医学英语疾病介绍——Breast-Cancer(乳腺癌).ppt

单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Breast Cancer,乳腺癌,“,粉红丝带,”,作为全球乳腺癌防治活动的公认标识，用于宣传,“,及早预防，及早发现，及早治疗,”,这一信息，足迹遍布全球数十个国家。各国政府亦将每年的,10,月定为,“,乳腺癌防治月,”,。粉红丝带是一场关爱乳房的运动，更是人们对健康和美丽的一种追求，她已经成为了一种爱心和时尚，她正在世界各地迅速升温，越来越多的媒体、政要、名人、明星正在参与进来，我们已经进入了一个全新的,“,粉红时代,”,。,The Pink Ribbon,Breast Cancer Today,概述,Causes And Risk Factors,病因学,Breast Anatomy,解剖学结构,Pathological Changes,病理改变,M,etastasis,转移,Symptoms,症状,Signs And Tests,诊断,Staging,分期,Treatment,治疗,Expectations,预后,Prevention,预防,Summary,综述,Breast Cancer Today In America,Breast cancer today is not what it was 20 years ago.Survival rates are climbing,thanks to greater awareness,more early detection,and advances in treatment.(,归功于更多的关注，更早的监测和更先进的治疗技术,),For roughly 200,000 Americans who are diagnosed with breast cancer each year(,每年约有二十万美国人被诊断为乳腺癌,),there are plenty of reasons to be hopeful.,In America,About 1 out of 8 women are diagnosed with breast cancer every year.(,在美国，一年统计数据表明，大约每八个女性中有一个会罹患乳腺癌,),Breast Cancer Today In China,China is one of the countries with lower incidence of breast cancer(,中国是乳腺癌低发病率的国家之一,),But in recent years,the incidence increased significantly(,但近年来发病率出现了引人注目的增长,),An annual(,每年的,)increase of 3%to 4%,More than 1 to 2%of the world level,The incidence rate is one of the women most susceptible to tumor(,发病率为女性易患肿瘤第一位,).,The incidence of breast cancer from age 40 to 60 years generally,But chinese patients with early age of onset,The 45-year-old is the maximum age of sickness.(,乳腺癌的好发年龄为,4060,岁，但我国患者发病年龄提前，,45,岁为发病最高峰,),Hormonal influence(,激素影响,):,Long duration of reproductive,(riprdktv),life(,育龄的长时间持续,),Nulliparity,(,nli,p,rti,未产妇,),Late age at first child(,老龄生育,),Functioning ovarian,(veri:n),tumor(,卵巢肿瘤影响,),Fibrocystic,(,fabro,sstk),disease(,乳腺纤维囊性病,),Radiation exposure(,射线照射,),Obesity(,肥胖,),Genetic predisposition,(pridsp,zn)(,遗传倾向,),Virus(,病毒,),Causes And Risk Factors,Outline,The most obvious risk factor for breast cancer is being a woman.Men get the disease,too,but it is about 100 times more common in women.Other top risk factors include being over age 55 or having a close relative(,有亲缘关系,)who has had the disease.But keep in mind that up to 80%of women with breast cancer have no family history of the illness (,80%的乳腺癌患者 并无家族病史,).,Causes And Risk Factors,Breast Cancer:Why Me?,The genes most commonly involved in breast cancer are known as BRCA1 and BRCA2.Women with mutations(,突变,)in these genes have up to an 80 percent chance of getting breast cancer at some point in life(,有大于,80%,的几率在其一生的某个年龄段罹患乳腺癌,).,Causes And Risk Factors,Breast Cancer Genes,Being overweight(,过度肥胖,),getting too little exercise(,极少锻炼,),and drinking more than one alcoholic beverage per day(,每天喝超过一定量的含酒精饮料,)can raise the risk of developing breast cancer.,Birth control pills(,避孕药,)and some forms of postmenopausal,(pst,men,pzl),hormone therapy(,某些形式的绝经后激素疗法,)can also boost your risk(,提高发病几率,).,Recent studies suggest that physical activity(,体育活动,)may help lower the risk of a