Problem description:
Slice: a fatty tissue, 4cm*3.5cm* 1cm,
A scleroma is seen on the section, and the mass with a diameter of 1cm is not obvious.
Pathological diagnosis:
Invasive ductal carcinoma grade 2
Immunopathology: Cancer cells were er positive (60%,++), PR positive (20%,+) and CERBB-2 positive (+).
Do you need chemotherapy?
Analysis:
According to the report:
1. Invasive ductal carcinoma was diagnosed as grade 2.
It shows that the diameter of cancer is between 1 cm and 2 cm.
2.ER positive (60%,++), PR positive (20%,+), CERBB-2 positive (+).
It shows that estrogen receptor is positive and endocrine therapy can be carried out.
Generally speaking, you need to check further: 1. Is there lymph node metastasis?
2. Is there any distant transfer?
3. Breast-conserving surgery or radical surgery is needed.
But breast cancer is a kind of cancer with high survival rate. Don't worry too much. Let me send you some relevant information.
* * * Cancer
* * * Cancer is one of the common malignant tumors of women, and its incidence accounts for 7 ~ 1O% of all kinds of malignant tumors in China, second only to cervical cancer. The onset age is mostly 40 ~ 60 years old. The incidence of male cancer is extremely low.
Early cancer patients do not feel any discomfort, but there is a relatively small lump in * * *, which is painless, painless and unchanged. Most of them were found by doctors during physical examination, and a few of them were inadvertently touched by patients themselves and then diagnosed by doctors. Therefore, in order to find * * * cancer early, especially middle-aged women, we should always check whether there is a lump in * * *. The correct method of examination is to touch your fingers together, not to scratch them, so as not to mistake normal breast tissue for a lump. If you find a suspicious lump in * * * *, you must see a doctor and do necessary examinations, including molybdenum target X-ray and biopsy, before you can make a definite diagnosis.
Advanced tumors are more than 5 cm in diameter and even fester. Not only axillary lymph nodes are enlarged, but also supraclavicular lymph nodes, parasternal lymph nodes and contralateral lymph nodes can be enlarged. Cancer cells can also metastasize to the lungs, bones or liver through blood. * * * Cancer develops particularly rapidly during pregnancy, and cancer is inflammatory. * * * is redness, swelling, congestion and fever, like acute mastitis, which is easy to be misdiagnosed. It also shows that the incidence of cancer is related to the changes of sex hormones. As for the relationship between the incidence of cancer and fertility and breastfeeding, there are still differences. * * * cancer accounts for the largest proportion in * * * tumors, and * * * benign tumors may also become malignant. Therefore, we should be vigilant and carefully examine female tumors to prevent misdiagnosis and missed diagnosis. Cancer should be differentiated from lobular hyperplasia and fibroadenoma.
There are many methods to treat * * * cancer, including surgery, radiotherapy, hormones, anticancer chemotherapy, Chinese herbal medicine, etc. But at present, the most satisfactory and reliable method is still early surgery, and other methods can only be used as auxiliary measures or when * * * cancer is inoperable in its advanced stage. During the operation, the tumor can be locally removed first, and the frozen section examination can be done immediately, and the radical operation can only be performed after the cancer is confirmed.
At present, western medicine is the first choice for the treatment of civil surgical resection, combined with radiotherapy, chemotherapy, endocrine therapy and immunotherapy. The specific treatment method is selected according to the different stages of the disease.
Generally speaking, radical mastectomy is feasible for clinical stage ⅰ and ⅱ breast cancer; Patients with stage ⅱ need adjuvant therapy (chemotherapy, radiotherapy or hormone therapy) after operation; Stage ⅲ cases also achieved good results through preoperative radiotherapy and chemotherapy preparation and root irrigation treatment; Stage ⅳ patients, because of distant metastasis, most of the general treatment is useless and can only be treated with radiotherapy, chemotherapy or hormone therapy. In recent years, due to the study of hormone receptor (er) in breast cancer, ER-positive patients received anti-estrogen therapy and achieved remarkable results.
