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Healthy breasts are a beautiful scenery on women’s chests. However, breast enlargement, breast cancer and other gynecological diseases make women’s chest crisis! At present, malignant lesions of the breast still rank first among female cancers in China, and are called “the first killer of women’s health” by the medical profession.
Brief description of the anatomy and physiology of the breast
Adult women’s breasts are two hemispherical sexual and lactation organs located on the superficial surface of the pectoralis major muscle, between the superficial and deep subcutaneous fascia at the level of the 2nd and 6th ribs. The outer upper part forms the axillary tail of the mammary gland extending angularly into the axilla. The nipple is located in the center of the breast and is surrounded by a pigmented area called the areola.
The mammary gland has 15 to 20 glandular lobes, each of which is divided into many glandular lobules, which are composed of small milk ducts and vesicles. The lobules are composed of small ducts and vesicles, which are the basic units of the breast. Each lobe has its own duct (milk duct), and both lobes and ducts are centered on the nipple and arranged in a radial pattern. The lobes and ducts are arranged in a radial pattern with the nipple at the center. The small milk ducts converge to the milk ducts, which open at the nipple, and the 1/3 of the milk duct near the opening is slightly enlarged, making it a good place for papillomas in the milk ducts. This is the preferred site for intraductal papillomas. The lobes, lobules and alveoli are separated by connective tissue, and there are also fibrous bundles between the lobes that drape over the skin. The lobe of the gland has a straight fibrous bundle that connects the superficial fascia above and the deeper superficial fascia below, called Cooper’s ligament.
The mammary gland is the target organ of many endocrine glands, and its physiological activity is influenced by the anterior pituitary, ovarian and adrenal cortical hormones. The physiological activity of the mammary gland is influenced by anterior pituitary, ovarian and adrenal cortical hormones. During pregnancy and lactation, the mammary glands are significantly enlarged, the ducts are lengthened, and the follicles secrete milk. After lactation, the mammary glands are again in a relatively quiescent state. After lactation, the mammary glands are again in a relatively quiescent state. Normally, the physiological state of the mammary gland varies during the different phases of the menstrual cycle in women of childbearing age under the influence of various hormones. The physiological state of the breast changes cyclically under the influence of various hormones. After menopause, the glands shrink and are replaced by fatty tissue.
Breast examination methods
The examination room should be brightly lit. The patient should be sitting or lying down with both breasts fully exposed for comparison.
(a) Visual examination to observe whether the shape and size of both breasts are symmetrical, whether there is any restrictive bulge or depression, and whether the skin of the breast is red and hydrated. The skin of both breasts should be observed for redness, edema and “orange peel-like” changes, whether the superficial veins of the breasts are dilated, and whether the nipples on both sides are at the same level. If there is a cancer above the nipple, the breast will be examined. If there is cancer above the nipple, the nipple can be pulled upward so that the two nipples are at different heights. Inverted nipples can be caused by developmental problems. If one nipple is recently invaginated, it is clinically significant. Attention should also be paid to the presence of erosion of the nipple and areola.
(B) palpation patient sitting, both arms naturally drooping, breast hypertrophy sagging obvious, can be lying down position, under the shoulder pad small? pillow, so that the chest is elevated. The examiner uses the palm surface of the fingers rather than the fingertips for palpation, do not use the fingers to pinch the breast tissue, otherwise? The pinched glandular tissue may be mistaken for a lump. The upper outer breast (including the caudal axilla), lower outer breast, lower inner breast, and upper inner breast should be examined sequentially. Each quadrant and the central region should be examined comprehensively. The healthy side should be examined first, followed by the affected side.
There are four groups of axillary lymph nodes (Figure 25-2), which should be examined sequentially. The examiner faces the patient, and the right hand is used to feel the left axilla and the left axilla. The right axilla is felt with the left hand. The patient’s upper extremity is first abducted, and the patient’s hand is inserted into the top of the axilla with the palm of the fingers pressing against the patient’s chest wall. Then ask the patient to relax the upper limb, rest on the forearm of the examiner, and use gentle movements from the top of the axilla to search the central lymph nodes from top to bottom. The lymph nodes of the central group are then palmarly turned to the anterior wall of the axilla and the lymph nodes of the pectoralis major muscle are examined on the deep side. The lymph nodes of the scapular group should be examined from above. When examining the lymph nodes of the subscapular group, it is advisable to stand behind the patient and feel the anterior medial aspect of the latissimus dorsi muscle. Finally, the subclavian and supraclavicular lymph nodes should be examined.
Special examination methods for the breast.
If you find lumps in the breast, overflowing nipples, edema and nodules in the breast skin, you should go to the hospital for examination in time. The following methods are now commonly used.
