Erken ve Lokal İleri Meme Kanseri
Özet
Meme kanseri, kadınlarda tüm dünyada olduğu gibi ülkemizde de en sık görülen kanser türüdür. Ülkemizde tanı konulan her 4 kadın kanserinden 1’i meme kanseridir. Ülkemizde meme kanseri evreleri incelendiğinde, vakaların %48,2’sinin lokal evrede tanı aldığı görülmektedir. İnvaziv meme kanseri, Luminal A, Luminal B, HER-2 pozitif ve triple negatif meme kanseri olarak temel 4 moleküler sınıflama altında incelenir. Erken evre meme kanseri ve lokal ileri kanser hastaları, neoadjuvan kemoterapi ve cerrahi açısından multidisipliner olarak değerlendirilmelidir. Hastalar, cerrahi sonrasında patolojik yanıt durumuna göre medikal tedavileri düzenlenmelidir. Hastalara, primer tedaviden sonraki ilk 3 yıl boyunca her 3 ile 6 ayda bir, 4. ve 5. yıllarda her 6 ile 12 ayda bir ve daha sonra yılda bir mutlaka fizik muayene yapılmalıdır. Tedavi sonrası ilk mamografi, tanıya yol açan ilk mamografiden 1 yıl sonra, ancak kesin radyasyon tedavisinden en erken 6 ay sonra çekilmelidir. Tüm kadınlar için düzenli jinekolojik takip önerilir; tamoksifen alan hastalara herhangi bir vajinal kanamayı bildirmeleri tavsiye edilmelidir. Hastalarda takipte, tümör markerları, PET-CT veya meme MR görüntülemesi, hemogram veya karaciğer fonksiyon testlerine bakılması önerilmemektedir.
Breast cancer is the most common type of cancer in women in our country as in the whole world. In our country, 1 out of every 4 female cancers diagnosed is breast cancer. When the stages of breast cancer are analysed in our country, it is seen that 48.2% of the cases are diagnosed at the local stage. Invasive breast cancer is analysed under 4 molecular classifications as Luminal A, Luminal B, HER-2 positive and triple negative breast cancer. Early stage breast cancer and locally advanced cancer patients should be evaluated multidisciplinarily for neoadjuvant chemotherapy and surgery. After surgery, medical treatment should be arranged according to the pathological response status. Patients should undergo physical examination every 3 to 6 months for the first 3 years after primary treatment, every 6 to 12 months in the 4th and 5th years, and annually thereafter. The first post-treatment mammogram should be performed 1 year after the first mammogram that led to the diagnosis, but no earlier than 6 months after definitive radiation therapy. Regular gynaecological follow-up is recommended for all women; patients receiving tamoxifen should be advised to report any vaginal bleeding. Tumour markers, PET-CT or breast MRI, haemogram or liver function tests are not recommended at follow-up.
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