癌瘤转移规律的探讨

The Investigation of The Metastatic Pattern of Malignant Tumors

在 4 0 0例恶性肿瘤尸解中 ,32 1例 (80 3% )癌 ,79例肉瘤 ,其中 6 5例淋巴瘤 ,14例 (3 5 % )为软组织及骨肿瘤 ,肿瘤转移到肝及肺最常见。有 16 3例转移到肺及肝 ,各占 4 0 5 %。肝的转移瘤依次主要来自乳腺、大肠、卵巢、胃及非何杰金淋巴瘤 (NHL)。肺的转移瘤主要来自乳腺、肝、NHL ,胃及卵巢。淋巴结转移主要累及颈部、纵隔及主动脉周围淋巴结。广泛转移的肿瘤是肺癌、胃癌、乳腺癌和淋巴瘤。尸检材料显示 ,宫颈癌、膀胱癌、咽癌及睾丸肿瘤主要是局部侵犯 ,转移并不广泛。本研究显示 ,恶性肿瘤的扩散与转移基本有下列方式 :直接侵袭 :很多肿瘤可能直接累及周围组织。例如胃肠癌 ,癌细胞沿着肌组织间隙进入临近器官。淋巴管扩散 :任何器官或组织的肿瘤细胞可能进入淋巴管而转移到局部或远处淋巴结 ,它是癌的主要转移方式。血道转移 :远处转移在尸检材料中很常见 ,最常累及的器官是肝和肺 ,特别是软组织肉瘤 ,但晚期癌也很常见血道转移。种植性转移 :这也是很常见的转移方式 ,特别是胃癌、大肠癌、卵巢癌等。本研究也显示与癌瘤手术标本对比研究、肿瘤转移与临床分期、肿瘤部位。

To compare the metastatic pattern between the surgical specimens and the autopsy of malignent tumors,Four hundred autopsy cases of malignant tumors were analyzed.Of these 321 cases (80.3%) had carcinoma and 79(19.7%) sarcoma.In 79 cases,65 had malignant lymphoma,and 14(3.5%) soft tissue and bone tumor.The tumor cells metastasized to the lung and liver were common in the autopsy cases.There were 163 cases of metastatic tumors in the lung and liver respectively (40.5%).The metastatic tumor in the liver was mainly from the breast,large intestine,ovary,stomach and NHL and in the lung mainly from the breast,liver,NHL,stomach and ovary.The lymph node metastases were mainly located in the neck,mediastina,around aorta.The extensive metastatic tumors were lung cancer,gastric cancer,breast cancer and NHL,In the surgical specimens,many tumors (including esophageal cancer,gastric cancer,breast cancer and so on ) had been analyzed for metastatic pattern,From these materials,It can be seen:The carcinoma from any organs had metastasis mainly to the lymph node first,The metastasized number of lymph node were less than that of the autopsy cases and the cancer cell metastasized to the organ were also lower during the operation period.But,The cancer in the different organs,the spreading pattern had many difference and The extensive ranges was also difference.In the autopsy,carcinoma in the uterus cervix,urinary bladder,pharynex and testis was mainly infiltreated in the original region and the metastasis was not extention.Therefore,the clinical try to make better procedure for these tumors,It may get twice the results with half the effort.This results showed that the malignant tumors spread and metastasize basically in the following ways:Direct spread:Many tumors may spread directly to around tissue.In the Gastric-Intestinal carcinoma,the cancer cells can be infiltration along the space of the muscular layer into the neighboring organs by contiguous extension.Lymphatic spread:The tumor cells may penetrate into lymphatic vessels in any organs or tissue,then spread by the lymphatic into local lymph nodes or distance lymph nodes.This is mainly pattern of metastasis of the carcinoma.Hematogeneous metastasis:Distant metastases are common at autopsy.The most commonly involving organs are the liver and the lung,particularly in the soft tissue sarcoma,but carcinoma in the late cases is also commonly spreading into the organs by the blood stream.Implantation metastasis:This is common pattern of the carcinoma of the metastsis,particularly in the carcinoma of stomach,intestine and ovary etc.The cancer cells penetrate out of organs and spread into body cavity.This results was also showed that,the tumor metastatasis was related to the clinical stage,tumor location,histologic type,differentiation and so on.