Malignant cells can form in all organs of the human body. The most common cancer in women is breast cancer. That is why ultrasound diagnostics and mammography are included in the list of mandatory studies during a preventive examination. If a neoplasm is suspected, taking into account the patient's complaints, the doctor prescribes appropriate tests to make an accurate diagnosis. Breast cancer occurs in both women and men.
Causes
- Hormonal changes:
- early onset of the menstrual cycle,
- late menopause,
- late birth of the first child,
- nulliparous women,
- multiple miscarriages or abortions,
- long-term use of hormonal drugs (hormone replacement therapy or contraceptives).
- Heredity (malignant tumor of the mammary glands or ovaries in the closest relatives).
- At risk are women suffering from the following diseases:
- mastitis,
- fibroadenoma,
- mastopathy.
Forms
Depending on its localization and methods of spread, breast cancer is divided into:
- diffuse form (there are several types: edematous, erysipelas, armored and mastitis);
- Paget's cancer.
The most common type of cancer is the nodular form. A lump or hardening is palpated under the skin. This dense formation has no clear boundaries and is not separated from the surrounding tissues. As the compaction develops, disintegration may occur with the appearance of an ulcer and its opening to the surface of the skin. The ulcer looks like a normal inflammation, but it does not heal for a long time, it does not respond well to local treatment with anti-inflammatory drugs. An infection can join the wound site, while the body temperature rises, signs of intoxication appear. A tumor of the breast can grow deep, reaching the ribs and sternum.
With a tumor of a diffuse form, the focus is large, often occupies a segment of the mammary gland or the entire breast. At the same time, a large lump is palpated in the chest. Seals do not have clear boundaries, soldered to the surrounding tissue. Outwardly, changes appear on the chest, similar to erysipelas - the chest becomes swollen, reddens, body temperature rises. For a malignant tumor with an edematous variant, a change in the skin like a lemon peel is characteristic. With a decrease in breast size and retraction of the nipple, they speak of an armored form of cancer. This type of cancer metastasizes rapidly.
The third type of tumor is Paget's cancer. With this type of cancer, a neoplasm appears near the nipple of the breast. This type of tumor grows slowly and is less common than other types of cancer. At the beginning of the disease, small scales form near the nipple. Then the nipple is retracted, inflammation may occur around it. The lump grows deep into the gland with the development of regional or distant metastases.
Classification
Modern oncology provides for the division of cancer into 4 stages depending on the size of the tumor:
- at stage T1, the size of the tumor does not exceed 2 cm, the tumor does not extend beyond the tissue;
- stage T2 is characterized by a focus size of up to 5 cm;
- at stage 3, the size of the tumor exceeds 5 cm;
- in stage T4, the formation spreads beyond the borders of the mammary gland, grows into other tissues.
The letter N in the classification means the presence of metastases in the lymph nodes.
- N0 - there are no metastases in the lymph nodes.
- N1 - metastases are detected in the axillary region, they are not soldered to each other, one or two lymph nodes are affected.
- At stage N2, lymph nodes of the axillary region are soldered together.
- Stage N3 is established when enlarged internal lymph nodes of the mammary gland are detected. The appearance of metastases in the lymph nodes is detected at stage 3 of the disease.
Stage 3 cancer can be manifested by distant metastases, which are indicated by the letter M. M0 - there are no distant metastases. M1 - there are distant metastases.
Cancer Symptoms
In the early stages, the tumor does not manifest itself in any way. The first signs of cancer are discovered by chance during a medical examination. You can detect seals on your own during palpation or a routine medical examination by a gynecologist, on an ultrasound scan, or on a mammogram. A seal found in the breasts of women should always be a concern for cancer. 
Breast cancer shows its first symptoms often at an advanced stage.
- On examination, you can see the retraction of the nipple, discoloration of the skin, unevenness and tuberosity of the mammary gland, the appearance of redness and ulcers, discharge from the nipple.
- In the presence of regional metastases in stage 3, the axillary lymph nodes increase.
- Sometimes, on examination, you can see a dense path leading from the mammary gland to the axillary fossa.
- As the tumor spreads, general signs of intoxication appear - weakness, fatigue, weight loss.
Do breasts hurt with cancer? In the later stages, the glands begin to hurt. This is due to the fact that the process affects the nerves that innervate the mammary gland. The pain occurs pulling, can give to the arm or axillary region.
Palpation is carried out in the supine and standing position. To determine the benignity or malignancy of the tumor, surgeons use the symptom of the palm. If you put your hand on the area of \u200b\u200bthe mammary gland, then the malignant tumor will stick out and be felt under the fingers, then they talk about a positive symptom of the palm. A benign tumor is not felt when touched, then they talk about a negative symptom.
During ultrasound examination, seals are determined. The seal has an uneven fuzzy contour and increased blood flow. The focus can be identified by mammography. Doctors often prescribe both research methods to clarify the diagnosis. In the general blood test, the level of ESR rises, anemia occurs. To clarify the tumor process, a blood test is prescribed for a specific oncomarker CA 15-3. CEA and CA markers are considered less specific 27,29. Some oncologists believe that these tumor markers should be assessed collectively. A biopsy of a suspicious area of tissue will help determine cancer.
How to conduct a self-examination
Self-examination helps in early diagnosis of the disease. Detection of a tumor at an early stage improves the prognosis for the patient.
Before starting the palpation, it is necessary to examine the chest. They must be of the same size, have no defects in the skin or nipples. The same must be done when raising your arms up above your head. If no changes are detected, proceed to palpation. To inspect the right heaps, the right hand is raised behind the head, and the palpation of the gland is carried out with the left hand. The palm is placed flat on the mammary gland and begin to gradually move in a spiral, feeling each area and determining if there are lumps in the chest. Then you need to examine the nipple and areola area, make sure that there is no discharge. Then the same examination is carried out in the supine position. The examination is completed by palpation of the axillary lymph nodes.
Treatment
The tactics of managing a patient with a tumor depends on the stage of the disease. In the absence of metastases, surgical treatment is performed. Modern oncology involves a radical operation, which consists in the complete removal of the mammary gland with adipose tissue and axillary lymph nodes. With a large tumor size and germination in neighboring tissues, a radical mastectomy is performed in conjunction with the removal of the pectoral muscles and, sometimes, the ribs. With early detection of cancer at the initial stage, a sparing operation is possible - sectoral removal of the tumor site and axillary lymph nodes.
Radiation therapy is mandatory after any operation. Chemotherapy may be given before surgery to shrink the tumor, or after surgery to prevent metastasis. Usually spend several courses of such treatment. When distant metastases are detected, radiation therapy and chemotherapy are performed, which are supplemented with hormonal therapy. Supportive treatment and periodic examination of a woman with breast cancer is carried out for 5 years after surgery. The question of the methods of treatment for a particular patient is decided individually by the oncoconsilium.
The prognosis depends on the identified stage of the disease. In case of cancer of the initial stage without detected metastases, the prognosis is favorable. Timely surgery and radiation or chemotherapy can prolong the life of the patient and avoid relapse. The prognosis for breast cancer with metastases is uncertain. Only conservative therapy aimed at removing intoxication is possible.
Metastasis
Pathological cells enter other organs through the bodice and blood. This is usually characteristic of stage 3 and 4 cancer. The axillary lymph nodes are the first to be affected. Then the tumor spreads to the peristernal, subclavian, cervical and subscapular nodes. They become painful, increase in size, solder to the surrounding tissue. Distant metastases usually form in the liver, lungs, bones, and brain. With the appearance of metastases, the prognosis is unfavorable.
Prevention
It has long been known that an increase in blood estrogen leads to an increased risk of tumors. Their lowest activity is observed during pregnancy and lactation.
Independent or uncontrolled use of hormonal contraceptives also leads to a shift in the level of hormones in the blood and may contribute to the development of a tumor. In the period leading up to menopause and during the menopausal period, it is necessary to control the level of hormones in the blood in order to prevent the risk of disease.
Having a baby and breastfeeding is the best prevention of breast cancer!
Breast cancer often appears in nulliparous women over 30 years of age, especially those with unfavorable heredity for oncological diseases. This is the main risk group. During this period, an annual examination by a gynecologist is necessary with additional instrumental studies.
The main prevention of cancer is its early detection. An annual visit to a gynecologist and mammologist, an ultrasound of the mammary glands or mammography, and self-examination are necessary.
Breast cancer is a serious disease characterized by tumor growth in the mammary gland. It is considered one of the most common diseases in women with a constant increase in the number of cases. The risk group includes women over 45-50 years old and women who have not given birth, which is associated with the hormonal background in the body. Signs of breast cancer largely depend on the stage of the disease and increase with tumor growth. Every woman is able to independently recognize the first signs of breast cancer with a proper examination of herself.
Causes of development and the first signs of the disease
The appearance of a breast tumor in women is associated with the impact on their body of both external and internal factors.
In some cases, it is also possible for the woman herself to assume the diagnosis of a breast tumor during self-examination, which is a good opportunity for early diagnosis of the disease. Therefore, it is important for every woman to know the answer to the question of how to determine breast cancer.
The first signs of breast cancer are:
That is, with a careful attitude to their health, women may well independently detect the initial symptoms of the development of a tumor lesion. It should be noted that the detection of these changes is not always a manifestation of a malignant pathology. In some cases, similar signs can be found in other diseases of the mammary gland - inflammatory mastitis, mastopathy, etc. If a woman has found signs of breast cancer, then she needs to contact a medical institution for diagnostic measures and appointment, if necessary, timely comprehensive treatment.
Proper breast self-examination
For early diagnosis of breast cancer, it is necessary to undergo regular self-examination, which allows to identify the first signs of the disease, including precancerous conditions (mastopathy, inflammatory mastitis, etc.).
How to identify breast cancer? To do this, it is necessary to conduct frequent examinations in front of the mirror and with the help of palpation according to the following algorithm:
Other symptoms that you can identify yourself
The clinic of breast cancer is diverse, which makes it a little difficult to diagnose it in oncology. Symptoms in women depend on the stage of the process, its prevalence, destruction of adjacent tissues, and the presence of metastases.
The main symptom of the nodular form of breast cancer is the presence of a round formation of various diameters (from a few centimeters to 10 cm or more) in the mammary gland. In addition, there are other signs that have been listed above as the first symptoms, or will be described later.
The diffuse type of tumor is divided into several subspecies: erysipelatous, mastitis-like and shell-like. Such types of cancer in women are very aggressive and differ from nodular and other forms of benign tumors in the absence of growth boundaries. Erysipelas-like and mastitis-like types of breast tumors are necessarily associated with the development of an inflammatory process, which leads to an increase in body temperature, reddening of the skin and tenderness of the mammary gland during its palpation.
Very often, doctors confuse these forms of the disease with erysipelas or mastitis, respectively. Such a mistake leads to the appointment of antibacterial agents and other drugs that are not able to cope with the true disease. As a result, the tumor grows and develops, aggravating the clinical picture and prognosis for the woman's health.
The shell type of cancer begins with the formation of seals under the skin, which eventually form a characteristic dense "shell". In this case, there is a contraction of healthy breast tissue and its reduction, very often easily noticeable during external examination.
In a small number of cases, the first symptoms of the disease are associated with the manifestation of symptoms of metastases in the lymph nodes. In this case, the breast tumor is called latent, as it is quite difficult to detect.
If the size of the neoplasm is small, then symptoms in women may not occur. It is possible to independently detect a node only with a small breast size or its superficial location. Women with large breasts most often cannot find such formations in their breasts. In cases where the node is still detected, it is necessary to evaluate its characteristics: mobility, relationship with surrounding tissues, pain, etc.
A benign tumor is characterized by an elastic structure, mobility in the subcutaneous tissue, smooth edges and slight pain on compression. In the case of a malignant neoplasm, the detected node of irregular shape is soldered to the surrounding tissues, practically does not move and is painful even at rest. The inflammatory nature of the compaction can be established on the basis of the addition of an intoxication syndrome, in these cases it is worth being as careful as possible and not to miss mastitis and erysipelas-like forms of breast cancer.
