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Breast cancer｜Breast Cancer

1. Basic knowledge

 

        Breast cancer occurs more than milk duct, also known as "breast duct cancer". Breast cancer that starts in the lobules of the breast is called lobular carcinoma. When breast cancer tissue is examined under a microscope (pathological examination), it can be divided into ductal carcinoma and lobular carcinoma. Other special types of breast cancer exist, but there are not many types.

 

        Before a hard lump of breast cancer is discovered, cancer may also metastasize to lymph nodes around the breast and distant organs (bone, lung, pleura, liver, brain, etc.). Depending on the type and nature of breast cancer, the ease of spreading and the degree of metastasis will vary greatly.

 

symptom:

        Usually, breast cancer is discovered only after a health checkup such as mammography is performed, and suspicion of lesions is obtained, or the patient itself is aware of physical symptoms. When self-examination finds that the physical condition is different, it is often the following.

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(1) breast lump

        Breast cancer tumors will gradually become larger and will be found after careful palpation. However, not all lumps in the breast qualify as breast cancer. For example, fibrocystic changes, breast fibroadenoma, breast phyllodesarcoma, etc., will also appear hard lumps. Phyllosarcoma of the breast is a rare tumor, while fibroadenoma of the breast is a benign tumor, which may become a malignant tumor when it easily recurs or metastasizes. The above-mentioned breast cancers are different. Once you find a lump, please seek help from a specialist as soon as possible.

 

(2) Skin changes such as dimpled breasts

        Breast cancer tumors are skin very close to the surface of the breast, with depressions in the epidermis, eczema, erosion on the nipple or areola, orange peel, redness and swelling. Sometimes there may even be a bloody discharge from the nipple.

 

        Inflammatory breast cancer is a breast cancer in which the skin of the breast is red, painful, and hot without a lump in the breast. Inflammatory breast cancer is characterized by the proliferation of cancer cells in the lymphatic vessels close to the skin, resulting in inflammation of the lymphatic vessels.

 

        Symptoms such as pain, edema, and swelling are diseases other than breast cancer, such as breast fibroadenoma in benign tumors, fibrocystic changes, or bacterial infections. The same symptoms can occur with mastitis or cellulitis, but you still need to check for breast cancer in detail.

 

(3) Swollen lymph nodes around the breast

        Breast cancer is likely to spread to the lymph nodes near the breast: the lymph nodes in the armpit (axillary lymph nodes), the lymph nodes in the longitudinal center of the front of the chest and the parasternal lymph nodes (parasternal lymph nodes), and the supraclavicular lymph nodes. The above lymph nodes are called "territorial lymph nodes" of breast cancer . After the lymph nodes in the armpit become enlarged, lumps form under the armpit, blocking the delivery of lymph fluid, causing swelling in the arm, and compressing the nerves in the arm to cause arm paralysis.


Axillary lymph nodes can be divided into grades I, II, and III.
Level I: Lateral lymph nodes along the outer border of the minor pectoral muscles
Zone II: Lymph nodes behind the small pectoral muscles and between the large pectoral muscles and the small pectoral muscles.
Level III: Medial lymph nodes along the inner border of the small pectoral muscle below the clavicle.

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        Lymph node metastasis generally moves from zone I to zone II, and may also move to zone III. Preoperative palpation, imaging diagnosis, and sentinel lymph node biopsy (see "Breast Cancer Treatment-1, Surgery 4" for details) The axillary lymph nodes (axillary lymph node dissection) have clinically proven axillary lymph node metastasis, and the axillary lymph nodes Washout to level II is the standard lymph node dissection procedure.

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(4) Symptoms of distant metastasis

        Symptoms vary according to the organ transferred, and there are also cases where there are no symptoms at all. Swelling of lymph nodes other than regional lymph nodes is called distant lymph node metastasis, and metastasis to other organs is also considered the same. Sustained pain in the waist, back, and shoulders may cause bone metastases. If the bone metastases occur in the stress-bearing area, there is a risk of fracture (fracture due to illness). Symptoms of lung metastases include cough and shortness of breath. In the case of liver metastasis, although the symptoms are not obvious, the liver will be swollen, the abdomen will be enlarged, and the appetite will be lost. Or pain and jaundice.

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cause:

    (1)It is well known that the cause of breast cancer has a deep relationship with the female hormone estrogen. Increased estrogen in the body, or the use of oral contraceptives and postmenopausal hormone supplementation therapy to increase estrogen in the body will increase the risk of breast cancer.

