Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Tacoma Family Medicine, Tacoma, WA, USA.
Am Fam Physician. 2021 Aug 1;104(2):171-178.
Breast cancer is the leading cause of death from cancer in women worldwide, and the second most common cause of death from cancer in women in the United States. Risk assessment tools can identify the risk of breast cancer, and patients at high risk may be candidates for risk-reducing medications. The choice of medication varies with menopausal status. Breast cancer treatment depends on the stage. Stage 0 is ductal carcinoma in situ, which is noninvasive but progresses to invasive cancer in up to 40% of patients. Ductal carcinoma in situ is treated with lumpectomy and radiation or with mastectomy. If ductal carcinoma in situ is estrogen receptor-positive, patients may also receive endocrine therapy. Early invasive stages (I, IIa, IIb) and locally advanced stages (IIIa, IIIb, IIIc) are nonmetastatic and have three treatment phases. The preoperative phase uses systemic endocrine or immunotherapies when tumors express estrogen, progesterone, or ERBB2 receptors. Preoperative chemotherapy may also be used and is the only option when tumors have none of those three receptors. There are two options for the surgical phase with similar survival rates; a lumpectomy with radiation if the tumor can be excised completely with good cosmetic results, or a mastectomy. Sentinel lymph node biopsy is also performed when there is suspected nodal disease. The postoperative phase includes radiation, endocrine therapy, immunotherapy, and chemotherapy. Postmenopausal women should also be offered postoperative bisphosphonates. Stage IV (metastatic) breast cancer is treatable but not curable. Treatment goals include improving the length and quality of life.
乳腺癌是全球女性癌症死亡的主要原因,也是美国女性癌症死亡的第二大常见原因。风险评估工具可以识别乳腺癌的风险,高危患者可能是降低风险药物的候选者。药物的选择因绝经状态而异。乳腺癌的治疗取决于分期。0 期为导管原位癌,虽为非浸润性,但在多达 40%的患者中会进展为浸润性癌。导管原位癌采用肿块切除术和放疗或乳房切除术治疗。如果导管原位癌雌激素受体阳性,患者还可能接受内分泌治疗。早期浸润性阶段(I、IIa、IIb)和局部晚期阶段(IIIa、IIIb、IIIc)无转移,有三个治疗阶段。术前阶段,当肿瘤表达雌激素、孕激素或 ERBB2 受体时,使用全身内分泌或免疫疗法。术前化疗也可能使用,当肿瘤没有这三种受体时,这是唯一的选择。手术阶段有两种选择,生存率相似;如果肿瘤可以完全切除且美容效果良好,则采用肿块切除术加放疗;如果肿瘤较大或位置不佳,则采用乳房切除术。当怀疑有淋巴结疾病时,还进行前哨淋巴结活检。术后阶段包括放疗、内分泌治疗、免疫治疗和化疗。绝经后妇女还应接受术后双膦酸盐治疗。IV 期(转移性)乳腺癌是可治疗但不可治愈的。治疗目标包括延长和提高生活质量。
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