![]() 分類 膠質瘤. 最常見的腦瘤是膠質瘤(glioma),其源自膠細胞,而膠細胞是腦組織中的支持性組織。其分類為 : 星形細胞瘤.Background Ewing's sarcoma and primitive neuroectodermal tumor of bone are closely related, highly malignant tumors of children, adolescents, and young adults. A new. Brain tumors are a diverse group of neoplasms arising from different cells within the central nervous system (CNS) or from systemic tumors that have metastasized to. AJR:200, May 2013 W485 MRI of Pediatric Supratentorial Tumors behavior, and genetic characterization. This group of tumors includes diffuse astrocytoma. Accurate, up-to-date, comprehensive cancer information from the U.S. government's principal agency for cancer research. Grier HE. The Ewing family of tumors. Ewing's sarcoma and primitive neuroectodermal tumors. Pediatr Clin North Am 1997; 44:991. Ambros IM, Ambros PF, Strehl S, et al. World Health Organization (WHO) Updates Official Classification of Tumors of the Central Nervous System. On May 9, 2016, the World Health Organization (WHO) published. NERVOUS SYSTEM DISEASE Ed Friedlander, M.D., Pathologist [email protected] No texting or chat messages, please. Ordinary e-mails are welcome. A glioma is a type of tumor that starts in the glial cells of the brain or the spine. Gliomas comprise about 30 per cent of all brain tumors and central nervous. An Error Occurred Setting Your User Cookie. This site uses cookies to improve performance. If your browser does not accept cookies, you cannot view this site. Setting Your Browser to Accept Cookies. There are many reasons why a cookie could not be set correctly. Below are the most common reasons: You have cookies disabled in your browser. You need to reset your browser to accept cookies or to ask you if you want to accept cookies. Your browser asks you whether you want to accept cookies and you declined. To accept cookies from this site, use the Back button and accept the cookie. Your browser does not support cookies. 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Brain Cancer 或 Brain Tumour)是指腦內異常細胞的形成[2],定義為任何顱內腫瘤,發生的位置包括了腦本身各種細胞(神經元、膠質細胞、淋巴組織以及血管)、腦神經(許旺氏細胞)、腦膜、頭骨、腦下垂體以及由其它器官轉移的轉移性腦瘤[7]。主要分成兩種:惡性或癌症腫瘤,以及良性腫瘤[2]。癌症腫瘤可再分為原發性腦瘤與轉移性腦瘤[1]。所有型態的腦瘤都會產生症狀,因為腦瘤漸漸增大必會壓住該處之神經,影響其功能,所以臨床表現因部位不同[2],包含頭痛、抽搐、視力問題、嘔吐、意識改變[1]。典型的頭痛為早晨時惡化,並伴隨嘔吐而頭痛減緩[2]。其他特殊的症狀包含行走、說話困難,以及感覺異常[1][3]。當疾病進展時,可能發生失去意識[3]。在惡性腦瘤晚期,腫瘤細胞也會轉移至身體其他臟器。大部分腦瘤的發生原因不明[2]。某些危險因子可能牽涉其中,包括一些基因症候群如神經纖維瘤病(神經纖維瘤症後群),以及暴露於化學物質(如氯乙烯)、人類皰疹病毒第四型(Epstein- Barr virus)或游離輻射[2][1][3]。