Breast cancer

2021-03-19 12:00 AM

Breast cancer, in particular, is strongly associated with a family history: the risk of the disease in women whose mothers have had breast cancer before menopause is nine times higher than normal.

Breast cancer, which is closely related to the endocrine glands, is called endocrine-dependent disease, the second most common disease after cancer of the uterus. According to the American Cancer Society, in 1993 there were 182,000 new cancer cases and 46,000 of them died of breast cancer.

Breast cancer is easy to detect, if treated in an early stage, it will bring good results. However, in many cases the prognosis is not expected.

Reason

There are three main factors: hormonal disturbances, radiation effects and diet.

The number of births is also an advantageous factor: having never given birth is more susceptible to the disease than those who have had children, are pregnant at 35 years old, or have had menopause before 12 years old, or have menopause after 55 years old.

Breast cancer, in particular, is closely related to a family history: the risk of disease in women whose mothers have had breast cancer before menopause is nine times higher than normal. 50% of them may get sick. It is thought that families carry a genetic defect. It is this gene that increases the receptor for specific cancers. Mutations in the p53 germ cell line and e2bB-2 precancer have been reported in breast cancer etiology (Freboug 1991; Loffs 1992) and approximately 20% of breast cancer patients have precancerous factors. e2bB-2 and 17q21 work. Genetic factor C-Myc plays an important role in advanced cancer (Shui 1993). Family-related breast cancer is caused by a dominant chromosomal disorder in women, especially the long chromosome 17 branch.

If you have unilateral breast cancer, you are more likely to have breast cancer on the opposite side.

In addition, taking estrogen during pregnancy increases the risk of breast cancer, taking birth control pills, cancer of the lining of the uterus, and breast cancer.

Lack of sunlight is also a significant cause, with sunlight and vitamin D being able to inhibit the growth of breast cancer cells.

Organizational classification

Based on the organization and location of the tumor to standardize classification. The most common is ductal cancer with 53%, mixed with 28%, and 6% for endothelial cancer and 5% for lobe cancer. Tubular cancer has the worst prognosis. Paget's disease is the type associated with carcinoma or invasive cancer.

Symptoms and progression

Often patients feel a lump in the breast, hard, with a diameter of 1- 3cm (if early), usually the tumor is not painful, the edge is not clear, located on the outer 1/4, or 1/4 on the inside of the breast. From 4-6 months, the tumor can be twice as large and invade the upper skin to form an orange image on the face of the tumor. Spread downwards into the chest muscles, making the entire mammary gland less mobile. After a while, 70% of the skin may become ulcerative or necrotic. Patients with painless breast lumps, 90% have breast lumps that are self-detected by the patient.

The axillary ganglia is the first lymph node to be invaded step by step through the chest muscle into the lymph nodes such as the Roter, then spread to the superlarged and the inner mammary glands can be metastasized to the lateral lymph node, distal metastasis, lung, pleura. .

Organizationally, 30% have microscopic lymph node metastases, although clinically not palpable. If axillary lymph nodes are found clinically, 85% are organizationally correct. Positive axillary nodules increase with initial tumor size and local tumor invasion. If biopsy is positive for the adrenal ganglia, the disease is present in stage IV. Lateral arm edema is usually caused by an invasive lymph node.

Progression: very variable, depending largely on the type of cancer. Invasive ductal epithelium progresses erratically, sometimes growing rapidly for a few weeks and then stopping, sometimes up to 5 years. Paget type is uncommon, usually occurs in women over 40 years old, lasts about 3 years, sometimes both breasts. The endotracheal type progresses slowly, rarely with nipple discharge, rarely invasive axillary lymph nodes. Papillary type usually occurs in women 40-60 years old. May develop into large masses but rarely attach to muscles or axillary lymph nodes.

Diagnose

clinical

Tumor size, tumor progression, nipple fluid, mobility and adhesion, look for axillary lymph nodes, adrenal lymph nodes (number, firmness, mobility, adhesion).

Mammography (mammography)

Valuable diagnostic method even when the tumor is not palpable. A mammogram can help diagnose breast cancer for 2 years when clinically detectable.

