图片来源(←内含连结)

可能很多人都不知道10月是国际乳癌防治月…

而图片中的粉红丝带则是全球关怀乳癌的标志…

Few ppl know October is also called International Breast Cancer Awareness Month…

N the pink ribbon is the symbol…

 

图片来源(←内含连结)

说到乳癌最近比较有名的新闻大概就是安洁莉娜裘莉的消息了…

大家应该多少看到新闻都听到她为了战胜乳癌勇敢的把双乳都切掉了…

相关新闻(←点我可看‧来自奇摩新闻)

Speaking of breast cancer, you might hear the news of Angelina Jolie underwent a double mastectomy to prevent breast cancer.

And here are some news that you can check if you haven’t heard about it.

news from CNN

1.Angelina Jolie’s cancer decision

2.Angelina Jolie reveals double mastectomy

 

但到底大家知道什么是乳癌吗???

乳癌又该怎么预防跟治疗呢???

以下来跟大家浅谈乳癌的一些小观念…

So do you know what breast cancer is?

And what’s the prevention and treatment?

Here are some basic views of breast cancer…

 

Q：乳癌有那些症状啊???

Q：The symptoms of breast cancer.

 

图片来源(←内含连结)

 乳癌最常见的临床表现是乳房可触摸到硬块或结节…

如果是发展到后期的则会看到胸部皮肤溃烂或有分泌物…

Usually you could touch the lump around your breast, even worse there would be some discharge and ulcer.

Q：到底甚么是乳癌???

Q：What is breast cancer?

图片来源(←内含连结)

 乳癌是乳房细胞不正常分化增生产生的恶性肿瘤…几乎都发生在女性同胞…但别怀疑…男生也是会得乳癌的…

Breast cancer is a malignant tumor that starts in the cells of the breast.

A malignant tumor is a group of cancer cells that can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body.

The disease occurs almost entirely in women, but men can get it, too.

---

Q：那么要做哪些检查才能得知并诊断自己得到乳癌呢???

Q：The diagnosis of breast cancer.

图片来源(←内含连结)

 通常是借由自己触诊或诊视自己的乳房…

发现到乳房跟之前比起来有不正常的变化…

进而求助于医师…

才会做进一步的检查以确立诊断…

Usually you could find something abnormal with your breast by BSE. Then you go to see the doctor to do further exams.

 

为了确认乳房硬块是否真为乳癌…

细胞学或组织病理学的检查是不可或缺的…

细针抽吸细胞学检查(fine needle aspiration cytology examination)

通常只要一支10c.c的空针套上22号针头进行采样…

不需局部麻醉即可进行…

一般来说如果临床触诊怀疑是乳癌…

加上乳房X光摄影呈现典型乳癌的变化…

再由细针抽吸细胞学检查证实为”阳性”结果…

则可确立诊断…精确率几乎达100%...

另外有时也会采局部麻醉行活体切片(biopsy)送组织病理学检查…

等病理报告出炉后再视情况进行乳房切除或乳房保留术式的外科治疗…

To ensure whether the breast lump you found is cancer or not, the cytology and pathology examinations are necessary.

Under a fine needle aspiration cytology examination, you don’t have to take a local anesthesia to get the example.

If you doubt the lump as a cancer while doing the palpation,

after the mammography and the positive finding of the needle aspiration cytology examination,

then you could diagnose it as a breast cancer, and the accuracy is almost 100%.

In addition, the biopsy would be done under a local anesthesia for the cytology, and after the pathologic data,

the doctor will do the surgery either mastectomy or MRM(depends on the stage of cancer.)for you.

 

哈不过感觉像我这种小奶奶根本没大到可以放在台面上的…

好像没办法做乳房X光摄影吼…囧…

(非专业内文恕不翻译: P)

(No translation for this sentence which is not related to this article. :P)

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Q：为什么我会得到乳癌呢???

Q:Why I get breast cancer?

 

图片来源(←内含连结)

 由于饮食习惯西化…

再加上初经年龄提早、妇女怀孕次数减少、停经年龄延后等…

使国内乳癌的发生率逐年增加…

且罹病年龄层有逐渐下降趋势…

Because the change of people’s habit about food (westernized) today,

many women start their menstruation in their early age(under 12).