Signs of a malignant tumor
The malignant nature of the formation is primarily evidenced by changes in the skin. Most often, due to the infiltrating and constricting growth of the tumor, the skin acquires a wrinkled or “lemon peel” appearance. In severe cases, it is possible for the tumor to grow to the surface - then the skin swells and takes on the appearance of a "cauliflower". However, this situation is very rare in oncology in women.
It is important to pay attention to the axillary lymph nodes at any stage of breast cancer, since it is in them that the primary metastasis of the tumor occurs. If the lymph nodes are not changed, painless and not enlarged, then there is no reason for concern. However, a change in their size, consistency, limitation of mobility and pain is a serious cause for concern, since very often these symptoms reflect the process of tumor metastasis.
A number of patients have swelling of the shoulder and the upper part of the lower limb. These manifestations are also associated with tumor metastasis and impaired lymph outflow as a result of these processes.
To summarize, the main symptoms of breast cancer can be identified:
Symptoms at different stages of breast cancer
How does breast cancer manifest itself in various stages of the disease in women? The answer to this question will help to better understand the possibilities of early diagnosis and its methods.
The first stage of the disease is associated with the onset of tumor germination in the breast tissue. The size of the neoplasm is 0.5-1.5 cm. Despite such a small size, the tumor can already be detected during self-examination or during a preventive medical examination. Other symptoms are very rare. It is important to note that at this stage the disease is best served by therapeutic methods of treatment without the need for surgery.
In the second stage of cancer, the symptoms expand and become more pronounced. Small compaction increases or remains the same. But it is at this stage that metastases and changes in the axillary lymph nodes most often occur. However, this stage also refers to an early form of cancer.
In the third stage of a breast tumor, women experience more vivid manifestations: the tumor continues to grow - up to 10 cm or more, grows into adjacent tissues and leads to a visible deformation of the mammary gland. Perhaps the appearance of mucous or bloody discharge from the nipple of a different nature.
Pathological changes are observed in the lymph nodes, including those of an inflammatory nature. Not only the axillary lymph nodes are affected, but also the thoracic, supra- and subclavian, etc. At this stage, only surgical treatment is possible with the simultaneous use of chemotherapy and radiation therapy.
At the next stage, metastases affect the internal organs, various paraneoplastic syndromes develop with various symptoms. As a rule, in this case, only palliative treatment is used, aimed at alleviating the suffering of women, but not at fighting the tumor itself. In the fourth stage, the symptoms of damage to internal organs outweigh the threat to health local changes in the mammary gland.
Breast cancer is a serious pathology that develops for a long period of time and leads to a serious decrease in the quality of life, up to death. In this regard, every woman should pay maximum attention to her health and breast self-examination. In cases of detection of seals in the mammary glands or any other symptoms, it is necessary to contact a medical institution for diagnostic measures.
tumor in women
This disease occupies the first place in frequency among women, the second - after among the male and female audience, since cancer also occurs in men (less than 1%).
What is breast, mammary gland, breast cancer?
The sweat gland that evolved into the mammary gland is called the breast. The structure of the female and male mammary glands is identical, but the degree of their development is different. During puberty, against the background of hormonal changes, the development and functioning of the breasts of boys and girls begins to differ, since in boys the body starts processes that are different from the female internal processes.
With breast growth that begins before the onset of menstruation, the girl turns into a woman, which indicates that the breast is a hormone-dependent organ.
It is important to know! Since the breast consists of a right and left organ, hormonal changes affect both breasts in the same way.
Therefore, with the ongoing changes in the chest, you can correctly respond to the current process. For example, if both breasts ache before menstruation, then this is due to premenstrual swelling of the gland. But with pain in only one breast, you should immediately consult a gynecologist-mammologist, if it is not associated with scuffs from the bra. Pain can be associated with pathological processes inside the breast, like breast cancer.
Breast anatomy
The pectoral muscle holds both mammary glands, which are based on glandular and adipose tissue. The size of the breast depends on the amount of adipose and glandular tissue. The connective tissue divides the gland into 15-20 lobes, and each lobe into many small lobules with a diameter of 0.05-0.07 mm, the space between which is filled with fatty tissue. At the site of attachment of the gland to the chest wall, there is also adipose tissue in the form of a pillow. It supports the gland and creates the shape of the breast.
Separate mammary glands, consisting of many tubes with extensions at the end - alveoli (microscopic vesicles) make up the glandular part, located in the lobules of the gland. Milk is produced in the alveoli. The excretory ducts (tubules) transport it to the gland through the terminal sections of the tubules and further dilated lactiferous sinuses that open on the nipple. The nipple is located just below the center of the chest and opposite the 4-5 rib gap. The shape of the nipple is conical in nulliparous women and cylindrical in those who have given birth.
On the surface of the nipples and their areolas (pigmented area with a diameter of 3-5 cm) there are muscle cells with a large number of nerve endings, due to irritation of which breast milk is released from the nipples during feeding. The color of the nipple and areola is pinkish or dark red in nulliparous women, brownish in those who have given birth.
Nipples with nerve endings become a sensitive erogenous zone and rise with the contraction of muscle cells during sexual arousal (erection). Small vestigial mammary glands of Montgomery are also present in the circle near the nipples in the form of small elevations.
The nipples are covered with wrinkled skin with small holes at the top - milky pores (ends of the milk ducts) with a diameter of 1.7-2.3 mm. When some milk ducts merge with each other, the number of holes reaches 8-15, which is less than the total number of ducts.
The mammary glands are supplied with blood through the thoracic arteries: internal and lateral.
Type of mammary gland at maturity
Until the age of 11-12, the mammary glands in girls consist of mammary glands in the form of short tubes without branching and alveoli. Against the background of estrogen, which is produced by the ovaries, the growth of the milky tubes in length begins, and at their ends - the alveoli with a simultaneous increase in the amount of connective, adipose and glandular tissue. This is how a woman's breast size is formed.
The appearance of the breast during the menstrual cycle
During menstruation, cycles of changes in the mammary gland begin. In the second phase of the cycle, progesterone promotes the development of alveoli within 12-14 days. When the production of progesterone stops, the alveoli stop developing and disappear until the next cycle begins.
At the end of the cycle of menstruation, the size of the mammary glands slightly increases, they “sharp” with simultaneous discomfort and soreness. This is how premenstrual syndrome begins.
Type of breast during pregnancy and after childbirth
Pregnancy contributes to the full development of the mammary gland, since there is a long-term release of progesterone, which activates the development of the alveoli. By the end of pregnancy, another hormone is produced - prolactin, which contributes to the production of colostrum in the alveoli - a special secret that contains a lot of protein and less lipids, unlike breast milk.
The synthesis of the hormone prolactin, which is responsible for the secretion of milk and stimulation of the development of milk lobules, occurs in the pituitary gland. Men also produce prolactin. Elevated prolactin levels lead to stress and problems in the breast.
After childbirth, the mammary gland produces breast milk - lactation begins under the influence of the alveoli of the main hormone - oxytocin, as well as thyroid hormones.
So, the functioning of the breast is affected by: progesterone, prolactin and oxytocin, as well as insulin, so women with diabetes are more likely to get breast cancer. The state of the thyroid gland is directly related to the mammary glands and uterus.
Under the influence of hormones produced by the thyroid gland: thyroxine (T4) and triiodothyronine (T3) occurs:
- regulation of metabolism in the body;
- cardiovascular activity;
- work of the gastrointestinal tract;
- functional work of the reproductive system;
- mental activity.
Interesting to know! The left breast is larger than the right breast. Disorder of the endocrine system leads to an increase in men's breasts and secretion of milk. In newborns, the mammary glands are capable of pathological secretion, the so-called "witch's milk".
The development of the mammary glands may be abnormal, so observe:
- amastia - unilateral or bilateral atrophy of the mammary glands (MF);
- macromastia - an increase in the breast up to 30 kg on both sides;
- polymastia - the presence of additional MF in the area of \u200b\u200bthe armpits;
- polythelia - abnormal development of the breast in the form of several nipples along the line of the body.
Breast cancer - what is it?
An epithelial tumor originating from the lobules or ducts of the gland is called breast or breast cancer. Most often, malignant oncopathology occurs - with late diagnosis and with a negative outcome.
Breast cancer (BC) can be triggered by the following factors:
- high blood levels of estrogen;
- taking hormonal contraceptives;
- drugs with hormones that regulate the menstrual cycle;
- the use of hormone replacement therapy in menopause;
- the presence of relatives in the 1st female line with breast cancer;
- first pregnancy after 30 years;
- infertility;
- over 40 years old;
- previous ovarian cancer or MOH;
- contact with a radioactive source;
- the occurrence of changes in the breast, such as atypical epithelial hyperplasia;
- endocrinological and metabolic disorders - thyroid disease, obesity;
- increased consumption of fatty foods;
- early onset of menstruation (at 9-11 years old);
- late onset of menopause.
With an increase in the size of the breast, the risk of developing cancer increases.
Causes of tumors, precancerous diseases of the breast
Cancer can develop in connection with previous pathological processes in the tissues of the breast - repeated dyshormonal hyperplasia, in which foci of fibrocystic mastopathy (fibroadenomatosis) are formed.
Endocrine disorders against the background of ovarian diseases, improper feeding of the child, in connection with abortions become the causes of these pathological processes.
The causes of breast cancer in women may be due to mutations occurring in healthy breast cells. Exposure to carcinogens, as well as cancer risk factors, can change DNA, which is why mutations and the transformation of normal cells into oncogenic ones occur, especially with their frequent division.
A malignant tumor in the breast can develop due to the presence of:
- mechanical injuries: bruises of the breast with hematomas, bruises;
- elevated estrogen levels;
- disorders of the adrenal glands and other endocrine glands;
- frequent abortions, which excludes lactation;
- bad habits: smoking, increased consumption of animal fats and beer;
- daily stress, sedentary lifestyle;
- in men - a concomitant disease - gynecomastia.
Frequent precancerous diseases:
Fibroadenoma
- fibrocystic mastopathy is characterized by benign hormonal and morphological changes in breast tissue;
- mastitis - refers to purulent inflammation of the breast, which often occurs after childbirth during the formation of seals due to a sharp excess of milk;
- skin lesions of the breast without tumors combine eczema of the nipple, candidiasis of the folds under the breast, bacterial infections.
Breast cancer - symptoms and signs of the disease in women and men
Signs of breast cancer in the early stages of a woman may not be noticed during a thorough self-palpation of the breast. Even experienced specialists may not detect a tiny tumor by palpation. You can determine all changes in the breast using mammography. With certain risk factors, the diagnosis is confirmed by screening for ultrasound or MRI.
If signs of breast cancer in the form of a tumor began to be detected during palpation at home or at a doctor's appointment, then this already indicates the development of a more serious stage of cancer.
During daily breast examinations, you should be alert if you have:
- redness and peeling of the skin;
- visual change in the nipple and pain in it;
- discharge from the nipple;
- a lump or small lump, especially in one breast;
- deformation and swelling of the breast;
- changes in the contour of the breast during palpation, which is called a symptom of the site;
- "lemon peel" - noticeable pores on the skin;
- sores on the skin;
- retraction of the nipple and over the tumor - the skin;
- enlarged lymph nodes under the armpits.
If breast cancer is suspected, the symptoms can be checked with diagnostic tests: biopsy and mammography, which will show the tumor even through the dense tissue of the breast.
Do breasts hurt with cancer? Answering this question, we can add that a pulling pain appears not only in the chest, but also in the back between the shoulder blades during a night's sleep. At the same time, deep breathing and / or body position are not associated with it.
Symptoms and signs are most often manifested in an unfavorable environmental situation, the negative impact of harmful chemicals in production and from household chemicals, penetrating radiation, solar radiation, and the widespread and unreasonable use of drugs among residents of large industrial cities.
Breast cancer in men (teenagers and the elderly) can occur if:
- gynecomastia - an increase in breast tissue in violation of the balance of hormones;
- the appearance of a tumor or liver disease, which leads to increased production of estrogen - the female sex hormone;
- the use of certain drugs in the treatment of peptic ulcers and diseases of the heart and blood vessels that cause gynecomastia;
- Klinfelter syndrome, a rare genetic disease that causes gynecomastia and increases the risk of breast cancer.
