Breast tumors: types, early diagnosis, treatment and prognosis. Malignant tumor in the breast in women: breast cancer How long does it take to develop breast cancer

Breast cancer is a disease accompanied by the formation of an epithelial tumor formation in the breast, in which its growth occurs from the ducts of the gland or from its lobules. Breast cancer, the symptoms of which may be based on damage to one or both glands at the same time, is one of the most common tumor (cancerous) pathologies found in women.

general description

If we look at the percentage of morbidity rates in a little more detail within the framework of global indicators, we can highlight the figure of 22.9% - this is exactly the percentage of female cancers that accounts for the pathology of interest to us. This figure does not take into account non-melanoma skin cancers. By the way, breast cancer in men is also accepted as a possible pathology, although women are almost 100 times more likely to experience it. Accordingly, there is an unfavorable trend in terms of outcomes for men with breast cancer, which is associated with late diagnosis.

The following factors are considered as the main risks leading to the development of breast cancer: heredity, obesity, early onset of menstruation (before age 12), late menopause (after the age of 55), smoking, etc. We will consider several features of predisposing factors below in the appropriate section.

As for such a question as the symptoms of breast cancer, they can be briefly summarized as follows: compaction in the mammary gland, enlargement of the lymph nodes located in the axillary region, the appearance of discharge from the nipple of a different nature, changes in the contours and color of the mammary gland, etc. On all these We will also discuss the symptoms below.

Diagnosis of pathology is carried out by palpating the glands and visually examining them, performing ultrasound, mammography and biopsy. Features of treatment are based on the characteristics of the course of breast cancer, the stage corresponding to this course, the form and other criteria relevant to the pathology. Based on such features, the method of surgical removal of tumor formation, drug treatment or radiotherapy can be used.

Regarding the age at which women most often develop breast cancer, it can be noted that with its gradual increase, the risk of developing this disease also increases. The pathology is especially often diagnosed starting from 40 years of age and older. Breast cancer under the age of 30 is an extremely rare diagnosis; mainly, its relevance implies a combination of several simultaneously influencing risk factors that cause this pathology. It should also be noted that with such early onset of breast cancer, the disease is very difficult to treat.

Breast cancer: causes

The causes that provoke the development of breast cancer (glands) have been studied to a sufficient extent today, therefore the identification of individual predisposing factors, as these causes are considered, allows a somewhat more substantive approach to the issue. Based on the approximate compliance, in turn, you can determine for yourself the feasibility of specific risks or, conversely, eliminate them. As causes (factors) that provoke breast cancer, it is customary to highlight options that we will consider below. Meanwhile, there are additions to certain variants of these factors, and some of them are controversial; below we will also dwell on them, but now we will highlight the main number of reasons (factors) considered as provoking the development of breast cancer:

• Heredity. This factor plays a significant role in the possible development of breast cancer in a woman. In practice, it has been confirmed that if close relatives have been diagnosed with breast cancer, then the risk for a woman with such family ties increases almost three times compared to others. This feature is genetically determined. So, the point is that such a relationship determines the presence of a specific gene in women, which, in turn, is directly responsible for the further development of this tumor pathology (we are talking in particular about the BRCA1, BRCA2 genes). Meanwhile, even if such genes are absent, this does not exclude the possible development of breast cancer. As it was revealed, of the total number of women who suffered from the disease we are considering, hardly 1% were found to have such predisposing genes.
• Individual characteristics of the female reproductive system. This factor includes a lot of accompanying factors, we initially listed them. In particular, this includes early onset of menstruation (before the age of 12 years), late onset of the first pregnancy (after the age of 30 years), and late menopause (after the age of 55 years). This also includes the absence of pregnancy as such during life, and, accordingly, childbirth and lactation - the risk also increases.
• Having a “history” of breast cancer. In this case, such a risk factor implies the presence in the woman’s medical history of breast cancer in the past, which was diagnosed and subsequently cured. The risk in this case is determined for the second mammary gland (that is, the one in which there was no tumor formation before).
• Fibroadenoma or fibrocystic form of mastopathy. In the first case, that is, with fibroadenoma, we are talking about the presence of such a disease in a woman, which acts as a predisposing factor for the development of breast cancer, in which a benign tumor formation develops in the gland based on fibrous tissue, which is quite dense in its own structure. In the second, that is, with fibrocystic mastopathy, a pathology accompanied by the growth of connective tissue in the gland, in which fluid-filled cavities (i.e. cysts) are also formed, is considered as a predisposing factor.
• Taking hormonal drugs. In this case, in particular, the option of taking such drugs during the postmenopausal period, which is otherwise defined as the period following the completion of a woman's last menstrual period, is considered. This factor is relevant for consideration as a risk when we are talking about an appointment lasting more than three years.
• Taking oral contraceptives. In other words, a certain amount of risk occurs if a woman takes contraceptive medications. This risk is insignificant, although it does exist; in particular, it is determined for the situation with taking such drugs, lasting for 10 or more years in a row. Separately, patients over the age of 35 who also take contraceptives are also at risk in this area.
• Exposure to radiation. The risk of developing the disease we are considering increases in women living in unfavorable areas with increased radiation noted in them. In addition, this item also includes radiotherapy, during which intentional irradiation is performed, which, as the reader can assume, is done for therapeutic purposes in the event of the occurrence of malignant tumor formations that are not related to breast cancer.
• Presence of concomitant diseases. You can get breast cancer even if a certain type of disease is relevant; examples include obesity, hypothyroidism (a disease accompanied by decreased thyroid function), high blood pressure, and diabetes.

