乳腺癌的诊断和综合治疗进展

乳腺癌是危害妇女健康的主要恶性肿瘤,全世界每年约有120万妇女发生乳腺癌,有超过扣万妇女死于乳腺癌。我国虽是乳腺癌的低发地区,但其发病率正逐年上升,尤其是沪、京、津及沿海地区是我国乳腺癌的高发地区。随着医学诊断和治疗技术的不断进步、新药的不断研制,乳腺癌已可通过手术、放疗、化疗和内分泌治疗获得较高的治愈率,尤其是早期患者。本文就近几年国外在乳腺癌诊断和分期的综合治疗等方面作以下综述。1乳腺癌的早期诊断对于乳腺癌的早期发现,乳腺X线检查是比较重要和常用的影像方式,但是临床上常由于不能正确地估计乳腺浸润…     

乳腺癌常规治疗失败后的替代药物

乳腺癌的治疗药物众多。多药耐药的复发或转移性乳腺癌患者,有很多可能在常规治疗失败之后考虑未曾用过的替代药物,包括:已上市但尚未被普遍认知的抗乳腺癌新药;已经上市用于其他肿瘤治疗但对乳腺癌可能有效的新药;已明确有效但一线治疗不常用于乳腺癌的细胞毒药物;已在临床研究但未上市的抗乳腺癌药物(我国肿瘤学界越来越多地加入国际多中     

研究护士在国内新药临床试验中的现状与进展

新药临床试验研究属于人体生物医学研究范畴,是新药开发研制过程中不可缺少而又极其重要的阶段。新药临床研究者通过试验,掌握人体对新药的耐受程度、新药的药代动力学指标以及药物的安全性、有效性研究数据,为药品上市提供临床相关依据。由于     

乳腺癌辅助化疗实施TT方案的护理

乳腺癌是危害妇女健康的主要恶性肿瘤,外科手术为乳腺癌治疗的主要手段.但基础与临床研究均证实,乳腺癌在临床确诊是50%～60%已有微小转移灶存在,单纯的手术治疗无法将乳腺癌根治.故作为全身治疗的化疗,日益被重视.紫杉醇注射液是一类具有抗微管作用的抗肿瘤新药.     

丹红注射液与盐酸罂粟碱注射液存在配伍禁忌

随着新药的不断研制及临床应用,目前注射药物禁忌表已经不能满足新药的查询要求,在临床工作中我们发现丹红注射液与盐酸罂粟碱注射液存在配伍禁忌。     

头孢他啶和盐酸氨溴索的配伍观察

随着新药的不断研制及应用于临床,原来的静脉注射药物禁忌表已经不能满足新药配伍的查询要求.在临床的工作中我们发现一些新药之间存在配伍禁忌,头孢他啶与盐酸氨溴索二者配伍会出现白色混浊.……     

沐舒坦与碳酸氢钠之间存在配伍禁忌

随着新药的不断研制及应用于临床，原来的静脉注射药物禁忌表已经不能满足新药配伍的查询要求。在临床工作中我们发现一些新药之间存在配伍禁忌，如沐舒坦与碳酸氢钠两者配伍会出现白色混浊。现报道如下。     

对开发中药新药的探讨

目的：本文主要探讨利用中药方剂、剂型开发中药新药。方法：对古今中药方剂、中西医治疗方法的比较、发展中药剂型进行分析。结果：研究中药方剂及其剂型开发中药新药切实可行。结论：应用中药方剂及剂型为研制中药新药奠定了基础。     

注射用复方骨肽与泮托钠唑存在配伍禁忌

随着新药的不断研制及运用于临床,原来的静脉注射药物禁忌表已经不能满足新药配伍查询要求.笔者发现注射用复方骨肽与注射用泮托钠唑存在配伍禁忌,报告如下.     