The occurrence of a tumor
Risk factors for getting sick also include heredity, radiation exposure, physical inactivity and obesity. Symptoms clearly indicate breast cancer in men, which is characterized by neoplasms in the breast located under the nipple or in the areola area. A bloody substance will come out of the nipple. In the last stages of cancer, they will be disturbed by: ulcerations of the skin, a rapid increase in axillary lymph nodes and their compaction. In this case, cancer can spread beyond the breast, since in men it is smaller than in women. The prognosis for recovery can be disappointing.
Other symptoms of breast cancer
When examining and suspecting cancer, the doctor pays attention to the nature of the seals, which are then examined in the laboratory. Oncology is indicated by nodes (single or group) with clear contours, painless, with a dense texture, limited mobility and the presence of wrinkled skin retractions above the node (nodes). In this case, lymph nodes can be palpated under the armpits. The nipple becomes thicker, the skin ulcerates and looks like a lemon peel.
Diffuse seals are similar to the acute form of mastitis or mastopathy. They come in five varieties:
- edematous, more often during pregnancy and breastfeeding. The skin of the breast swells and becomes saturated with infiltrate, turns red and looks like a lemon peel. Edema appears due to compression of the infiltrate of the milk ducts;
- armored with characteristic tissue infiltration and spread to the chest. The skin becomes dense, bluish-red, inactive and wrinkled. In it, you can feel a lot of nodules, find ulcerations and a shell crust;
- erysipelatous (inflamed) with focal redness, swollen jagged edges. The skin of the chest wall is involved in the inflamed process. Accompanied by inflammation with high temperature up to 40C and fever. It is badly treated.
- Vastitis-like with an increase in the area on the skin, tension, redness and an increase in local temperature in the compaction zone. They will be dense, slightly mobile and palpable under the fingers in all areas. Characterized by rapidly spreading inflammation accompanied by fever.
- in the form of psoriasis or eczema (with Paget's disease) accompanied by bright hyperemia, engorgement of the nipple and areola with the appearance of first dry, then weeping crusts and scabs on them, and under them - wet granulations. The spread of carcinogenesis will take place through the milk ducts deep into the breast.
Metastases in breast cancer
Metastases of breast cancer appear when single tumor cells spread through the bloodstream (hematogenous way) and lymphatic fluid (lymphogenic ways) during the early development of an oncogenic tumor. The rapid occurrence of secondary tumors due to metastases occurs only in the case of a depleted immune system of the body, especially in aggressive forms of cancer.
With high immunity, the body prevents the reproduction of cancer cells outside the mammary glands and metastatic foci are not formed. A tumor that does not go beyond the place of its formation: the mammary gland or duct is called non-invasive.
If the tumor enlarges with uncontrolled growth and spreads beyond the lobule or duct of the breast, it is called invasive (invading).
With the expression of tumor cells - ErbB-2 proteins, metastasis begins. Therefore, immunological analysis of breast biopsy can show this expression in order to confirm the aggressiveness of the early stage of the disease, before metastases appear. When metastases are detected by scintigraphy or PET-CT, it is already possible to indicate the spread of cells in the tissues of the liver, brain, lungs, and bones.
Breast cancer, metastases can be detected both in the initial stages of neoplasm development and after its recurrence. Tumor metastases often remain in a latent (dormant) state for a long time. After the removal of the primary tumor formation, they tend to "sleep" for 7-10 years and appear only under the influence of provocative factors.
The site of metastasis development is the nearest (regional) lymph nodes - anterior thoracic, axillary, subclavian, supraclavicular and parasternal. As the cancer progresses, the lymph nodes increase in size, which is called lymphadenopathy.
Regional lymph nodes are no longer able to prevent further metastasis of cancer cells, so hematogenous metastases reach:
- brain and spinal cord;
- liver and kidneys;
- lungs;
- spongy bones.
When cancer cells enter these organs, the tumor island increases to the size of a metastasis, and manifests itself with the following symptoms:
- in the brain- headache, general and muscle weakness in the limbs, visual impairment: double vision or loss of visual field, psychological disorders, decreased level of consciousness, convulsions;
- in the spinal cord- pain and numbness, paresthesia and muscle weakness, symptoms of a dangling hand and a slapping foot, Horner's syndrome may be observed in the brachial plexus;
- in the liver- heaviness and bloating of the abdomen, accompanied by prolonged pain, the development of jaundice with a decrease in liver tissue capable of functioning, weight loss;
- in the kidneys- blood in the urine, hematuria, fatigue, sudden weight loss, lack or decrease in appetite, high sweating, high fever, bouts of back pain, anemia, impaired hormone production and consequently a decrease in red blood cells, high blood pressure;
- in the lungs- persistent cough: dry and wet, shortness of breath during exertion and at rest;
- in spongy bones- steadily increasing pain in the back (vertebrae), pelvic bones and large joints, including knee and ankle, hip and shoulder. When the roots of the spinal nerves are compressed by the affected vertebrae (more often in the lumbar region), the symptoms are manifested by numbness or weakness of the limbs, a violation of the physiological activity of the intestines and bladder: fecal and urinary incontinence develops.
Stages of breast cancer and their classification
When determining five stages of breast cancer (from 0 to 4), a treatment regimen for patients is outlined and the effectiveness of recovery is predicted.
determined by the following factors:
- tumor size (T1, T2, T3, T4);
- invasiveness of education;
- damage to the lymph nodes (N 0, N1, N2, N3);
- the presence of metastases in other organs - M0, (absent) M1 (available).
Stages of breast cancer - classification:
| Stage | Size, see | The defeat of the lymph nodes | distantmetastases |
| 0 | Absent | Missing | |
| I | T1 = 2 | No metastases - N 0 | Not identified - M 0 |
| II | T2 = 3-5 | N 1 - metastases of I-II level were detected in the lymph nodes on the one hand, palpable | M 0 or M 1 - absent or there are single distant metastases |
| II-A | T2 = 2 or 2-5 | Affected lymph nodes under the armpits, lymph nodes are not affected |
«» «» |
| II-B | T3= 2-5 or T3>5 | Lymph nodes are affected., lymph nodes are not affected. | |
| III | T 3 >5 | N 2 metastases of I-II level were detected in the lymph nodes in the cavity under the armpits | M 0 or M 1 - absent or there are distant metastases. |
| III-A | Any | Under the armpits soldered lymph nodes | «» |
| III-B | Any | Grows into the skin of the breast, lymph nodes are soldered under the armpits | «» |
| III-C | Any | Lymph nodes below and above the collarbone are affected and/or the tumor has grown into the chest | «» |
| IV | Any | The tumor spread beyond the borders of the breast, there are nodules and ulcerations on the skin, N 3 - level III metastases on both sides of the chest, under the breast, under the armpits, above the collarbone, palpable | M 1 - there are multiple metastases in any organ and bones |
Early stages of breast cancer - 1, II-A, II-B and III-A.
After the operation, the treatment of stage 1 breast cancer lasts 2-3 weeks. To say about life expectancy, its degree is determined within 10 years after the end of therapy. If stage 1 breast cancer is diagnosed, the prognosis is positive, the 5-year survival rate exceeds 85% of all cases. If stage 2 breast cancer is identified, life expectancy over 5 years will account for about 66% of all cases.
Late stages of breast cancer - III-B, III-C and IV. The forecast is optimistic or negative. If stage 3 breast cancer is diagnosed, life expectancy of more than 5 years is 41% of all cases. This is possible in the presence of tumors over 5 cm with their germination in the tissues surrounding the breast, lesions of the lymph nodes under the arms and in other areas, but in the absence of metastases.
If the diagnosis is “stage 4 breast cancer”, patients will have a life expectancy of more than 5 years in only 10% of all cases. This is possible with a tumor size of more than 5 cm, the presence of lesions in the lymph nodes, and if metastases are detected in distant important organs.
Every professional doctor approaches the issue of life expectancy with caution. There are examples when carcinogenesis was inhibited in the diagnosis of stage 4 breast cancer, but the development of breast cancer of stage 3 and earlier was accelerated.
Of great importance are:
- individual characteristics: age, comorbidities, support from family and friends, own desire to fight for life;
- timeliness and effectiveness of treatment.
Breast cancer - types:
Cancer nosological forms are divided into precancerous or non-invasive, ductal and lobular. The level of estrogen and progesterone in the body of the mammary gland, a specific protein HER2 / neu, indicates the type (form) of cancer.
The condition of women varies depending on the hormonal background. For them, the hormones that the ovaries produce are important. Natural physiological processes occur under the influence of estrogens, progesterone, pituitary hormones - LH, FSH.
Many forms of breast hyperplasia occur with endocrine disorders and high levels of estrogens and prolactin with a reduced level of progesterone. Breast cancer can manifest itself at the same ratio and be estrogen-dependent and progesterone-dependent.
For hormonal imbalance in the treatment, endocrine therapy is used. The effectiveness of treatment is 75%. At the same time, ovarian function is regulated and physical (irradiation) and surgical castration is used.
Negative cancer is the most severe form because it is difficult to treat. It is called triple-negative breast cancer because of the presence of receptors for one of three proteins in the body, such as estrogen, progesterone, and the specific tumor protein HER2/neu.
There are two types of estrogen-dependent cancer, A and B.
Luminal cancer type A women can get sick during menopause in 30-40% of all cases. Hormone cells: estrogen and progesterone will be well perceived by tumor cell receptors, but cells of the HER2/neu tumor protein will not be perceived at all. Their sensitivity to the breast cancer cell growth marker will be low - Ki67.
Luminal cancer is well treated with hormone therapy with Tamoxifen (an estrogen antagonist) and an aromatase inhibitor, an adrenal enzyme that promotes the conversion of testosterone to estrogen. At the same time, relapses are reduced, and the percentage of cure is increased.
Luminal cancer type B women of childbearing age get sick (14-18%). Cancer is characterized by frequent relapses accompanied by metastases to the lymph nodes. The disease is difficult to treat, it is poorly amenable to hormone and chemotherapy. In rare cases, stops cell growth (stimulation of immunity) using the drug Transtuzumab, a human monoclonal antibody to the HER2 / neu tumor protein.
Infiltrating cancer comes in several forms:
- two forms of non-invasive cancer in the ducts and lobules of the breast;
- two forms of invasive (infiltrating) cancer in the ducts and lobules;
- histological form of cancer: metaplastic, papillary, colloidal, medullary.
With infiltrating cancer, flows and lobules are affected, and in 70% they have symptoms of ductal carcinoma. The tumor may have the appearance of a dense potato-like formation.
If poorly differentiated cells are detected, then the course of the disease is characterized by aggressive symptoms, accompanied by metastases in the armpit and damage to the lymph nodes.
The most severe is the mixed form with histological changes in the lobules and ducts. Treatment is with surgical removal and chemotherapy.
Diagnosis of breast cancer in women
Breast cancer is diagnosed at an early stage. The doctor examines the patient in a standing position. At the same time, they release and raise their hands so that he can assess the contours, size, symmetry and condition of the skin of the chest.
The doctor may identify:
- how much the nipple has shifted, deformed and its level has changed;
- the presence of pathological wrinkling of the skin of the nipple, swelling, hyperemia and discharge;
- when palpating the lymph nodes under the armpits, above and below the collarbones - the presence of a lesion (enlargement of the node);
- when palpating the gland - the consistency and structural homogeneity of the gland.
Diagnosis of breast cancer includes tests to rule out (or confirm) Hodgkin's disease, cancers in the lungs, ovaries, pancreas, and to identify skin conditions like squamous cell carcinoma. In some cases, a blind mastectomy is performed - the mammary gland is removed without a cytological examination.
After a clinical examination, the diagnosis is confirmed on the basis of indications:
- mammography (x-ray of the mammary glands);
- ultrasound examination (ultrasound) to determine the nature of the formation: solid or cystic;
- puncture biopsy - cytological examination of breast tissue;
- aspiration biopsy and subsequent cytological examination of the aspirate;
- selective excisional biopsy of formations located deep.
If there are estrogen and progesterone receptors in the biopsy, then hormone therapy is used to treat receptor-positive tumors. After it, the prognosis improves even with stage 3 breast cancer.