recurrence(,降低复发率,)and its a proven mood-booster(,被公认为“愉悦情绪激发器”,).,Causes And Risk Factors,Risk Factors in Your Control,Breast Anatomy,outer,upper quadrant (,外上四分之一区域,),50%,Central zone(,中心区域,),20%,10%,outer,lower quadrant(,外下四分之一区域,),10%,inner,lower quadrant (,内下四分之一区域,),inner upper,quadrant (,内上四分之一区域,),10%,Breast Anatomy,Site(,发病部位,):,Breast cancer is a cancer that starts in the tissues of the breast.There are two main types of breast cancer(,乳腺癌有两种主要类型,):,Ductal carcinoma(,导管癌,)starts in the tubes(ducts)that move milk from the breast to the nipple(,从乳房向乳头运输乳汁的导管,).Most breast cancers are of this type(,大多数乳腺癌隶属此种类型,).,Lobular,(lbjl),carcinoma(,小叶癌,)starts in the parts of the breast,called lobules,(lbjul),that produce milk(,产生乳汁的小叶,).,Pathological Changes,Breast cancer may be invasive,(n,vesv,侵袭性的,)(,临床常见约占70%),or noninvasive.Invasive means it has spread from the milk duct or lobule to other tissues in the breast(,已经从乳腺管向其他组织扩散,).Noninvasive means it has not yet invaded other breast tissue(,尚未累及其他乳腺组织,).Noninvasive breast cancer is called“in situ,(sitju:).,”,(,非侵袭性乳腺癌又称为原位癌,),Ductal carcinoma in situ(DCIS)or intraductal carcinoma(,导管内原位癌,),is breast cancer in the lining of the milk ducts(,穿过乳腺导管壁,)that has not yet invaded nearby tissues(,累及邻近组织,).It may progress to invasive cancer if untreated(,如未及时治疗会发展为侵袭性癌,).,Lobular carcinoma in situ(LCIS)(,小叶原位癌,),is a marker for an increased risk of invasive cancer in the same or both breasts(,它是一个向一侧或双侧乳房呈侵袭性癌发展的危险标志,).,Pathological Changes,Comedocarcinoma(,粉刺癌,)(,隶属非浸润性癌中的导管内原位癌,(DCIS),high grade malignant,(mlgnnt),cells,central necrosis,(nekrss),micro calcifications,(,k,lsfken)(,高度恶性细胞，中央区域坏死，微钙化,),Grossly(,肉眼观,):,infiltrating,(nfltret),the surrounding breast tissues,(,乳腺组织周围浸润,)stony,(stni),hard on palpation,(p,lpet)(,触诊坚硬如石,),retracted,(rtr,kt),dimpling,(dmpl),of skin(,皮肤收缩凹陷,).Mass or ropy,(rp),cords(,团块状或丝状束,),no capsule(,无被囊包被,),infiltrating peripheral,(prf()r()l),tissues(,浸润累及周围组织,).,Invasive ductal carcinoma(,浸润性导管癌,)(,隶属浸润性癌,)(,临床常见约占,70%),More bilateral,(ba,l,t()r()l)(,多累及双侧乳腺,),multicentric diffusely,(di,fju:zli),invasive(,弥漫性多灶性分布,)single files of small cells in concentric ring(,同心的环状,)about ducts(,癌细胞呈列兵样排列,部分围绕乳腺小导管环形排列,).,Grossly(,肉眼观,):,rubbery,(rbr)(,切面呈橡皮样,)and poorly circumscribed,(skmskrab)(,与周围组织无明确界限,),Invasive lobular carcinoma(,浸润性小叶癌,)(,隶属浸润性癌,),Direct spread(,直接扩散,),Lymphatic,(lmf,tk)(,淋巴道转移,):,Axillary,(,kslr),node(,腋窝淋巴结,),Subclavian,(sbklevn),node(,锁骨下淋巴结,).,Bloodstream(,血道转移,):,Lung,Bone,Liver,and Brain.(,肺、骨、肝和脑,),1,锁骨上淋巴结,2,锁骨下淋巴结,3,腋窝淋巴结,4,胸肌内淋巴结,5,乳内淋巴结,Metastasis,There are often no symptoms of breast cancer,but sometimes women may discover a breast problem on their own.Signs and symptoms to be aware of may include:,A painless lump,(lmp)(,无痛的肿物,)in the breast.,Changes in breast size or shape(,乳房大小和形状改变,).,Swelling in the armpit,(,mpt).(,腋窝处隆起,),Nipple changes or discharge.