breast disease
Introduction
Introduction to breast disease Breast disease, which is painful for women, is a common and frequently-occurring disease. It is a major disease that jeopardizes women's physical and mental health. It is divided into five major categories: mastitis, breast hyperplasia, breast fibroma, breast cyst, and breast cancer. Complex, such as treatment is not timely or improper treatment, it may occur lesions, life-threatening at any time. Changes in women's breasts at various times Infancy: Breast changes: The entire breast is in a resting state. However, after a week or so of birth, 60% of the newborn baby's nipples have a broad bean-sized induration, bilateral breast enlargement, and sometimes even a small amount of secretions. Care principle: don't squeeze, don't worry, let it be left. The breast is an organ that is greatly affected by hormones. It is abnormal when the hormone changes. The maternal hormone supply suddenly stops after the baby is born, and it is immediately discovered. After about 3 weeks, the baby adjusted the balance of the body and the breast naturally returned to normal and entered a stationary phase. Adolescence: Breast changes: From the age of 9 to 10 years, the breasts are stimulated by ovarian secretion of hormones, and the milk nucleus appears and gradually increases. It is basically formed when it is 15 years old. However, at first, the breasts are more tough because of the lower content of fat cells. Some people may have different breast sizes. As the body develops, this difference will naturally disappear. Although the size of the breast has a lot to do with heredity, at this time, the foundation will be played. We can work hard in two aspects. One is to do more chest exercises, such as push-ups, swimming and various ball games, to keep the chest and abdomen at any time. Second, pay attention to balanced nutrition, not partial eclipse, especially to add enough fat and moisture. Wear Bra at the right time. Wearing a bra too late affects the shape, hindering development too early, and the wear time can be judged accordingly: the nipple becomes obvious, the breast shakes when running, and the breast outline is obvious. If the upper and lower chest circumference difference is greater than 16 cm, you can also wear a bra. In addition: the bra should not be too tight, do not wear more than 12 hours a day, every three or four months to re-test the bust to replace. In adulthood menstruation, 7 to 10 days before menstruation, the effect of estrogen in the recipient begins to increase until the level of menstrual cramps decreases, the breast gradually recovers, and returns to normal 7 to 8 days after menstruation. The degree of mammary gland development during pregnancy is one of the important factors determining the amount of milk secretion. The normal breast weighs about 200 grams, the subcutaneous varices after pregnancy, the glandular lumen enlarges, the color of the areola becomes darker, the breast volume increases, and the breast can reach 400-800 grams at the end of pregnancy. Within 2 to 3 days after lactation, under the action of prolactin, the secretion activity of the lobular lobe of each breast is increased, and the milk is alternately secreted, and the breast is swollen and firm. With the establishment of regular breastfeeding, the breasts will be filled regularly, emptyed, refilled, and then emptied. After middle-aged, the hormones secreted by the ovaries begin to decrease, and the stimulation of the lack of estrogen in the breast gradually shrinks. The glands are gradually replaced by adipose tissue, and the breast volume becomes smaller. Even if the increase is increased, the fat is increasing. basic knowledge Proportion of disease: according to different breast diseases, the proportion of illness is different Susceptible people: women Mode of infection: non-infectious Complications: irregular menstruation Breast cancer Bacteremia
Cause
Causes of breast disease
1, menarche, early menopause and late menstruation. Menstrual menarche age less than 12 years old and greater than 17 years old, the relative risk of breast tumors increased by 2.2 times. The risk of developing breast tumors is more than double when the age of amenorrhea is greater than 55 years and less than 45 years. Early menarche and early menopause are the two most important risk factors for breast cancer.
2. Genetic factors. Studies have found that women whose mothers have had bilateral breast tumors before menopause are 9 times more likely to have breast cancer than the average woman, and the average age of breast cancer in the second generation of breast cancer patients is about 10 times earlier than the average person. About a year. Among the sisters, there are women with breast tumors, and the risk is three times that of ordinary people. It should be emphasized that breast tumors are not directly inherited, but a kind of "tumor quality". The relatives of breast cancer patients do not necessarily have breast cancer, but they are more likely than ordinary people to have breast tumors.
