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.
Cancer Breast 