“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
Part6.2 多原发癌
本节提出治疗方案针对两个或两个以上不关联的病灶。这些肿块叫做多原发肿瘤。那些已经扩散到N2或N3淋巴结的人被视为转移性疾病。阅读第7部分寻找治疗方案。
This section presents treatment options for two or more unrelated masses of cancer cells. These masses are called multiple primary tumors. Those that have spread to N2 or N3 lymph nodes are treated like metastatic disease. Read Part 7 for treatment options.
阅读本节学习N0和N1疾病的治疗方案。治疗方案按症状是否存在分组。
Read this section to learn treatment options for N0 or N1 disease. Treatment options are grouped by whether symptoms are present. Options for survivorship are on page 80.
1、无症状的肿瘤
指导18为多个无症状的肿瘤给出了治疗方案。根据肿瘤是否同时出现进行分组。
Guide 18 lists treatment options for multiple tumors not causing symptoms. Options are grouped by whether the tumors appeared at the same time or not.
2、同时出现的肿瘤
这些肿瘤出现在同一时间。其中一些肿瘤可能不会很快引起症状。他们可能是增长缓慢。其他的可能在一个不会引起严重症状的地方。如果症状没有出现，就不需要进行治疗。
These tumors appeared at the same time. Some of these tumors may not cause symptoms soon. They may be slow-growing. Others may be in a place that won’t cause severe symptoms. If symptoms won’t start soon, treatment isn’t needed at this time.
一些同时出现的肿瘤在将来可能会导致症状。在这些情况下，建议进行治疗。治疗方案取决于局部治疗是否能治愈癌症。
Some co-occurring tumors may cause symptoms in the near future. In these cases, treatment is advised. Treatment options depend on if local treatments may cure the cancer.
如果局部治疗可行，手术是NCCN专家推荐的首选。手术应该尽可能多地切除肺部。局部治疗的其他选择是放射治疗或消融。
If local treatments are options, surgery is preferred by NCCN experts. The surgery should spare as much of the lung as possible. Other options for local treatment are radiation therapy or ablation.
局部治疗可能不可行。在这些情况下，需进行化疗伴或不伴局部治疗以缓解症状。第二种选择是观察，也就是观察和等待。观察就是观察癌症状态变化的一段时期。
Local treatment may not be an option. In these cases, chemotherapy with or without local treatments for symptom relief may be received. A second option is observation, also known as watch and wait. Observation is a period of testing to watch changes in cancer status.
3、接连发生的肿瘤
这些肿瘤一个接一个的出现。如果局部治疗是可行的，NCCN专家更愿意推荐做手术。手术应该尽可能多地切除肺部。局部治疗的其他选择是放射治疗或消融。
These tumors appeared one after the other. If local treatments are options, surgery is preferred by NCCN experts. The surgery should spare as much of the lung as possible. Other options for local treatment are radiation therapy or ablation.
局部治疗可能不可行。在这些情况下，需进行化疗伴或不伴局部治疗以缓解症状。第二种选择是观察，也就是观察和等待。观察就是观察癌症状态变化的一段时期。
Local treatment may not be an option. In these cases,chemotherapy with or without local treatments for symptom relief may be given. A second option is observation, also known as watch and wait. Observation is a period of testing to watch changes in cancer status.
4、有症状的肿瘤
指南19列出有症状的多个肿瘤的治疗方法。治疗方案取决于局部治疗是否能治愈癌症。
Guide 19 lists treatment options for multiple tumors causing symptoms. Treatment options depend on if local treatments may cure the cancer.
如果局部治疗可行，手术是NCCN专家推荐的首选。手术应该尽可能多地切除肺部。局部治疗的其他选择是放射治疗或消融。
If local treatments are options, surgery is preferred by NCCN experts. The surgery should spare as much of the lung as possible. Other options for local treatment are radiation therapy or ablation.
局部治疗可能不可行。在这些情况下，需进行化疗伴或不伴局部治疗以缓解症状。第二种选择是观察，也就是观察和等待。观察就是观察癌症状态变化的一段时期。
Local treatment may not be an option. In these cases, chemotherapy with or without local treatments for symptom relief may be received. A second option is observation, also known as watch and wait. Observation is a period of testing to watch changes in cancer status.
5、生存者计划
指南20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 20 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.
6、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 20 for recommended time frames. Your doctor will decide when testing is needed within a time frame.
7、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.
8、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.
9、健康的生活方式
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.
综述
单原发肿瘤
试图治愈I期肺癌，可以选择手术或放射治疗。你可以接受更多的治疗，以治疗任何残留癌症。一旦治疗结束，开始你的生存计划。
To try to cure stage I lung cancers, surgery or radiation therapy is given. You may receive more treatment for any remaining cancer. Once treatment is done, follow a survivorship plan.
II期肿瘤没有外侵可能通过手术治愈。手术后通常会给予更多的治疗。如果手术不可行，放疗可以治疗N0疾病，而放化疗用于N1疾病。放疗后可给予更多治疗。一旦治疗结束，开始你的生存计划。
Stage II tumors without invasion may be cured with surgery. More treatment is often given after surgery. If surgery isn’t an option, radiation therapy to cure is used for N0 disease, and chemoradiation is used for N1 disease. Moretreatment may be given after radiation. Once treatment is done, follow a survivorship plan.
II期外侵肿瘤可能通过手术治愈。你可以事先接受化疗或放化疗治疗再进行更多的治疗。如果手术不可行，那么放化疗将被用来治愈癌症。一旦治疗结束，开始你的生存计划。
Stage II tumors with invasion may be cured with surgery. You may receive chemotherapy or chemoradiation beforehand and more treatment afterward. If surgery isn’t an option, chemoradiation is used to cure. Once treatment is done, follow a survivorship plan.
III期肿瘤，N0和N1疾病可能被手术或放化疗治愈。术后可给予化疗，放射治疗，或两者都给。放化疗是在治疗前发现的N2和N3疾病最常见的治疗方法。一旦治疗结束，开始你的生存计划。
For stage III tumors, N0 or N1 disease may be cured with surgery or chemoradiation. Chemotherapy, radiation therapy, or both is given after surgery. Chemoradiation is the most common treatment for N2 and N3 disease found before treatment was started. Once treatment is done, follow a survivorship plan.
多原发肿瘤
多个原发肿瘤已经扩散到N2和N3或胸部以外的区域被称为转移性疾病。请阅读第7部分。
Multiple primary tumors that have spread to N2 or N3 nodes or outside the chest area are treated the same as metastatic disease. Read Part 7.
N0和N1的多原发肿瘤治疗方案是基于癌症的一些特征。
Multiple primary tumors with N0 or N1 disease are treated based on traits of the cancer.
当癌症没有什么症状时,同时出现的多原发肿瘤不需要马上治疗。
When cancer symptoms are unlikely, multiple primary tumors that appear at the same time don’t need treatment right away.
需要治疗的包括：当前或很快出现症状。另一个需要治疗的情况是出现一个接一个的原发性肿瘤。在这种情况下，如果癌症可以治愈，局部治疗是可行的。否则，可以化疗伴或不伴局部治疗。
Signs that treatment is needed include current or soon-to-start symptoms. Another sign is primary tumors that appear one after the other. In these cases, local treatments are an option if the cancer may be cured. Otherwise, chemotherapy with or without local treatments may be received.
