Breast cancer (BC) is a malignant tumor that occurs in the epithelial or ductal epithelium of the breast.
North America and Northern Europe are high incidence areas. China is a low incidence area, but its incidence is increasing year by year. Beijing, Tianjin, Shanghai and coastal cities are high incidence areas of breast cancer. Mainly in women, male breast cancer accounts for about 1%. It is rare before 20 years old. The incidence of the disease increases gradually after 30 years of age, at the age of 40-50, and the incidence of postmenopause continues to rise.
Most of the early breast cancers have no obvious symptoms, and most of them are found in the health survey. Common symptoms include breast mass, nipple change, skin and shape changes, breast pain, regional lymph node enlargement, and organ involvement after distant metastasis.
The etiology of breast cancer is not fully understood. It may be related to family history and breast cancer related genes, reproductive factors, sex hormones, nutrition and diet, environmental factors and so on.
The common detection methods of breast cancer include X-ray, ultrasonography, MRI examination, PET-CT and bone scan. However, in order to identify the nature and understand the characteristics, pathological range and biological characteristics of the breast cancer, pathological examination is necessary.
The treatment was divided into new adjuvant therapy, auxiliary treatment and rescue treatment. The specific treatment includes surgical treatment, chemotherapy, radiotherapy, targeted therapy and endocrine therapy. We should follow the principle of individualized treatment and choose the treatment according to the biological behavior of cancer.
Treatment
The target of breast cancer treatment:
The treatment of 0, stage I, stage I, and stage III is to be cured as much as possible, and the stage IV is palliative treatment.
1. Neoadjuvant therapy
Neoadjuvant chemotherapy
1. It can reduce the size of the primary tumor and reduce the staging of the tumor, which is beneficial to the resection of the tumor and the chance of keeping the breast. For the patients with high stage of breast cancer, the tumor can be reduced obviously, the clinical stage is reduced, and the prognosis is improved.
2. Guide the choice of chemotherapy
Taking the size of primary tumor as the standard of evaluation, we observed the changes of tumor size, pathology and biological indicators before and after treatment, and intuitively understood whether tumor is sensitive and effective to chemotherapy drugs and programs. We found that some insensitive chemotherapeutic drugs were adjusted in time to replace effective chemotherapeutic drugs, providing a credible basis for developing effective chemotherapy programs, and improving the effect of chemotherapy.
3, pCR can be obtained in some breast cancer patients. The more important meaning of pCR is the impact on the forward survival rate. NSABP B-18 of the selected 1523 cases of breast cancer patients 10 years of follow-up, the primary tumor response to chemotherapy is good (CR and PR) significantly increased the survival rate and the metastasis of axillary lymph nodes negative patients, especially pCR patients 5 year survival rate was 85%, pCR did not get the 5 year survival rate 58%.
Two. Breast reconstruction
The purpose is to make the patients get the most survival benefits, as well as to restore the female image as much as possible, reduce the psychological trauma and improve the quality of life.
Three. Adjuvant therapy
1, the significance of adjuvant endocrine therapy has been confirmed, tamoxifen between premenopausal and postmenopausal breast cancer patients showed good curative effect, effectively reduce the metastasis rate of breast cancer recurrence and improve disease-free survival and overall survival rate: aromatase inhibitors in the treatment of postmenopausal breast cancer positive effect, the latest reports the tumor free survival rate and overall survival rate after treatment is better than tamoxifen and aromatase inhibitors, the adverse reactions were quite [1,2].
2, adjuvant biological targeting drugs are mainly trastuzumab Herceptin and tyrosine kinase inhibitor Lapatinib, which can be applied or combined with chemotherapy at the end of chemotherapy. The literature reports can effectively improve the therapeutic effect of breast cancer [3].
Four, recurrent metastatic breast cancer
The purpose of the treatment is to relieve the symptoms, improve the quality of life and prolong the life of the patients. The strategy for prolonging the survival of patients with recurrence and metastasis is rational selection of comprehensive treatment, selection of the best first-line treatment and follow-up treatment. Systemic systemic therapy is mainly combined with rational local treatment.
General rule of treatment:
The principle of staging treatment is strictly mastered: excessive treatment or insufficient treatment should be avoided, which is the prerequisite for standardized and comprehensive treatment.
1. the principle of equal weight with the whole body: breast cancer is a systemic disease. In the treatment, we should pay attention to the planned and rational local treatment and general treatment. The effective treatment for local recurrence of breast cancer is surgery and radiotherapy, and the effective methods for distant dissemination are chemotherapy, endocrine therapy and biological therapy. The choice of treatment should be based on a comprehensive assessment and analysis of prognostic and predictive factors in the clinical data of the individual, should take into account two. These include tumor histology, clinical and pathological features of primary tumors, axillary lymph node status, tumor hormone receptor level, expression level of Her-2, metastatic lesions with or without detectable disease, complications, age and menstrual status of patients. Patients with an obvious tendency to diffuse systemic dissemination were given general treatment first and treated with local treatment after the disease was controlled.
2. the principle of individualized treatment: the individualized treatment according to the different pathological stage of disease, illness, and the patient's general condition, get the best effect at the same time, as far as possible to reduce the adverse reaction caused by treatment, improve the quality of life, as far as possible to save health resources. Endocrine therapy is the best example of individualized treatment for breast cancer. Many years of clinical practice have proved that only hormone receptor positive breast cancer patients can be treated with endocrine therapy. Clinically, ER, aromatase, and luteinizing hormone releasing hormone (LHRH) receptors are commonly used targets in endocrine therapy. The syndrome differentiation and treatment of traditional Chinese medicine is also a form of individualized diagnosis and treatment. The people of qi deficiency and yin deficiency are prone to tumours, and at the same time, the tumor will lead to Qi deficiency and yin deficiency at a certain stage. Radiotherapy and chemotherapy can cause or aggravate the yin deficiency. Through the syndrome differentiation of qi deficiency, yin deficiency or deficiency of Qi and Yin, the patient's disease can be alleviated. Patients' requirements are also important factors affecting decision-making, especially when alternative treatments have the same survival rate. The age of patients is also important factors deciding treatment strategies, for example of patients over the age of 70, due to the lack of chemotherapy related clinical data for this group of patients, there is no unified chemotherapy treatment strategy, therefore, the choice of chemotherapy in patients over 70 years old should follow the individual principle, should fully consider the complications. The application of microarray technology to analyze breast cancer molecular heterogeneity and guide clinical individualized treatment has also been widely concerned. Although there are still many problems to solve before the technology is put into clinical application, it is an important direction of individualized treatment of cancer.
3., according to evidence-based medical evidence, the principle of choice of treatment is whether standardization or individualized treatment is inseparable from evidence-based medicine, and clinical practice is the standard for testing therapeutic effect. The results based on large-scale randomized clinical trials and meta-analysis have an important guiding role in clinical practice. More attention should be paid to evidence-based medical evidence in the treatment.
4. constantly summing up the principle of experience: Clinicians should not only summarize the experience of success, but also be good at analyzing the causes of failure. There are many reasons for the failure of treatment, such as sequential arrangement of treatment, chemotherapy plan, dosage and treatment course. Another important reason is that little is known about the prognostic factors of breast cancer, and it is not effective for patients with high risk of recurrence.
