Breast cancer

Breast cancer-About Breast cancer:

Breast cancer is one of the most common malignant tumors, the incidence rate of 7-10%,40-60-year-old body a variety of malignant tumors among premenopausal and postmenopausal women have a higher prevalence. The onset is often associated with genetic, only about 1-2% of breast patients are men. Worldwide each year about 1.2 million women with breast cancer and 500,000 women died of breast cancer.

Breast cancer - OverviewBreast breast cancer breast epithelial cells in a variety of carcinogen effect, the occurrence of gene mutations, resulting in the loss of control of cell proliferation. Changed due to the biological behavior of cancer cells, showing the disorder, unlimited malignant proliferation. Its histological manifestation of a large number of naive cancer cells to proliferate indefinitely and disorderly like crowded into a group, extrusion and erosion damage to the surrounding normal tissue, and destruction of breast normal tissue structure.
Breast cells after a mutation in the loss of normal cell characteristics, organizational structure disorders, loosely connected cells, the cancer is very easy to fall off free, with the blood or lymph disseminated systemic, the formation of early distant metastases to the breast cancer cure very difficult.
The transfer of the body of vital organs such as lung metastases, brain metastases, bone metastases and so will be a direct threat to human life, so breast cancer is a malignant disease seriously endanger human life.
Breast cancer - classificationMore complex form of breast cancer tissue, many types, and often in the same piece of cancer tissue, even with a slice may have two or more types exist. Pathological classification of breast cancer in international and domestic, in the practical application is not uniform. Domestic pathological classification of breast cancer are as follows:
Non-invasive cancerRefers to the the carcinoid earliest stage lesions confined to the ductal or acinar basement membrane, known as non-invasive.
Early invasive carcinomaFrom non-invasive cancer to invasive cancer is a progressive development process.
Invasive carcinomaCancer tissue to extensive infiltration of the stroma, the formation of various forms of cancer tissue and interstitial mixed image.
Breast cancer cells, invasive non-specific cancer:
① simple cancer: more common, accounting for more than breast cancer half. The main quality of the cancerous tissue and the stroma close to cancer cells often gather into small nests, sheets or thick rope-like.
② hard cancer: accounting for about 10% of the total number of breast cancer, cancer primary quality, stromal characterized. Small size, texture hard, cut porcelain white, cancer the edge of the Crab-like infiltration to the surrounding.
③ medullary cancer: accounting for breast cancer 10 to 20 percent of the total number of cancerous tissue of primary quality, mesenchymal less. Tumor up to a huge size, the cut off-white, the center often necrosis. Depending on the degree of interstitial infiltration of lymphocytes can be divided into two subtypes: lymphocytic infiltration of the few non-yellow medullary carcinoma infiltrating more than those of typical medullary carcinoma. The latter is a better prognosis, often assigned to a special type of invasive carcinoma.
2, infiltration of specific cancer
① papillary carcinoma: a large intraductal carcinoma, and rarely the evolution of large intraductal papilloma. More common in women aged 50 to 60 mass single or multiple parts of a nipple discharge, most of them bloody, discharge smear can be found in cancer cells. The cut surface brownish-red nodules, crisp, nodule the pink carrion-like or papillary organization. This cancer is slow growing, metastases were also late. Cancer in real terms more than half of the duct-like structures, can be diagnosed as adenocarcinoma.
② mucinous adenocarcinoma: also known as colloid carcinoma, is rare. The age of onset, slow-growing, state clearly the section translucent jelly-like material, the cancer tissue is rich in mucus, the lower the degree of malignancy, axillary lymph node metastasis is less common.
③ the eczematous cancer: also known as mammary Paget's disease. On the morphology of this cancer is characterized by: the nipple and areola skin was eczematous changes within the epidermis of a big characteristic of Paget's cells. The majority of this cancer with intraductal carcinoma and lobular carcinoma in situ, part of the invasive ductal carcinoma.


