Breast cancer is a common disease in women. The incidence of breast cancer is related to factors such as genetics, diet, radiation, and lifestyle. The incidence of breast cancer has increased in recent years, causing great harm to female friends. For female breast health, early treatment of breast cancer must be effective. Before treating breast cancer, you must first understand the grading and staging of breast cancer so that you can treat it symptomatically. Grading and staging of breast cancer
1. Classic TNM staging.
The basic structure is to comprehensively analyze TNM based on the tumor size (abbreviated as T), whether and the number of lymph node metastases (abbreviated as N), and whether there is distant organ metastasis (abbreviated as M) to determine the risk of breast cancer. installment. The value of TNM, anatomical and pathological tumor staging, for predicting tumor recurrence and metastasis cannot be underestimated, and it is a relatively mature risk assessment indicator in clinical practice.
Primary tumor (T) stage: Tx The status of the primary tumor is unknown (has been removed). T0 The primary tumor is not palpable. Tis carcinoma in situ (including lobular carcinoma in situ and intraductal carcinoma), Paget's disease is limited to the nipple, and no mass is palpable in the breast. T1 tumor has a maximum diameter less than 2cm. T2 tumors have a maximum diameter of 2 to 5 cm. T3 tumor has a maximum diameter exceeding 125px. T4 Tumors of any size that directly invade the chest wall and skin (including inflammatory breast cancer).
Regional lymph node (N) stage: N0 regional lymph nodes are not palpable. The status of Nx regional lymph nodes is unknown (resected in the past). N1 The axillary lymph node on the ipsilateral side is swollen and can be moved. N2 The axillary lymph nodes on the same side are enlarged, fused with each other, or adhered to other tissues. N3 There is metastasis to the internal mammary lymph node on the same side, and metastasis to the subclavian and superior lymph nodes on the same side.
Distant metastasis (M) stage: Mx Whether there is distant metastasis is unknown. M0 No distant metastasis. M1 distant metastasis.
2. Practical clinical staging.
Different clinical stages can be formed according to different TNM, which is also the most commonly used stage for clinicians to explain the condition to patients and their families.
3. Pathological classification and histological grading.
Breast cancer pathological tissue morphology is relatively complex and there are many types, and more than two types can coexist in the same piece of cancer tissue or even in the same slice. Each type of breast cancer has different comprehensive treatment methods and prognosis, and clinical treatment plans must also take into account the pathological type and histological grade. At present, the international and domestic pathological classification of breast cancer is still not unified in practical application.
(1) Currently, the following pathological classifications are mostly used in China.
1. Non-invasive cancer. < /p>
③Intraductal papillary carcinoma;
④Nipple eczematous breast cancer. This type is early stage and has a better prognosis.
2. Early invasive cancer.
① Early invasive ductal carcinoma (cancer cells break through the basement membrane of the duct wall and begin to infiltrate into the interstitium);
② Early invasive lobular carcinoma (cancer cells break through the terminal milk duct or The acinar basement membrane begins to infiltrate into the stroma, but is still limited to the lobules). This type is still in the early stage and the prognosis is good. (Early invasion means that the invasive component of cancer is less than 10%).
3. Invasive cancer.
(1) Invasive special cancers: papillary carcinoma, medullary carcinoma (with massive lymphocyte infiltration), canalicular carcinoma (well-differentiated adenocarcinoma), adenoid cystic carcinoma, mucinous adenocarcinoma, large Sweat gland-like carcinoma, squamous cell carcinoma, etc. This type of disease is generally highly differentiated and has a good prognosis.
(2) Invasive non-specific cancer: including invasive ductal carcinoma (the most common type in clinical practice), invasive lobular carcinoma, hard carcinoma, medullary carcinoma (without massive lymphocyte infiltration), and simple carcinoma , adenocarcinoma, etc. This type is generally poorly differentiated and has a worse prognosis than the above types. It is the most common type of breast cancer, accounting for 80%. However, the prognosis needs to be combined with factors such as disease staging.
4. Other rare cancers.
(2) Histological grading standards.
The relationship between tumor histological grade and patient prognosis has long attracted the attention of oncologists. The degree of differentiation of breast cancer is closely related to the prognosis, but the various grading standards vary greatly.
The histological grading of breast cancer is mainly evaluated from the following three aspects:
1. The degree of glandular duct formation.
2. Pleomorphism of the nucleus.
3. Mitotic counting.
Grading standards for the diagnosis and treatment of common malignant tumors in my country:
1. Glandular duct formation: ① A score of 1 is found if there are many obvious glandular ducts. ② Moderately differentiated glandular ducts are scored as 2 points. ③Cells growing in solid patches or cords are scored as 3 points.
