Invasive breast cancer

Introduction to invasive breast cancer Invasive breast cancer is the predominant type of breast cancer. The cancer cells have penetrated the basement membrane of the mammary duct or lobular acinus and invaded the stroma. Can be divided into two categories: 1, invasive ductal cancer: the most common, accounting for about 70% of breast cancer. The tumor is unclear, the gray color is hard, and the radial trabeculae are visible. Microscopically, the arrangement of cancerous tissues and the morphology of cancer cells are diverse. They are usually arranged in solid lines or agglomerates, and have no glandular structure. Therefore, they are called solid cancers. According to the ratio of cancer parenchyma to interstitial, solid cancer can be divided into simple cancer, hard cancer and atypical medullary carcinoma, which are collectively referred to as invasive ductal carcinoma; 2. Invasive lobular carcinoma: 20% can affect both sides Breast. The tumor is unclear, the texture is tough, and the cut surface is grayish white. A typical feature of the microscope is that a single line of cancer cells is linearly infiltrated into the fibrous stroma. The cancer cells are small, the cytoplasm is less, the nuclear size is more consistent, the nucleoli are not obvious, and the division is rare. basic knowledge The proportion of illness: 0.001% - 0.007% Susceptible population: women before and after menopause. Mode of infection: non-infectious Complications: skin metastasis of breast cancer

Causes of invasive breast cancer

The etiology of breast cancer is multifactorial and involves diet, fertility and hormonal imbalances. Epidemiological data show that breast cancer is a "rich disease" in economically developed countries. It is closely related to the lifestyle of Western countries. It is characterized by eating a high-calorie diet rich in animal fats and proteins, and lacking physical activity. The incidence of breast cancer in countries and regions (North America, Northern Europe, and Australia) that have lived in this way for a long time is currently in a high platform phase of 70 to 90 patients/100,000 people per year. The increase in industrialization has led to a significant increase in the incidence and mortality of breast cancer in rich countries. In addition to breast cancer, lifestyles in Western countries are also risk factors for prostate cancer, colon/rectal cancer, and endometrial cancer. It has been confirmed that exposure to special environments (such as radiation, alcohol and exogenous hormones) also plays a role in the pathogenesis of breast cancer, but the relative risk factor is low. Breast cancer often shows family clustering characteristics compared to other tumors. Two high exogenous genes (BRCA1/2) are closely related to the onset of breast cancer. At the same time, it can be speculated that in the genetic susceptibility of breast cancer, the interaction of multiple genes also plays an important role.

Invasive breast cancer prevention

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

2. Adhere to physical exercise, actively participate in social activities, avoid and reduce mental and psychological stress factors, and maintain a calm state of mind.

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

4. Actively treat breast diseases.

5, do not mess with exogenous estrogen.

6, do not drink too much alcohol for a long time.

7. Drug prevention in high-risk populations of breast cancer. The National Cancer Center is responsible for the exploratory study of tamoxifen and raloxifene to prevent breast cancer.

It is recommended that female friends understand the scientific knowledge of some breast diseases, master the self-examination method of breasts, develop regular self-examination habits of breasts, and actively participate in breast cancer screening to prevent problems before they occur.

Invasive breast cancer complications Complications breast cancer skin metastasis

1. A small number of breast cancer patients may have different degrees of tenderness or nipple discharge in the early stage. Breast cancer masses grow faster. The breast may have an "orange peel" change, the surface of the tumor is sunken, the nipple is biased toward the direction of the tumor, and the nipple is invaginated. By lymphatic metastasis and distant metastasis in the late stage of breast cancer, a series of other symptoms can be complicated.

2, breast cancer patients in the middle and late can appear "tumor loss of appetite - cachexia syndrome". Loss of appetite is both a cause of cachexia and a clinical manifestation of cachexia. There may be symptoms such as loss of appetite, anorexia, weight loss, fatigue, anemia and fever. In severe cases, life may be dangerous.

3, lymphatic metastasis may occur in the late stage of breast cancer, the ipsilateral axillary lymph nodes are enlarged, and the number of enlarged lymph nodes is increasing, sticking to each other, and a small number of patients may have lymphatic metastasis of the contralateral axilla. Long-term metastasis can occur in the late stage of breast cancer, breast cancer will be transferred to the lungs, chest pain, pleural effusion, shortness of breath and other symptoms. Spinal metastases can cause severe pain and even paraplegia in the affected area. Liver metastases can cause jaundice and hepatomegaly.

Most of the complications of breast cancer occur in the middle and late stages of cancer. The patient's physical condition is relatively poor and the disease is serious. Need to actively control the spread of cancer cells.

