What is breast cancer? Most malignant tumors of the breast originate from the epithelial tissue of the breast (breast cancer), while a few may originate from various non-epithelial tissues of the breast (various sarcomas), and occasionally mixed carcinosarcomas may be seen. The incidence of breast cancer is increasing year by year, with a population incidence of 23 per 100,000; it accounts for 7-10% of all malignant tumors in women.
What causes breast cancer?
The cause of breast cancer is still not fully understood, and there are still many controversial factors that have been proven to cause the disease. Pre- and post-menopausal estrogen is the obvious factor that stimulates the development of breast cancer. In addition, genetic factors, dietary factors, external physical and chemical factors and certain benign breast diseases are related to the occurrence of breast cancer.
What are the symptoms of breast cancer?
The earliest sign of breast cancer is the appearance of a single, painless and progressive lump in the affected breast. The most common lumps are located in the outer upper quadrant, followed by the nipple, areola area and inner upper quadrant. The lumps are often found unintentionally (e.g., bathing, dressing) because there are no conscious symptoms. A small number of patients may have varying degrees of tenderness or irritation and nipple discharge. The growth rate of the lump is fast, and invasion of the surrounding tissues may cause changes in the shape of the breast and a series of physical signs. For example, the skin on the surface of the tumor may be sunken; the cancerous tumor adjacent to the nipple may draw the nipple toward the cancerous tumor; the nipple may be invaginated, etc. If the cancer is larger, it can make the whole breast tissue contract and the lump protrude obviously. The cancer continues to grow and forms the so-called orange peel-like changes. These are all important signs of breast cancer.
When breast cancer develops to advanced stage, skin invasion on the surface may lead to hard skin nodules, or even skin ulcers, and the cancer invades deeper into the pectoral fascia and pectoral muscle, resulting in the lump being fixed in the chest wall and not easily pushed. Lymphatic metastasis of breast cancer is mostly manifested as enlarged lymph nodes in the ipsilateral axilla, which are scattered, painless, hard, less in number and can be pushed; later, the number of enlarged lymph nodes increases and adhere to each other to form a group, which is fixed by adhesion with skin or deep axillary tissues. Few patients may have contralateral axillary lymph node metastasis. In case of distant metastasis of breast cancer, chest pain, shortness of breath and pleural fluid may appear when it reaches the lung; in case of vertebral metastasis, severe pain or even paraplegia may appear at the affected area; in case of liver metastasis, jaundice and hepatomegaly may appear. It should be noted that certain special forms of breast cancer (such as inflammatory breast cancer and eczema-like carcinoma of the nipple) have different development patterns and clinical manifestations from those of general breast cancer.
What tests are needed for breast cancer?
Most patients’ tumors are discovered by themselves. After detailed medical history and clinical examination, most of the lumps can be correctly diagnosed.
X-ray diagnosis: Mammography is a common method for breast cancer diagnosis, which is divided into dry plate and low-dose tonography. The breast tissue of young women is easily damaged by radiation. Therefore, mammography is often not recommended for women under 35 years old.
Ultrasound imaging: Ultrasound imaging is non-invasive and can be used repeatedly. Ultrasonography is often more accurate in determining the size of the lump and can therefore be used to compare the efficacy of non-surgical treatments (e.g. chemotherapy, radiotherapy, endocrine therapy, etc.).
Other diagnostic imaging methods include thermography, near-infrared scanning, CT examination, magnetic resonance imaging, etc.
Laboratory tests: cytology and histological diagnosis; exfoliative cytology; fine needle aspiration cytology (FNAB) is increasingly being adopted for its safe operation and rapid diagnosis. The final diagnosis of breast cancer should come from biopsy.
What are the symptoms of breast cancer?
The earliest sign of breast cancer is the appearance of a small, painless, progressive, solitary lump in the affected breast. Lumps are most commonly found in the outer upper quadrant, followed by the nipple, areola area and inner upper quadrant. The lumps are often found unintentionally (e.g., bathing, dressing) because there are no conscious symptoms. A small number of patients may have varying degrees of tenderness or irritation and nipple discharge. The growth rate of the lump is fast, and invasion of the surrounding tissues may cause changes in the shape of the breast and a series of physical signs. For example, the skin on the surface of the tumor may be sunken; the cancerous tumor adjacent to the nipple may draw the nipple toward the cancerous tumor; the nipple may be invaginated, etc. If the cancer is larger, it can make the whole breast tissue contract and the lump protrude obviously. The cancer continues to grow and forms the so-called orange peel-like changes. These are all important signs of breast cancer.
When breast cancer develops to advanced stage, skin invasion on the surface may lead to hard skin nodules, or even skin ulcers, and the cancer invades deeper into the pectoral fascia and pectoral muscle, resulting in the lump being fixed in the chest wall and not easily pushed. Lymphatic metastasis of breast cancer is mostly manifested as enlarged lymph nodes in the ipsilateral axilla, which are scattered, painless, hard, less in number and can be pushed; later, the number of enlarged lymph nodes increases and adhere to each other to form a group, which is fixed by adhesion with skin or deep axillary tissues. Few patients may have contralateral axillary lymph node metastasis. In case of distant metastasis of breast cancer, chest pain, shortness of breath and pleural fluid may appear when it reaches the lung; in case of vertebral metastasis, severe pain or even paraplegia may appear; in case of liver metastasis, jaundice and hepatomegaly may appear.
How to treat breast cancer?
There are many treatment methods and measures for breast cancer, including surgery, radiotherapy, chemotherapy and endocrine therapy. At present, most of them adopt the comprehensive treatment mainly based on surgery.
1.Surgical treatment: Radical excision of breast cancer has a history of one hundred years and is still the main treatment for breast cancer, and is most effective for early stage breast cancer without axillary lymph node metastasis.
2.Radiotherapy: usually used after surgery to prevent local recurrence. For advanced breast cancer, radiation therapy can shrink the tumor, and in some cases, it can even make breast cancer that is not suitable for surgery metastasize to be surgically resectable. For isolated local recurrent lesions and skeletal metastases of breast cancer, it has certain palliative effect. However, for patients with early breast cancer without lymphatic metastasis, it is not necessary to routinely carry out radiation therapy to avoid damaging the immune function of human body.
3.Endocrine therapy: For primary advanced breast cancer that is not suitable for surgery or radiation therapy, and those with positive estrogen receptor measurement, endocrine therapy can be used alone or in combination. The drugs and means used vary according to the menstrual condition.
Chemotherapy: chemotherapy is a necessary systemic adjuvant treatment (cyclophosphamide, lomustine, nitrogen mustard phenylbutyrate).
Incidence rate and population?
Breast cancer is the most common and important breast disease, with an incidence rate of 23/100,000. The main clinical manifestation is a breast lump. The majority of cases occur in women between the ages of 40 and 60, around the time of menopause. It may be associated with sex hormone disorders. Breast cancer can also occur in men, often secondary to gynecomastia. Therefore, early diagnosis and early surgical treatment is the key.