Chen Xiaoxu, Ahsan, Ye Fan, Yao Beina – they are all stars and all “victims” of breast cancer.
On January 16, 2015, according to Shenzhen Evening News, the famous singer Yao Beina, who had a recurrence of breast cancer, died. The song of this beautiful singer’s life finally came to a halt at the age of 33.
Here, I also want to remind women that according to the “China Breast Disease Survey Report” released by the Chinese Population Association, breast cancer has become the most threatening disease to women’s health, and the incidence of breast cancer ranks first among female tumors in large cities.
If breast cancer is detected and treated at an early stage, the clinical cure rate is much higher than other cancers, reaching 90-95%. However, the key is the word “early”, and some patients will still have recurrence.
Today, we will discuss how to prevent and detect the recurrence of breast cancer as early as possible.
How to assess the risk of breast cancer recurrence
The biggest concern of breast cancer patients after surgery is recurrence, but how to determine their chances of recurrence has always been a confusing issue. The latest International Breast Cancer Research Organization’s criteria for grading the risk of breast cancer recurrence include the following.
I. Low risk: negative lymph nodes with all of the following characteristics simultaneously.
1. Lesion size (pT) ≤ 2 cm
2. Histological grading or nuclear grading of grade I
3.The peritumor vasculature is not invaded
4, no overexpression or amplification of HER-2 gene
5.Age ≥35 years old
II. Moderate risk: negative lymph nodes with at least one of the following.
1, pathological tumor infiltration diameter (pT) ≥ 2 cm
2. Histological grading or nuclear grading grade II-III
3, peritumor vascular involvement
4.HER2 overexpression or neu gene amplification
5, Age ≤35 years
6, 1-3 lymph nodes positive but no HER2 overexpression or neu gene amplification, and ER, PR positive
High risk.
1, 1-3 lymph nodes positive with HER2 overexpression or neu gene amplification
2.1-3 lymph nodes positive and ER, PR negative
3.4 or more positive lymph nodes
What are the risk factors for breast cancer recurrence?
The number of positive axillary lymph nodes is the most valuable and stable of all prognostic factors. In general, at least 10 lymph nodes should be removed for a compliant lymph node dissection. And the higher the number of invaded lymph nodes, the lower the survival rate of the patient and the higher the recurrence rate.
Tumor size is also a very valuable predictive factor in determining the recurrence of metastasis after breast cancer surgery. Tumor size has a linear logarithmic relationship with the probability of eventual metastasis. The larger the tumor, the shorter the time to develop metastasis.
Histologic grading is included. The higher the histologic grade, the greater the risk of recurrence.
HER-2 expression: HER-2-positive breast cancer will have an increased risk of recurrence after surgery.
Lymphovascular and vascular invasion. If postoperative pathology shows lymphatic or vascular invasion, the risk of postoperative recurrence is also increased.
Other risk factors for recurrence include age, hormone receptor status, and postoperative adjuvant therapy. It is generally accepted that age <35 years, negative hormone receptor status, and absence of postoperative adjuvant therapy in high-risk patients may increase the risk of recurrence.
5 years after breast cancer surgery is the risk period for recurrence
Dialing the pendulum against cancer, 1-3 years after surgery is the most critical: for breast cancer patients, 5 years after breast cancer surgery is the high risk of recurrence, with the highest risk from 1 to 3 years after surgery. Once breast cancer recurrence or metastasis occurs, it will be much more difficult to treat and may directly threaten the patient’s life.
Some data show that after breast cancer metastasis occurs, the survival rate of patients will be significantly reduced, for example, the 5-year survival rate of bone metastasis is about 16%, the 5-year survival rate of lung metastasis is about 12%, and the 5-year survival rate of liver metastasis is almost zero.
Generally, breast cancer recurrence can take many forms, mainly local recurrence, contralateral neoplasia and distant metastasis. Contralateral recurrence refers to the occurrence of breast cancer in one breast after mastectomy and then in the other breast. Usually, the risk of primary breast cancer in the opposite breast increases 3-4 times after breast cancer in one side.
Distant metastasis refers to the metastasis of breast cancer to distant parts of the body such as lungs, bones, liver and other organs or tissues through blood channels. Usually nearly 2/3 of breast cancer recurrence will lead to distant metastasis, which is the biggest cause of death from breast cancer. Therefore, experts say that preventing breast cancer recurrence and metastasis within 5 years requires adopting a scientific attitude in deciding treatment plans, as well as supporting patients with care and encouragement.
How to monitor the recurrence and metastasis of breast cancer
After effective treatment, all breast cancer patients should have regular checkups in order to keep abreast of the recovery and whether there is recurrence or metastasis.
The time of review: the month of surgery is the starting time, followed up every three months in the first year after surgery, every six months in the second and third year, and every year after that until the end of life. If you encounter some discomfort in normal times, you should go to the hospital for consultation and treatment in time.
Review items: first of all, check whether the regional lymph nodes are enlarged or not, whether there are small nodules on the skin of the chest wall, the examination of easy metastasis sites such as bone, lung, liver and brain, ultrasound, X-ray radiography, CT, etc. as needed for regular examination.
The immune status of the body, such as cellular immune function and immunoglobulin, can also be checked by blood, and if the immune function is low, it should be corrected and prevented in time. Blood test can also detect tumor markers such as CEA, CAl53 and SF.
CAl53 is a specific indicator to monitor breast cancer recurrence, and its monitoring rate is 33.3%-57%. In patients with elevated indicators before treatment, a decrease in monitoring value indicates good efficacy. Patients who do not return to standard after treatment are more troublesome than those who return to standard levels.
CEA can be increased in 20-30% of breast cancer patients, and exceeding normal after surgery is a little more troublesome than in those who are normal.
In addition, serum ferritin is also associated with disease stage and recurrence. For those tumor markers that are increased before surgery, they can generally be retested on the 6th day after surgery until they return to normal, and should be measured every 3 months in the first year, and every 6 months thereafter. It should be clarified that not all breast cancer patients will have abnormal tumor markers, and a negative result before surgery is not necessary for postoperative measurement as a monitoring tool.
Follow-up clinic: In order to ensure the completeness of the follow-up information, patients (including foreign patients) are required to visit the breast specialist clinic during the follow-up time. The follow-up visit includes: checking the healing of surgical wounds; supervising the implementation of postoperative chemotherapy, radiotherapy and other adjuvant treatments; checking for recurrence or metastatic lesions and timely treatment; checking the contralateral breast; and evaluating the efficacy of new drugs and protocols. If there are no special circumstances, patients are advised to come to the outpatient clinic for follow-up by themselves and should be accompanied by a family member during the visit.
What are the symptoms of breast cancer recurrence and metastasis?
The main symptoms of bone metastasis are fatigue, bone pain, and constant pain in the back of the shoulder, hip and thigh, which is worse at night;
Patients with lung metastasis usually present with cough, shortness of breath, chest pain, etc;
Patients with lung metastases usually present with cough, shortness of breath and chest pain;
The main clinical manifestations of brain metastases are headache, vomiting, loss of vision, and impaired movement of limbs;
Chest wall masses or enlarged lymph nodes are not accompanied by any discomfort and are usually detected by physical examination.