It is probably common for people to go to the hospital in a hurry when they feel a large, hard lump on their breast and worry that they have breast cancer. If breast cancer is diagnosed at this time, most of them are in the progressive stage (also called invasive breast cancer), which is actually not too early.
If the cancer cells are still in the same place and have not infiltrated and spread to the surrounding tissues, it is called “carcinoma in situ” in medical science. What are the signs of in situ cancer and invasive cancer? When cancer cells break through the basement membrane, it is called infiltrative cancer, but if they do not break through the membrane, it is called in situ cancer (as shown in the figure below).
The breast is made up of many milk-secreting glands with multiple lobes and their ducts, and the ducts and alveoli are surrounded by epithelial cells (below). Breast cancer in situ is the malignant transformation of these epithelial cells. Breast cancer in situ means that it has not yet broken through the basement membrane under the epithelial cells of the breast, once it has broken through the basement membrane, it is called invasive cancer.
Will breast cancer in situ metastasize and can it be cured? It will not metastasize because there are no lymphatic vessels and blood vessels in the epithelial layer (metastasis is caused by cancer cells entering the blood vessels and lymphatic vessels and running to distant places). Once cancer cells break through the basement membrane, they may enter the blood vessels and lymphatic vessels and spread. Therefore, in the stage of in situ cancer, it can be cured after surgery, but in the stage of infiltrating cancer, it may run into the lymph and blood, which may not be completely removed by surgery alone.
The general public does not know much about “carcinoma in situ of the breast”. It is expected that 60,290 new cases of breast cancer in situ will be detected in the United States in 2015, which will account for 20% of all new breast cancer discoveries. In our country, there are no exact statistics, and the number should not be too small. About 83% of breast carcinoma in situ comes from the ductal epithelial cells of the breast, and about 12% from the epithelial cells of the alveolar ducts of the breast.
Do all carcinomas in situ of the breast develop into invasive breast cancer? In the past, it was thought that if left untreated, they would eventually become invasive. However, recent studies have shown that not all carcinoma in situ will become invasive, and that about 20% to 50% of untreated carcinoma in situ of the breast will eventually develop into invasive breast cancer. What is the reason why some do not develop into invasive carcinoma while others do? But unfortunately, it is not known what the cause is.
What is the status of the incidence of carcinoma in situ of the breast? According to the data released by the United States, the overall incidence rate ranges from 14.4 to 25.8 per 100,000 people per year at all ages, and is estimated to be 23.9 in our country. the incidence rate increases with age, reaching a peak at the age of 70 to 79: about 3.4/100,000 before the age of 40, about 37.9/100,000 at the age of 40 to 49, about 57.9/100,000 at the age of 50 to 59; about 81.8/100,000 at the age of 60 ～about 81.8/100,000 at the age of 69, 84.3/100,000 at the age of 70-79, and 47.4/100,000 at the age of 80 or above.
Risk factors for the occurrence of breast cancer in situ? The so-called risk factor is that the incidence rate will be significantly higher than that of the general population under certain circumstances. An epidemiological study of 1.2 million women in the United Kingdom found an increased incidence in those with the following factors
1. not having children or having few children.
2. older age at first childbirth
3. age at menopause over 50 years.
4. a family history of breast cancer
5. having used estrogen replacement therapy during menopause or menopause
6. Women with high breast density. In the past, young age at menarche, obesity and alcoholism were considered as high risk factors, but this study found no significant relationship.
How to detect breast carcinoma in situ early? Carcinoma in situ of the breast is very small, and few people go to the hospital because of breast pain and other discomfort, or because a “benign” lump is found to have cancerous cells after surgery. Since most of them have no manifestation, neither can they feel the lump nor have any discomfort, so it is difficult to detect. Therefore, early detection mainly relies on regular medical checkups, and breast cancer screening for women is currently being carried out nationwide, during which many in situ or early stage cancers of the breast are detected. If the mammogram shows local structural disorder, calcified spots, or dilated ducts, it should be taken seriously and treated early according to the doctor’s advice. Women who are older than 40 years old and have high-risk factors should be more alert. Do not be too axial and one-track minded, and do not listen to your doctor’s advice and advice and regret it (there are still many one-track minded people in the clinic who always question the doctor’s advice). In the United States, the incidence and mortality rate of breast cancer has been decreasing year by year since mammogram screening was introduced to women in the country around 2000.
What should I do if I find an abnormality? For an organ like the breast, which is greatly affected by sex hormones, if there is an abnormality, especially if the doctor suspects malignancy, one should not be careless and should first rule out malignancy before considering conservative treatment. There are some bad concepts in our country, some people love to listen to some “godly doctors” or overwhelming “miracle drugs”, drink “cans of medicine” every day “A small, minimally invasive surgery is much easier than drinking “soup and medicine” all day long. Changing our mindset can reduce a lot of “tragedies”.
For the isolated mass on the breast, regardless of benign or malignant, my point of view can cut it or cut it off, do not feed the tiger for the trouble, even if some malignant rate is very low, but can not be completely ruled out, a small probability of things happen to individuals, at present, only “heaven” knows. The observation of conservative period to go to the hospital often to review, both costly and effort, but also fearful life. Surgery is not that scary.
Most of the in-situ breast cancers have no symptoms, no pain, no itch, and cannot be felt, but are basically discovered by mammogram during physical examination. Mammogram report has BI-RADS classification, which is a professional doctor’s judgment after looking at the mammogram film, and is divided into 5 levels: level 1 (negative, no abnormal findings); level 2 (benign); level 3 (benign possible, chance of malignancy is less than 2%, note that it should be reviewed around 6-12 months); level 4 (malignant possible, chance of 30% or more, need to take biopsy); level 5 (chance of malignancy is 95% or more, must be dealt with immediately). (above, must be dealt with immediately). This grading system, combined with your medical history and other tests, such as ultrasound and MRI, will allow your clinician to make a comprehensive judgment and give you an appropriate recommendation or opinion.
How do I get a pathology biopsy? If you need to further rule out the possibility of malignancy and decide whether to have immediate surgery or regular observation, then you need to take some lesion tissue for pathological examination, there are two ways to take biopsy.
1, breast biopsy needle, this is a special vacuum needle, in the B ultrasound or nuclear magnetic positioning guidance, the lesion tissue out of a piece of laboratory, of course, this is not 100% can be taken, too small, there may be missed, the cost of this method is also more expensive.
2, surgical excision for pathological examination, with B ultrasound positioning, a local anesthesia, cut a small mouth, the lesion range of tissue are cut down, sent to the pathological examination, high reliability, cost is not high, is an extra incision.
Once the pathology is clearly diagnosed, surgery is definitely needed, and the surgical methods and approaches are described in a special section later.