Breast cancer - the cause ofBreast cancer to date in 2012, the world medical community on the cause of breast cancer are not accurate understanding, because there are a variety of reasons can lead to the occurrence of breast cancer. Data analysis of breast cancer etiology from clinical practice and animal experiments with the following factors:
An early menarche, late menopause.
Menarche younger than 12 years of age compared with more than 17 years of age, the relative risk of breast cancer increased by 2.2 times. The amenorrhea older than 55 years of age the risk of breast cancer than less than 45 years of age increased by 1. Early menarche, late menopause, breast cancer, the two most important risk factors.
2, genetic factors.
Studies have found that his mother suffered from bilateral breast cancer in premenopausal women, their risk of breast cancer risk was nine times that of women in general, and the average age of the second generation of breast cancer of the breast cancer patients about earlier than the average person about 10 years. Sisters, the risk of breast cancer in women, the risk is three times that of ordinary people. Needs to be emphasized is that breast cancer is not directly inherited, but as a "cancer quality of the genetic relatives of breast cancer patients not necessarily suffering from breast cancer, but the possibility of breast cancer than the average person to.
3, marriage and child rearing.
Epidemiological studies show that women, although the marriage rather than education or first child after 30 years of age is also a disadvantage, but the unmarried breast cancer risk was married 2 times. Experts believe that fertility has a protective effect on the breast, but refers only to the previous 30-year-old full-term. In recent years, studies suggest that breastfeeding has a protective effect of breast cancer, primarily premenopausal women.
4 and ionizing radiation.
The mammary gland is more sensitive to ionizing radiation and carcinogenic activity of the organization. Young breast mitotic activity stage, the most sensitive to the carcinogenic effects of ionizing radiation, ionizing radiation effects of the additive, multiple small doses of exposure to the same degree of risk and a big dose of exposure, a dose - response relationship.
5, unhealthy eating habits.
Breast cancer morbidity and mortality and per capita digest fat mass is a strong correlation. Some staff caused by high-income high standard of living, the formation of the unscientific, unhealthy high-calorie, high-fat eating habits, a result, the incidence of breast cancer greatly improve.
6, an unhealthy lifestyle.
Female white-collar workers to sit some long-term office work moving little more than lack of exercise, less exposure to sunlight. Most professional women working relationship, long tight Guzhuo bra, rare to the breast "relaxation"; also some professional women forced to work under pressure or to pursue a career of success and live singles or DINK family life, not a home, not to have children .
7, estrogen is one of the prerequisites of the mammary tumor incidence.
Incidence of breast cancer ranging from 18-70 years old, the age between 30-60 years of age, especially the growth period, menopausal women with breast cancer of high stage, the use of estrogen replacement therapy than women over 10 years should be closely monitoring.

