Breast Cancer

Noninvasive cancer

It is an early cancer staying inside the duct or in the leaflets. Since the risk of metastasis is low, it will be nearly 100% cured by resection by surgery.

Invasive cancer

It means that it extends to the outside of ducts and leaflets. As cancer cells flow into blood vessels and lymph vessels, it may spread to surrounding lymph nodes and organs other than the breast.

Paget's disease

Paget's disease is a special type of breast cancer spreading around the circumference, occurring in the breast duct near the nipple without making a lump, showing symptoms like dermatitis. Normally it does not cause metastasis and is a cancer with a good prognosis.

Eczema, redness and erosion of the papilla become clues for the discovery.

Breast lump

Breast cancer becomes about 1 cm from about 5 mm, you will be able to find it yourself.
There is no pain first.

• Change in breast skin
  When breast cancer occurs near the skin of the breast, the skin turns red and swells and a dimple is made.

papillary secretions

When cancer cells reach the papilla, secretions mixed with blood come out from the teat.
Noninvasive cancer has increased subjective symptoms such as a lump without being subjective symptoms, but the rate at which it is discovered in medical examinations is increasing, but sometimes it is noticed abnormally by blood secretion from the nipple.

Depression of the nipple and depression of the breast

It may appear by cancer reaching the breast's skin or near the papilla.

Inflammatory Breast Cancer

Although no obvious lump can be found, the skin on the breast surface becomes red like the skin of the orange, causing pain and heat. This is because breast cancer cells are packed in the lymphatic vessels of the skin.

Inflammatory breast cancer is a pathological condition that is likely to cause systemic metastasis. Swollen lymph nodes near the breast Breast cancer tends to spread to the regional lymph nodes near the breast, and as regional lymph nodes become larger, the flow of lymph is blocked, arms swollen, nerves to the arm You may squeeze and cause numbness in your arms.

Paget's disease

Eradication of the nipple and eczema of the surrounding skin are seen.

Swollen lymph nodes near the breast

When metastasizing to lymph nodes near the breast, the lymph nodes may swell, the surrounding nerves may be pressed, and the arms may become numb and numb.

Symptoms of distant metastasis

The symptoms are different depending on the metastasized organs. If lymph nodes other than regional lymph nodes are swollen, they are called remote lymph node metastasis and are treated like metastasis to other organs.

Bone metastasis is suspected when waist, back, shoulder pain persists, there is a danger of fracture if it is made in the part to which load is applied.

In case of pulmonary metastasis, coughing may occur or breathing may become painful.

Metastasis of the liver is less likely to cause symptoms, but as the liver grows, the abdomen may stretch and appetite may disappear, and pain and jaundice may result.

Main risk factors of breast cancer

• Menarche age is young
• Long period from menarche to menopause
• Elderly first-age (or no birth history / lactation history)
• Obesity after menopause
• I have a benign breast disease
• Families (especially mother and sister) have become breast cancer
• Heavy weight at birth
• Long-term enforcement of hormone replacement therapy (combination therapy with progesterone)
• Exposure to radiation
• smoking
• night work
• High intake of alcohol

X-ray shooting (mammography)

Mammography is an examination in which breasts are sandwiched between apparatuses and squeezed and radiographed.
Small cancers that can not be found by palpation may be found. I climb the breast with a transparent plate, spread it flatly and take a picture, I will look at the mammary gland really called breast duct in detail.
At this time, if cancer is suspected, there may be a lump of lumps different from the surroundings or a calcified state in which calcium deposited on the duct is seen to sand.
Even with these symptoms, not everything is malignant.

• Shooting method
  Standing in front of the device barely upper body bare, place the breast on the equipment shooting table. There is a plastic plate called a compression plate in the device, which strongly presses the breast against the imaging table and presses it to a thickness of about 4 to 5 cm. Shoot with the breast at the specified thickness. Normally, you shoot a total of 4 images, each with 2 images, changing the shooting direction vertically and horizontally, respectively.
  • Sensitivity is said to decrease when breast tissue is low in fat and there are many glands (high breast density).

3D mammography

Mammography (2D - MMG) compresses the breast and takes pictures with X - rays, but this may be difficult to understand because the parts of the mammary gland tissue overlap because of the thickness of the mammary gland tissue.
For postmenopausal patients, it is easier to understand because mammary gland decreases and fat tissue increases, but judgment becomes difficult for young people and those with many mammary glands by all means.
In 3D mammography (3D-MMG), images are picked up from a plurality of directions at different shooting angles, the collected data are three-dimensionally reconstructed to eliminate overlapping images, and lesion judgment is made by mammography (2D- MMG) is easier.

