discovered, chemotherapy has still been staying one of the first choices for many cancers. Chemotherapy can quickly control certain cancers, but the side effects are too great, causing great pain to patients and reducing the immune system's ability to fight cancer. 80% of patients still develop resistance or relapse.

 

二.传统外科手术 Traditional Surgery

晚期扩散的癌细胞是无法通过传统外科手术彻底清除干净的,而且有迅速发展和远端扩散的风险,因此更多手术往是和化疗配合进行,即所谓“减灭术”,切除部分或大部分可见肿瘤。

 

Advanced spreading cancer cells cannot be completely removed by traditional surgery, and there is a risk of rapid development and distant spread. Therefore, more surgery is often performed in conjunction with chemotherapy, so-called cytoreductive surgery, to remove some or most parts of the tumor that is visible.

 

三.达芬奇机器人Da Vinci Si(da Vinci robot system)

达芬奇机器人使用微创的方法实施复杂的手术,属于高级的腹腔镜系统。腹腔镜仅二维视觉,而达芬奇机器人的三维视觉可放大10-15倍,使手术精确度大大增加,甚至作为胃癌根治和结直肠癌根治的手段。达芬奇机器人由三部分组成:外科医生控制台、床旁机械臂系统(Patient Cart)和成像系统(Video Cart)。

 

Da Vinci robots perform complex surgery in a minimal invasive way, an advanced laparoscopic system. Laparoscopy only has two-dimensional vision, while the three-dimensional vision of the Da Vinci robot can be magnified 10-15 times, greatly increasing the precision of surgery, even as a means of radical cure of gastric cancer and colorectal cancer. The Da Vinci robot consists of three parts: Surgeon's Console, Patient Cart and Video Cart.

 


四.传统放疗 Traditional radiotherapy

传统的放疗为疗光子放疗,例如采用X射线或者γ射线照射,达到杀死肿瘤细胞的目的。不过,同时也在伤害着正常的细胞,因此无法彻底杀灭癌细胞。

 

Traditional radiotherapy is Photon therapy such as X-ray or γ-ray, used to kill tumor cells. However, it is also harming normal cells, so it cannot completely kill cancer cells.

 

五.现代放疗手段

V. Modern radiotherapies

近年出现很多先进的放疗设备,可以对癌细胞强力杀灭,而对正常细胞只有较小伤害甚至几乎没有伤害。

 

In recent years, many advanced radiotherapy equipment have been developed, which can powerfully kill cancer cells, with little or no harm to normal cells.

 

1. 三维适形放射治疗3DCRT

1. 3-dimensional conformal radiation therapy (3D-CRT

 


2. 调强适形放射治疗

2.Intensity Modulation Conformal Radiation Therapy (IMRT)

即调强的三维适形放射治疗。

It is Intensity-modulated three-dimensional Conformal Radiation Therapy.

 

3. 伽马刀 Gamma knife

立体定向放射外科,,主要用于颅内<3cm的病变。

 

 Stereotactic Radiosurgery (SRS), mainly used for intracranial lesions <3cm.

 


4. 射波刀Cyber knife

射波刀为影像引导放射治疗,通过机器人手臂对靶区进行最大剂量的照射,而周围正常组织几乎不会受到射线的照射,用于头部和全身肿瘤的治疗,包括肺癌、脑部肿瘤、脊椎肿瘤、前列腺癌、胰腺癌、肝癌、肾癌等各种肿瘤,只需3~5次的照射,即可杀死肿瘤组织。

 

The Cyber knife is an image-guided radiotherapy (IGRT). The robot arm is used to irradiate the target area at the maximum dose, and the surrounding normal tissue is hardly exposed to the radiation, for the treatment of head and whole-body tumors, including lung cancer, brain tumors, Spinal tumors, prostate cancer, pancreatic cancer, liver cancer, kidney cancer and other tumors can kill tumor tissue with only 3 to 5 irradiations.


