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유방암이란?

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발생 부위

유방은 기름샘이 변형된 것으로서 피부의 한 부속 기관입니다. 젖을 분비하는 샘인 유선(젖샘)과 젖을 유두(젖꼭지)로 운반하는 유관, 그리고 지방 조직 등으로 이루어져 있습니다. 유선은 두 번째 늑골(갈비뼈)과 여섯 번째 늑골 사이, 좌우로는 복장뼈(흉골, Sternum)와 겨드랑이 중심선 사이에 분포합니다. 유방의 주요 기능은 출산 후의 수유로, 아기의 성장에 필수적인 영양을 공급합니다.

유방암의 정의와 종류

유방암이란 유방 밖으로 퍼져서 생명을 위협할 수 있는 악성 종양입니다. 발생 부위에 따라 유관과 소엽(小葉) 같은 실질(實質)조직에 생기는 암과 그 외의 간질(間質)조직에 생기는 암으로 나뉘며, 유관과 소엽의 암은 암세포가 주위 조직으로 퍼진 정도에 따라 다시 침윤성 유방암과 비침윤성 유방암으로 나뉩니다. 남성의 유방암은 여성 유방암의 1% 이하로, 침윤성 유관암이 가장 많이 발견됩니다.

침윤성 유관암

유관을 이루고 있는 세포에서 기원한 암으로 암이 유관의 기저막을 침범한 경우입니다. 전체 유방암의 약 75~85%를 차지하는 가장 대표적인 유방암입니다.

침윤성 소엽암

소엽을 이루는 세포에서 기원한 암으로 전체 유방암의 약 5~10%를 차지합니다. 이 암의 예후는 침윤성 유관암과 비슷하지만, 침윤성 유관암에 비해 다발성 및 양층성의 빈도가 더 높은 것으로 보고되고 있습니다.

유관 상피내암(비침윤성)

유관을 이루는 세포에서 생긴 암으로, 유관의 기저막을 침범하지 않은 0기 암이라고도 합니다. 침윤성 유방암보다 훨씬 예후가 좋지만 암세포가 기저막을 뚫고 성장할 경우 침윤성 유관암으로 진행할 수 있습니다.

소엽 상피내암(비침윤성)

소엽을 이루는 세포에서 생긴 암으로, 소엽의 기저막을 침범하지 않은 0기압입니다. 유관 상피내암에 비해 젊은 연령층에 흔하고 다발성, 양측성의 빈도가 높습니다. 이 또한 암세포가 기저막을 뚫고 성장할 경우 침윤성 유관암 및 침윤성 소엽암으로 진행할 수 있습니다.

파제트병

유두 및 유륜의 피부에 주로 발생하는 유방암의 특수한 형태로 전체 유방암의 1~2% 미만의 드문 암입니다.

기타

침윤성 유방암의 기타 종류로 점액성암, 수질성암, 유두상암, 관상암, 선양낭성 양종, 분비성 암종, 아포크린 암종, 화생성 암종 등 여러 종류가 있습니다.

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위험 요인

유방암의 위험요인으로는 우선 비만, 음주, 방사선 노출, 유방암 가족력 등이 있고, 호르몬과 관련해서는 이른 초경, 늦은 폐경, 폐경 후의 장기적인 호르몬 치료, 모유 수유를 하지 않거나 첫 출산 연령이 늦은 것 등을 들 수 있습니다.

예방법

암은 여러 가지 인자들의 복합적인 작용에 의해 발생하기 때문에 유방암을 예방하거나 피하는 간단하고 확실한 방법은 없습니다. 그러나 금연과 절주를 하고 적절히 운동하면서 영양 상태를 알맞게 유지하는 한편, 가능하면 30세 이전에 첫 출산을 하고 수유 기간을 길게 유지합니다. 그러나 효과적이고 즉각적인 방법은 아직은 확인되지 않습니다. 유전적 요인으로 유방암이 발생할 확률이 높을 경우에는 전문가와 상의하여 항호르몬 제제를 복용하는 것을 고려할 수 있습니다.

