breast cancer in older adults
Introduction
Introduction to breast cancer in the elderly Breast cancer is a malignant tumor that occurs in the glandular epithelial tissue of the breast. It is one of the most common tumors that seriously affect women's physical and mental health and even life-threatening. basic knowledge The proportion of the disease: 0.03% of the elderly Susceptible people: good for older women Mode of infection: non-infectious Complications: pleural effusion, hepatic jaundice, hemiplegia
Cause
The cause of breast cancer in the elderly
(1) Causes of the disease
The cause of breast cancer is not clear, but the data indicate that it is more closely related to the following factors.
1. Menstruation: The incidence of menstrual cramps less than 13 years old and/or menopausal age over 50 years old is higher.
2. Marriage and childbirth, breastfeeding: those who are unmarried or infertile for the first time, the first childbearing age is greater than 30 years old and the incidence of breastfeeding after childbirth is higher.
3. Family history: The family history of breast cancer has a high incidence, which is called family genetic susceptibility.
4. Breast disease itself: Patients with important cystic hyperplasia have a higher incidence of breast cancer. If one side of the breast has cancer, it is a higher risk factor for the contralateral breast.
5. Previous medication: The incidence of long-term use of estrogen is high. It has been reported that long-term use of risepine, methyldopa, tricyclic analgesics, etc. can lead to elevated levels of prolactin and cancer in the breast.
6. Ionizing radiation: The mammary gland is a tissue that is more sensitive to ionizing radiation. Those who are exposed to radiation excessively have a greater chance of developing cancer.
7. Body shape: There is data showing that obese people have an increased chance of developing breast cancer after the age of 50. In fact, this is only a phenomenon, which can only be used as a reference in the analysis of multiple risk factors. What is obesity and breast cancer? The occurrence of the correlation is not clear.
(two) pathogenesis
There are many pathological classification systems for breast cancer. Currently, the WHO classification system is commonly used, which classifies breast malignant tumors into the following types:
Non-invasive tumor
(1) Intraductal cancer.
(2) lobular carcinoma in situ.
2. Invasive tumor
(1) Invasive ductal carcinoma.
(2) Invasive ductal carcinoma with obvious intraductal cancer components.
(3) invasive lobular carcinoma.
(4) Mucinous cancer.
(5) medullary carcinoma.
(6) papillary carcinoma.
(7) Tubular cancer.
(8) cystic adenoid carcinoma.
(9) Secretory cancer.
(10) sweat gland cancer.
(11) cancer that changes between: 1 squamous cell carcinoma; 2 spindle cell carcinoma; 3 cartilage or bone-like tumor; 4 mixed type.
(12) Others.
3. Nipple Paget's disease
(1) Non-invasive cancer: The cancer tumor stays in the milk duct or acinar, and there is no breakthrough in the basement membrane. If it has been infiltrated, it is included in invasive cancer.
Lobular carcinoma in situ: increased leaflet uniformity, structure, glandular duct, acinar enlargement and enlargement, filled with non-polar cancer cells, forming many irregular small round cancer cell masses, occasionally muscle epithelial cells, The outer layer is the basement membrane. The cancer cells are slightly larger than the normal cells, the cytoplasm is richer, the nucleus is slightly larger, it is often lightly stained, and it can be deeply stained. There is no obvious abnormal shape. The mitotic image can be found. It is often necessary to take more materials and multi-slices. Careful observation to rule out invasion, sometimes see glandular ducts in the glandular duct and acinar cavity. Because the tubules and cell size are the same, it cannot be assumed that the expansion of the ductal carcinoma from the small duct is also classified as lobular carcinoma in situ. .
Identification:
1 If the cancer cell mass sprouts or breaks through the basement membrane, it is a lobular invasive carcinoma, but it is common for small cancer cells to be single-celled or dispersed;
2 other intraductal cancer spread along the mammary duct to the small leaf, often does not involve all the tubes in the leaflet, foam, cancer cells vary in size, there are obvious abnormalities, the size of the mass is often inconsistent, and there are often lymphocyte infiltration around;
3 The difference between lobular carcinoma in situ and lobular hyperplasia is that the cells of lobular hyperplasia are small, glandular ducts, acinar cells often have double epithelial cells, and there is no polarity disorder.
Intraductal cancer: Cancer cells are relatively uniform in size, ranging from mild to moderately heterogeneous. They can be arranged in a variety of ways, and can move to each other. Sometimes in a tumor, several structures are visible. The following types are common:
1 solid intraductal cancer: many dense breast ducts are highly dilated, full of mildly shaped, but non-polar cancer cells can be found in mitotic figures, sometimes in the middle of cancer cell masses, see a small amount of necrotic cancer cells or small round gaps , no violation of the violation.
2 sieving intraductal cancer: In some densely-expanded milk ducts, the cancer cells are arranged in a sieve shape. The cancer cells are larger than the basal cells, have no polarity, the cytoplasm is lightly acidophilic, and the nucleus is mild to moderately abnormal. See some round holes, no leaching tube, cancerous necrosis is common in the middle of the cancer nest. In the above two types, if the cancer cell mass is a large piece of necrotic cancer cells, it can be called acne-like intraductal cancer.
