Moderator: Breast cancer is the biggest killer threatening women's lives. In recent years, the incidence of breast cancer has been on the rise, right?
Zhang Baoning: At the end of 1970s, breast cancer ranked first among female malignant tumors in the world, increasing at a rate of 2% every year. It is estimated that the annual incidence of breast cancer will reach about10.4 million in 20 10. Although China is not a country with high incidence of breast cancer, it is not optimistic, and its annual growth rate is 3-4% higher than the global 1-2 percentage points. Breast cancer in big cities of China.
Moderator: What are the typical symptoms of breast cancer?
Yu Zihao: The main manifestation of breast cancer is a lump in the breast. The mass has certain characteristics, such as hard texture, unsmooth surface, unclear boundary, no obvious pain, and a few patients will have dull pain and tingling; Another feature is that the mass will continue to grow. Clinical manifestations of breast cancer: 1, mass; 2, nipple discharge; 3, breast morphological changes; 4, nipple changes; 5. Pain; 6, skin changes; 7, axillary lymph node enlargement, nipple eczema-like changes, itchy skin, running water, nipple long-term decay.
Moderator: Is there any way to find breast changes as soon as possible?
Zhang Baoning: 1, conduct a general survey; 2, for high-risk groups, such as those with a family history of breast, regular monitoring; 3. The most commonly used method of imaging examination is Muba photography of breast cancer. In the United States, women over 50 years old do it once a year, and people aged 40-49 do it once every 65,438+0-2 years, as shown in the figure: put the breast into a breast camera, and you can take axial and standing images through this instrument, so that you can know whether there are tumors or abnormal changes. Muba photography provides pictures for doctors. Another method is self-examination. Nowadays, many patients who are admitted to the hospital go to the hospital after finding breast problems.
Moderator: How to conduct self-examination?
Zhang Baoning: 1. Look in the mirror to see if there is any abnormality in the shape and skin of the breast, including nipple and areola. 2. Touch it with your hand. The method of touching is: stick your hand on your chest, the upper outer quadrant → lower outer quadrant → lower inner quadrant → armpit. In this order, you mainly use the auxiliary side of your fingers to touch whether there is any abnormality between the skin and the chest wall. This kind of examination is chosen between two menstrual periods. If the menstrual regularity can be checked on the 9th 9- 10/0 day, women with irregular menstruation or amenorrhea will choose a fixed day for check-up every month.
Moderator: 85% of breast lumps in the United States are found by themselves, and the awareness of self-examination is very strong. So what is the situation in China?
Yu Zihao: Women in China generally attach importance to self-examination. Many patients have small tumors, which were discovered by accident in bathing, changing clothes or other occasions. Through self-examination, they can still find the lesion as soon as possible.
Moderator: Is it cancer that the self-examination found a lump in the breast?
Zhang Baoning: The proportion of breast cancer in the breast is relatively small, 90% of which are benign lesions, most of which are breast adenosis and breast hyperplasia, and the other is breast fibroadenoma (benign). See a doctor as soon as possible, don't be too nervous.
Moderator: Is it abnormal that there is no lump in the breast but there will be water flow on the nipple?
Zhang Baoning: This condition is called nipple discharge. It can be divided into true nipple discharge and false nipple discharge. Nipple dysplasia can cause inflammation, and there are often secretions called pseudonipple discharge. The discharge of the mammary gland through the nipple mammary duct is called true nipple discharge. There are yellow, watery, milky and bloody nipple discharge, and the probability of bloody and serous breast cancer is high.
Moderator: What is the relationship between breast hyperplasia and breast cancer?
Yu Zihao: Breast hyperplasia is a common disease of women, which usually occurs during the period from marriage to delivery. The main clinical manifestation is breast pain, sometimes quite serious. The pain before menstruation is more obvious, and it disappears after menstruation and will appear repeatedly. Self-examination found that the breast was thickened and had the feeling of nodules. This disease is benign. According to medical literature statistics, the probability of breast cancer in female patients with benign diseases may increase in the future, but the proportion is relatively small. Patients with hyperplasia of mammary glands should be actively treated, and more importantly, they should be reviewed regularly.
Moderator: Do you need to remove the breast after discovering breast cancer?
