Secrets of the most female cancer – breast cancer. The first signs of breast cancer - causes, types of tumors, diagnosis, treatment and prevention. Precursors of breast cancer

Content

When a person is told that he has a malignant tumor, there is a feeling that the world is collapsing. Women should know that breast cancer, the symptoms of which are detected at an early stage, is treatable and has a favorable prognosis. Why does the disease develop, what are the first signs of pathology, how does recovery occur - it is necessary to understand these issues in order to avoid dire consequences.

What is breast cancer

The female body is complex; there are many reasons why hormonal changes occur in it. The mammary glands are very sensitive to changes. Pathological processes begin to develop in them. Uncontrolled growth of aggressive tumor cells occurs, which leads to the emergence of a dangerous tumor. A high percentage of cancer incidence is observed in women over 50 years of age, but cases of pathologies in young women cannot be excluded. The tumor grows and metastasizes to:

• The lymph nodes;
• pelvic bones, spine;
• lungs;
• liver.

Symptoms

To begin treatment for breast cancer in a timely manner, you need to know how it manifests itself. The danger is that at an early stage the processes occur without visible signs. This complicates treatment and prognosis - women turn to specialists when radical interventions are required. Symptoms for the development of cancer are:

• formation of lumps in the breast;
• thickening or retraction of the nipple;
• the appearance of a “lemon peel” over the lesion;
• redness of the skin.

If one or more symptoms are detected, you must be examined by a doctor. A malignant breast tumor is characterized by the formation of signs:

• compaction of the retrosternal, axillary lymph nodes;
• disproportionate increase in the size of one breast;
• the appearance of pain;
• breast deformation;
• edema formation;
• the occurrence of ulcers, crusts;
• presence of discharge from the nipple;
• temperature increase;
• weakness;
• dizziness;
• sudden weight loss;
• manifestations of pain in the bones and liver with metastases at a late stage of cancer.

Does your chest hurt?

You need to know that the development of cancer is not always accompanied by pain, especially when the pathology is detected early. The appearance of the symptom is influenced by the location of the tumor. The mammary glands, like other organs, have nerves. With an increase in the size of the tumor:

• swelling occurs;
• healthy tissue is pushed aside;
• there is pressure on the nerve endings;
• There is a constant aching pain.

Umbilization

This symptom of cancer is observed at an early stage of the disease. It signals that an infiltrative process is developing deep in the mammary gland, causing tissue fibrosis. During umbilization:

• the ligaments of the organ are pulled towards the tumor;
• a small depression is observed above the source of inflammation;
• there is a retraction of the skin surface inward;
• a similar process may occur in the nipple.

Lemon peel on the mammary gland

The occurrence of this symptom of breast cancer is typical for the last stages of cancer. The phenomenon is often observed in the lower part of the chest. As the tumor enlarges, the shape of the mammary gland changes, ulcerations and “lemon peel” form on the skin. Reasons for this phenomenon:

• when the lymph nodes become enlarged, the outflow of lymph is disrupted;
• tissue swelling occurs;
• the skin thickens;
• pores increase in size;
• “lemon peel” is observed on the surface of the skin.

Kernig's sign

At one of the stages of breast cancer development, lymphatic and venous vessels are involved in the malignant process. There is a decrease in the elasticity of breast tissue. For Kernig's sign:

• compaction occurs in the thickness of the glandular tissues;
• the size of the tumor formation is up to several centimeters;
• the area is dense, mobile, painless.

Signs of breast cancer at an early stage

To avoid the risk of complications, women should perform breast self-exams monthly. With regular monitoring, you can notice changes, detect cancer at an early stage and be successfully treated. Having discovered the first symptoms of the disease, you need to contact a mammologist for a clinical examination. It is possible that it will be a benign tumor or fibroadenoma, but if left untreated, everything can develop into cancer.

How does breast cancer start? Women discover during self-examination:

• lumps in the chest;
• damage to the armpits;
• expansion of saphenous veins;
• the occurrence of ulcers;
• retraction of the nipple skin;
• change in breast shape;
• appearance of “lemon peel” on the skin;
• redness;
• thickening of the skin of the nipple and areola around;
• enlarged lymph nodes of the sternum of the armpits;
• retraction of the skin over the site of the outbreak;
• discharge from the nipple.

Causes

It is impossible to say for sure what causes breast cancer in women. There are many provoking factors for the development of pathological neoplasms. Breast cancer can progress for the following reasons:

• advanced benign diseases;
• presence of relatives with cancer;
• chest injuries;
• age over 40 years;
• alcohol abuse;
• smoking;
• obesity;
• early onset of the menstrual cycle;
• diabetes;
• gynecological inflammatory diseases.

A malignant neoplasm in the breast can occur as a result of:

• frequent abortions;
• late first birth;
• short period of breastfeeding;
• absence of children;
• history of hormonal therapy;
• late menopause;
• exposure to chemical carcinogens;
• irregularity of the menstrual cycle;
• stressful situations;
• infertility;
• ovarian cysts;
• brain tumors;
• carcinoma of the adrenal cortex;
• diets with a lot of fat;
• exposure to radiation.

Classification

In medicine, several classifications of breast cancer are used. They differ in characteristics, structural features of the neoplasm, and macroscopic forms. When considering histotypes one encounters:

• non-invasive cancer - malignant cells are located within the duct or lobule of the mammary gland;
• Invasive carcinoma - infiltrating cancer - originates in one structure and gradually moves to others.

There is a classification of malignant breast tumors according to macroscopic forms. It includes:

• diffuse cancer - characterized by the speed of development, damage to the lymph nodes, edema, an increase in the size of the mammary glands, and the formation of ulcerations;
• nodular type - located on the outside and at the top of the chest, involving fatty tissue, muscles, skin;
• Paget's cancer - accompanied by an enlargement of the nipple, the appearance of crusts and ulcers on the surface, the tumor is diagnosed late - the symptoms are similar to eczema.

Stages

For ease of diagnosis and selection of treatment methods, it is customary to divide the development of pathological neoplasms into stages. Each is characterized by certain characteristics. There are four stages:

		Tumor size, cm	Lymph node changes	Lesions by metastases
		No more than 2	Not affected	Not observed
			Absent	Invasion into adjacent tissues
			Axillary	Do not penetrate the skin or adipose tissue
			Not observed	Grow into muscles, tissues, skin
			Parasternal, subclavian, axillary
Fourth		Doesn't matter		Throughout the body

How quickly does cancer develop?

The growth of a malignant breast tumor can occur at different rates. This depends on the timeliness of treatment, hormonal sensitivity, and aggressiveness of cancer cells. Some women live for many years after the diagnosis of malignant neoplasms, while others die within a few months. Cancers are classified according to their growth rate:

• rapidly growing – in three months the number of malignant cells doubles;
• with average development - similar changes occur within a year;
• slow growing – tumor growth doubles over more than 12 months.

Diagnostics

The basis for effective treatment of breast cancer is timely diagnosis. After detecting symptoms of the disease during self-examination, women go to the clinic to see a mammologist. Testing methods to detect cancer include:

• visual inspection;
• palpation;
• survey about the likelihood of contracting hereditary cancer;
• biopsy - study of cells;
• Mammography is an X-ray method that detects cysts, fibroadenomas, and the location of the tumor.

• ultrasound scanning of the armpits, chest, to identify metastases and tissue lesions;
• immunohistochemical analysis - determining the resistance of a malignant neoplasm to hormonal therapy;
• cytological examination - assessment of cell structure;
• tests for tumor markers - determination of proteins that are produced only in the presence of a malignant tumor;
• computed tomography to detect organ metastases.

Treatment

The choice of treatment regimen is influenced by the stage of the disease, age and health status of the woman. The location and size of the tumor, primary or secondary, plays a role. There are radiation, medication and surgical removal methods. Effective treatments:

• breast amputation with preservation of lymph nodes;
• sectoral resection of the mammary gland - excision of part of the breast with axillary tissue;
• tumor embolization – stopping the nutrition of cancer cells;
• radiation therapy - to exclude relapses of the disease.

In the final stages:

• radical removal of lymph nodes along with the mammary gland, tissue, and muscles is used - extended axillary-sternal mastectomy;
• excision of the ovaries is practiced as a source of production of sex hormones estrogen;
• chemotherapy is carried out after tumor removal;
• for large lesions, hormonal therapy is performed;
• a combination of the last two techniques is possible.

