In my clinical work, I often encounter patients/families with suspected breast cancer who question me: Dr. Liu, am I breast cancer? You are not scaring me, right! I believe other doctors will also encounter similar situations. I believe this reaction is also a normal reaction of the patient who is scared and afraid/unwilling to believe the truth when he/she is first informed of the bad news. After I became a mature physician, I did not avoid the aggressive questions and aggression of the patient when I encountered this situation. I confronted their questions directly, and my communication with the breast cancer patient began with where exactly the breast cancer was. If you have breast cancer, where is the breast cancer? I would say to the affected party in three areas: cancerous mass, cancerous nodules, and cancerous cells. A cancerous mass is a cancerous nodule in the breast (parametrium). The most common scenario is the lump in the breast. If the situation cannot be felt, it will test the doctor’s precise diagnosis and treatment skills more. Cancer nodes, not referring to nodular primary breast cancer foci, specifically refer to axillary lymph nodes that may be metastasized by breast cancer cells, which is the most common route of breast cancer metastasis. Cancer cells refer to primary foci, metastatic foci, and cancer cells in the process of metastasis. Trust the doctor to remove the lesions accurately and maximize the balance between removing the lesions and preserving healthy tissues in a good way. Trust your doctor to minimize the pain and after-effects of diagnostic treatment. For cancerous masses? Cancerous nodules? The management of cancer cells are three important aspects of the diagnosis and treatment of breast cancer. They are specifically reflected in the following discussion. Cancer masses refer to cancerous nodules in the breast (parametrium). It can be one to multiple and can be palpable or non-palpable. The surgical treatment of cancerous lesions is valuable in terms of accuracy. First is the accurate removal of the lesion, and it is the surgeon’s obligation to provide an accurate specimen of the lesion to the pathologist. Accurate presentation of the specimen is even reflected in telling the pathology pickup physician in which subregion of the specimen the suspicious lesion is located, rather than sending a generalized pile of specimens to the pathology department. I have a special article on this, An Intraoperative Localization Technique for a Postexcision Specimen of Nonpalpable Breast Calcifications has been published in the American Surgeon American Surgeon; accuracy in the surgical management of cancerous lesions, for modern breast surgery, is also reflected in the incision margin. A uniform, safe margin is preferred. During the operation, the lead surgeon, with the left index finger, should constantly probe the cut edge. Hard, grainy, or grayish ones are usually unsafe. A homogeneous, white gland is usually a safe margin. This is important for the tumor safety of breast-conserving surgery. As far as cancer nodes (potentially metastatic axillary lymph nodes) are concerned, for most breast cancer patients, modern breast surgery has made it possible to accurately identify the anterior lymph nodes and thus to more accurately determine whether or not the axillary lymph nodes are metastatic, and thus to prevent the removal of innocent lymph nodes. For surgeons who perform sentinel lymph node biopsies, palpation of the axillary field and the softness/strength of the sentinel lymph nodes should be of concern to the surgeon. The above focuses on the surgical management of cancerous masses and nodes. The precise management of both has given rise to breast and axillary conserving surgery, that is, although having breast cancer, it is possible to safely preserve the breast and preserve the axillary lymph nodes for the earlier stage of breast cancer patients among them. Instead of the traditional (two-incision) modified radical surgery. By two cuts, it means that one cut is made to the breast, regardless of the extent of the breast cancer mass. It also means that another cut is made to the axillary lymph nodes, regardless of whether the anterior lymph nodes in the axillary nodes have metastasized. Preservation of the breast, preserving the appearance. With axillary preservation, the movement function of the upper extremity is significantly less affected. After axillary preservation, little to no edema occurs in the upper extremity. In contrast, less than 10% of patients will have varying degrees of upper extremity lymphedema after the traditional axillary clearance surgery, the modified radical surgery with two incisions. Cancer cells refer to primary foci, metastatic foci, and metastatic process. Its importance is reflected in determining the survival and death of patients. The cancer mass mentioned before, even if it is as big as a fist or even grows all over or through the breast, affects mostly only the quality of life, and has nothing to do with vital organs such as lung, liver, brain and spinal cord. However, once metastatic cancer cells form clinically detectable metastases in the above-mentioned life-affecting organs, the survival period will be seriously affected, and patients’ survival can mostly be measured in months only. Chen Xiaoxu, Yao Beina, etc., all died from metastases (metastatic cancer cells) rather than the primary foci (cancer masses in this article). It can be seen that the treatment of cancer cells should be paid more attention. In today’s medicine, it is still difficult to accurately detect stray cancer cells (circulating tumor cells, CTCs). Circulating cancer cells most often colonize in bone and internal organs such as lung, liver, and brain, and when they form clinically apparent metastatic lesions, the disease is often advanced. Thus, it seems that the control/elimination of cancer cell link is more important than the above mentioned cancer masses and nodules. The cancerous masses and nodules are like a group of local criminals with a fixed and identifiable location, one in the breast and one in the armpit. It is easy to catch them all at once. Breast and axillary conserving surgery does not palliate them, it precisely catches them all in one pot. The surgeon concentrates on eradicating the lesion and preserving the body’s normal structures in the vicinity of the breast cancer to the greatest extent possible. This is the remarkable advancement of modern breast surgery. In my surgical approach to primary breast cancer cases last year, traditional modified radical surgery (the aforementioned two incisions) accounted for only 1/4, breast-conserving surgery for 1/2, axillary-conserving surgery for 2/3, and breast and axillary-conserving surgery for 40%. (Breast-conserving and axillary-conserving procedures are counted as breast-conserving and axillary-conserving procedures). In the near future, traditional modified radical surgery will no longer be the mainstream procedure, and breast-conserving, axillary-conserving, breast-conserving and axillary-conserving procedures will become the mainstream. For patients with early-stage breast cancer, the metastasis and survival rates of the latter three procedures are comparable to those of conventional modified radical surgery, and have been tested in RCTs (randomized controlled clinical trials) and clinical practice in terms of tumor safety. Metastatic cancer cells are like roving criminals, though only a small number, but the metastases formed by them are not detectable in the subclinical stage. From microscopic to macroscopic, from few to many. Once the metastases appear, except for the regional metastases such as axillary lymph nodes, the chance to cure K is often lost. This is precisely the scary part of breast cancer. Cancer cells in metastasis are still difficult to deal with. Metastatic focal cancer cells are often difficult to obtain. Thus, doctors who are trying to deal with the devil of breast cancer have intensified the examination and treatment of cancer cells in the primary foci. This includes molecular pathology, genetic testing, etc., in order to make targeted treatment. Endocrine therapy and targeted therapy are all related to the molecular markers of cancer cells. Chemotherapy also takes into account the cancer mass and axillary lymph nodes. Adjuvant radiotherapy is a local treatment, which is mainly decided according to the local characteristics of cancer mass and axillary nodes.