抗癌治疗后，记得别与医生失联
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【林女士的故事】</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">林女士，40岁，3年前因子宫颈恶性肿瘤做了宫颈癌根治术。术后，病理提示她患的是预后较差的腺癌，复发<span style="color: black;">危害</span>高。经<span style="color: black;">大夫</span>综合<span style="color: black;">评定</span>后，林女士接受了规范的放化疗。治疗结束后，林女士总算松一口气，<span style="color: black;">逐步</span>恢复了正常的工作生活。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">多姿多彩的生活，让林女士慢慢忘记了<span style="color: black;">大夫</span>嘱咐的<span style="color: black;">定时</span>随诊。近半年来，她的下腹及腰背部<span style="color: black;">显现</span><span style="color: black;">病痛</span>，并<span style="color: black;">逐步</span>加剧。林女士这才想起<span style="color: black;">大夫</span>的嘱咐，赶快到门诊复查。不幸的是，<span style="color: black;">检测</span>结果<span style="color: black;">表示</span>，林女士的肿瘤复发，并扩散到膀胱及直肠，双肺<span style="color: black;">亦</span>有多发转移灶。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q3.itc.cn/q_70/images03/20240416/6e659153945c42ff8e3bc2b1a82cbc11.png" 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;">妇科<span style="color: black;">平常</span>的三大恶性肿瘤是<strong style="color: blue;">宫颈癌、子宫内膜癌和卵巢癌</strong>。随着医学的发展，<span style="color: black;">都数</span><span style="color: black;">病人</span>经过规范治疗，<span style="color: black;">能够</span><span style="color: black;">得到</span>满意的治疗效果。然而，恶性肿瘤的凶险之处在于它的扩散能力，<strong style="color: blue;"><span style="color: black;">病人</span>存在复发或转移的<span style="color: black;">危害</span></strong>，而越早<span style="color: black;">发掘</span>，治疗效果越好。这便是<span style="color: black;">定时</span>随诊的<span style="color: black;">要紧</span>性所在。遗憾的是，不少<span style="color: black;">病人</span>在肿瘤治疗结束后就和<span style="color: black;">大夫</span>断了联系，或忘记复诊。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">治疗后随访有多<span style="color: black;">要紧</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">像林女士<span style="color: black;">这般</span>很<span style="color: black;">注意</span>手术和放化疗，却<span style="color: black;">忽略</span>治疗结束后复查随访的妇科肿瘤<span style="color: black;">病人</span>并不少见。<span style="color: black;">定时</span>随访对<span style="color: black;">病人</span>有<span style="color: black;">那些</span>好处呢？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1.癌症<span style="color: black;">病人</span>即便在接受治疗后，仍存在复发或转移的<span style="color: black;">危害</span>，且<span style="color: black;">都数</span><span style="color: black;">病人</span>复发时<span style="color: black;">无</span><span style="color: black;">显著</span>症状，只能<span style="color: black;">经过</span><span style="color: black;">定时</span>的随访、体检，<span style="color: black;">才可</span>尽早<span style="color: black;">发掘</span><span style="color: black;">反常</span>信号。<span style="color: black;">疾患</span>本身要早诊早治，面对<span style="color: black;">疾患</span>复发，<span style="color: black;">一样</span><span style="color: black;">必须</span>早诊早治，<span style="color: black;">仅有</span>尽早治疗，<span style="color: black;">才可</span>将肿瘤的<span style="color: black;">害处</span>降到最低。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.有些<span style="color: black;">病人</span>在<span style="color: black;">发掘</span>肿瘤时已属晚期，但<span style="color: black;">亦</span><span style="color: black;">一样</span><span style="color: black;">必须</span>复查随访，只是要边治疗边复查，复查的目的是<span style="color: black;">帮忙</span><span style="color: black;">大夫</span>观察疗效，以便<span style="color: black;">即时</span><span style="color: black;">调节</span>治疗<span style="color: black;">方法</span>，得到更好的疗效。另一方面，妇科肿瘤的诊疗技术发展<span style="color: black;">火速</span>，<span style="color: black;">定时</span>随访有助于<span style="color: black;">病人</span><span style="color: black;">即时</span><span style="color: black;">得到</span>最优的治疗<span style="color: black;">选取</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3.癌症<span style="color: black;">病人</span>在经历大手术、<span style="color: black;">长期</span>放化疗后，会面临<span style="color: black;">有些</span>不适症状和心理问题，随访有助于化解困惑。