breast tumor
Introduction
Introduction to breast tumors Breast tumors are mostly benign, and breast cancer is a common malignant tumor in women. There are no obvious clinical symptoms in the early stage, or only mild breast pain, the nature is mostly dull or painful, and a few are acupuncture-like pain, often intermittent and confined to the lesion, and the pain does not change with the menstrual cycle. When the advanced cancer invades the nerve, the pain is more severe and can be radiated to the shoulder and arm of the same side. Breast tumor masses are most common in the upper superior quadrant, followed by the nipple, areola, and upper superior quadrant. Because of the lack of self-conscious symptoms, the mass is often found by the patient inadvertently (such as bathing, changing clothes). A small number of patients may have varying degrees of tenderness or irritation and nipple discharge. The growth rate of the mass is faster, and invasion of the surrounding tissue can cause changes in the shape of the breast, resulting in a series of signs. Such as: the surface of the tumor is sunken, the cancer adjacent to the nipple can lead the nipple to the direction of the cancer, nipple retraction and so on. The larger the cancer, the whole breast tissue can be contracted, and the mass is obviously protruding. The cancer continues to grow, forming a so-called "orange peel" change. These are important symptoms of breast tumors. basic knowledge The proportion of illness: 0.064% Susceptible people: women who occur before and after menopause Mode of infection: non-infectious Complications: skin metastasis of breast cancer
Cause
Breast tumor etiology
Virus factor (30%):
Viral particles can be transmitted through breastfeeding, which has led to the occurrence of this disease. This has been confirmed by more animal experiments. Some scholars have speculated that the cause of breast tumors may be a virus, but there is still insufficient epidemiological basis for further research. .
Endocrine factors (30%):
Endocrine disorders can also trigger breast tumors. Because the breast is prolonged by the abnormal stimulation of endocrine, the tumor of the breast is transformed, and estrogen and lutein are the two endocrine hormones that are most closely related to the malignant transformation of the breast. This has been confirmed by many clinical, pathological and physiologists.
Genetic susceptibility (20%):
Clinical data from family history surveys indicate that genetic factors are also one of the important causes of this disease. In particular, patients with bilateral breast tumors and those with younger onset of age are 9 times more likely to develop this disease than women, and may be associated with genetic factors, giving them a susceptibility to the breast tumor and an internal cause of the disease.
Other factors (20%):
The body's anti-tumor immune function is low, so that the immune function of anti-tumor factors is inhibited; and the breast has traumatic stimulation, radiation damage, etc., are all factors that are prone to breast tumors.
Prevention
Breast tumor prevention
1, regular exercise:
Recently, a study published in the National Cancer Society report pointed out that exercise can reduce the incidence of breast cancer in women before and after menopause by 60%. A survey of 25,624 women by a Norwegian research institute found that women who exercised at least four hours a week had a 37 percent lower risk of developing breast cancer.
2, control weight:
Exercise can prevent breast cancer, the root cause is that it can control the body to gain weight. A Harvard study showed that women who gained weight quickly after 18 years of age had almost twice the risk of developing breast cancer after menopause compared with women who maintained standard weight for a long time.
3. Don't drink alcohol:
American experts believe that if you drink alcohol once a day, your risk of breast cancer increases by 11%; the risk of drinking twice a day is 24%; if you drink more than twice a day, the risk increases to 40%. Therefore, it is best to advise women who like to drink alcohol not to drink more than 3 times a week, and the amount should be adequate.
4, taking vitamin D:
The latest research shows that vitamin D has the effect of preventing breast cancer. The study found that women who took 200 international units (about two teaspoons of vitamin D milk powder) per day had a 30% reduction in the risk of breast cancer. Doctors therefore recommend that women aged 50 years and younger take at least 200 international units of vitamin D per day; for women over the age of 50, it is best to take 400 to 600 international units of vitamin D per day.
5, more sun:
Related to taking vitamin D, more sun exposure can also reduce the incidence of breast cancer, because the skin can only synthesize vitamin D in the sun. American experts say that for most people, the sun is enough for 10 to 15 minutes a day, which is enough to keep people's vitamin D. However, some experts have suggested that if the skin is exposed to the sun too much, the risk of skin cancer will increase, so the sun should be adequate.