Indications for breast imaging: solid plaque in the breast of unknown cause, lumpy breast, breast secretion, check the opposite breast when the other breast has cancer, when palpating axillary lymph nodes and finding screening.

Criteria for diagnosis are cancer on mammography:

Unbalanced dominant tumor mass.

Image of calcification.

The star phenotype of organizational density.

Elongation of organizational fibers in subcutaneous fat.

Thick skin.

Absorb fluid to make cells

Both for diagnosis and treatment.

Small needle aspiration with high negative pressure can be used to remove cells from a dense breast tumor. It helps us to know benign or malignant tumors, increase the ability to accurately predict and decide the biopsy time.

The rate of false negative in cytology is about 6-26.5%. False positives are in the 0.4% range. Therefore, if there is a close cooperation between the clinician and experienced cytologist, it will bring good results. However, the cell aspiration method also has limitations because small needles of the extracted fluid are not enough to evaluate, moreover, in-situ damage cannot be distinguished from invasive cancer.

Breast biopsy

Deciding to do breast biopsy after having all factors such as clinical examination, mammography, cancer cells.

Biopsy indications:

Tumor is three-dimensional and long-lasting.

Unexplained nipple bleeding with or without a tumor.

Once breast cancer is diagnosed, a biopsy of the opposite breast should be done, especially if it is a lobular neoplasm or a suspicious mammogram on the opposite breast.

Technique: local anaesthesia or general anaesthesia.

Langer's incision crossed the tumor to remove unresolved lesions, seen through mammography. Use technique of locating preoperative with needle or injecting dye to make it stand out.

Take the whole tumor partially cold cut, if benign hemostasis, if malignant mastectomy.

Breast ultrasound: helps clinically confirm the diagnosis of breast tumors. Cystic lesions do not need surgery, but suction is enough. Ultrasound helps to distinguish between benign tumors or breast cancer.

Differential diagnosis

First of all, it is necessary to exclude inflammatory diseases and benign tumors: nonspecific mastitis, acute or chronic inflammation, and abscess in the nursing person.

Mammary adenomas: These can be enlarged before menstruation and smaller after menstruation.

Fibroadenoma, or endotubic Papilloma.

Nipple eczema is identical to Paget's disease.

Arrange the clinical stages according to the TNM system of the International Cancer Society

Tx: U was not detected.

To: no sign of u.

Tis: cancer in the epithelium (intraductal carcinoma; lobular carcinoma in-situ, Paget's disease of the nipple with no tumour).

TI: tumor <2cm.

Tla: d < 0,5cm.

Tlb: 0,5cm < d < lcm Tlc: lcm < d < 2cm T2: 2cm < d < 5cm T3: d > 5-10cm

T4: The tumor is of any size, with the tumor growing to the chest wall and skin. T4a: The tumor goes to the chest wall

T4b: skin edema, ulceration, and surrounding skin infiltrates T4c: T4a + T4b

T4d: inflammatory carcinoma N: lymph node

Nx: regional lymph nodes cannot be assessed No: NI lymph nodes are not found: mobile axillary lymph nodes N2: sticky axillary lymph nodes

N3: metastasis to the superior lymph nodes, lower blows, and edema of the arm

MI: distant metastasis to the parietal lymph nodes. ranked by stage

0: Tl, No, Mo.

I: Tl, No, Mo.

            To, Nl, Mo.

lIa: Tl, Nl, Mo.

Ilb:       T2, No, Mo.

Illa: To, N2, Mo.

           T1, N2, Mo.

           T2, N2, Mo.

           T3, Nl, N2, Mo.

Illb: Any T4 N2, Mo.

           any T, N2, Mo.

IV: any T, any N, MI.

The authors evaluated according to the PEV notation development stage (poussée evolutive).

PEVo: Tumor is stable.

PEV1: The tumor grew 2 times larger in 6 months.

PEV2: There are signs of dermatitis on the tumor area or part of the breast.

PEV3: inflammatory markers of the entire breast.

The clinical form of breast cancer

 Peget’s disease carcinoma

Lesions often infiltrate the endotube, a very different type of cancer.

