乳腺癌根治術(shù)后放療課件整理

乳腺癌術(shù)后放療(二)乳腺癌(改良)根治術(shù)后放療宋銳乳腺癌術(shù)后放療(二)1今乳腺癌的保乳術(shù)乳腺癌的根治術(shù)及改良根治術(shù)今乳腺癌的保乳術(shù)2☆保乳術(shù)是指完整切除腫塊塊及腋淋巴結(jié)清掃?！羧橄侔└问中g(shù)是指整個(gè)乳房,胸大肌,胸小肌、腋窩及鎖骨下淋巴結(jié)的整塊切除。今改良術(shù)由兩種,一種是保留胸大肌,切除胸小肌,一種是指保留胸大小肌,前者淋巴結(jié)清除范圍與根治術(shù)相仿,后者不能清除腋上組淋巴結(jié)☆保乳術(shù)是指完整切除腫塊塊及腋淋巴結(jié)清掃。3保乳術(shù)的相對(duì)指征:1腫瘤≤30cm2腋窩淋巴結(jié)未見(jiàn)腫大3單個(gè)及非多中心或病灶4.大乳房5年青保乳術(shù)的相對(duì)指征:4今乳腺根治術(shù)后放療今乳腺根治術(shù)后放療5NarionalComprehensiveNCCNCancerNetworkNCCNClinicalPracticeGuidelinesinOncology(NCCNGuidelines)BreastcancerVersion3.2019NCCN.orgNccnGuidelinesforPatientsavailableatnccn.colContinueNarional6NCCNCaonprnensvNCCNGuidelinesVersion3.2019StagingNCCNGuidelinesIndexBreastCancerTableofcontenNetwork"BreastCancerDiscussionTNMStagingSystemForBreastCancereextensiontothechestwallrimaryTumor(T)TheTclassificationoftheprimarysgeshessbemeasrredstotheeaestmilameterfthefumersizeth.Note:Invasionofthedermisalonedoesnotqualifyhestwall,notincludingonlmmatorycarcinomaimarytumorcategonzerbasednthesizedcharactsiesortheisease.althoughtheTumor520lessingrTImiTumors1mmingreatestdimensionbuts5mmingreatestdimensionTumor>5mmbut510mmingreatestdimensioT1cTumor>10mmbuts20mmingreatestdimensionstagingcontinuedonnextpage(51-2)ScNo,c3013none.TheNOCNGadeirecandtasianuwnotterepodcadhnangtmaST-1NCCNCa7ComprchensiveNCCNGuidelinesVersion3.2019StagingNCCNGuidelinesIndexNCCNncerBreastCancerTable1(continued)Pathologic(pN)(continued)lymphnodeslymphnodebiapsybutnotclinicallydetectedmorethanclinicallydetectedisdefinedasnotdetectedbyimagingstudiesDN1bMetastasenalmammarynodeswithbasedonfneneedleaspirationbiopsywithcyclonicexaminationmacrometastasesdetectedbysentinellymphnodebiopsystantMopN2Metastasesin4-9axillarylymphnodes;orinclinicalllargerthan0.2mminapatientwithoutsymptomsorsignspNAdepositgreaterthan2.0nymphnodes(atleastonetumorM1Distantdetectablmetastasesasdeterminedbyclassicclinicalandclinicallydetected"intemalmammarylymphnodesintheabofaxillarybymphnodePMetastasesintenorPNaStagingcontinuedonnextpageST-41STComprchensiveNCCNGuidelines8NCCNGuideinesIndexNCCNCancerNCCNGuidelinesVersion3.2019StagingBreastCancerTbleoNetworkBreastCanceNATOMICSTAGEPROGNOSTICGROUPSstagestage舊BMMMMM加G2Intermediatecombinedhistologiegrade(mederatelyfavorable)therwisespecfied)MPaget'sdiseaseandintraductTDastasesonlyareexcludedfromclassifiedStageIBInvasiveCarcinomaslDshouldbecirDuctalaedullarywithlymphoidstromarecarriedoutMucronTHamisLFritscheH,MennelRetal.AmericanSocietyofClinicalOncologyPostneoadjuvanttherapyisdesignatedwithycoryppremo.ofnote,nothereisacompletepathologicresponse(CR)adjuvanttherapy,forexample,ypTDypNOcMOHISTOLOGICGRADE(G0C以R知如shouldbegraded.ThcombinedheinclusionofthisinformationhereindoesnotauthorizeessedSpringersBM,onbehalfoftheAJCCwordn3ulEau3西Nancarhawakhcicu,Nihsenst.TheNCCNGaklee'andttshuaanmayndteregodacadhnanntmwtothe.paswhenpodandNNCCNGuideinesIndex9NcCN乳腺癌解剖學(xué)紫色:T3(腫瘤最大黃色:Ts(原位癌)直徑>50mm)紅色:T4(腫瘤無(wú)論綠色:T1(腫瘤最大大小,直接侵犯胸壁直徑≤20mm)和/或皮膚)黑色:已遠(yuǎn)處轉(zhuǎn)移色:T2(腫瘤最大直徑>20mm,但50mm)NcCN乳腺癌解剖學(xué)10乳腺癌根治術(shù)后放療課件整理11乳腺癌根治術(shù)后放療課件整理12乳腺癌根治術(shù)后放療課件整理13乳腺癌根治術(shù)后放療課件整理14乳腺癌根治術(shù)后放療課件整理15乳腺癌根治術(shù)后放療課件整理16乳腺癌根治術(shù)后放療課件整理17乳腺癌根治術(shù)后放療課件整理18乳腺癌根治術(shù)后放療課件整理19乳腺癌根治術(shù)后放療課件整理20乳腺癌根治術(shù)后放療課件整理21乳腺癌根治術(shù)后放療課件整理22乳腺癌根治術(shù)后放療課件整理23乳腺癌根治術(shù)后放療課件整理24乳腺癌根治術(shù)后放療課件整理25乳腺癌根治術(shù)后放療課件整理26乳腺癌根治術(shù)后放療課件整理27乳腺癌根治術(shù)后放療課件整理28乳腺癌根治術(shù)后放療課件整理29乳腺癌根治術(shù)后放療課件整理30乳腺癌根治術(shù)后放療課件整理31乳腺癌根治術(shù)后放療課件整理32乳腺癌根治術(shù)后放