肿瘤免疫编辑与免疫治疗

Schreiber等人于2002年提出肿瘤免疫编辑学说.肿瘤免疫编辑分为3个阶段:清除阶段、均衡阶段和逃逸阶段.肿瘤免疫编辑学说较全面的阐释了肿瘤与宿主免疫系统之间的复杂的相互作用.肿瘤免疫编辑学说对肿瘤免疫治疗具有一定的指导意义.依据肿瘤免疫治疗实践,提出了肿瘤免疫编辑和肿瘤免疫治疗的一些观点.     

肿瘤免疫编辑理论与树突状细胞个体化治疗肿瘤策略的思考

利用树突状细胞瘤苗提高机体免疫系统对肿瘤的特异杀伤能力,已成为肿瘤免疫治疗中的研究热点。根据肿瘤免疫编辑理论,肿瘤免疫可分为清除、平衡和逃逸3个阶段。应用该理论阐述应用树突状细胞个体化治疗肿瘤的策略具有重要意义。     

肿瘤免疫编辑理论与树突状细胞个体化治疗肿瘤策略的思考

利用树突状细胞瘤苗提高机体免疫系统对肿瘤的特异杀伤能力,已成为肿瘤免疫治疗中的研究热点.根据肿瘤免疫编辑理论,肿瘤免疫可分为清除、平衡和逃逸3个阶段.应用该理论阐述应用树突状细胞个体化治疗肿瘤的策略具有重要意义.     

肿瘤免疫治疗需要综合性

自从人们发现肿瘤与免疫有密切关系以来,对肿瘤免疫治疗寄予了厚望,然而,由于免疫机制、免疫途径的网络性和复杂性,免疫治疗未从根本上改变肿瘤治疗的现状,而仅仅是传统治疗手段的有益补充.     

从自然选择学说看肿瘤免疫

当今人类生存的环境发生了变化,肿瘤的发病率和病死率也越来越高,肿瘤细胞面对强大的免疫系统生存下来,说明肿瘤生存能力增强已经适应了其生存环境,这是环境对肿瘤细胞自然选择的结果。自然选择学说始终贯穿于肿瘤免疫学的免疫监视理论和免疫编辑学说之中,从自然选择的角度看肿瘤免疫学,将为肿瘤治疗策略开创一条新路。     

肿瘤免疫中的细胞凋亡

在肿瘤免疫编辑的三个阶段：清除、平衡和逃逸,细胞凋亡发挥重要作用。清除阶段,免疫细胞通过诱导肿瘤细胞凋亡发挥免疫清除作用;平衡阶段,在免疫选择作用下,肿瘤细胞凋亡促进肿瘤恶性演进;逃逸阶段,肿瘤细胞凋亡耐受性增强,进而反向促使免疫细胞凋亡,削弱肌体免疫力,产生免疫耐受。     

肿瘤疫苗治疗肿瘤的前景

肿瘤疫苗的发展已经历了一个多世纪,20世纪50年代,人们开始了自体肿瘤疫苗的研究.使肿瘤疫苗(主动性免疫治疗)成为继手术、放疗、化疗之后的肿瘤治疗方法.肿瘤疫苗作为主动特异性免疫治疗,在临床中起到越来越重要的作用,人们开始尝试利用多种方法制备肿瘤疫苗并利用其促进机体免疫应答,从整体细胞,分子水平调控机体对肿瘤的免疫.目前肿瘤疫苗的研制已取得很大进展,给人类战胜肿瘤提供很大希望。     

肿瘤疫苗治疗肿瘤的前景

肿瘤疫苗的发展已经历了一个多世纪,20世纪50年代,人们开始了自体肿瘤疫苗的研究.使肿瘤疫苗(主动性免疫治疗)成为继手术、放疗、化疗之后的肿瘤治疗方法.肿瘤疫苗作为主动特异性免疫治疗,在临床中起到越来越重要的作用,人们开始尝试利用多种方法制备肿瘤疫苗并利用其促进机体免疫应答,从整体细胞,分子水平调控机体对肿瘤的免疫.目前肿瘤疫苗的研制已取得很大进展,给人类战胜肿瘤提供很大希望.     

