去年11月底才分享麻吉兼戰友Angela產下健康女娃的好消息,沒想到本月初她就發現乳癌復發,又需要再經歷一輪的治療過程。

於是1月中她做了淋巴廓清,14顆淋巴裡面有三顆是腫瘤,所以進入二期。(Angela之前為一期)

手術完後,醫師安排歐洲紫杉醇化療,次數尚未決定,預計4~6次。

古溜(寶寶名)才兩個月大,現在母乳也不能餵了,改喝配方奶。

「化療結束後還可以餵母乳嗎?」我問

「醫師說打完隔兩三月,等藥效退才能再餵了。」Angela說。

「你確定2~3個月就可以再餵?化療藥有這麼快排出體外?」我再追問。

「醫師就這樣講啊!還是你可以幫我問一下你的醫師?」Angela回答。

經詢問廖醫師的結果,歐洲紫杉醇半衰期很長,不建議哺乳Angela聽了很感傷,她本來打算母乳能餵多久就餵多久,但為了寶寶著想,也只能改喝配方奶了。

Angela確診的時間比我早一個月(2012年8月),媽咪都笑稱我們真的是"患難與共"的死黨,連罹癌的時間也差不多。

當時Angela檢查出來為乳癌一期,手術切除1/4乳房後,醫師為她安排了化療和放療等「預防性治療」。

我們也曾討論過「預防性治療」到底有沒有必要的問題......

「如果是我的話不會去做預防性治療,我覺得應該要從根本去改變,改變飲食、作息、運動等,罹癌的因子如果沒有去除,就算做了預防性治療,癌症還是會再復發。」我告訴她自己的想法。

後來她還是採納了主治醫師的建議,接受了6次小紅莓及25次局部放療,再吃了一年的抗雌激素藥物;抗雌激素藥物一般要吃五年,但因為她有生孩子計畫,故醫師建議最短吃一年。

我開始思考,所謂的「預防性治療」到底有沒有效果?

還是改變心吃動睡(心態、飲食、運動、睡眠)的習慣比較重要?

或許兩者雙管齊下更有效吧!

乳癌戰友最好不要吃乳製品,因為乳製品本身就含雌激素,我千叮嚀萬交代,只是Angela常常把我的話當耳邊風,從不忌口,也沒運動,我想因為她沒有經歷生死交關的時刻,所以不會有這麼深刻的體悟吧!

現在的我,也只能陪伴她做完第二輪的治療,再慢慢幫助她把身體調養好了......

mombaby-cartoon  

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星希亞的抗癌日誌

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  • 訪客
  • 请问她是属于哪一种的乳癌?
  • 我今天問她...結果是不知道...@@
    感覺跟主治醫師的溝通上有很大的進步空間,哈哈!

    Cincia 於 2016/01/30 14:36 回覆

  • 黃嘉家
  • 她現在有了女兒,應該會更努力去實行妳告知的話,且為母則強,祝她治療順利
  • 嗯嗯!她還想生第二胎,希望可以實現心願了!

    Cincia 於 2016/01/30 14:36 回覆

  • 悄悄話
  • Gary YC LIN
  • Angela加油!! 現在教主的話,Angela會乖乖聽了吧??
  • 看起來好像有比較聽話一點,希望可以持續久一點XDDDD

    Cincia 於 2016/01/30 14:37 回覆

  • 訪客
  • @()又是醫生開不乾淨
    加速轉移………
    偉大媽媽要加油喔
    為了小孩
    快過年祝大家健康快樂
  • 是因為開不乾淨而加速移轉嗎?乳癌我不是很清楚....
    目前Angela看起來很堅強,我相信她可以痊癒的。

    Cincia 於 2016/01/30 14:43 回覆

  • David
  • 聽起來Angela應該是ER+ PR+
    她的癌細胞是靠雌激素驅動的
    女性於懷孕和哺乳期間 雌激素會降低
    所以Angela的癌細胞很安份
    小孩生出來後 Angela的雌激素又回到高水平
    癌細胞又開始繁衍擴張

    把身體內的雌激素降到最低水平 是非常重要的
    有兩件事Angela可以考慮
    一是和Angelina Jolie 一樣把卵巢切除
    二是打停經針+諾曼癌素...

    我個人覺得手術切除是最安全的方式
    打針會導致其他癌症的可能

    下面是一位乳癌病友Amanda的訊息 提供參考
    我沒有考証內容的真實性

    停經前婦女荷爾蒙受體陽性乳癌,手術後無論是否輔助化學治療,使用Zoladex(諾雷德)併用Aromasin(諾曼癌素)比使用Zoladex(諾雷德)併用Tamoxifen(諾瓦得士),可以下降復發率及增加存活率 。根據統計某些停經前婦女荷爾蒙受體陽性乳癌,術後不打化療,只用Zoladex(諾雷德)併用Aromasin(諾曼癌素) 五年後乳癌不復發可達97%。 所以某些停經前婦女荷爾蒙受體陽性乳癌,Zoladex(諾雷德)併用Aromasin(諾曼癌素)是一個很好的治療方式。

    Source:
    http://lovegod777.pixnet.net/blog/post/205062145-9-29%e3%80%8110-13-%e8%bd%89%e7%a7%bb%e5%be%8c%e5%8c%96%e7%99%82%ef%bc%9a%e5%a4%aa%e5%b9%b3%e6%b4%8b%e7%b4%ab%e6%9d%89%e9%86%87%ef%bc%8b%e5%81%a5%e6%be%a4-1#comments
  • David真厲害,真的有研究耶!我現在才開始查乳癌的資料,還在腦中整理,哈哈~
    我死黨還想生第二個寶寶,希望她這次治療完可以順利達成心願。