조기 검진

국가 암검진 프로그램에서는 매달 유방 자가검진을 하고 만 40세 이상 여성은 1~2년 간격으로 유방촬영술 및 의사의 임상진찰을 받도록 권장하고 있습니다.

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일반적 증상

초기에는 대부분 아무런 증상이 없으며, 유방의 통증은 초기 유방암의 일반적 증상이 아닙니다(사실 대부분의 유방 통증은 유방암과 관련이 없습니다). 당사자가 암을 의심하게 되는 가장 흔한 계기는 유방에서 멍울이(즉 덩어리가) 만져지는 경우 입니다. 그 밖에 유두에서 피가 섞인 분비물이 나올 수 있으며, 암이 진행되면 유방 피부가 오렌지 껍질처럼 두꺼워지기도 합니다.

통증이 없는 멍울

유방 및 겨드랑이의 덩어리

유두의 피 섞인 분비물

젖꼭지의 잘 낫지 않는 습진(파제트 병)

유방 피부 혹은 유두의 함몰

염증성 유방암

유방피부의 변화

겨드랑이의 덩어리

진단 방법

유방의 병소는 자가검진과 임상 진찰, 방사선 검사(유방촬영술, 유방초음파), 조직검사(생검) 등으로 진단합니다.
유방에서 멍울이 만져진다고 해서 모두 유방암은 아니며 섬유낭성 질환, 섬유선종 따위의 양성 질환인 경우가 더 흔합니다.
유방암으로 진단이 되면 수술 전 상태를 평가하기 위하여 자기공명영상(MRI), 전산화 단층 촬영(CT), 뼈스캔(Bone scan), 양전자 방출단층촬영(PET)등의 검사를 필요에 따라 시행합니다.

유방 자가 검진의 적절한 시기는 매월 월경이 끝나고 3~5일 후가 최적기인데 이때가 유방이 가장 부드럽기 때문입니다.
자궁 제거술을 시행하였거나 폐경이 된 여성은 매월 일정일(예:1일, 15일, 30일)을 정하여 정기적으로 자가 검진을 합니다.
먼저 거울에 비추어 자신의 유방의 형태를 관찰하고, 한 손을 머리위로 올린 후 다른 한 손을 이용하여 가운데 세 손가락을
끝 바닥을 이용하여 유방을 촉진합니다.
촉진은 유방을 부드럽게 누르면서 비비듯이 바깥쪽부터 원형을 그리면서 유두를 향하여 실시합니다.
유방 자가 검진을 할 때는 멍울, 통증, 유두분비, 유두의 함몰, 유방의 주름, 유두습진,
유방 피부 변화와 같은 사항을 주의 깊게 보아야 합니다.

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치료방법

유방암 치료의 주축은 수술과 약물요법, 방사선치료입니다. 아주 초기의 유방암을 제외하고는 수술 후에 항호르몬요법이나 항암화학요법, 혹은 둘 다를 시행하게 되는데, 어느 것까지 할지는 환자의 연령과 폐경 여부, 종양의 크기, 겨드랑이 림프절로의 전이 정도, 환자의 건강 상태 등을 두루 감안하여 의사가 정합니다.