Invasive breast cancer symptoms Common symptoms Breast lumps Breast pain Female breasts superficial... Nipple discharge breast sclerosis

1, symptoms and signs early breast cancer can be asymptomatic, with the development of the disease, may show local and systemic symptoms.

(1) Lump: It is the first symptom of breast cancer. According to foreign reports, most of the masses are located in the outer upper quadrant, followed by the inner upper and the nipple areola area, and the lower part is less. The size of the tumor is different, and it is more common in the size of 2 to 3 cm. Most of them are single-shot, and occasionally multiple. The masses are mostly round or oval, and the borders are unclear. They are generally indurated and have poor mobility.

(2) Pain: Most breast cancer patients lack pain symptoms. Breast cancer is not easily detected early because of less pain. Pain often manifests as tingling, pain or dull pain in the breast, such as periodic pain in the breast with cystic hyperplasia of the breast.

(3) Breast skin changes: The breast tissue is surrounded by a superficial fascia located under the skin, and the deep fascia is connected by a Cooper ligament. Because the superficial fascia is connected to the skin, when the breast cancer invades the Cooper ligament between the breasts to shorten it, it will pull the skin and make the local skin sag, like a dimple, called "dimple sign." In addition, adhesion of the tumor directly to the skin may also cause this condition. Dimples can appear earlier in breast cancer and are more pronounced when the affected arm moves up and down.

1 redness and swelling: tumors with faster growth and larger volume may have superficial venous engorgement and elevated local skin temperature. The skin may turn red when the tumor is close to the surface of the skin. If the cancer cells block the subcutaneous lymphatics, skin edema can occur and "orange peeling" occurs.

Breast skin redness and swelling are most typical of inflammatory breast cancer. The skin color is light red or deep red, and the limited piece quickly spreads to most breasts and even whole milk (Fig. 14). At the time of palpation, the whole breast thickened and hardened, the skin temperature increased, and it was swollen and rough, and there was obvious orange peel-like change.

2 skin ulceration: the tumor develops to the advanced stage, the tumor grows up, can make the skin bulge, such as insufficient blood supply, with the skin redness, thinning, can occur ulceration. Patients often have pain, sometimes severe pain. Because the wound has a large amount of necrotic tissue and bloody secretions exudation, patients often have signs of weight loss and anemia.

3 skin nodules: when the nodules are distributed around the skin of the lesion, it is called a satellite nodule, which is caused by the direct infiltration of cancer cells along the lymphatic vessels, mammary ducts or subcutaneous fascia. Satellite nodules can be single or several, and the latter are mostly distributed.

4 armor cancer: several skin nodules are fused into a piece, covering the entire affected side of the chest wall, and can extend to the back of the armpit to the back, even beyond the midline of the sternum, extending to the contralateral chest wall. The skin of thick and hard plates is like the armor worn by ancient soldiers, so it is called armor cancer.

(4) Maize wheel corridor change: When the mass is large, the mammary gland may have local uplift and the mammary gland enlarges. When the tumor affects the skin or the chest muscles, the breast can be hardened and shrunk. When the patient is sitting, the affected breast can be raised.

(5) Nipple areola changes:

1 nipple retraction and orientation change: the nipple is flat, retracted, sunken, and changed in orientation until it is completely retracted into the areola, and the nipple is not visible. The nipple depression caused by breast cancer is different from congenital nipple retraction. The latter can often be pulled by hand, and the nipple retraction caused by breast cancer cannot be pulled out, and the lumps can be swollen under or around the nipple.

2 Eczema-like changes in the nipple: initial nipple itching, nipple epithelial thickening, desquamation, exudate, gradual erosion, erosion and repeated scarring, spasm, red granulation after the exfoliation of the areola skin, the nipple can slowly flatten And finally disappeared.

(6) nipple discharge: nipple discharge with lumps, breast cancer accounted for a larger proportion. The discharge may be colorless, milky white, light yellow, brown, bloody, etc.; it may be watery, bloody, serous or purulent; the amount of overflow may be more or less, and the interval time is also inconsistent.

(7) Regional lymphadenopathy:

1 lymph node metastasis: the most common, when the metastases are small, the lymph nodes are not swollen, or the swelling is not obvious, it is difficult to reach. Metastatic lesions generally involve the lateral lymph nodes of the pectoral muscle. The touch is hard, irregular, and the activity is poor, and the late stage can be invaded.

2 supraclavicular lymph nodes: metastatic lymph nodes are mostly located in the left supraclavicular fossa or the right supraclavicular fossa, the lesion is hard, generally small.

