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乳腺癌治疗（成人）(PDQ®)

乳腺癌概述

乳腺癌是乳腺组织中形成恶性（癌）细胞的一种疾病。

乳房由腺叶和导管组成。每个乳房有15到20个腺叶。每个腺叶都有许多乳小叶。乳小叶的末端有几十个可以制造乳汁的腺泡。腺叶、乳小叶和腺泡由称为导管的细管连接。

女性乳房的解剖。乳头和乳晕显示在乳房外侧。其他为乳腺内部的淋巴结、乳腺叶、乳腺小叶、导管和其他部分。

每个乳房也有血管和淋巴管。淋巴管携带一种几乎无色的水状液体，叫做淋巴。淋巴管在淋巴结之间运送淋巴。淋巴结是遍布全身的豆状小结构。它们过滤淋巴，储存有助于抵抗感染和疾病的白细胞。在腋窝（腋下）、锁骨上方和胸部的乳房附近都存在多组淋巴结。

乳腺癌最常见的类型是导管癌，其始于导管细胞。 始于腺叶或小叶的称为小叶癌，比其他类型的乳腺癌更常见于两个乳房。炎性乳腺癌是一种罕见的乳腺癌，表现为乳房发热、发红和肿胀。

有关乳腺癌的更多信息，请参阅以下PDQ摘要：

  • 乳腺癌预防
  • 乳腺癌筛查
  • 妊娠期乳腺癌的治疗
  • 男性乳腺癌治疗
  • 儿童乳腺癌的治疗

    • 有乳腺癌家族病史和其他因素会增加患乳腺癌的风险。

    任何会增加患病几率的因素都称为危险因素。有危险因素并不是说一定会得癌症；没有危险因素也不代表一定不会得癌症。如果认为自己有患病危险，请咨询医生。

    乳腺癌的危险因素包括：

  • 既往有浸润性乳腺癌、乳腺导管内原位癌或乳小叶原位癌的个人病史。
  • 拥有良性（非癌症）乳腺疾病史。
  • 一级亲属中有乳腺癌家族病史（母亲、女儿或姐妹）。
  • BRCA1或BRCA2基因或其他增加乳腺癌风险基因的遗传性变异。
  • 乳房X线光片中乳腺组织密集。
  • 乳腺组织暴露于人体产生的雌激素中。这可能是由以下原因造成的：
  • 初潮年龄小
  • 初胎年龄较大或从未生育
  • 较大年龄绝经
  • 服用激素，例如为应对某些更年期症状而同时服用黄体酮和雌激素。
  • 接受对乳腺/胸部的放射治疗。
  • 饮酒
  • 肥胖。

    • 年龄是大多数癌症的主要危险因素。随着年龄的增长，患癌症的几率也会增加。

    美国国家癌症研究所（NCI）的乳腺癌风险评估工具使用女性的风险因素来评估其在未来5年至90岁期间患乳腺癌的风险。该在线工具由医务人员应用。想要查看乳腺癌风险方面的更多信息，请电话咨询1-800-4-CANCER。

    乳腺癌有时是遗传性基因突变（变异）导致的。

    细胞中的基因携带着从父母那里获得的遗传信息。遗传性乳腺癌约占所有乳腺癌的5%至10%。某些与乳腺癌有关的突变基因在某些特定族群中更为常见。

    有某些基因突变的女性，例如BRACA1或BRACA2突变，患乳腺癌的风险会更高。这些女性同时会有更高的患卵巢癌的风险，患其他癌症的风险也可能会更高。有乳腺癌相关的基因突变的男性患乳腺癌的风险也会更高。有关更多信息，请参阅关于男性乳腺癌治疗的PDQ摘要。

    有些检测可用来找出变异的基因。这些基因检测有时被用于具有较高患乳腺癌风险的家庭成员。有关更多信息，请参阅乳腺癌和妇科癌遗传学的PDQ摘要。

    使用某些药物及其他方法可以降低患乳腺癌的风险。

    任何降低患某种疾病风险的因素称为保护性因素。

    乳腺癌相关的保护性因素包括以下：

  • 可采用以下：
  • 子宫切除术后的单纯雌激素治疗
  • 选择性雌激素受体调节剂(SERMs)
  • 芳香化酶抑制剂
  • 乳腺组织较少暴露于身体产生的雌激素。这可能是由于：
  • 早孕
  • 哺乳
  • 充分锻炼。
  • 接受任何以下手术：
  • 乳房切除术降低患癌症的风险
  • 卵巢切除术降低患癌症风险
  • 卵巢摘除

    • 乳腺癌的征兆包括乳房中的肿块或变化。

    这些及其他体征可能是由乳腺癌或其他原因引起的。 如果您有以下任何情况，请咨询医生：

  • 在乳房或其周围或腋下附近有肿起或增厚现象。
  • 乳房大小、形状改变。
  • 乳房皮肤下凹或起皱
  • 乳头向里凹陷。
  • 非母乳液体从乳头流出，如果带血的话尤其需要引起重视。
  • 乳腺、乳头或乳晕（乳头周围的深色区域）出现鳞状的、红色或肿胀的皮肤。
  • 乳房上的凹陷看起来像橘皮，称“橘皮样病变”。

    • 乳房相关检查可用于检测和诊断乳腺癌。

    如果发现乳房有任何变化，请咨询医生。可采用以下检查及方法：

  • 体检和病史：对身体进行的检查，以检查身体的一般健康迹象，包括疾病迹象检查，如肿块或任何看似异常的东西。同时还需参考患者的健康习惯、既往史及治疗史。
  • 临床乳腺检查是由医生或其他健康专家进行的一项检查。医生会仔细触摸乳房和腋下的肿块或其他看似异常的地方。
  • 乳房钼靶检查：对于乳腺的X光检查。
    • 乳腺钼靶 乳房被压在两个板之间。使用X光来拍摄乳房组织图像。
  • 超声检查：一种将高能声波（超声波）从内部组织或器官上反射并产生回声的检查方法。这些回声形成了一种称为超声图的人体组织图像。图像可以打印，用于后期查看。
  • 磁共振成像（MRI）：一种利用磁铁、无线电波和计算机对身体内部区域进行一系列详细成像的方法，也称为核磁共振成像(NMRI)。
  • 血液化学核查：一种检查血样中器官和组织所释放某些物质（如胆红素或乳酸脱氢酶(LDH)）含量的方法。某种物质含量异常（高于或低于正常值）可能是疾病的征兆。
  • 活组织检查：取出部分细胞或组织，由病理学家在显微镜下观察，以检查是否有癌症的迹象。如果发现乳房有肿块，可以进行活检。

    • 有四种活检方法可用于检查乳腺癌：

  • 切除活检：切除一整块组织。
  • 切取活检：取出部分肿块或组织样本。
  • 空心针活检：使用粗针取出组织。
  • 细针穿刺活检：使用细针取出组织或体液。

    • 如果检查出有癌症，需要进行更多检查来研究癌细胞。

    基于这些检查的结果做出何种治疗方案最佳的判断。这些检查有助于了解以下信息：

  • 癌症可能以何种速度扩散。
  • 癌症有多大几率扩散至全身。
  • 某些疗法效果如何
  • 癌症复发的几率有多大。

    • 这些检查包括：

  • 雌激素和孕激素受体检测：一种测量癌症组织中雌激素和孕激素（激素）受体含量的检测。 如果雌激素和孕激素受体高于正常水平，则该癌症称为雌激素和/或孕激素受体阳性。这种类型的乳腺癌可能会更快地生长。 检测结果可表明，阻断雌激素和孕激素的治疗是否可阻止癌的发展。
  • 人类表皮生长因子2型受体（HER2 / neu）检测：一种实验室检测，用于测量组织样本中有多少HER2 / neu基因以及产生多少HER2 / neu蛋白。如果HER2/neu基因含量大于正常量，则该癌症称为HER2 / neu阳性。这种类型的乳腺癌可能会更快地生长，并且更有可能扩散到身体的其他部位。可采用靶向HER2 / neu蛋白的药物（例如曲妥珠单抗和帕妥珠单抗）治疗该癌症。
  • 多基因检测：同时检测组织样本中多基因的活动规律。这种检测有助于预测癌症是否会扩散到身体的其他部位以及是否会复发。

    • 多基因测试的类型很多。 在临床试验中已经研究了以下多基因测试：

  • 癌型DX：该检测有助于预测雌激素受体阳性和淋巴结阴性的早期乳腺癌是否会扩散到身体的其他部位。 如果癌症扩散的风险很高，可给予化疗以降低风险。
  • MammaPrint：一项实验室检测，即在患有早期浸润性乳腺癌且未扩散到淋巴结或已扩散到3个或更少淋巴结的妇女的乳腺癌组织中，观察70种不同基因的活性。这些基因的活性水平有助于预测乳腺癌是否会扩散到身体其他部位或是否会复发。如果检测显示癌症扩散或复发的风险很高，可给予化疗来降低风险。

    • 根据这些检测，乳腺癌可被描述为以下类型之一：

  • 激素受体阳性（雌激素和/或孕激素受体阳性）或激素受体阴性（雌激素和/或孕激素受体阴性）。
  • HER2/neu阳性或HER2/neu阴性。
  • 三阴性（雌激素受体、孕激素受体和HER2 / neu阴性）。

    • 这些信息会帮助医生决定哪些疗法会对治疗你的癌症最有效。

    某些因素还会影响预后（恢复几率）和治疗方案的选择。

    预后和治疗方案取决于以下因素：

  • 癌症的阶段（肿瘤的大小以及是否仅在乳房中或已扩散到淋巴结或体内其他部位）。
  • 乳腺癌类型。
  • 肿瘤组织中雌激素受体和孕激素受体的水平。
  • 肿瘤组织中人表皮生长因子2型受体（HER2 / neu）的水平
  • 肿瘤组织是否为三阴性（不具有雌激素受体、孕激素受体或高水平的HER2/neu的细胞）。
  • 肿瘤增长的速度有多快。
  • 肿瘤复发的几率有多大。
  • 女性的年龄、整体健康状况、更年期情况（是否已经绝经）。
  • 癌症是刚被确诊还是属于复发。
    • Breast Cancer Treatment (Adult) (PDQ®)

    General Information About Breast Cancer

    Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

    The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes. Each lobe has many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can make milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

    Anatomy of the female breast. The nipple and areola are shown on the outside of the breast. The lymph nodes, lobes, lobules, ducts, and other parts of the inside of the breast are also shown.

    Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless, watery fluid called lymph. Lymph vessels carry lymph between lymph nodes. Lymph nodes are small, bean-shaped structures found throughout the body. They filter lymph and store white blood cells that help fight infection and disease. Groups of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.

    The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.

    See the following PDQ summaries for more information about breast cancer:

  • Breast Cancer Prevention
  • Breast Cancer Screening
  • Breast Cancer Treatment During Pregnancy
  • Male Breast Cancer Treatment
  • Childhood Breast Cancer Treatment

    • A family history of breast cancer and other factors increase the risk of breast cancer.

    Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk to your doctor if you think you may be at risk for breast cancer.

    Risk factors for breast cancer include the following:

  • A personal history of invasive breast cancer, ductal carcinoma in situ (DCIS), or lobular carcinoma in situ (LCIS).
  • A personal history of benign (noncancer) breast disease.
  • A family history of breast cancer in a first-degree relative (mother, daughter, or sister).
  • Inherited changes in the BRCA1 or BRCA2 genes or in other genes that increase the risk of breast cancer.
  • Breast tissue that is dense on a mammogram.
  • Exposure of breast tissue to estrogen made by the body. This may be caused by:
  • Menstruating at an early age.
  • Older age at first birth or never having given birth.
  • Starting menopause at a later age.
  • Taking hormones such as estrogen combined with progestin for symptoms of menopause.
  • Treatment with radiation therapy to the breast/chest.
  • Drinking alcohol.
  • Obesity.

    • Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.

    NCI's Breast Cancer Risk Assessment Tool uses a woman's risk factors to estimate her risk for breast cancer during the next five years and up to age 90. This online tool is meant to be used by a health care provider. For more information on breast cancer risk, call 1-800-4-CANCER.

    Breast cancer is sometimes caused by inherited gene mutations (changes).

