必要晓得！癌症的平常晚期症状有哪些？能初期识别吗？
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/SXRe3MpAqF14IHxnGp4GotZTSzbia3xH2eA703OWoPXBc6QBk4liayU2XKu0epj4sia8YzHIxibsicMx2sOkicwfjuibg/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;">英国8000例<span style="color: black;">平常</span>实体瘤晚期症状回顾，除外颈部<span style="color: black;">反常</span>肿块，其他晚期症状的特异性都比较低……</span><span style="color: black;"><span style="color: black;">初期</span>诊断<span style="color: black;">干涉</span>，日益<span style="color: black;">作为</span><span style="color: black;">全世界</span>癌症<span style="color: black;">掌控</span>战略的一部分。<span style="color: black;">非常多</span>癌种<span style="color: black;">初期</span><span style="color: black;">发掘</span>，5年<span style="color: black;">存活</span>率都在90%以上。<span style="color: black;">然则</span>，<span style="color: black;">平常</span>生活中还是会经常听到：某某癌症，<span style="color: black;">初期</span><span style="color: black;">没</span><span style="color: black;">显著</span>的症状，一确诊<span style="color: black;">便是</span>中晚期……</span><span style="color: black;">面对晚期癌症，<span style="color: black;">各样</span>治疗策略在改善<span style="color: black;">存活</span>预后方面效果相当有限。《柳叶刀》<span style="color: black;">发帖</span>揭示了<span style="color: black;">平常</span>的20种癌症的症状和12个癌种诊断分期之间的关系。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/EjZcMyGNiatydqUEvAol3eb4icDX7BrSr5cyyHozofLrntSR3uI0sTsJMNcPY7jlxrWe1QzxWhcpP8kk9Nk1fFKw/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">癌症晚期症状有<span style="color: black;">那些</span>？有特异性吗？</span></p><span style="color: black;">在这项<span style="color: black;">科研</span>中，<span style="color: black;">科研</span>者分析了2014年英国国家癌症诊断审查数据库中年龄25岁及以上患12种实体瘤（膀胱癌、乳腺癌、结肠癌、子宫内膜癌、喉癌、肺癌、黑色素瘤、口腔或口咽癌、卵巢癌、前列腺癌、直肠癌、肾癌）的人群特征。<span style="color: black;">科研</span>者分析了20种<span style="color: black;">平常</span>的临床症状，并<span style="color: black;">运用</span>logistic回归分析了分期（TNM IV期与I-III期）与症状的<span style="color: black;">关联</span>性，<span style="color: black;">针对</span>每一种症状单独报告和与其他症状<span style="color: black;">一块</span>报告时<span style="color: black;">评定</span>这之间的<span style="color: black;">关联</span>性。</span><span style="color: black;">该<span style="color: black;">科研</span>从12927例癌症<span style="color: black;">病人</span>中，排除1291例诊断为白血病、淋巴瘤、骨髓瘤或脑癌的<span style="color: black;">病人</span>，2717例<span style="color: black;">疾患</span>分期不<span style="color: black;">知道</span>的<span style="color: black;">病人</span>，896例<span style="color: black;">疾患</span>分期信息缺失的<span style="color: black;">病人</span>，26例年龄<span style="color: black;">少于</span>24岁的<span style="color: black;">病人</span>，<span style="color: black;">最后</span>分析纳入7997例。</span><span style="color: black;">表1 依据IV期癌症<span style="color: black;">病人</span>的总体比例排序症状</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/EjZcMyGNiatydqUEvAol3eb4icDX7BrSr5cMdu39odkXk2iaJiaKSrgHQWGc3AKLIWcgqK75OKicpWD9HbNSpr7a08A/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;">在筛选出的12种实体肿瘤 IV期<span style="color: black;">病人</span>中，最<span style="color: black;">平常</span>的 IV期临床症状是<strong style="color: blue;">乳房肿块</strong>（n=1260），最不<span style="color: black;">平常</span>的临床症状是<strong style="color: blue;">颈部肿块</strong>（n=105）。<span style="color: black;">然则</span><strong style="color: blue;">80%</strong><span style="color: black;">病人</span>以颈部肿块为单独<span style="color: black;">或</span><span style="color: black;">伴同</span>症状<span style="color: black;">显现</span>时，诊断即是 IV期。</span><span style="color: black;">其中，单独报告即为 IV期的症状超过50%的有：咯血（56%）、胸部感染（54%）、背痛（58%）、胸痛（60%）。</span><span style="color: black;"><span style="color: black;">做为</span><span style="color: black;">伴同</span>症状出<span style="color: black;">此刻</span>IV期的超过50%的有：嘶哑（54%）、疲劳（50%）、体重减轻（51%）、咳嗽（57%）、咯血（53%）、胸部感染（56%）、背痛（62%）、胸痛（62%）。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/EjZcMyGNiatydqUEvAol3eb4icDX7BrSr5Bet0n3QAu1ia42SCDicGkB2C70wfkWuewzJ5JXTPr5QJ9j1hEXQg8zmA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;">图1 I-III期和IV期癌症<span style="color: black;">病人</span>的症状和比例 </span><span style="color: black;"><span style="color: black;">大概</span>三分之一的<span style="color: black;">病人</span>（34%，2685/7997）诊断为 IV期时，有两种及以上症状<span style="color: black;">同期</span><span style="color: black;">显现</span>。