Here are some risk factors of breast cancer:

 

危险群：

高危险群-

1.年龄超过50岁

2.一侧乳房曾有侵犯性乳癌或原位癌

3.乳房切片有不正常细胞増生现象

4.特殊家庭史(如停经前罹患过2侧乳癌)

次危险群-

1.母亲或姊妹罹患过乳癌

2.30岁以后才生第1胎

3.未曾生育者

4.停经后肥胖

5.子宫内膜癌及卵巢癌

6.胸部曾暴露于大量放射线

略高危险群-

1.中量饮酒(1oz/day)

2.初经较早(小于12岁)

3.停经较晚(大于55岁)

4.接受荷尔蒙治疗

high risk group-

1.over 50years old

2.one side of the breast has been undergoing an invasive breast cancer or DCIS(Ductal carcinoma In Situ)

3.abnormal growing cell which is found in the biopsy of the breast

4.family history:

medium risk group

1.your mother or sister had the breast cancer

2.give the first birth to your baby over 30years old

3.no experience of giving a birth to a baby

4.get fat after the menopause

5.history of cervical cancer and ovary cancer

6.exposure to a high radiation

slightly high- risk group

1.take alcohol 1oz/day

2. women who start their menstruation in their early age(under 12)

3.women whose menopause over 55years old

4.undergo a hormone therapy

---

Q：那得到乳癌该怎么处理治疗呢???

Q: The treatments of breast cancer.

 

根据不同期别的乳癌有不同的治疗策略…

The treatment are different from every stage.

 

第I期与第II期乳癌

Stage I &II

主要以外科手术切除为主…

然后再视预后因子给予术后辅助性治疗(adjuvant treatment)…

20世纪初最常被使用的手术方式为…

乳房根治性切除术(radical mastectomy)…

因当时观念为乳癌主要是经由局部淋巴腺推扩散及转移展开来…

所以切除部位应包含整个罹病乳房、胸大肌、胸小肌和邻近部位整体的淋巴腺…

当时认为这样比较不会再复发…

Surgery of cutting the breast is the main treatment during the stage I and II,

and the prognostic factors would be considered in to decide the post-treatment(adjuvant treatment).

In 20century, the common treatment is radical mastectomy.

The doctors believed that the more range of the breast you cut the less recurrence.

The cutting part includes the whole breast, pectoralis major muscle, pectoralis minor muscle, and the lymph node around.

 

之后则提倡改良型根治性乳房切除术(modified radical mastectomy)…

可保有同样治疗效果…

也保留胸大肌避免术后外观与功能缺陷…。

因早期治疗倾向广泛性淋巴扩清术…

容易导致肩关节僵硬、疼痛、患侧淋巴水肿等后遗症…

严重影响生活品质…

After, coming up the surgery called modified radical mastectomy; MRM which advocated most.

Because it has the same effect compared to the radical mastectomy, and you still could keep your appearance and function of your breast,

plus less side effect of the lymph node dissection.(pain, lymphedema of the affected side, and stiff shoulder etc)

 

所以借由检查前哨淋巴结(sentinel lymph node)

先得知淋巴结是否被癌症侵袭…

再决定是否做淋巴扩清术以避免上述后遗症发生…

Therefore by doing the examination of sentinel lymph node to see if the lymph node is attacked.

And then decide to take the lymph node dissection or not for avoiding the side effects after the surgery.

 

(注)侦测前哨淋巴结的方法是于术前在癌症肿块附近注射蓝色染剂或含有放射性同位素的物质，当染剂回流至前哨淋巴结，则可将淋巴切片送病理检验。

p.s.the way to detect the lymph node: by injecting a blue dye or radio-isotope around the lump, after the dye returning back to the lymph node and then get the biopsy for pathology.

 

第III期与第IV期乳癌

Stage III&IV

 

针对第III期乳癌的治疗…

原则上如果可以进行外科手术切除的话…

可以先行改良型根治乳房切除术…

再以辅助性的化学治疗及放射线治疗…

如果不适合开刀…

则可以先行3~4个疗程的引导性化疗…

待肿瘤缩小之后再以手术切除或给予放射线治疗…

最后还要给予手术后的化学治疗…

 

The treatment of Stage III breast cancer, in principle, we could take the MRM surgery then adjuvant chemotherapy and radiotherapy.

