1. Is breast cancer hereditary?
Whether breast cancer is hereditary or not is a question of great concern to patients and their families. Indeed, genetic factors play a role in the development of breast cancer. Studies have found that if a woman has a family history of breast cancer, if her mother or sister had breast cancer before menopause, her risk of developing breast cancer is 6 times higher than normal. If a woman’s mother or sister has had bilateral breast cancer, her risk of breast cancer is 8 times higher than normal, i.e. the average age of breast cancer in the second generation of breast cancer patients is about 10 years earlier than that of the general population, mostly before menopause. If a mother has breast cancer, but two of her sisters have breast cancer, the risk is three times higher than normal. However, it is important to emphasize that breast cancer is not directly inherited, but is a “cancer quality” that is inherited as a susceptibility to breast cancer (i.e., a predisposing factor for breast cancer), not breast cancer itself. This means that breast cancer is not an inevitable genetic disease and that relatives of breast cancer patients do not necessarily have breast cancer, but are more likely than the general population to have breast cancer. The occurrence of breast cancer is also related to other factors, such as fertility, diet, endocrine, etc. Only the combination of multiple factors will cause breast cancer to occur. To clarify these, there are two aspects to guide people with family history of breast cancer. On the one hand, you should avoid unnecessary fear and mental burden and realize that breast cancer is not directly inherited; on the other hand, you should pay attention to the prevention of breast cancer by taking some preventive measures and regular breast self-examination. If breast lumps are found, it is important to consult a doctor as early as possible to facilitate the early detection, diagnosis and treatment of breast cancer and to increase the cure rate, which is very meaningful for people with family history of breast cancer. Wu Kejin, Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University
2.What is breast-conserving surgery?
It is a surgical procedure relative to radical mastectomy, mainly through local excision of breast tumor, coupled with regular chemotherapy and radiation therapy, to achieve the same treatment effect as radical mastectomy, while maintaining a better appearance and upper limb movement function, and improving the patient’s quality of life. This surgical method has become a routine treatment in developed western countries.
3.What is “receptor positive”?
When breast cancer patients visit the doctor, they often ask about “receptors”. What are they and what are their functions?
About 60-70% of breast cancer is related to female hormones, which means that if female hormones are suppressed, cancer cells may be suppressed. Therefore, it is important to know the status of estrogen and progesterone receptors of patients during the treatment process to guide the treatment. Patients with positive “receptors” tend to respond well to endocrine therapy. Commonly used endocrine therapy drugs include: triamcinolone, fluron and phalloctone.
4.What are the anterior lymph nodes?
Recently, it has been found that if cancer cells do not metastasize in the lymph nodes that first flow from the lesion (called “sentinel lymph nodes”), it can be said that there is more than 95% possibility of not metastasizing to other lymph nodes. For this reason, if the CT test results suggest no axillary lymph node metastasis, we can find the sentinel lymph node and remove it for examination during surgery, and if there is no metastasis, then we can not perform axillary lymph node dissection.
5.What is targeted therapy
Scientific development has made it possible to study the development of breast cancer and other malignant tumors at the molecular level, and to design new drugs targeting different targets at the molecular level. For example, HER2 overexpression is an early event in tumor formation, while HER1 overexpression is a more advanced event in tumor development. Breast cancers that express both HER1 and HER2 are mostly resistant to endocrine therapy. Therefore, drugs targeting the HER family are a hot topic of research. Trastuzumab (Herceptin), a recombinant humanized monoclonal antibody against the HER2 receptor, is the first molecularly targeted drug in the field of breast cancer treatment. The efficiency of Herceptin monotherapy is 15%-30%, and the combination with chemotherapy can better improve the efficacy.
6. What are the differences between endocrine therapy before and after menopause?
Since estrogen in the body can stimulate the proliferation of breast cancer cells, inhibiting the effect of estrogen can achieve the effect of inhibiting tumor cells. In pre-menopausal patients, estrogen in the body mainly comes from the ovaries, so removing the function of the ovaries through drugs or surgery (depot treatment) is one of the options for pre-menopausal patients; while for post-menopausal patients, estrogen mainly comes from androgens secreted by the adrenal glands converted by aromatase, so the use of aromatase inhibitors (e.g. Fluron) can inhibit the production of estrogen and achieve the purpose of tumor suppression. In contrast, estrogen-only inhibitors (such as triamcinolone) can be used for both pre- and post-menopausal patients.
7.What is a mammogram?
”Mammography is actually an x-ray diagnosis of the breast using a special x-ray device for mammography. Because the breast is mainly made up of soft, fatty tissue, the film is taken between special plastic plates to detect abnormalities such as breast lumps, calcifications and structural deformities of the breast. Clamping them tightly may be a little painful, but you can get a good film that will help to make a correct diagnosis.
