What are the symptoms of breast cancer?

1. Symptoms and signs Breast cancer may be asymptomatic in the early stage, but it may show local and systemic symptoms with the development of the disease.

(1) lump: the first symptom of breast cancer. According to foreign reports, the masses are mostly located in the outer upper quadrant, followed by the inner upper and nipple areola areas, and less below. Tumors vary in size, with the size of 2 ~ 3 cm more common, mostly single and occasionally multiple. The masses are mostly round or oval, with unclear boundaries, usually induration and poor mobility.

(2) Pain: Most breast cancer patients lack pain symptoms. Because of less pain, breast cancer is not easy to be found early. Pain is often manifested as breast tingling, swelling or dull pain, such as cystic hyperplasia of breast around cancer, and periodic pain can also occur.

(3) Breast skin changes: Breast tissue is surrounded by superficial fascia, which is connected by Cooper ligament. Because the superficial fascia is connected with the skin, when breast cancer invades the Cooper ligament between breasts to shorten it, it will pull the skin and make the local skin sunken like dimples, which is called "dimple sign". In addition, the direct attachment of the tumor to the skin may also cause this situation. Dimple sign can appear in the early stage of breast cancer, especially when the affected arm moves up and down. (fig. 12).

(1) Redness: For tumors with fast growth and large volume, superficial skin veins can be dilated, and the local skin temperature of the tumor will be increased. If the tumor is close to the skin surface, the skin may become red. If cancer cells block subcutaneous lymphatic vessels, skin edema and "orange peel degeneration" may occur (figure 13).

Inflammatory breast cancer is the most typical breast cancer, and its skin color is reddish or crimson, which rapidly expands from a limited piece to most of the breast or even the whole breast (Figure 14). During palpation, the whole breast thickened and hardened, the skin temperature increased, the swelling was rough, and there were obvious orange peel-like changes.

② Skin ulceration: When the tumor develops to the late stage, the lump grows up, which can make the skin bulge. For example, if the blood supply is insufficient, ulcers may occur as the skin turns red and thin. Patients are often accompanied by pain, and sometimes the pain is unbearable. Due to a large number of necrotic tissues and bloody secretions oozing from the wound, patients often show signs of emaciation and anemia. (Figure 15)

③ Skin nodules: When the nodules are distributed in the skin around the focus, they are called satellite nodules, which are caused by cancer cells directly infiltrating the skin along lymphatic vessels, mammary ducts or subcutaneous fascia cords. Satellite nodules can be single or several, and the latter are mostly scattered.

④ Thyroid cancer: several skin nodules are fused into a block, covering the whole chest wall of the affected side, extending to the armpit to the back, even beyond the midline of the sternum, and extending to the opposite chest wall. The skin is thick and hard and looks like the armor worn by ancient soldiers, so it is called nail cancer (Figure 16).

(4) Changes in breast contour: When the mass is large, the breast may be locally raised and enlarged. When the tumor involves the skin or pectoral muscle, it can make the breast harden and shrink. When the patient sits up, the affected breast can be improved. (fig. 17).

(5) nipple areola changes:

① Nipple retraction and orientation change: the nipple is flat, retracted, sunken and orientation changed until it is completely retracted under the areola, and the nipple is invisible. The nipple depression caused by breast cancer is different from congenital nipple invagination. The latter can often be pulled out by hand, but the nipple invagination caused by breast cancer cannot be pulled out, and the mass can be palpated under or around the sunken nipple. (fig. 18).

② Eczematous change of nipple: at first, it is nipple itching, nipple epithelium thickening, desquamation, exudation, gradual erosion, erosion and repeated scabbing and splitting, red granulation appears after areola skin peeling, and nipple can gradually flatten out and finally disappear.

(6) nipple discharge: breast cancer accounts for a large proportion of nipple discharge with mass. Overflow can be colorless, milky white, light yellow, brown, bloody, etc. It can be water sample, blood sample, serous fluid or suppuration; Overflow can be more or less, and the interval is inconsistent.

