일반외과

분류  

암 이야기 : 담낭암의 병기 종류

작성자 닥터코리아 조회수 2064

담낭암의 병기 분류

 

table 1. primary tumor (t)a

 
areprinted with permission from ajcc: gallbladder. in: edge sb, byrd dr, compton cc, et al., eds.: ajcc cancer staging manual. 7th ed. new york, ny: springer, 2010, pp 211-7.
tx primary tumor cannot be assessed.
t0 no evidence of primary tumor.
tis carcinoma in situ.
t1 tumor invades lamina propria or muscular layer.
t1a tumor invades lamina propria.
t1b tumor invades muscular layer.
t2 tumor invades perimuscular connective tissue; no extension beyond serosa or into liver.
t3 tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum, or extrahepatic bile ducts.
t4 tumor invades main portal vein or hepatic artery or invades at least two extrahepatic organs or structures.

table 2. regional lymph nodes (n)a
 
areprinted with permission from ajcc: gallbladder. in: edge sb, byrd dr, compton cc, et al., eds.: ajcc cancer staging manual. 7th ed. new york, ny: springer, 2010, pp 211-7.
nx regional lymph nodes cannot be assessed.
n0 no regional lymph node metastasis.
n1 metastases to nodes along the cystic duct, common bile duct, hepatic artery, and/or portal vein.
n2 metastases to periaortic, pericaval, superior mesenteric artery, and/or celiac artery lymph nodes.

table 3. distant metastasis (m)a
 
areprinted with permission from ajcc: gallbladder. in: edge sb, byrd dr, compton cc, et al., eds.: ajcc cancer staging manual. 7th ed. new york, ny: springer, 2010, pp 211-7.
m0 no distant metastasis.
m1 distant metastasis.

table 4. anatomic stage/prognostic groups
 
stage 
 
0 tis n0 m0
i t1 n0 m0
ii t2 n0 m0
iiia t3 n0 m0
iiib t1–3 n1 m0
iva t4 n0–1 m0
ivb any t n2 m0
any t any n m1

 


 

localized (stage i)

 

암이 담낭에만 국한되어 존재하고 완전히 제거 가능하다.

하지만 담낭암 환자 중에서 아주 소수에 불과하다. (발견시점에서)

5년 생존율은 100% 이다.

근육층을 침범하거나 근육층을 벗어난 환자의 5년 생존율은 15% 이하이다.

담낭과 함께 주변의 국소 림프계 그리고 림프절을 제거한다.

 

these types of patients have cancer confined to the gallbladder wall that can be completely resected. they represent a minority of cases of gallbladder cancer.

 

patients with cancers confined to the mucosa have 5-year survival rates of nearly 100%.

 

patients with muscular invasion or beyond have a survival of less than 15%.

 

regional lymphatics and lymph nodes should be removed along with the gallbladder in such patients.

 

 

unresectable (stage ii–iv)

 

2a의 국소적인 병기이외에는 완전한 절제가 불가능하다.

당남암의 대부분을 차지한다.

종양은 간 담낭의 림프절에 퍼져있고 복강에 전이된다.

원격 기관에 전이되는 경우가 흔하다.

표준치료는 완화요법이다.

 

 

with the exception of some patients with focal stage iia disease, these types of patients have cancer that cannot be completely resected.

 

they represent the majority of cases of gallbladder cancer. often the cancer invades directly into adjacent liver or biliary lymph nodes or has disseminated throughout the peritoneal cavity. spread to distant parts of the body is not uncommon.

 

at this stage, standard therapy is directed at palliation. because of its rarity, no specific clinical trials exist; however, such patients can be included in trials aimed at improving local control by combining radiation therapy with radiosensitizer drugs.

 

 

cellular classification of gallbladder cancer

 

 

the histologic types of gallbladder cancer

 

•carcinoma in situ.
•adenocarcinoma, not otherwise specified (nos).
•papillary carcinoma.(the best prognosis.)
•adenocarcinoma, intestinal type.
•clear cell adenocarcinoma.
•mucinous carcinoma.
•signet-ring cell carcinoma.
•squamous cell carcinoma.
•adenosquamous carcinoma.
•small cell (oat cell) carcinoma.
•undifferentiated carcinoma.

      spindle and giant cell types.
      small cell types.
•carcinoma, nos.
•carcinosarcoma.
•other (specify).