Uveal Melanoma Symptom, Diagnosis, Staging, Treatment, Prognosis

1. With uveal melanoma

The uvea, it is a general term ciliary body and iris, choroid. Color is brown, I is located between the retina and strong film of the eye. The organization that belongs to the uvea, is responsible each, iris to adjust the light entering the eye, ciliary body at a constant temperature of the eye or to provide nutrients to the retina choroid to focus, rich in blood vessels I want to work and. The uveal malignant melanoma, melanin cells containing many, refers to those cancer into this grape film. It is said than tumors that occur in the skin and mucous membranes, and is slightly malignancy is low. Annual incidence in Japan, 2.5 people to 10 million. Not so much difference between regional and gender, there is a tendency that the incidence will rise with increasing age, there is almost no generation from children. The frequency of occurrence of white high, as much as 43 people per 10 million, the development of approximately 17 times the size of Japan has been reported If you look at the world. It is described for one of the risk factors of developing a uveal melanoma is ultraviolet light, this is because, the amount of ultraviolet light enters the eyes of many white pigment of the iris is thin. It should be noted that, indeed, incidence is higher the area is strong sunlight near the equator.

2. Symptom

The iris malignant melanoma, be found in the deformation of the pupil is large masses of blotchy black iris also, as (mainstream), it may be discovered by complicated by glaucoma. The ciliary body melanoma, that it may give rise to cataract by compressing the lens, to visit and conscious vision loss position of the lens is to be shifted is the majority. Choroidal malignant melanoma, the symptoms will vary the location of the tumor, depending on the size, but the vision loss is most often, then you may have (there is an invisible part, the upper half and not visible) visual field abnormalities. There are also symptoms such as: (I feel like a mosquito flying in front of Hibunsho) other, you (look distorted) metamorphopsia, floaters. In addition, there is much if the tumor is discovered by chance to have visited the ophthalmology in other symptoms, and underwent fundus examination. Tumor is increased by proceeding, and other symptoms (with loss of vision) hyperemia and eye pain caused by glaucoma will appear.

3. Diagnosis

The diagnosis of uveal malignant melanoma, and fundus examination (most fierce fight) microscopy is a slit-lamp examination ophthalmic will be basic. As imaging ancillary, there ultrasonography, and MRI examination. To the pathological examination, because other than the enucleated technically difficult, treatment may be determined on the basis of clinical diagnosis. When observed with a slit lamp microscope in the iris malignant melanoma, it appears as a black mass was raised from the iris surface. Ultrasonography of the high frequencies, and measuring the size of the iris tumor, suspect strongly melanoma when there is increasing tendency. In addition, there is a case of benign blisters which are common to the iris ciliary body of iris cyst When the inspection. In the ciliary body melanoma, tumor that compresses the lens can be seen from the gap between the lens and iris. Verify the existence and spread in diagnostic imaging such as MRI examination and ultrasonography, suspect strongly malignant melanoma If there is increasing tendency. In choroidal malignant melanoma, performing fundus examination, tumor hemispherical looks blackish brown under the retina. If there is activity in the tumor, it will cause a retinal detachment exudate from the tumor is collected in the back of the retina. Further, the fluorescent fundus angiography, leakage and punctate contrast agent was injected in the portion of the tumor, the reservoir is confirmed. There is no characteristic findings in small masses, definitive diagnosis is difficult. Even in a large-scale study was conducted in North America, because the diagnosis can not be reliably, it is recommended to follow-up when the thickness of the tumor is less than 3mm. If you have confirmed an increase in the tumor in follow-up, and the emergence of retinal detachment, and then diagnosed with malignant melanoma clinically. Based on the clinical diagnosis like this, diagnostic concordance rate when you make eye removed as a result is very high and 99.5%, it is determined that treatment based on clinical diagnosis is reasonable.

4. Staging

In uveal malignant melanoma, staging is not established. In choroidal malignant melanoma, for the treatment decision making, small (the thickness of the tumor is more than 5mm tumor diameter and 1 ~ 3mm), 16mm less than the tumor diameter and 10mm from 2-3 the thickness of (tumor medium intraocular tumor comparison test) classification of malignant melanoma that have been made ​​(Collaborative Ocular Melanoma Study, in North America has been commonly used COMS tumor diameter or 10mm or more is classified into three groups of 16mm or more) the thickness of the large (tumor) You.

5. Treatment

The survival rate, usually calculated by the treatment content and progress of cancer, but is also affected by the presence or absence of (non-cancer diseases such as diabetes) complications and the patient’s age. for (frequency) is different from the distribution of the other elements of these data by using, there is a possibility that the value of the survival rate is different. Survival rate to show you here is what was on the website of the National Cancer Center so far. Rather than the value itself of survival, to a certain width (depending on the data, but 10%, etc. such as 5% ±) by remembering, please consider us as a rough guide.
The iris malignant melanoma, tumor if confined to the iris, it is possible to be removed by surgery. After surgery, can cause progression of cataract, and deformation of the pupil. Make enucleation if the tumor cells have spread to the eye within. In the ciliary body melanoma, it can be said to be able to remove a tumor in the range of 30% or less of the ciliary body, treatment with surgery is good. If you tumor diameter less than 15mm even if it is larger than this, brachytherapy due to the radiation treatment is possible. It is a treatment enucleation is reasonable if it is large 15mm or more. In choroidal malignant melanoma, treatment policy varies depending on the size. Mentioned above, the observation with no treatment for small tumors, perform the therapy according to the medium tumor only when the tumor growth was observed. In the case of medium tumors, since in case of providing a brachytherapy is typical with the eye removed, that there is no difference in mortality has been demonstrated by a randomized clinical trial COMS, and making a brachytherapy now You have more. In the case of large tumors, enucleation is a reasonable choice. The COMS, for large tumors, in the case of performing enucleation immediately comparison when performing irradiation excision prior studies or reduce tumor metastasis has been but the radiation preoperative a result that is not valid has come out. In addition, to irradiate the lesion particle radiation such as heavy particle or proton particle beam treatment of the validity of a special radiation have also been reported. Result difference is that, not compared with brachytherapy proton beam irradiation has been reported from several facilities, in Japan, treatment with heavy particle beam therapy, such as carbon ions are carried out research, the therapeutic effect of tumor is becoming recognized. Even in choroidal malignant melanoma, there is a treatment to excise the tumor only to leave the eye. Because of that require a high degree of skill, may produce serious complications of proliferative vitreoretinopathy and bleeding in the eyeball, adaptation is limited. If there is a partial relapse following treatment, or when the thickness of the tumor is small, you can make the heat treatment with an infrared laser. It may require multiple treatments, bleeding, results in inflammation within the eye. There is currently no effective treatment for metastatic. Since there is no lymphoid tissue in the uvea, tumor metastasis will occur along with the flow of blood. Many, especially in the liver metastases, it is possible that is found in the case of about two-thirds, and found lung, bone, even in the subcutaneous other. In the case where it is spread to the liver only, you can take the method of embolization chemotherapy, but the results 71% in one year, the survival rate of 42% over two years has come out.

The brachytherapy
is a treatment that is removed where using radioisotopes shape to match the curved surface of the eye, fixed to the portion corresponding to the tumor from outside the eye wall surgically this, a certain time has elapsed. I’m using a radioactive isotope of ruthenium 106 in Japan. Iodine 125, 103 and palladium are used in Europe and the United States. The release of β-ray, ruthenium 106 can be irradiated with enough radiation to tumors to a thickness of about 5mm. For dampening distance leaves, treatment methods developed for the fraction of only about irradiated on the wall of the contralateral eye is irradiated enough radiation therapy while reducing radiation damage of the surrounding tissue is. During treatment, the fact that there is a possibility of exposure to around, you need to spend in a special hospital room that is shielded enough. Never radioactivity remaining after removal of the source, normal life is possible. As a complication, you might move radiation retinopathy, cataract, eye is slightly restricted.

6. Prognosis

The survival rate, usually calculated by the treatment content and progress of cancer, but is also affected by the presence or absence of (non-cancer diseases such as diabetes) complications and the patient’s age. for (frequency) is different from the distribution of the other elements of these data by using, there is a possibility that the value of the survival rate is different.
Survival rate to show you here is what was on the website of the National Cancer Center so far. Rather than the value itself of survival, to a certain width (depending on the data, but 10%, etc. such as 5% ±) by remembering, please consider us as a rough guide.

The tumor to be found within a very small, tissue-type is also good prognosis malignancy compared to the choroidal malignant melanoma low, but the iris malignant melanoma, has been transition to occur is about 5% in 10 years . Choroidal malignant melanoma and ciliary body, be evaluated separately exactly is difficult. Cases that proceed from that discovery is often difficult to ciliary body melanoma in general, has been a poor prognosis. The result of the comparison test by COMS, in tumors of medium size, 82% 5-year survival rate. If you look at the result of the lapse of ’12, there was no difference in prognosis in brachytherapy and first enucleation. The success rate can be saved ocular 85% for five years if the treatment is brachytherapy. The large size of the tumor, the 5-year survival rate is 57% even after the first enucleation, irradiation before enucleation was not seen the effect of metastasis prevention. 79% 5-year, 56% in ’10, the survival rate of enucleation after in Japan, was 41% in ’15.


Retinoblastoma Cancer, Genetic, Symptom, Diagnosis, Staging, Treatment, Prognosis

1. Retinoblastoma

Retinoblastoma is a disease common in infants with malignant tumors that arise from the retina. The retina is the part that corresponds to a film when compared to a camera eye. It is projected on the retina and is refracted by the lens where light entering the pupil to the action of the lens. Space between the retina and the lens is filled with a material such as white taste of transparent eggs viscous called the vitreous body. At a rate of one out of every 15,000 births, there is no difference between gender, race, due to regional incidence of retinoblastoma. Currently, about 80 people each year have developed in our country. There is the case with only one eye and may result in both eyes, the ratio is one eye 2.6 per 1 both eyes. This tumor is known to occur due to an abnormality of the RB1 gene is a tumor suppressor gene in the region of 13q14 13 of the long arm of chromosome.

2. Genetic

There are 23 pairs of chromosomes in the cell of one of the body, has two same gene. There is no genetic abnormalities in the cells of the body originally, both of RB1 gene pair will not only work in some cells of the retina, as a result, there is a tumor that occurs. This case is always unilateral, there is no hereditary. On the other hand, if there is an abnormality of the RB1 gene in the egg or sperm of the parents, all cells of the body of the fetus that occur from now on will have an abnormality in one of the RB1 gene. Cell works normally even in this state, but is considered in the process of the retina is made, abnormality occurs in the RB1 gene and the other, retinoblastoma occurs. And all cases of binocular, 10-15% of cases of unilateral has been with the state. Because it has an important role in cell division, RB1 gene care must be taken incidence of malignant tumors of different kind of future, such as osteosarcoma is high. If you have (children) child of retinoblastoma, the probability that retinoblastoma occurs in children of children and child to be born then, is calculated as follows already. If there are no patients of retinoblastoma only one in family, 49% to the children of the children, occurs with a probability of 3% in the sister and brother of the children, of unilateral in the case of binocular 5% to the child of the children, will occur with a probability of 2% to sister and brother of the children if. Advances in genetic analysis technology, it has become possible to detect genetic abnormalities in the blood test. However, you can not only find 60-80% with current technology. There is also a pre-implantation diagnosis technology, such as amniocentesis, but retinoblastoma does not become a target in the current ethical guidelines. For the purpose of the genetic testing, understanding fully the limits, counseling is also done in such as genetic counseling clinic.

3. Symptom

The main symptom, there are white tumor increases in the eye, be able to see through the glowing white eyes, is what is referred to as a white pupil. Then, (when the direction of the eye of the two is not correct) perspective, there is such (if the tumor has spread to extraocular in advanced cases) fine of eyelid. The average age of the ophthalmic examination in any of these symptoms occur is 27 months old and 11 months, in a unilateral in binocular. 95% are diagnosed by age 5.