(7) regional lymphadenopathy:

① Axillary lymph node metastasis: the most common. When the metastatic focus is small, the lymph nodes are not swollen, or the swelling is not obvious and difficult to reach. Metastatic lesions generally involve the lateral lymph nodes of pectoral muscles, with hard and irregular texture, poor mobility and late invasion. ah ref = "/Jian cha/huaxue/bian/4e 794 . html " target = " _ blank " class = blue & gt； Calcium? /P & gt；

② Supraclavicular lymph nodes: Metastatic lymph nodes are mostly located in the left supraclavicular fossa or the right supraclavicular fossa, and the lesions are hard and generally small. (Figure 19)

③ Internal mammary lymph nodes: Metastasis is often not significant, and there is no diagnosis method before operation. Only when the tumor is born in the inner half of the breast can it be found in radical surgery.

④ Edema of upper limbs is widely transferred from axillary lymph nodes: palpation can touch the metastatic lymph nodes with fixation, fusion and swelling in axillary or clavicle.

(8) Distant metastasis: Breast cancer can metastasize through blood or lymph, and the most common parts are lung, pleura, bone, liver, brain and soft tissue.

① Lung and pleural metastasis: Lung is a common metastatic site of breast cancer, which often presents as nodular multiple metastases, mostly bilateral. Cough, dyspnea, hemoptysis and chest pain may occur. The main manifestations of pleural metastasis are cough, fatigue, weakness and dyspnea, and some patients have chest pain.

② Bone metastasis: The most easily involved parts are spine, ribs, pelvis and long bones, and can also appear in scapula and skull. The main manifestation is pain.

③ Liver metastasis: When liver metastasis is small, there are no special symptoms. When the mass is large or extensive, hepatomegaly, liver pain, loss of appetite and abdominal distension may occur. Jaundice and ascites may occur in the late stage.

④ Brain metastasis: Brain metastasis mainly manifested as meninges and brain parenchyma metastasis. Headache and mental state change are common symptoms, and brain dysfunction and visual impairment may occur. If the spinal cord membrane is invaded, back pain, sensory disturbance, bladder dysfunction and dysuria may occur.

2. Clinical Staging At present, the most commonly used TNM classification and staging in the world is to design and analyze the treatment effect for unified treatment, which is followed by the international community.

(1) general rules of TNM staging system: tnm staging system is mainly based on the anatomical range involved in the disease, and the classification is only applicable to cancer and needs histological confirmation.

T (primary tumor): The range of primary tumor should have the data of physical examination and imaging examination.

N(regionalnodes): regional lymph nodes, which are classified according to physical examination and imaging examination.

M (metastasis): distant metastasis should be based on physical examination and imaging examination.

(2) Classification and staging of International Union for Cancer Control (UICC):

① Clinical classification:

T: primary tumor.

Pre-invasive carcinoma of Tis (carcinoma in situ), non-invasive ductal carcinoma and non-invasive lobular carcinoma are limited to paget's disease without obvious masses in papillary breast parenchyma.

The breast did not touch the tumor.

T 1 maximum diameter of tumor ≤2.0cm.

T 1a has no adhesion to fascia or chest muscle.

T 1b has adhesion with fascia or chest muscle.

The largest diameter of T2 tumor is more than 2.0 cm, but less than 5.0 cm.

T2a has no adhesion with pectoral fascia or pectoral muscle.

T2b has adhesion with fascia or pectoral muscle.

The maximum diameter of T3 tumor is >: 5.0cm, or more than two tumors.

T3a has no adhesion with fascia or pectoral muscle.

T3b is attached to fascia or pectoral muscle.

T4 No matter the size of the tumor, as long as it directly invades the chest wall or skin, the chest wall refers to the ribs, intercostal muscle and serratus anterior muscle, excluding pectoralis major.

T4a tumor and chest wall fixation.

T4b edema, infiltration or ulcer of breast skin (including celluloid degeneration, or satellite nodules confined to the ipsilateral breast).

T4c includes T4a and T4b.

T4d inflammatory breast cancer.

The tumor focus of Tx has been removed, and the data is unknown.

N: regional lymph nodes.

No active swollen lymph nodes were touched in the ipsilateral axilla of N0.

N 1 There are active lymph nodes in the ipsilateral axilla.

N 1a thought there was no lymph node metastasis.

N 1b consider lymph node metastasis.

N2 ipsilateral axillary lymph nodes fused into a cluster or adhered to other tissues.

Metastasis of upper and lower clavicular lymph nodes N3 or edema of upper limbs (caused by edema of upper limbs or lymphatic obstruction).

Nx lymph node unknown.

M: Transfer from different places.

M0 has no evidence of distant metastasis.

M 1 has distant metastasis, including skin infiltration exceeding ipsilateral breast.

