Breast cancer is a malignant neoplasm of the glandular tissues of this organ. Being the most common form of female cancer in the world, this disease during life affects every thirteenth( in the age category from thirteen to thirty five) and every ninth( from sixty to ninety years old) woman.
In terms of the entire human population, breast cancer ranks second( the first belongs to lung cancer) among all cancers.
This statistics also applies to the male population, given the identity of the tissues of this organ in women and men, although cases of male breast cancer account for not more than one percent of the total number of cases of this disease.
World Health Organization experts testify that around 1 million new cases of breast cancer are registered annually in the world. In a number of deaths from women's cancer, breast cancer belongs to the second place.
Classification of mammary tumors
Tumor processes in the mammary gland can be benign and malignant in nature.
Benign types of
All kinds of benign breast tumors are commonly referred to as mastopathy.
Its most common varieties( there are more than fifty of them) are:
- fibroadenomas;
- by intracurrent papillomas;
- fatty cysts( galactocele);
- lipomas;
- fibro-cystic changes.
Philloid( leaf-shaped)
A leaf tumor, a type of fibroadenoma, stands apart from a benign neoplasm of the mammary gland, as only it is able to degenerate into a malignant tumor( sarcoma).
A phyloid tumor is characterized by:
- having clear boundaries separating it from adjacent tissues;
- lack of capsules;
- lack of mobility in the breast tissue and skin adhesion;
- painful when pressed on the tissue of the affected area of the breast;
- by the presence of uneven polycyclic contours;The
- is prone to extremely rapid growth.
Taking into account the possibility of malignancy, the leaf-like tumor is removed exclusively surgically, subjecting to sectoral resection not only the neoplasm itself, but also the adjacent tissues. When a large tumor is performed a radical mastectomy - an operation to remove the affected breast.
Malignant
Histological types of malignant tumors are represented by cancer:
- lobular;
- protocol;
- metaplastic;
- is medullary;
- is inflammatory;
- is colloidal;
- undifferentiated;
- is low-grade;
- infiltrating protocol;
- Paget.
To the same histological type are malignant tumors of the mammary gland, represented by:
- adenocarcinomas;
- carcinomas;
- by sarcomas.
Photo of a malignant breast cancer in a woman
What are malignant breast tumors:
- invasive;
- hormone-dependent;
- is estrogen dependent.
Breast cancer can be primary and secondary.
Hormone-dependent
Hormonal-dependent breast tumors are detected in 40% of patients. In the outer layers of tumor tissues are located receptors, endowed with the ability to contact the receptors of the sex hormones of the female body. This contact stimulates the further growth of cancer cells.
To confirm or exclude the presence of receptors sensitive to progesterone and estrogen, a special test is performed. Material for immunohistochemical examination is taken during a biopsy. If a tenth of tumor cells also contain receptors, the neoplasm is considered hormone dependent.
This not only makes it possible to start hormonal treatment, but also allows you to make a prediction about the risk of relapse. For hormone-dependent breast cancers, a more calm course and relatively rare metastasis is characteristic.
Anti-estrogen therapy aimed at suppressing the synthesis of estrogen and the destruction of cancer cells, although it has an auxiliary role, supplementing chemotherapy, surgical treatment and radiation therapy, but it is of particular importance in the case of hormone-dependent tumors.
Invasive
Invasive breast tumors prefer to be localized in connective and fatty tissues. A distinctive feature of invasive tumors is the ability of cancer cells to leave the primary focus, quickly penetrating into adjacent tissues and lymph nodes.
For advanced stages of invasive breast cancer, metastasis is typical in the tissues of the brain and spinal cord, bones, lungs, liver and kidneys.
Invasive breast tumors are:
- invasive cancerous cancer, initially affecting the milk ducts, gradually penetrating into adipose tissue, then - through the lymph nodes and the bloodstream - metastasizing to other organs. On a share of a stream cancer there are 80% of malignant tumors of a breast.
- with pre-invasive cancer, developing and remaining exclusively in the milk ducts. In the absence of diagnosis and proper treatment, this type of cancer can be regenerated into ductal form;
- invasive lobular carcinoma , initially affecting the ducts and lobules of the mammary glands, and then metastasizing throughout the body. Invasive tumors of this type are found in 15% of patients.
Treatment of invasive breast tumors includes a full range of anti-cancer therapies: surgical treatment, radiation therapy, radiotherapy, hormone and chemotherapy.
Reasons for the formation of
Because the causes of breast cancer are still unknown, it is customary to talk only about the risk factors for this disease. These include:
- the presence of hereditary predisposition;
- early( up to 11 years) menarche;
- conscious planning of pregnancy and childbirth at a fairly late age;
- refusal from prolonged breastfeeding;
- presence of bad habits( especially smoking);
- later( after 55 years) the onset of menopause;
- lack of regular sex;
- permanent exposure to severe stress and physical overwork;
- the presence of obesity, diabetes and hypertension;
- continuous( over 10 years) continuous intake of exogenous hormones;
- mammary gland trauma;
- exposure to increased radiation background.
