握拳运动——术后24h手腕运动——术后48h前臂运动——术后d3肘部运动——术后d5抱肘运动——术后d7松肩运动——术后d9上臂运动——术后d10颈部运动——术后d11体转运动——术后d12抬肩运动——术后d14
1、低回声结节:一般为实性的肿块,大家就需要重视了;如果您的超声报告内出现了以下字眼(低回声结节、团块,边界不清楚,形态不规则,无明显包膜,呈蟹足样生长),应高度重视,到肿瘤专科医院就诊。2、高回声结节:通常为脂肪瘤,无需过多担心,多数情况观察随访。3、无回声结节:通常为乳腺囊肿,单纯的乳腺囊肿恶变几率低,观察随访。
对乳腺癌患者来说,单学科诊疗模式是传统模式,逐渐暴露其弊端:诊疗不全面不规范等。现代医学诊疗模式强调多学科诊疗模式(Multi disciplinary team MDT)。该概念最早由美国率先提出,国际上特别是欧美,MDT已成为常态。 乳腺中发现癌组织,不一定是乳腺癌。某患者发现一侧乳腺无痛性肿块而其他部位均未见明显异常。依赖多学科肿瘤专家MDT团队和先进设备,诊断:胃癌乳腺转移。如没有MDT和先进设备,有可能误诊为乳腺癌而错误地切除了乳房。乳腺恶性肿瘤是全身性疾病,晚期可出现全身的恶病质症状,需要全身性治疗和多学科诊疗模式(MDT)。
约50%服用芳香化酶抑制剂的乳腺癌患者报告出现肌肉骨骼痛或症状加重,18%~30%报告出现疲劳。这些都是女性提高终止治疗的重要原因。 2012年ASCO年会上公布了VITAL研究结果,VITAL研究是一项III期随机、安慰剂对照的双盲试验,纳入了147名乳腺癌女性,发现来曲唑治疗时,添加维生素D3(30000IU/周)可减少骨骼肌肉痛。 本研究纳入了147名I~III期乳腺癌患者,都接受来曲唑治疗+维生素D(600IU/d)+钙(1200mg/d)治疗。被随机分配接受额外的30000IU/周的维生素D3或安慰剂,分别在基线水平、12周和24周检测维生素D水平和进行症状调查。安慰剂组有三个病人,由于骨骼肌肉痛在早期终止治疗。维生素D组,基线、12周和24周的维生素D水平分别为22、53、57ng/mL,安慰剂组分别为25、32、31ng/mL。维生素D组和安慰剂组出现骨骼肌肉痛事件的比例分别为51%和37%(p=0.069)。研究还评估了不良生活质量事件的发生率,安慰剂组明显较高(72% vs 42%,p<0.001)。 研究结果表明,使用芳香酶抑制剂辅助治疗的患者,补充维生素D可减少肌肉骨骼痛和疲劳。
美国研究人员在线发表于《临床肿瘤学杂志》(JCO)上一项大型、前瞻性观察性研究显示,早期乳腺癌完成治疗的妇女定期服用阿司匹林可降低死亡危险50%。研究人员称,这是首次发现阿司匹林可显著降低乳腺癌复发和死亡风险。 美国哈佛大学医学院米歇尔·霍姆斯及其团队从1976年起对参加“护士健康研究”项目的4164例(30~55岁)女护士(诊断为I、II、III期乳腺癌)到2006年6月,进行长达30年的随访研究。 结果显示,400例妇女发生癌细胞扩散,341例护士死于乳腺癌。乳腺癌患者如每周服用阿司匹林2-5天,体内癌细胞扩散和死于乳腺癌的危险分别降低60%和71%。那些每周服用阿司匹林6-7天的乳腺癌患者癌细胞扩散危险降低43%,死于乳腺癌危险降低64%。接受早期乳腺癌治疗的患者服用阿司匹林后,癌细胞扩散和死于乳腺癌的风险均降低50%。 霍姆斯说,“如果这些研究结果被其他的临床试验所验证,服用阿司匹林可能成为又一种简单、低成本和相对安全的工具,帮助乳腺癌妇女延长寿命和生活得更健康。” 研究人员指出,对于阿司匹林同类的其他非类固醇类抗炎药是否也可以帮助降低乳腺癌,对此尚不确定其以何种方式对肿瘤施以影响,但这类药可以减少炎症。以往其他的研究也显示,阿司匹林和非类固醇类抗炎药可降低患结肠癌危险。 但研究者强调,乳腺癌患者不应在接受放射治疗或化疗期间服用阿司匹林。因为可能出现副作用。原文摘要:Aspirin Intake and Survival After Breast Cancer Michelle D. Holmes,* Wendy Y. Chen, Lisa Li, Ellen Hertzmark, Donna Spiegelman, and Susan E. Hankinson From the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Department of Medical Oncology, Dana-Farber Cancer Institute; and Departments of Epidemiology and Biostatistics, Harvard School of Public Health, Boston, MA.Purpose: Animal and in vitro studies suggest that aspirin may inhibit breast cancer metastasis. We studied whether aspirin use among women with breast cancer decreased their risk of death from breast cancer.Methods: This was a prospective observational study based on responses from 4,164 female registered nurses in the Nurses' Health Study who were diagnosed with stages I, II, or III breast cancer between 1976 and 2002 and were observed until death or June 2006, whichever came first. The main outcome was breast cancer mortality risk according to number of days per week of aspirin use (0, 1, 2 to 5, or 6 to 7 days) first assessed at least 12 months after diagnosis and updated.Results: There were 341 breast cancer deaths. Aspirin use was associated with a decreased risk of breast cancer death. The adjusted relative risks (RRs) for 1, 2 to 5, and 6 to 7 days of aspirin use per week compared with no use were 1.07 (95% CI, 0.70 to 1.63), 0.29 (95% CI, 0.16 to 0.52), and 0.36 (95% CI, 0.24 to 0.54), respectively (test for linear trend, P < .001). This association did not differ appreciably by stage, menopausal