Breast cancer. Causes, symptoms, diagnosis and treatment of the disease. Early diagnosis of breast cancer Methods for early diagnosis of breast cancer

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

Statistics say that this disease is one of the most common causes of female mortality. Among the regions where there is a fairly high incidence are Moscow, St. Petersburg, the Chechen Republic and the Kaliningrad region.

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

Causes and conditions of development

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

More often, pathology occurs in patients with the following concomitant conditions:

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

To reduce the likelihood of illness, you should avoid certain external factors, for example:

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

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

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

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

Pathology is also registered in men; their ratio to sick women is 1:100. Their symptoms, diagnosis and treatment principles are the same as for female patients, adjusted for gender characteristics of hormonal levels and anatomical structure.

Preventive actions

Prevention of breast cancer is necessary both in healthy women and in those who have a unilateral tumor, to prevent metastasis and spread to the second breast.

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

However, before surgery for preventive purposes, it is recommended to consult a geneticist, who will confirm the increased risk of developing the disease, given the presence of mutated BRCA1 and BRCA2 genes in the woman.

Surgical removal may be offered to patients with certain precancerous signs:

• atypical ductal hyperplasia;
• atypical lobular hyperplasia;
• lobular carcinoma in situ (unspread).

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

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

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

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

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

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

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

For secondary prevention, you should regularly undergo a medical examination with a therapist and gynecologist.

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

Classification

Stages of breast cancer

Depending on how the tumor grows, diffuse and nodular forms of the tumor, as well as atypical cancer (). The rate is characterized by a rapidly growing cancer (the total mass of tumor cells doubles in 3 months), a tumor with an average growth rate (the mass doubles within a year) and a slowly growing tumor (the tumor doubles in size within more than a year) .

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

Based on their cellular structure, adenocarcinoma, squamous cell carcinoma and sarcoma are distinguished. Malignancy also varies depending on the type of cells.

TNM classification

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

• Stage 0 disease

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

• Stage 1 disease

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

• Breast cancer stage 2 (stages)

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

• Breast cancer stage 3 (stages)

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

• Breast cancer stage 4 with metastases

Characterized by the spread of tumor cells to the following organs:

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

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

External signs and symptoms

Types of breast cancer (more precisely, forms):

• nodal;
• diffuse;
• atypical.

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

• swelling and swelling of the gland;
• resembles in features;
• similar to erysipelas;
• causes compaction and reduction of the gland (armored form).

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

• nipple damage;
• tumor arising from skin appendages;
• two-way education;
• a tumor growing from several centers at once.

Suspicion of breast cancer should appear when a small, dense, painless node forms in the breast. You should pay attention to areas of skin wrinkling or nipple retraction. At the onset of the disease, enlarged axillary lymph nodes are often visible. With intraductal forms, discharge from the nipple appears - light, yellowish, sometimes mixed with blood.

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

Symptoms for individual types of breast cancer are characterized by their own characteristics.

• Edematous-infiltrative is accompanied by the formation of a large infiltrate - edematous compacted tissue. The gland enlarges significantly, turns red, swells, the skin becomes marbled in color, and a “lemon peel” appears.
• The mastitis-like form is manifested by enlargement and thickening of the gland. An infection occurs, causing tissue breakdown. The temperature rises.
• The erysipelas-like form, upon external examination, is similar to inflammation caused by microflora (erysipelas): bright red lesions on the surface of the gland spreading to the surface of the chest, skin ulcers are often observed.
• Armored is an advanced stage of cancer, in which the gland shrinks, changes shape, and several nodules form in it.
• Paget's cancer is identified as a special variant that primarily damages the nipple and the area around it.

Do breasts hurt with breast cancer?

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

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

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

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

How quickly does breast cancer develop?

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

Diagnostics

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

If a breast tumor is suspected, certain diagnostic interventions must be performed before starting any treatment.

Diagnosis of breast cancer includes the following steps:

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

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

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

Breast cancer treatment

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

Breast cancer treatment methods:

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

Treatment without surgery

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

Radical methods involve complete removal of the tumor and affected lymph nodes. Palliatives are designed to alleviate the patient’s condition. Symptomatic treatment relieves pain and reduces the severity of intoxication symptoms. Traditional recipes for this disease are ineffective.

Surgical intervention

Surgery for breast cancer is the basis of treatment.

The following operations can be performed:

• ordinary radical mastectomy - the entire gland, pectoral muscle, lymph nodes under the collarbone, armpit, under the scapula are removed;
• extended radical mastectomy – additionally, peri-sternal lymph nodes and thoracic vessels, through which metastasis can occur, are removed;
• superradical mastectomy – supraclavicular lymph nodes and tissue between the chest organs are additionally removed;
• modified radical mastectomy preserves the pectoral muscles and has better cosmetic results, so it is considered a more gentle operation;
• mastectomy with removal of axillary lymph nodes of only the lower group - performed in the early phase of the disease with the tumor located in the outer parts of the gland in weakened elderly patients;
• simple mastectomy is a palliative operation that involves removing only the gland; such an operation to remove a tumor is carried out in advanced forms of the disease, decaying formation, severe concomitant diseases;
• radical – removal of only a segment of the gland for a small tumor at an early stage; the mammary gland is preserved; After the intervention, an increased risk of recurrence remains, so additional radiation is performed.

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

Chemotherapy

Breast cancer is a tumor prone to metastasis, so almost all patients are prescribed antitumor drugs. The use of chemotherapy significantly reduces the likelihood of relapse and death in patients. Chemotherapy drugs can reduce the stage of the disease, eliminate heavy operations or reduce their volume.

The best medications for treating breast cancer are:

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

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

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

Systemic therapy is sometimes not given to patients with an initial favorable prognosis - over 35 years of age, with a small tumor, sensitive to hormones and without lymph node involvement.

Breast cancer is a common cancer among women. The success of treatment and the patient’s life expectancy depend on timely detection of the disease. The symptoms, stages of development, methods of diagnosis and treatment of breast cancer are described below.

The mammary glands consist of lobules, or glands, channels for transporting milk to the nipples, fat, connective tissue, blood and lymphatic vessels.

Breast cancer is a lesion of the breast by malignant neoplasms that replace glandular tissue. Most often, carcinoma is detected that develops in the lobules or ducts, but besides this, there are about 20 other types of malignant breast tumors.

The incidence of the disease is high among women over the age of 40, and the maximum number of cancer cases is observed in the period 60-65 years.

Cancer cells have an abnormal structure and a high rate of division due to the rapid metabolism in them. Appearing in the breast tissue, as the disease progresses, they penetrate into nearby lymph nodes, and in the later stages they also affect distant tissues, including bones and internal organs.

In addition, the life cycle of malignant cells is shorter than healthy ones, and their decay causes general intoxication of the body.

Doctors see the main cause of breast cancer in. More often, the disease develops in women when the production of hormones changes dramatically. At the same time, less progesterone and estrogen are produced, which affects the condition of the mammary glands.

Not only a deficiency, but also an excess of female sex hormones is considered unfavorable; for example, the risk of developing breast cancer is increased in nulliparous women after 30 years of age and as a result of abortions. Pregnancy, childbirth and breastfeeding, on the contrary, significantly reduce the likelihood of malignant cells appearing in the mammary gland.

Stages of breast cancer, symptoms

The International Classification of Breast Cancer Stages identifies four stages of disease development.

Stage 1

The pathological focus does not exceed 2 cm in diameter, and the cancer has not yet affected adjacent tissues and lymph nodes. There are no metastases, breast fat and skin are not affected.

Upon palpation, a painless small lump is felt - this is the only sign of breast cancer at an early stage.

Stage 2

The tumor reaches from 2 to 5 cm and does not grow into adjacent tissues. The second stage is divided into two categories:

• IIb – the neoplasm increases in size;
• IIa – penetration of cancer cells into the axillary lymph nodes.

