乳癌手術的沿革

Changing Trend in Breast Cancer Surgery

侯明鋒(Ming-Feng Hou) ； 陳芳銘(Fang-Ming Chen) ； 歐陽賦(Fu Ouyang)

《中華民國癌症醫學會雜誌》 24卷2期 (2008/04) Pp. 102-107

https://doi.org/10.6588/JCOS.2008.24.2.4

摘要

隨著對乳癌的觀念改變，乳癌的手術治療方式亦隨著時間演變。目前認為乳癌其實是一異質性的族群，乳癌自始至終可能只侷限於乳房內，但也可能在診斷的時候，已有遠端轉移。以乳管原位癌而言，乳房保留手術加上輔助性放射線治療，與全乳房切除術治療效果相當，針對腫瘤較小、病理型態較好、且切除邊緣大於1公分以上者，可考慮單獨乳房部份切除。而侵襲性乳癌的手術治療，則包括乳房保留手術加上放射線治療，及改良性全乳根除術。施行乳房保留手術前應考慮其相對及絕對的禁忌症，而不論是乳房保留或全乳房切除手術，都應考量腫瘤整形手術的觀念。轉移性乳癌的局部治療，及影像指引下乳癌除去術的治療效果尚在研究中。

關鍵字

乳癌 ； 乳房保留手術 ； 改良性全乳根除術 ； 腫瘤整形手術

並列摘要

The evolution of surgery for breast cancer reflects the changing concept of breast cancer. It is currently believed that breast cancer is a heterogeneous disease. Some patients may have their cancer confined to the breast throughout their life, while others may present with distant metastasis at the time of diagnosis. For intraductal carcinoma, the result of breast conserving surgery with radiotherapy is comparable to that of total mastectomy. Breast conserving surgery without radiotherapy may be considered in tumors with a small tumor size, favorable histopathology and a surgical margin more than one centimeter. For invasive ductal carcinoma, both breast conserving surgery with radiotherapy and modified radical mastectomy are viable options. When breast conserving surgery is chosen, absolute and relative contraindications should be considered. In addition, whatever option is taken, the principle of oncoplastic surgery should be incorporated in the surgical planning. The efficacy of local treatment of metastatic breast cancer and the potential of imaged-guided ablation of breast cancer are under investigation.

並列關鍵字

breast cancer ； breast conserving surgery ； modified radical mastectomy ； oncoplastic surgery