What Are the Concerns about Breast Cancer in the Lymph Nodes?

Female breasts are composed of skin, fibrous tissue, breast glands, and fat. Breast cancer is a malignant tumor that occurs in the epithelial tissues of the breast. 99% of breast cancers occur in women and only 1% in men.

Basic Information

English name: breast cancer
Visiting department: Oncology, Breast Surgery

Multiple groups: Family history of breast cancer, non-fertility or late fertility
Common causes: Not completely clear
Common symptoms: Early breast cancer often does not have the typical symptoms and signs

Causes of breast cancer

The cause of breast cancer is not completely clear. Studies have found that the incidence of breast cancer has a certain regularity. Women with high risk factors for breast cancer are susceptible to breast cancer. The 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 China Cancer Registry Annual Report, the age-specific incidence of breast cancer in women is low at the age range of 0 to 24 years, gradually increasing after 25 years of age, reaching a peak in the 50 to 54 years old group, and gradually decreasing after 55 years of age. Family history of breast cancer is a risk factor for breast cancer. The so-called family history refers to patients with breast cancer in first-degree relatives (mother, daughter, sister). In recent years, it has been found that dense breast glands have become a risk factor for breast cancer. Risk factors for breast cancer include early menarche (<12 years) and late menopause (> 55 years); unmarried, unfertile, late fertility, and no breastfeeding; no timely diagnosis and treatment of benign breast disease; hospital biopsy (biopsy) Atypical breast hyperplasia has been confirmed; the chest has been exposed to high doses of radiation; long-term use of exogenous estrogen; postmenopausal obesity; long-term excessive drinking; and mutations associated with breast cancer. What needs to be explained is the susceptibility genes of breast cancer. European and American countries have done a lot of research. BRCA-1, BRCA-2, p53, and PTEN are known. Breast cancers associated with these gene mutations are called genetics. Sexual breast cancer accounts for 5% to 10% of all breast cancers. Women with these high risk factors do not necessarily have breast cancer. It can only be said that their risk of breast cancer is higher than normal people. The incidence of breast cancer in Chinese women is still low.

Clinical manifestations of breast cancer

Early breast cancer often does not have the typical symptoms and signs, and is not easy to attract attention. It is often found through physical examination or breast cancer screening. The following are typical signs of breast cancer.

Breast lump

80% of breast cancer patients are first diagnosed with a breast mass. Patients often find breast masses unintentionally, mostly single, hard, irregular edges, and less smooth surfaces. Most breast cancers are painless masses, and only a few are accompanied by varying degrees of faint or tingling pain.

2. Nipple discharge

The non-pregnant period of blood, serum, milk, pus from the nipple, or stop breastfeeding for more than six months still have milk outflow, called nipple discharge. There are many causes of nipple discharge. Common diseases include intraductal papilloma, breast hyperplasia, duct dilatation, and breast cancer. Unilateral and single-hole bloody discharge should be further examined, if accompanied by breast masses, more attention should be paid.

3. Skin changes

There are many signs of skin changes caused by breast cancer. The most common is that the tumor invades the Cooper ligament, which connects the breast skin and the deep pectoralis fascia, shortens and loses its elasticity, pulls the skin of the corresponding part, and causes "dimple sign" That is, a small depression in the breast skin, like a small dimple. If the cancer cells obstruct the lymphatic vessels, there will be "orange peel-like changes", that is, many small dot-like depressions in the breast skin, just like orange peel. In the advanced stage of breast cancer, cancer cells infiltrate into the skin along the lymphatic, glandular or fibrous tissues and grow, forming scattered hard nodules in the skin around the main cancerous foci, the so-called "skin satellite nodules."

4. Nipple and areola abnormalities

Tumors are located at or near the depth of the nipple and can cause nipple retraction. The tumor is far away from the nipple, and the large duct in the breast is invaded and shortened, which can also cause the nipple to retract or raise. Nipple eczema-like cancer, known as Paget's disease of the breast, is manifested by itching, erosion, ulceration, scabbing, scaling, and burning pain of the nipple skin, causing the nipple to retract.