    The genes in cells carry the hereditary information that is received from a person’s parents. Hereditary breast cancer makes up about 5% to 10% of all breast cancer. Some mutated genes related to breast cancer are more common in certain ethnic groups.

    Women who have certain gene mutations, such as a BRCA1 or BRCA2 mutation, have an increased risk of breast cancer. These women also have an increased risk of ovarian cancer, and may have an increased risk of other cancers. Men who have a mutated gene related to breast cancer also have an increased risk of breast cancer. For more information, see the PDQ summary on Male Breast Cancer Treatment.

    There are tests that can detect (find) mutated genes. These genetic tests are sometimes done for members of families with a high risk of cancer. See the PDQ summary on Genetics of Breast and Gynecologic Cancers for more information.

    The use of certain medicines and other factors decrease the risk of breast cancer.

    Anything that decreases your chance of getting a disease is called a protective factor.

    Protective factors for breast cancer include the following:

  • Taking any of the following:
  • Estrogen-only hormone therapy after a hysterectomy.
  • Selective estrogen receptor modulators (SERMs).
  • Aromatase inhibitors.
  • Less exposure of breast tissue to estrogen made by the body. This can be a result of:
  • Early pregnancy.
  • Breastfeeding.
  • Getting enough exercise.
  • Having any of the following procedures:
  • Mastectomy to reduce the risk of cancer.
  • Oophorectomy to reduce the risk of cancer.
  • Ovarian ablation.

    • Signs of breast cancer include a lump or change in the breast.

    These and other signs may be caused by breast cancer or by other conditions. Check with your doctor if you have any of the following:

  • A lump or thickening in or near the breast or in the underarm area.
  • A change in the size or shape of the breast.
  • A dimple or puckering in the skin of the breast.
  • A nipple turned inward into the breast.
  • Fluid, other than breast milk, from the nipple, especially if it's bloody.
  • Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple).
  • Dimples in the breast that look like the skin of an orange, called peau d’orange.

    • Tests that examine the breasts are used to detect (find) and diagnose breast cancer.

    Check with your doctor if you notice any changes in your breasts. The following tests and procedures may be used:

  • Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Clinical breast exam (CBE): An exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual.
  • Mammogram: An x-ray of the breast.
    • Mammography. The breast is pressed between two plates. X-rays are used to take pictures of breast tissue.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of both breasts. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, a biopsy may be done.

    • There are four types of biopsy used to check for breast cancer:

  • Excisional biopsy: The removal of an entire lump of tissue.
  • Incisional biopsy: The removal of part of a lump or a sample of tissue.
  • Core biopsy: The removal of tissue using a wide needle.
  • Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid, using a thin needle.

    • If cancer is found, tests are done to study the cancer cells.

    Decisions about the best treatment are based on the results of these tests. The tests give information about:

  • how quickly the cancer may grow.
  • how likely it is that the cancer will spread through the body.
  • how well certain treatments might work.
  • how likely the cancer is to recur (come back).

    • Tests include the following:

  • Estrogen and progesterone receptor test: A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more estrogen and progesterone receptors than normal, the cancer is called estrogen and/or progesterone receptor positive. This type of breast cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing.
  • Human epidermal growth factor type 2 receptor (HER2/neu) test: A laboratory test to measure how many HER2/neu genes there are and how much HER2/neu protein is made in a sample of tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer is called HER2/neu positive. This type of breast cancer may grow more quickly and is more likely to spread to other parts of the body. The cancer may be treated with drugs that target the HER2/neu protein, such as trastuzumab and pertuzumab.
  • Multigene tests: Tests in which samples of tissue are studied to look at the activity of many genes at the same time. These tests may help predict whether cancer will spread to other parts of the body or recur (come back).

    • There are many types of multigene tests. The following multigene tests have been studied in clinical trials:

  • Oncotype DX: This test helps predict whether early-stage breast cancer that is estrogen receptor positive and node negative will spread to other parts of the body. If the risk that the cancer will spread is high, chemotherapy may be given to lower the risk.
  • MammaPrint: A laboratory test in which the activity of 70 different genes is looked at in the breast cancer tissue of women who have early-stage invasive breast cancer that has not spread to lymph nodes or has spread to 3 or fewer lymph nodes. The activity level of these genes helps predict whether breast cancer will spread to other parts of the body or come back. If the test shows that the risk that the cancer will spread or come back is high, chemotherapy may be given to lower the risk.

    • Based on these tests, breast cancer is described as one of the following types:

  • Hormone receptor positive (estrogen and/or progesterone receptor positive) or hormone receptor negative (estrogen and/or progesterone receptor negative).
  • HER2/neu positive or HER2/neu negative.
  • Triple negative (estrogen receptor, progesterone receptor, and HER2/neu negative).

    • This information helps the doctor decide which treatments will work best for your cancer.

    Certain factors affect prognosis (chance of recovery) and treatment options.

    The prognosis and treatment options depend on the following:

  • The stage of the cancer (the size of the tumor and whether it is in the breast only or has spread to lymph nodes or other places in the body).
  • The type of breast cancer.
  • Estrogen receptor and progesterone receptor levels in the tumor tissue.
  • Human epidermal growth factor type 2 receptor (HER2/neu) levels in the tumor tissue.
  • Whether the tumor tissue is triple negative (cells that do not have estrogen receptors, progesterone receptors, or high levels of HER2/neu).
  • How fast the tumor is growing.
  • How likely the tumor is to recur (come back).
  • A woman’s age, general health, and menopausal status (whether a woman is still having menstrual periods).
  • Whether the cancer has just been diagnosed or has recurred (come back).
    • 乳腺癌治疗（成人）(PDQ®)

    乳腺癌的分期

    乳腺癌确诊之后，进行检测以查明癌细胞是在乳腺内扩散还是已扩散至身体其他部位。

    用来查明癌症是在乳腺内扩散还是已扩散至身体其他部位的过程称为分期。从分期过程中收集的信息决定了疾病所处阶段。为了计划治疗方案，了解癌症所处阶段很重要。一些用于诊断乳腺癌的检测结果也用于分期。（请参阅“一般信息”部分。）

    以下检测和方法也可用于分期过程：

  • 前哨淋巴结活检：术中切除前哨淋巴结。前哨淋巴结是一组淋巴结中第一个从原发肿瘤接受淋巴引流的淋巴结。这是癌症可能从原发性肿瘤扩散到的第一站淋巴结。在肿瘤附近注射放射性物质和/或蓝色染料。该物质或染料通过淋巴管流到淋巴结。取出接受该物质或染料的第一个淋巴结。病理学家在显微镜下观察组织以寻找癌细胞。如果未发现癌细胞，则可能没有必要去除更多的淋巴结。有时，在超过一组的淋巴结中发现前哨淋巴结。
  • X线胸片：是指胸腔内部器官和骨头的X射线片。X射线是能量光束的一种，可以穿透身体并成像，最后形成一张体内各区域情形的图片。
  • CT扫描（CAT扫描）：通过将电脑与X射线机连接从不同角度拍摄人体内部区域一系列详细图像的方法。可能需将染料注射至静脉或进行吞服，以提高器官或组织显示的清晰度，也称作计算机体层摄影术、计算机断层扫描、或计算机化轴向层面X射线摄影法。
  • 骨扫描：一种检查骨骼中是否存在快速分裂的细胞（例如癌细胞）的方法。极少量的放射性物质被注入静脉并随血流移动。放射性物质聚集在患癌的骨骼中，由扫描仪检测。
  • PET扫描（正电子发射断层扫描）：一种发现体内恶性肿瘤细胞的方法。少量放射性葡萄糖（糖）注入静脉。PET扫描仪绕着身体旋转，拍摄葡萄糖在身体中的位置。恶性肿瘤细胞比正常细胞更活跃，吸收更多的葡萄糖，因此在图片中显得更明亮。

    • 癌症在体内扩散有三种方式。

    癌症可通过组织、淋巴系统和血液扩散：

  • 组织。癌从其起源处向周围生长扩散。
  • 淋巴系统。癌通过侵入淋巴系统从其起源处扩散，经淋巴管到达身体其他部位。
  • 血液。癌通过侵入血液从其起源处扩散，经血管到达身体其他部位。

    • 癌可从起源处扩散至身体其他部位。

    当癌扩散至身体的另一部位时，称之为转移。癌细胞从起源（原发癌）处脱离并通过淋巴系统或血液移动。

  • 淋巴系统。癌侵入淋巴系统，通过淋巴管移动，在身体另一部位形成肿瘤（转移癌）。
  • 血液。癌侵入血液，通过血管移动，在身体另一部位形成肿瘤（转移癌）。

    • 转移瘤和原发性肿瘤是同一类型的癌症。例如，如果乳腺癌扩散到骨骼中，那么骨骼中的癌细胞实际上就是乳腺癌细胞。这种疾病是转移性乳腺癌，并不是骨癌。

    许多癌症死亡是由于癌从最初的肿瘤转移到其他组织和器官而造成的。这叫做转移癌。以下动画演示了癌细胞从其起源处转移至身体其他部位的方式。

    在乳腺癌中，分期取决于原发肿瘤的大小和位置、癌细胞向邻近淋巴结或身体其他部位的扩散情况、肿瘤分级以及是否出现某些生物标志物。

    为了规划最佳治疗方案并了解您的预后，了解乳腺癌的分期很重要。

    乳腺癌分3种类型：

  • 首先，临床预后阶段根据病史、体检、影像学检查（如果完成）和活检为所有患者划分阶段。临床预后阶段由TNM系统、肿瘤分级和生物标志物状态（ER、PR、HER2）进行描述。在临床分期中，使用钼靶摄像或超声检查淋巴结是否有癌症迹象。
  • 病理预后分期则用于首次接受手术治疗的患者。病理预后分期基于所有临床信息、生物标志物状态以及手术中切除的乳腺组织和淋巴结的实验室检测结果。
  • 解剖分期基于TNM系统描述的癌症大小和扩散情况。解剖分期用于缺乏生物标记物检测的地区。 在美国不使用。

    • TNM系统用于描述原发性肿瘤的大小以及肿瘤向邻近淋巴结或身体其他部位的扩散。

    对于乳腺癌，TNM系统描述肿瘤如下：

    肿瘤(T) 肿瘤的大小和位置

    肿瘤大小通常以毫米或厘米为单位。可以用mm表示肿瘤大小的常用项目包括：尖铅笔尖（1 mm）、新的蜡笔尖（2 mm）、铅笔式橡皮擦（5 mm）、豌豆（10 mm）、花生（20 mm）和石灰石（50 mm）。
  • TX：原发性肿瘤无法评估。
  • T0：无乳房原发肿瘤的征兆。
  • Tis：原位癌。原位乳腺癌有两种类型：
  • Tis (DCIS):DCIS是一种在乳腺导管内壁发生异常细胞的疾病。这些异常细胞没有扩散到乳腺导管外的其他组织。在某些情况下，DCIS可能成为浸润性乳腺癌，并能扩散到其他组织。目前，还没有办法知道哪些病变会成为侵袭性病变。
  • Tis（Paget病）：Paget病是一种在乳头皮肤细胞中发现异常细胞并可能扩散到乳晕的疾病。其不是根据TNM系统进行分期。如果Paget病和浸润性乳腺癌存在，TNM系统用于分期浸润性乳腺癌。
  • T1：肿瘤小于等于20mm。根据肿瘤的大小，T1肿瘤有4种亚型：
  • T1mi：肿瘤小于等于1毫米。
  • T1a：肿瘤大于1毫米但小于等于5毫米。
  • 肿瘤大于5毫米但小于等于10毫米。
  • 肿瘤大于10毫米但小于等于20毫米。
  • T2：肿瘤大于20毫米但小于等于50毫米。
  • T3：肿瘤大于50毫米。
  • T4：肿瘤描述如下：
  • T4a：肿瘤已经长到了胸壁。
  • T4b：肿瘤已长入皮肤，在乳房皮肤表面形成溃疡，与原发肿瘤在同一乳房内形成小肿瘤，和/或乳房皮肤发生肿胀。
  • T4c：肿瘤已经生长到胸壁和皮肤。
  • T4d：炎性乳腺癌的乳腺上三分之一或更多的皮肤是红色和肿胀的（称为橘皮样改变）。

