manifestation of breast cancer. Types and symptoms of breast tumors in women. Clinical forms of breast cancer

Content

A malignant tumor of the breast occurs in every 10 women. Oncology is characterized by a tendency to metastasize and aggressive growth. Breast cancer has a number of symptoms that are similar to other breast diseases in women. For this reason, at the first disturbing symptoms, you should immediately contact a qualified specialist.

What is breast cancer

A malignant tumor of the breast is an uncontrolled growth of epithelial cells. Oncology of this type develops mainly in women, but sometimes occurs in the male population. A malignant neoplasm in the breast is one of the most dangerous oncologies. The mortality rate for this type of cancer is 50%. The main cause of death is the neglect of the disease. If breast cancer is diagnosed at stage 1 or 2, then the survival rate after treatment is very high and long-term results are favorable.

Symptoms

Often precancerous manifestations are visible on the breast. Peeling of the skin, swelling, soreness of the nipples are not only hormonal disruptions, but also symptoms of infections, cysts or mastopathy. All these pathologies are a manifestation of a precancerous condition. Symptoms of breast cancer, in which you should urgently consult a doctor:

1. Discharge from nipples. Seen at all stages of breast cancer. The liquid is yellow-green or clear. After a while, reddening of the skin of the nipple, ulcers, spots and wounds on the halo are formed on the chest.
2. Seals in the chest. You can easily feel them on your own.
3. appearance deformation. With the growth of the tumor in the denser tissues of the mammary glands and the appearance of metastases, the structure of the breast changes (especially with edematous form or shell cancer). The skin over the focus acquires a purple color, peeling occurs, dimples are formed according to the "orange peel" type.
4. Flattening, elongation of the chest. A sunken or wrinkled nipple retracts into the gland.
5. Enlargement of the lymph glands. When raising the arms in the armpits, pain occurs.

First signs

At the initial stage of the disease, the clinical picture is almost always asymptomatic. More often it resembles different types of mastopathy. The only difference is that with a benign tumor, seals are painful, but not with oncology. According to statistics, in 70% of women who were diagnosed with cancer, the presence of a lump in the chest was first determined, which was easily palpable. The reason for going to the doctor is soreness in the mammary gland, even a small one. The first sign of cancer is a lump in the breast that does not disappear after menstruation.

The reasons

The main factor in the occurrence of cancer is a change in the hormonal background. The cells of the ducts of the mammary glands mutate, acquiring the properties of cancerous tumors. The researchers analyzed thousands of patients with this disease and deduced the following factors that contribute to the risk of pathology:

• female;
• heredity;
• no pregnancy or its occurrence after 35 years;
• malignant neoplasms in other organs and tissues;
• exposure to radiation;
• the presence of menstruation for more than 40 years (increased estrogen activity);
• tall woman;
• alcohol abuse;
• smoking;
• low physical activity;
• hormone therapy in high doses;
• obesity after menopause.

stages

A woman may notice the first symptoms of breast cancer at stage 1 or 2 of the disease. The zero (initial) stage is non-invasive, so carcinoma may not appear for a long time. As a rule, a woman first learns about an oncological disease during the examination. The primary tumor can also be recognized by palpation. At the second stage of cancer, the size of the neoplasm already reaches 5 cm, the lymph nodes increase above the collarbones, near the sternum and in the armpits.

The third degree of breast oncology is characterized by an increase in body temperature, retraction of the skin and / or nipple at the location of the carcinoma, the tumor begins to grow on the surrounding tissues, and affects the lymph nodes. High risk of detecting metastases in the lungs, liver, chest. In the fourth stage of breast oncology, the internal organs and bones are affected, the cancerous tumor spreads to the entire gland (Paget's cancer). This degree is characterized by the presence of metastases. The disease is almost untreatable, so the likelihood of death is very high.

Types

Breast cancer is classified by type:

1. ductal. It is characterized by the fact that the cellular structures did not transfer to healthy breast tissue.
2. Lobular. Localization of the tumor is found in the lobules of the breast.
3. Medullary. It has an accelerated increase in the size of the tumor, quickly begins and gives metastases.
4. tubular. The origin of malignant cells occurs in the epithelial tissue, and growth is directed to adipose tissue.
5. Inflammatory. Occurs very rarely. The inflammatory disease is aggressive, the diagnosis is difficult, as it has all the signs of mastitis.

Is there a cure for breast cancer

At the zero stage, breast cancer treatment leads to a 100% recovery. At a later date, there are rarely cases of healing, the question is mainly about prolonging life. After detecting cancer in breast tissue, doctors rely on a five-year patient survival rate. These are average statistics. There are many cases when, after treatment, a woman lived for 20 years or more, forgetting about the terrible diagnosis. It should be remembered that the earlier cancer is diagnosed, the better the prognosis.

Diagnostics

Detection of breast cancer is an integrated approach, consisting of many methods. The main goals of diagnosis are the detection of seals at an early stage and the choice of a more appropriate method of treatment. Primary changes in the breast can be detected during the examination, both independently and by a surgeon, endocrinologist, oncologist or mammologist. To clarify the nature of the tumor and the degree of spread of cancer, the doctor prescribes laboratory and instrumental studies:

• Ultrasound of the mammary glands;
• mammography;
• biopsy;
• blood for tumor marker;
• cytology of discharge from the nipple;
• blood for abnormal genes (for familial cancer).

How to examine the chest

An important step to early detection of lumps in the breast is regular self-examination. The procedure should become a habit for every woman, regardless of age, to recognize cancer at an early stage. First, you should evaluate how the breast looks: shape, color, size. Then you need to raise your hands up, examine the presence of protrusions of the skin, depressions, redness, rash, swelling or other changes.

Next, you should feel the axillary lymph nodes - they should not be large and cause pain. Then the right and left breasts are carefully examined in a circular motion in the direction from the armpits to the collarbone, from the nipple to the upper abdomen. It is necessary to pay attention to the presence of secretions. Any suspicion is a reason to consult a doctor.

Breast Cancer Treatment

Cancer therapy is prescribed only after all of the above methods of examination. They try to treat breast cancer with the help of local and systemic therapy. With early diagnosis, surgical intervention is more often prescribed. When cancer is detected at a late stage, patients are recommended complex treatment, in which surgical removal of the mammary glands is combined with hormonal, radiation or chemotherapy. Additionally, biological, immunological and alternative treatment can be prescribed.

