Breast malignant tumors include cancer, sarcoma and carcinosarcoma. And breast cancer accounts for the majority.
Redundant breast tumor: A tumor that grows on the redundant breast is called a redundant breast tumor. It can be benign or malignant, and cancer is the most common.
Male breast tumors: Benign tumors include cysts, adenofibromas, lipomas and papillomas. Malignant tumors include cancer and sarcoma.
Benign breast tumor
Adenofibroma of breast: it is most common in young women aged 20~25. Generally, it is single, and there may be multiple cases in one or both mammary glands. The occurrence of breast adenofibroma is closely related to the stimulation of estrogen (vigorous ovarian function). Therefore, it rarely occurs in premenstrual or postmenopausal women.
Clinical manifestations: Breast fibromas are mostly located in the upper quadrant outside the breast. Usually oval, the small one is as big as a cherry or walnut, but it can be bigger. Generally, the tumor surface is smooth and hard. The tumor has clear boundary and no adhesion with skin and surrounding tissues. Can be pushed around the breast without hindrance. Although you can push it, you can return to your original position when you let it go. No spontaneous pain or tenderness.
Intraductal or intracapsular papilloma of the breast: This disease is rare and mostly occurs in women aged 40-50. Can be single or multiple. Tumors are usually located in mammary ducts that expand at the nipple or in cysts that communicate with mammary ducts near the nipple. Papillomas are usually small, pedicled and have a lot of villi. Because it is rich in thin-walled blood vessels, it is easy to bleed.
Clinical manifestations: Patients generally have no pain, the main symptoms are nipple discharge and bleeding, and sometimes small rectangular tumors can be felt in the nipple, which are soft, do not adhere to the skin and can be pushed. When squeezing the breast, bloody secretions can be discharged from the nipple. The canceration rate of breast intraductal or cystic papilloma can reach 6-8%.
Malignant tumor of breast
Breast malignant tumors include cancer, sarcoma and carcinosarcoma. And breast cancer accounts for the majority.
Breast cancer is one of the most common malignant tumors in women. According to statistics, its incidence rate accounts for 7- 10% of all kinds of malignant tumors in the whole body, second only to female uterine cancer. Its incidence is often related to heredity. Women aged 40-60 have a higher incidence around menopause. Only about 1-2% of breast patients are male.
Classification of breast cancer:
(1) Patients with high malignancy: most of them are breast cancer. Pathologically, all belong to undifferentiated adenocarcinoma.
Divided into: hard cancer: about 70%;
Medullary carcinoma: rare;
Acute breast cancer: also known as inflammatory breast cancer, it is common in young women during pregnancy or lactation;
Glial carcinoma: rare.
(2) Low malignancy: There are several types of breast cancer, such as papillary carcinoma, ductal carcinoma, adenocarcinoma, papillary eczema-like carcinoma and lobular carcinoma.
-Expansion of breast cancer: Expansion of breast cancer is usually divided into internal breast and external breast.
(1) Intramammary expansion: Breast cancer mainly originated from ductal epithelial cells of the breast, and only about 5% came from acinar carcinoma, which was initially confined to single or multiple lesions, and then expanded in the breast in the following ways: continue to generate new cancerous lesions; Continuous or jumping diffusion along the mammary duct; Abduction along the fascia space; Invasion of mammary duct first causes reactive hyperplasia of connective tissue, and then invades connective tissue; The tumor spread along the acinus and lymphatic vessels around the mammary duct and nerve.
(2) Extramammary dilatation: skin invasion, lymph node metastasis and blood metastasis: lung is the most common metastatic site, which can invade pleura after lung metastasis, and breast cancer can also metastasize to liver, brain, ovary, ribs, pelvis or spine in the late stage.
-Clinical manifestations:
1, lump: the first symptom.
2, pain: about 30% of patients have pain, mostly dull pain.
3. Changes of the skin: When the tumor invades the skin, there are many depressions in different degrees, which are called "dimple" sign. With the continuous development of tumor, skin thickening, skin adhesion and other "orange peel-like changes" can occur, which are more common in patients with shallow tumor location. Obese or suspended breast patients often have subcutaneous edema, followed by subcutaneous nodules around the tumor, the so-called "satellite nodules", and the cancer can continue to develop and erode the skin.
4. Changes of breast contour and radian
5. nipple discharge: it can be pure blood, serous blood, milk-like or water-like liquid.
6. nipple shape change
7. Regional lymphadenopathy
8. When the tumor metastasizes to lung, liver and bone, corresponding symptoms will appear.
Breast sarcoma: Although rare, there are many kinds, such as fibrosarcoma, adenosarcoma, carcinosarcoma, osteosarcoma, liposarcoma, myoma, angiosarcoma, lymphosarcoma and melanoma.
Breast sarcoma often has the following characteristics:
1, onset age is similar to breast cancer.
2. The growth law is mostly small swelling, which grows slowly for a long time and suddenly increases rapidly.
3. The overall situation of the patient is good.
4. The local tumor can be very large, but it is mostly confined to one place, with obvious boundary, activity, medium hardness or rubbery hardness, but it may also be softened and softened.
