3、为么会得肺癌(1)——癌症的发病机制
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肺癌科普系列<span style="color: black;">文案</span>：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;">1、</span>初识癌症</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;">2、</span>初识肺癌</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;">3、</span><span style="color: black;">为何</span>会得肺癌(1)——癌症的发病机制</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;">4、</span><span style="color: black;">为何</span>会的肺癌(2)——肺癌的危险<span style="color: black;">原因</span></a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;">5、</span>走近肺癌(1)——怎么<span style="color: black;">晓得</span>得了肺癌</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;">6、</span>走近肺癌(2)——<span style="color: black;">为么</span>肺癌对病人<span style="color: black;">导致</span>巨大<span style="color: black;">损伤</span>？</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;">7、</span>走近肺癌(3)——<span style="color: black;">仅有</span><span style="color: black;">看清</span>肺癌<span style="color: black;">归类</span>，<span style="color: black;">才可</span>分而治之</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;">8、</span>肺癌的治疗(1)——外科篇</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;">9、</span></a>肺癌的治疗(2)——放疗篇</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;">十、肺癌的治疗(3)——化疗篇</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;">十<span style="color: black;">1、</span>肺癌的治疗(4)——靶向篇</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;">十<span style="color: black;">2、</span>肺癌的治疗(5)——免疫篇</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;">十<span style="color: black;">3、</span>姑息治疗：有质量地活着</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;">十<span style="color: black;">4、</span>肺癌<span style="color: black;">病人</span>应该<span style="color: black;">怎样</span>面对治疗？</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;">十<span style="color: black;">5、</span>肺癌的其他支持(1)：营养篇</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;">十<span style="color: black;">6、</span>肺癌的其他支持(2)：心理篇</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;">十<span style="color: black;">7、</span>肺癌的其他支持(3)：<span style="color: black;">恢复</span>&护理</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;">有些</span>临床<span style="color: black;">科研</span>中</a><span style="color: black;">平常</span>的词汇（肺癌）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3.1 癌症的<span style="color: black;">出现</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肿瘤学的英文是Oncology，在古希腊语中意思是螃蟹，<span style="color: black;">寓意</span>着肿瘤在人<span style="color: black;">身体</span>像螃蟹<span style="color: black;">同样</span>横行霸道，向各个方向蔓延，<span style="color: black;">那样</span>这个坏螃蟹最初的怎么产生的呢？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">大部分正常的细胞<span style="color: black;">常常</span>进入成年后就不分裂了，除了部分细胞，如毛囊细胞、生殖细胞、骨髓干细胞、消化道细胞、表皮细胞等，以及某些<span style="color: black;">情况</span>下修复<span style="color: black;">损害</span>的细胞。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">癌症有个<span style="color: black;">显著</span>的特点：不受限制地分裂，正常细胞的分裂是受限制的，从干细胞到某一特定细胞，分裂的次数大约为56次，而癌细胞<span style="color: black;">能够</span>大大地超越这个限度。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一位美国宫颈癌<span style="color: black;">病人</span>名叫Hela，她于1951年去世后，癌细胞还被<span style="color: black;">保存</span>并继续培养，用作科学<span style="color: black;">科研</span>，<span style="color: black;">此刻</span><span style="color: black;">已然</span>培养出5000万吨，体积相当于100多幢纽约帝国大厦，从中<span style="color: black;">咱们</span>足以<span style="color: black;">认识</span>癌细胞的分裂能力。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-3717f1c555e72d40b1b27dc921aea9d8_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>电子显微镜下的Hela细胞，<span style="color: black;">源自</span>：生物探索<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">癌症是基因<span style="color: black;">疾患</span>：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">第1</span>方面是癌症基因的<span style="color: black;">功效</span>：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">虽然它叫做癌症基因，<span style="color: black;">然则</span>其实是一种与细胞生长<span style="color: black;">相关</span>的基因，正常细胞的分裂与增殖<span style="color: black;">亦</span><span style="color: black;">必须</span>用到它。<span style="color: black;">然则</span>正常细胞内，癌症基因<span style="color: black;">仅有</span>在<span style="color: black;">必须</span>的时候才会被<span style="color: black;">起步</span>，发挥<span style="color: black;">功效</span>，而癌细胞内的癌症基因被<span style="color: black;">反常</span>激活，则<span style="color: black;">连续</span>地发挥<span style="color: black;">功效</span>，促进细胞分裂与增殖。