breast cancer
Introduction
Introduction to breast cancer Breast cancer is one of the most common malignant tumors in women. According to statistics, the incidence rate is 7-10% of all malignant tumors in the body. In women, it is second only to uterine cancer. Its incidence is often related to heredity, and 40-60. Between the ages, the incidence of women before and after menopause is high, and only about 1-2% of breast patients are male. A malignant tumor that usually occurs in the glandular epithelial tissue of the breast. It is one of the most common malignant tumors that seriously affect women's physical and mental health and even life-threatening. Breast cancer is rare in men. The cause of breast cancer is not fully understood. The study found that there is a certain regularity in the incidence of breast cancer. Women with high risk factors for breast cancer are prone to breast cancer. The so-called high-risk factors refer to various risk factors associated with the onset of breast cancer, and most of the risk factors for breast cancer patients are called high risk factors for breast cancer. Early detection and early diagnosis of breast cancer are the key to improving the efficacy. basic knowledge The proportion of patients: 0.007%-0.01% (women over 40 years old have a higher probability of getting sick) Susceptible people: women who occur before and after menopause. Mode of infection: non-infectious Complications: septic shock
Cause
Cause of breast cancer
Age (30%):
In women, the incidence rate increases with age, is rare before menarche, and is rare before 20 years old, but the incidence rate rises rapidly after 20 years old, 45 to 50 years old, but relatively flat, after menopause The incidence rate continues to rise, reaching its peak at around 70 years of age, and the mortality rate also rises with age. After the age of 25, the mortality rate gradually rises until the old age.
Non-invasive cancer (30%):
It is the early stage of breast cancer. When the cancer is confined to the mammary duct or acinus, it is called non-invasive cancer when it does not break through the basement membrane. (1) Intraductal cancer: The cancer cells are confined to the catheter and do not break through the basement membrane of the wall. It occurs mostly in small and medium-sized catheters. Larger catheters are rare and generally have a multi-center scattered distribution. (2) lobular carcinoma in situ: cancer occurring in the lobular duct and peripheral duct epithelial cells, more common in premenopausal women, the age of onset is 5-10 years earlier than the average breast cancer. The leaflets are enlarged, the tubes and bubbles are increased, and the cells are obviously thickened, and are filled with non-polar cancer cells. Lobular carcinoma in situ develops slowly and has a good prognosis.
Invasive special type cancer (20%):
(1) Papillary carcinoma: It occurs in the epithelial cells of the large breast duct, and the cancerous parenchyma is mainly composed of a fibrous vascular bundle or a fibrous papillary bundle, and may be a non-invasive and invasive papillary carcinoma. Its infiltration often occurs at the base of the nipple hyperplasia. (2) medullary carcinoma is accompanied by a large number of lymphocytic infiltration: necrosis and hemorrhage often occur in the cut surface, and a large number of lymphocytes and plasma cells infiltrate in the interstitial cells of large cancer cells. It is more obvious in the peripheral part of the cancer, and is generally considered to be the resistance of the body to the tumor. (3) Tubulous carcinoma: occurs in ductal or small ductal epithelial cells, which is a type with low malignancy and a good prognosis. (4) Adenoid cystic carcinoma: basal cell-like cells form patches or small stains of different sizes and shapes, with a number of circular cavities of different sizes and uniformity. Myoepithelial cells can be seen around the luminal surface and around the cell mass. (5) apocrine adenoid carcinoma: cancer cells are rich in cytoplasm, acidophilic, sometimes visible apical prominence, nucleus mild to moderately shaped, forming ductal, acinar or small nipple structure. (6) mucinous adenocarcinoma: occurs on the basis of mammary glandular epithelial mucinous gland metaplasia, more common in women near menopause or postmenopausal, especially in women over 60 years old. In the cancer parenchyma, the epithelial mucus component accounts for more than half. Most of the mucus is outside the cell, forming a mucus lake; occasionally in the cell, it shows a sign-like cell. (7) Squamous cell carcinoma: a ductal epithelium derived from squamous metaplasia. The cancerous parenchyma is all typical squamous cell carcinoma, and the intercellular bridge and keratinization can be seen. If other types of cancer develop partial squamous metaplasia, they are not listed here. (8) nipple pie disease: also known as nipple eczema-like cancer, Paget (1874) first described the disease. After years of research, it is believed that the morphology of the tumor cells under the microscope is large, the cytoplasm is rich and lightly stained, often vacuolated, the nucleus is large, obviously irregular, and occasionally mitotic figures.
