distant metastasis of breast cancer
Introduction
Introduction The first two to three years after early breast cancer surgery is the peak of recurrence. Even after receiving the traditional drug tamoxifen, there is still a risk of recurrence. 75% of these relapsed patients will have bone, lung, liver, bone marrow, brain and ovary. The distant transfer of organ tissues, and these distant metastases are often life-threatening. Data show that breast cancer patients with distant metastasis have a mortality rate of 75% within 5 years after diagnosis, and patients with distant metastases have an intermediate survival time of only 18-24 months.
Cause
Cause
Breast cancer can metastasize to almost any part of the body, and distant metastasis is the leading cause of death in breast cancer patients.
It can directly invade the skin, chest fascia and chest muscles. It can also be metastasized early through lymph node metastasis or blood circulation. Lymph node metastasis is most common.
It is usually lymph node pathway blood or direct invasion of blood vessels and blood to the lungs, bones and liver.
1. Pulmonary metastasis of breast cancer: The lung is the most common metastatic site of breast cancer. 70% of untreated breast cancer patients have already had lung metastasis. The lung metastasis of breast cancer can be metastasis of blood, lymphatic metastasis or direct Infringement.
2, bone metastasis of breast cancer: is also a common metastatic symptoms of breast cancer, breast cancer is prone to bone metastasis, in the past, even patients with pathological fractures as the first symptom of breast cancer, clinical multiple bone metastases Commonly, 60% of patients with untreated breast cancer develop bone metastasis, and bone metastasis of breast cancer is mainly caused by blood transfer. Thoracic and lumbar vertebrae and pelvis are the most common sites of bone metastasis in breast cancer, accounting for 64.7% and 41.2%, followed by ribs (more common in adjacent areas), bone, femur, skull, and sternum. The transfer rate is the lowest, about 3.5%.
3, liver metastasis of breast cancer symptoms: the liver is one of the most common metastatic sites of breast cancer, about 60% of untreated breast cancer patients will have liver metastasis, bringing difficulties to the treatment of patients, often late breast cancer The main reason for treatment failure. Liver metastasis is mainly caused by hematogenous metastasis and lymphatic metastasis, especially hematogenous metastasis.
Examine
an examination
Related inspection
Breast lymph node experiment chest B-ultrasound needle biopsy erythrocyte enolase cancer antigen 15-3 (CA15-3)
Local recurrence of breast cancer is a sign of distant metastasis. Premenopausal, node-negative patients with a tumor diameter of less than 2 cm or no vascular infiltration, local recurrence rate (with or without distant metastasis) is low, the 10-year recurrence rate is 8%. If the tumor is larger than 2 cm or has vascular invasion, the local recurrence rate is significantly increased to 19%, and the corresponding recurrence rate in postmenopausal women is 16%.
Studies suggest that tumor size and vascular invasion can be an indicator of the risk of recurrence in patients. Since the risk of local recurrence is close to 20%, this group of patients should receive postoperative adjuvant radiotherapy.
For patients with positive lymph node metastasis, the number of lymph nodes and histological grade are predictors of local recurrence before and after menopause. The researchers believe that this emphasizes the importance of accurate pathology for resected specimens because tumor size and vascular invasion provide additional prognostic information. For lymph node-positive patients, the 10-year local recurrence rate was 35% and 34%, respectively, before and after menopause.
Diagnosis
Differential diagnosis
Lymphatic metastasis: It is the most common form of metastasis of cancer. It refers to the invasion of tumor cells through the lymphatic wall. After shedding, the lymph fluid is brought to the lymph nodes of the confluence area, and the same tumor is grown as the center.
Lymph node metastasis: Generally, the lymph nodes closest to the tumor are first reached, and then to the distant distance, when the tumor cells infiltrate and grow at each station, they also spread to the adjacent lymph nodes in the group. However, there are exceptions. In some patients, it is also feasible to bypass the lymph nodes in the pathway to directly transfer to distant lymph nodes. The mode of clinical transfer is called a jump transfer. These features increase the complexity of tumor metastasis, resulting in clinical lymph node metastasis that is difficult to find the primary lesion.
The liver is an organ that is prone to metastasis of various malignant tumors and is one of the most prevalent sites for metastatic cancer. Liver metastasis refers to the non-hepatic primary tumor that can be transferred to the liver via the blood or lymphatic pathway. Common liver metastases are mostly from the digestive tract, lung, pancreas, kidney and breast.
Pulmonary metastasis: generally refers to the deterioration of malignant tumors and metastasis to the lungs. The lung is the only place for systemic blood flow, and its abundant capillary bed is a high-efficiency filter, which is a good site for the metastasis of various malignant tumors. 20 to 54% of people who die of malignant tumors have lung metastasis, and 15% of the lungs are the only metastatic site. The occurrence of lung metastases is generally thought to be that the tumor cells stay in the bifurcation of the small arteries or capillaries of the lungs, adhere to the endothelium of the capillaries to form a clot, and pass through the wall of the tube into the connective tissue outside the blood vessels, and then the cells Hyperplasia, becoming a small tumor, forming metastatic tumors.
Bone metastasis: It is the transfer of some primary diseases through the blood. Breast cancer is the cancer most prone to bone metastasis. Breast cancer is the most common malignant tumor in the female breast, and it is also one of the most common malignant tumors in women.
Local recurrence of breast cancer is a sign of distant metastasis. Premenopausal, node-negative patients with a tumor diameter of less than 2 cm or no vascular infiltration, local recurrence rate (with or without distant metastasis) is low, the 10-year recurrence rate is 8%. If the tumor is larger than 2 cm or has vascular invasion, the local recurrence rate is significantly increased to 19%, and the corresponding recurrence rate in postmenopausal women is 16%.
Studies suggest that tumor size and vascular invasion can be an indicator of the risk of recurrence in patients. Since the risk of local recurrence is close to 20%, this group of patients should receive postoperative adjuvant radiotherapy.
For patients with positive lymph node metastasis, the number of lymph nodes and histological grade are predictors of local recurrence before and after menopause. The researchers believe that this emphasizes the importance of accurate pathology for resected specimens because tumor size and vascular invasion provide additional prognostic information. For lymph node-positive patients, the 10-year local recurrence rate was 35% and 34%, respectively, before and after menopause.