    Cincia 於 2016/01/30 15:44 回覆

  • David
  • 其實不是"預防性治療" 而是治療
    2期無掖下淋巴結擴散 手術後復發可能性大需做放療
    有掖下淋巴結擴散 還要加上化療
    ER+ PR+ 在加上 5年Tamoxifen
    HER2+ 在加上 1年Herceptin

    只是標準療程沒有包括切除卵巢這個禍源
    這需要病人自己瞭解病因 下定決心做的決定
    可以先試打停經針+諾曼癌素一年看看是否能有效抑制癌症增生擴散
  • 橘子
  • 一般治疗结束3年后才考虑怀孕,她太着急了吧。激素receptor建议减少日常饮食中动物制品的摄入,尽量购买有机肉类。最好不用含激素化妆品,家居清洁用品最好买无harsh chemicals,因为有些化学品在体内模拟激素反应。虽然生活restriction 不是绝对的,但注意一些对防止复发还是有帮助的。
  • 感謝你的建議,我會轉告Angela的。

    Cincia 於 2016/01/30 15:46 回覆

  • David
  • 台大林璟宏醫師在下面影片談到打停經針和芳香環媒抑制劑來治療ER+ PR+ HER-病人 (13分鐘處)

    https://www.youtube.com/watch?v=D2F0sxtwQog

  • 感謝David提供的資訊,我會轉給Angela的。

    Cincia 於 2016/01/30 16:32 回覆

  • David
  • 聽起來Angela對自己的病不清楚
    榮總趙大中醫師的影片是我看過最好入門教材

    乳癌的分期與治療

    https://www.youtube.com/watch?v=GaFT2NpnypA
  • 謝謝你~我傳給Angela看~

    Cincia 於 2016/02/01 08:56 回覆

  • peter
  • 加油,只要知道問題,解答就不遠了。
  • David
  • Ovarian suppression

    Ovarian suppression is the medical terms used to prevent the ovaries from producing oestrogen, either temporarily or permanently.

    All women produce a hormone called oestrogen which stimulates some breast cancers to grow. If oestrogen stimulates your breast cancer to grow it is known as oestrogen receptor positive breast cancer or ER+ breast cancer.

    Before the menopause, oestrogen is mainly produced by the ovaries. If the ovaries are removed or stopped from working there is less oestrogen in the body to stimulate the cancer to grow. Fat cells will still produce small quantities of oestrogen.

    Who may be offered ovarian ablation or suppression?
    Ovarian suppression may be needed if you’ve not yet reached the menopause (pre-menopausal) and your breast cancer is oestrogen receptor positive.

    It may also be used to try to protect your fertility during chemotherapy.

    It’s also sometimes used to shrink and control breast cancer that has spread.

    Recent research suggests that some women who remain pre-menopausal after chemotherapy may benefit from ovarian suppression, as it reduces the risk of the cancer coming back. Older pre-menopausal women (over the age of 40) may not get as much benefit from ovarian suppression.

    Your medical team should discuss what the best treatment plan is for you and why.

    What does it involve?
    Ovarian suppression can be achieved by:

    hormone therapy (drug therapy)
    surgery
    Your specialist team should help you decide which is best for you. Ovarian suppression using hormone therapy is the only form of ovarian suppression that may not be permanent. This may be something to consider when making your decision especially if you want to have children.

    Hormone therapy
    Certain drugs ‘switch off’ oestrogen being made by the ovaries. They interfere with signals from the brain that control how the ovaries work.

    One of the drugs most commonly used is goserelin (Zoladex). Goserelin comes as an implant or a small pellet given as an injection under the skin (subcutaneously) into your tummy area (abdomen). It is usually given every 28 days. You may still be able to get pregnant while having goserelin treatment but the drug could harm a developing baby so talk to your doctor about contraception.

    Surgery to remove the ovaries
    An operation to remove the ovaries is called an oophorectomy. The fallopian tubes, which are close to the ovaries, are usually removed at the same time. The surgery is done under a general anaesthetic.

    It can be done as ‘keyhole’ surgery, which means an instrument called a laparoscope (a flexible thin tube with a camera lens attached) is used so that the surgeon can look into the abdomen. There are usually three small cuts made; one near the belly button, one near the bikini line and one on the side of the abdomen.

    Sometimes it isn’t possible for the ovaries to be removed through ‘keyhole’ surgery. In this case the ovaries are removed through a short incision made below the bikini line.

    Removing the ovaries will mean an immediate and permanent menopause. This means that your periods will stop straight away.

    Ovarian suppression combined with tamoxifen or aromatase inhibitors
    The most common treatment for pre-menopausal women with oestrogen receptor positive breast cancer has been tamoxifen. There are ongoing studies testing the benefit of combining ovarian suppression with hormone treatments such as tamoxifen or aromatase inhibitors. Some recent research suggests that an aromatase inhibitor combined with ovarian suppression may reduce breast cancer recurrence more than tamoxifen combined with ovarian suppression.

    Your specialist team should discuss this if they think it would help you.

    Side effects of ovarian suppression
    During a natural menopause the ovaries stop producing oestrogen and some women get menopausal symptoms such as hot flushes, night sweats, vaginal dryness and loss of sex drive. The removal of the ovaries or their suppression can also cause menopausal symptoms.

    Experiencing a sudden menopause can mean these symptoms come on more quickly and may be more intense than with a natural menopause.

    For further information you can also read our pages on menopausal symptoms and sex and intimacy.

    In the long term, there is some concern that women who have an early menopause because of treatment for breast cancer are more at risk of heart disease and osteoporosis (thinning of the bones) in later life.

    Guidance recommends that anyone with primary breast cancer having ovarian suppression treatment is offered a baseline bone density scan (DEXA scan). Read more about osteoporosis and reducing your risk.