    • 淋巴结（N）。癌细胞扩散的淋巴结的大小和位置。

    当淋巴结被手术切除并在显微镜下被病理学家研究时，病理分期被用来描述淋巴结。淋巴结的病理分期描述如下。

  • NX：无法评估淋巴结。
  • N0：淋巴结中没有癌症的迹象，或淋巴结中不超过0.2毫米的微小癌细胞团。
  • N1：有以下其中一种情况：
  • N1mi：癌细胞扩散到腋窝淋巴结，大于0.2毫米但小于等于2毫米。
  • N1a：癌细胞已经扩散到1到3个腋窝淋巴结，其中至少一个淋巴结的癌细胞大于2毫米。
  • N1b：癌细胞已扩散到与原发肿瘤同侧胸骨附近的淋巴结，癌细胞大于0.2毫米且已经前哨淋巴结活检发现。腋窝淋巴结未发现癌。
  • N1c：癌细胞已经扩散到1到3个腋窝淋巴结，其中至少一个淋巴结的癌细胞大于2毫米。与原发性肿瘤位于同侧胸骨附近的淋巴结在前哨淋巴结活检中也发现癌细胞。
  • N2：癌症被描述为以下之一：
  • N2a：癌细胞已经扩散到4到9个腋窝淋巴结，其中至少一个淋巴结的癌细胞大于2毫米。
  • N2b：癌细胞已经扩散到胸骨附近的淋巴结，通过影像学检查发现癌细胞。前哨淋巴结活检或淋巴结清扫均未发现腋窝淋巴结癌。
  • N3：癌症被描述为以下之一：
  • N3a：癌细胞已经扩散到10个或更多的腋窝淋巴结，其中至少一个淋巴结的癌细胞大于2毫米，或者癌细胞已经扩散到锁骨下淋巴结。
  • N3b：癌细胞已经扩散到1到9个腋窝淋巴结，其中至少一个淋巴结的癌细胞大于2毫米。癌细胞也扩散到胸骨附近的淋巴结，通过影像学检查发现癌细胞；

    • 或

    癌细胞已经扩散到4到9个腋窝淋巴结，其中至少有一个淋巴结大于2毫米。癌细胞也已经扩散到与原发肿瘤同侧胸骨附近的淋巴结，癌细胞大于0.2毫米，且通过前哨淋巴结活检发现。

  • N3c：癌症已经扩散到与原发肿瘤位于同一侧的锁骨上方的淋巴结。

    • 当使用乳腺钼靶或超声进行淋巴结检查时，会产生临床分期。淋巴结的临床分期在这里没有描述。

    转移（M）。癌症扩散到身体其他部位。

  • M0：没有迹象表明癌症已经扩散到身体的其他部位。
  • M1：癌症已经扩散到身体的其他部位，通常是骨骼、肺、肝或大脑。如果癌细胞已经扩散到远处的淋巴结，那么淋巴结中的癌细胞就大于0.2毫米。这种癌症被称为转移性乳腺癌。

    • 分级系统用来描述乳腺肿瘤生长和扩散的速度。

    该分级系统基于癌细胞和组织在显微镜下的外观异常以及癌细胞可能生长和扩散的速度来描述肿瘤。低等级癌细胞看起来更像正常细胞，并且生长和扩散的速度往往比高级癌细胞慢。为了描述癌细胞和组织的异常情况，病理学家将评估以下三个特征：

  • 有多少肿瘤组织中含有正常的乳腺导管。
  • 肿瘤细胞中细胞核的大小和形状。
  • 有多少分裂细胞存在，这是衡量肿瘤细胞生长和分裂的速度。

    • 对于每一个特征，病理学家的评分为1到3分；评分为“1”表示细胞和肿瘤组织看起来最像正常的细胞和组织，评分为“3”表示细胞和组织看起来最不正常。每个特征的分数相加得到的总分在3到9之间。

    可能有三个等级：

  • 总分3-5分：G1（低级别或高分化）。
  • 总分6-7分：G2（中级别或中分化）。
  • 总分8-9分：G3（高级别或低分化）。

    • 生物标记物检测是用来确定乳腺癌细胞是否有某些受体。

    健康的乳腺细胞，和一些乳腺癌细胞，有附着雌激素和孕激素受体（生物标记物）。这些激素是健康细胞和一些乳腺癌细胞生长和分裂所必需的。为了检查这些生物标记物，在活检或手术过程中会取出含有乳腺癌细胞的组织样本。这些样本在实验室进行测试，以确定乳腺癌细胞是否有雌激素或孕激素受体。

    另一种被称为HER2的受体（生物标记物）在所有乳腺癌细胞表面都有发现。HER2受体是乳腺癌细胞生长和分裂所必需的。

    对于乳腺癌，生物标志物检测包括以下内容：

  • 雌激素受体（ER）。如果乳腺癌细胞有雌激素受体，癌细胞被称为ER阳性（ER+）。如果乳腺癌细胞没有雌激素受体，癌细胞被称为ER阴性（ER-）。
  • 孕酮受体（PR）。如果乳腺癌细胞有孕酮受体，癌细胞被称为PR阳性（PR+）。如果乳腺癌细胞没有孕酮受体，癌细胞被称为PR阴性（PR-）。
  • 人表皮生长因子2型受体（HER2/neu或HER2）。如果乳腺癌细胞表面的HER2受体数量大于正常值，则称为HER2阳性（HER2+）。如果乳腺癌细胞表面有正常数量的HER2，癌细胞称为HER2阴性（HER2-）。HER2+乳腺癌比HER2-乳腺癌生长和分裂的速度更快。

    • 有时乳腺癌细胞会被描述为三阴性或三阳性。

  • 三阴性。如果乳腺癌细胞雌激素受体阴性，孕激素受体阴性，及HER2受体阴性，癌细胞被称为三阴性。
  • 三阳性。如果乳腺癌细胞确实有雌激素受体、孕激素受体和大于正常量的HER2受体，则癌细胞被称为三阳性。

    • 重要的是要了解雌激素受体，孕激素受体和HER2受体的状态，以选择最佳的治疗方法。有一些药物可以阻止受体附着在激素雌激素和孕激素受体上，并阻止癌症的发展。可以使用其他药物来阻断乳腺癌细胞表面的HER2受体并阻止癌症的发展。

    将TNM系统、分级系统和生物标志物状态结合起来，可以确定乳腺癌的分期。

    以下是三个结合TNM系统、分级系统和生物标记物状态的例子，以确定第一次治疗是手术的妇女乳腺癌的病理预后阶段：

    如果肿瘤大小为30毫米（T2），没有扩散到附近的淋巴结（N0），没有扩散到身体的远处（M0），并且是：

  • 1级
  • HER2+
  • ER-
  • PR-

    • 癌症是ⅡA期。

    如果肿瘤大小为53毫米（T3），扩散到4到9个腋窝淋巴结（N2），没有扩散到身体的其他部位（M0），并且是：

  • 2级
  • HER2+
  • ER+
  • PR-

    • 肿瘤是 IIIA期。

    如果肿瘤大小为65毫米（T3），扩散到3个腋窝淋巴结（N1a），扩散到肺（M1），并且是：

  • 1级
  • HER2+
  • ER-
  • PR-

    • 癌症是IV期（转移性乳腺癌）。

    咨询你的医生，了解你的乳腺癌是什么阶段，以及如何利用它来为你规划最佳治疗方案。

    手术后，你的医生将收到一份病理报告，描述原发肿瘤的大小和位置，癌细胞向附近淋巴结的扩散，肿瘤分级，以及是否存在某些生物标志物。病理报告和其他检测结果用于确定乳腺癌的分期。

    你可能会有很多问题。请你的医生解释分期是如何决定治疗癌症的最佳选择，以及是否有适合你的临床试验。

    乳腺癌的治疗在一定程度上取决于疾病的分期。

    对于导管原位癌 (DCIS) 治疗方案，请参阅导管原位癌。

    有关I期、II期、IIIA期和可手术IIIC期乳腺癌的治疗方案，请参阅早期、局部或可手术乳腺癌。

    对于IIIB期、不可手术IIIC期和炎症性乳腺癌的治疗方案，请参阅局部晚期或炎症性乳腺癌。

    对于在其初始形成区域附近复发的癌的治疗方案，请参阅局部区域复发性乳腺癌。

    有关第四阶段（转移性）乳腺癌或在身体其他部位复发的乳腺癌的治疗方案，请参阅转移性乳腺癌。

    Breast Cancer Treatment (Adult) (PDQ®)

    Stages of Breast Cancer

    After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.

    The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of some of the tests used to diagnose breast cancer are also used to stage the disease. (See the General Information section.)

    The following tests and procedures also may be used in the staging process:

  • Sentinel lymph node biopsy: The removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node in a group of lymph nodes to receive lymphatic drainage from the primary tumor. It is the first lymph node the cancer is likely to spread to from the primary tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. Sometimes, a sentinel lymph node is found in more than one group of nodes.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

    • There are three ways that cancer spreads in the body.

    Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

    • Cancer may spread from where it began to other parts of the body.

    When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

    • The metastatic tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bone, the cancer cells in the bone are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

    Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.

    In breast cancer, stage is based on the size and location of the primary tumor, the spread of cancer to nearby lymph nodes or other parts of the body, tumor grade, and whether certain biomarkers are present.

    To plan the best treatment and understand your prognosis, it is important to know the breast cancer stage.

    There are 3 types of breast cancer stage groups:

  • Clinical Prognostic Stage is used first to assign a stage for all patients based on health history, physical exam, imaging tests (if done), and biopsies. The Clinical Prognostic Stage is described by the TNM system, tumor grade, and biomarker status (ER, PR, HER2). In clinical staging, mammography or ultrasound is used to check the lymph nodes for signs of cancer.
  • Pathological Prognostic Stage is then used for patients who have surgery as their first treatment. The Pathological Prognostic Stage is based on all clinical information, biomarker status, and laboratory test results from breast tissue and lymph nodes removed during surgery.
  • Anatomic Stage is based on the size and the spread of cancer as described by the TNM system. The Anatomic Stage is used in parts of the world where biomarker testing is not available. It is not used in the United States.

    • The TNM system is used to describe the size of the primary tumor and the spread of cancer to nearby lymph nodes or other parts of the body.

    For breast cancer, the TNM system describes the tumor as follows:

    Tumor (T). The size and location of the tumor.

    Tumor sizes are often measured in millimeters (mm) or centimeters. Common items that can be used to show tumor size in mm include: a sharp pencil point (1 mm), a new crayon point (2 mm), a pencil-top eraser (5 mm), a pea (10 mm), a peanut (20 mm), and a lime (50 mm).
  • TX: Primary tumor cannot be assessed.
  • T0: No sign of a primary tumor in the breast.
  • Tis: Carcinoma in situ. There are 2 types of breast carcinoma in situ:
  • Tis (DCIS): DCIS is a condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive breast cancer that is able to spread to other tissues. At this time, there is no way to know which lesions can become invasive.
  • Tis (Paget disease): Paget disease of the nipple is a condition in which abnormal cells are found in the skin cells of the nipple and may spread to the areola. It is not staged according to the TNM system. If Paget disease AND an invasive breast cancer are present, the TNM system is used to stage the invasive breast cancer.
  • T1: The tumor is 20 millimeters or smaller. There are 4 subtypes of a T1 tumor depending on the size of the tumor:
  • T1mi: the tumor is 1 millimeter or smaller.
  • T1a: the tumor is larger than 1 millimeter but not larger than 5 millimeters.
  • T1b: the tumor is larger than 5 millimeters but not larger than 10 millimeters.
  • T1c: the tumor is larger than 10 millimeters but not larger than 20 millimeters.
  • T2: The tumor is larger than 20 millimeters but not larger than 50 millimeters.
  • T3: The tumor is larger than 50 millimeters.
  • T4: The tumor is described as one of the following:
  • T4a: the tumor has grown into the chest wall.
  • T4b: the tumor has grown into the skin—an ulcer has formed on the surface of the skin on the breast, small tumor nodules have formed in the same breast as the primary tumor, and/or there is swelling of the skin on the breast.
  • T4c: the tumor has grown into the chest wall and the skin.
  • T4d: inflammatory breast cancer—one-third or more of the skin on the breast is red and swollen (called peau d’orange).

