《乳腺癌的临床表现与体征课件.pptx》由会员分享，可在线阅读，更多相关《乳腺癌的临床表现与体征课件.pptx（16页珍藏版）》请在三一办公上搜索。
1、乳腺癌的临床表现与体征,Clinical Manifestation And Symptoms of The Breast Cancer,1,Stage I,II I,Operable I.Breast Cancer Treatment(PDQ)J.,The most common type ofbreast cancerisductal carcinoma,which begins in thecellsof theducts.Cancerthat begins in the lobes orlobulesis calledlobular carcinomaand is more often
2、 found in bothbreaststhan are other types ofbreast cancer.Inflammatory breast canceris 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 of this hospital for manageme
3、nt 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 noted the lesion,digital mammogra
4、phy,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 heterogeneous echogenicity and with irregular mar
5、gins 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、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、乳晕和内上象限。多单发、硬、不光滑、活动欠佳、分界不清。早期肿块尚能活动，中、后期则活动度差，或固定不移。,4,临床表现 Clinical M
6、anifestation,2、乳房外型改变 酒窝征 dimple sign：肿瘤侵及COOPER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。橘皮征: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.局部突起。,5,临床表现 Clinical Manifestation,橘皮征,酒窝征,6,7,3、晚期局部表现 肿块固定。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。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。,临床表现 Clinical Manifestation,8,破溃,临床表现 Clinica
7、l Manifestation,9,4、转移 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。,临床表现 Clinical Manifestation,10,临床表现 Clinical Manifestation,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，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肌淋巴结（rotter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。2.部分乳房内侧的淋巴
8、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,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，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,13,5、特殊类型的乳癌 炎性乳癌 inflammatory breast carcinoma 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。乳头湿疹样癌 Pagets carcinoma of the breast 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，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,乳头湿疹样癌,临床表现 Clinical Manifestation,15,16,Thank you!,