Zhang Baoning: Breast-conserving therapy can be used for early breast cancer, and breast-conserving surgery can also be used for surgery, as shown in the figure: the beauty difference between breast-conserving surgery and radical surgery. The picture above shows breast-conserving surgery, and the picture below shows radical mastectomy (mastectomy). Breast-conserving surgery is widely carried out abroad, but it is more cautious in China. On the one hand, it is an isolated tumor with multiple centers and multiple lesions, which is not suitable for breast-conserving surgery. It is also not suitable for breast-conserving surgery, because its peripheral position is near nipple and areola, or areola. At home, the size of the tumor is limited to less than 2 cm, without axillary and distant metastasis, a lot of radiation or other diseases, including collagen.
Moderator: Where is the incision of breast-conserving surgery, and how is the operation carried out?
Zhang Baoning: Breast-conserving surgery requires not reducing the long-term survival rate, minimizing the local recurrence rate and improving the quality of life. There are two principles in the design of surgical incision: 1, which is beneficial to surgery and anatomy, and also considers aesthetics; 2, surgery should be cleaned, especially the edge of the tumor. If necessary, intraoperative freezing examination should be done, and axillary lymph nodes must be in place; 3. Radiotherapy must be performed after operation.
Moderator: After breast-conserving treatment, the breast is preserved, but will it recur after a period of time?
Yu Zihao: In order to save the breast, there is a great chance that the tumor will recur after resection. Science has proved that although it is a single lesion, there will be small lesions in other parts of the breast. Only removing the lump without other treatment is sure to recur. After tumor resection, radiotherapy must be combined with systemic chemotherapy. Only after comprehensive treatment can breast preservation be allowed.
Moderator: If breast cancer is found early, breast-conserving surgery can't be done in this case, right?
Zhang Baoning: Yes, radical surgery is needed. What we are doing now is an improved radical operation, mastectomy, preservation of pectoralis major and pectoralis minor, and dissection of axillary veins.
Moderator: Mr. Li from Anhui, 1 years ago, his wife found a lump in her breast. She had an operation 65,438+0 months ago, and it was found to be infiltrative ductitis. She was completely eliminated and the pathology did not spread. She had chemotherapy twice. What should she pay attention to in the future?
Zhang Baoning: If cancer is undergoing surgical chemotherapy and endocrine therapy can continue, there are many methods of endocrine therapy. For example, tamoxifen is used for 5 years. It is very important to follow up regularly to prevent recurrence and metastasis, 3 months 1 time in the first year, 6 months 1 time in the second year, 6- 12 months/time in the third year, and every year thereafter.
Moderator: Ms. He from Guangxi, I have left breast cancer and had a radical operation. How to recover after operation?
Yu Zihao: After breast surgery, it mainly affects the function of upper limbs. Many patients can't lift their hands and feel pain, so they should do upper limb exercise as soon as possible after operation, and they can try to return to normal level by climbing the wall. Don't eat estrogen, such as royal jelly and bee milk, and don't be obese.
Moderator: Mr. Zhang from Shijiazhuang, my wife has invasive lobular carcinoma and lymphatic metastasis. How to treat it?
Zhang Baoning: Chemotherapy or endocrine therapy may be needed.
Moderator: Ms. Gao from Beijing, I had breast cancer eradication surgery in May, 438+10 last year. The tumor was twice 1.5cm, and I received 6 times of chemotherapy. There was no lymphatic metastasis, and the receptors PR and ER were high. How should I treat it now?
Zhang Baoning: Endocrine therapy is recommended. Endocrine therapy should be given after chemotherapy.
Moderator: Ms. Cheng from Shaanxi, daughter 18 years old, with hyperplasia of mammary glands. Is it the reason that menstruation is not allowed? Menstruation is accurate, can mammary gland hyperplasia be good?
Yu Zihao: Breast hyperplasia is related to endocrine disorders. Domestic researchers have done research and found that 90% of people have endocrine disorders, and they will decide whether to treat breast hyperplasia after menstruation.
Moderator: Mr. Jin Jilin, my wife was diagnosed with simple breast cancer on the left side four months ago and had a total resection. The lymphatic part did not spread or metastasize. Now her left arm always hurts. What's the matter? What should I do?
Zhang Baoning: Lymphatic reflux is blocked after lymph node dissection, like a traffic jam, as shown in the figure. With the passage of time, the establishment of collateral circulation can be improved, but the improvement effect is not obvious. At present, the operation to anastomose the lymphatic dilatation tube with the axillary vein is not very satisfactory. There are other conservative treatments. Sleeping at night can raise the upper limbs.
Moderator: Ms. Zhang, a native of Hunan, got breast cancer two years ago. I received radiotherapy and chemotherapy after operation, and now I am recovering well. Do I still need treatment?
Yu Zihao: The longer the treatment time, the better the effect. The main task after the treatment is to review regularly.