• It is effective for the following patients.
  • For young people with thick breast tissue
  • Those who were considered precision inspections with mammography
  • Worried person of local recurrence after breast cancer surgery

Breast ultrasonography (echo)

Lie on your back on the examination table, apply jelly to the skin, hit the probe (terminal) and observe the interior of the breast. There is no pain, there is little burden on the body.
During the examination, the examination room will be darkened to make the screen easier to see. It is an inspection that finds a small lump (lump) of several mm and can understand the properties of the lump in detail. I can not see fine calcification.

Automated Breast Ultrasound System (AUBS)

Scan the entire breast like a copy and inspect the breast from various directions.
It is a device that can express images like CT and MRI because images can be constructed in three dimensions.
The inspection data can be saved temporarily and review can be reviewed by temporarily saving it.

Dense Breast

In the case of dense breasts, ultrasonic examination (echo), which is not affected by the mammary gland and the cancer is depicted black, is suitable.

For women with high mammary gland density in breasts, breast tissue appears white in mammography and cancer cells also appear white, making it difficult to distinguish cancer.

Breast Magnetic Resonance Imaging (MRI)

Mammary gland MRI examination is an examination that images and diagnoses breast lesions using an MRI apparatus that generates strong magnetic force. You can differentiate between breast tumor and normal breast tissue. In principle, we will inspect with gadolinium contrast medium.

• Gadolinium contrast medium
  Compared to iodinated contrast agents, the incidence of side effects is said to be low, but there are side effects such as nausea, vomiting, urticaria, pruritus, rash etc.

MRI inspection has the advantage that you can adjust the contrast of the image by changing shooting conditions and obtain tomographic images from any direction such as vertical, horizontal, diagonal. It is also effective for examining the condition of the mammary gland after surgery, and it is also done as a regular examination.

• Shooting method
  Remove metallic objects such as accessories from the body, put a metallic coil dedicated to breasts, will be in a stomach posture on the bed. A strong magnetic field super-electric device is automatically moved to the chest, and shooting is performed.

• • Fast spin echo method (FSE method)
    After photographing the T1 weighted image (fat is white and the tumor appears black) and T2 weighted image (fat is black and tumor is white), dynamic imaging using Gd-DTPA contrast agent is performed and finally the contrast Take a later T1 weighted image.
  • Take T1 emphasized images with the contrast agent while adjusting (fat suppression) so that fat does not appear strongly from the beginning.

CT (computed tomography)

It is a special X-ray tomography system that uses a computer to display the cross section of the body. It is effective for finding distant metastasis to other organs such as the lung, liver, brain, etc. because the range to shoot is wide.

Bone Scintigraphy

It is an exam for examining the transfer of breast cancer to bone. We will check the presence or absence of metastasis by injecting radioactive material (isotope) and utilizing the property of isotope gathering in the bone with metastasis.
It is often done when it is judged that the possibility of metastasis to bone is high and it may not be done for early breast cancer.

Positron mammography (PEM)

It is based on the principle of positron emission tomography (PET), and the radiation detector is applied to the breast to image. It does not have pain like mammography, it has high precision and the shooting range is also wide.

Positron emission tomography (PET) inspection

I inject a radioactive test drug that cancer cells take more than normal cells into the body and photograph the radiation generation site. Since PET examination is whole-body shooting and the spatial resolution is 5 mm, breast cancer cells can only be imaged.

puncture aspiration cytology

Puncture Aspiration cytology is a method of ultrasound guided piercing a small needle into a lump in the breast, sucking the cells, blowing it onto the glass, staining it, and examining the properties of the cells with a microscope.

There is a little bit of pain as it stabs the needle, but local anesthesia is not required and there are no marks of injection left. On the other hand, because it uses a thin needle, the amount of cells that can be harvested is very small, so accurate diagnosis may be difficult.
Cytodiagnosis is often done to estimate whether it is benign or malignant, and in order to be confirmed as cancer it is necessary to have an organizational examination to collect more tissues.

secretion fine herpes

The secretion solution from the nipple (nipple) is taken in an object glass or physiological saline, and the property of the cells in it is examined microscopically.

