Breast lump is the most common symptom of breast cancer, and about 90% patients come to see a doctor with this symptom. With the popularization of tumor knowledge and the investigation of tumor prevention and treatment, this proportion may increase. If there is a lump in the breast, you should know the following aspects. Location (1): centering on the nipple, the breast is divided into five regions: upper inner region, upper outer region, lower inner region, lower outer region and central region (areola). Breast cancer is more common outside than inside. It is rare to see inside and outside. (2) Quantity: Single breast lump is the most common breast cancer, while multiple breast lumps and primary bilateral breast cancer are rare in clinic. However, with the improvement of the level of tumor prevention and treatment, the survival time of patients is prolonged, and after a breast cancer operation, the chance of another primary tumor in the contralateral breast will increase. (3) Size: The mass of early breast cancer is generally small, and sometimes it is not easy to distinguish it from lobular hyperplasia or some benign lesions. However, even a small lump sometimes involves the suspensory ligament of the breast, causing symptoms such as local skin depression or nipple invagination, which is easier to find early. In the past, due to the poor medical level, when I came to see a doctor, the lump was often very large. Nowadays, with the popularization of breast self-examination and the development of general survey, early clinical breast cancer has increased. (4) Morphology and boundary: Most breast cancers are invasive with unclear boundary. Some can be flat, the surface is not smooth, and there is a sense of nodules. However, it should be noted that the smaller the lump, the less obvious the above symptoms are. Moreover, a few special types of breast cancer can expand because of light infiltration, showing smooth, active and clear boundaries, which is not easy to distinguish from benign tumors. (5) Hardness: The breast cancer mass is hard in texture, but the medullary carcinoma rich in cells can be slightly soft, and some cases 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) Activity: When the mass is small, the activity is large, but this activity is that the mass moves with its surrounding tissues, which is different from the activity 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. Let breast cancer cells

Patients with hands akimbo, chest contraction, visible on both sides of the breast is obviously asymmetric. Advanced breast cancer can invade the chest wall, then completely fix it and invade the lymph nodes around the tumor. The skin edema can be orange peel-like, which is called "orange peel disease", and the subcutaneous nodules around the tumor are called "satellite nodules". In benign breast tumors, it is not uncommon to find breast masses, and the most common is breast fibroadenoma. The disease is more common in young women, and the incidence rate is low over 40 years old. Tumors are usually solid, tough, with a complete capsule, a smooth surface and a slippery feeling to the touch. Generally, there is no skin adhesion or nipple invagination. Intraductal papilloma, the mass is often very small and difficult to palpate. Slightly older patients can palpate small nodules around areola, with nipple discharge as the main clinical symptom. Breast lobular hyperplasia rarely forms a clear lump, mainly because the local breast tissue is thickened, the texture is tough, there is no envelope feeling, and there is often pain before menstruation. Some only show thickening of local glands in the breast, no obvious mass and unclear boundary, and most of them are diagnosed as "hyperplasia of mammary glands". However, careful examination of the thickened area is limited. If there is a little skin adhesion, you should pay attention to it. You can take a mammogram.

