骨肉瘤（骨癌）：青年人的癌症
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">德医国际医疗顾问、百汇癌症中心的儿童血液肿瘤专家<a style="color: black;">李志伟</a><span style="color: black;">大夫</span>针对骨肉瘤这类骨癌的<span style="color: black;">关联</span>问题进行解答。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">问: 什么是骨肉瘤？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">答：骨肉瘤是一种最<span style="color: black;">平常</span>的骨癌类型，<span style="color: black;">一般</span>10至30岁的青少年或<span style="color: black;">青年</span>人会患这种<span style="color: black;">疾患</span>。骨肉瘤病历占儿童和青少年所有癌症病例的2%。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">其他<span style="color: black;">出现</span>在骨骼中的癌症<span style="color: black;">包含</span>尤因肉瘤、朗格汉斯细胞增生症和淋巴瘤。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">问：会<span style="color: black;">导致</span><span style="color: black;">那些</span>症状？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">答：<span style="color: black;">病痛</span>几乎总是骨肉瘤的<span style="color: black;">第1</span>症状，但<span style="color: black;">一般</span>在最<span style="color: black;">初期</span>为人所忽略。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">不知<span style="color: black;">为么</span>，骨肉瘤<span style="color: black;">常常</span><span style="color: black;">出现</span>在成<span style="color: black;">长时间</span>，<span style="color: black;">亦</span><span style="color: black;">便是</span><span style="color: black;">孩儿</span>接近或进入青春期的时候，<span style="color: black;">疾患</span><span style="color: black;">导致</span>的不适<span style="color: black;">常常</span>会误以为是成长<span style="color: black;">导致</span>的。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">非常多</span>时候，<span style="color: black;">病人</span>会一次意外的受伤，感到<span style="color: black;">病痛</span>而到医院进行治疗。一段时间后，会<span style="color: black;">显现</span>肿胀。在<span style="color: black;">有些</span>儿童，受骨肉瘤影响的骨头可能会<span style="color: black;">出现</span>骨折，此时<span style="color: black;">孩儿</span>难以忍受<span style="color: black;">病痛</span>，父母便把<span style="color: black;">孩儿</span>送到医院进行治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">问：<span style="color: black;">那些</span>人群<span style="color: black;">拥有</span>患病<span style="color: black;">危害</span>？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">答：骨肉瘤的病因尚不<span style="color: black;">知道</span>。男孩比<span style="color: black;">女子</span><span style="color: black;">更易</span>患骨肉瘤。<span style="color: black;">身患</span>骨肉瘤的儿童的身高<span style="color: black;">常常</span>比同龄人高。一小部分<span style="color: black;">病人</span>会<span style="color: black;">出现</span><span style="color: black;">反常</span>的基因突变，使<span style="color: black;">她们</span><span style="color: black;">拥有</span>患骨肉瘤的<span style="color: black;">危害</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">RB基因<span style="color: black;">反常</span>的儿童很容易患上一种叫做视网膜母细胞瘤的眼癌。<span style="color: black;">同期</span>，<span style="color: black;">她们</span><span style="color: black;">亦</span>有患上骨肉瘤的<span style="color: black;">危害</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">其他<span style="color: black;">身患</span>Li-Fraumeni<span style="color: black;">综合症</span>的<span style="color: black;">病人</span>有肉瘤、白血病和肾上腺癌的患病<span style="color: black;">危害</span>。<span style="color: black;">她们</span>的p53基因<span style="color: black;">没</span>法发挥<span style="color: black;">功效</span>。接受过放射治疗的儿童<span style="color: black;">亦</span>容易患骨肉瘤。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">问：骨肉瘤是<span style="color: black;">怎样</span>诊断出来的？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">答：大腿骨（股骨）和腿骨（胫骨和腓骨）是最常受骨肉瘤影响的骨骼。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一张简单的X光片便能够为医生<span style="color: black;">供给</span>诊断骨癌的<span style="color: black;">要紧</span>线索。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">CT或MRI能够<span style="color: black;">表示</span>骨肉瘤的特殊性表征。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">利用细针（活组织<span style="color: black;">检测</span>）从肿瘤中获取<span style="color: black;">有些</span>组织以进行病理学<span style="color: black;">检测</span>，这<span style="color: black;">便是</span>诊断骨肉瘤的确认<span style="color: black;">办法</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胸部X光和骨扫描，<span style="color: black;">或</span>仅仅借助PET扫描便能够判断骨肉瘤的分期，以<span style="color: black;">检测</span>除了原发位置以外<span style="color: black;">可否</span><span style="color: black;">出现</span>了任何扩散。