    - See more at: https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/going-through-treatment-breast-cancer/hormone-therapy/ovarian-suppression#sthash.3uS4z4Ml.dpuf
  • David
  • Aromatase Inhibitors 芳香酶抑制劑

    Aromatase inhibitors stop the production of estrogen in postmenopausal women. Aromatase inhibitors work by blocking the enzyme aromatase, which turns the hormone androgen into small amounts of estrogen in the body. This means that less estrogen is available to stimulate the growth of hormone-receptor-positive breast cancer cells.

    There are three aromatase inhibitors:

    Arimidex (chemical name: anastrozole)
    Aromasin (chemical name: exemestane)
    Femara (chemical name: letrozole)
    Each is a pill, usually taken once a day. All three are available as generic medicines.

    Aromatase inhibitors can't stop the ovaries from making estrogen, so aromatase inhibitors are mainly used to treat postmenopausal women. But because aromatase inhibitors are so much more effective than tamoxifen in postmenopausal women, researchers wondered if there were a way to successfully treat premenopausal women diagnosed with hormone-receptor-positive, early-stage breast cancer with an aromatase inhibitor. Results from the SOFT (Suppression of Ovarian Function Trial) study published in 2015 suggest that premenopausal women diagnosed with hormone-receptor-positive breast cancer can be successfully treated with the aromatase inhibitor Aromasin if their ovarian function is suppressed. If you’re a premenopausal woman willing to take medicine to suppress your ovaries, you may be able to take Aromasin instead of tamoxifen for your hormonal therapy treatment.

    You should not take an aromatase inhibitor if you are breastfeeding, pregnant, trying to get pregnant, or if there is any chance that you could be pregnant. Aromatase inhibitors may cause damage to developing embryos. You should use an effective non-hormonal type of birth control -- such as condoms, a diaphragm along with spermicide, or a non-hormonal I.U.D. – while you are taking an aromatase inhibitor. Ask your doctor which type of non-hormonal birth control would be best for you, as well as how long you should use this type of birth control after you stop taking an aromatase inhibitor.

    Benefits of aromatase inhibitors
    A number of studies have compared aromatase inhibitors with tamoxifen to see which type of medicine was more effective in treating early-stage, hormone-receptor-positive breast cancer in postmenopausal women. Based on the results, most doctors recommend that after initial treatment (surgery and possibly chemotherapy and radiation therapy):

    an aromatase inhibitor is the best hormonal therapy to start with. When treating early-stage, hormone-receptor-positive breast cancer, aromatase inhibitors have more benefits and fewer serious side effects than tamoxifen.
    switching to an aromatase inhibitor after taking tamoxifen for 2 to 3 years (for a total of 5 years of hormonal therapy) offers more benefits than 5 years of tamoxifen.
    taking an aromatase inhibitor for 5 years after taking tamoxifen for 5 years continues to reduce the risk of the cancer coming back, compared to no treatment after tamoxifen.
    Side effects of aromatase inhibitors
    Aromatase inhibitors tend to cause fewer serious side effects than tamoxifen, such as blood clots, stroke, and endometrial cancer. But aromatase inhibitors can cause more heart problems, more bone loss (osteoporosis), and more broken bones than tamoxifen, at least for the first few years of treatment. If you and your doctor are considering an aromatase inhibitor as part of your treatment plan, you may want to ask your doctor about having a bone density test to see if a bone strengthening medicine might be necessary while you're taking the aromatase inhibitor.

    The most common side effects of aromatase inhibitors are joint stiffness or joint pain.

    If you're experiencing side effects from taking one aromatase inhibitor medicine, tell your doctor. You may be able to take a different medicine. Arimidex and Femara have similar chemical structures, while Aromasin has a different structure.
  • David
  • 認識乳癌荷爾蒙治療

    曾令民醫師

    一、雌激素與乳癌的關係

    (一)雌激素 Estrogen

    女性體內主要的性荷爾蒙,可以刺激生殖相關器官的生長與成熟。

    (二)雌激素受體 Estrogen Receptor(ER)

    分佈在細胞上的受體,當雌激素受體跟血液中的雌激素結合後,傳導細胞生長的訊息至細胞核,引發細胞的分裂、增生,ER主要存在於乳房、子宮內膜的細胞中,這類細胞需要雌激素的存在才能存活、增生。

    (三)ER(+)乳癌

    這類乳癌細胞也有雌激素受體的存在,若能阻斷雌激素對癌細胞的刺激,將有可能抑制癌細胞的生長,進而達到腫瘤縮小、停止生長的目標。

    二、乳癌荷爾蒙療法的兩大策略

    1.直接阻斷雌激素受體,使癌細胞因為缺乏刺激而死亡、停止生長。

    (1)抗雌激素:Tamoxifen(諾瓦得士錠)

    (2)抗雌激素拮抗劑:Fulvestrant(法洛德注射劑)

    2.降低體內雌激素產生,減少雌激素對癌細胞的刺激

    (1)中樞生成抑制劑:包含Goserelin(諾雷德)、Leuplide

    (2)芳香環轉化酶抑制劑:包含Anstrozole(安美達錠)、Letrozole、Exmestane

    四、Tamoxifen荷爾蒙輔助治療

    1.Tamoxifen的最佳療程是五年,為標準荷爾蒙治療選擇。

    2.超過30%早期乳癌病患接受 Tamoxifen治療,在15年內產生復發。

    3.轉移性乳癌無法治癒。

    4.發展新藥理由:

    (1)術後前2年是復發高峰期

    (2)Tamoxifen抗藥性(De novo及acquired)

    (3)Tamoxifen治療5年後部份病人復發或死亡

    (4)副作用(子宮內膜癌、深部靜脈栓塞腦血管栓塞)


    完整資料請至

    http://www.tbca-npo.org.tw/information_content2.asp?ser_no=20
  • 安
  • cincia可否麻煩請教台大醫生Keytruda所引起之嘔吐感和食慾不振如何解決?
    如果長期使用止敏吐是否有不可逆之副作用?感謝您。
  • David
  • 十八、總結

