Tumor is a new organism formed by the loss of normal regulation of its growth by a cell of local tissue at the genetic level under the action of various tumorigenic factors, resulting in its clonal abnormal proliferation. According to the biological characteristics of tumors and their harmful effects on the body, tumors are generally classified into two categories: benign tumors and malignant tumors, and all malignant tumors are always called cancer. Breast cancer is the result of various carcinogenic factors inside and outside the body, the epithelial cells of the breast may lose their normal characteristics and proliferate abnormally, so that they exceed the limit of self-repair and become cancerous and form a lump. Breast cancer is one of the most common malignant tumors in women, according to statistics, its incidence accounts for 7-10% of all kinds of malignant tumors in the body. If breast cancer is not detected early, the cancer cells will spread to other parts of the body, and one of the earliest parts is the lymph nodes in the armpit.
The main symptoms of breast cancer are: breast lumps, breast pain, nipple overflow, nipple skin changes, and enlarged axillary lymph nodes. As long as women have a strong awareness of cancer prevention and a comprehensive understanding and knowledge of breast cancer prevention and treatment, it can play an important role in maintaining breast health and early detection and treatment of breast diseases.
Breast lump is the most common symptom of breast cancer, and about 90% of patients come to the clinic with this symptom. With the popularization of tumor knowledge and cancer screening, this percentage may increase. Among the five areas of breast cancer, the lumps are mostly found in the upper, upper, lower, lower and central areas (areola), followed by upper, lower and lower areas; the number of breast cancer lumps is mostly single lumps in unilateral breast, while multiple lumps and primary bilateral breast cancer are not common.
However, with the improvement of tumor prevention and treatment level, the survival period of patients continues to be prolonged, and the chance of second primary cancer in the opposite breast will increase after surgery of one side of breast cancer; the size of breast cancer lump is usually small in early stage, and sometimes it is not easy to distinguish from lobular hyperplasia or some benign lesions. The majority of breast cancer lumps are infiltrative and the border is not clear. It should be noted that the smaller the breast cancer lump is, or a few special types of breast cancer can be infiltrative and swollen, showing smooth, active and clear border, which is not easy to distinguish from benign tumors; breast cancer lumps are hard in texture, but medullary carcinoma rich in cells can be slightly soft, and individual can be cystic, such as cystic papillary carcinoma. When the tumor invades the fascia of the pectoralis major muscle, the activity is reduced and disappears when the tumor involves the pectoralis major muscle, the patient’s arms are folded and the pectoral muscles are contracted, and the breast is obviously asymmetric on both sides. The lymph nodes around the tumor can be invaded and the skin edema can be orange peel-like, which is called “orange peel syndrome”, and the nodes under the skin around the tumor are called “satellite nodes”.
Among benign breast tumors, it is not uncommon to see breast lumps, the most common of which is breast fibroadenoma, but the disease is more common in young women, and the tumor is often solid, tough, with intact envelope, smooth surface, sliding sensation to touch, generally without skin adhesions, and does not cause nipple retraction. The main symptom is nipple overflow; lobular hyperplasia rarely forms a clear mass, but is mainly a thickening of the local breast tissue, with a tough texture and no sense of envelope, often with swelling and pain before menstruation, and some only show local glandular thickening of the breast and no obvious masses, without clear borders. The difference can be made by mammography.
Although breast pain can be seen in many breast diseases, pain is not a common symptom of breast tumors, whether benign or malignant, and is usually painless. According to some studies, the detection rate of breast cancer is higher in postmenopausal women with breast pain and glandular thickening. Of course, there can be swelling and pain or pressure when the tumor is accompanied by inflammation.
There are physiological and pathological nipple overflow, physiological nipple overflow is mainly seen in pregnant and lactating women, pathological nipple overflow refers to the secretion of milk ducts under non-physiological condition, which is usually referred to the latter. Nipple discharge can be caused by a variety of breast diseases and is easily noticed by patients. It is one of the main reasons why about 10% of patients come to the clinic and is second only to breast lumps and breast pain among the symptoms of various breast diseases. Nipple discharge can be classified according to its physical nature: bloody, serous, plasma, watery, purulent, and milk-like. Among them, plasma, watery and lactic overflows are more common, and bloody overflows account for only 10% of overflows. When the lesion is located in the large duct, the overflow is mostly bloody; when it is located in the smaller duct, it can be light blood or plasma; if the blood stays in the duct for too long, it can be dark brown; when there is inflammation combined with infection in the duct, it can be mixed with pus, liquefied necrotic tissue can be watery, lactic or brown liquid; the fluid of ductal dilatation is often plasma.