头孢他啶和盐酸氨溴索的配伍观察

随着新药的不断研制及应用于临床，原来的静脉注射药物禁忌表已经不能满足新药配伍的查询要求。在临床的工作中我们发现一些新药之间存在配伍禁忌，头孢他啶与盐酸氨溴索二者配伍会出现白色混浊。     

Pilot study of the breast cancer experiences of African American women with a family history of breast cancer: implications for nursing practice

Experts in the area of breast cancer detection and control recommend that women at increased risk discuss their risk status and risk management with their health care providers. In spite of the excessive breast cancer burden borne by African American women, little attention has been given to studying breast cancer risk communication and/or breast cancer risk management in this at-risk population group. This report summarizes the outcomes of a study undertaken to explore the degree to which breast cancer, breast cancer risk, and breast cancer risk management were discussed by African American women and their health care providers Targeted for inclusion in the study were African American women who had a first degree relative or multiple second degree relatives that had been diagnosed with pre-menopausal breast cancer. Of particular interest was the extent to which African American women with a family history of breast cancer perceived themselves to be at risk for developing breast cancer and the extent to which they discussed their family history, their breast cancer risk, and, breast cancer risk management with their providers.     

Chemoprevention of breast cancer among Asian women--its perspective and problems.

Chemoprevention of breast cancer employing tamoxifen and others has been demonstrated to be effective in reducing the frequency of developing breast malignancy in Western countries. In Asian countries, the frequency of breast cancer as well as its premalignant lesions has recently increased. Therefore, the possible chemoprevention may benefit those women with potential high risks of developing breast cancer and with premalignant lesions. However, the details of these findings of chemoprevention in Western countries have not been available for women with Asian descendant. In addition, risk factors of developing breast cancer in healthy women have not been established in Asian countries compared to Western countries with relative paucity of familial breast cancer cases. Thus, possible chemoprevention of breast cancer in Asian countries may be targeted toward those with established premalignant breast lesions such as ductal carcinoma in situ and/or atypical ductal hyperplasia. However, due to their recent increment of their incidence, biological and/or clinical features of these premalignant breast lesions have not been extensively characterized in Asian women and further investigations are required for wide spread chemoprevention.     

DNA甲基化在乳腺癌中的研究进展

随着DNA甲基化在乳腺癌中的分子机制逐渐被发现,得到临床的广泛认识和重视.DNA启动子高度甲基化会引起基因沉默,进而表达失调,并以此调控乳腺癌的发生 、发展,并且DNA甲基化检测能作为乳腺癌临床诊断及预后的生物标志物,为乳腺癌的治疗提供新的靶标,因此,DNA甲基化在乳腺癌中有重要价值和广阔的应用前景.本文综述DNA甲基...     

Breast cancer: new technologies for risk assessment and diagnosis.

