Breast cancer is the most common malignant tumor in women, and its incidence is increasing year by year. Since its treatment requires removal of the breast, it affects the beauty of women’s appearance while endangering their lives. In this article, we will introduce some general knowledge about breast cancer so that women can have a general understanding of its occurrence, clinical symptoms, examination methods and treatment to reduce their fear of breast cancer.
I. Concept of breast cancer and its causes.
Breast cancer is a malignant tumor that occurs in the epithelial tissue. It is a malignant tumor that occurs in the epithelial tissues of the breast. It is caused by the uncontrolled and disorderly malignant proliferation of breast epithelial cells due to the action of various pathogenic factors, which compresses and erodes the surrounding normal tissues and destroys the normal structure of the breast, and can metastasize to distant organs through lymphatic vessels and microcirculation during its growth.
According to the current epidemiological survey, there are many risk factors for breast cancer, such as family history of breast cancer, early menstruation but late menopause, advanced childbirth or infertility, history of benign breast disease, history of breast cancer on one side, abnormal endogenous and exogenous estrogen levels, and ionizing radiation to the breast are all high risk factors for breast cancer. Other factors associated with the development of breast cancer include breastfeeding, diet, obesity, medications, psychological factors and lifestyle. In general, breast cancer is the result of a combination of factors, and no single factor can be explained as the cause of breast cancer.
Symptoms of breast cancer
1.Lumps.
Painless lump is the most common symptom of breast cancer. More than 90% of the first symptoms of breast cancer are painless lumps in the breast, and most of them are discovered by the patients themselves when bathing or changing clothes.
2, nipple overflow.
Nipple overflow is divided into physiological overflow and pathological overflow. Nipple overflow in women during pregnancy and lactation is physiological overflow, and nipple overflow in non-physiological state is pathological overflow; nipple overflow can be caused by a variety of breast cancer diseases, which is also easy for patients to notice. According to its physical properties, nipple overflow can be classified into: bloody, purulent, lactic, plasma, watery, serous, etc. About 5% to 10% of breast cancers can show nipple overflow, and the overflow is mostly monotubular.
3. Nipple changes.
(1) Nipple invagination: Some breast cancers growing under or near the nipple can invade the fibrous tissue and duct system of the breast, causing them to shorten and thus leading to nipple invagination, so if there is nipple invagination recently, you should go to the hospital for consultation in time.
(2) Nipple erosion: There is a special type of breast cancer called “Paget’s disease”, the main manifestation of which is nipple erosion, which may be accompanied by itching and may or may not be accompanied by breast lumps. Some patients often prefer to go to dermatology, and some inexperienced dermatologists treat it as “eczema” because of its manifestation. This is especially important for patients who do not improve after dermatological treatment.
4. Changes in the skin of the breast.
The appearance of human bilateral breasts is symmetrical. If there are local skin depressions, bulges, redness, edema, ulceration, surface varicose veins or small unexplained nodules on the skin, you should go to the hospital for consultation.
5. Enlarged axillary lymph nodes.
When breast cancer develops gradually, it can invade the lymphatic vessels and metastasize to the local drainage area, the most common site is the ipsilateral axillary lymph nodes, the lymph nodes are small at first, but as the disease develops, they keep increasing in size and number, and evolve from single activity at the beginning to fusion and grouping, if the axillary vein is pressed, upper limb edema can appear. In addition to metastasis to the ipsilateral axillary lymph nodes, breast cancer can also metastasize to the ipsilateral internal breast lymph nodes or even the contralateral axillary lymph nodes through the traffic of chest wall and internal breast lymphatic network.
Breast cancer examination methods.
1.B ultrasound examination.
Ultrasound examination has many advantages such as non-invasive, painless, safe, non-radiation, low cost, and can be repeatedly examined without any harm to human body, so it is easily accepted by patients. Ultrasound can also make dynamic observation of breast lesions, and the clinical diagnosis rate is also high, which is currently one of the most widely used methods in clinical practice.
In addition to conventional ultrasound, color Doppler, energy Doppler, elastography, three-dimensional ultrasound imaging and ultrasonography have been widely carried out, and these new technologies play an important role in the diagnosis of breast diseases.
2.X-ray examination of the breast.
This is the only imaging method that can significantly reduce the mortality rate of breast cancer. The incidence of breast cancer is high in Europe and America, but because women in these countries receive mammography from the age of 40, the detection rate of early breast cancer increases, and the breast preservation rate and long-term survival rate also increase accordingly.
3. MRI of the breast.
MRI is one of the most rapidly developing imaging techniques in recent years. Its high soft tissue resolution can detect early breast cancer that cannot be detected by clinical examination and other examination methods, especially in detecting multiple breast cancers, contralateral breast cancers, preoperative staging of breast cancer, evaluating the efficacy of neoadjuvant chemotherapy for breast cancer, assessing whether there are metastases in the internal breast lymph nodes and axillary lymph nodes of breast cancer patients, breast However, the long examination time and high cost as well as the high price of the examination equipment are the reasons that affect its common application.
