1、第 1 页 共 3 页Dalian Medical University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 CancerSymptoms and SignsMost breast cancers are discovered as a lump by the patient or during routine physical examination or mammography. Less commonly, the presen
2、ting symptom is breast pain or enlargement or a nondescript thickening in the breast. Pagets 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. Ab
3、out 50% of patients with Pagets disease of the nipple have a palpable mass at presentation. 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 massa lump distinctly dif
4、ferent 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 chara
5、cterized by fixation of the lump to the chest wall 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 dorange). Matted or fixed axillary lymph nodes suggest tumor spread, as does supraclavicular or
6、 infraclavicular lymphadenopathy. Inflammatory breast cancer is characterized by diffuse inflammation and enlargement of the breast, often without a lump, and has a particularly aggressive courseDiagnosisTesting is required to differentiate benign lesions from cancer. Because early detection and tre
7、atment of breast cancer improves prognosis, this differentiation must be conclusive before evaluation is terminated.考生须知1、检查所发试卷是否和自己所报科目一致，试卷有无缺页、漏印、字迹模糊，如有可举手请求换卷。2、必须将自己的学号、姓名、专业班级写在试卷指定位置上。3、在试卷密封线以外填写姓名、学号或写有与答题内容无关的语句和作其它标记的试卷一律作废，后果自负。第 2 页 共 3 页Dalian Medical UniversityIf advanced cancer is
8、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 d
9、ecision 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
10、 ultrasound-guided 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 multiple cas
11、es 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 family history includes a single case of male breast cancer.Che
12、st 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 d
13、one 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 st
14、aging follow the TNM classification (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 health care practitioners, and mon
15、thly breast self-examination (BSE).Mammography, done annually, reduces mortality rate by 25 to 35% in women 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 (Nat
16、ional Cancer Institute), and no periodic mammography (American College 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 rather than replaces screening mammography. However, in some co
17、untries 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.第 3 页 共 3 页Dalian Medical University