5. Axillary lymph nodes

Axillary lymph node metastasis occurs in more than 1/3 of breast cancer patients admitted in large hospitals. Ipsilateral axillary lymphadenopathy may occur early, and the enlarged lymph nodes are hard, scattered, and pushable. As the disease progresses, the lymph nodes gradually fuse, and adhere to and fix with the skin and surrounding tissues. In the later stages, metastatic lymph nodes can be felt on the clavicle and on the contralateral axilla.

Breast cancer screening

In the breast clinic, the doctor will first perform a physical examination to check the bilateral breasts after understanding the medical history. They will also combine imaging examinations, including mammography (mammography of mammography), color ultrasound, and if necessary, magnetic resonance examinations of the breast ( MRI). Mammography is the main method of breast cancer screening recommended internationally in recent years. It can be found that breast cancer can not be detected by clinical examination. It is usually used for women over 40 years of age. Sensitive, with limited radiation damage and relatively low breast density, abnormal signs are easy to find on mammograms. Color Doppler ultrasound is not harmful to the human body, and is ideal for young women and dense breasts. Magnetic resonance imaging (MBI) can detect multifocal and multicenter small lesions, and it is also an imaging method for early diagnosis. Finally, the diagnosis will be based on cytopathology (in conditional hospitals) and histopathological diagnosis. Biopsy will be performed on the basis of abnormalities found in clinical examinations. Puncture or surgical methods can be used. Take treatment. If the patient has a nipple discharge, some examination methods for nipple discharge can also be developed, such as bronchoscopy, mammography, cytology smear, etc.

Breast cancer diagnosis

Early detection and early diagnosis of breast cancer is the key to improving the efficacy. The diagnosis and differential diagnosis of breast cancer should be combined with the patient's clinical manifestations and medical history, physical examination, imaging examination, histopathology and cytopathology examination (in conditional hospitals).

Most of the patients came to the hospital for finding a breast mass by accident, and a few patients were found to have breast masses or suspicious lesions through regular physical examination or screening. The palpable mass can be confirmed by needle aspiration biopsy or surgical resection biopsy. If the tumor is not detected clinically, the suspicious lesion is found by imaging examination. Biopsy can be performed with the help of imaging examination. Pathological examination is the gold standard for breast cancer diagnosis.

The breast is located on the surface of the human body, and it is not difficult to diagnose it. However, according to the statistics of hospitals in China, early cases are still a minority. What are the reasons for delaying the early diagnosis of breast cancer?

1. Female friends don't know enough about medical science, don't know the clinical characteristics of breast cancer, and lack vigilance about this disease in daily life.

2. Early breast cancer is mostly a painless mass, and the body can be free of any discomfort, which does not affect life or work.

3. A few women are constrained by outdated ideas, they are old-fashioned, ashamed to examine the body, and are unwilling to go to the hospital for breast examination.

4. The time-saving figure in Figure 1 is convenient and convenient. I listened to the nonsense of an individual person or was too superstitious about the diagnosis of a certain device, and relaxed my vigilance, and did not check further.

5. Some people have read some tumor books or are affected by people around them. They have fear of cancer. They are afraid to get breast cancer and do nt dare to go to the hospital for examination. Go to the hospital. Seeing a doctor can rule out breast cancer and relieve psychological pressure. Once diagnosed as breast cancer, it is also detected early and can be treated in time.

6. The pace of life is fast, work is busy, new problems are emerging, and you are too busy to cope with your own health. Even if you have discomfort, you have no time to go to the hospital and deal with it casually. These wrong practices have caused many breast cancer patients to delay the early diagnosis.