大<span style="color: black;">都数</span>(>80%)在确诊时表现为<span style="color: black;">关联</span>部位的症状，例如乳房肿块(乳腺癌)、<span style="color: black;">反常</span>的痣(黑色素瘤)、绝经后<span style="color: black;">流血</span>(子宫内膜癌)、下尿路症状(前列腺癌)、咯血、<span style="color: black;">呼气</span>困难、胸部感染、胸部<span style="color: black;">病痛</span>、咳嗽(肺癌)。</span><span style="color: black;">相比之下，<span style="color: black;">有些</span>不太<span style="color: black;">拥有</span>特异的症状，例如腹痛、肠胃习惯改变、背痛、疲劳、体重减轻的癌症发病部位各异。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/EjZcMyGNiatydqUEvAol3eb4icDX7BrSr55Q219TrDCLjPia35azbOMzxOy1TVjW3hbNPFQUmjJwyLE7Xcg6Ajq1g/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;">图2 IV期癌症<span style="color: black;">显现</span>单独症状时的<span style="color: black;">优良</span>比</span><span style="color: black;"><span style="color: black;">统计校准后，</span><strong style="color: blue;"><span style="color: black;">颈部肿块、胸痛和背痛三种症状与诊断IV期癌症的几率<span style="color: black;">增多</span><span style="color: black;">关联</span>，而<span style="color: black;">反常</span>的痣、乳房肿块、绝经期<span style="color: black;">反常</span><span style="color: black;">流血</span>、直肠<span style="color: black;">流血</span>与诊断为IV期癌症的概率相对较低。</span></strong></span><span style="color: black;">这个结论似乎与<span style="color: black;">咱们</span>平时的认知有很大距离。</span><span style="color: black;">究其<span style="color: black;">原由</span>，可能<span style="color: black;">由于</span>在英国，</span><strong style="color: blue;">宫颈癌、乳腺癌、肠癌</strong><span style="color: black;">是国家筛查项目，与这三种癌症<span style="color: black;">关联</span>的症状如：绝经期<span style="color: black;">反常</span><span style="color: black;">流血</span>、乳房肿块、直肠<span style="color: black;">流血</span>，绝大<span style="color: black;">都数</span>在<span style="color: black;">初期</span>筛查中得到确诊，<span style="color: black;">因此</span>诊断为IV期肿瘤症状的<span style="color: black;">关联</span>性较小。但英国仍然有90%以上的癌症是经非筛查手段确诊的，找到更有效的<span style="color: black;">初期</span>筛查<span style="color: black;">办法</span>是<span style="color: black;">日前</span>各国都在积极<span style="color: black;">奋斗</span>的工作。</span><span style="color: black;">美国癌症协会（ACS）<span style="color: black;">亦</span>会<span style="color: black;">颁布</span><span style="color: black;">初期</span>癌症检测指南，癌症筛查率的数据和趋势，以及<span style="color: black;">选取</span>与癌症筛查<span style="color: black;">相关</span>的问题。2019年ACS癌症筛查指南的更新中，<span style="color: black;">意见</span>对<strong style="color: blue;">乳腺癌、宫颈癌、结肠直肠癌、肺癌和前列腺癌</strong>进行规范筛查。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">预防癌症，有<span style="color: black;">那些</span>是<span style="color: black;">能够</span>做的呢？</span></p><span style="color: black;">我国卫健委<span style="color: black;">亦</span>在今年推出健康中国行动——癌症防治实施<span style="color: black;">方法</span>（2019—2022年），制订重点癌症早诊早治指南。对发病率高、筛查手段和技术<span style="color: black;">方法</span>比较成熟的胃癌、食管癌、结直肠癌、宫颈癌、乳腺癌、肺癌等重点癌症，组织制订统一规范的筛查和早诊早治技术指南，在全国推广应用。</span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">▍</span></strong></span></strong></span></strong><span style="color: black;"><strong style="color: blue;"><span style="color: black;">诱发癌症的<span style="color: black;">原因</span>和预防<span style="color: black;">办法</span>：</span></strong></span><span style="color: black;">1、吸烟、<span style="color: black;">肥壮</span>、缺少运动、不<span style="color: black;">恰当</span>膳食习惯、酗酒、压力、心理紧张等都是癌症<span style="color: black;">出现</span>的危险<span style="color: black;">原因</span>，应该<span style="color: black;">尽可能</span>避免。</span><span style="color: black;">2、戒烟限酒、平衡膳食、适量运动、心情舒畅<span style="color: black;">能够</span>有效降低癌症的<span style="color: black;">出现</span>。</span><span style="color: black;">3、癌症的<span style="color: black;">出现</span>是全生命周期<span style="color: black;">关联</span>危险<span style="color: black;">原因</span>累积的结果。要尽早关注癌症预防，从小养成健康的生活方式，避免接触烟草、酒精等致癌<span style="color: black;">原因</span>，降低癌症的<span style="color: black;">出现</span><span style="color: black;">危害</span>。