Six methods of breast cancer screening

In recent years, the incidence of breast cancer is on the rise, and doctors have been calling for early detection and early treatment. The ten-year survival rate of early risers is over 90%. Breast examination has the following examination procedures: breast B-ultrasound examination and mammography examination-if there is an indistinguishable lump or abscess-cytological puncture examination. Article 1: Self-check every month. Every woman should have a self-examination on the fifth day after the end of menstruation every month. The method is to apply soap by hand and search this breast, armpit and clavicle fossa clockwise with the fingertips of middle finger and index finger. Tip: Many patients with early breast cancer can't feel it at all, so they can't rely entirely on self-examination. It is more important to go to the hospital for regular check-ups! Caucasians (Europeans and Americans) have a large proportion of breast fat, and the load rate of molybdenum target experiment is high; Mongolian people (East Asians) have a small proportion of breast fat and dense glands, so B-ultrasound +CDFI screening is the first choice. The second type: the doctor is very experienced in palpation, and it is more accurate to judge whether there is a lump through palpation. This simple touch can screen quite a few patients. The third type: infrared breast scanning infrared breast scanning is the greenest, non-side effect and effective method for detecting female breast diseases. According to the principle that different tissues absorb different degrees of infrared light, the breast diagnostic instrument scans the breast tissue instantaneously with infrared light, collects images through a special infrared CCD camera, and displays various lesions of the breast tissue on the screen after computer processing. Different tissue changes present different images, and various breast diseases can be diagnosed according to the different gray levels of images and the relationship between vascular changes and gray levels. Clinically, it provides accurate basis for doctors to diagnose various breast diseases, especially for early detection of breast cancer, which is recognized as the most effective means. The fourth type: B-ultrasound examination When the doctor suspects that there is a lump in the breast, it is necessary to do B-ultrasound examination, through which the nature and position of the lump can be judged. At present, CDFI is commonly used to prompt the benign and malignant classification of tumors according to blood flow signals. It is suggested that it has poor ability to identify masses with a diameter below 1 cm, and may miss the diagnosis of smaller masses. Fifth, molybdenum target X-ray examination is the most accurate method to preliminarily judge breast cancer at present, which can get clear images and detect some tiny tumor buds that are difficult to find by palpation, but the cost is higher than that of B-ultrasound examination. As mentioned above, molybdenum target X-ray examination is more suitable for Europeans and Americans and other women with larger breasts. Tip: It is recommended for women over 40 years old or with high risk factors (such as family history of breast cancer, cancer in situ, etc.). ) molybdenum target inspection should be carried out regularly every year. The sixth type: cytological puncture examination is unfamiliar to many people. Zhang phosphorus introduced that when mammography is performed, the lump or cyst in the breast may overlap with the hyperplastic gland and cannot be clearly displayed; There are other lesions similar to breast cancer, such as cysts and fibroadenomas, which are very similar on mammograms and difficult to distinguish. Diagnostic puncture is needed to determine the nature of the lesion. The method is to accurately perform fine needle puncture (intramuscular injection of No.7 needle) under direct vision, and the qualitative differentiation rate of benign and malignant tumors can reach over 90%. Tip: It is suitable for diagnosis after B-ultrasound examination and molybdenum target X-ray examination. Some people worry that puncture will lead to tumor metastasis, and there are no cases reported yet. Considering the defects of cytological puncture (unable to observe the structure of tissue scaffold, low coincidence rate, high requirement for operator experience, potential risk of "needle implantation", etc. ), at present, some large specialized hospitals mostly use excision biopsy to prepare for improved radical operation. The way of radical mastectomy

clinical diagnosis

Medical history inquiry: lump is often the first symptom of breast cancer patients. Ask about the time, location, size, growth rate, time and nature of pain, nipple erosion and pus discharge, and whether there is a lump under the armpit.

test method

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: infrared breast scanning infrared breast scanning is the greenest and effective method to detect female breast diseases without side effects. Using KJ- 1002 breast diagnostic instrument of Hengkang Yewei Company, the breast tissue was scanned by infrared rays, and the images were collected by a special infrared CCD camera. After computer processing, various lesions of breast tissue are displayed on the screen, and different tissue changes present different images. According to the different gray levels of images and the relationship between blood vessel changes and gray levels, various breast diseases can be diagnosed. Clinically, it provides accurate basis for doctors to diagnose various breast diseases, especially for early detection of breast cancer, which is recognized as the most effective means. 3. Biopsy method Lump removal: 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 4: determination of estrogen and progesterone receptors after breast tumor resection, determine the level of estrogen and progesterone receptors in the tumor. If the receptor level is high, it means that the tumor is sensitive and effective to endocrine therapy such as tamoxifen. Five: Ultrasonic imaging Ultrasonic imaging is non-invasive. Generally, B-ultrasound is the first choice for breast hyperplasia, which is simple, accurate and reusable. Six: 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.