而對於手機使用產生的相關疑慮,目前缺乏明確證據[3]。在成人病患中最常見的原發性腦瘤是腦膜瘤和星狀細胞瘤,後者如神經膠母細胞瘤(glioblastoma)[1];而在兒童病患中最常見的則是髓母細胞瘤(medulloblastoma)[3]。腦瘤的診斷以身體診察搭配電腦斷層掃描(computed tomography)或磁共振影像(magnetic resonance imaging)為主[2],之後會進行切片檢查確認[1],再根據病理結果區分為不同等級或嚴重度[1]。治療方式可能綜合包括手術、放射線療法和化學療法數種方式[1]。若有抽搐情形可使用抗癲癇藥物[1]。Dexamethasone 與Furosemide[註 1][1]。部分腫瘤成長較緩慢,僅需要長期追蹤[1]。以病患的免疫系統作為治療方式,目前仍然在研究中[2]。預後則依腫瘤型態而定[3]。神經膠細胞瘤通常預後較差,而腦膜瘤較好[3]。在美國,腦瘤平均五年存活率為3. Astrocytoma):是最常見的膠質瘤,占膠質瘤的7. Pilocytic Astrocytoma),第二級- 星狀細胞瘤(Astrocytoma)屬低惡性腫瘤,第三級- 分化不良星狀細胞瘤(Anaplastic Astrocytoma;AA),第四級- 多型性神經膠母細胞瘤(Glioblastoma Multiform;GBM)屬惡性腫瘤。寡樹突膠質瘤(Oligodendroglioma)室管膜瘤(Ependymoma)非膠質瘤[編輯]其它的非膠質腦瘤,常見的有下列幾種:胚芽腫瘤(Embryonal Tumor):屬惡性腫瘤,依部位及分化程度可分為成神經管細胞瘤、室管膜母細胞瘤(Ependymoblastoma)、原始性神經外胚層腫瘤(Primitive Neuroectodermal Tumor;PNET)以及非典型性畸胎樣橫紋肌肉瘤(Atypical Rhabdoid/Terotoid Tumor;AT/RT)腦膜瘤(Meningioma)顱咽管瘤(Craniopharyngioma)神經鞘瘤(Schwannoma)神經節膠質細胞瘤(Ganglioglioma)腦下垂體腫瘤(Pituitary Adenoma)脈絡叢腫瘤(Choroid Plexus Tumor)腦腫瘤的症狀主要取決於兩個因素:腫瘤的大小(體積),腫瘤的位置。而症狀出現的時間點和病程通常和腫瘤的性質有關(良性-慢速增長/晚期症狀出現,或惡性-快速增長/早期症狀出現)。大型腦腫瘤或腫瘤腫脹伴隨的腦水腫會導致顱內壓升高,在臨床上會造成頭痛、嘔吐、意識狀態改變(嗜睡、昏迷)亦或是瞳孔病變。此外,即便是小型腫瘤,也都可能阻礙腦脊液(CSF)的通過而導致早期顱內壓的增加。在幼兒,顱內壓的增加也可能導致頭骨直徑增加和囟門鼓脹。根據腦腫瘤的位置,無論是經由壓迫或滲透轉移,都有可能會直接損害腫瘤生長部位以及附近的腦結構,導致局部神經症狀的發生,例如認知和行為能力的下降、個性變化、偏癱、感覺遲鈍、失語症、視野變小以及顏部癱瘓等[1. Pub. Med也有相關報導指出膠質母細胞瘤、間變性星形細胞瘤,和genetic acute hepatic porphyrias(PCT、AIP、HCP和VP)有關。影像診斷在腦腫瘤的判讀上是相當重要的。影像檢查:除了臨床症狀的判斷,隨著科學的進步,影像檢查可快速並增加腦瘤診斷的準確性,對於術後追蹤治療也相當有幫助。目前影像檢查包括有:電腦斷層掃瞄(Computed Tomography;CT)、磁共振成像(Magnetic Resonance Imaging;MRI)、腦波圖(Electroncephalography;EEG)以及腦血管攝影。切片檢查:雖然影像檢查的進步,醫師常常可以藉由影像檢查來做腦病變的診斷,但有些情形更需要做切片檢查以確定病理診斷,尤其在腦瘤經評估是無法開刀切除時,切片手術有助於後續治療,目前切片檢查包括了立體定位切片檢查以及開顱切片檢查[1. ALA)標定癌細胞,使其顯現螢光,能夠幫助腫瘤切除率的提升,現已有產品Gliolan(medac Gmb. H)在歐洲取得核准上市。而針對一些較深層的腫瘤或無法以傳統開刀手術移除的腫瘤,立體定向放射手術(Gamma knife、Cyberknife or Novalis Tx radiosurgery)也是另一種手術的選擇。對於良性腫瘤,採用手術完全切除的機率較高,病人的存活率也較高,如大腦或小腦星狀細胞瘤、蝶鞍顱咽管瘤、腦室脈絡叢瘤等,不需進行放射線或化學藥物治療,復發機率低,但需定期做CT或MRI復檢。未能以手術全部切除的殘餘的良性瘤可視情況予以觀察追蹤、或隨即使用化學藥物治療,或放射線治療。對於一般的惡性腦瘤,如退行性星狀細胞瘤、髓母細胞瘤、腦室膜瘤、畸胎瘤等,能夠完全切除或接近完全切除者,預後較佳,但必需加上放射治療及或化學藥物治療,方能達到控制腫瘤生長的目的。初發性腦瘤病人的存活率與腫瘤的類型及病人的年齡和生理機能有相當大的關聯性,這些因素將會影響病人選擇治療的模式[1. BBB)的特殊結構,腦瘤的化學治療仍受到許多限制,任何化療藥物只能通過藥物的脂溶性通過血管內膜細胞,進而進入腫瘤細胞產生作用,這樣的模式影響了藥物作用的速度與效率[1. BCNU和CCNU,或者用PVC方案(甲基苄肼+長春新鹼+CCNU),有一定療效,但有延遲和累積骨髓抑制和肺毒性等副作用,易產生耐藥性。在新型治療腦瘤的化療藥物研發方面,目前有了新的進展。一種是口服藥物「Temozolomide」,另一則是於手術時直接植入的藥物晶片「Gliadel(BCNU) 」。