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    (2)Low age at menopause, delayed age at menopause, no childbirth experience, increased age at first childbirth, and no breastfeeding experience are all high-risk groups for breast cancer. The part related to living habits, alcohol consumption, postmenopausal obesity, and lack of exercise will also increase the risk of breast cancer.

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    (3) There is a history of breast cancer in the family, and people who find themselves with dense breasts, tall, and radiation can cause damage to normal cells. This type is also very likely to trigger breast cancer.

乳癌期數
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2. Treatment

(1) Surgery

        The basic method of breast cancer treatment is to remove the cancerous tumor by surgery. It can be roughly divided into: "wide local mastectomy" for breast preservation and "total mastectomy" for total mastectomy.

 

  • wide local mastectomy

       The affected part of the breast is resected along the outermost 1~2cm of the tumor. Mastectomy is to remove the tumor and meet the patient's beautiful purpose of maintaining the appearance of the breast. The conditions for performing a partial mastectomy are not clear, and the size of the tumor, the size of the breast, and the patient's own expectations need to be thoroughly discussed with the surgeon who performs the surgery.

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        If the breast tumor is too large, preoperative adjuvant chemotherapy is given to help the tumor shrink so that the operation can be performed. The surgically removed tissue stump (incision) must be examined under a microscope for cancer cells to confirm that the tumor has been removed. If it is found that the affected area is more extensive than expected before the operation, the operation method must be temporarily changed to a total mastectomy; or a second operation may be performed with a mastectomy. Often, radiation therapy to the breast is still necessary after surgery to prevent recurrence of remaining breast tissue.

 

  • total mastectomy

       When breast cancer affects too much area or multiple tumor lumps are too scattered, a mastectomy in which all breast tissue is removed will be performed.

 

  • breast reconstruction surgery

       After breast cancer surgery, the breast is reshaped by taking tissue from the patient's own abdomen or back (autologous tissue), or using artificial fillers such as silicone. This is called breast reconstruction surgery. Nipple reconstruction is also no problem. The timing of reconstruction is as follows: when breast cancer surgery is performed at the same time (primary reconstruction) and when reconstruction is performed several months or years later (secondary reconstruction). Breast reconstruction surgery is primarily performed by plastic surgeons. In the past, national insurance was only applicable to autologous transplants. Now, artificial fillers such as silicone and breast implants are used, which has expanded the scope of insurance coverage. Even so, regarding the content of the operation, there will be cases of self-financed diagnosis and treatment depending on the hospital. Or please express your request for reconstruction to the doctor first, and discuss carefully.

 

  • Lower Lymph Node Dissection in the Armpit (Axillary Lymph Node Dissection)

       It is currently known that cancer cells will invade and migrate to peripheral lymph nodes along with the lymph fluid. However, the current preoperative examination cannot accurately determine whether the lymph nodes have been metastasized by cancer cells. Therefore, in breast cancer surgery, lymph node dissection is performed to investigate whether there is metastasis. Symptoms such as inability to raise the arm, numbness, and edema will occur after the lymph node profile is completed. Therefore, only if the metastasis to the lymph nodes is known before the operation, the lower lymph node dissection of the armpit can be performed directly.

 

side effect:
      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Difficulty moving arms and shoulders
      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Swelling of arms and hands
      _cc781905-5cde-319 4-bb3b-136bad5cf58d_ Surgical scars are shocking

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(2) Radiation therapy

Radiation therapy is a local treatment. The linear accelerator is used to accurately deliver radiation energy to the tumor, destroying the combination of DNA double helix in the cells within the treatment range, and the cells lose their regenerative function and die. After 6 weeks of radiation treatment, the malignant tissue within the treatment range was eliminated, while the normal tissue still maintained certain functions, because the repair function of normal tissue was better than that of malignant cells. Moreover, when many malignant cells are dividing, the lethality of radiation therapy to the dividing cells is much higher than that of normal tissues in the quiescent phase. Combining these two factors and using fractionated treatment can achieve radiation therapy. purpose of tumor control.

 

side effect:

        The biggest side effect of radiotherapy for breast cancer patients is redness and swelling of the skin. Very few (less than 1%) cellulitis caused by broken skin leads to sepsis and requires hospitalization for antibiotic treatment.