Moderator: What factors are related to the occurrence of breast cancer?
Zhang Baoning: The risk factors of breast cancer are: menarche (/kloc-before 0/3 years old); "Menopause" is late (not yet 54 or 55 years old); Unmarried or late childbirth (childbirth after the age of 30 or 35); Do not breastfeed after giving birth; After amenorrhea, women gain weight and become obese. Family history, maternal or elder sister has breast cancer, so the incidence of such people is higher; Other lesions of the breast; When I was young, my chest was repeatedly irradiated; The causes of breast cancer caused by heavy drinking and smoking are still unclear, and breast cancer is closely related to endocrine hormones. Endocrine hormones are related to nutrition. For example, children eat a lot of fat and protein, and their menstruation comes too early, so parents should adjust their children's diet reasonably, adolescent girls should also pay attention to it, besides, they should do exercise, and women after amenorrhea should also control their weight, eat more fruits and vegetables, strengthen exercise and advocate breastfeeding.
Moderator: Mr. Liu from Ningxia My wife got breast cancer and had an operation, but why did the doctor give her radiotherapy? What are the side effects?
Yu Zihao: Comprehensive treatment should be done after operation, and radiotherapy is part of it. Radiation therapy can reduce the chance of recurrence. Not all patients do this. Radiotherapy is needed for breast masses (more than 5 cm) and postoperative lymph node metastasis (more than 4). After radiotherapy, the skin color changes, drying and peeling, but it will recover after a while.
Moderator: Ms. Ji, a native of Zhejiang, has been doing radical mastectomy for 3 and a half years. Now I have been taking tamoxifen. Does this medicine have any side effects?
Zhang Baoning: There are side effects. The biggest possibility is to induce endometrial cancer, but the incidence is very low. It is recommended to go to the hospital regularly to check the endometrial thickness.
Moderator: Ms. Wang from Shenyang, after examination by the hospital, I have developed into stage 4 breast cancer. There are lumps in the right armpit and neck. The hospital said that surgery was not allowed and only chemotherapy was allowed. Is there a better treatment? Can you have another operation after chemotherapy?
Yu Zihao: To do comprehensive treatment, do chemotherapy first. After chemotherapy reached a certain stage, the tumor regression was observed. If you can operate, you still have to remove it. Postoperative radiotherapy and systemic chemotherapy are needed.
Moderator: Ms. Yue from Beijing, I have had breast cancer surgery 1 for many years. Now there are lymph nodes in the groin and left neck. Is there a transfer? What should I do?
Zhang Baoning: It is recommended to do further examination, cytology or puncture examination, and timely treatment after diagnosis.
Moderator: Ms. Jia from Beijing, what is invasive breast cancer? If it is early, can you not need radiotherapy?
Yu Zihao: Invasive breast cancer, commonly known as malignant tumor, will spread around. Early detection and operation should be based on the specific situation to decide whether to do radiotherapy or chemotherapy.
Moderator: Ms. Yang from Tianjin, I found a lump on my breast. In order to diagnose whether it is malignant, I went to many hospitals. Some doctors advised me to have a biopsy, while others thought I should try not to do it. Should I do it?
Zhang Baoning: Biopsy is recommended to avoid misdiagnosis and mistreatment. Needle aspiration biopsy is not so painful. If the hospital does not have the conditions, it is best to operate within 2 weeks after diagnosis. Too long time will affect the postoperative cure.
Moderator: Can Ms. Li, a breast cancer patient in Hebei, have children and breastfeed?
Yu Zihao: According to foreign literature, breast cancer patients were observed for 2 years after being cured. Two years later, nothing happened and they could have children. It is up to the patient to decide, and fertility is generally not advocated.
Moderator: Mr. Zhang, a native of Heilongjiang, my wife 1998 had a second-stage radical mastectomy, and both radiotherapy and chemotherapy were done. He has been taking tamoxifen for 4 years after operation. How many more years does she have to endure?
Zhang Baoning: It is better to eat for five years than for two years. Another international study is the comparison between five years and 10 years. So far, eating for five years is better than eating for two or three years.
Moderator: Ms. Ao, Jiangxi, whose daughter is 20 years old. Last year, she found that one side of her breast was enlarged and examined the thumb-sized lump. The doctor said that she couldn't operate until her breasts changed. Will it delay her illness?
Yu Zihao: It is recommended to go to the hospital for examination, such as mammography and super-birth.