3. Marriage and childbearing. Epidemiological studies have shown that although women are infertile or the first child is also a disadvantage after the age of 30, the risk of breast cancer in unmarried persons is twice that of the married person. Experts believe that fertility has a protective effect on the mammary gland, but only refers to those who have full-term birth before the age of 30. In recent years, studies have shown that breastfeeding has a protective effect on the occurrence of breast tumors, mainly for premenopausal women.
4. Ionizing radiation. The mammary gland is a tissue that is more sensitive to the carcinogenic activity of ionizing radiation. When young, it is the stage of mammary mitosis activity, which is most sensitive to the carcinogenic effect of ionizing radiation, and the effect of ionizing radiation is additive. Multiple low-dose exposures have the same risk of exposure to a large dose, and have a dose-effect relationship. Among the survivors of the Nagasaki atomic bomb explosion in Japan, the proportion of breast cancers has increased significantly. In children and adolescents who have undergone chest radiotherapy, the chance of developing breast tumors increases.
5. Unhealthy eating habits. Unhealthy eating habits cause a significant increase in the incidence of breast tumors, and the incidence and mortality of breast tumors have a strong relationship with the amount of digested fat per capita. Some company employees have high incomes and high standards of living. The diet has changed. People's diets are mainly based on meat and seafood products, and they have gradually formed an acidic body that is now more popular. Most people form unscientific and unhealthy "high-calorie, high-fat" eating habits, resulting in a greatly increased incidence of breast tumors.
6, unhealthy lifestyle. Some white-collar workers who have been working in the office for a long time are less active, lack of exercise, have less exposure to sunlight, and exercise more sweat in the sun, which can help eliminate excess acidic waste in the body. However, people are now more and more car-driven, and the amount of exercise is greatly reduced. Over time, acid metabolites will remain in the body for a long time, leading to acidification of the system. Most professional women have a tight relationship with the bra for a long time because of their working relationship. It is rare to loosen the breasts. Some professional women are forced by the pressure of work or the pursuit of success in their careers. They live a single noble or Dink life, not a family, not child. These factors are all related to breast disease.
Prevention
Breast disease prevention
1. A healthy lifestyle. Eliminate tobacco and alcohol, eat yellow-green vegetables, melons, edible fungi, soy products; consistently participate in exercise and colorful entertainment activities to strengthen the mind; promote late marriage and family planning, marriage is no more than 28 years old, it is not appropriate to have children More than 30 years old, prevent multiple abortions, breastfeeding after giving birth.
2. Regular sex life. A harmonious sex life can not only bring you physical and mental pleasures and pleasures, but also help to reduce the relationship between breast and hyperplasia and breast cancer.
3, found abnormalities in time to the hospital for treatment. If you find breast or axillary mass, nipple discharge, nipple depression, areola eczema, and skin ulceration, go to the hospital in time. All adult women perform a self-examination once a month. It is best for women over the age of 30 to have an ultrasound examination of the breast every year. Women over the age of 40 undergo a mammogram and clinical examination every year.
4. Maintain a psychological balance. Women must learn to self-regulate and control their emotions, and rationally deal with emotional disputes and emotional crises in interpersonal relationships, family, marriage, etc. Only the spirit is comfortable, which is conducive to psychological balance and physiological balance.
5. Control body obesity. Obesity should be prevented during pregnancy and menopause, and proper weight should be maintained to reduce the risk of cancer.
Complication
Breast disease complications Complications, irregular menstruation, breast bacteremia
1, irregular menstruation: often accompanied by menstrual delay, increased pain, less menstruation, fatigue, weakness, backache, cold, less abdomen and cold, etc., a long time lost, a small number of breast cancer can occur.