5, the nipple does not retract and does not overflow.
6. The epidermis is tense, shiny and reddish due to the rapid growth of the tumor, and there are veins bulging. You can often see breasts drooping with tumors. If the tumor droops excessively, it will make the breast skin edema. However, adhesion and "orange peel degeneration" generally do not occur, and the tumor can burst and turn into flowers in the later stage.
Differential diagnosis between common breast masses and breast cancer
1, adenocystic hyperplasia: the second disease is a pathological stage of breast dysplasia, which is mostly older and prone to multiple and sometimes unclear cord-like nodules, belonging to precancerous lesions.
2. Breast pain: It is also a pathological stage of abnormal hyperplasia of breast, which is mainly manifested by touching most uneven nodules on the breast, and most of them have slight spontaneous pain. Especially before menstrual cramps, breast swelling pain is obvious, and even the pain is beyond touch, and the patient is very painful.
3, papilloma: can be single or multiple. Most patients living alone are elderly women, and 50% have bloody secretions. Most patients showed diffuse nodules without obvious masses. This tumor is malignant.
4. Adenofibroma: It is common in young women with strong endocrine and disordered regulation, mostly in the period of 20-30 years old. The mass is obvious, with clear boundary, smooth, active, soft and nodular. Slow growth, little pain, but the possibility of malignant transformation.
5, fat necrosis: common in the lateral part of obese women's breasts, most of them have a history of trauma, and need to be removed for biopsy to identify.
6, breast tuberculosis: mostly spread by chest wall tuberculosis, can fester and flow out caseous pus. Note that tuberculosis lesions in other parts often coexist.
7, plasma cell mastitis: also known as non-lactating mastitis. It is rare, with a history of acute attack, pain and fever. However, it quickly subsided after anti-inflammatory treatment.
8. Lobular cystsarcoma: more common in people aged 35-40, with slow development. The tumor is lobulated, some as hard as stone, and some areas are cystic. Tumors are usually large, sometimes fester, and are rarely fixed in the chest. It is often mistaken for advanced breast cancer, but the curative effect after radical operation is very good. Metastasis is rare, mainly blood, with occasional lymphatic metastasis.
Traditional Chinese Medicine and Breast Tumors
As early as the Han Dynasty, there were records of breast diseases, such as breast addiction in China's Tibetan scriptures, A Complete Collection of Women's Prescriptions by Ru Yan in the Song Dynasty, mastitis in the Principles of Surgery in the Ming Dynasty, mastitis in the experience book of sores and ulcers, etc.
Tumor breast diseases are generally caused by depression, liver and spleen damage, qi stagnation and phlegm coagulation, and become "tuberculosis in milk".
Breast tuberculosis: equivalent to breast tuberculosis in western medicine. This is a tuberculous disease of the breast. Because of the late stage of the disease, there are often manifestations of virtual tuberculosis, so it is named as breast tuberculosis. Purulent fluid is as thin as phlegm after festering, so it is also called milk phlegm.
Its characteristics are: the course of the disease progresses slowly. At the beginning, there are one or several lumps in the breast, such as plum-shaped, with unclear boundaries and connected flesh and blood. This disease is rare in clinic, accounting for about 1% of all breast diseases. Most of them are married pregnant women aged 20-40.
The name of this disease was first seen in Principles of Surgery, and it was discussed in more detail in Great Success of Surgery. The Golden Mirror of the medical sect also pointed out: "Although the situation is small, we should not neglect it. After a long delay, it turned into a milky rock. "
Traditional Chinese medicine believes that it is mostly due to physical weakness, deficiency of lung and kidney yin, yin deficiency leading to excess fire, fire burning body fluid as phlegm, and phlegm fire condensing into nuclei; Or liver depression turns into fire, yin and body fluid are exhausted, and phlegm is condensed and qi is depressed.
Breast fetish: induration of different shapes and sizes appears in the breast area, which is called breast fetish. It is equivalent to breast fibroma in modern medicine. This disease is a common tumor disease of breast. .
Its characteristics are: nodules in milk, like eggs, smooth surface, pushing, generally single. It is common in young women aged 20-25, and its incidence accounts for about 10% of breast swelling.
The name of this disease was first seen in Chinese and Tibetan classics. The symptoms of this disease are described in Selected Experiences of Diseases in Qing Dynasty. "The True Sutra of Surgery" points out the possibility of rock change, saying that "diet should be controlled to vent anger and avoid breast rock change." It's actually an experience.
Traditional Chinese medicine believes that it is mostly caused by emotional internal injury, liver depression and phlegm coagulation, and phlegm and blood stasis are combined with breasts. Such as "choose a doctor encyclopedia?" "On the Master of Confucianism" said: "Confucianism ... is mostly caused by thinking hurting the spleen, anger hurting the liver and stagnation." Or due to imbalance of chong and ren, qi stagnation and phlegm coagulation.
Breast hyperplasia: It is a non-inflammatory disease of breast.
It is characterized by breast mass, which aggravates the swelling pain before menstruation and relieves it after menstruation. It is common in women aged 30-40.