(1) Ultrasound examination: It can detect the presence of diseased tissues in the breast and the size, density and surrounding blood flow of the diseased tissues, and can identify whether the lump is cystic or solid.
(2) Mammography: It can show the images of different tissues such as nipple, areola, skin, subcutaneous fat, ducts, glands and blood vessels in the X-ray, which is helpful to detect the microscopic breast cancer lesions in the early stage and deep part of the breast.
3) CT and MRI examination: CT and MRI are expensive and can be used for auxiliary diagnosis of patients with special conditions.
4) PET (positronemissiontomography) can be used for early detection of primary and metastatic occult breast cancer, and its development has attracted attention; while SPECT has been included in the routine examination of advanced breast cancer for early diagnosis of breast cancer bone metastasis. In addition, fiberoptic ductal endoscopy has also entered the clinic for the examination of breast ductal diseases such as nipple overflow.
5) Biopsy: Currently, fine needle aspiration cytology, coarse needle aspiration histology, McMurdo sampling biopsy, and nipple overflow smear cytology are commonly used. If the nipple erosion is suspected to be eczema-like breast? In the case of adenocarcinoma, cytological examination of the scraped or printed part of the eroded nipple can be performed.
Benign breast diseases: breast fibroadenoma, chronic cystic hyperplasia, breast abscess, etc.
Fibroadenoma is the most common breast disease. The main symptom is a painless lump in the breast with a large mobility, smooth surface and clear border. In addition, there are also the following common breast diseases, such as intraductal papilloma, whose main symptom is nipple overflow; mastopexy, whose main symptom is breast pain and lumps, and the pain often comes on with the menstrual cycle and decreases or disappears after menstruation; breast pain, which is mostly seen in sexually active women, whose main symptom is breast pain, which usually increases before menstruation and decreases or disappears after menstruation, and most of the pain Most of the pain is located in the outer upper side of the breast, and a few will have diffuse swelling and pain in both breasts; breast cysts can be felt at the breast as small cystic lumps, which sometimes cause pain, and the nature of the fluid in the cyst should be observed when it is drawn out; mastitis is mainly caused by poorly ventilated milk ducts, milk stagnation, and inflammation of the breast secondary to bacterial infection. If mastitis recurs during lactation, necrotic lesions may form in the milk ducts and bruised cysts may appear.
Mammary gland hyperplasia: breast swelling, hidden pain, lumps may be the initial manifestation of mammary gland hyperplasia, some mammary gland hyperplasia delayed treatment may even cause lesions, mammary gland hyperplasia accounts for more than 75% of young and middle-aged women, is the most common type of breast disease, cystic hyperplasia of the lobules of the breast can have a 4%-6% cancer rate, occurring at any age after the onset of puberty. It occurs in women of any age after the onset of puberty.
Breast lumps, breast pain and nipple discharge are the basic manifestations of mastopathy. About 80% of patients have symptoms of breast pain, mostly bilateral, but also unilateral, and the nature of the pain can be classified as swelling, tingling, hidden pain or tenderness. Breast lumps are not only one of the main symptoms of mastocytosis, but also the first symptom of early breast cancer. It is worth noting that painless lumps in the breast should be more alert to the occurrence of breast cancer.
Experts point out that after excluding malignant tumor, you can choose to treat with endocrine regulation, immunotherapy, acupuncture point injection, physical therapy, minimally invasive surgery and other Chinese and Western medicine methods according to your condition. In short, you must insist on regular preventive examination, early diagnosis and timely treatment.
Breast Cancer
About 1.2 million women worldwide suffer from breast cancer and 500,000 die from it every year. In developed countries such as Western Europe and North America, the incidence of breast cancer is the first malignant tumor among women. Among them, China is one of the countries with the fastest growing incidence of breast cancer, and breast cancer has become the number one killer of urban women. The incidence rate of breast cancer in Shanghai reached 56.2 per 100,000 in 2000.
The causes of breast cancer include ovarian function, genetics, nutritional imbalance, poor living habits and mental health, etc. However, the main cause of breast cancer is excessive estrogen in the body. Breast cancer is a disease closely related to endocrine secretion. Once the hormone secretion in the body is out of balance, resulting in excessive secretion of estrogen, the epithelial cells of breast ducts will change from normal development to abnormal proliferation under the stimulation of estrogen, and then have the possibility of cancer. Therefore, hormones play a vital role in the formation of female breast cancer.
High-risk factors 35 to 55 years old is the age of prevalence, so you should be careful of breast cancer if you have the following conditions
○Women who have early menstruation before the age of 13 or have not stopped menstruating until the age of 50 have a higher chance of getting breast cancer.