4. Diagnosis

Fundus examination is the basic diagnosis of retinoblastoma. The combination of imaging as needed. Pediatrician will do the examination for staging. To ablate the tumor only in the eyeball is contraindicated because of the risk of metastasis, to begin a therapy based on clinical diagnosis rather than a pathological diagnosis when performing eye saving treatment.
1) anterior segment of the eye-fundus examination
Open the pupil in the eye drops, do the fundus examination. In this way, you can also detect small tumors less than 1mm. In addition, it is possible to check whether the invasion vitreous to the anterior chamber, such as the presence or absence of retinal detachment associated with tumors together is important in treatment decisions.

(1) ultrasonography
You can not in danger of exposure, and to measure the size of the tumor. It can also be useful when fundus examination can not be sufficient, such as corneal opacity. Retinoblastoma will be a diagnostic aid is characteristic arises calcification inside the tumor, when it detects this with ultrasound.
(2) CT
It is effective in the detection of calcification for intraocular tumors. In addition, it is possible to detect the spread of tumors to extraocular. Because of the risk of secondary cancer with X-ray exposure, and then select the MRI if you require imaging a plurality of times.
(3) MRI
In tomography using a magnetic field of magnetic resonance method, it is useful for the detection of trilateral retinoblastoma tumor spread of extraocular, complicated by brain tumors in both eyes retinoblastoma. Detection of calcification is not possible.
Examination of 3) pediatrician
Interview was carried out, and auscultation, and to understand the general condition. If the tumor has spread to extraocular, if the transition is suspected, perform blood tests, bone marrow examination, and cerebrospinal fluid examination for the staging.

5. Staging

There is no staging for intraocular tumors, as a reference for the eye save, Reese-Ellsworth classification (historically Table 1 ) was been used as a classification of the degree of progress. International Classification (now Table 2 ) is becoming established. Many current, do the treatment by classifying the extraocular tumor and intraocular tumors.

6. Treatment

If there is a transition, extraocular invasion
Tumor resection as possible
(high-dose chemotherapy combined with bone marrow transplantation) postoperative radiation, systemic chemotherapy
patients is small, treatment is not established
If stay intraocular
(If you can not be expected of vision, such as complications of glaucoma cases) progressive eye: eye enucleated
Chemotherapy for metastatic prevention extraocular invasion if confirmed in excised eye
Eye-sparing treatment (if it can be expected of vision) nonprogressive eye
Treatment in combination radiation, chemotherapy, and ocular topical treatment
transition to chemotherapy from radiation therapy worldwide
standard treatment with a (Evidence) firm basis has not been established
effect of treatment is determined by fundus examination. Judgment of scar (scar) tissue of the residual tumor is difficult to image inspection
1) enucleation surgery
It is a surgical procedure to excise each eye, a tumor. Resection of intraocular tumors contraindicated from the risk of metastasis, in the case of retinoblastoma, tumor resection means enucleation. It is a surgery of about one hour under general anesthesia. After removal, there is a case you do not want to embed the case of embedding the foundation of artificial eye stand. You may be bleeding spots of subcutaneous and Me臉swelling may occur, but I will close by 1-2 weeks after surgery. The set any artificial eye of a transparent plastic called fenestrated artificial eye immediately after surgery, and helps in the formation of conjunctival sac. I will wear a temporary artificial eye that are drawn by the cornea in 2-4 weeks after surgery. You may have to adjust the artificial eye and then, to make this artificial eye. Artificial eye is necessary to wash it clean with water and the conjunctival sac Remove every day, to keep it clean. When eye discharge, the more you need to use the eye drops and eye ointment of antibiotics.

2) radiation therapy
(1) radiation
To avoid cataract due to exposure of the lens, and then irradiated from the side. I irradiated for 5 days a week, for about four weeks. This is done on an outpatient visits for one irradiation end in a short time and does not require anesthesia. Tumor remission in the case of about 60% by radiation therapy, you can expect the most therapeutic effect, but the side effects secondary cancer by radiation, such as impaired bone growth of the eye are many, in difficult to treat advanced cases now and as long as they are.
(2) brachytherapy (internal radiation)
By fixing to the tumor from outside the eye the metal plate of the radioactive isotope, it is a treatment that is irradiated with a large amount of radiation to the tumor, reduce the radiation damage of the surrounding. Ruthenium brachytherapy has been used in Japan. Requires admission to special hospital room, which was shielded by lead. During surgery, for moving temporarily muscles that move the eye, may occur because of double vision that looks double object.
3) eyeball local treatment
(1) laser irradiation
By using the infrared laser usually will be devoted to the tumor through the pupil, it is to encourage treatment (heat treatment), tumor cell death warmed to 45 ~ 50 ℃ the tumor. Laser alone for relatively small tumors, it is done in conjunction with chemotherapy for large tumors. There is no serious complications.
(2) Frozen coagulation
It is a treatment to destroy by devoted to the wall of the eye instruments only that had been cooled to -80 ℃, and freeze the tumor. In the (front of the eye) the periphery of the retina, it is done in relatively small tumors. I will cause a postoperative conjunctival hyperemia.
: (See 4) chemotherapy drug therapy of cancer )
(1) systemic chemotherapy
Chemotherapy in order to preserve the eye, treatment results have been reported in Europe and the United States in 1996, the reduction effect of the tumor has been made ​​clear. Standard of careGlossary icon does not have to become, but it has been performed widely in Europe and the United States, it has been done in recent years in Japan. Methods of treatment using the anti-cancer agent three vincristine, carboplatin, etoposide that, repeated six times in every month is common, but it depends on the facility. Tumor shrinks, but cured with chemotherapy alone in some cases small, many will require a combination of local eye treatment. As a side effect, there is mild immunosuppression, cytopenias, hair loss, and nausea.
(2) regional chemotherapy
Treatment of selective ophthalmic artery infusion has been done in some facilities as a way of country-specific for the administration of anti-cancer drugs to the eye only. It is a systemic treatment side effects such as immune suppression does not occur, but the number of cases is limited procedures is difficult. Rather than the standard treatment, a research treatment, it is stage you are evaluating the therapeutic effect currently. A method of treating a tumor within the eye by injecting an anti-cancer agent (the part of the white of the eye) subconjunctival, how to inject the anti-cancer agent in a needle directly into the eye also been attempted.

7. Prognosis

The survival rate, usually calculated by the treatment content and progress of cancer, but is also affected by the presence or absence of (non-cancer diseases such as diabetes) complications and the patient’s age. for (frequency) is different from the distribution of the other elements of these data by using, there is a possibility that the value of the survival rate is different.
Survival rate to show you here is what was on the website of the National Cancer Center so far. Rather than the value itself of survival, to a certain width (depending on the data, but 10%, etc. such as 5% ±) by remembering, please consider us as a rough guide.
Life prognosis, has been reported 93.1% 5-year survival rate, and 90.6% 10-year survival rate from the results of the national registration. If the tumor has spread to extraocular, and then decreased 71.2% 5-year survival rate to 66.0% 10-year survival rate. Eye preservation rate is about 50% in total. 83% in the (A ~ C of the International Classification) non-advanced cases, 5-year eye preservation rate of the National Cancer Center was 33% in the (D ~ E of the International Classification) advanced cases.

Reese-Ellsworth classification
Ia group A single tumor diameter of less than 4 nipple (the same one nipple diameter: about 1.5mm, below) behind the equator
Ib group In multiple tumor diameter of less than 4 nipple, behind the equator all
IIa group A single tumor of 4-10 papilla diameter, behind the equator
IIb group In multiple tumor of 4-10 papilla diameter, behind the equator all
IIIa group Tumors located in front of the equator
IIIb group In a single large tumor than 10 papillary diameter, behind the equator
IVa group Multiple tumors, including tumors larger than 10 papillary diameter
IVb group Tumors that have reached up to (the front end of the retina) ora serrata
Va group Tumors that are larger than half of the retina
Vb group If there is (a state in which tumor has collapsed intraocular) vitreous seeding

International classification
A Tumors of less than 3mm, are away 1.5mm 3mm, from the optic disc from the macula
B Tumors without vitreous seeding, subretinal seeding, retinal detachment not exceeding 5mm from tumor
C Cases with seeding in the range that can be cured by brachytherapy, retinal detachment does not exceed 1/4 quadrant
D Patients with disseminated marked, retinal detachment may exceed 1/4 quadrants
E State of either neovascular glaucoma, intraocular hemorrhage of mass, orbital cellulitis, anterior chamber invasion, huge tumor in contact with the lens, diffuse infiltrative tumor, the eye tabes

Pituitary Adenoma Diagnosis, Symptom, Treatment

1. With pituitary adenomas

The pituitary adenoma, is a type of brain tumor that can be in the pituitary gland. Pituitary gland is a thing of about pea-sized, which is in the recess of sella turcica in the bottom-center of the skull. Above the pituitary gland, we are crossing the optic nerve is necessary in order to see things is gradually extending to the left and right eye. In addition, next to the pituitary gland, nerves that move the eyeball and (internal carotid artery) important blood vessels that send blood to the brain has been through. Pituitary gland is divided into two parts of the small posterior lobe and the anterior lobe, which account for the most part, I am secretes many hormones as the center of hormones throughout the body. Important thing is the next five in a hormone secreted from the anterior lobe.
Important thing is the next five in a hormone secreted from the anterior lobe.
1. Growth hormone
Through puberty from childhood, I encourage the growth of internal organs and limbs.
2. Prolactin
I will serve to secrete milk after delivery. menstruation has ceased while this hormone is secreted large amounts.
3. Thyroid stimulating hormone
And it works to secrete thyroid hormone by the thyroid gland to instruction. You need a lifetime for both men and women.
4. Adrenocorticotropic hormone
And it works to secrete adrenocorticotropic hormone with instructions to the adrenal glands. You need a lifetime for both men and women.
5. Gonadotropin
There are two types of luteinizing hormone and follicle-stimulating hormone. Dominates the ovaries in women and testes in men and promotes the secretion of sex hormones, respectively. In addition, it is also important hormone for normal development of sperm or eggs.
Hormone from the posterior lobe is the following two.
1. Antidiuretic hormone
It serves to reduce the amount of urine and works on the kidneys, you need life for both men and women.
2. Oxytocin
I shrink the uterus at the time of delivery.
Growth rate is slow benign, it spread to other organs other than the brain is very rare pituitary adenoma most. It often occurs in adults 20-50 years of age, accounting for about 15% of the entire brain tumor. The Turkey saddle near the presence of a pituitary gland, another tumor, such as craniopharyngioma can be some, but they are ” brain tumor (adult) “or” brain tumor (children) see the section “of . The pituitary adenoma, and there is a (non-hormone-secreting adenoma) in which the (adenoma of hormone production type), do not secrete hormones that secrete many abnormal hormone. In adenoma of hormone production type, abnormalities of various body will appear depending on the type of hormone produced, but in the case of hormone-secreting adenomas, it may not be found easily for asymptomatic until tumors grow quite large. As with many cancers, the probability of being able to totally cure the treatment used mainly with surgery to be found between pituitary adenoma is small will be higher. Tumor becomes large, when I come to involve such important brain tissue, cranial nerves, brain blood vessels of the peripheral, also be that Kiru taken completely by surgery more difficult, treatment with drugs or radiation therapy is performed after surgery there. In addition, the hormone-producing adenoma type of some sort, there is also that the drug therapy is tried first. Tumor becomes large, the pituitary gland of normal and will come under pressure by the tumor, the hormone necessary for the body to come in short supply even more, replacement therapy of hormone missing is required in this case.

2. Symptom

The symptoms due to pituitary adenoma, due to the fact that the hormone is secreted in excess can be roughly divided into hormone syndrome and, of local due to the tumor increases pressure symptoms you may be. Hormone-producing adenoma type can be classified by the type of hormone produced. I will describe the symptoms for each below.

1) prolactin-producing adenoma
It is a tumor that accounts for about 40% of the pituitary adenoma, found predominantly in women. And lactation amenorrhea is seen in women. In the case of men, impotence and decreased libido can be seen. There is also a view that the failure to appear when it becomes large. More women likely to be detected at an early stage, that of small tumors of less than 1cm are many, and it is one of the causes of female infertility.

