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 tumors grow in the outer upper part of the breast, and their shapes are 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.
Hello, audience friends! This is CCTV's live program "The Road to Health". Today we are going to talk about the early treatment, diagnosis and treatment of breast cancer.
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 breast cancer Muba photography, which is done once a year for women over 50 years old in the United States and once every 65,438+0-2 years for people aged 40-49, as shown in the figure: the breast is clamped into a breast camera, through which axial and standing images can be taken, so as to 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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1. What are breast hyperplasia and breast cancer?
Mammary hyperplasia is a benign disease that occurs in the breast, which is characterized by cord-like, patchy or cystic nodules in the breast. Hyperplastic nodules of breast are generally soft or moderate in texture, accompanied by tenderness, good in fluidity, clear in boundary, often changing with menstrual cycle or mood, and their tumor size does not increase in a short time.
Breast cancer is a malignant tumor that occurs in the breast. It is characterized by lumps in the breast, no tenderness, unclear boundary, no activity, obvious enlargement in a short time, or axillary or supraclavicular lymph node enlargement, or nipple invagination, and orange peel-like changes in breast skin.
Breast hyperplasia and breast cancer are two common diseases of female breast. Their clinical manifestations are all breast masses, but their nature is fundamentally different and their treatment methods are different. Therefore, when finding a lump in the breast, you should go to the hospital in time to do the corresponding examination, make a clear diagnosis and treat it in time. ?
2. What is the difference between breast hyperplasia and breast cancer in onset age?
Breast hyperplasia mostly occurs in women aged 30 ~ 50, and the incidence rate of women over 30 years old accounts for 30% ~ 50% in China, and it is rare in adolescent and postmenopausal women. The incidence rate of urban women is higher than that of rural women.
The incidence of breast cancer increases with age, and it is rare before menarche and before the age of 20. However, after the age of 20, the incidence of breast cancer rises rapidly, and it is relatively flat at the age of 45-50, and the incidence of postmenopausal women continues to rise, reaching a peak around the age of 70. ?
3. How to distinguish breast hyperplasia from breast cancer?
The incidence of breast hyperplasia is high, so breast cancer is often misdiagnosed as breast hyperplasia and delayed treatment. Breast cancer mostly occurs in women after the age of 20, with an increasing trend year by year. Most of them are painless masses in the outer upper quadrant of the breast, which can be single or 2-3, with different sizes. Generally, the mass size is not affected by menstrual cycle, and the mass has irregular shape, uneven surface, nodular feeling, unclear boundary, poor fluidity, hard texture and sandy hardness. However, some breast cancer patients have smooth surface, no nodule, clear boundary, good mobility and no adhesion with surrounding tissues, so it is necessary to dynamically observe the changes of tumor size. Because of the rapid proliferation of cancer cells, breast cancer patients often have enlarged masses in a short time, while breast hyperplasia does not have this feature. Its main symptom is breast swelling and pain, and breast nodule tenderness is obvious, which is closely related to menstrual cycle.
In addition, the nipple of breast cancer patients may be desquamated and eroded, or the nipple may be retracted and fixed due to tumor infiltration and traction. The skin on the surface of breast mass can also show orange peel-like changes. The further development of breast cancer can occur local infiltration, axillary and clavicular lymph node metastasis, and even distant metastasis of lung, bone, liver, adrenal gland and brain.
X-ray examination, B-ultrasound examination, near infrared scanning and other auxiliary examinations are more helpful for the differential diagnosis of the two. Fine needle aspiration biopsy or tumor resection biopsy should be performed in time for early diagnosis and treatment of suspected breast cancer. ?
4. What is breast fibroma?
Breast fibroma is also one of the common diseases of breast, which is more common in women around the age of 20, mostly painless masses. It can be single or multiple, involving one or both breasts. Masses can occur anywhere in the breast, but they are more common in the outer upper quadrant. The mass size is 1 ~ 2 cm, generally less than 3cm. The mass is round or oval with clear boundary, smooth surface, tough texture, good fluidity and no tenderness. X-ray examination can show that the mass density is increased, which is round or oval, lobulated, smooth and complete. B-ultrasound showed a round or oval solid hypoechoic area behind the tumor, with uniform weak points inside, clear boundaries and enhanced echo. Cytological examination showed that the cells in the cell cluster were evenly arranged and varied in size, and bipolar null cell often existed in the cell cluster. ?