2, liver qi stagnation: this type of breast hyperplasia patients may have insufficient menstrual cycle, menstrual flow, chest tightness, heat, depression, upset and other symptoms.
3, sepsis and bacteremia: the course of the disease into the stage of acute suppurative mastitis, patients can be complicated by sepsis and bacteremia. At this time, the patient continued to have high fever, and the complexion was flushed and sputum. A metastatic abscess can occur.
4, breast fistula: abscess formation period, abscess can be inward or outward ulceration, the formation of skin breach and breast fistula. If improperly treated, it can form long-term unhealed purulent sputum or chyle. It can be seen that milk and pus are discharged from the fistula.
5, cancer: there is the possibility of cancer. Once a tumor with rapid growth or hardening in a short period of time is found, it is highly suspected that it may be cancerous. If necessary, biopsy or simple resection of the breast, intraoperative frozen section of the cancer, should be treated as breast cancer.
Symptom
Symptoms of breast disease Common symptoms Breast redness and heat pain Breast pain Before menstruation Breast pain Breast nipple Itching Nipple peeling Breast tissue Large necrotic breast Hypertrophy Breast pain Painful breast pain
In clinical practice, 80% of patients are unintentionally discovered when taking a bath or dressing. When they see symptoms, they are mostly in stage II and III. Some breast cancer patients have lost hope of cure. If stage I breast cancer is detected early, the five-year survival rate can reach more than 90%.
First, mastitis
A, acute mastitis:
It is an acute suppurative disease of the breast, usually caused by Staphylococcus aureus infection, and is more common in the lactation period of primipara. Due to improper breast-feeding methods, poor milk outflow, breast tube obstruction, etc., the most prone to milk deposition, causing bacterial growth; or in the case of nipple rupture, nipple deformity or nipple trauma, bacteria can retrograde from the nipple into the breast and spread to The breast causes infection.
B, chronic mastitis:
First, the treatment of acute mastitis is not treated properly, such as improper use of antibiotics; second, the onset of the disease is a chronic inflammatory process, mostly due to poor milk discharge to form an induration. It is characterized by slow onset, long course of disease, difficult to heal, and difficult to eliminate after a long time; the breast can touch the mass, with the mass as the main performance, the texture of the mass is hard, the boundary is unclear, there is tenderness, it can adhere to the skin, and the mass does not collapse. It is not easy to become pus and is not easy to dissipate; there is no typical redness and heat pain in the breast, and the systemic symptoms such as fever, chills and fatigue are not obvious.
Second, breast hyperplasia occurs mostly in middle-aged women, often in the breast there are multiple irregular nodules of different sizes and hard, and the surrounding tissue is unclear. Patients often feel breast pain, exacerbation of premenstrual symptoms, is a benign hyperplasia of the mammary gland, clinically characterized by breast lumps, pain and irregular menstruation. Modern medicine is believed to be associated with endocrine disorders and ovarian dysfunction.
Third, breast fibroma is the most common tumor in the breast, more common in young women, and the body is too high in estrogen, can occur in one or both breasts, usually single. The mass is oval or round, the surface is smooth, the texture is medium hardness, the boundary with the surrounding tissue is clear, and there is no adhesion to the skin, and the mass is easily pushed. At present, most of the treatments are surgical treatments, but most of them cannot be accepted by young women. The main reason is that although the local tumors have been removed, the endocrine disorders in the body have not been corrected, so it is easy to relapse, followed by leaving scars on the breasts.
Fourth, breast cysts Breast cysts are caused by poor breast structure, inflammation and other causes of breast glandular or lobular ductal epithelial shedding or other substances block the catheter, the glandular leaves of milk discharge is not smooth, the accumulation of milk in the milk causes the catheter to expand to form a cyst. Breast cysts are a benign lesion of the breast, mostly located in the center of the breast, around the nipple, especially in the upper part of the nipple, often with a history of breast inflammation and breast trauma, resulting in blockage of the large catheter.
