Diagnosis and treatment of breast cancer

Introduction

Currently, in Japan, about 1 in 12 women are breast cancer, the morbidity rate is the number one in women's cancer, and it is the most malignant tumor in Kumamoto. Breast cancer patients are increasing even overseas, but the mortality rate has declined since the 1990s, unlike Japan. It is believed that this is due to the spread of breast cancer screening by mammography and standardization of postoperative treatment. 

Currently, the treatment of breast cancer is about to change drastically. That is, the so-called targeted treatment of hormone therapy and molecular targeted therapy is the center of breast cancer treatment, and new drugs are introduced one after another, making it a situation where we can not keep an eye on treating breast cancer. I would like to explain recent trends in the diagnosis and treatment of breast cancer like this one.

Diagnosis

The diagnosis of breast cancer in the past was often done by palpation, but recently there are more cases that it is completely unknown by palpation in many cases of surgery. Many of them are microcalcifications found by mammography screening, diagnosis is done by cytodiagnosis, needle biopsy, and mammotome. In addition, it is also true that there are an increasing number of examples to be missed if palpation, such as a small tumor image with ultrasound or disorder of construction with mammography. However, it can be said that the important thing is palpation including self-examinations. For example, there are types of inflammatory breast cancer that do not make lumps such as redness, swelling and hardness enhancement of the skin reminding inflammation. Diagnosis may be difficult with mammography or ultrasound. Palpation is important with this type.

Interview

First of all, at age, those who took breast cancer had become the most frequent at the age of 45 to 50 years, but recently it is increasing at age 60 to 65 and slightly older people. 

The type and content of the patient's past diseases, current condition, etc. are important information that will be a major clue to diagnosis and treatment. 

In the interview, the following things are mainly asked.

What are the symptoms?

When did you notice symptoms?

Have you ever had breast cancer?

Does anyone have breast cancer on their mothers or sisters? (Hereditary breast cancer is considered 5-10% of breast cancer patients.)

Female hormone (estrogen) is greatly related to the onset of breast cancer, and it is said that the longer the period during which female hormone is secreted, the more it is prone to breast cancer. Women without childbirth / lactation experience, women with firstborn age, obese postmenopausal women, and women with a family history of breast cancer are risk factors.

Visual palpation

Size and shape of the breast · position of the left and right papilla · skin condition · presence of secretions from the papilla 

Observe the following points.

Presence or absence of a lump

Presence or absence of secretions from the nipple

When touched the lump check the size, shape, hardness, surface condition of the lump, mobility etc

Recent view of diagnosis

What is important in diagnosis is not only breast cancer but also its personality diagnosis and spreading diagnosis. Personality reflects the prognosis, and treatment methods and correspondence are decided naturally. In addition, although spreading diagnosis is related to breast-conserving surgery becoming widespread in recent years, first of all, understanding the exact cancer spread within the breast, assuming the range of resection, judging whether or not sparing surgery is possible I will do. 

Based on the policy of the Ministry of Health, Labor and Welfare, mammography screening started nationwide, but the screening examination rate is still low at around 30%. Raising this to 50% is the immediate goal. However, it is expected to be accompanied by considerable difficulty. The important thing is enlightenment, then further improvement of the precision institution. The treatment begins only after the correct diagnosis is made. Regarding this point, we would like to cooperate with you and consider examining improvement of the examination rate.

Surgical method

Currently, the proportion of breast-conserving surgery in Japan is over 50%, and preserved surgery is adequately recognized as standard treatment. For that purpose, it is indispensable to carry out postoperative pathologic diagnosis as well as surgical diagnosis of the spread of the surgery. Postoperative radiation therapy is also performed as a standard treatment in many cases, contributing to prevention and reduction of breast recurrence. In addition, in July 2013, breast reconstruction surgery by the tissue expander is insured, and depending on spreading, the number of people who rebuild after mastectomy is increasing. 

Sentinel lymph node biopsy is also commonly performed, and it is already standard treatment. This contributes to maintaining and improving QOL by omitting useless lymph node dissection by sentinel lymph node biopsy. Furthermore, even if there is a slight metastasis in the sentinel lymph node, it is done not to take the lymph node in the back side.

Drug therapy

One of the features of breast cancer is hormone dependence. This indicator will be determined by immunostaining with or without estrogen and progesterone receptor (ER.PgR). The extent of hormone sensitivity is estimated from its stainability, proportion, combination of ER and PgR positive negatives and other biological markers, and appropriate treatment options are selected. 

There is also a lot of evidence regarding the usefulness of chemotherapy, CMF, anthracycline, taxane drugs etc. are used according to the case. 

Molecular target treatment is taking the limelight in recent years, and Herceptin (Trastuzumab) is the representative one. Although it was used in many cases in relapse treatment, it is shown that data to make recurrence risk about half by postoperative use is shown and it is approved as adjuvant therapy after surgery. Thereafter, many medicines such as anti-HER2 therapy, angiogenesis inhibitor, signal transduction inhibitor, etc. of Tykerb, Parga, Cadsaila, etc. have appeared. 

There is preoperative medication as a more important treatment. Chemotherapy is performed when somewhat large tumor or clear lymph node metastasis is recognized, not only enables breast-conserving surgery but also the reactivity of the drug can be confirmed, and attention is also paid in terms of clinical research. It is expected that it will continue to increase more and more in the future, but to that end, it is considered important to make a type that is more responsive.

Rehabilitation after surgery

After surgery, arm and shoulder will be difficult to move, so in order to recover the motor function as soon as possible, rehabilitation of light action starts just after surgery. However, it will be done only in accordance with the patient's surgical operation status and physical condition recovery. 

From about 1 to 2 days after surgery, start with scissors, bending and stretching one finger one by one, gripping the towel firmly, slowly bending elbow, etc. 

About 1 to 3 weeks after surgery, while exercising the elbow and hand, I will take the exercise to move the shoulder joint little by little. Hold the hands together and raise and lower at the same time, put the force with the ball with both hands, grasp the wrist of the operation side with the opposite hand and pull it up.

Measures against lymphedema

When lymph node dissection under the armpits is performed, the flow of lymph may become worse and the arm or hand on the side that has operated may be swollen (edema). One way to help the flow of lymph and relieve swelling is massage. Massage yourself three times a day, once a day about 15 minutes as a guide. There are various ways to massage, but induction massage to bring the accumulated lymph fluids to the whole body is one way to make lymph flow active. 

"Compression dressing for the arm" (sleeve for the upper limb) which presses the whole arm strongly and tightens is also useful. This is aimed at maintaining the state of the arms by massage etc., by applying a strong pressure from the outside to reduce the space where the lymph liquid accumulates. You can also expect a massage effect by putting sleep for upper limbs and moving your arms. In addition, keeping your hands and elbows higher than your heart when you go to bed can also prevent swelling.

in conclusion

Diagnosis and treatment of breast cancer are changing dramatically in this way, and it seems that there is no mistake that it is a situation where we can keep an eye on the development of new drugs in the future. We hope that you will continue to have an understanding and interest in breast cancer.