    • Lymph Node (N). The size and location of lymph nodes where cancer has spread.

    When the lymph nodes are removed by surgery and studied under a microscope by a pathologist, pathologic staging is used to describe the lymph nodes. The pathologic staging of lymph nodes is described below.

  • NX: The lymph nodes cannot be assessed.
  • N0: No sign of cancer in the lymph nodes, or tiny clusters of cancer cells not larger than 0.2 millimeters in the lymph nodes.
  • N1: Cancer is described as one of the following:
  • N1mi: cancer has spread to the axillary (armpit area) lymph nodes and is larger than 0.2 millimeters but not larger than 2 millimeters.
  • N1a: cancer has spread to 1 to 3 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters.
  • N1b: cancer has spread to lymph nodes near the breastbone on the same side of the body as the primary tumor, and the cancer is larger than 0.2 millimeters and is found by sentinel lymph node biopsy. Cancer is not found in the axillary lymph nodes.
  • N1c: cancer has spread to 1 to 3 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer is also found by sentinel lymph node biopsy in the lymph nodes near the breastbone on the same side of the body as the primary tumor.
  • N2: Cancer is described as one of the following:
  • N2a: cancer has spread to 4 to 9 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters.
  • N2b: cancer has spread to lymph nodes near the breastbone and the cancer is found by imaging tests. Cancer is not found in the axillary lymph nodes by sentinel lymph node biopsy or lymph node dissection.
  • N3: Cancer is described as one of the following:
  • N3a: cancer has spread to 10 or more axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters, or cancer has spread to lymph nodes below the collarbone.
  • N3b: cancer has spread to 1 to 9 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer has also spread to lymph nodes near the breastbone and the cancer is found by imaging tests;

    • or

    cancer has spread to 4 to 9 axillary lymph nodes and cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer has also spread to lymph nodes near the breastbone on the same side of the body as the primary tumor, and the cancer is larger than 0.2 millimeters and is found by sentinel lymph node biopsy.

  • N3c: cancer has spread to lymph nodes above the collarbone on the same side of the body as the primary tumor.

    • When the lymph nodes are checked using mammography or ultrasound, it is called clinical staging. The clinical staging of lymph nodes is not described here.

    Metastasis (M). The spread of cancer to other parts of the body.

  • M0: There is no sign that cancer has spread to other parts of the body.
  • M1: Cancer has spread to other parts of the body, most often the bones, lungs, liver, or brain. If cancer has spread to distant lymph nodes, the cancer in the lymph nodes is larger than 0.2 millimeters. The cancer is called metastatic breast cancer.

    • The grading system is used to describe how quickly a breast tumor is likely to grow and spread.

    The grading system describes a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells. To describe how abnormal the cancer cells and tissue are, the pathologist will assess the following three features:

  • How much of the tumor tissue has normal breast ducts.
  • The size and shape of the nuclei in the tumor cells.
  • How many dividing cells are present, which is a measure of how fast the tumor cells are growing and dividing.

    • For each feature, the pathologist assigns a score of 1 to 3; a score of “1” means the cells and tumor tissue look the most like normal cells and tissue, and a score of “3” means the cells and tissue look the most abnormal. The scores for each feature are added together to get a total score between 3 and 9.

    Three grades are possible:

  • Total score of 3 to 5: G1 (Low grade or well differentiated).
  • Total score of 6 to 7: G2 (Intermediate grade or moderately differentiated).
  • Total score of 8 to 9: G3 (High grade or poorly differentiated).

    • Biomarker testing is used to find out whether breast cancer cells have certain receptors.

    Healthy breast cells, and some breast cancer cells, have receptors (biomarkers) that attach to the hormones estrogen and progesterone. These hormones are needed for healthy cells, and some breast cancer cells, to grow and divide. To check for these biomarkers, samples of tissue containing breast cancer cells are removed during a biopsy or surgery. The samples are tested in a laboratory to see whether the breast cancer cells have estrogen or progesterone receptors.

    Another type of receptor (biomarker) that is found on the surface of all breast cancer cells is called HER2. HER2 receptors are needed for the breast cancer cells to grow and divide.

    For breast cancer, biomarker testing includes the following:

  • Estrogen receptor (ER). If the breast cancer cells have estrogen receptors, the cancer cells are called ER positive (ER+). If the breast cancer cells do not have estrogen receptors, the cancer cells are called ER negative (ER-).
  • Progesterone receptor (PR). If the breast cancer cells have progesterone receptors, the cancer cells are called PR positive (PR+). If the breast cancer cells do not have progesterone receptors, the cancer cells are called PR negative (PR-).
  • Human epidermal growth factor type 2 receptor (HER2/neu or HER2). If the breast cancer cells have larger than normal amounts of HER2 receptors on their surface, the cancer cells are called HER2 positive (HER2+). If the breast cancer cells have a normal amount of HER2 on their surface, the cancer cells are called HER2 negative (HER2-). HER2+ breast cancer is more likely to grow and divide faster than HER2- breast cancer.

    • Sometimes the breast cancer cells will be described as triple negative or triple positive.

  • Triple negative. If the breast cancer cells do not have estrogen receptors, progesterone receptors, or a larger than normal amount of HER2 receptors, the cancer cells are called triple negative.
  • Triple positive. If the breast cancer cells do have estrogen receptors, progesterone receptors, and a larger than normal amount of HER2 receptors, the cancer cells are called triple positive.

    • It is important to know the estrogen receptor, progesterone receptor, and HER2 receptor status to choose the best treatment. There are drugs that can stop the receptors from attaching to the hormones estrogen and progesterone and stop the cancer from growing. Other drugs may be used to block the HER2 receptors on the surface of the breast cancer cells and stop the cancer from growing.

    The TNM system, the grading system, and biomarker status are combined to find out the breast cancer stage.

    Here are 3 examples that combine the TNM system, the grading system, and the biomarker status to find out the Pathological Prognostic breast cancer stage for a woman whose first treatment was surgery:

    If the tumor size is 30 millimeters (T2), has not spread to nearby lymph nodes (N0), has not spread to distant parts of the body (M0), and is:

  • Grade 1
  • HER2+
  • ER-
  • PR-

    • The cancer is stage IIA.

    If the tumor size is 53 millimeters (T3), has spread to 4 to 9 axillary lymph nodes (N2), has not spread to other parts of the body (M0), and is:

  • Grade 2
  • HER2+
  • ER+
  • PR-

    • The tumor is stage IIIA.

    If the tumor size is 65 millimeters (T3), has spread to 3 axillary lymph nodes (N1a), has spread to the lungs (M1), and is:

  • Grade 1
  • HER2+
  • ER-
  • PR-

    • The cancer is stage IV (metastatic breast cancer).

    Talk to your doctor to find out what your breast cancer stage is and how it is used to plan the best treatment for you.

    After surgery, your doctor will receive a pathology report that describes the size and location of the primary tumor, the spread of cancer to nearby lymph nodes, tumor grade, and whether certain biomarkers are present. The pathology report and other test results are used to determine your breast cancer stage.

    You are likely to have many questions. Ask your doctor to explain how staging is used to decide the best options to treat your cancer and whether there are clinical trials that might be right for you.

    The treatment of breast cancer depends partly on the stage of the disease.

    For ductal carcinoma in situ (DCIS) treatment options, see Ductal Carcinoma in Situ.

    For treatment options for stage I, stage II, stage IIIA, and operable stage IIIC breast cancer, see Early, Localized, or Operable Breast Cancer.

    For treatment options for stage IIIB, inoperable stage IIIC, and inflammatory breast cancer, see Locally Advanced or Inflammatory Breast Cancer.

    For treatment options for cancer that has recurred near the area where it first formed, see Locoregional Recurrent Breast Cancer.

    For treatment options for stage IV (metastatic) breast cancer or breast cancer that has recurred in other parts of the body, see Metastatic Breast Cancer.

    乳腺癌治疗（成人）(PDQ®)

    炎症乳腺癌

    炎性乳腺癌，是指癌症已经扩散到乳腺部位的皮肤，看上去发红肿胀并伴有发热。这是因为癌细胞阻碍了皮肤中的淋巴血管。乳腺部位的皮肤表面还有可能出现凹凸不平，我们称之为橘皮样病变（像橘子的外表皮一样）。这个时候不可能感受到乳腺中存在的任何肿块。炎性乳腺癌可能是IIIB期、IIIC期或IV期。

    左乳腺炎性乳腺癌，呈橘皮征、乳头内陷。
    Breast Cancer Treatment (Adult) (PDQ®)

    Inflammatory Breast Cancer

    In inflammatory breast cancer, cancer has spread to the skin of the breast and the breast looks red and swollen and feels warm. The redness and warmth occur because the cancer cells block the lymph vessels in the skin. The skin of the breast may also show the dimpled appearance called peau d’orange (like the skin of an orange). There may not be any lumps in the breast that can be felt. Inflammatory breast cancer may be stage IIIB, stage IIIC, or stage IV.

    Inflammatory breast cancer of the left breast showing peau d’orange and inverted nipple.
    乳腺癌治疗（成人）(PDQ®)

    复发性乳腺癌

    复发性乳腺癌是指治疗后复发的癌症。癌症可能会复发于乳腺、乳腺皮肤、胸壁或附近淋巴结。

    Breast Cancer Treatment (Adult) (PDQ®)

    Recurrent Breast Cancer

    Recurrent breast cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the breast, in the skin of the breast, in the chest wall, or in nearby lymph nodes.

    乳腺癌治疗（成人）(PDQ®)

    治疗方案描述

    乳腺癌患者有不同的治疗方案。

    针对不同的乳腺癌患者会采取不同的治疗方案。一些属于标准疗法（正在使用中的疗法），一些还处于临床试验阶段。临床试验是一种研究性课题，旨在帮助提升现有疗法或为乳腺癌患者获取新型疗法的相关信息。当临床试验显示新疗法比标准疗法更好时，新疗法可成为标准疗法。患者可能会考虑参加临床试验。某些临床试验仅对没有开始治疗的患者开放。

    当前有六种标准治疗正在使用：

    手术

    大多数乳腺癌患者可做手术切除癌细胞。

    前哨淋巴结活检：术中切除前哨淋巴结。前哨淋巴结是一组淋巴结中第一个从原发肿瘤接受淋巴引流的淋巴结。这是癌症可能从原发性肿瘤扩散到的第一个淋巴结。在肿瘤附近注射放射性物质和/或蓝色染料。该物质或染料通过淋巴管流到淋巴结。取出接受该物质或染料的第一个淋巴结。病理学家在显微镜下观察组织以寻找癌细胞。如果未发现癌细胞，则可能没有必要去除更多的淋巴结。有时，在超过一组的淋巴结中发现前哨淋巴结。前哨淋巴结活检后，外科医生采用保乳手术或乳腺切除术切除肿瘤。如果发现癌细胞，更多的淋巴结将通过一个单独的切口被切除，称为淋巴结清扫术。

    手术类型包括以下几种：

  • 乳房保留手术是一种移除肿瘤及其周围一些正常组织，但保留乳房本身的手术。如果癌症位于胸壁内层附近，也可能将部分胸壁内层移除。这类手术也被称为病灶切除术、部分乳房切除术、乳腺区段切除术、象限切除或保留乳房手术。
    • 保乳手术。肿瘤及周围的一些正常组织被去除，但乳房本身未被去除。手臂下方的一些淋巴结可能会被去除。如果癌症在胸壁膜附近，也可能去除部分胸壁膜。
  • 全乳房切除术：手术切除患癌的整个乳房。此过程也称为单纯乳房切除术。手臂下方的一些淋巴结可能会被清除并检查是否有癌症。这可以在乳房手术的同时或之后，通过单独的切口完成。
    • 全（单纯）乳房切除术。虚线表示整个乳房被切除的位置。手臂下的一些淋巴结也可能切除。
  • 乳房改良根治术：将整个已患癌症的乳房以及许多腋下的淋巴结、胸肌筋膜、有时还包括部分胸壁肌肉，一起移除的手术。
    • 改良根治术。虚线显示整个乳房和一些淋巴结被切除的位置。部分胸壁肌肉也可能切除。