Breast cysts are divided into two categories: simple breast cysts and milk deposit cysts. A simple cyst of the mammary gland is a cyst formed by the secretion of mammary gland cells in the duct. The mass is round or elliptical, and the surface aura and boundary are clear, single or multiple. The milk-slumping cyst is a cyst formed by the obstruction of the mammary duct and the accumulation of milk. The breast is partially accompanied by redness, swelling, heat and pain.
5. Breast cancer is the most common malignant tumor that occurs in the breast. In the early stage, it is a small lump that is painless and single. It is hard, the surface is not smooth, and the tissue boundaries are unclear and difficult to be promoted. Early unconscious symptoms, most of which were inadvertently discovered by patients. When the breast cancer mass increases, it adheres to the skin, and the local skin can be sunken and orange-like. When the cancer invades the milk duct, the nipple can be retracted.
Examine
Breast disease examination
Women aged 35-60 are regularly checked annually
The high-risk age of breast cancer is 40-60 years old. Female patients in China are mostly pre-menopausal, accounting for about 60% of the total number of patients. The data show that the age of onset is younger in recent years. The current medical level has reached a very early stage of breast cancer, such as breast cancer in situ (stage 0) occult breast cancer. Most early breast cancers are able to achieve satisfactory results.
Regular physical examination is the best way to find early breast cancer. Female friends should find early breast cancer as the focus of breast examination. Female friends aged 35-60 should take this item as a top priority. Some female friends missed the best treatment opportunity because they ignored the physical examination and caused breast cancer to develop in the middle and late stages.
Inspection method: Palpation is the most convenient, direct and economical inspection method. Experienced specialists can reach the breast mass by palpation, and understand the size, smoothness, hardness, and activity of the mass, and obtain first-hand information. However, some of the lumps are small and deep in position, and it is difficult to reach by hand. Some early breast cancers have not formed a lump and cannot be judged by both hands.
CR digital molybdenum target inspection
Full name: CR digital breast high frequency mammography X-ray examination
Computerized X-ray imaging (CR) is applied to mammography, which is the first and most convenient and most reliable non-invasive detection method for the diagnosis of breast diseases. It is relatively small, simple and easy to perform, and has high resolution. , reproducible, the images are available for comparison before and after, regardless of age, body shape, has been used as a routine examination, it is characterized by the detection of breast lumps that the doctor can not touch, especially for large breasts and The fat type of breast can be diagnosed up to 95%. For T0 stage breast cancer, which is the only manifestation of a little microcalcification (negative percussion), it can only be detected and diagnosed early by soft X-ray examination. The diagnostic sensitivity is 82% to 89%, and the specificity is 87% to 94%.
Mammography is the most effective method for early diagnosis of breast cancer (the optimal detection time is 3-5 days after the end of menstruation or the most relaxing mammary gland on the 10th day of menstrual cramps). The molybdenum target can show a lumpy shadow with increased density and irregular burr-like boundaries. Sometimes, small and dense calcification spots are visible, which are called sand-like calcification points. Especially in the early stage of breast cancer before the formation of the tumor, the molybdenum target can provide a very valuable diagnosis by discovering the "sand-like calcification point". Many carcinomas in situ (stage 0) rely on the mammography. However, the ability of the molybdenum target to resolve the sac and solid mass is poor. It is recommended that women over the age of 35 should have a mammography test for one to two years. Because the mammography has a certain dose of radiation, it is not appropriate to check the frequency. Pregnant women and lactating women cannot perform mammography. The specificity of serum tumor markers is low, and the results have certain reference significance, but can not explain the existence of tumors.
Diagnosis
Diagnosis and diagnosis of breast diseases
First, breast inflammation
1. Breast cyst: The latter has no typical clinical manifestations of inflammation; the cyst is regular in shape, the wall is smooth, the cystic fluid is clear, and the posterior wall echo is enhanced.
2, ductal dilatation of the breast: occurs in the area around the areola.