2. The size, shape and chromatin of the cell nucleus are irregular. ① The size, shape and chromatin of the cell nucleus are consistent and the score is 1 point. ② Moderately irregular nuclei are scored as 2 points. ③ Score 3 if the cell nucleus is obviously pleomorphic.
3. Increased chromatin and mitotic phase (?400) ①1/10HPF is 1 point. ②2～3/10HPF is 2 points. ③>3/10HPF is 3 points.
The scores determined by the three indicators of each standard are added up. 3 to 5 is divided into grade I (well differentiated), 6 to 7 is divided into grade II (moderately differentiated), and 8 to 9 is divided into III. grade (poor differentiation).
4. Molecular typing (new classification based on gene level).
In recent years, molecular typing of breast cancer based on DNA microarray technology and multi-gene RT-PCR quantitative detection methods has been used to predict the risk of recurrence and metastasis of breast cancer and its response to treatment. Currently, it is often used Combining the molecular subtyping of gene chip technology with immunohistochemistry, breast cancer can be clinically divided into four categories [55-57]: Luminal A (ER+/PR+, HER-2-), Luminal B (ER+) /PR+,HER-2+), HER-2+ type (ER-/PR-/HER-2+) and Basal-like type (ER-/PR-/HER-2-). Different molecular subtypes of breast cancer have different clinical treatment responses and survival times, which have attracted more and more clinical attention.
5. Risk classification (2007 St, Gallen***).
According to the patient’s age, tumor size, hormone receptor status, tumor cell grade, vascular tumor thrombus, HER2 status, and lymph node status, in 2007 St. Gallen expert consensus classified them into low, The groups at medium and high risk of recurrence provide a basis for clinicians to choose appropriate treatment options. Breast Diseases Causes of Breast Cancer
Causes of Breast Cancer 1:
Early menarche and late menopause. The relative risk of breast cancer increases by 2.2 times when the age of menarche is younger than 12 years old compared with older than 17 years old. People older than 55 years old with amenorrhea have twice the risk of breast cancer than those younger than 45 years old. Early menarche and late menopause are the two main risk factors for breast cancer.
Cause 2 of breast cancer:
Genetic factors. Studies have found that women whose mothers had bilateral breast cancer before menopause have a risk of developing breast cancer that is nine times higher than that of other women. Moreover, the average age of breast cancer in the second generation of breast cancer patients is about earlier than that of the average person. About 10 years. If a woman among her sisters has breast cancer, the risk is three times that of ordinary people. It needs to be emphasized that breast cancer is not directly inherited, but is a kind of "cancer predisposition" inheritance. Relatives of breast cancer patients are not necessarily affected by breast cancer, but they are more likely to develop breast cancer than the average person.
Three causes of breast cancer:
Marriage and childbirth. Epidemiological studies have shown that even if a woman is married but is infertile or has her first child after the age of 30, it is also a disadvantage. However, the risk of breast cancer for unmarried women is twice that of married women. Experts believe that childbirth has a protective effect on the breast, but only refers to those who have full-term births before the age of 30. Studies in recent years believe that breastfeeding has a protective effect on the occurrence of breast cancer, mainly in premenopausal women.
The fourth cause of breast cancer:
Ionizing radiation. The breast is a tissue that is sensitive to the carcinogenic activity of ionizing radiation. Young people are in the active stage of breast mitosis and are most sensitive to the carcinogenic effects of ionizing radiation. The effects of ionizing radiation are additive. Multiple small-dose exposures have the same risk as one large-dose exposure, with a dose-effect relationship.
Five causes of breast cancer:
Unhealthy eating habits. The incidence and mortality of breast cancer are strongly related to the amount of digested fat per capita.
The high income of some company employees has led to high living standards, resulting in unscientific and unhealthy high-calorie, high-fat eating habits. As a result, the incidence of breast cancer has greatly increased.
Six causes of breast cancer:
Unhealthy lifestyle. Some female white-collar workers who have been working in offices for a long time sit more and move less, lack exercise, and have less exposure to sunlight. Most professional women wear bras tightly for a long time due to their work, and it is difficult to loosen their breasts. Some professional women are forced by the pressure of work or the pursuit of career success and live a single aristocratic or DINK life without starting a family or having children. .
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