2) growth hormone-producing tumor
Accounts for about 20% of adenomas, I seen slightly more men. It becomes gigantism If you develop during puberty, but this is relatively rare. It becomes acromegaly tip of the hands and feet, forehead, chin, lips, and tongue will have hypertrophy develops in adults many. Therefore, the size of the shoes and ring or no longer fit, look or you will have changed within a few years. Abnormal secretion of growth hormone is followed by a long period of time, making it easier to merge the vascular lesions, such as high blood pressure and associated diabetes.

3) adrenocorticotropic hormone-producing adenoma
Is a rare tumor that can not be found only a few percent of all pituitary tumors, many middle-aged women from the young, it is called Cushing’s disease. Obesity was observed in 90% or more, face rounded to the moon in particular, central obesity to breast-belly gain weight compared to the limbs is a characteristic. Acne is easy to appear, body hair is darker, you are Sujigami of blue-violet in the lower abdomen. In addition, there is also complicated by diabetes and high blood pressure at a high rate, psychiatric symptoms may appear.

occur because the tumor is increased pressure symptoms include the following:.
1) pituitary hormone production failure (pan-pituitary dysfunction)
Libido and impotence is reduced irregular menstruation or amenorrhea, in men, hair will also thin in women. In addition, it becomes the lack stamina and tired easily. In addition, you may not be able to recover easily from a state of shock when strong physical shock occurs. Antidiuretic hormone is insufficient, (diabetes insipidus) will occur symptoms leaving a large amount of thin urine.
Failure of

2) visual acuity, field of view
When the tumors will have expanded upward, I will begin to put pressure on the optic nerve cross-section immediately above. First, I’ll be difficult to see from the outside on both eyes. Outside half of both eyes is becoming invisible and further progresses, it becomes the typical symptoms called bitemporal hemianopia.

3) headache
Headache also often observed.

3. Diagnosis

The diagnosis of pituitary adenoma, there is the (hormone test) endocrinological examination and diagnostic imaging, such as by X-ray mainly.
1) diagnostic imaging

(1) MRI
You can even get a free image of the fault plane in a test using a strong magnetic field of magnetic resonance method, it is possible to reflect the only brain tumor or no effect of the skull, and also can be. It is possible the structure of the pituitary gland near the brain and can be observed over the details, to know the exact extent and size of the tumor. Further, since it is possible running of important blood vessels is also depicted, it can be said imaging modalities currently the most useful.

(2) CT
In tomography using a computer and X-ray, it is a diagnostic method most common. It has excellent characteristics such that it can check the status of the bone adenomas around when the combination of the contrast agent, the diagnosis of small adenomas becomes possible also increased.
X-ray examination of (3) head
I examine the bone changes such as deformation and destruction of the sella turcica.

(4) cerebral angiography
Important internal carotid artery to send nutrients to the brain is traveling on both sides immediately pituitary, can get to know preoperatively whether or not there is a malformation or traveling abnormality of this artery is important. This is done by advancing to the blood vessels in the brain narrow tube from the femoral artery.

2) hormone test
The hormone test, there is a meaning and examine the meaning and to examine the hormone that is secreted in excess by adenoma, a hormone in a state in which secretion was decreased in reverse, do the blood collection from vein mainly. In the case of hormone-producing adenoma, blood levels (prolactin, growth hormone, and adrenocorticotropic hormone) of the hormone indicates the abnormally high, I will lead to direct diagnosis. It may make various suppression test and test stimulus, to investigate the secretion kinetics. On the other hand, for a hormone that decreases the secretion, I will do the test stimulus secretion of the hormone. After injection of each formulation stimulating hormone secretion usually examine the changes in the blood levels of the hormone of interest continuously bled 15-30 minutes each.

Inspection of 3) ophthalmology
Make a thorough examination vision, field of view, of the fundus.
Inspection of 4) otolaryngology
If you are planning a nasal surgery described below, you should examine whether there is any problem or inflammation in the paranasal sinus and nasal cavity.

4. Treatment

For the treatment of pituitary adenomas, there is a treatment of three of chemotherapy surgery, and radiation therapy, and combination therapy is determined type and size of each tumor, symptoms, such as by age.

1) Surgery
There are two ways of craniotomy and nasal surgery, and is selected by a variety of conditions such as the size and direction of adenoma development. After surgery, hormone replacement therapy is required in many cases.

(1) nasal surgery
An incision was made the oral mucosa of the base of the upper front tooth, you will reach just below the pituitary gland through the paranasal sinuses on the back of the nasal cavity. An incision was made with a thin film, and a hard bone, to remove a pituitary adenoma while leaving the pituitary gland of normal.

(2) craniotomy
Open the window to the bone through an incision in the skin of the hairline of the forehead, were dissected the dura mater covering the brain and reach the pituitary Lift with a special spatula brain. I removed a tumor from between the normal tissues such as the internal carotid artery and optic nerve located around.

2) radiation therapy
Usually, in combination with surgery, etc., it is used as adjunctive therapy for tumors that remained after surgery. For five consecutive days per week, I will irradiation over a period of approximately 4-5 weeks. It is also possible to be treated while ambulatory. In recent years, a method of irradiating a short period of time-intensive part of the tumor in a narrower range is also becoming possible. There are few side effects, but as if it does not come grow with the case where the hair of the part before the ear is missing, come grow again. After treatment, hormone replacement therapy is required in many cases. It is believed that the effect of radiation lasts for a relatively long period of time, and has worked for several years.

(See: 3) chemotherapy drug therapy of cancer )
It is a treatment to suppress the production of hormones that adenomas secreting abnormally. Some of them show a marked response to chemotherapy for adenoma of hormone production type, but some less effective. As that obtained the most reliable therapeutic effect current (trade name: Paroderu) bromocriptine being used for prolactin-producing adenoma there is. This drug, effect was observed in 1/3 of the growth hormone-producing tumor and most of the prolactin-producing tumors, hormone levels in the blood not only decrease, reducing the effect of the tumor will also be expected to prolactin-producing adenoma in particular. Therefore, if there is residual tumor or at small tumor, bromocriptine therapy have been made without radiotherapy in these tumors. There is no serious side effects to taking bromocriptine, but can be lightheadedness and nausea taking at the start of symptoms such as constipation can be seen.
(See 4) hormone replacement therapy: . 12 hormone therapy drug therapy of cancer )

For essential hormone, replacement therapy is required depending on the degree of deficiency. I supplements in oral medicine thyroid hormone and adrenocorticotropic hormone. There is a medicine that blowing the nose anti-diuretic hormone. Refill for your situation for gonadotropin hormone and growth hormone.

5. Summary of treatment policy in each adenoma

1. Hormone-secreting adenoma
Surgery + “radiation therapy”
2. Prolactin-producing adenoma
Bromocriptine therapy surgery + + “radiation therapy”
3. Growth hormone-producing adenoma
Surgery plus radiation therapy + “bromocriptine therapy”
4. Adrenocorticotropic hormone-producing adenoma
Surgery + “radiation therapy”
5. Recurrent pituitary adenoma
I will attempt (combination therapy also included) treatment method described above type of tumor, the treatment of the past, such as from the general condition.

6. Survival rate

The survival rate, usually calculated by the treatment content and progress of cancer, but is also affected by the presence or absence of (non-cancer diseases such as diabetes) complications and the patient’s age. for (frequency) is different from the distribution of the other elements of these data by using, there is a possibility that the value of the survival rate is different.
Survival rate to show you here is what was on the website of the National Cancer Center so far. Rather than the value itself of survival, to a certain width (depending on the data, but 10%, etc. such as 5% ±) by remembering, please consider us as a rough guide.
Complications of nasal surgery, cerebrospinal fluid rhinorrhea and epistaxis postoperative: Yes (below-cerebrospinal fluid cerebrospinal fluid that quench the brain leaks from surgery portion), it is about 1%, respectively. Complications of craniotomy will remain the craniotomy by other disease. Complications of radiation, there is a failure of the pituitary gland of normal that was left, the probability of causing a pan-hypopituitarism if Mase irradiation dose in the hope that the radical increases. 10-year survival rate of pituitary adenoma as a whole is a good prognosis and almost 100%. However, those huge and 3 ~ 4cm, adenoma itself is about what hormone value was not normalized after treatment with (Cushing’s disease or acromegaly that is) adrenocorticotropic hormone secreting tumors or growth hormone regardless of the type of , not least be forced to impaired life from complications of the disease itself.

7. Life after discharge

If the pituitary hormone of normal is reduced, hormone replacement therapy is required. Able to compensate for the thyroid hormone and adrenal cortical hormone is required, you may want to oral formulations, respectively. Outpatient Required once a month if you want to continue chemotherapy. In addition, it is necessary to go to CT or MRI about once a year, to confirm the presence or absence of recurrence and tumor growth.

Brain Glioma Symptom, Diagnosis, Feature, Treatment

1. And glioma

Glioma and (glioma), malignant tumor that occurs in the brain, accounting for about 30% of primary brain tumor. From the morphology of the cells that make up the tumor, astrocytoma (astrocytoma Last Name: accounts for about 22% of primary brain tumors include the glioblastoma is the most malignant), oligodendroglioma (Boutokki offense and defense: primary Classification in such as about 1.2%): (context papilla Zhu about 1.1%), choroid papilloma: (Yuzuru heterogeneous about 1.3 percent of sex brain tumor), ependymoma about 0.4%), medulloblastoma (Zuigashu will be. In general, spreads so as to penetrate the surrounding brain tumor is this: boundary (infiltration infiltration), and normal brain is unclear, be all removed at surgery is difficult. For this reason, such as chemotherapy or radiation therapy after surgery is required in order to prevent recurrence usually. The 12 or so people for 100,000 people, the frequency of occurrence of (except for metastatic brain tumor) brain tumor in Japan, is said to be about the same as the U.S. and Europe. Accounted for approximately 30% of them, gliomas are the most common tumor. The most common among the glioma in astrocytomas, are divided into (grade 1-4) 4 big stage by the malignancy. In astrocytomas that occur in the cerebellum of children, only this tumor does not invade surrounding brain too much, grade 1 low-grade the most, you can expect to be cured by surgery alone. That only surgery to recurrence is often grade 2 or more, chemotherapy with anti-cancer agents and radiation therapy is performed after surgery. Is one of the highly malignant tumor in the most brain tumors, grade 4, is called (this elegance) in particular glioblastoma. Glioblastoma is a disease your current treatment is difficult, often to relapse within a few months, chemotherapy or radiation therapy after surgery is required only surgery.

2. Symptom

Updated filed no symptoms (skull 1) increased intracranial pressure symptoms)
Commentary view of the brain median section

Headache, nausea and vomiting is often raised as a symptom of brain tumor, symptoms caused by pressure inside the skull increases this is the (increased intracranial pressure symptoms). Since the brain is surrounded by a rigid container of the skull, as a result of volume in this container is increased by brain tumor, the internal pressure is increased, these symptoms will occur. In malignant tumors, the rate at which the increase is fast, yet to accompany a wide range of brain edema around the tumor, pressure will rise rapidly in particular. The most common symptoms are headache, not least also be hurt in agreement with the site of the tumor. Depending on the site capable of tumor, flow special water (cerebrospinal fluid), which is in the brain tumor is small is failure, the water will accumulate in the place that is said to ventricle, causing hydrocephalus . Intracranial pressure will be greater in this case, because water comes accumulated in the skull of a certain volume. Pressure within the skull becomes too extreme, brain hernia that part of the brain is recessed toward the foramen magnum to contact and gap of the membrane that tent located between the cerebellum and cerebrum, brain and spinal cord occurs, suddenly I will cause a serious condition or lost consciousness, breathing such as stopping.