Breast cancer - pathological changesNon-invasive cancerBreast cancer, intraductal carcinoma in situ (intraductal carcinoma in situ) of the terminal duct lobular, catheters, a remarkable expansion of cancer cells confined to the expansion of the intraductal catheter basement membrane integrity. Mammography imaging studies and census, the detection rate significantly improved, has been accounted for 5% of all breast cancer rose to 15% -30%. According to the histological changes into acne cancer and non-comedo subtype of intraductal carcinoma in situ;
Located breast the ① acne cancer (comedocarcinoma) more than half of the central part of the section visible expansion of the catheter containing a greyish yellow cream-like necrotic material within the catheter extrusion can be overflowed, like a skin, acne, so called acne cancer. As the acne cancer, interstitial fibrosis and necrosis calcification, hard texture, the mass obviously likely to be clinical and mammography to check see.
Microscope, the larger cancer cell volume, eosinophilic cytoplasm, ranging from differentiation, large and small, prominent nucleoli, with a wealth of mitotic Cancer cells in solid arrangement, Central will always check to see necrosis is a characteristic change. Necrotic areas can often check to see calcification. Around the catheter to see the interstitial fibrous tissue hyperplasia and chronic inflammatory cells.
② Non-comedo subtype of intraductal carcinoma (noncomedo intraductal carcinoma) cells showed varying degrees of special-shaped, but less obvious acne cancer, small cell size, shape comparison rules, usually no necrosis or only slight necrosis. The cancer cells are arranged in other forms of solid, papillary or cribriform intraductal. Tube surrounded by interstitial fibrous tissue proliferation is not such as acne cancer significantly.
By biopsy confirmed intraductal carcinoma in situ, such as without any treatment, after 20 years, 30%, which can develop into invasive carcinoma, indicating that not all DCIS can change for invasive cervical cancer, such as into invasive, usually required after a few years or ten years. Into the risk of invasive and tissue types, acne, cancer is much higher than non-acne-type ductal carcinoma.
2, lobular carcinoma in situ (lobular carcinoma in situ), lobular carcinoma in situ lobular peripheral catheters and acini. Expansion of lobular peripheral ducts and acinar filled was the entity arrangement of cancer cells, cancer cell volume compared with intraductal carcinoma cancer cells, a more consistent size and shape, nuclear round or oval, mitotic rare. Proliferation of cancer cells did not exceed the basement membrane. General cancer cell necrosis nor interstitial inflammation and fibrosis.
About 30% of lobular carcinoma in situ involving the bilateral breast, often for multi-center, generally palpable mass in a small, clinical no obvious mass, is not easy, and hyperplasia of mammary glands difference. Development for the probability of invasive cancer and ductal carcinoma in situ.
Invasive carcinoma1, invasive ductal carcinoma (invasive ductal carcinoma)
Come by the development of ductal carcinoma in situ, the cancer cell breakthrough catheter basement membrane, interstitial infiltration is the most common type of breast cancer, accounting for about 70 percent of breast cancer. Endoscopic and histologic features a variety of cancer cells arranged in nests, Mission cords, or accompanied by a small amount of adenoid structure. May retain some of the existing structure of DCIS, or completely absent. The size of the cancer cells of various shapes, generally pleomorphic obvious mitotic common, common local tumor necrosis. Cancer cells surrounded by interstitial dense fibrous tissue proliferation, invasion and growth of cancer cells within the fibrous stroma, the ratio between the two is not the same. Different proportions of carcinoma of the substance and fibrous tissue interstitial divided into carcinoma (carcinoma the simplex) (carcinoma of the essence and the proportion of interstitial roughly equal), and scirrhous carcinoma (scirrhous carcinoma) (stroma dominant, a small amount of cancer cells was cord like distribution of the proliferation of fibrous tissue) and atypical medullary carcinoma (carcinoma in real terms than interstitial), now collectively known as invasive ductal carcinoma.
2, infiltrating ductal breast cancer: cancer tissue was cord or island-like distribution, the growth of the interstitial infiltration.

Breast cancer - clinical manifestationsWomen with breast cancerBreast cancer, some of patients with early breast cancer in the breast department has not yet been able to touch a definite mass, but often the local discomfort, especially in women after menopause, and sometimes feel the side of the breast discomfort, mild pain or the side of the shoulder back heaviness, soreness, or even pull the side of the upper arm.
Early breast touched the bean size lump, hard, movable. Generally no significant pain, a small number of paroxysmal pain, dull pain, or tingling.
3, the breast shape changes: the visible mass at the skin bulge, some local orange peel-like, or even edema, discoloration, eczema-like changes.
4, the nipple near the center associated with nipple retraction. Mild depression (medically called "dimple disease") of the breast skin, nipple erosion, the asymmetry of the nipple or breast skin thickening thicker pores increases phenomenon (medically called "orange peel syndrome").
Nipple discharge: on discharge was bloody, serous bloody should pay special attention for further examination.
6, the regional lymph nodes, ipsilateral axillary lymph nodes is the most common. Advanced stage of the supraclavicular lymph nodes.
Male breast cancerThe clinical symptoms of male breast cancer is usually discovered by the patients themselves - a symptom is a painless mass, usually located below the areola, just concentrated areas of male breast tissue and tumor growth. When patients seek treatment, the tumor is not the only symptom. Nipple discharge is more susceptible to breast cancer in men. In addition, nipple retraction, skin changes, but also more common than breast cancer in women. Newly diagnosed male patients with breast cancer, about half of the axillary lymph nodes can reach.
In general, male breast cancer is mostly unilateral, often located in the left breast, while bilateral and into the breast may also occur. Age of male patients than female patients age at diagnosis is often large, and a clear diagnosis often than female patients for the night.
1, caking and swelling;

