In the early stage of breast cancer recurrence and metastasis, patients often have no symptoms, but regular examination in hospitals (preferably in newly treated tumor specialized hospitals) can find signs of early metastasis. Generally, the time of recurrence and metastasis is the most common within two years after operation. With the extension of postoperative time, the probability of recurrence and metastasis will gradually decrease. However, many patients have recurrence and metastasis for more than ten years or even two years after operation. Therefore, patients with breast cancer should be followed up regularly for life after operation: every three or four months two years before operation, every six months from the third year to the fifth year, and every year after five years until life.
The contents of follow-up examination mainly include clinical examination, B-ultrasound and X-ray examination of organs and parts prone to metastasis, and necessary bone radionuclide scanning, CT and magnetic resonance imaging (MRl) examination. Another important content of follow-up is to check the contralateral breast, because the risk of primary breast cancer in the contralateral breast will increase by 3 ~ 4 times after one side suffers from breast cancer.
There are various forms of recurrence and metastasis.
The recurrence of breast cancer can occur in the local chest wall and lymph node metastasis of surgical incision, and can also be transferred to lung, bone, liver, soft tissue and brain through blood. Different metastatic sites have different symptoms and treatment methods.
Most patients with lung metastasis lack typical symptoms, only 1/3 can have cough, hemoptysis, excessive phlegm, chest pain, shortness of breath and so on. Chest X-ray examination is the simplest method, and breast cancer patients are examined once every six months to one year. Chest CT and MRI can also find smaller lesions, but they are not used as routine applications. For patients with isolated lesions or lesions confined to one lung or lobe, and no definite metastatic lesions were found in other parts of the body, surgical resection can be performed, and some patients can still survive for a long time after operation.
Bone Metastasis Bone metastases are mostly located in the spine, pelvis and femur. The main symptoms are gradual aggravation, definite pain and local tenderness, but often no lump can be felt. Some may have symptoms of nerve compression or pathological fracture. Whole-body radionuclide bone imaging can find bone destruction 3 to 6 months earlier than X-ray, so this method can be used for early diagnosis of bone metastasis and win time for early treatment and pain relief. The treatment after diagnosis of bone metastasis mainly includes bisphosphonates to reduce bone destruction, local radiotherapy and systemic anticancer and analgesic treatment.
Liver metastasis is usually asymptomatic in the early stage of liver metastasis, and when there are symptoms such as emaciation, loss of appetite, swelling and pain in liver area, fatigue, low fever and jaundice, it is mostly late. Therefore, if we pay attention to the examination of liver in clinical follow-up, we can often find relatively early liver metastasis, and about 10% patients with liver metastasis can be surgically removed.
Soft tissue recurrence and metastasis mainly include local recurrence of chest wall, ipsilateral axillary (residual) and supraclavicular lymph nodes and contralateral breast, axillary and supraclavicular lymph nodes metastasis. There are also parasternal internal mammary lymph nodes and mediastinal lymph nodes metastasis. Metastasis of superficial parts can be found by clinical palpation, while deep lymph nodes need to be examined by B-ultrasound or CT and MRI. For local recurrence and metastasis, some patients can be cured by reoperation or local radiotherapy.
Other brain metastases can be manifested as headache, nausea, vomiting, blurred vision and other symptoms; Pleural cavity metastasis can cause chest pain, shortness of breath, pleural effusion and so on.
It should be noted that postoperative metastasis of breast cancer is mostly a systemic disease involving multiple organs, which requires systemic treatment, such as chemotherapy and endocrine therapy. The purpose of comprehensive treatment is to prolong the life of patients and alleviate the pain caused by tumors.
Some points for attention in preventing recurrence
Prevention of postoperative recurrence and metastasis of breast cancer is still one of the difficult problems faced by the medical community. If we can keep a good attitude, take proper physical exercise and improve bad living habits, it will help to reduce the occurrence of recurrence and metastasis.
First of all, we should adjust our mentality, be good at controlling our emotions, adopt a positive and optimistic attitude, treat diseases correctly, establish confidence, cooperate with treatment and face life with a smile. Secondly, take an active part in social activities and take part in healthy physical exercises, such as Tai Ji Chuan, so as to get rid of the shadow that cancer brings to life. This is not only conducive to rehabilitation, but also reduces the burden on other family members and increases the interest of life. Third, Chinese medicine is extensive and profound. Patients with breast cancer have low immunity, so they can go to Chinese medicine hospital or Chinese medicine department of tumor hospital, and the Chinese medicine of "strengthening the body" is prescribed by tumor Chinese medicine for conditioning. Finally, diet adjustment, smoking cessation, alcohol withdrawal and other bad habits. Eat more green vegetables, beans and fresh fruits, and high-protein foods such as lean meat, eggs and fresh milk are also essential. It is also necessary to correct some folk misconceptions, such as "no chicken, no crab, no turtle ……", which have no scientific basis. As long as it suits the taste of patients, it is a healthy protein.
Breast-conserving surgery
With the enhancement of people's awareness of cancer prevention and the progress of medical science and technology, the dream of eradicating cancer and preserving breasts has become a reality. However, while people are undergoing breast-conserving surgery, they still have doubts: can the local resection of the tumor be complete? Once the cancer cells remain, won't it leave a curse and bury the hidden danger of recurrence or metastasis in the future? It is reasonable for people to have such concerns, but after understanding the following situation, they will dispel their doubts.