6, appropriate selenium:
Selenium is an indispensable trace element in the human body and has strong antioxidant capacity. Selenium supplementation can enhance the antioxidant capacity of cells, regulate endocrine and metabolism, remove toxins from the body, and have a miraculous effect on preventing breast diseases. However, the harm of excessive selenium supplement is not small, so taking the body of Hengzheng Selenium Weikang chewable tablets containing selenium malt can safely and effectively supplement selenium without any side effects and excessive amount. It is the first choice for female friends to prevent and treat breast diseases. .
Complication
Breast tumor complications Complications breast cancer skin metastasis
The progressive development of breast cancer can invade the lymphatic vessels and metastasize to its local lymphatic drainage area.
Symptom
Breast tumor symptoms Common symptoms Lactation disorder Breast painless single hair... Breast mass before menstrual breast pain Lymph node swelling nipple discharge
Early symptoms
Breast tumor masses are most common in the upper superior quadrant, followed by the nipple, areola, and upper superior quadrant. Because of the lack of self-conscious symptoms, the mass is often found by the patient inadvertently (such as bathing, changing clothes). A small number of patients may have varying degrees of tenderness or irritation and nipple discharge. The growth rate of the mass is faster, and invasion of the surrounding tissue can cause changes in the shape of the breast, resulting in a series of signs. Such as: the surface of the tumor is sunken, the cancer adjacent to the nipple can lead the nipple to the direction of the cancer, nipple retraction and so on. The larger the cancer, the whole breast tissue can be contracted, and the mass is obviously protruding. The cancer continues to grow, forming a so-called "orange peel" change. These are important symptoms of breast tumors.
Breast pain
Although breast pain can be seen in a variety of breast diseases, pain is not a common symptom of breast tumors, and benign or malignant breast tumors are usually painless. In early breast cancer, occasionally pain is the only symptom, which may be dull pain or traction, especially when lying on the side. Studies have shown that postmenopausal women with breast pain and glandular thickening, breast cancer detection rate will increase. Of course, tumors can have pain or tenderness when accompanied by inflammation. Advanced tumors may have shoulder pain if they invade the nerves or axillary lymph nodes and compress or invade the brachial plexus.
Nipple discharge
The nipple discharge has physiological and pathological points. Physiological nipple discharge is mainly seen in pregnant and lactating women. Pathological nipple discharge refers to the secretion of mammary ducts in a non-physiological state. What is commonly referred to is the latter. Nipple discharge can be caused by a variety of breast diseases, and it is easier for patients to pay attention to. It is one of the main reasons why about 10% of patients come to the clinic clinically. The incidence of various breast diseases is only second. Pain in the breast mass and breast.
1, nipple discharge according to its physical properties can be divided into: blood, serum, serous, watery, purulent, milky and so on. Among them, serous, watery and milky-like discharges are more common, and bloody discharges account for only 10% of the cases. When the lesion is located in a large catheter, the discharge is mostly bloody. When it is located in a small catheter, it may be bloody or serous. If the blood stays in the catheter for too long, it may be dark brown. When there is inflammation in the catheter and infection, it can be mixed. There is pus, liquefied necrotic tissue can be watery, milky or brown, and the mammary duct dilatation fluid is often serous. Bloody discharge is mostly caused by benign lesions, and a small number of breast cancers can also be bloody. Physiological nipple discharge is mostly bilateral, and its discharge is often milky or watery.
2, the cause of nipple discharge is mainly divided into: external factors and intra-milk factors.
5% to 10% of breast cancer patients have nipple discharge, but only 1% with nipple discharge as the only symptom. The discharge is often single-tube and the traits can be varied, such as blood, serous, watery or colorless. Breast cancer originated in the large catheter or in the form of intraductal carcinoma combined with nipple discharge is more common, such as intraductal papilloma malignant transformation, nipple eczema-like cancer can have nipple discharge. It is worth noting that although most people think that breast cancer is rarely associated with nipple discharge, and even if there is a discharge, it almost occurs after or at the same time, and those who do not have a lumps are rarely considered cancer. However, recent studies have shown that nipple discharge is an early clinical manifestation of certain breast cancers, especially intraductal carcinomas, and can exist alone before a significant mass is formed.