    1.荷爾蒙療法提供乳癌患者化療之外,另一個有效且副作用較低的治療選項。

    2.早期乳癌開完刀後,病患仍應積極接受輔助療法,包含化療以及荷爾蒙療法。

    3.泰莫西芬(Tamoxifen)與第三代芳香環酶抑制劑Aromatase inhibitor(安美達錠Arimidex)在早期乳癌輔助治療,皆可明顯降低復發率,每位荷爾蒙受體陽性病患都應盡量使用滿五年,以達到最佳的保護、遠離復發。

    4.安美達錠(Arimidex) 在降低復發的效果較泰莫西芬(Tamoxifen)明顯,而且在熱潮紅、陰道出血、子宮內膜癌,血栓栓塞,心血管疾病發生率較低,在骨折及骨關節症狀略高,但為可以預防的問題。

    5.停經前乳癌的荷爾蒙治療以諾雷德(Zoladex)人工停經方式2-3年,對病人可達最大的保護且副作用輕微,且可保存病患生育能力。

    6.荷爾蒙療法生力軍法洛德(Faslodex)提供進展性乳癌多一線的荷爾蒙選項。

    完整資料請至

    http://www.tbca-npo.org.tw/information_content2.asp?ser_no=20
  • David
  • Breast Cancer Research Highlights from ASCO 2014

    aromasin more effective than tamoxifen in preventing recurrence in younger women

    Premenopausal women with early-stage hormone receptor-positive breast cancer may benefit more from the drug Aromasin (exemestane) than tamoxifen, the current standard adjuvant therapy.

    The combined results of the Tamoxifen and Exemestane Trial (TEXT) and the Suppression of Ovarian Function Trial (SOFT) show that when Aromasin is combined with ovarian suppression (treatment to shut down the ovaries), the risk of breast cancer recurrence is reduced by 34%, compared with tamoxifen and ovarian suppression.

    Ovarian suppression has long been used as a breast cancer treatment for premenopausal women with hormone receptor-positive breast cancer. However, it was previously unknown as to whether there was any additional benefit of combining it with other treatments. The SOFT trial also included a group of participants who received tamoxifen without ovarian suppression; those results are expected later this year.

    Aromasin is a type of drug known as an aromatase inhibitor (AI). AIs are currently given to postmenopausal women only. After menopause, the ovaries stop making estrogen, but low levels of estrogen are still being made by a rather complex process involving the enzyme aromatase which can be found in fat, muscle, liver and breast tissues. AIs stop or inhibit aromatase from working, resulting in lowered levels of estrogen in the body.

    In premenopausal women, the ovaries produce most of the estrogen in the body. For some young women suppressing the ovaries may be recommended to decrease estrogen to postmenopausal levels. An AI can therefore be given to a premenopausal woman if her ovaries have been shut down and she is in a “temporary menopause”.



    - See more at: http://www.willow.org/breast-cancer-research-highlights-asco-2014/#sthash.4KlX38kS.dpuf
  • David
  • Aromasin

    Aromasin (chemical name: exemestane) is an aromatase inhibitor approved by the U.S. Food and Drug Administration (FDA) to treat:

    postmenopausal women diagnosed with hormone-receptor-positive, early-stage breast cancer after they've taken tamoxifen for 2 to 3 years to reduce the risk of the cancer coming back
    postmenopausal women diagnosed with advanced-stage or metastatic hormone-receptor-positive breast cancer
    Women stop taking tamoxifen when they start taking Aromasin.

    Aromatase inhibitors can't stop the ovaries from making estrogen, so aromatase inhibitors are mainly used to treat postmenopausal women. But because aromatase inhibitors are so much more effective than tamoxifen in postmenopausal women, researchers wondered if there were a way to successfully treat premenopausal women diagnosed with hormone-receptor-positive, early-stage breast cancer with an aromatase inhibitor. Results from the SOFT (Suppression of Ovarian Function Trial) study published in 2015 suggest that premenopausal women diagnosed with hormone-receptor-positive breast cancer can be successfully treated with Aromasin if their ovarian function is suppressed. If you’re a premenopausal woman willing to take medicine to suppress your ovaries, you may be able to take Aromasin instead of tamoxifen for your hormonal therapy treatment.

    Aromasin won't work on hormone-receptor-negative breast cancer.

    Aromasin is a pill taken once a day. Most doctors recommend taking Aromasin at the same time each day.

    You should not take Aromasin if you are breastfeeding, pregnant, trying to get pregnant, or if there is any chance that you could be pregnant. Aromasin may cause damage to developing embryos. You should use an effective non-hormonal type of birth control -- such as condoms, a diaphragm along with spermicide, or a non-hormonal I.U.D. – while you are taking Aromasin. Ask your doctor which type of non-hormonal birth control would be best for you, as well as how long you should use this type of birth control after you stop taking Aromasin.

    Benefits of Aromasin
    The large IES (Intergroup Exemestane Study) trial was started in 1998 and compared switching to Aromasin after taking tamoxifen for 2 to 3 years to staying on tamoxifen for 5 years. The results have shown that switching to Aromasin for 2 to 3 years AFTER taking tamoxifen 2 to 3 years (for a total of 5 years of hormonal therapy medicine) was better than staying on tamoxifen for 5 years for:

    increasing the time before the cancer comes back in those who experience a recurrence
    reducing the risk of a new cancer developing in the other breast
    for postmenopausal women diagnosed with hormone-receptor-positive, early-stage breast cancer.