Symptoms of stage 2a breast cancer include wrinkled areas of the breast and decreased elasticity of the skin over the tumor. After the skin is compressed in this area, the wrinkles do not straighten out for a long time.

No more than two metastases may be detected in the affected gland; a symptom of umbilification often appears - retraction of the nipple or skin at the site of the tumor.

Stage 3

The diameter of the neoplasm exceeds 5 cm, it can affect the subcutaneous fat layer and dermis. Symptoms of stage 3 breast cancer: the skin resembles a lemon peel, it is retracted over the tumor, often swollen, if there are metastases, then no more than two.

Stage 4

The pathology affects the entire mammary gland, and ulcers appear on the skin of the breast. Metastases are multiple and spread to other organs and tissues, primarily affecting the lymph nodes located under the shoulder blades, in the armpits and collarbones.

Distant spread of metastases affects the skin and soft tissues, from internal organs - lungs, ovaries, liver, from bones - femoral and pelvic.

Symptoms and signs of breast cancer by stage

For breast cancer, symptoms and signs can be divided into four groups:

1. The appearance of compactions;
2. Changes in the skin of the breast;
3. Discharge from juices;
4. Enlarged lymph nodes.

At the first stage When the size is small, the cancer does not actively manifest itself. It can be detected accidentally when a dense nodule is felt in the mammary gland. If the tumor is malignant, in most cases it is painless to the touch, and the presence of pain during palpation most often indicates a benign tumor (mastitis, mastopathy).

The cancerous node is very dense, with an uneven surface (lumpy), immobile or moves slightly when exposed, often attached to the skin or surrounding tissues, fixed. Large lumps appear at stages 2-4 of breast cancer (from 3 to 10 cm).

Attention! There are forms of breast cancer in which the mammary gland is painful to the touch - these are erysipelas and pseudo-inflammatory forms of a diffuse tumor. They are characterized by rapid growth, the absence of individual dense nodes, redness of the skin of the chest, and increased body temperature.

With a malignant formation on the chest, skin retraction, folds, wrinkles, and localized swelling appear in the area above the tumor. With further development of cancer, small non-healing ulcers appear on the skin, nipple or areola area, which then merge, bleed, and suppuration develops (last stage).

The next symptom of breast cancer in women is nipple discharge. Depending on the form and stage of the disease, they may be cloudy or transparent, whitish or yellowish, and contain impurities of pus or blood.

The nipple is hardened and looks swollen. Any discharge from the mammary gland, especially outside of pregnancy and breastfeeding, should be regarded as a warning sign and a reason to be examined by a mammologist.

Starting from stage 2 cancer cells penetrate into the nearest lymph nodes, which leads to an increase in the latter. If the tumor affects only one mammary gland, then this symptom is observed on one side.

A clear sign of metastatic damage to the lymph nodes is their large size, density, drainage, and most often they are painless. In this case, the armpit area may swell, and in the later stages the arm may also swell due to poor drainage of lymph and blood (lymphostasis).

Diagnosis of breast cancer

Basic methods for diagnosing breast cancer:

• taking a mammogram;
• blood test for the presence of tumor markers (in women under 30 years of age);
• Ultrasound of the mammary glands;
• biopsy (taking a piece of tissue for examination).

The following methods allow us to assess the patient’s general condition and the level of prevalence of cancer cells in the body:

• blood tests - general and biochemical (to determine the level of formed elements, ESR, cholesterol, amylase, liver tests, glucose, total protein, creatinine);
• CT scan;
• urine examination to exclude genitourinary pathology;
• Ultrasound of internal organs;
• X-ray of bones and chest.

When determining the course of the disease, doctors use the TNM system; in conclusion, they put a number next to each letter:

• T indicates tumor size (0 to 4);
• N – degree of lymph node damage (from 0 to 3);
• M – presence or absence of distant metastasis (0 or 1).

Self-examination

Since breast cancer does not manifest itself in the initial stages of development, regular self-diagnosis is of great importance. It should be carried out on days 5-7 of the monthly cycle, in good lighting, in front of a large mirror, completely removing clothes to the waist.

The mammary glands should be examined with both arms raised and lowered, paying attention to their size, skin condition, color, and symmetry. After this, you need to carefully feel the breast - any tissue compactions (both nodular, focal, and diffuse, affecting evenly the entire gland) should alert you.

The self-exam also checks for discharge from the nipples by pressing on them. At the end of the examination, palpation of the axillary, supra- and subclavian lymph nodes is carried out - with cancer they are smooth, dense, enlarged, and often painless.

Treatment for breast cancer is aimed at completely destroying malignant cells. At a later stage, if complete recovery is not possible, symptomatic therapy is prescribed, for example, taking powerful painkillers to alleviate the condition. Treatment includes several areas, which are most often combined with each other.

Radiation therapy

The goal of this method is to stop the aggressive development of the tumor and its growth for surgical intervention. It is considered as a preparatory stage before surgery and is carried out after removal of the tumor.

Radiation therapy is also indicated if surgery is not possible, for example, if there are metastases in the brain.

Hormone therapy

It is used if receptors sensitive to progesterone and estrogen are detected in laboratory tests in cancer cells. Analogs or antagonists of sex steroids are used to treat breast cancer.

In some cases, in addition to hormone therapy, the ovaries are removed, since they produce hormones that provoke tumor growth.

Targeted therapy

It is also called sighting. Cancer cells are able to protect themselves from the effects of radiation, chemotherapy and hormone therapy by releasing special substances (EGFR factor). This is a definite obstacle to a quick cure.

For immunocorrection, that is, reducing the response of malignant cells to medications, the drug Herceptin (Trastuzumab) is used. These are purified monoclonal antibodies specific for the protective factor of cancer cells.

The use of targeted therapy requires special equipment and highly qualified personnel in the clinic.

Chemotherapy

This method involves the administration of medications, is prescribed taking into account the patient’s characteristics and is indicated if:

• The diameter of the neoplasm is more than 2 cm;
• Tumor cells are poorly differentiated;
• The woman is of childbearing age;
• Cancer cells do not have receptors sensitive to progesterone and estrogen.

For chemotherapy for breast cancer, cytostatics are used - antitumor agents that have a detrimental effect on cancer cells. Examples of drugs are Cyclophosphamide, Adriablastin, Mitoxantrone, Doxorubicin, Fluorouracil.

In oncology, there are three types of such treatment:

1. Adjuvant (preventive, additional) therapy is indicated if the tumor is operable, and is used before and/or after surgery. It prepares the tumor for surgical removal.
2. Therapeutic is prescribed for a generalized form of cancer, that is, for metastatic lesions of other tissues and organs. This method is aimed at destroying or reducing metastases to a minimum.
3. The induction type of chemotherapy is indicated if the tumor is inoperable and its size needs to be reduced to the size that is possible for surgery.

Cytostatics have a number of side effects, which are the negative side of their use. During chemotherapy, some healthy cells inevitably die along with cancer cells.

Side symptoms may include:

• dyspnea;
• nausea and vomiting, diarrhea;
• yellowish coloration of mucous membranes, skin pigmentation;
• dizziness, fog;
• decreased visual acuity;
• hematuria (urine mixed with blood);
• arrhythmia, pronounced palpitations;
• hair loss;
• itching, allergic skin rashes.

These problems are temporary and go away after rehabilitation treatment. Before chemotherapy, a detailed consultation is carried out and the woman is thoroughly prepared for the procedures.

Surgical treatment of breast cancer

An operation to completely remove the mammary gland is called a mastectomy and is indicated starting from stage 3. Regional lymph nodes are also removed along with the breast. After surgery for breast cancer, radiation therapy is prescribed, as well as additional examination of the preserved lymph nodes and nearby tissues.

