1.Who are prone to breast cancer?
A: 1) Those with family history, if immediate family members such as mother, sister or daughter have breast cancer, then the chance of their own disease will increase 3-5 times.
2) Reproductive factors: first menstruation earlier than 12 years old, or age of menopause later than 55 years old, age of first pregnancy older than 30 years old, not having children, etc.
3) Hormones: long-term use of birth control pills and estrogen-containing foods and drugs, etc.
4) nutritional factors: long-term excessive alcohol consumption, long-term excessive high animal fat diet, etc.
5) environmental factors: those with a history of radiotherapy or radiation exposure, such as survivors of atomic bombings, etc.
(6) Other factors: postmenopausal obesity, history of atypical hyperplasia of the breast, etc.
2.What are the clinical manifestations of breast cancer?
A: Most of the early stage patients have no obvious symptoms, but as the disease progresses, the following symptoms and abnormal breast signs will appear.
(1) Breast lump. 80% of patients have breast lump as the first symptom, mostly solitary, hard texture, irregular margin and painless.
2) Nipple overflow. Brown or even bloody fluid secretion from the nipples, unrelated to pregnancy.
(3) Skin changes: the most common are skin adhesions and local depressions (dimple sign); in advanced stages, there may be thickening of the skin, dilatation of the hair follicle opening, and deep sinking, showing the typical “orange peel sign”.
(4) Nipple abnormalities: nipple retraction or elevation, erosion and other abnormalities.
(5) Axillary mass: enlarged lymph nodes appear in the ipsilateral axilla, sometimes they may fuse into a mass and become fixed.
3.What are the common examination means for breast cancer?
(1) Physical examination: Visual examination: changes in breast morphology and skin, symmetry, nipple retraction and erosion, abnormal skin color, edema and orange peel sign, etc.
Palpation: check the breast and surrounding lymph nodes clockwise or by quadrant with the fingertips.
2) Laboratory tests: blood routine, blood biochemistry. Tumor markers such as CEA, CA-153, etc.
3) Imaging examinations: mammogram, breast ultrasound, breast magnetic resonance imaging (MRI).
(4) Pathological examination: It is the “gold standard” of breast cancer diagnosis and is often used for the selection of treatment plan, judgment of treatment effect and prognosis analysis.
4.What are the characteristics of different imaging examinations for breast cancer?
A: 1) Mammography. It is the most commonly used clinical adjuvant examination method, which is simple and convenient and can make judgments on most breast cancer lesions. It is simple, convenient and can determine most of the breast cancer lesions. It should be noted that mammograms are sometimes more difficult to judge in oriental women, especially in women with enlarged and full breasts.
2) Breast ultrasound. Economical, simple, non-invasive and painless; it is often used to examine young women, especially pregnant and lactating women, to identify solid masses and fluid-filled cysts, and to examine both the breast and axillary lymph nodes.
(3) Magnetic resonance imaging (MRI): high resolution, can identify microscopic lesions, and is often used for staging assessment, tumor scope determination, determining whether there are multifocal fire multicenter tumors, and can also be used for surgical evaluation before breast conservation.
5.What are the stages of breast cancer?
A: Staging of breast cancer is extremely important, as it determines the treatment plan and prognosis. Early stage (stage I) is more than 90% curable, while advanced stage has significantly lower cure rate. Tumor size (T), lymph node metastasis (N) and the presence of distant metastasis (M) are the three determinants of staging.
Stage I. Tumor ≤50px with no or only minor lymph node metastasis; or no evidence of primary focus but minor lymph node metastasis.
Stage II. Tumor > 50px without lymphatic metastasis; or tumor > 50px but < 125px with metastasis in axillary lymph and good lymph node mobility.
Stage III. Regardless of tumor size, axillary lymph node metastasis with fusion and fixation, or supraclavicular lymph node metastasis; or tumor invading chest wall or skin, but no lymph node metastasis.
Stage IV. Regardless of tumor size and lymph node status, but distant metastasis occurs
6.What are the staging of breast cancer?
A: According to the hormone receptor and HER-2 receptor staging, called molecular staging.