M 1 further indicates the range with the following symbols:

Lung aspiration: bone marrow labeling; OSS pleuropel of bone; Hepatitis B; Peritoneal PERBrain BRA skin skiing; Lymph node lymph, anOTHer oth.

② Clinical staging:

Tis carcinoma in situ: papillary paget's disease, non-invasive ductal carcinoma and non-invasive lobular carcinoma.

Phase I T 1aN0- 1aM0.

T 1bN0- 1bM0 .

T0N 1bM0 .

Phase II T1A-1BN1BM10.

T2a-2bN0- 1aM .

T2bN 1bM0 .

Any T3 and any NM0 in the third stage.

Any t and any N2M0.

Any t and any N3M0.

Ⅳ any t, any n, M 1.

(3) TNM classification and staging jointly developed by American Cancer Society (TJCC) and International Alliance for Cancer Control:

①TNM classification:

T: primary tumor.

The primary tumor of Tx has not been determined.

T0 primary tumor was not touched.

Tis primary carcinoma: intraductal carcinoma, lobular carcinoma in situ or paget's disease without touching the nipple (if there is a lump, classify it according to the size of the lump).

T 1 maximum diameter of tumor ≤2.0cm.

The maximum diameter of T 1a tumor is ≤ 0.5cm ..

T 1b tumor maximum diameter

The maximum diameter of T 1c tumor is > 1.0cm, but ≤ 2.0cm ..

The largest diameter of T2 tumor is > 2.0cm, < 5.0 cm.

The maximum diameter of T3 tumor is > 5.0cm.

T4 No matter the size of the tumor, as long as it directly invades the chest wall and skin (chest wall refers to ribs, intercostal muscles and serratus anterior muscle, excluding pectoralis muscle).

T4a invades the chest wall.

T4b breast skin edema (including celluloid degeneration), with ulcers and satellite nodules on the same side of the breast.

T4c * * * exists in both cases (T4a+T4b).

T4d inflammatory breast cancer.

N: regional lymph nodes.

Nx was unable to evaluate regional lymph nodes.

N0 has no palpable regional lymph nodes.

N 1 There are single or multiple metastatic lymph nodes in the ipsilateral axilla.

One or more metastatic lymph nodes in N2 ipsilateral axilla are fused with each other or fixed with other tissues.

N3 ipsilateral single or multiple internal mammary lymph node metastasis.

M: Transfer from different places.

Mx can't determine whether there is a remote transmission.

M0 has no distant metastasis.

M 1 has distant metastasis (including single or multiple lymph node metastasis on the same clavicle). M 1, and the specific parts are marked with corresponding symbols.

②TNM staging:

0 TisN0M0。

Phase I T 1N0M0.

Phase Ⅱ a T0N0M0.

T 1N 1M0 .

T2N0M0 .

Phase Ⅱ b T2N 1M0.

T3N0M0 .

ⅲa t0n2m 0。

T2N2M0 .

T2N3M0 .

T3N 1M0 .

Ⅲ b period T4 arbitrary NM0.

Any TN3M0.

The fourth stage is any t any NM 1.

③ Pathological classification:

PT primary tumor (in accordance with the above T classification).

Lymph nodes in PN region.

Patients with regional lymph nodes that can't be made by PNx (including lymph nodes that have been excised or not before pathological study).

Histological examination of PN0 showed no regional lymph nodes.

PN 1 ipsilateral armpit can touch metastatic single or multiple lymph nodes.

PN 1a only slightly shifted (

PN 1b has 1 or more metastases (>: 0.2cm).

PN 1bi has one or three lymph nodes metastasis, any of which is more than 0.2cm, but the diameter of the metastatic lymph nodes is.

PN 1bii4 has four or more metastatic lymph nodes, any metastatic focus is more than 0.2cm, but the diameter of metastatic lymph nodes is.

PN 1biii metastasis 1 has invaded the lymph node capsule, but the lymph nodes with the largest diameter are all

The maximum diameter of metastatic lymph nodes in PN 1biv is ≥2.0cm.

PN2 ipsilateral axillary metastatic lymph nodes fused with each other or invaded other tissues for adhesion and fixation.

The lymph nodes in the ipsilateral internal mammary region of PN3 can be palpable for metastasis.

PM has distant metastasis (according to the above classification).

④ Pathological staging:

0 TisN0M0。

Phase I T 1N0M0.

Phase II T0N 1M0.

T 1N 1M0 .