2, the skin to sag and wrinkle;
3, inverted nipple;
4, the nipple or breast skin redness, nipple size is abnormal;
5, nipple discharge.
Breast cancer - complications1, a small number of patients with breast cancer at an early stage may have varying degrees of tenderness or nipple discharge. Relatively rapid growth rate of breast cancer tumor. Breast can have the "orange peel-like" change, the tumor surface skin depression, nipple bias the direction of the tumor is located, such as inverted nipples. To advanced breast cancer lymph node metastasis and distant metastasis can be complicated by a host of other symptoms.
"Advanced, breast cancer patients to tumor loss of appetite - cachexia syndrome". Loss of appetite both cachexia reasons, the clinical manifestations of cachexia. , There may be loss of appetite, anorexia, weight loss, fatigue, anemia and fever and other symptoms, severe cases can cause life-threatening.
Breast cancer late lymph node metastasis in ipsilateral axillary lymph nodes, and enlarged lymph nodes growing number of adhesion to each other into a corporation, a small number of patients with contralateral axillary lymph node metastasis. Breast cancer late distant metastasis in breast cancer metastasis to the lungs, chest pain, pleural effusion, shortness of breath symptoms. Vertebral metastasis lesion pain, or even paraplegia and other liver metastases may develop jaundice, hepatomegaly.
Most of the complications of breast cancer in the late emergence of the relatively poor physical condition of patients, the disease is more serious. Need to actively control the proliferation of cancer cells.

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Breast cancer - diagnosisGeneral diagnosticBreast cancer can be diagnosed based on clinical manifestations and pathological findings of breast cancer.
Carefully to understand the history of diagnosis of breast cancer. The history should also pay attention to age, occupation, lifestyle, diet, menstruation, fertility, lactation history, with or without endocrine system disorders, and drug situation in the past, application of hormones, breast area whether repeatedly received irradiation, with or without a family history of breast tumors (especially maternal), whether breast disorders and treatment in the past, whether the female reproductive system disorders. History of breast cancer risk factors in the cases or suspected cases, even if the clinical no lumps, breast film, and other auxiliary examinations and regular follow-up.
Clinical stageThe clinical stage of breast cancer patients with lesion size, regional lymph node metastasis and distant metastasis of the disease a judgment and estimates.
Phase Ⅰ (early): The tumor is less than 2 cm, lymph node enlargement does not.
II period (early): tumors larger than 2 cm but less than 5 cm, axillary lymph node metastasis, lymph node activity.
Ⅲ (locally advanced) tumors larger than 5 cm, axillary lymph node metastasis, lymph nodes fixed.
Ⅳ (advanced or metastatic) tumor the size of any, but the cancer has spread to other parts of the body.
Breast cancer - differential diagnosisIdentify with breast cancer, breast disease clinical disease are:
A mammary gland hyperplasia, also known as mammary dysplasia, women are the most common non-inflammatory, non-neoplastic breast disease. More than women because of endocrine function disorders caused. Age of onset is 20 to 40 years, developed countries the incidence of up to 1/3 of the country accounts for about 50%, mainly as thickening of breast tissue, the later can be touched nodules, skin and breast the rear of no adhesion. Occur in the breast upper outer quadrant, mostly bilateral. Patients with varying degrees of pain, menstrual significantly alleviate menstrual cramps or discharge.
2, mammary duct ectasia
This disease, also known as plasma cell mastitis, occurs in 37 to 50-year-old middle-aged women. Mainly as breast pain, nipple discharge, nipple retraction, mimicking breast cancer. The following points can be identified with breast cancer:
① patients with younger age, more than 40 years.
The ② nipple discharge is more than serous or purulent, and few can also be bloody.
③ nipple or areola and sometimes can be touched, thickening of the milk ducts.
The ④ breast lumps were located around the areola, the pain associated closely with the conduit.
⑤ breast inflammatory or inflammatory history and history of breast-feeding obstacles, breast lumps can be reduced or increased.
The ⑥ laticifer angiography can show the catheter dilatation.
⑦ nipple discharge, a large number of inflammatory cells.
⑧ breast tumor puncture can be seen a large number of inflammatory cells or pus.
The ⑨ axillary lymph nodes, softer quality and tenderness.
(3), breast tuberculosis.
Most have a history of tuberculosis or other parts of tuberculosis; a small number of patients with nipple discharge or needle aspiration of pus, smears of Mycobacterium tuberculosis; mammary tuberculosis and breast cancer coexistence of about 5%.
4 mammary fat necrosis
The main discriminant analysis as follows: (1) the lack of characteristic clinical manifestations, the disease is generally hard lumps, irregular in shape, resembles breast cancer. Generally sub-clinical Type 2: glandular appearance, superficial, located in the breast skin, irregular, inflammatory changes, easy diagnosis of breast tuberculosis; gland type tumor in the breast parenchyma, the lack of features, easily misdiagnosed as breast cancer.
② lack of effective secondary screening, especially in older women, located in the subcutaneous tumor, and the mass but not the growth or narrow circumstances, and breast have a history of trauma. Metastatic lymph node excisional biopsy should be done.
5, acute mastitis
Common in secretory breast, especially the early postpartum 3 ~ 4 weeks, most of the pathogen is Staphylococcus aureus and a few streptococci, routes of infection usually caused by the nipple at retrograde infection caused. Can also be caused by bacteria invade the milk ducts, up to the gland lobule cause infection.
Acute mastitis and breast cancer comparison:
① breast skin, orange peel-like change, no satellite nodules.
The ② breast lumps rarely occupy the whole milk, more than half of the capsule sexy.
③ breast lumps are rare.
④ the majority of body temperature and white blood cell count increased.
(5) anti-inflammatory treatment.
The ⑥ needle aspiration of pus or inflammatory cells, contribute to the diagnosis.
6, adenofibroma
Occurred in 20 to 25-year-old young women, posed by the glandular and fibrous tissue, youthful type and two of the giant fibroadenoma, but qualitatively different. To fibroadenoma of the breast capsule, gray cut surface, shiny, smooth, visible section most of the irregular cracks for the expansion of the milk tube.
Giant fibroma X-ray seen huge mass in a uniform density, lobulated. The surrounding tissue is pushed to the formation of the translucent zone, the Cancer Center may have calcification, more associated in the vicinity of blood vessel enlargement and varicose. Adenofibroma tumor is very small, but a greater chance of malignancy and therefore must be carefully treated.
7, intraductal papilloma
Occurred in women aged 40 to 50, and 75% occurred in the large milk ducts near the nipple, or the occurrence of cysts around the nipple and milk ducts connected. The single can also be multiple. The tumor is small, but often with fluff and more thin-walled blood vessels, and easily bleeding. Clinical pain, bloody liquid overflow from the nipple during non-menstrual weeks, the mass multi-touch, if palpable found a lump in the areola region, more than a few millimeters in diameter. Breast tumor often has a circular quality hard, not adhesion to the skin, can promote this tumor, soft reduction can have a bloody nipple discharge.
Intraductal papilloma of about 6% to 8% can be cancerous, so the preoperative angiography should be done to confirm the diagnosis. Surgical resection should be complete resection, the prevalence of the milk ducts and the surrounding glandular tissue, in order to avoid troubles. Older women should do breast simple excision

