Chen Xiaoxu, Asang, Ye Fan, Yao Beina - they are all celebrities and "victims" of breast cancer . If breast cancer is detected and treated early, the clinical cure rate is much higher than other cancers, and can reach 90%-95%. But the key is the word "early", as some patients will still relapse.
Today, we will discuss how to prevent and detect the recurrence of breast cancer as early as possible.
Breast cancer patients are most worried about recurrence after surgery, but how to determine their chances of recurrence has always been a confusing issue for everyone. The latest International Breast Cancer Research Organization's risk classification standards for breast cancer recurrence include the following:
1. Low risk: lymph node negative, and have all of the following characteristics:
1. Lesion size (pT) ≤ 2cm
2. tissue The scientific grade or the nuclear grade is grade I
3. The blood vessels around the tumor have not been invaded
4. The HER-2 gene is not overexpressed or amplified
5. Age ≥35 years old
2. Moderate risk: negative lymph nodes, and at least the following One item:
1. Pathologically, tumor infiltration diameter (pT) ≥ 2cm
2. Histological grade or nuclear grade II-III grade
3. Vascular involvement around the tumor
4. HER2 overexpression or neu gene amplification
5. Age ≤ 35 years old
6. 1-3 positive lymph nodes without HER2 overexpression or neu gene amplification, and ER and PR positive
3. High risk:
1.1-3 positive lymph nodes with HER2 overexpression or neu gene amplification
2.1- 3 positive lymph nodes and ER, PR negative
3. 4 or more positive lymph nodes
What are the risk factors for breast cancer recurrence
The number of positive axillary lymph nodes is the most valuable and stable factor among all prognostic factors. Under normal circumstances, a qualified lymph node dissection should remove at least 10 lymph nodes. The greater the number of infected lymph nodes, the lower the patient's survival rate and the higher the recurrence rate.
Tumor size is also a very valuable predictive factor in determining the recurrence and metastasis of breast cancer after surgery. There is a linear logarithmic relationship between tumor size and final metastasis probability. The larger the tumor, the shorter the time for metastasis to occur.
includes histological grading. The higher the histological grade, the greater the risk of recurrence.
HER-2 expression. The risk of recurrence after surgery for HER-2-positive breast cancer will increase.
Lymphatic and blood vessel invasion. If postoperative pathological examination shows invasion of lymphatic vessels or blood vessels, the risk of postoperative recurrence will also increase.
Other risk factors for recurrence include age, hormone receptor status, and whether adjuvant treatment is given after surgery. It is generally believed that patients aged <35>
Five years after breast cancer surgery is the high-risk period for recurrence
To set the anti-cancer pendulum, 1 to 3 years after surgery are the most critical: For breast cancer patients, the five years after breast cancer surgery are the high-risk period for recurrence, with the first year after surgery being the most critical. The risk is highest by 3 years. Once breast cancer recurs or metastasizes, treatment becomes more difficult and may directly threaten the patient's life.
Data show that after breast cancer metastasizes, the survival rate of patients will be significantly reduced. For example, the 25-year survival rate of bone metastasis is about 16%, the 5-year survival rate of lung metastasis is about 12%, and the 5-year survival rate of liver metastasis is about 5%. The annual survival rate is almost zero. .
Generally, breast cancer recurrence occurs in many forms, mainly local recurrence, new contralateral disease, and distant metastasis. Contralateral new breast cancer refers to the occurrence of breast cancer in the other breast after one mastectomy. Usually, after breast cancer occurs on one side, the risk of primary breast cancer on the opposite breast will increase by 3-4 times.
Distant metastasis refers to the metastasis of breast cancer to distant parts of the body through blood vessels, such as lungs, bones, liver and other organs or tissues. Usually nearly 2/3 of breast cancer recurrences lead to distant metastasis of breast cancer, and distant metastasis is the largest cause of breast cancer death. Therefore, experts said that to prevent breast cancer recurrence and metastasis within 5 years, a scientific attitude must be adopted to determine treatment plans, and patients must also be supported with care and encouragement.
How to monitor the recurrence and metastasis of breast cancer
After effective treatment, breast cancer patients should have regular check-ups to keep abreast of their recovery status and whether there is recurrence or metastasis.
Reexamination time: Starting from the month of surgery, follow-up will be conducted every three months in the first year after surgery, every six months in the second and third years, and then annually until life. If you encounter some discomfort at ordinary times, you should go to the hospital for diagnosis and treatment in time.
Review items: First, check whether regional lymph nodes are swollen, whether there are small nodules on the chest wall skin, check bones, lungs, liver, brain and other easily metastasized parts, and conduct regular ultrasound, X-ray, CT, etc. as needed examine.
The body's immune status, such as cellular immune function and immunoglobulin, can also be checked through blood. If the immune function is low, timely correction and precautions should be taken. Blood tests can also detect tumor markers CEA, CA153, SF, etc.
CAl53 is a specific indicator for monitoring breast cancer recurrence, and its monitoring rate is 33.3%-57%. For patients with elevated indicators before treatment, a decrease in monitoring values indicates good curative effect. Patients who do not return to par after treatment have more trouble than those who do.
CEA can increase in 20%-30% of breast cancer patients, and it is more troublesome than normal patients after surgery.
In addition, serum ferritin is also related to disease stage and recurrence. For those tumor markers that are increased before surgery, reexamination can generally be started on the 6th day after surgery until it returns to normal. It should be measured every 3 months in the first year, and every 6 months thereafter. If If it increases, it should be re-examined within 1 month. Two increases indicate the possibility of recurrence or metastasis. It should be noted that not all breast cancer patients will have abnormal tumor markers. If the preoperative result is negative, there is no need for postoperative measurement as a monitoring method.
Follow-up clinic: In order to ensure the integrity of follow-up data, patients (including patients from other places) are required to go to the breast specialist clinic for follow-up within the follow-up time. Follow-up content includes: checking the healing status of surgical wounds; supervising the implementation of postoperative chemotherapy, radiotherapy and other adjuvant treatments; checking for recurrence or metastasis and timely treatment; checking the contralateral breast; and evaluating the efficacy of new drugs and new regimens. Unless there are special circumstances, it is recommended that patients come to the outpatient clinic for follow-up on their own, and a family member should accompany them during the visit.
What are the symptoms of breast cancer recurrence and metastasis?
The main symptoms of bone metastasis are fatigue, bone pain, persistent pain in the shoulders, back, hips, and thighs, which worsen at night;
Patients with lung metastasis usually present with cough, shortness of breath, chest pain, etc.;
Liver metastasis rarely causes clinical symptoms, and only a few show pain, anorexia, and jaundice;
The main clinical manifestations of brain metastasis are headache, vomiting, decreased vision, and impairment of limb movement;
Chest wall tumors or enlarged lymph nodes are not accompanied by any Uncomfortable, usually detected by physical examination.
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