To determine diploidy (with DNA index = 1.00) or aneuploidy (with DNA index + 1.00) and the fraction of cells in the S-phase of mitosis, duct cytometry is performed. High fraction aneuploid tumors worsen the prognosis after treatment.
To determine metastases and if a recurrence is suspected, apply:, and determine their level. Since it is necessary to examine a large area of the body when looking for metastases, scintigraphy of the skeletal system is performed with simultaneous examination of single suspicious nodes using X-rays.
A tumor marker for breast cancer is used to confirm the diagnosis along with classical research methods:
- Ultrasound of the abdominal organs;
- MRI of the brain and spinal cord;
- computed tomography of the brain, pelvis, abdomen, chest;
- PET-CT.
Informative video: breast cancer
Methods of treatment of breast cancer
Surgical treatment of breast cancer is carried out taking into account the stage of the disease, the size and location of the tumor in the breast, the number of oncogenic neoplasms, the shape and size of the breast. The question of the availability of technical probabilities for radiation therapy and the operation itself, the possibility of preserving the mammary gland is considered.
Treatment of breast cancer with a modified radical mastectomy will save the mammary gland. Tylectomy is performed to correctly assess the extent of the tumor and improve the cosmetic result.
Contraindications to organ-preserving operations on the mammary gland are:
- large tumors on small mammary glands;
- primary tumors located near the nipple;
- multiple tumors in the breast;
- contraindication to radiation therapy;
- late treatment (after stage 2);
- microcalcifications in the duct or a large lesion within it.
Held or radical. In this case, in the case of multifocal cancer, the entire affected breast and lymph nodes under the arms are removed.
Lumpectomy (sectoral resection), Lymphadenectomy of the lymph nodes under the arms (1 and 2 levels), irradiation (after surgery) is performed when small primary tumors (less than 4 cm) and intraductal carcinoma are detected.
Also carried out:
- mastectomy:
- simple (Maden operation): the breast is removed near the nipple and lymph nodes of the 1st level;
- modified radical (Patey operation): skin is removed within the breast, mammary gland, pectoralis minor muscle and fatty tissue, lymph nodes under the armpits, above and below the collarbone;
- radical Halsted operation: tissue is removed as in Patey's operation and the pectoralis major muscle, but the pectoral nerve is preserved to prevent denervation of the serratus anteriorly and eliminate the symptom of the pterygoid scapula;
- extensive and radical, during which mediastinal lymph nodes, large or medially located tumors with the presence of parasternal (inside the chest) metastases are removed;
- reconstructive surgery using subpectoral prosthetics.
Breast reconstruction is combined with a mastectomy or it is performed after the first surgical wound has healed.
When diagnosed with breast cancer, how long do they live after surgery? All patients want to know about this, but hardly anyone can give a definite answer. The prognosis depends on the age, location, degree of invasion and spread of the tumor, stage, histological parameters, operability (complete or partial removal of the tumor) and concomitant diseases. The most favorable prognosis will be with a completely removed primary lesion and regional lymph nodes, no metastases, a positive response after a course of chemotherapy and no recurrence within a year after surgery and treatment.
Conducting radiation therapy
There are three types of radiotherapy for breast cancer. Spend:
- external beam therapy;
- radiotherapy with modulated intensity;
- brachytherapy (internal or interstitial using a balloon or catheter). Used as an independent method of treatment or additional after surgery.
Here you can find out how it is done. The mammary gland and metastasis zones in the regions of the body are irradiated before the operation, after it - the mammary gland and lymph nodes, subject to the presence of metastases.
Radiation therapy after surgery is carried out by those who have not been performed before it, as well as patients with risk factors:
- tumors (primary) more than 5 cm;
- metastases in 4 or more lymph nodes under the armpits;
- penetration of the tumor into the fascia and / or muscle of the chest, reaching the resection line, spreading into the fatty tissue under the armpits from the lymph nodes.
The classic effects of radiation therapy for breast cancer, such as hair loss and persistent nausea, are not present due to the very small dose of ionizing radiation. Acute radiation sickness will not develop.
Side effects in the middle of the course are manifested:
- general fatigue that lasts 1-2 months after therapy;
- episodic short-term attacks of pain in the gland: sharp shooting (rarely) and dull aching;
- radiation dermatitis: local irritation of the skin of the breast after 3-4 weeks, accompanied by swelling of the subcutaneous tissue, redness, itching, dry skin or dermatitis in the form of a sunburn, in which the epidermis exfoliates and wet blisters form (usually under the breast and under the armpits).
The consequences of irradiation that do not require additional treatment are manifested:
- moderate swelling disappearing after 6-12 months;
- bronzing (darkening) of the skin;
- moderate pain discomfort in the chest and muscles around them due to myositis after irradiation.
Important! Require treatment for complications that manifest themselves:
- lymphedema (edema) of the upper limb after irradiation of the lymph nodes under the armpits and lymphadenectomy (surgery to remove the lymph nodes)
- severe paresthesia with chronic pain syndrome against the background of loss of muscle strength of the upper limb, including the hand, due to degeneration of nerve fibers;
- radiation pneumonitis - reactive inflammation of the lungs after x-ray exposure (after 3-9 months);
- radiation ulcers on the skin of the breast. They may need surgical treatment.
Conducting chemotherapy
Adjuvant with an increased risk of distant metastasis is carried out in conjunction with radiation therapy to slow or prevent recurrence, improve survival in patients with or without lymph node metastases.
Combined chemotherapy for breast cancer is more often performed than monotherapy, especially with metastases. Conduct six monthly courses. Treatment is performed with drugs tested for toxicity.
Maximum doses are prescribed, for example:
- three drugs at once: Fluoruracilla, and;
- with frequent relapses or metastases - hydrochloride and cyclophosphamide;
- with metastases - Taxol (), Thiofosfamide, Doxorubicin.
Do not carry out radiation therapy for the reason:
- pregnancy;
- previously received exposure to another organ;
- connective tissue diseases: lupus erythematosus, systemic vasculitis, scleroderma, against which the patient will suffer from increased sensitivity to procedures;
- the presence of concomitant diseases: severe diabetes mellitus, cardiovascular insufficiency, anemia.
The classic side effects of chemotherapy for breast cancer are:
- lack of appetite due to nausea and vomiting;
- indigestion, diarrhea and constipation;
- apathy, weakness, lethargy and loss of strength;
- hair loss (alopecia);
- fever and fever;
- a decrease in the body's defenses and the activation of chronic diseases, the emergence of acute new diseases;
- inhibition of the functional work of the ovaries;
- anemia and decreased hemoglobin levels;
- leukopenia (decrease in the number of leukocytes) and thrombocytopenia (decrease in the number of platelets) in the blood.
Carrying out hormone therapy
Adjuvant hormone therapy for breast cancer is prescribed if:
- a long period (more than 5 years) without the formation of metastases;
- elderly patients;
- the presence of metastases in bone tissues;
- development of minimal metastases in the lungs and multiple regional ones;
- histological confirmation of I and II degrees of cancer;
- a long period of remission after hormone therapy performed earlier.
Hormone therapy for breast cancer is effective after chemotherapy and in the case of progesterone receptors (PR +) and estrogen receptors (ER +) on cancer cells.
Treatment of patients during premenopause is carried out with drugs, such as:
- Tamoxifen, Luliberin antagonists: Leuprolide acetate, Aminoglutethimide, Hydrocortisone.
Treatment of patients in the postmenopausal period is carried out with drugs, such as:
- Tamoxifen, Megestrol acetate, Aminoglutethimide;
- high doses of estrogen - Diethylstilbestrol, Luliberin antagonists.
In the presence of ERc-positive tumors, it is preferable to treat with Tamoxifen. In ERc-negative tumors, Tamoxifen is less effective. Also, treatment is carried out with aromatase enzyme inhibitors, Zoladex (Goserelin) and oophorectomy (removal and/or irradiation of the ovaries). After an oophorectomy, a woman becomes infertile. Side effects are manifested by redness and dryness of the skin, dryness in the vagina, a sharp change in mood.
Conducting targeted therapy
In breast cancer refers to new developments in the treatment of cancer. Its difference from the above types of treatment is the absence of side effects on body tissues and the rapid destruction of the tumor. The treatment is carried out with targeted drugs (point exposure) that affect the molecule that promotes the growth of tumor cells. This treatment is called "molecular targeted therapy" because it blocks the growth of tumor cells and starts the process of their destruction. It is often combined with chemotherapy and radiotherapy.
Before using targeted therapy, tests are performed to determine receptor sensitivity by immunohistopathological examination of tumor tissue removed during or during surgery.
Immunohistochemistry is used to determine the number of HER-2 receptors, estrogen and progesterone on the surface of tumor cells.
Therefore, the treatment is carried out with the following drugs:
- Tamoxifen, Toremifene (Fareston), Fulvestrant (Fazlodex);
- drugs that affect ER-positive tumors, such as: Anastroizol (Arimidex), Letrozole (Femara), Exemestane (Aromasin) - inhibitors of the aromatase enzyme that produces estrogens;
- selective growth factor blockers: (), Panitumumab (Vectibix), (), trastuzumab (Herceptin). They block angiogenesis (vascular growth) and inhibit the development of a network of vessels around tumor cells, thereby slowing down tumor growth.
Damaged DNA in cells is repaired with inhibitors (blockers) of the PARP protein, after which the apoptosis program (“cell death”) is activated with drugs: Veliparib, Iniparib, Olaparib, provided that there are no such main receptors in the cells as:
- Her-2 (epidermal growth factor);
- estrogen receptor ER;
- progesterone receptor PR.
The prognosis of targeted therapy for breast cancer is optimistic. It is used as a prevention of possible recurrence and to control the spread of metastases. The use of drugs allows patients to live long with cancer without compromising the quality of life.
Carrying out immunotherapy
With immunotherapy, cancer cells can be marked and made visible to immune cells. It can directly kill reborn cells or strengthen the immune system.
Immunotherapy of breast cancer is performed by non-specific vaccination: the use of BCG, stimulation of phagocytic activity with the help of a protein derivative of tuberculin, the inclusion of Timidrin in leukocytes, etc.
It is important to know! Immunotherapy:
- restores and normalizes immune-protective mechanisms, if reduced indicators of immunity are found: humoral and cellular;
- used after surgery, radiation and chemotherapy, if as a result of this stress has occurred and the body's reactivity has been impaired;
- used for distant metastases: manifesting and subclinical to prevent the appearance of a secondary tumor.
Treatment with drugs showed itself well: Levimezol, Zimozan, Prodigiozan. At the same time, specific and nonspecific immunity factors were activated. Restored immunity contributes to a long relapse-free period after mastectomy.
In the case of relapses and metastases, immunotherapy helps to increase the frequency of regression of cancer foci. With persistent inhibition of immunoreactivity in patients, immunotherapy will not bring high results.
Disease prevention
Prevention of breast cancer includes self-examination of the breast after menstruation. Should:
- timely conduct conservative therapy of fibrocystic mastopathy;
- to be observed annually by a gynecologist-mammologist, especially after 30-40 years;
- women 40-50 years old to undergo mammography annually or once every 2 years;
- women 50 years of age with risk factors - annually examine the breast with a mammogram;
- wear a comfortable bra with wide straps so that there are no chafing and redness, especially during menstruation with swelling of the chest;
- lead a healthy lifestyle, including a healthy diet;
- protect the chest from direct sunlight, injuries and surgical interventions.
Informative video: modern view of breast cancer
However, over the past few decades, the incidence of malignant neoplasms has increased significantly.
Such progress of the disease is associated with a sharp deterioration in the environmental situation in the world, with a change in the lifestyle of women themselves, with a deterioration in their nutrition, etc.
In addition, the causes of the development of this disease may lie in predisposing heredity, in the tendency of women to terminate pregnancies, in refusing to breastfeed.
And these are far from all the reasons why such a formidable and life-threatening disease can develop.
Why do doctors think breast cancer occurs?
As we have already said, the well-known (with evidence) reasons why a woman develops breast cancer are not known to modern medicine.
And that means, in each of the specific cases, it is simply not possible to unambiguously answer the question: what caused the patient to develop breast cancer.