Invasive non-specific cancer (10%):
(1) invasive lobular carcinoma: lobular carcinoma is infiltrated into the extralobular area, including small cell type invasive carcinoma.
(2) Invasive ductal carcinoma: ductal carcinoma clearly infiltrates the interstitial, but the infiltrated part does not exceed half of the cancerous substance. If it is more than half, it is named after the main form of invasive cancer.
(3) Hard cancer: The cancer cells are arranged in a thin strip or scattered, rarely forming an adenoid structure, and the fibrous interstitial component accounts for more than two-thirds and is dense.
(4) medullary carcinoma: The cancer nest is densely flaky or clumpy, and may have an adenoid structure. The cancer parenchyma accounts for more than two-thirds, and the interstitial may have a small amount of lymphocytes and plasma cells.
(5) simple cancer; between hard cancer and medullary carcinoma, that is, the ratio of cancerous substance to fibrous interstitial component is similar. Cancer cells mainly form irregular solid strips or small stains, and may also have adenoid structures.
(6) Adenocarcinoma: The size of cancer cells is consistent, the cytoplasm is rich, and there may be secretion, deep nuclear staining, and mitotic figures are common. The cancer cells are arranged in a glandular tube, with many layers, disordered polarity, lack of basement membrane, and Infiltrating growth in the mass, cancer cells can also be arranged in strips, and the glandular arrangement should account for more than one-half.
Prevention
Breast cancer prevention
Early detection of breast cancer
As we all know, cancer is not an incurable disease. The key is early detection and early treatment. For many years, clinical practice has confirmed that for most cancers, if you want to improve the cure rate, it is difficult to improve the treatment alone. Satisfied, in terms of breast cancer, in recent decades, although there have been many improvements in treatment methods at home and abroad, the mortality rate has not decreased significantly. The main reason is still due to late treatment. Among the patients treated, the majority of cases are caused by the middle and late stage. This requires us to advocate the detection of early cancer to reduce the appearance of advanced cancer, which will be an effective way to improve the survival rate of breast cancer.
Modern requirements for early breast cancer should be that small cancers (0, 5 cm in diameter) and To cancers that are clinically inaccessible to the mass are classified as early, because such cancers are rarely metastasized, and their 10-year survival rate after surgery is generally Up to 90% or more, a large number of such cancers will be detected, which may have a positive effect on survival rate. In order to detect such early cancer more, the following points are proposed:
1. Establish a new concept of early cancer: Early cancer is not uncommon in patients who are routinely examined, and it should be more common than common advanced cancer, because in the natural course of breast cancer growth, the preclinical period accounts for about 2/ of the whole process. 3. Despite this, early cancer is rarely detected, indicating that most of the early cancers leaked from the examiner during the examination. The reason is mainly due to the lack of sufficient knowledge of the early cancer by the examiner. The clinician still uses the breast lumps as the traditional concept for diagnosing the primary signs of breast cancer, and the aforementioned early cancers do not necessarily form obvious lumps. Under the guidance of this concept, early cancer is inevitably difficult to detect, so it is necessary to re-recognize the new cancer. concept.
2, seriously query the risk factors of breast cancer: breast cancer is a lot of risk factors, the common ones are as follows: (1) family history of breast cancer, especially whether the mother and sister of the subject have suffered from the disease (2) menstruation Premature menarche (less than 12 years old), or late (more than 50 years old) (3) More than 40 years old (4) One side of the breast has cancer, the contralateral breast is also a vulnerable part, etc. People with factors should be considered as susceptible to breast cancer and should be the focus of examination.
3. Any cause of abnormalities in the breast should be identified.
(1) nipple discharge, especially bloody discharge, coexists with breast cancer, especially when there is bloody discharge in women over 50 years old, about half of them may be malignant.
