A. Breast lump: Breast lump is the most common symptom of breast cancer. If you distinguish whether it is a symptom of breast cancer, you should understand the following aspects.

1, location: Breast cancer is mainly canceration in the outer upper breast region.

2. Numbers: Single breast mass is the most common breast cancer. Unilateral multiple masses and primary bilateral breast cancer are rare in clinic.

3. Size: The lump of early breast cancer is generally small, but some patients are often found to be larger because of their poor medical level.

4. Morphology and boundary: The vast majority of breast cancer is invasive growth with unclear boundary. Some can be flat, the surface is not smooth, and there is a sense of nodules.

5, hardness: breast cancer mass texture is hard, but the cell-rich medullary carcinoma can be slightly soft, and some can also be cystic, such as cystic papillary carcinoma. Around some lumps, there is more adipose tissue around them, which makes them feel flexible during palpation.

6. Mobility: When the mass is small, the mobility is large, but this mobility is that the mass moves with its surrounding tissues, which is different from that of fibroadenoma. If the tumor invades the fascia of pectoralis major, the activity will be weakened; When the tumor enters the pectoralis major muscle, the activity disappears.

B, breast pain: Although breast pain can be seen in a variety of breast diseases, pain is not a common symptom of breast tumors, whether benign or malignant breast tumors are usually painless. Studies have shown that the detection rate of breast cancer will increase in postmenopausal women with breast pain and gland thickening. Of course, when the tumor is accompanied by inflammation, there may be swelling or tenderness. If the advanced tumor invades the nerve or the axillary lymph nodes swell and oppress or invade the brachial plexus, shoulder pain may occur.

C. nipple discharge: nipple discharge can be divided into physiological and pathological. Physiological nipple discharge is mainly found in pregnant women and lactating women. Pathological nipple discharge refers to the secretion of mammary duct in non-physiological state. One of the symptoms of breast cancer usually refers to the latter.

D, skin changes: breast tumors cause skin changes, which are related to the location, depth and degree of invasion of the tumor. There are usually skin adhesions, superficial varicose veins, redness and edema.

E, axillary lymph node enlargement: breast cancer gradually develops, which can invade lymphatic vessels and transfer to its local lymphatic drainage area. Among them, the most common site of lymphatic metastasis is ipsilateral axillary lymph nodes.

F nipple areola abnormality: the nipple is flat, retracted and sunken until it is completely retracted under the areola, and the nipple is invisible. Sometimes the whole breast bulges, and the nipples on both sides are not on a horizontal line. Nipple erosion is also a typical symptom of breast cancer. In inflammatory breast cancer, local skin presents inflammatory-like manifestations; The color changed from light red to deep red, which was limited at first and soon spread to most breast skin, accompanied by skin edema. The skin is thick and rough, and the surface temperature rises.

diagnostic criteria

1. History: Mass is often the first symptom of breast cancer patients. Ask about the time, place, size and speed of growth, whether it has changed recently, whether it hurts or not, and the nature of pain. The time of nipple erosion and secretion, and the nature of secretion. Whether there is a lump under the armpit, pregnant and breastfeeding. Menstrual history and family history. 2. Physical examination: First, start with a comprehensive examination, and pay attention to the transfer of chest, abdomen, pelvic cavity and iliac road. Then check the breast, check the healthy side first, and then check the affected side. The inspection should be continuous and careful. See a doctor first, pay attention to whether the bilateral breasts are symmetrical, whether the appearance is abnormal, whether the skin has inflammatory changes and orange peel edema. Touch with your fingers. During breast examination, the upper arm extends over the top of the head to check the inner half of the breast, and the upper arm droops to check the outer half of the breast. When a mass is found, the position is recorded according to three zones and four quadrants, and the nature and activity of the mass are described in detail. And press the areola, whether there is overflow discharge, and when there is liquid discharge, record the nature of the liquid. When examining supraclavicular lymph nodes, we should pay attention to the sentinel lymph nodes in the depth before the starting point of sternocleidomastoid muscle. When examining axillary lymph nodes, raise the patient's upper arm with one hand, press the other hand under the armpit, then put it down, hold the patient's elbow with your hand, and examine axillary lymph nodes and subclavian lymph nodes. It is difficult to find because of the coverage of pectoral muscles. When multiple lymph nodes metastasize, it is full.