5. 托姆刀Tomo knife

高速螺旋放射治疗系统是影像导引放射治疗(IGRT)系统,可以准确地区分需要接受放射治疗的范围,可用于全身实体肿瘤的治疗,特别是重要器官附近的肿瘤如脑癌、鼻咽癌等,和已经转移的癌症。

 

High-speed spiral radiotherapy system (TomoTherapy) is an image-guided radiotherapy (IGRT) system, which can specisely distinguish the range that needs radiotherapy. It can be used for treatment of whole- body solid tumors, especially tumors near important organs such as brain cancer , Nasopharyngeal cancer, etc., and cancers metastasized.

 


6. 质子刀 Proton knife

质子重离子放疗属于粒子放疗,质子线在到达肿瘤部位才释放出最大能量,经过肿瘤后几乎没有能量射出。因此,能够将放射能量精确停留在肿瘤上而对周围正常组织很少照射。对于所有没有远端转移的实体瘤包括肺癌、卵巢癌、淋巴瘤、复发性直肠、耳鼻喉肿瘤、前列腺癌、脑肿瘤、胰腺癌、肝癌等,都可以考虑用质子治疗。


Proton heavy ion radiotherapy is particle radiotherapy. The proton line only releases the maximum energy when it reaches the tumor site, and almost no energy is emitted after passing through the tumor. Therefore, it is possible to precisely keep the radiation energy on the tumor and rarely irradiate the surrounding normal tissue. For all the solid tumors without distant metastases including lung cancer, ovarian cancer, lymphoma, recurrent rectum, ENT tumor, prostate cancer, brain tumor, pancreatic cancer and liver cancer, etc. proston therapy can be considered to be used.



 



7. 速锋刀 EDGE 

速锋刀是放射手术肿瘤治疗系统,其高强度的精准射线可以清除肿瘤组织,是目前最先进的放疗设备。对周围正常组织及免疫系统几乎没有影响,并可以实时追踪及锁定“逃逸”的肿瘤细胞并清除。治疗时间短,每天治疗8~20分钟,总计1~5天。费用也很低,赴美国治疗费用约40万人民币左右,而赴意大利治疗仅需10万人民币左右。意大利米兰Humanitas

医院更是一个专业化的综合性研究医院、研究中心和教学中心。

 

EDGE is a tumor radiosurgery system. it is the most advanced radiotherapy equipment at present, and its high-intensity and precise radiation can remove tumor tissues, with no effect on the surrounding normal tissues and immune system. It can also track and locate "escaped" tumor cells in real time and clear them all. The treatment time is short, 8 to 20 minutes per day for a total of 1 to 5 days. The cost is also very low. The cost of treatment in the United States is about 400,000 yuan RMB, while the cost of treatment in Italy is only about 100,000 yuan RMB. Humanitas Hospital in Milano, Italy is a specialized comprehensive research hospital, research center and teaching center.

  


六.日本)硼中子俘获疗法

VI. (Japan) Boron neutron capturing therapy (BNCT)

硼中子俘获疗法可选择性地破坏癌细胞而不会对正常细胞造成严重损害,是治疗高度恶性肿瘤的有效方法,包括肺癌、局部复发性乳腺癌、原发性脑肿瘤、黑色素瘤、头颈部肿瘤、肝脏肿瘤、膀胱癌、结肠癌、间皮瘤等。

 

BNCT can selectively destroy cancer cells without causing serious damage to normal cells as an effective therapy for highly malignant tumors, including lung cancer, locally recurrent breast cancer, primary brain tumors, melanoma, head and neck tumors, liver tumors, bladder cancer, colon cancer, mesothelioma, etc.