(2) Localized thickening of the breast gland, which is a clinically common but not valued sign. This situation occurs in women who are not menopausal, especially when there are some changes in the menstrual cycle. If the thickened tissue persists for a long time, it has nothing to do with the menstrual cycle, or it is increasing and increasing in scope, especially in postmenopausal women.
(3) nipple erosion after repeated local treatment is ineffective, should consider the disease, the positive rate of cell smear is high, should be promptly diagnosed.
(4) breast pain, in premenopausal women, especially with menstrual cycle changes, the degree of pain also has different changes in light or heavy, mostly physiological, such as pain is limited, there are fixed parts, and has nothing to do with the menstrual cycle Or for postmenopausal women, the cause should be identified.
(5) Unexplained areola skin edema, nipple retraction and breast skin limitation depression, etc., all need to carefully find out the reasons.
In short, early detection and early treatment are undoubtedly the development direction of breast cancer prevention and treatment. What is urgently needed is to popularize the knowledge of early breast cancer diagnosis, extensively carry out breast cancer screening and women's self-examination of breast, in order to achieve early improvement of survival rate and mortality. the goal of.
Complication
Breast cancer complications Complications septic shock
Common complications of breast cancer
The common complication of breast cancer is tumor loss of appetite-cachexia syndrome. Loss of appetite is one of the causes of cachexia and clinical manifestation of cachexia.
As with the cachexia of other advanced cancers, patients may experience loss of appetite or anorexia, weight loss, fatigue, anemia and fever, severe exhaustion and even death.
Common complications of breast cancer surgery
Breast cancer surgery is a surface surgery, but because of the wide range of surgery and trauma, there are many complications after surgery. Common surgical complications related to breast tumors are:
First, bleeding
One of the common complications after surgery, such complications can occur after mass resection or radical resection. The causes of bleeding are often:
1, intraoperative hemostasis is not complete, leaving active bleeding points
2, due to the application of continuous negative pressure drainage, position changes or severe cough and other reasons, the coagulation clots fall off or the ligature of the silk slip, resulting in drainage bleeding
3, preoperative application of chemotherapy or hormone drugs to make the wound easy to ooze blood
Thorough hemostasis during surgery, especially the intercostal vascular penetration of the sternum should be ligated to the bleeding point of the muscle stump and profile. The ligation or electrocoagulation should be used to flush the wound and carefully check for active bleeding. The position of the tube placement, proper pressure dressing can help prevent postoperative bleeding. In addition, attention should be paid to the patency and drainage of the negative pressure drainage tube after operation. The nature of the drainage fluid should be treated in time for patients with poor coagulation mechanism.
Second, effusion
There is fluid accumulation between the flap and the chest wall or the armpit, which makes the flap not close to the wound. It is also one of the common complications after breast tumor surgery. Common causes are:
1. Poor drainage makes the exudate of the wound not accumulate in time and accumulate
2, blood coagulation in the wound to form a clot, can not be drained, and later liquefied to form effusion
3, when dissecting the lymphatic fat around the iliac vein, some small lymphatic vessels are not ligated with poor drainage to form effusion, which usually occurs outside the armpit
4, the use of electric knife to dissect the iliac vein when the opportunity to accumulate more than the use of scalpel, may have a certain impact on the healing of the wound, and after the electrosurgical anatomy, some small lymphatic vessels are temporarily closed and under negative pressure After being attracted, it is open again, causing effusion
In addition, the excessive tension of the flap makes the wound difficult to cover and the drainage tube is removed too early.
When the anatomy of the ankle is found to have a small exudate, it should be ligated to reduce the tension of the flap and keep the negative pressure unobstructed. Appropriate pressure dressing will help reduce the occurrence of effusion, such as the occurrence of effusion, if the amount is small It is advisable to repeatedly use the empty needle to pump the negative pressure suction or the skin drainage and the pressure dressing if the amount is large or the multiple suction is invalid.