3.x-ray examination: mammography is a common method to diagnose breast cancer. Common breast diseases can generally be divided into mass or nodular lesions, calcified shadows and skin thickening syndrome, and duct shadow changes. It is very helpful for diagnosis when the mass density is high and the edge has burr sign. When the burr is longer than the diameter of the lesion, it is called a stellate lesion. X-ray film shows that the mass is often smaller than clinical palpation, which is also one of the malignant signs. Attention should be paid to the shape, size and density of calcification points in the film, and the number and distribution of calcification points should be considered. When calcifications appear in clusters, especially in the range of 1 cm, the possibility of breast cancer is very high. When the calcification point exceeds 10, the possibility of malignancy is great.

4. Ultrasonic image examination: Ultrasonic image examination is non-invasive and can be reused. It is valuable to use ultrasound imaging in patients with dense breast tissue, but its main purpose is to distinguish whether the mass is cystic or solid. The correct rate of ultrasound diagnosis of breast cancer is 80% ~ 85%. Images such as strong echo band formed by tumor infiltrating into surrounding tissues, normal breast structure destroyed, local skin thickening or depression above tumor are all important reference indexes for diagnosis of breast cancer.

5. Thermal image inspection: the image is used to display the temperature distribution on the body surface. Because of the rich blood supply of cancer cell proliferation block, the corresponding body surface temperature is higher than that of surrounding tissues, and the diagnosis can be made by using this difference. However, this diagnostic method lacks accurate imaging standards, the abnormal parts of heat do not correspond to tumors, and the diagnostic coincidence rate is poor, so it is less and less used in recent years.

6. Near-infrared scanning: The wavelength of near-infrared is 600 ~ 900μ m, which easily penetrates soft tissues. Using infrared rays to show various gray shadows through breast tissues with different densities, thus showing breast masses. In addition, infrared ray is sensitive to hemoglobin, and the shadow of breast blood vessels is clearly displayed. Breast cancer often has an increase in local blood supply and thickening of nearby blood vessels. Infrared rays have a good image of this, which is helpful for diagnosis.

7.CT examination: it can be used to locate palpable breast lesions before biopsy, diagnose preoperative staging of breast cancer, and check whether there is swelling in the posterior region, axillary region and internal mammary lymph nodes, which is helpful to formulate treatment plans.

8. Examination of tumor markers: In the process of canceration, tumor cells produce, secrete and directly release cell tissue components, which exist in tumor cells or host body fluids in the form of antigens, enzymes, hormones or metabolites. This substance is called a tumor marker.

(1) carcinoembryonic antigen (cEA): It is a nonspecific antigen, which is elevated in many tumor and non-tumor diseases, and has no value in differential diagnosis. About 20% ~ 30% of blood cEA in operable breast cancer is increased, while 50% ~ 70% of advanced and metastatic cancers have higher CEA values.

(2) Ferritin: Serum ferritin reflects the storage state of iron in the body, which is increased in leukemia, pancreatic cancer, gastrointestinal tumor, breast cancer and other malignant tumors.

(3) Monoclonal antibody: Monoclonal antibody cA was used to diagnose breast cancer, and the diagnostic coincidence rate of 15-3 was 33.3% ~ 57%.

9. Biopsy: The diagnosis of breast cancer must be confirmed before treatment begins. Although there are many examination methods at present, only the pathological results obtained by biopsy can be the only basis for positive diagnosis.

survey fee

One: mammography

Mammography is a non-invasive method. Siemens -ElemaAB breast X-ray machine is easy to operate, and its plain breast images are clear, rich in layers and informative, which is of great significance for the general survey of breast diseases, especially for the early stage of breast cancer.

Two: biopsy pathological examination methods

Lump resection: the whole lump or suspicious tissue in the breast is removed for pathological examination.

Biopsy: Cut some tissues from the lump or suspicious tissue for examination.

Fine needle puncture: use a very fine needle to extract some tissues and cells from lumps, suspicious tissues or effusion for examination. Others, such as nipple discharge, can do cytological examination of nipple discharge smear, nipple erosion scraping or printing cytological examination.

3. Determination of estrogen and progesterone receptors

After breast tumor resection, the levels of estrogen and progesterone receptors in the tumor were measured. If the receptor level is high, it indicates that the tumor is sensitive and effective to endocrine therapy such as tamoxifen.

Four: ultrasonic imaging

Ultrasound imaging is non-invasive, 1 is the first choice for breast hyperplasia, which is simple, accurate and reusable.

Five: Mammary duct endoscopy.

