治療方法乳癌手術幾乎所有乳癌病人 (99.6%) 均接受了乳房切除手術, 以將癌腫瘤切去 ( 圖 36) 61% 的病人接受了乳房保留手術, 另 39% 接受了全乳切除手術 26% 在接受全乳切除手術的同時, 亦接受乳房重建手術 ( 表 11) 不論使用何種乳房手術 ( 硬塊切除手術或全乳切除手

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1 Treatment Methods Breast cancer surgery Table 11. Types of surgical operation in breast cancer patients Almost all breast cancer patients (99.6%) underwent surgical operation to remove tumours (Figure 36). Sixty-one percent of the patients had breast conserving treatment whilst 39% had total mastectomy. Among the mastectomy group, 26% of the subjects had immediate breast reconstruction (Table 11). Irrespective of the type of breast surgery (lumpectomy or mastectomy), removal of lymph nodes from axilla of the affected side helped to determine whether the disease has spread beyond the breast. However, removal of lymph nodes may result in lymphoedema. In recent years, sentinel node biopsy was developed to determine axillary involvement in early breast cancer with clinically negative axilla. If sentinel nodes were positive, the standard treatment was to perform level I & II axillary dissection. If sentinel nodes were negative, patient can be spared further axillary surgery, thereby reducing the risk of lymphoedema. For patients with involved axillary node on clinical examination, conventional axillary dissection was performed..4% Breast conserving surgery Yes No Mastectomy Yes No Reconstruction among mastectomy group Yes No Nodal surgery Yes No Type of nodal surgery Sentinel node biopsy Sentinel node biopsy & axillary dissection Axillary dissection Relative percentage (%) 61% 39% 39% 61% 26% 74% 86% 14% 6% 18% 22% No surgery Surgery 99.6% Table 36. Percentage of the subjects undergone surgical operations 67

2 治療方法乳癌手術幾乎所有乳癌病人 (99.6%) 均接受了乳房切除手術, 以將癌腫瘤切去 ( 圖 36) 61% 的病人接受了乳房保留手術, 另 39% 接受了全乳切除手術 26% 在接受全乳切除手術的同時, 亦接受乳房重建手術 ( 表 11) 不論使用何種乳房手術 ( 硬塊切除手術或全乳切除手術 ), 將受感染一邊的腋下淋巴切除, 有助測出癌細胞是否已擴散至乳房之外然而, 將腋下淋巴切除可導致淋巴水腫近年, 前哨淋巴抽檢術可用於診斷臨床上早期乳癌的淋巴受感染程度如前哨淋巴屬陽性, 病人便需接受 I 及 II 期淋巴切除如前哨淋巴屬陰性, 則可免除額外的腋下手術, 減低淋巴水腫風險如腋下淋巴受感染, 需作傳統腋下淋巴切除手術.4% 表 11. 乳癌病人的手術種類乳房保留手術有否全乳切除手術有否全乳切除手術後的乳房重建有否淋巴結手術有否所佔百份比 (%) 61% 39% 39% 61% 26% 74% 86% 14% 無接受手術曾接受手術淋巴結手術種類前哨淋巴抽檢術前哨淋巴抽檢術與腋下淋巴切除腋下淋巴切除 6% 18% 22% 99.6% 表 36. 乳癌病人接受手術的比率 68

