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mammary cancer


The female mammary gland is composed of skin, fibrous tissue, mammary glands, and fat, and breast cancer is a malignancy that occurs in the epithelial tissues of the mammary glands. 99% of breast cancers occur in women and only 1% in men.


essential information

Chinese name breast cancer

English name breast cancer

Attending Department of oncology, breast surgery

Family history of breast cancer in multiple cohorts, nulliparous or late in life

Aetiology Pathol

The etiology of breast cancer is not fully understood, and studies have found that there is a certain regularity in the incidence of breast cancer, and women with high-risk factors for breast cancer are prone to it. So called high-risk factors refer to various risk factors related to the incidence of breast cancer, and the risk factors that most breast cancer patients have are called high-risk factors for breast cancer. According to the cancer registry of China, the age-specific incidence rate of breast cancer in women is low at the age range of 0-24 years, gradually increasing after the age of 25 years, peaking in the age group of 50-54 years, and gradually decreasing after the age of 55 years. Family history of breast cancer is a risk factor for the development of breast cancer, so-called family history refers to the presence of breast cancer patients in first-degree relatives (mother, daughter, sister). It has been found in recent years that dense mammary glands also become a risk factor for breast cancer. Risk factors for breast cancer are also early menarche (< 12 years), late menopause (> 55 years); Unmarried, nulliparous, late born, not lactating; Benign breast disease without prompt diagnosis; Had breast atypical hyperplasia confirmed by hospital biopsy (biopsy); The chest was exposed to high-dose radiation; Chronic administration of exogenous estrogens; Postmenopausal obesity; Chronic excessive alcohol consumption; And carrying a mutated gene associated with breast cancer. An explanation is that breast cancer susceptibility genes European, American families have done a lot of research, now known to have BRCA-1, BRCA-2, but also p53, PTEN, etc., and breast cancer associated with mutations in these genes is called hereditary breast cancer, which accounts for 5% - 10% of all breast cancer. Women with several of the above high-risk factors do not necessarily develop breast cancer, only to say whether their risk of breast cancer is higher than normal and whether the incidence of breast cancer in Chinese women is low.

clinical manifestation

Early breast cancer often does not have the typical signs and symptoms, is not easily appreciated, and is often detected by physical examination or breast cancer screening. The following are typical signs of breast cancer.

1. Breast masses

Eighty percent of breast cancer patients are first diagnosed with a breast mass. Patients often inadvertently find breast masses, which are mostly single, hard, with irregular margins and a less smooth surface. The majority of breast cancers are painless masses, with only a few associated with varying degrees of occult pain or tingling.

2. Nipple discharge

Those who non pregnant shed blood, serous fluid, milk, pus from the nipple, or who continue to have milk outflow more than half a year after stopping lactation, are called nipple discharge. There are many causes of nipple discharge, and common conditions include intraductal papilloma, breast hyperplasia, ductal ectasia, and breast cancer. Unilateral unilocular hematochezia should be further investigated, more so with a breast mass.

3. Skin alterations

Breast cancer causes skin changes can present with a variety of signs, and it is common for the tumor to invade the Cooper's ligament connecting the skin of the mammary gland with the deep pectoral fascia, causing it to shorten and lose elasticity, pull on the skin of the corresponding site, and appear "" dimple sign "", that is, a small dimple in the skin of the mammary gland appears, like a small dimple. If cancer cells obstruct lymphatic vessels, an "" orange peel like change "" occurs, whereby breast skin exhibits many small dot like depressions, much like orange peels. In the late stages of breast cancer, cancer cells infiltrate and grow into the skin along lymphatic, glandular or fibrous tissue, forming scattered hard and hard nodules in the skin around the main cancer foci, so-called "" cutaneous satellite nodules "".

4. Nipple and areola abnormalities

The tumor is located deep in or close to the nipple and can cause nipple retraction. The tumor can also cause retraction or elevation of the nipple when it is relatively distant from the nipple and the large ducts within the mammary gland are invaded and retracted short. Eczematous carcinoma of the nipple, Paget's disease of the breast, presents with itchy, erosive, ulcerated, crusted, desquamated skin with burning to the point that the nipple retracts.

5. Axillary lymphadenopathy

More than 1 / 3 of breast cancer patients admitted to large hospitals had axillary lymph node metastasis. Initially, there may be ipsilateral axillary lymph node enlargement, with enlarged nodes that are hard, scattered, and pushing. As the disease progresses, the lymph nodes gradually fuse and become adherent and fixed with the skin and surrounding tissues. Metastatic lymph nodes can be reached in the supraclavicular and contralateral axilla in advanced stages.

Treatment and prognosis

With the increasing understanding of the biological behavior of breast cancer, as well as the transformation and update of treatment concepts, the treatment of breast cancer has entered the era of integrated treatment, forming a treatment paradigm in which local treatment of breast cancer is considered concurrent with systemic treatment. Physicians will use surgery, radiotherapy, chemotherapy, endocrine therapy, biological targeted therapy, and adjuvant therapy with Chinese medicine (TCM), as appropriate, depending on the stage of the tumor and the physical status of the patient. Surgery plays an important role in the diagnosis, staging, and comprehensive treatment of breast cancer. Radiotherapy is the use of radiation to destroy the growth, reproduction of cancer cells, to achieve control and eliminate the effects of cancer cells. Surgery and radiotherapy are local treatments. Chemotherapy is a treatment that applies anticancer drugs to inhibit cancer cell division and destroy cancer cells, referred to as chemotherapy. Endocrine therapy is the use of drugs or the removal of endocrine glands to regulate body endocrine function, reduce the amount of secretion of endocrine hormones, so as to achieve the purpose of treatment of breast cancer. Molecular targeted therapy is one of the active research fields in recent years and is a new antineoplastic therapeutic with a multi-linking mechanism of action compared with chemotherapeutic drugs. TCM treatment of tumors emphasizes the principle of regulating and balancing, restoring and enhancing the disease resistance ability within the body, so as to achieve the purpose of yin yang balance treatment of tumors. Chemotherapy, endocrine therapy, targeted therapy and traditional Chinese medicine treatment, all belong to systemic therapy. The treatment process of TCM students will use both local treatment and systemic treatment for the patients, strive for cure for patients with early-stage and intermediate stage breast cancer, and extend the life span and improve the quality of life for patients with advanced stage disease.

The surgical procedure for breast cancer included two parts of breast and axillary lymph nodes. Breast surgery has breast conserving surgery (breast conserving surgery) and total mastectomy. Axillary lymph node surgery had sentinel lymph node biopsy and axillary lymph node dissection. Sentinel lymph node biopsy is the excision of only the sentinel lymph node, after detection of sentinel lymph node metastasis followed by axillary dissection, also called axillary sparing surgery. Breast conserving surgery has strict indications for surgery and is currently not done in all breast cancer patients. There is also a need for breast resection in patients with breast cancer who are not candidates for breast conserving surgery, and physicians can employ orthopedic techniques to reconstruct the breast. Breast reconstruction can be performed with autologous tissue reconstruction or with prosthetic reconstruction. Breast reconstruction may be performed at the same time as oncologic resection or at the end of treatment, when the results of each review are normal. Performing breast reconstruction does not affect the overall management of breast cancer.

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