3 low papillary duct cancer: many breast ducts are highly dilated, dense, and lining cancer cells from mild to moderately shaped, forming many regular low nipples, generally no fibrous vasculature, cytoplasm of cancer cells in the lumen The side may have vacuoles, which are like ruptures, sometimes rich in cytoplasm, acidophilic, and may have apical protrusions.
Identification:
1 The difference between solid intraductal carcinoma and solid papilloma is that the former has a heterogeneous cell, many mitotic figures, no polarity, a large number of cancer cell nests, and a uniform size. The common flaky cancer cells in the nest are necrotic, often accompanied by There are intraductal cancer or acne-like intraductal cancer.
2 The difference between the intraductal carcinoma and the adenoid cystadenocarcinoma is that the latter cancer cells are basal-like cells with few cytoplasm, alkalophilic, no nucleus, and there are myoepithelial cells and adhesion in the tube and around the cell nest. Polysaccharide.
3 The difference between the intramyocardial carcinoma and the squamous papilloma is that the latter have fewer cell nests, different sizes, and the tumor cells are polar, no cell-shaped, and no flaky necrosis.
4 The difference between the low papillary ductal carcinoma and the cystic hyperplasia of large cysts is that the number of cysts of cystic hyperplasia is very small, in which the size of the nipple is relatively uniform, the cells are often intact, and there is no abnormality.
Early invasive cancer: Breast cancer from non-invasive carcinoma in situ to invasive carcinoma is a gradual process of development, which requires an early infiltration stage, which refers to the period when the cancer tissue begins to break through the basement membrane and begins to infiltrate into the interstitial It is different from carcinoma in situ and different from general invasive carcinoma. According to the different morphology, it can be divided into early invasive lobular carcinoma and early invasive ductal carcinoma.
Early invasive lobular carcinoma: an early invasive stage of lobular carcinoma in situ, showing that cancer cells filled in the lumen of the lumen pass through the basement membrane to infiltrate into the interlobular mesothelial, but have not infiltrated beyond the lobular extent.
Early invasive ductal carcinoma: Like invasive ductal carcinoma, cancer cells in part of the intraductal carcinoma break through the basement membrane to interstitial infiltration, but the extent of infiltration is small, and the cancer cell nest extends only like a germination to the interstitial. Does not form extensive infiltration.
(2) invasive cancer:
Invasive lobular carcinoma: The cancer cells in the lobules break through the basement membrane and the interlobular extent to the interstitial infiltration, which is called invasive lobular carcinoma. After infiltration, most of them become small cell type hard cancer or simple cancer. The glandular lobular carcinoma infiltrates the interstitial. Tumor-like carcinoma is often formed. The interstitial infiltrating cancer cells often surround the catheter and form a concentric image to form a target image, which is the morphological feature of invasive lobular carcinoma.
Identification: The difference between lobular invasive carcinoma and sclerosing adenosis is that sclerosing adenosis generally maintains lobular structure, epithelial cells have no abnormality, no mitotic figures, common bilayer epithelial cells form tubules, epithelial cells often atrophy, and lobular invasive carcinoma not only has cells Mildly shaped and invasive.
Invasive ductal carcinoma: cancer cells of intraductal carcinoma, which break through the basement membrane in some areas and infiltrate into the interstitial, some of which have clear intraductal cancer components, and the invasive ducts referred to in the WHO Breast Tumor Histological Classification (1981). The form of cancer is diverse, including simple cancer, hard cancer, and medullary carcinoma without lymphocyte infiltration, which is the most common type of breast cancer.
Simple cancer: It is the most common type of breast cancer, accounting for more than 80%. The morphological characteristics are the proportion of the main substance and the interstitial in the cancer tissue. The morphology is complex and diverse, and the cancer cells are often arranged into nests, cords, adenoids or Piece-like, when several types of breast cancer are mixed together, and it is difficult to measure the type, it can also be diagnosed as simple cancer.
Medullary carcinoma: medullary carcinoma is rarer than simple cancer. The volume of the tumor is large, about 3 to 9 cm. The texture is soft. It is often located in the deep part of the breast tissue. The boundary with the surrounding tissue is clear, the edge is neat, and it tends to swell and grow. Grayish white, common bleeding, necrosis.
Microscopic examination: The main quality of cancer is small, the interstitial is small, the cancer cells are large, oval, round, polygonal, cytoplasm rich, basophilic, large and vacuolated, nucleoli clear, split image More common, sometimes visible mononuclear and multi-nuclear giant cells, cancer cells are closely arranged, mostly in patchy distribution, sometimes in the form of thick cords, small nests or diffuse distribution, sometimes confused with malignant lymphoma, many The medullary carcinoma is accompanied by abundant small lymphocyte infiltration and even visible plasma cells, which indicates the body's immune response to cancer tissues.