Treatment without surgery

When a malignant tumor occurs in the breast, some patients refuse surgery, radiation and chemotherapy, citing toxicity and side effects. Among the methods of non-surgical treatment there are acupuncture, Ayurveda, yoga, massage, homeopathy. Sometimes alternative methods of treatment include hypnosis, reading prayers, curative fasting, the use of dietary supplements. The effectiveness of these methods has no evidence, so such therapy is a great risk to the patient's life.

hormone therapy

It is indicated if the malignant neoplasm is sensitive to hormones. To determine this, after examining the mammary glands, an immunohistochemical study of the biopsy material is performed. Based on the results of the examination, the following drugs can be prescribed:

1. Estrogen receptor modulators. Assign if the tumor has estrogen, progesterone receptors. These drugs include: Tamoxifen, Toremifene, Raloxifene.
2. Estrogen receptor blockers. Do not allow estradiol molecules to attach to estrogen receptors. The most famous medicines of the group: Faslodex, Fulvestrant.
3. aromatase inhibitors. Used to reduce the production of the ovarian hormone estrogen during menopause. Exemestane, Anastorozol, Letrozol are widely used in oncological practice.
4. Progestins. Reduce the secretion of pituitary hormones that produce estrogens, androgens. Oral tablets, vaginal suppositories or ampoules for intramuscular injections are used. This group of drugs includes: Exluton, Continuin, Ovret.

Radiation therapy

It is not used as monotherapy. The role of radiation exposure in complex treatment increases with organ-preserving operations. Depending on the purpose, lymph nodes or the mammary gland (on the side of the lesion) may be exposed to radiation. Radiation therapy is divided into several types:

• preoperative;
• postoperative;
• independent (with inoperable tumors);
• interstitial (with nodular form).

Chemotherapy

The principle of operation of the method is based on the use of anticancer drugs. They are administered intravenously, drip or orally. The duration of chemotherapy depends on the condition of the patient. One course consists of 4 or 7 cycles. The procedure is prescribed both before and after breast removal. In breast cancer, chemotherapy requires an individual selection of medications.

“Knowledge is power” - we got used to this term from our Soviet childhood, and we don’t think that knowledge is life. First of all, it concerns breast cancer. The average life expectancy in patients with newly diagnosed breast cancer is 12-15 years in Western Europe and 3-5 years in our country. Such a significant difference in the outcome of the disease, given the generally common approaches to the diagnosis and treatment of the disease itself, was analyzed in detail and the results depressed the experts.

The first fundamental difference is the woman's careful attitude to her own health, timely assessment of the early symptoms of the disease. correct perception of the need for regular check-ups. As a result, over 90% of European women and only 30% of our compatriots seek medical help for the first time at the 1st stage of breast cancer. Many are simply afraid to come to the doctor's office so as not to hear the diagnosis of cancer. Most of our women seek medical help for the first time already at the 2nd and 3rd stages of cancer. In many ways, this difference is dictated by the low level of knowledge and desire to protect their own health. Then the psychological perception of the diagnosis "cancer" as a sentence that no longer gives a chance for healing.

The second fundamental difference between our patients is the fact that after the diagnosis of "cancer" is made, about 90% of all patients during the first six months, the most valuable for them, practically disappear from the doctors' field of vision, trying to achieve treatment with "folk remedies".

Given that every 8th woman develops breast cancer during her life, it is necessary to firmly grasp the main early manifestations of cancer, the principles of self-diagnosis and early diagnosis of breast cancer.

Who needs to be particularly vigilant and alert about breast cancer?

The main risk factors for developing breast cancer are caused by disturbances in the hormonal balance of a woman. First of all, this is a burdened family history (breast cancer along the female line - in a sister, mother, grandmother), changes in the mammary glands (after injuries, childbirth; fibrocystic mastopathy), early menopause (especially before 30 years of age as a result of surgical castration, for example, bilateral resection of the ovaries after apoplexy), late childbirth or childlessness over the age of 30 years.

How does breast cancer manifest itself?

Warning signs for alarm can be symptoms such as:

• "Lump" or seal in the area of ​​the mammary gland, which does not disappear after menstruation;
• focal changes in the contours, size or shape of the breast, mainly on one side;
• discharge from the nipples (light liquid or bloody);
• a bump or lump in the breast the size of a pea;
• redness of the nipple or skin of the breast, retraction of the nipple on one side;
• stone-like compaction in the breast;
• change in the appearance of the nipple or breast skin (inflammation, peeling, dimpling, or wrinkled skin);
• the area on the chest is distinctly different;
• enlarged lymph nodes under the arm;
• swelling of the tissues of the armpit and shoulder.

These changes can be seen first only by women themselves. It is necessary to learn not only to carefully see the changes in your body, but also to master the practical skills of self-examination, including self-palpation of the breast and nearby lymph nodes.

Breast self-exams should be done monthly, approximately 3-5 days after your period. It must be remembered that more than half of women find changes in the mammary glands, and only one in eight gets breast cancer.

If you suspect this insidious disease, you should urgently seek help from specialists (mammologist and oncologist). In a medical institution, an examination and professional palpation of the mammary glands and surrounding tissues will be carried out, a detailed survey will be conducted to clarify the history of life and disease (anamnesis), and adequate diagnostic methods will be assigned, based on the results of which it will already be possible to judge the presence of the disease and its stage.

The following tests help detect breast cancer:

• ultrasound - ultrasound;
• cytological examination of a smear separated from the nipple of the mammary gland;
• mammography (X-ray);
• magnetic resonance imaging - MRI.
• biopsy of a suspicious tissue area under ultrasound control.

In some cases, especially with nodes less than 5 mm, a precision computerized biopsy can be performed using an automated system.

The material obtained from the biopsy must necessarily undergo a histological examination, preferably in two different centers, as well as with a positive diagnosis of cancer - an immunohistochemical study and a study on the expression of estrogen, progesterone and other receptors by tumor cells.

As necessary, the doctor may prescribe additional studies that help assess the general condition of the body, the prevalence of the tumor process, determine the presence of metastases in the lymph nodes or other organs, and identify comorbidities:

• radiography of the lungs;
• Ultrasound of the abdominal cavity and small pelvis;
• general clinical tests, examinations;
• biopsy of peripheral lymph nodes;
• skeletal scintigraphy;
• CT scan of the chest and abdominal organs.

