Study of 160 breast cancer patients with distant metastasis after operation by way of TCM syndromes classification

Wenping Lu,Hongsheng Lin

About 10%females in the western countries are suffering from breast cancer, which becomes a main factor in female death.In China, for the past ten years, as the raising of life standard and environment pollution, the morbidity of breast cancer has raised to 27%.Forty percent of the patients died in five years. Most of the death cases are caused by distant metastasis. Although the treating method for breast cancer has been improved continuously, low sensitive to chemotherapeutic drugs after long time use

and distant metastasis are still main factors, which cause the patient’s living time and the cases without distant metastasis have not raised obviously. So a treatment could be guided by the accurate prognosis of potential metastasis. At present, clinical pathology and molecule biology factors are main standards to prognosis this disease. However there is few report on early stage of breast cancer and TCM syndromes classification. This paper aimed to analyse the cases and treating methods of Guanganmen Hospital in the recent years from this point of view.

Materials and methods

Participants

There were 160 postoperative 5-year breast cancer patients from 1995 to 2000 with pathology diagnosis by operation and body imaging. Forty of them were metastasis cases, including 8 cases of the liver,10 of the lungs,5 of the bones,5 of the skin,5 of the brain and 7 of two or more than two places. For all the 160 cases,100 of them were under systematic treatment and 60 without systematic treatment. These cases were divided into four groups according to TCM syndromes as stagnation hepatic qi, spleen-deficiency leading to retention of phlegm-dampness, blood stasis and toxin stagnation, deficiencies of both blood and qi. Forty cases in each group. The age ranged from 30 to 70(median 46 years).

Observe items

The relationship between postoperative breast cancer with distant metastasis, lymph node metastasis, tumor size,Her-2 and its receptor and the TCM syndromes classification.

Statistical method

Dates were comparing using bilateral disorder R×C table andχ2 test.
Results

The metastatic rate of blood stasis and toxin stagnation TCM syndrome was 45%during 5 years. And the meta-static rate of the other three TCM syndromes were 15%, 17.5%and 22.5%respectively.The distant metastasis rate was 27.5%during five years(χ2=12.00,P=0.007),with a close relationship between postoperative breast cancer patients with distant metastasis and TCM syndromes classification. Distant metastasis is mainly related to toxin stagnation. Lymph node metastasis, tumor size,Her-2 and its receptor has no obvious relationship to the TCM syndromes classification(P>0.05).

Discussion

Breast cancer is considered to be a typical disease which affects the whole body. The re-attack and metastasis rate in the postoperative cases is about 50%.Even the cases in early stage with the diameter of 1 cm tumor has the potential metastasis possibility. Distant metastasis is a main factor in most cases for the death of breast cancer. Most patients had no evidence of distant metastasis in their body examination, biopsy or film in the clinic. In the operation the local area and the cancer cell in the lymph node of the axillary fossa is totally removed. The re-attack and metastasis of breast cancer happens in 30% of the patients during 5 years. This research showed:(1) Metastasis is closely related to blood stasis and toxin stagnation in TCM syndromes classification. It recorded in the“Neijing”,or“The Yellow Emperor’s Inner Classics” that tumor is caused by the stagnation of evil qi. The evil qi stagnates in different kinds of places causes different tumor, such as tumor in the muscle or in the bone, etc. It’s written in “Zhongzangjing” that the cause of tumor is related to toxin stagnation. The stagnation not only in Ying(blood)and Wei(Qi),but also in abdominal organs. For breast cancer, after operation, there’s still some toxin which block qi and blood to make stagnation. Blood stagnation combines with cancer toxin which makes the tumor as hard as stone. Modern medicine shows that toxin is a material that not exist when the human body is in a normal condition or a material which supply more than the body need to cause the disease. This toxin have its own special way to harm blood vessel membrane and external cell material. All these cause blood stagnates with blood platelet and cancer cells which block the related collateral meridians. So blood stagnation in the collateral meridians is a special biological standard to show the metastasis of the tumor. (2)There’s no obvious relationship between lymph node metastasis, tumor size,Her-2 and its receptor and the TCM syndromes classification. This result was the same with the medical literature abroad.

Their research showed that the metastasis ability of most tumors is a genetic characteristic which programmed in the early stage of the disease. This characteristic is not totally related to the size of the tumor or the metastasis of lymph nodes. This result challenges the well-accepted traditional idea that metastasis is in the late stage of the cancer development and guides the individual treating method.(3)The results mentioned before have certain value in predicting the metastasis potential and the survival rate in the breast cancer patients. The blood stasis and toxin stagnation type in TCM syndromes classification is a bad factor in the prognosis of the breast cancer patients. So doctors should track these patients after their treatments finished. Besides using the modern medical method, it’s necessary and helpful to attack the evil qi, cancer cells and promote blood circulation to remove the stagnation in the early stage of breast cancer to prevent metastasis in the treatment.