Third, skin flap necrosis
It is also a common complication of postoperative breast cancer. Because the delayed healing of skin necrosis may affect the subsequent treatment, radical mastectomy often requires more skin to be removed, and the range of flap separation is larger, and the flap is too thin or Uneven thickness will damage the capillary in the dermis and affect the blood supply of the postoperative flap or the tension of the flap. The postoperative wound effusion will also cause ischemic necrosis of the flap, sometimes due to the use of an electric knife. Improper local skin burns or vascular coagulative embolism can also lead to skin flap necrosis. Skin flap necrosis usually shows that the ischemic skin becomes pale after 24 hours, gradually showing blue-violet edema, small blisters on the surface, and necrosis after 3-7 days. The boundaries of the area gradually became clear and the skin gradually became black and hard.
Reasonable design of the incision before surgery, avoiding the side flaps being too long, paying attention to the separation of the flaps, reducing the flap tension, and if necessary, skin grafting to avoid fluid accumulation, proper dressing and other measures will help reduce the necrosis of the flap, if Skin flap necrosis occurs, and the necrotic flap can be removed after the boundary of the necrotic area is obvious. For example, the marginal necrosis of the incision is less than 2cm. After debridement, the wet dressing is applied, and the dressing is often self-healing. If the skin is necrotic and the patient is unwilling to receive skin grafting, the wound healing is often delayed, and the epidermis that grows later is often white and thin, and is easily damaged after rubbing.
Fourth, upper limb edema
After radical mastectomy, the upper limb edema is easily caused by the lymphatic and blood return of the upper limb. The incidence of upper extremity edema has been reported from 5% to 40%. In recent years, the incidence of severe upper extremity edema has decreased significantly. Not more than 5%, causing severe reflux disorders in the upper limbs:
1. The axillary cleaning range is improper, destroying the local collateral circulation, and the previous anatomy of the lymphatic fat around the iliac vein. The sacral sheath is often removed at the same time, which also affects the postoperative lymphatic drainage. Therefore, if there is no obvious swelling during operation, In the case of large lymph nodes, it is not necessary to remove the vascular sheath. In fact, if the axillary lymph nodes invade the tendon sheath, it is often completely non-surgical to achieve the purpose of radical cure.
2, there is fluid or infection in the sputum area, causing local congestion, fibrosis, scar formation hindered the establishment of collateral circulation.
3, postoperative treatment of the supracondylar, lower area and sacral area, causing local edema, connective tissue hyperplasia, local fibrosis and then edema.
Upper extremity edema can occur several days after surgery, and the swelling part is often in the upper arm. It can also be used in the forearm or back of the hand. The upper limb function is often exercised after surgery. Avoiding excessive physical exertion of the upper limb and avoiding infection of the upper limb can reduce the upper limb. The occurrence of edema, once the upper extremity appears edema can only use symptomatic treatment to reduce edema.
Fifth, upper limbs and hand muscle atrophy
Often due to injury to the brachial plexus or its sheath, the atrophy of the small fish muscle is common.
Symptom
Breast cancer symptoms Common symptoms Breast lumps Lactation disorders Breast cancer distant metastasis Chest pain Acute edema nipple retraction Nipple nipple Broken hepatomegaly
(a) recessive breast cancer
Refers to breast cancer that is clinically undetectable and confirmed by pathological examination after mastectomy. Often found by X-ray examination or axillary lymph node metastasis as the first symptom, should be differentiated from para-breast cancer. Treatment, it is now generally believed that once diagnosed as occult breast cancer, if there is no metastases and distant metastases, radical surgery should be treated. Most reported that the efficacy is better or similar to breast cancer with axillary lymph node metastasis.
(two) male breast cancer
Male breast cancer is rare, with an incidence of 1% in breast cancer and 0.1% in male malignancies. The age of onset was 6 to 11 years higher than that of female breast cancer.
The symptoms of male breast cancer are mainly painless masses under the areola. 20% of patients have nipple retraction, crusting, and drainage. The boundary of the mass is often unclear. There is skin or chest muscle adhesion in the early stage, and the rate of axillary lymph node metastasis is higher. The pathological manifestations of male breast cancer are similar to those of female breast cancer. The vast majority are invasive ductal carcinoma, and the male breast has no lobular tissue. Therefore, there is no report of lobular carcinoma in situ. The treatment of male breast cancer is the same as that of female breast cancer. However, due to the small breast tissue in male cases and the early invasion of the chest muscle, the surgical approach should be based on radical surgery or extended radical surgery.
