婦科英語學習:乳腺癌(3)

Diagnosis

診斷

Testing is required to differentiate benign lesions from cancer. Because early detection and treatment of breast cancer improves prognosis, this differentiation must be conclusive before evaluation is terminated.

需通過化驗檢查鑒別良性病變和癌變。乳腺癌早發(fā)現(xiàn)、早治療可改善預后，因此，只有鑒別結(jié)論出來后才可以結(jié)束評估。

If advanced cancer is suspected based on physical examination, biopsy should be done first; otherwise, the approach is as for breast lumps. A prebiopsy bilateral mammogram may help delineate other areas that should be biopsied and provides a baseline for future reference. However, mammogram results should not alter the decision to perform a biopsy. Biopsy can be needle or incisional biopsy or, if the tumor is small, excisional biopsy. Any skin with the biopsy specimen should be examined because it may show cancer cells in dermal lymphatic vessels. Routinely, stereotactic biopsy (needle biopsy during mammography) or ultrasound-guided biopsy is being used to improve accuracy.

若體檢時懷疑有晚期癌癥，應先做活檢。否則就按乳房腫塊處理�；顧z前行雙側(cè)乳房X線照相可幫助劃定其他活檢部位，并為將來提供參考依據(jù)。只是，乳房X線照相結(jié)果不應影響活檢決定�；顧z分針吸活檢或切開式活檢，小腫瘤也可行切除活檢。活檢標本皮膚應作檢查，因為它可以揭示皮膚淋巴管的癌細胞。按常規(guī)，趨實體活檢（乳房X線照相時的針吸活檢)或超聲引導活檢可提高準確率。

Evaluation after cancer diagnosis: Part of a positive biopsy specimen should be analyzed for estrogen and progesterone receptors and for HER2 protein. WBCs should be tested for BRCA1 and BRCA2 genes when family history includes multiple cases of early-onset breast cancer, when ovarian cancer develops in patients with a family history of breast or ovarian cancer, when breast and ovarian cancer occur in the same patient, when patients have Ashkenazi Jewish heritage, or when family history includes a single case of male breast cancer.

乳腺癌診斷后評估：部分陽性活檢標本應作雌激素、黃體激素受體分析和HER2蛋白分析。下列情況應作白血球BRCA1和BRCA2基因檢測：有多例早發(fā)乳腺癌家族史，卵巢癌病人有乳腺癌或卵巢癌家族史，同一病人患乳腺癌和卵巢癌，病人有北歐猶太教徒血統(tǒng)，有一例男性乳癌家族史。

Chest x-ray, CBC, and liver function tests should be done to check for metastatic disease. Generally, measuring serum carcinoembryonic antigen (CEA), cancer antigen (CA) 15-3, CA 27-29, or a combination is not recommended because results have no effect on treatment or outcome. Bone scanning should be done if patients have tumors > 2 cm, musculoskeletal pain, lymphadenopathy, or elevated serum alkaline phosphatase or Ca levels. Abdominal CT is done if patients have abnormal liver function results, hepatomegaly, or locally advanced cancer with or without axillary lymph node involvement.

應進行轉(zhuǎn)移性疾病檢查，包括胸部X檢查、全血計數(shù)和肝功能檢查等。一般不建議作血清癌胚抗原（CEA)、癌抗原（CA)15－3、CA 27－29、或上述結(jié)合測定，因為測定結(jié)果對治療或結(jié)果并無影響。下列情況應作骨掃描：病人腫瘤> 2 cm、肌骨痛、淋巴結(jié)病、血清堿性磷酸酶或鈣值增高。如病人出現(xiàn)下列情況則應作腹部CT：肝功異常、肝腫大、局部晚期癌癥伴或無腋淋巴結(jié)受累。

Grading and staging follow the TNM classification (see Table 2: Breast Disorders: Staging and Survival of Breast Cancer). Staging is refined during surgery, when regional lymph nodes can be evaluated.

腫瘤淋巴結(jié)轉(zhuǎn)移分類后的分組與分期（見表2：乳房疾�。喝橄侔┑姆制谂c存活)。腫瘤分期在手術(shù)期間進行，此時可對局部淋巴結(jié)作評估。

Screening: Screening includes mammography, clinical breast examination (CBE) by health care practitioners, and monthly breast self-examination (BSE).

篩查：篩查包括乳房X線照相術(shù)、保健醫(yī)師臨床乳房檢查（CBE)和每月乳房自我檢查（BSE)。

Mammography, done annually, reduces mortality rate by 25 to 35% in women ≥ 50 yr. However, there is considerable disagreement about screening for women 40 to 50 yr; recommendations include annual mammography (American Cancer Society), mammography every 1 to 2 yr (National Cancer Institute), and no periodic mammography (American College of Physicians).

