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乳腺癌治疗和生存率的内分泌后果
Meg Henze1, Bronwyn G A Stuckey1,2,3
1Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
概括
乳腺癌的生存率正在改善,但更年期和骨健康等长期内分泌问题需要谨慎管理. 保存生育能力和管理更年期症状是幸存者关心的关键问题.
科学领域:
- 在瘤学瘤学.
- 内分泌学 在内分泌学.
- 生殖医学 生殖医学
背景情况:
- 由于早期诊断和治疗的进步,乳腺癌的生存率正在增加.
- 长期的内分泌后果,包括早期更年期,骨健康,生育能力和更年期症状,是幸存者的重大担忧.
- 化疗经常导致卵巢衰竭,影响年轻女性的生育能力.
研究的目的:
- 审查乳腺癌幸存者面临的内分泌相关问题.
- 讨论生育保护选择和辅助疗法的影响.
- 在这个人群中概述管理骨健康和更年期症状的策略.
主要方法:
- 关于乳腺癌存活率和内分泌后果的当前文献的综述.
- 对辅助疗法 (他莫西芬,芳酶抑制剂,GnRH激动剂) 对内分泌功能和骨健康的影响进行分析.
- 对乳腺癌患者的生育保存技术和怀孕结果的评估.
- 对更年期症状的管理策略的评估.
主要成果:
- 生育保存的选择包括卵巢抑制和冷保存 (卵子/胚胎).
- 塔莫西芬可以引起卵巢刺激和潜在的怀孕,需要仔细的咨询,因为产性风险.
- 芳酶抑制剂 (含有或不含GnRH激动剂) 导致显著的骨质损失,需要抗吸收疗法.
- 塔莫西芬可以在绝经后妇女中保存骨,但不能在绝经前妇女中.
- 在年轻的幸存者中,怀孕是允许的,可能涉及暂停辅助治疗.
- 绝经期荷尔蒙疗法通常不建议,但可以选择非荷尔蒙疗法,荷尔蒙疗法作为知情患者的考虑因素.
结论:
- 乳腺癌幸存者面临着重大的长期内分泌挑战,包括生育能力丧失和骨健康下降.
- 管理策略包括保护生育能力,仔细考虑辅助疗法的效果,并解决更年期症状.
- 虽然更年期荷尔蒙疗法通常是避免,个性化决策可以为生活质量在知情的患者.
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