3 Radiation therapy Radiation therapy was performed in 71% of the cases (Figure 37). Figure 38 depicted the percentage distribution of radiated regions. These included 22% of the subjects with breast conserving surgery to the affected breast and 11% of the subjects with mastectomy either to chest wall, supraclavicular fossa (SCF), internal mammary chain (IMC) or axilla. Chemotherapy Chemotherapy was a form of systemic therapy to reduce risk of recurrence in subjects with breast cancer for curative intent, or as therapeutic measure in de novo metastatic cancer. More than 7% of invasive breast cancer cases underwent chemotherapy. (Figure 39). The used chemotherapy regimen included: AC+T (33%), FAC/ FEC (19%), AC (19%), TC/DC (), FEC+T (3%), CMF (1%) and TAC (1%) and others (9%) (Figure 4). 29% 71% Radiation therapy No radiation therapy 4% 29% No chemotherapy Adjuvant chemotherapy 67% Neoadjuvant chemotherapy Figure 37. Percentage of the subjects receiving radiation therapy 4% 35% 25% 1% 5% 23% whole breast 22% local boost 8% 5% 3% 2% 2% Chest wall SCF Radiation region 35% Figure 38. Radiated regions Note: * = percentages add to more than 1% because more than one response could be checked SCF: supraclavicular fossa IMC: internal mammary chain Axilla IMC Partial breast Unreported Figure 39. Percentage of invasive breast cancer patients on chemotherapy 35% 33% 25% 1% 5% AC+T 19% FAC/FEC only 19% AC only TC/DC only 3% FEC+T Figure 4. Regimen of chemotherapy 1% 1% CMF only TAC 9% Others 69

4 參加者所佔百份比9% 電療 71% 乳癌病人均曾接受電療 ( 圖 37) 圖 38 則列出接受電療的位置比率, 包括 22% 接受乳房保留手術的病人接受局部電療, 另有 11% 接受全乳切除的病人, 術後於胸壁或區域性淋巴系列處接受電療 ( 圖 38) 化療化療屬全身治療的其中一種, 目的是減低乳癌患者的復發機率, 同時亦可作為治療惡性轉移腫瘤的方法之一超過 7% 入侵性乳癌病人接受化療 ( 圖 39) 所使用的化療藥物療程包括 : AC+T (33%), FAC/ FEC (19%), AC (19%), TC/DC (), FEC+T (3%), CMF (1%), TAC (1%) 及其他 (9%) ( 圖 4) 29% 71% 曾接受電療無接受電療 4% 29% 無接受化療輔助性化療 67% 新輔助性化療圖 37. 乳癌病人接受電療的比率圖 39. 入侵性乳癌病人接受化療的比率 4% 35% 25% 1% 5% 23% 整個乳房22% 局部剌激8% 胸壁5% 電療位置 3% 2% 2% 部份乳房腋下銷骨上窩內乳鏈35% 不明參加者所佔百份35% 33% 25% 比1% 5% AC+T 19% FAC/FEC 19% AC only TC/DC 3% FEC+T 1% 1% CMF TAC 其他7 圖 38. 接受電療位置備注.. * = 因參加者可作多於一個選擇, 故百份比高於 1% 圖 4. 化療藥物療程使用的比率

5 Endocrine therapy Endocrine therapy was a form of systemic therapy targeted at hormone responsive tumours. Figure 41 showed 58% of the subjects underwent endocrine therapy. Endocrine therapy was used in 65% of invasive cancer as treatment modalities and in 18% of in situ cancer only as chemopreventive measure. Targeted therapy Targeted cancer therapy was a form of treatments that targeted specific processes of cancer cell growth, division and lifecycle or, in some cases, the blood vessels nourishing a tumour. About 11% of invasive cancer was treated with targeted therapy (Figure 43). 11% 58% 42% No endocrine therapy Endocrine therapy No targeted therapy Targeted therapy 89% Figure 41. Percentage of the subjects on endocrine therapy The most common drug used for endocrine therapy was Tamoxifen (77%), followed by aromatase inhibitor (17%), medical ovarian suppression (1%) and unreported (6%). Other forms of endocrine therapy including ovarian irradiation (%) and oophorectomy (%) was not reported (Figure 42). Figure 43. Percentage of invasive breast cancers treated with targeted therapy Among those receiving targeted therapy, all (1%) used trastuzamab as their first line drug in targeted therapy (Figure 44). 9% 8% 7% 6% 5% 4% 1% 77% Tamoxifen 17% Aromatase inhibitor 1% % Ovarian suppression Ovarian irradiation / oophorectomy 6% Unreported 1% 9% 8% 7% 6% 5% 4% 1% 1% trastuzamab Figure 44. Types of targeted therapy drug used for patients with invasive cancer % lapatinib % bevacizumab Figure 42. Forms of endocrine therapy Note: * = percentages add to more than 1% because more than one response could be checked 71

