Complex factors for breast cancer

More breast cancer risk factors, a more precise reason for this is genetic factors, especially genetic mutations in familial breast cancer is more important, including BRC1, BRC2 gene mutation.

There are more precise emotional spiritual factors, in particular the urban white-collar women, long life working pressure, the pressure itself does not directly cause cancer, but due to chronic poor immunity to stimulate the body down, may cause breast cancer.

Another point, breast cancer and women exposed to estrogen for too long about. Such as early menarche, before the age of 12 incoming tide; menopause late, 52 years later menopause; together in perimenopausal or postmenopausal hormone replacement therapy after prolonged use; life without breast-feeding; 35 years of age of first pregnancy child birth ; are considered high-risk breast cancer women.

Hollow needle is a common method of diagnosis of breast cancer

Early detection of breast cancer, generally the first in the hospital or specialist by video-assisted examinations, including B-, mammography, magnetic resonance imaging, found that the issue will be clear once the diagnosis.

The gold standard for diagnosis of breast cancer or pathological diagnosis, the pathological diagnosis of breast cancer used the following:

1. Fine needle aspiration cytology, invasive, simple, rapid, high accuracy, but can not determine carcinoma in situ or invasive cancer, a relatively high false positive and false negative, and the need to have experience in cell pathology expert film-reading .

2. Core needle biopsy is more accurate pathological diagnosis, the pathologist are correspondingly higher, while some of the breast cancer gene expression and receptor status, which will help future treatment options, hollow needle biopsy is now used more hospital approach.

3. Mammotome minimally invasive technique, can be repeated continuously cutting large specimens, the smaller breast tumors can be completely removed, more accurate diagnosis, but the cost is relatively high.

4. Breast duct endoscopy, 90-20th century invention of a micro-endoscope, a very good solution to the etiological diagnosis of nipple discharge, breast cancer patients, 20-30% of patients associated with nipple discharge, while ductoscopy fluid for TCT (TCT), as it may increase if the diagnosis of nipple discharge.

More breast cancer patients should be given psychological help

Many breast cancer patients with varying degrees of psychological barriers will exist, some patients came good, over time there will be depression, insomnia, anxiety phenomenon, it is very common. After mastectomy has changed his appearance and feel attractive worse, while the value of their knowledge has changed, which has led to relatively large pressure inside the patient. She was very necessary at this time family members, including medical personnel listen to her feelings for a female doctor speaking, deep inside the patient’s feelings may be more willing to tell you.

Other doctors to patients even more positive incentive effect only good feelings of the patient makes a good, if the patient can maintain the breast milk, but the cut, and no matter how her will not be too happy. In accordance with the development of advanced concepts to the patient the best treatment plan, such as Paul axillary breast conservation patients the possibility of psychological problems of patients and the total removal of more than a small chance.

At the same time, encourage patients to take part in social activities, the energy shift work and family, changing roles as a patient, let her into the society and the family as soon as possible. Many patients also have herd mentality, we use the point regular patient education to patients in a number of prevention and treatment of breast cancer, treatment philosophy, while allowing patients access to each other, there are some talent show. Many patients do not get sick every day before the busy work, got breast cancer later in life may be re-examined for more treasure now have all, some patients said: “I lost my breast, but has the world.”

Also when the patient is willing to participate in social welfare activities, we can let them organize regular visits to a number of new patients, had just diagnosed with breast cancer patient was Chuyu psychological suffering grief period, a recovery than other people who say the theories hype have effect.

Or breast examination by a doctor on their own?

Women over 30 years of age should learn breast self-examination and friends, generally 3-7 days after menstruation, you can choose the time in the bath.

First, look, look in the mirror the look of the breast is not symmetric, some breast cancer tumors grow in relatively shallow parts of the growth process may be infiltrating the skin of the ligament, the surface appearance of breast lesions will have a small dip, we disease called dimples, lumps or nipple long near the bottom of the nipple, the nipple on the back trap, if the lump near the nipple long as infiltration of the surrounding ligaments to stretch to the side of the tilt nipple to see when we can see these early signs of breast cancer . If the breasts have orange peel like appearance, it would be too late.

Then touch, touch on the right breast with his left hand, right hand touch the left breast, the breast can be divided into four quadrants and fro, from the shallow touch again, and then touch it again areola area, squeeze the nipple and then look to see if there is no nipple discharge, which is superficial palpation. Deep palpation, supine, shoulder pads a small pillow, a little deeper and the four fingers close together, or by more than a means to touch.