    Research published in 2011 showed that Aromasin can lower risk in high-risk, postmenopausal women who've never been diagnosed with breast cancer. Aromasin is not approved by the FDA for this use, but doctors may consider it a good alternative to tamoxifen or Evista. In 2013, the American Society of Clinical Oncology (ASCO) released new guidelines on using hormonal therapy medicines to reduce breast cancer risk in high-risk women. These guidelines recommend that doctors talk to high-risk postmenopausal women about using Aromasin to reduce risk. ASCO is a national organization of oncologists and other cancer care providers. ASCO guidelines give doctors recommendations for treatments that are supported by much credible research and experience.

    It's possible that the FDA may approve Aromasin to be used to reduce risk in high-risk, postmenopausal women who haven’t been diagnosed.

    Side effects of Aromasin
    Because Aromasin lowers the amount of estrogen in the body, less estrogen reaches bone cells, which can lead to bone thinning and weakening and a higher-than-average risk of broken bones. This side effect can be very troubling for some women. If you have osteoporosis, your doctor may recommend that you take tamoxifen rather than Aromasin because of this possible side effect.

    Other common side effects of Aromasin are:

    bone and joint pain
    hot flashes
    fatigue
    headache
    insomnia
    increased sweating
    Some women may have other side effects while taking Aromasin:

    nervousness
    dizziness
    dry skin
    diarrhea
    vision changes
    hair changes
    Some side effects may mean that you're having an allergic reaction to Aromasin. If you have shortness of breath or chest pain, call your doctor immediately.

    How long do I take Aromasin?
    In most cases, you'll take Aromasin for 2 or 3 years. Doctors may recommend that some women take it for a longer time.

    Source:
    http://www.breastcancer.org/treatment/hormonal/aromatase_inhibitors/aromasin
  • David
  • Goserelin (Zoladex)

    1. Overview

    Goserelin is a type of hormone therapy used to treat breast cancer. Goserelin is the generic (non‑branded) name of the drug. Its current brand name is Zoladex.

    It’s suitable for women whose breast cancer is sensitive to the female hormone oestrogen – known as oestrogen receptor positive or ER+ breast cancer.

    2. Who might be offered goserelin?

    Primary breast cancer
    Goserelin is used to treat women with primary breast cancer who haven’t been through the menopause (pre-menopausal).

    Goserelin may be given on its own or with another hormone therapy such as tamoxifen or drugs called aromatase inhibitors.

    Secondary breast cancer
    Goserelin may also be used to treat pre-menopausal women with secondary breast cancer. It may be prescribed either alone or, more commonly, with other types of drugs such as tamoxifen.

    Preserving fertility
    Chemotherapy can cause damage to the ovaries and affect a woman’s ability to become pregnant. Studies have shown that goserelin may be able to protect the ovaries. A dose of goserelin is usually given just before chemotherapy starts, then every four weeks during chemotherapy, and a last dose after the final chemotherapy treatment. More research is needed to find out more about the role of goserelin during chemotherapy to preserve fertility.

    Goserelin is not suitable during pregnancy or while breastfeeding.

    3. How goserelin works

    Before the menopause, oestrogen is mainly produced by the ovaries. Oestrogen stimulates some breast cancers to grow, and goserelin works by switching off the production of oestrogen from the ovaries. This is known as ovarian suppression.

    Goserelin does this by interfering with hormone signals from the brain that control how the ovaries work.

    Within about three weeks of the first injection, your oestrogen will be lowered to a level similar to that of a post-menopausal woman. This effect is generally temporary and will only last for as long as you’re having goserelin.

    When you stop having the drug, your ovaries will usually start to produce oestrogen again. However, if you’re approaching the age of natural menopause when treatment finishes, your ovaries may not start working again.

    4. How goserelin is given

    Goserelin comes as an implant (a very small pellet) in a pre-filled syringe. It’s given as a subcutaneous (under the skin) injection into your abdomen (tummy).

    Some people find the injection uncomfortable. If necessary you may be prescribed a local anaesthetic cream to numb the skin before the injection to reduce any discomfort. After the cream has been applied you’ll need to wait for at least an hour before the area is numb, so it’s important to ask about using this cream before your injection.

    You may be given your first injection as an outpatient at the hospital. After this your GP (local doctor), community nurse or practice nurse may give the injections at the GP surgery or at home if you can’t get to the surgery. It can be useful to make an appointment for your next dose after each injection so it’s given at the right time.

    How often is goserelin given?
    For primary breast cancer, it’s recommended that goserelin is given every 28 days (four weeks). The injection is called a ‘depot injection’, which means that the drug is steadily released into the bloodstream over the four weeks.

    It may be given less frequently for secondary breast cancer. Your specialist can talk to you about this in more detail.

    How long will I be on goserelin?
    If you have primary breast cancer, goserelin is usually given for two years. In some cases it may be given for up to five years.

    If you have secondary breast cancer, you’ll be given goserelin for as long as it keeps the cancer under control.

    5. Will goserelin affect my periods?

    Goserelin can cause periods to stop temporarily. Most women will start their periods again within three months to a year of having their last goserelin injection.

    Some women who are approaching their natural menopause while having goserelin may find their periods don’t start again after they finish treatment.

    6. Contraception while taking goserelin

    It’s important not to get pregnant while you’re having goserelin because the drug could harm a developing baby. Although your periods may stop or become irregular, you could still become pregnant while having goserelin.

    If you’re sexually active with a man, use a non-hormonal method of contraception, such as condoms, Femidoms or a diaphragm. It may also be possible to use a coil (IUD or intrauterine device). However, you would need to discuss this with your specialist as not all types are suitable for women with breast cancer.

    8. Side effects of goserelin

    Everyone reacts differently to drugs and some people have more side effects than others. As goserelin can be given in addition to chemotherapy or tamoxifen, it’s sometimes difficult to know which side effects are being caused by which treatment.