Symptoms of
Most neoplasms of the mammary glands( both benign and malignant) do not cause pain at the initial stage of their development and do not manifest themselves in any way, so their regular and thorough examination is so important. It is thanks to him that it is possible to detect the presence of a tumor at the earliest stage of development.
How to identify a breast tumor:
- presence of swelling and seals in the tissues of the mammary glands;
- some changes in the consistency and structure of the gland during palpation;
- reconfiguration and general outline of the gland;
- presence of peeling, redness or wrinkling of the skin of the breast;
- formation of pits on the surface of the gland with the hands behind the head;
- presence of a retracted nipple;
- discharge from the nipple( with benign neoplasms, they are always watery, with malignant - bloody);
- presence of seals on the nipple;
- discomfort or pain;
- presence of enlarged lymph nodes on the side of lesion.
Breast cancer stages
Cancerous breast tumors in their development consistently pass through the following stages:
- 0: is characterized by the localization of cancer cells exclusively in the thoracic duct and the absence of penetration into adjacent tissues;
- IA: at this stage, the size of the neoplasm does not exceed two centimeters, the tumor is localized in the tissues of the breast, there are no pathological processes in the lymph nodes;
- IB: for this stage is characterized by the presence of a tumor not exceeding two centimeters or small groups of tumor cells in a number of lymph nodes;
- IIA: a neoplasm not exceeding 2 cm is localized in the tissues of the breast and metastasizes to the axillary lymph nodes( in another variant the tumor can reach from two to five centimeters and not give metastases);
- IIB: , a tumor not exceeding five centimeters can metastasize to the lymph nodes( second option: no metastases if there is a tumor larger than five centimeters);
- IIIA: , not only axillary, but also other lymph nodes are involved in the pathological process;
- IIIB: at this stage, a neoplasm of any size begins to affect the breast wall and skin of the breast( the process of lymph node involvement continues);
- IIIC: in the pathological( with metastasis) process involves tissues of the axillary, thoracic and subclavian areas;
- IV: The tumor and metastases affect the entire female body.
Diagnostics
A number of instrumental and laboratory studies are being carried out to diagnose breast cancer:
- mammography;
- doktografiyu( method of radiocontrast study of the ducts of the mammary glands);
- breast ultrasound( under his control, often perform aspiration and puncture biopsy);
- NMR visualization;
- positron emission tomography, which gives the specialist information not only about the anatomical structure of the tumor, but also about the nature of the metabolic processes occurring in the lesion;
- biopsy for suspected breast cancer can be: aspirating, excision, stereotactic( puncture biopsy performed using a thin needle, trepan-biopsy - using trepan: a needle with a wide lumen);
- laboratory test for the presence of hormonal receptors.
Video tells how to conduct self-examination of mammary glands at home:
To identify comorbidities and distant metastases, the following:
- X-ray of the chest cavity;
- of the adrenal gland, thyroid, liver, ovaries;
- computed tomography;
- scanning of bone tissue.
Treatment of benign tumors
The leading method of treatment of benign breast tumors is surgical treatment, and the scale of intervention is determined solely by the size of the lesion. Fibroadenomas of small sizes are not removed, leaving the patient under dynamic observation.
In the surgical treatment of small size tumors subjected to:
- enucleation( vyluschivanu): in this version of treatment only tumor tissues are removed, leaving surrounding tissues intact;
- sectoral resection, removing them together with the capsule and a small portion of the adjacent tissue;
- a simple mastectomy( removal of the tumor along with the mammary gland).This operation is performed for neoplasms exceeding 8 cm.
- Mastopathy of mammary glands is treated with poultices and herbal packs: roots and leaves of burdock, cabbage, coltsfoot, wormwood, celandine, St. John's wort, calendula, gentian and sweet clover.
- A mass obtained by passing freshly collected medicinal plants through a meat grinder, is used to perform cold applications of .
- From honey and powder of medicinal herbs do plaster and apply it to the affected areas of the mammary glands.
- Assortment of small fibroadenomas is facilitated by dressings with ointment from baked onions and tar .
- A mixture of freshly squeezed vegetable juices and "cahors" is used to prepare a drug for internal administration that has an antitumor effect.
- For the internal use of , decoctions and infusions of medicinal herbs are also used.
Therapy of Oncology
Effective treatment of breast cancer should be comprehensive, combining methods of surgical treatment, immunotherapy, chemotherapy, radiation treatment and targeted therapy. Leading importance is attached to surgical treatment.
Surgery
Surgical intervention gives good results if the tumor process is limited to the outside of the breast and its internal lymph nodes.
As an independent method, surgical treatment is used only at early( preclinical, first and second) stages of breast cancer.
In this case, the following organ-preserving operations are performed:
- lumpectomy;
- radical sectoral resection;
- hemimastectomy with lymphadenectomy;
- quadrantectomy with lymphadenectomy;
- subcutaneous mastectomy with lymphadenectomy.
In later stages, surgical intervention is part of a comprehensive therapy: sometimes as a first stage of treatment, sometimes after a preliminary course of drug or radiation therapy.