수술이 가능한 경우: (선행 항암화학요법→)수술 → 필요한 경우 항암화학요법 또는 항호르몬 요법 → 필요한 경우 방사선 치료

선행 항암화학요법은 종양이 클 경우에 먼저 그 크기를 줄여 놓고 수술을 하기 위해 시행하거나 또는 유방암이 초기 단계가 아니라 진행성 유방암으로 평가 되는 경우, 전신치료의 개념인 선행 항암 화학 요법을 수술 전에 시행합니다.
수술 후 항암화학요법이 필요한 경우는 방사선 치료보다 먼저 항암 화학치료를 시행하는 것이 일반적입니다.
방사선 치료는 유방 전체를 절제를 하지 않고 부분적으로 절제하는 유방 보존적 절제술을 시행하는 경우에 잔여 유방 조직에
대하여 국소재발을 억제하기 위하여 시행합니다. 유방을 모두 제거한 환자의 일부에서도 방사선 치료가 필요한 경우가 있습니다.
항호르몬치료는 조직검사 결과 여성 호르몬에 반응하는 유방암으로 진단되는 경우에 시행하고, 최소한 5년을 사용합니다.
또한 조직검사 결과 허투 수용체 (Her2 receptor)와 같은 표적치료에 대한 수용체가 발달되어 있는 환자의 경우
수술 후 표적치료를 시행합니다.
다른 장기로 원격전이가 있어서 수술이 불가능한 경우에는 항암 화학치료와 항호르몬치료, 방사선 치료,
표적치료 등을 우선적으로 고려할 수 있고, 치료계획은 환자의 상태에 따라서 결정됩니다.

치료의 부작용

수술 후에 올 수 있는 장기적인 부작용은 림프부종(浮腫)입니다.
항암화학요법의 가장 흔한 부작용은 탈모, 구역질(오심), 구토, 전신 쇠약, 백혈구 감소증(세균 등에 쉽게 감염),
혈소판 감소증(피가 쉽게 나며 잘 멈추지 않음), 조기 폐경 등입니다.
항호르몬 치료제인 타목시펜은 안면 홍조, 불규칙한 생리, 질의 분비물 등의 부작용이 있으며, 드물게 체액 저류(체액이 고임),
우울증, 피부 홍반 등이 나타나기도 합니다.

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통증

병원에서 처방과 복용에 대한 지도를 받은 진통제가 있다면 통증이 시작될 때 바로 약을 복용하도록 합니다.
통증이 없어야 더 적극적으로 충만한 삶을 영위할 수 있습니다.
병원에서 처방받은 진통제에 대한 중독은 걱정하지 않으셔도 됩니다.
대부분의 쑤심이나 통증이 암의 재발을 의미하지 않으니 지나치게 걱정하지 않으셔도 됩니다.
통증에 대한 대처를 했는데도 며칠이 지나도록 증상이 사라지지 않으면 병원을 방문하셔야 합니다.

휴식과 수면

휴식을 충분히 취하도록 합니다. 충분하게 잠을 잘 수 없을 때에는 가능한 운동을 해봅니다.

가사

가끔씩 필요할 땐 쉬기도 하지만, 일상생활과 활동은 할 수 있는 만큼 유지하시는 것이 좋습니다.

운전

봉합사 제거 후에는 가능하지만 개인적인 치유 과정이나 적응도에 따라 차이가 있을 수 있습니다.

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유방암이 가장 흔히 전이 되는 곳은 폐, 간, 뇌, 뼈 등으로 이러한 재발을 조기에 발견하기 위하여 유방암 치료 후에도
정기검진을 하게 됩니다. 정기검진은 처음 2년간은 3~6개월 간격으로 그 이후에는 6개월~1년 간격으로 하는데,
촉진과 사진 등으로 유방, 목, 간, 피부 부위 등을 검사하고, 유방 촬영이나 초음파를 통하여 남아있는
유방에 문제가 없는지도 확인합니다. 또한 폐 X-선 촬영 및 혈액 검사로 간 기능과 신장의 기능, 혈중 암 표지자 등을 검사합니다.
상황에 따라, 동위원소를 이용하여 뼈스캔 사진을 찍어 전이 여부도 관찰하고 가슴 CT, 복부 초음파 등을 시행하기도 합니다.
때로는 PET 등의 특수 검사를 하게 될 경우도 있습니다.
유방암은 진단 후 5년을 기준으로 생존 및 재발률을 평가하며 대부분의 유방암의 재발은 5년 이내에 일어나게 됩니다.

자료 출처:  국가암정보센터 www.cancer.go.kr
질병관리본부 cdc.go.kr
서울대학교병원 의학정보 www.snuh.org
a

DR CATHERINE CASTILLO

Neurologist

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441 Comments
  • sugarbaby
    November 9, 2017 at 9:31 am

    유방암의 정의와 종류에 대해 자세히 알 수 있어서 좋습니다.

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