2) local symptoms

Another symptom of brain tumor, is a symptom caused by the action of the brain part that can be tumor is failure. Because the work is clearly divided by site, symptoms appear, resulting in sites of tumor can have different brain. For example, just before the groove in the heart groove that separates the frontal and parietal lobe is called the motor cortex, motor nerve cells are ordered feet, hands, face toward the side from the center. Strong motor paralysis will appear due to a failure in this area. Behind is a sensory area immediately in the center groove, sensory nerves are listed in order feet, hands, face as well. In addition, the side of the frontal lobe of and there is a language center in the rear upper portion of the temporal lobe, upon receiving a fault each, talk about the other party can understand but motor aphasia not speak on your own (left cerebral hemisphere more) dominant hemisphere and, I brought about a sensory aphasia be impossible to understand him naturally. Occipital lobe is the center of the optic nerve, failure of the temporal lobe can cause (a state in which the field of view of the left half or right half lacks both left and right) hemianopia on the opposite side of the rear of one side. For a variety of symptoms appear other, due to the occurrence site of the tumor, a wrong left and right, the calculation can not be, it is impossible to read and write, memory and worse, it can be inferred the site of the tumor in the opposite from their symptoms . Since the cerebellum is the part that takes the balance of movement, trembling of limbs and gait disturbance, such as not walk in a straight line will appear in the small brain tumor. In addition, due to its proximity to the passage of cerebrospinal fluid, hydrocephalus will also appear by the obstruction. For brain stem is the part to move to spinal nerve of all of the brain collection, limb is paralyzed in small lesions. In addition, you cause such as hemiplegia of the opposite side in the cerebral lesions, but the paralysis of limbs and paralysis of eye movements and face will be on the opposite side of the brain stem.

3. Diagnosis

Diagnosis of brain tumors is most possible CT, by MRI. Specialist point of view, as well as the site of the tumor, it will be possible to diagnose the type of tumor often. It is using the X-ray CT, MRI is what makes the tomography by using magnetic, but more of an MRI is often the amount of information, influence on the human body is also less. However, the use of the strong magnetic, sometimes inspection can not or when using a pacemaker, for example, if it is to embed the metal body in surgery of the past. When performing surgery, cerebral angiography is performed for the purpose of examining or looking the relationship between the blood vessel and brain tumor, how much the vessel or the like is entering the tumor. Insert the small tube from an artery at the base of the foot, do the x-rays by injecting a contrast agent vertebral artery and carotid artery to proceed. There is also a simpler method, the contrast medium is injected by a needle directly into the carotid artery. Further, a method to project cerebrovascular using CT and MRI are also taken in recent years.

4. Various features of glioma

The survival rate, usually calculated by the treatment content and progress of cancer, but is also affected by the presence or absence of (non-cancer diseases such as diabetes) complications and the patient’s age. for (frequency) is different from the distribution of the other elements of these data by using, there is a possibility that the value of the survival rate is different.
Survival rate to show you here is what was on the website of the National Cancer Center so far. Rather than the value itself of survival, to a certain width (depending on the data, but 10%, etc. such as 5% ±) by remembering, please consider us as a rough guide.

1) astrocytoma
Symptoms of brain tumors, features a neurological symptoms such as headache and hemiplegia to enhance gradually in general. In astrocytoma high grade, time to cause impairment of consciousness to severe onset of symptoms is short, a few weeks to several months, but there are also several years in low-grade. In addition, you may want to develop convulsions sudden (convulsions) seizure. Astrocytoma low grade is reflected as images swollen black in CT in general. Since the change is hardly observed even after intravenous injection of contrast agent, but some difficult to distinguish from cerebral infarction, but are distinguished from cerebrovascular disease in a manner of appearance of symptoms many. It is still missing black for astrocytoma grade is high, is the contrast in white on the ring-shaped marginal by the contrast agent, and the inside has caused necrosis (Shi d). In addition, a wide range of brain edema is observed in the peripheral. By MRI, the relationship between normal brain and surrounding the spread of the tumor will be more clearly and more. See below for treatment, but because the boundary between the normal brain is unclear, because it can not all tumors excised, chemotherapy and radiation therapy is done after surgery than surgery alone. The prognosis varies depending on the grade. The five-year survival rate is 60-70% if astrocytoma of grade 2 of comparatively mild type, but less than 10% in grade 4 of the most malignant.

Depletion 2) projection glioma
Compared to astrocytomas, that course is long in many cases, it is not uncommon to be the main symptoms of seizures for several years. It is more common in the frontal lobe, to be associated with calcification in many cases, can be seen also intratumoral hemorrhage and infiltration into the dura mater at the time. Repeat recurrence rarely, transition to extracranial have also been reported. Better than astrocytoma, five-year survival rate at 70-80%, it also responds to the chemotherapy relatively well in oligodendroglioma of malignant prognosis.

3) ependymoma
There is room for storing the cerebrospinal fluid, called ventricles deep in the brain, it is cells called ependymal cell’s and form a wall. Is an ependymoma occurs from the ependymal cells, usually exists in the form that is in contact with the ventricle wall. There is no so high grade, but because can occur cerebral deep often, be all removed in surgery is difficult, chemotherapy and radiation therapy will be added after surgery. The relapse soon after treatment in the ependymoma, in some cases, medical condition is rapidly progressive. The five-year survival rate is 60-70% or so.

4) brain stem glioma
It is treated as a brain stem glioma specially, brain stem, astrocytomas that occur in the middle part of the spinal cord and brain, called the bridge in particular, will predilection in children. It is a characteristic paralysis of limbs and failure side of the brain, such as facial nerve that moves the muscles of the face and oculomotor nerve that controls the movement of the eye can become the other side. You may also extremities of hands and feet are paralyzed. Because it is the site surgery is difficult, things only to confirm the organization even if the surgery was done in many cases, treatment of radiation principals have been made, which is not very good prognosis.

5) medulloblastoma
It is a malignant tumor of children that occur central part of the cerebellum from (vermis). It is a disease due to obstruction of cerebrospinal fluid, likely brought about a hydrocephalus. Other increased intracranial pressure symptoms headache, nausea, and vomiting may occur, or brought about a walking ataxia, postural or you will become difficult. Originally, the grade is high tumor of extremely poor prognosis, but by the therapeutic effect of radiation is high, after removal by surgery, to perform the irradiation whole brain, the whole spinal cord, long-term survival has come to be expected were. Moreover, anti-cancer agent is effective, other used contemporaneously with radiation, attempt to reduce the dose by performing chemotherapy before irradiation is done.

5. Treatment

Treatment that combines surgery, radiation therapy, and chemotherapy is performed for malignant glioma. The tumor to develop in a manner that infiltrate normal brain, can be all removed at surgery is impossible, survival is prolonged as when it was excised widely as possible in glioblastomas aggressive most have. However, it is possible that impair the normal brain function if you removed all the tumor. Radiation therapy is done against malignant glioma principle all. Once it had been irradiated to the whole brain, but in order to reduce the failure of radiation treatment, and have come to irradiation confined as possible to the tumor in recent years. Anti-cancer agent is not great therapeutic effect on brain tumors alone, but by the combination with radiation, the treatment effect increases. In Japan, (Nidran) is often used ACNU is an agent of nitrosourea. It is twice the intravenous injection of 6 weeks and radiation therapy at the start of the general, but it can be administered, such as interferon and anti-cancer agents other further combination. Repeat in about every two months thereafter, these drugs are administered as maintenance therapy. In recent years, Temodar is an anticancer agent of oral is approved for the treatment of new, I am beginning to be used in the treatment of malignant glioma.

6. Treatment at relapse

Many of malignant glioma is the current situation recur in a few months to several years from initial treatment even if we are treated, as defined above, treatment is has become more difficult in that case. In some cases, re-operation is possible even after recurrence, but if you progress to deep motor cortex, such as the language area, re-operation can be difficult. Were excised tumor surgery as much as possible, and add exposure to radiation if possible. However, the amount of radiation that can be irradiated in many cases, irradiation of large dose has already been done, and think about the impact on the normal brain by additional irradiation so limited, the treatment effect will be lower compared to the irradiation of the first. In addition, in the case of recurrence while not using ACNU also anti-cancer agent, selection of the agents of the other is required, the treatment effect will be lower still. Recently, lesion recurrence is small, (“For details stereotactic radiotherapy can be performed to radiation and to focus only on that part have been made ​​stereotactic irradiation see section “).

7. (Side-effect reaction by surgical therapy) side effects of treatment

The craniotomy for brain tumor, never complications is large as compared to the surgery of other organs. Advances in diagnostic imaging of the recent spread and the site of the tumor prior to surgery is now visualized in detail. When the monitoring and various use of the microscope, in order to extraction range can be known fairly accurately, surgery as planned was also carried out during surgery, the neurological symptoms after surgery is worse than before surgery less I will say that. However, the symptoms are severe and cause, such as postoperative bleeding once, because sometimes leave or a strong paralysis, or brought about a disturbance of consciousness, hemostasis at the end of surgery is done carefully in particular. Postoperative hematoma, can happen to any part of the tumor cavity that was removed, the brain, subdural, epidural. If the headache of strength or followed after surgery, such as paralysis or disturbance of consciousness appeared, followed by CT as soon as possible post-operative hematoma doubt, do the surgery again if necessary. I may brain edema is strengthened for a few days after surgery, even if there is no hematoma, nerve symptoms worse. In general, you improved by the use of brain hypotensive agent such as glycerol and steroids, but may craniotomy for decompression is needed sometimes. If there is a motor paralysis after surgery, for the recovery of motor function and prevention of, requires rehabilitation of early (holidays term) of joint contracture. Well as rehabilitation on motor paralysis, rehabilitation for the language disorder also have been made.

8. Complications

In other complications associated with surgery, complications associated with chemotherapy and radiation therapy can be a problem. Failure to do so may result in brain edema associated with exposure to radiation, nausea and headache, and malaise during irradiation appears. If you do not use an anti-cancer agent, it platelet count and white blood cell count is reduced is small, when irradiation is carried out in all spinal cord, such as treatment for medulloblastoma, function to build the blood of bone marrow suppression in strength It may be (bone marrow suppression). It takes note that it is or it easier to bleeding platelet count that play an important role when you can cause serious infections white blood cell count is reduced, to stop the blood is low. I brought about a bone marrow suppression in the treatment of only anti-cancer agent. Depending on the type of drug, blood condition will deteriorate over a period of one week to several weeks. In ACNU which are often used for brain tumors in particular, bone marrow suppression is seen most strongly in 3-4 weeks after treatment. It is necessary to devise or to postpone the anti-cancer agent the next dose, such as reducing the dose.

7 Brain Tumor Symptoms Symptom, Staging, Treatment

1. Brain tumors

A brain tumor, it is a disease in which abnormal cells grow in the brain tissue. In brain tumors, there are two types of primary brain tumors arising from brain tissue itself, metastatic brain tumor cancer of other organs have been transferred to the brain. The primary brain tumors, there are two types of benign and malignant. Even benign tumors, and failing to pressure the normal brain increases, the brain tumor that occurs in a limited space of the intracranial are subject to even if treatment. Incidence (including the central nervous) brain tumors, is about 3.5 people per 10 million people per year. Those of many malignant brain tumor as a whole, and it is finely divided by the nature and shape of the cell. The prognosis and possible treatment, the cure, it is approximately determined by the general condition and the type of this brain tumor. I shows the percentage and type of primary brain tumor below.