Treatment without surgery

Russian scientists have developed a method of influencing malignant neoplasms with electromagnetic radiation at a certain frequency - NIERT. When affecting a cancer cell, it is heated and destroyed. The treatment method allows you to avoid surgery. During the process:

• aggressive cells throughout the body are exposed;
• healthy tissues that have a different resonant frequency do not change.

Drug therapy

An alternative to surgery is hormonal therapy. Its task is to reduce the influence of estrogens on the growth of tumor cells. The method is effective in treating the sensitivity of malignant neoplasms to hormones. Treatment is carried out as a preventive measure, used in the early stages of cancer development, after operations. Therapy involves:

• use of drugs to suppress the function of the endocrine system;
• introduction of hormone antagonists at the cellular level - Bromocriptine, Tamoxifen.

Organ-preserving operations

When the tumor is small and it is possible to save the breast, breast-conserving surgery is used. There is a gentle intervention in the woman’s body. There are 3 types of effects that are effective:

• tumor embolization - a special substance is injected into a large vessel near the tumor, malnutrition occurs, and cancer cells die;
• quadrantectomy – a quarter of the breast and axillary lymph nodes are removed;
• radical resection - only the affected sector, lymph nodes, and the membrane of the pectoralis major muscle are excised.

Mastectomy

If large lesions are detected and metastases have spread, a mastectomy is performed. The operation includes resection of the breast, surrounding tissues and organs. There are 4 methods of intervention:

• simple - only the breast is removed, muscles and nodes are not touched;
• radical modified - the mammary gland, lymph nodes, and the membrane of the pectoralis major muscle are excised;
• Holstred mastectomy – fatty tissue, all lymph nodes, muscles and the entire breast are removed;
• bilateral - both glands are excised.

Radiation therapy

Irradiation of a malignant neoplasm is used in the complex treatment of breast cancer. This helps to avoid the spread of aggressive cells and eliminate relapses. Radiation therapy is used:

• after organ-preserving operations;
• at risk of relapse;
• if the size of the primary tumor is more than 5 cm;
• after radical resection of invasive cancer;
• in the presence of several tumors;
• detection of cancer cells in 4 or more lymph nodes.

Chemotherapy

The use of chemical drugs for treatment is practiced after surgery or before it begins in order to reduce the size of the tumor. In armored, metastatic cancer, when metastases spread throughout the body, the method improves the patient’s quality of life. The duration of the course is 2 weeks, repeated monthly. Chemotherapy helps:

• lower the stage of cancer;
• improve the outcome of the operation;
• helps control symptoms.

Forecast

Predicting the results of treatment of a malignant tumor depends on its prevalence, aggressiveness, and the presence of metastases. A positive result is the absence of relapses for five years. The incidence of tragic outcomes due to late tumor detection reaches 30%. Some time after recovery, a resumption of the cancer process is possible. The five-year survival rate of patients, depending on the stage of the disease, is as a percentage:

• first – up to 95;
• second – 50-80;
• third – up to 40;
• fourth – 5-10.

Prevention

There are no methods that can completely protect a woman from breast cancer. There are remedies that help reduce the risk of developing pathology. Women who have relatives who have had cancer that contains a gene that causes cancer need to be especially careful. They are recommended to have their ovaries removed. Methods of primary prevention include:

• self-examination;
• regular mammography;
• pregnancy planning;
• weight control;
• breastfeeding;
• prevention of mastitis;
• taking hormonal medications after the examination.

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Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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Malignant tumor in the breast in women: breast cancer

Breast cancer (BC), or breast, is diagnosed in women of all age categories. However, most often women at the age of menopause get sick and after it - 45-55 years and older. Breast cancer is also extremely rare among men.

Often the development of this type of disease is preceded by benign neoplasms: fibroadenoma or mastopathy.

RMJ statistics:

• About 18% of all cancers in women are breast cancer.
• Approximately every tenth woman in the world between the ages of 15 and 90 develops breast cancer.
• According to the World Health Organization (WHO), approximately one million new cases of breast cancer are registered every year.
• The mortality rate from breast cancer ranges from 20% in developed countries (USA, Japan, EU countries) to 60% in developing countries.
• The main reason for high mortality is the advanced stage of the tumor.
• The tumor occurs equally often in both the right and left breasts.

The earlier the disease is diagnosed, the more effective the treatment and the more favorable the prognosis.

Unfortunately, the symptoms and signs of breast cancer in most cases are not noticeable at an early stage. This is why the tumor is often diagnosed in an advanced form.

CAUSES

This is a multifactorial disease. Its development is associated with changes in the genetic material of breast cells under the influence of certain external influences.

Risk factors for breast cancer:

• Lack of realization of a woman’s reproductive function.
• Avoid breastfeeding after childbirth.
• Bad habits (smoking, alcohol, drugs).
• The appearance of the first menstruation before the age of 12 years.
• The end of menstruation (menopause) after 55 years.
• History of gynecological diseases - infertility, inflammatory processes in the uterine appendages, benign tumors of the uterus and ovaries.
• History of breast diseases - benign tumors (fibroadenoma, mastopathy), mastitis, etc.
• Long-term use of female sex hormones - estrogens (contraception, replacement therapy).
• Obesity.
• Physical inactivity.
• Some somatic diseases are hypertension, diabetes mellitus, atherosclerosis and their combination with other risk factors.

Plays a major role in the occurrence of malignant breast pathology heredity. When certain genes are mutated, for example, BRCA1, BRCA2, p53 and others, there is a very high probability of developing the disease.

CLASSIFICATION

Breast cancer is classified according to several criteria.

Based on the histological structure, there are quite a few forms of breast cancer, but the most commonly diagnosed are ductal and lobular types.

Types of breast cancer:

• Ductal - occurs in almost 80% of all cases. Formed in the milk ducts.
• Lobular.
• Mastitis-like - in this case, the symptoms of breast cancer resemble the course of mastitis (breast inflammation).
• Mucus-like.
• Brainy.
• Tubular.
• Apocrine and others.

According to the prevalence of the tumor process:

• Non-invasive cancer(in situ).
• Invasive cancer- the tumor moves from its localization to the breast tissue and nearby lymph nodes.

All over the world, the TNM classification is used to assess the prevalence of any tumor process, as well as to plan effective treatment and predict the further course of the disease. Based on it, the stage of the disease is determined.

Stages of breast cancer:

• "Zero." Used to describe pathological cells. Non-invasive cancer (insitu) is also included in this stage.
• First (initial). The diameter of the neoplasm is no more than two centimeters, and it does not spread beyond the breast tissue.
• Second. The size of the tumor varies from two to five centimeters. Metastases are detected in the axillary lymph nodes.
• Third. There are three subspecies of this stage (A, B, C). The diameter of the tumor can be absolutely any; it begins to grow into the chest or skin. Metastases spread to the retrosternal, as well as sub- and supraclavicular lymph nodes.
• Fourth. Distant metastases appear.

SYMPTOMS

Unfortunately, breast cancer can proceed for quite a long time without obvious signs. Often the reason for visiting a doctor is the discovery by a woman of a lump in the mammary gland.

Important symptoms of breast cancer:

• Neoplasm in the mammary gland. The presence of various nodules, tumor-like growths or compactions in the chest tissue should be a reason to immediately seek medical help.
• Discharge from the nipples in the absence of breastfeeding. They come in different colors and consistencies.
• Changes in the appearance and shape of the breast - asymmetry, displacement to the side, etc.
• Enlarged lymph nodes. Cancer cells (metastases) in breast malignancy already at the second stage spread to regional lymph nodes, for example, axillary ones.
• Changes in the skin of the gland and nipple - swelling, flattening, retraction, etc.
• Sores, crusts, scales appearing in the area of ​​the nipple or areola.
• Discomfort or even chest pain.

If malignant degeneration of the mammary gland is not diagnosed at the stage of the first symptoms, the disease progresses with the subsequent appearance of distant metastases. They are most often found in the liver, bones, lungs, kidneys, spinal cord and brain.

Sometimes the breast cancer clinic is of an erased or atypical nature. For example, with a mastitis-like form of the disease, the symptoms of the tumor resemble the course of mastitis - an inflammatory lesion of the mammary gland. At the same time, the body temperature rises, the breasts become enlarged, painful and swollen.