Considering the fact that some of the factors we discussed above cannot be eliminated, and also given that the development of breast cancer is allowed even in the absence of any of these factors, the most important task is to reduce the risk that determines the possibility of developing this pathology. This is achieved in particular by the struggle aimed at preventing such factors. So, for example, we highlighted above fibrocystic mastopathy, which in itself is a precancerous pathology that can be eliminated using appropriate drugs that have proven effective with such use. In some cases, we can talk about almost 90% effectiveness of drugs, which means that with their use it is possible to eliminate not only the primary pathology, but also the risk associated, as we have already noted, with the development of breast cancer on this basis.

Basically, hormonal changes that are relevant to the body are considered as the causes of breast cancer. In particular, this is the period of entry into menopause, during which intensive restructuring is noted at the level of hormonal regulation of the female body. The production of estrogen, as well as progesterone (all of these are female sex hormones), decreases, the ovaries lose their characteristic activity - all this indicates the so-called “hormonal crisis”. The uterine mucosa (i.e., endometrium) and mammary glands react to this kind of changes to the greatest extent; in the mammary glands, in particular, tissue begins to dissolve, and replenishment of such losses occurs due to adipose tissue.

A scientifically established fact is that estrogen plays a leading role in the development of breast cancer - in particular, an excess of sex hormones acts as a conditioning factor for the development of pathology. What is noteworthy is that the lowest estrogen activity is observed during pregnancy, as well as after delivery (during lactation, i.e. breastfeeding). A woman’s risk of developing breast cancer is significantly reduced if she breastfeeds for a long time (a year or more), this information is scientifically confirmed.

Lifestyle as a predisposing factor to the development of breast cancer

As a separate factor, I would like to dwell on lifestyle, which also plays an important role in considering factors predisposing to the development of breast cancer. In particular, such a factor as smoking, including its early onset, is considered here. Women who smoke for a long time face an increase in their risk of developing breast cancer from 35% to 50%.

It should also be noted the characteristics of physical activity in women as a predisposing factor in the framework of considering the characteristics of lifestyle, in particular we are talking about its lack, while the situation of such a connection is relevant in 10% of the total number of cases of pathology development.

As for the connection between breast cancer and breastfeeding noted above, it is not fully understood at the moment, and therefore the opinion about the relevance of such a connection is controversial.

During the 80s, another hypothesis was formed, this time concerning abortion as a factor predisposing a woman to develop breast cancer. This hypothesis began to be considered as a fairly popular option for study within the framework of ongoing scientific research. However, it was found that abortions, as well as miscarriages, have no connection with the development of breast cancer in women, and this, accordingly, determines that the factor indicated in the list above is at least controversial. Meanwhile, a “hormonal explosion” against this background is an unconditional fact, therefore the development of tumors against this background should not be excluded as a possible option.

The issue of the connection between breast cancer (in particular, the premenopausal period of its development) and the use of contraceptives is also controversial, and if this connection exists, then it makes sense to talk about a small effect. It should also be noted that the use of modern types of oral contraceptives does not determine a significant impact in terms of increasing the risk of developing breast cancer in women. There is no consensus regarding the effect of contraceptives, but even if they reduce the risk of developing breast cancer, they predispose to other, also quite serious pathologies, and these are osteoporosis and cancer of the female genital organs.

