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Câncer de mama metastático

  • Обзор
  • Теория
  • Диагноз
  • Лечение
  • Последующее наблюдение
  • Источники
Последний просмотренный: 17 Aug 2025
Last updated: 24 Apr 2025

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • presença de fatores de risco
  • dor óssea
  • derrame pleural
  • massa palpável após tratamento do tumor primário
Полная информация

Другие диагностические факторы

  • dispneia
  • tosse (não produtiva)
  • anorexia
  • perda de peso
  • sintomas neurológicos (por exemplo, dor nevrálgica, fraqueza, cefaleias, convulsões)
Полная информация

Факторы риска

  • sexo feminino
  • idade >50 anos
  • história familiar de câncer de mama, ovário, pâncreas e/ou próstata
  • genes de suscetibilidade ao câncer de mama (BRCA1, BRCA2, CDH1, PALB2, PTEN, STK11 e TP53)
  • tumor >5 cm de diâmetro
  • alto número de linfonodos axilares positivos (por exemplo, >10)
  • invasão linfovascular
  • assinatura de 70 genes de alto risco
  • assinatura de 21 genes de alto risco
  • assinatura de gene PAM50 de alto risco
  • Síndrome de Lynch (câncer colorretal hereditário sem polipose)
  • mutações CHEK2
  • mutações ATM
  • doença residual mínima (DRM)
  • assinaturas de genes de metástase óssea e metástase no pulmão
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • Hemograma completo
  • TFHs
  • cálcio
  • tomografia computadorizada (TC) do tórax e abdome
  • cintilografia óssea
Полная информация

Исследования, проведение которых нужно рассмотреть

  • RNM (com foco na área preocupante; por exemplo, cérebro, medula espinhal, osso)
  • FDG-PET/CT
  • biópsia da lesão metastática
  • teste de linha germinativa para genes de suscetibilidade ao câncer de mama com alta penetrância
  • testes adicionais de biomarcadores
  • ecocardiograma
  • angiografia sincronizada multinuclear (MUGA)
  • citologia pleural
Полная информация

Алгоритм лечения

ПРОДОЛЖЕНИЕ

positivo para receptores hormonais, negativo para HER2, sem crise visceral: menopausada

positivo para receptores hormonais, negativo para HER2, sem crise visceral: pré-menopausa

positivo para receptores hormonais, positivo para HER2, sem crise visceral: menopausada

positivo para receptores hormonais, positivo para HER2, sem crise visceral: pré-menopausa

negativo para receptores hormonais, positivo para HER2, sem crise visceral

PD-L1 negativo, triplo negativo (receptor de hormônio negativo, HER2 negativo), sem crise visceral

PD-L1 positiva, triplo negativo (receptor de hormônio negativo, HER2 negativo), sem crise visceral

positivo ou negativo para receptor hormonal, negativo para HER2, com crise visceral

positivo ou negativo para receptor hormonal, positivo para HER2, com crise visceral

Составители

Авторы

Edward Sauter, MD, PhD
Edward Sauter

Medical and Program Officer

Division of Cancer Prevention

National Cancer Institute

Rockville

MD

Раскрытие информации

ES declares that he has no competing interests.

Wajeeha Razaq, MD

​Breast Cancer Site Chair

University Oklahoma School of Medicine

Oklahoma City

OK

Раскрытие информации

WS declares that she has no competing interests.

Выражение благодарностей

Dr Edward Sauter and Dr Wajeeha Razaq would like to gratefully acknowledge Dr Puja Nistala, Dr Donald Doll, Dr Carl E. Freter and Dr Michael Perry, previous contributors to this topic.

Раскрытие информации

PN, DD, CEF and MP declare that they have no competing interests.

Рецензенты

Alan Neville, MD

Professor

Assistant Dean

Undergraduate Program

McMaster University

Hamilton

Ontario

Canada

Раскрытие информации

AN declares that he has no competing interests.

Gianfilippo Bertelli, MD, PhD, FRCP (Edin)

Consultant

Honorary Senior Lecturer in Medical Oncology

South West Wales Cancer Centre

Swansea

UK

Раскрытие информации

GB has received honoraria for participation in advisory boards (AstraZeneca, Novartis, Pfizer, Roche, GSK, Cephalon, Amgen, Sanofi, Aventis), speaker's fees (AstraZeneca, Novartis, Sanofi, Aventis), and hospitality at conferences (AstraZeneca, Novartis, Pfizer, Roche, Aventis).

Christos Vaklavas, MD

Assistant Professor

Division of Hematology/Oncology

Department of Medicine

University of Alabama at Birmingham

Birmingham

AL

Раскрытие информации

CV declares that University of Alabama at Birmingham has received research support from Pfizer, F. Hoffmann-La Roche, and Incyte.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Gennari A, André F, Barrios CH, et al. ESMO clinical practice guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. Ann Oncol. 2021 Dec;32(12):1475-95.Полный текст  Аннотация

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: breast cancer [internet publication].Полный текст

Rugo HS, Rumble B, Macrae E, et al. Endocrine therapy for hormone receptor-positive metastatic breast cancer: American Society of Clinical Oncology Guideline. J Clin Oncol. 2016 Sep 1;34(25):3069-103.Полный текст  Аннотация

Giordano SH, Franzoi MAB, Temin S, et al. Systemic therapy for advanced human epidermal growth factor receptor 2-positive breast cancer: ASCO guideline update. J Clin Oncol. 2022 Aug 10;40(23):2612-35.Полный текст  Аннотация

Van Poznak C, Somerfield MR, Barlow WE, et al. Role of bone-modifying agents in metastatic breast cancer: an American Society of Clinical Oncology-Cancer Care Ontario focused guideline update. J Clin Oncol. 2017 Dec 10;35(35):3978-86.Полный текст  Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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