Symptoms and signs of breast cancer are varied and sometimes insidious due to their atypical form of presentation. Therefore, any changes in general well-being or in the organ itself should force the woman to immediately consult a doctor.

DIAGNOSTICS

The choice of diagnostic method is made to determine the stage of the pathological process and treatment option.

Research methods for suspected breast cancer:

• Inspection and palpation of the mammary glands and peripheral lymph nodes.
• Ultrasonography.
• Magnetic resonance imaging.
• Determination of tumor markers (CA 15-3; CA 27-29; CEA; HER2).
• Various types of biopsy - excision of a section or the entire tumor, followed by pathohistological examination.
• Genetic diagnostics - determines the presence of genes whose mutations are most likely to lead to the development of cancer.
• Mammography.
• A radioisotope or contrast method for studying the “sentinel” lymph nodes, which are the first to be affected by a breast tumor.
• Immunohistochemical analysis - determination of the sensitivity of organ tissue receptors to hormones (estrogen and progesterone).

TREATMENT

The choice of treatment method for malignant breast lesions directly depends on the stage of the disease and the degree of organ damage Therefore, it is very important to recognize the symptoms of breast cancer at an early stage. Complex treatment is usually used, which consists of surgical removal of the focus of the malignant pathological process in combination with chemotherapy or radiation therapy. Sometimes hormonal treatment is used.

Surgical methods:

• Lumpectomy. Performed in the treatment of stage 1 or 2 breast cancer. In this case, the tumor itself is excised along with some of the adjacent tissue.
• Segmentectomy. The breast tumor and most of the surrounding tissue are removed.
• Quadrantectomy. A quarter of the breast is removed.
• Mastectomy. The organ is completely removed. The operation can be total (without removing regional lymph nodes) or radical - with removal of lymph nodes and some part of the pectoral muscles.

Other types of breast cancer treatment:

• The essence radiation therapy and in breast cancer consists of an ionizing effect on tumor cells, which then die. This method can be used both in complex treatment of a tumor and independently.
• Use of special medications- cytostatics, which suppress the growth of cancer cells, constitute the principle of chemotherapy.
• Hormonal treatment is done in the form of direct removal of the source of hormones, for example, oophorectomy, or by prescribing certain medications (antiestrogens, corticosteroids, androgens, etc.).

In recent years, developments have been carried out with the introduction into clinical practice of innovative methods for the treatment of malignant lesions of the mammary gland: cryoablation, therapy with stem cells or monoclonal antibodies, activation of the p53 blocker gene, etc. However, all these methods are still at the stage of scientific and clinical testing .

COMPLICATIONS

Complications from breast cancer can occur both under the influence of the neoplasm itself and its metastases, and as a result of the treatment.

When a tumor compresses or grows into blood vessels and nerve trunks, bleeding and pain of varying intensity may occur. Sometimes trophic lesions of the skin and adjacent tissues occur, which often leads to the development of inflammation.

Metastasis of the tumor to distant organs and tissues also disrupts their functions. Thus, when metastases enter the respiratory organs, inflammatory damage develops; pain and bone fractures develop in the skeletal system, etc.

PREVENTION

The main direction in the prevention of breast cancer is the timely identification and correction of hormonal imbalance and pathology in the female genital area, as well as the exclusion of carcinogenic factors.

Prevention of advanced forms of malignant neoplasms of the mammary gland is aimed at early detection of the disease. Therefore, absolutely all women, starting at menarche, are recommended to undergo regular breast cancer screening.

Breast cancer screening includes:

• Examination by a gynecologist and, if possible, a mammologist (at least once a year).
• Regular breast self-examination. Performed once a month - on the 7-10th day from the start of menstruation. And during menopause - on any day of the month.
• Mammography. Often allows you to detect breast cancer even before the first signs appear. Recommended to all women, without exception, aged 50 to 70 years. Performed once every two years. If a woman is at high risk for developing breast cancer based on the results of genetic analysis, then mammography is recommended at a younger age.

PROGNOSIS FOR RECOVERY

The success of treatment and prediction of life expectancy for breast cancer depends mainly on the stage of the process, the speed of the tumor process, the woman’s age and concomitant diseases.

With a localized form of breast cancer (stages 1-2), the five-year survival rate can be 85% or more. And for locally advanced breast cancer - up to 60%.

If distant metastases have already been diagnosed, the treatment results are much worse. With advanced pathology, the lifespan is on average two to three years.

Psychological aspect

A sign of breast cancer in the early stages can be lumps in the breast, which are very difficult to detect without undergoing screening, so a person for a long time does not even realize that he has such a serious disease. The diagnosis and treatment procedure can negatively affect the psychological state of the patient, cause problems associated with social adaptation, especially in cases where a woman’s breasts are removed as a result of surgery.

Many modern clinics specializing in the prevention and treatment of such diseases cooperate with rehabilitation groups. The purpose of such interaction is to create supportive conditions using psychotherapeutic methods both for those patients who are yet to undergo treatment and for those who have already undergone therapy.

There are also online rehabilitation groups. Such communication and help are chosen by people who are insecure or shy, especially if they have a negative image of themselves due to their illness.

A patient diagnosed with breast cancer must communicate more with professionals - psychologists and psychotherapists, that is, specialists who will provide the correct information and help you adapt. Communication with similar patients who are not medical professionals can only aggravate the situation.

When making a diagnosis such as breast cancer, do not isolate yourself, get information only from reliable sources, that is, from doctors, remember that the disease can be cured only if you believe in healing.

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Breast cancer is a very dangerous disease, primarily because it slowly and practically without any symptoms takes over a woman’s body.

Symptoms of this disease may be different, moreover, these signs may indicate other diseases of the mammary gland, but still, if they are detected, you should immediately contact a mammologist. A woman can herself identify the presence of a tumor through an external examination of the breast and palpation. As a rule, the tumor at the initial stage does not exceed 2 centimeters in size, and its structure can be irregular and lumpy.

Main signs of breast cancer: the formation of a small abrasion, a wound on the nipple, some pain in some areas of the mammary gland, bloody discharge from the nipple, a change in the shape of the mammary gland when examined by palpation (by palpation). When the subcutaneous layer is pulled towards the tumor, a certain “retraction” occurs, which is another sign of a cancerous tumor. Irritation or peeling may appear on the nipples, and nipple retraction is often observed. In advanced form, an ulcer appears on the skin of the mammary gland. Swelling and redness of the mammary gland is also often observed. Because Cancer tumors metastasize, then swelling of the axillary lymph nodes is observed.

A cancerous tumor can be localized in different ways in the mammary gland. Both the right and left breasts are affected with equal frequency. Moreover, a node in the second breast can be either an independent tumor or a metastasis from the first tumor. Much less common is breast cancer that affects both breasts.

The naked eye may notice a small lump on the affected breast, similar to small cartilage, or a rather soft knot with a consistency similar to dough. Such formations, as a rule, have a round shape, clear or blurred boundaries, a smooth or knobby surface. Sometimes the tumors reach impressive sizes.

If at least one was found

of the above symptoms, you should immediately go to the hospital. Today, there are many methods for diagnosing a malignant breast tumor: ultrasound, biopsy, mammography, tumor markers, etc. But remember that half of women over 30 years of age have some changes in the mammary glands, and if you notice some lumps, then you should not panic prematurely, but simply visit a doctor immediately.

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BREAST CANCER

STRUCTURE OF THE BREAST

The mammary gland is located on the anterior surface of the chest from the 3rd to the 7th ribs. The mammary gland consists of lobules, ducts, adipose and connective tissue, blood and lymph vessels. Lymphatic vessels carry lymph, a clear liquid containing cells of the immune system. Inside the mammary glands there are lobules that produce milk after the baby is born and tubes connecting them to the nipple (ducts). Most of the lymphatic vessels of the mammary gland drain into the axillary lymph nodes. If tumor cells from the breast reach the axillary lymph nodes, they form a tumor in that area. In this case, there is a possibility of tumor cells spreading to other organs.

incidence of breast cancer.