References:
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Breast cancer is a malignant tumor caused by mammary duct epithelium, which is a common malignant tumor in women. In many western countries, the incidence of breast cancer ranks first among women. In China, breast cancer accounts for the top two malignant tumors of women. According to relevant data, the incidence rate is 23/65438+ 10,000 for females and only 0.49/65438+ 10,000 for males. Male breast cancer accounts for about 1% of the total breast cancer. Breast cancer mostly occurs in women aged 40-60, or around menopause, especially in women aged 45-49 and 60-64.
What is the cause of breast cancer?
According to the current clinical medical practice and animal experiments, the occurrence of breast cancer is related to the following factors:
(1) Hormone secretion disorder: The so-called hormone secretion disorder mainly refers to estrogen secretion disorder. Because women with high incidence of breast cancer are 40 to 60 years old. This age is a period of imbalance in female estrogen secretion and high estrogen level. Due to the increase of estrogen secretion in the body, this can cause excessive proliferation of mammary duct epithelial cells, leading to cancer.
(2) Fertility and breastfeeding: In recent years, a large number of surveys have proved that women who have no children or have children but seldom breastfeed are more likely to develop breast cancer than women who have breastfed many times and breast-fed for a long time. This shows that having more children and breastfeeding may increase the risk of breast cancer.
(3) Fibrocystic Mammary Disease: As mentioned above, it is a precancerous lesion that can easily turn into breast cancer.
(4) Genetic factors: mainly manifested in the family history of breast cancer. According to foreign data, positive family history can be manifested in two forms: one is that the mother suffers from breast cancer, and the daughter is also prone to breast cancer, which mostly occurs before amenorrhea, often on both sides; The other is that the mother has never had breast cancer, but at least two sisters in a family have breast cancer. The incidence of breast cancer in this family is 2 ~ 3 times higher than that in families without family history, and this kind of breast cancer mostly occurs after amenorrhea, often unilateral.
What is early breast cancer?
There are two classification criteria for early breast cancer: one is lobular carcinoma in situ and ductal carcinoma in situ (1); (2) Small invasive carcinoma (subclinical carcinoma) with a diameter less than 5 mm; (3) Microcarcinoma with diameter less than 65438±0cm, large local activity and no axillary lymph node enlargement was classified as early breast cancer. However, Tianjin People's Hospital proposed (1) that axillary lymph nodes are cancer-free. (2) Primary cancer is not special as long as its diameter does not exceed1cm; Or primary cancer is a special type, as long as its diameter does not exceed 3 cm, it is classified as early cancer.
What are the early clinical manifestations of breast cancer?
(1) Breast lump: The main manifestation of breast cancer is a lump on the breast, which is often an early symptom of breast cancer. Most patients don't feel pain, only less than 1/3 patients feel a little tingling or dull pain, but it is not obvious. About 60% of the tumor grows in the upper part of the breast, and its shape is round and irregular. There was no infiltration of early cancer tissue. The mass can still move. However, because the lump of breast cancer is very similar to benign breast tumor in many aspects, it is not exact to determine its nature only by touching the lump, so we must go to the hospital for examination.
(2) Unilateral nipple discharge: Non-lactating women suddenly have nipple discharge (milk sample, blood sample, watery liquid), which should be paid attention to, because some of them are breast cancer.
How to check your own breasts?
Self-examination method: (1) Take off your coat, let your arms droop naturally, and observe whether the nipples are symmetrical in front of the mirror. (2) Put your head on your arm, and then observe whether the breast is symmetrical and whether there are lumps or pits; (3) Lie on your back, put a flat pillow under your shoulders, straighten your fingers, and touch all areas of the breast horizontally (don't pinch the breast with your hands, because normal breast tissue will be mistaken for a lump at this time); (4) After examining each area of the breast in sequence, put your hand into the top of the armpit (the arm will droop at this time), and also check whether there are swollen lymph nodes under the armpit with straight fingers; (5) Check the areola area (press with your fingers) to see if there is any liquid flowing from the nipple.
What is the preventive method of breast cancer?
(1) Once you find yourself with fibrocystic mastopathy, you should treat it immediately, and don't delay the treatment.
(2) For lactating women, milk should be discharged as much as possible every time they breastfeed, so that on the one hand, milk secretion can be increased, and on the other hand, the retention time of the last lactation can be reduced.
(3) Reduce drinking and abstain from alcohol. Studies in some western countries have proved that women who have drinking habits are more likely to develop breast cancer than women who don't drink.
(4) Women with a family history of breast cancer should not only insist on self-examination, but also go to the hospital regularly for a more comprehensive examination.