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1、乳腺癌骨轉(zhuǎn)移和骨相關(guān)疾病的診斷和治療Diagnosisandtreatmentofbonemetastasisofbreastcancer流行病學(xué)Epidemiology骨轉(zhuǎn)移的比例僅次于肺、肝臟的轉(zhuǎn)移Theratioofbonemetastasisissecondarytolungandliver通常為多發(fā)，單發(fā)轉(zhuǎn)移者僅占10%Usuallyformultiplebonemetastasis,only10%forsingle80%為中軸骨，如脊柱和骨盆80%foraxialskeleton,suchasthespineandpelv
2、is目錄Catalogue乳腺癌骨轉(zhuǎn)移概述1.Overview二.乳腺癌骨轉(zhuǎn)移診斷方法2.Diagnosticmethod三.乳腺癌骨轉(zhuǎn)移臨床表現(xiàn)3.Clinicalmanifestation四.乳腺癌骨轉(zhuǎn)移治療4.Treatment概述Overview骨轉(zhuǎn)移是乳腺癌最常見的遠(yuǎn)處轉(zhuǎn)移部位Bonemetastasisisthemostcommondistantmetastasesinbreastcancerpatients晚期乳腺癌骨轉(zhuǎn)移發(fā)生率為65%～75%Theincidenceofbonemetastasisinterminalb
3、reastcanceris65%～75%骨痛、骨相關(guān)事件（SREs）及生活質(zhì)量降低是乳腺癌骨轉(zhuǎn)移的常見并發(fā)癥Bonepain,bonerelatedevents(SREs)andreducedqualityoflifearecommoncomplicationsofbonemetastasisofbreastcancer參考文獻(xiàn)references1.ColemanRE.CancerTreatRev.2001Jun;27(3):165-76.2.JohnR.Johnson,GrantWilliams,etal.JClinOncol21
4、:1404-1411.3.KinnaneN.EurJOncolNurs.2007;11Suppl2:S28-31.Epub2007Sep4.診斷方法Diagnosis骨轉(zhuǎn)移初篩診斷方法：骨放射性核素掃描（ECT）Thepreliminaryscreeningmethodofbonemetastasis：ECT推薦用于出現(xiàn)骨疼痛、骨折、AKP升高、或高鈣血癥等可疑骨轉(zhuǎn)移的常規(guī)初篩診斷檢查Itisrecommendedtobeusedforpatientsofbonepain,fracture,AKPelevation,orhyperca
5、lcemia乳腺癌分期＞T3N1M0患者常規(guī)檢查Routineexaminationofpatientswithbreastcancerstage>T3N1M0復(fù)發(fā)轉(zhuǎn)移乳腺癌患者的常規(guī)檢查Routineexaminationofpatientswithrecurrentmetastasis骨轉(zhuǎn)移的影像學(xué)確診檢查方法：骨X線/CT/MRIConfirmedRadiographicdiagnosisofbonemetastasis:X-ray/CT/MRI60%-78%溶骨性破壞、10%-20%成骨性、12%-20%混合性O(shè)steolys
6、is60%-78%,ossify10%-20%,mixed12%-20%骨活檢：診斷乳腺癌骨轉(zhuǎn)移的金標(biāo)準(zhǔn)Biopsy:Diagnosticcriteriaforbonemetastasisinbreastcancer臨床表現(xiàn)Clinicalmanifestation癥狀：疼痛、病理性骨折、高鈣血癥、肢體功能障礙等Symptoms:pain,pathologicalfracture,hypercalcemia,andlimbdysfunction乳癌骨轉(zhuǎn)移特點(diǎn)：早期一般無(wú)癥狀，晚期疼痛劇烈，以夜間痛為主。Inearlystage:gen
7、eralasymptomatic;Inthelateseverepain,anditmainlyhappensatnight治療方法Treatment化療、內(nèi)分泌治療、分子靶向治療等Chemotherapy,endocrinetherapy,moleculartargetedtherapy鎮(zhèn)痛和其他支持治療Analgesiaandothersupportivetreatments雙膦酸鹽治療Diphosphonate手術(shù)治療Operation放射治療Radiationtherapy雙膦酸鹽治療Diphosphonate適應(yīng)癥:Indi
8、cations高鈣血癥Hypercalcemia骨痛Bonepain治療和預(yù)防骨相關(guān)事件（SREs）Treatmentandpreventionofbonerelatedevents明確有骨轉(zhuǎn)移的乳腺癌患者，應(yīng)首先考慮給