Needle biopsy (biopsy)

It is an examination to investigate the cause of the symptom by collecting the diseased tissue by stabbing a thick needle in the lesion.
Needle biopsy is divided into core needle biopsy and aspiration breast tissue biopsy, depending on the type of machine used to collect tissue. Both are examined using local anesthesia to reduce pain.

Core needle biopsy / puncture needle aspiration inhalation examination

It is a method of inserting a thick needle (usually 14 gauge) into a lesion under ultrasonic guidance, cutting out and collecting tissue pieces, and pathologically diagnosing with a microscope.

Suction type breast tissue biopsy / mammotome biopsy (negative pressure aspiration type needle biopsy under stereo mammography guide)

If palpation can not find a clear lump and abnormality is pointed out only by image examination, a special needle biopsy called mammotome biopsy may be performed.

Multiple large pieces of tissue can be collected with one collection.
It is possible to perform biopsy of microcalcification foci and microscopic lesions which are difficult to diagnose more reliably.

Inspection of distant metastasis

There are lungs, liver, bones, lymph nodes, etc. as distant organs where breast cancer tends to spread easily.
To diagnose whether there is distant metastasis, chest radiography, liver CT and ultrasound examination, bone isotope examination (bone scintigraphy), etc. are performed.

sentinel lymph node biopsy

Sentinel lymph node biopsy is a method to investigate whether there is an axillary lymph node metastasis with less burden.

Sentinel lymph nodes (watch-around lymph nodes) are lymph nodes that are most likely to develop lymph node metastasis of breast cancer first.
In other words, if there is no metastasis in this sentinel lymph node, it is considered that no metastasis has occurred in other lymph nodes.

If you find this sentinel lymph node before surgery and you can confirm that there is no metastasis in the lymph node by microscopic examination, unnecessary lymph node dissection can be omitted. As a result, postoperative complications can be prevented.

Surgical Therapy

I will do it to resect the cancers made in the breast. We will simultaneously resect normal surrounding tissues including cancer tissue.

Tumor nuclear surgery

It is an operation to resect only breast lump. Aspiration cytology or needle biopsy is often done when cancer diagnosis is not available, it is not common as cancer surgery.

If you strongly suspect cancer, you should resect about 1 cm from the cancer. Also called breast circular partial resection.

partial breast excision

It is a method of resecting a part of the breast including a lump and is called "breast conservation surgery".

Depending on the site and spread of the lesion, it is cut out in a fan shape centered on the nipple, or it is cut to a circle taking a safe area of about 2 cm around the cancer.

Included in this are breast sector partial resection to remove one fan duct duct system.

If the lump is large, when breast cancer is spreading within the mammary gland, if there are multiple lumps in the mammary gland, no preservation operation will be performed.

We usually irradiate after surgery to prevent recurrence in the remaining breasts.

Breast simple resection

I will remove all breasts on the cancer side and do not remove muscles, lymph nodes under the armpits.

Pectoral muscle preserving mastectomy

I will resect the lymph nodes under the breast and armpits. In some cases, you may cut off part of the chest muscle. The most common breast cancer surgical method.

There are two things: Petty surgery that leaves only the pectoralis major muscle, and otinclos surgery that leaves both the pectoralis major and pectoralis muscle. I will do both lymph node dissection.

Pectoral muscle combined mastectomy (Halstead method)

Besides breast and underarm lymph nodes, remove the large pectoral muscle and pectoral muscle under the mammary gland. It is done when cancer reaches chest muscle.

Axillary lymph node dissection (surgery for lymph nodes under the armpit)

Axillary lymph node dissection prevents lymph node recurrence in the area of breast cancer. It is also very important to predict the likelihood of recurrence and to judge whether drug therapy is necessary after surgery.

• Side effects of axillary lymph node dissection
  Lymphedema (swelling) may appear on the arm on the side of the operation, shoulder pain or movement disorder may occur.

sentinel lymph node biopsy

Sentinel lymph nodes are found by injecting radioisotopes or pigments near cancer.

In many cases, the lymph nodes under the armpit will be sentinel lymph nodes, but when there is no metastasis in the sentinel lymph node, we know that there is no metastasis in the lymph nodes under the armpits.

subcutaneous mammary total cure

Total chemotherapy with subcutaneous mammary gland leaves the skin, papilla, and isola from small scratches and totally eliminates the mammary glands to compensate for the disadvantages of total cure (skin lack, papillary / island lack, large scratches).