If he touched the exception should go to the hospital doctors, but to some conventional medical institutions may be the early detection of breast cancer and not much help, while doctors Buyi Ding is a full-time doctors breast Division, another use of the near infrared, far away Infrared inspection is limited.

Or regularly go to the hospital to find a specialist, 30 years old at least once a year should check to establish personal health records useful for early detection of breast cancer.

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1. Skin care: make skin protection measures, the main purpose is to prevent infection, because of its interstitial lymphedema after the protein-rich, minor skin damage can lead to bacterial infection. Therefore, avoid injury, limb blood, injections, blood pressure, or intravenous injection; to avoid heavy and prolonged mobile limbs droop; to avoid insect bites, prevent skin damage, skin damage if there should be dealt with immediately.

2. Ipsilateral upper extremity exercise: moderate activity and exercise help to improve lymph circulation. Such as stretching, abdominal breathing can change the internal thoracic pressure, and promote lymphatic drainage. Arm lifting exercise can stimulate the lymph flow of muscle contraction. However, excessive movement or static activities (such as heavy lifting, etc.) may cause lymphatic overload, increase upper extremity edema. Remember not to over-exercise, should be gradual. The following exercise can help you to restore upper limb function, and reduce the incidence of edema. Movement should adhere to the limb distal to the proximal events (from wrist to elbow and then to the shoulder joint), according to exercise reasonable way.

Hands clasped rubber ball (surgery within a week), hands over the wall (1 ~ 2 weeks after surgery), elbows pushed (the third week after surgery), Cabei practice (the fourth week after surgery).

3. Massage: is the treatment of lymphedema, the most important means, first empty the surrounding tissue through massage lymphatic vessels, thus speeding up the return of upper limb of the lymph. However, having experienced massage professional masseur for.

4. Pressure gloves: wearing pressure gloves can prevent swelling of lymphedema and to avoid deterioration. Pressure can suppress the swollen gloves to avoid fluid accumulation; the same time as the limbs of the stent, to help the muscles pump fluid away. Pressure gloves specially designed so that the pressure concentrated in the lower half of the arm to facilitate drain.

5. Pressure pump therapy: the use of lymphedema machine. Inflatable cuff placed on the body edema, intermittent aeration to edema fluid flow to the heart. The air pressure equipment and more room for the multi-chamber, sequential, adjustable pressure gradient pump, pump pressure decreased to the same mind as a wave, the edema fluid to squeeze into the blood circulation. This method of early lymphedema, subcutaneous fibrosis significantly before the occurrence of a certain effect.

6. Drug treatment: There is no effective drug. Recent studies indicate that benzo-pyrone may be a promising class of drugs, the drug may be deposited in the tissue space in the protein binding, enhanced macrophage phagocytosis, induce proteolysis in order to improve symptoms, but its long-term effects to be further study.

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Currently, lymphedema clinically there is no way to completely cure. As the poor treatment of upper extremity edema, so prevention is important. Theoretically, two principles should be followed:

① to avoid upper extremity blood flow is too high, because of the increase in blood flow will increase to the production of lymph, so that the burden lymph circulation. Such as high-intensity arm exercise, infections, and high temperature.

② avoid resistance increased lymphatic drainage. Such as tight clothes can be pressure in the supraclavicular area, the local arm of the infection could fibrosis, lymphatic vessel stenosis.

Based on the above two principles, after treatment of breast cancer patients should pay attention to:

1. Prevention of upper limb injury, infection;

2. To avoid the injection of upper limbs, blood, immunization, and blood pressure measurement;

3. To avoid the heat of upper limbs, such as hot water immersion, sunlight exposure, sauna, etc.;

4. Avoid wearing tight underwear, necklace and bra straps;

5. To avoid the affected upper extremity for high-intensity exercise, heavy lifting and other activities.

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John said that the traditional breast X ray photography compared to breast CT scanning technology as safe, but more comfort. Next, John wants to use the breast CT scanner interference guide treatment of breast cancer therapy, for example, biopsy, radiofrequency ablation and surgery such as freezing damage. This technology can make the breast lesion temperature, high temperature to kill tumor (thematic interview advice). There is also help some patients avoid breast tumor and subsequent radiotherapy. “But there are limitations,” Georgetown University Hospital, professor of radiation oncology chica? Dr. Ma Du said, to do this CT scan energy level must be adjusted, or the skin of patients may increase toxicity. In addition, for small breast tumors and breast cancer near the chest wall, poor efficacy.