常有<span style="color: black;">病人</span>因<span style="color: black;">各样</span><span style="color: black;">原由</span>自己纠结了很久，在随访时听到<span style="color: black;">大夫</span>的专业<span style="color: black;">诠释</span>后，一下子豁然开朗。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4.与普通人群相比，肿瘤<span style="color: black;">病人</span>容易伴发其他<span style="color: black;">疾患</span><span style="color: black;">乃至</span>恶性肿瘤，<span style="color: black;">定时</span>随访有利于及早<span style="color: black;">发掘</span>这些危险<span style="color: black;">原因</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">5.对<span style="color: black;">有些</span><span style="color: black;">青年</span>、有<span style="color: black;">保存</span>生育功能需求的<span style="color: black;">病人</span>，肿瘤治疗结束后何时能孕育新生命，<span style="color: black;">亦</span><span style="color: black;">必须</span><span style="color: black;">定时</span>随访，<span style="color: black;">按照</span>复查的<span style="color: black;">状况</span>来决定。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">因此呢</span>，肿瘤<span style="color: black;">病人</span>治疗后仍要和<span style="color: black;">大夫</span>保持联系，<span style="color: black;">保持</span>随访，<span style="color: black;">定时</span>复查。如今，不少医院都有随访服务，当<span style="color: black;">病人</span>或家属接到随访<span style="color: black;">tel</span>或短信时，不要“左耳朵进右耳朵出”，应<span style="color: black;">尽可能</span>克服困难，按随访<span style="color: black;">需求</span>去做。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q8.itc.cn/q_70/images03/20240416/6ae8463787e14ad3b4c0b116cb7146fa.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">何时随访最合适</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">癌症有5年<span style="color: black;">存活</span>率的说法，5年没复发，基本算是治愈或慢性病化了。<span style="color: black;">因此呢</span>，<span style="color: black;">一般</span>对肿瘤<span style="color: black;">病人</span>的随访重点在治疗结束后的5年内，<span style="color: black;">详细</span>到妇科恶性肿瘤，<span style="color: black;">病人</span>应该何时去随访呢？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在我国部分城市，子宫内膜癌<span style="color: black;">已经是</span>最<span style="color: black;">平常</span>的妇科恶性肿瘤，大<span style="color: black;">都数</span>复发出<span style="color: black;">此刻</span>治疗后3年内。<span style="color: black;">因此呢</span>，在治疗结束后的2~3年内，<span style="color: black;">病人</span>应每3~6个月复查1次，之后每半年1次，5年后每年1次。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">宫颈癌在我国仍是发病和死亡率最高的妇科恶性肿瘤，“宫颈癌根治术”只是一个理想的手术名<span style="color: black;">叫作</span>，<span style="color: black;">是不是</span>真的根治了，远期随访说了算。宫颈癌治疗结束2年内复发概率最大，复查频率<span style="color: black;">亦</span>最高，<span style="color: black;">因此呢</span><span style="color: black;">意见</span><span style="color: black;">病人</span>治疗结束后2年内每3~6个月复查1次；第3~5年每半年复查1次；5年后每年复查1次。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">卵巢癌被<span style="color: black;">叫作</span>为“妇癌之王”。我国卵巢癌<span style="color: black;">病人</span>的5年<span style="color: black;">存活</span>率不足四成。<span style="color: black;">因为</span><span style="color: black;">都数</span>卵巢癌<span style="color: black;">病人</span>复发的<span style="color: black;">初期</span>症状不<span style="color: black;">显著</span>，“<span style="color: black;">定时</span>随访，不适随诊”尤为<span style="color: black;">要紧</span>。卵巢癌的随访间隔为初始治疗后的前2年里每2~4个月随访1次；第3~ 5年每3~6个月1次；5年后每年1次。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">除了按时随访外，妇科肿瘤<span style="color: black;">病人</span><span style="color: black;">亦</span>要在<span style="color: black;">平常</span>生活中<span style="color: black;">重视</span>自我观察。观察的重点<span style="color: black;">包含</span>治疗后<span style="color: black;">显现</span>不明<span style="color: black;">原由</span>的阴道流血或排液，接触性<span style="color: black;">流血</span>，腹痛腹胀<span style="color: black;">乃至</span>扪及包块，盆腔、髂关节、背部或腿部<span style="color: black;">病痛</span>，咳嗽，<span style="color: black;">呼气</span>困难，下肢肿胀，厌食、恶心、呕吐，停止排气，排便、排尿习惯改变，血尿、血便，体重<span style="color: black;">显著</span>减轻等。这些症状不会<span style="color: black;">没</span>缘<span style="color: black;">没</span>故<span style="color: black;">显现</span>，最好的做法是<span style="color: black;">即时</span>去医院就诊，让<span style="color: black;">大夫</span>帮忙判断<span style="color: black;">原由</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q1.itc.cn/q_70/images03/20240416/94f28757489f447b85b0c2eef72d8999.