In my early thirties, male breast cancer, this small probability event happened to me.
In February 2021, during a change of clothes, I inadvertently touched my left chest and felt a little pain. Touching it with my hand, it turned out that there was a lump just below the left nipple, and it was soft and soft to press, but it was painful.
"Daughter-in-law, you see, I have a lump here, is it a cyst?" A few years ago my daughter-in-law had a cyst behind her ear and had to go to the hospital for surgery and drainage. Because of this experience, I subconsciously felt that my chest was an ordinary cyst.
At that time, I also joked with my daughter-in-law in a serious way: "It may be breast cancer, and men will also get breast cancer." "Then we started discussing whether to go to the hospital to see it, whether we should hang up breast surgery, general surgery or dermatology. After some research, I finally hung up the breast surgery specialist number of a top three hospital nearest to home.
Is it a cyst?
The boy was more or less embarrassed to see the mammary glands, so I dragged my daughter-in-law with me. On the day of the visit, the doctor first squeezed the lump of my left breast with his fingers, then opened a B ultrasound examination, saying: "You can continue to observe, if it gets bigger, do a small operation to cut it off." ”
The ultrasound concluded that it was an epidermoid cyst, and incidentally also found that my bilateral breast was developed. After the doctor of breast surgery saw the result of ultrasound B, he suddenly realized and said with a slightly relaxed tone: "It's just an epidermoid cyst!" "Then he told me to come back if the cyst got bigger.
I think the cyst will get smaller on its own, just don't bother much, life will go as usual, and work will continue to be the whole of my life.
Ultrasound results of "epidermoid cysts" 丨 Author courtesy of the author
There is even a solid part!
The time is August 2021, for nearly a month or two, I obviously feel that my body is prone to fatigue, five days a week after work and two days of weekend rest can not be relieved, and the left half of the body often has obvious discomfort. These were not good signs, so I made up my mind to go to the hospital for surgery to remove the mass. This time, I chose another top three hospital near my home, and before I went, I also consulted online to make sure that general surgery could handle it.
Therefore, I chose a deputy chief physician of general surgery, whose specialty is "minimally invasive and comprehensive treatment of benign and malignant breast diseases". The doctor was both professional and decisive, as well as humorous, which made me less afraid of unknown diseases. He asked me to do another B ultrasound, and the B ultrasound doctor first agreed with the cyst, but carefully analyzed and said: "Your cyst, or there is a solid part, and then look for a doctor." ”
Combined with the results of B ultrasound, the deputy chief physician told me three points: (1) my joke with my daughter-in-law may come true, and men will also get breast cancer; (2) we must treat it as soon as possible, early breast cancer is only the size of a fingernail cap, and the prognosis of surgical treatment is good; (3) there is a patient, when the lump is found, it grows to 7 cm, missing the best treatment time, which is a pity.
I asked what "capsule solidity" meant, and he explained to me, "In layman's terms, there is a lump of flesh, so there is a possibility of malignancy." So, on the advice of the doctor, I decided to operate on it.
Ultrasound examination results of "cystic solid masses" 丨 Author courtesy of the author
"Your pathological results are not very good"
The surgery went well, and on August 26 I was hospitalized, the next afternoon the operation was performed, with local anesthesia, which ended in half an hour, and then directly discharged from the hospital.
The resident doctor instructed me to wait for the pathological results of the excision and not to notify if it was benign. The doctor gave me a two-week sick leave, but I only took 2.5 days off, went to the hospital on the morning of August 30 to change my medication, and went to the company in the afternoon to arrange the work plan for September. As a result, at 3:30 p.m. that day, I received a call from the hospital: "Is it the patient himself?" Your pathological results are not very good and you need to do immunohistochemistry... Hurry up and register, and then go to the pathology department to pay the fee, remember? ”
The three words "not good" hit me instantly, and from the B ultrasound doctor's sentence "there is a solid component in the cyst", I had a bad premonition. But I remained calm and asked the doctor on the other end of the phone two questions: "What do you mean that the pathological results are not good?" What is immunohistochemistry? ”
The doctor patiently explained to me: "The pathology of the excision, found that there are alien cells. Alien cells are abnormal cells, immunohistochemistry is to go to the molecular level to determine what the specific alien cells are..." The doctor once again instructed me to register quickly, and could not delay any longer, and hung up the phone.