    有时可能会在手术前进行化疗，以便移除肿瘤。当在手术前进行化疗时，化疗会使肿瘤缩小，减小需要通过手术移除的组织大小。在手术前进行的治疗被称为术前治疗或新辅助治疗。

    在医生进行手术时会切除所有能看到的癌细胞后，一些患者可能在手术后接受放射治疗、化疗、靶向治疗或激素治疗，以杀死任何残留的癌细胞。术后给予治疗，以降低癌症复发的风险，称为术后治疗或辅助治疗。

    如果病人要接受乳房切除术，可能会考虑乳房再造（在乳房切除术后重塑乳房形状的手术）。乳房再造可能与乳房切除术同时进行，也有可能在之后进行。再造的乳房可能会由病人自己的（非乳房）组织造就，也有可能是用盐水或硅树脂植入而成。在决定植入新的乳房之前，病人可以拨打1-888-INFO-FDA（1-888-463-6332）咨询食品和药物管理局（FDA）的设备和放射卫生中心，也可以上FDA网站查询更多乳房再造方面的信息。

    放射治疗

    放射治疗是一种利用高能x射线或其他类型的辐射杀死或阻止癌细胞生长的癌症治疗方法。放射治疗有两种类型：

  • 外部放射治疗使用体外的一台机器向癌变部位发送辐射。
  • 内部放射治疗指使用一种密封在针头、种子、金属丝或导管中的放射性物质，直接置于癌变部位中或其附近进行的治疗。

    • 放射治疗的方式取决于所治疗癌症的类型和阶段。外部放射疗法用于治疗乳腺癌。锶89（放射性核素）内部放射疗法用于缓解因乳腺癌扩散到骨骼而引起的骨骼疼痛-将锶89注射到静脉中并扩散至骨骼表面，释放辐射并杀死骨骼中的癌细胞。

    化疗

    化学药物治疗是一种用药物来阻止（或通过杀死癌细胞，或通过阻止癌细胞分裂）癌细胞生长的癌症治疗方法。当通过口服或注射到静脉或肌肉中时，药物进入血液并能到达全身的癌细胞（全身化学疗法）。当直接进入脑脊液、器官或腹腔等体腔时，药物主要影响这些区域的癌细胞（区域化学疗法）。

    有关更多信息，请参阅获准用于乳腺癌的药物。

    查看“已获批准的乳腺癌药物”获得更多信息。

    激素疗法

    激素疗法是一种去除激素或阻止其作用并阻止癌细胞生长的癌症治疗方法。荷尔蒙是由体内的腺体制造并在血液中循环的物质。有些荷尔蒙会导致某些癌症的生长。如果测试表明癌细胞有一些地方可以附着激素（受体），那么药物、手术或放射治疗就可以用来减少激素的产生或阻止激素发挥作用。使一些乳腺癌生长的雌激素主要是由卵巢产生的。阻止卵巢产生雌激素的治疗称为卵巢消融术。

    三苯氧胺激素疗法通常用于可通过手术切除的早期局限性乳腺癌患者和转移性乳腺癌患者（癌细胞已经扩散到身体其他部位）。用三苯氧胺或雌激素进行激素治疗可作用于全身细胞，并可能增加子宫内膜癌的发生几率。服用三苯氧胺的妇女应该每年做一次盆腔检查，看看是否有癌症的迹象。任何月经以外的阴道出血情况都应该尽早报告给医生。

    一些利用促黄体素释放激素 (LHRH) 的激素疗法适用于一些刚被确诊患有激素受体阳性乳腺癌的绝经前妇女。 LHRH可减少人体的雌激素和孕酮。

    一些绝经后乳腺癌激素受体阳性的妇女使用芳香化酶抑制剂进行激素治疗。芳香化酶抑制剂通过阻止芳香化酶将雄激素转化为雌激素来降低体内的雌激素。阿那曲唑、来曲唑和依西美坦是芳香化酶抑制剂的类型。

    对于可以通过手术切除的早期局限性乳腺癌的治疗，某些芳香化酶抑制剂可以代替三苯氧胺作为辅助治疗，或者在三苯氧胺使用2-3年后换成芳香酶抑制剂。对于转移性乳腺癌的治疗，芳香化酶抑制剂正在临床试验中进行测试，以将其与三苯氧胺的激素治疗进行比较。

    在激素受体阳性的乳腺癌患者中，至少需要5年的辅助激素治疗才可以降低癌症再发（复发）的风险。

    其他类型的激素治疗包括醋酸甲地孕酮或抗雌激素治疗，如氟维斯群

    有关更多信息，请参阅获准用于乳腺癌的药物。

    靶向治疗

    靶向治疗是一种利用药物或其他物质攻击特定癌细胞而不损害正常细胞的治疗方法。单克隆抗体、酪氨酸激酶抑制剂、细胞周期蛋白依赖性激酶抑制剂、雷帕霉素（mTOR）抑制剂的哺乳动物靶点和PARP抑制剂是乳腺癌治疗中使用的几类靶向治疗。

    单克隆抗体疗法是一种癌症治疗方法，它使用在实验室中从单一类型的免疫系统细胞中制备的抗体。这些抗体可以识别癌细胞上的物质或可能帮助癌细胞生长的正常物质。抗体附着在这些物质上，杀死癌细胞、阻止其生长、或阻止其扩散。单克隆抗体通过输注给予。可以单独使用，也可以直接携带药物、毒素或放射性物质到癌细胞。单克隆抗体可与化疗联合作为辅助治疗。

    单克隆抗体包括以下几种类型：

  • 曲妥珠单抗(Trastuzumab)是一种单克隆抗体，可阻断生长因子蛋白HER2的作用，HER2向乳腺癌细胞发送生长信号。可与其他疗法联合应用治疗HER2阳性乳腺癌。
  • 帕妥珠单抗(Pertuzumab)是一种单克隆抗体，可与曲妥珠单抗和化学疗法联合使用以治疗乳腺癌。可用于治疗某些已转移（扩散到身体其他部位）的HER2阳性乳腺癌患者。也可以在局部晚期、炎性或早期乳腺癌患者中用作新辅助治疗。在某些早期HER2阳性乳腺癌患者中，也可以用作辅助治疗。
  • 曲妥珠单抗是一种与抗癌药物连接的单克隆抗体。被称为抗体药物偶联物。用于治疗已扩散到身体其他部位或再发（复发）HER2阳性乳腺癌。对于术后有残留疾病的HER2阳性乳腺癌患者也可作为辅助治疗。
  • Sacituzumab govitecan（抗体药物偶联物）是一种可将抗癌药带到肿瘤的单克隆抗体。称为抗体-药物偶联物。正在研究用于治疗以前至少接受过两种化疗方案的三阴性乳腺癌女性。

    • 酪氨酸激酶抑制剂是用来阻碍肿瘤生长所需信息的靶向治疗药物。酪氨酸激酶抑制剂可以与其他抗癌药物一起用作辅助治疗。酪氨酸激酶抑制剂包括以下：

  • 拉帕替尼（Lapatinib）是一种酪氨酸激酶抑制剂，可阻断HER2蛋白和肿瘤细胞内其他蛋白的作用。 可与其他药物一起使用，以治疗曲妥珠单抗治疗后进一步发展的HER2阳性乳腺癌患者。
  • 来那替尼（Neratinib）是一种酪氨酸激酶抑制剂，可阻断HER2蛋白和肿瘤细胞内其他蛋白的作用。 在利用曲妥珠单抗治疗后，可用于治疗早期HER2阳性早期乳腺癌患者。

    • 细胞周期蛋白依赖性激酶抑制剂是用于阻断促进癌细胞生长的细胞周期素依赖性激酶的靶向治疗药物。细胞周期蛋白依赖性激酶抑制剂包括：

  • 帕博西尼（Palbociclib）是一种与细胞周期蛋白有关的激酶抑制剂，与来曲唑药物一起使用可治疗雌激素受体阳性和HER2阴性、并已扩散到身体其他部位的乳腺癌。 用于绝经后未经激素治疗的女性。 Palbociclib也可与氟维司群同时用于激素治疗后病情恶化的女性。
  • 瑞博西林（Ribociclib）是一种与细胞周期蛋白有关的激酶抑制剂，与来曲唑药物一起使用可治疗雌激素受体阳性和HER2阴性且复发或已扩散到身体其他部位的乳腺癌。 用于绝经后未经激素治疗的女性。也可与氟维司群一起用于已扩散到身体其他部位或复发的激素受体阳性和HER2阴性乳腺癌的绝经后女性。 也用于已扩散至身体其他部位或复发的激素受体阳性和HER2阴性乳腺癌的绝经前女性。
  • Abemaciclib（玻玛西林）是一种细胞周期蛋白依赖性激酶抑制剂，用于治疗晚期或已扩散到身体其他部位的激素受体阳性和HER2阴性乳腺癌。 可单独使用或与其他药物一起使用。
  • Alpelisib（pi3kα特异性抑制剂）是一种周期蛋白依赖性激酶抑制剂，与氟维斯群药物一起用于治疗，有一定的基因变异、且已经发展或扩散到身体其他部位的激素受体阳性和HER2阴性的乳腺癌。用于激素治疗期间或治疗后乳腺癌恶化的绝经后妇女。

    • Mammalian target of rapamycin (mTOR) 抑制剂阻断了一种叫做mTOR的蛋白质，其可以阻止癌细胞生长，阻止肿瘤生长所需的新血管的生长。mTOR抑制剂包括：

  • 依维莫司是一种mTOR抑制剂，用于患有晚期激素受体阳性或HER2阴性、其他治疗中没有得到改善的乳腺癌绝经后妇女。

    • PARP抑制剂是一种靶向治疗，可阻断DNA修复，并可能导致癌细胞死亡。PARP抑制剂包括：

  • 奥拉帕尼（Olaparib）是一种PARP抑制剂，用于治疗BRCA1或BRCA2基因突变和HER2阴性已经扩散到身体其他部位的乳腺癌患者。PARP抑制剂治疗三阴性乳腺癌的研究正在进行中。
  • 他拉唑帕尼（Talazoparib）是一种PARP抑制剂，用于治疗BRCA1或BRCA2基因突变和HER2阴性局部发展或已扩散到身体其他部位的乳腺癌患者。

    • 有关更多信息，请参阅获准用于乳腺癌的药物。

    免疫疗法

    免疫疗法是一种利用病人的免疫系统对抗癌症的疗法。由身体产生或实验室制造的物质用于增强、指导或恢复身体对癌症的自然防御。这种癌症治疗也被称为生物治疗或生物疗法。

    有不同类型的免疫疗法：

  • 免疫检查点抑制剂疗法：PD-1是T细胞表面的一种蛋白质，有助于保持机体的免疫反应。当PD-1与癌细胞上另一种叫做PDL-1的蛋白质结合时，阻止T细胞杀死癌细胞。PD-1抑制剂与PDL-1结合，使T细胞能杀死癌细胞。Atezolizumab（阿特珠单抗）是一种PD-1抑制剂，用于治疗已经扩散到身体其他部位的乳腺癌。
    • 免疫检查点抑制剂。检查点蛋白，例如肿瘤细胞上的PD-L1和T细胞上的PD-1，有助于保持免疫反应。PD-L1与PD-1的结合阻止T细胞杀死体内的肿瘤细胞（左图）。用免疫检查点抑制剂（抗PD-L1或抗PD-1）阻断PD-L1与PD-1的结合，可以使T细胞杀死肿瘤细胞（右图）。
    免疫疗法利用人体的免疫系统抵抗癌症。该动画演示了一种使用免疫检查点抑制剂治疗癌症的免疫疗法。