5. What is the relationship between breast hyperplasia and breast cancer and endocrine function?
The causes of mammary gland hyperplasia are complicated, mostly related to the imbalance of estrogen and progesterone secretion in the body. Under normal circumstances, estrogen promotes the growth of mammary duct and perimammary fibrous tissue, while progesterone promotes the development of mammary lobules and vesicles. In the menstrual cycle, if estrogen secretion is too much and progesterone secretion is too little, it will easily lead to imbalance between the two, leading to excessive proliferation and incomplete recovery of breast tissue, increased breast tissue and disordered tissue structure. In addition, long-term bad mental stimulation and emotional discomfort can also lead to breast hyperplasia; After a breast cancer operation, compensatory hyperplasia may occur in the contralateral breast.
Breast tissue is the target organ of many hormones, and many epidemiological characteristics of breast cancer are also related to endocrine function.
Estrogen is the basic factor of mammary gland development and one of the prerequisites of canceration. Estrogens produced by ovaries are estradiol, estrone and estriol. Experiments have proved that the first two are strong estrogens and have strong carcinogenic effects. Estriol has little effect and has no possibility of causing cancer. On the contrary, it can resist the carcinogenic effects of the other two hormones. Therefore, it is considered that the abnormal increase of estradiol and estrone and the lack of estrone are one of the causes of breast cancer. To detect the content of estrogen in urine of women in high and low incidence areas of breast cancer. It was found that the urine estriol of women in low-incidence areas was higher than that in high-incidence areas, especially young people. Epidemiological observation shows that there is almost no breast cancer before puberty. In addition, women who have undergone ovarian resection before the age of 40 are less likely to develop breast cancer. On the contrary, the younger the age of menarche and the later the menopause, the higher the incidence of breast cancer. According to reports, the risk of menarche before 13 years old is 2? The risk of postmenopausal women over 55 years old is higher than that of women under 45 years old 1 times, and that of postmenopausal women over 40 years old is higher than that of postmenopausal women under 30 years old 1 times. In clinical treatment, ovariectomy can alleviate the condition of some breast cancer patients. Androgens such as testosterone can also be used to treat advanced breast cancer. The above shows that ovarian endocrine function is closely related to the occurrence and development of breast cancer.
Another study shows that the occurrence of breast cancer may be related to the low level of progesterone. The physiological function of progesterone is to stimulate mammary gland growth, inhibit pituitary gonadotropin and resist estrogen and androgen. According to the survey, 66% of married women with breast cancer have a history of primary or secondary infertility, which shows that patients have less ovulation history before and after illness, and the production of progesterone is reduced because of stopping ovulation.
Breastfeeding can reduce the risk of breast cancer. After the first delivery, the risk of breast cancer in nursing elderly people is reduced. The total breastfeeding time is negatively correlated with the risk of breast cancer. This may be related to the delay of postpartum ovulation and menstrual reconstruction and the perfect development of breast tissue by breastfeeding.
Thyroxine is closely related to the occurrence of breast cancer. It is generally believed that women with hypothyroidism have a higher incidence of breast cancer, while patients with hyperthyroidism rarely suffer from breast cancer, which may be due to the increase of thyrotropin, thus promoting the secretion of prolactin. ?
6. What are invasive breast cancer and non-invasive breast cancer?
Invasive cancer and non-invasive cancer are histological classification methods of breast cancer, which are determined according to their histological characteristics.
Non-invasive breast cancer, also known as carcinoma in situ, refers to tumors whose cancer cells are confined to the basement membrane of mammary duct, including lobular carcinoma in situ and intraductal carcinoma. This kind of breast cancer has a good prognosis after radical operation, but radiotherapy or chemotherapy is not allowed.
Invasive breast cancer refers to the extensive infiltration of cancer tissue into the stroma, forming a mixed image of cancer tissue and stroma with various structures. In China, invasive cancers with special tissue structure are classified as special types of cancers, such as papillary carcinoma, medullary carcinoma with massive lymphocyte infiltration, tubular carcinoma, adenoid cystic carcinoma, mucinous adenocarcinoma, sweat adenocarcinoma, squamous cell carcinoma and paget's disease. Other invasive cancers, except special cancers, are all invasive non-special cancers, including invasive lobular carcinoma, invasive ductal carcinoma, simple carcinoma, hard carcinoma, medullary carcinoma and adenocarcinoma.
Generally speaking, non-invasive breast cancer has the best prognosis, with a 5-year survival rate of over 90% and a 10-year survival rate of over 80%. The prognosis of invasive special cancer is moderate, with a 5-year survival rate of about 70% and a 10 survival rate of about 60%. The prognosis of invasive nonspecific cancer is relatively poor, with a 5-year survival rate of about 60% and a 10-year survival rate of about 40%. ?