论肿瘤免疫的复杂性

免疫系统是一个复杂自适应巨系统,它还具有开放复杂巨系统的所有特征。体内已建立的肿瘤是一个复杂适应系统,两者间的相互作用造就了肿瘤免疫的复杂性。本文从复杂性科学角度阐释肿瘤免疫,以期对肿瘤细胞免疫治疗的研究有所裨益。     

临床肿瘤免疫的研究近况

免疫系统具有特异性破坏肿瘤而不损伤正常组织的能力,并且可以产生长久记忆从而阻止肿瘤复发。过去30年的肿瘤免疫研究充分证明肿瘤可以被免疫系统识别,并且机体免疫监视可以阻止肿瘤的发展或长期控制。目前的临床试验提示免疫治疗可能成为肿瘤治疗非常重要的一部分,试验中发现免疫相关的毒性、疗效评价标准以及观察终点与传统的细胞毒药物及靶向治疗均存在很大的差别。为了充分发挥免疫治疗的疗效,研究者需要更深入地了解肿瘤与宿主免疫反应之间动力学关系以及肿瘤的免疫逃逸机制,识别、评价及处理免疫相关反应。     

肝癌综合治疗的发展与展望

原发性肝癌是我国最常见的恶性肿瘤之一,预后较差,病死率较高。经过多年的探索与努力,人们利用辩证思维的方法,在总结了各种治疗方法的优、缺点后,取长补短兴起了肝癌的综合治疗。包括手术治疗、化疗、放疗、导向治疗、局部治疗、中医治疗、免疫治疗、基因治疗的综合治疗,成为进一步提高肝癌疗效的新途径。     

The Impact of Cancer on Psychological and Social Outcomes

Cancer is now the biggest cause of mortality worldwide. Although the debilitating physical symptoms of cancer have long been known, the psychological and social impacts of cancer have become the subject of examination only relatively recently. The psychological outcomes that have been examined are primarily negative emotional variables, e.g., anxiety, but emerging research has focused on positive emotional variables, e.g., post‐traumatic growth, or cognitive outcomes. In this article, we provide a synthesis of reviews that have addressed the psychosocial impact of cancer. The framework for this synthesis is provided by a conceptualisation in which the presence of cancer impacts on psychosocial outcomes either directly or via mediating variables, including physical symptoms and treatment, and that this effect may be moderated by several variables, some characteristic of the person with cancer (demographic or personality‐related variables) and some characteristic of their environment (social support and medical variables). We also briefly examine the impact of cancer on the broader family unit following cancer diagnosis, treatment, survivorship and bereavement. We conclude that the heterogeneity of the cancer experience highlights the need for theoretically driven research and consistency in measurement approaches to determine mechanisms by which cancer exerts influence on psychosocial outcomes. This would allow development and delivery of targeted psychological interventions and a clearer delineation of the roles of the various parties, including clinical psychologists, family members and policymakers.     

Writing Effective Insurance Justification Letters for Cancer Genetic Testing: A Streamlined Approach

The topic of insurance coverage and justification letters for cancer predisposition testing has been the subject of much discussion on the National Society of Genetic Counselors Cancer Special Interest Group (NSGC Cancer-SIG) listserv. Some counselors have stated that they have had difficulty in obtaining insurance coverage for their patients, while others have indicated that they would appreciate seeing examples of successful letters. The purpose of this paper is to provide practical guidance in writing successful letters of justification and to share insurance success stories in the area of cancer genetic testing.     