Phase ii a T0N 1M0.

T 1N 1M0 .

T2N0M0 .

Phase Ⅱ b T2N 1M0.

T3N0M0 .

ⅲa t0n2m 0。

T 1N 1M0 .

T2N 1M0 .

T3N 1-2M0 .

Ⅲ b period T4 arbitrary NM0.

Any TN3M0.

The fourth stage is any t any NM 1.

diagnose

There are many diagnostic methods for breast cancer, among which mammography is commonly used and pathological diagnosis is the most accurate. Generally, imaging examination should be done first, and then pathological examination should be done in case of doubt. With the in-depth study of the close relationship between the pathological results of western medicine and TCM syndromes, the TCM diagnosis of breast can not be underestimated, and the ultimate goal of diagnosis is treatment. The diagnosis of integrated traditional Chinese and western medicine will play an important role in promoting the rational comprehensive treatment of traditional Chinese and western medicine.

First, the diagnostic method of breast cancer-western medicine imaging examination

Early detection of breast cancer plays an important role.

① Ultrasound examination: Breast mass has tiny calcification and edge "burr" sign, and the aspect ratio is greater than 1, which is the most likely to become cancerous. It is very helpful to observe the peak blood flow velocity, average density of color pixels and average density of blood vessels of tumors by semi-quantitative method and color capture technology. Perforated blood vessels and MVD are highly sensitive in the diagnosis of breast cancer.

②MRI examination: paramagnetic contrast agent enhanced, and the display rate of breast cancer reconstructed by MIP was 100%. MRS strongly suggests that the choline level in breast cancer tissue is increased, and the water/lipid ratio is significantly higher than that in normal tissue, which is an important criterion for diagnosis of breast cancer.

③CT examination: Thin-layer scanning can find cancer foci with a diameter of 0.2cm, and the related parameters of breast cancer enlargement are closely related to MVD. Metastatic lymph nodes showed well.

④X-ray examination: It is most beneficial to find calcified lesions of breast cancer, and X-ray digital photography is helpful to CAD. MWA and CMRP can improve the reliability of judging breast cancer.

⑤ Infrared thermogram: Quantify the temperature of breast cancer hot spots with a digital quantitative system, calibrate the temperature difference between the focus center and surrounding tissues, and judge whether the tumor is benign or malignant.

⑥ Minimally invasive imaging: Ultrasound-guided biopsy was performed on tiny lesions lacking imaging features, and the quality of ultrasound imaging and CT-guided biopsy was improved by using 3DCEPDU.

Second, the evaluation of western medicine in the diagnosis of breast cancer

To comprehensively evaluate the role of needle aspiration cytology, DNA content analysis of cancer cells, carcinoembryonic antigen detection and molybdenum target photography in the diagnosis of breast cancer; The diagnostic coincidence rate of needle aspiration cytology is the highest, which is 85.35%. The false positive rate of cell DNA content determined by flow cytometry was the highest, which was 34.20%. The false negative rate of molybdenum target X-ray film is the highest, which is 44.54%. Combined diagnosis of the four indicators, the diagnostic coincidence rate of breast cancer increased to 92.35%, the false positive rate decreased to 1.96%, and the false negative rate decreased to 5.93%. The combined diagnosis of four indexes can obviously improve the correct diagnosis rate of breast cancer and contribute to early diagnosis.

Needle aspiration cytology of breast is of great value not only for the diagnosis of breast diseases, but also for the early diagnosis and typing diagnosis of breast cancer, especially for differentiating breast hyperplasia from breast fibroadenoma canceration. The success rate of puncture is as high as 100%, the early diagnosis rate is 16.9%, and the total diagnosis accuracy rate is as high as 98.6%. Breast needle aspiration cytology has the advantages of less trauma, simplicity, rapidness, safety, reliability, economy and practicality, accurate results, etc. Its technical indicators are obviously higher than traditional diagnostic methods, which is irreplaceable by any method at present, and has high popularization and practical value.

Thirdly, the correlation between TCM syndrome types and western medicine pathology

To study the molybdenum target X-ray imaging characteristics of breast cancer with liver depression and phlegm coagulation, and to explore its pathological basis. 1 case of breast cancer with stagnation of liver-qi and phlegm coagulation, most of the breast types were dense mixed type (78%). The frequency of abnormal vascular sign and ring-piercing sign is high (more than 80%). The axillary lymph node metastasis rate was low (12%).