Breast cancer is one of the most common malignant tumors in women, with an incidence rate of 7-10% of all malignant tumors in the body, according to statistics. Its incidence is often associated with heredity, as well as a higher incidence in women between the ages of 40-60, around the time of menopause. Only about 1-2% of breast patients are male. It is a malignant tumor that usually occurs in the glandular epithelial tissue of the breast. It is one of the most common malignant tumors that seriously affects women’s physical and mental health and even endangers their lives, and male breast cancer is rare.
Symptoms
The main symptoms are breast lumps, breast pain, nipple overflow, nipple changes, skin changes, and enlarged axillary lymph nodes. As long as women can have a strong awareness of cancer prevention, comprehensively understand and master these knowledge, and carefully do self-examination and regular medical checkups, with the improvement of medical care, it is believed that cancer is never an incurable disease.
Breast lumps
Breast lump is the most common symptom of breast cancer, and about 90% of the patients come to the clinic with this symptom. With the popularization of tumor knowledge and cancer screening, this percentage may increase.
Breast cancer lumps can be single or multiple, mostly hard, non-tender, with unsmooth surface, unclear border and poor mobility.
Some of them only show localized glandular thickening and no obvious lump with no clear border, and most of them are diagnosed as “breast enlargement”. However, a closer examination of the thickened area with a little skin adhesions should be noted and a mammogram should be performed.
Breast pain
Although breast pain can be seen in many breast diseases, pain is not a common symptom of breast tumor, regardless of benign or malignant breast tumors. When the tumor is accompanied by inflammation, there may be painful swelling or pressure. In advanced stage, if the tumor invades the nerve or the axillary lymph nodes are enlarged and compress or invade the brachial plexus nerve, the shoulder may be swollen and painful.
Nipple overflow
There are physiological and pathological nipple discharge. Physiologic nipple discharge is mainly seen in women during pregnancy and lactation. Pathological nipple discharge refers to the secretion of fluid from the ducts of the breast in a non-physiological state. Nipple overflow can be caused by a variety of breast diseases and is more easily noticed by patients. It is one of the main reasons why about 10% of patients come to the clinic and is second only to breast lumps and breast pain in the incidence of various breast disease symptoms. Among the symptoms of various breast diseases, it is second only to breast lumps and breast pain. 5-10% of breast cancer patients have nipple discharge, which is mostly bloody.
Nipple changes
If breast cancer patients have abnormal nipple changes, they usually present as nipple erosion or nipple retraction.
(1) Nipple erosion: there is a typical manifestation of breast Paget’s disease, often accompanied by itching, and about 2/3 of patients may have lumps in the areola or other parts of the breast.
(2) Nipple retraction: When the tumor invades the nipple or the subareolar area, the fibrous tissue and duct system of the breast may shorten as a result, pulling the nipple, causing it to be depressed, deflected, or even completely retracted into the posterior part of the areola.
Skin changes
Skin changes caused by breast tumors are related to the location, depth and degree of invasion of the tumor, and usually have the following manifestations.
(1) Skin adhesions: When tumor invades these ligaments, it can shrink and shorten them, pulling the skin to form depressions, like dimples, so it is called “dimple syndrome”. If you have this symptom, you should be alert to the possibility of breast cancer, but benign tumors rarely have this symptom.
(2) Skin edema: Because the subcutaneous lymphatic ducts of breast are blocked by tumor cells or the central area of breast is infiltrated by tumor cells, the reflux of lymphatic ducts is obstructed and lymphatic fluid accumulates in the lymphatic ducts, the skin becomes thicker and the opening of hair follicle is enlarged and deepened, showing “orange peel-like changes” (medically called “orange peel”). This is known as “orange peel”.)
In addition, advanced breast cancer can also directly invade the skin and cause ulcers, and if combined with bacterial infection, the smell is unpleasant. If the cancer cells infiltrate into the skin and grow, they may form scattered hard nodules in the skin around the main lesion, known as “skin satellite nodules”.
Lymph node enlargement in the axilla
Breast cancer can gradually develop and invade the lymphatic vessels and metastasize to their local lymphatic drainage areas. The most common site of lymphatic metastasis is the ipsilateral axillary lymph node. The number of lymph nodes increases gradually from small to large.
Breast cancer can metastasize to the ipsilateral axillary lymph nodes and also to the contralateral axillary lymph nodes through the intercommunication between the anterior chest wall and the internal breast lymphatic network, the incidence is about 5%. In addition, advanced breast cancer may also have ipsilateral supraclavicular lymph node metastasis or even contralateral supraclavicular lymph node metastasis.
Areola abnormalities
In inflammatory breast cancer, the skin is inflammatory; the color ranges from light red to dark red, and is initially limited but soon expands to most of the breast skin, accompanied by skin edema. The skin is thickened, rough and the surface temperature is increased.
Epidemiology
Epidemiological surveys have found that 5% to 10% of breast cancers are familial. If one close relative has breast cancer, the risk of the disease increases by 1.5 to 3 times; if two close relatives have breast cancer, the prevalence will increase by 7 times. The younger the age of onset of the disease, the greater the risk of breast cancer among relatives. This proves that breast cancer is very likely to be inherited and has a clear tendency to run in families.