Breast cancer is the most common type of malignant tumor in women and ranks second after lung tumors as a cause of cancer death. About 1 million women worldwide are diagnosed with breast cancer every year. Breast cancer is diagnosed every 2 minutes in the European Union; every 6 minutes one woman dies. It is also one of the best studied and, when detected early, best treatable forms of cancer. Breast cancer most often occurs between the ages of 55 and 65, however, there are regional and age differences, so breast cancer can also be found in much younger women.

WHY DOES BREAST CANCER OCCUR?

Although some risk factors are known to increase the likelihood of developing breast cancer, there is no precise information about what causes most types of breast cancer or how these factors turn normal cells into cancerous ones. Female hormones are known to sometimes stimulate the growth of breast cancer. However, how this happens has not yet been clarified.

Another challenge is understanding how certain DNA changes can turn normal breast cells into tumor cells. DNA is a chemical substance that carries information about the various activities of all cells. We usually look like our parents because they are the source of our DNA. However, DNA affects more than just our physical appearance.

Some genes (parts of DNA) control the processes of cell growth, division and death. Breast cancer, like most cancers, occurs as a result of the natural aging process of cells and is caused by accumulated damage to genes. Some genes promote cell division and are called oncogenes. Other genes slow down cell division or cause cell death and are called tumor-inhibiting genes. It is known that malignant tumors can be caused by mutations (changes) in DNA that trigger tumor development or disable genes that inhibit tumor growth.

The BRCA gene is a gene that inhibits tumor growth. When it mutates, it no longer inhibits tumor growth. This raises the risk of developing cancer. Some inherited DNA changes can cause a high risk of cancer in people.

RISK FACTORS FOR BREAST CANCER.

Risk factors increase your chance of getting cancer. However, having a risk factor or even several risk factors does not mean that cancer will occur. The risk of breast cancer can change over time due to, for example, changes in age or lifestyle.

Risk factors that cannot be changed:

Floor. Simply being a woman means having a major risk factor for breast cancer. Because women have significantly more breast cells than men, and possibly because their breast cells are affected by female growth hormones, breast cancer is much more common among women. Breast cancer is also possible in men, but this disease is observed 100 times less frequently than in women.

Age. The risk of breast cancer increases with age. About 18% of breast cancer cases are diagnosed in women aged 40-50 years, while 77% of breast cancer cases are diagnosed after 50 years of age.

Genetic risk factors. About 10% of breast cancer is inherited as a result of gene changes (mutations). The most common changes occur in the BRCA1 and BRCA2 genes. Normally, these genes help prevent cancer by producing proteins that prevent cells from becoming tumor cells. However, if you inherit the altered gene from one of your parents, then there is an increased risk of breast cancer.

Women with an inherited BRCA1 or BRCA2 mutation have a 35-85% chance of developing breast cancer during their lifetime. Women with these inherited mutations also have an increased risk of ovarian cancer.

Other genes have been identified that can lead to hereditary breast cancer. One of them is the ATM gene. This gene is responsible for repairing damaged DNA. In some families with a high incidence of breast cancer, mutations of this gene have been identified. Another gene, SNEC-2, also increases the risk of breast cancer if it is mutated.

Inherited mutations of the tumor suppression gene p53 can also increase the risk of developing breast cancer, as well as leukemia, brain tumors and various sarcomas.

Familial breast cancer. The risk of breast cancer is higher among women whose close (blood) relatives have had the disease.

The risk of developing breast cancer is increased if:

have one or more relatives with breast or ovarian cancer, breast cancer occurred before the age of 50 years in a relative (mother, sister, grandmother or aunt) on the father's or mother's side; the risk is higher if the mother or sister has had breast cancer, has a relative with breast or ovarian cancer, has one or more relatives with two breast and ovarian cancers or two different breast cancers, has a male relative (or relatives) with breast cancer, a family history of breast or ovarian cancer, a family history of diseases associated with hereditary breast cancer (Li-Fraumeni or Cowdens syndromes).

Having one immediate relative (mother, sister, or daughter) with breast cancer approximately doubles a woman's risk of breast cancer, while having two immediate relatives increases her risk by 5 times. Although the exact risk is unknown, women with a family history of breast cancer in a father or brother also have an increased risk of breast cancer. Thus, about 20-30% of women with breast cancer have a family member with the disease.

Personal history of breast cancer. A woman who develops cancer in one breast has a 3- to 4-fold increased risk of developing a new tumor in another gland or in another part of the same breast.

Race. White women develop breast cancer at slightly higher rates than African-American women. However, African American women are more likely to die from this cancer due to later diagnosis and advanced stages that are more difficult to treat. It is possible that African American women have more aggressive tumors. Women of Asian and Hispanic descent have a low risk of developing breast cancer.

Previous irradiation of the breast. If women were treated for another tumor at a younger age and received radiation therapy to the chest area, they have an increased risk of developing breast cancer. Younger patients have a higher risk. If radiation therapy was carried out in combination with chemotherapy, the risk is reduced, since it often leads to the cessation of ovarian hormone production.

Menstrual periods. Women who started menstruating early (before age 12) or who entered menopause late (after age 50) had a slightly increased risk of breast cancer.

Lifestyle factors and breast cancer risk:

No children. Childless women and women who have their first child after age 30 have a slightly higher risk of developing breast cancer.

COMPLAINTS

Breast cancer does not always appear as a lump in the breast in all women. It also happens that women who discover a mass in the breast consult a doctor only after many months. Unfortunately, during this time the disease could already progress.

The most common symptoms of breast cancer are pain And discomfort. There may also be other changes in the appearance and feel of your breasts.

Breast mass

The doctor will determine the properties of the formation:

size (measuring); location (clockwise direction and distance from the areola); consistency; connection with the skin, pectoral muscle or chest wall.

Skin changes

The following changes in the skin of the breast can be observed:

erythema; edema; recesses; nodules.

Nipple changes

Breast cancer can cause the following changes to the nipple:

retraction; color changes; erosion; discharge.

The lymph nodes

Breast cancer often spreads to nearby lymph nodes, so your doctor will examine the lymph nodes:

in the armpit; above the collarbone; under the collarbone.

Other

Other possible signs and symptoms:

pain or tenderness in the mammary glands (about 15% of cases); changes in breast shape or size; deepening, retraction or thickening of the skin; symptom of lemon peel, nipple retraction, rash or discharge.

SURVEY METHODS

Medical checkup

Gynecologists have extensive experience examining the mammary glands, so they are able to make the most accurate diagnosis. If the specialist does not have any suspicions, then you should not worry. Many doctors prefer to play it safe and may suggest further examination.

Blood analysis

In some types of breast cancer, a compound known as CA153 appears in the blood. The presence of such a “marker” in the bloodstream indicates breast cancer, but, unfortunately, its absence does not indicate the opposite, since in many types of cancer this substance is not produced. Therefore, a negative test result does not mean that breast cancer does not exist.

Mammography

Mammograms are most often done for screening purposes, but they can also be used if cancer is suspected. That's why they are called diagnostic mammograms. The study may show that there is no pathology, and the woman can continue routine examination using this method. Otherwise, a biopsy (removing a piece of tissue for microscopic examination) may be required. A biopsy may also be necessary in cases where mammography findings are negative, but a tumor formation in the mammary gland is detected. The only exception is when an ultrasound examination shows the presence of a cyst.

Ultrasound examination (ultrasound) of the mammary glands

This method helps to distinguish a cyst from a tumor formation.

Biopsy

The only way to prove breast cancer is a biopsy. There are several biopsy methods. In some cases, a very fine needle is used to obtain fluid or cells from the tumor mass. In other cases, thicker needles are used or part of the breast tissue is surgically removed.

A needle biopsy uses a thick needle to obtain a tissue sample from the site of the suspected tumor. To make the procedure painless, local anesthesia is given before it is performed.

If the diagnosis is still doubtful, it is necessary to perform an excisional biopsy, or in other words, a biopsy by excision. The advantage of this method is the ability to determine the size of the tumor and evaluate the features of the histological structure in more detail.

During aspiration cytology, a small amount of fluid is removed from a suspicious area using a needle and examined under a microscope to see if it contains cancer cells.

A frequently performed and relatively easy examination method is fine needle aspiration. This method is often used when a cyst is suspected rather than breast cancer. The cyst usually contains a greenish fluid and usually collapses after aspiration.