Type of brain tumor Percentage
1. Glioma 28% (Malignant)
(Astrocytoma Static) 1-1 astrocytoma (28%) Relatively benign
1-2 malignant astrocytoma (18%) Malignancy
(This elegance) 1-3 glioblastoma (32%) Malignancy
1-4 medulloblastoma (Zuigashu) (4%) Malignancy
1-5 Other (18%)
2. Meningioma 26% (Benign) (less malignant)
3. Pituitary adenoma 17% (Benign)
4. Schwannoma (neurosis Zhu) 11% (Benign)
5. Congenital tumor (such as craniopharyngioma) 5% (Relatively benign)
6. Other 13%

The most common in primary brain tumors, arise from glial (new trend) cell glioma in what is called, I will account for about 28% of the total. And glial cells, and between the nerve cells and nerve cells, is located in between the nerve cells and blood vessels, it has to provide a source of nerve cell nutrients and oxygen. Of the gliomas, one of the most common are astrocytomas. It is a thing that many in the cerebral hemispheres in adults, likely to occur in the cerebellum in children. Some of the astrocytoma in children, (“For more information It is something to be cured with surgery brain tumor (children) see the section “of). The astrocytoma adult generation, there is a malignant astrocytoma and malignant astrocytoma relatively benign. Astrocytoma tumor is relatively benign, but it is a tumor that require attention because it can undergo malignant transformation. Accounts for about 1/3 of the entire glioma, grade is the highest among the glioma, glioblastoma, tumor treatment is very difficult to emit good men of 45-65 years old. It is a meningioma often next to that glioma occurs at the meninges that surrounds the brain. Other, occur in the pituitary gland is a central hormone of pituitary adenoma , occurring in acoustic nerve schwannoma there is such. It is unlikely that primary brain tumors, spread to other organs such as liver and lung lesions from intracranial, but not least is that the cancer that occurred in other organs spread to the brain. I called a metastatic brain tumor this. Lung cancer, metastasis to the brain seen many, in particular, is such as breast cancer. In addition, the interior of the brain called the brain parenchyma, metastasis of lung cancer has the property of easily fixed to the membrane, such as the dura mater in the case of metastasis of breast cancer. I also raised As one of the features of metastatic brain tumor, metastasis is found a plurality of locations. In addition, it is possible that in the liquid surrounding the brain called cerebrospinal fluid, cancer cells to proliferate. Treatment will be extremely difficult in this case.

2. Symptom

Let’s see a doctor if the degree of headache may become stronger gradually, the frequency of vomiting or have increased, and the contents of the speech talking about how to walk and has become strange. Symptom may be such occur also responsible for brain tumors other than, you need to be careful. Symptoms of brain tumor cause, thick Updated symptom-free (intracranial intracranial hypertension symptoms that occur with local symptoms or destroy pressure on the nerve tumor itself, by the tumor increases in intracranial space is limited There is).

1) local symptoms

The brain is the center of the nerve, but a variety of functions, such as sensation and movement is being conducted in a distributed in the brain. For example, (when the tumor was on the right side, paralysis can happen to the left side of the body) and so on paralysis of the right side of the body that takes place tumor is possible at a site to move the hands and feet of the motor cortex of the frontal lobe of the left. In the case of a right-handed person could be tumor on the left side of the frontal lobe in front of the brain, urinary incontinence and personality change lethargy, such as dementia like behavior, paralysis of the right side of the body, such as language disorder will appear. When the tumor was able to occipital lobe, (constriction and then), will be visual field defect Nadogami tunnel vision. Language disorder will occur to be able to tumors (right frontal lobe in a lot of people left-handed) left frontal lobe of the right-handed person. In the center of the brain the pineal gland and pituitary (Tai fire fighting), or abnormally (object can be seen in the double), such as double vision in the failure of the oculomotor nerve that moves the eye to be able to tumors in the hypothalamus near, There is the thing that endocrine disorders such as growth failure and amenorrhea occurs due to the abnormal secretion of the hormone. If the tumor could be at a site called the brain stem and cerebellum, hands and feet wander, or become ataxia adjustment does not work, hearing loss, facial paralysis, dizziness comes happened.

2) increased intracranial pressure symptoms
Tumor increases in intracranial a limited, intracranial pressure rises in pressure on the normal brain. (The optic nerve head is swollen in the fundus examination) persistent headache, nausea, papilledema I will allow you to Nadogami by this. Chronic headache is what you should be aware of the most in that. Headache can also occur in diseases other than brain tumor, there is a tendency to persist chronically in the case of a brain tumor, strongly upon waking in the morning, the symptoms will gradually weakened thereafter. You can hear about 20% of brain tumors early, you should be able to see 70% or more progresses. Nausea, convulsions, fainting and will also be seen along with the exacerbation of headache. When these symptoms were seen, you must seek medical attention immediately.

3. Diagnostic imaging

In the case of brain tumors, there is no screening system, as is done in other cancers, except for brain dock. If there is a subjective symptoms suggestive of brain tumors such as those described up to now, that you seek early, please explain in detail the progress of the symptoms, you get to determine whether there is abnormal neurological is important. Also, if you are undergoing treatment for cancer and other cancer that is easy to spread to the brain, when the symptoms mentioned before appears, you must undergo a thorough examination CT, such as MRI.
1) CT (computed tomography), MRI (magnetic resonance image)
It is the imaging method that forms the center of the image diagnosis of current. Position and size, characteristics of the image of the tumor is known, is an important test. Tumor size of about 5mm up so users will know now. It is important to look at the temporal changes in the shape or change in size, position and relationship with the surrounding brain.
2) cerebral angiography
By the imaging blood vessels of the brain, is an important test that can obtain detailed information, such as the properties of the blood vessels in the tumor itself and nutrition blood vessels into the tumor, is used for surgery examination and diagnosis.
3) Other
Ultrasound examination is performed during surgery now, it will play an important role in understanding the exact location of the tumor during surgery. In addition, a variety of testing equipment have been developed.

4. Staging

If the adult brain is found in the image diagnosis, it is necessary to determine whether the benign brain tumors or the malignant in any kind to determine the method of treatment then, whether malignant extent in the case of malignant . To do this, examine under a microscope the organization to take as much as possible the tumor by performing a craniotomy, pathological diagnosis to malignancy is done in the case of a malignant type of brain tumor. Also, depending on the diagnostic imaging findings, there is a way to do the pathological diagnosis in the same way by removing a part of the tumor with surgery. Many of the criteria What you choose, it depends on the general condition and diagnostic imaging.

5. Type of treatment

For the treatment of brain tumors, there is a chemotherapy surgery, radiation therapy, with anti-cancer agents.
1) Surgery
It is the most effective treatment to be removed all the affected area by surgery. Benign tumor many will heal in this. However, there may be a brain tumor can not be resected in all benign. If a brain tumor could be in place with the nerve to move the hands and feet, hands and feet is no longer move A damaged brain of normal, you may not be able to removed all tumors. Difficult decision to where to and you can removed without impairing the function to surgery is required, there is a remarkable progress of medical equipment and surgical technique less invasive of (Shinshu) than using a computer state-of-the-art technology of recent, outcome has also been improved.
2) radiation therapy
For a portion of the tumor benign or relatively all, malignant brain tumors, radiation therapy is one of the most important treatment. Or in conjunction with chemotherapy or surgery, do the treatment alone. In this case, make sure that you do not irradiated with normal cranial nerve is irradiated onto the only lesion as much as possible. Even benign tumors, small schwannoma, the meningioma, may also be used method of gamma knife treatment now, but this is also the application of radiation therapy. The gamma knife is effective against malignant brain tumors. Source is different, but (“For more information you can also of focused irradiation of SMART stereotactic irradiation refer to the section of “).
(See: 3) chemotherapy drug therapy of cancer )
Chemotherapy with anti-cancer agents, have been made to be used in combination with radiation therapy or surgery as a treatment for malignant brain tumors. There are oral administration, intravenous injection, or topical administration. Method of administration and combination of a variety of drugs, have been developed by clinical research. There is a make a difference with systemic chemotherapy for other cancers, blood-brain barrier exists in the brain, anti-cancer agent is less effective.
Therapy 4) other
Gene therapy, clinical research has been done in the United States now, but its application to malignant brain tumors has been noted among them, but it is one. In addition, treatment using the immunity humans have originally ( immunotherapy clinical trial is carried out also), study on the effectiveness have been made.

6. Treatment and type of tumor

( glioma , pituitary adenoma , schwannoma see the following sections for more information on.)
1) adult astrocytoma
Is done mainly (lumpectomy) surgery.
If the findings of malignancy is suspected in a somewhat pathological diagnosis, you may be surgery after radiation therapy is performed.
The effectiveness of chemotherapy and radiation therapy after surgery, consideration by the clinical trial have been made.
Adult glioblastoma and 2) adult malignant astrocytoma
Usually were removed as much as possible the tumor by surgery, therapy hit a tumor that remained by radiation therapy and then is done.
In high-grade, chemotherapy is done in addition to the surgery after radiation therapy.
There are many methods currently in radiation therapy, the method in addition to the irradiation method, called external beam normal, irradiated by a needle into the tumor interior, a method of irradiating the cavity is removed, a method of irradiating during surgery, There are irradiation method using a radiation sensitizer. Clinical trial is carried out for these, consider whether or not effective as compared to existing therapies have been made.
Treatments such as immunotherapy and chemotherapy after radiation therapy, study of effectiveness have been made in clinical trials.
3) adult ependymoma
Removed by surgical therapy is therapy center.
If the findings of malignancy is suspected in a somewhat pathological diagnosis, you may be surgery after radiation therapy is performed.
4) adult malignant ependymoma
Radiation therapy is enforced in postoperative removed by surgery.
After excision, radiation therapy chemotherapy combination, study of effectiveness has been carried out by the clinical trial.
Projection cell tumors depletion 5) adult malignant
Radiation therapy is enforced in postoperative removed by surgery.
For the types of chemotherapy work better and high-grade, chemotherapy and radiation therapy is done in surgery after excision.
Treatments such as immunotherapy and maintenance chemotherapy after radiation therapy, study of effectiveness have been made in clinical trials.
6) adult medulloblastoma
(” brain tumor (children) see “a)
After surgery, radiation therapy is done.
It is in clinical trials for efficacy of treatment you underwent radiation therapy after surgery and chemotherapy further.
7) adult meningioma
If you make a full recovery in the surgery are often, but sometimes radiation therapy is performed in the case of post-surgical tumor remained.
8) adult malignant meningioma
After surgery, and radiotherapy.
For immunotherapy and chemotherapy after radiation therapy, study of effectiveness have been made in clinical trials.

7. Survival rate

The survival rate, usually calculated by the treatment content and progress of cancer, but is also affected by the presence or absence of (non-cancer diseases such as diabetes) complications and the patient’s age. for (frequency) is different from the distribution of the other elements of these data by using, there is a possibility that the value of the survival rate is different.
Survival rate to show you here is what was on the website of the National Cancer Center so far. Rather than the value itself of survival, to a certain width (depending on the data, but 10%, etc. such as 5% ±) by remembering, please consider us as a rough guide.
5-year survival rate of the entire brain tumor is now over 75%. 93% in meningiomas are benign brain tumors, pituitary adenomas 96%, schwannoma is 97%. On the other hand, 38% in the entire glioma, glioblastoma aggressive most 6%, malignant astrocytoma high-grade 23%, astrocytoma is about 66% in the next. Metastatic brain tumor is only 13%. Treatment of malignant brain tumors has become an issue in the future as this.

Brain Tumor Symptoms, Diagnosis, Type

1. Children and brain tumors

The brain tumor of children (children), as compared with the adult brain tumor of (adult), since the type of tumor, favorite site is different, the course of the symptoms different from that of many adults. Brain tumor of the majority occurs in the cerebrum in adults, (paresthesia), words or gone because well the hands or feet or longer dominated by the generation site (paresis), or have numbness and then (language disorder). Brain tumor in children, is that from the fact that nearly half are present in the brain stem and cerebellum and, it is easy to cause hydrocephalus by obstruction of brain water (cerebrospinal fluid). However, since even if there is water retention in the brain, suture of bone is likely to dehiscence children, an increase in the (intracranial pressure) pressure in the head is not uncommon, or a bad mood simply, light walking Sometimes the symptoms are not seen but to indicate a failure. The most common childhood brain tumors, accounting for about 20% (cell tumor surname) astrocytoma benign that can be in the cerebellum. Other, 12% medulloblastoma malignant (Zuigashu), 10% germ cell tumors (astrocytoma so yes), 9% of benign tumors (N Zugaii pitcher) craniopharyngioma tumors of congenital, ependymoma (Yuzuru heterogeneous) has become a 5%.