Most of the hemorrhagic overflow is caused by benign lesions, but a few breast cancers can also be hemorrhagic. Physiologic nipple discharge is mostly bilateral, and the fluid is often milky or watery. The causes of nipple discharge are mainly divided into extramammary and intramammary factors. In breast cancer, the nipple discharge is often monoductal and can have various characteristics, such as bloody, plasma, watery or colorless. It is noteworthy that although most people believe that breast cancer is rarely accompanied by nipple discharge, and even if there is discharge, it is almost always after or at the same time as the appearance of a lump, and those without a lump are rarely considered to be cancerous, recent studies have shown that nipple discharge is the most common cause of breast cancer. However, recent studies have shown that nipple discharge is an early clinical manifestation of some breast cancers, especially intraductal carcinoma, and can exist alone before the formation of a significant lump. Intraductal papilloma is a disease that occurs more often in nipple discharge, accounting for the first of all nipple discharge lesions, among which intraductal papilloma in the areola area is the most common, either solitary or multiple, with age distribution ranging from 18 to 80 years old, but mainly common between 30 and 50 years old, with tumor diameter ranging from 0.3 to 3.0 cm, with an average of 1.0 cm, and greater than 3.0 cm is often malignant. It is generally believed that papillomas in large ducts are solitary and rarely become cancerous, while those in small and medium ducts are often multiple and can become cancerous. Cystic hyperplasia is the most common benign lesion in breast tissue, mostly seen in premenopausal women, but rarely seen after menopause, in which cysts, ductal epithelial hyperplasia and papillomatosis are the basis of its overflow.
Nipple skin changes are one of the main signs of breast cancer. The nipple is flattened, retracted, and sunken until it is completely retracted under the areola and the nipple is invisible, sometimes the whole breast is elevated and both nipples are not on the same level. Nipple erosion in breast cancer patients usually starts with nipple debridement or small nipple fissures, nipple debridement is often accompanied by a small amount of secretion and crust, and the scabs are removed to reveal a bright red erosion surface that does not heal over time. In breast cancer patients, nipple retraction is the result of the tumor invading the nipple or the subareolar area. The fibrous tissue and duct system of the breast may shorten as a result, pulling the nipple, making it concave, deviated or even completely retracted into the back of the areola, at this time, the affected nipple is often higher than the healthy side. Of course, nipple retraction and indentation are not always malignant lesions. Some of them can be caused by congenital dysplasia or chronic inflammation, and in this case, the nipple can be pulled out by fingers and is not fixed. Skin changes of breast cancer are related to the location, depth and degree of invasion of the tumor, and usually have the following manifestations.
(1) Skin adhesion: The breast is located between the deep and superficial fascia, the superficial layer of superficial fascia is attached to the skin, and the deep layer is attached to the superficial surface of pectoralis major muscle. The superficial fascia forms lobular intervals in the breast tissue, i.e. breast suspensory ligaments. When the tumor invades these ligaments, it can shrink and shorten them and pull the skin to form a depression, which is like a dimple, so it is called “dimple disease”. When the tumor is small, it can cause very slight skin adhesion, which is not easy to detect. At this time, we need to lightly hold the affected breast under better lighting conditions to increase its surface tension, and when we move the breast, we can see that the skin on the surface of the tumor is slightly pulled and sunken. If you have this symptom, you should be alert to the possibility of breast cancer, but benign tumors rarely have this symptom.
(2) Superficial skin varicose veins: When the tumor is large or growing fast, the surface skin can become thin and the superficial blood vessels and veins under it can often be varicose. It is clearer in LCD thermogram and infrared scan, and is commonly seen in giant fibroadenoma and lobulated cystic sarcoma of the breast. Tumors in the acute inflammatory phase, pregnancy, and lactation also often have superficial varicose veins.
(3) Redness of skin: In acute and chronic mastitis, the skin of the breast may be red and swollen. However, in breast cancer, it is mainly seen in inflammatory breast cancer. The skin color is light red to deep red, which is limited at first and soon extends to most of the breast skin, accompanied by skin edema, thickening and skin temperature increase.