This disease is the name of modern medicine and belongs to the category of "breast addiction" in traditional Chinese medicine. In order not to be confused with breast fibroma in modern medicine, it is discussed separately.
Traditional Chinese medicine believes that this disease is mostly caused by depression and anger, and the liver is depressed and qi is stagnant; Thinking hurts the spleen, the spleen loses its health, and phlegm and dampness accumulate, so that both liver and spleen are injured, phlegm and qi intersect, and blood stasis becomes lumps. Or it is caused by deficiency of liver and kidney, imbalance of chong and ren, yang deficiency and phlegm-dampness.
Masticatory myopathy: painful agglomeration occurs in the areola of boys, girls, children or middle-aged and elderly men, which is called breast adenoma. It's breast dysplasia.
It is characterized by an oblate lump in the center of areola. It can be divided into male breast dysplasia and child breast dysplasia. The former is found in middle-aged and elderly men, while the latter is found in boys and girls around 10.
The name of this disease first appeared in the book Experience of Sores and Furuncles? Volume two also calls you.
Chinese medicine believes that men lose the support of the liver because of insufficient kidney qi; The woman lost her balance because of her appointment. "Experience Book of Sore and Furuncle" said: "The cause of this disease is that the female is fifteen or sixteen years old, and the meridians will pass, or twice a month, or the month is impassable." It shows that the occurrence of this disease is related to chong and ren meridians. In short, it is caused by deficiency of kidney qi, imbalance of chong and ren, liver dystrophy, qi stagnation and phlegm coagulation.
Ru Yan: A lump in the breast, as hard as a stone, looks like a cave when it collapses, and it is called Ru Yan.
Its characteristics are: the breast swells fast, the texture is hard, and it bulges like lotus or cauliflower after collapse. It is one of the most common malignant tumors in women. According to statistics, its incidence rate accounts for 7- 10% of all kinds of malignant tumors in the whole body, second only to female uterine cancer. Its incidence is usually related to genetic factors, and it is higher among women aged 40 to 60, about menopause.
Male breast cancer is relatively rare, accounting for about 1-2% of Ru Yan. The onset age is later than that of women.
At present, there is no consensus on the relationship between the occurrence of milk rock and fertility and lactation. It is generally believed that childbearing and breastfeeding can reduce the incidence of this disease.
The name of Ru Yan's disease was first seen in Women's Prescription in the Song Dynasty, and it also recorded the symptoms and causes in the early and late stages. The experience book of sores and ulcers in Song Dynasty clearly pointed out the importance of early diagnosis and treatment. "Danxi Heart Therapy" in Yuan Dynasty not only described the cause, symptoms and treatment of Ru Yan in detail, but also recorded the situation of men suffering from Ru Yan. Ming orthodox surgery has a detailed understanding of this disease. The gold mirror of medical records puts forward the symptoms of axillary and chest wall involvement in the late mastoid stage.
Chinese medicine believes that (1) the breast belongs to Yangming meridian and the nipple belongs to Jueyin liver meridian, which leads to emotional disorder, liver-qi disorder and long-term stagnation of qi and blood; Spleen injury is caused by abnormal transport and transformation, endogenous phlegm, damage to spleen and liver, obstruction of meridians, phlegm and blood stasis with milk.
(2) Chong Ren is the blood sea, the main embryo, and the pulse is in the liver and kidney. Impairment of chong and ren, irregular menstruation, poor circulation of qi and blood, and obstruction of meridians. Because its onset age is more common before and after menopause, it is related to the imbalance of chong and ren.
The treatment of breast tumors should be based on early detection and early diagnosis. Women should be alert to breast disease, a high-risk disease for women, and conduct self-examination regularly every month, preferably after menstruation 1 week, because at this time, the breasts are soft, and if there is a lump, it is easy to touch. Go to the hospital for standardized examination as soon as possible after discovery. As a comprehensive hospital, our hospital has a complete set of inspection methods. Patients can have a variety of examinations, such as B-ultrasound, molybdenum target X-ray, tumor markers and so on. If necessary, it can be combined with cytological puncture. Clinically, it has been proved that more than 94% of breast masses can be scientifically diagnosed by cytological puncture, and advanced molybdenum target X-ray can distinguish benign from malignant tumors and can find breast cancer without mass symptoms.
Surgical treatment is mainly divided into two categories: modified radical mastectomy and breast-conserving surgery. The former can't conserve milk. Because of the fear of cancer, many people tend to choose a modified radical operation with a wide range of resection in order to "cut the cancer clean". In fact, the latest medical research proves that the 20-year long-term survival rate of breast-conserving surgery with standardized radiotherapy is almost the same as that of modified radical mastectomy without breast-conserving. Faced with the same long-term effect, it has become an irresistible trend to choose breast-conserving surgery that can not only preserve the breast, but also do little harm to women's physical appearance and psychology, especially for young patients. Breast-conserving surgery abroad has reached 46%. However, the necessary condition of breast-conserving surgery is that the quality of postoperative radiotherapy should be excellent, and it is best to perform it in a large hospital with guaranteed radiotherapy equipment and doctors.
References:
China conquered cancer network.