○Unmarried women who are celibate are more likely to get breast cancer than married women, and this tendency becomes more obvious the older they are; (women who marry late and have few children are more likely to get breast cancer than those who marry early and have many children)
○Women who have not had children after marriage have a higher incidence of breast cancer than those who have had children
○Women who have not been breastfeeding after childbirth or have been breastfeeding for too long or too short a period have a higher chance of getting breast cancer than those who are breastfeeding normally
o women with a family history of breast cancer have a significantly higher chance of getting breast cancer than those without a family history of breast cancer
○Women who have had breast cancer on one side have a higher chance of getting cancer on the opposite side than those who have not had cancer normally
○The chance of developing cancer is also increased if the breast is repeatedly exposed to radiation for various reasons.
○Women who are obese because they eat a lot of fat.
Factors that may be related to breast cancer.
Women who work at night are more likely to develop breast cancer
According to a study reported in The Scotsman, women who work night shifts are more likely to develop breast cancer because they have little production of an important hormone that inhibits breast disease while working night shifts.
Scientists have confirmed for the first time that when people sleep at night, the body secretes an internal melatonin hormone that can inhibit the growth of breast tumors. However, if women do not rest on time, but instead are under strong light, so that melatonin is produced under ischemic conditions, but it is conducive to the growth of tumors, and the growth rate is about twice the normal rate.
Urban white-collar workers are prone to breast cancer
As these women are prone to depression, such as tension and anxiety, loneliness and depression, sadness and sorrow, bitterness and disappointment, impatience and irritation, etc., long-term emotional stimulation, the body’s life rhythm is disturbed and the neuroendocrine system is dysfunctional, which leads to the imbalance of the internal environment and the decrease of immunity, which can reduce the production and release of thymosin from the thymus gland, and the monitoring ability and phagocytosis of lymphocytes and macrophages on mutated cells in the body. The ability of lymphocytes and macrophages to monitor and phagocytose mutated cells in the body decreases, making them prone to cancer.
Pretty women are prone to breast cancer
Nowadays, some women pay much attention to maintenance and take estrogen or estrogen-containing supplements to keep their beautiful faces.
Older women smokers have a higher chance of breast cancer
Older women who smoke a pack of cigarettes a day and have been smoking for more than 11 years will have a 30% to 40% higher chance of developing breast cancer than non-smokers. Long-term smokers who combine hormone replacement therapy are more than twice as likely to develop breast cancer as non-smokers or those who do not receive hormone replacement therapy.
Women who eat well are more likely to develop breast cancer
A recent study published jointly by Swedish and American scientists showed that young women with anorexia nervosa have a lower risk of developing breast cancer. This suggests that a woman’s caloric intake in her early years may have a greater role in the formation and development of breast cancer later in life.
Left-handed women are prone to breast cancer!
A study by Dutch scientists has shown that left-handed women are more likely to develop breast cancer.
Women with large busts are more likely to develop breast cancer
”A study by Dutch scientists shows that left-handed women are more prone to breast cancer.
1) Diet like Western fast food Epidemiological survey shows that the consumption of animal fat, protein and sugar in the diet is positively related to the occurrence of breast cancer. Especially high-calorie western fast food, its fat will make people’s hormone secretion out of balance, and the increase of estrogen will stimulate the breast gland and increase the risk of breast cancer. Therefore, girls entering the puberty period, in meeting the various nutrients required for growth and development, to control the intake of high-fat, high-sugar foods, and eat more vegetables and fruits.
(2) Playing for fun and pursuing excitement and tension Playing computer games and watching movies and TV for a long time will easily lead to tension, anxiety, loneliness and depression, which will easily cause neuroendocrine dysfunction and induce breast cancer if these bad emotions are not relieved for a long time. Therefore, adolescent girls should pay attention to the regularity of living, combining work and rest, ensuring sleep, and insisting on exercising for 30 minutes every day.
(3) Daily products in pursuit of fashionable premature use of cosmetics, especially those containing hormones or weight loss products, can disrupt the balance of estrogen in the body. In addition, the premature use of extruded bras will affect local blood circulation, and will also hinder the development of breasts and surrounding tissues and organs, resulting in breast deformation and flattened nipples, which are not conducive to normal breast development. Therefore, it is best for adolescent girls to use less cosmetics. Brassieres should fit well and should not be worn for more than 12 hours a day, and should be removed at night when sleeping.
Diagnosis
1) Prevalence factors; breast tissue is a target organ for sex hormones, and a variety of factors such as increased secretion of estrogen stimulate breast tissue, which can induce breast lesions. The following conditions are at high risk: age of menarche less than 12 years old, age of menopause more than 55 years old, first birth more than 35 years old, repeated abortions; celibacy or those who are infertile or not breastfeeding after marriage; family history of cancer, especially if their mother or sister has had breast cancer, or they have had breast cancer on their own side; common use of hormonal drugs and cosmetics, repeated long-term exposure to various kinds of radiation; defective lifestyle, such as lack of exercise and exercise, diet high fat, high protein, depressed and easy to get angry; suffering from benign breast disease for many years without healing, etc.