Lymphocytic carcinoma with lymphocytic infiltration has a better prognosis than medullary carcinoma without lymphocytic infiltration. Lymphocytic infiltration of medullary carcinoma, 5-year survival rate is 83.23%, 10-year survival rate is 69.40%, no lymphocytic infiltration In medullary carcinoma, the 5-year survival rate is 67.28%, and the 10-year survival rate is 44.09%.
Hard cancer: pure hard cancer is rare, often coexisting with other types of breast cancer. The WHO classification has classified hard cancer into invasive ductal carcinoma, and no longer includes hard cancer. The gross specimen is small in size. The boundary is unclear, and it has a radial junction with the surrounding breast tissue. The texture is hard. When the cut surface is made, there is a sense of resistance on the knife. The cut surface of the tumor is grayish white or yellowish. There are scattered yellow-white strips, and bleeding and necrosis are rare.
Microscopically, the cancer cells are polygonal, cuboidal or short fusiform, with nuclear division easy to see, connective tissue hyperplasia in the interstitium, more interstitial mass than the main substance, composed of dense fibrous tissue, which may have collagen degeneration and may occur. Calcification, ossification.
Identification: Identification with plasma cell mastitis, especially in the diagnosis of frozen sections, this cancer is aggressive, easy to metastasize, and has a high degree of malignancy.
Mucinous adenocarcinoma: The patient is generally older. The gross specimen is large in size, clear in boundary, irregular in edge, translucent in cut surface, and jelly-like.
Under the microscope, there is abundant mucus in the interstitial, which divides the cancer cells into small nests. The cancer cells are round, polygonal, and the outline is unclear. The cytoplasm can contain small vacuoles, and the nucleus is small and round, deeply stained. On the cell side, there are few mitotic figures. When the mucus volume is more than that of the mucus lake, the cancer cells are few and become small islands floating in the mucus lake. Sometimes you need to look carefully to find the epithelial components and float in the mucus lake. Cells are often reduced in size due to secretory failure, with little cytoplasm, deep nuclear staining, and sometimes difficult to detect, especially in frozen sections. This cancer is also known as jelly-like cancer, which is a cancer containing a large amount of extracellular epithelial mucus.
Mucinous adenocarcinoma grows slowly, mostly expansive growth, invasiveness is not strong, metastasis is late, and the prognosis is good. If it is a signet ring cell type with a large amount of intracellular mucus, the prognosis of mucinous adenocarcinoma is extremely poor.
Because this type of breast cancer contains a large amount of extracellular mucus, and the amount of cancer cells is small, when the biochemical method is used to determine the estrogen receptor of breast cancer, false negative results often appear, and by immunohistochemistry, the cancer cells can be clearly seen. Brown positive particles.
Papillary carcinoma: occurs mostly in large breast ducts, rarely caused by intraductal papilloma, papillary carcinoma can be single or multiple, mostly slow growth, late metastasis, but nipples are often seen in metastases. Some cases have nipple discharge, mostly bloody, such as finding cancer cells in the smear of the spill, which is helpful for diagnosis.
The tumor was seen as a reddish-brown nodule, which was brittle and had pink carrion or papillary tissue in the nodules.
Under the microscope, the cancer cells are arranged in a nipple shape, the connective tissue in the center of the nipple is sparse, and sometimes the papillary structures are in agreement with each other, forming a complex glandular structure, or forming a wheel-like or even a sieve-like structure, and the cancer cells are lined with the connective tissue axis. On both sides, it can be single-layer or multi-layer, or it can be substantially hyperplasia, cell size, shape, polarity disorder, nuclear deep staining, splitting common, according to different ways of nipple structure, papillary carcinoma It is divided into long-branched papillary adenocarcinoma, short papillary adenocarcinoma and fusion papillary adenocarcinoma, or divided into papillary, reticular, sieve-like and microcapsule type 4.
Identification: It is difficult to distinguish between cell-rich atypical papilloma and papillary carcinoma, especially in rapid diagnosis, limited to providing less tissue for examination, and the quality of frozen sections below paraffin is more difficult, but Even in paraffin sections, the two are difficult to distinguish. This is mainly because the tumor cells of papilloma have a double-layer structure, the tumor cells are arranged neatly, without invasive growth, and the tumor cells of papillary carcinoma are multi-layered and lose polarity. Invasive growth can be seen, followed by the obvious connective tissue interstitial in the former, the nipple can be fused into a complex glandular structure, but there is no sieving structure, there is a sclerosing breast gland metaplasia and sclerosing breast disease adjacent to the breast tissue. The latter has a small or no connective tissue interstitial, tumor cells can increase the formation of a sieve-like structure, apocrine sweat gland metaplasia, sclerosing breast disease without adjacent breast tissue.
Adenoid carcinoma: This type is rare, slow to develop, low in malignancy, often bilateral and multicentric, with a small tumor volume, mostly less than 1 cm.
Microscopic examination: manifested as highly differentiated invasive carcinoma, the heterogeneity of cancer cells is not obvious, forming a gland tube composed of monolayer cells, fibrous tissue hyperplasia or hyalinization around the gland tube, attention and sclerosis Identification of breast disease, ductal carcinoma can be combined with other types of cancer.