乳房X線檢查每年一次，這可使≥50歲婦女死亡率減少25－35%。不過，對40－50歲婦女作篩查仍有很大分歧，不同建議包括，每年一次乳房X線照相（美國癌癥學會)、每1－2年一次乳房X線照相（國家癌癥研究所)及不定期乳房X線照相（美國醫(yī)師學院)。

CBE is usually part of routine annual care for women > 35; it can detect 7 to 10% of cancers that cannot be seen on a mammogram. In the US, CBE augments rather than replaces screening mammography. However, in some countries where mammography is considered too expensive, CBE is the sole screen; reports on its effectiveness in this role vary.

全血計數(shù)是＞35歲婦女常規(guī)年度保健內(nèi)容之一，在乳房X線照相無法發(fā)現(xiàn)的乳腺癌中，有7－10%的病例可通過這種方法檢出。不過，在有些國家，人們認為乳房X線照相太貴，因此，全血計數(shù)是唯一的篩查方法，但對其有效性也是看法各異。

BSE has not been shown to reduce mortality rate but is widely practiced. Because a negative BSE may tempt some women to forego mammography or CBE, the need for these procedures is reinforced when BSE is taught.

乳房自檢似乎并未減少死亡率，但它用得很廣。由于陰性BSE可誘使一些婦女放棄乳房X線照相檢查或CBE檢查，因此，在教育婦女做BSE時就應強調(diào)這些檢查的必要性。

Prognosis

預后

Long-term prognosis depends on extent of lymph node involvement, number of axillary lymph nodes involved, size of primary tumor, tumor grade, stage, presence of estrogen and progesterone receptors, patient age, and presence of HER2 protein.醫(yī)學.全.在線.網(wǎng).站.提供

長期預后取決于淋巴結(jié)的受累程度、受累的腋淋巴結(jié)數(shù)量、原發(fā)性腫瘤的大小、腫瘤級別、分期、是否有雌激素和黃體激素受體、病人年齡及是否有HER2蛋白。

Nodal status correlates with disease-free and overall survival better than other prognostic factors. For node-negative patients, 10-yr disease-free survival rate is > 70%, and overall survival rate is > 80%. For node-positive patients, rates are about 25% and 40%, respectively.

與其他預后因素相比，結(jié)節(jié)狀況與無病及總存活率關(guān)系更大。對結(jié)節(jié)陰性病人來說，10年無病存活率> 70%，總存活率> 80%，結(jié)節(jié)陽性病人分別為25%和40%。

Larger tumors are more likely to be node-positive and also confer a worse prognosis independent of nodal status. Patients with poorly differentiated tumors have a worse prognosis.

較大腫瘤的結(jié)節(jié)陽性可能性更大，預后更差，且與結(jié)節(jié)狀況無關(guān)。低分化腫瘤病人預后較差。

Patients with ER+ tumors have a somewhat better prognosis and are more likely to benefit from hormone therapy. Patients with progesterone receptors on a tumor may also have a better prognosis.

ER＋腫瘤病人預后稍好，也更容易從激素治療中受益。腫瘤有黃體激素受體的病人預后較好。

When the HER2 gene is amplified, HER2 is overexpressed, increasing cell growth and reproduction and often resulting in more aggressive tumor cells. Overexpression of HER2 may be associated with high histologic grade, ER– tumors, greater proliferation, larger tumor size, and thus a poor prognosis.

HER2基因放大，HER2就會表達過度，增加細胞生長繁殖，并經(jīng)常導致更多的攻擊性腫瘤細胞。HER2的過分表達可能與組織學等級高、ER-腫瘤、增生擴大、腫瘤較大及因此而致的預后不良有關(guān)。

For any given stage, patients with the BRCA1 gene appear to have a worse prognosis than those with sporadic tumors, perhaps because they have a higher proportion of high-grade, hormone receptor-negative cancers. Patients with the BRCA2 gene probably have the same prognosis as those without the genes if the tumors have similar characteristics. With either gene, risk of a 2nd cancer in remaining breast tissue is increased (to perhaps as high as 40%).

不管處于哪一階段，BRCA1基因病人的預后似乎都要比散發(fā)性腫瘤病人差，這也許是因為他們高等級、激素受體陰性癌比率較高的緣故。在腫瘤特征接近的情況下，BRCA2基因病人與無此基因病人的預后大致相同。不管哪種基因，在其他乳房組織發(fā)生繼發(fā)癌的危險都會增加（也許高達40%)。