Temozolomide(替莫唑胺)(schering- plough)Temozolomide是一個具有抗腫瘤活性,含有咪唑四嗪(imidazotetrazine)環的烷化劑類抗腫瘤藥物。它本身並沒有活性,屬於前體藥物,須在生理水平PH下經非酶途徑轉化為活性化合物MITC(5- (3- 甲基三氮烯- 1- 基)咪唑- 4- 醯胺),後者再進一步水解成活性代謝物方能顯現抗腫瘤活性。理論上,MTIC的抗腫瘤活性主要是通過與鳥嘌呤的第六位氧原子產生主要的烷基化作用,同時也會與鳥嘌呤的第七位氮原子發生次要的附加性烷基化作用,因此隨後發生的細胞毒性被認為是與這些異常修復的甲基化合物有關。Temozolomide採用口服給藥的方式,可採用放射治療同步進行輔助性治療,可用於治療新診斷的多形性神經膠母細胞瘤或復發性惡性神經膠質瘤,在治療過程中需嚴密監測化療過程中嗜中性白血球以及血小板的數量,避免發生血液毒性的副作用。美國FDA於1. Guilford公司開發,以BCNU為活性成分,聚苯丙生2. Gliadel,治療復發性惡性腦瘤的申請,可在手術後,將藥物直接放置於復發性惡性膠質細胞瘤之腦組織中,讓藥物緩慢釋放,進行持續性化學治療。經過多年多中心臨床試驗,FDA於2. Gliadel用於原發性惡性腦瘤的治療,據文獻報導,Gliadel可延長原發性及復發性惡性腦瘤患者的中間存活期。該治療方法的獨特之處在於其給藥方式及釋放系統。在外科手術過程中,先將腫瘤組織切除,留下一個小空腔,然後植入這種定期釋放的晶片。這些晶片會在2~3周之內慢慢地分解、融化,釋放出的藥物可直接進入腫瘤區,殺死那些在外科手術中沒有切除乾淨的腫瘤細胞,並且能在不損害其它組織的情況下使病變局部能達到有效的血藥濃度,延緩了疾病的進展。美國癌症中心聯盟(National Comprehensive Cancer Network,NCCN)針對惡性腦瘤的最新治療原則中指出,原發及復發惡性腦瘤患者皆可予以手術切除腫瘤時同時置入Gliadel(BCNU),術後輔以放射線治療或Temozolomide等化療藥物治療,據文獻報導,採用此治療模式可有效延長患者的存活中位數[2. The cancer also bad for a man's brain!放射線治療[編輯]放射線治療是利用放射線或者γ射線、高速中子射線對腫瘤細胞進行殺滅,簡稱放療。放射線治療是最常見的腫瘤輔助治療手段,一般於手術後1至2星期開始。放射線治療主要利用腫瘤細胞對放射線比較敏感,容易受到放射線的傷害來殺死腫瘤細胞,一般治療約需四至八個星期,會依據不同的腫瘤病理診斷、分化程度及影像醫學檢查結果而決定照射範圍的大小及劑量。對許多惡性腫瘤及無法安全切除的深部位良性瘤,放射線治療是一種有效的方法。目前放射線治療己發展至隨形或定位方式,包括直線加速器的放射治療、伽傌射線定位放射手術、光子刀等。但部分惡性腦瘤仍需進行大範圍腦部放射線治療或全顱及脊椎放射治療。2. Texas出版,Anderson Cancer Center研究指出病人接受立體定向放射外科手術(stereotactic radiosurgery;SRS)和全腦放射治療(whole brain radiation therapy;WBRT)對於病人學習和記憶的損傷有較大的副作用和風險性[2. DC- CIK生物免疫治療[編輯]DC- CIK生物免疫療法是以回輸DC細胞(樹狀細胞)、CIK細胞(細胞因子誘導的殺傷細胞)為主的免疫治療,通過專門的血液分離機採集患者自身體內抗癌細胞送至GMP潔淨實驗室進行體外培養,增強病人免疫細胞數量和功能。獲取成熟的、具有識別腫瘤能力的DC細胞和數量增值1. CIK細胞後,將兩種細胞以輸液的方式回輸至患者體內,對腫瘤細胞回輸至患者體內,對腫瘤細胞進行徹底、精準的殺傷。在美國經過多年臨床研究,相關臨床試驗基本全部宣告失敗,DC- CIK免疫療法沒有在大規模臨床實驗中有統計意義上的顯著療效,因此DC- CIK療法在美國沒有得到上市許可,在美國已經鮮有DC- CIK用於癌症治療的臨床試驗。盛行率[編輯]死於腦癌的名人[編輯]中華民國(台灣)[編輯]參考文獻[編輯]^ 1. Adult Brain Tumors Treatment. NCI. 2. 01. 4- 0. June 2. 01. 4]. ^ 2. General Information About Adult Brain Tumors. NCI. 2. 01. 4- 0. June 2. 01. 4]. ^ 3. World Cancer Report 2. World Health Organization. Chapter 5. 1. 6. ISBN 9. SEER Stat Fact Sheets: Brain and Other Nervous System Cance. NCI. [1. 8 June 2. July 2. 01. 4). ^GBD 2. Disease and Injury Incidence and Prevalence, Collaborators. Wall of Memory [ARCHIVED] | Cancer Kids. Please note that this is an archived version of the Cancer Kids Wall of Memory. No further effort will be made to update this page. Some of these links may not work. David Edward Lowe. March 1. 5, 1. 97. November 0. 