2. Symptom

And (Updated filed no intracranial symptoms) increased intracranial pressure symptoms that occur tumor or can in the limited space of the skull, the water in the brain is or accumulated, symptoms of brain tumors, brain of the site by the tumor I can be divided into local symptoms that occur function is impaired.
1) increased intracranial pressure symptoms
That compared to adults, it is possible to narrow space called a fossa after a brain stem and cerebellum in many cases, passage of water brain (cerebrospinal fluid) is liable to blockage, water will cause disease head water to accumulate in the head pediatric brain tumor. As a result, intracranial pressure increases, and head circumference will expand if infants. In addition, intracranial pressure increases and becomes larger in cerebral tumor. In adults, headache, nausea and vomiting will appear as its symptoms, in children, and may or may not be the only or a bad mood appetite may decrease simply, it also, or vomiting suddenly.
2) local symptoms
The sites of possible brain tumor, nerve cells in the area is damaged, the characteristic symptoms will appear. For example, there is a region where the gathering of the motor nerves, called the motor cortex to the rear of the frontal lobe, paralysis of the limbs on the opposite side will appear by its failure. In addition, there is a language center to the side of the left frontal lobe in a right-handed person, able to talk by its failure will be crippled. Constriction of the visual field (stenosis) will occur in the failure of the occipital lobe. When the cerebellum is impaired, staggering when walking in and out, holding the attitude or you will become difficult. However, care must be taken that both do not show typical symptoms as adults in children much so.

3. Diagnosis

An MRI examination and CT, most tumors are diagnosed can be accurately and safely. CT uses X-rays, using a magnetic, MRI will create a tomographic image processing is performed on the computer. I can guess the location of the tumor, the relationship between the normal tissue, such as a change from the before and after administration of contrast agent, the location of the tumor, as well as spread, to a small tissue diagnosis. Cerebral angiography was required for the diagnosis in the past, however, it is performed unless it is suspected of vascular lesions or if it is the premise surgery has become less recently. It is thought accuracy (MRA, helical CT) of even better angiography using CT or MRI, to be further reduced in the future.

4. Type of childhood brain tumor

The survival rate, usually calculated by the treatment content and progress of cancer, but is also affected by the presence or absence of (non-cancer diseases such as diabetes) complications and the patient’s age. for (frequency) is different from the distribution of the other elements of these data by using, there is a possibility that the value of the survival rate is different.
Survival rate to show you here is what was on the website of the National Cancer Center so far. Rather than the value itself of survival, to a certain width (depending on the data, but 10%, etc. such as 5% ±) by remembering, please consider us as a rough guide.
For childhood brain tumor typical, I will describe the characteristics of each.
1) medulloblastoma
It is one of the highly malignant tumor most, radiation therapy and chemotherapy for the effect of a high, long-term survival is now obtained by appropriate treatment. The 5-year survival rate of 50-60% or more has come to be reported in recent years. Peak age of onset is 5 to 14 years, accounting for 13% of childhood brain tumors. It occurs midline cerebellum many, invasive to the cerebellar tissue surrounding: you can proceed to (blame invasion spread violated the surrounding tissue). Disturbance of posture and maintain gait disturbance appeared as cerebellar symptoms, walking and open to the left or right foot is characteristic. In addition, the hydrocephalus associated with obstruction of cerebrospinal fluid, intracranial pressure is elevated, or complained of nausea and headache, and vomiting or sudden. However, sometimes the symptoms are hard to appear intracranial pressure is relieved by the release of open bone suture line even if there is hydrocephalus. Diagnosis, is used to evaluate MRI and CT. Most shows the image of the circular white stain uniformly by the contrast agent around the midline cerebellum. When, seeded into spinal cord cavity and the ventricular wall through the spinal fluid this tumor: To (seeding spread like seeded), spinal cord by MRI as well as examination of the brain even in the absence of symptoms for example You must also check the. Treatment, radiation therapy and surgery is the major function. It is is a tumor radiation therapy is effective, and is more effective when performed radiation therapy after excision enough. After the irradiation to the whole brain, and additional irradiation to the lesion of the cerebellum radiation therapy. I will also to a whole spinal cord. In addition, it is thought prognosis is good is better to chemotherapy agents after irradiation and radiation during irradiation. It’s a problem most side effects associated with treatment, it is due to exposure to radiation. Is (that the functions that make platelets and white blood cells in the bone marrow is reduced) bone marrow suppression by irradiation for the entire spinal cord, reduced resistance to infection by leucopenia, with thrombocytopenia when used in combination with chemotherapy agents, especially early Therefore, attention must be paid to bleeding tendency. In addition, as the failure of after a few years after treatment, because there is a developmental disorder of intelligence by whole brain irradiation, in the case of 3 years of age, and tend to first select the chemotherapy instead of radiation postoperative I will have to. It is associated with medulloblastoma, there is a group of tumors called (PNET) primitive neuroectodermal tumors germ leaf. It is a generic term for tumor undifferentiated differentiated from medulloblastoma occurring in the central nervous system is difficult, an indication of the differentiated glial cells, nerve cells, etc. ependymal cells also observed this. I have similar response to treatment and the nature of the tumor and medulloblastoma.

2) astrocytoma

In many tumor in children 5-14 years of age, it is good to emit tumor cerebellum. It is a tumor with high very often in childhood brain tumors as well as medulloblastoma, but completely cured by performing a surgery to remove benign extremely, it is said that the five-year survival rate is 80% or more. It often occurs in cerebellar hemisphere, but it is not uncommon to midline. The walk to open the foot from side to side by cerebellar ataxia, staggering the stronger. The pressure on the passage of cerebrospinal fluid, such as cerebral aqueduct and the fourth ventricle, causing hydrocephalus, and increased intracranial pressure is reduced due to the release opening of bone suture line, may not appeal to the initial nausea and headache It is not uncommon. The diagnostic, CT, MRI will be used. This tumor cyst: be formed (farming bag of water within the tumor) in many cases, will be recognized as a circular image in the black within the cerebellum. Present in the nodular in the form of part of the wall of the cyst is thickened, it is called a mural nodule, tumor body is rendered white by the contrast agent. It is the boundary between the cerebellum and the surrounding mural nodule is clear, that there is no recurrence of the tumor be left a portion of the cyst wall if completely removed this in surgery. Many of astrocytoma of the cerebellum that occurs in children, it is a extractable benign tumor in this way, but with some others to progress to invasive as astrocytomas that occur in adults, malignant pathological after surgery depending on the time radiation therapy is also the case of performing.

3) ependymoma
It is said that in tumors emit good in 5-9 years, accounting for about 5% of childhood brain tumors, and to reach 20% when limited to infants. Order to generate from ependymal cells that make up the ventricular wall, is present in contact with the fourth ventricle, lateral ventricle, the third ventricle, is seen frequently as a spinal cord tumor. In order to proceed in a manner that the retraction the surrounding brain tissue, the boundary between the brain and the tumor is relatively clear tumor. Progress because it is slow, it does not show any symptoms until much larger number, not a few can also develop in rapid hydrocephalus caused by obstruction of cerebrospinal fluid. If you progress to the brain parenchyma from the lateral ventricle wall, symptoms such as visual field disorder and hemiplegia will appear. In addition, you may want to progress to cervical spinal cord direction in tongue from the fourth ventricle, limitation of motion and stiffness in the neck appears. When accompanied by calcification and reflected white in CT, by leaving black in MRI. There also is enhanced or irregularly uniform With the contrast agent, circular cyst are found in the interior. This healing if possible (removal of the tumor all) complete removal surgery is present in a cerebellum deep and cerebrum, is not possible when all摘手surgery, radiation therapy and is used together with. The prognosis is generally good, five-year survival rate is 60 percent, but it can make a transition to disseminated through the cerebrospinal fluid at the time.

4) craniopharyngioma
Benign tumor that occurs in the upper pituitary gland, accounting for 9% of childhood brain tumors, you predilection to 5-9 years old. By retraction to the pituitary gland, and cause stunted growth of the body from impaired secretion of growth hormone, skin is a fine-grained white, body hair will be less. Tumor if the pressure cross-section of the optic nerve, the field of view of the outside will constriction in both eyes, but not in a clear semi-blindness about the time of pituitary adenoma, and it is in a slightly irregular field failure. Obstruction of cerebrospinal fluid is the water head disease caused tumor further increases. In simple skull X-ray imaging, Turkey saddle is flattened into a dish shape, and acknowledge irregular calcification in the upper part. Calcification of nodular was observed more clearly in CT, tumor part is strongly enhanced by the contrast agent. It is not uncommon to form part cyst. By MRI, rate of development of the tumor is visualized more clearly. Because it is a benign tumor, it is curable if possible complete removal surgery, but in some cases adhesion of the hypothalamus is strong and difficult all摘手surgery sometimes. Be careful if you try all摘手surgery by force, because there is that consciousness is impaired polyuria, polydipsia, called diabetes insipidus after surgery not only angry. If all摘手surgery could not be, postoperative radiation therapy to make. The five-year survival rate is 95 percent.

5) germ cell tumor
Tumor from cells called germ cells at the time of the fetus that occurs in Turkey suprasellar pineal gland and (Tai fire fighting), and predilection to 10-19 years of age, accounting for about 10% of childhood brain tumors. If it occurs in the pineal gland, it becomes hydrocephalus by obstruction of the cerebral aqueduct from early, it is one of the symptoms characteristic of other intracranial hypertension symptoms occur, it is becoming hard to watch an upward. Tumor is increased further, hearing loss and fluctuation will occur. Tumor occurs in Turkey suprasellar, urine volume increases or first, field of view becomes narrower. Germ cell tumors are classified into the following five types of pathologically. And then progress to invasive but, embryonal tumors therapeutic effect of radiation is high (seminoma), difficult treatment of choriocarcinoma, malignant teratoma is high benign fetal cancer, and yolk sac tumor, extremely . CT, in MRI, embryonal tumors are visualized whitish than normal brain, it will be enhanced uniformly by the contrast agent. Be heterogeneously enhanced more in embryonic and cancer teratoma seem to be many. In addition, blood, HCG of cerebrospinal fluid (hormone of villus epithelial origin), AFP (fetal protein) is significantly higher in the yolk sac tumor in choriocarcinoma. Diagnostic imaging CT, with MRI, examination of the tumor marker is useful to distinguish in this way. Treatment of embryonal tumors radiation therapy is the major function. Depending on the size and location that is made ​​of the tumor, but there may decide to perform the irradiation of 20Gy about it also serves as a means of diagnosis in the first, and be treated by determining the diagnosis by the degree of tumor shrinkage. Response to radiation therapy if not good, to perform surgery at the thought of tumors other than germ tumor, fetal and cancer choriocarcinoma, in the yolk sac tumor chemotherapy and is used together with. However, it is a principle to carry out the radiation pathology diagnosis since been confirmed in a strict sense, it is now advancing the therapy after performing the first surgery in recent years. In addition, there is an attempt in order to reduce the impaired secretion of hormones and developmental failure of intelligence associated with exposure to radiation, tissue diagnosis after surgical, followed by chemotherapy first in recent years, that will reduce the dose of radiation.

