1、乳腺癌的临床表现与体征乳腺癌的临床表现与体征Clinical Manifestation And Symptoms of The Breast Cancer1Stage I, II I, Operable I. Breast Cancer Treatment (PDQ)J.The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular car
2、cinoma and is more often found in both breasts than are other types of breast cancer.Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.2临床表现 Clinical Manifestation A 36-year-old woman was seen in the multidisciplinary breast cancer clinic o
3、f this hospital for management of hormone-receptorpositive breast cancer. Approximately 3 months earlier she noted a lump in her right breast. Her primary care provider palpated a mass, adjacent to the nipple, in the upper central quadrant of the right breast. Approximately 2 months after she first
4、noted the lesion, digital mammography, performed at another hospital, showed heterogeneously dense breast parenchyma, with no discrete mass, architectural distortion, or suspicious microcalcifications. The same day, ultrasonography of the breast revealed a mass, 1.3 cm by 1.2 cm by 0.9 cm, of hetero
5、geneous echogenicity and with irregular margins along the inferior and lateral borders, located at the 12 oclock position, 5 cm from the nipple. The patient declined to have a biopsy performed later that day.3临床表现 Clinical Manifestation 1 1 、肿块、肿块 首发症状多为无意发现的无痛性肿块首发症状多为无意发现的无痛性肿块 常位于外上象限，其次在乳头、常位于外上
6、象限，其次在乳头、乳晕和内上象限。多单发、硬、不光滑、活动欠佳、分界不清乳晕和内上象限。多单发、硬、不光滑、活动欠佳、分界不清。早期肿块。早期肿块尚能活动，中、后期则活动度差，或固定不移。尚能活动，中、后期则活动度差，或固定不移。4临床表现 Clinical Manifestation 2 2、乳房外型改变、乳房外型改变 酒窝酒窝征征 dimple signdimple sign：肿瘤侵及肿瘤侵及COOPERCOOPER韧带，使其收缩而失去弹性，牵拉皮肤所致。韧带，使其收缩而失去弹性，牵拉皮肤所致。 乳头偏移或回缩：肿瘤侵及入乳管收缩所致。乳头偏移或回缩：肿瘤侵及入乳管收缩所致。 橘皮征橘皮征
7、: :肿瘤细胞堵塞皮肤和皮下淋巴管致使皮肤水肿，毛囊处出现点状凹陷，形似桔皮样肿瘤细胞堵塞皮肤和皮下淋巴管致使皮肤水肿，毛囊处出现点状凹陷，形似桔皮样. . 局部局部突起。突起。5临床表现 Clinical Manifestation 橘皮征橘皮征酒窝征酒窝征673 3、晚期局部表现晚期局部表现 肿块肿块固定。固定。 卫星结节卫星结节 癌细胞浸润表面大片皮肤，表现为局部多数坚硬的结节。癌细胞浸润表面大片皮肤，表现为局部多数坚硬的结节。 皮肤破溃皮肤破溃 肿瘤向外生长突破皮肤，形成坏死溃疡，易出血感染，有恶臭。肿瘤向外生长突破皮肤，形成坏死溃疡，易出血感染，有恶臭。 临床表现 Clinical
8、Manifestation 8破溃破溃临床表现 Clinical Manifestation 94 4、转移转移 淋巴淋巴转移多为同侧腋下淋巴结转移，少有对转移侧。早期淋巴结先是散转移多为同侧腋下淋巴结转移，少有对转移侧。早期淋巴结先是散在、活动好，以后数目增多、融合；甚至可和皮肤及深部组织粘联。晚在、活动好，以后数目增多、融合；甚至可和皮肤及深部组织粘联。晚期可出现上肢淋巴水肿、锁骨上淋巴结肿大。远处常见肺、骨、肝转移。期可出现上肢淋巴水肿、锁骨上淋巴结肿大。远处常见肺、骨、肝转移。临床表现 Clinical Manifestation 10临床表现 Clinical Manifestati
9、on 淋巴引流淋巴引流1.乳房大部分淋巴液经胸大肌外侧缘淋巴管流至腋窝淋巴结，乳房大部分淋巴液经胸大肌外侧缘淋巴管流至腋窝淋巴结，再流向锁骨下淋巴结再流向锁骨下淋巴结(75%)。部分乳腺上部淋巴液可流向胸大小。部分乳腺上部淋巴液可流向胸大小肌淋巴结（肌淋巴结（rotter淋巴结），直达锁骨下淋巴结。通过锁骨下淋淋巴结），直达锁骨下淋巴结。通过锁骨下淋巴结后，淋巴液继续流向锁骨上淋巴结。巴结后，淋巴液继续流向锁骨上淋巴结。2.部分乳房内侧的淋巴液通过肋间淋巴管流向胸骨旁淋巴结。部分乳房内侧的淋巴液通过肋间淋巴管流向胸骨旁淋巴结。3.两侧乳房间皮下有交通淋巴管，一侧乳房的淋巴液可流向另两侧乳房间皮
10、下有交通淋巴管，一侧乳房的淋巴液可流向另一侧。一侧。4.乳房深部淋巴网可沿腹直肌鞘和肝镰状韧带通向肝乳房深部淋巴网可沿腹直肌鞘和肝镰状韧带通向肝11临床表现 Clinical Manifestation 12前哨淋巴结是原发肿瘤引流区域淋巴结中的特殊淋巴结，前哨淋巴结是原发肿瘤引流区域淋巴结中的特殊淋巴结，是原发肿瘤发生淋巴结转移所必经的第一批淋巴结。是原发肿瘤发生淋巴结转移所必经的第一批淋巴结。临床表现 Clinical Manifestation 135 5、特殊类型的乳癌、特殊类型的乳癌 炎性乳癌炎性乳癌 inflammatory breast carcinomainflammatory
11、 breast carcinoma 多多见于妊娠期或哺乳期的年轻妇女。表现为乳腺明显增大，皮肤充血、发红、发热，犹见于妊娠期或哺乳期的年轻妇女。表现为乳腺明显增大，皮肤充血、发红、发热，犹如乳腺炎。体检：乳腺肿大发红发硬，多无局限性肿块。该类型乳癌发展快，预后极差如乳腺炎。体检：乳腺肿大发红发硬，多无局限性肿块。该类型乳癌发展快，预后极差。乳头乳头湿疹样湿疹样癌癌 Pagets carcinoma of the breastPagets carcinoma of the breast 初初发乳头刺痒、灼疼。以后表现为乳头处呈慢性湿疹样改变：发红、溃烂、潮湿、结痂，发乳头刺痒、灼疼。以后表现为乳头处呈慢性湿疹样改变：发红、溃烂、潮湿、结痂，反复交替进行。局部有或无肿块。预后好，恶性程度低、转移少见。反复交替进行。局部有或无肿块。预后好，恶性程度低、转移少见。临床表现 Clinical Manifestation 14炎性乳癌炎性乳癌 乳头湿疹样癌乳头湿疹样癌 临床表现 Clinical Manifestation 1516Thank you !