3 internal mammary lymph nodes: metastasis is often not significant, there is no diagnosis before surgery, only when the tumor is born in the inner half of the breast, it can only be found when super radical surgery.

4 Upper extremity edema is widely metastasized from axillary lymph nodes: palpation can reach the axillary fossa or metastatic lymph nodes with fixed and fusion swelling on the clavicle.

(8) Distant metastasis: Breast cancer can be metastatically transferred through the blood or lymphatic route. The most common sites are lung, pleura, bone, liver, brain and soft tissue.

Invasive breast cancer examination

1, X-ray inspection:

Mammography is a common method for breast cancer diagnosis. Common breast diseases can be divided into lumps or nodular lesions, calcification and skin thickening, catheter shadow changes, and the density of the mass is high. When there is a burr sign, it is very helpful for diagnosis. When the burr is longer than the diameter of the lesion, it is called a star lesion. The x-ray film shows that the mass is often smaller than the clinical palpation. This is also one of the malignant signs, and the calcification point in the slice. Attention should be paid to its shape, size, density, and considering the number and distribution of calcification points. When calcification points are clustered, especially in the range of 1 cm, the possibility of breast cancer is very high. When the calcification point exceeds 10, the malignancy may be Very sexual.

2, ultrasound imaging inspection:

Ultrasound imaging examination is non-invasive and can be applied repeatedly. It is valuable for the application of ultrasound imaging in patients with dense breast tissue, but the main purpose is to identify the cystic or solid nature of the tumor. The accuracy of ultrasound examination for breast cancer diagnosis is high. 80%85%, the strong echogenic band formed by the infiltration of cancer into surrounding tissues, the destruction of normal breast structure and the thickening or depression of local skin above the mass are important reference indicators for the diagnosis of breast cancer.

3, thermal image inspection:

The application image shows the body surface temperature distribution. Because the cancer cell proliferation block is rich in blood supply, the corresponding body surface temperature is higher than the surrounding tissue. The difference can be used for diagnosis. However, this diagnosis method lacks exact image standard, thermal abnormal site and tumor. Not corresponding, the diagnostic compliance rate is poor, and it has been gradually applied in recent years.

4, near infrared scanning:

The near-infrared wavelength is 600-900&mum, which easily penetrates into soft tissues. It uses infrared rays to transmit various grayscale shadows through different density tissues of the breast, thereby displaying breast lumps. In addition, infrared rays have strong sensitivity to hemoglobin, and the breast blood vessels are clearly displayed. Breast cancer often has increased local blood supply, and the nearby blood vessels become thicker. Infrared rays have a better image display, which is helpful for diagnosis.

5, CT examination:

It can be used for pre-biopsy localization of breast lesions that cannot be removed, to confirm the preoperative staging of breast cancer, to check whether there is swelling in the posterior breast area, ankle and internal mammary lymph nodes, and to help formulate a treatment plan.

6, tumor marker inspection:

In the process of carcinogenesis, tumor cells produce, secrete, directly release cellular tissue components, and are present in tumor cells or in host body fluids in the form of antigens, enzymes, hormones or metabolites. Such substances are called tumor markers.

(1) Carcinoembryonic antigen (cEA): is a non-specific antigen, which is elevated in many tumors and non-tumor diseases. There is no differential diagnostic value. Preoperative examination of operable breast cancer is about 20% to 30% of blood cEA. The content is elevated, while in advanced and metastatic cancer, 50% to 70% of CEA has a high value.

(2) Ferritin: Serum ferritin reflects the iron storage state in the body, and there is an increase in ferritin in many malignant tumors such as leukemia, pancreatic cancer, gastrointestinal tumor, and breast cancer.

(3) Monoclonal antibody: The monoclonal antibody cA used for the diagnosis of breast cancer, 15-3 has a diagnostic accuracy rate of 33.3% to 57% for breast cancer.

7, biopsy:

Breast cancer must be established before the diagnosis can be started. Although there are many current examination methods, only the pathological results obtained by biopsy can only be used as the basis for the only confirmed diagnosis.

(1) Needle aspiration biopsy: Acupuncture cytology was established by Gutthrie in 1921 and has been developed into a fine needle aspiration cytology. The method is simple, rapid, and safe. It can replace some tissue frozen sections, and the positive rate is higher. It is between 80% and 90% and can be used for anti-cancer screening. If the clinical diagnosis is malignant and the cytology reports benign or suspicious cancer, surgical biopsy should be selected to confirm the diagnosis.

(2) Cut biopsy: Because this method is easy to promote the spread of cancer, this method is generally not recommended, and it can be considered only when advanced cancer is used to determine the pathological type.