Intraductal papilloma is a disease with more nipple discharge, which is the first in all nipple discharge lesions. Among them, intraductal papilloma is more common in the areola area, which can be single or multiple, and the age is between 18 and 80 years old. Not equal, mostly seen in 30 to 50 years old. Tumor diameters range from 0.3 to 3.0 cm, with an average of 1.0 cm, and greater than 3.0 cm are often malignant. The nature of the discharge is mostly bloody or serous, and other rare. It is generally believed that papillomas that occur in large catheters are mostly single-shot, with few cancerous changes, while those with small and medium-sized catheters are often multiple and can be seen as cancerous. The two are similar lesions, but the location and growth process are different.
Although cystic hyperplasia is not a tumor, the most common benign lesions of breast tissue are more common in the 40s and are rare after menopause. Among them, three pathological changes of cyst, ductal epithelial hyperplasia and papilloma are the basis of its discharge. The nature is mostly serous, and the disease combined with discharge only accounts for 5%.
Nipple change
Breast cancer patients with abnormal nipple changes usually show nipple erosion or nipple retraction.
1, nipple erosion: There is a typical manifestation of breast Paget disease, often accompanied by itching, about 2 / 3 patients may be accompanied by areola or other parts of the breast. At the beginning, only the nipples are desquamated or the nipples are small. The nipple desquamation often accompanied by a small amount of secretions and crusting, revealing the bright red smashed surface of the suede, long-lasting unhealed. When the entire nipple is involved, it can invade the surrounding tissue. As the lesion progresses, the nipple can disappear. Some patients may also have breast lumps first, and then nipple lesions.
2, nipple retraction: When the tumor invades the nipple or the areola area, the fibrous tissue and catheter system of the breast can be shortened, pulling the nipple, causing it to sag, bias, or even completely retract into the back of the areola. At this time, the affected side of the nipple is often higher than the healthy side. May occur in early stage breast cancer, but sometimes it is also a late sign, depending on where the tumor is growing. When the tumor is under or near the nipple, it can occur early. If the tumor is located in the deep tissue of the breast and is far from the nipple, this sign is usually advanced. Of course, the nipple retraction, depression is not a malignant lesion, and some may be caused by congenital dysplasia or chronic inflammation. At this time, the nipple can be pulled out by fingers, not fixed.
Skin change
Breast tumors cause changes in the skin, which are related to the location, depth, and extent of the tumor. They usually have the following manifestations:
1. Skin adhesion: The mammary gland is located between the deep and shallow fascia. The superficial layer of the superficial fascia is connected to the skin, and the deep layer is attached to the superficial surface of the pectoralis major. The superficial fascia forms a leaflet space within the breast tissue, the breast suspensory ligament. When the tumor invades these ligaments, it can be contracted and shortened, and the skin is pulled to form a depression, which is like a dimple, so it is called "dimple sign." When the tumor is small, it can cause very slight skin adhesion and is not easy to detect. At this time, under better lighting conditions, the milk should be lightly applied to increase the surface tension, and when the breast is moved, the skin on the surface of the tumor is slightly pulled and sunken. If you have this symptom, you should be alert to breast cancer. This disease is rare in benign tumors.
2, superficial varicose veins: when the tumor is larger or faster, it can make the surface of the skin become thinner, and the superficial blood vessels and veins can often be varicose. Clearer in liquid crystal heat maps and infrared scans, common in breast giant fibroadenomas and lobulated cystosarcoma. Superficial varices are also common in tumors during acute inflammation, pregnancy, and lactation.
3, skin redness: acute, chronic mastitis, breast skin can be red and swollen. But in breast cancer, it is mainly seen in inflammatory breast cancer. Because the subcutaneous lymphatic vessels are all cancerous suppositories, it can cause cancerous lymphangitis. At this time, the skin color is reddish to deep red, which begins to be limited. It soon spreads to most breast skin, accompanied by skin edema, thickening, and skin. The temperature rises and so on.
