「乳」你同行 新藥療共抗乳癌

乳癌是本澳女性罹患癌症之首，每19人就有一人中招，且近年更有年輕化趨勢，可謂女性們的頭號大敵！然而，隨著醫學進步，治療乳癌的技術及藥物愈來愈多，早期乳癌的存活率更可高達九成，即使是乳癌復發，仍然有不同的治療方案可供選擇。因此，患者應勇敢地與醫生及家人攜手對抗乳癌。

早期發現提高存活率

乳房的保養與健康是女性一生的課題，但由於傳統觀念影響，即使摸到出現硬塊，亦因羞於聞診而錯過最佳的治療機會。臨床腫瘤科專科醫生陳亮祖表示，若乳癌能及早發現並作出適當治療，不僅能提高治癒率，亦更有利進行乳房保留手術，存活率可高達九成，「由於第一、二期乳癌患者的腫瘤細胞面積相對較少，醫生可根據患者病情，在適合的情況下選擇施行乳房保留手術。」在手術後，為了減低復發機會，陳醫生表示會按患者的腫瘤類型而選擇適合的術後輔助治療，如放射治療、化療等；以雌激素受體呈陽性的乳癌為例，病人需服用為期五年的荷爾蒙藥物，如「三苯氧胺 (Tamoxifen)」，作輔助治療；若病人已屆更年期，亦可考慮服用「芳香酶抑制劑 (Aromatase Inhibitors, Als)」。

正向態度面對乳癌復發

若乳癌不幸復發，患者往往會因為要接受化療而變得擔憂，害怕化療的副作用會影響她們現時的生活質素。「若患者屬年長、身體較弱，又或癌症沒有擴散至重要器官，只要病情適合，患者仍可繼續選擇荷爾蒙治療。」陳醫生以更年期後雌激素受體呈陽性的患者為例，指出除了上述的口服荷爾蒙藥物外，現時更有針劑荷爾蒙藥物如「氟維司群 (Fulvestrant)」供病人選擇。「氟維司群」已獲證實能有效控制更年期後雌激素受體呈陽性的原位復發或出現轉移性乳癌的病人使用，「它的藥理是與雌激素受體結合，阻礙雌激素於癌細胞的作用，並可減少癌細胞中雌激素受體的數目，與其他荷爾蒙藥物的藥理完全不同，對更年期患者有更佳治療效果。」陳醫生補充，每種藥物都有其副作用，因此在選擇治療藥物時，患者應與主診醫生詳細討論最適合的治療方案。

同路人支持戰勝乳癌

除了醫生、護士的照顧外，家人的體諒、朋友的鼓勵、同路人的扶持，亦是患者戰勝乳癌的重要關鍵。只要時常抱著樂觀、正面的態度，遇上困難即向有關人士尋求協助，抗癌的道路便會相對輕鬆。

開心樂園協會 抗癌路上共扶持

無論面對哪一種癌症，於患者及家屬而言，都是人生中的一大挑戰；由於一般人對癌症都甚少了解亦沒有心理准備，在突然獲知罹患癌症時，往往會因恐慌而感到焦慮無助，令心理及情緒大受影響，若此刻能有同伴指點帶路，於抗癌路上所承受的壓力將會大大降低。

為促進本澳、海內外長期病患者及其家屬之間的交流，並普及治療和復康知識，本地志願組織「開心樂園協會」於今年2月正式成立。會場林詠儀表示，由於很多患者對癌症缺乏了解，再面對一連串手術、化療或電療時，會容易產生壓力而令情緒備受困擾，也正因為治療癌症是一場長期抗戰之路，旁人的鼓勵關懷能對患者及家屬有很大幫助，「為協助患者建立正面積極的態度，本會會定期舉辦不同的病友聚會，透過相互打氣及交換心得，藉由別人的經驗令自己獲得能量，讓患者知道他們在抗癌路上並不孤單。」協會除有專業醫療人士為患者及家人解答疑難，亦會與不同的團體合作舉辦醫療講座，分享最新的癌症資訊及護理知識，以加深患者和家屬對癌症的認識，有助建立正面態度共抗癌症。

參考資料:  www.exmoo.com
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的腫瘤科專科醫生查詢，而不應單倚賴以上提供的資料。

預防大腸癌

大腸癌是香港常見癌症之一。根據醫院管理局○九年的統計數字，它是第二常見的癌症，共有四千三百三十五宗新症，約佔同年所有新增癌症的百分之十七。相對一 九九九年的三千零二十四宗新症的總體數字，升四成有多。究其增長原因有三：一為香港總體人口增加；二是人口老化；三是香港人生活方式改變，趨向西方的飲食 習慣。