In the presence of what factors is breast cancer manifested?

• age 40 and older;
• in the blood - an increased level of estrogen;
• long-term use of high-dose hormonal drugs;
• 1st line relatives who have been diagnosed with breast cancer;
• previous oncological disease of the breast or ovary;
• the first pregnancy was at the age of 30 or older, or the woman is infertile;
• prolonged contact with radioactive isotopes and/or hard X-ray sources;
• absence of pregnancy and childbirth;
• atypical changes in the epithelium of the thoracic ducts (epithelial hyperplasia) - are detected during a cytological examination of the smear from the mammary gland;
• the onset of menstruation before the age of 12 and / or the onset of menopause later than usual;
• metabolic and endocrine disorders (obesity, type 2 diabetes mellitus);
• excessive consumption of fatty foods.

What is breast cancer prevention?

First of all, the development of this disease can be prevented by observing the normal physiological rhythm of life (pregnancy, childbirth, prolonged feeding) with the exclusion or reduction to a minimum of the number of abortions. It is also important for patients to treat precancerous seals in the mammary glands in a timely manner.

Monthly breast self-exams should be performed. Women over 40 years of age undergo annual preventive examinations and once every 2 years - mammography. An annual mammogram is recommended for women at risk (regardless of age) and over 50 years of age.

Breast cancer is very common in women and the incidence is constantly increasing. This is partly due to the improvement in the detection of the disease, but it should be noted that the disease itself began to occur more often (approximately 60-70 people per 100,000 women per year). The incidence of patients of working age is increasing.

Statistics show that this disease is one of the most common causes of female death. Among the regions where there is a rather high incidence are Moscow, St. Petersburg, the Chechen Republic and the Kaliningrad Region.

It is worth noting the success of public health in the fight against breast cancer. In addition to improving the detection of the disease, based on mass preventive studies using a mammograph, there is a decrease in mortality in the first 12 months after confirmation of the diagnosis. That is, the disease is now detected at earlier stages, it is successfully treated, and the life expectancy of patients with this diagnosis is increasing.

Causes and conditions of development

The direct cause of the disease has not been reliably established, but breast cancer is most likely associated with mutations in certain genes that are inherited. That is, the risk of getting sick increases significantly if two close relatives have breast cancer, as well as ovarian cancer.

More often, pathology occurs in patients with such concomitant conditions:

• irregularity, abnormal duration of the menstrual cycle, infertility, lack of childbirth, breastfeeding, the onset of menstruation before the age of 12 years, over the age of 60;
• inflammatory diseases of the uterus and ovaries;
• endometrial hyperplasia (for example,);
• obesity, high blood pressure, atherosclerosis;
• liver disease and hypothyroidism;
• the patient has a brain tumor, sarcoma, lung cancer, larynx, leukemia, carcinoma of the adrenal cortex, intestines and other tumors associated with syndromes (for example, Bloom's disease).

To reduce the likelihood of illness, some external factors should also be avoided, for example:

• influence of ionizing radiation;
• smoking;
• chemical carcinogens, preservatives;
• high-calorie diet containing too many animal fats and fried foods.

The role of hormonal imbalance in the female body is high. Diseases of the ovaries, adrenal glands, thyroid and hypothalamic-pituitary system increase the possibility of breast cancer.

Finally, the role of genetic disorders has been proven. They can be of two types:

• a genetic mutation in the genes that are responsible for the growth and reproduction of cells; when they change, cells begin to divide uncontrollably;
• induction of cell proliferation, that is, an increase in their division in the formed node.

Pathology is also registered in men, their ratio with sick women is 1:100. Symptoms, diagnosis and principles of treatment are the same as in female patients, adjusted for the sex characteristics of the hormonal background and anatomical structure.

Preventive actions

Breast cancer prophylaxis is necessary in both healthy women and those with a unilateral tumor to prevent metastasis and spread to a second breast.

Currently, according to foreign and recent domestic recommendations, for the prevention of breast cancer in healthy women, bilateral breast cancer is indicated, followed by prosthetics. Such an intervention reduces the likelihood of a neoplasm to almost zero.

However, before a prophylactic operation, it is recommended to consult a geneticist who will confirm the increased risk of getting sick, given the presence of mutated BRCA1 and BRCA2 genes in a woman.

Surgical removal may be offered to patients with some precancerous features:

• atypical ductal hyperplasia;
• atypical lobular hyperplasia;
• lobular carcinoma in situ (non-common).

When tissues are removed directly during the intervention, an emergency histological analysis is performed. When cancer cells are detected, the scope of intervention can be expanded depending on the characteristics of the resulting pathological changes.

The same tactics (removal of a healthy gland in case of cancer of the second breast) is also indicated for unilateral lesions, if gene mutations are genetically confirmed or there are precancerous conditions.

It is believed that the removal of the mammary glands with a preventive purpose is indicated even if the risk of getting sick in a woman is the same as the average for the population. However, in our country, mass mastectomy as a means of preventing breast cancer is treated with caution.

Traditionally, three components of prevention are used to prevent breast cancer in Russia.

Primary prevention is carried out in healthy women and includes education of the population, promotion of breastfeeding. It is necessary to explain the benefits of regular sexual relations with a regular partner, the timely birth of a child. A woman should avoid external risk factors - radiation, smoking, carcinogens. When planning a family with a person in whose family there have been repeated cases of this tumor in women, it is better to visit a geneticist.

Secondary prevention is aimed at diagnosing and eliminating diseases that can later cause a malignant tumor:

• endocrine disorders;
• diseases of the female reproductive system;
• liver disease.

For secondary prevention, you should regularly undergo a dispensary examination by a general practitioner and a gynecologist.

Tertiary prevention is aimed at timely detection of tumor recurrence and metastasis in a woman who has already been treated for this disease.

Classification

Stages of breast cancer

Depending on how the tumor grows, diffuse and nodular forms of the neoplasm are distinguished, as well as atypical cancer (). The rate is characterized by rapidly growing cancer (the total mass of tumor cells becomes 2 times greater in 3 months), a tumor with an average growth rate (an increase in mass by a factor of two occurs within a year) and a slowly growing one (a tumor increases by a factor of 2 occurs in more than a year) .

The structure of the tumor is determined by its source, therefore, invasive ductal (growing from glandular ducts) and invasive lobular (growing from glandular cells) cancer and combinations of these forms are distinguished.