6) optic glioma
It is one of the benign tumor originating good to the optic nerve of the 3-7 year-old children. To those made ​​in the place of those that cause visual impairment of one side occurs (under eyes) in orbit, that part chiasm in the brain, to cause abnormalities of vision field of view of both sides, the symptoms vary depending site of occurrence is. Sometimes for speed of growth is very slow, it is to a considerable size in the onset. Eye becomes larger projects, intracranial If increase in orbit, it becomes the hydrocephalus by obstruction of cerebrospinal fluid. In addition, the disease is hereditary, which is characterized deformation and softening of the bones of the whole body called Recklinghausen’s disease, subcutaneous tumors (neurofibromas), brown pigment spots in the skin (café au lait spot), and hypercalcemia It is the merger of the disease is large. Diagnosis, check the swollen optic nerve head CT and x-rays, in the MRI. Complete removal is possible with surgery, is good prognosis extremely, If you like to blindness in both eyes and spread to cross lesion is seen, by performing the extraction, and with a diagnosis by surgery, radiation therapy and the chemical therapy is performed mainly of.
7) choroid plexus (choroid likely) papilloma
with a good prognosis tumors relatively under-five, emit good especially in infants, accounting for 1.6% of childhood brain tumors. By involving overproduction of cerebrospinal fluid, most of the symptoms is due to hydrocephalus enlarging head size, vomiting features of this tumor. Order to generate from tissue rich in blood vessels called the choroid plexus in the brain, you predilection to the fourth ventricle and the lateral ventricles that developed the choroid plexus. The CT and MRI using a contrast agent, it will be rendered in white on the cauliflower-like intraventricular. Is a slow-growing tumor, the principle of treatment is removed in surgery. It is said radiation treatment effect is low, but when there is residual tumor radiation therapy also have been made. That it may be disseminated through the cerebrospinal fluid at the time, inspection over time of the post-operative is also important.
8) brain stem glioma
Tumor that occurs in children and young people, it is a disease of poor prognosis. In order to be a part of the nerve fibers run from the brain is concentrated, not only motor nerve paralysis of the extremities, cranial facial nerve paralysis symptoms, such as eye movement disorder also involves the brain stem. Cranial nerve paralysis on the side opposite to the paralysis of the limbs will appear as a feature. Recognized the great brain stem tumor in MRI and CT, will be enhanced by the white contrast agent as a whole or in part the. In order to be a part that can not be removed by surgery, the purpose of the surgery is kept to a removal of part or the determination of diagnosis, radiation therapy is done. Reduction effect of tumor temporary can be obtained by irradiation, but the treatment effect is very poor, 1-year survival rate is 50 percent.

7 Breast Cancer Awareness Symptom, Diagnosis, Stage, Treatment

1. And breast cancer

The breast of an adult woman, is lined 15-20 pieces radially mammary gland around the nipple. Mammary gland of each are divided into lobules, lobules are connected by (Kuda) tube called ducts. About 90% of breast cancer generated from this milk duct, it is called ductal carcinoma. There are approximately 5-10% breast cancer generated from small leaf, it is called lobular carcinoma. Ductal carcinoma, lobular carcinoma can distinguish test result (pathological examination) with a microscope breast cancer tissue. There is a breast of a special type in addition to this, but it does not give too large. Incidence of breast cancer in women as seen by age (separation) rate began to increase from 30 years of age, and reached a peak around the age of 50, and decreases gradually thereafter. In women, the number applied to the breast cancer is more than three times the number of people who die from breast cancer. This is related to the relatively high survival rate of breast cancer in women. Breast cancer in men is a rare cancer of less than one-hundredth of breast cancer in women in the number of deaths a year, (poor prognosis) survival rate is lower than that of breast cancer in women that has been known. The annual change, has increased consistently in both the morbidity, mortality, birth in the age group, there is a tendency morbidity, mortality rate, the higher the person who was born recently. In international comparison of morbidity, Europe, the United States Caucasian higher than East Asia in particular, has tended to be higher than in Japan residents Japanese immigrants in the United States. Occurrence of breast cancer, the growth, estrogen is a sex hormone has an important role. Among the risk factors that have been previously established, those that affect the estrogen levels in the body are often. It is also that, high estrogen levels in the body in fact, that there is a possibility that as hormones from outside the body, the higher the risk of breast cancer by hormone replacement therapy after menopause and use of oral contraceptives. The physiological and reproductive factors, early menarche age, menopause age is slow, there is no reproductive history, age at first birth that is slow, there is no history of breast-feeding has been a risk factor. In addition, obesity after menopause is a risk factor that has been established, but for premenopausal breast cancer, the risk is lower in obese individuals on the contrary, are almost certain. And also, is that there is a possibility that by drinking habits, the higher the risk of breast cancer, breast cancer risk reduction due to movement are almost certainly in postmenopausal women. Other meals, with respect to nutrients, vegetables, fruit, isoflavones and the like have been noted, but not yet what the basis is aligned well. It is other, a risk factor family history of breast cancer in the first degree, a history of benign breast disease, high density of mammographic findings, well-established breast cancer. In the case of breast cancer, it is thought the cancer cells spilled from mammary gland tissue from a relatively small time, and shape the small metastases (lung, liver, and bone) to organs away from the mammary glands along with the flow of blood and lymph . Symptoms or out of a micrometastasis of these increases, it is called a “distant metastasis” is now or may be detected in the test. For example, the nature of which is a breast cancer called “lung metastasis of breast cancer”, even in the lung, if it has metastasized to the lungs is different from the lungs occur originally as “lung cancer”. This is called a “metastatic breast cancer” will be used as a generic breast cancer with distant metastasis in this way. This is called “recurrent breast cancer” when it is discovered as distinct from the case of having distant metastases already at the time the cancer is found in the breast, make the initial treatment such as surgery. Among the recurrent breast cancer, is called a “local recurrence” that recur in only the part you a surgery. In addition, breast cancer that can not be surgery as it is referred to as “locally advanced breast cancer” because the cancer has been extended to the chest wall or skin. For breast cancer that can be operative without distant metastases, by systemic therapy for micrometastases that may have spilled systemically, that is, be treated by drugs, it is possible to prevent recurrence. I called the “post-operative drug therapy” treatment of such drugs. There is also a case to be performed prior to the surgery the treatment of medicine in recent years, is called a “pre-operative drug therapy” this. Treatment of medicine will be selected by the age and size of the risk of recurrence. There is and the size of the lump, the number of metastatic lymph nodes under the arm to (axillary lymph nodes), and presence or absence of hormone receptors in scale to predict the risk of recurrence of breast cancer. Adding local therapy, such as radiation, depending on the age and risk, and perform medication as a systemic treatment in the case where there is risk of relapse is recommended.

2. Symptom

Lump of 1) breast
Breast cancer is the lump can be seen when it comes to the size of about 1cm from about 5mm, to the touch carefully on your own. However, not all that is breast cancer just because there is a lump.
Skin changes such as dimpling of 2) breast
Breast cancer has reached near the skin of the breast, or can depression such as dimple, red skin tumor or you will be (is). Breast lump is not clear, the skin surface of the breast becomes red as orange peel, when accompanied by fever and a feeling of pain, it is called “inflammatory breast cancer”. Inflammatory breast cancer presents the appearance of such, is because the breast cancer cells is jammed into the lymph vessels in the skin, inflammatory breast cancer is a disease state that is easy metastases systemic much.
Swollen lymph nodes in the vicinity of 3) breast
Lymph nodes in the vicinity of the breast, ie (supraclavicular lymph nodes, breast cancer subclavian lymph nodes lymph nodes above and below the clavicle lymph nodes near the lymph nodes under the arm (axillary lymph nodes), the sternum and (internal mammary lymph nodes) It is easy to metastases), is called the “lymph nodes” and these lymph nodes. You may want to or brought about a numbness in an arm by squeezing the arm nerves or have swollen lymph flow is dammed area lymph nodes and become big, towards the arm.
Symptoms of 4) distant metastases
Symptoms vary depending on the organ that has metastasized, and there may be no symptoms at all. If the lymph nodes in the area other than the lymph nodes are swollen, is called distant lymph node metastasis, it is treated in the same way as metastasis to other organs. Bone metastasis was suspected when such pain hip, back, shoulder persists, if it is possible at a site load is applied there is also a risk of causing fractures (pathological fracture). You may cough and out, breath becomes painful in the case of lung metastases. Symptoms is hard to come out of the liver metastasis, sometimes abdominal or stretched liver is increased, there is no appetite, sometimes pain and jaundice may appear.

3. Diagnosis

1) x-rays (mammography)
Mammography is a test that X-ray imaging and pressure across the device breast. There is that small cancers such as missing in palpation is found. There is also a municipality with respect to women 45-50 years of age or older, has conducted mammography examination once a year as a regular medical examination.
Image Other tests of 2) mammary gland
To lump to diagnose the spread of the disease and whether it is cancer, ultrasound examination of the mammary gland, MRI examination, such as computed tomography (CT) is also useful.
Needle biopsy and cytology 3) needle aspiration cell
If a lump is found, “investigations, even smelt smoke cells to refer to fine needle to lump fine-needle aspiration cytologyGlossary icon by “diagnosis of whether the cancer is confirmed in the case of 80-90%. You may want to obtain a tissue of part of the lump to refer to thick needle to get even more information (needle biopsy). There is also no mention obvious lumps palpation, when abnormality such as those noted by imaging, to perform special needle biopsy called Mammotome biopsy.
Inspection of 4) distant metastases
There are lung, liver, bone, lymph nodes and distant organs as breast cancer is likely to spread. For the diagnosis of whether there is distant metastasis, chest x-rays, ultrasound or CT of the liver, isotope investigation of bone (such as bone scintigraphy) is made.

4. Stage

If the diagnosis of breast cancer with, inspection cancer how spread out in the mammary gland, about what has spread to distant organs is done. The spread of breast cancer, that is classified clinical stage of the five stage (stage) big presence or absence of lymph node metastasis in the size of the breast lump, in the area of ​​the mammary gland, depending on the presence or absence of distant metastases, treatment depending on the clinical stage law will vary.
Stage 0
those that are staying in the mammary gland which breast cancer occurs, it is very early breast cancer. I say “non-invasive (Hishinjun) cancer” and this.
Stage I
It is a stage that seems the size of the lump is below (the size of one yen coin) 2cm, it has not spread to the lymph nodes under the arm, in other words that it has not spread outside the breast.
Stage II
I is divided into stage IIb and IIa period.
IIa period: If the size of the lump is the 2cm or less, there is a transition to the lymph nodes under the arm, or if there is no metastasis to lymph nodes of 2 ~ 5cm Dewakinoshita the size of the lump.
IIb period: If there is metastasis to the lymph nodes of 2 ~ 5cm Dewakinoshita the size of the lump.
Stage III
Referred to as “locally advanced breast cancer”, can be divided IIIa, IIIb, IIIc in period.
IIIa period: The size of the lump is in less than 2cm, there is metastasis to the lymph nodes under the arm, the inside of the sternum And there is no lymph node metastasis of underarm or state, is fixed to the surrounding tissue lymph nodes or has adhered solidly each other If the lymph nodes (internal mammary lymph nodes) is swollen. Or if there is metastasis to lymph nodes inside the chest or underarm at 5cm or more the size of the lump.
IIIb period: It is in the state regardless of the presence or absence of metastasis to the lymph nodes under the arm and the size of the lump, lump or are fixed firmly to the chest wall, skin as swollen skin collapses lump or out the face to the skin. Inflammatory breast cancer are also included in this stage.
IIIc period: Regardless of the size of the lumps, when there is a transition both in lymph nodes inside the chest and the lymph nodes under the arm. Or if there is spread to the lymph nodes above and below the clavicle.
Stage IV
It is if you have metastasized to distant organs. Bone, lung, liver, an organ that is easy to metastasis of breast cancer is such as the brain.
Recurrent breast cancer
After the initial treatment for breast lump, is called the “recurrence” that breast cancer will come out again. Refers to come out on the other organs (called “transition”), is called a “metastatic breast cancer” in conjunction with stage IV breast cancer usually. That you come out in the area of ​​the breast that has the surgery to distinguish the three is called “local-regional recurrence.”

5. Treatment

The treatment of breast cancer, there are surgery, radiation therapy, and drug therapy. Effects can be expected only in the part of performing the radiation therapy and surgery is a “local therapy”, drug therapy will be positioned as a “systemic therapy”.
1) Surgery
This is done in order to excise the cancer that can be breast. I will cut at the same time the normal surrounding tissue, including cancerous tissue. Range to be cut is determined by the spread of cancer in the breast. Usually, at the same time as the resection of breast cancer, I will also cut fatty tissue under the arm, including the lymph nodes under the arm. I call “armpit (axillary) lymph node dissection (poles apart),” and this. The surgery of breast cancer, there is a surgical procedure such as the following. “For rehabilitation after undergoing surgery to remove a breast rehabilitation of mastectomy , please refer to section “.

