Homegrown pet怎么玩 家养宠物玩法技巧，

“美国非小细胞肺癌NCCN指南，该指南旨在给患者提供治疗信息，帮助患者从“0”到“1”认识肺癌，找到适合的治疗方案。本指南有些建议也许不适合你，你的医生可能会根据你的情况和其他因素制定不一样的治疗方案。​”

本公众号将非小细胞肺癌NCCN指南重新整理拆分，将以中英文在公众号连载的方式发布，本指南不能做任何商业用途，转载请联系本公众号。

译者：朱志华、梅伟健

Part6.1.3 原发肿瘤 III期

1、III

II期经常被定义为癌症扩散到肺外淋巴结。肺之间并靠近肺的N2淋巴结转移。有些淋巴结就在气管的下面。在肺之间靠近肺的N3淋巴结而没有转移。其他N3淋巴结靠近锁骨或颈部。

Stage III is often defined by cancer spread to lymph nodes far outside the lungs. N2 nodes are between the lungs but next to the lung with cancer. Some are right below the windpipe. N3 nodes are between the lungs close to the lung without cancer. Other N3 nodes are near the collarbone or in the neck.

一些iii a期癌症没有远处淋巴结转移。这些癌症的N分期是N0或N1。然而，在同一肺中可能有一个原发肿瘤和一个二次肿瘤。或者，肿瘤可能侵入胸壁、支气管或纵隔。

Some stage IIIA cancers have not spread far among lymph nodes. The N stage for these cancers is either N0 or N1. Instead, there may be a primary and secondary tumor in the same lung. Or instead, the tumor may have invaded the chest wall, bronchus, or mediastinum.

III期癌症的治疗选择分为四个部分。

Options for stage III cancers are grouped into four sections.

N0和N1疾病

指南16列出N0和N1疾病的初选治疗选择。N0表示淋巴结中未发现癌症。N1是指在肺周围、肺内或肺门淋巴结上有转移的原发肿瘤。

Guide 16 lists options for initial treatment for N0 or N1 disease. N0 means that no cancer has been found in lymph nodes. N1 means that cancer has been found in peribronchial, intrapulmonary, or hilar nodes of the lung with the primary tumor.

肿瘤没有外侵

这些肿瘤没有外侵到胸壁，支气管或纵隔。首次治疗，选择取决于你是否能做手术。

Tumors without invasion These tumors have not grown into the chest wall, bronchi, or mediastinum. For initial treatment, options depend on if you are able to have surgery.

手术

如果肺手术是一个选项了，建议切除肿瘤和淋巴结。外科手术的目的是治疗癌症。如果可以化疗，你可以在手术前接受它来缩小肿瘤。

Surgery. If lung surgery is an option, removal of the tumor and lymph nodes is advised. The goal of surgery is to cure the cancer. If chemotherapy is likely, you may receive it before surgery to shrink the tumor.

手术后

将进行辅助治疗。这种疗法是为了减少癌症复发的机会。如果手术边缘无癌，建议进行化疗。如果手术切缘阳性，放化疗是一种选择。放化疗应该同时进行。如果在显微镜下只能看到边缘的癌细胞，也可以使用序贯放化疗。

After surgery, adjuvant treatment will be given. This treatment is given to reduce the chances of the cancer returning. Chemotherapy is advised if the surgical margins are cancer-free. When the margins have cancer, chemoradiation is an option. These two types of treatment can be given at the same time. They may also be given back-to-back if cancer in the margins can only be seen with a microscope.

放化疗

你可能无法手术或拒绝做手术。在这种情况下，放化疗是一种选择。放化疗应同时进行。如果在2次或2次以上的放化疗周期后，癌症没有恶化，那么下一步可以使用durvalumab。它也可能减缓癌症的生长。

Chemoradiation. You may be unable or refuse to have surgery. In this case, chemoradiation is an option. These two types of treatment should be received at the same time. If the cancer does not worsen after 2 or more cycles of chemoradiation, durvalumab may be received. It may also slow down the growth of the cancer.