(,乳头变化 或出现非生理性泌乳,),Symptoms,Signs and tests,Tests used to diagnose and monitor patients with breast cancer(,用于诊断和监控乳腺癌患者的试验,)may include:,Mammography,(m,mgrf)(,乳房X线摄影术,),to screen for breast cancer(,显示乳腺癌病灶,)or help identify the breast lump.(,帮助辨别乳房肿物,),The earlier breast cancer is found,the easier it is to treat.And mammograms,X-rays of the breast,can detect tumors(,能够探测肿瘤,)before they are large enough to feel(,在它们生长到足够大以至于可以被感觉到之前,).,Signs and tests,Breast MRI(,乳房核磁共振成像,)to help better identify the breast lump(,帮助更好地辨别乳房肿物的性质),or evaluate,(,v,ljet),an abnormal change on a mammogram(,评估乳房造影摄片上可见的异常改变),Breast ultrasound,(,ltrsand)(,乳房超声检测,),to show whether the lump is solid(,固态的,)or fluid-filled(,充满液体的,),An ultrasound can help determine the presence of cysts,fluid-filled sacs that are not cancer(,超声检测可以帮助判定病灶区包囊的出现和充满液体的囊并非都是癌症改变,).,MRI:,Magnetic,(m,g,netk),Resonance,(,rez()nns),Imaging,核磁共振成像,Signs and tests,The only sure way to determine whether a lump is cancer is to do a biopsy,(,baps)(,活体组织切片检查,).,This involves taking a tissue sample for further examination in the lab,sometimes through a small needle(,通过细小针头抽取,).Sometimes surgery is done to take part of or the entire lump for testing(,手术切除部分肿物送检,).,The results will show whether the lump is cancer,and if so,what type.(,活检结果会显示肿 物是否为癌症，如果是还 可以判定它的型别,),It was once widely recommended that women check their own breasts once a month(,一月一检,).But studies suggest these breast self-exams play a very small role in finding cancer(,实际成效并不显著,).,The current thinking is that(,现在的想法是,)its more important to know your breasts(,更重要的是要了解你的乳房,)and be aware of any changes(,并且及时注意你的乳房出现的任何改变,),rather than checking them on a regular schedule(,比定时规律地检查它们更加有效,).,Signs and tests,Breast Self-Exams,First,dont panic(,首先不要恐慌,).Eighty percent of breast lumps are not cancerous(80%,的乳房肿块并不是癌性的,).Lumps often turn out to be harmless cysts(,常常被证明是无害的囊肿,)or tissue changes related to your menstrual,(,menstrl),cycle(,或是与你的月经周期相关的组织改变,).But you should let your doctor know right away if you find anything unusual(,不寻常的,)in your breast.If it is cancer,the earlier its found the better.And if its not,testing can give you peace of mind.,Signs and tests,What If You Find a Lump?,Once breast cancer has been diagnosed(,一旦被确诊为乳腺癌,),the next step is to determine how big the tumor is and how far the cancer has spread.This process is called staging(,这个过程称为分期,).,Staging,Doctors use Stages 0-4 to describe whether cancer is localized(,是否局限于,)to the breast,has invaded,(nved),nearby lymph nodes(,已经侵入临近淋巴结,),or has spread to other organs(,或是已经扩散到其他器官,),such as the lungs(,常扩散到肺,).,There are many types of breast cancer surgery,from taking out the area around the lump(lumpectomy,(lm,pktmi)(,乳房肿瘤切除术,)or breast-conservation,(kns,ve()n)(,保留,)surgery(,乳腺癌保乳治疗,)to removing the entire breast(mastectomy,(mstektm)(,外科,全乳房切除术,).)Its best to discuss the pros and cons(,各自的优缺点,)of each of these procedures,(prsi:d)(,流程,)with your doctor before deciding whats right for you.,Treatment,Surgery,Radiation Therapy,(,erp)(,放射疗法,),for Breast Cancer,Radiation therapy uses high-energy rays to kill