(1) Luminal A: ER/PR positive, HER-2 negative, Ki-67 low expression; most of this type only need endocrine therapy
2) luminal B: ER/PR positive, HER-2 negative, Ki-67 high expression (HER-2 negative type) Most of this type requires endocrine therapy + chemotherapy.
ER/PR positive, HER-2-positive, Ki-67 high expression (HER-2-positive type)
Most of this type requires endocrine therapy + chemotherapy + anti-HER-2 therapy
3) HER-2-positive type: ER/PR negative, HER-2-positive, regardless of Ki-67. This type requires chemotherapy + anti-HER-2 therapy
4) Triple negative breast cancer: ER/PR negative and HER-2 negative, this type needs chemotherapy.
7. How to detect HER-2 expression?
A: Detection of HER-2 expression is of great significance in determining the prognosis of breast cancer and formulating treatment plan. FISH is more sensitive and accurate, but the detection technique is demanding and expensive.
HER-2 immunohistochemistry can be considered negative if it is detected as 0 or +.
++ is indeterminate and can be tested again by FISH method.
+++ can be regarded as positive and does not need to be tested by FISH.
8.What are the main treatment methods for breast cancer?
A: The treatment methods of breast cancer include surgery, chemotherapy, radiotherapy, endocrine therapy and molecular targeted therapy, in addition, immunotherapy and Chinese herbal medicine treatments also occupy a certain position.
1) Surgical excision. It is mainly applied to early stage breast cancer, and the scope of surgery is developing in the direction of narrowing in recent years.
2) Radiotherapy. It is a local treatment method, mainly used for postoperative adjuvant treatment for high-risk patients and palliative treatment for locally advanced patients.
(3) Chemotherapy. It is a systemic treatment method, mainly used for patients with risk of recurrence, preoperative neoadjuvant, postoperative adjuvant treatment, also used for relief treatment of advanced patients and palliative treatment of some patients.
4) Endocrine therapy. It is a systemic therapy, mainly used for preoperative neoadjuvant or postoperative adjuvant treatment for patients with estrogen and, or progesterone receptor positive patients, or rescue treatment for patients with advanced disease.
5) Molecular targeted therapy. It is an important tool for breast cancer treatment. For HER-2 positive (amplified) patients, the applied drugs include Herceptin, Lapatinib, Patuximab, T-DM-1, etc., with positive efficacy.
6) Bioimmunotherapy and Chinese herbal medicine treatment. It has a certain effect on improving the immunity of patients and regulating the function of organs of the body, which is an important part of comprehensive treatment.
9.How to prevent postoperative lymphedema?
A: Surgical resection of breast cancer often requires lymphatic dissection, resulting in lymphatic vessel dissection, lymphatic flow obstruction, and consequently edema. If not handled properly, lymphangitis can easily be combined with lymphoma, and sometimes the edema is very serious. Adequate attention should be given to.
Early postoperative period: the arm on the operated side should be elevated with pillows in the lying position, and the arm on the operated side should be placed on the chest in the sitting position to avoid prolonged drooping of the operated arm.
Avoid excessive weight-bearing or mechanical stimulation of the operated arm.
Avoid mosquito bites or infections on the operated arm, and avoid sun exposure.
Avoid wearing tight underwear or halter bras.
Perform progressive rehabilitation training, such as wall climbing, as early as possible after surgery.
If you feel swelling in the affected arm, or arm discomfort, use a tape measure to measure the thickness of the upper limbs bilaterally to identify edema as early as possible, and if necessary, go to the hospital for early intervention and treatment. The more timely the treatment, the better the effect.
10.How to carry out rehabilitation training after surgery?
A: Day 1 after surgery: shoulder joint braking, fist clenching, elbow flexion and extension exercises.
2-5 days after surgery: use the upper arm on the healthy side to help the arm on the operated side to do front supination, so that the upper arm on the affected side is straightened as much as possible until it exceeds the top of the head.
1 week postoperatively: gradual upward crawling of the fingers of the affected side along the wall so that the palm of the hand goes over the top of the head and touches the contralateral ear as far as possible.