肺上沟瘤

肺上沟瘤起源于肺的顶端。它们很容易侵入胸壁。他们是浸润性的癌症。

Superior sulcus tumors start at the top of the lung. They easily grow into the chest wall. They are invasive cancers.

治疗方案取决于你是否可以手术。手术可能是T3肿瘤的一个选择，但可能不是T4肿瘤的选择。无论是哪种情况，放化疗都应该是初始治疗。

Treatment options are based on if you can have surgery. Surgery is likely an option for T3 tumors but may not be for T4 tumors. In either case, chemoradiation is the first treatment given.

放化疗可能缩小癌症使其能够接受外科手术。肿瘤将通过影像学检查重新评估。建议进行增强或不曾强胸部CT。PET/ CT也可以使用。如果手术仍然不是一种选择，那么就需要进行放化疗治疗。

Chemoradiation may shrink the cancer enough for surgery. The tumor will be re-assessed using imaging tests. A chest CT with or without contrast is advised. PET/CT may also be used. If surgery is still not an option, finish chemoradiation.

手术后，建议进行额外的化疗。它将减少癌症复发的机会。

After surgery, more chemotherapy is advised. It will reduce the chances of the cancer returning.

肿瘤可能不够萎缩。在这种情况下，你可以进行放射治疗。建议进行额外的化疗。

The tumor may have not shrunk enough. In this case, you may complete radiation therapy. More chemotherapy is advised.

如果没有手术，durvalumab可能是一个选择。如果在2次或以上的放化疗周期后，肿瘤不会恶化。它也可能减缓癌症的生长。

If surgery wasn’t received, durvalumab may be an option. It is given if the cancer does not worsen after 2 or more cycles of chemoradiation. It may also slow down the growth of the cancer.

其他外侵肿瘤

其他III期肿瘤可以像肺上沟瘤一样外侵。这些其他的肿瘤已经侵入胸壁，支气管或纵隔。首次治疗u选择取决于如果你是否做手术。

Other stage III tumors can be invasive like superior sulcus tumors. These other tumors have grown into the chest wall, bronchi, or mediastinum. For initial treatment, options depend on if you are able to have surgery.

手术。如果手术是一种选择，那么单独手术是NCCN专家的首选方案。建议切除肿瘤和淋巴结以治疗癌症。其他的选择是放化疗或化疗，在手术前缩小肿瘤。

Surgery. If surgery is an option, surgery alone is the preferred option of NCCN experts. Removal of the tumor and lymph nodes is advised to try to cure the cancer. Other options are chemoradiation or chemotherapy to shrink the cancer before surgery.

手术后，将进行辅助治疗。这种疗法是为了减少癌症复发的机会。如果之前没有进行过化疗，则建议切缘阴性的患者选择化疗。否则，你就可以开始你的生存计划了。

After surgery, adjuvant treatment will be given. This treatment is given to reduce the chances of the cancer returning. If not received before, chemotherapy is advised if the surgical margins are cancer-free. Otherwise, you can start your survivorship plan.

当手术切缘阳性，二次手术是一种选择。如果没有接受过化疗，可以在术后进行化疗。如果曾经放疗过，你可能需要提高剂量以改善治疗结果。

When the margins have cancer, a second surgery is an option. If not received before, chemotherapy may follow surgery. If prior radiation, you may receive a boost to improve treatment results.

第二个选择是放化疗（如果之前没有接受过过）。放化疗应该同时进行。如果在显微镜下只能看到边缘的癌细胞，也可以使用序贯放化疗。

When the margins have cancer, a second option is chemoradiation if not received before. These two types of treatment can be given at the same time. They may also be given back-to-back if cancer in the margins can only be seen with a microscope.