7. Which parts of breast cancer are easy to metastasize?
Breast cancer, like other tumors, often spreads to other parts through lymphatic channels or blood channels.
(1) Lymphatic metastasis: axillary lymph nodes and internal mammary lymph nodes are breast cancer metastasis 1 station. The axillary lymph node metastasis rate of breast cancer patients is very high. It is reported that 50% ~ 70% of breast cancer patients have axillary lymph node metastasis when they see a doctor. Axillary lymph node metastasis is related to the size of primary tumor. The larger the tumor volume, the higher the axillary lymph node metastasis rate and the more metastatic foci.
The metastasis rate of internal mammary lymph nodes is related to the lesion site and disease stage. It is reported that the metastasis rate of internal mammary lymph nodes in breast cancer with lateral lesions is 12? 9%, center transfer rate 22%, 2 1? 9%。 Patients with axillary lymph node metastasis also have an increased rate of internal mammary lymph node metastasis.
Supraclavicular lymph node is the second stop of breast lymphatic drainage, and its metastatic focus is mainly axillary lymph node or intramammary lymph node, mostly ipsilateral, and can also be transferred to contralateral supraclavicular lymph node.
Tumor cells can also be transferred to the contralateral axillary or inguinal lymph nodes by retrograde route.
(2) Hematogenous metastasis: Breast cancer cells can directly invade blood vessels and cause distant metastasis. The incidence of distant metastasis is related to the size of primary tumor, the number of lymph node metastasis and pathological grade.
The most common distant metastasis is lung, followed by bone, pleura, liver, brain and adrenal gland.
Although breast cancer is prone to lymphatic metastasis and hematogenous metastasis, it can be effectively controlled as long as effective preventive measures are taken. ?
8. What is the staging of breast cancer?
The staging of breast cancer is a kind of judgment and estimation according to the size of the lesion, lymph node metastasis and distant metastasis of the patient, so as to determine the corresponding treatment plan and estimate the prognosis.
There are two commonly used clinical staging methods: one is TNM international staging method, where T refers to the size of the primary tumor, and the order from small to large is T 1, T2, T3 and T4; N refers to local lymph node metastasis, which can be divided into N0 ~ N3；; M refers to distant metastasis, M0 refers to no distant metastasis, and M 1 refers to distant metastasis. The second is the clinical staging method, which is divided into four stages, namely stage I, stage II, stage III and stage IV. Stage ⅰ and ⅱ belong to the early stage, and stage ⅲ and ⅳ belong to the middle and late stage. Their treatment principles and prognosis are different. ? What are estrogen receptors and progesterone receptors, and what are their clinical significance?
Estrogen receptor (ER) is a protein that can bind estrogen, and progesterone receptor is a protein that can bind progesterone (PR).
The content of ER in normal breast tissue is less, and about 7% of breast cells contain ER. ER is closed in the first half of menstrual cycle. When breast cells become cancerous, some cells containing ER still retain ER after a large number of proliferation, which depends on the regulation of estrogen level and belongs to estrogen-dependent cells. Some breast cells containing er lose ER after malignant transformation, and breast cancer cells formed after malignant transformation of breast cells without ER are hormone-independent cells, which are not regulated by estrogen levels. When measuring er, if there are fewer hormone-dependent cells in breast cancer tissue, < 10%, ER is negative. If there are more hormone-dependent cells > 60% in breast cancer tissue, er is positive. About 70% of patients with primary breast cancer are er-positive, and the ER-positive rate is positively correlated with their age. The positive rate of estrogen receptor in postmenopausal patients was significantly higher than that in premenopausal patients. The positive rate of estrogen receptor is higher in patients with well-differentiated tumors, but lower in patients with tumor lymphocyte infiltration.
The positive rate of progesterone receptor (PR) is lower than er, which is about 40% ~ 50% clinically.
The determination of hormone receptors plays an important role in the treatment decision of breast cancer. Clinicians often regard it as an important reference factor when making breast cancer treatment plans. Therefore, in conditional hospitals, hormone receptors should be determined when breast tumor samples are taken. Its clinical significance is mainly:
① After endocrine therapy, the effective rate of estrogen receptor positive breast cancer patients can reach 50% ~ 60%, while the effective rate of estrogen receptor negative breast cancer patients is very low, only about 10%. If er and PR are positive at the same time, the curative effect of endocrine therapy is higher, which is reported to be 70% ~ 80%.
② The proportion of breast cancer cells in patients with positive receptors.