The use of endocrine therapy in advanced or relapsed cases is better than female breast cancer. The main treatment method is bilateral orchiectomy, the effective rate can reach 50% to 60%, the reason for this high efficacy rate is due to nearly 84% of tumor tissue ER positive. The validity period lasts for an average of 12 months. If the patient is unwilling to undergo testicular resection, or if the condition is recurred after resection, the female hormone, male hormone or TAM can still be used to obtain good results. This type of endocrine therapy will be produced if the patient has shown that orchiectomy is not effective. Good effect, the effective efficiency of this second-line endocrine therapy is between 30% and 50%. Chemotherapy is only for endocrine therapy, including defamation and addition. It should start after failure. Its medication and method are equivalent to female breast cancer.
(three) inflammatory breast cancer
It is an extremely rare clinical type, often diffuse and hard, and the skin is red, swollen, hot, painful and edematous. The incidence is explosive, very similar to acute inflammation, which is also known as cancerous mastitis.
The diagnosis points of this disease are:
1 Although the local manifestations are redness and heat pain, there is no systemic inflammatory reaction such as cold fever.
2 body temperature and white blood cell counts are mostly in the normal range.
3 early skin is a typical violet, patchy edema, clear boundary, slightly raised edge, large pores such as orange peel changes, red swelling range is more than 1/3 of the breast, red swelling after 1 week of anti-inflammatory treatment does not disappear.
4 In the red and swollen breast tissue, sometimes the texture of the hard and tough mass can be touched.
5 The ipsilateral armpits can touch the harder lymph nodes.
6 fine needle aspiration cytology and pathological section can provide a basis for diagnosis.
The prognosis of inflammatory breast cancer in the past with surgery or radiation therapy is very poor, the average survival time is 4 to 9 months, so surgery is not recommended for inflammatory breast cancer. At present, most authors use chemotherapy and radiotherapy for inflammatory breast cancer, that is, after 3 to 4 courses of chemotherapy, radiotherapy, and chemotherapy after radiotherapy.
(4) Pregnancy and lactation breast cancer
Breast cancer occurs in pregnancy or lactation, accounting for 0.75% to 31% of breast cancer cases. During pregnancy and lactation, due to changes in hormone levels in the body, tumor growth may be accelerated and the degree of malignancy is increased. At the same time, the physiology of the breast tissue during pregnancy and lactation is increased and congestion, making the tumor difficult to find early and easy to spread.
The principle of treatment of breast cancer during pregnancy is similar to that of general breast cancer, but the choice of treatment depends on the stage of the tumor and the different stages of pregnancy. Whether to terminate the pregnancy in early pregnancy should be based on different stages of disease, the early stage of the disease may not need to stop the pregnancy, the stage is II, III or estimated postoperative chemotherapy and radiotherapy should stop the pregnancy to improve the survival rate, on the contrary Often due to the termination of pregnancy delay surgery, but affect the treatment effect.
Breast-feeding breast cancer treatment should first stop breastfeeding, and postoperative adjuvant treatment is similar to general breast cancer. Preventive removal of the ovaries does not improve survival.
Examine
Breast cancer examination
1, X-ray inspection:
Mammography is a common method for breast cancer diagnosis. Common breast diseases can be divided into lumps or nodular lesions, calcification and skin thickening, catheter shadow changes, and the density of the mass is high. When there is a burr sign, it is very helpful for diagnosis. When the burr is longer than the diameter of the lesion, it is called a star lesion. The x-ray film shows that the mass is often smaller than the clinical palpation. This is also one of the malignant signs, and the calcification point in the slice. Attention should be paid to its shape, size, density, and considering the number and distribution of calcification points. When calcification points are clustered, especially in the range of 1 cm, the possibility of breast cancer is very high. When the calcification point exceeds 10, the malignancy may be Very sexual.