放化疗。

你可能无法手术或拒绝做手术。在这种情况下，放化疗是一种选择。放化疗应该同时进行。如果在2次或2次以上的放化疗周期后，癌症没有恶化，那么就可以使用durvalumab。它也可能减缓癌症的生长。

Chemoradiation. You may be unable or refuse to have surgery. In this case, chemoradiation is an option. These two types of treatment should be received at the same time. If the cancer does not worsen after 2 or more cycles of chemoradiation, durvalumab may be received. It may also slow down the growth of the cancer.

N2期疾病

指南15列出了N2期疾病的治疗方法。N2期是肺间与肺旁的淋巴结转移。有些就在气管的下面。

Guide 15 lists treatment options for N2 disease. N2 nodes are between the lungs but next to the lung with cancer. Some are right below the windpipe.

初始治疗

有两种选择初始。放化疗是一种选择。放化疗应同时进行。放化疗可以大大降低肿瘤的大小。如果在2次或2次以上的放化疗周期后，癌症没有恶化，那么就可以使用durvalumab。它也可能减缓癌症的生长。

There are two options for initial treatment. Chemoradiation is one option. These two types of treatments should be given at the same time. Chemoradiation may greatly reduce tumor size. If the cancer does not worsen after 2 or more cycles of chemoradiation, durvalumab may be received. It may also slow down the growth of the cancer.

你的医生可能会把诱导治疗当成是一个选项。它只在一定条件下使用。这些条件包括t1-t3肿瘤和无侵袭。在这种情况下，建议使用化疗伴或不伴放疗。诱导治疗可以阻止癌症恶化。如果诱导治疗有效，手术可能会被接受。

Your doctor may decide that induction treatment is an option. It is used only under certain conditions. These conditions include T1–T3 tumors and no invasion. In such cases, chemotherapy with or without radiation therapy is advised. Induction treatment may stop the cancer from getting worse. If induction treatment works, surgery may be received.

N2初始治疗期间的诊断

更多措施被建议使用来改善初始治疗的结果。在放化疗后，可以接受durvalumab。如果在2次或以上的放化疗周期后，肿瘤不会恶化。它也可能减缓癌症的生长。

Post-initial treatment for N2 at diagnosis More treatment is advised to improve the results of initial treatment. After chemoradiation, durvalumab may be received. It is given if the cancer does not worsen after 2 or more cycles of chemoradiation. It may also slow down the growth of the cancer.

你可能已经接受了诱导化疗不管你有没有手术。在接受治疗或手术后，如果没有接受放射治疗，建议接受放射治疗。在放射治疗前你可能会接受更多的化疗。

You may have received induction chemotherapy with or without surgery. After induction treatment or surgery, radiation therapy is advised if not received before. You may receive more chemotherapy before radiation therapy.

对N2的术后辅助治疗

有些N2只能在手术后发现。辅助治疗用于减少癌症复发的机会。治疗方案取决于手术切缘是否阳性。如果切缘阴性，单纯化疗或序贯放化疗是可行的。

Adjuvant treatment for N2 found after surgery Sometimes N2 disease is found only after surgery. Adjuvant treatment is given to reduce the chances of the cancer returning. Options are based on if there’s cancer in the surgical margins. If there’s no cancer, chemotherapy alone or chemoradiation given backto-back is an option.

当切缘阳性时，放化疗是一种选择。放化疗应该同时进行。如果在显微镜下只能看到边缘的癌细胞，也可以使用序贯放化疗。

When the margins have cancer, chemoradiation is an option. These two types of treatment can be given at the same time. They may also be given back-toback if cancer in the margins can only be seen with a microscope.

N3疾病

指南16列除了N3疾病的治疗方案。外科手术将无法完全切除癌症。因此，放化疗是一种选择。放化疗应该同时进行。放化疗可以大大降低肿瘤的大小。如果在2次或2次以上的放化疗周期后，癌症没有恶化，那么就可以使用durvalumab。它也可能减缓癌症的生长。

N3 disease Guide 16 lists treatment options for N3 disease. Surgery will not remove enough of the cancer. Thus, chemoradiation is an option. These two types of treatments should be given at the same time. Chemoradiation may greatly reduce tumor size. If the cancer does not worsen after 2 or more cycles of chemoradiation, durvalumab may be received. It may also slow down the growth of the cancer.