(4) Skin edema: Because the subcutaneous lymphatic ducts of breast are blocked by tumor cells or the central area of breast is infiltrated by tumor cells, the reflux of breast lymphatic ducts is blocked, lymphatic fluid accumulates in the lymphatic ducts, the skin becomes thicker, and the opening of hair follicle is enlarged and deeply sunken, showing “orange peel-like changes” (medically called “orange peel”). “). In obese, sagging breasts, mild skin edema is common underneath the outer part of the breast. In addition, advanced breast cancer may directly invade the skin and cause ulcers, which may smell bad if combined with bacterial infection. If the cancer cells infiltrate into the skin and grow, they may form scattered hard nodes in the skin around the main lesion, which is called “skin satellite nodes”.
Enlarged lymph nodes in the axilla of breast cancer are caused by the progressive development of the tumor to the lymphatic vessels and metastasis to its local lymphatic drainage area. The most common site of lymphatic metastasis is the ipsilateral axillary lymph node. At first, the enlarged lymph nodes can be pushed, but finally they fuse with each other and become fixed. If the enlarged lymph node invades and compresses the axillary vein, it can often cause edema in the ipsilateral upper limb; if it invades the brachial plexus nerve, it can cause shoulder pain. When examining the axillary lymph nodes, the upper limb on the affected side should be relaxed as much as possible so that the top of the axilla can be palpated. If the enlarged lymph nodes can be palpated, the number, size, texture, mobility and surface of the lymph nodes should be noted in order to differentiate them from inflammation and tuberculosis.
When the swollen lymph nodes in the axilla are pathologically confirmed to be metastatic cancer, in addition to careful examination of the lymphatic drainage area, lung and gastrointestinal tumors should also be excluded. If the pathology suggests metastatic adenocarcinoma, we should pay attention to the possibility of “occult breast cancer”. In this case, the breast lesion is usually not detected and mammography may be useful for diagnosis. If the lymph nodes are positive for hormone receptors, even if all tests fail to detect a breast lesion, it is still important to consider a tumor of breast origin. Breast cancer can metastasize to the ipsilateral axillary lymph nodes and also to the contralateral axillary lymph nodes through the intercommunication between the anterior chest wall and the internal breast lymph network, with an incidence of about 5%. In addition, advanced breast cancer may also have ipsilateral supraclavicular lymph node metastasis or even contralateral supraclavicular lymph node metastasis. In inflammatory breast cancer, the skin is typically inflammatory: the color ranges from pale red to deep red, and it is limited at first, but soon expands to most of the breast skin, accompanied by skin edema. The skin is thickened, rough and has an increased surface temperature.
Risk factors for breast cancer include: early onset of menstruation (before the age of 13); late menopause (55 years old); unmarried or late childbirth (35 years old); no breastfeeding after childbirth; significant weight gain and obesity in postmenopausal women; family history of breast cancer in the maternal line or sisters; and a higher chance of occurrence in such people;
Long-term estrogen supplementation after menopause, or long-term use of estrogen-based cosmetics, or other causes of elevated estrogen in the body; postmenopausal hyperplastic breast disease, especially those with atypical hyperplasia; repeated radiation to the chest when young; heavy alcohol consumption, smoking, etc. The cause of breast cancer is not clear at present, but breast cancer is very closely related to endocrine hormones. Endocrine hormones are related to nutrition, for example, the early onset of menstruation due to large intake of fat and protein during childhood, parents should reasonably adjust the diet of children, adolescent girls should also pay attention to it, in addition to doing exercises, postmenopausal women should also control their weight, eat more vegetables and fruits, strengthen exercise and promote breastfeeding.
Breast cancer is a common and frequent disease that seriously threatens women’s health, yet many breast cancers are difficult to be detected at an early stage so far. In fact, it is not difficult to detect and diagnose breast cancer at an early stage, as long as you are careful and often conduct self-examination of your breasts, and go to the hospital for further examination and diagnosis when you find abnormalities, you will not miss the traces of breast cancer. Breast self-examination is simple and can be done when you wake up, sleep, change clothes or take a shower. The American Cancer Society recommends three methods of breast self-examination: Self-examination in the mirror: First, face the mirror, cross your arms and observe the shape of your breasts. Then raise your arms above your head and carefully observe whether there is any change in the shape and contour of both breasts; whether there is any redness, rash, superficial venous anger, skin folds, orange peel-like changes and other abnormalities in the skin of the breasts; whether the nipples are at the same level, whether there is elevation, retraction, depression, whether there is abnormal discharge from the nipples, and whether there is any change in the color of the areola.