Modern medicine proves that breast cancer has a family history, also known as familial cancer. It has been clinically proven that there are maternal grandmothers or mothers or sisters in the family of women with breast cancer, which is consistent with autosomal dominant inheritance, a site-specific type of inheritance, and the tumor that their family members are susceptible to is breast cancer. Patients with benign breast lesions are reminded here that they should be alert and treated aggressively to prevent developing breast cancer because of the susceptibility to genetic mutations in people at high risk for breast cancer.
Etiology and Pathology
The etiology of breast cancer is not completely clear, but factors such as infertility, low number of births, late age of first full-term birth, early age of menarche, history of benign breast disease, family history of breast cancer, oral contraceptives, and radiation exposure have been identified to be associated with breast cancer.
Long-term dietary structure and living habits cause excessive acidification of the body, and the overall function of the body decreases, resulting in kidney deficiency.
In addition, genetic factors, dietary factors, external physical and chemical factors, and certain benign breast diseases are related to the occurrence of breast cancer.
Several major factors known to induce breast cancer.
1. Menstrual status: Menarche earlier than 12 years old, menopause later than 50 years old, and periods longer than 35 years are all recognized risk factors.
Marital status: The first full-term birth at the age of 35 or above, or the first full-term birth at the age of 40 or above, and repeated abortions may increase the risk of breast cancer.
Breastfeeding history: Those who have not breastfed after delivery have an increased risk of breast cancer.
Hormone level: The occurrence of breast cancer is closely related to estrogen level, and high level of growth hormone is also a contributing factor to breast cancer. Currently, it is believed that estradiol and estrone are directly related to the occurrence of breast cancer.
History of breast disease: Atypical hyperplasia of the breast may progress to breast cancer, and a unilateral history of breast cancer may increase the incidence of the opposite side by 2 to 5 times compared to the normal population.
6.Heredity and family history: Heredity and familial nature of breast cancer is one of the risk factors of breast cancer.
7.Diet: High fat, high protein and high calorie diet will increase the risk of breast cancer.
8.Environmental factors: ionizing radiation, low-dose diagnostic radiation, active or passive smoking.
9.Other factors: mental stimulation, psychological disorders, especially depression, obesity, viral infection, drugs, diabetes, etc.
Six methods of breast cancer screening
The incidence of breast cancer has been on the rise in recent years. Physicians have been calling for early detection and early treatment, and about 90% of breast cancer patients can survive.
Breast examinations include the following procedures: Breast ultrasound and mammogram – If there is an indistinguishable lump or abscess – Cytology aspiration.
Examination methods
I: Mammography
Mammography is a non-invasive method. It is simple and easy to perform, and its mammograms are clear, rich in layers and informative, which is important for screening breast diseases, especially early breast cancer.
2: Ultrasonography
Ultrasound imaging is non-invasive and is the first examination method for breast enlargement, which is simple, accurate and can be used repeatedly.
Three: Biopsy methods
Excision of lumps: The entire lump or suspicious tissue in the breast is excised for pathological examination.
Excisional biopsy: A portion of tissue is excised from the lump or suspicious tissue for examination.
Fine needle aspiration: A very fine needle is used to extract some tissue and cells from the lump, suspicious tissue or fluid collection for examination. Others, such as smear cytology of nipple overflow for those with nipple overflow, scraping or print cytology of the eroded part of the nipple.
Fourth: endoscopic examination of the breast ducts.
Breast duct endoscopy allows direct visual observation of the ductal epithelium and ductal lumen in patients with nipple overflow, which greatly improves the accuracy of the diagnosis of the etiology observed in patients with nipple overflow and provides great assistance in the accurate localization of the diseased ducts for surgical treatment.
Treatment.
Surgery. Surgery is still one of the main treatments for breast cancer, and the procedures are divided into: radical surgery (removal of the pectoralis major and minor muscles), modified radical surgery (divided into preservation of the pectoralis major and minor muscles or preservation of the pectoralis major muscle only), breast-conserving surgery, stage I reconstruction of breast cancer, stage II reconstruction, etc. The general trend is to minimize surgical damage and try to preserve the shape of the breast for early stage breast cancer patients as long as the equipment allows.
Radiation therapy. Radiation therapy is required for patients with heavy local disease after surgery (i.e. large lumps, many axillary lymph nodes, breast-conserving surgery, etc.) to reduce the local recurrence rate.
Endocrine therapy. There is a clear relationship between hormone receptor assay and breast cancer outcome. Patients with positive postoperative immunohistochemical results for estrogen and progesterone receptors should be treated with oral triamcinolone acetonide, letrozole, anastrozole, exemestane and other drugs.
Chemotherapy. The purpose of systemic chemotherapy is to eradicate the residual tumor cells in the body to improve the cure rate of surgery.
(1) Postoperative adjuvant chemotherapy should be applied early in the postoperative period and within 2 weeks after surgery, and not later than one month after surgery.
(2) The efficacy of combination chemotherapy in adjuvant chemotherapy is better than that of single agent chemotherapy.
(3) Postoperative chemotherapy is selected according to specific conditions (CAF, TAC, TA, TC, etc.).
Targeted therapy. For C-erbB-2 positive patients who are further examined by FISH or CISH to detect Her-2 positivity, additional treatment with Herceptin is required for one year to increase the long-term survival rate of breast cancer patients.