Adenoid cystic carcinoma: occurs mostly in the salivary gland, occurs in the breast is very rare, in other types of breast cancer often seen focal adenoid cystic carcinoma structure, this cancer grows slowly, axillary lymph nodes less metastasis, prognosis It is better than salivary adenoid cystic carcinoma.
Giant examination: The mass of the mass is clearly separated from the surrounding breast tissue, and there is no capsule, and the cut surface is similar to other types of breast cancer.
Microscopic examination: Cancer cells form many lumen structures of different sizes. If the lumen size is uniform, they will be sieved, sometimes the lumen is not obvious, forming a bundle or nest that intersects vertically and horizontally. It can also be in the form of a piece, tubular structure. Lined with single or several layers of cells, the cancer cells are smaller, the cytoplasm is less, the nucleus is deeply stained, and the division is rare. The microscopic images are indistinguishable from the tumors that occur in the salivary glands.
Apocrine adenocarcinoma: This cancer is rare and comes from the ductal epithelium of the breast.
Microscopic examination: special morphology, large cancer cells, abundant cytoplasm, eosinophilic, granular, glandular or alveolar structure, a few can form nipples, pure apocrine adenocarcinoma is rare, but in other types of breast cancer Focal apocrine adenocarcinoma is often seen inside.
Adenocarcinoma: Pure adenocarcinoma is rare, often mixed in simple cancer. When more than half of the cancerous parenchyma is expressed as a ductal structure, it can be diagnosed as adenocarcinoma.
Microscopic examination: the glandular cavity is irregular, there is a single gland cavity, but it is often seen that several glandular cavities are connected together, and the cancer cells can be arranged in a single layer, but most of them are multi-layered, the cell is abnormal, and the division is easy to see.
Eczema-like cancer: also known as Paget's disease (Paget's disease), mainly occurs in women aged 40 to 60 years, mainly manifested as eczema-like changes in the nipple and areola skin.
Microscopic examination: Peijie cells are seen in the nipple and areola epidermis. The cells are large in size, 2 to 3 times larger than the epithelial cells in the same layer. They are round, oval, clear in cell boundaries, rich in cytoplasm, lightly stained or translucent. The nucleus is large and round, the staining is shallow, the chromatin granules are fine, there is a chromatin clot, the cleavage is easy to see, the nucleolus is clear, some pigment granules are visible in the cytoplasm, and the geek cells are nest-like, adenoid or scattered. In the epidermis, mainly distributed in the epidermis, it can also occupy the entire epidermis. The breast cancer coexisting with Paget's disease is mainly intraductal carcinoma and lobular carcinoma in situ, and some are invasive ductal carcinoma, simple cancer and medullary carcinoma. The survival rate of Paget's disease is higher than that of normal breast cancer.
Squamous cell carcinoma: true squamous cell carcinoma is rare. It occurs on the basis of squamous metaplasia of ductal epithelium. It has a high degree of malignancy and morphological features of squamous cell carcinoma that occurs in other parts. If the cancer tissue is mostly squamous cell carcinoma, Only a small proportion of other types of breast cancer can also be diagnosed as squamous cell carcinoma.
(3) Other rare breast cancers:
Secretory (young) cancer: more common in children.
Microscopic examination: It is characterized by a glandular or luminal structure, with shallow staining of cancer cells, significant secretion activity, and PAS-positive substances in the cytoplasm and glandular cavity.
Lipid-rich cancer: lipid-rich cancers have a high degree of malignancy, and the morphology of lymph node metastases can sometimes resemble tissue cell proliferation.
Microscopic examination: The cancer cells are arranged in a sheet and a strip, the cytoplasm is rich, transparent or foamy, and the fat staining is strongly positive. The ultrastructural study also proves that the cytoplasmic lipid is a secreted product, rather than denatured, and many fats are visible. The vacuoles, some of the lipid vacuoles are larger, causing the nucleus to push to one side.
Carcinoid: Breast carcinoid is rare, and the morphology is similar to carcinogenesis in various parts of the breast. Silver staining shows granules with weak protein silver in the cytoplasm. Tumor cells secrete silveramine, but because of the small amount of secretion, Under the destruction of normal liver tissue, carcinoid syndrome, flushing, diarrhea, bronchi and pulmonary artery spasm are only present when the tumor is large and the liver has metastasis.
Mucoepidermoid carcinoma: mucoepidermoid carcinoma of the same form as the salivary gland, rare, composed of glandular epithelial cells secreting mucus, epidermal cells and intermediate cells, the degree of malignancy varies with the proportion of constituent cells.
Undifferentiated cancer: For poorly differentiated breast cancer, cancer cells are diffuse into pieces, and the nested structure is not obvious. It needs to be differentiated from lymphoma. When observed carefully, the cancer cells are characterized by adenocarcinoma.