In the absence of contraindications, it is possible to perform plastic surgery to reconstruct it simultaneously with breast removal.

Complications after mastectomy:

• bleeding from the wound;
• temporary restriction of mobility of the shoulder joint;
• swelling of the arm and chest.

At stages 1 and 2 of breast cancer, surgery is often limited to organ-preserving intervention, that is, removal of only the tumor focus while preserving the breast. In any case, psychological support from loved ones and specialists is important for a woman.

Prognosis and life expectancy

In oncology, the indicator of treatment success is 5-year survival. After breast cancer treatment, slightly more than half of all patients cross this threshold. This is a conditional border, since having overcome it, many women live for many more years.

Life expectancy is influenced by the shape of the cancer tumor, the degree of its aggressiveness (speed of growth), as well as the stage at which treatment began.

The worst prognosis for life is for the diffuse type of neoplasm and stage 4 breast cancer - none of those affected survive 5 years.

With stage 2 breast cancer, life expectancy, or rather achieving a five-year, or more often ten-year, survival rate is about 80%. Moreover, more than half of this number of women will live 20 years or more.

The chances are higher with the effective selection and combination of several therapy methods. If stage 3 cancer is detected, then life expectancy of 5 or more years reaches from 40 to 60% of women, depending on the substage (3A, 3B).

Breast cancer has a tendency to reappear, in most cases this occurs in the first two years after treatment.

Prevention

Effective prevention of breast cancer includes the following measures:

• Attentive attitude to the state of the endocrine system - correction of hormonal levels, taking oral contraceptives;
• Pregnancy and childbirth;
• Absence of abortions, and therefore effective contraception;
• Prevention and timely treatment of benign breast tumors - fibroadenoma;
• Regular mammography examinations – 1-2 times a year;
• Giving up bad habits, healthy eating, active lifestyle, good sleep.

How breast cancer is diagnosed and what treatment medicine currently offers us will be discussed in this article.

Initial examination by a doctor

Initially, the doctor collects a detailed medical history from the woman. Then the doctor performs an external examination of the mammary glands. This manipulation takes place in a well-lit office. The doctor begins to examine the mammary gland, while the woman stands straight with her hands down, and then the doctor repeats the examination, only the woman is already standing with her hands raised up.

During the procedure, the doctor evaluates the external characteristics of the mammary glands, examines the condition of the skin, nipples (areolas), and symmetry.

An examination may reveal:

• changes in the skin (hyperemia),
• edema,
• modification of nipples,
• not symmetrical mammary glands.

Next, the doctor proceeds to such manipulation as palpation of the mammary glands. To accurately determine the presence of possible pathological formations, the doctor carefully palpates the mammary gland without missing a single area. The procedure may reveal:

• approximate sizes of neoplasms - usually noted up to 1.2 cm, from 2 to 5 cm and more than 5 cm;
• form of neoplasm - locally widespread, nodular, locally infiltrative, and others;
• consistency - lumpy, dense, densely elastic;
• localization location - outer squares, central, inner squares.

The doctor must palpate the lymph nodes in the axillary and subclavian regions. This allows:

• establish the absence of seals (or presence);
• increase in nodes;
• presence (absence) of lymph node compactions;
• location;
• whether there is swelling of the upper extremities or not.

If during the examination the doctor finds even the slightest lump, then other diagnostic methods are prescribed.

Diagnostic methods

Mammography

Mammography is one of the most commonly used technologies nowadays and is popular among women. The study is carried out on certain days of the menstrual cycle. In other words, this is an X-ray of the mammary glands, with which breast cancer can be identified by such signs as:

• compaction (local) of breast tissue - on an x-ray this is shown as a shadow of a node;
• deformation of the pattern (irregular edges - lumpy, rays, etc.);
• accumulation of micro-calcifications;
• size (from 0.5 mm and below).

A tumor is well diagnosed in this study when the size of the tumor is from 2 to 5 centimeters. The study establishes a suspicion of breast cancer, but a biopsy is necessary to make an accurate diagnosis. Mammography shows indirect signs of the development of breast cancer (primary signs), as well as mastopathy.

• in one breast the tumor is invasive, and in the other breast it is pre-invasive;
• lobular (or intraductal) structure of the tumor in both mammary glands;
• there are structures of a pre-invasive nature around the tumor;
• lymph nodes are not damaged;
• the degree of malignancy in both mammary glands is different.

Mammography

Breast biopsy

Biopsy has several types:

• Puncture - this material is taken for cytological examination using a syringe. This type of diagnosis makes it possible to accurately diagnose by 87%
• Trephine biopsy - this diagnosis helps to obtain tumor cells using a special needle (trephine). Then the cells are sent for histological examination.
• Excision - this procedure involves complete excision of the tumor along with the surrounding tissue. Allows you to examine the edges (borders) of cut tissue for the presence of pathological cells.
• Stereotactic - carried out under the control of mammography equipment to accurately take pathological material.

Breast biopsy

Analysis of gene expression levels

The analysis allows you to assess the likelihood of relapse. The study is carried out to determine the purpose of chemotherapy.

Ductography, galactography and breast tomography

Ductography- X-ray examination, which is carried out using a contrast agent, which is injected through a special needle through the nipple.

Galactography- the same principle, only different in that this diagnosis allows you to accurately determine the location. Helps distinguish between an inflammatory process and a dystrophic process from a tumor.

Tomography- layer-by-layer incision of all parts of the mammary gland. Helps accurately identify all pathological processes of even the smallest sizes.

Ultrasound diagnostics of the breast

The study does not have a negative impact on the female body as a whole. Ultrasound makes it possible to determine:

• degree of germination of pathological cells,
• length,
• structure of the neoplasm,
• whether adjacent tissues are affected.

The presence of fluid in the neoplasm also appears.

Ultrasound cannot show an accurate result without additional diagnostic methods to make an accurate diagnosis.

Other methods can be used to diagnose breast cancer:

• physical examination;
• screening examinations.

Indications for ultrasound

Breast cancer treatment

Treatment for breast cancer includes methods such as:

• surgical,
• chemotherapy,
• drug.

In turn, the medicinal method is divided into:

• for neoadjuvant treatment, which is prescribed before surgical treatment to reduce tumor volume;
• for adjuvant treatment, which is prescribed immediately after surgery to prevent relapse.

Surgical treatment

It is considered one of the most effective methods of treating breast cancer. It may consist of either partial removal of the affected area of ​​the mammary gland or complete removal of the mammary gland.

Lumpectomy

Lumpectomy is a method of surgical intervention that is used in the presence of a small tumor (within an area of ​​4 cm). During the operation, the affected area and healthy tissue adjacent to the tumor are directly removed. After surgery, further treatment is prescribed, which may consist of chemotherapy and radiation. All this is used to prevent the re-development of the tumor.

If there is damage to the lymph nodes, they are completely removed. But, if the cancer is non-invasive, then the lymph nodes are preserved whenever possible. Since after removal of lymph nodes, complications very often occur in the form of severe swelling of the upper limb, severe limitation of arm movement, and pain. To accurately determine whether the lymph nodes are affected or not, a biopsy is performed during the operation.

Examination of the removed tissue is mandatory. For this purpose, histological examination is used.

Sectoral resection

Sectoral resection is a surgical intervention that is performed when the tumor is up to 2 cm in size and does not spread to other organs (beyond the breast). To do this, an incision is made through which the tumor is removed and then an intradermal suture is applied.

Central resection

Central resection is a surgical intervention that is used for multiple lesions of intraductal papillomas. The operation is performed by making an incision that passes through the milk ducts (all), cutting out both the affected area and the healthy one 3 cm from the tumor. After the operation, the woman will no longer be able to feed the child.

Nipple resection. This manipulation is prescribed to determine cancer of the nipple (areola). The procedure also affects the milk ducts, which leads to the absence of lactation.