Indeed, today (this is precisely the opinion of practicing doctors), many cases have been recorded when breast cancer develops in a fairly young, practically healthy woman, with positive, in the sense of oncology, heredity, without bad habits, who have not had abortions, etc.
At the same time, it also happens that women do not limit themselves in any way during their life, in terms of bad habits and malnutrition, they have many diseases that can provoke the development of an oncological disease, but nevertheless, they live quietly to a very old age, do not faced with a terrible diagnosis.
Today, doctors know for sure only one thing - the causes of the appearance of malignant cells in the female body (which indicate that breast cancer has developed) are contained in mutations of normal cellular tissues of the mammary gland.
However, from what, under the influence of certain carcinogens, initially healthy genetic cellular material begins to change pathologically, unfortunately, is not known.
At this point in time, doctors can only discuss with a certain degree of certainty some of the factors that may possibly provoke the development of the disease.
Major Risk Factors for Breast Cancer
Scientists have long proven that the more often this or that cell of the body begins to divide, the more chances it has for further degeneration (under the influence of certain carcinogens) into malignant material.
In cases of breast cancer, doctors note many factors that can play a leading role in cell carcinogenesis, which these factors can enhance.
These factors are commonly referred to as:
- A slightly elevated level in the blood of a woman, estrogens, or their clear predominance relative to other hormones. What often happens in patients who have heard the diagnosis of breast cancer.
- Some irregularities in the menstrual cycle.
- Frequent abortions.
- Refusal or physiological absence of normal lactation.
- Certain disorders of the functioning of the thyroid gland.
- Some violations of the physiologically normal functioning of the adrenal glands.
- Fibrocystic disease in its nodular and severely neglected forms.
It is impossible not to say that young (or not so) men also have breast cancer, although much more rarely than women. You may ask why men experience these ailments - much more often, this disease can affect those men who previously suffered from gynecomastia.
In addition, a woman’s complete absence of children or the presence of only one child, rather late first motherhood, frequent stress, bad habits (smoking, alcoholism), excessive love for a strong tan without the top of a swimsuit, can also become breast cancer provoking factors. Since breast cancer most often occurs in women over forty-five years old, another factor provoking the problem can be called long-term (for 10 years or more) taking drugs, the so-called hormone replacement therapy.
Women who consider themselves to be at risk (often encountering the manifestations described above) should regularly undergo the necessary examinations and monitor their own health status together with a mammologist.
Unfortunately, despite such an abundance of external and internal risk factors, the only way today (and this has been proven by scientists) to protect yourself from the negative manifestations of the disease is the method of regular medical examinations.
It is the timely detection and rapid treatment of the problem that allows most women to cope with this terrible disease.
How does breast cancer manifest itself?
The only manifestation of a malignant neoplasm of the mammary gland, directly at the earliest stages of development, can be considered the presence of a certain seal (nodule), palpable in the thickness of the chest tissues. Otherwise, the disease is asymptomatic at first.
Such small formations are most often detected by women themselves, or they are detected during routine ultrasound examinations on mammography, etc. It must be understood that in the absence of adequate treatment, breast cancer will progress - over time, the tumor will increase in size, it may grow into the skin or other organs, from which the prognosis of survival for the patient can significantly worsen.
Recall that if the process of developing an oncological disease is left without control and correction (treatment), malignant cells can quickly spread through the blood throughout the female body, thereby giving life to new dangerous tumors or metastases.
Most often, a malignant tumor of the breast prefers to metastasize to the lymph nodes, lungs, bones, liver, spinal cord or brain.
Naturally, the defeat of such vital organs leads to the disintegration of their tissues and the subsequent death of the patient. And that means that every sane woman can and should be examined in a timely manner, detect and start fighting the disease in the early stages.
This article gave me the impetus to think about my health. I was skeptical about breast cancer. But after reading this article, I seriously thought about my health. Understanding the state of our current ecology and the nuances that I often undergo psychic attacks. I am grateful to the doctors for their work in revealing and working on such an important disease that many women are exposed to!
We are happy for you, if we make you think about your health, about the need for scheduled preventive examinations, about the need to correct at least a few people who are not always the right lifestyle and nutrition, then our resource was really not created in vain. We wish you to always appreciate and protect what you still have - your health and go to the doctors only for the purpose of preventive examinations (recall, a preventive examination of the mammary glands for completely healthy women is necessary at least once a year).
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Symptoms and treatment of breast cancer in women
In recent years, breast cancer has been ranked 3rd among all causes of death in women. These figures could be significantly lower if each representative of the weaker half of humanity treated themselves more carefully, did not neglect preventive examinations at the gynecologist and mammologist. This is the only way to detect the first symptoms of breast cancer in time.
Causes
The causes that lead to breast cancer are not fully understood. However, there are known factors by which women are considered to be at an increased risk of developing this type of cancer:
- Age after 50 years.
- History of breast cancer.
- Cases of cancer, including breast cancer, in close relatives, especially on the maternal side.
- Lack of children before adolescence.
- Beginning of menses before 11 years of age.
- Menopause after 55 years.
- Contact with sources of radiation.
- Long-term consumption of fatty foods.
Symptoms
Almost all subtypes of breast cancer are characterized by pain and discomfort. Sometimes there may be other common changes for all types, for example:
With any type of breast cancer, a woman may experience a number of skin symptoms. For example, when the skin over the tumor is infringed, one can see a violation of the usual direction of the skin folds, the appearance of grooves of various depths between them. Visually, this symptom is similar to senile wrinkles, but appears only in a limited area of \u200b\u200bthe chest.
Such pathological wrinkling usually manifests itself in the early stages of the development of the disease. Also in this phase of breast cancer, another more characteristic symptom is often found - skin retraction. It can also manifest itself in the second stage of the disease, and is detected when the skin is pinched with fingers when the patient is lying.
Varieties
There are several types of breast cancer. They are similar to each other, but each has its own characteristics.
Already at the first stage, this subtype of cancer is manifested by such an external sign as wrinkling of the skin, and as the growth of the node increases, skin retraction is observed. A late symptom of this disease is skin that visually resembles the peel of a lemon. The nodular form of breast cancer can also affect the nipple, which appears as its noticeable deformation.
The edematous form affects mainly young women. Most often, it develops during the period of bearing a child or lactation. The course of this type of breast cancer is acute, but there is practically no pain. Symptoms include swelling of the skin and breast tissues. At the first stage, a compacted area of \u200b\u200bthe breast with reddened skin is found, which eventually spreads throughout the mammary gland.
Erysipelatous cancer is accompanied by reddening of the skin. This symptom is easy to distinguish from other rashes or irritations, since the edges of the redness are uneven, tongue-like. The disease is acute, the body temperature can rise to 40 ° C, but the tumor is almost impossible to detect on palpation.
Mastitis-like cancer is common in young women and is manifested by the following symptoms:
- Increase in body temperature.
- Swelling and redness of the skin of the chest.
Paget's cancer is considered the form of the disease with the most favorable prognosis for cure. This is a localized species that affects the nipple and/or areola. Clinically, it manifests itself in the form of symptoms such as ulceration and maceration of the nipple. If untreated, the disease progresses, the nipple collapses, leaving an ulcer in its place.
With shell cancer (diffuse-infiltrating form), there is a decrease in the mammary gland, thickening of the skin. The affected chest is limitedly mobile. The disease usually affects the gland on one side of the body, but if left untreated, it spreads to the other.
Occult breast cancer is also referred to as occult breast cancer because it is almost impossible to detect. The first clinical sign is an increase in the lymph nodes in the armpits, but at the same time, the tumor formation is not palpable in the gland itself. Often a woman with this type of cancer is treated for inflammation of the lymph nodes, and it can only be detected when peripheral metastases appear.
Ductal breast cancer begins to develop from the inner walls of the milk canals, while not affecting the lobes and other glandular tissues. Invasive ductal (infiltrating) breast cancer presents with symptoms such as nipple discharge, soreness, and hard or pineal areas in the breast.
stages
Formally, there are 5 stages of breast cancer:
- Stage zero - non-invasive cancer, that is, the tumor formation has remained within its primary appearance in the breast lobe or duct and does not spread to other areas of the breast. Clinical symptoms of the disease at stage 0 are absent, axillary lymph nodes are not affected.
- Stage 1 - invasive breast cancer. The tumor appears in the surrounding tissues, but there are no metastases. The size of the neoplasm is about 2 cm.
- Stage 2 is characterized by an increase in axillary lymph nodes from the affected breast in the absence of metastases. The tumor is larger than 2 cm.
- Stage 3 - locally advanced cancer. Its main symptom is axillary lymph nodes soldered together (or with adjacent fatty tissue), forming conglomerates (packages).
- Stage 4 - metastatic cancer, in which metastases may occur in any organ and part of the body, most susceptible to damage to the bones of the skeleton. The disease can spread to the lungs and liver, sometimes to the brain, skin, and adrenal glands.
Diagnostics
To determine breast cancer are used:
- Clinical blood test (including oncomarkers, biochemical).
- Mammography (chest X-ray).
- Ductography (x-ray of the mammary glands using a contrast agent, necessary for the destruction of the milk ducts).
- Ultrasound of the chest, chest and abdominal cavity, small pelvis.
- Biopsy of breast tissue and lymph nodes.
- Magnetic resonance imaging (MRI).
- Immunohistochemical and histological examination of the biopsy.
- Computed tomography (CT).
- Radiography of the lungs.
- Osteoscintigraphy (radioisotope study of bones).
Treatment
- Chemotherapy. For the treatment of cancer, cytostatic (cytotoxic) drugs are prescribed, which disrupt the mechanism of division of pathological cells and, as a result, stop their proliferation. These funds include:
- platinum preparations - Carboplatin, Cisplatin, Cytoplastin, Triplatin, etc.;
- means of the alkaloid group - Vinblastine, Vincristine, Vinorelbine, Maverex;
- oxazaphosphorin derivatives - Mafosfamide, Trofosfamide, Endoxan, etc.;
- fluoropyrimidine carbamate derivatives - Xeloda, Capecitabine, etc.
Chemotherapy for breast cancer can be carried out as the main and only treatment, in order to reduce the size of the tumor formation before surgery or stop the formation of metastases after surgical treatment.
In the treatment of stage 0 breast cancer, the removal of the cancerous area of the breast (sectoral resection) or lumpectomy is mainly used. Operations may be accompanied by lymph node dissection - the removal of nearby lymph nodes. Also, in the treatment of stage 0 cancer, a course of radiotherapy is mandatory, and in some cases, targeted therapy is carried out.
For the treatment of stage 1, lumpectomy is used with the elimination of the axillary lymph node. To get rid of the remaining cancer cells and avoid their re-proliferation, hormonal, radiation or chemotherapy is prescribed after the operation, according to indications.
The first stage of treatment for stage 2 cancer is the partial removal of breast tissue (lumpectomy) or its complete removal (mastectomy). In this case, enlarged regional lymph nodes are also subject to elimination. After the operation, a course of chemotherapy is prescribed. For those patients whose tumor has reached 5 cm or more, a course of chemotherapy is prescribed 2 times: before and after surgery. In addition, according to indications, courses of hormonal and radiation therapy are carried out.
In the treatment of stage 3 breast cancer, a complex attack on cancer-affected cells is first applied using cytotoxic agents (chemotherapy) and oncological hormone therapy. If the first stage gave positive results, then the attending doctor decides to perform the operation, the result of which is fixed by a second course of chemotherapy or ionized radiation. In hormone-dependent cancers, long-term use of aromatase inhibitors (hormonal therapy) is indicated, and in cancer overexpression of receptors, the use of monoclonal antibodies.
Treatment of grade 4 breast cancer is mainly aimed at alleviating the condition of patients. Properly selected complex therapy at this stage of the disease can significantly prolong life. To reduce the level of intoxication of the body, mastectomy is used, and all anti-cancer methods are used to combat metastases: hormonal, radiation and chemotherapy. Supportive treatment of concomitant diseases is also prescribed.