</span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">▍</span></strong></span></strong></span></strong></span></strong><span style="color: black;"><strong style="color: blue;"><span style="color: black;">癌症不会传染，但<span style="color: black;">有些</span>致癌<span style="color: black;">原因</span>会传染：</span></strong></span><span style="color: black;">1、减少与癌症<span style="color: black;">出现</span>密切<span style="color: black;">关联</span>的细菌（如幽门螺杆菌）、病毒（如人乳头状病毒、肝炎病毒、EB病毒等）的接触。</span><span style="color: black;">2、<span style="color: black;">经过</span>保持个人卫生和健康生活方式、接种疫苗（如肝炎病毒疫苗、人乳头状病毒疫苗）<span style="color: black;">能够</span>避免感染<span style="color: black;">关联</span>的细菌、病毒，从而预防癌症的<span style="color: black;">出现</span>。</span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">▍</span></strong></span></strong></span></strong></span></strong><span style="color: black;"><strong style="color: blue;"><span style="color: black;">规范的防癌体检能够<span style="color: black;">初期</span><span style="color: black;">发掘</span>癌症：</span></strong></span><span style="color: black;">1、胸部低剂量螺旋CT<span style="color: black;">能够</span><span style="color: black;">检测</span>肺癌；</span><span style="color: black;">2、超声结合钼靶<span style="color: black;">能够</span><span style="color: black;">检测</span>乳腺癌；</span><span style="color: black;">3、胃肠镜<span style="color: black;">能够</span><span style="color: black;">检测</span>消化道癌等。</span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">▍</span></strong></span></strong></span></strong></span></strong><span style="color: black;"><strong style="color: blue;"><span style="color: black;">关注身体<span style="color: black;">显现</span>的癌症危险信号：</span></strong></span><span style="color: black;">1、身体浅表部位<span style="color: black;">显现</span>的<span style="color: black;">反常</span>肿块；</span><span style="color: black;">2、体表黑痣和疣等在短期内色泽加深或<span style="color: black;">快速</span>增大；</span><span style="color: black;">3、身体<span style="color: black;">显现</span>的<span style="color: black;">反常</span>感觉，如哽咽感、<span style="color: black;">病痛</span>等；</span><span style="color: black;">4、皮肤或粘膜经久不愈的溃疡；</span><span style="color: black;">5、<span style="color: black;">连续</span>性消化不良和食欲<span style="color: black;">衰退</span>；</span><span style="color: black;">6、大便习惯及性状改变或带血；</span><span style="color: black;">7、持久性声音嘶哑、干咳、痰中带血；</span><span style="color: black;">8、听力<span style="color: black;">反常</span>、鼻血、头痛；</span><span style="color: black;">9、阴道<span style="color: black;">反常</span><span style="color: black;">流血</span>、<span style="color: black;">尤其</span>是接触性<span style="color: black;">流血</span>；</span><span style="color: black;"><span style="color: black;">十、</span><span style="color: black;">没</span>痛性血尿、排尿不畅；</span><span style="color: black;">11、不明<span style="color: black;">原由</span>的发热、乏力、进行性的体重减轻；</span><span style="color: black;"><span style="color: black;">显现</span>以上症状应<span style="color: black;">即时</span>到医院进行诊治。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">参考文献</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> Koo M M , Von Wagner C , Abel G A , et al. Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis. Cancer Epidemiology, 2017, 48:140-146.</span></p><span style="color: black;"> Robert A. Smith, Kimberly S. Andrews, Durado Brooks,等. Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening. CA A Cancer Journal for Clinicians, 2019, 69(1).</span><span style="color: black;">http://www.nhc.gov.cn/jkj/s5878/201909/2cb5dfb5d4f84f8881897e232b376b60.shtml</span><span style="color: black;">http://www.nhc.gov.cn/guihuaxxs/s3585u/201907/e9275fb95d5b4295be8308415d4cd1b2.shtml</span><span style="color: black;">http://www.nhc.gov.cn/jkj/s5878/201903/81140f820513439f8a8a57f49f8ae8b7.shtml</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">本文首发：医学界肿瘤频道</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">本文作者：<span style="color: black;">江喃</span></span></p>
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