4, skin edema: because the subcutaneous lymphatic vessels of the breast are blocked by tumor cells or the central region of the breast is infiltrated by tumor cells, the lymphatic drainage of the breast is blocked, the lymphatic fluid accumulates in the lymphatic vessels, the skin becomes thicker, and the hair follicles are enlarged and deep, indicating "orange The skin sample changes." In obesity, sagging breasts often have mild skin edema on the outside and below, such as bilateral symmetry, which is caused by local circulatory disorders. If it is unilateral, it should be cautious and beware of cancer.
In addition, advanced breast cancer can directly invade the skin and cause ulcers. If combined with bacterial infection, the smell is unpleasant. If cancer cells infiltrate into the skin and grow, scattered hard nodules, "skin satellite nodules", can form on the skin around the main lesion.
Axillary lymphadenopathy
The progressive development of breast cancer can invade the lymphatic vessels and metastasize to its local lymphatic drainage area. Among them, the most common lymphatic metastasis site is the ipsilateral axillary lymph node. Lymph nodes often increase gradually from small to small, and the number of lymph nodes gradually increases. At first, swollen lymph nodes can be promoted, and finally merge and fix. If the swollen lymph nodes invade and compress the iliac vein, the ipsilateral upper limbs may be edema, such as shoulder pain caused by invasion of the brachial plexus. When examining the axillary lymph nodes, the upper limbs of the affected side should be relaxed as much as possible so that the dome can be removed. If you can reach the enlarged lymph nodes, you need to pay attention to the number, size, texture, activity and surface of the lymph nodes to distinguish them from inflammation and tuberculosis.
If there is no mass in the breast, and the axillary lymph node enlargement is the first symptom to come to the clinic, when the axillary lymph node is swollen and the pathology proves to be metastatic cancer, in addition to carefully examining the lymphatic drainage area, the lung should be excluded. And tumors of the digestive tract. If the pathological suggestion is metastatic adenocarcinoma, it is necessary to pay attention to "occult breast cancer". At this time, many breast lesions were not found, and molybdenum target imaging may be helpful for diagnosis. In the lymph node, the hormone receptor is determined. If it is positive, even if the lesions are not found in the breast, the breast-derived tumor should still be considered.
Breast cancer can metastasize to the ipsilateral axillary lymph nodes, and can also be transferred to the contralateral axillary lymph nodes through mutual communication between the anterior chest wall and the internal mammary lymphatic network, with an incidence of about 5%. In addition, advanced breast cancer can still have ipsilateral supraclavicular lymph node metastasis, and even contralateral supraclavicular lymph node metastasis.
Examine
Breast tumor examination
A formal breast examination should include both a visual examination and a palpation. The patient will be taken into an examination room with good natural light or daylight. Before the examination, the front chest and the bilateral breasts should be fully exposed, and the sitting and lying positions should be adopted according to the requirements of the examiner. When sitting, both hands fall on the lap and the upper limbs relax. Sometimes the supine position needs to be padded to make the shoulders and chest properly lifted, so that the breast can be examined in a relatively flat condition, and it is not easy to miss the lesion.
When the doctor visits the doctor, he will observe the development of the breast, whether the two sides are symmetrical, whether the size is similar, whether the bilateral nipples are in the same position, whether the nipple has erosion, retraction, discharge, abnormality of the breast skin, etc. Changes such as orange peel sign and dimple sign are important manifestations of breast cancer diagnosis. During the examination, patients are often asked to raise their hands to show the lower side of the breast and the tail of the breast.