Cancer that reaches these stages of development is radically removed along with the mammary gland( mastectomy), regional lymph nodes and adjacent tissues.
The following types of mastectomy are used:
- according to Halstead;
- for Madden;
- for Pay;
- for Pirogov.
Mastectomy can be simple and extended( modified and axillary-sternal).
Contraindication to surgical treatment is:
- germination of malignant neoplasm in the chest wall;
- presence of tumor of mastitis or erysipelas;
- spread of the tumor process to supraclavicular lymph nodes;
- presence of edema of the upper limb;
- occurrence of distant metastases
Cost of operation
- radical resection of the breast: 9000-235000 rub.
- of radical mastectomy: 13000-235000 rub.
- subcutaneous mastectomy: 8000-90000 rub.
- mastectomy with a one-stage reconstruction of its own tissues: 21000-115000 rub.
- mastectomy( with one-stage endoprosthetics): 20000-185000 rub.
Radiotherapy
Radiation therapy for breast cancer has an auxiliary significance. During the sessions, irradiation of the affected gland and its regional lymph nodes takes place. Radiation therapy can be both preoperative and postoperative.
The goal of preoperative radiotherapy is to reduce the degree of malignancy of the neoplasm by destroying low-grade cells, reducing the dissemination of tumor cells at the time of surgery, and the likelihood of recurrence. Sometimes under its influence, inoperable neoplasms become operable.
Sessions of postoperative radiotherapy are conducted to reduce local recurrences after mastectomy and lumpectomy, when metastasis is detected in regional lymph nodes and after partial removal of lymph nodes.
Medications
Chemotherapy happens:
- neoadjuvant( preoperative), used to reduce the size of the tumor;
- adjuvant( postoperative), aimed at preventing the occurrence of metastases and relapses;
- curative, intended for the treatment of already identified metastases.
Distinguish:
- monochemotherapy( single drug treatment);
- polychemotherapy( combination drug treatment).
The use of chemotherapy significantly prolongs the life of patients. Breast cancer is most often treated with cyclophosphamide, farmorubicin, adriamycin, fluorouracil.
With the help of hormonal therapy, decrease of estrogen in the female body is achieved. A number of specialists recommend using it before chemotherapy begins to confirm the sensitivity of the tumor to the action of hormonal drugs( tamoxifen, testolactone, testosterone, aminoglutethimide, sustanone).
Each patient is treated in strict accordance with the individual plan drawn up for her.
Palliative care for
Palliative breast cancer treatment is used when the chance of complete healing of a patient with advanced disease is negligible or when radical therapy can not be used.
If palliative care involves surgical intervention, only a few tumor sites are removed, if chemotherapy is performed, a reduced dosage of drugs is prescribed.
The main goal of all medical measures is to maximize life extension and significantly improve its quality. If palliative care was provided on time, it gives the patient a chance to live a few more years.
Follow-up after treatment
After completion of treatment, the patient must stand on dispensary records and undergo follow-up examinations with the attending physician:
- in the first year - quarterly;
- the next three years - every six months;
- five years after operation to visit the doctor follows once a year.
Inspections are necessary to prevent the occurrence of relapses and to control the likely side effects.
After the organ-preserving operation, visits to the mammologist should be annual. If the tumor is suspected of relapse, the doctor will make the necessary studies. When the relapse is confirmed, a course of treatment taking into account the location of the tumor and the therapy used before is prescribed.
Breast cancer in men
Men suffer from it a hundred times less often than women. Despite this, the male survival rate for breast cancer is significantly lower than that of women. The reason for this is a very late diagnosis of a disease that does not manifest itself in any way.
This issue of the video "Live Healthily" says about the causes of breast cancer in men:
The methods of treating men's breast cancer are almost identical to the methods used to treat women. In surgical treatment, a radical modified mastectomy is most often performed.
Breast cancer in males is extremely sensitive to the effects of estrogens, therefore, when metastases arise and tumors relapse, patients are prescribed tamoxifen, an anti-estrogenic drug( akin to castration), so there is no need to remove the testicles.
Cancer of the first stage in men ends with 100% recovery. The five-year survival of operated patients after radical mastectomy is more than 98%, the ten-year survival rate is more than 94%.
Prognosis for cancer
Five-year survival of patients with breast cancer:
- 1st stage - 70-96% ;
- 2nd stage - 55-85% ;
- 3rd stage - 15-50% ;
- 4 stages - no more than 10% .
Prevention of
To reduce the risk of breast cancer or to stop its development in the early stages, it is necessary:
- to perform regular self-examination of the mammary glands;
- after reaching the age of forty visit a mammologist once every two years, after fifty years - annually;
- in the presence of a family history, burdened with cases of breast cancer, mammography is done annually, beginning at the age of 35;
- if you see any suspicious symptoms, seek medical advice immediately;
- does not abandon the child's prolonged feeding;
- to control weight, monitor the level of sugar;
- the choice of oral contraceptives should be agreed with the treating specialist( after an appropriate examination).
Why it is necessary to operate benign breast tumors, this video will tell: