医学英语疾病介绍——Breast-Cancer(乳腺癌)ppt课件

.,1,BreastCancer,乳腺癌,.,2,“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”。,ThePinkRibbon,.,3,BreastCancerToday概述CausesAndRiskFactors病因学BreastAnatomy解剖学结构PathologicalChanges病理改变Metastasis转移Symptoms症状SignsAndTests诊断Staging分期Treatment治疗Expectations预后Prevention预防Summary综述,.,4,BreastCancerTodayInAmerica,Breastcancertodayisnotwhatitwas20yearsago.Survivalratesareclimbing,thankstogreaterawareness,moreearlydetection,andadvancesintreatment.(归功于更多的关注，更早的监测和更先进的治疗技术)Forroughly200,000Americanswhoarediagnosedwithbreastcancereachyear(每年约有二十万美国人被诊断为乳腺癌),thereareplentyofreasonstobehopeful.InAmerica,About1outof8womenarediagnosedwithbreastcancereveryyear.(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),.,5,BreastCancerTodayInChina,Chinaisoneofthecountrieswithlowerincidenceofbreastcancer(中国是乳腺癌低发病率的国家之一),Butinrecentyears,theincidenceincreasedsignificantly(但近年来发病率出现了引人注目的增长),Anannual(每年的)increaseof3%to4%,Morethan1to2%oftheworldlevel,Theincidencerateisoneofthewomenmostsusceptibletotumor(发病率为女性易患肿瘤第一位).,Theincidenceofbreastcancerfromage40to60yearsgenerally,Butchinesepatientswithearlyageofonset,The45-year-oldisthemaximumageofsickness.(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),.,6,Hormonalinfluence(激素影响):Longdurationofreproductive(riprdktv)life(育龄的长时间持续)Nulliparity(,nliprti未产妇)Lateageatfirstchild(老龄生育)Functioningovarian(veri:n)tumor(卵巢肿瘤影响)Fibrocystic(,fabrosstk)disease(乳腺纤维囊性病)Radiationexposure(射线照射)Obesity(肥胖)Geneticpredisposition(pridspzn)(遗传倾向)Virus(病毒),CausesAndRiskFactorsOutline,.,7,Themostobviousriskfactorforbreastcancerisbeingawoman.Mengetthedisease,too,butitisabout100timesmorecommoninwomen.Othertopriskfactorsincludebeingoverage55orhavingacloserelative(有亲缘关系)whohashadthedisease.Butkeepinmindthatupto80%ofwomenwithbreastcancerhavenofamilyhistoryoftheillness(80%的乳腺癌患者并无家族病史).,CausesAndRiskFactorsBreastCancer:WhyMe?,.,8,ThegenesmostcommonlyinvolvedinbreastcancerareknownasBRCA1andBRCA2.Womenwithmutations(突变)inthesegeneshaveuptoan80percentchanceofgettingbreastcanceratsomepointinlife(有大于80%的几率在其一生的某个年龄段罹患乳腺癌).,CausesAndRiskFactorsBreastCancerGenes,.,9,Beingoverweight(过度肥胖),gettingtoolittleexercise(极少锻炼),anddrinkingmorethanonealcoholicbeverageperday(每天喝超过一定量的含酒精饮料)canraisetheriskofdevelopingbreastcancer.Birthcontrolpills(避孕药)andsomeformsofpostmenopausal(pst,menpzl)hormonetherapy(某些形式的绝经后激素疗法)canalsoboostyourrisk(提高发病几率).Recentstudiessuggestthatphysicalactivity(体育活动)mayhelplowertheriskofarecurrence(降低复发率)anditsaprovenmood-booster(被公认为“愉悦情绪激发器”).,CausesAndRiskFactorsRiskFactorsinYourControl,.,10,BreastAnatomy,.,11,outerupperquadrant(外上四分之一区域)50%,Centralzone(中心区域)20%,10%outerlowerquadrant(外下四分之一区域),10%innerlowerquadrant(内下四分之一区域),innerupperquadrant(内上四分之一区域)10%,BreastAnatomySite(发病部位):,.,12,Breastcancerisacancerthatstartsinthetissuesofthebreast.Therearetwomaintypesofbreastcancer(乳腺癌有两种主要类型):Ductalcarcinoma(导管癌)startsinthetubes(ducts)thatmovemilkfromthebreasttothenipple(从乳房向乳头运输乳汁的导管).Mostbreastcancersareofthistype(大多数乳腺癌隶属此种类型).Lobular(lbjl)carcinoma(小叶癌)startsinthepartsofthebreast,calledlobules(lbjul),thatproducemilk(产生乳汁的小叶).,PathologicalChanges,.,13,Breastcancermaybeinvasive(nvesv,侵袭性的)(临床常见约占70%)ornoninvasive.Invasivemeansithasspreadfromthemilkductorlobuletoothertissuesinthebreast(已经从乳腺管向其他组织扩散).Noninvasivemeansithasnotyetinvadedotherbreasttissue(尚未累及其他乳腺组织).Noninvasivebreastcanceriscalled“insitu(sitju:).”