cancer cells(,用高能量的射线杀伤癌细胞,).It may be used after breast cancer surgery to wipe out any cancer cells that remain(,通常在乳腺癌手术之后采用放射疗法来清除任何残存的癌细胞,).It can also be used along with chemotherapy,(,kim(),erp;,kem-)(,与化疗一同使用,)for treatment of cancer that has spread to other parts of the body(,针对已经扩散到身体其他 部位的乳腺癌,).Side effects can include(,副作用包括,)fatigue,(f,tig)(,疲劳,)and swelling(,水肿,)or a sunburn-like feeling in the treated area(,治疗局部有烈日 灼烧感,).,Treatment,Additional Treatments,Treatment,Additional Treatments,Chemotherapy for Breast Cancer,Chemotherapy uses drugs to kill cancer cells anywhere in the body(,化疗使用药物来杀伤体内任何部位的癌细胞,).The drugs are often given by IV(,intravenous injection,通常采用静脉注射,),but are sometimes taken by mouth(,有时也经口服,).Chemotherapy may be done after surgery to lower the odds(,优势，几率,)of the cancer coming back(,术后进行化疗可以降低癌症的复发率,).In women with advanced breast cancer(,处于 进展期乳腺癌的妇女,),chemotherapy can help control the cancers growth(,化疗可以 帮助控制肿瘤的生长,).Side effects(,副作用,)may include hair loss(,脱发,),nausea,(,ns;-z-)(,恶心,),fatigue (,疲劳,),and a higher risk of infection(,更易受细菌感染,).,Hormone-Sensitive Breast Cancer(,激素敏感型乳腺癌,),Some types of breast cancer are fueled by the hormones estrogen,(,estrdn)(,雌激素,)or progesterone,(pr,destrn)(,孕酮)(某些类型的乳腺癌可由雌激素和孕酮刺激引起,).A biopsy can reveal whether a tumor has receptors for estrogen(ER-positive)and/or progesterone(PR-positive)(,活检可以显示肿瘤是否有雌激素受体(,ER,阳性,)和,孕酮受体,(PR,阳性,).About two out of three breast cancers are hormone sensitive(,已证实约2/3的乳腺癌是激素敏感性的,).There are several medications that keep the hormones from promoting further cancer growth(,已知 有多种药物能够阻止这些 激素进一步促进癌症的发展,).,The image shows a molecular,(m,lekjl),model(,分子模型,)of an estrogen receptor(,雌激素受体,).,Treatment,First You Should Know,Hormone Therapy for Breast Cancer(,乳腺癌的激素疗法,),Hormone therapy is an effective treatment for women with ER-positive or PR-positive breast cancer(,激素疗法对,ER,阳性或,PR,阳性乳腺癌十分有效,).These are cancers that grow more rapidly in response to the hormones estrogen or progesterone(,即指对雌激素和孕酮的反应具有生长加速作用的乳腺肿瘤,).Hormone therapy can block this effect(,激素疗法可以阻断这个效应,).It is most often used after breast cancer surgery to help keep the cancer from coming back.It may also be used to reduce the chance of breast cancer developing in women who are at high risk (,激素疗法同样也能减少乳腺癌 易感妇女的患病几率,).,Treatment,Additional Treatments,HER2-Positive Breast Cancer(,高雌激素应答者-2阳性乳腺癌,),In about 20%of patients(,约有20%的病人,),breast cancer cells have too many receptors for a protein called HER2(,乳腺癌细胞内有过多针对,HER2,蛋白的受体,).This type of cancer is known as HER2-positive(HER2-,阳性,),and it tends to spread faster than other forms of breast cancer(,这类乳腺癌的发生发展要远远快于其他形式的乳腺癌,).Its important to determine whether a tumor is HER2-positive(,判定是否为,HER-2,阳性乳腺癌显得尤为重要,),because there are special treatments for this form of cancer(,因为这类乳腺 癌有着特殊的治疗方法,).,A HER2-positive breast cancer cell is illustrated,(,lstret),here(,图解为一个,HER2-,阳性的乳腺癌细胞,),with abnormal growth signals shown in green(,图中绿色标 识为异常生长信号,).,Treatment,First