2, 1. Neuroblastoma. Lawrence Michael Mc. Reynolds. May 1. 2, 1. August 1. 7, 1. 97. Medulla Blastoma. You were such a beautiful baby boy. I loved you dearly. I often wonder what you would look like today. You were so smart,funny, lovable, strong and determined. I have never forgotten you, and look forward to the day that we will meet again. Kathy Lynn Atkinson. March 1. 7, 1. 96. October 1. 3, 1. 97. Ewing’s Sarcoma. Christopher Timothy Claffey. June 0. 2, 1. 96. August 0. 8, 1. 97. Burkitt’s Lymphoma. My brave and loving brother. I share your legacy with my children. I will remember and love you always. You will always be my motivation and inspiration. We will hug you in heaven. Robert Kieswetter. January 0. 9, 1. 97. August 1. 7, 1. 97. Leukemia. Ricky Alexander Tilly. July 0. 7, 1. 97. October 1. 5, 1. 97. Neuroblastoma. Jamie Shomo. July 1. 5, 1. 96. August 1. 0, 1. 97. Leukemia. A wonderful friend who I think of often and still miss greatly…love you Jamie. Robert Patrick Parke. August 1. 5, 1. 97. March 3. 1, 1. 98. Ependymoblastoma. Amber Marie Calistro. February 2. 8, 1. October 3. 0, 1. 98. Rhabdomyosarcoma. Amber knew why she was sent to earth. A few days before she died, she called me to her side and told me, “Mom, I KNOW I’m here to help a lot of people.” Although she said many wise and wonderful things in her 4 1/2 years, I was astounded. From the moment she was born, I knew I was “chosen” to be Amber’s mother but the reason why was unclear. I documented our life together and especially her journey through cancer with recordings, movies, photos, media coverage, her drawings, and a journal. It helped me cope, gave me purpose, and ensured that her life and death would have meaning, even after she died. Having found Bernie Siegel to care for her, I was blessed beyond words. He helped us help her “cross the threshold” between life and death. Her death was miraculous. The moment she stopped breathing, I physically felt God… the Higher Power… the world that we cannot see with our eyes. Amber died on my 2. Before she died, she gave me the most precious gift I’ve ever received: The secret to what happens after our body dies. Mom, when I die, I’ll still be Amber, I’ll just be DIFFERENT.” Knowing that, I did not “lose a child,” she did not “pass away.” She simply changed. She is with me now, but different. For most of the 3. I dug deep to call up the feelings and emotions I needed to write “Embrace