(非侵袭性乳腺癌又称为原位癌)Ductalcarcinomainsitu(DCIS)orintraductalcarcinoma(导管内原位癌),isbreastcancerintheliningofthemilkducts(穿过乳腺导管壁)thathasnotyetinvadednearbytissues(累及邻近组织).Itmayprogresstoinvasivecancerifuntreated(如未及时治疗会发展为侵袭性癌).Lobularcarcinomainsitu(LCIS)(小叶原位癌),isamarkerforanincreasedriskofinvasivecancerinthesameorbothbreasts(它是一个向一侧或双侧乳房呈侵袭性癌发展的危险标志).,PathologicalChanges,.,14,Comedocarcinoma(粉刺癌)(隶属非浸润性癌中的导管内原位癌(DCIS)highgrademalignant(mlgnnt)cells,centralnecrosis(nekrss),microcalcifications(,klsfken)(高度恶性细胞，中央区域坏死，微钙化),.,15,Grossly(肉眼观):infiltrating(nfltret)thesurroundingbreasttissues,(乳腺组织周围浸润)stony(stni)hardonpalpation(plpet)(触诊坚硬如石),retracted(rtrkt),dimpling(dmpl)ofskin(皮肤收缩凹陷).Massorropy(rp)cords(团块状或丝状束),nocapsule(无被囊包被),infiltratingperipheral(prf()r()l)tissues(浸润累及周围组织).,Invasiveductalcarcinoma(浸润性导管癌)(隶属浸润性癌)(临床常见约占70%),.,16,Morebilateral(balt()r()l)(多累及双侧乳腺),multicentricdiffusely(difju:zli)invasive(弥漫性多灶性分布)singlefilesofsmallcellsinconcentricring(同心的环状)aboutducts(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)andpoorlycircumscribed(skmskrab)(与周围组织无明确界限),Invasivelobularcarcinoma(浸润性小叶癌)(隶属浸润性癌),.,17,Directspread(直接扩散)Lymphatic(lmftk)(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,andBrain.(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,.,18,Thereareoftennosymptomsofbreastcancer,butsometimeswomenmaydiscoverabreastproblemontheirown.Signsandsymptomstobeawareofmayinclude:Apainlesslump(lmp)(无痛的肿物)inthebreast.Changesinbreastsizeorshape(乳房大小和形状改变).Swellinginthearmpit(mpt).(腋窝处隆起)Nipplechangesordischarge.(乳头变化或出现非生理性泌乳),Symptoms,.,19,Signsandtests,Testsusedtodiagnoseandmonitorpatientswithbreastcancer(用于诊断和监控乳腺癌患者的试验)mayinclude:Mammography(mmgrf)(乳房X线摄影术)toscreenforbreastcancer(显示乳腺癌病灶)orhelpidentifythebreastlump.(帮助辨别乳房肿物)Theearlierbreastcancerisfound,theeasieritistotreat.Andmammograms,X-raysofthebreast,candetecttumors(能够探测肿瘤)beforetheyarelargeenoughtofeel(在它们生长到足够大以至于可以被感觉到之前).,.,20,Signsandtests,BreastMRI(乳房核磁共振成像)tohelpbetteridentifythebreastlump(帮助更好地辨别乳房肿物的性质)orevaluate(vljet)anabnormalchangeonamammogram(评估乳房造影摄片上可见的异常改变)Breastultrasound(ltrsand)(乳房超声检测)toshowwhetherthelumpissolid(固态的)orfluid-filled(充满液体的),Anultrasoundcanhelpdeterminethepresenceofcysts,fluid-filledsacsthatarenotcancer(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(mgnetk)Resonance(rez()nns)Imaging核磁共振成像,.,21,Signsandtests,Theonlysurewaytodeterminewhetheralumpiscanceristodoabiopsy(baps)(活体组织切片检查).Thisinvolvestakingatissuesampleforfurtherexaminationinthelab,sometimesthroughasmallneedle(通过细小针头抽取).Sometimessurgeryisdonetotakepartofortheentirelumpfortesting(手术切除部分肿物送检).Theresultswillshowwhetherthelumpiscancer,andifso,whattype.