    目前，新的治疗方式正接受临床试验。

    有关临床试验的信息可从NCI网站获得。

    乳腺癌的治疗可能会产生副作用。

    有关在癌症治疗期间开始出现的副反应的信息，请参阅“副作用”页面。

    某些针对乳腺癌的疗法可能产生副作用，这种副作用的影响可能从治疗结束后延续几个月或者几年，也可能在几个月或几年后才出现。这些被称为后期副作用。

    放疗的后期副作用并不常见，但可能包括：

  • 乳腺接受放疗后肺部发炎，尤其是在化疗同时进行的情况下。
  • 手臂出现淋巴水肿，尤其是在淋巴结清扫术后接受放疗期间。
  • 当未满45岁的女性在乳房切除术后接受胸壁放疗时，另一个乳房患乳腺癌的风险可能会更高。

    • 化疗的后期副作用取决于使用了哪些药物，但可能会包括：

  • 心力衰竭。
  • 血凝块。
  • 更年期提前。
  • 第二种癌症，例如白血病。

    • 曲妥珠单抗、拉帕替尼或培妥珠单抗靶向治疗的晚期效应可能包括：

  • 心脏问题，例如心力衰竭。

    • 患者可能会想要考虑参与临床试验。

    对某些患者而言，参与临床试验可能是最好的治疗方式。临床试验是癌症研究的一部分。临床试验的目的是确认新的癌症治疗方式是否安全、有效，或者是否优于标准疗法。

    现在的很多癌症标准治疗都是基于早期的临床试验。参与临床试验的患者会接受标准疗法或成为首批接受新疗法的人。

    参与临床试验的患者其实是在助推以后癌症方面的治疗。即便临床试验并没有直接发现有效的疗法，但是其结果仍然有助于回答重要问题以及研究的推进。

    患者可以在开始癌症治疗之前、期间或之后加入临床试验。

    某些临床试验只纳入还没有接受治疗的患者。另一些试验用于测试对癌症患者未奏效的治疗方案。还有一些用于测试阻止癌症复发或者减少癌症治疗副作用的新方法。

    临床试验正在全国许多地方进行。在NCI的临床试验搜索网页上可以找到有关NCI支持的临床试验的信息。其他组织支持的临床试验可以在Clinical trials.gov网站上找到。

    可能需要的后续检查。

    一些诊断癌症或确定癌症分期的检查可能会重复进行。为了观察治疗效果，会重复某些检查。是否继续、改变或停止治疗的决定可能均基于这些检查结果。

    某些检查在治疗结束后仍然要反复做多次。检查的结果可以看出患者病情是否改变或癌症是否复发。这些检查有时称为跟进测试或检查。

    Breast Cancer Treatment (Adult) (PDQ®)

    Treatment Option Overview

    There are different types of treatment for patients with breast cancer.

    Different types of treatment are available for patients with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

    Six types of standard treatment are used:

    Surgery

    Most patients with breast cancer have surgery to remove the cancer.

    Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node in a group of lymph nodes to receive lymphatic drainage from the primary tumor. It is the first lymph node the cancer is likely to spread to from the primary tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. Sometimes, a sentinel lymph node is found in more than one group of nodes. After the sentinel lymph node biopsy, the surgeon removes the tumor using breast-conserving surgery or mastectomy. If cancer cells were found, more lymph nodes will be removed through a separate incision. This is called a lymph node dissection.

    Types of surgery include the following:

  • Breast-conserving surgery is an operation to remove the cancer and some normal tissue around it, but not the breast itself. Part of the chest wall lining may also be removed if the cancer is near it. This type of surgery may also be called lumpectomy, partial mastectomy, segmental mastectomy, quadrantectomy, or breast-sparing surgery.
    • Breast-conserving surgery. The tumor and some normal tissue around it are removed, but not the breast itself. Some lymph nodes under the arm may be removed. Part of the chest wall lining may also be removed if the cancer is near it.
  • Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed and checked for cancer. This may be done at the same time as the breast surgery or after. This is done through a separate incision.
    • Total (simple) mastectomy. The dotted line shows where the entire breast is removed. Some lymph nodes under the arm may also be removed.
  • Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
    • Modified radical mastectomy. The dotted line shows where the entire breast and some lymph nodes are removed. Part of the chest wall muscle may also be removed.

    Chemotherapy may be given before surgery to remove the tumor. When given before surgery, chemotherapy will shrink the tumor and reduce the amount of tissue that needs to be removed during surgery. Treatment given before surgery is called preoperative therapy or neoadjuvant therapy.

    After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy, chemotherapy, targeted therapy, or hormone therapy after surgery, to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called postoperative therapy or adjuvant therapy.

    If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast’s shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at some time after. The reconstructed breast may be made with the patient’s own (nonbreast) tissue or by using implants filled with saline or silicone gel. Before the decision to get an implant is made, patients can call the Food and Drug Administration's (FDA) Center for Devices and Radiologic Health at 1-888-INFO-FDA (1-888-463-6332) or visit the FDA website for more information on breast implants.

    Radiation therapy

    Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

  • External radiation therapy uses a machine outside the body to send radiation toward the cancer.
  • Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

    • The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat breast cancer. Internal radiation therapy with strontium-89 (a radionuclide) is used to relieve bone pain caused by breast cancer that has spread to the bones. Strontium-89 is injected into a vein and travels to the surface of the bones. Radiation is released and kills cancer cells in the bones.

    Chemotherapy

    Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

    The way the chemotherapy is given depends on the type and stage of the cancer being treated. Systemic chemotherapy is used in the treatment of breast cancer.

    See Drugs Approved for Breast Cancer for more information.

    Hormone therapy

    Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working. The hormone estrogen, which makes some breast cancers grow, is made mainly by the ovaries. Treatment to stop the ovaries from making estrogen is called ovarian ablation.

    Hormone therapy with tamoxifen is often given to patients with early localized breast cancer that can be removed by surgery and those with metastatic breast cancer (cancer that has spread to other parts of the body). Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase the chance of developing endometrial cancer. Women taking tamoxifen should have a pelvic exam every year to look for any signs of cancer. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.

    Hormone therapy with a luteinizing hormone-releasing hormone (LHRH) agonist is given to some premenopausal women who have just been diagnosed with hormone receptor positive breast cancer. LHRH agonists decrease the body's estrogen and progesterone.

    Hormone therapy with an aromatase inhibitor is given to some postmenopausal women who have hormone receptor positive breast cancer. Aromatase inhibitors decrease the body's estrogen by blocking an enzyme called aromatase from turning androgen into estrogen. Anastrozole, letrozole, and exemestane are types of aromatase inhibitors.

    For the treatment of early localized breast cancer that can be removed by surgery, certain aromatase inhibitors may be used as adjuvant therapy instead of tamoxifen or after 2 to 3 years of tamoxifen use. For the treatment of metastatic breast cancer, aromatase inhibitors are being tested in clinical trials to compare them to hormone therapy with tamoxifen.

    In women with hormone receptor positive breast cancer, at least 5 years of adjuvant hormone therapy reduces the risk that the cancer will recur (come back).

    Other types of hormone therapy include megestrol acetate or anti-estrogen therapy such as fulvestrant.

    See Drugs Approved for Breast Cancer for more information.

    Targeted therapy

    Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies, tyrosine kinase inhibitors, cyclin-dependent kinase inhibitors, mammalian target of rapamycin (mTOR) inhibitors, and PARP inhibitors are types of targeted therapies used in the treatment of breast cancer.

    Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies may be used in combination with chemotherapy as adjuvant therapy.

    Types of monoclonal antibody therapy include the following:

  • Trastuzumab is a monoclonal antibody that blocks the effects of the growth factor protein HER2, which sends growth signals to breast cancer cells. It may be used with other therapies to treat HER2 positive breast cancer.
  • Pertuzumab is a monoclonal antibody that may be combined with trastuzumab and chemotherapy to treat breast cancer. It may be used to treat certain patients with HER2 positive breast cancer that has metastasized (spread to other parts of the body). It may also be used as neoadjuvant therapy in patients with locally advanced, inflammatory, or early-stage breast cancer. It may also be used as adjuvant therapy in certain patients with early-stage HER2 positive breast cancer.
  • Ado-trastuzumab emtansine is a monoclonal antibody linked to an anticancer drug. This is called an antibody-drug conjugate. It is used to treat HER2 positive breast cancer that has spread to other parts of the body or recurred (come back). It is also used as adjuvant therapy to treat HER2 positive breast cancer in patients who have residual disease after surgery.
  • Sacituzumab govitecan is a monoclonal antibody that carries an anticancer drug to the tumor. This is called an antibody-drug conjugate. It is being studied to treat women with triple-negative breast cancer who have received at least two previous chemotherapy regimens.

    • Tyrosine kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow. Tyrosine kinase inhibitors may be used with other anticancer drugs as adjuvant therapy. Tyrosine kinase inhibitors include the following:

  • Lapatinib is a tyrosine kinase inhibitor that blocks the effects of the HER2 protein and other proteins inside tumor cells. It may be used with other drugs to treat patients with HER2 positive breast cancer that has progressed after treatment with trastuzumab.
  • Neratinib is a tyrosine kinase inhibitor that blocks the effects of the HER2 protein and other proteins inside tumor cells. It may be used to treat patients with early-stage HER2 positive breast cancer after treatment with trastuzumab.

    • Cyclin-dependent kinase inhibitors are targeted therapy drugs that block proteins called cyclin-dependent kinases, which cause the growth of cancer cells. Cyclin-dependent kinase inhibitors include the following:

  • Palbociclib is a cyclin-dependent kinase inhibitor used with the drug letrozole to treat breast cancer that is estrogen receptor positive and HER2 negative and has spread to other parts of the body. It is used in postmenopausal women whose cancer has not been treated with hormone therapy. Palbociclib may also be used with fulvestrant in women whose disease has gotten worse after treatment with hormone therapy.
  • Ribociclib is a cyclin-dependent kinase inhibitor used with letrozole to treat breast cancer that is hormone receptor positive and HER2 negative and has come back or spread to other parts of the body. It is used in postmenopausal women whose cancer has not been treated with hormone therapy. It is also used with fulvestrant in postmenopausal women with hormone receptor positive and HER2 negative breast cancer that has spread to other parts of the body or has recurred. It is also used in premenopausal women with hormone receptor positive and HER2 negative breast cancer that has spread to other parts of the body or has recurred.
  • Abemaciclib is a cyclin-dependent kinase inhibitor used to treat hormone receptor positive and HER2 negative breast cancer that is advanced or has spread to other parts of the body. It may be used alone or with other drugs.
  • Alpelisib is a cylin-dependent kinase inhibitor used with the drug fulvestrant to treat hormone receptor positive and HER2 negative breast cancer that has a certain gene change and is advanced or has spread to other parts of the body. It is used in postmenopausal women whose breast cancer has gotten worse during or after treatment with hormone therapy.

    • Mammalian target of rapamycin (mTOR) inhibitors block a protein called mTOR, which may keep cancer cells from growing and prevent the growth of new blood vessels that tumors need to grow. mTOR inhibitors include the following:

  • Everolimus is an mTOR inhibitor used in postmenopausal women with advanced hormone receptor positive breast cancer that is also HER2 negative and has not gotten better with other treatment.

    • PARP inhibitors are a type of targeted therapy that block DNA repair and may cause cancer cells to die. PARP inhibitors include the following:

  • Olaparib is a PARP inhibitor used to treat patients with mutations in the BRCA1 or BRCA2 gene and HER2 negative breast cancer that has spread to other parts of the body. PARP inhibitor therapy is being studied for the treatment of patients with triple-negative breast cancer.
  • Talazoparib is a PARP inhibitor used to treat patients with mutations in the BRCA1 or BRCA2 genes and HER2 negative breast cancer that is locally advanced or has spread to other parts of the body.

    • See Drugs Approved for Breast Cancer for more information.

    Immunotherapy

    Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy.

    There are different types of immunotherapy:

  • Immune checkpoint inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When PD-1 attaches to another protein called PDL-1 on a cancer cell, it stops the T cell from killing the cancer cell. PD-1 inhibitors attach to PDL-1 and allow the T cells to kill cancer cells. Atezolizumab is a PD-1 inhibitor used to treat breast cancer that has spread to other parts of the body.
    • Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).
    Immunotherapy uses the body’s immune system to fight cancer. This animation explains one type of immunotherapy that uses immune checkpoint inhibitors to treat cancer.

    New types of treatment are being tested in clinical trials.