As with preserving surgery, survival rate is the same even if the total surgery is done from the beginning even if the total surgery is performed after the local recurrence. Scratches are not noticeable and natural breast reconstruction becomes possible.

Skin Sparing Surgery

I leave the skin and totally pick out the nipple / isola and mammary gland.

breast reconstruction surgery

It is an operation to form breasts lost by surgery to remove cancer using their own muscles, or artifacts. You can also form a papilla.

For details, please refer to the page of breast reconstruction

Radiation therapy

Radiation has the effect of killing cancer cells. In breast cancer, it may be done to relieve symptoms of metastatic lesions such as bone pain, if it is done for the purpose of preventing recurrence of the breast and its area after resecting the cancer by surgical operation.

• Radiation side effects
  It also occurs by irradiation of normal tissues around the lesion.
  Specific side effects will appear depending on the irradiated organs. The main side effect is dermatitis.

Accelerated breast partial irradiation method (APBI)

Without applying radiation to the entire breast, concentrate on the excised part and apply strong radiation. Simultaneously with the operation, or after the operation, pierce the breast with about 5 to 15 plastic tubes with a diameter of 2 mm, centering on the site from which the cancer was removed.

Pass the iridium (brachytherapy) radiation material 1 mm long and 5 mm long connected to the tube with a metal wire.
Operate with the equipment and irradiate partial irradiation while moving. The dose is 6 gray at a time. Treatment of about 10 minutes each time twice a day ends in 3 days.

During treatment, stay in the hospital and stab the tube and pull out 6 times after the irradiation is over. Advantages Compared to whole breast irradiation, the effect of radiation on the heart and lung is small.

• cost
  If you include public health insurance, including hospitalization expenses etc, you will bear the burden of tens of thousands of yen (in case of 30% burden) almost equal to the total breast irradiation.

Hormonal therapy

Drugs used to treat breast cancer are roughly divided into three types: hormone therapy, chemotherapy, and molecular target therapy.
There are individual differences in drug therapy, but large and small side effects occur. About 70% of breast cancers with hormone receptors have hormone receptors, and breast cancer with hormone receptors is said to have stimulation of female hormone (estrogen) affecting cancer proliferation.

Hormone receptor (estrogen receptor and progesterone receptor) examination It is examined whether it is breast cancer which is susceptible to female hormone or not, by doing in breast cancer tissue taken by surgery.
Breast cancer susceptible to female hormones is called "hormone-sensitive breast cancer" or "hormone-dependent breast cancer", and treatment effect by hormonal therapy is expected.

• On female hormones
  In women with menstruation and active ovarian function, the ovaries become the main source of female hormones. Also, in postmenopausal women, the secretion of female hormones from the ovaries is stopped and male hormones secreted from the adrenal cortex are used as raw materials, and female hormones are slightly produced by the action of an enzyme called "aromatase" . In postmenopausal women, the level of female hormone decreases to about 1/100 of that before premenopause.

Hormone therapy drugs

Antiestrogens, selective aromatase inhibitors, luteinizing hormone secretion stimulating hormone inhibitors, and the like.
Side effects of hormonal therapy are generally characterized by being extremely lighter than chemotherapy.

Antiestrogen agent

• Norvadex tablets, Tasuomin tablets (generic name: tamoxifen citrate)
  It is used for breast cancer surgery and for metastatic breast cancer.
  It inhibits the binding of female hormones to the estrogen receptor.
• side effects
  When used for a long time, there is a risk of uterine cancer or thrombosis.

Selective aromatase inhibitor (AI)

Treatment of hormone receptor positive postmenopausal breast cancer has been replaced by aromatase inhibitor from tamoxifen. Postoperative adjuvant therapy has an effect of suppressing recurrence beyond tamoxifen, medication after tamoxifen treatment has an effect of improving survival rate more than treatment without treatment.