(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),.,22,Itwasoncewidelyrecommendedthatwomenchecktheirownbreastsonceamonth(一月一检).Butstudiessuggestthesebreastself-examsplayaverysmallroleinfindingcancer(实际成效并不显著).Thecurrentthinkingisthat(现在的想法是)itsmoreimportanttoknowyourbreasts(更重要的是要了解你的乳房)andbeawareofanychanges(并且及时注意你的乳房出现的任何改变),ratherthancheckingthemonaregularschedule(比定时规律地检查它们更加有效).,SignsandtestsBreastSelf-Exams,.,23,First,dontpanic(首先不要恐慌).Eightypercentofbreastlumpsarenotcancerous(80%的乳房肿块并不是癌性的).Lumpsoftenturnouttobeharmlesscysts(常常被证明是无害的囊肿)ortissuechangesrelatedtoyourmenstrual(menstrl)cycle(或是与你的月经周期相关的组织改变).Butyoushouldletyourdoctorknowrightawayifyoufindanythingunusual(不寻常的)inyourbreast.Ifitiscancer,theearlieritsfoundthebetter.Andifitsnot,testingcangiveyoupeaceofmind.,SignsandtestsWhatIfYouFindaLump?,.,24,Oncebreastcancerhasbeendiagnosed(一旦被确诊为乳腺癌),thenextstepistodeterminehowbigthetumorisandhowfarthecancerhasspread.Thisprocessiscalledstaging(这个过程称为分期).,Staging,DoctorsuseStages0-4todescribewhethercancerislocalized(是否局限于)tothebreast,hasinvaded(nved)nearbylymphnodes(已经侵入临近淋巴结),orhasspreadtootherorgans(或是已经扩散到其他器官),suchasthelungs(常扩散到肺).,.,25,Therearemanytypesofbreastcancersurgery,fromtakingouttheareaaroundthelump(lumpectomy(lmpktmi)(乳房肿瘤切除术)orbreast-conservation(knsve()n)(保留)surgery(乳腺癌保乳治疗)toremovingtheentirebreast(mastectomy(mstektm)(外科全乳房切除术).)Itsbesttodiscusstheprosandcons(各自的优缺点)ofeachoftheseprocedures(prsi:d)(流程)withyourdoctorbeforedecidingwhatsrightforyou.,TreatmentSurgery,.,26,RadiationTherapy(erp)(放射疗法)forBreastCancerRadiationtherapyuseshigh-energyraystokillcancercells(用高能量的射线杀伤癌细胞).Itmaybeusedafterbreastcancersurgerytowipeoutanycancercellsthatremain(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).Itcanalsobeusedalongwithchemotherapy(,kim()erp;,kem-)(与化疗一同使用)fortreatmentofcancerthathasspreadtootherpartsofthebody(针对已经扩散到身体其他部位的乳腺癌).Sideeffectscaninclude(副作用包括)fatigue(ftig)(疲劳)andswelling(水肿)orasunburn-likefeelinginthetreatedarea(治疗局部有烈日灼烧感).,TreatmentAdditionalTreatments,.,27,TreatmentAdditionalTreatments,ChemotherapyforBreastCancerChemotherapyusesdrugstokillcancercellsanywhereinthebody(化疗使用药物来杀伤体内任何部位的癌细胞).ThedrugsareoftengivenbyIV(intravenousinjection通常采用静脉注射),butaresometimestakenbymouth(有时也经口服).Chemotherapymaybedoneaftersurgerytolowertheodds(优势，几率)ofthecancercomingback(术后进行化疗可以降低癌症的复发率).Inwomenwithadvancedbreastcancer(处于进展期乳腺癌的妇女),chemotherapycanhelpcontrolthecancersgrowth(化疗可以帮助控制肿瘤的生长).Sideeffects(副作用)mayincludehairloss(脱发),nausea(ns;-z-)(恶心),fatigue(疲劳),andahigherriskofinfection(更易受细菌感染).,.,28,Hormone-SensitiveBreastCancer(激素敏感型乳腺癌)Sometypesofbreastcancerarefueledbythehormonesestrogen(estrdn)(雌激素)orprogesterone(prdestrn)(孕酮)(某些类型的乳腺癌可由雌激素和孕酮刺激引起).Abiopsycanrevealwhetheratumorhasreceptorsforestrogen(ER-positive)and/orprogesterone(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).Abouttwooutofthreebreastcancersarehormonesensitive(已证实约2/3的乳腺癌是激素敏感性的).Thereareseveralmedicationsthatkeepthehormonesfrompromotingfurthercancergrowth(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).Theimageshowsamolecular(mlekjl)model(分子模型)ofanestrogenreceptor(雌激素受体).,TreatmentFirstYouShouldKnow,.,29,HormoneTherapyforBreastCancer(乳腺癌的激素疗法)HormonetherapyisaneffectivetreatmentforwomenwithER-positiveorPR-positivebreastcancer(激素疗法对ER阳性或PR阳性乳腺癌十分有效).Thesearecancersthatgrowmorerapidlyinresponsetothehormonesestrogenorprogesterone(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).Hormonetherapycanblockthiseffect(激素疗法可以阻断这个效应).Itismostoftenusedafterbreastcancersurgerytohelpkeepthecancerfromcomingback.Itmayalsobeusedtoreducethechanceofbreastcancerdevelopinginwomenwhoareathighrisk(激素疗法同样也能减少乳腺癌易感妇女的患病几率).,TreatmentAdditionalTreatments,.,30,HER2-PositiveBreastCancer(高雌激素应答者-2阳性乳腺癌)Inabout20%ofpatients(约有20%的病人),breastcancercellshavetoomanyreceptorsforaproteincalledHER2(乳腺癌细胞内有过多针对HER2蛋白的受体).ThistypeofcancerisknownasHER2-positive(HER2-阳性),andittendstospreadfasterthanotherformsofbreastcancer(这类乳腺癌的发生发展要远远快于其他形式的乳腺癌).ItsimportanttodeterminewhetheratumorisHER2-positive(判定是否为HER-2阳性乳腺癌显得尤为重要),becausetherearespecialtreatmentsforthisformofcancer(因为这类乳腺癌有着特殊的治疗方法).AHER2-positivebreastcancercellisillustrated(lstret)here(图解为一个HER2-阳性的乳腺癌细胞),withabnormalgrowthsignalsshowningreen(图中绿色标识为异常生长信号).,TreatmentFirstYouShouldKnow,.,31,TargetedDrugs(靶向药物治疗)forBreastCancerTargetedtherapies(靶向药物疗法)arenewerdrugs(新药)thattargetspecificpropertieswithincancercells(具有攻击癌细胞的特性).Forexample,womenwithHER2-positivebreastcancerhavetoomuchofaproteincalledHER2(举例来说，一个HER2-阳性乳腺癌妇女体内有过多的HER2蛋白).Targetedtherapiescanstopthisproteinfrompromotingthegrowthofcancercells(靶向药物可以阻断这些蛋白促进癌细胞生长的作用).Thesedrugsareoftenusedincombination(kmbne()n)withchemotherapy(这些药物经常与化疗结合使用).Theytendtohavemilder(mald)sideeffectscomparedtochemotherapy.(相对化疗来说副作用较小),TreatmentAdditionalTreatments,.,32,Theresnodoubtthatcancerisalife-changingexperience.Thetreatmentscanwearyouout(使你精疲力尽).Youmayhavetroublemanagingdailychores(t)(日常家庭杂务),work(工作),orsocialoutings(社交).Thiscanleadtofeelingsofisolation(这可能会导致让你觉得自己被孤立了).Itscrucialtoreachouttofriendsandfamilyforsupport(因而多接触朋友、获得家人的支持是至关重要的).Theymaybeabletogowithyoutotreatments,helpoutwithchores,orjustremindyouthatyouarenotalone.Manypeoplechoosetojoinasupportgroup(许多患者会选择参加一个互助小组)-eitherlocallyoronline(无论是本地的还是网上的).,ExpectationsLifeAfterDiagnosis,.,33,Manywomenwhohaveabreastremovedchoosetoundergoreconstructivesurgery(经受重建外科手术).Thisreplacestheskin,nipple,andbreasttissuethatarelostduringamastectomy(全乳房切除术).Reconstruction(乳房再造术)canbedonewithabreastimplant(mplnt)(乳房假体)orwithtissuefromsomewhereelseinyourbody(或是来源于你身体上其他部位的组织),suchasthetummy(tm胃，肚子).Somewomenopttobeginreconstructionatthesametimeastheirmastectomy(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).Butitsalsopossibletohavereconstructivesurgerymonthsoryearslater(当然切除乳房后数月甚至数年再进行乳房再造术亦可).,ExpectationsBreastReconstruction(乳房再造术),.,34,Analternativetobreastreconstruction(一种不做乳房再造术的替代方式)istobefittedfor(适合于)abreastform.Thisisabreast-shapedprosthesis(prsiss;prs,ss)(这是一种类似乳房形状的假体)thatfitsinsideyourbra(能够适合于你的胸罩).Wearingabreastformallowsyoutohaveabalancedlook(和谐的外观)whenyouaredressed-withoutundergoingadditionalsurgery(不用遭受额外的手术).Likereconstructivesurgery,breastformsareoftencove