The relative degree of connection between breast cancer and dietary patterns is also highlighted, in particular, if a diet with a predominant content of fat is considered, as well as if frequent alcohol consumption is relevant, obesity. Focusing on the last factor, that is, obesity, we can determine that it can cause tumor diseases, not only of the mammary glands, but also of the entire female reproductive system in general. The presence of an excess amount of adipose tissue in the body determines its certain autonomy, within the framework of which it acts as an independent endocrine organ, due to which the production of estrogens begins. Their quantity in the body becomes excessive, which means that a favorable background is created for the development of tumor formations in it (in the body), incl. and breast cancer.

Again, here, among the causes of cancer in connection with the current lifestyle, it makes sense to highlight radiation, shift work, exposure to certain chemicals (organic solvents, aromatic polycyclic hydrocarbons, polychlorinated biphenyls, etc.) and environmental features. By the way, the radiation on this list, received during the same mammography procedure, despite the insignificance of the acting doses in it, is in almost 225 cases the main cause of cancer development in a million studied patients aged between 40-80 years.

The patient's experience of mastitis determines their subsequent predisposition to the development of the pathology we are considering. As for benign diseases affecting the mammary glands, such as fibroadenosis and fibrocystic mastopathy, although they do not lead to cancer, they create the appropriate background for its development.

Breast cancer: forms

Basic pathogenetic forms Breast cancer looks like this:

• Hypothyroid form. This pathology is considered as the so-called “cancer of the young.” It occurs in approximately 4.3% of cancer cases; the main age group in this case is patients from 15 to 32 years old. The main predisposing factors for this form of cancer include early obesity, the appearance of menstruation before the age of 12 years, actual hypothyroidism, hyperplasia of ovarian tissue and follicular cysts in them. Breast cancer in this case determines an unfavorable prognosis in its own course, which in this case is rapid. In addition, distant metastases from this form of pathology begin to develop quite quickly.
• Ovarian form. This form of pathology is relevant for about 44% of patients. The peculiarities of the pathogenetic effects in this group are directly related to the functions of the ovaries (fibroadenomatosis, sex life and childbirth). In this case, the prognosis is also defined as unfavorable, which is determined by the speed of lymphogenous dissemination (spread of cancer cells), as well as multicentric growth.
• Hypertensive-adrenal form. This form of pathology is diagnosed in 39.8% of cases, the age group is patients from 48 to 64 years old. Features that are relevant for them in this case are the following: increased cholesterol levels, obesity, increased cortisol levels, and the presence of hypertension. The following concomitant diseases may also be relevant: uterine fibroids, diabetes mellitus, signs indicating accelerated aging. The prognosis is characterized as unfavorable.
• Pituitary (senile) form. Diagnosed in 8.6% of patients during menopause. Age-related changes corresponding to this period are relevant. According to this form, the prognosis is relatively favorable; the pathological process itself is characterized by its relative localization. If metastasis develops, it occurs somewhat later and is characterized by a slow course.
• Breast cancer developing during actual pregnancy or lactation. In this case, the prognosis is extremely unfavorable, due to features specific to these periods associated with increased levels of growth hormone and prolactin.

As for the other group of forms, this is clinical forms manifestations of breast cancer, which are primarily divided into types of cancer such as non-invasive cancer and invasive cancer.

Non-invasive breast cancer (nodular form) otherwise defined as carcinoma and implies a form of cancer in the early stages of its development, for which germination to the surrounding tissues of the affected gland is uncharacteristic. This feature of cancer determines the possibility of successful treatment and, accordingly, a favorable prognosis for cancer. This form of pathology can be concentrated in the area of ​​the lobule or duct of the gland.

A not so favorable option for the development of pathology is invasive breast cancer (or diffuse form). This is due to the fact that in this case the tumor growth occurs in the surrounding tissues. In particular, there is the following classification corresponding to the invasive form of the pathology:

• Lobular form;
• Ductal form (or ductal form);
• Paget's disease;
• Inflammatory form;
• Other types of breast cancer (medullary, tubular, mucidous breast cancer).

At ductal form The tumor formation is localized on the side of the wall of the milk duct, then, gradually, it grows to the surrounding tissues of the gland. At lobular form (lobular form) The tumor formation is initially localized in the area of ​​glandular tissue, after which it grows to the tissues in the immediate surroundings. Inflammatory form (or inflamatory form) in practice, it is observed quite rarely; the peculiarities of its symptoms often become the cause of errors in diagnosis, during which the diagnosis of mastitis is made in such cases. The prognosis for this form is defined as unfavorable. The next form, and this is on our list Paget's disease, characterized either by the appearance of an ulcer in the mammary gland, or by changes noted in the area of ​​its areola or nipple.