8, radiotherapy patients sometimes have discomfort in the lower throat what to do
Chest receive radiotherapy disease, people when radiotherapy to about two weeks, patients will appear hypopharyngeal pain or discomfort behind the sternum, especially when eating buns, rice, this is because in the radiation field of the esophagus received radiotherapy, mucosal congestion, edema, which is generally mostly a temporary phenomenon, through into soft, light food, radiotherapy field changes, the above symptoms will be reduced or adapt, patients should not be anxious. If the symptoms are aggravated and the patient cannot eat, the symptoms can be relieved by infusion, oral local anesthetic drugs, or even suspension of radiotherapy.
9.What is “PET” examination
Positron emission tomography (PET) is a functional test that reflects the metabolic differences between tumor cells and normal tissues with the help of different molecular imaging agents, and then infer the biological characteristics of tumors. 18FDG PET is performed by applying the principle that 18F positron-labeled deoxyglucose, formed as FDG-6 phosphate by the action of hexokinase, is not involved in normal glucose metabolism, but has a higher radioactive concentration in the highly glycolytic tumor site. Usually, the higher the malignancy of the tumor, the more FDG aggregation, on the contrary, low metabolic benign diseases have less or no FDG concentration, therefore, 18FDG PET imaging is not only used for tumor diagnosis, but also for differential diagnosis of benign and malignant diseases.
10.How to treat breast cancer bone metastasis
The main goals of comprehensive treatment for breast cancer bone metastasis are: ① to relieve pain, restore function and improve quality of life; ② to prevent and treat SRE; ③ to control tumor progression and prolong survival.
Treatment principles: Breast cancer bone metastasis is already a systemic disease and the treatment options include: ① chemotherapy, endocrine therapy, molecular targeted therapy, etc.; ② bisphosphonate therapy; ③ surgery; ④ radiation therapy; ⑤ analgesia and other supportive treatments. Doctors should make individualized and comprehensive treatment plans according to patients’ specific conditions.
11.How should breast cancer patients be followed up?
Follow-up time: every 3 months for 2 years after treatment, every 6 months for the next 3 years (that is, 3-5 years after surgery), and then every year after that. If you are unable to come to the hospital for follow-up, you can send a letter or telephone to follow up.
Follow-up testing items: routine blood, liver and kidney function tests. Chest X-ray, ultrasound (breast and regional lymph nodes, liver area). Mammography. 4. Observe the presence of lumps around the breast and its incision, the cosmetic effect of the breast after breast conservation surgery, the lymphedema of the affected upper limb and the recovery of the function of the upper limb. For those who are suspected of having bone metastasis, whole body bone scan should be performed.
12.Will lobular hyperplasia become cancerous?
Recent studies have shown that simple lobular hyperplasia without ductal epithelial hyperplasia, which accounts for 70% of all breast hyperplasia, will not turn into breast cancer. The percentage of mammary hyperplasia with ductal epithelial hyperplasia but without epithelial cell anisotropy is 20%, and the malignancy rate is 1-2%. Ductal epithelial hyperplasia with mildly heterogeneous epithelial cells has a malignancy rate of 2-4%. In ductal epithelial hyperplasia, if the epithelial cells are severely heterogeneous, the rate of malignancy is 75%-100%, although the incidence is only 5%. Therefore, although only a very small number of mammary gland hyperplasia can become cancerous, but still should not be careless, every three months or six months should go to the hospital to review. If a unilateral lesion of limited scope is found, or if a breast nodule increases in size and hardens within a short period of time, you should be alert. Pre- and post-menopausal patients and elderly patients, especially women with family history of breast cancer, should go to the hospital frequently for review so as to detect pre-cancerous lesions and deal with them in time to prevent them from occurring.
13.Guiding the functional exercise of postoperative breast cancer patients
Breast cancer is now the top disease of female malignant tumor incidence, which seriously threatens women’s physical and mental health. Now, as a specialized breast disease ward, the four wards of general surgery in our hospital have successfully cured 100 breast cancer patients, and early postoperative functional exercise is the key to postoperative recovery of breast cancer. The patient’s wrist and elbow activities were carried out on the first day after surgery and shoulder activities on the second day, and gradually progressed to combing hair, washing face and brushing teeth by themselves. Now we firstly paste the instructional drawings of post-operative recreational exercises in the breast cancer ward, distribute elastic small balls, and have a nurse organize patients to conduct physical training of calisthenics in a corner of the corridor of the area twice a month. Every year, medical and nursing staffs plan to organize “Breast Cancer Patients’ Association” from time to time to provide a platform for information exchange. It is worth mentioning that a new measure recently implemented in the ward is to change the original axillary drainage by wall negative suction to a light negative pressure bottle for breast, which is shaped like a space cup, thus facilitating patients to get out of bed at an early stage.