2, ultrasound imaging inspection:
Ultrasound imaging examination is non-invasive and can be applied repeatedly. It is valuable for the application of ultrasound imaging in patients with dense breast tissue, but the main purpose is to identify the cystic or solid nature of the tumor. The accuracy of ultrasound examination for breast cancer diagnosis is high. 80%85%, the strong echogenic band formed by the infiltration of cancer into surrounding tissues, the destruction of normal breast structure and the thickening or depression of local skin above the mass are important reference indicators for the diagnosis of breast cancer.
3, thermal image inspection:
The application image shows the body surface temperature distribution. Because the cancer cell proliferation block is rich in blood supply, the corresponding body surface temperature is higher than the surrounding tissue. The difference can be used for diagnosis. However, this diagnosis method lacks exact image standard, thermal abnormal site and tumor. Not corresponding, the diagnostic compliance rate is poor, and it has been gradually applied in recent years.
4, near infrared scanning:
The near-infrared wavelength is 600-900&mum, which easily penetrates into soft tissues. It uses infrared rays to transmit various grayscale shadows through different density tissues of the breast, thereby displaying breast lumps. In addition, infrared rays have strong sensitivity to hemoglobin, and the breast blood vessels are clearly displayed. Breast cancer often has increased local blood supply, and the nearby blood vessels become thicker. Infrared rays have a better image display, which is helpful for diagnosis.
5, CT examination:
It can be used for pre-biopsy localization of breast lesions that cannot be removed, to confirm the preoperative staging of breast cancer, to check whether there is swelling in the posterior breast area, ankle and internal mammary lymph nodes, and to help formulate a treatment plan.
6, tumor marker inspection:
In the process of carcinogenesis, tumor cells produce, secrete, directly release cellular tissue components, and are present in tumor cells or in host body fluids in the form of antigens, enzymes, hormones or metabolites. Such substances are called tumor markers.
(1) Carcinoembryonic antigen (cEA): is a non-specific antigen, which is elevated in many tumors and non-tumor diseases. There is no differential diagnostic value. Preoperative examination of operable breast cancer is about 20% to 30% of blood cEA. The content is elevated, while in advanced and metastatic cancer, 50% to 70% of CEA has a high value.
(2) Ferritin: Serum ferritin reflects the iron storage state in the body, and there is an increase in ferritin in many malignant tumors such as leukemia, pancreatic cancer, gastrointestinal tumor, and breast cancer.
(3) Monoclonal antibody: The monoclonal antibody cA used for the diagnosis of breast cancer, 15-3 has a diagnostic accuracy rate of 33.3% to 57% for breast cancer.
7, biopsy:
Breast cancer must be established before the diagnosis can be started. Although there are many current examination methods, only the pathological results obtained by biopsy can only be used as the basis for the only confirmed diagnosis.
(1) Needle aspiration biopsy: Acupuncture cytology was established by Gutthrie in 1921 and has been developed into a fine needle aspiration cytology. The method is simple, rapid, and safe. It can replace some tissue frozen sections, and the positive rate is higher. It is between 80% and 90% and can be used for anti-cancer screening. If the clinical diagnosis is malignant and the cytology reports benign or suspicious cancer, surgical biopsy should be selected to confirm the diagnosis.
(2) Cut biopsy: Because this method is easy to promote the spread of cancer, this method is generally not recommended, and it can be considered only when advanced cancer is used to determine the pathological type.
(3) Excisional biopsy: When a malignant mass is suspected, the mass is removed and a certain area around the tissue is a biopsy. It is generally required to remove as much as possible from the edge of the tumor at least 1 cm. The following examination of the cut specimen can be used to determine the malignancy:
1 The texture of medullary carcinoma is soft, the cut surface is grayish white, and there may be bleeding spots, necrosis and cyst formation.
2 The cut surface of the hard cancer is grayish white, shrinking, like a scar, extending radially around, without a capsule.
3 The characteristics of intraductal cancer involve multiple catheters, and even infiltrate in the direction of the nipple. The cut surface is grayish white, and sometimes the acne-like substance can be extruded.
4 The texture of lobular carcinoma is soft, the shape is irregular, the cut surface is grayish white, pink, sometimes the tumor is not obvious, only the breast thickening.