2) physical examination.
3) Imaging data.
4) Cellular or histological examination.
Treatment of breast cancer
Surgery is one of the main treatments for breast cancer, along with adjuvant chemotherapy, endocrine, radiation, ? immunotherapy, and, more recently, biological therapy.
Surgical procedures: Extended radical mastectomy – Radical mastectomy – Modified radical mastectomy – Total mastectomy – Radical mastectomy with breast preservation – Biopsy of anterior lymph nodes – Local excision.
There is disagreement about the choice of surgical approach, but no single surgical approach is appropriate for all cases of breast? cancer. The choice of surgical approach should also be based on pathological staging, disease stage, and the conditions of adjuvant therapy. For resectable? s breast cancer patients, surgery should achieve maximum local and regional lymph node clearance to improve survival, and then? Then consider the appearance and function. For stage I and II breast cancer, modified radical mastectomy and breast-cancer-preserving mastectomy can be used. excision. In areas where comprehensive adjuvant treatment is poor, radical breast cancer surgery is still the more suitable surgical procedure. Sternum? If there are metastases in the parietal lymph nodes, extended radical surgery is feasible without postoperative radiotherapy. In recent years, studies on anterior lymph nodes of breast cancer have been carried out in order to clarify whether there are local lymph node metastases before radical treatment, thus avoiding blind lymphatic dissection.
Don’t reject breast-conserving surgery too much
Breast-conserving surgery has strict indications, i.e. under 60 years of age, single tumor, located outside the nipple and areola, and less than or equal to 3 cm in diameter; no axillary lymph node metastasis.
Currently, about 50% of breast cancer patients abroad undergo breast-conserving surgery, i.e. local excision with chemotherapy and radiotherapy. This method not only eradicates the tumor, but also preserves the shape of the breast, and there is no difference in the long-term survival rate and local recurrence rate of patients compared with radical surgery. However, in China, patients often desire “cure” and refuse breast conservation. This fear has led many elderly breast cancer patients to ask their doctors to remove the entire breast and even the pectoralis major muscle and lymphatic tissue together, leaving a “hole” in the chest. In addition, breast-conserving surgery is mainly suitable for early-stage breast cancer patients, while breast cancer patients in China are usually in the middle and late stages once they are detected, which makes it difficult to popularize this surgery.
A new approach to comprehensive breast cancer treatment
Although breast cancer is highly prevalent, it is not as terrible as imagined. The combination of surgery, chemotherapy, radiotherapy and endocrine therapy has greatly improved the efficacy of breast cancer, and many patients can still survive with tumor for a long time even after the occurrence of systemic metastasis. In recent years, many new concepts and methods have been recognized – (1) the treatment of early-stage breast cancer, and (2) the treatment of early-stage breast cancer.
(1) To reduce the scope of surgery, preserve the breast and enhance comprehensive treatment for early stage breast cancer. Through long-term observation and comparison, the efficacy is similar to the efficacy of previous radical surgery. This treatment method has been accepted by women in western countries and has been carried out in a larger scale. There are also many hospitals in China that carry out this treatment.
(2) Comprehensive treatment is widely used to improve the efficacy of treatment for patients with intermediate and advanced stages. In particular, adjuvant chemotherapy is used before surgery to make the tumor shrink or even subside before surgery, and radiotherapy, chemotherapy or endocrine therapy is applied after surgery, so that even patients with intermediate and advanced stages can obtain long-term survival.
(3) The aim of treatment for advanced breast cancer is mainly to improve patients’ quality of life and prolong high-quality survival. For patients who are hormone receptor positive and whose lesions develop slowly, endocrine therapy shows its advantages, while for patients who are hormone receptor negative and whose tumors develop rapidly, chemotherapy becomes the first choice.
(4) Endocrine therapy. Since hormone receptor determination can be done for breast cancer patients, patients with positive receptors, especially those after menopause, can be treated with oral anti-estrogen drugs such as triamcinolone or letrozole if the lymph nodes are not metastatic as confirmed by surgery, which are not only efficacious but also convenient to take and have milder adverse effects compared with chemotherapy.
(5) Targeted drugs (such as Herceptin) combined with chemotherapy may become the future direction of adjuvant treatment for breast cancer. For breast cancer with a positive tumor marker called HER2, Herceptin alone or Herceptin in combination with chemotherapy becomes the first choice. The biochemotherapy modality of Herceptin combined with chemotherapy has achieved good efficacy in the preoperative and postoperative adjuvant treatment of breast cancer and in the treatment of advanced breast cancer, and is gradually becoming the standard treatment modality for HER2-positive breast cancer and is being promoted in clinical practice.