4.Pathological examination.
Pathological examination is to determine the nature of breast diseases by directly observing the morphological characteristics of lesions under microscope, combining with immunohistochemistry, molecular pathology and other advanced methods, revealing the law of lesion occurrence and development, predicting the prognosis of patients and guiding clinical formulation of individualized treatment plans. Pathological diagnosis is the highest diagnosis in clinical medical diagnostics and is regarded as the “gold standard” for disease diagnosis.
Pathological examination requires puncture, biopsy and surgery to obtain specimens for cytological and histological examination of the lesion. Frozen section rapid diagnosis is a routine examination for surgical treatment of breast lesions. The surgeon sends the surgical specimen to the pathology department, and the pathologist is asked to make a diagnosis of the nature, extent, and margin condition of the lesion within a short period of time, while the surgeon implements or changes the surgical plan based on the frozen pathology report. The accuracy rate of frozen section diagnosis is about 95%. For some lesions between benign and malignant, frozen sections are often difficult to diagnose and have to wait for paraffin sections for pathological diagnosis.
Treatment of breast cancer.
1.Surgical treatment.
For breast cancer that requires surgery, surgery is the most important treatment for breast cancer. Surgical methods include radical surgery, extended radical surgery, modified radical surgery, simple mastectomy and extended lumpectomy + axillary lymph node dissection (i.e. breast-conserving surgery). The most widely used procedure is modified radical surgery, which involves excision of the entire breast, pectoralis major fascia, supra-axillary and mid-axillary lymph nodes, and removal of the pectoralis minor muscle and supra-axillary lymph nodes as needed. With the further understanding of the biological behavior of breast cancer and the increase in the detection rate of early breast cancer, the use of breast-conserving surgery is increasingly being used as the scope of breast cancer surgery is narrowing and the patient’s demand for breast aesthetics is increasing.
For early-stage breast cancer, the results of breast-conserving surgery with standardized treatment are similar to those of radical surgery. It is now generally accepted that breast-conserving surgery can be performed in patients with negative surgical margins, without affecting postoperative breast aesthetics and without contraindications to radiotherapy. Sentinel lymph node biopsy is another surgical procedure to avoid axillary lymph node dissection, reduce the scope of surgery and minimize postoperative complications. Breast reconstruction surgery is the use of autologous tissue grafts or breast implants to reconstruct chest wall deformities and breast defects after mastectomy. Breast reconstruction surgery has the advantages of aesthetics and good results, which is a good choice for patients with high requirements for breast aesthetics but cannot preserve the breast.
2.Breast cancer chemotherapy, endocrine therapy, radiotherapy and targeted therapy.
Chemotherapy is chemotherapy, which emphasizes systemic treatment and is different from local tumor treatment such as surgery and radiation therapy. Chemotherapy for breast cancer is divided into adjuvant chemotherapy, neoadjuvant chemotherapy and rescue chemotherapy.
Endocrine therapy is also one of the systemic treatments. The breast is a target organ of estrogen, so endocrine therapy is to suppress the tumor by inhibiting estrogen, and the main methods are drugs: estrogen receptor antagonists, aromatase inhibitors, and ovarian debulking. Endocrine therapy is suitable for patients with estrogen receptor positive breast cancer.
Radiation therapy is another important measure in the local treatment of breast cancer, which can improve the long-term survival of patients. In general, whole breast irradiation is necessary after breast-conserving surgery. Those with ≥4 axillary lymph node metastases or lumps located in the medial or central region of the breast can also receive radiotherapy. Radiotherapy is also used in recurrent metastatic breast cancer to effectively control local recurrence, including chest wall recurrence and lymphatic drainage areas, and to relieve pain caused by posterior metastases and neurological symptoms caused by brain metastases.
Targeted therapy refers to the targeted treatment that acts on certain key targets in the growth process of breast cancer cells to inhibit tumor growth. Anti-Her-2 therapy is the most important part of targeted therapy for breast cancer, and the most important drug is trastuzumab.
V. Psychological rehabilitation of breast cancer patients
The treatment of breast cancer has long been focused on surgery, chemotherapy, radiotherapy, endocrine therapy and traditional Chinese medicine, but the role of psychological rehabilitation in the overall treatment of breast cancer is often neglected, in fact, psychological rehabilitation has a very important relationship with the treatment and prognosis of breast cancer. Psychological problems not only run through the whole process of treatment of breast cancer patients, but also affect the future of patients to different degrees, and the implementation of psychological treatment has a positive and irreplaceable role in the overall treatment of breast cancer.
1. Important factors affecting the psychology of breast cancer patients and their psychological change process.
There are many factors that cause patients’ psychological problems, and there are important factors that affect patients’ psychology in each process and each treatment stage of breast cancer treatment.