生存者计划

指南17为你的生存计划列出了卫生保健方面的建议。这些计划在治疗结束而且相关检查没有发现癌症的迹象时就应该开始了。这个计划应该处理好你的整个健康状况。和你的医生谈谈如何制定一个计划。

Guide 17 lists the health care that is advised for a survivorship plan. These plans start when treatment is done and tests show no signs of cancer. The plan should address your whole health and well-being. Talk with your doctor about making a plan together.

癌症测试

随访癌症复查用于早期发现新的肿瘤。这些检查包括病史、体检、增强或不增强的胸部CT扫描。复查的时机取决于你是否接受放射治疗。阅读指南17推荐的时间框架。你的医生会在一个时间段内决定何时进行复查。

Follow-up cancer tests are given to find any new lung tumors early. These tests include a medical history, physical exam, and chest CT scan with or without contrast. The timing of tests partly depends if radiation therapy was part of your treatment. Read Guide 17 for recommended time frames. Your doctor will decide when testing is needed within a time frame.

一般健康测试

除了随访复查,建议你持续检查你的整体健康建议。在经历了癌症的治疗之后，想要处理“不那么重要”的问题可能会很困难。然而，你的健康状况会对你的身体有很大的影响。定期检查你的血压、胆固醇和葡萄糖。有些人还需要进行骨密度测试。

Besides follow-up tests, tests of your general health are advised. After going through treatment for cancer, it may be hard to think about taking care of “less important” issues. However, your general health can have a big impact on your well-being. Have your blood pressure, cholesterol, and glucose checked on a regular basis. Some people also need bone density testing.

疾病预防

同样的，你需要采取措施防止其他疾病。这些措施包括：注射疱疹和其他疾病的疫苗。定期洗牙和定期检查可以预防疾病，进行其他肿瘤的影像学检查也很重要。

Likewise, take steps to prevent other diseases. Such steps can include getting immunization shots for the flu, herpes, and other diseases. Dental cleaning and exams on a regular basis can prevent disease, too. Screening tests for other cancers are also very important.

健康生活方式

最后一个建议是开始或保持一个健康的生活方式。有证据表明，健康的行为可以改善你的治疗效果。限制你的酒精使用，远离太阳直射，保持健康的体重是很重要的。

The last recommendation is to start or keep a healthy lifestyle. There is proof that healthy behaviors can improve your treatment results. Limiting your use of alcohol, protecting yourself from the sun, and being at a healthy weight are important.

健康饮食包括均衡饮食，吃适量的食物，喝足够的水。但是，在治疗前后，你可能需要特殊的食物。一个营养专家可以帮助你。

Healthy eating includes eating a balanced diet, eating the right amount of food, and drinking enough fluids. However, you may have special food needs during and after treatment. A nutritionist—an expert in creating a healthy diet—can help.

许多病人能从锻炼中获益。锻炼可以锻炼肌肉，降低压力，改善健康。锻炼计划是根据人们的需要进行的。和你的治疗小组讨论哪些运动对你最好。

Many patients benefit from some exercise. Exercise tones muscles, lowers stress, and improves health. Exercise programs differ between people based on their needs. Talk with your treatment team about which exercises would be best for you.

尼古丁（吸烟）是最难停止的嗜好之一。肺癌的压力可能会使戒烟变得更困难或更容易。戒烟很重要，因为吸烟可以限制癌症治疗的效果。和你的治疗团队谈谈戒烟的方法。

Being hooked on nicotine is one of the hardest addictions to stop. The stress of lung cancer may make it harder or easier to quit. Quitting is important since smoking can limit how well cancer treatment works. Talk with your treatment team about ways to quit.