Breast cancer treatment

With the continuous deepening of the understanding of the biological behavior of breast cancer, as well as the change and renewal of the treatment concept, the treatment of breast cancer has entered the era of comprehensive treatment, and a treatment model with equal emphasis on local breast cancer treatment and systemic treatment has been formed. Doctors will use surgery, radiotherapy, chemotherapy, endocrine therapy, bio-targeted therapy, and Chinese medicine adjuvant therapy as appropriate according to the stage of the tumor and the physical condition 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 and reproduction of cancer cells, to control and destroy cancer cells. Surgery and radiotherapy are local treatments. Chemotherapy is a treatment method that uses anti-cancer drugs to inhibit cancer cell division and destroy cancer cells, referred to as chemotherapy. Endocrine therapy is to use drugs or remove endocrine glands to regulate the endocrine function of the body and reduce the secretion of endocrine hormones to achieve the purpose of treating breast cancer. Molecular targeted therapy is one of the most active research fields in recent years. Compared with chemotherapeutic drugs, it is a new type of anti-tumor therapy with multiple links of action. Traditional Chinese medicine treats tumors by emphasizing the principles of regulation and balance, restoring and enhancing the disease resistance inside the body, so as to achieve the goal of yin-yang balance treatment of tumors. Chemotherapy, endocrine therapy, targeted therapy and traditional Chinese medicine treatment are all systemic treatments. During the treatment, doctors will take into account the patient's local treatment and systemic treatment, strive for cure for patients with early and mid-term breast cancer, extend life expectancy for patients with advanced stage, and improve quality of life.

Surgery for breast cancer involves breast and axillary lymph nodes. Breast surgery includes breast-preserving surgery (breast-conserving surgery) and total mastectomy. Axillary lymph node surgery includes sentinel lymph node biopsy and axillary lymph node dissection. Sentinel lymph node biopsy is to remove only the sentinel lymph nodes, detect the sentinel lymph node metastasis, and then perform axillary lymph node dissection. It is also called axillary preservation surgery. Breast-conserving surgery has strict surgical indications. At present, all breast cancer patients cannot perform breast-conserving surgery. Breast cancer patients who are not suitable for breast-conserving surgery also need to have their breasts removed, and doctors can use plastic surgery techniques to reconstruct the breasts. Breast reconstruction can be performed using autologous tissue or prosthesis. The breast reconstruction can be performed at the same time as the tumor removal operation, or it can be performed when the results of the review are normal after the treatment is completed. Breast reconstruction does not affect the overall treatment of breast cancer.

Breast cancer prevention

The cause of breast cancer is not fully understood, so there is no exact way to prevent breast cancer. From the epidemiological analysis, the following aspects can be considered in the prevention of breast cancer:

1. Establish a good lifestyle, adjust the pace of life, and maintain a comfortable mood.

2. Insist on physical exercise, actively participate in social activities, avoid and reduce mental and psychological tension factors, and maintain a peaceful mindset.

3. Develop good eating habits. Pay attention to nutritional balance in infants and young children and promote breastfeeding; reduce excessive intake of high-protein and low-fiber diets during child development; do not consume large amounts of fat and animal protein during adolescence, and strengthen physical exercise; control total calorie intake after menopause obesity. Usually develop dietary habits such as not excessive intake of meat, fried eggs, butter, cheese, sweets, eat less salted, smoked, fried, grilled food, increase consumption of fresh vegetables, fruits, vitamins, carotene, olive oil, fish, beans Products.

4. Actively treat breast diseases.

5. Do not mess with exogenous estrogen.

6. No long-term excessive drinking.

7. Carry out drug-based prevention in high-risk groups of breast cancer. The National Cancer Center has conducted exploratory research on the prevention of breast cancer with drugs such as tamoxifen and raloxifene.

It is recommended that female friends know some popular knowledge about breast diseases, master the methods of breast self-examination, develop the habit of regular breast self-examination, and actively participate in breast cancer screening to prevent problems before they occur. ^[1-3]