(1) surgical treatment
Surgical treatment is still one of the main treatments for breast cancer. There are many kinds of surgical methods, and there is no unified opinion on their choice. In the past 10 years, the scope of surgical treatment for stage I and II breast cancer has been significantly reduced, and the classic universal treatment for breast cancer in halsted has been rarely used for the treatment of stage I and II breast cancer. Many foreign studies have confirmed that compared with radical resection, the tumor-free survival rate and recurrence-free survival rate of double-sided three-knife group have no statistical difference with the total harvest rate. Therefore, retaining students for * * * treatment has become the main treatment method for stage I and II breast cancer in western countries. Due to the limitation of patients' acceptance ability and equipment technical conditions (such as radiotherapy equipment), the treatment scheme of retaining * * * cannot be widely promoted in China.
1. Indications for surgical treatment.
Breast cancer patients received stage I, II and III treatment for the first time, which was in line with international clinical staging.
2. Contraindications for surgical treatment
(1) Distant metastasis of tumor.
(2) The elderly are too weak to bear major surgery.
(3) those with cachexia.
(4) dysfunction of important organs.
(5) One of the following conditions occurs in patients with stage III:
(1) * * * The orange peel edema of the skin is more than half of the area of * * *.
② Satellite nodules appeared on the skin of * * *.
③ Breast cancer invaded the chest wall.
④ Clinically, paraosseous lymphadenopathy was found, which was confirmed as metastasis.
⑤ Edema of the affected upper limb.
⑥ Supraclavicular lymphadenopathy was diagnosed as metastatic cancer.
6. Inflammatory breast cancer.
(six) in any of the following circumstances
(1) Tumor ulceration.
(2) The * * * epidermal edema accounts for more than 1/3 of the total * * area.
③ Tumor and pectoralis major muscle fixation.
④ The maximum diameter of axillary lymph nodes is larger than 2.5㎝.
⑤ Axillary spray butters up or adheres to deep skin tissue.
(2) Adjuvant treatment of breast cancer surgery
1. Adjuvant chemotherapy for hematogenous metastasis of breast cancer is the main cause of treatment failure. Systemic chemotherapy can control blood metastasis, which is undoubtedly a reasonable measure to improve the long-term curative effect of breast cancer. In addition, the metastasis of blood imprisonment of breast cancer can occur at an early stage. It is inferred that about 50% ~ 60% of breast cancer has undergone blood metastasis at the time of clinical diagnosis, and it is hidden in the body as a tiny cancer focus. Therefore, breast cancer should be regarded as a systemic disease, and systemic treatment such as systemic chemotherapy should be strengthened.
(1) indications: mainly premenopausal patients with positive lymph nodes. Chemotherapy is generally not recommended for patients with negative axillary lymph nodes, but for those patients with poor prognosis, such as hormone receptor negative, poor differentiation, large tumor volume (>: 2㎝) and aneuploid DNA tumors, the recurrence rate is usually high, so systemic adjuvant chemotherapy should be given.
(2) Commonly used chemotherapy schemes: There are many adjuvant chemotherapy schemes, and it is still uncertain which one is the most effective. The following three postoperative adjuvant chemotherapy schemes are recommended in China:
① CMF scheme
Cyclophosphamide 600 ㎎/m2, intravenous injection;
Methotrexate 30 ~ 40 ㎎/㎡, intravenous injection;
Fluorouracil 600㎎/㎡, intravenous injection;
All the above three drugs can be used on 1 day, once every three weeks, or on 1 day and 8/time, once every four weeks.
② CAF scheme
Cyclophosphamide 40㎎/㎡, intravenous injection, the first 1 day;
Adriamycin 50㎎/㎡, intravenous injection, 1 day;
Fluorouracil 500㎎/㎡, after intravenous injection 1 day;
The above three drugs were repeated every 3 weeks 1 time and rested 1 month.
③ CF scheme
Cyclophosphamide 50㎎/㎡, oral, the first 1 day;
Fluoropyrimidine 50㎎/㎡, intravenous injection, day 1, day 3 and day 5.
The above two drugs are repeated every 3 weeks, used twice each time, with a rest 1 month.