(3) Excisional biopsy: When a malignant mass is suspected, the mass is removed and a certain area around the tissue is a biopsy. It is generally required to remove as much as possible from the edge of the tumor at least 1 cm. The following examination of the cut specimen can be used to determine the malignancy:

1 The texture of medullary carcinoma is soft, the cut surface is grayish white, and there may be bleeding spots, necrosis and cyst formation.

2 The cut surface of the hard cancer is grayish white, shrinking, like a scar, extending radially around, without a capsule.

3 The characteristics of intraductal cancer involve multiple catheters, and even infiltrate in the direction of the nipple. The cut surface is grayish white, and sometimes the acne-like substance can be extruded.

4 The texture of lobular carcinoma is soft, the shape is irregular, the cut surface is grayish white, pink, sometimes the tumor is not obvious, only the breast thickening.

Diagnostic identification of invasive breast cancer

diagnosis

There are many methods for the diagnosis of breast cancer. The most commonly used breast mammography is the most accurate pathological diagnosis. Generally, the imaging examination is performed first. If there is any doubt, the pathological examination will be carried out. With the close relationship between the pathological results of Western medicine and the syndrome type of TCM, The diagnosis of breast in the Chinese medicine can not be underestimated. The ultimate goal of diagnosis is treatment. The combined diagnosis of Chinese and Western medicine will play a significant role in promoting the comprehensive treatment of Chinese and Western medicine.

1, the diagnosis of breast cancer - Western medical imaging

Early detection of breast cancer is important.

1 Ultrasound examination: microcalcification in the breast mass, edge & ldquo burr & rdquo sign, aspect ratio greater than 1, the possibility of cancer is the greatest, through the semi-quantitative method and color capture technology to observe the peak flow velocity of cancer, the average density of color pixels, blood vessels The average density is helpful for the differential diagnosis of malignant tumors. The penetrating blood vessels and MVD are highly sensitive to the diagnosis of breast cancer.

2MRI examination: The use of paramagnetic contrast agent to strengthen MIP reconstruction showed a 100% indication of breast cancer. MRS strongly suggested that the level of choline in breast cancer tissues was increased, and the water/fat ratio was significantly larger than that of normal tissues. It is an important criterion for the diagnosis of breast cancer.

3CT examination: thin-layer scanning can find 0.2 cm in diameter, and the related parameters of breast cancer increase are closely related to MVD, which shows the metastatic lymph nodes.

4X-ray examination: The most advantageous detection of breast cancer calcifications, X-ray digital photography can help CAD, MWA and CMRP technology can improve the reliability of breast cancer.

5 Infrared thermography: quantitative analysis of breast cancer hot zone temperature by digital quantitative system, calibration of the temperature difference between the lesion center and surrounding tissue, to determine the tumor is good, malignant.

6 Minimally invasive imaging: Ultrasound-guided biopsy was performed on small lesions lacking image features, and 3D CE PDU improved ultrasound was characterized by CT-guided biopsy.

2. Evaluation of Western medicine diagnosis of breast cancer

Comprehensive evaluation of needle aspiration cytology, analysis of cancer cell DNA content, detection of carcinoembryonic antigen and mammography in the diagnosis of breast cancer. The highest coincidence rate was found by needle cytology. The cell DNA was determined by flow cytometry at 85.35 %. The highest false positive rate of content was 34.20%. The false negative rate of mammography X was the highest, which was 44.54%. The combined diagnosis of 4 indicators increased the diagnostic coincidence rate of breast cancer to 92.35%, and the false positive rate decreased to 1.96 %. The negative rate dropped to 5.93%. The combined diagnosis of the four indicators can significantly improve the correct diagnosis rate of breast cancer and contribute to early diagnosis.

Breast aspiration cytopathology not only has important applicability to the diagnosis of breast diseases, but also has important value for early diagnosis and classification of breast cancer. It is of great significance to identify breast hyperplasia and breast fibroadenoma with carcinogenesis. The rate is as high as 100%, the early diagnosis rate is 16.9%, and the total diagnostic accuracy is as high as 98.6%. The needle aspiration cytopathology of the breast has the advantages of small trauma, simple and rapid, safe and reliable, economical and practical, accurate results, etc. The traditional diagnostic method is currently irreplaceable by any method and has a high promotion and practical value.

3. Correlation between TCM Syndromes and Western Medicine Pathology

To study the characteristics of mammography of hepatic stagnation type breast cancer and to explore its pathological basis. In liver stagnation type breast cancer, the type of breast type is dense and mixed (78%), abnormal vascular signs and The frequency of peritoneal signs was higher (accounting for more than 80%), and the frequency of axillary lymph node metastasis was low (12%).

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