Surgery to remove a lump in the breast
(1) tumor enucleation
It is a surgical procedure to excise only the breast lump. Be performed when the diagnosis of cancer does not stick to the preoperative needle biopsy and aspiration cytology in many cases, is not as common as cancer surgery.
(2) partial breast resection
In a way that cut a portion of the breast, including lumps, it is called a “breast-conserving surgery.” By spread and site of the lesion, and then cut into a circle by taking a safety margin of about 2cm around the cancer resection or, in a fan shape that is around the nipple. If the lump is large, when the breast cancer has spread within the mammary glands, if there is more than one lump in the mammary gland, it is not an adaptation of conserving surgery as a general rule. Is performed radiation to normal after surgery, to prevent the recurrence of breast in left.

(3) Simple mastectomy
This is called a case of excised all the breast on the side that could be cancer, it is not performed excision of lymph nodes under the arm.
(4) breast muscle-sparing mastectomy
I excised lymph nodes under the arm and breast. In some cases, you may want to separate a portion of the chest muscles. This type of operation is the operative procedure of breast cancer the most common.
(5) pectoral muscle merger mastectomy (Halstead method)
I will cut as well as lymph nodes under the arm and breast, the pectoralis minor muscle and the pectoralis major muscle at the bottom of the mammary gland. This surgery method has been implemented as a standard operative procedure in the past, but it is done only when the cancer has reached the chest muscles now.
The surgery for lymph nodes under the arm
(1) axillary lymph node dissection
Usually, at the same time as the resection of breast cancer, I will also cut fatty tissue under the arm, including the lymph nodes under the arm. I called “axillary lymph node dissection” this. Axillary lymph node dissection is very important in the sense that not only prevent lymph node recurrence in the area of ​​breast cancer, to predict the likelihood of recurrence, consider whether you need a drug therapy after surgery. If you do axillary lymph node dissection, (edema) in and out lymphedema in the arm on the side where the surgery (depending on report but the frequency is 10-20% or so), that the movement disorder and shoulder pain occurs there.
(2) sentinel lymph node biopsy
Is the meaning of “sentry lymph node” in Japanese is a sentinel lymph node, which refers to the regional lymph nodes of breast cancer cells spilled from breast cancer to reach the first. Locate by injecting a dye or radioisotope in the vicinity of the cancer. I have found that in many cases, lymph nodes under the arm becomes the sentinel lymph nodes, when there is no transition to the sentinel lymph node, in many cases, that there is no spread to lymph nodes under the arm. Sentinel lymph node biopsy has been expected as a means to select the patients there is a good possibility even without axillary lymph node dissection, but it is the treatment of the research stage still is now.
Breast reconstruction surgery
It is a surgical procedure to form using the artifact or muscle, my breast lost in surgery to remove the cancer. You can also form a nipple. Please consult with your doctor If you would like to reconstruction.
2) radiation therapy
Has the effect of killing the cancer cells to radiation. Radiation therapy is a local treatment to be effective only in a portion subjected to irradiation. And (the “post-operative radiation therapy” this) if you make for the purpose of preventing the recurrence of the region and breast after you cut the cancer surgery, relieve symptoms caused by lesions of bone pain, such as the transition in breast cancer there are times when it is done to. Amount and range of irradiating the radiation is selected purpose of the radiation treatment, the location of the lesion, such as by size of the lesion. This occurs by radiation is also applied to normal tissue around the lesion, specific side effects will appear in the organ that is included in the region where the radiation struck side effects. For example, inflammation of the digestive tract and skin is expected when it is applied to the lumbar spine radiation.

3) drug therapy
Medicine used in the treatment of breast cancer, are divided into three types hormone therapy, chemotherapy, a new molecular target therapy. The severity depends on the drug to drug therapy, more or less side effects are expected. In addition, there is a difference in attitude in each person to be treated, there are individual differences in side effects. If you receive a drug therapy, that it received a sufficient explanation for such and Countermeasures side effects therapeutic effect the purpose of the medication is expected, expected, to understand is important.
Hormone therapy (see: . 12 hormone therapy drug therapy of cancer )
It is breast cancer of about 70% has a hormone receptor, stimulation of female hormone (estrogen) is to have effect on the growth of breast cancer with hormone receptor. By examining the (progesterone receptor and estrogen receptor) hormone receptors in breast cancer tissue taken at surgery, or breast cancer that is sensitive to female hormones, or breast cancer this is not the case you can see to some extent. Called “hormone-sensitive breast cancer” and “hormone-dependent breast cancer” breast cancers are sensitive to female hormones, the treatment effect of hormone therapy is expected. Ovary is the primary source of female hormones in women ovarian function is active if there is a physiological. In addition, women will celebrate the “menopause” by the action of the ovaries declines as a boundary around the age of 50 usually, menstruation stops. Secretion of female hormones from the ovaries to stop, male hormone that is secreted by the adrenal cortex becomes the raw material, female hormone is produced only by the action of an enzyme called “aromatase” in postmenopausal women. Level of female hormone is reduced to about 1/100 compared to pre-menopausal women with postmenopausal. There are anti-estrogen, selective aromatase inhibitor, and luteinizing hormone secretion stimulating hormone inhibitor in hormone therapy. Used for metastatic breast cancer after surgery or breast cancer “tamoxifen” is an anti-estrogen agent representative, to inhibit binding to the estrogen receptor of the female sex hormone. I suppress the function of aromatase, the mechanism of action of selective aromatase inhibitor, suppresses the production of female hormones in postmenopausal women. In the case of pre-menopausal, you can use the luteinizing hormone secretion stimulating hormone inhibitor to suppress the secretion of female hormones from the ovaries. There are other, and progesterone formulation, but it is not well understood mechanism of action. Side effects of hormone therapy, is characterized by very light in general as compared to the chemotherapy, the risk of thrombosis and uterine cancer, and osteoporosis in the case of selective aromatase inhibitors in long-term users of tamoxifen risk will increase.

Chemotherapy (anti-cancer agent) (see: drug therapy of cancer )
Has the effect of killing the cancer cells and works on the various stages of cell division chemotherapy, breast cancer is a cancer that is easy to respond to chemotherapy relatively. While killing cancer cells, it also acts on cells of normal bone marrow cells of cancer cells other than the mucosal cells of the gastrointestinal tract, such as the hair root cells, decrease in white blood cells, platelets, chemotherapy nausea loss of appetite and, hair loss side effects such as will appear. There is an oral medicine and injection drug chemotherapy used against cancer. Such as the frequency and characteristics of side effects will vary depending on the method of administration and the drug to be used, it is preferable to create a frame of mind to understand them well in advance is important.

New molecular target therapy – Herceptin –
It is believed that 20-30% of breast cancer, has a lot of protein called HER2 protein on the surface of breast cancer cells, the HER2 protein is involved in the proliferation of breast cancer. Treatment you pick off the HER2 recently (molecular targeted therapy) have been developed, and have significantly changed the treatment of breast cancer. Effect is expected only to breast cancer have an excess of the HER2 gene or protein HER2, Herceptin treatment.

6. Assembling the treatment of breast cancer

Depending on the stage, do the treatment in combination surgery, radiation therapy, drug therapy is the treatment of breast cancer. I called the “combined modality therapy” this. Treatment of cancer will change with advances in treatment technology, it is called the “standard of care” and the best treatment based on scientific evidence that has been obtained at that time. However, standard of care is not a “full treatment”. Efforts to scientifically validated the usefulness of the new treatment by the “clinical trial”, increase the outcome of cancer have been conducted at all times in various parts of the world, treatment that is considered standard of current clinical trials, better treatment A new standard of care is born that is if proven. That is the current standard of care is a treatment that has been born out of a stack of clinical trials. Clinical trials are currently being conducted in reverse is the therapeutic capable of being a standard of care in the future, it can be said to be one of the fine treatment options. (Clinical trials for researchers and physicians to practice, part of the clinical trial doctors and pharmaceutical companies and to implement) for clinical trials in patients with breast cancer have been conducted in Japan currently, clinical trials of “cancer The “look you can in and view the information that has been classified into different stages of development.

7. Stage (stage) another treatment

Standard of care for breast cancer varies by stage of disease (stage). Also because there is a case where treatment is different depending on the nature and extent of the cancer at the same stage, please have a sufficient explanation to the attending physician.
Stage 0
Make the irradiation and partial breast resection or mastectomy. We may process the hormone therapy to prevent recurrence in the opposite breast or breast-conserving, after surgery.
Stage I ~ IIIa period
It is a breast cancer surgery can be. Operative procedures (both breast muscle-sparing mastectomy or partial resection,) will be selected by the size of the lump. After the surgery, you can search under a microscope specimens were surgically removed (histopathology). By histopathological examination, the size of the cancer, the number of lymph node metastasis of underarm, histologic atypia index. Grade of which is determined by the form of the cancer cells and the number of (cell division “histological grade Evaluate the risk of relapse is examined also called “), the presence or absence of hormone receptors. And when it is determined that the risk of recurrence is high, medications purpose of according to the size of the risk of recurrence thereof, the status of menstrual age and the presence of hormone receptors and prevent recurrence after surgery (surgery I will do a post-drug therapy). You may also radiation therapy is recommended after surgery depending on the type of operation you have selected and spread of cancer (post-operative radiation therapy). In the case of IIIa period, you may want to make anti-cancer drug therapy earlier or if the lump is greater in stage II, and then to perform the surgery. My name is “preoperative chemotherapy” this. The preoperative chemotherapy, a possibility that can be performed (breast-conserving surgery) surgery to leave the shape of the breast and the smaller good therapeutic effect of the anti-cancer agent is also seen by how shrinkage of breast lump that, come out There are advantages. It turns out that even after in either of chemotherapy and surgery, the order will not affect the ease of recurrence.

IIIb, IIIc period
It is a breast cancer surgery can not in principle. In some cases, the lump is reduced by carrying out drug therapy, radiation therapy, to perform the surgery surgery becomes possible, but the significance of surgery in this stage is not clear yet. Perform the “biopsy” to determine the nature of the cancerous tissue against breast lump before performing medication (to be collected lump or the entire portion, the lump is carried out histopathology). You may want to select a drug to be used based on the result of histopathological examination.
Stage IV
I perform a biopsy of metastatic lesions or lump in the breast. This stage because it is a state in which the cancer has spread throughout the body, there is no sense to be taken by breast surgery. As with breast cancer that has recurred, followed by systemic treatment of drug treatment that is based on the histopathological examination, reduces the progression of cancer, reducing the symptoms of cancer. To relieve symptoms partial due to brain metastasis and bone metastasis, it may radiation or surgery is performed.
Recurrent breast cancer
The (local recurrence), you may want or surgically removed only that part and to do radiation therapy if you have recurrence only or near the location where you have the surgery for breast cancer. In the case of distant metastases was observed, because the cancer has spread throughout the body, you need to do a drug therapy that is systemic therapy in principle, reduce the Gangafueru of it scattered throughout the body. Treatment of drug is selected depending on the nature of breast cancer and the spread of cancer. to cure the disease completely if the cancer has brought about a distant metastasis is difficult. To allow and reducing the progression of cancer, may relieve the pain and other symptoms emitted by transfer, sending without hindrance daily life as possible is the object of treatment. Values ​​of the patient’s own is more important than anything and balance, side effects and therapeutic effects when treatment. Able to build relationships of trust Communicate well with your doctor on a regular basis is very important. In order to take the symptoms and will also topical therapy according to the condition in addition to medications systemic. And go to radiation therapy to bone metastatic sites in fracture pain and risk of nerve compression, when the tension of the abdomen and breathing difficulty is strong, you or remove the water and put a needle malignant pleural effusion, by ascites. Sometimes orthopedic surgery is performed when the nerve is compressed or by bone metastasis, and fracture. In addition, there may be radiation therapy or surgery is performed in the case where it is spread to the brain.