 

 

七.肿瘤电场治疗

XII. Tumor Treating FieldsTTF)

电场治疗仪是个特制的帽子或背心,可以随身携带,通电后能在局部产生一种特殊电场,利用特定频率和强度的交替电场来选择性地破坏癌细胞,同时激活患者抗肿瘤免疫反应,可持续治疗,精准靶向阻止癌细胞,尤其适合脑瘤及实体瘤,对正常细胞没有任何副作用。实验证明对于很多癌症的治疗效果远远超过化疗,如卵巢癌、胰腺癌、肝癌、乳腺癌,以及非小细胞肺癌、非小细胞肺癌脑转移、恶性间皮瘤、恶性脑胶质瘤等。

 

The TTF device is a special hat or vest that can be carried with all the time. After being powered on, a special electric field can be generated locally. The alternating electric field with a specific frequency and intensity is used to selectively destroy cancer cells and activate the patient's anti-tumor immune response. With continuous treatment, targeting and stop cancer cells, it is especially suitable for brain tumors and solid tumors, without any side effects on normal cells. Experiments have shown that it has better treatment effect than chemotherapy for many cancers such as ovarian, pancreatic, liver, and breast cancers, as well as non-small cell lung cancer, non-small cell lung cancer brain metastasis, malignant mesothelioma, and malignant glioma.

 

目前电场治疗主要在日本、美国进行,但日本费用远低于美国,而且可以将仪器带回国长期多次使用。实验证实电场疗法更适合亚洲患者。

 

At present, electric field treatment is mainly used in Japan and the United States, but the cost in Japan is much lower than that in the United States, and the device can be brought back to the your own country for long-term and repeated use. Experiments have shown that TTF is more suitable for Asian patients.



八.腹腔热灌注化疗(CHIP)

XIII. Chemotherapeutic Hyperthermic Intraperitoneal Perfusion (CHIP)

由波兰医生研发,治疗晚期癌症包括腹膜癌、卵巢癌、膀胱癌、胃癌、结直肠癌等,特别是有效地降低腹腔内的癌症复发和转移。腹腔热灌注化疗结合热疗可以治疗恶性腹水。

 

Developed by Polish doctors, CHIP treats advanced cancers including peritoneal cancer, ovarian cancer, bladder cancer, gastric cancer, colorectal cancer, etc., especially effectively reduces cancer recurrence and metastasis in the abdominal cavity. CHIP combined with hyperthermia is used for the treatment of malignant ascites.

 

治疗方法可以是:经腹腔穿刺放出腹水后,将43-45℃的温度的生理盐水(NS,500 ml)+顺铂(60 mg / m ^ 2)和1000 毫升 NS + 5-FU 500 mg / m ^ 2,在一个小时内迅速注入腹腔,然后通过外部高频热疗仪HG-2000对患者进行高温治疗(60分钟,每周两次),持续两周。

 

The therapy may be in such a way: normal saline (NS, 500 ml)+Cisplatin (60 mg/m^2) and 1000 ml NS+5-FU 500 mg/m^2  at 43-45℃ is infused rapidly into abdominal cavity in an hour after ascites were drained by perituneucentesis, and then the patient is treated with hyperthermia by external high frequency thermo-therapeutic apparatus HG-2000 (60 min, twice a week) for two weeks.



九.日本)病毒疗法 Viral therapy (Japan)

通过改造具有感染性的病毒,利用腺病毒来攻克癌细胞。

病毒疗法的关键,在于要确保病毒准确击中癌细胞而不伤害正常细胞,方法是为其安装一个基因开关,碰到癌细胞就会自动打开,用于治疗胰腺癌、恶性黑色素瘤、骨髓瘤、头部和颈部癌症等。

 

By modifying infectious viruses, adenoviruses are used to defeat cancer cells.

The key to viral therapy is to ensure that the virus precisely hits cancer cells without harming normal cells, in the way of installing a gene switch for it in order to switch on automatically when it encounters cancer cells. Viral therapy is used to treat pancreatic cancer, malignant melanoma and myeloma , Head and neck cancer, etc.