    Common side effects
    The most common side effects of goserelin are menopausal symptoms, such as:

    hot flushes
    sweats
    vaginal dryness
    mood changes
    a decrease in libido (sex drive).
    Although these symptoms may be quite intense in the beginning, they usually improve over time.

    Find out more about coping with menopausal symptoms.

    Our information on sex and intimacy may also be helpful.

    After goserelin has been given, you may notice an area of redness or bruising at the injection site each time, but this should disappear within a few hours. Some bruising may stay for a few days.

    Less common side effects
    Less common side effects include:

    headaches
    mild skin rashes
    tingling in fingers and toes (known as parasthesia)
    changes in breast size.
    Some women have also reported:

    weight gain
    tiredness
    nausea.
    You may also experience low mood or depression.

    In the first month of treatment you may have some vaginal bleeding caused by the withdrawal of the hormone oestrogen.

    Changes in blood pressure can also occur. Blood pressure can be higher or lower than normal, but doesn’t normally need treatment or mean that goserelin has to be stopped.

    When first starting goserelin treatment, some women notice joint pain and stiffness. This is due to the reduced oestrogen levels and usually improves over time. If it doesn’t, talk to your specialist or breast care nurse.

    Lack of oestrogen over a long period of time can cause thinning of the bones (osteoporosis). Guidance in England and Wales recommends that anyone with primary breast cancer having ovarian suppression treatment is offered a DEXA scan (dual energy X-ray absorptiometry) within three months of starting goserelin. A DEXA scan measures bone density. If you’re having goserelin for secondary breast cancer, you can talk to your specialist breast team about whether a DEXA scan is appropriate for you. If you’re concerned about your risk of developing osteoporosis, talk to your specialist team.

    If you’re given goserelin to treat secondary breast cancer in the bone, you may have a temporary increase in your symptoms for a short time after treatment starts (sometimes referred to as ‘tumour flare’).

    In rare cases the level of calcium in the blood may temporarily increase. This can cause symptoms such as nausea, vomiting, constipation or drowsiness. If you have any of these symptoms, contact your specialist team.

    If you have persistent side effects from goserelin, tell your specialist team so that they can decide how best to manage them.

    - See more at: https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/going-through-treatment-breast-cancer/hormone-therapy-3#sthash.VniJ98Gl.dpuf
  • David
  • 十六、早期乳癌輔助性賀爾蒙療法

    1.適用病患:臨床分期為第一期,第二期之早期乳癌,若腫瘤表現雌激素受體陽性的病患,不論是否接受化療,都應進一步接收完整的荷爾蒙療法,以期降低腫瘤復發。

    2. 停經前乳癌之荷爾蒙療法選擇:由於停經前婦女體內雌激素濃度高,適合使用內科去勢(LHRH Agonist),使雌激素濃度降低至人工停經狀態,再配合泰莫西芬(Tamoxifen)使用,可明顯降低乳癌復發。

    3.停經後乳癌之荷爾蒙療法選擇-手術後使用泰莫西芬(Tamoxifen)五年作為輔助治療可以明顯降低乳癌復發,是廣為接受的選項,但目前新的的臨床試驗證實第三代芳香環酶抑制劑(Aromatase inhinitor)可提供比泰莫西芬(Tamoxifen)更好的預防復發效果,目前已經有越來越多病患選擇使用AI作為輔助療法。


    完整資料請至

    http://www.tbca-npo.org.tw/information_content2.asp?ser_no=20
  • 謝謝David提供這多資料,我會請Angela好好閱讀的。^^

    Cincia 於 2016/02/01 08:52 回覆

  • David
  • Aromasin Plus Ovarian Suppression Reduces Recurrence Risk Better Than Tamoxifen Plus Ovarian Suppression in Premenopausal Women Who’ve Received Chemotherapy (with video)

    After surgery, women diagnosed with early-stage, hormone-receptor-positive breast cancer usually take hormonal therapy medicine to reduce the risk of the cancer coming back (recurrence). Hormonal therapy given after surgery is called adjuvant hormonal therapy.

    Hormonal therapy medicines work in two ways:

    by lowering the amount of estrogen in the body
    by blocking the action of estrogen on breast cancer cells
    There are several types of hormonal therapy medicines. Tamoxifen, a selective estrogen receptor modulator (SERM), is one of the most well-known. Tamoxifen can be used to treat both premenopausal and postmenopausal women. The aromatase inhibitors:

    Arimidex (chemical name: anastrozole)
    Aromasin (chemical name: exemestane)
    Femara (chemical name: letrozole)
    have been shown to be more effective at reducing recurrence risk in postmenopausal women and are now used more often than tamoxifen to treat women who’ve gone through menopause.

    Right now, aromatase inhibitors aren’t commonly used to reduce recurrence risk in premenopausal women. But because they’re so much more effective in postmenopausal women, researchers wondered if there were a way to successfully treat premenopausal women diagnosed with hormone-receptor-positive, early-stage breast cancer with an aromatase inhibitor. Researchers also wondered if ovarian suppression would make tamoxifen more effective in reducing recurrence risk.

    The results of the SOFT (Suppression of Ovarian Function Trial) study suggest that tamoxifen plus ovarian suppression reduces recurrence risk a little more than tamoxifen alone for premenopausal women diagnosed with early-stage, hormone-receptor-positive breast cancer. But Aromasin plus ovarian suppression reduces the risk of recurrence even more for this group of women.

    The study was published online on Dec. 11, 2014 by the New England Journal of Medicine and presented at the 2014 San Antonio Breast Cancer Symposium on the same day. Read the abstract of “Adjuvant Ovarian Suppression in Premenopausal Breast Cancer.”