According to the cellular structure, adenocarcinoma, squamous cell carcinoma and sarcoma are distinguished. Depending on the type of cells, malignancy also varies.

TNM classification

The classification of this malignant neoplasm is carried out according to the TNM system. According to this classification, the stages of breast cancer are characterized by a certain combination of the qualities of the tumor node itself (T), the involvement of lymph nodes (N) and the presence of metastases (M).

• Disease stage 0

It is characterized by an extremely small amount of damage without the participation of neighboring tissues.

• Stage 1 disease

It does not metastasize to other organs, except for the possible entry of tumor cells into the lymph nodes of the axillary group on the corresponding side. The diameter of the node does not exceed 2 cm, the penetration of its cells into the surrounding healthy tissues does not occur.

• Breast cancer grade 2 (stages)

Does not form metastases, except for the possible involvement of the axillary lymph nodes of the corresponding side. The main difference is the characteristic of the node. It can grow up to 5 cm and even penetrate the surrounding glandular tissue.

• Breast cancer grade 3 (stages)

Does not cause metastatic lesions of distant organs, but may affect the axillary lymph nodes. Other groups of regional lymph nodes may also be involved, lying under the scapula, under the collarbone and above it, near the sternum. In this case, the node can be of any diameter, there is germination in the chest wall, the skin is affected. The third stage includes inflammatory cancer, a disease in which thickening of the skin with dense edges is noted on the breast without a clearly defined tumor area.

• Breast cancer stage 4 with metastases

It is characterized by the spread of tumor cells to the following organs:

- lungs;
- axillary and supraclavicular lymph nodes on the opposite side;
- bones;
- walls of the pleural cavity surrounding the lungs;
- peritoneum;
- brain;
- Bone marrow;
- skin;
- adrenal glands;
- liver;
- ovaries.

The most common localization of distant foci is bone tissue (for example, vertebrae), lungs, skin, and also the liver.

External signs and symptoms

Types of breast cancer (to be more precise - forms):

• nodal;
• diffuse;
• atypical.

The diffuse form includes tumors that affect the entire gland. Externally, diffuse cancer manifests itself:

• swelling and swelling of the gland;
• resembles by signs;
• similar to erysipelas;
• causes compaction and reduction of the gland (shell form).

Atypical forms are rarely recorded, they have features of localization and / or origin:

• nipple damage;
• a tumor originating from the appendages of the skin;
• bilateral education;
• a tumor growing from several centers at once.

Breast cancer is suspected when a small, firm, painless nodule forms in the breast. Pay attention to areas of wrinkling of the skin or retraction of the nipple. Enlarged axillary lymph nodes are often seen early in the disease. With intraductal forms, discharge from the nipple appears - light, yellowish, sometimes with an admixture of blood.

The first signs of breast cancer at an early stage, listed above, with the progression of the disease, are supplemented by reddening of the skin, the formation of a “lemon peel” on it, an increase in the tumor, deformity, or the appearance of non-healing ulcers. In the axillary region there are conglomerates of immobile lymph nodes, swelling of the arm develops due to stagnation of lymph in it.

Symptoms in individual variants of breast cancer are characterized by their own characteristics.

• Edema-infiltrative is accompanied by the formation of a large infiltrate - edematous compacted tissue. The gland is significantly enlarged, reddens, swells, the skin acquires a marble color, a "lemon peel" appears.
• The mastitis-like form is manifested by an increase and compaction of the gland. Attached infection, causing tissue breakdown. The temperature rises.
• The erysipelas-like form, on external examination, is similar to inflammation caused by microflora (erysipelas): bright red foci on the surface of the gland with spread to the surface of the chest, skin ulcers are often noted.
• Shell - an advanced stage of cancer, in which the gland decreases, changes shape, several nodules form in it.
• Paget's cancer is singled out as a special variant, primarily affecting the nipple and the area around it.

Do breasts hurt with breast cancer?

The pain caused by the tumor itself does not appear at an early stage of the disease. It is associated with swelling of the gland, compression of surrounding tissues, and the formation of skin ulcers. In this case, it is constant, aching, passing for a while after taking conventional painkillers.

Pain can also be cyclical, recurring from month to month in women of reproductive age. In this case, they are more associated with the existing precancerous disease - mastopathy and are caused by natural fluctuations in hormone levels. If you experience pain in the breast of any nature, you should consult a doctor.

The earlier the disease is detected, the more effective the treatment will be. The prognosis for stage 1 breast cancer, which can be detected with timely diagnosis, is good. After 5 years after confirmation of the diagnosis, the survival rate is 98%, after 10 years - from 60 to 80%. This means that almost all women who have been diagnosed with the disease at an early stage achieve remission of the disease. Of course, they have to monitor their health and regularly see a doctor.

The more advanced breast cancer, the lower the survival rate. At the 2nd stage of the disease, the prognosis is satisfactory, 5-year survival is up to 80%, after 10 years - up to 60%. At stage 3, the forecasts are worse: 10-50% and up to 30%, respectively. Stage 4 breast cancer is a deadly disease, with a 5-year survival rate of only 0 to 10%, and a 10-year survival rate of 0 to 5%.

How fast does breast cancer develop?

The process proceeds for each patient at its own pace. Without treatment, the tumor can completely destroy the mammary gland and give distant metastases within a short time - up to a year. In other patients, the course is slower. Therefore, it is necessary at the first signs of trouble to contact a gynecologist or mammologist and undergo the necessary diagnostics.

Diagnostics

Early diagnosis was traditionally based on self-examination of the mammary glands: once a week, a woman carefully probed the glands in front of a mirror, paying attention to discharge from the nipples, uneven skin, and swollen lymph nodes. However, in modern guidelines, the effectiveness of this technique is questionable. It is believed that a doctor should determine the disease at an early stage with the help of an annual or ultrasound examination (ultrasound).

If a breast tumor is suspected, it is necessary to perform certain diagnostic interventions before starting any treatment.