The palpation of the breast is very important. Especially when examining the mass, the doctor will pay attention to the location, size, boundary, texture, activity, and adhesion to the skin and chest muscles, so as to make a judgment on the nature of the lesion. An experienced doctor at the time of palpation often gently lifts the breast or increases the skin tension by hand to find out if the skin is slightly depressed after pulling, which often indicates the possibility of early breast cancer. In order to check the relationship between the mass and the deep tissue, the patient is sometimes required to have both hands on the hips, so that the pectoral muscles are in a contracted state. If the mass invades the pectoral fascia or the pectoral muscle, the ipsilateral breast is elevated when the pectoral muscle contracts, and the activity is limited. Use the two fingers to flatten the breast surface in quadrant or clockwise direction. Do not grasp the breast with your fingers, so as not to mistake the normal breast tissue for the mass.
The axillary and supraclavicular lymph nodes are regional lymph nodes of breast cancer, so the palpation of the armpits is also part of the physical examination, and sometimes the recessive breast cancer is found because the underarms touch the lymph nodes. The examination generally adopts a sitting position, and the patient's arm is lifted by the examiner to naturally relax the armpit for examination. When the supraclavicular lymph node is examined, the doctor often uses the bilateral thumb to touch the patient's supraclavicular fossa.
In addition to breast clinical examinations, women of all ages can also learn breast self-examination, which is a simple and economical means of early detection of breast cancer, but requires some training. The breast self-test is usually performed once a month. The pre-menopausal women should choose the 9th to 11th day after the menstrual cramps. At this time, the endocrine hormone is mainly the estrogen has the least influence on the mammary gland, and the mammary gland is in the relatively static period and the easiest. Abnormal changes in the mammary gland are found; postmenopausal women should choose a time that is easy to remember, such as the first day of each month; when a breast mass is found during lactation, an additional examination should be performed after stopping breastfeeding.
Diagnosis
Diagnosis and diagnosis of breast tumor
Breast tumor diagnosis
(1) nipple discharge;
(2) nipple and areola changes;
(3) local skin changes;
(4) breast contour changes;
(5) Axillary fossa and supraclavicular lymph nodes.
Staging of breast cancer (tumor)
Staging is an important part of the treatment plan. The most common staging method is
Stage I: refers to the primary tumor of the primary tumor less than 2cm lymph node without metastasis;
Stage II: primary tumor greater than 2 cm with axillary lymph node metastasis, lymph node activity;
Stage III: The primary tumor is greater than 5 cm with axillary lymph node metastasis and lymph node fixation;
IV refers to distant metastasis of any size of the supraclavicular or subclavian lymph node metastasis in the primary tumor stage.
Differential diagnosis of common breast mass and breast cancer
1, cystic hyperplasia disease: this disease is a stage of breast hyperplasia, mostly older, and more prone, sometimes with a strip of nodules, the border is unclear, is a precancerous lesion.
2, breast pain: for a stage of breast hyperplasia, mainly in the mammary gland can touch most of the uneven small nodules, and more spontaneous spontaneous pain. In particular, the pain of the breast before the menstrual cramps is obvious, and even the pain is untouchable, and the patient is very painful.
3, papilloma: can be single or multiple. Single women are mostly elderly women, and 50% have bloody discharges. Multiple patients with diffuse nodules, no obvious lumps. This tumor can be malignant.
4, adenoma: a young woman with a strong endocrine regulation and disorder, mostly in the 20-30 years. The mass is clear, the border is clear, smooth, active, soft, and nodular. It grows slowly and there is very little pain, but there is a possibility of malignant transformation.
5, fat necrosis: occurs in the outer part of the breast of obese women, most of the history of trauma, need to be removed biopsy to identify.
6, breast tuberculosis: mostly spread from the chest wall tuberculosis, can be broken, and out of the cheese-like pus. Attention to the examination often found that other parts of the tuberculosis lesions exist at the same time.
7, plasma cell mastitis: also known as non-lactating mastitis. Less common, more history of acute attacks, may have pain, fever, etc., but quickly subsided after anti-inflammatory treatment.
8, phyllodes cystosarcoma: more common in 35-40 years old, the development is slower, the tumor is lobulated, part of the hard as stone, some areas are sac sexy. The tumor is often huge, sometimes broken, and rarely fixed with the chest. Often mistaken for advanced breast cancer, but the curative effect is very good after radical surgery. The transfer is rare, usually with blood behavior, and occasional lymph node metastasis.