    In the SOFT study, 3,066 premenopausal women diagnosed with hormone-receptor-positive, early-stage breast cancer were randomly assigned to get one of three treatments:

    tamoxifen for 5 years
    tamoxifen for 5 years plus ovarian suppression with either 5 years of Trelstar (chemical name: triptorelin), surgical removal of the ovaries, or ovarian radiation
    Aromasin for 5 years plus ovarian suppression with either 5 years of Trelstar, surgical removal of the ovaries, or ovarian radiation
    About 47% of the women in the study hadn’t received chemotherapy before, and about 53% had received chemotherapy but were still premenopausal. In other words, their ovaries were still functioning after chemotherapy.

    After about 5.5 years of follow-up, the 5-year disease-free survival rates were:

    86.6% for all women treated with tamoxifen and ovarian suppression
    84.7% for all women treated with tamoxifen alone
    This slight difference wasn’t statistically significant, which means that it could have been due to chance and not because of the difference in treatment.

    Disease-free survival means the women were alive without the cancer coming back.

    When the researchers looked at the women who had received chemotherapy before, they found that Aromasin plus ovarian suppression reduced the risk of recurrence more than tamoxifen plus ovarian suppression or tamoxifen alone. Five years after treatment, the numbers of women who had not had a recurrence were:

    78.0% of the women treated with tamoxifen
    82.5% of the women treated with tamoxifen plus ovarian suppression
    85.7% of the women treated with Aromasin plus ovarian suppression
    “We found that with the addition of ovarian suppression to tamoxifen, four or five fewer patients out of 100 experienced a breast cancer recurrence within 5 years in the group of patients who remained premenopausal after chemotherapy,” said Prudence Francis, M.D., head of breast medical oncology at the Peter MacCallum Cancer Centre in Melbourne, Australia and lead author of the study. “However, we found an even greater reduction in recurrence in this same patient group with the use of ovarian suppression plus the aromatase inhibitor exemestane, which resulted in seven or eight fewer patients out of 100 experiencing a breast cancer recurrence within 5 years.”

    Women younger than 35 who had been treated with chemotherapy seemed to get the most benefits from Aromasin plus ovarian suppression:

    one in three women of this age treated with tamoxifen alone had a recurrence within 5 years
    one in six women of this age treated with Aromasin plus ovarian suppression had a recurrence within 5 years
    “I believe that these results will result in changes in clinical practice,” Dr. Francis continued. “For women who have not reached menopause and have hormone-receptor-positive breast cancer that carries sufficient risk of recurrence that they receive chemotherapy, physicians are likely to discuss the option of treatment with ovarian suppression plus an aromatase inhibitor.”

    Both tamoxifen and aromatase inhibitors can cause side effects. Tamoxifen may cause hot flashes and increase the risk of blood clots and stroke. Aromatase inhibitors may cause muscle and joint aches and pains, as well as hot flashes. Less common but more severe side effects of aromatase inhibitors are heart problems, osteoporosis, and broken bones.

    About 30% of the women in all three treatment groups reported severe side effects. Women who were taking Aromasin were slightly more likely to withdraw from the studies because of side effects. The researchers are continuing to follow the women in the SOFT study and plan to offer future updates on side effects and the quality of life of the women in the study.

    If you’re a premenopausal woman diagnosed with early-stage, hormone-receptor-positive breast cancer that’s been treated with chemotherapy and are considering which hormonal therapy medicine to take, you may want to talk to your doctor about this study.

    If you’re willing to take medicine to suppress your ovaries, you may be able to take Aromasin instead of tamoxifen for your hormonal therapy treatment.

    While the side effects of hormonal therapy can be very severe for some women, they’re overshadowed by the reality that hormone-receptor-positive breast cancer can come back. Hormonal therapy after surgery reduces that risk. If side effects are a major problem for you, talk to your doctor about ways to manage them. Studies have shown that exercise and acupuncture may reduce hormonal therapy side effects. Visit the Breastcancer.org Staying on Track With Treatment pages to learn more about how to ease side effects.

    And stay tuned to Breastcancer.org Research News for the latest updates on the SOFT study.

    Source:
    http://www.breastcancer.org/research-news/ovary-suppression-w-aromasin-better-than-w-tamoxifen
  • David
  • #21 有各種賀爾蒙療法5年復發率 請細讀

    78.0% of the women treated with tamoxifen
    82.5% of the women treated with tamoxifen plus ovarian suppression
    85.7% of the women treated with Aromasin plus ovarian suppression

    資料來源 breastcancer.org
  • David
  • 更正
    #21 有各種賀爾蒙療法5年"未"復發率 請細讀

    Five years after treatment, the numbers of women who had not had a recurrence were:

    78.0% of the women treated with tamoxifen
    82.5% of the women treated with tamoxifen plus ovarian suppression
    85.7% of the women treated with Aromasin plus ovarian suppression

    資料來源 breastcancer.org
  • Ming-Yi
  • 樓上說開不乾凈所以轉移,是不正確的,乳癌本身就有轉移的特性,因為乳房是佈滿血管和淋巴的器官,癌細胞不只會從淋巴轉移,還有可能從血管出去,即使手術把腫瘤都拿乾淨了,還是會有一些已經跑出去的癌細胞在體內,所以才需要化療,放療,荷爾蒙療法來抑制那些已經跑出去的細胞,不是什麼開不乾凈所以復發轉移=.=
  • 肺癌應該也是一樣的狀況,就算開刀再乾淨,也不保證不會移轉,所以通常也會再搭配化放療。

    Cincia 於 2016/02/03 16:27 回覆

  • 訪客
  • 所以開刀手法也要進步
    我有看到最新手法
    打顯影劑在用夜視鏡開刀
    癌細胞看的一清二楚
  • David
  • Angela 掖下淋巴結有癌細胞 癌症已經轉移可能性很大
    化 放療 荷爾蒙療法都是必需的
    癌症是難纏的疾病 Angela 對自己的病要多多瞭解
    並有長期抗戰的心裡準備

    youtube 榮總趙大中醫師的 "乳癌的分期與治療" 有詳細的解說
  • 可可
  • 三顆有感染應該是二期B,應該要先顧身體把身體養好再思考要不要生孩子,乳製品是乳癌患者的敵人千萬不要吃,盡量不要吃紅肉,雞肉也是要沒打針的
    加油!癌症是人生的重要課題,堅強的面對,積極治療,心情放輕鬆,很多人都可以跟癌和平共存!加油!加油!
  • 我知道,這些我都有提醒Angela,感謝可可的熱心喔!