 

另外,溶瘤病毒疗法——H101,商品名为Oncorine,是一种经基因修改的病毒,会优先选择攻击肿瘤细胞,已被用于治疗骨髓瘤及头部和颈部癌症。

 

In addition, oncolytic virus therapy, H101, trade name Oncorine, is a genetically modified virus that preferentially attacks tumor cells and has been used to treat myeloma and head and neck cancers.

 


十.内分泌疗法 Endocrine therapy

增添或消减性内分泌的疗法通过减少激素以减轻病情,是一种保守的(姑息性)疗法.,用于如乳腺癌、子宫内膜癌、卵巢癌、前列腺癌等,甚至乳腺癌,卵巢癌和前列腺癌中的一些种类可以被荷尔蒙治疗所治愈。

 

Additive or subtractive endocrine therapy is a conservative (palliative) therapy by reducing hormones to reduce the severity, used for breast cancer, endometrial cancer, ovarian cancer, prostate cancer, etc. And even fome types of breast cancer, ovarian cancer and prostate cancer can be cured by hormonal treatment.

 

十一.介入疗法 Interventional therapy

肿瘤的血管介入疗法分为血管内介入和血管外介入。氩氦刀冷冻疗法即为血管外介入;血管内介入是指将导管插入支配肿瘤的血管内,注射化疗药物,或将血管阻断(栓塞),“饿”死肿瘤。几乎所有实体癌肿,均可进行血管介入治疗,包括肺癌、子宫癌,特别是肝癌。

 

Tumor vascular interventional therapy is divided into intravascular intervention and extravascular intervention. Argon-helium knife cryotherapy is extravascular intervention; intravascular intervention means inserting a catheter into the blood vessel that controls the tumor, injecting chemotherapy drugs, or blocking (embolizing) the blood vessel, and "starving" the tumor. Vascular interventional therapy is used for almost all solid cancers, including lung cancer, uterine cancer, and especially liver cancer.

 


十二.联合疗法 Combined therapy

联合疗法在癌症治疗中非常重要。

联合疗法可以是化疗药物联合应用即联合化疗,特别是对于不适合放化疗的晚期癌症最为有效的,例如不可切除的小细胞肺癌、食管癌、膀胱癌等。

 

Combined therapy is very important in cancer treatment.

The combined therapy can be a combination of chemotherapeutic drugs, that is, combined chemotherapy, especially for advanced cancers that are not suitable for radiotherapy and chemotherapy, such as unresectable small cell lung cancer, esophageal cancer, and bladder cancer.

 

组合疗法也可以是两种不是有效的药物,组合使用会让它们更好地增强效果,特别是在卵巢癌治疗中。

联合疗法也可以是联合使用靶向药,可有效治疗卵巢癌、脑癌、肺癌、神经母细胞瘤、结肠癌、乳腺癌、复发头颈癌、前列腺癌、黑色素瘤等。

 

Combined therapies can also be two drugs that are not effective, and the combination can make them better, especially in the treatment of ovarian cancer.

Combined therapy can also be combined use of targeted drugs, which can effectively treat ovarian cancer, brain cancer, lung cancer, neuroblastoma, colon cancer, breast cancer, recurrent head and neck cancer, prostate cancer, melanoma, etc.

与免疫疗法配合的联合疗法更多,包括其他种类免疫疗法、化疗、放疗、靶向疗法、疫苗等。例如,放疗+免疫组合疗法,放疗将“冷”肿瘤变成“热”肿瘤,可以大大增强免疫疗法的效果。

 

There are more combined therapies with immunotherapy, including other types of immunotherapies, chemotherapy, radiotherapy, targeted therapy, vaccines, etc. For example, in radiotherapy + immune combined therapy, radiotherapy can change "cold" tumors into "hot" tumors, which can greatly enhance the effect of immunotherapy.