 

 

(3) Drug therapy

乳癌治療方式
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  • hormone therapy

       Women with developed ovarian function are mostly caused by the secretion of female hormones from the ovaries. For women who enter menopause around the age of 50, the female hormones secreted from the ovaries stop, and the male hormones secreted by the adrenal cortex are used as raw materials, and the enzyme called "aromatase" is converted to produce female hormones. Compared with premenopausal women, postmenopausal women have about 1% less female hormones.

 

  • chemotherapy

(1) Chemotherapy before surgery

        For patients with large local breast cancer lumps, chemotherapy is usually injected several times first to shrink the local breast cancer, and then surgical resection is performed. In addition, for patients who want to undergo breast-conserving surgery, pre-operative chemotherapy can also be performed to reduce the lump and increase the chance of successful breast-conserving surgery.

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(2) Chemotherapy after surgery (preventive chemotherapy, adjuvant chemotherapy)

        Most breast cancer patients will relapse if they no longer receive chemotherapy after surgical resection. The risk of recurrence is related to the stage. The higher the stage, the higher the recurrence rate. After relapse, most patients' condition cannot be cured. Therefore, chemotherapy after surgery can effectively reduce the risk of recurrence. Once the recurrence rate is reduced, relatively speaking, the chances of cure can be improved. Therefore, chemotherapy after surgery is a very important part of the whole breast cancer treatment.

 

side effect:

        Nausea, osteoporosis, hair loss, ovarian function damage, nail pigmentation or cracking, taste effects and many other side effects.

 

  • Targeted therapy

       Targeted therapy drugs refer to drugs that mark molecules related to cancer cell proliferation and block their functions. There are many types of targeted therapy drugs. In breast cancer, anti-HER2 drugs block the function of the cancer cell proliferation and predictable protein (HER2: ハーツー), and are used according to the nature of the tumor before and after surgery and in the case of recurrence. When HER2 positive is detected, the treatment method is being researched and discussed. In order for the targeted drug to only attack cancer cells, generally speaking, the side effects are mild, such as chills and elevated body temperature, etc., please confirm in detail before treatment.

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  • Representative treatment options for drug therapy

       The treatment plan is a treatment plan that clearly records the usage, dosage, and treatment period of the medicine. A comprehensive judgment is made on the nature and current state of the patient's cancer cells, and the decision is made with the consent of the patient.

 

3.  convalescence

 

(1) After treatment

        Discomfort, numbness, and sickness in the chest and arms are common. Difficulty in self-acceptance after treatment may also occur. Although the appearance has not changed much, it is often difficult for the person to express the pain, depression, and discomfort. Please don't force yourself, seek help from relatives, friends and people around you. Concretely convey "I want to do ◯◯" to others. In this way, family members will more easily understand the inconvenience and emotions of their current actions, and then they can better understand how to help and overcome difficulties together.

 

(2) Diet

        Diet is not particularly restricted. Balanced nutrition is the primary goal, to maintain a good dining mood. However, for nausea caused by chemotherapy, etc., you can take the antiemetic (to suppress vomiting) prescribed by the doctor in advance, and eat small meals frequently.

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(3) Sports

        In line with the recovery of physical strength, start exercising with simple walks. Increase the amount of exercise one by one to execute. During the period of doing housework, you can exercise your body moderately, and exercise your arms and shoulders appropriately. Take your rehabilitation exercises slowly. At this time, you can place some small objects in the direction of hand stretching, and find a way to join the activities of the other hand while fetching objects. With the help of your family and those around you, please do it without forcing yourself. According to the project and degree of exercise, you can gradually start to do what you are currently able to do. However, after undergoing axillary lymph node dissection, if the arm on the side of the wound is given a heavy load of exercise, it may cause symptoms, so please consult your doctor carefully.

 

(4) Sexual life and pregnancy

        No harm to sex life. Please use contraception during treatment. If you have plans to become pregnant or give birth, please discuss it carefully with your doctor. If you want to take special hormonal agents such as oral contraceptives, please also communicate with your doctor first.

 

(5) Work and return to society

        You don't have to quit your job after being diagnosed with cancer. Returning to society can be considered slowly after the treatment has come to an end and the time for drug therapy or radiation therapy has been set. In most cases, while continuing to receive hospital treatment, when the health is not good, the working hours are shortened and you can take a break. Please check in detail whether you can go to the hospital regularly.

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For breast cancer-related drug information, you can refer to the blog of medical assistants

https://www.medicalsupporter.org/medicalblog/tag/ breast cancer

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