(b) Postoperative day 9: rotational movements of the patient with the shoulder joint as the axis.
Postoperative day 10: Gradually do upper limb lifting, rotation and abduction exercises according to the physical strength and wound healing.
11.What should I pay attention to in my postoperative diet?
A: During treatment, avoid estrogen-containing foods, such as snow clams, sheep placenta, etc. Diet should be mild and moderate, avoiding cold, sour and spicy stimulating foods. In general, the following principles apply.
High-calorie diet: contain moderate amount of sugar to supplement calories and consume more sugar-rich foods such as rice and noodles.
High protein diet: easily digestible, high-protein foods such as milk, eggs, fish, soy products, etc., which can improve the immunity and anti-cancer ability of the body.
High vitamin diet: fresh fruits and vegetables.
Adequate hydration: drinking more water.
12.What are the precautions for targeted therapy?
A: At present, the approved targeted therapy drugs listed in China are Herceptin and Lapatinib. These drugs have mild side effects and are well tolerated.
When Herceptin and other drugs are first applied, fever and cold-like symptoms can occur, most of them are mild and do not need to be treated.
When Herceptin is used alone, cardiac side effects are rare; when combined with anthracyclines, such as adriamycin, cardiac toxic side effects increase, manifesting as reduced cardiac ejection fraction (EF) on echocardiography, which can generally be recovered with brief discontinuation of the drug. If there is underlying cardiac disease, the drug should be used with caution.
Lapatinib adverse reactions include rash, diarrhea, skin changes, and effects on heart and liver function. The drug may be taken one hour before or one hour after a meal, avoiding grapefruit and grapefruit juice during this time. When rash appears, avoid using alkaline soap, avoid sun exposure, pay attention to shade and sun protection when going out, wear soft and clean clothes to keep skin from stimulation.
13.What are the precautions for endocrine treatment?
A: The following matters should be noted in endocrine therapy.
Adhere to taking it for a long time. Most of the endocrine therapy drugs need to be taken for a long time of 5 or even 10 years, therefore, it is very important to take them consistently. Regular check of liver function during medication, usually about 2-4 times a year.
Prevention and treatment of osteoporosis. Aromatase inhibitors can cause bone loss and decreased bone mass, which in turn can lead to osteoporosis. To check bone density regularly and administer bisphosphonate therapy or active vitamin D and calcium supplementation if necessary.
Menstrual disorders and hot flashes symptoms: endocrine drugs can interfere with the body’s hormone metabolism, which can cause abnormal menstruation and reversible amenorrhea, and can also cause fatness, sweating, hot flashes and other symptoms, which generally do not affect the treatment and do not require excessive stress.
14.What are the precautions for chemotherapy?
A: Among all treatments for breast cancer, chemotherapy has relatively more adverse events and greater impact, which should be addressed or dealt with in a timely manner by paying attention to.
Prevention of oral ulcers: keep the mouth clean and gargle with salt water; appropriate food temperature and avoid irritating food or rough and raw food.
Prevent constipation: most of them have poor appetite and eat less during chemotherapy; also the application of antiemetic drugs affects gastrointestinal peristalsis, and all these reasons can cause constipation. Prevention: appropriate increase in fiber diet, such as vegetables, fruits, grains and cereals; a glass of water in the morning, regular bowel movements; moderate exercise to prevent constipation.
Diarrhea care: take antidiarrheal medication as prescribed by the doctor; eat a light diet and pay attention to maintaining water-electrolyte balance; clean food.
15.What should be noted for platelet and white blood cell reduction?
A: thrombocytopenia is should pay attention to the following points.
moderate activity, slow movements to avoid bumping and bleeding; remember to avoid strenuous exercise.
Brush teeth with a soft toothbrush, or use mouthwash to prevent bleeding gums.
Avoid emotional excitement.
The most important thing is to apply platelet-raising drugs to boost platelets as soon as possible.
The following points should be noted in case of leukopenia.
Paying attention to rest, drinking more water and taking appropriate indoor exercise.
Pay attention to indoor ventilation.
Paying attention to keeping warm and preventing the occurrence of colds.