Oncoplastic resection

Oncoplastic resection - this operation is no different in principle from lumpectomy. The only difference is that after the tumor is removed, breast surgery is performed to restore the shape of the breast. To do this, a second healthy breast is often operated on to restore symmetry and the same shape. After surgery, radiation therapy is subsequently prescribed to prevent relapse.

Mastectomy

Mastectomy is an operation that involves the complete removal of the mammary gland, but the lymph nodes are not removed. The operation is prescribed for women who are diagnosed with large non-invasive breast cancer or a hereditary factor for breast cancer. After surgery, plastic surgery can be used to restore the breast.

Radical mastectomy

Radical mastectomy - the operation involves the complete removal of the breast, fatty tissue and partially (or completely) adjacent muscles. Surgery is prescribed when there are many metastases in the lymph nodes, the tumor grows into tissues and muscles. This method allows you to completely remove the tumor and prevent the development of metastases. After surgery, chemotherapy and radiation therapy are required.

Palliactive mastectomy

Palliactive mastectomy is an operation usually performed in the later stages of cancer to make a woman’s life easier. The tumor is not completely removed, but only part of it is removed. After this operation, drugs are prescribed.

Chemotherapy

The method involves the use of drugs that help destroy cancer cells. Medicines are prescribed only individually for each woman. The drugs are very toxic and allergens, so they almost always cause nausea, vomiting, and can affect the functioning of the heart, liver, and kidneys.

Antiallergic drugs are prescribed simultaneously with treatment.

Treatment is carried out by drip infusion, which takes place only within the walls of a medical institution under the supervision of medical personnel.

As a rule, 5-8 courses of drips are prescribed. But there are often cases when the course cannot be completed due to severe drug intolerance.

Radiation therapy (radiotherapy)

Allows you to get rid of cancer in the early stages. If this method is prescribed in later stages of cancer, it helps to improve and prolong a woman’s life.

Irradiation is carried out according to indications:

• the tumor itself;
• The lymph nodes;
• muscles in the area of ​​the tumor.

Thus, radiation therapy is of two types:

1. contact,
2. remote.

With the help of radiation therapy, it is possible to destroy the smallest lesions that may remain after the main tumor is removed.

Indications:

• with a high risk of relapse (after surgery);
• with complex therapy;
• in the presence of multiple tumors;
• in the presence of metastases;
• in case of damage to pathological tissue of the lymphatic system, muscles, blood vessels;
• with damage to the nipples, areolas, and pectoralis major muscles.

Varieties:

I often use radio waves with a linear accelerator in practice.

Brachytherapy for the early development of cancer, with the wave directed directly to the affected area. A very important fact is that healthy cells are not harmed.

IMRI - allows you to adjust the intensity of the wave. At the same time, it has virtually no effect on the heart and lungs.

UCHO - this therapy is prescribed after surgery. 5 sessions are enough. Both internal and external irradiation are used.

Side effects:

• pain in the radiation zone;
• muscle stiffness;
• edema;
• possible lymphostasis;
• affecting (destructing) healthy tissue;
• darkening of the skin in the area affected by rays;
• the skin may lose elasticity and become wrinkled;
• weakness, dizziness;
• hair loss;
• weight loss;
• nausea, vomiting;
• in the CBC, leukocyte and platelet counts decrease;
• decreased hearing and vision.

Systemic treatment

Systemic treatment is a complex of drugs that affect both the tumor itself and directly the entire body. Such treatment may include chemotherapy, hormonal therapy, and immunotherapy.

Hormone receptor status

Hormone receptor status is the most important factor determining the treatment regimen for breast cancer. Hormonal therapy is prescribed after surgery to prevent relapses. For example:

• Aromatase inhibitors are prescribed to postmenausal women.
• Gonadodiberin analogues have a property that inhibits the normal functioning of the ovaries.
• Tamoxifen blocks estrogen hormone receptors.

Targeted Therapy

Medicines in combination with chemotherapy. This treatment inhibits the growth of cancer cells and leads to an increase in life expectancy. The disadvantages of this technique are that some options for this therapy have not been fully studied. But there are also positive aspects. The types of techniques are very diverse and this makes it possible to choose individual treatment.

Preclinical trials

• Protein tyrosine phosphatase 1B (PTP1B) - protein tested. The drug is able to inhibit tyrosine phosphatase 1B, which slows down the development of cancer growth.
• Cholesterol blockers - for example, the drug PRIMA-1 - affect cholesterol and suppress cholesterol production.
• Antihyperglycemic drugs - this is how Metformin is mainly tested
• Thermotherapy is a technique that has not yet been used to treat cancer. For now it is only used in America.
• Flax seeds - A study on rats showed that flax helps slow tumor growth and metastases.

Immunotherapy

Immunity plays a huge role in both the treatment and prevention of cancer. So, for the treatment of breast cancer, such drugs are included in the cancer treatment complex.

Do not forget that in the modern world anti-cancer vaccines are used.

In the treatment of breast cancer they use:

• Herceptin,
• Neuvenge vaccine,
• RESAN vaccine,
• Tykerb.

Chemoimmunotherapy

The method involves treating cancer using one's own immunity. Many medications in combination can not only boost immunity, but also inhibit the development of cancer cells.

Drugs for the treatment of mammary gland mastopathy in women

Breast cancer (BC) ranks first among cancer diseases in terms of prevalence. It affects every year 1 million 600 thousand women in the world and over 66 thousand in the Russian Federation.

In the next 20 years, an almost twofold increase in the incidence of breast cancer in women is predicted in all countries, which is explained by increased life expectancy and improved diagnostic methods.

In recent years, due to earlier detection of tumors, mortality from breast cancer in women has been decreasing. In developed countries where mammography screening of the population is used, this figure has decreased by 30–50%.

Biological subtypes of breast cancer

Breast cancer is not a uniform disease. When treating, clinicians take into account whether the tumor belongs to a specific subtype. Genetic testing and immunohistochemical methods can reliably determine the biological subtypes of breast cancer. These subtypes themselves include many risk factors and predictive signs, which allows you to select the most effective therapy for the patient.

The pathogenetic diversity of breast cancer, proven using molecular genetic analysis and immunohistochemical studies, allows for individualized treatment.

Increased survival from breast cancer is associated not only with the widespread implementation of mammography screening, but also with the adequate use of systemic treatments.

Diagnosis of breast cancer

To identify malignant breast tumors, there is a certain diagnostic algorithm, and its primary element is mammographic screening. The sensitivity of this diagnostic method for tumors from 2 mm to 5 mm is about 85%. Mammographic examination is performed in two projections.

Young women with a dense breast structure need to include ultrasound and MRI in their surveillance program.

Magnetic resonance imaging

Since traditional mammography screening in women under 40 years of age is ineffective, screening may require an alternative technique - MRI. Modern contrast magnetic resonance imaging is a highly sensitive method for diagnosing breast diseases.

MRI diagnosis of breast cancer

Hereditary risk factors for breast cancer

Only 5–10% of breast cancer cases are caused by inherited mutant BRCA genes. But at the same time, among mutation carriers, the risk of developing the disease can reach 80%.

The younger the age of diagnosis of primary breast cancer, the higher the likelihood of developing contralateral cancer, i.e. opposite mammary gland.

1. “Formation”, compaction, node, infiltrate, tumor, “ball” - you found something similar to this. This is not yet a reason to decide that you have breast cancer, but a reason to see a specialist.
2. Deformation of the contour of the breast, areola or nipple (skin retraction or, conversely, bulging)
3. Nipple retraction; especially if it appeared recently
4. Discharge of blood from the nipple
5. Swelling of the skin of the entire breast or its local area
6. The appearance of irritation, wet “sores”, ulcers, crusts on the nipple or areola
7. Ulcerations (long lasting, for no apparent reason) on the skin of the chest
8. Discomfort in the armpit and detection of lymph nodes (“balls”) in the armpit
9. Change in skin color of the breast - redness, increased skin temperature in this area.