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">随访要查<span style="color: black;">那些</span>项目</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">随访的重点在于<span style="color: black;">评定</span>症状、识别复发征象，不给肿瘤卷土重来的机会。<span style="color: black;">那样</span>，随访时<span style="color: black;">必须</span>关注<span style="color: black;">那些</span>项目呢？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">症状和体征：</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">寻找肿瘤复发的蛛丝马迹</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">随诊时<span style="color: black;">大夫</span><span style="color: black;">一般</span>会询问肿瘤复发的<span style="color: black;">关联</span>症状（不明<span style="color: black;">原由</span>腹痛、阴道流血或排液等），并进行全身<span style="color: black;">检测</span>和妇科<span style="color: black;">检测</span>。<span style="color: black;">针对</span>宫颈癌<span style="color: black;">病人</span>，专家<span style="color: black;">举荐</span><span style="color: black;">最少</span>每年进行1次子宫颈（<span style="color: black;">保存</span>生育功能者）或阴道细胞学<span style="color: black;">检测</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">抽血化验：</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">查看肿瘤标志物</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">肿瘤标志物是能反映肿瘤<span style="color: black;">出现</span>、发展，监测肿瘤对治疗反应的一类物质，<span style="color: black;">经过</span>抽血化验来检测。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">肿瘤标志物<span style="color: black;">包含</span><span style="color: black;">非常多</span>种，<span style="color: black;">针对</span>卵巢癌和子宫内膜癌<span style="color: black;">病人</span>最有<span style="color: black;">道理</span>的指标是糖类抗原125（CA125），随访时<span style="color: black;">检测</span>CA125或其他初诊时<span style="color: black;">上升</span>的肿瘤标志物，有助于监测<span style="color: black;">疾患</span>复发或转移。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">CA125受炎症、<span style="color: black;">大姨妈</span>、子宫内膜异位症等<span style="color: black;">原因</span>的影响，轻度<span style="color: black;">上升</span>时不必恐慌。<span style="color: black;">针对</span>子宫颈鳞癌<span style="color: black;">病人</span>最有<span style="color: black;">道理</span>的指标是鳞状细胞抗原（SCC），宫颈腺癌<span style="color: black;">病人</span>可<span style="color: black;">显现</span>CA125、癌胚抗原（CEA）、糖类抗原19-9（CA19-9）等标志物的<span style="color: black;">上升</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">影像学<span style="color: black;">检测</span>：</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">拍个片子，让肿瘤病灶原形毕露</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">随访时，<span style="color: black;">按照</span>临床<span style="color: black;">必须</span>，<span style="color: black;">大夫</span>会<span style="color: black;">意见</span>完善<span style="color: black;">彩超</span>（腹部、盆腔）、CT（胸部、腹部、盆部）、磁共振（MRI）或PET/ CT<span style="color: black;">检测</span>。这些影像学<span style="color: black;">检测</span>是肿瘤病灶的照妖镜，<span style="color: black;">针对</span>有临床指征或体检<span style="color: black;">发掘</span>有复发征象的<span style="color: black;">病人</span>，<span style="color: black;">大夫</span>会<span style="color: black;">选取</span>相应的影像学<span style="color: black;">检测</span>，以判断有<span style="color: black;">没</span>复发和转移。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">肿瘤随访看似简单却<span style="color: black;">道理</span>重大。癌后余生，请记得与<span style="color: black;">大夫</span>保持联系，不做抗癌“孤勇者”。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">文</span>：首都医科大学<span style="color: black;">附庸</span>北京世纪坛医院妇产科 章静菲 赵欣欣 白文佩</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">编辑：</span><span style="color: black;">穆薪宇</span><span style="color: black;">管仲瑶</span></p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">审核：</span><span style="color: black;">徐秉楠 <span style="color: black;">杨利</span><span style="color: black;">春</span></span></p>
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