Inflammatory breast cancer: rare, clinically known as red, swollen, hot, pain and other basic symptoms of inflammation, many are misdiagnosed as "mastitis."
Microscopic examination: There is no histological basis for the inflammation usually referred to, such as inflammatory cell infiltration, etc. In some cases, skin lymphatic vessel dilatation and cancer detection can be seen. This type develops rapidly and the prognosis is poor. Sometimes, when the patient is newly diagnosed, there is a distant field. Metastasis, because its nature is non-inflammatory, it is more suitable for acute breast cancer.
Prevention
Breast cancer prevention in the elderly
Due to the complex etiology of breast cancer, the pathogenesis has not yet been fully explored. To minimize the threat to breast cancer for women, the investment in defense should be increased.
Primary prevention
Primary prevention is the prevention of the cause, efforts to identify the cause of cancer, reduce or eliminate exposure to carcinogens, measures to address the cause and enhance the body's ability to resist disease. Because of its complex causes, primary prevention is still in the exploratory stage.
Some of the risk factors for breast cancer are inevitable, such as menstruation, birth history, etc., but there are also many factors that are artificial, through adjustments to the diet, such as reducing excessive calorie intake, reducing fat intake, reducing excess Ingestion of meat, omelettes, butter, sweets, etc., increase the intake of green vegetables, fruits, carotene, try to avoid exposure to ionizing radiation, etc. can reduce the risk of breast cancer.
(1) Lifestyle change: With the development of the economy, the living standard is gradually improved, and the proportion of fat in the dietary ingredients is gradually increasing. For example, in the 1960s and 1970s, the fat intake reached 35% to 40% of the total calories. Fatty and high-fat diets increase the risk of breast cancer Although not yet finalized, foreign experts have advocated a gradual change in people's eating habits and diets, such as the ban on the sale of meat with fat layers in the United States, and the promotion of people to reduce fat intake , so that the percentage of fat in total heat is controlled at about 25%.
(2) Health promotion: For breast cancer, lose weight, maintain ideal body shape, use less estrogen-containing drugs after menopause to treat menopausal symptoms, drink less alcohol, participate in physical exercise, social activities, avoid or reduce mental stress Factors, etc., are very important and strengthen prevention for high-risk groups.
2. Secondary prevention
Refers to the benign lesions of breast cancer, the prevention of preclinical and carcinoma in situ in breast cancer, including screening and early detection programs to identify cases in the early stages of cancer development, thereby increasing the chance of cure.
(1) Principles of breast cancer screening (screening), the United States Anti-Cancer Association in 1980 proposed the following:
1 Women older than 20 years old, breast self-examination once a month.
Women aged 220 to 40 are examined by a doctor every 3 years.
3 Women over 40 years old are examined by a doctor once a year.
For women aged 430 to 35 years, there should be a mammography (X-ray film) as the basis for future examinations.
5 Women younger than 50 years old, according to individual circumstances, consult a doctor whether you need to perform mammography, family history of breast cancer and personal history, you should consult the doctor's frequency of mammography.
6 Women older than 60 years old, once a year mammography.
(2) census methods for breast cancer: census methods generally use mammography, and special cases use breast puncture cytology.
The appropriate age and interval of 1X-ray photography have different views. In general, young women's breast tissue is in a sensitive period, which is not suitable for X-ray photography. Postmenopausal women can be examined once every 2 to 3 years.
2 histological examination of breast puncture: it is characterized by high sensitivity, specificity, rapid and accurate diagnosis, especially when it is difficult to define a mass or nodular lesion. Puncture is more important after mammography. For further examination of selective cases, the indications for selection are:
A. Qualitative diagnosis of breast masses.
B. Determination of the degree of hyperplasia of breast tissue.
C. Histological and cytological diagnosis of cases of metastatic breast tumors.
D. Perform hormone receptor assays on breast tissue or breast tumor tissue.
3 breast cold light projector screening has also recently shown a broad application prospects.
(3) Breast self-examination:
1 Reasons why this method is widely accepted:
A. No damage to the human body.
B. Economical convenience.
C. No professional is required to participate in the inspection.
D. Self-test to determine the occurrence of early breast cancer, self-test breast cancer mass is small, lymph node metastasis rate is low, such as FOSTER reported in the self-test group, breast cancer 5-year survival rate of 75%, non- The self-examination group was 57%, the self-test group had a 5-year survival rate of 76.17%, and the non-self-test group was 60.9%.
2 breast self-examination method: If the breast mass is found to be persistent regardless of the menstrual cycle, it should be consulted and examined by the doctor.
Looking around: Observe the shape of the breast before wearing the mirror, whether the bilateral breasts are symmetrical, whether the breast skin has abnormal changes, such as skin retraction, orange peel-like changes, uplift, edema, etc. There are 3 types of body position:
1 sit straight and rub your hands to make the pectoralis major muscles contract;
2 sit straight up and straight up;
3 Standing arms straight to the sides, bending forward, the upper body bent down and the legs are 90 °, the breasts naturally sag.