What happens with breast cancer: features of pathogenesis

Depending on the characteristics of the histological structure, breast cancer in one form or another mainly refers to adenocarcinoma or solid cancer, which is also characterized by a variety of its own transitional forms.

What is noteworthy is that in addition to tumor formations that form during cancer, malignant tumor formations of a non-epithelial nature can also form. Such formations include sarcomas; treatment (as well as preliminary diagnosis) is based on principles similar in their features to the principles of cancer treatment.

Features of the classification of breast cancer lie in the current indicators of ERC (or estrogen receptors), the state of which (their presence or absence) can often completely change the course of the pathological process. In approximately 70% of cases of primary cancer diagnosis, the presence of ERC is noted. As for ERC-negative tumor formations (that is, formations in which there are no estrogen receptors), they are in the vast majority of cases diagnosed in patients who are in the premenopausal period (that is, the period before menopause). Based on the state of the ERc, the selection of appropriate treatment tactics is accordingly determined.

Metastasis in breast cancer

Along with the lymph flow, which is quite well developed in the tissues of the mammary glands, tumor cells spread (transfer) to the lymph nodes, which causes the appearance of initial metastases in patients. First of all, the axillary, subscapular and subclavian lymph nodes are affected. If the tumor is concentrated within the medial quadrants of the glands, then the chain of parasternal lymph nodes is affected. This is followed by the next stage of metastasis, within which it spreads to the mediastinal, cervical and supraclavicular lymph nodes, in addition to heading to the armpit opposite the main lesion. Thus, cross-metastasis is noted, which spreads to the second mammary gland. Sometimes metastasis to the axillary lymph nodes occurs somewhat earlier than the tumor formation itself is detected in the affected gland, which requires the priority exclusion of subsequent cancerous lesions.

Hematogenous spread determines the further occurrence of metastases in the pleura and lungs, bones, liver and brain of patients. Bone metastases are characterized mainly by damage to the spine, as well as damage to the ribs, pelvic bones (flat), and skull. In addition, the humerus and femur are affected, which is accompanied by the manifestation of symptoms in the form of aching pain localized in the bones (of a variable nature), subsequently such pain becomes excruciating for patients.

Depending on the degree of damage and the characteristics of the course of breast cancer, it is customary to distinguish 4 stages of breast cancer (or 4 degrees of pathology), we will consider them below, also briefly dwelling on the survival rate corresponding to each of the options.

• Stage 0 breast cancer. In this case, there is a pathology of a non-invasive lesion, which, as we have already considered, is concentrated in the gland or in the duct, without subsequent spread to surrounding tissues. Basically, stage zero breast cancer is diagnosed during the patient's routine mammography procedure (i.e., as part of a preventive examination, randomly). Adequately provided treatment determines a ten-year survival rate for patients in 98% of cases.
• Stage I breast cancer. At this stage, the tumor formation in breast cancer is no larger than 2 centimeters (diameter), and does not spread to tissues in the immediate vicinity. If adequate treatment is provided, the ten-year survival rate for stage I breast cancer is diagnosed in 96% of cases.
• Stage II breast cancer. Let us immediately highlight the prognosis for this stage of the pathology; in this variant of the course, ten-year survival is determined for patients in 75-90% of cases. This stage is, first of all, characterized by a division into two main variants of substages:
  • 2A. This designation for this stage of breast cancer indicates that the tumor formation in its own size does not exceed 2 centimeters (the diameter is taken into account, respectively), or we are talking about a diameter of 5 centimeters, but without concomitant spread to the axillary lymph nodes.
  • 2B. This designation, in turn, determines the size of the tumor formation, approximately 5 centimeters in diameter, while simultaneously spreading to the axillary lymph nodes (affecting 1-3 of them). Another option is also possible, in which the tumor formation has dimensions exceeding 5 centimeters in diameter, but without spreading to the lymph nodes along with the pathological process.
• Stage III breast cancer. Similar to the previous stage, the third stage is subject to division into substages, this time there are three of them, we will consider them below. Each of these substages has its own characteristics in terms of survival.
  • 3A. This stage of breast cancer indicates the size of the tumor formation is up to 5 centimeters (diameter), as well as its spread to the axillary lymph nodes (if 4-9 of them are affected). It is also possible to enlarge the lymph nodes concentrated in the area of ​​the mammary glands on the same side that was affected by the tumor formation. As for ten-year survival, adequate treatment used for this stage determines its possibility in approximately 65-75% of cases.
  • 3B. The peculiarities of this stage are that the tumor formation in the lesion has reached either the wall of the chest area or the skin. This stage also corresponds to the inflammatory form of breast cancer. If adequate treatment is selected, then ten-year survival is allowed in approximately 10-40% of cases.
  • 3C. At this stage, we are talking about the spread of tumor formation to the axillary lymph nodes and to the lymph nodes in the area near the sternum. Ten-year survival rate with adequate treatment is about 10% of cases.
• Stage IV breast cancer. This stage determines the spread of tumor formation to other organs, which, in other words, indicates metastasis of the pathological process. As for the size of the tumor formation, there are no clear numbers here; the sizes, accordingly, can be very different. If we consider the ten-year survival rate at this stage, then it is acceptable in approximately 10% of cases.