Treatment with folk remedies
- At the first signs of breast cancer, it is useful to take an infusion, for which mix equal proportions of calendula and immortelle flowers, valerian roots, burnet, angelica, dandelion, St. eucalyptus, coltsfoot, sage, birch, linden, pine, fennel, chamomile. Pour 1 tablespoon of the mixture with 250 ml of boiling water and leave for 30 minutes, then strain. Take a folk remedy 5 times a day.
- Belladonna leaves have an analgesic effect and are used as applications on the affected mammary gland.
- Propolis is one of the most powerful natural immunostimulants, which has a universal effect on all parts of the human immune system. In its pure form, propolis is recommended to be taken 5 times a day, 5-6 grams daily, 1 hour before meals. To prepare medicinal propolis oil, you will need 1 kilogram of unsalted butter and 160 grams of purified and crushed propolis. Melt the butter, bring to a boil, add prepared propolis to it, then immediately remove from heat and stir constantly for 30 minutes. For the treatment of breast cancer, 0.5 tablespoon of milk must be added to 1 tablespoon of the drug and drunk 3 times a day before meals.
In men
Breast cancer in men can appear both with gynecomastia (growth of glandular tissue) and in a previously healthy gland. The reason for such a rare pathology is the lack of male and an excess of female hormones. A cancerous tumor in the breast in men is several times more aggressive than in women, and is less treatable. Symptoms of breast cancer in men include discharge from the nipples and the appearance of neoplasms.
In children
Breast cancer in children is very rare. It can occur in adolescence in girls as a result of hormonal changes in the body. Predisposing factors include:
- Heredity;
- earlier initiation of smoking;
- alcohol abuse;
- strong emotional loads and stresses.
Breast cancer in children is not as aggressive as in adults. It can manifest itself in the form of general signs: weakness, fatigue, weight loss, a slight increase in body temperature. The cause of breast cancer is a violation of cellular metabolism in the child's body. After some time, a small nodule may appear in the child's chest, which is easily palpable. In rare cases, sores, erosions, accompanied by weeping, scales and crusts may appear on the skin of the breast.
Prevention
It is impossible to insure yourself against breast cancer, but if you follow some simple rules, you can significantly reduce the risk of its occurrence:
- monitor your diet and eat exclusively healthy food, adhere to a diet with a sufficient content of vegetables and fruits;
- stop smoking, minimize alcohol consumption;
- avoid hormone replacement therapy during menopause.
The main preventive measure that allows for early diagnosis of the disease is systematic breast examinations, both independent at home and professionally performed by a gynecologist or mammologist.
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breast cancer
Breast cancer is a malignant tumor that develops in the cells of the breast. This type of tumor is considered a typical female disease.
It grows and develops not only in the mammary gland itself, but can also spread to other organs.
Anatomy of the female breast
The female breast is a mammary gland. It is a convex disc, consisting of 15-20 cone-shaped lobules - glands. The lobules, in turn, are connected to the nipple by ducts.
Around them are adipose and connective tissue that perform a protective function, as well as blood and lymphatic vessels that nourish the mammary glands.
Where do tumors form?
Most often, cancer cells appear around the ducts of the breast. The process of tumor formation can also begin in the cells lining the lobules. Tumors in other parts of the breast are less common.
Where do breast tumors metastasize?
The female breast is permeated with lymphatic vessels. Tumor cells enter them and move to the lymph nodes to which the breast is “connected”: axillary, in the chest and in the region of the collarbone.
Most often, breast cancer metastases develop in the axillary lymph nodes, leading to their growth. If tumors appear in the axillary lymph nodes, the risk of their metastasis to other organs and tissues of the body increases significantly.
Are all breast tumors malignant?
Most breast tumors are benign - they are simply lumps formed in the connective tissue (fibrosis) or fluid-filled cavities (cysts).
To determine what type of tumor it is, you need to do a biopsy - take a small piece of the tumor for examination.
Benign breast tumors do not form metastases and do not pose a threat to life. However, they are an additional risk factor for the development of a malignant tumor and require constant monitoring of the condition.
How common is breast cancer?
This is the most common form of cancer in women. It occurs in one of nine women. However, in one case out of a hundred, breast cancer occurs in men.
Why does breast cancer develop?
1. Sex. Women are significantly more likely than men to develop breast cancer. The risk of tumor formation in women is higher because the female sex hormones estrogen and progesterone constantly have a stimulating effect on breast cells.
2. Age. The risk of breast cancer increases with age. It affects one in eight women over 45 and two out of three women aged 55 and over.
3. Genetics. Five to ten percent of breast cancer cases are a direct result of genetic defects inherited from parents.
4. Cases of breast cancer in the family. Having one next of kin with breast cancer doubles the risk of developing the disease. Strict control of the state of the mammary glands allows you to notice the onset of tumor formation in time and remove it.
5. Personal history of breast cancer. If the tumor was found in one breast, the risk of its formation in the second increases by 3-4 times.
6. Drinking alcohol seriously increases the risk of breast cancer. Moreover, this risk increases with the amount of alcohol consumed. Those who drink two to five drinks a day have a one and a half times increased risk of breast cancer.
7. Overweight. The female sex hormone estrogen is produced not only by the ovaries. It is also produced in adipose tissue. Therefore, large doses of estrogen and its longer effect on the tissues of the glands in obese women increases the risk of a cancerous tumor.
8. Sedentary lifestyle. Studies have shown that just 10 hours of walking per week reduces the risk of breast cancer by almost 20 percent.
9. Smoking. Tobacco consumption and passive smoking increase the risk of developing breast cancer.
10. Dense tissues of the mammary glands. Women who have a large amount of breast tissue and little fat have a higher risk of breast cancer.
11. Certain types of benign breast tumors increase the risk of breast cancer. Women who have such tumors should carefully monitor the condition of the mammary glands themselves and undergo regular examinations.
12. Features of the menstrual period. If women start menstruating very early (before age 12) and menopause starts very late (after age 55), the risk of developing breast cancer is increased. This is due to the longer exposure of the hormones estrogen and progesterone to breast tissue.
13. Childlessness or late delivery. Women who have no children and those who have had children after the age of 30 have a higher risk of developing breast cancer. Having multiple pregnancies and pregnancies before age 30 reduces the risk of breast cancer.
14. Refusal of breastfeeding. Breastfeeding reduces the chance of breast cancer. According to Yale Medical University in the United States, women who have breastfed a child for more than 13 months or who have breastfed more than three children have half the risk of developing breast cancer than women who have never breastfed.
Contrary to popular myths, regular use of antiperspirants, wearing bras, and breast implants do not increase the risk of developing breast cancer.
How to detect breast cancer in time?
The reason for going to the doctor should be the appearance of a seal and any other changes in the mammary gland, in the area of the nipple or areola.
After the age of 40, every woman needs to undergo an annual examination by an oncologist, including x-ray mammography and ultrasound of the mammary glands.
This examination is free, painless and does not take much time. The question of the frequency of examination is decided individually, depending on the patient's complaints, the presence of benign tumors and other factors.
If breast cancer is detected early, a complete cure is possible in more than 80 percent of cases.
The most important
Breast cancer is the most common cancer among women. Many factors contribute to its development, including an unhealthy lifestyle.
Regular examination by a doctor will allow you to detect the tumor in time and completely cure it.
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breast cancer (breast cancer)
What is breast cancer (breast cancer) -
Breast cancer is one of the most studied and researched forms of cancer. The oldest known description of breast cancer (although the term "cancer" itself was not yet known or used) was found in Egypt and dates back to around 1600 BC. The so-called "Edwin Smith Papyrus" describes 8 cases of tumors or ulcerations of the mammary gland, which were treated by cauterization by fire. The text reads: “There is no cure for this disease; it always leads to death.” At least one of the eight cases of breast cancer described in the papyrus occurred in a man.
What provokes / causes of breast cancer (breast cancer):
Age over 40 years;
High levels of estrogen in the blood;
The presence of relatives of the 1st line (mother, sister, aunt, grandmother) with breast cancer;
Taking hormonal drugs for the purpose of contraception or regulation of the menstrual cycle, hormone replacement therapy in menopause;
First pregnancy over the age of 30;
Previously transferred ovarian or breast cancer;
Contact with sources of radiation;
Changes in the mammary gland, interpreted by the doctor as the occurrence of atypical epithelial hyperplasia. Despite the fact that fibrocystic mastopathy is not a precancerous condition, atypical changes in the epithelium of the breast ducts increase the risk of breast cancer;
Lack of childbirth and pregnancy;
Endocrinological and metabolic disorders (thyroid disease, obesity);
Early onset of menses (before age 12) and/or late onset of menopause;
Increased intake of fatty foods.
Pathogenesis (what happens?) during Breast Cancer (breast cancer):
The lymph flow, which is very developed in the breast tissue, tumor cells are transferred to the lymph nodes and give initial metastases. First of all, the axillary, subclavian and subscapular groups of nodes are affected, and when the tumor is located in the medial quadrants of the gland, the chain of parasternal lymph nodes is affected. The next stage is metastasis to the supraclavicular, cervical and mediastinal lymph nodes, as well as crosswise to the opposite axillary cavity. There is cross-metastasis to the second mammary gland. In some cases, metastases in the axillary lymph nodes appear before a tumor is detected in the mammary gland, and then, first of all, it is necessary to exclude its cancerous lesion.
Symptoms of breast cancer (breast cancer):
In addition to the usual clinical picture of breast cancer, its special forms are distinguished: mastitis-like form, erysipelatous form, shell cancer and Paget's cancer.
Have you found a lump in your chest?
There were discharge from the nipples;
Breast skin has changed (“lemon peel”, retraction, redness, swelling);
The nipple has changed (it has retracted, a bleeding wound has appeared).
Diagnosis of breast cancer (breast cancer):
The method of magnetic resonance imaging (MRI).
Mammography is the most informative diagnostic method.
A biopsy is necessary to make an accurate diagnosis. Biopsy - a minimally invasive method - allows you to take a piece of suspicious tissue for histological examination before starting treatment. Histopathological examination determines the type of tumor, and immunohistochemical tests allow to determine the hormone dependence of the tumor (i.e., the presence of estrogen and progesterone receptors, as well as the presence of Her2neu receptors). hormonal status affects the prognosis and choice of treatment. All necessary types of biopsies are performed in our hospital, including high-tech stereotaxic biopsy, which is rare for Ukraine. A special installation allows you to very accurately and almost painlessly take for research, and sometimes completely remove, formations with a size of 1 mm. The procedures are performed with anesthesia on an outpatient basis, no special preparation is required before such manipulations.
Ultrasound examination of the abdominal organs;
Computed tomography of the abdominal cavity and chest;
Scintigraphy (radioisotope study) of the skeleton;
General clinical analyzes and examinations;
Examination of lymph nodes before treatment.
Treatment for breast cancer (breast cancer):
Plastic surgery with own tissues taken from other parts of the body (as a rule, this is the stomach, less often the back). At the same time, figure correction is possible;
Plastic surgery with an artificial implant;
A combination of both methods.
To reduce the likelihood of recurrence after excision of a tumor in the mammary gland and after removal of the affected lymph nodes;
For symptomatic (palliative) treatment of non-removable tumors, in case of complications - ulceration, bleeding;
For palliative treatment of distant metastases, if they cause severe complications - compression of the brain or spinal cord, severe pain, etc.
Prevention of breast cancer (breast cancer):
The simplest and most accessible method of prevention, however, and the least effective, is self-examination - examination and palpation of the mammary glands by the woman herself. This procedure allows you to identify the tumor at an early stage. Self-examination is carried out once a month. First, an examination is made in front of a mirror. The following signs should be a mandatory reason to see a doctor:
visually defined education,
Changes resembling "lemon peel".
Screening is the most effective way to prevent breast cancer.
Screening is a planned examination of a healthy population in order to identify the earliest forms of a tumor. Breast cancer screening procedures are very simple and painless. So, women are recommended, depending on age, to carry out:
Flight - self-examination of the breast monthly, annually ultrasound (ultrasound), especially if the woman is at risk;
Perform a mammogram once at age;
From the age of 40 - self-examination monthly, annually - mammography.