Diagnosis
Diagnosis of breast cancer
diagnosis
There are many methods for the diagnosis of breast cancer. The most commonly used breast mammography is the most accurate pathological diagnosis. Generally, the imaging examination is performed first. If there is any doubt, the pathological examination will be carried out. With the close relationship between the pathological results of Western medicine and the syndrome type of TCM, The diagnosis of breast in the Chinese medicine can not be underestimated. The ultimate goal of diagnosis is treatment. The combined diagnosis of Chinese and Western medicine will play a significant role in promoting the comprehensive treatment of Chinese and Western medicine.
First, the diagnosis of breast cancer - Western medical imaging
Early detection of breast cancer is important.
1 Ultrasound examination: microcalcification in the breast mass, edge & ldquo burr & rdquo sign, aspect ratio greater than 1, the possibility of cancer is the greatest, through the semi-quantitative method and color capture technology to observe the peak flow velocity of cancer, the average density of color pixels, blood vessels The average density is helpful for the differential diagnosis of malignant tumors. The penetrating blood vessels and MVD are highly sensitive to the diagnosis of breast cancer.
2MRI examination: The use of paramagnetic contrast agent to strengthen MIP reconstruction showed a 100% indication of breast cancer. MRS strongly suggested that the level of choline in breast cancer tissues was increased, and the water/fat ratio was significantly larger than that of normal tissues. It is an important criterion for the diagnosis of breast cancer.
3CT examination: thin-layer scanning can find 0.2 cm in diameter, and the related parameters of breast cancer increase are closely related to MVD, which shows the metastatic lymph nodes.
4X-ray examination: The most advantageous detection of breast cancer calcifications, X-ray digital photography can help CAD, MWA and CMRP technology can improve the reliability of breast cancer.
5 Infrared thermography: quantitative analysis of breast cancer hot zone temperature by digital quantitative system, calibration of the temperature difference between the lesion center and surrounding tissue, to determine the tumor is good, malignant.
6 Minimally invasive imaging: Ultrasound-guided biopsy was performed on small lesions lacking image features, and 3D CE PDU improved ultrasound was characterized by CT-guided biopsy.
Second, the evaluation of Western medicine diagnosis of breast cancer
Comprehensive evaluation of needle aspiration cytology, analysis of cancer cell DNA content, detection of carcinoembryonic antigen and mammography in the diagnosis of breast cancer. The highest coincidence rate was found by needle cytology. The cell DNA was determined by flow cytometry at 85.35 %. The highest false positive rate of content was 34.20%. The false negative rate of mammography X was the highest, which was 44.54%. The combined diagnosis of 4 indicators increased the diagnostic coincidence rate of breast cancer to 92.35%, and the false positive rate decreased to 1.96 %. The negative rate dropped to 5.93%. The combined diagnosis of the four indicators can significantly improve the correct diagnosis rate of breast cancer and contribute to early diagnosis.
Breast aspiration cytopathology not only has important applicability to the diagnosis of breast diseases, but also has important value for early diagnosis and classification of breast cancer. It is of great significance to identify breast hyperplasia and breast fibroadenoma with carcinogenesis. The rate is as high as 100%, the early diagnosis rate is 16.9%, and the total diagnostic accuracy is as high as 98.6%. The needle aspiration cytopathology of the breast has the advantages of small trauma, simple and rapid, safe and reliable, economical and practical, accurate results, etc. The traditional diagnostic method is currently irreplaceable by any method and has a high promotion and practical value.
3. Correlation between TCM Syndromes and Western Medicine Pathology
To study the characteristics of mammography of hepatic stagnation type breast cancer and to explore its pathological basis. In liver stagnation type breast cancer, the type of breast type is dense and mixed (78%), abnormal vascular signs and The frequency of peritoneal signs was higher (accounting for more than 80%), and the frequency of axillary lymph node metastasis was low (12%).
Differential diagnosis
(1) Recessive breast cancer refers to breast cancer that is not clinically accessible, and confirmed by pathological examination after mastectomy. It is often found by X-ray examination or axillary lymph node metastasis as the first symptom, which should be differentiated from para-breast cancer. In terms of treatment, it is generally believed that once the diagnosis is occult breast cancer, if there is no metastases on the spine and distant metastasis, radical surgery should be performed. Most of the reports are better than or similar to breast cancer with axillary lymph node metastasis.
