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Breast cancer is the most common malignant tumor
in women.
Patient, female, 30 years of age
: right breast mass for 5 months, lymphadenopathy in left neck for 5 days
.
Breast cancer with contralateral cervical lymph node metastases is very rare, and the exact drainage route is currently controversial
.
Breast cancer with contralateral cervical lymph node metastasis is advanced clinical and was once considered a contraindication to surgery, because of the high incidence of blood metastasis to distant organs, which is the main cause
of postoperative death.
However, Hong Pan et al.
noted that breast cancer-specific survival (BCSS) and total survival (OS) in patients with distant lymph node metastases (DLNM) are similar to those in patients with ipsilateral supraclavicular lymph node metastases (ISLM), and that local treatment is significantly associated
with OS improvement in patients with DLNM.
At present, domestic scholars have not yet formed a consensus
on whether such patients should undergo cervical lymph node dissection at the same time as radical breast resection.
Bisase B et al.
argue that indications for cervical lymph node dissection of breast cancer include feasible local surgical treatment of breast cancer; No distant organ metastases; intraoperative axillary lymph node metastasis, but no axillary vein involvement; There is no residue after surgery, the cervical lymph node mobility is good, and there is no fixed fusion
.
Teshome M believes that the existence of primary foci is undoubtedly the root cause of distant metastasis, and increases the possibility of further metastasis
.
Therefore, a certain range of surgical treatment should be carried out as soon as possible, which can reduce the tumor burden and promote better treatment effect
of radiotherapy and chemotherapy.
NCCN guidelines state that patients with stage IV breast cancer should undergo appropriate systemic therapy
based on the type of molecule.
The efficacy and chances of surgical removal of the primary tumor are still being studied, and it is necessary to develop an individualized protocol
.
For some patients who respond well to initial treatment, topical treatments such as breast surgery and/or radiation therapy may be considered
.
Standard electrochemotherapy (ECT) has been shown to be an effective treatment for solid tumors
.
One study reported success in treating patients with recurrent breast cancer with recurrent breast cancer with lower electric field strength (LVHF ECT) and bleomycin, including local control and narrowing of metastatic lymph nodes, avoiding secondary surgery, and reducing adverse effects
of standard ECT.
Its good efficacy, safety and tolerability make it a new treatment option for patients with cervical lymph node metastases in breast cancer, especially as a new treatment option
to avoid secondary cervical lymph node dissection after radical resection of breast cancer 。 References: [1] Zhong X, Ding F, Qian L, Wu W, Wen Y, Ding B.
Breast cancer combined with contralateral neck lymph node metastasis:a case report.
Diagn Pathol.
2022 Jul 15; 17(1):60.
doi:10.
1186/s13000-022-01236-1.
PMID:35841040; PMCID:PMC9284882.
Where did it come from? Can't clear the lymph nodes? What should I do if I encounter this rare breast cancer?
Breast cancer is the most common malignant tumor
in women.
Patient, female, 30 years of age
: right breast mass for 5 months, lymphadenopathy in left neck for 5 days
.
Breast cancer with contralateral cervical lymph node metastases is very rare, and the exact drainage route is currently controversial
.
Breast cancer with contralateral cervical lymph node metastasis is advanced clinical and was once considered a contraindication to surgery, because of the high incidence of blood metastasis to distant organs, which is the main cause
of postoperative death.
However, Hong Pan et al.
noted that breast cancer-specific survival (BCSS) and total survival (OS) in patients with distant lymph node metastases (DLNM) are similar to those in patients with ipsilateral supraclavicular lymph node metastases (ISLM), and that local treatment is significantly associated
with OS improvement in patients with DLNM.
At present, domestic scholars have not yet formed a consensus
on whether such patients should undergo cervical lymph node dissection at the same time as radical breast resection.
Bisase B et al.
argue that indications for cervical lymph node dissection of breast cancer include feasible local surgical treatment of breast cancer; No distant organ metastases; intraoperative axillary lymph node metastasis, but no axillary vein involvement; There is no residue after surgery, the cervical lymph node mobility is good, and there is no fixed fusion
.
Teshome M believes that the existence of primary foci is undoubtedly the root cause of distant metastasis, and increases the possibility of further metastasis
.
Therefore, a certain range of surgical treatment should be carried out as soon as possible, which can reduce the tumor burden and promote better treatment effect
of radiotherapy and chemotherapy.
NCCN guidelines state that patients with stage IV breast cancer should undergo appropriate systemic therapy
based on the type of molecule.
The efficacy and chances of surgical removal of the primary tumor are still being studied, and it is necessary to develop an individualized protocol
.
For some patients who respond well to initial treatment, topical treatments such as breast surgery and/or radiation therapy may be considered
.
Standard electrochemotherapy (ECT) has been shown to be an effective treatment for solid tumors
.
One study reported success in treating patients with recurrent breast cancer with recurrent breast cancer with lower electric field strength (LVHF ECT) and bleomycin, including local control and narrowing of metastatic lymph nodes, avoiding secondary surgery, and reducing adverse effects
of standard ECT.
Its good efficacy, safety and tolerability make it a new treatment option for patients with cervical lymph node metastases in breast cancer, especially as a new treatment option
to avoid secondary cervical lymph node dissection after radical resection of breast cancer 。 References: [1] Zhong X, Ding F, Qian L, Wu W, Wen Y, Ding B.
Breast cancer combined with contralateral neck lymph node metastasis:a case report.
Diagn Pathol.
2022 Jul 15; 17(1):60.
doi:10.
1186/s13000-022-01236-1.
PMID:35841040; PMCID:PMC9284882.