乳腺癌-英文版

Breast Cancer,Anatomy,Anatomy,乳房主要由腺体、 导管、脂肪组织 和纤维组织等构 成。其内部结构 有如一棵倒着生 长的小树。内部,1. Introduction,Western countries100/100,000stable incidencedeclined mortalityChina7-10% of all malignancies2nd most common Cancer in China3% yearly increase rate,2. Etiology,Hormonal influenceLong duration of reproductive life NulliparityLate age at first childFunctioning ovarian tumorFibrocystic disease Radiation exposure Obesity Genetic predisposition,3. Pathological typing,一、Noninvasive breast carcinoma二、Early invasive breast carcinoma三、Special types of invasive breast cancer四、Ordinary types of invasive breast cancer-most special type： 1. Inflammatory breast cancer 2.Pagets carcinoma of the breast,Lymphatic metastasis,5. Clinical Findings,Site: Mostly in outer upper quadrant It is the high-risk area,outer upper quadrant 50%,Central zone 20%,10% outer lower quadrant,10% inner lower quadrant,inner upper quadrant 10%,Breast Anatomy(Left) Site,Palpable painless lumpLocal protrusionChanges in skin and nippledimple signOrange-peel signNipple retraction and inverted nippleHuge mass and ulcerationEczematoid change over areola or nipple Inflammatory breast cancer,Presentation in breast,Palpable painless lump,hard, irregular shape, rough surface, low mobility80% in the upper half of the breast,Local protrusion,asymmetrical bilateral breasts change in shape,asymmetric breast,change in shape,Change in skin- Delle and dimple sign,Delle: visible skin retraction,dimple sign: pinched skin retraction,invasion of Coopers ligaments and breast duct incomplete fixation of skin,Change in skin- orange-peel sign,thickening of skindermal edema induced by invasion of lymphatic vessels,Change in nipple- nipple retraction and inversion,differentiated from congenital nipple retraction invasion of mammary ducts,Change in nipple & areola- eczematoid change (Pagets disease),low malignant degree, slow development better prognosis 90% accompanied by invasive cancer,Huge mass and ulceration- locally advanced carcinoma,20% of all cases 50% in elderly women (70 yr),Inflammatory breast cancer,high malignant degree, fast development, poor prognosis younger women,5.3. Clinical presentation- distal metastasis,Axillary Lymphadenectasis Bone metastasis local pain, fracture Liver metastasis liver enlargement, jaundice(黄疸)Lung metastasisChest pain, dyspnea,Clinical presentation- axillary临床表现-腋窝,palpated movable, ipsilateral axillary nodes fixed or fused ipsilateral axillary nodes ulcerative ipsilateral axillary nodes,Mammography乳房X线照相术,Screening tool(筛选工具)Age of 40Estimated reduction in mortality 15-25%10% false positive rate,Mammography,Diagnosis -biopsy,FNAC（fine needle aspiration cytology） Cytology70% accuracyCore needle biopsyHistology90% accuracyAvoid excisional biopsy,Meaning Guidance for therapeutic approachesPrediction of recurrence riskPrediction of therapeutic responseStaging criteriaPrimary tumorsNumber of metastatic lymph nodesDistal metastasis,Staging,8. Treatment principle,Surgery radical mastectomy (Halsted) Extensive radical mastectomy modified radical mastectomy Breast conservative surgery Sentinel axillary LN biopsy,8.1. Operation methods (1) radical mastectomy,Remove the pectoral major and small chest muscles,(2) Extended radical mastectomy扩大根治术,further remove the internal thoracic vessels and surrounding lymph nodes,(3) modified radical mastectomy+ axillary dissection改良根治术+腋窝淋巴结切除,Sentinel lymph node-SLN前哨淋巴结,The SLN is the first regional lymph node draining the primary tumor. If the cancer has spread, it is most likely to find metastases in the SLN. SLN（）， axillary regional lymph node negative,SLNB indications适应症,SLNB(Sentinel Lymph Node Biopsy 前哨淋巴结活检 ) -clinical axillary lymph node negative patients 。However，patients with positive axillary lymph nodes after the fine needle biopsy,The choice of the tracer示踪剂的选择,Combination of radioactive isotopes and chemical dyeing agent can significantly improve the detection positive rate and accuracy .The effect of the radioactive isotope is better than that of chemical stain,The dose and the location,At present, many scholars have conducted the shallow injection such as the the areola, subcutaneous, and intradermal injection, and got similar results with deep injection , and appear the acceptable false negative rate .,化学染色剂,放射性同位素,前哨淋巴结,染料法SLNB,SLNB the latest data report,1. Combined use of methylene blue（亚甲蓝） and nuclide（核素） tracer mark sentinel lymph node (99.5% ) ,which makes patients negative SLN better avoid ALND.2. SLN positive rate and the primary tumor size significantly correlated, appearing patients with smaller tumor should choose SLNB to replace ALND. 3. The result of a median follow-up of 26 months show patients with negative SLN, use SLNB and replace LND, and axillary recurrence rate is low ；4.SLNBcan significantly reduce the occurrence of postoperative complications and improve the patients quality of life .,Evaluation of SLNB SLNB 评价,If axillary lymph nodes is palpable and needle aspiration cytology is negative, half of the axillary lymph node is no metastasis , these patients can avoid ALND,SLNB positive without ALND or axillaryRadiation therapy SLNB阳性而未进行ALND或辅助放疗,Comparing SLN negative patient with positive patient, their disease-free survival and overall survival differences had no statistical significance. AS to patient with positive SLN, only accept SLNB safe probably.,Timing neoadjuvant chemotherapy and SLNB新辅助化疗与SLND的时机,In recent years, most scholars have reached a consensus that neoadjuvant chemotherapy should be done before SLNB。Reasons：The results of the latest survey Neoadjuvant chemotherapy can change axillary po