Treatment-Breast cancer in women

如果您患有乳腺癌，则应分配一个多学科团队（MDT），这是一群专家，他们共同提供最佳的治疗和护理。

乳腺癌的主要治疗方法是：

• 手术
• radiotherapy
• chemotherapy
• 激素疗法
• targeted therapy

You may have one of these treatments, or a combination. The type or combination of treatments you have will depend on how the cancer was diagnosed and the stage it's at.

Breast cancer diagnosed at routine screening may be at an early stage, but breast cancer diagnosed when you have symptoms may be at a later stage and require a different treatment.

Your MTD should discuss with you which treatments are most suitable.

为您选择正确的治疗

When deciding what treatment is best for you, your doctors will consider:

• 癌症的阶段和等级（它的大小和蔓延多远）
• your general health
• whether you have experienced the绝经

您应该可以随时与您的护理团队讨论您的治疗方法并提出问题。

Want to know more?

The online tool预测helps you see how different treatments for early invasive breast cancer might affect you.

Treatment overview

手术通常是乳腺癌治疗的第一类。您接受的手术类型将取决于您所拥有的乳腺癌类型。

手术通常进行化疗或放疗，或者在某些情况下是激素或靶向疗法。

同样，您将获得的治疗将取决于乳腺癌的类型。

Your doctor will discuss the most suitable treatment plan with you. Chemotherapy or hormone therapy will sometimes be the first treatment.

继发性乳腺癌

Most breast cancers are discovered at an early stage. But a small proportion of women discover they have breast cancer after it's spread to other parts of the body (metastasis).

If this is the case, the type of treatment you have may be different. Secondary cancer, also called "advanced" or "metastatic" cancer, is not curable.

治疗旨在使癌症缩小或消失的地方缓解，并且您会感到正常并能够充分享受生活。

Want to know more?

• Macmillan Cancer Support: treatments for breast cancer
• 乳腺癌现在：继发（转移）乳腺癌

Surgery

There are 2 main types of breast cancer surgery:

• breast-conserving surgery, where the cancerous lump (tumour) is removed
• 乳房切除术，清除整个乳房

In many cases, a mastectomy can be followed by reconstructive surgery to try to recreate a breast.

Studies have shown that breast-conserving surgery followed by radiotherapy is as successful as total mastectomy at treating early-stage breast cancer.

乳腺癌手术

乳腺癌手术的范围从肿块切除术或宽大的切除术，其中肿瘤和少量乳房组织被切除，到部分乳房切除术或四室切除术，最多可去除乳房的四分之一。

如果您接受了乳房的手术，则去除的乳腺组织量将取决于：

• 您患有癌症的类型
• the size of the tumour and where it is in your breast
• the amount of surrounding tissue that needs to be removed
• the size of your breasts

您的外科医生将始终清除肿瘤周围健康乳腺组织的区域，该区域将测试癌症的痕迹。

If there's no cancer present in the healthy tissue, there's less chance that the cancer will return.

If cancer cells are found in the surrounding tissue, more tissue may need to be removed from your breast.

经过乳房的手术后，通常会提供放射疗法来破坏任何剩余的癌细胞。

Mastectomy

A mastectomy is the removal of all the breast tissue, including the nipple.

If there are no obvious signs that the cancer has spread to your lymph nodes, you may have a mastectomy, where your breast is removed, along with a sentinel lymph node biopsy.

If the cancer has spread to your lymph nodes, you'll probably need more extensive removal (clearance) of lymph nodes from the area under your arm (axilla).

重建

乳房重建是手术，使新的乳房形状看起来像其他乳房一样尽可能多。

重建can be done at the same time as a mastectomy (immediate reconstruction), or it can be done later (delayed reconstruction).

可以通过插入乳房植入物或使用从身体另一部分的组织来创建新乳房来完成。

淋巴结手术

To find out if the cancer has spread, a procedure called a sentinel lymph node biopsy may be done.

前哨淋巴结是癌细胞扩散的第一个淋巴结。它们是您手臂下淋巴结的一部分（腋窝淋巴结）。

前哨淋巴结的位置有所不同，因此使用放射性同位素和蓝色染料的组合来鉴定它们。

The sentinel lymph nodes are examined in the laboratory to see if there are any cancer cells present. This provides a good indicator of whether the cancer has spread.

如果前哨节点中有癌细胞，则可能需要进一步的手术来从手臂下方去除更多的淋巴结。

Want to know more?

• Cancer Research UK: types of breast cancer surgery
• 现在的乳腺癌：乳房重建和假肢

放疗

放射疗法使用受控剂量的辐射杀死癌细胞。通常在手术和化学疗法后进行杀死任何剩余的癌细胞。

If you need radiotherapy, your treatment will begin about a month after your surgery or chemotherapy to give your body a chance to recover.