    Information about clinical trials is available from the NCI website.

    Treatment for breast cancer may cause side effects.

    For information about side effects that begin during treatment for cancer, see our Side Effects page.

    Some treatments for breast cancer may cause side effects that continue or appear months or years after treatment has ended. These are called late effects.

    Late effects of radiation therapy are not common, but may include:

  • Inflammation of the lung after radiation therapy to the breast, especially when chemotherapy is given at the same time.
  • Arm lymphedema, especially when radiation therapy is given after lymph node dissection.
  • In women younger than 45 years who receive radiation therapy to the chest wall after mastectomy, there may be a higher risk of developing breast cancer in the other breast.

    • Late effects of chemotherapy depend on the drugs used, but may include:

  • Heart failure.
  • Blood clots.
  • Premature menopause.
  • Second cancer, such as leukemia.

    • Late effects of targeted therapy with trastuzumab, lapatinib, or pertuzumab may include:

  • Heart problems such as heart failure.

    • Patients may want to think about taking part in a clinical trial.

    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

    Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

    Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

    Patients can enter clinical trials before, during, or after starting their cancer treatment.

    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

    Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

    Follow-up tests may be needed.

    Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

    Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

    乳腺癌治疗（成人）(PDQ®)

    乳腺癌的治疗选择

    有关下面列出的治疗的信息，请参阅“治疗方案概述”部分。

    早期、局部或可手术的乳腺癌

    早期、局部或可手术乳腺癌的治疗可包括：

  • 乳房保留手术和前哨淋巴结活检。如果在淋巴结发现癌症，可能要做淋巴结清扫。
  • 乳房改良根治术。可能还需要乳房再造。

    • 对于进行了保乳手术的妇女，对整个乳房进行放射治疗以减少癌症复发的机会。 也可以对该区域的淋巴结进行放射治疗。

    对于经过改良根治性乳房切除术的妇女，如果满足以下任一条件，则可以进行放射治疗以减少癌症复发的机会：

  • 在4个或更多淋巴结中发现癌。
  • 癌症已经扩散到淋巴结周围的组织。
  • 肿瘤很大。
  • 在已经移除肿瘤的地方附近或者周边组织里仍然存在肿瘤。

    • 全身疗法是使用可以进入血液并到达全身癌细胞的药物。 给予术后全身治疗以减少手术切除肿瘤后癌症复发的机率。

    术后全身治疗取决于以下情况：

  • 肿瘤是激素受体阴性还是阳性。
  • 肿瘤是HER2/neu阴性还是阳性。
  • 肿瘤是激素受体阴性和HER2/neu阴性（三阴性）。
  • 肿瘤的大小。

    • 对于患激素受体阳性肿瘤的绝经期前的女性，不需要更多的治疗，或者可接受的术后治疗包括：

  • 有、无化疗结合的三苯氧胺治疗。
  • 他莫昔芬疗法和治疗旨在停止或减少卵巢产生的雌激素。 可以使用药物治疗、卵巢切除术或卵巢的放射治疗。
  • 芳香酶抑制剂疗法和治疗旨在停止或减少卵巢产生雌激素的量。  可以使用药物治疗、切除卵巢的手术或卵巢的放射治疗。

    • 对于患激素受体阳性肿瘤的绝经后的女性，不需要更多的治疗，或者可接受的术后治疗包括：

  • 有、无化疗结合的芳香酶抑制剂治疗。
  • 有、无化疗结合的芳香酶抑制剂治疗，然后使用三苯氧胺治疗。

    • 对于患激素受体阴性肿瘤的女性，不需要接受更多的治疗，或者可接受的术后治疗包括：

  • 化疗。

    • 患HER2/neu阴性肿瘤的女性，术后治疗包括：

  • 化疗。

    • 对于HER2/neu阳性的小肿瘤，淋巴结无癌的妇女，可能不需要更多的治疗。如果淋巴结有癌，或肿瘤较大，术后治疗可包括：

  • 化疗和靶向治疗（曲妥珠单抗）。
  • 激素疗法，如三苯氧胺或芳香化酶抑制剂疗法，用于激素受体阳性的肿瘤。
  • 使用ado-trastuzumab emstansine的抗体药物偶联物。

    • 对于患有激素受体阴性和HER2 / neu阴性的小肿瘤（三阴性）且淋巴结无癌的女性，可能无需进一步治疗。 如果淋巴结中有癌症或肿瘤较大，则术后治疗可能包括：

  • 化疗。
  • 放射治疗
  • 新化疗方案的临床试验。
  • PARP抑制剂治疗的临床试验。

    • 全身疗法是使用可以进入血液并到达全身癌细胞的药物。术前进行全身治疗可在手术前缩小肿瘤。

    患激素受体阳性肿瘤的绝经后女性，术后治疗包括：

  • 化疗。
  • 激素疗法，比如三苯氧胺或者芳香酶抑制剂治疗，适用于那些不能化疗的女性。

    • 患激素受体阳性肿瘤的绝经前期的女性，术后治疗包括：

  • 激素治疗的临床试验，比如三苯氧胺或者芳香酶抑制剂治疗。

    • 患HER2/neu阳性肿瘤的女性，术后治疗包括：

  • 化疗和靶向治疗（曲妥珠单抗）。
  • 靶向治疗（帕妥珠单抗）。

    • 患HER2/neu阴性肿瘤的女性，术后治疗包括：

  • 化疗。
  • 新化疗方案的临床试验。
  • 单克隆抗体疗法的临床试验

    • 使用我们的临床试验搜索来查找NCI支持的（正在接受患者）癌症临床试验。您可以根据癌症类型、患者年龄以及进行试验的地点搜索试验。也可以获取有关临床试验的一般信息。

    局部晚期或炎性乳腺癌

    局部晚期或炎性乳腺癌的治疗是多种疗法的组合，其中可能包括：

  • 淋巴结清扫术（保乳手术或全乳切除术）
  • 手术前、后的化疗
  • 术后放疗
  • 雌激素受体阳性或雌激素受体未知的肿瘤手术后的激素治疗。
  • 临床试验，用于测试新抗癌药物的、新的药物组合和新的治疗方法。

    • 使用我们的临床试验搜索来查找NCI支持的（正在接受患者）癌症临床试验。您可以根据癌症类型、患者年龄以及进行试验的地点搜索试验。也可以获取有关临床试验的一般信息。

    局部复发性乳腺癌

    局部复发性乳腺癌的治疗（在乳腺癌、胸壁或附近淋巴结治疗后复发的癌症）可能包括：

  • 化疗。
  • 激素受体阳性肿瘤的激素治疗
  • 放疗
  • 手术
  • 靶向治疗（曲妥珠单抗）
  • 新疗法的临床试验

    • 有关已扩散到乳房、胸壁或附近淋巴结以外的身体部位的乳腺癌治疗方案的信息，请参见“转移性乳腺癌”部分。

    使用我们的临床试验搜索来查找NCI支持的（正在接受患者）癌症临床试验。您可以根据癌症类型、患者年龄以及进行试验的地点搜索试验。也可以获取有关临床试验的一般信息。

    转移性乳腺癌

    转移性乳腺癌（已扩散到身体远处的癌症）的治疗方案可能包括：

    对于刚被确诊患有激素受体阳性或激素受体状态未知的转移性乳腺癌的的绝经后女性，治疗可能包括：

  • 他莫昔芬疗法
  • 芳香化酶抑制剂治疗（阿那曲唑、来曲唑、或依西美坦）。有时也给予细胞周期蛋白依赖性激酶抑制剂治疗（帕博西尼、瑞博西林、abemaciclib（玻玛西林）或alpelisib（pi3kα特异性抑制剂））

    • 对于刚被确诊为激素受体阳性的转移性乳腺癌的绝经前妇女，治疗可能包括：

  • 他莫昔芬，一种LHRH激动剂，或两者兼有
  • 细胞周期蛋白依赖性激酶抑制剂治疗（核糖体）

    • 对于肿瘤为激素受体阳性或激素受体未知、仅扩散至骨或软组织，且已接受过他莫昔芬治疗的女性，治疗可包括：

  • 芳香化酶抑制剂疗法
  • 其他激素治疗，如醋酸甲地孕酮、雌激素或雄激素治疗，或抗雌激素治疗，如氟维司群。

    • 对于激素受体阳性且对其他治疗无反应的转移性乳腺癌患者，可选择靶向治疗，如：

  • 曲妥珠单抗、拉帕替尼、帕妥株单抗 或 mTOR 抑制剂。
  • 使用ado-trastuzumab emstansine的抗体药物偶联物。
  • 细胞周期蛋白依赖性激酶抑制剂治疗（帕博西尼、瑞博西林或abemaciclib（玻玛西林）），可与激素治疗结合使用。

    • 对于HER2/neu阳性的转移性乳腺癌患者，治疗可能包括：

  • 靶向治疗，如曲妥珠单抗、 帕妥株单抗、 曲妥珠单抗抗体-药物偶联物或 拉帕替尼。

    • 对于HER2阴性、BRCA1或BRCA2基因突变且接受过化疗的转移性乳腺癌患者，治疗可能包括：

  • 利用PARP抑制剂（奥拉帕尼 或 他拉唑帕尼）进行靶向治疗。

    • 对于激素受体阴性、未接受激素治疗、已扩散至其他器官或已引起症状的转移性乳腺癌患者，治疗可包括：

  • 用一种或多种药物进行化疗。

    • 对于激素受体阴性和HER2阴性的转移性乳腺癌患者，治疗可能包括：

  • 化疗和免疫治疗 （阿特朱单抗）
  • 乳腺开放性或疼痛性病变的全乳房切除术。术后可进行放射治疗。
  • 切除扩散到大脑或脊柱癌症的手术。术后可进行放射治疗。
  • 切除扩散到肺部癌症的手术
  • 修复或帮助支撑脆弱或破裂骨骼的手术。 手术后可进行放射治疗。
  • 清除肺或心脏周围积液的手术
  • 对骨骼、大脑、脊髓、乳房或胸壁进行放射治疗，以减轻症状，提高生活质量。
  • 锶-89（一种放射性核素），用于缓解癌症扩散到全身骨骼的疼痛。

    • 转移性乳腺癌的其他治疗方案包括：

  • 用双膦酸盐或狄诺塞麦进行药物治疗，以减少癌症扩散到骨骼时的骨骼疾病和疼痛。（有关双膦酸盐的更多信息，请参阅关于癌症疼痛的PDQ摘要。）
  • 大剂量化疗联合干细胞移植的临床试验
  • 抗体药物偶联物（sacituzumab）的临床试验。
  • 测试新的抗癌药、新药组合和新的治疗方法的临床试验

    • 使用我们的临床试验搜索来查找NCI支持的（正在接受患者）癌症临床试验。您可以根据癌症类型、患者年龄以及进行试验的地点搜索试验。也可以获取有关临床试验的一般信息。

    Breast Cancer Treatment (Adult) (PDQ®)

    Treatment Options for Breast Cancer

    For information about the treatments listed below, see the Treatment Option Overview section.

    Early, Localized, or Operable Breast Cancer

    Treatment of early, localized, or operable breast cancer may include the following:

  • Breast-conserving surgery and sentinel lymph node biopsy. If cancer is found in the lymph nodes, a lymph node dissection may be done.
  • Modified radical mastectomy. Breast reconstruction surgery may also be done.

    • For women who had breast-conserving surgery, radiation therapy is given to the whole breast to lessen the chance the cancer will come back. Radiation therapy may also be given to lymph nodes in the area.

    For women who had a modified radical mastectomy, radiation therapy may be given to lessen the chance the cancer will come back if any of the following are true:

  • Cancer was found in 4 or more lymph nodes.
  • Cancer had spread to tissue around the lymph nodes.
  • The tumor was large.
  • There is tumor close to or remaining in the tissue near the edges of where the tumor was removed.

    • Systemic therapy is the use of drugs that can enter the bloodstream and reach cancer cells throughout the body. Postoperative systemic therapy is given to lessen the chance the cancer will come back after surgery to remove the tumor.

    Postoperative systemic therapy is given depending on whether:

  • The tumor is hormone receptor negative or positive.
  • The tumor is HER2/neu negative or positive.
  • The tumor is hormone receptor negative and HER2/neu negative (triple negative).
  • The size of the tumor.

