大连医科大学硕士研究生试卷
2010年级专业外语试卷
学号 __________ 姓名 ______________ 命题单位：附属二院 教研室：肿瘤学 教研室主任审核签字: 阅卷人: _______
一 二 三 四 五 总分 分数
Breast Cancer
Symptoms and Signs
Most breast cancers are discovered as a lump by the patient or during routine physical
examination or mammography. Less commonly, the presentiiig symptom is breast pain or
?
enlargement or a nondescript thickening in the breast. Paget s disease of the nipple presents with skin changes, including erythema, crusting, scaling, and discharge; these usually appear so benign that the patient ignores them, delaying diagnosis for a year or
，
more. About 50% of patients with Pagets disease of the nipple have a palpable mass at presentstion. A few patients with breast cancer present with signs of metastatic disease (eg, pathologic fracture, pulmonary dysfunction).
A common finding during physical examination is a dominant mass一a lump distinctly different from the surrounding breast tissue. Diffuse fibrotic changes in a quadrant of the breast, usually the upper outer quadrant, are more characteristic of benign disorders; a slightly firmer thickening in one breast but not the other may be a sign of cancer. More advanced breast cancers are characterized by fixation of the lump to the chest wal 1 or to overlying skin, by satellite nodules or ulcers in the skin, or by exaggeration of the usual skin markings resulting from lymphedema (so-called peau d‘ orange). Matted or fixed axillary lymph nodes suggest tumor spread, as does suprac1avicu1ar or infraclavicular 1ymphadenopathy. Inflammatory breast cancer is characterized by diffuse inflammation and enlargement of the breast, often without a lump, and has a particularly aggressive course
Diagnosis
Testing is required to differentiate benign 1esions from cancer. Because early detection and treatment of breast cancer improves prognosis, this differentiation must be conclusive before evaluation is terminated.
If advanced cancer is suspected based on physical examination, biopsy should be done first; otherwise, the approach is as for breast lumps. A prebiopsy bilateral mammogram may help delineate other areas that should be biopsied and provides a baseline for future reference.
However, mammogram results should not alter the decision to perform a biopsy. Biopsy can be needle or incisional biopsy or, if the tumor is small, excisional biopsy. Any skin with the biopsy specimen should be examined because it may show cancer cells in dermal lymphatic vessels. Routinely, stereotactic biopsy (needle biopsy during mammography) or u1trasound-guidec! biopsy is being used to improve accuracy.
Evaluation after cancer diagnosis: Part of a positive biopsy specimen should be analyzed for estrogen and progesterone receptors and for HER2 protein. WBCs should be tested for BRCA1 and BRCA2 genes when family history includes multipie cases of early-onset breast cancer, when ovarian cancer develops in patients with a family history of breast or ovarian cancer, when breast and ovarian cancer occur in the same patient, when patients have Ashkenazi Jewish heritage, or when fami1y history includes a single case of male breast cancer.
Chest x-ray, CBC, and liver function tests should be done to check for metastatic disease. Generally, measuring serum carcinoembryonic antigen (CEA), cancer antigen (CA) 15~3, CA 27~29, or a combination is not recommended because results have no effect on treatment or outcome. Bone scanning should be done if patients have tumors 〉2 cm, musculoskeletal pain, lymphadenopathy， or elevated serum alkaline phosphatase or Ca levels. Abdominal CT is done if patients have abnormal liver function results, hepatomegaly, or locally advanced cancer with or without axillary lymph node involvement.
Grading and staging fol 1 ow the TNM classificatioii (see Table 2: Breast Disorders: Staging and Survival of Breast Cancer). Staging is refined during surgery, when regional lymph nodes can be evaluated.
Screening: Screening includes mammography, clinical breast examination (CBE) by heal th care practitioners, and month1y breast seif-exami nat i on (BSE).
Mammography, done annually, reduces mortality rate by 25 to 35% in women 三 50 yr. However, there is considerable disagreement about screening for women 40 to 50 yr; recommendations include annual mammography (American Cancer Society), mammography every 1 to 2 yr (Natioiial Cancer Tnstitute)， and no periodic mammography (American Col 1ege of Physicians).
CBE is usually part of routine annual care for women > 35; it can detect 7 to 10% of cancers that cannot be seen on a mammogram. In the US, CBE augments rat her than replaces screening mammography. However, in some countries where mammography is considered too expensive, CBE is the sole screen; reports on its effectiveness in this role vary.
BSE has not been shown to reduce mortality rate but is widely practiced. Because a negative BSE may tempt some women to forego mammography or CBE, the need for these procedures is reinforced when BSE is taught.
大连医科大学肿瘤研究生硕士试卷(专业外语).doc