You Should Know,Targeted Drugs(,靶向药物治疗,)for Breast Cancer,Targeted therapies(,靶向药物疗法,)are newer drugs,(新药),that target specific properties within cancer cells(,具有攻击癌细胞的特性,).For example,women with HER2-positive breast cancer have too much of a protein called HER2(,举例来说，一个,HER2-,阳性乳腺癌妇女体内有过多的,HER2,蛋白,).Targeted therapies can stop this protein from promoting the growth of cancer cells(,靶向药物可以阻断这些蛋白促进癌细胞生长的作用,).These drugs are often used in combination,(kmb,ne()n),with chemotherapy(,这些药物 经常与化疗结合使用,).They tend to have milder,(,mald,),side effects compared to chemotherapy.(,相对化疗来说 副作用较小,),Treatment,Additional Treatments,Theres no doubt that cancer is a life-changing experience.The treatments can wear you out(,使你精疲力尽,).You may have trouble managing daily chores,(t)(,日常家庭杂务,),work(,工作,),or social outings(,社交,).This can lead to feelings of isolation(,这可能会导致让你觉得自己被孤立了,).Its crucial to reach out to friends and family for support(,因而多接触朋友、获得家人的支持是至关重要的,).They may be able to go with you to treatments,help out with chores,or just remind you that you are not alone.Many people choose to join a support group (,许多患者会选择参加一个互助 小组,)-either locally or online (,无论是本地的还是网上的,).,Expectations,Life After Diagnosis,Many women who have a breast removed choose to undergo reconstructive surgery(,经受重建外科手术,).This replaces the skin,nipple,and breast tissue that are lost during a mastectomy(,全乳房切除术,).Reconstruction(,乳房再造术,)can be done with a breast implant,(mpl,nt)(,乳房假体,)or with tissue from somewhere else in your body(或是来源于你身体上其他部位的组织,),such as the tummy(,tm,胃，肚子,).Some women opt to begin reconstruction at the same time as their mastectomy(,一些妇女选择在 做全乳房切除术的同时就进行 乳房再造术,).But its also possible to have reconstructive surgery months or years later (,当然切除乳房后数月甚至数年 再进行乳房再造术亦可,).,Expectations,Breast Reconstruction(,乳房再造术,),An alternative to breast reconstruction(,一种不做乳房再造术的替代方式,)is to be fitted for(,适合于,)a breast form.This is a breast-shaped prosthesis,(prs,iss;,prs,ss)(,这是一种类似乳房形状的假体,)that fits inside your bra(,能够适合于你的胸罩,).Wearing a breast form allows you to have a balanced look(,和谐的外观,)when you are dressed-without undergoing additional surgery(,不用遭受额外的手术,).Like reconstructive surgery,breast forms are often covered by insurance,(n,r()ns)(,通常由 保险公司支付,).,Expectations,Breast Forms,Many risk factors,such as your genes and family history,cannot be controlled.However,eating a healthy diet and making a few lifestyle changes may reduce your overall chance(,总体几率,)of getting cancer.,There is still little agreement about whether lifestyle changes can prevent breast cancer.The best advice is to eat a well-balanced diet(,平衡的膳食,)and avoid focusing(,避免只关注,)on one“cancer-fighting”food(,所谓的抗癌食物,).The American Cancer Societys(,美国癌症协会,)dietary guidelines(,膳食指南,)for cancer prevention recommend that people:,Choose foods and portion sizes(,一部分大小,)that promote a healthy weight(,健康地增加体重,),Prevention,Prevention,Choose whole grains instead of refined grain products(,选择全麦食物而不是精制谷物产品,),Eat 5 or more servings of fruits and