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Cyclophosphamide (CTX) 400mg/m2 intravenously d1d8

Methotrexate (MTX) 200mg/m2 intramuscular d1d8

Fluorouracil (5-Fu) 400mg/m2 intravenous infusion of dl-5

Repeat every three weeks

30(2) CAF program

Cyclophosphamide (CTX) 400mg/m2 intravenously d1d8

Adriamycin (ADM) 300m8/m2 infusion d1

Fluorouracil (5-Fu) 400mg/m2 infusion d1-s

Repeat every three weeks

(3) Cooper program

Daily cyclophosphamide 2.5mg/kg, oral

Methotrexate weekly 0.7mg/kg, intravenously Lianyong 8 weeks.

5 – fluorouracil weekly 12mg/kg, intravenous injection, every other week after 1

Changchun new weekly 34mg/kg alkaline totally 4 to 5 weeks.

Strong pine daily 0.75mg/kg, after l / 2 volume with the 10d, 5mg / d 连用 3 weeks

4. Second-line chemotherapy of breast cancer

(1) CEF program

D1d8 intravenous cyclophosphamide 500g/m2

Epirubicin 50mg/m2 IV d1

5 – fluorouracil 500mg/m2 IV d1-3;

(2) DCF program

M due anthraquinone 10mg/m2 intravenous dl

Cyclophosphamide 500mg/m2 IV d1

5 – fluorouracil looomg/m2 intravenous d1

Bone metastases chemotherapy combined with chemotherapy on the brain, liver, lung and other soft tissue transfer of bone metastasis than effective. But there are also reports a strong combination chemotherapy with bone metastasis foci to disappear. Brilliant adriamycin (MTH) inhibit the osteolytic effect clinically for the treatment of osteolytic bone metastasis caused by hypercalcemia. Frequently used programs: AMO program: Adriamycin (ADM) 40mg/m2 IV, No. l, 8 days; Changchun new alkaline 1.4mg/m2, intravenous injection, on days 1,8; brilliant adriamycin (MTH ) 2mg 200m15% glucose dissolved in 2 hours and drops complete the first l, 8,15,22 days; every 28 days as a course of treatment, a total of three courses. Localized lesions, could meet the radiotherapy.

Chemotherapy for central nervous system metastasis

1. Absence of brain edema can be the first to use x ray tomography localization, radiotherapy. Patients with cerebral edema, mannitol and diuretics should be used to high-dose corticosteroids for brain edema.

2. Widespread disease or can not locate, they can easily through the blood-brain barrier with a first-soluble chemotherapeutic agents, such as CCNU 100mg orally every 3-4 weeks 1, MECCNul25mg orally every 4 to 6 weeks 1.

(6) chemotherapy in malignant pleural effusion pleural effusion as the net pumping, and then use the following chemotherapeutic agents into the thoracic cavity: ① consumer Mustard 40 ~ 60mg; ② nitrogen mustard 10mg; ⑦ thiazolyl for sending 30mg; ④ mitomycin 6 ~ 8mg ; ⑤ fluorouracil looomg; ⑥ cis chloride platinum 90 ~ 120mg. More chemotherapy drugs, in addition to cis platinum chloride injection to 1 every 3 weeks (and body hydration), the general Intrapleural injection of 1 week.

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Neoadjuvant chemotherapy

1. The significance of preoperative chemotherapy

(1) early control of micrometastases.

(2) to the primary cancer and the proliferation of cancer cells around the degenerated or partially kill in order to reduce the recurrence and metastasis.

(3) in advanced breast cancer and inflammatory breast cancer, limiting the implementation of surgical treatment. Preoperative chemotherapy can shrink tumors in order to surgery.

(4) to remove the tumor samples according to the preoperative evaluation of the effectiveness of chemotherapy after surgery or recurrence as the selection of chemotherapy for reference.

2. Method of preoperative chemotherapy

(1) preoperative chemotherapy: Shanghai Medical University Cancer Hospital since 1978, 96 cases of breast cancer patients before oral pyrimidine benzene mustard, daily 15mg, stop serving ld 2d, taking the total to 45mg after the surgery. Compared with the control group 94 cases, Ⅲ 5-year survival rate of patients in the treatment group was 56.3%, 39.3% of the control group.

(2) preoperative arterial chemotherapy: a thoracic artery and the subclavian artery of two ways.

Adjuvant chemotherapy

1. Indication for adjuvant chemotherapy

(1) axillary lymph node-positive premenopausal women, regardless of how estrogen receptors are combined with chemotherapy has been prescribed, should be the standard treatment program.