Chest X-ray

It is used to detect damage to lung tissue by a tumor process.

Bone scan

Allows you to identify their cancer. In this case, the patient receives very low doses of radiation. The detected lesions may not necessarily be cancer, but may be the result of an infection.

Computed tomography (CT) )

A special type of x-ray examination. With this method, multiple images are taken from different angles, which allows you to get a detailed picture of the internal organs. The study makes it possible to detect damage to the liver and other organs.

Magnetic resonance imaging (MRI)

Based on the use of radio waves and strong magnets instead of X-rays. This method is used to study the mammary glands, brain and spinal cord.

Positron emission tomography (PET))

This method uses a special form of glucose containing a radioactive substance. Cancer cells take up large amounts of this glucose, and a special detector then identifies these cells. A PET scan is performed when there is suspicion that the cancer has spread, but there is no evidence to examine the lymph nodes before they are removed.

Once breast cancer is detected, additional examination is carried out and a decision is made regarding therapy.

breast cancer treatment

There are several treatments for breast cancer. A conversation with a doctor after the examination will help you make the right decision regarding the treatment method. It is necessary to take into account the patient's age, general condition and tumor stage. Each treatment method has positive and negative sides. Side effects and complications may occur.

Local and systemic treatment

The goal of local treatment is to target the tumor without damaging other parts of the body. Surgery and radiation are examples of such treatments.

Systemic treatment involves giving anticancer drugs orally or intravenously to target cancer cells that may have spread beyond the breast. Chemotherapy, hormonal treatment and immunotherapy are among such treatments.

After surgery, when there are no obvious signs of a tumor, additional therapy may be prescribed. This is due to the fact that even in the early stages of breast cancer, tumor cells can spread throughout the body and eventually lead to the formation of lesions in other organs or bones. The goal of this therapy is to destroy invisible cancer cells.

Some women are given chemotherapy before surgery to shrink the tumor.

Operation

Most women with breast cancer undergo some type of surgery to treat the primary tumor. The goal of the operation is to remove the tumor as much as possible. Surgery may be combined with other treatments, such as chemotherapy, hormonal treatment, or radiation therapy.

The operation can also be performed to determine the spread of the process to the axillary lymph nodes, to restore the appearance of the mammary gland (reconstructive surgery), or to reduce the symptoms of intoxication in advanced cancer.

1. Do a self-examination.

2. Consult your doctor.

3. It is better to be on the safe side by doing a blood test as described above.

4. Ultrasound examination once a year is safe and reasonable.

5. A suspicious area detected during an ultrasound examination should be examined using mammography.

6. If cancer remains suspected after a mammogram, a needle biopsy, excisional biopsy, aspiration cytology, or fine needle aspiration should be performed.

Signs of breast cancer may not be noticeable in the initial stages. But, if a woman takes care of her health and visits a mammologist and gynecologist twice a year, then recognizing it and prescribing treatment will not be difficult. Breast cancer is the second most common cancer in the world. This is a very dangerous disease that can lead to the death of the patient.

In developed countries, the percentage of surviving people is quite high and amounts to 80%, which cannot be said about countries that are developing. The risk group includes women who are over 60 years old, childless, who gave birth after 30 years, and those who have a genetic predisposition to cancer.

It also occurs in men, but according to statistics, it affects 100 times more women. The problem is that the male half of society often does not even suspect that they have breast cancer, which is why the number of calls in late stages and advanced forms is higher. Timely diagnosis is very important, since the disease is characterized by the early appearance of metastases.

Symptoms of breast cancer

The first signs of breast cancer and the reasons for visiting a doctor are the discovery of any lumps or neoplasms in a woman’s breast. Only a specialist can understand the nature of such a compaction with the help of additional studies (for example, cancer is clearly visible during a mammogram).

In addition, the first external symptoms include:

1. Changes in the shape, size and appearance of the breast (usually one).
2. Changes in skin texture (redness, swelling). It often becomes like a lemon peel (wrinkled and dense).
3. The nipple sinks inward or changes location, a rash forms around it and purulent-bloody discharge is present.
4. Formation of ulcers around the nipple areola.
5. Pain in the affected mammary gland or between the shoulder blades (more disturbing at night and does not decrease with changes in body position).
6. Itching, peeling and variations in skin color (yellowing, bluishness, redness). The reason is the toxic substances produced by the malignant tumor. They destroy skin cells and impair blood microcirculation, thereby provoking the death of the outer layer of the epidermis.
7. Swelling of the shoulder and armpit.
8. Enlarged lymph nodes on the side of the affected breast.
9. Formation of dimples on the chest when a woman raises her arms up.

Internal symptoms of breast damage include the formation of a lump, which can be either painless or painful during palpation. Uncured mastopathy is a precursor to this symptom. The tumor can grow, sometimes very rapidly. The faster its size increases, the more malignant the tumor, and treatment will be more difficult.

The breasts also become larger in proportion to the growth of the tumor. Basically, it doubles over a period of time from 6 to 12 months.

Forms of breast cancer and their signs

Based on severity, breast cancer is divided into 4 stages:

• The first stage is the size of the neoplasm up to 2 cm. No external changes have appeared. There is still minor germination into neighboring tissues. Lymph nodes enlarge.
• Stage two – the tumor reaches 5 cm in size. Cancer affects the lymph nodes. The skin becomes wrinkled.
• The third stage – the tumor size is more than 5 cm. A “lemon peel” develops on the skin, and metastases appear. The tumor affects the muscular system. Swelling, ulcers, purulent discharge from the nipple and other signs appear.
• Stage four – metastases are found in any organ or part of the body, most often spreading to the bones of the skeleton.

Sometimes they also distinguish stage zero (non-invasive form) - the very first stage of the disease, the tumor has already formed, but there are no cancer cells outside it yet.

Zero, first and second stages are determined to be early; the survival rate with timely treatment is 70%. Cancer detected at the third and fourth stages requires a serious approach to treatment and the survival rate is significantly lower.

In addition to gradation by severity (stage), there are several other forms of cancer that differ in the signs and course of the disease:

1. Erysipelatous. It is characterized by sharp redness of the skin of the breast, the edges of the mammary gland become uneven, often protruding beyond the contours. There is an elevated body temperature. This form is dangerous because it can easily be mistaken for simple erysipelas and the wrong treatment can be prescribed.
2. Mastitis-like. Accounts for 7% of all cases of the disease. It differs from other forms in its rapid development. The mammary gland quickly enlarges, swelling is observed, and the skin becomes red. When palpated, the chest is hot. This type of cancer can develop with or without lumps. Seals often have a smooth, round shape. The symptoms are very similar to acute mastitis, which also often leads to misdiagnosis.
3. Paget's cancer. This form affects the nipple of the breast. It lasts a very long time, in some cases several years. It begins with slight irritation and peeling of the nipple, which may not cause any alarm to the patient. Then the symptoms become more obvious: itching and burning, pain and discharge from the nipple appear. They are often confused with eczema, but later the nipple loses its shape and a lump develops, which grows deeper, metastasizes to the lymph nodes and forms cancerous nodes in the mammary gland. Paget's cancer is also common among men, but the symptoms do not differ from those in women.
4. Armored. Affects the lymphatic system. A characteristic symptom is that the skin becomes lumpy and looks like a shell, which can spread to the entire chest. This is the most malignant type of cancer.
5. Ductal. Also called ductal carcinoma. It is dangerous because it does not manifest itself for a long time. A woman may not feel pain or other signs of cancer. Most often it is discovered by chance, during a routine ultrasound or mammogram. This is why an annual examination of a woman by a specialist is so necessary. Symptoms of this form become apparent already at the stage of metastasis. The woman feels pain in the spine and limbs, constant fatigue, irritability, and sometimes cramps. There is swelling in the armpits and fluid appears in the abdominal cavity. There are invasive and non-invasive forms of ductal carcinoma. A safer, non-invasive carcinoma that does not extend beyond the milk duct.

As noted earlier, the most dangerous manifestation of cancer is the formation of metastases. This significantly complicates treatment and reduces the survival rate of patients. Metastases spread throughout all organs and tissues of the human body, disrupting their functioning. They usually move first through the milk ducts and then through the lymphatic vessels. First, metastases affect the axillary, subscapular and subclavian zones, and then are localized in the bones (usually the pelvis) and internal organs (liver, lungs and uterus).