In the US, one in every eight women will develop breast cancer in her lifetime. Despite the advances made in treating breast cancer, the causal mechanisms underlying this disease have yet to be fully elucidated; 85% of breast cancer cases occur sporadically without any known genetic mutation. Too little is known about the pathogenesis of breast cancer for primary prevention to be feasible in the near- to mid-term. Secondary prevention through screening offers an alternative that has been widely adopted. For decades, breast self-examination has been touted as a technique for the early identification of breast cancer. However, it has been recently suggested that this technique is a waste of time and resources for both doctors and patients. Mammography finds breast cancer earlier than breast self-examination, and will reduce the risk of death from breast cancer by approximately 30% in women over 50 years old. Mammography is limited in that cancer, like breast tissue, appears white on the x-ray; therefore lesions may be difficult to detect in women with very dense breasts, and a tumor may not cast a significant shadow until it is quite large. Some cancers are so aggressive that they can spread quickly, before routine screening can detect them. Despite these limitations, mammography is still viewed as the best tool currently available for screening and early diagnosis. Improved methods to detect and diagnose breast cancer early, when it is most curable, are required if a significant impact on morbidity and mortality from breast cancer is to be made. Various new and innovative technologies are being investigated for improving the early detection and diagnosis of breast cancer. About 85% of breast cancers begin in the milk ductal system of the breast. As cancer develops in the breast, abnormalities occur, including atypical hyperplasia, ductal carcinoma in situ, and invasive breast carcinoma. Thus, the early screening of ductal cells can provide a parallel benefit to the 'Pap' smear, which is used virtually universally to identify the abnormal cells that can lead to cervical cancer. Two technologies to monitor for atypical ductal epithelial cells are Cytyc Corporation's FirstCyte Ductal Lavage system and Nastech Pharmaceutical Company's Mammary Aspiration Cytology Test. Matritech, Inc. is searching for biomarkers linked to breast cancer. Researchers at Matritech have detected the presence of nuclear matrix protein (NMP) in the blood of women at the early stage of breast cancer, which is absent in the blood of healthy women, as well as those with fibroadenoma, a benign breast disease. NMP66 has been selected as a marker for further development and clinical trials of a test for use in the detection and monitoring of women with, or at risk for, breast cancer have been initiated. Technologies developed by the US Department of Defense are under investigation as breast cancer screening. Advanced Image Enhancement, Inc. has licensed naval sonar technology for digital image enhancement of mammograms. New thermography applications are also being investigated in two separate projects sponsored by the US Department of Defense using military thermal surveillance tools adapted for cancer detection. Both are enhancements of older thermal imaging technology based on the principle that heat equates to unwanted activity, in the case of breast cancer, abnormal cell proliferation.     

Updates in the Evaluation and Management of Breast Cancer

Breast cancer is the most commonly diagnosed cancer worldwide. More than 200,000 new cases of invasive breast cancer are diagnosed annually in the United States; approximately 40,000 patients die of the disease. The etiology of most breast cancer cases is unknown, although multiple factors predisposing to the disease have been identified. Apart from increasing age and female sex, these other factors account for only a minority of breast cancer diagnoses. This article provides an overview of the management of noninvasive and invasive breast cancer, which is often complex and varies according to patient factors, disease stage, and breast cancer subtype. Although much progress has been made, continued research endeavors are ongoing; enrollment of eligible patients in prospective clinical trials is an essential way to improve patient outcomes.     

基于乳腺癌干细胞的临床治疗进展

背景：肿瘤干细胞在肿瘤的发生、发展、转移和复发等方面发挥着重要的作用。由于常规疗法无法消灭乳腺癌干细胞,故乳腺癌干细胞已被假定为乳腺癌治疗失败的根源。目的：阐明乳腺癌干细胞的生物学特性及一些乳腺癌靶向治疗药物的疗效,为制定提高乳腺癌患者生存率的治疗方案提供一些建议。方法：应用计算机检索PubMed数据库2000-01/2010-08有关乳腺癌干细胞的标志物与鉴定、新型药物针对乳腺癌干细胞靶向治疗方面的相关文献,检索词为＂breast cancer,cancer stem cells,therapy＂,限定文章语言种类为English。检索文献包括临床研究、基础研究及综述类文章,初检得到文献总计203篇,排除重复性研究,保留33篇文献进一步分析。结果与结论：乳腺癌干细胞是第一个在实体瘤中被鉴定的肿瘤干细胞,人们采用多种策略成功分离出乳腺癌干细胞,对其生物学行为的认识正逐渐深入。乳腺癌干细胞的自我更新、分化等特性受到微环境和许多信号转导通路的调控。如何靶向治疗乳腺癌干细胞,最终根治乳腺癌,正逐渐成为肿瘤靶向治疗研究的一个热点。     