(2) Male breast cancer Male breast cancer is rare. The incidence rate is 1% in breast cancer and 0.1% in male malignant tumor. The age of onset is 6-11 years higher than that of female breast cancer.
The symptoms of male breast cancer are mainly painless masses under the areola. 20% of patients have nipple retraction, crusting, and drainage. The boundary of the mass is often unclear. There is skin or chest muscle adhesion in the early stage, and the rate of axillary lymph node metastasis is higher. The pathological manifestations of breast cancer are similar to those of female breast cancer. The vast majority are invasive ductal carcinoma, and the male breast has no lobular tissue. Therefore, there is no report of lobular carcinoma in situ. The treatment of male breast cancer is similar to that of female breast cancer. In male cases, the breast tissue is small, and it is easy to invade the chest muscle at an early stage. The surgical method should be based on radical surgery or extended radical surgery.
The application of endocrine therapy to advanced or recurrent cases is better than female breast cancer. The main treatment method is bilateral orchiectomy, the effective rate can reach 50% to 60%, the reason why the high efficacy rate is due to nearly 84% of tumor tissue ER positive, the effective period lasts for an average of 12 months. If the patient is unwilling to undergo orchiectomy, or if the condition is recurred after resection, female hormones, male hormones or TAM can be taken to obtain good results. This type of endocrine therapy has been shown in patients. If the orchiectomy is ineffective, it will produce good results. The effective efficiency of this second-line endocrine therapy is between 30% and 50%. Chemotherapy is only for endocrine therapy, including defamation and additive, and it should start after failure. And giving the law is equivalent to female breast cancer.
(C) Inflammatory breast cancer is an extremely rare clinical type, often diffuse hardening and large, red, swollen, hot, painful and edematous, the incidence is explosive, very similar to acute inflammation, so it is also known as Cancerous mastitis, the diagnosis of this disease is: 1 local manifestations of redness and heat pain, but no cold and fever and other systemic inflammatory reactions.
2 body temperature and white blood cell counts are mostly in the normal range.
3 early skin is a typical violet, patchy edema, clear boundary, slightly raised edge, large pores such as orange peel changes, red swelling range is more than 1/3 of the breast, red swelling after 1 week of anti-inflammatory treatment does not disappear.
4 In the red and swollen breast tissue, sometimes the texture of the hard and tough mass can be touched.
5 The ipsilateral armpits can touch the harder lymph nodes.
6 fine needle aspiration cytology and pathological section can provide a basis for diagnosis.
Inflammatory breast cancer has a poor prognosis in surgery or radiation therapy. The average survival time is 4 to 9 months. Therefore, surgery is not recommended for inflammatory breast cancer. Most authors currently use chemotherapy for inflammatory breast cancer. The comprehensive treatment of radiotherapy, that is, first 3 to 4 courses of chemotherapy after radiotherapy, chemotherapy after radiotherapy.
(4) Breast cancer during pregnancy and lactation Breast cancer occurs in pregnancy or lactation, accounting for 0.75% to 31% of breast cancer cases. During pregnancy and lactation, due to changes in hormone levels in the body, it may accelerate tumor growth. The degree of malignancy is increased. At the same time, the physiological growth of the breast tissue during pregnancy and lactation is increased, and the tumor is not easily detected early, and is easy to spread.
The principle of treatment of breast cancer during pregnancy is similar to that of general breast cancer, but the choice of treatment method depends on the stage of the tumor and the different stages of pregnancy. Whether to terminate the pregnancy in early pregnancy should be based on different stages, and the disease period can be earlier. It is not necessary to stop the pregnancy. The stage is II, III or it is estimated that the need for chemotherapy and radiotherapy after surgery should stop the pregnancy to improve the survival rate. On the contrary, the surgery is delayed due to the termination of pregnancy, which may affect the treatment effect.
Breast-feeding breast cancer treatment should first stop breastfeeding. Postoperative adjuvant treatment is similar to general breast cancer. Preventive removal of ovaries does not improve survival.
