难以置信！甲状腺癌远处转移后能活53年！
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">普通人认知中</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肿瘤<span style="color: black;">出现</span>远处转移后</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">生命就进入倒计时</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>告诉你有的肿瘤远处转移后能活50年</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">你<span style="color: black;">必定</span>觉得在胡说八道</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-714bc377a94413f5ca8a2a2407c95e5d_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">安德森肿瘤中心近期完<span style="color: black;">成为了</span>跨越60年的统计</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">统计对象是<span style="color: black;">已然</span>远处转移的未成年甲癌<span style="color: black;">病人</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">包含</span>乳头状癌和滤泡癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">她们</span>中<span style="color: black;">非常多</span>虽然带癌<span style="color: black;">存活</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但确诊后平均活了52.8年</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">超过了半个世纪</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">是否</span>刷新你的认知？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">儿童（<10岁）和青少年（10-18岁）的甲癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">它们初来乍到时看起来凶</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">其实预后非常好</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">主治<span style="color: black;">大夫</span><span style="color: black;">倘若</span>不<span style="color: black;">认识</span>它的发展规律</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">过度的进行治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">乃至</span>能<span style="color: black;">引起</span><span style="color: black;">她们</span>少活几十年</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">今天<span style="color: black;">一块</span><span style="color: black;">认识</span>下未成年人的甲癌吧！</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">手术</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">成年人的甲状腺癌处理<span style="color: black;">办法</span><span style="color: black;">非常多</span></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>甲状腺癌不<span style="color: black;">必须</span>手术</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">即便手术有时<span style="color: black;">能够</span>半切</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但这些对未成年人不适用</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-e93798838328049d6171038b71e54df1_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">未成年人的淋巴转移比例很高（70%）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">很多术前超声上就有<span style="color: black;">显著</span><span style="color: black;">反常</span>的淋巴结（上图）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">腺外侵犯<span style="color: black;">亦</span><span style="color: black;">平常</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此</span><span style="color: black;">她们</span>都<span style="color: black;">必须</span>甲状腺全切手术</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">外加<span style="color: black;">必定</span>范围的淋巴结清扫</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">找一个清扫彻底的外科<span style="color: black;">大夫</span>是<span style="color: black;">第1</span>步</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">碘治疗</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">由于</span>局部转移严重</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">大<span style="color: black;">都数</span>未成年人的甲癌<span style="color: black;">必须</span>碘治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>甲癌<span style="color: black;">无</span>转移到远处</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一次碘治疗后就进入随访期</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">之后的问题<span style="color: black;">不外</span>是处理残留的淋巴结</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但不幸的是未成年人远转比例远高于成年人</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">大约在20%</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">此时</span>就有可能<span style="color: black;">必须</span>多次碘治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">亦</span>是治疗容易犯错的<span style="color: black;">地区</span></p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-d3647dcf2f748112d6f01f12c338bf67_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">未成年人的肺转移<span style="color: black;">一般</span>吸碘（上图）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但<span style="color: black;">倘若</span>毕业标准是Tg检测不到，肺结节消失</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">没</span>论接受多少轮碘治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">大<span style="color: black;">都数</span>人并<span style="color: black;">不可</span>毕业</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Dr. Alzahrani统计了20位肺转移的未成年<span style="color: black;">病人</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">她们</span>所有人碘治疗后都未达到毕业标准</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但除了一位被甲癌夺走生命外</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">其余都能够带癌<span style="color: black;">存活</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">J Clin Endocrinol Metab, 2019, 104, 103-110</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-20f9f12f9149dd4562467625c6acf4e6_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">非常多</span>核医学<span style="color: black;">大夫</span>看到肺部吸碘就<span style="color: black;">没</span>底线的碘治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">带来两个严重的<span style="color: black;">副作用</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肺纤维化和白血病</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">天涯的傲娇的塔伦蒂诺接受了18次碘治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">最后</span><span style="color: black;">由于</span>肺纤维化过世</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但18次并不是最多的</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">文案</span>后有人留言说喝了20次圣水</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">碘131和肺转移的关系很微妙</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">碘131很难完全消灭肺转移</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肺转移<span style="color: black;">通常</span><span style="color: black;">亦</span>不会<span style="color: black;">引起</span>未成年<span style="color: black;">病人</span>死亡</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">倘若你想一鼓作气用碘131杀干净这些转移灶</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">碘131先杀死的可能是<span style="color: black;">病人</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">安德森肿瘤中心的Dr. Waguespack就说</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">过去<span style="color: black;">她们</span>是碘治疗1年后<span style="color: black;">评定</span><span style="color: black;">可否</span>接着治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">此刻</span><span style="color: black;">针对</span>未成年<span style="color: black;">病人</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">思虑</span>的是碘治疗3-5年后再进行<span style="color: black;">评定</span></p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;"><span style="color: black;">药品</span>治疗</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">即便带着远处转移灶</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">绝大<span style="color: black;">都数</span>未成年<span style="color: black;">病人</span><span style="color: black;">能够</span>稳定几十年</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">不<span style="color: black;">必须</span>进一步的<span style="color: black;">干涉</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这不是医学奇迹</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">便是</span>这一类<span style="color: black;">疾患</span>的特点</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但<span style="color: black;">倘若</span>运气<span style="color: black;">欠好</span>，转移灶<span style="color: black;">持续</span>增长</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">乃至</span>影响了<span style="color: black;">病人</span>的<span style="color: black;">呼气</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">下一步该怎么办呢？</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-18f83d4d92e590cd960457c9e18cd3f8_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这儿</span>借用Dr. Waguespack给出的案例</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">13岁小男孩经历了两次手术，两次碘治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">尽管转移灶吸碘</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">然则</span>箭头所示的肺部转移灶仍然长到了2厘米</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">基因检测提示NTRK基因融合</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">而后</span><span style="color: black;">吃下</span>了2018年FDA<span style="color: black;">准许</span>的拉罗替尼</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">十个周期后2厘米的转移灶完全消失</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这么好治疗效果在成年人中非常少见</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-4366153dde534b1553762bd876e33846_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">还有<span style="color: black;">另一</span>一个案例</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一个大面积远处转移的未成年<span style="color: black;">病人</span>有症状</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">左边箭头所指的白花花的一片<span style="color: black;">便是</span>肺转移</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">基因检测提示有BRAF突变</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">吃下</span>BRAF<span style="color: black;">控制</span>剂后白花花的一片都消失了</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">BRAF<span style="color: black;">控制</span>剂对成年人的甲癌效果<span style="color: black;">通常</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">然则</span>到未成年这效果相当<span style="color: black;">明显</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">靶向<span style="color: black;">药品</span>分为两种</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一种是不针对特定基因突变的<span style="color: black;">药品</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">例如</span>索拉非尼，乐伐替尼</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一种是针对基因突变的<span style="color: black;">药品</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span>未成年<span style="color: black;">病人</span>应该<span style="color: black;">思虑</span>后者</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">笔记总结</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">未成年人的甲癌是非常特殊的肿瘤</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">看起来凶，但预后好</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">治疗中<span style="color: black;">必定</span>要考量治疗的副<span style="color: black;">功效</span></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>家长为了把<span style="color: black;">孩儿</span>治好</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">尽一切可能的积极治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">效果可能适得其反</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">为何</span>未成年人的甲癌来势汹汹？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">为何</span>它们容易远处转移？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">为何</span>它们吸碘但难以毕业？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">为何</span>它们远转后非常稳定？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">又<span style="color: black;">为何</span>它们对基于基因突变的<span style="color: black;">药品</span>有奇效？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">想<span style="color: black;">晓得</span>答案就给这篇<span style="color: black;">文案</span>点个赞</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">以后会从基因的<span style="color: black;">方向</span>揭秘！</p>最后，欢迎关注最有意思的甲状腺<span style="color: black;">微X</span>公众号「温哥华小文青」。
楼主的文章非常有意义，提升了我的知识水平。 “BS”（鄙视的缩写）
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