status, body mass index, or estrogen receptor status. Results were similar for distant recurrence. The adjusted RRs were 0.91 (95% CI, 0.62 to 1.33), 0.40 (95% CI, 0.24 to 0.65), and 0.57 (95% CI, 0.39 to 0.82; test for trend, P = .03) for 1, 2 to 5, and 6 to 7 days of aspirin use, respectively.Conclusion: Among women living at least 1 year after a breast cancer diagnosis, aspirin use was associated with a decreased risk of distant recurrence and breast cancer death
适应症: 临床I期、II期,肿块最大径小于3cm 肿块大于3cm或III期患者,经术前化疗降期后——慎重考虑 肿块与乳房体积比——乳房有适当体积,术后能够保持外观效果绝对禁忌症: 不能接受放疗者 两个或以上象限的多中心病灶 不能保证病理切缘阴性相对禁忌症: 肿瘤位于乳房中央区(乳晕及乳晕旁2cm),包括乳头Paget’s病 直径>3cm 钼靶X线显示弥散的恶性或可疑恶性的钙化灶保乳治疗的局部治疗方法: 原发灶切除范围应包括肿瘤、肿瘤周围1-2cm的组织以及肿瘤深部的胸大肌筋膜 腋窝淋巴结清扫,或者前哨淋巴结活检 全乳放疗保乳治疗的全身治疗方法: 同全乳切除加淋巴结清扫手术的全身治疗
意大利De Laurentiis等进行了一项荟萃分析,比较在蒽环类药物为基础的化疗方案中加入紫杉类药物是否可以延长高危早期乳腺癌患者的无病生存期(DFS)及总生存期(OS)。该论文发表在 J Clin Oncol 2008,26: 44 分析者检索了PubMed数据库和San Antonio乳腺癌大会、ASCO年会的会议记录,从中纳入13项相关随机对照临床研究数据进行分析。这些研究共包含随机入选的22452例女性患者,其中5829例复发,3329例已经死亡。对各项研究DFS和OS的风险比(HR)及其95%可信区间(CI)数据进行汇总评估。 结果显示,对于高复发危险早期乳腺癌患者,在蒽环类药物为基础的化疗方案中加入紫杉类药物,可以显著降低其复发和死亡危险,其中复发危险约降低17%,死亡危险约降低15%。分析表明,DFS的HR为0.83(95% CI为0.79~0.87,P<0.00001),OS的HR为0.85(95% CI为0.79~0.91,P<0.00001)。这一结果具有临床意义,即与早期乳腺癌术后辅助化疗金标准蒽环类药物治疗相比,在以蒽环类药物为基础的方案中加入紫杉类药物可使5年复发危险降低5%,死亡危险降低3%。 另外,对不同亚组患者分析显示,复发或死亡危险的降低不受紫杉类药物种类、雌激素受体(ER)表达、腋窝淋巴结转移数目(1~3枚或≥4枚)、患者年龄(<50岁或≥50岁)及绝经状态的影响。 原文摘要如下:Taxane-Based Combinations As Adjuvant Chemotherapy of Early Breast Cancer: A Meta-Analysis of Randomized TrialsPurpose We conducted a meta-analysis of randomized trials that evaluated the efficacy of incorporating taxanes into anthracycline-based regimens for early breast cancer (EBC). We aimed to determine whether this approach improves disease-free survival (DFS) and overall survival (OS) and whether benefits are maintained across relevant patient subgroups. Methods Studies were retrieved by searching the PubMed database and the proceedings of major conferences. We extracted hazard ratios (HR) and 95% CIs for DFS and OS from each trial and obtained pooled estimates using an inverse-variance model. Results Thirteen studies were included in the meta-analysis (N = 22,903 patients). The pooled HR estimate was 0.83 (95% CI, 0.79 to 0.87; P < .00001) for DFS and 0.85 (95% CI, 0.79 to 0.91; P < .00001) for OS. Risk reduction was not influenced by the type of taxane, by estrogen receptor (ER) expression, by the number of axillary metastases (N1 to 3 v N4+), or by the patient's age/menopausal status. Sensitivity analysis showed that taxanes given in combination with anthracyclines, unlike sequential administration, did not significantly improve OS. However, the test for interaction showed that HR did not differ between the two schedules (P = .54). Taxane administration resulted in an absolute 5-year risk reduction of 5% for DFS and 3% for OS. Conclusion The addition of a taxane to an anthracycline-based regimen improves the DFS and OS of high-risk EBC patients. The DFS benefit was independent of ER expression, degree of nodal involvement, type of taxane, age/menopausal status of patient, and administration schedule.