乳腺癌英文版解读

1、乳腺癌英文版解读乳腺癌英文版解读第1页乳腺癌英文版解读第2页Anatomy乳腺癌英文版解读第3页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 长小树。内部乳腺癌英文版解读第4页乳腺癌英文版解读第5页1. IntroductionWestern countries100/100,000stable incidencedeclined mortalityChina7-10% of all malignancies2nd most common Cancer in China3% yearly increase rate乳腺癌英文版解读第6页2. E

2、tiologyHormonal influenceLong duration of reproductive life NulliparityLate age at first childFunctioning ovarian tumorFibrocystic disease Radiation exposure Obesity Genetic predisposition乳腺癌英文版解读第7页3. Pathological typing一、Noninvasive breast carcinoma二、Early invasive breast carcinoma三、Special types

3、of invasive breast cancer四、Ordinary types of invasive breast cancer-most special type： 1. Inflammatory breast cancer 2.Pagets carcinoma of the breast 乳腺癌英文版解读第8页Supraclavicular nodesSubclavicular nodesInternal mammary nodessubareolar plexusLymphatic metastasis乳腺癌英文版解读第9页5. Clinical Findings Site: Mo

4、stly in outer upper quadrant It is the high-risk area乳腺癌英文版解读第10页 outer upper quadrant 50%Central zone 20% 10% outer lower quadrant 10% inner lower quadrant inner upper quadrant 10%Breast Anatomy(Left) Site乳腺癌英文版解读第11页Palpable painless lumpLocal protrusionChanges in skin and nippledimple signOrange-

5、peel signNipple retraction and inverted nippleHuge mass and ulcerationEczematoid change over areola or nipple Inflammatory breast cancerPresentation in breast 乳腺癌英文版解读第12页Palpable painless lumphard, irregular shape, rough surface, low mobility80% in the upper half of the breast乳腺癌英文版解读第13页Local prot

6、rusion asymmetrical bilateral breasts change in shapeasymmetric breastchange in shape乳腺癌英文版解读第14页Change in skin- Delle and dimple signDelle: visible skin retractiondimple sign: pinched skin retraction invasion of Coopers ligaments and breast duct incomplete fixation of skin乳腺癌英文版解读第15页Change in skin

7、- orange-peel sign thickening of skindermal edema induced by invasion of lymphatic vessels乳腺癌英文版解读第16页Change in nipple- nipple retraction and inversion differentiated from congenital nipple retraction invasion of mammary ducts乳腺癌英文版解读第17页 Change in nipple & areola- eczematoid change (Pagets disease)

8、 low malignant degree, slow development better prognosis 90% accompanied by invasive cancer乳腺癌英文版解读第18页Huge mass and ulceration- locally advanced carcinoma 20% of all cases 50% in elderly women (70 yr)乳腺癌英文版解读第19页Inflammatory breast cancer high malignant degree, fast development, poor prognosis youn

9、ger women乳腺癌英文版解读第20页5.3. Clinical presentation distal metastasisAxillary Lymphadenectasis Bone metastasis local pain, fracture Liver metastasis liver enlargement, jaundice(黄疸)Lung metastasisChest pain, dyspnea乳腺癌英文版解读第21页Clinical presentation axillary临床表现腋窝 palpated movable, ipsilateral axillary no

10、des fixed or fused ipsilateral axillary nodes ulcerative ipsilateral axillary nodes乳腺癌英文版解读第22页Mammography乳房X线摄影术Screening tool(筛选工具)Age of 40Estimated reduction in mortality 15-25%10% false positive rate乳腺癌英文版解读第23页Mammography 乳腺癌英文版解读第24页乳腺癌英文版解读第25页Diagnosis -biopsyFNAC（fine needle aspiration cyt

11、ology） Cytology70% accuracyCore needle biopsyHistology90% accuracyAvoid excisional biopsy乳腺癌英文版解读第26页Meaning Guidance for therapeutic approachesPrediction of recurrence riskPrediction of therapeutic responseStaging criteriaPrimary tumorsNumber of metastatic lymph nodesDistal metastasisStaging乳腺癌英文版解

12、读第27页8. Treatment principleSurgery radical mastectomy (Halsted) Extensive radical mastectomy modified radical mastectomy Breast conservative surgery Sentinel axillary LN biopsy乳腺癌英文版解读第28页8.1. Operation methods (1) radical mastectomy Remove the pectoral major and small chest muscles乳腺癌英文版解读第29页(2) E

13、xtended radical mastectomy扩充根治术further remove the internal thoracic vessels and surrounding lymph nodes乳腺癌英文版解读第30页(3) modified radical mastectomy+ axillary dissection改良根治术+腋窝淋巴结切除乳腺癌英文版解读第31页Sentinel lymph node-SLN前哨淋巴结The SLN is the first regional lymph node draining the primary tumor. If the canc

14、er has spread, it is most likely to find metastases in the SLN. SLN（）， axillary regional lymph node negative乳腺癌英文版解读第32页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 need

15、le biopsy 乳腺癌英文版解读第33页The choice of the tracer示踪剂选择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 乳腺癌英文版解读第34页The dose and the location At pr

16、esent, 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 .乳腺癌英文版解读第35页化学染色剂放射性同位素前哨淋巴结乳腺癌英文版解读第36页染料法SLNB乳腺癌英文版解读第37页SLNB the latest data repo

17、rt 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.

18、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 .乳腺癌英文版解读第38页Evaluation of SLNB SLNB

19、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 乳腺癌英文版解读第39页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 pati

20、ent, their disease-free survival and overall survival differences had no statistical significance. AS to patient with positive SLN, only accept SLNB safe probably. 乳腺癌英文版解读第40页Timing neoadjuvant chemotherapy and SLNB新辅助化疗与SLND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 chemo