Diagnosis of breast cancer includes the following steps:

• questioning the patient and her complete external examination;
• blood analysis;
• biochemical study, including liver parameters (bilirubin, transaminases, alkaline phosphatase);
• mammography on both sides, ultrasound of the glands themselves and surrounding areas, if necessary, clarifying diagnostics - magnetic resonance imaging (MRI) of the glands;
• digital chest x-ray, if necessary, more accurate diagnosis - computed tomography (CT) or chest MRI;
• Ultrasound of the liver, uterus, ovaries; according to indications - CT / MRI of these areas with contrast;
• if the patient has a widespread process or metastases, she is prescribed a study of the bones to identify tumor foci in them: scanning and radiography of the zones of accumulation of the radiopharmaceutical. If the stage of cancer T 0-2 N 0-1 is proven, such a study is carried out with complaints of pain in the bones and with an increase in the level of alkaline phosphatase in the blood; even during the initial treatment of the patient, the probability of having bone micrometastases in her is 60%;
• biopsy of the alleged tumor with a study of the resulting tissue; with the help of a biopsy taken before the start of any treatment, a pathomorphological diagnosis is determined - the basis of therapy; a biopsy is not performed if a mastectomy is immediately assumed - during it such a study will be carried out;
• determination of estrogen and progesterone receptors, as well as HER-2 / neu and Ki67 - specific proteins that can be considered as tumor markers for breast cancer;
• a biopsy with a thin needle of a lymph node with suspicion of the spread of a tumor there;
• a biopsy with a thin needle of a cyst if a tumor is suspected to develop there;
• assessment of ovarian activity by determining the appropriate hormones;
• examination by a geneticist to detect a mutation of the BRCA1 / 2 gene (breast cancer test) - when cancer of the breast is confirmed in two or more close relatives, in women under 35 years of age, as well as in primary multiple cancer.

To determine the general health of a woman, she is prescribed the following tests and studies:

• verification of blood group and Rh factor;
• isolation of antibodies to pale treponema (), to hepatitis C virus and human immunodeficiency, determination of hepatitis B virus antigen (HBsAg);
• coagulogram to determine blood clotting;
• Analysis of urine;
• electrocardiogram.

Breast Cancer Treatment

Methods of treatment of the disease are varied. The number of their combinations exceeds 6000. The approach to each patient should be individual. A plan of preoperative therapy is drawn up to reduce the volume of the tumor, surgical intervention is proposed and postoperative measures are developed.

Breast cancer treatment methods:

• local (surgery, radiation);
• acting on the whole body (the use of chemotherapeutic agents, hormones, immunotropic agents).

Treatment without surgery

It is carried out when the patient refuses more radical measures, her general serious condition, edematous-infiltrative form, but it will never be fully effective and can only temporarily improve the patient's well-being. This therapy involves radiation.

Radical methods involve the complete removal of the tumor and affected lymph nodes. Palliative care is designed to alleviate the patient's condition. Symptomatic treatment relieves pain, reduces the severity of symptoms of intoxication. Folk recipes for this disease are ineffective.

Surgical intervention

Surgery for breast cancer is the basis of treatment.

The following operations can be performed:

• conventional radical mastectomy - the entire gland, pectoral muscle, lymph nodes under the collarbone, armpit, under the shoulder blade are removed;
• extended radical mastectomy - the peristernal lymph nodes and thoracic vessels are additionally removed, through which metastasis can occur;
• superradical mastectomy - additionally remove the supraclavicular lymph nodes and fiber between the organs of the chest;
• modified radical mastectomy preserves the pectoral muscles, has better cosmetic results, so it is considered a more gentle operation;
• mastectomy with removal of the axillary lymph nodes of only the lower group - performed in the early phase of the disease with the location of the tumor in the outer sections of the gland in debilitated elderly patients;
• simple mastectomy - a palliative operation that involves the removal of only the gland; such an operation to remove the tumor is carried out with advanced forms of the disease, decaying formation, severe concomitant diseases;
• radical - removal of only a segment of the gland with a small tumor at an early stage; while the mammary gland is preserved; after the intervention, an increased risk of recurrence remains, therefore, radiation is additionally performed.

Surgical treatment for metastases to regional lymph nodes should be supplemented with other methods, otherwise there is a high risk of distant metastases and recurrence of the disease. Irradiation is applied both before and after surgery to destroy the most active tumor cells. Techniques have been developed for irradiating tissues directly during surgery, which makes it possible to reduce the dose and increase the effectiveness of such therapy.

Chemotherapy

Breast cancer is a tumor prone to metastasis, so almost all patients are prescribed anticancer drugs. The use of chemotherapy significantly reduces the likelihood of relapse and death of patients. Chemotherapy drugs are able to reduce the stage of the disease, allow you to abandon major operations or reduce their volume.

The following medications are best for treating breast cancer:

• Cyclophosphamide;
• Fluorouracil;
• Methotrexate;
• Doxorubicin.

Especially in combination. Special schemes have been developed that allow in each case to choose the best option for the patient. Sequential identical courses can be used (up to 10-12 courses of chemotherapy), and in other cases, after several courses, the drug regimen is changed.

Before chemotherapy, the tumor is examined for hormone sensitivity. With low hormonal sensitivity, the use of polychemotherapy is recommended, since this is a factor in the unfavorable course of the disease.

Systemic therapy is sometimes not given to patients with an initial favorable prognosis - older than 35 years, with a small tumor that is sensitive to hormones and without involvement of the lymph nodes.

One of the most common cancers in the world today is breast cancer. In terms of the total number of cases among the entire population (men and women), this type of oncological pathology ranks second after lung cancer, and in women, breast cancer is the most common malignant neoplasm. However, does breast cancer always mean a sentence? Of course not, because modern medicine has developed many effective ways to treat this disease. However, much depends on the woman herself. After all, the ability to recognize the symptoms of the disease in time will facilitate the process of healing the patient for doctors.

Disease prevalence

Breast cancer has been known since ancient civilizations. For example, a disease that has a typical set of signs of breast cancer is described in ancient Egyptian papyri. In that era, the disease was considered incurable and leading to quick death. However, in earlier times this ailment was most likely a rarity. Currently, there is a rapid increase in the number of cases. Statistics say that in developed countries, approximately one in ten women is faced with breast cancer. Every year, only in Russia, malignant tumors in this organ are found in 50,000 women. And worldwide this number exceeds one million. And the statistics on survival are also disappointing so far. Almost half of the cases in women are fatal.