Palpation: check whether the breast has a lump, induration, axillary lymph nodes, etc., can lie flat on the bed, the subject's arm is stretched, the shoulder is slightly padded with the pillow, and the flat part of the opposite finger is touched. Breast and axillary lymph nodes, the key to breast examination is that the fingers are stretched together, and the palm fingers touch the breast in a plane, but cannot be grasped with fingers.
Self-inspection once every 7 to 10 days after the end of menstruation. The results of the examination should be compared with the results of the previous month. If the following conditions are found, you should go to the hospital for consultation:
1 bilateral breast asymmetry;
2 The breast has a lump or induration or the texture is harder than before, showing a membranous change, and has nothing to do with the menstrual cycle.
3 breast skin has such as edema, depression, incomplete and so on.
4 breasts have an overflow, depression.
5 The areola area has an "eczema-like" change.
3. Three levels of prevention
It refers to the implementation of scientific and rational comprehensive treatment for breast cancer patients to prevent inappropriate or premature death of clinical complications, especially active treatment of advanced patients, in order to prolong the life expectancy of patients and improve their quality of life, and promote the rehabilitation of patients. In some developing countries, 30% to 80% of breast cancer patients are diagnosed in the late stage, so it is of great practical significance to strive to change the quality of tertiary prevention of breast cancer.
4. Risk factors
Early menarche, early birth of the first child and late menopause are the three most important risk factors for breast cancer.
(1) Marriage: Unmarried is a risk factor for breast cancer. The facts show that nuns, single women, women with short marriage and short duration of marriage have a high incidence of breast cancer.
(2) primiparity age: the most relevant to the risk of breast cancer among the fertility factors is the age of the first full-term birth. The primiparity age will reduce the risk of breast cancer, and the full-term pregnancy is necessary for protection. The earlier the primiparity, the lower the risk. The first-term full-term producer before the age of 20, the incidence of breast cancer is only 1/3 of the 30-year-old born in the first full-term child. The age of primiparous age is gradually increasing, and the risk of primiparity after 35 years of age is higher than that of those without birth history.
(3) Productivity: Most researchers recently believe that the birth rate is indeed an independent factor. Leons prospective study in 1989 concluded that the number of times of birth is greater than or equal to 5 times compared with only one producer. The risk is 0.6, while a few researchers reported that the protective effect of multiple births is only effective for more than 50% of women who may be sick. For younger people, prolificacy increases the risk of breast cancer.
(4) Breastfeeding: Breastfeeding can reduce the risk of breast cancer. After the first birth, the risk of breast cancer is reduced, and the total length of breastfeeding is negatively correlated with the risk of breast cancer. It may be that breastfeeding delays postpartum ovulation and Reconstruction of menstruation and perfection of breast tissue.
(5) Artificial menopause: Ovariectomy can reduce the risk of breast cancer. The younger the age of oophorectomy, the lower the risk. The risk of breast cancer in women who have had ovarian resection before the age of 35 is 45-54 years old natural menopausal women. One-third of this protection can last a lifetime.
(6) Menstrual history:
1 The age of menarche: The age of menarche is an important risk factor for breast cancer. The risk of onset of menarche earlier than 13 years is 2.2 times that of 17 years old. It is generally considered that the age of menarche is delayed by 1 year and the risk of breast cancer is reduced. %, the age of menstruation is small, the risk of breast cancer is large, and the regularity of one year is more than 2 times higher than that of 5 years.
The age of menarche is closely related to the nutrition and diet of children. As the nutrition in childhood improves, the menarche gradually advances. This phenomenon may be related to the increase of breast cancer incidence.
2 Menopause age: late menopause, increase the risk of breast cancer, 45-year-old menopause than 50-year-old menopause, the risk of breast cancer is reduced by 30%, there are people who believe that 45-year-old menopause is more dangerous than breast cancer in 55-year-old menopause Sexually reduced by 50%, the risk of premenopausal breast cancer is high, the risk of postmenopausal breast cancer is small, after menopause is only 1 / 6 of the risk of breast cancer before menopause, after artificial menopause, the incidence of breast cancer is reduced, menopause Long, women with irregular menstruation, increased risk of breast cancer, the incidence of breast cancer in women with menstruation is related to the role of estrogen, women with breast cancer, circulating estrogen concentration is 2 times higher than the average person.
(7) Weight: Weight gain may be a risk factor for breast cancer in postmenopausal women, and weight gain in premenopausal women has little to do with breast cancer risk.
(8) Fat diet: changes in eating habits, especially fat diet, can change the internal environment, strengthen or prolong the stimulation of estrogen on mammary epithelial cells and increase the risk of breast cancer. Fat increases the risk of breast cancer, possibly with Fat accelerates childhood growth and development, early premature maturity, early exposure of mammary epithelial cells to estrogen and prolactin, increasing the chance of cancer, fat can also increase the conversion of androstenedione to estrogen, may increase the release of pituitary In addition, the role of the hormone, in addition, fat metabolism is strong, cholesterol generation is high, the conversion rate is high, and the estrogen outside the ovary increases.