    Cincia 於 2016/02/03 16:25 回覆

  • David
  • 這篇來自和信

    少吃全脂乳品降低乳癌復發?

    文 / 棕櫚子 綜合報導

      愛吃冰淇淋、乳酪或優格的乳癌婦女,可能要稍加小心了。美國凱撒醫療機構(Kaiser Permanente)最近的一項乳製品與乳癌強烈相關的研究指出,每天吃1份全脂乳製品,可能使乳癌病人死亡的風險增加達5成。
      《紐約時報》報導指出,有1500名乳癌婦女接受這項研究問卷調查,她們都是在1997至2000年診斷出罹患乳癌的病人。結果指出,受訪的乳癌病人最常吃冰淇淋、優格、乳酪、加全脂牛奶的拿鐵及熱巧克力。研究人員發現,這些乳製品每天只要吃1份,乳癌病人在12年內死亡的風險增加5成。
      研究人員說,美國和英國的牛奶產自懷孕的乳牛,含有豐富的荷爾蒙雌激素,而雌激素會誘發腫瘤生長。事實上,每天攝取1份全脂乳製品的婦女,不只死於乳癌的風險升高,死於其他疾病的機率也提高64%。
      這項研究是不是有點「危言聳聽」呢?醫界認為,研究指出的「飲食中脂肪高」應該有更精準的「定義」。並且應該找出高脂肪的飲食是如何對這些婦女產生影響的,包括體重增加,血液中高血脂等,並且找出它的原因。
      事實上,飲食或生活方式,其與癌症的因果關係或復發的關係之研究,是不容易進行。它不像嘗試一種化療藥物或做輻射治療,相關研究的參與研究者,他們的各種營養素的量是難以量化。當我們回味在過去的一年個人吃什麼,錯誤可以是巨大的,結果也往往不可靠,基本上它始終是有問題的。
      醫界一般相信,健康的飲食和生活方式可以預防癌症,並且在癌症的診斷後,一定程度上提高病人的存活率。它不一定是具體的脂肪奶製品,但儘量避免攝取過多的脂肪,基本是一件好事;更積極的方式是每天慢走10-20分鐘,每天的運動鍛練對癌症病人是很有幫助的。
      羅萬醫師(Dr. Rowan Chlebowski)是醫療腫瘤學家,他特別是乳癌的研究者及專家,也是著名的「WHI(婦女健康主張)試驗的主持人。幾年前,他做了一個名為“WINS”的試驗,這是一個前瞻性試驗。他找營養師輔導婦女做低脂肪飲食,來在低脂飲食未被勸說的的婦女比對研究。研究確實證明,低脂肪飲食可降低20%乳癌復發風的險。
      癌症專科醫師一般會建議病人,包括乳癌或其他癌症病人,避免油炸食物,減少吃紅肉,吃雞肉時不要吃雞皮,每天至少運動鍛練30分鐘,或相等的快節奏活動。減肥可以降低大約20%的乳癌復發風險。

    Source: http://www.kfsyscc.org/about/interview-topics/shao-chi-quan-zhi-ru-pin-duo-yun-dong-ke-yi-jiang-di-ru-ai-fu-fa-lv-
  • 感謝分享!

    Cincia 於 2016/02/19 13:01 回覆

  • 風清揚
  • 朋友的父親罹患肝癌,換肝後一年多就復發。這可是無癌變的肝,卻仍然會在新換的肝長出癌細胞。可見癌症是全身代謝性疾病,不是純粹單一器官病變,切、毒、燒只是急救,沒有後續全方位改善體質,斷絕不良習慣,是無法抑制癌症。就如感冒藥壓抑症狀,但不好好喝水、休息,甚至還猛吃冰,那當然就再次感冒。
    版主的大作已讀完,感覺身心受到大量洗滌,因這是真實的故事,當事人真實的感受。不是像一些書有點造神(超人)意圖。星希亞的書真實反應抗癌的人生。加油!大家彼此都會成功。
  • 同意您的看法,真的是要全方面去調整,才有可能找回身體健康。
    大家一起加油囉!

    Cincia 於 2016/02/03 16:24 回覆

  • 悄悄話
  • 悄悄話
  • Sandy
  • 我Breast Cancer 二期 開完刀後, 自費打停經針+諾曼癌素吃。二年後還是發現癌擴散,所以數據不一定準。門診也遇到過跟我一樣沒效ㄉ。大家參考 參考~
  • 辛苦了,希望Sandy現在治療一切順利!:)

    Cincia 於 2016/02/22 10:17 回覆

  • 97
  • 乳癌復發就很危險了
    因為那邊很多淋巴
    祝福她
  • 感謝祝福,會傳達給Angela~

    Cincia 於 2016/02/19 13:01 回覆

  • Cancer free
  • 腫瘤0.1公分就會大量轉移了,那些跑掉的癌細胞藏在哪裡,目前無法偵測。

    開刀後容易發現轉移,不是開不乾淨,是別的原因。

    癌症的確比較像全身性疾病,全植物飲食,天天吃多種抗癌植物,是最安全有效的療法。
  • xavi
  • 請問 Angela 治療一切還好嗎?
  • 還不錯唷!已經做完化放療,目前在吃抗賀爾蒙藥物。

    Cincia 於 2016/11/01 16:06 回覆