Description of the disease

The mammary gland is a paired organ that is a hallmark of the class of mammals, to which man also belongs. The ability to feed their offspring with milk containing easily digestible nutrients has given mammals a huge competitive advantage over other branches of the animal kingdom. However, you have to pay for everything. The mammary glands are also complex organs, whose work depends on the effects of sex hormones. The slightest deviations in the biochemical processes occurring in the body affect the mammary gland.

This organ consists of many alveoli collected in lobes, in which milk is produced. Through special ducts, milk enters the nipple, where it is secreted during lactation. Also in the chest there is a lot of adipose and connective tissue, there are blood and lymphatic vessels.

Women are well aware that their breasts are prone to various diseases - mastitis and mastopathy. Not uncommon and benign tumors of the mammary glands, for example, adenomas. Under certain circumstances, they can degenerate into malignant ones. However, breast cancer can also appear on its own, without being associated with other diseases. The tumor, in fact, is a conglomerate of overgrown glandular cells, constantly growing and spreading its pathogenic influence on other organs.

It should be noted that the mammary glands are by no means a female privilege, unlike other female genital organs. Under the nipples of a man, glands are hidden in the same physiological sense as in women, although many men are not aware of this. However, unlike women, the glands in men are in a “sleeping” state and are not active, since female hormones are needed to activate the glands. However, the similarity of male breasts to female breasts means that men can also suffer from breast tumors. Cancer of this organ, however, is observed in the stronger sex about 100 times less often than in women.

In terms of nosology, malignant tumors of the mammary gland are represented by two main varieties - these are ductal carcinoma and lobular carcinoma. In total, there are more than 20 types of tumors that form in the tissues of the mammary glands. Tumors can be invasive, that is, spread very quickly to other tissues and non-invasive. Also, cancerous tumors are divided into those that are susceptible to female hormones and actively respond to them, and those that are not susceptible to hormones. The last category of breast tumors is considered the most difficult to treat.

The reasons

As with many other cancers, the exact causes of breast cancer are still unknown. However, there is an assumption that cancer of this organ is largely associated with a violation of the hormonal balance in the body, primarily with an increase in estrogen levels above normal. According to this theory, women are at risk:

• who never gave birth to children
• who did not feed their children with their milk,
• multiple abortions,
• taking estrogens for a long time,
• who start menstruating early
• who have late menopause (aged 50 and older).

The significance of these factors is easily explained - the more a woman had menstrual cycles, the more her body is exposed to estrogens during her life. Estrogens stimulate the regeneration of tissues in many organs, including the mammary glands, which means that the likelihood of mutations in these tissues increases.

Also, in some cases, breast cancer is a genetically determined disease. Genes have been found, damage to which with a 50% probability causes disease in their carriers. However, genetically determined cancer accounts for only a small proportion of all cases of the disease.

Women also appear to be at risk:

• the elderly who have entered the menopause;
• suffering from oncological diseases of other organs;
• who had benign tumors of the mammary glands;
• obese, diabetic, arterial hypertension, atherosclerosis;
• having bad habits - using nicotine and alcohol;
• who had contact with carcinogenic substances or were often exposed to radiation exposure;
• eating large amounts of animal fats.

There is also a theory linking many cases of breast tumors with the negative effects of certain viruses.

Sometimes there is an opinion that mechanical trauma to the breast can lead to malignant tumors of the mammary glands. However, in fact, there is no substantiated evidence of such a relationship.

In most cases, malignant tumors of the breast occur in older women. The peak of the disease falls on 60-65 years. The proportion of women under 30 who have been diagnosed with the disease is small. And in most cases, their tumor is not particularly aggressive. And in adolescent girls, the disease occurs only in isolated cases.

Diagnostics

Malignant breast tumors are one of the few oncological diseases where self-diagnosis is extremely effective. This means that a woman can often detect a tumor herself when examining her mammary glands. In this case, it is necessary to know only a set of symptoms that accompany this disease. Indeed, in about 70% of cases of breast tumors, suspicious masses were initially discovered by the patients themselves, and not detected during a medical examination.

Therefore, any woman should make it a rule to conduct an independent examination of her mammary glands. This procedure is simple and should be carried out every month after the end of menstruation.

During the examination, priority attention should be paid to the following parameters:

• breast symmetry,
• their size
• color of the skin,
• skin condition.

If a suspicious symptom or formation of an incomprehensible nature is found, then you should consult a mammologist. He will perform a manual breast examination and may prescribe additional procedures such as ultrasound, mammography (x-ray of the breast area), ductography (mammography with a contrast agent). If suspicions of the malignancy of the formation still remain, then a biopsy is performed followed by a study of the cellular material. A blood test for tumor markers is also performed.

Symptoms

As mentioned above, a woman can often determine for herself whether everything is in order with her breasts during a self-examination. However, for this it is necessary to know the set of symptoms that accompanies cancer.

It should be borne in mind that pain is not the defining symptom in this case. Breast tumors in most cases develop in the early stages almost painlessly. If a woman, during self-examination, finds a painful induration, then in most cases it is a benign formation.

However, there are also exceptions to this rule. Symptoms of erysipelatous, shell and inflammatory diffuse tumors usually include severe chest pain. These forms of the disease are also often characterized by a set of symptoms such as high fever and inflammation, which can be confused with some kind of infectious disease. A sign of such tumors is the absence of clear boundaries and rapid spread over a large area. In the shell-like form of cancer, the tumor can compress the surface of the breast, due to which it decreases in size.

The main signs of breast cancer are a hard surface and uneven contours of the tumor. Smooth and round tumors, as a rule, are benign formations. Usually, a malignant tumor is immobile and only slightly shifts when pressed. Another symptom of a tumor is a change in the appearance of the skin located above it. The skin may retract and wrinkles and folds may form.

With the development of the disease, cancer cells can enter the lymph nodes, so they can increase in size. These signs - an increase in lymph nodes, their uneven surface, should also be alarming. In most cases, lymph nodes affected by cancer cells remain painless.

In addition, a common symptom of gland tumors is discharge from the nipples, not associated with lactation. These secretions are usually pathological and contain blood or pus.

Stages of breast cancer

Usually it is customary to distinguish 4 stages of the disease. Each of them is characterized by a set of specific symptoms, the intensity of which increases as the disease progresses.

The first stage is initial. At this stage, the size of the tumor is very small, it does not exceed 2 cm in diameter. Neighboring tissues and lymph nodes are not affected by the pathological process.