Signs of metastases vary depending on the location:

• Lungs (cough, shortness of breath, expectoration of sputum streaked with blood);
• Liver (nausea, yellowing of the skin, increase in its size);
• Musculoskeletal system (pain, aching bones, frequent fractures);
• Brain (severe headaches, mental disorders).

Timely diagnosis of cancer significantly increases the chances of recovery. At the first external signs or suspicions, you should immediately visit a doctor to avoid the terrible consequences of the disease. And don’t forget about a visit to a mammologist, especially if the woman is at risk.

Breast cancer (BC, breast cancer) is one of the most common malignant neoplasms in women. According to WHO, about a million new cases of tumor are registered in the world every year. Most often, patients have crossed the 40-year mark, however, this disease can also be diagnosed in young women. Rarely, but it is still possible for cancer of this location to occur in men, especially those with signs of gynecomastia (enlarged mammary glands) due to any hormonal disorders.

Almost every woman, one way or another, has encountered one or another change in the mammary gland. At a young age, dishormonal processes and benign tumors are the most common, and cancer accounts for no more than 5% of cases. During menopause and after its onset, the risk of developing cancer increases significantly, so the age category of patients with a tumor is 50-70 years.

The mammary gland, in addition to its main function - lactation during the period of breastfeeding children - is also important from the standpoint of the aesthetics and appearance of a woman, therefore any problems, and especially surgical interventions accompanied by the removal of an organ, bring considerable psychological discomfort. There are frequent cases of severe depression after radical breast surgery. To avoid such consequences, you need to be careful and attentive to your health, and regular medical examinations are extremely important for the timely detection of the disease.

Breast cancer is one of the most studied types of human tumors, and research into the mechanisms of its occurrence and ways to combat the disease continues to this day.

The first information about this insidious disease was discovered in ancient Egyptian papyri. Then the tumor was cauterized, but no one knew about metastasis, so the disease always ended in death. With the development of medicine came the awareness of the possibility of tumor spread through the lymphatic and circulatory systems, which was reflected in numerous observations. Removal of regional lymphatic collectors along with the tumor was a real breakthrough on the path to truly effective cancer treatment.

Today, science has invaluable knowledge in the field of causes, diagnosis and effective treatment of malignant tumors. However, despite the positive results of modern medicine, the frequency of advanced forms remains high (up to 40%). Such sad statistics are due to low awareness of the population about the first symptoms of the disease and methods of self-examination. Often women themselves ignore visiting a antenatal clinic or a mammologist, citing being busy, postponing the visit indefinitely, etc.

In many countries, including in the post-Soviet space, there are no adopted mandatory screening programs aimed at mass examination of a large number of people at risk (women over 40 years of age). Wide coverage of such a study as mammography would make it possible to diagnose significantly more early forms of breast tumors, and, accordingly, achieve better treatment results.

It is known that with early detection of a malignant neoplasm of the mammary gland, complete cure is possible in more than 95% of cases, and mortality is reduced by at least a third.

Why does cancer appear?

Any woman faced with the problem of breast cancer asks the question: why did the tumor arise in her? What were the reasons for this and was it possible to avoid the disease?

Today known and studied Risk factors that significantly contribute to the development of cancer:

• Genetic predisposition, unfavorable family history;
• Early onset of menstruation and late onset of menopause;
• Absence or late first birth;
• Benign lesions of the mammary gland parenchyma;
• Changes in metabolism and pathology of the endocrine system;
• Long-term use of hormone-containing drugs;
• The presence of mutations in the BRCA1 and BRCA2 genes.

It has long been noted that women whose mothers or grandmothers suffered from malignant breast tumors are much more likely to develop cancer, which made it possible to draw conclusions about availability family predisposition to the disease.

Since the mammary gland is a hormone-dependent organ, that is, it has receptors for female sex hormones, then any endocrine system disorders, in general, and the genital organs, in particular, contribute to pathology. Early onset and late termination of menstrual function, disturbances in the functioning of the hypothalamic-pituitary-ovarian system, abortions, early and multiple births or their absence, ovarian diseases contribute to hormonal changes that cause disruption of the processes of cell reproduction and hyperplasia of glandular tissue, which becomes the basis for the development of mastopathy .

In addition to dishormonal disorders, obesity, diabetes mellitus, arterial hypertension, and pathology of the thyroid gland and liver contribute to the appearance of a malignant breast tumor.

Among external causes that increase the risk of developing a malignant breast tumor, a special role is played by smoking, exposure to carcinogenic substances, contained in food and household chemicals, dietary errors with a predominance of fatty foods, as well as ionizing radiation.

Long taking hormonal drugs, prescribed to regulate the menstrual cycle, treat infertility, and also in postmenopausal women with endometrial pathology can also to some extent increase the likelihood of a tumor. However, in recent years this issue has been debated, and new data regarding modern medicines deny the presence of such a risk.

A special place among the causes of cancer of various localizations is given to genetic disorders. Advances in modern molecular genetics have made it possible to identify a number of genes whose mutations are most common in certain neoplasms. Such mechanisms of carcinogenesis have been very convincingly demonstrated in relation to breast tumors. It has been proven that carriers of the mutant BRCA1 and BRCA2 genes have a high likelihood of developing a tumor, while the BRCA1 gene is also associated with the risk of ovarian cancer. Thus, the breast cancer gene is known, and its detection is available in large clinics using modern equipment.

ratio of the number of breast cancer cases and identified hereditary factors

Examination of women at risk is the basis of oncogenetic counseling aimed at identifying a hereditary predisposition to malignant neoplasms of the mammary gland among close relatives of sick women, as well as among those whose mothers or grandmothers had a tumor. There are cases where women who were found to have the described mutations resorted to removal of the mammary glands in advance, without waiting for cancer to develop.

Pretumor processes in the mammary gland

The main place among precancerous changes in breast tissue is given to hyperplastic processes, combined into a group of mastopathy. Often this pathology is considered as a precancerous process.

signs of potentially precancerous breast changes

Mastopathy represents hyperplastic changes, accompanied by proliferation and an increase in the proportion of the glandular component in relation to the stromal component. In other words, the mass of glandular tissue in the form of lobules increases. At the same time, epithelial dysplasia is not uncommon, accompanied by impaired cell differentiation with the appearance of signs characteristic of malignant tumors. Mastopathy, or fibrocystic disease, is classified as a dishormonal disease that occurs when endocrine function is disrupted or pathology of the female genital organs. Frequent abortions, taking hormonal drugs, metabolic factors, in particular obesity, greatly contribute to this kind of changes. Young women are most susceptible to mastopathy, and according to various sources, signs of it can be found in more than half of the female population of the globe.

Fibrocystic disease characterized by pain, an increase in the volume of the mammary gland, and uneven compaction of the tissue. The process can be either diffuse or focal with the formation of nodes and cysts in limited areas of the organ. In all cases, morphological examination reveals areas of excessive proliferation of the epithelial component, an increase in the number of lobules and interlobular connective tissue, as well as dysplasia. Although mastopathy is a benign process, the presence of epithelial dysplasia makes it a dangerous condition with regard to the prospect of malignancy in its foci.

Timely diagnosis and treatment of hormonal changes that precede fibrocystic disease can significantly reduce the likelihood of cancer occurring in the future.

In addition to mastopathy, it is also possible to detect a benign breast tumor - papillomas or adenomas, consisting of epithelium lining the ducts or forming its lobules, as well as fibroadenoma, which has a mixed epithelial-connective tissue structure. Fibroadenoma often occurs in young girls in the form of a single dense node; in itself, it does not pose a danger if diagnosed and removed in a timely manner.

Types of malignant breast tumors

There are different approaches to the classification of malignant breast tumors, and the location, size, degree of differentiation and histological type of cancer, growth characteristics and the presence of receptors for the female sex hormones estrogens are of decisive importance in determining treatment tactics and prognosis.

According to the nature of tumor growth in the parenchyma, cancer can be:

1. Nodular - in the form of a limited node in the thickness of the gland;
2. Diffuse - organ tissue grows, does not have clear boundaries.

Atypical forms of growth are possible - Paget's cancer, primary metastatic cancer.