数字化钼铑双靶X线摄影对早期乳腺癌单纯簇状钙化的诊断应用研究

目的:通过分析研究数字化钼铑双靶乳腺X线摄片的影像表现,评价单纯簇状钙化对早期乳腺癌的诊断价值。材料与方法:使用美国LoradElite全数字化钼铑双靶乳腺摄影机型,常规头尾位、内斜位摄片及局部放大摄片,用全自动曝光条件。分析了68例经手术、病理证实的乳腺疾病,对68例钼铑双靶乳腺X线摄片中78个簇状钙化灶的形态、大小、数量及分布情况进行分析研究,观察其和早期乳腺癌的关系。结果:在本组68例乳腺疾病中,76个单纯簇状钙化经手术病理证实,发现32个乳腺癌(占47%),其中有17个为原位癌或早期导管浸润性癌(占53·125%);其余44个均为良性病变。乳腺内单纯簇状钙化是乳腺癌早期一个重要的甚至是唯一的征象,是检出乳腺癌的一个敏感但非特异性的指标。结论:乳腺钼铑X线数字摄影在发现单纯簇状钙化方面有不可代替的优势,优于其他检查设备,对无肿块乳腺癌的早期发现具有重要的价值。     

Review of hormonal treatment of breast cancer

This critical review focuses on the role of steroid hormones and their receptors in the development and treatment of breast cancer, with special reference to estrogen receptors, as well as mechanisms of receptor-ligand interactions, response or resistance to hormonal therapy against breast cancer, in conjunction with other modalities like surgery and chemotherapy. Tamoxifen is used in hormonal treatment of breast cancer for up to five years, depending on the presentation. However, there have been recent developments in hormonal therapy of breast cancer in the last ten years, with the introduction of many different alternative therapies for this condition. A critical review of published articles in Pubmed/Medline, Athens, AJOL, NHS Evidence, Science Direct and Google, relating to hormonal treatment of breast cancer, was undertaken, in order to evaluate the mechanisms of estrogen receptor-ligand interactions, their involvement in the etio-pathogenesis of breast cancer, resistance of breast cancer cells to anti-hormonal agents, as well as ways of treating breast cancer using anti-hormone drugs like tamoxifen. Although tamoxifen is the established drug for hormonal treatment of breast cancer, cases of hormone resistance breast cancer have been described recently in the literature. This can happen from the beginning, or during treatment. Therefore, we aim to examine the causes of resistance to hormonal treatment with a view to understand the options of tackling this problem, and suggest other novel alternative hormonal therapies that can be tried, which may overtake tamoxifen in the future. We also seek to emphasize that hormonal therapy has a definite place in the treatment of breast cancer along with surgery, chemotherapy and radiotherapy, as the disease is often considered to be multi-systemic even from the beginning.     

超声评估乳癌患者腋下淋巴结转移的临床价值

目的:通过对乳癌原发灶的灰阶超声,彩色多普勒(Color Doppler Flow Imaging,CDFI),频谱多普勒检查,评估腋下淋巴结有无转移。方法:术前运用超声检测122例乳癌患者原发灶的声学特性,术后根据腋下淋巴结有无转移分为两组,比较两组间年龄,原发灶的部位(象限分布),大小,内部回声,有无卫星灶,CDFI,频谱多普勒有无显著差异。结果:患者的年龄,内部回声,有无卫星灶,两组间无显著性差异;原发灶的大小,部位两组间有显著差异;CDFI显示:腋下淋巴结阳性组原发灶内血流比阴性组丰富(P<0.05);频谱多普勒显示:阳性组峰值流速(Vmax)高于阴性组(P<0.01),其中Vmax>33cm/s的14例患者腋下淋巴结均呈阳性。阻力指数(RI):两组间无显著差异,但如把RI=1的8位患者单独列组,两组间有显著差异(P<0.01)。结论:运用灰阶超声、多谱勒超声评价癌肿的声学特性,对判断腋下淋巴结状态,指导临床治疗,有一定帮助。     

钼靶摄片对乳腺癌的诊断及分析

目的 为进一步提高乳腺癌的诊断正确率。方法 钼靶诊断乳腺癌106例，经手术病理证实为乳腺癌95例。结果 钼靶摄片报告符合率为89.6%。95例有细小钙化灶，32例结构紊乱。结论 细小的钙化和结构紊乱对乳腺癌有重要的诊断价值。