共識診斷 臨床檢查 主要治療 輔助治療 術後追蹤 DCIS TisN0M0 LCIS TisN0M0 ER/PR/Her-2 ER/PR/Her-2 1. Partial mastectomy SLNB whole breast radiation therapy 2. Total mastectomy SLNB reconstruction Risk reduction surgery Adjuvant treatment Tamoxifen for 5 years ER or uncertain Risk reduction for contralateral breast cancer optional AI may also be considered in menopausal women -1 1 171 乳癌診療指引附註 :
共識 -2 ER/PR/Her-2 T 0.5cm No H/T 2 診斷 主要治療 賀爾蒙接受體 腫瘤大小 輔助治療 T 0.5cm Hormonal therapy ER( )and/or HBsAg PR( )or unknown 1. Hormonal Anti-HCV test optional 0.5 T 1.0 cm therapy C/T 2. Her-2( ) X Partial mastectomy 1 T 2.0 cm Consider 臨床檢查 R/T* Stage IA T1N0M0 Stage IB T1N1miM0 optional optional optional optional optional Total mastectomy Reconstruction ER( ) and PR ( ) 0.5 T 1.0 cm 1 T 2.0 cm 附註 : 依 NCCN-2013.V2 版建議 Stage I 臨床檢查加入考量生殖需求 4. * Herceptin 依健保使用規定或自費使用 5. 考慮接受化學治療或 Carrier 血液檢查 ( 需包含化療前 HBsAg 及 Anti-HCV test) 1. C/T 2. Her-2( ) Consider 追蹤 3 / ~ ~ X 4-5 / X 5 172 乳癌診療指引
共識 -3 3 X Partial mastectomy Stage IIA ALND or SLNB R/T* ER and/or T0 N1 M0 Total mastectomy PR or unknown T1 N1 M0 ALND or SLNB 臨床檢查 T2 N0 M0 reconstruction R/T* ER and PR ER/PR/Her-2 診斷 主要治療 賀爾蒙接受體 輔助治療 1. C/T H/T 2. Her-2 HBsAg Consider Anti-HCV test optional Stage IIB T2 N1 M0 optional T3 N0 M0 optional optional optional optional *MRM->R/T 1. Tumor > 5cm 2. LN positive 4 3. LN 1-3 strong consider optional 4. Margin positive 附註 : 依 NCCN-2013.V2 版建議 Stage II 臨床檢查加入考量生殖需求 4. * Herceptin 依健保使用規定或自費使用 5. RT*: 參閱一校三院放腫指引 6. 考慮接受化學治療或 Carrier 血液檢查 ( 需包含化療前 HBsAg 及 Anti-HCV test) 1. Chemotherapy 2. Her-2 Consider 追蹤 3 / ~ ~ X optional 4-5 / X (optional) 5 173 乳癌診療指引
共識 -4 Stage IIIA T0N2M0 T1N2M0 T2N2M0 T3N1M0 Stage IIIB T4N0M0 T4N1M0 T4N2M0 Stage IIIC Any TN3M0 臨床檢查 HBsAg Anti-HCV test X ER/PR/Her-2 (Alternative) Alternative PET scan optional 主要治療 Neoadjuvant therapy Neoadjuvant C/ T Target therapy and/or ER( )and/or PR( )or unknown Partial mastectomy R/T* Total mastectomy Reconstruction ER( ) and PR( ) 附註 : 4. RT*: 參閱一校三院放腫指引 5. Abdomen sono or abdomen CT Alternative 1. C/T H/T 2. Her-2( ) Concider Herceptin (LN negative) 1. C/T 2. Her-2 ( ) Concider Herceptin (LN negative) 斷賀爾蒙接受體 診 4 輔助治療 追蹤 3 / ~ ~ X 4-5 / X 5 174 乳癌診療指引
共識 -5 診斷 Stage IV Stage IV Any T Any N M1 臨床檢查 HBsAg Anti-HCV test X ER/PR/Her-2 Alternative Alternative PET scan optional Systemic chemotherapy Hormonal therapy Radiotherapy Her-2( ) >Herceptin Best supportive care Palliative surgery and other forms local treatment if needs 附註 : 4. Abdomen sono or abdomen CT Alternative 追蹤 3 / ~ ~ X 主要治療 5 (optional) 4-5 / X (optional) 5 175 乳癌診療指引
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