• Femara tablet (generic name: letrozole)
• Aromasin tablets (generic name: exemestane)
• Arimidex tablets (generic name: Anastrozole)
  Combined administration with anti HER2 monoclonal antibody preparation "for Herceptin injection" (generic name: trastuzumab) is successful
  • side effects
    Since bone mass decreases, ingenuity to make good use of bisphosphonate preparations that increase bone mass is necessary.
    • Actonel tablet (generic name: risedronate sodium hydrate)
    • Fosamak tablets (generic name: sodium alendronate hydrate)
    • Benet Tablets (generic name: Risedronate sodium hydrate)
    • Bonaron tablets (generic name: sodium alendronate hydrate)
    • Dyron 'nel tablet (common name: disodium disodium etidronate)

Gonadotropic hormone secretion inhibitor

• For Leupline Injection (generic name: leuprorelin)
  Leuplin inhibits secretion of gonadotropin. Therefore, it has the function of suppressing proliferation of prostate cancer and premenopausal breast cancer which are hormone-dependent cancers.
  Leuplin is a set of powder and liquid, if you inject both subcutaneously before use, the medicine continues to dissolve at a constant rate over a month.
  • side effects
    Hot flashes, hot feeling, hot flashes, stiff shoulders, headache, insomnia, dizziness, sweating, joint pain, bone pain
    Liver dysfunction, decreased libido, emotional instability, nausea, vomiting, illegal hemorrhage
    Jaundice, ulcer, depression, etc.

Progesterone (luteinizing hormone) secretion stimulating hormone inhibitor

In the premenopausal case, we suppress the secretion of female hormones from the ovary.

Chemotherapy (anti-cancer drug)

Chemotherapy has the effect of working on various stages of cell division to kill cancer cells, breast cancer is said to be relatively easy to respond to chemotherapy.

While chemotherapy kills cancer cells, it also acts on normal cells such as bone marrow cells other than cancer cells, mucosal cells of the gastrointestinal tract, hair root cells, etc., resulting in decreased white blood cells, platelets, decreased nausea and loss of appetite, depilation Side effects such as.

Chemotherapy includes injections and internal medicine. Depending on the drug to be used and its administration method, the characteristics and frequency of side effects vary.

Main anti-cancer drugs

Representative anticancer drugs used for breast cancer include the following, which is represented by an initial letter.
C

• Endox tablet (generic name: cyclophosphamide) alkylating agent

M

• Methotrexate tablets (generic name: methotrexate) Antimetabolites

F

• 5-FU tablet (generic name: 5-fluorouracil) anti-metabolite

A

• For Adriacine Note (Generic name: Adriamycin) Anthracycline series

E

• Forarmorubicin injection (generic name: epirubicin hydrochloride) Anthracycline series

T

• Taxotere for intravenous infusion (generic name: docetaxel hydrate) taxane system
• Taxol injection (generic name: paclitaxel)
• Abraxane for intravenous infusion (generic name: paclitaxel)

combination therapy

• CMF therapy
  Combine cyclophosphamide, methotrexate, fluorouracil. I do it mainly when there is no lymphatic metastasis.

• CAF therapy
  It is a combination of cyclophosphamide, doxorubicin, fluorouracil.
• AC therapy
  It is a combination of cyclophosphamide and doxorubicin.
• CEF therapy
  It is a combination of cyclophosphamide, epirubicin, fluorouracil.

Other anticancer agents

• Yufuti Capsule (generic name: Tegafur / Urashil)
  It is an anticancer drug whose hair can not escape. It is necessary to continue drinking every day for 2 years.

Molecular targeted therapy

It is a treatment with a drug that specifically acts only on cancer cells. It shows antitumor effect mainly by sticking to cancer cells or suppressing only the enzymes necessary for cancer cell proliferation.

Herceptin treatment

20% to 30% of breast cancers have a lot of proteins called receptor HER2 protein on the surface of breast cancer cells, and this HER2 protein is thought to be involved in breast cancer proliferation.
Herceptin treatment is applied only to cancer with metastatic breast cancer spreading beyond the breast or breast cancer with excessive receptor HER2 protein or HER2 gene. I will treat it by attacking this HER2 protein.

• For Herceptin Injection (generic name: trastuzumab molecular targeted drug)

• • side effects
    Nausea, headaches, fatigue, etc. may also appear, but there is not much frequency. Although it is less frequent, it may cause serious cardiac function deterioration and respiratory failure.
  • Serious side effects
    There are reports of interstitial pneumonia, bone marrow suppression, hepatic disorder, hepatic disorder, kidney disorder, cerebrovascular disorder, etc.

Bone metastasis treatment

When breast cancer metastasizes to bone, there may be cases of merger of pain and fracture. It is understood that bone metastasis involves osteoclasts (bone-destroying cells) in the bones, and work is accelerated.
Bisphosphonate preparations and denosumab are drugs that suppress the action of osteoclasts. These administrations will prevent pain and fractures.

• Poria subcutaneous injection syringe (generic name: denosumab)