    • In premenopausal women with hormone receptor positive tumors, no more treatment may be needed or postoperative therapy may include:

  • Tamoxifen therapy with or without chemotherapy.
  • Tamoxifen therapy and treatment to stop or lessen how much estrogen is made by the ovaries. Drug therapy, surgery to remove the ovaries, or radiation therapy to the ovaries may be used.
  • Aromatase inhibitor therapy and treatment to stop or lessen how much estrogen is made by the ovaries. Drug therapy, surgery to remove the ovaries, or radiation therapy to the ovaries may be used.

    • In postmenopausal women with hormone receptor positive tumors, no more treatment may be needed or postoperative therapy may include:

  • Aromatase inhibitor therapy with or without chemotherapy.
  • Tamoxifen followed by aromatase inhibitor therapy, with or without chemotherapy.

    • In women with hormone receptor negative tumors, no more treatment may be needed or postoperative therapy may include:

  • Chemotherapy.

    • In women with HER2/neu negative tumors, postoperative therapy may include:

  • Chemotherapy.

    • In women with small, HER2/neu positive tumors, and no cancer in the lymph nodes, no more treatment may be needed. If there is cancer in the lymph nodes, or the tumor is large, postoperative therapy may include:

  • Chemotherapy and targeted therapy (trastuzumab).
  • Hormone therapy, such as tamoxifen or aromatase inhibitor therapy, for tumors that are also hormone receptor positive.
  • Antibody-drug conjugate therapy with ado-trastuzumab emtansine.

    • In women with small, hormone receptor negative and HER2/neu negative tumors (triple negative) and no cancer in the lymph nodes, no more treatment may be needed. If there is cancer in the lymph nodes or the tumor is large, postoperative therapy may include:

  • Chemotherapy.
  • Radiation therapy.
  • A clinical trial of a new chemotherapy regimen.
  • A clinical trial of PARP inhibitor therapy.

    • Systemic therapy is the use of drugs that can enter the bloodstream and reach cancer cells throughout the body. Preoperative systemic therapy is given to shrink the tumor before surgery.

    In postmenopausal women with hormone receptor positive tumors, preoperative therapy may include:

  • Chemotherapy.
  • Hormone therapy, such as tamoxifen or aromatase inhibitor therapy, for women who cannot have chemotherapy.

    • In premenopausal women with hormone receptor positive tumors, preoperative therapy may include:

  • A clinical trial of hormone therapy, such as tamoxifen or aromatase inhibitor therapy.

    • In women with HER2/neu positive tumors, preoperative therapy may include:

  • Chemotherapy and targeted therapy (trastuzumab).
  • Targeted therapy (pertuzumab).

    • In women with HER2/neu negative tumors or triple negative tumors, preoperative therapy may include:

  • Chemotherapy.
  • A clinical trial of a new chemotherapy regimen.
  • A clinical trial of monoclonal antibody therapy.

    • Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

    Locally Advanced or Inflammatory Breast Cancer

    Treatment of locally advanced or inflammatory breast cancer is a combination of therapies that may include the following:

  • Surgery (breast-conserving surgery or total mastectomy) with lymph node dissection.
  • Chemotherapy before and/or after surgery.
  • Radiation therapy after surgery.
  • Hormone therapy after surgery for tumors that are estrogen receptor positive or estrogen receptor unknown.
  • Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

    • Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

    Locoregional Recurrent Breast Cancer

    Treatment of locoregional recurrent breast cancer (cancer that has come back after treatment in the breast, in the chest wall, or in nearby lymph nodes), may include the following:

  • Chemotherapy.
  • Hormone therapy for tumors that are hormone receptor positive.
  • Radiation therapy.
  • Surgery.
  • Targeted therapy (trastuzumab).
  • A clinical trial of a new treatment.

    • See the Metastatic Breast Cancer section for information about treatment options for breast cancer that has spread to parts of the body outside the breast, chest wall, or nearby lymph nodes.

    Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

    Metastatic Breast Cancer

    Treatment options for metastatic breast cancer (cancer that has spread to distant parts of the body) may include the following:

    In postmenopausal women who have just been diagnosed with metastatic breast cancer that is hormone receptor positive or if the hormone receptor status is not known, treatment may include:

  • Tamoxifen therapy.
  • Aromatase inhibitor therapy (anastrozole, letrozole, or exemestane). Sometimes cyclin-dependent kinase inhibitor therapy (palbociclib, ribociclib, abemaciclib, or alpelisib) is also given.

    • In premenopausal women who have just been diagnosed with metastatic breast cancer that is hormone receptor positive, treatment may include:

  • Tamoxifen, an LHRH agonist, or both.
  • Cyclin-dependent kinase inhibitor therapy (ribociclib).

    • In women whose tumors are hormone receptor positive or hormone receptor unknown, with spread to the bone or soft tissue only, and who have been treated with tamoxifen, treatment may include:

  • Aromatase inhibitor therapy.
  • Other hormone therapy such as megestrol acetate, estrogen or androgen therapy, or anti-estrogen therapy such as fulvestrant.

    • In women with metastatic breast cancer that is hormone receptor positive and has not responded to other treatments, options may include targeted therapy such as:

  • Trastuzumab, lapatinib, pertuzumab, or mTOR inhibitors.
  • Antibody-drug conjugate therapy with ado-trastuzumab emtansine.
  • Cyclin-dependent kinase inhibitor therapy (palbociclib, ribociclib, or abemaciclib) which may be combined with hormone therapy.

    • In women with metastatic breast cancer that is HER2/neu positive, treatment may include:

  • Targeted therapy such as trastuzumab, pertuzumab, ado-trastuzumab emtansine, or lapatinib.

    • In women with metastatic breast cancer that is HER2 negative, with mutations in the BRCA1 or BRCA2 genes, and who have been treated with chemotherapy, treatment may include:

  • Targeted therapy with a PARP inhibitor (olaparib or talazoparib).

    • In women with metastatic breast cancer that is hormone receptor negative, has not responded to hormone therapy, has spread to other organs or has caused symptoms, treatment may include:

  • Chemotherapy with one or more drugs.

    • In women with metastatic breast cancer that is hormone receptor negative and HER2 negative, treatment may include:

  • Chemotherapy and immunotherapy (atezolizumab).
  • Total mastectomy for women with open or painful breast lesions. Radiation therapy may be given after surgery.
  • Surgery to remove cancer that has spread to the brain or spine. Radiation therapy may be given after surgery.
  • Surgery to remove cancer that has spread to the lung.
  • Surgery to repair or help support weak or broken bones. Radiation therapy may be given after surgery.
  • Surgery to remove fluid that has collected around the lungs or heart.
  • Radiation therapy to the bones, brain, spinal cord, breast, or chest wall to relieve symptoms and improve quality of life.
  • Strontium-89 (a radionuclide) to relieve pain from cancer that has spread to bones throughout the body.

    • Other treatment options for metastatic breast cancer include:

  • Drug therapy with bisphosphonates or denosumab to reduce bone disease and pain when cancer has spread to the bone. (See the PDQ summary on Cancer Pain for more information about bisphosphonates.)
  • A clinical trial of high-dose chemotherapy with stem cell transplant.
  • A clinical trial of an antibody-drug conjugate (sacituzumab).
  • Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

    • Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

    乳腺癌治疗（成人）(PDQ®)

    原位导管癌（DCIS）的治疗方案

    有关下面列出的治疗的信息，请参阅“治疗方案概述”部分。

    导管原位癌的治疗可包括：

  • 乳房保留手术和有无三苯氧胺的放射治疗。
  • 有、无三苯氧胺的全乳房切除术。也可以进行放射治疗。

    • 使用我们的临床试验搜索来查找NCI支持的（正在接受患者）癌症临床试验。您可以根据癌症类型、患者年龄以及进行试验的地点搜索试验。也可以获取有关临床试验的一般信息。

    Breast Cancer Treatment (Adult) (PDQ®)

    Treatment Options for Ductal Carcinoma In Situ (DCIS)

    For information about the treatments listed below, see the Treatment Option Overview section.

    Treatment of ductal carcinoma in situ may include the following:

  • Breast-conserving surgery and radiation therapy, with or without tamoxifen.
  • Total mastectomy with or without tamoxifen. Radiation therapy may also be given.

    • Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

    乳腺癌治疗（成人）(PDQ®)

    了解更多关于乳腺癌

    了解更多国家癌症研究所关于乳腺癌信息，参阅以下：

  • 乳腺癌主页
  • 患有DCIS或乳腺癌的女性手术选择
  • 减低乳腺癌风险的手术
  • 乳房切除术后的乳房再造
  • 前哨淋巴结活检
  • 致密乳腺组织：常见问题解答
  • 乳腺癌批准使用药物
  • 乳腺癌的激素疗法
  • 肿瘤靶向治疗
  • 炎症乳腺癌
  • BRCA突变：癌症风险与基因检测
  • 遗传性癌症易感综合征的基因检测

    • 关于国家癌症研究所的一般癌症信息及其他资源，请参阅以下内容：

  • 关于癌症
  • 分期
  • 你和化疗的关系：帮助癌症患者
  • 你和放射疗法的关系：帮助癌症患者
  • 应对癌症
  • 可向医生咨询的关于癌症的问题
  • 幸存者与护理人员知识库
    • Breast Cancer Treatment (Adult) (PDQ®)

    To Learn More About Breast Cancer

    For more information from the National Cancer Institute about breast cancer, see the following:

  • Breast Cancer Home Page
  • Surgery Choices for Women with DCIS or Breast Cancer
  • Surgery to Reduce the Risk of Breast Cancer
  • Breast Reconstruction After Mastectomy
  • Sentinel Lymph Node Biopsy
  • Dense Breasts: Answers to Commonly Asked Questions
  • Drugs Approved for Breast Cancer
  • Hormone Therapy for Breast Cancer
  • Targeted Cancer Therapies
  • Inflammatory Breast Cancer
  • BRCA Mutations: Cancer Risk and Genetic Testing
  • Genetic Testing for Inherited Cancer Susceptibility Syndromes

    • For general cancer information and other resources from the National Cancer Institute, see the following:

  • About Cancer
  • Staging
  • Chemotherapy and You: Support for People With Cancer
  • Radiation Therapy and You: Support for People With Cancer
  • Coping with Cancer
  • Questions to Ask Your Doctor about Cancer
  • For Survivors and Caregivers
    • 乳腺癌治疗（成人）(PDQ®)

    About This PDQ Summary

    About PDQ

    Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

    PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

    Purpose of This Summary

    This PDQ cancer information summary has current information about the treatment of adult breast cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

    Reviewers and Updates

    Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

    The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.

    Clinical Trial Information

    A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

    Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

    Permission to Use This Summary

    PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

    The best way to cite this PDQ summary is:

    PDQ® Adult Treatment Editorial Board. PDQ Breast Cancer Treatment (Adult). Bethesda, MD: National Cancer Institute. Updated . Available at: https://www.cancer.gov/types/breast/patient/breast-treatment-pdq. Accessed . [PMID: 26389406]

    Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

    Disclaimer

    The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

    Contact Us

    More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

    Breast Cancer Treatment (Adult) (PDQ®)

    About This PDQ Summary

    About PDQ

    Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

    PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

    Purpose of This Summary

    This PDQ cancer information summary has current information about the treatment of adult breast cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

    Reviewers and Updates

    Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

    The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.

    Clinical Trial Information

    A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

    Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

    Permission to Use This Summary

    PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

    The best way to cite this PDQ summary is:

    PDQ® Adult Treatment Editorial Board. PDQ Breast Cancer Treatment (Adult). Bethesda, MD: National Cancer Institute. Updated . Available at: https://www.cancer.gov/types/breast/patient/breast-treatment-pdq. Accessed . [PMID: 26389406]

    Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

    Disclaimer

    The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

    Contact Us

    More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

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    目录
    章 节
    乳腺癌概述 乳腺癌的分期 炎症乳腺癌 复发性乳腺癌 治疗方案描述 乳腺癌的治疗选择 原位导管癌（DCIS）的治疗方案 了解更多关于乳腺癌 About This PDQ Summary
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