The size of the primary cancerous node often reflects the degree of its malignancy. The larger the tumor, the more aggressive it is and the worse its prognosis.

distribution of tumor locations

Localization determines the stages of metastasis along the lymphatic drainage pathways. The location of the tumor is characterized by the corresponding quadrant - a fragment of tissue obtained if the gland is schematically divided into four equal parts.

Histological types of breast cancer are distinguished depending on the source of growth:

• Ductal carcinoma arising from the epithelium of the milk ducts;
• Lobular cancer, the source of which is the glandular cells of the lobules.

Invasive breast cancer can be either lobular or ductal, and involves the tumor penetrating the basement membrane on which epithelial cells are located. This type of growth makes it more aggressive and prone to metastasis.

ductal carcinoma (left) and lobular carcinoma (right) - types of breast cancer from a histological point of view

Among the histological variants of malignant breast tumors the most common are adenocarcinoma (glandular cancer), solid cancer (undifferentiated variant) and transitional forms. This classification is complex and necessary for oncologists and mammologists.

Early cancer represents the initial stage of tumor development, when cells spread beyond the basement membrane, but not deeper than 3 mm. As a rule, this stage is not characterized by metastasis, since there are no vessels, and the prognosis is almost always quite favorable.

As for other malignant neoplasms, a classification of breast cancer has been developed according to the TNM system, which characterizes the characteristics of the primary tumor and metastases. Taking into account possible combinations of manifestations according to TNM There are four stages of breast cancer:

• Stage I – the tumor is no more than two centimeters in diameter, there is no growth into the surrounding tissue or metastases;
• Stage II (a, b) – tumor 2-5 cm, possible growth into the surrounding tissue and damage to regional lymph nodes;
• IIIa, IIIb – a tumor larger than five centimeters, growing into surrounding tissues, the presence of lymphatic metastases in the axillary lymph nodes and beyond;
• Stage IV – distant metastases are detected, regardless of the size of the primary tumor and lymph node involvement.

Metastasis

Metastasis is considered an integral component of almost all malignant tumors. Breast cancer is no exception. Lymphogenic metastases are detected in almost all cases, and this path of tumor spread occurs quite early. In later stages, it is possible to detect the spread of the tumor through the blood vessels.

The nature of the damage to specific groups of lymph nodes determines the stage of the disease, and also significantly affects the extent of the operation during subsequent surgical treatment. In this regard, regional (in the axillary, subscapular, sub- and supraclavicular, as well as parasternal lymph nodes located along the sternum) and distant metastasis (in the axillary and supraclavicular from the opposite side of the tumor, mediastinal and abdominal lymph nodes) are distinguished.

The localization of metastases also depends on the location of the malignant neoplasm in the parenchyma of the gland. So, when it is in the upper-outer quadrant, the axillary lymph nodes are among the first to be affected. Sometimes such metastases are detected earlier than the primary tumor itself, when it is small in size and lacks clinical manifestations.

The hematogenous spread of cancer is characteristic of later stages, when a malignant tumor grows into blood vessels. Cancer cells are carried through the bloodstream to various organs - brain, bones, liver, contralateral gland etc.

In some cases, metastases may manifest themselves many years after radical surgery. Thus, there are cases where brain damage from secondary tumor nodes occurred 10-15 years after effective treatment. In such a situation, imaginary well-being can end fatally in a fairly short time.

Manifestations of breast cancer

The manifestations of malignant breast tumors are not varied, however, the disease can go unnoticed by a woman for a long time. In cases where the tumor has not reached 2-3 cm, and the mammary gland contains a significant amount of adipose tissue, independent detection of cancer can be difficult.

As a rule, patients themselves turn to a specialist when they discover a lump or other changes in their breasts. Often, neoplasms are detected during medical examinations and even accidentally during consultations in connection with other diseases.

The most common symptoms of breast cancer:

1. Palpable nodular formation or diffuse enlargement of the gland, changes in its shape and consistency;
2. The appearance of ulcerations on the skin, in the areola or nipple;
3. Discharge from the nipple, often bloody in nature;
4. Discomfort in the armpit due to enlarged lymph nodes.

Clinical features of the course allow us to distinguish the following forms of cancer:

• Nodal;
• Diffuse (mastitis-like, armored cancer, etc.);
• Atypical variants (Paget's cancer).

The nodular variant is characterized by the growth of a formation in the form of a limited node, often of dense consistency and painless to the touch. As the size of the tumor increases, skin changes appear - wrinkling, thickening, possible retraction of the nipple, and breast deformation. Skin germination is accompanied by ulceration and the addition of secondary inflammation.

As the size of the tumor increases, the mobility of the mammary gland is also impaired. In advanced stages, when the cancer grows into the chest wall, the tumor becomes motionless.

To determine the location of cancer, as well as its connection with the skin, nipple, and chest wall, a thorough palpation examination of the mammary gland in different positions is necessary.

The diffuse form of breast cancer is represented by four main types:

1. Edema-infiltrative cancer;
2. Mastitis-like;
3. Erysipelatous;
4. Armor cancer.

Edema-infiltrative variant The course of breast cancer is more common among young women during pregnancy and lactation. This form is characterized by a significant increase in volume, swelling of the tissue, thickening of the gland, discoloration of the skin, and the appearance of the “lemon peel” symptom due to damage to the lymphatic vessels by cancer cells. As a rule, early metastasis is observed.

Mastitis-like cancer It is also more common among young women. Its manifestations in the initial stage are similar to the inflammatory process in the mammary gland - mastitis, so cases of delayed diagnosis are not uncommon. The clinical picture consists of an increase in body temperature, the appearance of signs of general intoxication against the background of changes in the organ in the form of an increase in size, the appearance of diffuse or focal compaction, swelling, pain, redness of the skin at the site of tumor growth. The malignant tumor progresses rapidly, and the appearance of metastases can be detected quite early. With this form of cancer, it is important to promptly suspect the possibility of malignant growth, especially in women who are breastfeeding and prone to mastitis.

some types of breast cancer

Erysipelas cancer, in addition to thickening of the breast tissue, it is manifested by peculiar skin changes similar to erysipelas. The skin over the affected area becomes hot to the touch, redness with uneven outlines appears, which can spread over a significant area, going beyond the gland. Possible increase in body temperature, ulceration of hyperemic areas, and secondary infection. It is very typical that cancer cells infect lymphatic vessels and metastasize to regional lymph nodes. Erroneous diagnosis with the prescription of anti-inflammatory and physiotherapeutic treatment for this form of cancer can lead not only to loss of time, but also provoke faster tumor growth.

Armored cancer received its name due to the characteristic appearance of the mammary gland for this form. A neoplasm growing from glandular tissue affects the skin and fatty tissue, and the mammary gland decreases in size and becomes deformed, the skin over it becomes dense and resembles a shell. The pathological process can spread to the chest wall or the second gland. The course of armored cancer is very unfavorable.

Paget's cancer is considered an atypical variant of a malignant breast tumor. affecting the nipple and areola. The source of the neoplasm is the ductal epithelium, from where neoplasia grows into the skin and spreads into the dermis. In the early stages, the tumor node is not detected, and damage to the nipple and areola comes to the fore. Characteristic signs are hyperkeratosis (excessive formation of horny masses) with the appearance of scales and peeling, redness and ulceration of the skin of the nipple and areola, and possible itching. As the tumor grows, the nipple becomes deformed and undergoes destruction. The clinical manifestations of this form of cancer are similar to eczema or psoriasis, which may be the reason for incorrect and delayed diagnosis.

Any changes in the mammary gland, even the most minor ones, should be a reason to consult a doctor, since the sooner the correct diagnosis is made, the more effective subsequent treatment will be.

Particular attention should be paid to young women and nursing mothers, in which malignant tumors grow very quickly and are prone to early metastasis. In elderly patients, cancer can develop for years without showing signs of spreading even to regional lymph nodes. Thus, the course of the disease depends on the woman’s age, the type of cancer, hereditary factors and the timeliness of the correct diagnosis.

Video: signs of breast cancer in the program “Live Healthy!”

Diagnostics

The possibilities of effectively combating the disease depend entirely on the stage at which the neoplasm is detected. Early diagnosis of breast cancer can be difficult, especially if a woman does not perform regular self-exams. However, examination of at least women at risk who have an unfavorable family history, hormonal imbalances, certain forms of precancerous processes in the mammary gland, and pathological changes in the uterus and ovaries can be effective. Also The risk group includes women over 35 years of age.