 

Breast cancer - CheckBreast cancer X-ray X-ray examinationBreast radiography is a commonly used method of diagnosis of breast cancer, breast disease in the x-ray films, in general can be divided into lumps or nodules calcification and thickening of the skin levy group catheter shadow changes, high mass density, edge the burr signs, the diagnosis of very much help, burr longer exceeds the diameter of the lesions, known as the star-shaped lesions, x-ray film, show the mass often than clinical palpation for small, which is also one of the malignant signs. calcification of the film should pay attention to its shape and size, density, taking into account the number and distribution of calcification, calcification cluster, especially concentrated in the range of 1 cm, the possibility of breast cancer and calcifications in more than 10 or more malignant possibility.

Ultrasound imaging examination
Noninvasive ultrasound imaging examination, can be applied repeatedly, the breast tissue more dense by the application of ultrasound imaging to check the more valuable, but the main purpose is to identify tumor Department of cystic or solid accuracy rate of ultrasound diagnosis of breast cancer echogenic band formed by 80% to 85% of cancer to the surrounding tissue infiltration, and structural damage in the normal breast, as well as the mass above the local thickening of the skin, or depression and other images are an important index of the diagnosis of breast cancer.

Thermal image inspection
The application image shows the surface temperature distribution, due to the proliferation of cancer cells block blood supply, then the corresponding surface temperature higher than the surrounding tissue, this difference can make a diagnosis, but this diagnosis, the lack of exact image standards, thermal anomalies parts with tumors that do not correspond to the diagnosis rate is poor, have diminished in recent years applications.