(2) axillary lymph node-positive and estrogen receptor-positive postmenopausal women, should be the preferred anti-estrogen therapy.

(3) axillary lymph node-positive and estrogen receptor-negative postmenopausal women, chemotherapy can be considered but not recommended as a standard program.

(4) axillary lymph node-negative premenopausal women, adjuvant treatment is not generally recommended, but some high-risk patients should consider adjuvant chemotherapy.

(5) axillary lymph node-negative postmenopausal women, regardless of their level of estrogen receptors, no indication for adjuvant chemotherapy, but some high-risk patients should consider adjuvant chemotherapy.

High-risk node-negative breast recurrence factors following points: ① hormone receptor (ER, PR) negative. ② high percentage of tumor cells in S phase. ③ aneuploid tumors. ④ CerbB-2 oncogene overexpression or amplification of those.

2. The modern view of the adjuvant chemotherapy

(1) Early postoperative adjuvant chemotherapy should strive for in 2 weeks after application, no later than one month after surgery, if the lesion to be clear before, that will reduce the effect.

(2) adjuvant chemotherapy in chemotherapy efficacy than single drug chemotherapy well.

(3) adjuvant chemotherapy need to reach a certain dose, to achieve the planned dose of 85% is better.

(4) The treatment period should not be too long on the breast cancer advocate for 6 cycles of chemotherapy.

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(2) fluorine-hydroxymethyl testosterone: and testosterone propionate were similar, but relatively little androgen. For oral dose 10 ~ 30mg / day. The drug sub-2mg, 5mg and 10mg dosage forms of three.

(3) dimethyl testosterone: testosterone derivatives, the role of testosterone propionate stronger than 2.5 times, for oral, 150 ~ 300mg / day.

Postmenopausal women (amenorrhea more than 1 year) treatment of patients, can use the following drugs.

1. Tamoxifen (TAM): an anti-estrogen drugs, with cancer cells of estrogen receptors, inhibit cancer cell proliferation. Commonly used dose of 10mg, orally, 2 times / day. Additional dose not improve efficacy. Main side effects are: ① gastrointestinal reactions: loss of appetite, nausea, vomiting and diarrhea individual; ② reproductive system: amenorrhea, vaginal bleeding, genital itching; ③ neuropsychiatric symptoms: headache, dizziness, depression; ④ skin: facial flushing, rash; ⑤ Blood: occasional neutropenia and thrombocytopenia, the blood used with caution as the low; ⑥ individual patients abnormal liver function; ⑦ affect the fetus, pregnancy, lactation Jiyong. ⑧ damage to the retina, can affect vision.

2. Ammonia Gelumite: 125mg, orally, 4 times / day, while oral administration of hydrocortisone 25mg, 2 times / day, or strong pine 5mg, 2 times / day. Ammonia Gelumite week increments to 250mg, 2 times / day, hydrocortisone 25mg, 4 times / day, or strong pine 5mg, 3 times / day.

3. Medroxyprogesterone intramuscular injection of 200 ~ 300mg, 2 times / day.

4. Diethylstilbestrol 1 ~ 2mg, orally, 3 times / day.

5. Ethinylestradiol (ethinylestradiol) product is a synthetic estrogen, vitality strong 0.5 ~ 1mg, oral, 3 times / day.

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1. Indications

(1) simple mastectomy.

(2) radical mastectomy with axillary pathology report on the group of group or axillary lymph node metastasis.

(3) metastatic lymph nodes after radical pathology examination of lymph nodes accounted for over half or more than 4 lymph node metastasis.

(4) pathologically confirmed cases of internal mammary lymph node (supraclavicular irradiation).

(5) the primary tumor in the breast or the inside of the central person for radical surgery, particularly with axillary lymph node metastasis.

2. Radiation principle

(1) Ⅰ, Ⅱ imitation of radical mastectomy or radical surgery, primary tumor in the breast quadrant, with negative axillary lymph node biopsy, surgery without radiotherapy; axillary lymph nodes, postoperative irradiation of internal mammary and supraclavicular area upper and lower areas; primary tumor in the breast area or within the central quadrant, axillary lymph node biopsy negative, only radiation within the breast area after surgery, axillary lymph node-positive, add up and down according to the subclavian area.

(2) Ⅲ of mastectomy, whether positive or negative axillary lymph nodes, all radiation levels inside the breast area and the collarbone area. According to the number of axillary lymph nodes and chest wall involvement were the number could be considered with or without chest wall radiation.