The second stage is characterized by a tumor diameter in the range of 2-5 cm. At this stage, cancer cells can begin to penetrate into the lymph nodes. In the third stage, the tumor exceeds 5 cm in size. Individual metastases can be found in the gland itself. At the fourth stage, the entire gland is affected by the process, metastases can be found in other organs.

TNM breast cancer staging system

Also, the stages of breast cancer are often indicated according to the TNM system, in which the T index determines the size of the tumor, N - the degree of damage to the lymph nodes, M - the presence of distant metastases.

Index T can take values ​​from 1 to 4:

• Stage T1 - tumor size up to 2 cm,
• Stage T2 - tumor size from 2-5 cm,
• Stage T3 - the size of the tumor is more than 5 cm,
• Stage T4 - The tumor has spread to the chest wall and skin.

Index M takes values ​​from 0 to 3:

• N0 - no metastases in the lymph nodes;
• Stage N1 - metastases in the axillary lymph nodes of the 1st and 2nd level, not soldered together;
• Stage N2 - metastases in the axillary lymph nodes of the 1st and 2nd level, soldered together, or damage to the internal mammary lymph node;
• Stage N3 - metastases in the subclavian lymph nodes of level 3 or metastases in the internal mammary and axillary lymph nodes, metastases in the supraclavicular lymph nodes.

Index M can take only two values ​​- 0 and 1 M0 - no remote metastases were found, M1 - distant metastases were found.

Treatment

Treating breast cancer is a difficult process. Its success largely depends on how aggressive the tumor is, how far the disease has gone.

Treatment involves several methods, but the main one is surgical. Previously, in the presence of even a small tumor, an operation was practiced to completely remove the gland (radical mastectomy). Needless to say, this practice is the reason why many women are afraid of surgery and often refuse such a method of treatment, which leads to a deterioration in the condition. And in the case of an operation, a woman left without a breast experiences psychological discomfort and stress, which is also undesirable, since the positive morale of the patient is one of the conditions for a successful fight against cancer.

Currently, the treatment of breast cancer is carried out in a slightly different way. In most cases, it is not necessary to remove the entire breast in the early stages of the disease. During an operation called a lumpectomy, only the part of the breast that is affected by the tumor is removed. Also, during treatment, lymph nodes adjacent to the tumor are removed. Complete removal of the breast is practiced only from the third stage. But here much depends on the characteristics of the disease in each case.
However, if the gland is not completely removed, there is a possibility of a recurrence of the disease. To prevent this from happening, treatment with chemotherapy and radiotherapy is used. Many breast tumors respond well to treatment with hormones that reduce the level of estrogen in the body. This feature is based on the fact that many cancer cells have estrogen receptors and, when exposed to these receptors, the cells accelerate their reproduction.

Hormone therapy, chemotherapy and radiotherapy can also be used as independent treatments for breast cancer, if surgery is not possible for some reason. A treatment approach can also be used in which exposure to the tumor with drugs and radiation is practiced before surgery in order to reduce the size of the neoplasm. This method of treating breast tumors is called neoadjuvant. In contrast, adjuvant therapy is designed to reinforce the results of surgery and prevent recurrence of the disease.

Of the cytostatic drugs used in breast cancer chemotherapy, the most common are:

• fluorouracil,
• methotrexate,
• cyclophosphamide,
• paclitaxel,
• doxorubicin.

Targeted therapy is a specific form of drug therapy for breast cancer. This type of treatment is aimed at increasing the sensitivity of tumor cells to chemotherapy drugs, as well as to radiation therapy. Targeted preparations contain special antibodies that neutralize substances secreted by tumor cells of the mammary glands.

Forecast

The chances of recovery from breast cancer are relatively high in the early stages of the disease. If treatment is started at stages 1-2, then 80% of patients live 5 years or more. With cancer of the third stage, this figure is 40%. For stage 4 breast cancer, five-year survival rates are only a few percent. Much also depends on the age of the patient, her concomitant diseases, the degree of aggressiveness of the cancer. With erysipelatous and armored forms of breast cancer, the five-year survival rate does not exceed 10%.

It must be remembered that even if the patient underwent a successful operation to remove a breast tumor, then after some time, sometimes years later, relapses are possible. Therefore, the patient must be under the constant supervision of an oncologist.

Prevention

Of course, there can be no absolute guarantee that a woman will not develop a malignant tumor of the breast. However, regular self-examination, visiting a mammologist, passing mammograms at least once a year, allows you to identify the disease at an early stage. Also reduce the likelihood of an illness due to a woman's childbirth, lactation, the absence of diseases of the female organs and mammary glands, control of the hormonal balance in the body, primarily during menopause. Of course, good nutrition, weight control, a healthy lifestyle, and the rejection of bad habits play an important role in the prevention of breast cancer.

Breast cancer is one of the most common cancers in women. It affects all segments of the population of different ages.

The risk of getting sick increases in women: older than fifty, who have not given birth to children or who have given birth to their first child after thirty years, if this pathology has been detected in a close relative.

In breast cancer, the cells of the glandular tissue degenerate into malignant ones. According to statistics, the disease is confirmed in 10% of cases aged 13 to 90 years. There is a pathology among men, but very rarely.

Reasons for the degeneration of normal cells:

• genetics- if the pathology occurred in the family, you should pay attention to the first signs of cancer;
• early and prolonged menstruation- cancer is more often detected in patients with high levels of estrogen;
• smoking and other carcinogens- reduce the protective properties of the body.

Only early detection of the disease can reduce the damage from the disease.

stages

The stage of pathology describes its size and localization. The choice of treatment and its success depends on the stage.

The following steps are used:

• Zero- malignant cells are enclosed in the thoracic milk ducts (through them milk flows to the nipple). Most often, intracanal cancer is curable.
• First– malignant cells have reached neighboring tissues. The tumor does not exceed 2 cm.
• Second- the tumor grows up to 5 cm, malignant tumors have penetrated into the lymph nodes that surround the gland.
• Third- consists of category A (neoplasm more than 5 cm, affected lymph nodes) and category B (tumor of any size, affected skin of the chest, lymph nodes, chest wall).
• Fourth- the neoplasm has gone beyond the mammary gland, the lymph nodes of the lungs, liver and other organs are affected.

The first three stages are considered early. If the disease is detected and treated in time, the survival rate is 70%.

Kinds

WHO staff, together with world oncologists, have developed the most complete classification of breast cancer. It allows you to fully describe the tumor.