1. screening was carried out by a highly qualified specialist who knows how to detect even the most insignificant signs of the disease;
2. the equipment used for screening was high-precision and in line with modern standards of world oncology;
3. The hospital provided comprehensive and effective cancer care.
Which doctors should you see if you have breast cancer (breast cancer):
Are you worried about something? Do you want to know more detailed information about breast cancer (breast cancer), its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can make an appointment with a doctor - the Eurolab clinic is always at your service! The best doctors will examine you, study the external signs and help identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. You can also call a doctor at home. The Eurolab clinic is open for you around the clock.
The phone number of our clinic in Kiev: (+3 (multi-channel). The clinic secretary will select a convenient day and hour for you to visit the doctor. Our coordinates and directions are listed here. Look in more detail about all the services of the clinic on its personal page.
If you have previously performed any studies, be sure to take their results for a consultation with a doctor. If the studies have not been completed, we will do everything necessary in our clinic or with our colleagues in other clinics.
You? You need to be very careful about your overall health. People do not pay enough attention to the symptoms of diseases and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called symptoms of the disease. Identifying symptoms is the first step in diagnosing diseases in general. To do this, it is simply necessary to be examined by a doctor several times a year in order not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the body as a whole.
If you want to ask a doctor a question, use the online consultation section, perhaps you will find answers to your questions there and read tips on self-care. If you are interested in reviews about clinics and doctors, try to find the information you need in the All Medicine section. Also, register on the Eurolab medical portal to be constantly up to date with the latest news and information updates on the site, which will be automatically sent to you by mail.
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breast cancer (breast cancer)- epithelial tumor originating from the ducts or lobules of the gland.
Every day, 50 women in Ukraine are diagnosed with breast cancer. Every month about 750 women die from this disease in Ukraine. Breast cancer rarely occurs in women under the age of 20, and with increasing age, the number of cases increases. The peak incidence occurs during the menopause and postmenopausal period. Unfortunately, a high mortality rate from this disease persists in our country, which is associated with the lack of screening programs for examining the population and the late visit of a woman to a doctor.
Historical Descriptions of Breast Cancer (Breast)
Breast cancer is one of the most studied and researched forms of cancer. The oldest known description of breast cancer (although the term "cancer" itself was not yet known or used) was found in Egypt and dates back to around 1600 BC. The so-called "Edwin Smith Papyrus" describes 8 cases of tumors or ulcerations of the mammary gland, which were treated by cauterization by fire. The text reads: “There is no cure for this disease; it always leads to death.” At least one of the eight cases of breast cancer described in the papyrus occurred in a man.
For centuries, doctors have described similar cases in their practice with the same sad conclusion. No advances in the treatment of breast cancer occurred until, in the 17th century, doctors gained a better understanding of the body's circulatory and lymphatic systems and were able to understand that breast cancer spreads (metastasizes) through the lymphatics and in the first place affects the nearest - axillary - lymph nodes. The French surgeon Jean-Louis Petit (1674-1750) and shortly after him the Scottish surgeon Benjamin Bell (1749-1806) were the first who guessed to remove not only the mammary gland itself, but also the nearest lymph nodes and the underlying pectoral muscle in case of breast cancer. Their successful work was taken up by William Steward Halsted, who in 1882 introduced a technically improved version of this operation, which he called the "radical mastectomy", into widespread medical practice. The operation became so popular for breast cancer that it was even named after its inventor, the Halsted mastectomy or the Halsted mastectomy.
At present, the expression of various genes in breast tumors has been studied and various molecular types of the tumor have been identified. Clinically, they have a significantly different risk of developing metastases and require different therapies. A collection of data on 17,816 gene expression in breast tumors is available online and is used not only for biomedical research, but also as a classic test case for data visualization and mapping.
According to the US Cancer Institute, with timely detection, breast cancer can be cured in 98.1% of women!
What provokes / causes of breast cancer (breast cancer):
Risk factors for breast cancer (breast cancer)
age over 40 years;
high levels of estrogen in the blood;
the presence of relatives of the 1st line (mother, sister, aunt, grandmother) with breast cancer;
taking hormonal drugs for the purpose of contraception or regulation of the menstrual cycle, hormone replacement therapy in menopause;
first pregnancy over the age of 30;
previous ovarian or breast cancer;
contact with sources of radiation;
changes in the mammary gland, interpreted by the doctor as the occurrence of atypical epithelial hyperplasia. Despite the fact that fibrocystic mastopathy is not a precancerous condition, atypical changes in the epithelium of the breast ducts increase the risk of breast cancer;
absence of childbirth and pregnancy;
endocrinological and metabolic disorders (thyroid disease, obesity);
early onset of menses (before age 12) and/or late onset of menopause;
increased intake of fatty foods.
In the development of breast cancer, an important role is played by previous pathological processes in its tissues, mainly repeated dyshormonal hyperplasia with the formation of foci of fibrocystic mastopathy (fibroadenomatosis). The causes of these changes in the breast tissue are a number of endocrine disorders, often due to concomitant ovarian diseases, repeated abortions, improper feeding of the child, etc. The risk increases with increasing size of the gland. Some importance in the development of breast cancer may have anatomical and embryological abnormalities - the presence of additional lobules of glandular tissue, as well as previous benign tumors - breast fibroadenomas. All these formations, regardless of their tendency to malignant transformation, are subject to removal, because sometimes it is difficult to distinguish them with sufficient certainty from incipient cancer.
Pathogenesis (what happens?) during Breast Cancer (breast cancer):
According to the histological structure, breast cancers are more often referred to as adenocarcinomas or solid cancer with many transitional forms. There are ductal and lobular cancers, represented by infiltrating and non-infiltrating forms.
It should be noted that, in addition to cancerous tumors, non-epithelial malignant tumors - sarcomas, in the diagnosis and treatment of which there are no fundamental differences from cancer, can extremely rarely (only in 1% of cases) occur in the mammary glands.
Breast cancers are classified by the presence or absence of ERts (Estrogen Receptor Condition). The condition of the ER can completely change the course of the disease. ERc-positive tumors are more often observed in postmenopausal women (after the onset of menopause). About 60-70% of primary breast cancers are characterized by the presence of ERts. ERc-negative tumors are more often observed in premenopausal patients (before menopause). The state of estrogen receptors affects the choice of treatment tactics.
Metastasis
The lymph flow, which is very developed in the breast tissue, tumor cells are transferred to the lymph nodes and give initial metastases. First of all, the axillary, subclavian and subscapular groups of nodes are affected, and when the tumor is located in the medial quadrants of the gland, the chain of parasternal lymph nodes is affected. The next stage is metastasis to the supraclavicular, cervical and mediastinal lymph nodes, as well as crosswise to the opposite axillary cavity. There is cross-metastasis to the second mammary gland. In some cases, metastases in the axillary lymph nodes appear before a tumor is detected in the mammary gland, and then, first of all, it is necessary to exclude its cancerous lesion.
Hematogenous metastases occur in the lungs, pleura, liver, bones and brain. Bone metastases are characterized by damage to the spine, flat bones of the pelvis, ribs, skull, as well as the femur and humerus, which is manifested at first by intermittent aching pains in the bones, which later take on a persistent painful character.
Symptoms of breast cancer (breast cancer):
Localization of cancerous tumors in the mammary glands is very different. Both the right and left glands are equally often affected; about 2.5% have bilateral breast cancers. A node in the second gland can be both a metastasis and a second independent tumor.
In the mammary gland itself, most often (approximately in 1/2 patients) tumors occur in the upper outer quadrant, sometimes at its very edge on the border with the armpit.
Unfortunately, obvious manifestations of breast cancer appear, as a rule, already with advanced forms of the tumor. As a rule, these are dense painless formations in the mammary glands. When germinating into the chest wall, the tumor and the entire gland become immobile. And when the tumor grows on the skin, it is deformed, retracted, ulcerated, the nipple is retracted. Discharge from the nipple, usually bloody, can also be a manifestation of cancer. When the process spreads to the lymph nodes, they increase, which can cause discomfort in the armpits.
In addition to the usual clinical picture of breast cancer, its special forms are distinguished: mastitis-like form, erysipelatous form, shell cancer and Paget's cancer.
Mastitis-like cancer characterized by a rapid course with a sharp increase in the mammary gland, its swelling and soreness. The skin is tense, hot to the touch, reddish. The symptoms of this form of cancer are similar to acute mastitis, which in young women, especially against the background of a postponed childbirth, often leads to severe diagnostic errors.
erysipelatous form cancer is distinguished by the appearance of a sharp redness on the skin of the gland, sometimes extending beyond its limits, with uneven jagged edges, sometimes with a high rise in temperature. This form can be mistaken for ordinary erysipelas with the corresponding prescription of various physiotherapeutic procedures and medicines, which leads to a delay in the correct treatment.
Third form - shell cancer occurs due to cancerous infiltration through the lymphatic vessels and crevices of the skin, which leads to a tuberous thickening of the skin. A dense shell is formed, covering half, and sometimes the entire chest. The course of this form is extremely malignant.
A special form of planar lesions of the nipple and areola is Paget's cancer. In the initial stages, peeling and weeping of the nipple appear, which is often mistaken for eczema. In the future, the cancerous tumor spreads deep into the ducts of the gland, forming its typical cancer node in the tissue with metastatic lesions of the lymph nodes. Paget's cancer proceeds relatively slowly, sometimes for several years, limited only to the defeat of the nipple.
In general, the course of breast cancer depends on many factors, primarily on the hormonal status and age of the woman. In young people, especially against the background of pregnancy and feeding, it proceeds very quickly, early giving distant metastases. At the same time, in older women, breast cancer can exist for 8-10 years without a tendency to metastasize.
When to see a doctor:
Have you found a lump in your chest?
There were discharge from the nipples;
Breast skin has changed (“lemon peel”, retraction, redness, swelling);
The nipple has changed (it has retracted, a bleeding wound has appeared).
In the early stages, the main manifestation of breast cancer is the presence of a volumetric formation in the mammary gland, detected by mammography, ultrasound or other research methods, or by the woman herself (much less often, and mainly in women with small breasts). But it must be understood that it is impossible to detect a tumor characterized by diffuse growth (without a dense part) without special instrumental methods. Regular preventive examinations once a year in most cases are sufficient to detect breast cancer in the early stages.
Diagnosis of breast cancer (breast cancer):
Modern diagnostic methods used all over the world are the key to successful treatment. As a result of a comprehensive diagnosis, it becomes clear to the doctor how widespread the process is. Then he can choose the optimal treatment tactics for each patient. Diagnostic methods can be divided into 3 groups:
Imaging methods for breast cancer (breast cancer):
X-ray (mammography);
ultrasonic;
method of magnetic resonance imaging (MRI).
Mammography is the most informative diagnostic method.
Diagnostic biopsy
A biopsy is necessary to make an accurate diagnosis. Biopsy - a minimally invasive method - allows you to take a piece of suspicious tissue for histological examination before starting treatment. Histopathological examination determines the type of tumor, and immunohistochemical tests allow to determine the hormone dependence of the tumor (i.e., the presence of estrogen and progesterone receptors, as well as the presence of Her2neu receptors). hormonal status affects the prognosis and choice of treatment. All necessary types of biopsies are performed in our hospital, including high-tech stereotaxic biopsy, which is rare for Ukraine. A special installation allows you to very accurately and almost painlessly take for research, and sometimes completely remove, formations with a size of 1 mm. The procedures are performed with anesthesia on an outpatient basis, no special preparation is required before such manipulations.
Additional Research in Breast Cancer
ultrasound examination of the abdominal organs;
radiography of the lungs;
computed tomography of the abdominal cavity and chest;
scintigraphy (radioisotope study) of the skeleton;
general clinical analyzes and examinations;
examination of the lymph nodes before treatment.
These studies are carried out to assess the prevalence of the tumor process in the body, the presence or absence of metastases in the lymph nodes or other organs. They also characterize the general condition of the body, comorbidities, which can also affect the choice of treatment.
Treatment for breast cancer (breast cancer):
In the last decade, global oncology has made significant progress in the treatment of breast cancer. The basis of successful treatment is an integrated approach - the optimal combination
surgical;
chemotherapeutic;
radiotherapy steps.