Adjuvant chemotherapy in addition to the above, most drugs are used after surgery, and adjuvant chemotherapy is used along the perioperative period to reduce postoperative recurrence and metastasis, that is, chemotherapy is given immediately after breast cancer is diagnosed before surgery, usually 3 weeks before surgery,/kloc-0 times during surgery and 4 weeks after surgery, which is called neoadjuvant chemotherapy. After research, the therapeutic effect of breast cancer can be further improved (about 20%). Continuous arterial infusion chemotherapy in our hospital can shorten the course of treatment by 2/3 because of the high concentration of drugs and plants in contact with tumors. CMF or CAF regimen is still commonly used in preoperative chemotherapy. Continuous arterial infusion of single drug in our hospital can also achieve the effect of multi-drug combination, and the side effects are very slight, which is worthy of wide clinical application.
2. Postoperative adjuvant radiotherapy can reduce local recurrence and is one of the local treatment methods. The principles and doses of postoperative radiotherapy are as follows:
(1) Conventional radiotherapy should be performed after breast cancer resection, and ultra-high energy rays are generally used for whole breast tangential irradiation. For patients with local extensive resection, the total radiation dose is 45 ~ 50 Gy/5 weeks; After local resection of the primary cancer, after completing the above dose, electronic red 10 Gy was added to the primary cancer area. If total axillary lymph node dissection has been done, postoperative axillary radiotherapy will not be done.
(2) After radical mastectomy or modified radical mastectomy for stage I and II breast cancer, if the primary focus is in the upper quadrant outside the breast and axillary lymph node metastasis is negative, no radiotherapy will be given after operation; When axillary lymph nodes are positive, the internal mammary region and
Upper and lower regions of the acicular bone; The main lesion is located in the central area or inner quadrant of the breast. When axillary lymph nodes are negative, only the inner area of breast is irradiated after operation, and when axillary spray is positive, the upper and lower areas of acicular bone are irradiated.
(3) After radical mastectomy for stage Ⅲ breast cancer, the internal mammary region, supraclavicular region and subclavian region were irradiated regardless of whether axillary lymph nodes were positive or negative. According to the positive number of axillary lymph nodes, chest wall irradiation can be considered or not.
(4) After radical mastectomy, axillary lymph nodes have been cleared, and the axillary area is generally not irradiated. Only when the operative space is incomplete or there are residual lesions will additional axillary radiotherapy be considered.
(5) Radiotherapy should be started within 4 ~ 6 weeks after operation, and skin grafting can be postponed appropriately according to the specific situation.
(6) 7 * * radiotherapy can be performed by using a 60 CO or 8MV linear accelerator, and the irradiation dose of the midline tumor is 2 Gy/ day, five times a week, with a total of 50 Gy/5 weeks, and then 6 ~ 10 MeV electron beam is used to reduce the field vertical irradiation of the local swelling area.
(7) The internal mammary region can be irradiated with mixed rays, the tumor dose is 50 Gy/5 weeks, the dose of 60CO is equal to that of electron beam, and the depth is calculated as 3㎝.
(8) The upper and lower clavicle areas were irradiated with the irradiation dose of 50 Gy/5 weeks. First, half irradiation was performed with 60CO and 10 ~ 12mV electron beams. The irradiation depth was calculated according to the thickness of the precursor layer and the back layer of 1/3, and the irradiation dose was 2Gy days, five times a week.
3. Adjuvant endocrine therapy Adjuvant endocrine therapy has been used to treat primary breast cancer with minimal metastasis. The role of ovariectomy in the treatment of breast cancer in premenopausal women is still unclear. In recent years, studies in the next few years tend to use tamoxifen (TAM) after surgical treatment with a dose of 65,438+00 ~ 20 ㎎/time twice a day for 65,438+0 ~ 2 years or as long as 3 ~ 5 years. If it fails, second-line antiestrogen drugs should be replaced. This treatment can delay the recurrence time of tumor and improve the survival rate. The curative effect of TAM is related to the contents of estrogen receptor and flavone receptor in tumor. The drug can improve the survival rate of patients with hormone receptor positive by 20%, but the effect on patients with hormone receptor negative is uncertain.
The general strategy of adjuvant therapy is that patients with poor prognosis should be given adjuvant chemotherapy regardless of whether their hormone receptors are positive or negative. Contrary to chemotherapy, the main recipients of endocrine therapy are postmenopausal patients.