The resection range has nothing to do with the survival rate.
In the past, most breast cancer patients had to remove the whole breast. Later, medical scientists realized that breast cancer is a systemic disease, and no matter how large the local resection range is, it can only control local recurrence, but can not significantly reduce the distant metastasis that has the greatest impact on survival rate. Local excision can obviously improve the quality of life of patients, so breast-conserving surgery is put on the agenda. Coupled with the popularization of health care knowledge, women's attention to breast self-examination and general survey, and the popularization and application of mammography technology, most breast cancers can be found in the early clinical stage (stage I and II), and the tumor volume at this stage is small, which also provides favorable conditions for breast-conserving surgery.
As early as more than two years ago, some developed countries have started this operation and accumulated a lot of experience. Their clinical practice shows that the long-term effect of breast-conserving surgery for primary breast cancer is similar to that of radical mastectomy, and the 5-year survival rate can reach over 90%. However, patients with breast preservation are obviously better than those without breast preservation, so this operation has been widely promoted. At present, in some countries in Europe and America, more than 1/3 patients with early breast cancer have received breast-conserving surgery.
Residual cancer was eradicated during and after operation.
Although breast-conserving surgery can improve the quality of life of patients, there are still some problems, such as unclean local resection, even if it is only 1%, but for individuals, it is 100%. In addition, about 20% of breast cancer occurs in multiple centers, that is, the tumor grows in different parts of a breast, and one is removed. Cancers in other parts may be too small to be found. If the patient happens to have breast-conserving surgery, these residual cancer cells may become the source of recurrence or metastasis in the future. According to statistics, the local recurrence rate after radical mastectomy is 10%, and that after breast-conserving surgery is 20%.
So, what should be done to remove the tumor more thoroughly and reduce the risk? Doctors believe that the following measures must be taken at the same time as breast-conserving surgery. First, in the operation of extensive tumor resection, we should immediately carry out rapid histological examination on the peripheral slices of cancer-containing tissues, and make sure that there are no cancer cells in the slices before the resection is completed. If there are cancer cells, continue to expand the scope of resection until complete resection. Secondly, in order to prevent the occurrence of residual or multicentric cancer, the preserved breast is treated with postoperative radiotherapy, that is, a certain dose of radiation is used to kill the possible residual cancer cells. Evidence shows that the local recurrence rate of radiotherapy is 65438 00%, and that of non-radiotherapy is 39%. Thirdly, patients with axillary lymph node metastasis after operation should be treated with chemotherapy again. Compared with those without chemotherapy, the recurrence rates were 6% and 65438 02% respectively. Fourth, for postmenopausal women with positive estrogen receptor in cancer tissue, tamoxifen should be taken for a long time. Practice has proved that taking the above measures can obviously reduce local recurrence.
The requirements for indications, technology and equipment are very high.
Because breast-conserving surgery has strict indications and must be carried out under the principle of complete tumor resection, it must be carried out in a specialized hospital with good technology and equipment. This study has been carried out in China for more than ten years. The preliminary results show that the efficacy of breast-conserving surgery in specialized hospitals in big cities is similar to that in foreign countries, and the quality of life of patients receiving this treatment has been significantly improved. Therefore, patients must not go to some medium-sized or non-specialist hospitals with limited technology or equipment for temporary convenience to receive irregular breast-conserving treatment.
In addition, patients should not be too anxious about breast-conserving, because breast-conserving therapy can only achieve better results if the following conditions are met: ① Breast cancer is in clinical stage I and II, and the tumor diameter is less than 3 cm, and the smaller it is, the more suitable it is for breast-conserving surgery; ② The cancer focus is close to the periphery of the breast, which is convenient for postoperative repair and can maintain the appearance of the breast.
Of course, after breast-conserving surgery, patients should also check themselves regularly and go to the hospital for re-examination, usually once every three months, and pay attention to whether there are new nodules around the incision and the whole breast. Attention should also be paid to lung, liver, bone and other parts that are prone to metastasis. If there are symptoms or it is necessary to prevent or find recurrence or metastasis in time, X-ray and ultrasound examination should be carried out. After breast-conserving surgery, once there is a local recurrence, don't be afraid, because you can do another radical mastectomy, and its long-term effect is still the same as that of the initial radical mastectomy, and patients can still maintain a high quality of life.
The following conditions are not suitable for breast-conserving surgery, otherwise it will easily lead to residual cancer cells or unsatisfactory appearance.
The lesion is located in the center of the breast, especially near the nipple, and the postoperative appearance is often not ideal.
There are many cancers, especially in different quadrants of the breast, which are difficult to cut and repair.
X-ray of breast showed extensive sand calcification, suggesting that the lesions were extensive and difficult to be completely removed.
Pathological examination showed that extensive intraductal carcinoma lesions were also difficult to remove.
The breast is small, the tumor is large, and the proportion is improper. If the reserved breast volume is too small, it will be difficult to repair it satisfactorily.
Radiotherapy is forbidden for pregnant women in the first half of pregnancy, and surgery can be performed first in the later period, followed by radiotherapy after delivery.
It is not suitable for patients who have undergone radiotherapy in breast area, so as to avoid local overexposure leading to other diseases.
People who have suffered from collagen angiopathy have poor tolerance to radiotherapy and are not suitable for this treatment.