乳腺癌化疗

预后不良因素
脉管浸润 高的核分级 高的组织学分级 HER2过表达 激素受体阴性
预后较好因素
管状腺癌 粘液癌 髓样癌（高的核分级，伴有淋巴细胞浸润，肿
瘤边界膨胀性生长）现在认为易于转移，且不 同病理医生间诊断意见常不能统一，故应该与 其他浸润性导管导管癌同等看待
术后辅助治疗
肿瘤＞1cm，淋巴结阴性，激素受体阴性，化 疗(1级)
主方案化疗(2B级) HER2/neu假阳性需要重视 IHC或FISH检测 HER2/neu优劣尚不清楚，倾向
于后者优于前者 化疗完成后放疗。放疗可以和CMF同时，但放
疗期间不用MTBiblioteka Baidu，或至多不超过2 个疗程(影响 保乳的美容效果)
肿瘤较大的ⅡA,ⅡB及T3N1M0：术前化疗
确诊要用粗针穿剌活检，可以在瘤床预 置钉以便日后手术
adjuvant endocrine therapy in postmenopausal women with early breast cancer
aromatase inhibitors either as initial adjuvant therapy, sequentially following 23 years of tamoxifen, or as extended therapy following 4.5 - 6 years of tamoxifen.
Bilateral diagnostic mammography should be performed to identify the presence of multiple primary tumors and to estimate the extent of the noninvasive lesion.
乳腺癌化疗
systemic therapies, based on
tumor histology clinical and pathologic characteristics axillary node status hormone receptor content level of HER2/ expression metastatic disease Comorbidity age menopausal status. Patient preference
目标在于保留乳房 对于 Ⅱ期乳腺癌, 尚无证据表明术前化疗
比术后化疗有生存优势 化疗一般为四个周期 如果多周期术前化疗无效，应立即手术
肿瘤较大的ⅡA,ⅡB及T3N1M0： 术前内分泌治疗
demonstrate that the use of either anastrozole or letrozole alone provide superior rates of breast conserving surgery and usually objective response.
aromatase inhibitors are not active in the treatment of women with functioning ovaries.
adjuvant endocrine therapy
The Arimidex, Tamoxifen, Alone or in Combination Trial (ATAC Trial) demonstrates that anastrozole is superior to tamoxifen or the combination of tamoxifen and anastrozole in the adjuvant endocrine therapy of postmenopausal women with hormone receptor-positive breast cancer.
肿瘤＞1cm但<3cm，淋巴结阴性，激素受体阳 性，内分泌治疗加化疗(1级)
淋巴结阳性，化疗后内分泌治疗 endocrine therapy and chemotherapy must be
based on balancing the expected absolute risk reduction and the individual patient's willingness
外周血常规 肝功能 胸部X线检查 双侧X线摄片
乳房MRI，如果需要: 乳腺B超，骨ECT
腹部影像学检查（ T3N1M0) 激素受体 HER2/neu（估价预后及蒽环类抗生素、
Herceptin疗效，2B）
Ⅰ,ⅡA,ⅡB期:治疗
保乳与根治效果相同(1级) 腋淋巴结阴性,HER2/neu阳性,蒽环类抗生素为
inoperable locoregional invasive carcinoma (clinical stage IIIB, stage IIIC, and some stage IIIA tumors);
metastatic or recurrent carcinoma (stage IV).
The goal of treatment of in situ carcinomas is either preventing the occurrence of invasive disease or diagnosing the invasive component.
Ⅰ,ⅡA,ⅡB期, :分期手段
systemic therapies, divided to
the pure noninvasive carcinomas, which include LCIS and ductal carcinoma in situ (DCIS) (stage 0);
operable, locoregional invasive carcinoma (clinical stage I, stage II, and some stage IIIA tumors);