3, breast hyperplasia: no clinical manifestations of typical inflammation; associated with menstrual cycle changes.
4, breast cancer: no typical clinical manifestations of inflammation; mass shape irregular, sawtooth or crab foot infiltration into the surrounding tissue; local skin with orange peel-like changes and nipple retraction.
Second, breast hyperplasia
1. Breast cancer: The invasiveness of the local mass is increased, and it has nothing to do with menstruation.
2, breast cyst: there is a history of cyst formation and breast-feeding and catheter obstruction, no pain symptoms.
Third, the differential diagnosis of breast cyst
1, breast abscess: the boundary is not complete, thickening, the inside is a heterogeneous dark area.
2, cystic hyperplasia of the breast: often multiple, not round, bilateral breast enlargement, and the menstrual cycle.
Fourth, breast duct dilatation
1, acute attack should be differentiated from acute mastitis, breast abscess (refer to the mastitis part).
2, breast fibroma: active, no inflammation, can occur in any part.
3, breast cancer: no history of acute inflammation, mostly located in the upper quadrant, gradually increased, no recurrent attacks.
Fifth, breast fibroma
1, breast cancer: not smooth, the border is not complete, the internal echo is uneven, there is infiltration.
2, breast cyst: for the echo-free zone, the posterior wall echo is enhanced.
3. Breast duct dilatation: refer to the previous section.
Six, phyllodes cystosarcoma
1, breast cyst: small size, the interior is a homogeneous anechoic zone.
2, breast fibroadenoma: small mass, hard, and active.
3, breast cancer: irregular, infiltration, rapid development.
7. Panniculitis and granulation tissue
Panniculitis is inflammation of the subcutaneous fat layer of the breast. Ultrasound is shown as an irregular medium-strong echo zone with a slight shadow behind. The disease has a strong echo in the dermis layer. If the fat is liquefied, it has an anechoic zone and can also form a cyst. Ultrasound images of granulation tissue are similar to lipoma.
Eight, foreign body in the breast
It can display foreign objects in the breast that cannot be displayed by ordinary X-ray examination. Depending on the acoustic impedance of the foreign object, the sonogram changes are also different and should be analyzed according to the specific situation.
Nine, breast tuberculosis
Breast tuberculosis accounts for about 1% of breast diseases, mostly blood circulation, and is mainly caused by tuberculosis in the lung or mesenteric lymph nodes. Most of the patients are married young and middle-aged women, with long course of disease, slow progress, early formation of nodules, and difficult to distinguish from breast cancer. After softening, it forms abscesses and even ulcers and sinus.
Ultrasound sonogram: The image itself is non-specific and needs to be combined with clinical diagnosis and identification.
X, breast papilloma
This disease is also known as intraductal papilloma or intracapsular tumor, and occurs mostly in women aged 40 to 50 years. Tumors often occur in the larger lactiferous duct below the areola, which is more common in single hair. The main clinical manifestations are: 1. Painless bloody discharge, which is bright red or brown; 2. Some patients may have a lumps and masses under the areola, which are round, soft and movable, and the diameter is less than 1cm. 3. Irrigation cytology can find tumor cells. 4. Mammary ductography can be seen in the filling defect area.
Differential diagnosis: breast cysts. Mammary duct dilatation and papillary carcinoma.
Eleven, breast malformation
Clinically common are breast milk and breast hypertrophy. It is caused by congenital dysplasia and abnormal hormone levels in patients.
Twelve, breast cancer
Breast cancer is a malignant tumor that occurs in the ductal epithelium and distal ductal epithelium of the breast. More common in women, the second in female malignant tumors.
Clinical manifestations: no symptoms in the early stage. Initially only the painful mass of the breast on one side of the body, hard, unclear borders, mostly single, can be pushed. As the cancer grows, it can be immersed in the fascia or Cooper ligament, and the skin at the mass appears orange-like changes or nipple retraction. Symptoms of swelling and distant metastasis of surrounding lymph nodes can occur.