When visiting a doctor, a palpation examination of the breast will be carried out to determine the presence or absence of lumps or tumor nodes, the displacement of the gland in different positions of the patient, the presence of deformation, changes in the nipples, etc.

After the examination, in addition to general clinical examinations (general and biochemical tests of blood, urine, etc.), special diagnostic procedures will be prescribed to detect a tumor.

The main ways to detect breast cancer are:

• Mammography (x-ray method);
• Ultrasonography;
• Needle biopsy.

To further clarify the diagnosis, they can be used CT, MRI, lung radiography, bone scintigraphy, ultrasound of the abdominal organs, also allowing to identify the presence and localization of metastases.

Mammography refers to x-ray research methods and in a number of countries is a screening test for women over 40 years of age. This method is rightfully considered the “gold standard” in diagnosing breast cancer, and the reliability of the data obtained reaches 95%. Mammography is carried out using special devices - mammographs, which make it possible to detect fairly small tumors with minimal radiation exposure.

performing mammography

On mammograms, it is possible to detect a tumor-like formation in the gland tissue, changes in the skin, lymphatic and blood vessels, as well as areas of calcium salt deposits that occur quite early in the presence of a cancerous tumor. Calcifications can be considered one of the reliable indicators of the malignancy of the pathological process.

If necessary, mammography can be supplemented ductography with the introduction of a radiopaque substance into the lumens of the ducts.

Ultrasonic the study is also highly informative, especially in young women who are pregnant or breastfeeding. Since in young people the breast tissue contains more fluid and the breasts have greater density, ultrasound sometimes provides more information than mammography. In addition, this method is harmless, therefore it can be used, including pregnant women, and the information content for some forms of cancer reaches 100%.

In all cases of the presence of a tumor-like formation in the breast tissue, a puncture biopsy, and subsequently - cytological and histological examination of the obtained tissue. Sampling of tumor fragments under the control of ultrasound or mammography allows taking material strictly from the affected area, thereby eliminating possible diagnostic errors.

In large medical centers equipped with modern digital X-ray equipment, it is possible to perform a stereotactic biopsy, which allows sampling of material with almost 100% accuracy.

Histological examination fragments of tumor tissue allows not only to determine the specific type of cancer, but also the presence of receptors for sex hormones, which is very important in choosing further treatment tactics.

Research into specific proteins, enzymes, hormones, the number of which increases in certain malignant tumors, is becoming increasingly popular. This method allows you to suspect cancer even before it can be detected by other available methods.

To diagnose breast cancer, an analysis is performed for the tumor marker CA 15-3, a protein whose content in the blood increases when a tumor appears. It is also important to monitor changes in its level over time, since an increase in concentration can be a consequence not only of an increase in the size of a malignant tumor, but also a sign of the onset of metastasis.

The development of molecular genetics also makes available genetic studies of susceptibility to cancer, in particular, determination of carriage of mutations of the BRCA1 and BRCA2 genes. Some women, having received a positive result, resort to removing both mammary glands without waiting for cancer to develop, which can be a very effective tumor prevention in such cases.

Video: self-examination and palpation with a doctor for breast cancer

Features of breast cancer therapy

Treatment of breast cancer consists of a combination of surgery, chemotherapy, and radiation. The choice of specific tactics is always determined by the stage of the disease, the size of the tumor and the presence or absence of metastases. The best results are obtained by treating early forms of cancer.

Surgical method still remains the mainstay in the case of malignant breast tumors. The most common types of surgery are Halstead radical mastectomy, lumpectomy, and quadrant resection of the breast.

The most radical and at the same time the most traumatic is Halstead mastectomy, implying the removal of the gland itself with the tumor, pectoral muscles, fiber and lymph nodes. This type of treatment is used in advanced, severe cases, and a serious cosmetic defect requires subsequent correction using various plastic surgeries.

Lumpectomy– a modern and gentle method of treatment, applicable for tumors of the first and second stages. In this case, the tumor and surrounding tissue are removed within two centimeters, and the axillary lymph nodes are removed through a separate incision. This operation gives a good cosmetic result, allowing you to preserve at least part of the gland tissue. Lumpectomy requires high qualifications and precision surgical technique on the part of the surgeon.

Quadrant resection of the breast involves removing a quarter of the organ in which the small tumor is located, and through a separate incision of the lymph nodes. This operation is complemented by chemoradiotherapy due to the possibility of tumor recurrence and gives a fairly good result, sometimes not inferior in effectiveness to more radical and traumatic interventions.

Since removal of breast cancer is accompanied by a disturbance in the appearance of the organ, which brings significant psychological discomfort to the woman, in most cases plastic surgeons are involved in treatment, replacing the defect with the patient’s own tissue or artificial implants.

During surgical treatment, the primary focus of tumor growth is removed, but this does not protect against the possibility of neoplasia spreading beyond the localization of the tumor. Chemotherapy for breast cancer, it is aimed at destroying malignant cells that have left the organ and are a source of metastases in the future.

The most effective drugs are adriamycin, cyclophosphamide, methotrexate and others. This treatment, simply called “chemistry,” is quite toxic and requires maintenance therapy (hepatoprotectors, vitamins, antioxidant complexes).

Radiation therapy used to reduce the likelihood of tumor recurrence after its removal. In severe cases, when removal of the tumor is impossible, irradiation is intended to alleviate the suffering of patients (palliative treatment). If distant metastases cause serious damage (in the brain, for example), then they can also be subjected to radiotherapy.

In all cases, adequate pain relief and support for the function of other organs are necessary, especially in the presence of metastases and severe intoxication.

Nutrition for breast cancer does not have any significant features, however, in the postoperative period, difficult-to-digest and heavy foods should be avoided. At all stages of treatment, it is useful to consume vegetables, fruits, herbs, and cereals containing large amounts of vitamins, microelements and natural antioxidants.

Folk remedies are very popular, especially in cases where patients are trying to cling to at least some “straw” or do not trust traditional medicine and doctors. In order to treat breast cancer, infusions of walnuts, nettles, decoctions of burdock root, valerian and even fly agaric are used. It is worth remembering that only treatment by a doctor using modern methods of fighting cancer can be truly effective, and traditional medicine has the right to exist as a supplement. In all cases when you plan to use one or another herbal remedy, you must definitely discuss this issue with your doctor, so as not to cause even more harm by using them.

Life expectancy after treatment of malignant breast tumors depends on the stage at which the disease was detected. In early forms, up to 95% of patients survive with a relatively good prognosis. Neglected patients have only two to three years to live.

In some cases of successful cancer treatment, there may be such unfavorable consequences as the appearance of distant metastases many years after surgery. It is necessary to remember this and regularly visit a doctor to monitor the patient’s condition.

How to prevent cancer?

Women often wonder: is it possible to prevent breast cancer? Yes, it's possible. Moreover, the representatives of the fair sex also need their own efforts. Regular self-examination, which is available to everyone without exception, should be the norm for women who care about their health. After forty years, you should undergo a mammogram every year, and if any, even seemingly minor, changes appear, immediately consult a doctor.

Self-examination is a fairly effective way of personal prevention. To carry it out, it is necessary to examine the mammary glands in a mirror, paying attention to changes in shape, contours, skin color, the appearance of deformation, etc. In a lying position, in a circular motion, you can feel the entire thickness of the gland, studying its consistency and the homogeneity of the parenchyma. By lightly pressing on the nipple, you need to make sure that there is no discharge.

A healthy lifestyle, the absence of bad habits, properly selected underwear, timely childbirth and breastfeeding are those nonspecific factors that also help to avoid malignant breast tumors.

Separately, it is worth noting that in rare cases, breast cancer may also occur in men. especially those suffering from obesity and endocrine pathology, so any changes should alert you and be a reason for consultation with a specialist.

The question of the likelihood of mammary cancer in cats and dogs, which sometimes become practically members of the family, also worries their owners. It is known that among all tumors in pets, cancer of this location ranks third, most often affecting cats. Animal owners, if they suspect such a disease, can contact veterinarians who will offer, among other things, surgical treatment methods to save the life of their furry pets.

Video: treatment and prevention of breast cancer