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">第二方面是癌症<span style="color: black;">控制</span>基因的缺陷：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">正常细胞中有一种<span style="color: black;">检测</span>机制，<span style="color: black;">便是</span><span style="color: black;">发掘</span>细胞<span style="color: black;">出现</span>了<span style="color: black;">反常</span>的变化，且<span style="color: black;">没</span>法修复，就会主动地结束自己的生命，避免以后的大问题，而<span style="color: black;">倘若</span>细胞的<span style="color: black;">检测</span>机制<span style="color: black;">已然</span>丢失了，<span style="color: black;">显现</span><span style="color: black;">没</span>法逆转的<span style="color: black;">反常</span><span style="color: black;">亦</span>不结束生命，结果这个<span style="color: black;">反常</span>就可能随着细胞分裂而遗传下去。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">第三方面是机体的肿瘤细胞逃过了免疫细胞的<span style="color: black;">检测</span>与<span style="color: black;">监测</span>：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在健康的人体中，<span style="color: black;">亦</span>有可能产生少量<span style="color: black;">拥有</span>癌症潜质的<span style="color: black;">反常</span>细胞，<span style="color: black;">然则</span>只要免疫系统能<span style="color: black;">经过</span>识别这些细胞<span style="color: black;">反常</span>的表面特征，就能把它们杀灭，不会<span style="color: black;">出现</span>癌症。<span style="color: black;">然则</span>当机体的免疫力<span style="color: black;">因为</span>多种<span style="color: black;">原由</span>减弱后，<span style="color: black;">反常</span>细胞就<span style="color: black;">不可</span>被<span style="color: black;">即时</span>清除，与免疫细胞<span style="color: black;">处在</span>一个平衡的状态，随着<span style="color: black;">反常</span>细胞的进化，它会<span style="color: black;">隐匿</span>自己的表面特征，使得自己更<span style="color: black;">不易</span>被免疫细胞<span style="color: black;">发掘</span>与杀灭，还可能<span style="color: black;">运用</span><span style="color: black;">各样</span>机制来<span style="color: black;">控制</span>免疫细胞发挥<span style="color: black;">功效</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">以上3个方面总结起来<span style="color: black;">便是</span><span style="color: black;">没</span>限分裂、免疫逃逸。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3.2 再往细看</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">刚才</span>看到在基因<span style="color: black;">出现</span>上，<span style="color: black;">最少</span>两方面的<span style="color: black;">原因</span><span style="color: black;">引起</span>肺癌的<span style="color: black;">出现</span>，<span style="color: black;">那样</span>基因层面上<span style="color: black;">出现</span>了什么呢？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">用前面的比喻，基因就像细胞生命活动的曲谱，细胞分裂的时候，基因的谱子<span style="color: black;">亦</span>会被复制一份。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">细胞的分裂是一个有序的过程，<span style="color: black;">起始</span>复制时，癌症基因<span style="color: black;">起步</span>，基因的谱子会严密、工整地抄写，传给下一个细胞，随后专门的“编辑——癌症<span style="color: black;">控制</span>基因”审核乐谱，<span style="color: black;">即时</span><span style="color: black;">发掘</span>错误，就会立即把错的音符改回正确，<span style="color: black;">倘若</span>觉得这个错误很难修复就干脆命令这个细胞自我牺牲。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-eb5f5a6c85ff542c2e354e615384b8d7_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在机体中，抄写错误的几率很低，人体<span style="color: black;">出现</span>某个细胞<span style="color: black;">出现</span>突变大概百万分之一（10^-7），任一个突变致癌的概率不大（不<span style="color: black;">必定</span><span style="color: black;">出现</span>在癌基因上），综合人体有1千兆（10^14）个细胞计算，可能概率还挺高，但<span style="color: black;">幸运</span>的是，<span style="color: black;">出现</span>一次突变<span style="color: black;">亦</span>不<span style="color: black;">必定</span><span style="color: black;">出现</span>癌症，<span style="color: black;">一般</span><span style="color: black;">必须</span>几个。<span style="color: black;">科研</span><span style="color: black;">发掘</span>癌症中平均<span style="color: black;">出现</span>的突变有1-10个，不同的癌症有所不同，如约4个突变<span style="color: black;">引起</span>肝癌、10个<span style="color: black;">引起</span>结直肠癌。人体<span style="color: black;">出现</span>3个突变的概率才是百万分之一（10^-7）或更小，看上去像买彩票中奖，<span style="color: black;">况且</span>还有错误<span style="color: black;">检测</span>机制，<span style="color: black;">为何</span>总人群的肺癌<span style="color: black;">出现</span>率能达到<span style="color: black;">为何</span>总人群的肺癌<span style="color: black;">出现</span>率能达到将近十万分之50（百万分之500）呢？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因为</span>不良生活习惯，例如烟草中的化学物质，使得基因伤痕累累，受伤就要基因的修复和细胞分裂<span style="color: black;">弥补</span>，<span style="color: black;">这般</span>的话，就相当于要抄<span style="color: black;">非常多</span>遍乐谱了，再耐心的抄写工都有可能犯<span style="color: black;">非常多</span>错，为了超负荷完成修复任务，编辑<span style="color: black;">亦</span><span style="color: black;">没</span>法<span style="color: black;">发掘</span>所有错误，基因突变就此产生，并传递下去。