您可能每周3至5天进行3至5周的放​​疗课程。每个会话将持续几分钟。

放疗的类型

The type of radiotherapy you have will depend on the type of breast cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.

Types of radiotherapy include:

• breast radiotherapy – after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
• 胸壁放射疗法 - 乳房切除术后，放射疗法被应用于胸壁
• 胸部提升 - 一些女性可能会在去除癌症的地区提供高剂量放射疗法的提升；但是，这可能会影响乳房的外观，尤其是如果您的乳房大，有时会产生其他副作用，包括乳房组织（纤维化）硬化
• 放射疗法对淋巴结 - 放射疗法针对腋窝（腋窝）和周围区域，以杀死可能在淋巴结中的癌症

放疗的副作用

放疗的副作用包括：

• 乳房上皮肤的刺激和黑暗，可能导致酸痛，红色，哭泣的皮肤
• extreme tiredness (fatigue)
• 由手臂下的淋巴结阻塞引起的手臂过多的液体积聚（淋巴水肿）

Want to know more?

• Macmillan Cancer Support: radiotherapy explained
• Breast Cancer Now: radiotherapy for primary breast cancer
• Cancer Research UK: radiotherapy for breast cancer

Chemotherapy

Chemotherapy involves using anti-cancer (cytotoxic) medicine to kill cancer cells.

通常在手术后使用它来破坏任何尚未去除的癌细胞。这称为辅助化疗。

在某些情况下，您可能在手术前接受化疗，这通常用于缩小大肿瘤。这称为新辅助化疗。

Several different medicines are used in chemotherapy, and 2 to 3 are often given at once.

药物和组合的选择将取决于您拥有的乳腺癌类型以及它已经传播了多远。

化学疗法通常作为门诊治疗，这意味着您不必在一夜之间住院。

这些药物通常是通过直接滴入静脉的。

In some cases, you may be given tablets that you can take at home. You may have chemotherapy sessions once every 2 to 4 weeks and then have a break. Each treatment session is known as a cycle. You may have up to 8 cycles of chemotherapy.

化学疗法的主要副作用是由其对正常健康细胞（例如免疫细胞）的影响引起的。

Side effects of chemotherapy include:

• 感染
• loss of appetite
• feeling sick
• being sick
• 疲倦
• 脱发
• 嘴巴酸痛

可以通过医生可以开出的药物来预防或控制许多副作用。

Chemotherapy medicine can also stop the production of oestrogen in your body, which is known to encourage the growth of some breast cancers.

If you have not experienced the menopause, your时期在进行化学疗法治疗时可能会停止。

After you have finished the course of chemotherapy, your ovaries should start producing oestrogen again.

但这并不总是发生，您可以输入early menopause。这在40岁以上的女性中更有可能，因为她们更接近更年期时代。

您的医生将与您讨论治疗对您的生育能力的影响。

Chemotherapy for secondary breast cancer

如果您的乳腺癌已超出乳腺癌，淋巴结扩展到身体的其他部位，化疗将无法治愈癌症，但它可能会缩小肿瘤，缓解症状并帮助您延长生活。

Want to know more?

• Breast Cancer Now: chemotherapy
• 英国癌症研究：乳腺癌化学疗法
• 麦克米伦癌的支持：化学疗法解释

Hormone treatment

一些乳腺癌被激素雌激素或孕激素刺激，这些癌症自然在您的体内发现。这些被称为激素受体阳性癌症。

Hormone therapy lowers the levels of oestrogen or progesterone hormones in your body or stops their effects.

您所拥有的激素疗法的类型将取决于癌症的阶段和成绩，癌症对您的年龄敏感，是否经历过更年期以及您所拥有的其他类型的治疗方法。

手术和化学疗法后，您可能会接受激素治疗，但是有时会在手术前进行肿瘤并更容易切除。

Hormone therapy may be used as the only treatment for breast cancer if your general health prevents you having surgery, chemotherapy or radiotherapy.

在大多数情况下，手术后需要服用5年或更长时间的激素治疗。

如果您的乳腺癌类型对激素不敏感，则激素治疗将无效。

他莫昔芬

他莫昔芬stops oestrogen from binding to oestrogen-receptor-positive cancer cells. It's taken every day as a tablet or liquid.

芳香酶抑制剂

If you have experienced the menopause, you may be offered an aromatase inhibitor.

This type of medicine blocks aromatase, a substance that helps the body to produce oestrogen after the menopause. Before the menopause, oestrogen is made by the ovaries.

