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口  腔  癌 分期與治療 ,[object Object],[object Object],[object Object],[object Object]
行政院衛生署國民健康局 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
現行癌症篩檢政策
臺灣 10  大癌症,按 發生率 排序 (2007)
臺灣 10  大癌症,按 死亡率 排序 (2007)
臺灣 男性 10  大癌症,按 發生率 排序
臺灣 男性 10  大癌症,按 死亡率 排序
台灣地區 男性 癌症 發生率 (2007):   口腔癌 + 鼻咽癌   : 第二名 行政院衛生署國健局
男性十大癌症發生率 10 年增減數 ( 最近 10 年成長 2 倍 )
96 年與 95 年國人 10 大癌症發生率比較
96 年國人主要癌症發生率性別比 ( 口腔癌、食道癌: 男人 的癌症,藍領階層為主 )
口腔癌:發生率及盛行率 ,[object Object],[object Object]
什麼是 口腔癌 ?   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
診斷依據與組織型態 (2007) 診斷依據:細胞學或組織病理切片證實
台灣口腔癌分布密度:國民健康局統計資料
白 X 50y/o M 李 X 財  47y/o M  陳 X 47 y/o M 陳 XX 51y/o M
健保申報首次療程治療方式  (2007)
 
 
 
口腔癌的分期: AJCC
口腔癌的分期: AJCC T4a: resectable T4b: unresectable
口腔癌的分期: AJCC
Stage grouping T = Stage  N(+) +2 ( 看誰大 )
口腔癌的分期 : AJCC 5 th  vs 6 th  edition
口腔癌的分期 : AJCC 7 th  edition 2010.
UICC: TNM 7 th  edition 2009
UICC: TNM 7 th  edition 2009
UICC: TNM 7 th  edition 2009 (e.g.: type, grade, site)
台灣口腔癌之臨床分期
台灣口腔癌病人初診病情   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
口腔癌的治療 ,[object Object],[object Object]
「台灣口腔癌之治療共識」  : 1. 外科手術治療 (T1N0) ( Elective  Neck Dissection) (Selective  Neck Dissection) ( Comprehensive  Neck Dissection) (T2N0) (T3 or N1) (T4a or N2,3)
「台灣口腔癌之治療共識」  : 1 . 手術 治療 廣泛切除原發腫瘤  (T4a)
加上頸部淋巴擴清 (N):  Elective, Selective , or Comprehensive  Neck Dissection
缺損之重建
重建方式多樣化
「台灣口腔癌之治療共識」  : 2. 放射治療
「台灣口腔癌之治療共識」  : 3. 化學藥物治療
蔡 X 清  Nov. 2009 : left lower gingival ca (T4a) Myocardial Infarction noted by PET/CT
「台灣口腔癌之治療共識」  : 4. 其他
口腔癌的治療:其他 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
標靶化療 Molecularly targeted therapy (MTT):
Molecularly targeted therapy (MTT):
光動力 治療 (Photodynamic Therapy) 優點 :  對正常組織破壞性小、可重複施行、仍可合併手術或放療 (From Pharm Power Biotec Co. Ltd.)
光動力 治療 (Photodynamic Therapy) From Pharma Power Biotec Co. Ltd.
光動力 治療 (Photodynamic Therapy) From Pharma Power Biotec Co. Ltd.
 
(cN0) (tumor 太大時,不適 R/T)
(T4a or N+)
 
PET-CT  Impact on Treatment of Head & Neck Cancers
PET-CT  Impact on Treatment of Head & Neck Cancers
吳 XX  42M :  Right Buccal Carcinoma  (cT3NoMo)
MRI vs PET/CT: pre-op evaluation
MRI vs PET/CT
Op excision
PM Flap Reconstuction
Post op F/U:
Selective  Neck Dissection guided by PET-CT
Trismus Management
Trismus Management  :  resection of coronoid process of mandible bone Click to Play
Trismus Management Pre-op Post-op Buccal ca
多團隊合作   Multidisciplinary Approach & Management 放射影像科 、 病理科 、 核醫科 社工師 、 身心科 、 病友會 放射腫瘤 、 腫瘤內科 復建師、語言治療師 內科 、 牙科 、 麻醉科 整形外科 患者與耳鼻喉 頭頸科 / 口腔外科 手術醫師
9.02 末期口腔癌
末期口腔癌: Skin carcinomatosis
 
 
 
 
 
 
 
 
 
 
KTGH ENT KEN-LIAO LIU  劉耿僚 醫師 ,[object Object]

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劉耿僚全院演講 口腔癌分期與治療20100903