大连医科大学肿瘤研究生硕士试卷(专业外语)

大连医科大学肿瘤研究生硕士试卷(专业外语) 大连医科大学硕士研究生试卷 2010 年级专业外语试卷 学号 姓名 命单位:附属二院 教研室:肿瘤学 教研室主任审核签字: 考生须知 1、检查所发试阅卷人 : 卷是否和自己 所报科目一 一 二 三 四 五 总分 致，试卷有无 缺页、漏印、分数 字迹模糊，如 有可举手请求 换卷。 Breast Cancer 2、必须将自己 的学号、姓名、 Symptoms and Signs 专业班级写在 试卷指定位置 Most breast cancers are discovered as a lump by the patient or during routine 上。 physical examination or mammography. Less commonly, the presenting symptom is breast 3、在试卷密封 pain or enlargement or a nondescript thickening in the breast. Paget's disease of 线以外填写姓 the nipple presents with skin changes, including erythema, crusting, scaling, and 名、学号或写 discharge; these usually appear so benign that the patient ignores them, delaying 有与答题内容 diagnosis for a year or more. About 50% of patients with Paget's disease of the nipple 无关的语句和 have a palpable mass at presentation. A few patients with breast cancer present with 作其它标记的 signs of metastatic disease (eg, pathologic fracture, pulmonary dysfunction). 试卷一律作 A common finding during physical examination is a dominant mass—a lump 废，后果自负。 distinctly different from the surrounding breast tissue. Diffuse fibrotic changes in a quadrant of the breast, usually the upper outer quadrant, are more characteristic of benign disorders; a slightly firmer thickening in one breast but not the other may be a sign of cancer. More advanced breast cancers are characterized by fixation of the lump to the chest wall or to overlying skin, by satellite nodules or ulcers in the skin, or by exaggeration of the usual skin markings resulting from lymphedema (so-called peau d'orange). Matted or fixed axillary lymph nodes suggest tumor spread, as does supraclavicular or infraclavicular lymphadenopathy. Inflammatory breast cancer is characterized by diffuse inflammation and enlargement of the breast, often without a lump, and has a particularly aggressive course Diagnosis Testing is required to differentiate benign lesions from cancer. Because early detection and treatment of breast cancer improves prognosis, this differentiation must be conclusive before evaluation is terminated. If advanced cancer is suspected based on physical examination, biopsy should be done first; otherwise, the approach is as for breast lumps. A prebiopsy bilateral 第 1 页 共 2 页 Dalian Medical University mammogram may help delineate other areas that should be biopsied and provides a baseline for future reference. However, mammogram results should not alter the decision to perform a biopsy. Biopsy can be needle or incisional biopsy or, if the tumor is small, excisional biopsy. Any skin with the biopsy specimen should be examined because it may show cancer cells in dermal lymphatic vessels. Routinely, stereotactic biopsy (needle biopsy during mammography) or ultrasound-guided biopsy is being used to improve accuracy. Evaluation after cancer diagnosis: Part of a positive biopsy specimen should be analyzed for estrogen and progesterone receptors and for HER2 protein. WBCs should be tested for BRCA1 and BRCA2 genes when family history includes multiple cases of early-onset breast cancer, when ovarian cancer develops in patients with a family history of breast or ovarian cancer, when breast and ovarian cancer occur in the same patient, when patients have Ashkenazi Jewish heritage, or when family history includes a single case of male breast cancer. Chest x-ray, CBC, and liver function tests should be done to check for metastatic disease. Generally, measuring serum carcinoembryonic antigen (CEA), cancer antigen (CA) 15-3, CA 27-29, or a combination is not recommended because results have no effect on treatment or outcome. Bone scanning should be done if patients have tumors > 2 cm, musculoskeletal pain, lymphadenopathy, or elevated serum alkaline phosphatase or Ca levels. Abdominal CT is done if patients have abnormal liver function results, hepatomegaly, or locally advanced cancer with or without axillary lymph node involvement. Grading and staging follow the TNM classification (see Table 2: Breast Disorders: Staging and Survival of Breast Cancer). Staging is refined during surgery, when regional lymph nodes can be evaluated. Screening: Screening includes mammography, clinical breast examination (CBE) by health care practitioners, and monthly breast self-examination (BSE). Mammography, done annually, reduces mortality rate by 25 to 35% in women ? 50 yr. However, there is considerable disagreement about screening for women 40 to 50 yr; recommendations include annual mammography (American Cancer Society), mammography every 1 to 2 yr (National Cancer Institute), and no periodic mammography (American College of Physicians). CBE is usually part of routine annual care for women > 35; it can detect 7 to 10% of cancers that cannot be seen on a mammogram. In the US, CBE augments rather than replaces screening mammography. However, in some countries where mammography is considered too expensive, CBE is the sole screen; reports on its effectiveness in this role vary. BSE has not been shown to reduce mortality rate but is widely practiced. Because a negative BSE may tempt some women to forego mammography or CBE, the need for these procedures is reinforced when BSE is taught. 第 2 页 共 2 页 Dalian Medical University