If We Build It … Will They Come? – Establishing a Cancer Genetics Services Clinic for an Underserved Predominantly Latina Cohort

Background: Cancer genetic counseling and testing is a standard of care option for appropriate families and can identify individuals at increased risk prior to diagnosis, when prevention or detection strategies are most effective. Despite documented efficacy of cancer risk reduction in high-risk individuals, underserved and minority individuals have a disproportionate cancer burden and limited access to genetic counseling. Methods: A needs assessment survey documented gaps in knowledge and interest in prevention. Satellite clinics were established at two indigent healthcare systems. Cancer genetics CME lectures were conducted and referral guidelines disseminated to clinicians who referred patients for counseling. Results: An increase in clinician knowledge was demonstrated post-CME and reflected by quality referrals. Eighty-eight percent of patients kept their appointments. In the predominantly Latina⁶ (n=77) clinic population, 71.4% were affected with cancer, and 17 mutation positive families were identified. Preliminary data shows a positive impact on patients' motivation and behavior. The majority has expressed satisfaction and reduction in anxiety. Conclusions: This study demonstrates feasibility and acceptability of cancer genetics services in this population, suggesting the potential to reduce cancer morbidity in underserved, high-risk families.“Latino” is the most common census term for individuals of Spanish, Mexican, Central and South American, Cuban, or Puerto Rican descent, referring to ethnicity, and is generally considered a more ethnically/culturally based term for individuals of the aforementioned groups. As this cohort is female the feminine noun “Latina” is used     

肿瘤化疗患者的心理分析和指导

肿瘤是一种常见的恶性疾病、病死率很高,化疗是主要治疗方法。由于化疗毒副作用较大,会引起肿瘤患者出现生理上和心理上较大的变化,产生烦躁、焦虑、沮丧等心理活动,并有可能引起病情的恶化,因此极有必要对病人进行心理指导。本文从心理方面对化疗患者进行指导探讨,使医务人员在治疗过程中能帮助患者减轻痛苦,体现人道主义精神。     

癌症患者对医疗风险的感知及对临床决策的影响

由于医学的复杂性和癌症疾病的不确定性,癌症的临床决策存在着一定的风险性。癌症患者对医疗风险的感知也因人而异,继而影响着临床决策。本研究应用癌症患者医疗风险感知问卷对唐山市4家三级综合医院内住院治疗的320名癌症患者进行调查,调查结果显示,癌症患者对于经济风险（67．5％）的感知和社会心理风险（40．3％）的感知均高于对身体功能风险的感知（21．6％）,患者的性别、家庭月收入和年龄影响患者对医疗风险的感知,患者对经济风险和社会风险的感知影响患者对临床决策的意愿。临床医护人员应注重评估癌症患者对医疗风险感知的特点,帮助患者制定适宜的临床决策。     

认识癌症与炎症间的因果关系及其意义

炎症是指机体对组织细胞损伤的反应,而癌症是指所有恶性肿瘤的总称.表面上看,两者是截然不同的.近年研究表明,大约1/5的癌症患者有长期慢性炎症刺激,因而提出＂癌症相关性炎＂的概念.显然,炎症是因,癌症是果.但是,4/5的癌症患者并找不到慢性炎症背景,然而,其癌症组织内也有炎细胞浸润,此种情况癌症应为因,但机理基本上不清楚.癌症与炎症的因果关系主要包括上述两种情况,阐明其机理对患者的防治均有重要意义.     

The Familial Cancer Program of the Vermont Cancer Center: Development of a Cancer Genetics Program in a Rural Area

In response to many scientific discoveries linking cancer in certain families to inherited factors, the Vermont Cancer Center established the Familial Cancer Program (FCP) in December 1993. This multifaceted program combines the expertise of clinicians and researchers in many disciplines, including genetics, oncology, psychology, and molecular biology. The program's goals are identification of families in its region with excess cancer, provision of clinical services to such families, and use of research protocols when available and appropriate. This article describes the experience of setting up a familial cancer program in a rural area and discusses both successes and challenges in such an endeavor.     

Psychological impact of breast cancer on the patient and the family: A clinical perspective

Breast cancer is the most frequently occurring cancer in women, with 182,000 new cases diagnosed in 1993. Breast cancer will strike a sizable percentage of women during the child-rearing years impacting, therefore, not only on the woman, but on the significant others in her life. This article explores the impact of breast cancer for the patient's life partner, parents, and children. A model intervention program for cancer patients with young children, piloted at the Derner Institute and developed in conjunction with the American Cancer Society, is also discussed.