Near-infrared scanning
The near-infrared wavelength of 600 ~ 900μm, easy to penetrate soft tissue, using infrared organizations through the breasts of different densities, show a variety of different gray shadow, thus showing breast lumps, in addition to the sensitivity of the infrared hemoglobin breast vascular shadow clear, breast cancer often increase local blood circulation, blood vessels near the thicker, the infrared have a good image display, contribute to the diagnosis.

CT scan
Can be used not palpable breast lesion biopsy localization diagnosed with breast cancer preoperative staging check the breast zone of axillary and internal mammary lymph node enlargement, contribute to the development of a treatment plan.
Breast cancer tumor markers examinationIn the carcinogenesis process, production and secretion by the tumor cells, release of tissue composition, and antigen enzyme hormone, or in the form of metabolites present in the tumor cells or host body fluids such substances called tumor markers.
1, carcinoembryonic antigen (CEA): non-specific antigen in tumor and non-neoplastic diseases has increased, no differential diagnosis of operable breast cancer before surgery, to check about 20% to 30%, blood CEA levels increased with advanced metastatic cancer, 50% ~ 70% of CEA high value.
Ferritin: serum ferritin, reflect the body iron store status, in many malignancies such as leukemia, pancreatic cancer, gastrointestinal tumors, breast cancer, ferritin increased.
3, monoclonal antibodies: monoclonal antibodies for diagnosis of breast cancer cA15-3 breast cancer diagnosis in accordance with rate of 33.3% to 57%.
BiopsyBreast cancer diagnosis must be established, before the start of treatment, the current inspection methods, but so far the results of the biopsy from the pathology in order to do the only sure basis for diagnosis.
A needle aspiration biopsy: fine needle aspiration cytology from Gutthrie, established in 1921, has been developed for fine-needle aspiration cytology.Check the method is simple, rapid and safe, instead of part of the organization, frozen sections of high positive rate of between 80% and 90%, and can be used for anti-cancer screening, clinical diagnosis of malignant, benign cytology report, or suspicious cancer need to choose a surgical biopsy to confirm the diagnosis.
2, cut biopsy: This method is easy to promote carcinoid tumor proliferation, generally do not advocate this method only in patients with advanced cancer may consider applications to determine the pathological type.
3, excisional biopsy: malignant tumor is suspected, removal of tumor and surrounding a range of organizations, is an excisional biopsy, general requirements, as complete as possible removal of at least about 1 cm from the tumor edge

 

Breast cancer - treatment
1, surgical treatment, is one of the main treatment for breast cancer, surgical There are many to choose still lack a unified view, the overall trend is to minimize the surgical destruction.

2, radiation therapy, is a major component of the treatment of breast cancer, is one of the local treatment. Most scholars do not advocate curable breast cancer line, radiotherapy, radiation therapy used for comprehensive treatment, including radical surgery, or made ​​after adjuvant therapy, palliative treatment of advanced breast cancer.

Three other treatments, such as immune therapy.

Breast cancer - prevention
Breast examination, we must uphold the scientific diet and lifestyle. Eat more fresh vegetables and fruits rich in vitamins and trace elements and a high-fiber foods; the prevention of breast cancer but also another non-smoking, limiting alcohol intake, eat high-fat foods and barbecue food.

2, adhere to the physical exercise, and enhance immunity.

Regular breast examination showed bilateral breast asymmetry, breast lumps or induration, or hardening texture, breast skin edema, depression, eczema-like changes in the areola, with particular attention to the prevention of breast cancer shall immediately request the confirmed by specialists for treatment.

① the age of 20-40 year-old female, a week after the monthly vacation to do a breast self-test; every two years by a professional physician to do a clinical examination or mammography.

② women age 40-49, addition to the regular monthly breast self-test every year to do a professional breast examination.

③ age women over the age of 50, per month should have regular breast self-test, and every year have to do a clinical breast examination and breast X-ray photography.

4, the prevention of breast cancer cosmetics and medicines that contain estrogen should be used with caution.

5, to avoid electromagnetic radiation and radiation exposure. Such as watching TV from the TV for more than two meters away from the oven when cooking.

Maintain a positive attitude towards life and open-minded and optimistic mood conducive to the prevention of breast cancer.

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