3 aromatase inhibitors may be offered. These areanastrozole，埃米斯坦和letrozole。These are taken as a tablet once a day.

卵巢消融或抑制

在尚未经历过更年期的女性中，雌激素是由卵巢产生的。

卵巢消融或抑制可阻止卵巢的工作和产生雌激素。

可以使用手术或放射疗法进行消融。它永久阻止卵巢工作，这意味着您会尽早体验更年期。

卵巢抑制涉及使用一种称为Goserelin的药物，这是一种曲曲霉激素释放激素激动剂（LHRHA）。

您的期间将在您服用时停止，尽管一旦您的治疗完成，他们应该再次开始。

If you're approaching the menopause (around the age of 50), your periods may not start again after you stop taking goserelin.

Goserelin是您每月一次的注射。

Want to know more?

• 乳腺癌现在：激素治疗

Targeted therapies

Targeted therapies are medicines that change the way cells work and help to stop cancer from growing and spreading. Not all types of breast cancer can be treated with targeted therapies

最常用用于治疗乳腺癌的靶向疗法是曲妥珠单抗（也以品牌名称Herceptin而闻名）。

Some targeted therapies are given through a drip into a vein. Others come as tablets.

Side effects of targeted therapies include:

• 颤抖和不适
• diarrhoea
• feeling and being sick
• headache
• 咳嗽
• 皮疹

Want to know more?

• Breast Cancer Now: targeted therapies for breast cancer
• Cancer Research UK: targeted cancer drugs

感染的风险

一些用于治疗乳腺癌的药物会使您更容易受到感染的影响。如果您出现可能的感染症状，则应立即与您的护理团队联系，例如：

• 高温
• 感到发抖
• you suddenly feel very unwell even though your temperature may be normal

Bisphosphonates

如果您经历了更年期，则可能会提供双膦酸盐（唑来膦酸或氯膦酸钠）。

最近的研究表明，它们可能有助于降低乳腺癌蔓延到您体内其他地方的风险。

双膦酸盐可能会与化学疗法同时给您，无论是直接进入静脉还是片剂。

很少会引起肾脏问题和颌骨的骨坏死（颌骨死亡时）。

您的医生将在开始此治疗之前解释可能的好处和可能的副作用。

Psychological support

对您，您的家人和朋友来说，处理癌症可能是一个巨大的挑战。它可能会造成情感和实际困难。

许多患有乳腺癌的妇女将不得不应对去除部分或全部乳房，这可能会非常沮丧。

It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness.

您的医院医生，专业护士或GP可以将您引用顾问。

If you're feelingdepressed，与GP交谈。一门课程antidepressantsmay help, or a GP can refer you to see a counsellor or psychotherapist.

与您经历过同一件事情的人交谈也可以帮助您。许多乳腺癌慈善机构都有求助热线和在线论坛，工作人员也可以使您与其他接受过癌症治疗的女性保持联系。

Want to know more?

• 现在乳腺癌：有人交谈
• Macmillan Cancer支持：在线社区

Clinical trials

在乳腺癌治疗中取得了很大的进展，现在有更多的女性寿命更长，治疗的副作用较少。

这些进步在临床试验，将新的治疗和治疗组合与标准治疗组合进行比较。

英国的所有癌症试验都经过精心监督，以确保它们有价值并安全地进行。

If you're invited to take part in a trial, you'll be given information about it and, if you want to take part, you'll be asked to sign a同意形式。

You can refuse or withdraw from a clinical trial without it affecting your care.

Want to know more?

• Against Breast Cancer: our research
• Breast Cancer Now: clinical trials
• 英国癌症研究：乳腺癌研究和临床试验

Complementary therapies

Complementary therapies是可以帮助改善身体和情感健康的疗法。

They're given alongside conventional treatments and include:

• breathing exercises for stress
• 按摩
• aromatherapy
• acupuncture

Complementary therapies can help some women cope with their diagnosis and treatment, and provide a break from their regular treatment plan.

您的医院或乳房单元可能能够提供互补疗法的机会，或建议您在哪里获得它们。

重要的是要与您的乳腺癌专家护士谈谈您希望尝试确保不会干扰您的常规治疗的任何补充疗法。

Want to know more?

• 立即乳腺癌：互补疗法

NHS会资助无执照的药物吗？

It's possible for your doctor to prescribe a medicine outside the uses it's licensed for if they're willing to take personal responsibility for this 'off-licence' use of treatment.

您的当地临床调试小组（CCG）可能需要参与其中，因为它必须决定是否支持您的医生的决定并从NHS预算中支付药物。