All these symptoms can be manifestations of various diseases (there are several dozen of them), perhaps not of a malignant nature. However, this can only be decided by a breast specialist.

Signs and symptoms of breast cancer

Stages of the disease

Stage 0
This is the stage when the primary tumor is not identified or cannot be assessed, and also in the case of non-invasive breast cancer (which means the tumor does not extend beyond its appearance, so-called in situ cancer).

Stage 1
Cancer cells at this stage invade or grow into neighboring tissues. The tumor node is no more than 2 cm, the lymph nodes are not affected at this stage.

Stage 2
At this stage, the tumor node exceeds 2 cm and can reach up to 5 cm. At this stage, lymph nodes may be affected, but the damage to the lymph nodes is single, they are not fused to each other and are located on the same side as the tumor. In case of lymph node involvement, the tumor size may be less than 2 cm.

Stage 3
Invasive cancer, more than 5 cm or with obvious and significant involvement of the lymph nodes. In this case, the lymph nodes can be fused together.

Stage 4
At this stage, the tumor has grown into the breast skin, chest wall, or internal chest lymph nodes. It can be of any size.

Stage 4 breast cancer is inflammatory cancer; it occurs in up to 10% of all cases. Symptoms of the inflammatory form of breast cancer are redness of the skin, the gland becomes warm, and there is an enlargement and/or hardening of part or all of the breast. The skin takes on the appearance of an orange peel. This form of cancer must be differentiated from inflammation of the mammary gland - mastitis.

Also, at stage 4, the tumor can spread beyond the chest, into the axillary region, and internal mammary lymph nodes. Metastases to the supraclavicular lymph nodes, as well as to the lungs, liver, bones or brain are possible.

What breast cancer looks like in different stages:

Breast cancer treatment methods

Surgery

Surgery is the main method of treatment for breast tumors, and the outcome of the disease largely depends on the quality of its implementation. According to some Indian states that do not offer surgical treatment for religious reasons, the incidence rates are almost equal to the mortality rates. Typically, the mortality rate from breast cancer is two to four times lower than the incidence rate.

Radical mastectomy

However, surgical treatment is most often followed by radiation. Local treatment without postoperative radiotherapy often leads to local-regional recurrence of the disease. The fact is that after completion of the surgical operation it is impossible to exclude the existence of hidden distant metastases. Even in patients with tumors less than 1 cm in diameter, recurrence of the disease is possible in 10% of cases.

Localization of distant metastases in breast cancer

Organ-preserving operations

Nowadays, there is a worldwide trend towards reducing the volume of surgical intervention without loss of effectiveness. Surgical and radiation treatment of breast cancer is developing and improving in the direction of organ preservation.

Thanks to the introduction of mammography screening, the number of patients with an early stage of the disease, when the lymph nodes are not affected by metastases, has sharply increased. In this case, the “classical” removal of all levels of lymph nodes would be an unnecessary mutilating procedure. The method of biopsy of sentinel lymph nodes came to the aid of surgeons.

Since metastases in the axillary lymph nodes appear sequentially from the first to the second, then to the third level, it is enough to determine the presence of metastases in the first lymph node. It was called “sentinel”: if the sentinel lymph node does not contain metastases, then other lymph nodes are also not metastatic.

Thanks to this organ-preserving method, thousands of patients have avoided unnecessary complete surgical dissection; removal of the cancerous tumor did not lead to breast removal.

The latest results of clinical trials, including with the participation of the Oncology Research Institute named after. N.N. Petrov, confirmed the safety of avoiding complete axillary dissection. Sentinel lymph node biopsy is gradually replacing axillary dissection as the standard procedure for staging breast cancer.

The concept of sentinel node biopsy is becoming increasingly accepted and has been introduced into the surgical treatment standards of the European Organization for Research and Treatment of Cancer (EORTC) for many tumor sites.

Chemotherapy

Chemotherapy, along with surgery, is one of the main methods of cancer therapy. Postoperative chemotherapy improves the results of surgical treatment, as well as the prognosis of the disease.

Previously, the decision to prescribe chemotherapy was based on two factors:

• stage of the disease
• condition of regional lymph nodes.

Thanks to numerous studies by scientists, ideas about the biology of breast cancer are changing, and the choice of chemotherapy regimens is significantly expanding. And today, chemotherapy treatment is prescribed even in the absence of metastases in the lymph nodes, if small tumors have aggressive biological characteristics.

Luminal A cancer
For luminal A cancer, chemotherapy is avoided, especially with negative lymph nodes, and endocrine therapy alone is used.

Luminal To cancer
Luminal B tumors are characterized by high aggressiveness. In this case, chemotherapy will most often be prescribed, and the choice of treatment is based on an assessment of the risk of relapse.

HER2-positive breast cancer
Treatment of HER2-positive breast cancer is based on the use of standard chemotherapy regimens - trastuzumab and chemotherapy based on anthracyclines and taxanes. However, only a small percentage of patients benefit from treatment, but all are susceptible to associated toxicity.

Triple negative breast cancer
Triple-negative breast cancer is usually associated with a poor prognosis. Due to the rare occurrence of specific types of breast cancer, there is insufficient data on the role of adjuvant chemotherapy.

Chemotherapy for breast cancer in very young women
Breast cancer at a young age usually has an aggressive course, and hormone-resistant and HER2-positive tumors are often found with different properties than in older women. For such patients under 35 years of age, adjuvant chemotherapy is almost always the necessary treatment.

Chemotherapy for elderly patients
In elderly patients (over 65 years of age), when deciding whether to prescribe adjuvant chemotherapy, the general condition of the body and the presence of concomitant chronic diseases must be taken into account.

Ideally, older patients should undergo geriatric evaluation to determine their suitability for adjuvant treatment. The potential effect of treatment must be balanced against the risks to the body that chemotherapy carries. The physician determines the most effective, yet safest, specific regimen based on the tumor subtype and individual patient characteristics.

Hormone therapy
Young women with hormone-positive breast cancer remain at risk of disease recurrence for at least 15 years after the initial disease. Oncologists must determine which patients require long-term adjuvant therapy with tamoxifen or aromatase inhibitors.

Neoadjuvant (preoperative) therapy
Neoadjuvant therapy plays a leading role in the treatment of women with inoperable breast cancer, and is also important for operable tumors when breast-conserving surgery is performed.

Effect of neoadjuvant treatment BEFORE (left) and AFTER (right)

Radiation therapy

After surgery, it plays an important role in the treatment of breast cancer and the prognosis of the disease. At the National Medical Research Center of Oncology named after. N.N. Petrov conducted a study of the role of radiation therapy after organ-conserving operations (sectoral resection with axillary lymphadenectomy) in patients with minimal breast cancer.

An analysis of ten-year relapse-free survival proved a higher effectiveness of treatment in the group of patients where postoperative radiation therapy was used.

Breast cancer prevention strategies

• Chemoprophylaxis
• Preventive surgical interventions
• Lifestyle correction

Using medications to reduce the risk of disease is called chemoprophylaxis. The currently approved drugs for the prevention of breast cancer are tamoxifen and raloxifene.

Tamoxifen can be used by both premenopausal and postmenopausal women. Taking tamoxifen leads to a 38% reduction in the risk of breast cancer over a period of more than 10 years. The most common adverse events while taking the drug are hot flashes.

Clinical trials are currently investigating the role of another class of drugs, aromatase inhibitors, to evaluate the risk-reducing effects of breast cancer, which are currently used only for the treatment of breast cancer. Preliminary results are promising. Aromatase inhibitors only work in women with nonfunctioning ovaries.