The classification uses 8 main features:

• the size of the malignant formation;
• place of localization;
• the volume of metastases in nearby lymph nodes;
• the presence of distant metastasis;
• tumor stage;
• cellular basis of pathology;
• level of histopathology;
• cellular expression.

Form classification

• nodal- tightness in the chest. It occurs both rounded and irregular. Painless on palpation. In subsequent stages, ulcers may appear on the skin, the mammary gland is deformed.
• Edema-infiltrative- occupies almost the entire gland, causing slight pain. The skin in the affected areas resembles an orange peel. Swelling appears near the nipple. It most often affects young women.
• Mastitis-like- edema develops. This leads to an increase in the body, an increase in temperature. A large painful induration is felt.
• erysipelatous- resembles inflammation, which is accompanied by redness of the skin, hardening of the gland. Nodular neoplasms are not palpable.
• armored- the tumor grows through fatty, glandular tissue. Possible spread to the second breast. Multiple seals are palpable, the gland may decrease in volume.
• Paget's cancer- a crust forms near the nipple, ulcers appear on the chest, the nipple is deformed, the patient feels itching. This pathology occurs only in 5% of cases.

Location classification

• Leather- there is redness, peeling, ulcers, erosive foci. Any area can be affected.
• Nipple and areola- crusts form near the nipple, it is deformed, drawn inward. With Paget's cancer, the nipple can collapse completely. Cancer occurs in this area in 18% of patients. Doctors mark the pathology with the code C50.0 and C50.1.
• Upper inner quadrant– malignant tumors occur in this area in 15% of patients. Code C50.2.
• Lower inner quadrant– the tumor is localized in 6% of patients. Code C50.3.
• Upper outer quadrant- pathology is localized in 50% of patients. Code C50.4.
• Lower outer quadrant– malignancy is detected in 11% of patients. Code C50.5.
• Posterior axilla- doctors mark the localization with the code C50.6.

Initial symptoms

The clinical picture of breast cancer in the initial stages is almost asymptomatic. It is similar to different types of mastopathy. Only with mastopathy, seals are painful, and with oncology, they are painless.

There are ten main symptoms by which you can suspect oncology.

Sores on the nipple

The oncological process causes the appearance of small wounds that do not heal for a long time. They turn into ulcers, which get bigger. Some of them merge together. They can form on the nipple, areola, skin.

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Discharge from the nipple

Discharge can be a normal sign during pregnancy and breastfeeding. In other cases, any liquid should alert. This is one of the signs of breast cancer.

Discharge color:

• transparent;
• cloudy whitish;
• bloody;
• purulent;
• yellowish.

The color of the discharge depends on how the disease proceeds.

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Nipple retraction

A change with the nipple often indicates the presence of a pathological process. The tumor, located close to it, captures the tissues of the nipple, causing it to be retracted inward. If your nipples were normal before, then retraction of one or both of them may be a sign of breast cancer.

The nipple can not only retract, but also deform, become flattened.

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Breast seals, noticeable when probing

Statistics say that about 70% of the women who applied, who were diagnosed with cancer, noticed some kind of induration when probing. This is what made them turn to a specialist.

The presence of a lump or nodule does not always imply malignancy. It often turns out to be a benign tumor.

Slight chest pain

By itself, breast tenderness in women of childbearing age is caused by stimulating hormones. However, along with other signs, pain is a reason to consult a specialist. It is also worth consulting if the pain is constant and has no apparent cause.

Soreness is more often inherent in the formation and enlargement of the cyst. Cancer, on the other hand, is a more insidious disease. In the early stages, it does not reach the nerve endings.

Form changes

In the nature of living organisms there is no complete symmetry. The mammary glands may vary slightly in size. Such an asymmetry is noticeable only in a detailed examination. In a malignant process, the asymmetry is so visible that it catches the eye. This happens when a tumor develops in one of the mammary glands.

Discomfort in the chest

Feeling of swelling, soreness is often associated with the menstrual cycle. However, if the discomfort persists, this is an occasion for a more detailed examination. Also, the first sign of breast cancer is a painful lump that does not disappear after menstruation.

Skin changes

The skin of the breast may turn red. Many women ignore this sign of breast cancer. They assume that they simply rubbed the skin or pressed with a bra. If the redness does not disappear, it is better to check with a specialist.

The cause of peeling, redness is a tumor that releases various toxins that irritate the skin.

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Chest dimple when raising arm

Raising your hands up, you should pay attention to the behavior of the mammary gland. If a depression forms on its surface, this sign of breast cancer cannot be ignored.

The cause of hollowness is a tumor that captures healthy tissues and attracts them to itself.

Enlargement and soreness of regional lymph nodes

The second stage of the pathology involves the defeat of malignant particles of the lymph nodes of the armpit. They increase in size, cause discomfort and soreness. There may be swelling of the armpit itself. This sign is the reason for contacting a specialist.

Self-diagnosis

The best way to identify the first signs of breast cancer is self-diagnosis. The procedure should be carried out no more than once a month. There is no sense in daily probing, since it will be difficult to recognize possible pathological changes.

The glands are examined on the seventh to tenth day of the menstrual cycle. It takes no more than 30 minutes. It will not be superfluous to keep records of the results of self-diagnosis. This will help to detect the first signs of breast cancer on your own in time.

If you find seals or something suspicious, you should contact a specialist. You should not be upset, because this will not always be an oncological disease.

The correctness of the self-diagnosis:

• prepare a large mirror;
• take care of good lighting;
• carefully inspect the bra for the presence of discharge in the nipples (dry peel spots of yellow or brown color);
• standing straight, lowering your hands to assess the size and shape of the chest;
• raising your hand and moving it behind your head, follow the movement of the gland, on which there should be no depressions, bulges, discharge in the nipples;
• check the skin for diaper rash, rash, orange peel;
• view nipples and areas for discoloration, cracks, spots, discharge;
• palpate the mammary gland.

How to properly palpate the chest:

• hands should be lubricated with cream or soap;
• the gland is examined with the opposite hand, fingertips;
• movements should be circular springy, starting from the nipple to move to the outer limits of the organ;
• pay special attention to the armpit (enlarged painful lymph nodes should alert).

If any changes are detected, it is worth contacting a specialist (gynecologist, mammologist). He differentiates the noticed changes, will be able to send for additional examination.

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