At this time, my heart was in a haze. I was in my early thirties, the father of a three-year-old boy, and my parents were about to turn seventy, and both families needed me to support. The great sense of responsibility and the fear of facing an unknown disease echoed and struck my heart.
But this pessimism lasted only two days before I picked myself up. On the one hand, I actively seek out relevant articles and books to supplement my knowledge, hoping to dispel the fear of uncertainty. During this time, I learned that through surgery + chemotherapy + endocrine therapy, many breast cancer patients still have great hope of survival. On the other hand, I was seeking spiritual solace. I once again read the biography of Wang Yangming, a Ming Dynasty Confucian scholar whom I regarded as an idol of life, and knew that only by seriously living the present can I make life more meaningful.
One less marker used to distinguish between the front and back
Coming to the hospital again, I got the results of the immunohistochemistry. After previous study, I can probably understand some indicators. Positive for estrogen and HER-2 indicates that this is a fast-moving type of breast cancer; Ki-67 (+50%) refers to a 50% proliferation rate of cells, meaning that cancer cells proliferate more rapidly.
I took the report sheet and went straight to the deputy chief physician of general surgery last time. He first comforted me, saying that as long as the surgery prognosis was good, and then arranged for me to be hospitalized as soon as possible for treatment. I was told that the surgery would remove the mammary glands and dissect the lymph nodes, and that a bandage would be tied after the operation to help the wound recover.
I learned before that breast cancer needs to be diagnosed by surgery and internal medicine together in order to develop a treatment plan. Since the hospital I was treating did not have an oncology department, I hung up the number of the director of the breast medicine department of the cancer hospital, hoping to get more comprehensive diagnosis and treatment opinions before the operation.
The doctor at the cancer hospital saw the results of my pathological diagnosis, and first comforted me, and then he pointed to the results of immunohistochemistry and told me: "You are considered to be carcinoma in situ, after surgery to remove all the breasts, you can chemotherapy or no chemotherapy after surgery." But I still recommend chemotherapy, after all, you are still young and need to reduce the risk of recurrence as much as possible. "The words of the director of the Department of Breast Medicine of the Cancer Hospital were like a star, illuminating the haze in my heart.
Considering the need for surgery as soon as possible, I decided to continue the operation at the upper hospital and go to the cancer hospital for postoperative chemotherapy after the operation.
In early September 2021, I had my second surgery, which was called breast cancer modified radical resection. I removed all of my left breast and 16 underarm lymph nodes, but after the operation I only looked like I was missing one nipple. Alas, the marker used to distinguish between my front and back is thus one less.
Postoperative pathology showed that all 16 of my lymph nodes were negative and that the cancer cells had not spread to the lymph. After 8 days of recuperation in the hospital, I was discharged from the hospital.
Results of immunohistochemistry 丨 Courtesy of the author
To sum up, male breast cancer only accounts for less than 1% of all breast cancers, so I didn't see a doctor and follow up in time when I first found the lump. Fortunately, Heaven did not directly close the door of my life, but gave me some warning signs that reminded me that I needed to change my lifestyle.
For a longer-term survival, I decided to undergo postoperative adjuvant therapy to remove possible cancer cells from my body and prevent recurrence. Because for cancer, once it comes back, it becomes very tricky and loses too much. So it's worth it to sacrifice short-term certainty (side effects of chemotherapy) for long-term gains, after all, I'm only in my early thirties and have a bright future to look forward to.
Finally, I would like to share the takeaways. First of all, to find the unknown mass in the body, to go to the regular hospital for examination at the first time, you can even go to several more hospitals to get a more comprehensive diagnosis; secondly, I hope that everyone can pay attention to the signals sent by the body, if I do not perceive the signals sent by the body or pay enough attention, it may make the cancer cells grow further and delay the best treatment time.
Doctor reviews
Wang Gang 丨 Attending Physician of Thyroid and Breast Surgery, Tenth People's Hospital Affiliated to Tongji University
Male breast cancer (MBC) is a rare malignancy that accounts for <1% of all breast cancers. MBC can be seen at any age, but is mostly in men aged 50 to 60. In recent years, the incidence of the disease has shown an upward trend.
The causes of MBC are complex, the mechanism is not yet fully understood, and it is currently believed that it is mainly related to the following reasons:
1. Imbalance in estrogen and androgen levels in the body: there are testicular diseases than before, which can lead to a decrease in androgen levels in the body; for example, some liver diseases will lead to a decrease in estrogen inactivation in the body, thereby inducing breast cancer.
2. History of breast disease: the strongest correlation with MBC is gynecomastia.
3. Family history of breast cancer: family history of breast cancer is one of the risk factors for MBC, and if there are breast cancer patients in first-level male and female relatives, the risk of MBC will increase by 2 to 3 times.
4. Genetic factors: BRCA1, BRCA2 gene mutations can increase the risk of breast cancer in carriers by 80 to 100 times.
5. Occupational and environmental factors: the working environment exposed to heat and electromagnetic radiation may be related to the onset of MBC, and occupational exposure to gasoline and exhaust gas can also increase the risk of disease.
6. Lifestyle: alcohol consumption is related to the occurrence of breast cancer, and for every 10 grams of alcohol intake increased per day, the risk of breast cancer increased by 15%, and the risk of heavy drinkers was 6 times higher than that of small drinkers. In addition, diabetes can increase the risk of breast cancer in men, and obesity is also associated with the onset of MBC.
Common symptoms of MBC are painless lumps under the areola, skin ulcers, and most patients have inverted nipples or discharges. This is due to the low subcutaneous fat of male breasts, and tumors are prone to invade the skin or pectoral muscles, resulting in depressions or ulcers. The mass itself is mostly round or semi-circular, hard texture, unclear boundaries, mostly adhered to or relatively fixed with the skin, and prone to axillary lymph node metastasis in the early stage.
In terms of pathological types, MBC is basically the same as female breast cancer, 90% of which are invasive carcinomas (mainly invasive ductal carcinomas), ductal carcinomas in situ account for about 5% to 10%, and other types account for a very low proportion. Like female breast cancer, MBC also expresses ER and PR genotypes, and the HER-2 positive rate is lower than that of women, about 2% to 15%.
Diagnosis of MBC relies heavily on mammography and ultrasonography, with suspected masses requiring puncture or surgical biopsy to confirm the diagnosis.
In terms of treatment, MBC treatment is similar to female breast cancer, which is a comprehensive treatment model including surgery, chemoradiation, endocrine therapy and targeted therapy. Surgical treatment is an important step in MBC treatment, including modified radical resection of breast cancer and sentinel lymph node biopsy.
Adjuvant chemotherapy is important in reducing the risk of breast cancer recurrence and metastasis. Because MBC is prone to nipple and skin involvement, lymph node metastasis, etc., the proportion of postoperative radiotherapy is higher than that of women. Endocrine therapy is very effective for most PATIENTs with POSITIVE ER and PR, and the commonly used drugs are generally tamoxifen and aromatase inhibitors. For a small number of HER-2-positive MBC patients, the same treatment principle as women can also be considered, that is, targeted therapy against HER-2.
Early detection, early diagnosis, early treatment is the key to improving the survival rate of all tumors and reducing the rate of recurrence and metastasis, with the increase of people's understanding of the disease and the continuous improvement of the level of diagnosis and treatment, the proportion of early cancer diagnosis is also increasing. Various treatments for breast cancer are constantly evolving, and it is believed that people will eventually overcome it one day.
Sharing personal experience does not constitute a diagnosis and treatment recommendation, can not replace the doctor's individual judgment of a specific patient, if you need to go to a regular hospital.
Author: Juno Shika
Editors: Knife Rider Te Wei, Li Xiaoqiu
This article is from The Fruit Shell Patient (ID: health_guokr), unauthorized reproduction is not allowed, please contact [email protected] if necessary