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">问：<span style="color: black;">怎样</span>治疗？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">答：骨肉瘤可利用化疗和手术进行治疗。<span style="color: black;">此刻</span>的标准疗法是先化疗两到三个月，等到肿瘤变小时，再<span style="color: black;">经过</span>手术完全切除。手术后，还要进行五个月的化疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">产生最佳治疗效果的化疗<span style="color: black;">方法</span>是甲氨蝶呤、阿霉素和顺铂（MAP<span style="color: black;">方法</span>）。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">所<span style="color: black;">举荐</span>的手术类型将取决于化疗后的肿瘤的范围，最<span style="color: black;">重点</span>的目的是保肢而不是截肢。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">问：骨肉瘤<span style="color: black;">病人</span>的<span style="color: black;">存活</span>几率有多大？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">答：骨肉瘤<span style="color: black;">存活</span>几率取决于确诊时的癌症发展程度。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">日前</span>，<span style="color: black;">身患</span>局部性骨肉瘤（<span style="color: black;">没</span><span style="color: black;">出现</span>癌细胞扩散）的儿童<span style="color: black;">病人</span>的<span style="color: black;">长时间</span><span style="color: black;">存活</span>几率介于70%到75%之间。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span><span style="color: black;">已然</span>扩散到肺部的骨肉瘤的儿童<span style="color: black;">病人</span>，<span style="color: black;">她们</span><span style="color: black;">长时间</span>的<span style="color: black;">存活</span>几率约为40%。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>骨肉瘤<span style="color: black;">已然</span>扩散到肺部以外的其他身体部位，<span style="color: black;">仅有</span>10%的<span style="color: black;">病人</span>能够存活下来。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">问：骨肉瘤有<span style="color: black;">那些</span>并发症？<span style="color: black;">怎样</span>治疗？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">答：骨肉瘤儿童<span style="color: black;">病人</span>有可能会<span style="color: black;">由于</span>癌症而失去一条肢体。即使在进行保肢手术后，<span style="color: black;">孩儿</span>们<span style="color: black;">亦</span>经常<span style="color: black;">必须</span>某种靠移植手术来替换缺失的骨头，有时<span style="color: black;">乃至</span><span style="color: black;">必须</span>假体来替代关节行使正常功能。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">化疗<span style="color: black;">亦</span>会产生短期和<span style="color: black;">长时间</span>的副<span style="color: black;">功效</span>。立即的副<span style="color: black;">功效</span><span style="color: black;">包含</span>恶心、呕吐、口腔溃疡、喉咙痛、便秘和腹泻。这些副<span style="color: black;">功效</span>在治疗结束后是<span style="color: black;">能够</span>消失的。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">感染是治疗过程中的主要问题，但仔细监控和<span style="color: black;">运用</span>生长因子或抗生素治疗<span style="color: black;">常常</span>会起到<span style="color: black;">必定</span>的<span style="color: black;">帮忙</span>。脱发可能是<span style="color: black;">病人</span>最不想经历的副<span style="color: black;">功效</span>，但化疗结束后头发还会再长回来。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲氨蝶呤的毒性有时会影响大脑和肾脏。然而，这些事情<span style="color: black;">出现</span>的可能性很小。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">阿霉素可能会对心脏产生<span style="color: black;">长时间</span>的副<span style="color: black;">功效</span>。顺铂可能会损害听力和肾脏，虽然严重的听力损失、心力衰竭和肾功能衰竭并不<span style="color: black;">平常</span>，但在治疗<span style="color: black;">时期</span>和治疗之后<span style="color: black;">必要</span>密切监测这些器官的功能。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">德医山水诊所由新加坡德医集团在北京投资设立，是一<span style="color: black;">因此</span>肿瘤治疗<span style="color: black;">特殊</span>为主的全科医疗中心。<span style="color: black;">做为</span>德医在中国内地<span style="color: black;">第1</span>家国际医疗中心，德医山水诊所专注为中国<span style="color: black;">病人</span><span style="color: black;">供给</span>专业且有温度的医疗服务。医疗中心结合了国内外医学技术精髓，引进新加坡以人为本的医疗服务理念与管理模式，秉承专业的医疗水平，国际化的护理标准，为<span style="color: black;">病人</span><span style="color: black;">供给</span>个性化的治疗<span style="color: black;">方法</span>。</p>
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