 


十三.姑息疗法 Palliative therapy

姑息疗法的核心是提高患者的生命质量、减轻苦痛,并在患者的癌症治疗过程中提供精神上的支持和慰藉。

姑息疗法与临终关怀(hospice care)或临终治疗(end-of-life treatment)不同,不要混淆。

 

The core of palliative therapy is to improve the quality of patients’lives, reduce their pain, and provide spiritual support and comfort during the cancer treatment.

Palliative therapy is different from palliative care or end-of-life treatment, so don't confuse them.

 

十四.免疫疗法 Immunotherapy

免疫疗法针对的靶标不是肿瘤细胞和组织,而是人体自身的免疫系统。这是肿瘤治疗的一个快速发展的研究方向。肿瘤细胞表面有能被免疫系统识别的肿瘤抗原,而这正是癌症免疫的基础。引起或增强免疫反应的免疫疗法,称为激活免疫疗法,而减少或抑制免疫反应则是抑制免疫疗法。

免疫治疗包括疫苗、检查点抑制剂免疫治疗的抗PD-1单抗和抗PD-L1单抗,细胞免疫疗法。免疫效应细胞包括淋巴细胞、巨噬细胞、树突状细胞、自然杀伤细胞(NK细胞),细胞毒性T淋巴细胞(CTL)等。

 


The target of immunotherapy is not tumor cells and tissues, but the body's own immune system. This is a rapidly developing research direction for tumor treatment. Tumor cells have tumor antigens that can be recognized by the immune system, and this is the basis of cancer immunity. Immunotherapy that causes or enhances the immune response is called activation immunotherapies, and reduction or suppression of the immune response is suppression immunotherapies.

Immunotherapy includes vaccines, checkpoint inhibitor immunotherapy as Anti-PD-1 mAb and anti-PD-L1 mAb, and cellular immunotherapy. Immune effector cells include lymphocytes, macrophages, dendritic cells, natural killer cells (NK cells), and cytotoxic T lymphocytes (CTL).

 

嵌合抗原受体T细胞疗法(CAR-T)通过收集患者体内具有免疫攻击性的T细胞,并对它们进行基因修饰,使得它们能够识别肿瘤表面上的特定靶标(抗原),然后将它们回输到相同患者体内进行癌细胞杀伤的。用于治疗非霍奇金淋巴瘤、急性淋巴细胞白血病、胶质母细胞瘤、肝癌、胃癌、食道癌等。

 

Chimeric Antigen Receptor T-Cell Therapy (CAR-T) collects immune-aggressive T cells from patients and genetically modifies them so that they can recognize specific targets (antigens) on the surface of the tumor and then transfuse them back into the same patient for cancer cell killing. It is used to treat non-Hodgkin's lymphoma, acute lymphocytic leukemia, glioblastoma, liver cancer, gastric cancer, esophageal cancer, etc.

 

NK细胞全名自然杀伤细胞(Natural Killer cell,NK)。所有的肿瘤细胞都会首先受到NK细胞的攻击因此具有广谱的抗肿瘤作用,包括肺癌、胰腺癌、肝癌、乳腺癌、胃癌、结直肠癌等。NK细胞治疗配合放化疗,可以有效清除手术不能完全切除的肿瘤细胞。对于不适合做手术或者放化疗的晚期癌症,NK细胞治疗是较好的选择。手术后定期NK细胞治疗可以预防癌症的复发和转移。

 

NK 细胞 


The full name of NK cell is Natural Killer cells (NK). All tumor cells will be attacked by NK cells first and therefore have a broad spectrum of anti-tumor effects, including lung cancer, pancreatic cancer, liver cancer, breast cancer, gastric cancer, colorectal cancer, etc. NK cell therapy combined with chemoradiation can effectively remove tumor cells that cannot be completely removed by surgery. For advanced cancers that are not suitable for surgery or chemoradiation, NK cell therapy is a better choice. Regular NK cell therapies after surgery can prevent the recurrence and metastasis of cancers

.