Apply leukopoietic drugs to boost leukocytes and get through the ground leukocyte phase as soon as possible.
16.How to reduce nausea and vomiting caused by chemotherapy?
A: Nausea and vomiting are the most common toxic side effects of chemotherapy, ranking among the top two in various toxic side effects. Effective prevention of nausea and vomiting can not only reduce the patient’s discomfort, but also ensure the smooth implementation of effective treatment and thus ensure good results of treatment, which is of great significance. To reduce the symptoms of nausea and vomiting, special attention should be paid to the following points.
Reasonable use of antiemetic medications.
Diet following the principle of small and frequent meals, light and varied.
Food should be mild and non-stimulating, avoid high-fat diet.
avoiding too cold and too hot foods, and eating more appetizing foods, such as sour plum soup
Mental relaxation, reduce anxiety and distraction.
17.Why is it necessary to review regularly?
A: With the continuous improvement of medical technology, long-term survival of breast cancer is no longer a dream, and the number of long-term survival is increasing, so regular follow-up checkups after surgery is especially important.
On the one hand, it can help to understand the degree of healing of surgical wound, monitor the implementation of adjuvant treatment such as chemotherapy and radiotherapy after surgery, detect early recurrence and metastasis of tumor in time, and take necessary and appropriate remedial measures as early as possible to improve the prognosis.
On the other hand, through regular review, physicians and patients can communicate well, understand the condition and psychological changes in a timely manner, and take corresponding measures to better promote patients’ recovery.
More and more evidence shows that most postoperative recurrences of breast cancer occur within 3-5 years after surgery. Therefore, paying attention to postoperative review can effectively achieve the three early stages, i.e. early detection, early diagnosis and early treatment, and thus effectively improve the prognosis.
18.What should be included in the regular review?
A: Regular post-operative review of breast cancer should include the following.
Clinical examination: every 4-6 months within 2 years after surgery, every 6 months within 3-5 years after surgery, and once a year after 5 years after surgery.
Breast ultrasound: every 6 months.
Mammogram: once a year.
Chest X-ray or CT: once a year.
Ultrasound of the abdomen: every 6 months for 3 years after surgery and once a year after 3 years
Bone scan at the start of treatment if there are risk factors such as four or more axillary lymph node metastases, and whole-body bone scan once a year, changing to once every two years after five years
If tamoxifen endocrine therapy is applied, examination of the uterus and its adnexa is performed once a year to understand the endometrial condition and prevent the occurrence of endometrial cancer.
19.How to carry out dietary modification?
A: Dietary principles.
Balanced diet and reasonable nutrition. The diet should be moderate, not excessive, with appropriate supplements and balanced nutrition.
Suitable diet for breast cancer patients.
It is advisable to eat more beans, vegetables, mushrooms, barley and seafood, such as seaweed and kelp.
Diet not suitable for breast cancer patients.
Stay away from hormones, such as snow clams, royal jelly, sheep placenta, birth control pills, etc.
Reducing the intake of high-calorie and high-fat foods.
Avoiding tobacco, alcohol, coffee, etc.
Reducing cold and spicy foods.
Avoid moldy and pickled food.
20.How to do psychological adjustment?
A: In addition to physical rehabilitation, psychological rehabilitation is also very important for breast cancer patients. Clinically, it is often seen that under the same medical condition, patients who are optimistic and confident in treatment have better results than those who are negative and depressed and feel sorry for themselves. Therefore, effective psychological adjustment is of great significance to build up confidence to overcome the disease and recover as soon as possible.
Firstly, breast cancer should be regarded as a chronic disease; in 2006, the World Health Organization (WHO) has declared that cancer is a controllable and treatable chronic disease, the basic meaning of which is that through systematic treatment, the disease can be effectively controlled and stopped from progressing, making it a chronic disease like hypertension.
Secondly, unwarranted worries have no positive effect except aggravating the disease and reducing the efficacy of treatment. On the contrary, optimism can even improve the immune status and facilitate the recovery of the disease.
Active participation in social activities, realizing social roles and finding joy in the group will also play a positive role in full recovery.