Treatment and care of breast cancer male patients

Male breast cancer is rare, early metastasis, poor prognosis. Currently the surgical treatment, and combined with radiation, chemotherapy and endocrine therapy. Our department from 1987 to 1999 were treated 7 cases of male breast cancer patients. Described below.

1, clinical data

7 cases the youngest 39 years old, maximum 67 years, an average of 58 years. 4 cases the tumor is located under the areola, papilla in 2 cases, the left breast upper outer quadrant in 1 case, and with nipple discharge, haemorrhagic 4 years. 7 patients underwent radical mastectomy and postoperative pathological diagnosis of breast cancer in 5 cases, hard cases with axillary lymph node cancer, 2 1 / 7 shift. 4 cases of postoperative chemotherapy, radiotherapy in 2 cases, 1 case of endocrine therapy. Tracking observation, 3 patients survived 1.5 years, 2 patients survived 3 years, 1 survived 5 years, 1 survived so far (5 years).

2, treatment

2.1 Surgical treatment is the most effective treatment. Operation range to the collarbone, down to the rectus sheath of the upper front, outside edge to the latissimus dorsi, internal to the parasternal. Around the entire breast cancer with at least 5 cm wide, skin, breast and axillary fascia hunger, subclavian all fat tissue and lymph nodes en bloc resection. Incision to stop bleeding completely, and set a drainage hose, sutures the skin, skin tension, after the suture to reduce tension, compression bandaging the wound.

2.2 The early line chemotherapy. 4 patients in this group were used 3 weeks after CMF chemotherapy: CTX (CTX) 900 mg plus 0.9% sodium chloride dissolved in 40 ml intravenous injection; then take the MTX (MTX) 60 mg with 0.9 % sodium chloride dissolved in 40 ml bolus; take 5% glucose injection solution 1 000 ml balanced line of 5-Fu 900 mg intravenously. 22 d after the first time start to chemotherapy, chemotherapy each s 1,8 d, 28 d to 1 cycle, 3 cycles of 1 course of treatment, rest and repeat a course of treatment after 3 months. Possible side effects of chemotherapy, symptomatic treatment [1].

2.3 line in the postoperative radiation therapy 2 to 3 weeks. District 2 patients axillary radiation therapy, radiation therapy requires surgical area and irradiated sites were skin inflammation, axillary lymph node positive. Radiation dose for every 5-week field total 45 ~ 50 Gy, 200 cGy / d, weekly exposure to 5 d (body rate 2 d), were successfully completed radiotherapy.

2.41 cases patients have estrogen receptor (ER), progesterone receptor (PR) positive, the line endocrine therapy after 3 weeks. 10 mg orally with triphenyl chloramine, 2 / d, taking 6 months.

3, discussion and nursing

3.1 It is reported that the rising trend of male breast cancer in recent years, the incidence rate of breast cancer of 1% to 2% [2], the general age of onset of 60 years old. Cancer mostly occurs in the side, beginning when the nipple or areola below the ill-defined, see a small painless lump, and the rapid growth in the short term, the development of breast cancer than women fast, hard and soft texture of the surface is not smooth, nodular feeling, and no tenderness in the growth process of gradually and skin adhesion, skin ulcers, and fixed with pleural adhesions, pain appeared earlier than women. Should arouse the attention of clinical medical staff, early detection and early treatment.

3.2 The psychological care of male breast cancer is particularly important, because the disease rare, poor prognosis, patients fear. Nurses should be warm, sincere, active and talk to them on the patient's patience to listen to the problems of the disease, to meet the psychological needs, and provide psychological support and enhance the body conditioning system function and disease tolerance, inferiority complex for the patient, patient enlighten. Around the same time make people work, families and organizations for cooperation, so that patients can feel at ease treatment [3].

3.3 Characteristics ① male breast gland care little, armpit and more gentle movements of preoperative skin preparation to avoid the blade pierced the skin, the puncture area covered with sterile gauze dressing. Yichuan cotton underwear, to facilitate ventilation. ② male breast less fat, more than cancer and chest wall abuts an increase surgical difficulties, intraoperative wound, and easy to damage the pleura. In order to avoid the wound fluid after surgery, blood clots, have bandaged the wound. The group 2 patients had subcutaneous fluid, after the affected area with sterile air make effusion needle aspiration and pressure dressing, the wound healed well. Bandaged wounds caused by difficulty in breathing easily, it should be closely observed after breathing exercises, watch for difficulty breathing, may be appropriate to give oxygen inhalation; non-adjustment of the tightness of the bandage, so close to the flap and the chest wall to facilitate healing. ③ large wounds due to surgery, we must encourage the patient to high-calorie, high protein, high vitamin diet, in order to facilitate wound healing. ④ axillary drainage tube usually placed 48 ~ 72 h, attention to drainage, to keep them open, to avoid subcutaneous fluid, blood clots affect wound healing and lead to flap necrosis. ⑤ After Taigaohuanzhi, pay attention to blood circulation, active elbow after 3 d, 5 d activities of the shoulder joint, and gradually activities to the limbs touch the fingertips can bypass the overhead door on the ear. In winter to keep warm.

3.4 postoperative chemotherapy, radiotherapy, endocrine therapy patients should be closely observed liver and kidney function, gastrointestinal reactions, attention to all adverse reactions; encourage patients to drink more water during the treatment may be appropriate for outdoor activities, and enhance the body's resistance to diseases, but avoid the flow of people and more places, in order to reduce respiratory tract infection. Treatment is completed, instruct patient to the hospital regularly reviewed.