Finally, put down both arms, cross the waist with both elbows and work backwards, so that the chest muscles are taut, and observe whether both breasts are equal and symmetrical, and whether there are any abnormalities in the nipples, areolas and skin. Flat touch method: first take the supine position, the right arm is raised above the head and a small pillow under the right shoulder, so that the right breast becomes flat. Then put the four fingers of the left hand together and use the palm of the fingertips to check for lumps or other changes in various parts of the breast. There are three methods of examination: one is the clockwise circular examination method, in which four fingers are used to examine the breast from the nipple area in a circular fashion from the inside out. The second is the vertical belt examination method, in which the four fingers are used to examine the entire breast from top to bottom. The third is the wedge examination method, in which the four fingers are used to examine the breast in a radial pattern from the nipple outward. The left breast is then examined in the same way, and the two breasts are compared for differences.
Finally, use your thumb and index finger to gently squeeze the nipple, and report any clear or bloody discharge to the doctor. Shower examination method: When showering, it is easier to find breast problems because the skin is moist. This is done by slowly sliding the palm of one finger and carefully examining all parts of the breast and the armpit for lumps. Breast examinations should be performed frequently. The best time for breast self-examination is usually the 9th to 11th day after the onset of menstruation. This is when estrogen has the least effect on the breast and the breast is in a relatively static state, making it easy to detect lesions. Also note that bras should be worn properly, too tight, too thick, poor ventilation, will affect the normal circulation of lymphatic fluid in the breast, can not remove harmful substances in a timely manner, over time, easy to make breast cell lesions.
There is no need to be nervous when self-examination reveals breast hyperplasia, because breast hyperplasia is not equal to pre-cancer, but we should not be paralyzed and should still insist on frequent self-examination. If there is cystic hyperplasia, lump or nodule, it may develop into breast cancer, therefore, although the incidence is not high, it should be treated as soon as possible. Once a woman finds suspicious signs during breast self-examination, she should go to a breast specialist (surgery or internal medicine) in a hospital for mammography and ultrasound examination to further clarify the diagnosis. At present, mammography and ultrasound are recognized as the most common and effective adjuvant examinations for breast cancer in clinical practice. Especially, the new generation of digital mammography makes the images clearer and the diagnosis rate of early breast cancer is higher, and its accuracy rate of differentiating benign and malignant tumors can even reach over 90%. Practice also shows that 85% of breast cancer patients under 50 years old are detected by mammography. Mammography screening can reduce the mortality rate of breast cancer in women over the age of 50 by 30%.
Therefore, the American Cancer Society recommends that women between the ages of 35 and 39 should undergo mammography screening once; after the age of 40, every one or two years; and after the age of 50, once a year. Ultrasound is also one of the common screening methods for breast diseases and can be used in combination with mammography. This method is non-toxic, harmless and easy to use, and can identify benign and malignant, cystic and solid, hyperplasia and other breast diseases.
However, ultrasonography can sometimes give false positives, and it is difficult to confirm the diagnosis for masses smaller than 1 cm. If the patient has nipple overflow (flowing water), breast ductoscopy can also be used. This method has a high confirmation rate and is less painful, and most patients can be diagnosed, but should be tested for hepatitis B surface antigen (HBsAg) and, if necessary, for HIV to prevent cross-infection from occurring. Pathological examination is essential for clinical diagnosis of breast cancer and is mainly used for mammography and B-ultrasound examination for suspicious cases. Pathological examination includes cytopathological examination and histopathological examination. Cytopathological examination is less invasive, less painful, faster and more convenient. Histopathological examination can not only characterize, but also determine the type of tumor before surgery and provide reference for treatment. The new generation of tissue aspiration equipment can even aspirate (excise) early cancer lesions without surgery.
The common treatment for breast cancer is still based on traditional surgery, supplemented by local or systemic radiation therapy, chemotherapy, endocrine and biological therapy after surgery to achieve high survival rate or even clinical cure, but the problem of postoperative recurrence and distant metastasis is still a major problem for scholars. With the rapid development of molecular biology and immunology technology and the deepening of human understanding of the pathogenesis of breast cancer, gene therapy led by translational medicine is gradually becoming an important part of tumor biology treatment, and has shown good application in breast cancer treatment, and has achieved certain effect.