Treatment tactics are chosen jointly by clinical oncologists, surgeons, radiotherapists. If necessary, a plastic surgeon is involved in this, participating in advance in planning the optimal operation or in performing its plastic stage.
The choice of treatment method is influenced by the type of tumor, its size, the presence of metastases, and the individual characteristics of each patient. The earlier a tumor is detected, the less spread of the disease - the easier, shorter, cheaper and more effective the treatment.
Until recently, the classical approach was considered to be the surgical removal of the tumor along with the entire mammary gland and the lymphatic drainage pathways - regional lymph nodes (mastectomy), followed by possible chemotherapy or hormone therapy. However, modern approaches to surgical treatment have changed significantly. Many studies have proven the possibility of a more "conservative" treatment. It is not always necessary to remove the entire breast and all lymph nodes. If the tumor is small, it is enough to remove only it, receding about 1 cm within healthy tissues (the so-called lumpectomy), and carry out postoperative irradiation of the mammary gland. This tactic gives results that are absolutely similar to mastectomy, but allows you to save the mammary gland.
Complete lymph node dissection, i.e. removal of all lymph nodes from the zone of lymph drainage of the mammary gland is necessary only if they are involved in the tumor process. If, according to the results of examinations, the lymph nodes are not enlarged, and the probability of their damage by a tumor remains, then a so-called study is possible. sentinel lymph node. This node is the first to receive lymph from the tumor area and is the first in which metastases develop. If metastases are not detected in the "sentinel" node, then the probability of their spread to other nodes does not exceed 2-3%. Thus, by examining the state of the sentinel lymph node, we can judge the state of all other lymph nodes with a very high degree of certainty, and save many patients from traumatic surgery and possible complications associated with it.
The procedure for detecting the sentinel lymph node is actively used throughout the world and is the standard in determining the prevalence of the tumor process with good long-term results. Unfortunately, this method is still unique for Ukraine.
After removal of the mammary gland or part of it, reconstruction is possible, i.e. restoration of its shape and volume. This is performed by the plastic surgeon during the primary operation (single-stage reconstruction) or after the end of the entire course of treatment (delayed reconstruction). Recovery is possible in three main ways:
plastic surgery with own tissues taken from other parts of the body (as a rule, this is the stomach, less often the back). At the same time, figure correction is possible;
plastic surgery with an artificial implant;
a combination of both methods.
The task of chemotherapy is the destruction of tumor cells not only in the main focus, but throughout the body. A tumor disease is initially considered as a systemic disease, i.e. tending to spread - metastasize - immediately to all systems and organs. In the early stages, the probability of spread is not high, and if it does, then at the level of individual cells. They cannot be detected by modern examination methods, but it is possible to destroy them with chemotherapeutic agents. The fewer tumor cells in the body, the easier and more effective it is to achieve a positive result. Therefore, local treatment - directly on the tumor - surgical or radiation, is almost always supplemented by systemic - chemotherapy. This significantly improves the results and, most importantly, the survival of patients.
Chemotherapy can be administered both before and after surgery. The goal of chemotherapy before surgery is to reduce the size of the primary tumor. In this case, conditions are created for radical removal of the tumor while preserving the mammary gland - lumpectomy.
Adjuvant chemotherapy is started 2-3 weeks after surgery. The most commonly used regimen is CMF (cyclophosphamide -100 mg / m2 orally, days 1-14 in combination with methotrexate - 40 mg / m2 IV, days 1 and 8 and 5-fluorouracil - 500 mg / m2 IV, 1st and 8th days; intervals between courses - 2-3 weeks, number of courses - 6). With a high content of ER and / or RP during menopause, tamoxifen is additionally given (20 mg daily for 2 years), and with a preserved menstrual cycle, oophorectomy is performed, then tamorsifen (20 mg) or prednisolone (10 mg) is used for a long time. With menopause for more than 10 years and a high level of EC, adjuvant therapy can be carried out only with tamoxifen.
With the development of distant metastases at various stages of the disease, drug therapy has the main therapeutic value. Chemotherapy regimens should include adriamycin:
1) adriamycin (20 mg/m2 IV, days 1, 8 and 15) in combination with methotrexate (20 mg/m2 IV, day 1), 5-fluorouracil (500 mg /m2 IV, day 8) and cyclophosphamide (400 mg/m2 IV on day 15); 2) adriamycin (40 mg/m2 IV, day 1) in combination with cyclophosphamide (600 mg/m2 IV, day 1); 3) adriamycin (30 mg/m2 IV, days 1 and 8) in combination with 5-fluorouracil (500 mg/m2, days 1 and 8) and cyclophosphamide (100 mg/m2 orally , 1-14th days); 4) adriamycin (60 mg/m2, i.v., day 1) and vincristine (1.2 mg/m2, days 1 and 8). Courses of treatment are carried out every 4 weeks. There is no clear evidence of differences in the effectiveness of these regimens.
With resistance to CMP and adriamycin, partial regression can be obtained using mitomycin C, cisplatin, vinblastine. The use of thiophosfamide (20 mg intramuscularly 3 times a week for 3 weeks) is of independent importance, however, such treatment significantly reduces the reserves of hematopoiesis. More often, thiophosfamide is injected into the pleural cavity (30-50 mg) after removal of the exudate.
Tamoxifon occupies a leading position in the endocrine therapy of breast cancer. Assign it with positive or unknown receptors orally at 20 mg / day for a long time. With an insufficient effect of tamoxifen, it is advisable to use aminoglutethemide (orimethene) - 500 mg / day with cortisone acetate - 50 mg / day for a long time. Retain the medicinal value of androgens (testosterone or medrotestron propionate-100 mg / m daily or every other day; omnadren, proloteston - 3 times a month). With a high level of RE, drug therapy can be started with endocrine drugs, and later supplemented with cytostatic drugs.
Radiotherapy or radiation therapy for breast cancer It is used mainly in three cases:
to reduce the likelihood of recurrence after excision of a tumor in the mammary gland and after removal of the affected lymph nodes;
for symptomatic (palliative) treatment of intractable tumors, in case of complications - ulceration, bleeding;
for palliative treatment of distant metastases, if they cause severe complications - compression of the brain or spinal cord, severe pain, etc.
Prognosis for breast cancer the prediction depends on the stage of the process, the speed of its course and the age of the patients. In advanced stages, life expectancy is 2-3 years. Early diagnosis of breast cancer ensures successful treatment of most patients. The five-year survival rate in the treatment of localized forms of stage I-II is 90%, with locally advanced cancer - 60%. The results of treatment are much worse in the presence of distant metastases.
Prevention of breast cancer (breast cancer):
Prevention of breast cancer consists primarily in the timely deliverance of patients from precancerous seals in the mammary glands, as well as in observing the normal physiological rhythm of a woman's life (pregnancy, feeding) with a reduction in the number of abortions to a minimum. In the diagnosis of breast cancer, systematic self-examinations (see the page "Self-examination of the mammary glands") and annual preventive medical examinations of women over the age of 40 are important. Mammography is recommended once every 2 years after the age of 40, once a year - after 50 years. For women at risk, an annual mammogram is recommended, starting as early as possible.
Early detection of breast cancer
The simplest and most accessible method of prevention, however, and the least effective, is self-examination - examination and palpation of the mammary glands by the woman herself. This procedure allows you to identify the tumor at an early stage. Self-examination is carried out once a month. First, an examination is made in front of a mirror. The following signs should be a mandatory reason to see a doctor:
skin retraction,
visual education,
changes resembling "lemon peel".
Then palpation is performed. If you find seals or heterogeneity in the structure of the gland, discharge from the nipple, you should contact an oncologist.
Screening is the most effective way to prevent breast cancer.
Breast Cancer Screening
Screening is a planned examination of a healthy population in order to identify the earliest forms of a tumor. Breast cancer screening procedures are very simple and painless. So, women are recommended, depending on age, to carry out:
at 20 - 39 years old - breast self-examination monthly, annually ultrasound (ultrasound), especially if the woman is at risk;
once at the age of 35-39 years, perform a mammogram;
from the age of 40 - self-examination monthly, annually - mammography.
When choosing a hospital for screening, it is important to remember that in the early stages, cancer is very mild or does not manifest itself, so it is very important that:
1. screening was carried out by a highly qualified specialist who knows how to detect even the most insignificant signs of the disease;
2. the equipment used for screening was high-precision and in line with modern standards of world oncology;
3. The hospital provided comprehensive and effective cancer care.
Which doctors should you see if you have breast cancer (breast cancer):
Are you worried about something? Do you want to know more detailed information about breast cancer (breast cancer), its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors will examine you, study the external signs and help identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.
How to contact the clinic:
Phone of our clinic in Kyiv: (+38 044) 206-20-00 (multichannel). The secretary of the clinic will select a convenient day and hour for you to visit the doctor. Our coordinates and directions are indicated. Look in more detail about all the services of the clinic on her.
(+38 044) 206-20-00
If you have previously performed any research, be sure to take their results to a consultation with a doctor. If the studies have not been completed, we will do everything necessary in our clinic or with our colleagues in other clinics.
You? You need to be very careful about your overall health. People don't pay enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called disease symptoms. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to several times a year be examined by a doctor not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the body as a whole.
If you want to ask a doctor a question, use the online consultation section, perhaps you will find answers to your questions there and read self care tips. If you are interested in reviews about clinics and doctors, try to find the information you need in the section. Also register on the medical portal Eurolaboratory to be constantly up to date with the latest news and information updates on the site, which will be automatically sent to you by mail.
Other diseases from the Oncological diseases group:
| pituitary adenoma |
| Adenoma of the parathyroid (parathyroid) glands |
| Thyroid adenoma |
| Aldosteroma |
| Angioma of the pharynx |
| Angiosarcoma of the liver |
| Astrocytoma of the brain |
| Basal cell carcinoma (basalioma) |
| Bowenoid papulosis of the penis |
| Bowen's disease |
| Paget's disease (cancer of the nipple of the breast) |
| Hodgkin's disease (lymphogranulomatosis, malignant granuloma) |
| Intracerebral tumors of the cerebral hemispheres |
| Hairy throat polyp |
| Ganglionoma (ganglioneuroma) |
| Ganglioneuroma |
| Hemangioblastoma |
| Hepatoblastoma |
| germinoma |
| Giant condyloma of Buschke-Levenshtein |
| glioblastoma |
| Glioma of the brain |
| Glioma of the optic nerve |
| Glioma chiasma |
| Glomus tumors (paragangliomas) |
| Hormonally inactive tumors of the adrenal glands (incidentalomas) |
| Fungal mycosis |
| Benign tumors of the pharynx |
| Benign tumors of the optic nerve |
| Benign tumors of the pleura |
| Benign oral tumors |
| Benign tumors of the tongue |
| Malignant neoplasms of the anterior mediastinum |
| Malignant neoplasms of the mucous membrane of the nasal cavity and paranasal sinuses |
| Malignant tumors of the pleura (pleura cancer) |
| Carcinoid syndrome |
| Mediastinal cysts |
| Cutaneous horn of the penis |
| Corticosteroma |
| Bone-forming malignant tumors |
| Bone marrow malignant tumors |
| Craniopharyngioma |
| Leukoplakia of the penis |
| Lymphoma |
| Burkitt's lymphoma |
| Thyroid lymphoma |
| Lymphosarcoma |
| Waldenstrom's macroglobulinemia |
| Medulloblastoma of the brain |
| Mesothelioma of the peritoneum |
| Mesothelioma malignant |
| Mesothelioma of the pericardium |
| Pleural mesothelioma |
| Melanoma |
| Melanoma of the conjunctiva |
| meningioma |
| Optic nerve meningioma |
| Multiple myeloma (plasmocytoma, multiple myeloma) |
| Neurinoma of the pharynx |
| Acoustic neuroma |
| Neuroblastoma |
| Non-Hodgkin's lymphoma |
| Balanitis xerotica obliterans (lichen sclerosus) |
| Tumor-like lesions |
| Tumors |
| Tumors of the autonomic nervous system |
| pituitary tumors |
| bone tumors |
| Tumors of the frontal lobe |
| Tumors of the cerebellum |
| Tumors of the cerebellum and IV ventricle |