6 內分泌治療內分泌治療亦為全身治療的其中一種, 內分泌治療是一種針對女性荷爾蒙受體呈陽性的腫瘤的全身療法圖 41 指, 共有 58% 乳癌病人曾接受內分泌治療入侵性乳癌病人當中,65% 曾接受內分泌治療作治療乳癌之用, 而原位癌乳癌病人當中,18% 亦曾接受內分泌治療作預防之用針對性治療針對性治療是用藥物針對癌細胞的生長特性分裂及生命循環, 或為腫瘤供應養份的血管作出阻擊約 11% 入侵性乳癌病人採用針對性治療 ( 圖 43) 11% 58% 42% 無接受內分泌療法曾接受內分泌療法 89% 無接受針對性治療曾接受針對性治療圖 41. 乳癌病人接受內分泌療法的比率最常使用的內分泌治療藥物為三苯氧胺 (77%), 接著為芳香酶抑制劑 (17%) 卵巢抑制劑 (1%), 有 6% 沒有詳細資料, 其他內分泌療法包括卵巢放射治療 (%) 及卵巢切除術 (%) 則較少採用 ( 圖 42) 參加者所佔百份比% 9% 8% 7% 6% 5% 4% 1% 77% 抗雌激素17% 芳香媒抑制劑1% % 卵巢抑制劑卵巢放射治療/卵巢切除術6% 不明圖 43. 入侵性乳癌病人接受針對性治療的比率在接受針對性治療的個案中, 所有人 (1%) 均以 trastuzamab 作為針對性治療的第一線藥物 ( 圖 44) 參加者所佔百份比1% 9% 8% 7% 6% 5% 4% 1% 1% trastuzamab 圖 44. 入侵性乳癌病人使用的針對性治療藥物種類 % lapatinib 針對性治療藥物種類 bevacizumab 圖 42. 病人接受的內分泌治療形式比率備注.. * = 因參加者可作多於一個選擇, 故百份比高於 1% 72

7 Alternative medicine management Apart from conventional western medical management for breast cancer, some patients may include complementary medicine, for example, herbal medicine or taking health pills in their fight against breast cancer. Less than 1% of the subjects took alternative medicine (Figure 45). Among them, 89% took Chinese medicine whilst 16% took health pills as complementary medicine to uplift their health status (Figure 46). 8% 92% No alternative medicine Alternative medicine Figure 45. Percentage of the subjects on alternative medicine 1% 9% 8% 7% 6% 5% 4% 1% 89% Chinese medicine 16% Health food Figure 46. Types of alternative medicine Note:* = percentages add to more than 1% because more than one response could be checked 73

8 另類療法除了各種傳統西方的乳癌治療方法外, 部份病人會在抗癌期間使用一些補充性的醫藥, 例如中草藥及健康藥丸等少於 1% 病人曾使用另類療法 ( 圖 45) 當中,89% 病人是使用中藥,16% 服用健康藥丸等補充性藥物, 以提升他們的健康狀況 ( 圖 46) 8% 92% 無使用另類療法曾使用另類療法圖 45. 使用另類療法的病人比率 1% 參加者所佔百份9% 8% 7% 6% 89% 5% 比4% 16% 1% 中藥健康食品 74 圖 46. 病人使用的另類療法備注.. * = 因參加者可作多於一個選擇, 故百份比高於 1%

Microsoft PowerPoint - Jt HKBCF Ca breast SE Talk_Nov 13_2010[PDF]

Microsoft PowerPoint - Jt HKBCF Ca breast SE Talk_Nov 13_2010[PDF] 如何處理乳癌治療的副作用 : 疲勞認知功能減弱性功能障礙更年期症狀等曾詠恆醫生香港大學臨床腫瘤學系助理教授香港大學內科學系榮譽助理教授二零一零年十一月十三日專題內容乳癌確診類型乳癌的發展及趨勢治療發展治療引