Preventive surgery to remove the mammary glands is carried out only in one case - if a woman is a carrier of mutations in the BRCA1 and BRCA2 genes, known as "". World practice has proven that when tissue from both mammary glands is removed, the risks of breast cancer are reduced by more than 90%. Such operations are performed in clinics in the USA and Israel. In Europe, the approach to this issue is more conservative.

At the National Medical Research Center of Oncology named after. N.N. Petrov, during surgical treatment, women with BRCA1 mutations are offered prophylactic removal and reconstruction of the mammary gland.

An active lifestyle is beneficial and should be encouraged among breast cancer survivors. Experts from such world communities as the American Cancer Society and the American College of Sports Medicine came to this consensus in their research. In addition to regular physical activity, experts recommend that women maintain a consistent weight and limit their alcohol intake to reduce their risk of breast cancer.

Video: Breast Cancer Questions and Answers

Breast cancer (carcinoma)– the most common malignant tumor of the mammary glands.

The disease is characterized by high prevalence. In developed countries it occurs in 10% of women. European countries are leading. The lowest prevalence of breast cancer is observed in Japan.

Some epidemiological data on breast cancer:

• most cases of the disease are registered after the age of 45 years;
• after 65 years, the risk of developing breast carcinoma increases by 5.8 times, and compared with a young age (up to 30 years) it increases by 150 times;
• most often the lesion is localized in the upper outer part of the mammary gland, closer to the armpit;
• 99% of all patients with breast carcinoma are women, 1% are men;
• Isolated cases of the disease in children have been described;
• the mortality rate for this neoplasm is 19–25% of all other malignant tumors;
• Today, breast cancer is one of the most common tumors in women.
  Currently, there is an increase in incidence throughout the world. At the same time, in a number of developed countries there are downward trends due to well-organized screening (mass examination of women) and early detection.

Causes of breast cancer

There are a large number of factors contributing to the development of breast carcinoma. But almost all of them are associated with two types of disorders: increased activity of female sex hormones (estrogens) or genetic disorders.

Factors that increase the risk of developing breast cancer:

• female;
• unfavorable heredity (presence of cases of the disease in close relatives);
• the onset of menstruation before 12 years or their end after 55 years, their presence for more than 40 years (this indicates increased estrogen activity);
• absence of pregnancy or its occurrence for the first time after 35 years;
• malignant tumors in other organs (uterus, ovaries, salivary glands);
• various mutations in genes;
• the effect of ionizing radiation (radiation): radiation therapy for various diseases, living in an area with increased background radiation, frequent fluorography for tuberculosis, occupational hazards, etc.;
• other diseases of the mammary glands: benign tumors, nodular forms of mastopathy;
• the effect of carcinogens (chemicals that can provoke malignant tumors), some viruses (these aspects are still poorly studied);
• tall woman;
• low physical activity;
• alcohol abuse, smoking;
• hormonal therapy in large doses and for a long time;
• constant use of hormonal contraceptives;

Different factors increase the risk of developing breast carcinoma to varying degrees. For example, if a woman is tall and overweight, this does not mean that her likelihood of getting the disease greatly increases. The overall risk is formed by summing up various reasons.

Typically, malignant tumors of the mammary glands are heterogeneous. They are made up of different types of cells that multiply at different rates and respond differently to treatment. Because of this, it is often difficult to predict how the disease will develop. Sometimes all the symptoms grow rapidly, and sometimes the tumor grows slowly, without leading to noticeable disorders for a long time.

First signs of breast cancer

Like other malignant tumors, breast cancer is very difficult to detect at an early stage. For a long time the disease is not accompanied by any symptoms. Its signs are often discovered by accident.

Symptoms that require immediate medical attention:

• pain in the mammary gland that has no apparent cause and persists for a long time;
• feeling of discomfort for a long time;
• lumps in the mammary gland;
• changes in the shape and size of the breast, swelling, deformation, the appearance of asymmetry;
• deformation of the nipple: most often it becomes retracted;
• discharge from the nipple: bloody or yellow;
• changes in the skin in a certain place: it becomes retracted, begins to peel or wrinkle, its color changes;
• a dimple, a depression that appears on the mammary gland if you raise your hand up;
• enlarged lymph nodes in the armpit, above or below the collarbone;
• swelling in the shoulder, in the area of ​​the mammary gland.

Measures for early detection of breast cancer:

• Regular self-examination. A woman should be able to properly examine her breasts and identify the first signs of a malignant neoplasm.
• Regular visits to the doctor. It is necessary to be examined by a mammologist (a specialist in the field of breast diseases) at least once a year.
• Women over 40 years of age are recommended to undergo regular mammography, an X-ray examination aimed at early detection of breast cancer.

How to properly examine your breasts yourself?

A breast self-examination takes about 30 minutes. It needs to be done 1 – 2 times a month. Sometimes pathological changes are not immediately felt, so it is advisable to keep a diary and note in it the data and your feelings based on the results of each self-examination.

Examination of the mammary glands should be carried out on days 5–7 of the menstrual cycle, preferably on the same days.

Visual inspection

This should be done in a warm, bright room with a mirror. Undress to the waist and stand exactly in front of the mirror so that you can clearly see your breasts. Relax and even out your breathing. Please note the following points:

• Are the right and left mammary glands located symmetrically?
• Is one mammary gland enlarged compared to the other (it is worth remembering that normally the sizes of the right and left mammary glands may differ slightly)?
• Does the skin look normal, are there any suspicious areas with a changed appearance?
• Do your nipples look normal?
• Have you noticed anything else suspicious?

Feeling

Feeling the breast can be done in a standing or lying position, whichever is more convenient. If possible, it is better to do this in two positions. The examination is carried out with your fingertips. The pressure on the breasts should not be too strong: it should be enough so that changes in the consistency of the mammary glands can be felt.

First, one mammary gland is felt, then the second. Start from the nipple, then move your fingers outward. For convenience, you can palpate in front of a mirror, conditionally dividing the mammary gland into 4 parts.

Points to pay attention to:

General consistency of the mammary glands - has it become denser since the last examination?

• the presence of compactions, nodes in the gland tissue;
• presence of changes, seals in the nipple;

The condition of the lymph nodes in the axillary region - are they enlarged?

If changes are detected, you must contact one of the specialists:
Self-examination can detect not only breast cancer, but also benign neoplasms and mastopathy. If you find something suspicious, this does not mean the presence of a malignant tumor. An accurate diagnosis can only be established after examination.

For the purpose of early diagnosis of breast cancer, women over 40 years of age are recommended to undergo three studies annually:

• Mammography – X-ray images of the breast. Identify existing compactions in the tissue. The modern method is digital mammography.
• Determination of the level of female sex hormones - estrogens. If it is high, there is an increased risk of developing breast cancer.
• Tumor marker CA 15-3 is a substance produced by breast carcinoma cells.

Symptoms and appearance of different forms of breast cancer

Nodular form of breast cancer	A painless, dense formation is felt in the thickness of the mammary gland. It can be round or irregular in shape and grows evenly in different directions. The tumor is fused with the surrounding tissues, so when a woman raises her arms, a depression forms on the mammary gland in the corresponding place. The skin in the area of ​​the tumor wrinkles. In later stages, its surface begins to resemble lemon peel, and ulcers appear on it. Over time, the tumor causes the mammary gland to increase in size. The lymph nodes are enlarged: cervical, axillary, supraclavicular and subclavian. What does nodular breast cancer look like?
Edema-infiltrative form	This form of breast cancer most often occurs in young women. Pain sensations are most often absent or mild. There is a compaction that occupies almost the entire volume of the mammary gland. Symptoms: breast lump; redness of the skin with jagged edges; increased skin temperature of the breast; no nodes are detected during palpation. What does erysipelas-like breast cancer look like?
Armored cancer	The tumor grows through all glandular tissue and fatty tissue. Sometimes the process goes to the opposite side, to the second mammary gland. Symptoms: reduction in size of the mammary gland; limited mobility of the affected mammary gland; thickened skin over the lesion with an uneven surface. What does armored breast cancer look like?
Paget's cancer	A special form of breast cancer, occurs in 3–5% of cases. Symptoms: crusts in the nipple area; redness; erosions – superficial skin defects; weeping nipple; the appearance of shallow bleeding ulcers; nipple deformation; Over time, the nipple is completely destroyed, and a tumor appears in the thickness of the mammary gland; Paget's cancer is accompanied by metastases to the lymph nodes only in late stages, so the prognosis for this form of the disease is relatively favorable. What does Paget's cancer look like?