If it’s not proper to do the surgery(usually because of the size of tumor is too big),

you could take 3~4 courses of chemotherapy first, and then take the surgery after the size of tumor becomes smaller,

 

至于已经有远处转移的第IV期…

则主要以全身系统性的化学治疗、分子标靶治疗及荷尔蒙治疗为主…

再搭配支持性照护(supportive care)…

来延长病患有限生命存活期…并维持其生活品质。

As for stage IV, the main treatment is the whole systematic chemotherapy, target therapy,

and hormone therapy, combined with supportive care to prolong the patients’ life and maintain the quality of life.

 

有关乳癌临床上的预后因子包含以下的有无：

腋下淋巴腺的转移…

动情素受体(estrogen receptor)…

黄体素受体(progesterone receptor)……

HER-2基因的过度表现…

肿瘤实质块的大小…

乳癌细胞分化的程度…

月经周期的有无等。

The prognosis factors of breast cancer which are emphasized in clinic are: metastasis of axillary lymph node, ER, PR, HER-2, tumor size etc.

 

不同于其他固态肿瘤(如肺癌、肝癌)…

病患即使能活超过5年…

也不代表乳癌已获得根治…

因此定期接受乳房放射线摄影…

做乳房自我检查(Breast self-examination; BSE)…

及定期追踪是有必要的…

Compared to other cancer, even a patient survives from the breast cancer over 5years, that doesn’t mean the breast cancer is cured completely.

Therefore take mammogram, BSE, and follow-up regularly are necessary.

 

Q：如何预防乳癌发生???

Q: The preventions of breast cancer.

 

前面既然提到过乳癌主要是跟荷尔蒙的变化有关…

(有可能是因为饮食西化导致摄取过多荷尔蒙…或是接受荷尔蒙治疗的关系…)

所以就饮食方面调整是最简单的预防方法…

虽然我也很喜欢吃G排啊炸G那些的…

(因为现在很多鸡只在饲养时都有注射荷尔蒙…)

可是为了健康著想…这类食物还是少碰为妙…

正所谓”放下G排…保住妳奶” XD

这句是开玩笑的…

重点是要告诉大家尽量避免这类的食物…

We mentioned earlier that one of the high risks of breast cancer is hormone.

(due to the food or hormone therapy etc)

So the easiest prevention is to avoid taking food that contains lots of hormone such as fried chicken.

(many chicken were injected hormone to grow better)

Though I also like to eat this kind of junk food, but I will quit it ASAP for my own good, and so do you!!!

 

另外早期发现早期治疗一直是治疗癌症的黄金法则…

虽然无法预防…但之后的预后会比较乐观…治疗也会较顺利…

所以平常的乳房自我检查…

定期追踪乳房超音波、乳房摄影都是相当重要的…

这里附上影片教大家如何做乳房自我检查…以及何时该做…

To find the cancer in an early stage and start the treatment as soon as possible is the principle of treating cancer.

Though it’s nothing to do with the prevention, but the prognosis and treatment will be more optimistic if you find it earlier.

So it’s really important to follow up the breast ultrasound, mammography, and do the breast self-examination regularly.

Here is a film teaching you how and when to do the BSE.

 

乳房自我检查示范影片

 

 

Breast Self-Exam How-to

 

  

希望这些有关乳癌的小资讯对大家有帮助喔…

Hope all the basic info is useful for you: )

 

更多乳癌相关知识可参考：

从「安洁莉娜裘莉」事件谈乳癌BRCA1及BRCA2基因(←点我点我)

(资料来自:财团法人台湾癌症基金会)

http://www.canceraway.org.tw/page.asp?IDno=1734

more info about breast cancer:

http://www.cancer.org/cancer/breastcancer/

 

参考资料

Reference

1.How is breast cancer diagnosed?

http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-diagnosis

2.陈敏鋑、黄采薇(2012)癌症护理学(3版，66-71页‧台北市：华杏。