บทบาทของรังสีรักษาในเนื้องอกเต้านม ชนิด DCIS (Ductal carcinoma in Situ)
Abstract
DCIS คือ เป็นภาวะที่เซลล์มีการเจริญเติบโตที่มากผิดปกติ แต่เซลล์มะเร็งอยู่ในท่อน้ำนมของเต้านม และไม่มีการ invasion คือไม่มี disrupt basement membrane หรือไม่ลุกลาม surrounding breast stroma โอกาสการแพร่กระจายไปต่อมน้ำ เหลืองน้อยมาก มักจะอยู่แต่ในเต้านม การแพร่กระจายไปต่อมน้ำเหลืองนั้นมักพบร่วมกับการพบ focus ของ invasive ในสมัยก่อน ผู้ป่วยมักมาด้วย DCIS ที่ก้อนใหญ่ มี nipple discharge และมักมี invasive component แต่เนื่องจาก ปัจจุบัน ผู้ป่วยมาคัดกรองมะเร็งเต้านมมากขึ้น จึงมักพบก้อนเล็ก ส่งผลให้มี breast cancer free survival ที่ดีขึ้นมาก [1] การรักษาเฉพาะที่ (local treatment) คือการผ่าตัดซึ่งได้แก่ การผ่าตัดเต้านมทั้งเต้า หรือ การผ่าตัดแบบสงวนเต้านม (breast conserving surgery) ผู้ป่วยที่ผ่าตัดเต้านมทั้งเต้า มักทำในผู้ป่วยที่มีโรคค่อนข้างมากเช่นพบรอยโรคตั้งแต่ 2 quadrants ของเต้านมขึ้นไป ผู้ป่วยเหล่านี้ไม่จำเป็นต้องได้รับการฉายรังสีตามหลังการผ่าตัดยกเว้นในผู้ป่วยที่มี positive margin สำหรับ ผู้ป่วยที่ได้รับการผ่าตัดแบบสงวนเต้านมการฉายรังสีตามหลังถือเป็นมาตรฐานในการรักษา
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https://www.trog.com.au/TROG-0701-DCIS
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