Professor Wu Gaosong: Progress in Breast Cancer Surgery and Systemic Treatment

Breast canceris a common and high-risk tumor in Chinese womenIn recent years, the systematic treatment of breast cancer has made great progress, at the same time, surgical treatment in the treatment of breast cancer still has an irreplaceable roleIn the context ofprecisionmedicine, how to weigh the benefits and risks of treatment decision-making from a surgical perspective, and make an individualized treatment plan suitable for patients, so that patients can maximize the benefits of their body and mind is the focus of clinical attentionthe progress and experience of breast cancer lymph node cleaning treatmentHalsted is known as the father of modern surgery in the United States, establishing breast cancer improvement root surgery and armpit lymph node cleaningIn the 70's, breast-preservation surgery was realized, and then the concept of outpost lymph nodes was introduced, with the progress of nuclide, blue dyeing and other technologies, breast cancer armpits were realizedThe classic breast cancer treatment works very well, but brings many complications, such as upper limb dysfunction, manifested as pain, numbness and lymphedema of the upper limbsThe application of outpost lymph node biopsy technology has allowed patients with lymph node salnode salision to be free from lymph node cleaning, and outpost lymph node biopsies have been routinely carried out internationally, although we are several years late, but are now routineIn previous years, some internationally published studies confirmed that a small number of early T1, T2 outpost sly node biopsies found that only 1-2 patients with positive lymph nodes, can also try to clean free, with radiotherapy instead of cleaning, can also achieve good resultsIn addition, a study was conducted in Europe, where by means of ultrasound, 1-2 early patients with positive lymph nodes could not do cleaning and use breast-feeding and radiotherapy, but the results have not yet come outIn general, the current international trend is to do as little as possible armpit lymph node cleaning, the use of radiotherapy replacement, but at present in China this strategy to implement there are still some difficulties, many county-level hospitals do not have radiotherapy, need to go to the regional central hospital, three hospitals above the radiotherapyfor patients who combine 3-4 lymph nodes positive, there is still a need for lymph node cleaning, and international trials have been made, such as a study conducted in the United States more than a decade ago to try to protect the outpost lymph nodes of the upper limbs, but there are still a large number of truly functional lymph nodes that are cut offOn this basis, we designed breast cancer armpit lymph node cleaning improvement, using a very simple method, based on foreign research, the application of blue dyes or fluorescence, nuclides, the entire upper limb lymph nodes lymphatic system markers, and protection, to achieve the estimated effect: neither increase the patient's tumor load, nor increase the recurrence rate, the patient's upper limb lymphedema and other complications significantly reduced Under the premise of ensuring tumor efficacy, the occurrence of disability rate is reduced, and the quality of life of patients is greatly improved in general, the current breast cancer treatment is rich, surgical treatment has played an indispensable role In addition, the survival of patients is getting longer and longer, we need to reduce the patient's tumor load as much as possible, reduce the rate of disability, improve the quality of life under the premise of ensuring the existence of existing survival therapeutic communication intervention sourcing patients with breast cancer surgery communication is difficult, but it is not difficult We want to listen, understand the needs of patients, spend more time as friends, and in a limited time to focus on, try to ensure patient satisfaction In addition, we can encourage patients to respond to questions and answers through online platforms For several years in the United States, I have also been answering patient stoushs online Online platforms are highly recommended because they are not limited by time and space In recent years, with high-quality online work and good reputation of patients, I also have the honor of three consecutive years to win the National Good Doctor of the Year Award in addition, more obstacles to surgical treatment of breast cancer, such as the choice of breast-care surgery, are an obstacle to the concept In the future, the latest surgical treatment concept of breast cancer still needs to be continuously preached by doctors, so that the world's most standardized treatment concept, a full range of patients the significance of new complementary treatment for breast cancer
new complementary treatment was initially introduced from abroad, and at an early stage, Chinese doctors and patients were not particularly adapted In the past, we thought it was safer and safer to remove the tumor as long as it could be cut off Therefore, the new auxiliary treatment in early China is mainly used for those who cannot operate, and the new assistive treatment turns non-surgical patients into surgical In recent years, the concept of breast-feeding surgery in China has been popularized and is slowly being practiced Oriental women's breasts are small, lumps are large, breast preservation has limitations However, after the new assisted treatment, patients who were previously insecure or difficult to protect can be turned into a protected breast patient In addition, the new complementary treatment can help us achieve efficacy assessment In the past, patients who routinely used postoperative complementary therapy were unable to assess the efficacy of complementary treatment regimens The efficacy of the treatment can be evaluated quickly with the new complementary treatment, and the evaluation of the new assisted treatment also has a guiding value for follow-up treatment, such as the follow-up of enhanced assistive therapy in patients who do not reach pCR In general, the new approach to complementary treatment has completely changed our understanding of breast cancer The progress of her2-positive early-stage breast cancer treatment in the past, HER2-positive is a factor of poor prognosis of breast cancer, and the application of anti-HER2 targeted drugs to this kind of patients to bring long-term survival possibilities But a decade ago, few patients in China could afford the drug, and only those with advanced diseases were able to use anti-HER2 targeted treatment With China's strong national strength, the common people are also rich, and qutozhu monotoma in recent years also into health insurance, almost every patient can afford, which is a good thing in addition, for patients with early-stage breast cancer who received anti-HER2 treatment, if the new auxiliary efficacy does not achieve pathological complete remission (pCR), this part of non-pathological complete remission (non-pCR) patients have a higher risk of recurrence or death than pCR patients, followed by intensive assistive therapy, i.e the addition of T-DM1, which has become the consensus international One of my patients, who discovered breast cancer during a family visit in the United States, had a 2.5 cm primary, HER2-positive, and adopted a first-of-two-target new complementary treatment However, its efficacy did not reach pCR after the new dual-target adjuvant treatment, so the patient subsequently chose to receive T-DM1 intensive assistive therapy during the auxiliary treatment phase in order to seek further cure opportunities At present, T-DM1 has also been approved for domestic market, the future will also give more new complementary treatment after non-pCR HER2-positive breast cancer patients bring hope Source: Cancer Information