Initial symptoms are often itchy, red nipples, may have eruptions or ulcers in the skin, to diagnose: press biopsy.

The 1% incidence of breast cancers is extremely important because it is easily confused with dermatitis and should be treated as bacterial dermatitis and thus leads to late detection. When the damage caused the nipple change, the axillary lymph node metastasis rate was 5%.

Inflammatory breast cancer

This is the most malignant form of breast cancer. The rate of encounter is 3%.

Clinical manifestations: breast tenderness, enlargement, redness, swelling, no palpable tumor because of infiltrating and widespread lesions.

Diagnosis: press biopsy shows cancer infiltrates the lymph vessels under the skin.

If cancer is suspected, antibiotics must be given for about 2 weeks and biopsy to diagnose, metastasis is often early and widespread.

The treatments

Depends on the stage of the disease. Combine changes between surgery, radiation, and chemicals.

Surgery

Assign in stage I and II.

Hansted Surgery: total mastectomy, chest muscles and axillary lymphadenectomy, which is currently not widely used as it produces no better results than complete mastectomy.

Patey method: removal of the entire tuber and part of the large chest muscle, axillary lymphadenectomy is a widely accepted method.

Radical improvement of mastectomy: cutting the whole breast, close to the weight of the big chest muscle, removing the axillary lymph nodes, this method is now widely applied because the chest muscle is retained so it is suitable for post-tissue breast formation.

Simple mastectomy: mastectomy only, no lymph nodes removed, this method applies to stage I and combines post-abutment radiation.

The best results in breast cancer treatment are radical mastectomy and a combination of radiotherapy after tissue.

Radiation therapy

Combined radiation after surgery or radiation before surgery may be in stage III.

Radiation dose before surgery: 3000 Rad, high dose 2-3 days.

Total dose 2000 - 3000 Rad.

After surgery: 4500 Rad / 5 weeks.

Chemotherapy

As an adjunct to breast cancer treatment with good results.

Treatment regimens with high results are: CMF (Cyclophosphamide, Methotrexate (MTX) and 5 Fluouracil). This is the regimen of Bonadona 1987.

Cyclophosphamide 600mg + Glucose 5% 200ml intravenous infusion 60 drops / day 1.

5FU: 250mg X 2 ampoules + 15mg MTX intramuscularly for 1-5 days (slow intravenous injection / day 1).

Inject 6-12 times within 6-12 months or can use the formula: FAC: 5FU - adriamycin - cyclophosphamide.

5FU: 250mg X 2 ampoules (slow vein)

Adriamycin 100mg + Glucose 5% 200ml IV 60 drops / 1.

Cyclophosphamide 600mg + Glucose 5% 200ml intravenous infusion 60 drops / 1.

Take 4 weeks off for the next infusion.

Hormone therapy

Based on the breast's receptor for estrogen and progesterone, receptor patients are expected to be treated with results.

Tamoxiíen: is an anti-estrogen drug.

Mechanism of action: prevents estrogen from stimulating hyperplasia by blocking the estrogen factor in breast cancer cells.

Indication of phase treatment

Stage I, II: radical mastectomy + radiation.

If the ganglion (+) combines backup chemicals.

Some authors believe that if the (-) ganglion can still give a bad outcome rate (15-20%), chemical reinforcement should be used.

Late stage (II, VI): radiation + surgery + radiation.

Preoperative chemicals and radiation should be used as necessary.

Prognosis and tracking

After treatment for breast cancer, patients must be monitored for recurrence or secondary breast cancer in the opposite breast. Metastasis usually occurs within the first 3 years, this time every 3 months to the routine examination. Then 6 months to 5 years.

Prognosis: related to breast cancer stage. If detected at an early stage, the prognosis is good.

In addition, the tumor's receptor to progesterone and estrogen also play an important role. Patients with cancer-sensitive estrogen receptors that have not metastasized lymph nodes have a lower recurrence rate than non-estrogen-receptor tumours.

If breast cancer patients have estrogen receptors and progesterone the 5-year survival rate is 90%. If there are axillary lymph node metastases the rate is reduced to 40-50% live 5 years.