Breast cancer: symptoms

The concentration of tumor formations in the area of ​​the mammary glands can be very different, while both the right mammary gland and the left mammary gland are affected with the same frequency. A variant of the course of the pathology in which the mammary glands are affected bilaterally cannot be excluded (this variant is diagnosed on average in 2.5% of cases). The appearance of a pathological node is allowed both as a metastasis and as an independent, already the second, tumor.

In approximately half of the cases, tumor formations form in the area of ​​the upper outer quadrant of the mammary gland, in some cases - from the very edge, where it borders the armpit.

It should be noted that any obvious manifestations characteristic of breast cancer are observed in patients already at an advanced stage of the pathological process. Basically, they are a dense type of formation, painless to the touch, and, accordingly, concentrated in the mammary glands.

In the case when the course of the pathological process has reached the stage of germination to the chest wall, both the mammary gland and the tumor formation in it lose mobility. The germination of the tumor process to the skin leads to the fact that the mammary gland is subject to deformation, ulcerations appear on it, it is stretched, and the nipple, on the contrary, is retracted. One of the manifestations of cancer can also be discharge from the nipple, which mainly contains an admixture of blood (that is, it is bloody discharge). If the tumor process spreads to the lymph nodes, then they enlarge, causing a feeling of severe discomfort in the armpit area.

Features of the clinical picture of the disease, in addition to its main manifestations, are determined on the basis of the specific form; let’s consider their main options.

Mastitis-like cancer. This form of breast cancer is characterized by its own rapid course. The mammary gland is sharply enlarged, and there is severe pain and swelling. The skin of the gland is in a tense state, there is redness and an increase in temperature. The symptoms of this form of cancer correspond to the course of acute mastitis, as a result of which, in frequent cases, a woman’s condition is diagnosed incorrectly. This is especially true for women who have recently had childbirth.

Erysipelas-like cancer. It is characterized by sudden redness of the skin of the gland, this redness in some cases extends to areas beyond its borders. The edges of this redness are jagged and uneven, and in some cases there is an increased temperature. In some variants of the course, this form of pathology is mistaken for the ordinary form of erysipelas, which is accompanied by the doctor’s subsequent prescription of physiotherapy procedures and appropriate medications. As a result, as is clear, a time delay is determined for adequate therapy.

Armor cancer. This form of cancer develops due to tumor infiltration, which occurs through the crevices of the skin and through the lymphatic vessels, against the background of which the skin noticeably thickens. As a result of such a flow, a kind of shell is formed, which has a fairly pronounced density. It covers half of the chest, although in some cases the option of affecting the entire chest is also allowed. Breast cancer in this form is characterized by an extreme degree of its own malignancy.

Considered as a special form Paget's cancer , in which there is a planar lesion of both the nipple and areola. The initial stages of the pathology are accompanied by peeling of the nipple and its weeping, which is why it is often confused with eczema. The subsequent spread of cancer is accompanied by damage to the gland ducts (deep damage), as well as the formation of a typical cancer nodule in the tissues, which is combined with metastasis, in which the lymph nodes are affected. The course of this form of cancer is characterized for the most part by its own duration; in some cases, a course of several years is considered possible, in which the lesion will affect only the nipple.

In general terms, the course of breast cancer can occur in different ways, which is determined by influencing factors, the woman’s age and the characteristics of the current hormonal status. Young women, especially if their tumor process began during pregnancy and lactation, are faced with its rapid progression, which, accordingly, determines the early onset of metastasis for them. As for the characteristics of the tumor process in older women, their breast cancer can last even for 8-10 years, and without a predisposition to metastasis.