有些基因突变还4两拨千金，<span style="color: black;">出现</span>一个突变后，<span style="color: black;">全部</span>基因组的不稳定都<span style="color: black;">增多</span>，突变率<span style="color: black;">升高</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这些基因突变中，<span style="color: black;">常常</span>有一个<span style="color: black;">重点</span>的基因突变，叫做驱动基因，就像一群小混混里的老大，<span style="color: black;">倘若</span><span style="color: black;">无</span>老大，一群小混混就回混乱不堪，<span style="color: black;">无</span><span style="color: black;">目的</span>。老大<span style="color: black;">无</span>小混混<span style="color: black;">亦</span>势单力薄。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">癌症的<span style="color: black;">出现</span>是一个接一个的基因突变<span style="color: black;">导致</span>的，机体还有免疫系统的封锁线，癌症给了<span style="color: black;">咱们</span><span style="color: black;">非常多</span>时间和机会，<span style="color: black;">常常</span>从<span style="color: black;">第1</span>个突变到癌症<span style="color: black;">出现</span>，经历了几十年，<span style="color: black;">咱们</span>要远离<span style="color: black;">知道</span>的致癌<span style="color: black;">原因</span>，别让基因突变一个接一个地<span style="color: black;">出现</span>。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-125d59d40f21a7c4909ae92dbdf8b48c_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>从单个细胞<span style="color: black;">显现</span>错误发展成癌症<span style="color: black;">必须</span>数十年，<span style="color: black;">照片</span><span style="color: black;">源自</span>：美中嘉和<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3.3 抄写次数</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">咱们</span><span style="color: black;">晓得</span>年龄几乎是所有癌症<span style="color: black;">一起</span>的危险<span style="color: black;">原因</span>（除了儿童和青少年肿瘤），<span style="color: black;">原由</span>是随着时间的<span style="color: black;">累积</span>，细胞复制的次数<span style="color: black;">增多</span>，出错的机会<span style="color: black;">亦</span>在<span style="color: black;">增多</span>，1个细胞基因抄写2遍不犯错很容易，<span style="color: black;">然则</span>多个细胞抄写几十遍，1个都不犯错就<span style="color: black;">不易</span>了。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-67e27aa83eb733b9b6b5972cdecb00dd_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">随着年龄的<span style="color: black;">增多</span>，基因突变<span style="color: black;">亦</span><span style="color: black;">逐步</span><span style="color: black;">累积</span>起来，<span style="color: black;">最后</span>这些基因<span style="color: black;">一起</span><span style="color: black;">功效</span>，表现出癌细胞的生物学特征，<span style="color: black;">出现</span>癌症。<span style="color: black;">时期</span>免疫力<span style="color: black;">亦</span>会缓慢下降，加上<span style="color: black;">各样</span>不良的生活方式，癌症<span style="color: black;">出现</span>势不可挡。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">各样</span>肿瘤的危险<span style="color: black;">原因</span>都是<span style="color: black;">经过</span>使细胞<span style="color: black;">出现</span>基因突变来发挥<span style="color: black;">功效</span>的。从大的<span style="color: black;">方向</span>看，<span style="color: black;">便是</span>致癌<span style="color: black;">原因</span><span style="color: black;">损害</span>基因，“编辑”修复基因，<span style="color: black;">没</span>法修复的就让细胞凋亡，细胞分裂去<span style="color: black;">弥补</span>死掉的细胞，细胞<span style="color: black;">经过</span>分裂来<span style="color: black;">弥补</span>就<span style="color: black;">必须</span>抄写<span style="color: black;">非常多</span>遍基因，抄写出错的机会大大<span style="color: black;">增多</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这般</span>长此以往，就<span style="color: black;">累积</span>了<span style="color: black;">非常多</span><span style="color: black;">出现</span>错误的细胞，它们既<span style="color: black;">无</span>被修复，<span style="color: black;">亦</span>永远不凋亡，带着已有的基因突变继续狂奔，<span style="color: black;">累积</span><span style="color: black;">更加多</span>的突变。<span style="color: black;">因此</span><span style="color: black;">咱们</span>说<span style="color: black;">有些</span>30岁<span style="color: black;">青春</span>人的肺就像70岁<span style="color: black;">同样</span>，<span style="color: black;">亦</span>是有道理的，<span style="color: black;">由于</span>他肺里的细胞受到<span style="color: black;">损害</span>，<span style="color: black;">持续</span>地<span style="color: black;">经过</span>细胞分裂来<span style="color: black;">弥补</span>和修复，基因抄写的次数<span style="color: black;">已然</span>和70岁不吸烟老人<span style="color: black;">同样</span>了。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">【参考文献】</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> Brittany C. , Nicholas L., David F., et al. Comprehensive Analysis of Hypermutation in Human Cancer.. Cell,2017,171(5).</p>
回顾历史，我们不难发现：无数先辈用鲜血和生命铺就了中华民族复兴的康庄大道。 回顾历史，我们不难发现：无数先辈用鲜血和生命铺就了中华民族复兴的康庄大道。
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