the Angel.” It is now published and I am ready to, once again, reach out and spread Amber’s message of “hope, heaven, and the miracle of life and death.”But there is one thing holding me back. It is not her death, it is cancer. It is not the fact that she was “killed,” is the the “murderer.” I am trying to “wrap myself around” this horrible disease that kills so many of our loved ones. I must find peace and understanding while working to bring people together, raise awareness, and facilitate change in the “Cancer World.” But how? Perhaps returning to the moment in time when my “Life Task” is the answer. After she died at home, we took her body to St. Raphael’s Hospital in New Haven, CT. Bernie called ahead to make the arrangements. Excerpt from Chapter 1. Crossing the Threshold: “I walked towards the automatic doors, her lifeless body swaying to my step. Beyond the parting doors, I could see a crowd. Nurses, doctors, secretaries, visitors, priests, and nuns had gathered there to pay their last respects to this little girltheir little girlwho had fought so bravely to the very end. At once, I could see I wasn’t alone, that they had suffered, too. They had hoped for her recovery, prayed for her life, and watched along with me as she slowly and painfully died. Many were crying. Their grief forced them to turn to each other for comfort. I felt no pangs of sadness or sorrow; I still felt the glory of God. I was at peace, and so was my baby. Dr. Raine, a young intern, directed us to a small room that was separated from the Emergency Room by a curtain. I placed her body on the stretcher and studied it… absorbing every inch… filling my mind with the memory of Amber. Perfect feet… hands… lips… eyes…” I stopped at the tumor. I moved closer to inspect it. Since she wasn’t there and could feel no pain, I shook it. It felt like gelatin: Soft, powerless, sickening. It was enormous; nearly the same size as her head. How can something so pathetic… so ugly… kill my beautiful little girl?!?!” Just under my skin, seething rage was coursing through my veins. In my mind, I could see a battlefield strewn with the bodies of all the other children who had died before Amber and the bodies of children yet to come. Instantly, I felt as though I’d been injected with a tranquilizer. My hatred gave way to a new understanding. Don’t waste your life hating.
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