(1) Confirmation period: When patients are first diagnosed with breast cancer, they often have emotional reactions such as shock, denial, fear and sleeplessness, repeatedly asking medical personnel and patients suffering from the same disease for information related to their disease, or searching for relevant information on the Internet, doubting the accuracy of the diagnosis, being psychologically contradictory and emotionally tense, trying to find out the examination, diagnosis and treatment of cancer from different sources. In this period, when the diagnosis of breast cancer is accurate, patients often appear pessimistic, disappointed, helpless, anxious and unstable, and some of them have indifferent and negative attitudes towards treatment measures, and even have desperate thoughts of dying.
(2) Surgical period: More serious psychological stress reactions appear in this period. As the incision pain may occur in the early postoperative period, there are worries about whether the limb function can be fully recovered after surgery due to the limitation of limb movement; worries about the aesthetics due to the change of shape caused by the loss of breast; worries about the sexual function change after surgery which may affect the sexual relationship and relationship between husband and wife; worries about the need for family care and the inability to take care of family members, especially the elderly and children due to surgery, etc. These worries form both physical and psychological aspects. Pessimism, anxiety, fear, despair, depression and other negative emotions.
(3) Radiotherapy and chemotherapy period: Fear and rejection of treatment due to loss of appetite, nausea and vomiting, hair loss, drop in white blood cells, mouth ulcers, dry stools and other discomfort due to chemotherapy, and skin erosion and pigmentation in the irradiated area due to radiotherapy.
(4) Recovery period: After a period of treatment, patients start to engage in various activities, work and socialization. Due to the reduced scope of social activities and weakened interpersonal skills after treatment, some patients cannot resume normal work, thus resulting in low self-esteem, suspicious, sensitive and timid emotions.
2. Psychological rehabilitation of breast cancer patients.
(1) The role of medical and nursing staff in the psychological rehabilitation of breast cancer patients
After patients are diagnosed with breast cancer, medical personnel should give them sincere, sympathetic and unconditional care, inform them of some knowledge about breast cancer, tell them that breast cancer is a malignant tumor with a good prognosis, that most patients can survive for a long time after comprehensive treatment, and that a considerable number of patients can return to work or live the same life as before the disease after treatment, so that breast cancer is not invincible. Therefore, breast cancer is not insurmountable, so patients should be supported in their beliefs, encouraged to express their feelings and anxieties and given timely guidance; always give positive care, encourage patients to actively fight against cancer, actively cooperate with treatment, and teach patients to learn to maintain an optimistic mindset.
During the treatment period, medical and nursing staff should communicate more with patients, explain the relevant knowledge and the necessity of treatment, correct some wrong ideas of patients, give patient and scientific answers to questions raised by patients during the treatment process, ease patients’ anxiety, especially those pessimistic and disappointed patients, pay more attention to communication and psychological guidance, cite some examples of successful treatment to enhance patients’ confidence, and invite some patients who have better treatment results and psychological status. Patients with better treatment results and psychological status can be invited to get to know each other, to promote mutual communication and encouragement among patients, so as to gain determination to overcome the disease, to encourage patients to re-enter society, to maintain good social relationships and normal social interaction, and to teach patients postoperative functional rehabilitation training to reduce the adverse effects of postoperative discomfort.
(2) The role of family in the psychological rehabilitation of patients is huge
If someone in the family has breast cancer, the family should give more care and love to the patient, encourage the patient to accept and cooperate with the treatment actively, and give more tolerance and patience to the patient’s impatience, irritability, anxiety and other negative emotions during the treatment process. The patient should not talk about people or things that can stimulate the patient or undermine the patient’s self-confidence. In short, the sincere care of family members and friends can play a great role in the psychological recovery of the patient.
(3) The role of the patient himself in the process of psychological recovery
As the old saying goes, “The bell must be untied”, “One must first love oneself and then be loved by others, and one must first help oneself and then be helped by others”, indicating that the main thing to do well is to rely on oneself. Therefore, as a patient itself, after the shock and doubt when diagnosed, try to adjust the mindset from the shortest possible time to cooperate with active treatment is the first step towards psychological recovery. We should know that “Who can eat grains without illness?” You should know that you are not alone, you have the support of your family and society and the careful treatment of medical staff, and you should have the confidence to overcome the disease; you should know that some discomfort in the treatment process is temporary, and you should think about things that make you happy, and not think too much about when there will be recurrence and metastasis and other things that undermine your confidence, because these things are only “Tell yourself to “live well” every day, then the whole life will be full of joy; go into the society actively, rebuild the original social relationship or establish a new social circle, do not feel sorry for yourself; know that life is originally unpredictable If you have self-confidence, life will be as wonderful as before. You should know that “the only person who can defeat you is yourself”. Breast cancer is not that scary.