Mammary duct endoscope can directly observe the mammary duct epithelium and duct lumen of patients with nipple discharge, which greatly improves the accuracy of etiological diagnosis of patients with nipple discharge and provides great help for the accurate location and surgical treatment of diseased ducts. Breast ductoscopy is helpful for early detection of intraductal carcinoma with nipple discharge, especially for patients with intraductal carcinoma without calcification by molybdenum target X-ray.

treat cordially

First, surgical treatment.

Surgical treatment is still one of the main treatments for breast cancer. There are many surgical methods, but there is still no consensus on their choice. The general development trend is to minimize surgical injuries. When the equipment conditions permit, patients with early breast cancer should try their best to keep the breast shape. No matter which surgical method is chosen, radical treatment is the main method, supplemented by function and morphology. Although the tumor can be removed by surgery, there are still cancer residues, regional lymph node metastasis, or tumor thrombus in blood vessels, and the probability of recurrence and metastasis is very high. Taking Zhenqing powder for a long time after operation can prevent recurrence and metastasis.

Second, radiotherapy.

There are many radiation complications, even resulting in partial loss of function. At the same time, it can be combined with Zhenqing powder to reduce the side effects of radiotherapy. Radiotherapy is the main part of breast cancer treatment and one of the local treatment methods. Compared with surgical treatment, radiotherapy is less limited by anatomical factors such as the patient's physique. However, the effect of radiotherapy is influenced by the biological effects of radiation. It is difficult to achieve the goal of "completely killing" the tumor with the commonly used radiotherapy facilities at present, and the effect is not as good as that of surgery. Therefore, at present, most scholars do not advocate simple radiotherapy for curable breast cancer, and radiotherapy is mostly used as an auxiliary means before or after radical surgery. Palliative treatment of advanced breast cancer In the past 65,438+00 years, the comprehensive treatment of early breast cancer, mainly local resection, has been increasing, and the curative effect is not significantly different from that of radical surgery. Radiotherapy has played an important role in narrowing the scope of surgery.

Third, the relationship between hormone receptor determination and endocrine therapy

There is a clear relationship between the determination of hormone receptor and the curative effect of breast cancer: ① The effective rate of endocrine therapy for estrogen receptor positive patients is 50% ~ 60%, and that for negative patients is less than 65,438+00%. At the same time, the determination of progesterone receptor can more accurately estimate the effective rate of endocrine therapy in two positive patients, which can reach more than 77%. The relationship between receptor content and curative effect is that the higher the receptor content, the better the curative effect. ② Cells with negative receptors are often negative for poorly differentiated receptors. Patients are prone to recurrence after operation, and lymph node metastasis is not considered. The prognosis of negative patients is worse than that of positive patients. If the positive patients have recurrence, they tend to have skin, soft tissue or bone metastasis, while the negative patients tend to have visceral metastasis. ③ The determination of hormone receptor has been used to formulate postoperative adjuvant therapy. Endocrine therapy can be used as postoperative adjuvant therapy for positive patients, especially postmenopausal patients, and adjuvant chemotherapy is mainly used for premenopausal or hormone receptor negative patients.

Fourth, chemotherapy.

(1) Adjuvant chemotherapy principle Chemotherapy can inhibit the decline of bone marrow hematopoietic system, mainly white blood cells and platelets. At this time, it is necessary to take Zhenqing Powder to make up for the deficiency of chemotherapy and reduce the damage of chemotherapy to hematopoietic system. Most breast cancer is a systemic disease, which has been confirmed by many experimental studies and clinical observations. When breast cancer develops to a mass larger than the clinical palpable mass of lcm, it is often a systemic disease with distant micrometastasis, which can only be found by current examination methods. The purpose of surgical treatment is to control the primary tumor and regional lymph nodes to the maximum extent, reduce local recurrence and improve the survival rate. But after tumor resection, there are still residual tumor cells in the body. Breast cancer is a systemic disease when it is diagnosed. The purpose of systemic chemotherapy is to eradicate the residual tumor cells in the body and improve the surgical cure rate.

Verb (abbreviation for verb) immunotherapy

In the 1970s, the United States initiated a concept, that is, the use of biological response regulators to improve the resistance to tumors. This method is called BRM therapy or immunotherapy. Since the late 1970s, Coriolus versicolor polysaccharide, Schizophyllum commune polysaccharide and Lentinus edodes polysaccharide have been approved by Japan and Phellinus igniarius polysaccharide by South Korea, which established the position of mushroom polysaccharide in BRM therapy and greatly promoted the research and application of bioactive components in mushrooms. Recent studies have found that Grifola frondosa D fraction, the most effective active ingredient extracted from Grifola frondosa, is the most effective anticancer active ingredient.