Breast cancer grades

The degrees of breast cancer are determined according to the generally accepted TNM system, in which each letter has a designation:

• T – state of the primary tumor;
• M – metastases to other organs;
• N – metastases to regional lymph nodes.

Degree of tumor process	Main characteristics
Tx	The doctor does not have enough data to assess the condition of the tumor.
T0	No tumor was detected in the mammary gland.
T 1	A tumor having a diameter of no more than 2 cm in its greatest dimension.
T 2	Tumor having a diameter of 2 to 5 cm in greatest dimension
T 3	Tumor larger than 5 cm.
T 4	A tumor growing into the chest wall or skin.
N
Nx	The doctor does not have enough information to assess the condition of the lymph nodes.
N 0	There are no signs indicating the spread of the process to the lymph nodes.
N 1	Metastases in axillary lymph nodes, in one or more. In this case, the lymph nodes are not fused to the skin and are easily displaced.
N 2	Metastases in the axillary lymph nodes. In this case, the nodes are fused to each other or to surrounding tissues and are difficult to move.
N 3	Metastases in parasternal lymph nodes on the losing side.
M
M x	The doctor does not have data that would help judge tumor metastases in other organs.
M0	There are no signs of metastases in other organs.
M 1	Presence of distant metastases.

Of course, only a doctor can classify a tumor to one stage or another according to the TNM classification after an examination. Further treatment tactics will depend on this.

Classification depending on the location of the tumor:

• breast skin;
• nipple and areola (skin around the nipple);
• upper inner quadrant of the mammary gland;
• lower inner quadrant of the mammary gland;
• upper outer quadrant of the mammary gland;
• lower outer quadrant of the mammary gland;
• posterior axillary part of the mammary gland;
• the location of the tumor cannot be determined.

Diagnosis of breast cancer

Inspection

Diagnosis of malignant breast tumors begins with an examination by an oncologist or mammologist.

During the examination, the doctor:

• will question the woman in detail, try to obtain the most complete information about the course of the disease, the factors that could contribute to its occurrence;
• will examine and palpate (feel) the mammary glands in a lying position, standing with arms lowered and raised.

Instrumental diagnostic methods

Diagnostic method	Description		How is it carried out?
Mammography– diagnostic section that deals with non-invasive(without cuts or punctures) by examining the internal structure of the mammary gland.
X-ray mammography	X-ray examination of the breast is carried out using devices that generate low-intensity radiation. Today, mammography is considered the main method for early diagnosis of malignant breast tumors. Has an accuracy of 92%. In European countries, X-ray mammography is routinely performed on all women over 45 years of age. In Russia it is mandatory for women over 40 years of age, but in practice not everyone has it. X-ray mammography best detects tumors measuring 2–5 cm. An indirect sign of a malignant neoplasm is a large number of calcifications - accumulations of calcium salts, which contrast well in photographs. If they are found to be more than 15 per cm 2, then this is a reason for further examination.		The study is carried out in the same way as conventional radiography. The woman is naked to the waist, leans against a special table, places the mammary gland on it, after which a photograph is taken. X-ray mammography machines must meet the requirements set by WHO. Types of X-ray mammography: film– use a special cassette with film on which the image is recorded; digital– the image is recorded on the computer, and can later be printed or transferred to any medium.
MRI mammography	MRI mammography is the examination of the mammary glands using magnetic resonance imaging. Advantages of MRI mammography over X-ray tomography: there is no x-ray radiation, which negatively affects tissues and is a mutagen; the opportunity to study metabolism in breast tissue, conduct spectroscopy affected tissues. Disadvantages of magnetic resonance imaging as a method for diagnosing malignant neoplasms of the mammary glands: high price; lower efficiency compared to X-ray tomography, inability to detect calcifications in the gland tissue.		Before the examination, you must remove all metal objects from yourself. You cannot take any electronics, as the magnetic field generated by the device can damage them. If the patient has any metal implants (pacemaker, prosthetic joints, etc.), you need to warn the doctor - this is a contraindication for the study. The patient is placed in the apparatus in a horizontal position. She must remain stationary throughout the entire study. The time is determined by the doctor. The result of the study is digital images that show pathological changes.
Ultrasound mammography	Ultrasound examination is currently an additional method for diagnosing malignant neoplasms of the mammary glands, although it has a number of advantages over radiography. For example, it allows you to take pictures in different projections and does not have a harmful effect on the body. Main indications for the use of ultrasound diagnostics for breast cancer: observation over time after the tumor was detected during X-ray mammography; the need to distinguish a cyst filled with fluid from dense formations; diagnosis of breast diseases in young women; control during biopsy; the need for diagnosis during pregnancy and lactation.		The technique is no different from conventional ultrasound. The doctor uses a special sensor that is applied to the mammary gland. The image is broadcast on the monitor and can be recorded or printed. During an ultrasound examination of the mammary glands, Doppler sonography and duplex scanning can be performed.
Computed tomomammography	The study is a computed tomography scan of the mammary glands. Advantages of computed tomomammography over x-ray mammography: the ability to obtain images with layer-by-layer sections of tissue; the possibility of clearer detailing of soft tissue structures. Disadvantages of computed tomomammography: The study does not reveal small structures and calcifications worse than X-ray mammography.		The study is carried out in the same way as a regular computed tomography. The patient is placed on a special table inside the device. She must remain motionless throughout the entire study.
Biopsy– excision of a fragment of breast tissue followed by examination under a microscope.
Needle biopsy	The accuracy of the method is 80 – 85%. In 20–25% of cases, a false result is obtained.	A fragment of breast tissue for examination is obtained using a syringe or a special aspiration gun. The procedure is performed under local anesthesia. Depending on the thickness of the needle, there are two types of puncture biopsy: fine needle; thick needle. The procedure is often performed under ultrasound or x-ray mammography guidance.
Trephine biopsy	Trephine biopsy of the mammary glands is performed in cases where it is necessary to obtain more material for research. The doctor receives a piece of breast tissue in the form of a column.	Trephine biopsy is performed using a special instrument consisting of a cannula with a mandrel into which a rod with a cutter is inserted. The intervention is performed under local anesthesia. The surgeon makes an incision in the skin and inserts a trephine biopsy instrument through it. When the tip of the incisor reaches the tumor, it is pulled out of the cannula. Using a cannula, a column of tissue is cut and removed. After receiving the material, the wound is carefully coagulated to prevent the spread of cancer cells. During research in the laboratory, it is possible to determine the sensitivity of tumor cells to steroid hormones (which include estrogens). This helps with further choice of treatment tactics.
Excisional biopsy	Excision is the complete removal of the tumor and surrounding tissues. The entire mass is sent to the laboratory for research. This makes it possible to detect tumor cells at the cut border and study the sensitivity of the tumor to sex hormones.	The surgeon removes the tumor and surrounding tissue during surgery. Thus, excisional biopsy is both a therapeutic and diagnostic procedure.
Stereotactic biopsy	During a stereotactic biopsy, samples are taken from several different locations through a single needle.	The procedure is similar to a regular needle biopsy. It is always carried out under the control of x-ray mammography. The needle is inserted into a certain place, a sample is obtained, then it is pulled, the angle of inclination is changed and it is inserted again, this time in a different place. Multiple samples are obtained, which makes the diagnosis more accurate.