疫苗是免疫疗法的研究热点 ,不仅可以预防癌症例如宫颈癌,也可以激活人体免疫系统杀伤肿瘤细胞。  

古巴治疗肺癌的疫苗cimavax-EGF是一种基于生物技术的疫苗,是针对表皮生长因子(EGF)的疫苗。治疗癌症的原理是阻断癌细胞的营养,将癌细胞饿死。基因检测没有突变的患者也可以使用!

 

Vaccines are a research hotspot in immunotherapy, which can not only prevent cancers such as cervical cancer from developing, but also activate the human immune system to kill tumor cells.

The Cuban vaccine for the treatment of lung cancer, cimavax-EGF, is a biotechnology-based vaccine that targets epidermal growth factor (EGF). The principle of treating cancer is to block the nutrition of cancer cells and starve them. Genetic testing is also available for patients without mutations!

 

十五.靶向疗法 Targeted therapy

这是重磅癌症治疗方法。近年来,新一代抗肿瘤药物的研发使得癌症的药物治疗进入基于基因组测序(即基因检测)的精准靶向治疗新时代。大量临床证明,分子靶向治疗不仅精准地“杀灭”癌细胞,而且有效阻止肿瘤的发展,以达到所谓“带瘤生存”的使得癌症成为类似高血压、糖尿病的“慢性病”的目标。

 

This is a cancer therapy of great significance. In recent years, the study and development of a new generation of anti-tumor drugs has led to the entry of cancer drug therapy into a new era of precise targeted therapy based on genome sequencing test (ie, genetic test). A large number of clinical cases have proven that molecular targeted therapy not only accurately "kills" cancer cells, but also effectively prevents the development of tumors, so as to achieve the so-called "survival with tumor", making cancer a "chronic disease" similar to hypertension and diabetes.

 

有些癌症可以直接接受靶向治疗,比如白血病,因为这类患者大多数都有BCR-ABL的基因突变,有名的“神药”格列卫可以直接救命。

Some cancers can be directly targeted to treatments, such as leukemia, because most of such patients have mutations in the BCR-ABL gene, and the famous "medicine" Gleevec can directly save their lives.

 

然而更多癌症治疗是必须做基因检测的,因为不同的靶向药针对不同的靶标,进行基因检测确定是否存在合适的靶点。为了提高效果或防止耐药,还可以联合使用靶向药物或与化疗药物组合使用。

 

However, more cancers treatment need badly genetical test because different targeted drugs target different target points, so genetic test aiming at determining if a suitable target point exists. In order to promote the effect or prevent drug resistance, it is also possible to use a combination of targeted drugs, use targeted drugs with chemotherapy drugs.

 

目前美国食品药品管理局批准的靶向药主要用于:胃癌、膀胱癌、脑癌、乳腺癌、宫颈癌、结直肠癌、皮肤肉瘤、头颈癌、神经内分泌肿瘤、胃肠道间质瘤、骨巨细胞瘤、肾癌、白血病、肝癌、肺癌、淋巴癌、多发性骨髓瘤、神经母细胞瘤、上皮卵巢癌、原发性腹膜癌、胰腺癌、前列腺癌、软组织肉瘤、甲状腺癌,以及具有NTRK或微卫星缺陷的实体瘤等。

 

At present, targeted drugs approved by the US Food and Drug Administration (FDA) are mainly used for: gastric cancer, bladder cancer, brain cancer, breast cancer, cervical cancer, colorectal cancer, cutaneous sarcoma, head and neck cancer, neuroendocrine tumor, gastrointestinal stromal tumor, giant cell tumor of bone, kidney cancer, leukemia, liver cancer, lung cancer, lymphoma, multiple myeloma, neuroblastoma, epithelial ovarian cancer, primary peritoneal cancer, pancreatic cancer, prostate cancer , soft tissue sarcoma, thyroid cancer, and solid tumors with NTRK or microsatellite defects.


基因检测


基因检测


未完待续 To be continued

 

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