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1、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 countries 100/100,000 stable incidence declined mortality China 7-10% of all malignancies 2nd most common Cancer in China 3% yearly increase rate,2. Etiology,Hormonal influence Long duration of re
2、productive life Nulliparity Late age at first child Functioning ovarian tumor Fibrocystic 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 in
3、vasive 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,i
4、nner upper quadrant 10%,Breast Anatomy(Left) Site,Palpable painless lump Local protrusion Changes in skin and nipple dimple sign Orange-peel sign Nipple retraction and inverted nipple Huge mass and ulceration Eczematoid change over areola or nipple Inflammatory breast cancer,Presentation in breast,P
5、alpable painless lump,hard, irregular shape, rough surface, low mobility 80% 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 sk
6、in retraction,invasion of Coopers ligaments and breast duct incomplete fixation of skin,Change in skin - orange-peel sign,thickening of skin dermal edema induced by invasion of lymphatic vessels,Change in nipple - nipple retraction and inversion,differentiated from congenital nipple retraction invas
7、ion 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 cance
8、r,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 metastasis Chest pain, dyspnea,Clinical presentation - axillary临
9、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 40 Estimated reduction in mortality 15-25% 10% false positive rate,Mammography,Diagnosis -biopsy,FNAC（fine needle aspira
10、tion cytology） Cytology 70% accuracy Core needle biopsy Histology 90% accuracy Avoid excisional biopsy,Meaning Guidance for therapeutic approaches Prediction of recurrence risk Prediction of therapeutic response Staging criteria Primary tumors Number of metastatic lymph nodes Distal metastasis,Stagi
11、ng,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 mastect
12、omy 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 fi
13、nd 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,Co
14、mbination 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 a
15、s 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.
16、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.SLNB can significantly reduce the occurrence of postoperative complications and improve the patient