Laboratory methods for diagnosing breast cancer

Study	Description	Methodology
Determination of tumor marker CA 15-3 in the blood (syn.: carbohydrate antigen 15-3, carbohydrate Antigen 15-3, cancer Antigen 15-3)	Tumor markers are various substances that are detected in the blood during malignant neoplasms. Different tumors are characterized by their own tumor markers. CA 15-3 is an antigen located on the surface of the mammary gland ducts and secreting cells. Its content in the blood is increased in 10% of women with early stages of breast cancer and in 70% of women with tumors accompanied by metastases. Indications for the study: diagnosis of cancer recurrence; monitoring the effectiveness of treatment; the need to distinguish a malignant tumor from a benign one; assessment of the spread of the tumor process: the higher the tumor marker content in the blood, the more tumor cells are present in the patient’s body.	For the study, blood is taken from a vein. You must not smoke for half an hour before the test.
Cytological examination of nipple discharge	If a woman has discharge from the nipple, it can be sent for laboratory testing. When examined under a microscope, tumor cells may be detected. You can also make an imprint of the crusts that form on the nipple	When examining nipple discharge under a microscope, cells characteristic of a malignant tumor are revealed.

Breast cancer treatment

Breast cancer treatment methods:

• surgical;
• chemotherapy;
• hormone therapy;
• immunotherapy;
• radiation therapy.

Combination treatment using two or more methods is usually carried out.

Surgery

Surgery is the main treatment for breast cancer. Currently, oncologist surgeons are trying to perform less voluminous interventions, to preserve breast tissue as much as possible, supplementing surgical methods with radiation and drug therapy.

Types of surgical interventions for breast cancer:

• Radical mastectomy: complete removal of the mammary gland along with fatty tissue and nearby lymph nodes. This type of operation is the most radical.
• Radical resection: removal of a sector of the mammary gland along with subcutaneous fatty tissue and lymph nodes. Currently, surgeons increasingly prefer this particular surgical option, since radical mastectomy practically does not prolong the life of patients compared to resection. The intervention must be supplemented with radiation therapy and chemotherapy.
• Quadrantectomy– removal of the tumor itself and surrounding tissues within a radius of 2–3 cm, as well as nearby lymph nodes. This surgery can only be performed in the early stages of the tumor. The excised tumor is necessarily sent for a biopsy.
• Lumpectomy– the smallest operation in terms of volume, during which the tumor and lymph nodes are removed separately. The surgical study was developed during the National Breast Surgical Supplementation Project (NSABBP, USA) studies. The conditions for the intervention are the same as for quadrantectomy.

The extent of surgical intervention is chosen by the doctor depending on the size, stage, type and location of the tumor.

Radiation therapy

Types of radiation therapy depending on timing:

Name	Description
Preoperative	Intensive short-term courses of radiation are carried out. Goals of preoperative radiotherapy for breast cancer: Maximum destruction of malignant cells along the periphery of the tumor in order to prevent relapses. Transfer of a tumor from an inoperable state to an operable one.
Postoperative	The main goal of radiation therapy in the postoperative period is to prevent tumor recurrence. Sites that are irradiated during postoperative radiation therapy: the tumor itself; lymph nodes that could not be removed during surgery; regional lymph nodes for the purpose of prevention.
Intraoperative	Radiation therapy can be used directly during surgery if the surgeon tries to preserve as much breast tissue as possible. This is advisable at the stage of the tumor: T 1-2; N 0-1; M0.
Independent	Indications for the use of gamma therapy without surgery: inability to remove the tumor surgically; contraindications to surgery; patient's refusal to undergo surgery.
Interstitial	The radiation source is brought directly to the tumor. Interstitial radiation therapy is used in combination with external beam therapy (when the source is located at a distance) mainly for nodular forms of cancer. Purpose of the method: deliver as high a dose of radiation as possible to the tumor in order to destroy it as much as possible.

Areas that may be exposed to radiation:

• the tumor itself;
• lymph nodes located in the axillary region;
• lymph nodes located above and below the collarbone;
• lymph nodes located in the sternum area.

Chemotherapy

Chemotherapy– drug treatment of breast cancer, which uses cytostatics. These drugs destroy cancer cells and suppress their proliferation.

Cytostatics are drugs that have numerous side effects. Therefore, they are always prescribed strictly in accordance with established regulations and taking into account the characteristics of the disease.

The main cytostatics used for malignant tumors of the mammary glands:

• adriblastine;
• methotrexate;
• 5-fluorouracil;
• paclitaxel;
• cyclophosphamide;
• docetaxel;
• xeloda.

Combinations of drugs that are usually prescribed for malignant tumors of the mammary glands:

• CMF (Cyclophosphamide, Fluorouracil, Methotrexate);
• CAF (Cyclophosphamide, Fluorouracil, Adriablastin);
• FAC (Fluorouracil, Cyclophosphamide, Adriablastin).

Hormone therapy

The main goal of hormonal therapy is to eliminate the influence of female sex hormones (estrogens) on the tumor. The techniques are used only in the case of tumors that are sensitive to hormones.

Hormone therapy methods:

Method	Description
Spaying	After removal of the ovaries, the level of estrogen in the body drops sharply. The method is effective in a third of patients. Suitable for ages 15 – 55 years.
“Medicinal castration” with drugs: Leuprolide; Buserelin; Zoladex (Goserelin).	Medicines suppress the pituitary gland's release of follicle-stimulating hormone (FSH), which activates the production of estrogen by the ovaries. The method is effective in a third of women aged 32 to 45 years.
Antiestrogenic drugs: Toremifene (Fareston); Tamoxifen; Faslodex.	Antiestrogens are drugs that suppress the functions of estrogen. Effective in 30% - 60% of women aged 16 to 45 years.
Medicines that inhibit the aromatase enzyme: Arimedex (Anastrozole); Femara (Letrozole); Amema (Fadrozole); Lentaron (Formestan); Aromasin (Examestane).	The aromatase enzyme takes part in the formation of steroid hormones, including the female sex hormones estrone and estradiol. By inhibiting aromatase activity, these drugs reduce estrogenic effects.
Progestins (gestagens): Provera; Megeys (Megestrol).	Progestins are a group of female sex hormones that interact not only with their own receptors on the surface of cells, but also with receptors intended for estrogens, thereby partially blocking their action. Medicines containing progestins are prescribed for people aged 9 to 67 years and are 30% effective.
Androgens are preparations of male sex hormones.	Androgens suppress the production of follicle-stimulating hormone (FSH), which activates the production of estrogen in the ovaries. The method is effective in 20% of girls and women aged 10 to 38 years.

How does a doctor choose breast cancer treatment tactics?

A treatment plan for breast cancer is developed individually.

Features that a doctor should consider:

• size of the tumor;
• the presence of metastases in the lymph nodes;
• germination into neighboring organs, presence of distant metastases;
• laboratory data characterizing the cellular composition and degree of malignancy of the tumor.

What traditional treatment methods can be used for breast cancer?

Modern treatment methods provide good prognosis for most women with malignant breast tumors. Thus, when starting treatment at stage I, about 95% of patients live longer than 5 years. Many experience full recovery.

Traditional methods are not able to provide an effective fight against the tumor process. Self-medication delays a visit to the doctor. Often such patients turn to a specialist when there are already distant metastases in the lymph nodes. However, 70% of patients do not survive for 3 years.

The only right decision for a patient with suspected breast cancer is to see a doctor as early as possible, carry out diagnostics and, if necessary, begin treatment in an oncology clinic.