要減少大腸癌的發病率，前兩因素我們不能控制。然而，養成良好的生活習慣，留意大腸癌的病徵，加上定期普查，正是關鍵所在。

何謂良好的生活習慣，這包括：

        1.每天進食蔬菜和水果；

        2.減少吃紅肉、燒烤、煙燻的食物；

        3.少吃高脂肪食物；

        4.每日運動；

        5.保持體重：體重指標（BMI）應在18.5與22.9之間；

        6.切勿吸煙及避免飲酒。

大腸癌的病徵，包括大便帶血、帶潺、變幼及大便習慣改變、腹痛，裏急後重（即感覺急需大便而無法排出）、貧血、體重減輕等。很多人以為大便帶血是痔瘡問題、怕麻煩或諱疾忌醫，因此錯過及早診斷及醫治的機會。倘若出現上述病徵，應盡早求醫。

陳亮祖醫生

香港防癌會化療中心臨牀腫瘤科顧問




參考資料:http://news.h1.com.hk/dailynews/headline_news_detail_columnist.asp?id=203799&section_name=hit&kw=11

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的腫瘤科專科醫生查詢，而不應單倚賴以上提供的資料。

Managing pain in a patient with pancreatic cancer (2)

Discussion

Pain is one of the most common symptoms experienced by cancer patients. It has been estimated that approximately 50 to 70 percent of patients with cancer experience some degree of pain, which usually progresses and intensifies as the disease progresses.¹ One study noted that the incidence of pain in patients with advanced stages of invasive cancer may be as high as 80 percent. The incidence can be as high as 90 percent for those with metastases in osseous structures.² However, more than half of cancer patients have insufficient pain control. Severe pain can significantly impair patients’ quality of life and interfere with their physical rehabilitation, nutrition and mobility. Furthermore, a large number of cancer patients suffer from depression.³

Several practice guidelines on pain control have been formulated. The most widely used algorithm in the management of cancer pain is probably the one formulated by the WHO, called the WHO cancer pain treatment step ladder. These guidelines recommend the use of paracetamol or NSAIDs as an initial step in pain management, followed by opioid analgesic for mild to moderate pain, and strong opioids for moderate to severe pain.⁴ (Figure 2) However, some experts have stated that the WHO guidelines may be inadequate to address current needs and suggested the addition of a fourth interventional step in the form of nerve blocks, intrathecal delivery systems, or surgical procedures.⁵

Oxycodone is a synthetic opioid metabolized to its active metabolite, oxymorphone, in the liver. A comparison of oxycodone CR and morphine demonstrated similar analgesic effects between the two drugs. However, there were significant differences in pain control for patients with underlying renal or hepatic impairment receiving oxyvodone.⁶ although oxycodone is generally more expensive than morphine, it has proven efficacy in treating moderate to severe pain, and its CR formulation allows for the convenience of 12-hour dosing intervals.⁷

The use of opioids, though often perceived to be associated with palliative care, plays and important role in pain management. In the case of our patient, it resulted in satisfactory pain control and improved quality of life, enabling him to undergo and tolerate subsequent chemotherapy, which can potentially control the disease and prolong survival.

Dr Leung-Cho Chan                                                 

Specialist in Clinical Oncology Private practice Hong Kong

 

 

 Reference information:  oncologytribune
The information aims to provide educational purpose only. Anyone reading it should consult Oncologist before considering treatment and should not rely on the information above.

Managing pain in a patient with pancreatic cancer (1)

Presentation and management

This is the case of a 53-year-old married male with children who sought consultation for progressive abdominal pain in April 2014. The pain had been present for 1 to 2 months prior to the consultation, and was previously diagnosed by other doctors as pain due to gastritis. The patient described the pain as severe, giving it a score of 7 to 8 on a numerical rating scale of 1 to 10. Esophagogastroduodenoscopy was unremarkable, but CT scan revealed a pancreatic tumor with liver metastasis and mild ascites, which was inoperable due to celiac plexus infiltration and secondary lesions in the liver. Pain management was initiated using oxycodone 10 mg controlled-release (CR) tablets twice daily and oxycodone 5 mg capsules as needed. The patient was informed of possible side effects such as dizziness, nausea, vomiting and constipation. Metoclopramide and a senna-based laxative were prescribed for nausea and vomiting, and constipation, respectively.

The patient then underwent intensity-modulated radiotherapy, receiving 3.0 Gy per fraction at the tumor area, 2.8 Gy at the 0.7 cm tumor margin, and 2.5 Gy at the 1.0 cm tumor margin for a total of 15 fractions given over 3 weeks. (Figure 1)

Pain intensity improved from a score of 7 to 8 initial consultation to 4 after 3 to 4 days of treatment with oxycodone. Two weeks after radiotherapy, pain intensity further reduced to a score of 2. The dose of oxycodone was reduced to one 10 mg CR tablet daily at night time. Oxycodone 5 mg capsule was discontinued and replaced by an NSAID taken as needed during daytime.

During follow-up visits every 1 to 2 months, the patient reported only mild pain. He is now receiving gemcitabine as single-agent chemotherapy at a public hospital.

Dr Leung-Cho Chan                                                 

Specialist in Clinical Oncology Private practice Hong Kong

Reference information:  oncologytribune
The information aims to provide educational purpose only. Anyone reading it should consult Oncologist before considering treatment and should not rely on the information above.