self-check

1. Observe whether the skin is ulcerated or sunken, and whether the nipple has anterior secretion. 2. Raise your hands and observe whether the breasts are sunken. And observe the shape of the breast from the front and side. 3. In addition to the method of rotation and revolution, you can also touch the breast from the outside to the inside in the horizontal direction. 4. Touch the breast extensively with three fingers other than thumb and little finger. The breast can be regarded as the sun, and the fingers move in the way of the earth's rotation and revolution. 5. Put your right hand down and your left hand under your armpit to see if you can touch the lymph nodes. Grab the nipple and check the secretion. Examination: Take off your coat, and do bilateral breast examination in front of the mirror under strong light: arms droop, and observe whether the arc contours of the breasts on both sides have changed, whether they are at the same height, whether the nipple and areola skin have peeled off or eroded, whether the nipple has bulged or retracted, and then continue to observe the above changes with hands akimbo. Palpation: Take a standing position or supine position, put your left hand behind your head, and check your left breast with your right hand. Fingers should be close together and moved clockwise from the top of the breast for examination. Check the system for lumps in the order of top, bottom, bottom, top and armpit. Be careful not to miss any part, and don't press or squeeze with your fingertips. After examining the breast, gently squeeze the nipple with the index finger and middle finger to observe whether there is bloody secretion.

Pathological examination: first, start with a comprehensive examination, pay attention to the metastasis of chest, abdomen and pelvic cavity, and then check the breast. 9 ~ 1 1 day after menstruation is the best time for breast examination. At this time, estrogen has the least influence on the breast, and the breast is in a relatively static state, so it is easy to find lesions. Check the healthy side first, and then check the affected side. Visual inspection: pay attention to whether the breasts on both sides are symmetrical, whether the appearance is abnormal, whether the skin has inflammatory changes and orange peel edema. Palpation: During the examination, put your five fingers together and touch the breast with your fingertips and the first half of your palm. When checking the left side, use your right hand and your left hand. Don't pinch them. In order to avoid omission, the touch sequence is from the inner top to the inner bottom, the outer bottom, the outer top and the areola area. Compression of areola, whether there is overflow discharge and its properties. Check the supraclavicular, infraclavicular and axillary lymph nodes. Ultrasonic imaging examination: Ultrasonic imaging examination can clearly understand the breast tissue morphology, boundary, presence or absence of tumor, size, shape and nature (cystic or solid), and provide reliable basis for differentiating benign from malignant tumors. At the age of 30, the accuracy 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. Ultrasound examination is non-invasive and can be reused. Thermal imaging inspection: the image is used to display the temperature distribution on the body surface. Because of the rapid proliferation of cancer cells, the increase of blood vessels and the increase of tumor surface temperature, that is, the corresponding body surface temperature is higher than the surrounding tissues, the diagnosis can be made by using this difference. However, this diagnostic method lacks accurate imaging standards, the abnormal heat position does not correspond to the tumor, and the diagnostic coincidence rate is poor, so it is less and less used in recent years. CT examination: It can be used to locate the untouchable breast lesions before biopsy, diagnose the preoperative staging of breast cancer, and check whether the lymph nodes in the posterior region, axillary region and breast are enlarged, which is helpful to formulate the treatment plan. Examination of tumor markers: In the process of carcinogenesis, 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. Examination methods include carcinoembryonic antigen (CEA), ferritin and monoclonal antibody. 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. ① Needle aspiration biopsy: This method is simple, rapid and safe, and can replace some frozen sections of tissues with a positive rate of 80% ~ 90%, which can be used for cancer screening. If the clinical diagnosis is malignant and the cytological report is benign or suspicious cancer, surgical biopsy is needed to confirm the diagnosis. ② Biopsy: This method is generally not recommended, because it is easy to promote the spread of cancer. Only in the late stage of cancer can we consider determining the pathological type. ③ Excision biopsy: When a malignant tumor is suspected, excision of the tumor and a certain range of tissues around it is called excision biopsy, which is generally required to be at least 1 cm away from the tumor edge and as complete as possible.