(3) mastectomy, axillary lymph nodes have been removed, generally no longer irradiation armpit area, unless the surgical removal of residual disease is not completely or only when considering exposure of additional axillary area.

(4) RT should be in the 4 to 6 weeks after the operation began, with skin grafting may be extended for 8 weeks.

3. Radiotherapy-based treatment

In the past for locally advanced tumors, those without surgical indications for radiation therapy is often palliative in nature. In recent years, with the radiation equipment and technology to improve and enhance, as well as the progress of radiation biology, radiation can be high local tumor dose, and less destructive to the surrounding normal tissue, treatment has improved significantly. Currently, minor surgery plus radiation therapy started early breast cancer research, so that radiation therapy in the treatment of breast cancer radical shift from palliative. Most of the original tumor that is less than 3cm, N0 or N1 patients could be considered minor surgery and radiotherapy. For locally advanced breast cancer, radiotherapy is still an effective local treatment, radiation or anterior resection for all tumors can improve the efficacy of simple mastectomy.

4. Recurrence, metastasis radiotherapy

Recurrence of breast cancer is a bad sign, but not without hope. Appropriate local treatment can improve the quality of life and prolong survival. Irradiation, the Ono Ono irradiation than radiation is effective, should maximize the use of irradiation Ono. For recurrent cases, should use radiation, chemotherapy and combined therapy, especially for rapidly developing recurrence. Distant metastasis in breast cancer, first consideration chemotherapy, radiation can be alleviated with appropriate symptoms, relieve pains. Such as patients with bone metastasis pain by radiotherapy reduce or disappear. For thoracic and lumbar spinal metastasis patients, radiation may prevent or delay the occurrence of paraplegia.

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1. Indications

(1) large primary tumor, it is estimated there are those in the direct operation.

(2) rapid tumor growth in the short term, significant growth in those.

(3) The original skin lesion marked edema, or chest muscle adhesions.

(4) axillary lymph nodes or large skin and surrounding tissues with significant adhesions.

(5) Application of preoperative chemotherapy in cases of tumor regression is not ideal.

(6) for inflammatory breast cancer surgery.

2. The role of preoperative radiotherapy

(1) can increase the resection rate, so some patients can not be re-operative surgery opportunity.

(2) Since the radiation in the tumor cell viability, can reduce the recurrence rate and metastasis rate, and thus increase the survival rate.

(3) The radiation, prolonged preoperative observation time and so some have subclinical distant metastasis in a case to avoid unnecessary surgery.

3. Disadvantage of preoperative radiotherapy

Increase in complications affecting the postoperative stage and hormone receptor correct determination.

4. Application of methods of preoperative radiotherapy

Preoperative radiotherapy should be adopted in high-energy radiation that can better protect normal tissue and reduce complications. Radiation technology, currently the majority of conventional segmentation, medium dose. Generally not fast radiation or hyperfractionated radiotherapy. Radiation 4 to 6 weeks after the operation the better.

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Directly to the expansion of breast cancer around the lymphatic and blood flow via. Lymph nodes should be to prevent cancer by primary tumor efflux from the first barrier, cancer cells through the lymph node barrier if they usually repeat offenders supraclavicular lymph node, and then penetrated into the blood vein. In addition to axillary lymph nodes of tumor metastasis, the parasternal lymph nodes can be involved, mostly the second and third and fourth intercostal space, a tumor in the breast and areola zone within the first half more so, in turn repeat offenders from the mediastinal lymph nodes where cancer. Breast cancer cells can also be caused by direct invasion of vascular metastasis. Collateral can intercostal vein into the ipsilateral internal thoracic vein entered the pulmonary circulation unknown. Deep breast tissue, breast and chest wall of the vein import axillary vein into the subclavian vein and innominate vein, lung metastasis is an important way, the flow of the intercostal vein azygos vein azygos vein and a half, and finally lungs through the vena cava, azygos vein system can intervertebral vein, vertebral vein plexus and the vertebral vein after the group attached to the vertebral venous system and the vena cava blood flow changes in intra-abdominal pressure each other to flow, therefore, some patients did not appear in the vena cava system (such as lung) metastasis before there skull, spine, pelvis and other transfers.

For a long time, people will find breast cancer at diagnosis may have distant metastasis, although not yet diagnosed clinically, which form the theoretical basis for the implementation of conservative chemotherapy. Today has been able to under the tumor size, number of involved lymph nodes as well as a variety of other biological characteristics of the initial estimate the distance of micrometastasis in the presence of risk.

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