(9) Relationship between breast cancer and ionizing radiation: Ionizing radiation is related to the onset of breast cancer, and its risk increases with the increase of irradiation dose.
(10) The relationship between breast cancer and benign breast tumors: breast lobular epithelial hyperplasia and dysplasia may be related to the onset of breast cancer. These benign diseases can increase the susceptibility of carcinogenic or cancer-promoting substances, so benign breast diseases can be Increase the risk of breast cancer.
(11) Breast cancer and family relationship: Women with a history of breast cancer in the first-degree family, the risk of breast cancer is 2 to 3 times that of the normal population, and the risk is related to the age of onset of breast cancer in the family. Single, bilaterally related, first-degree direct family, premenopausal breast cancer, such as unilateral, the risk of breast cancer in their family is 3.0, such as bilateral, the risk is 8.0; first-degree direct family family postmenopausal If breast cancer is unilateral, the risk of breast cancer in its family is 1.5, and the risk on both sides is 4.0.
(12) Breast cancer is related to endocrine function: When the ovary secretes too much hormone, it can lead to the occurrence of breast cancer. When the pituitary and ovarian hormones are lacking, the breast is not developed, and breast cancer is not easy to occur. Estrogen is taken for a long time in menopause. It can increase the risk of breast cancer, and testosterone has the protective effect of inhibiting or delaying tumorigenesis.
Complication
Elderly breast cancer complications Complications, pleural effusion, liver jaundice, hemiplegia
After blood circulation to distant organs, corresponding signs may appear, such as pleural effusion, weakened lung breath sounds, large liver, abdominal mass, jaundice, tenderness of bone metastases, paraplegia, hemiplegia, physiological reflexes of nerve reflexes weakened or disappeared , pathological reflexes and so on.
Symptom
Breast cancer symptoms in the elderly Common symptoms Chest pain, nipple discharge, fatigue, breast mass, pleural effusion, abdominal distension, abdominal pain, lymphatic metastasis, loss of appetite, shortness of breath
Painless mass
Breast lumps are the first symptoms of breast cancer patients, which are the main symptoms that prompt patients to see a doctor, accounting for more than 80% of the total number of visits, mostly painless, but fat women, breast hypertrophy, and tumor volume is small, texture is better Soft, general inspection is very easy to miss, should be taken, lying and other different positions carefully examined.
(1) Location: The outer upper limit of the breast is the predilection site of breast cancer, accounting for 36.1%, and the upper (outer, middle, and inner) of the breast is about 65.5%; the second is the nipple, the areola area and the upper limit; the whole breast, The incidence is lowest on the medial side and below.
(2) Size and number: The size of the tumor is different, the single hair is the majority, and occasionally more than two.
(3) Morphology and boundary: an irregular spherical mass or a hemispherical or uneven surface nodular mass resembling a coral stone. The boundary is unclear. The tumor is related to the gland, but it cannot be said to be circular. The oblong shape is relatively regular, and the medium texture must not be cancer. Clinically, the surface of the cancer is sometimes smooth, and the boundary is relatively clear. It seems that there is a capsule and a certain sense of movement, which is difficult to distinguish from benign tumors.
(4) Hardness: The texture of breast cancer is different, mostly solid lumps, like stone hard or rubber-like toughness, softer sac sexy, clinically hard and tough mass, long round or irregular cord Block, diagnosed as breast cancer is not difficult, but obese breast, rich in fat, occasionally the cancer is located below, the palpation is softer, difficult to identify with lipoma.
(5) Activity degree: When the cancer is located in the glandular parenchyma, the tumor and the breast tissue move together without a feeling of encapsulation. The deeper the mass, the worse the activity, such as the deep dip of the tumor and the pectoral fascia or Muscle, when the muscle contraction, the activity of the tumor is limited or unable to move. When the tumor continues to infiltrate into the chest wall, the cancer and the chest wall can not be completely fixed. This is a late manifestation, even if the early cancer is located in the glandular parenchyma, Compared with the degree of activity of benign tumors, benign tumors are detected by both hands and the tumor moves within the capsule. This difference is important.
2. Nipple and areola abnormalities
(1) nipple retraction: breast dysplasia or women who have not breast-feeding after childbirth, the nipple can be deep, but can be pulled out by fingers as normal, no fixation, when the cancer is located under and near the areola, dip and nipple large catheter, Gradually increase its retraction and fixed nipples are often higher than the healthy side, down or skewed, causing the nipples on both sides to be inconsistent, the cancer is deep in the mammary gland, the invasion is wider, the large catheter is hardened, contracted, resulting in nipple fixation It is a sign of advanced breast cancer. The breast is urgent, and chronic inflammation can also cause nipple retraction. It is not difficult to identify the detailed history.
(2) nipple itching, desquamation, erosion, ulceration, crusting, with burning pain, occasionally nipple discharge, resulting in nipple changes, is the performance of nipple Paget's disease.
(3) nipple discharge: breast cancer with nipple discharge accounted for more than 5%, its nature can be milk-like, watery liquid, serous, bloody, purulent, etc., these are different degrees of local development of cancer Reaction, clinical only nipple discharge, sputum less than mass, mostly intraductal early cancer or large intraductal papilloma, nipple discharge can be more or less, interval time is also inconsistent, less common, more with mammary gland Lump.
3. Breast contour and skin changes
Normal breasts have a complete curved contour regardless of any position. Once this contour is abnormal or defective, it indicates tumor formation, suggesting that the tumor invades the skin's copper fascia, sometimes for early breast cancer performance, and localized uplift. It is one of the local clinical manifestations of tumors.
Skin changes are related to the depth and degree of invasion of the breast cancer. The cancer is small, the site is deep, the skin is normal, the cancer is invasive, and the area is superficial. Due to subcutaneous infiltration and stretching of the skin, even the early cancer can show the skin. Adhesive, causing the skin to appear concave, called "dimple sign", when the cancer cells block the subcutaneous lymphatics, the skin edema is formed into orange peel-like changes, which is a late manifestation. The cancer invades the intradermal lymphatic vessels and forms around the cancer. Small cancerous lesions, called skin satellite nodules, are distributed in small patches to form thyroid carcinoma, which is further developed into advanced cancer. The skin is completely fixed or ulcerated. One side of the breast moves up, possibly on the breast. One of the signs of breast cancer.
Inflammatory breast cancer, the local skin is inflammatory like, the color is from reddish to deep red, which is relatively limited at the beginning, and soon expands to most of the breast skin, accompanied by skin edema. The skin is thickened and rough when palpated. The surface temperature is elevated, but it is more common around the areola and below the breast. The varicose veins on the surface of the tumor are common in rapidly growing tumors. The unilateral nipple retraction is progressive. In breast cancer, the nipple is often pulled to the lesion side, nipple Epidermal erosion and desquamation should exclude nipple-based disease.
4. Pain
About 1/3 of breast cancers have different degrees of pain, paroxysmal or persistent pain, or acupuncture-like pain, and some are the upper arm and shoulder traction pain, with heavy discomfort, also A small number of patients see a doctor because of the pain. In general, breast cancer patients are not advanced, and the pain is not serious. It is not as good as premenstrual pain in breast hyperplasia.
5. Recessive breast cancer
In a small number of cases, the axillary lymphadenopathy is the first symptom. The primary lesion in the breast is small and clinically difficult to treat. It is called recessive breast cancer.
6. Distant transfer
When the tumor occurs distantly and distantly, such as liver, brain, bone, lung, etc., the corresponding symptoms appear.
(1) lung metastasis: invasion of the trachea can occur cough, wheezing, chest tightness, cancerous lymphangitis can be seen breathing difficulties, cough, cyanosis and chest pain.
(2) pleural metastasis: bloody pleural effusion, common chest tightness, chest pain, shortness of breath and cough.
(3) Bone metastasis: the chest, lumbar vertebrae and pelvis are the most, followed by ribs, femurs, patients with persistent pain, progressive progression, spinal metastases due to spinal cord compression caused paraplegia.
(4) Liver metastasis: At first, there may be fatigue, loss of appetite, common abdominal distension in the later stage, abdominal pain, pain in the liver area, yellow staining of the skin, etc.
(5) brain metastasis: often multifocal, causing brain edema caused by increased intracranial pressure, visible headache, vomiting, decreased vision, convulsions, physical activity disorders, and even coma.
7. Signs of breast cancer metastasis
After lymphatic metastasis, the axillary lymph nodes can be touched under the armpits, hard and tough, and often fixed; the posterior and superior parts of the medial aspect of the affected clavicle often touch the swollen hard lymph nodes, and the affected lymph nodes are no more than 1 cm in diameter, if the cancer cells Blocking the main lymphatic or axillary veins of the axilla, causing waxy white edema or blue-violet edema in the affected arm, occasionally swelling of the contralateral or subclavian lymph nodes, contralateral breast mass, ipsilateral cervical lymph nodes or inguinal lymph nodes.
Examine
Elderly breast cancer examination
1.(CEA) 20%30%CEA50%70%CEACEACEA
2.38%100%25%
3.42%
4.CA15338.3%57%
CA153MCAB5.728.4IU/ml28FU
5.2-2-mG2-mG2.12±0.46µg/ml2-mG147±65µg/ml2-mG11%55%
6.LDH-5LDH-463%LDH-5LDH-483%LDH69%82%
X-ray inspection
X
(1)
X85%90%
A.45%
B.3
C.
D.XX
70%X40%X3
A.
B.
C.
(2)
14
X
Cooper's;
;
Cooper's
X
X
97%70%90%
2.X
3. Ultrasound examination
1
;;;
4.
75%80%
5.
77%88%
6.
7.CTMRI
CT14cmCT50HuCT97%68mmCT12mm×2mm
T1T2Gd-DTPA
Diagnosis
Diagnostic criteria
XX92.6%XX80%;X99%1%+X+
Differential diagnosis
1.
2.
18253040
3.
4.
5.