Now let us highlight those main signs (symptoms) against which we can assume the relevance of breast cancer and which, accordingly, accompany this pathology.

• Tight knot. This manifestation is the main symptom of breast cancer under consideration. The nodule is determined during self-examination or at a doctor’s appointment. The nodule is concentrated in the area under the nipple or in any other part of the breast.
• Skin change. In this case, any options for changes in the skin in the area of ​​the gland are considered, and this is a thickening of the skin of the gland (the features of the lesion in this case are very characteristic: the skin resembles the appearance of a lemon peel); wrinkling of a certain area of ​​the skin; changed skin color (skin may, for example, turn yellow, blue or red); the appearance of a small ulcerative formation in the area of ​​the nipple or its appearance in the area of ​​the areola and other areas.
• The appearance of discharge from the nipple. As we have already noted in the general discussion, they can be different; often in case of gland cancer, the presence of blood admixture is important.
• Changes in the contours of the gland. The patient may notice such changes, for example, when examining the position of the gland or its section, stretching of the gland or its section, a change in the nipple, a change in the size of the gland or a certain section of it, etc.
• Changes in lymph nodes in the axillary region. Here, in particular, their increase, as well as pain revealed during palpation, can be considered.
• The appearance of symptoms that may qualify as another type of breast disease. For example, the symptoms of mastitis may manifest themselves in breast cancer (which consists of inflammation of the gland and the redness that accompanies this process, and the appearance of pain). Similarly, symptoms of breast cancer may appear under the guise of erysipelas, which is usually characterized by inflammation of the skin of the affected gland, as well as tenderness in the area. Considering such variants of the course with concomitant changes in the glands, any symptoms indicating damage to one or another possible disease should be considered as a reason for an immediate visit to the doctor.

Separately, it should be noted that in the early stages of its course, breast cancer can occur without any symptoms at all. For this reason, systematic self-examination and visiting a doctor is a recommendation for all women, through the implementation of which it will be possible to identify the disease at an early stage of its course, and, accordingly, begin its treatment.

Diagnosis

As we have already noted, early diagnosis of breast cancer, that is, diagnosis of breast cancer in the early stages of the course of this disease, is extremely important in the context of considering the subsequent effectiveness of its treatment. As part of the modern protocol for breast cancer screening, the following items are distinguished:

• Primary examination by a mammologist, considered as the first stage in identifying tumor disease of the gland. This examination is carried out within the period between 5-12 days of the cycle (counting from the 1st day of menstruation). The mammologist's examination process is based on a visual examination of the mammary glands, during which he determines how symmetrical the position of the glands and their contours is, and whether there are any visible changes in the skin of the breast. The mammary glands are also palpated for actual lumps in them.
• Mammography. This procedure using x-rays is not only painless, but also informative. Here, again, the main recommendation comes down to carrying it out within a period of certain days of the cycle (the same as when examined by a doctor). Mammography is recommended especially for women aged 40-50 years as a preventive measure once every 1-2 years, after 50 years - every year. Compliance with this condition will allow timely detection of breast cancer during its initial stages, which are not accompanied by any specific symptoms.
• Ductography. This research method is carried out in cases in which diagnosing the disease is difficult for one reason or another. The area of ​​study in it is the milk ducts concentrated in the mammary glands. During the procedure, a substance is injected into the ducts, due to which the lumen of the duct is filled, which, in turn, makes it possible to examine them when taking an x-ray of this area.
• Ultrasound. Ultrasound is a common method of examining the glands for breast cancer. In particular, this method determines the possibility of diagnosis with the examination of a suspicious-looking compaction (if it is previously identified). In some cases, a cyst is mistaken for cancer - a benign formation in the form of a fluid-filled cavity; instead of fluid, it may also contain milk.
• Biopsy. This method is used if ultrasound did not make it possible to determine the structural features of the neoplasm in the mammary gland, which, accordingly, did not make it possible to establish the corresponding pathology. A biopsy uses a needle inserted into the skin of the breast at the location of the lump. Material from this area must be removed and subsequently examined using a microscope. If breast cancer is relevant, then, accordingly, the material determines the presence of cancer cells in it. However, sometimes this method does not allow diagnosing this pathology due to the impossibility of practically obtaining material. In this case, other types of diagnostics are applicable, for example, core biopsy (a thicker needle is used) or surgical biopsy (consists in surgical dissection of the skin to obtain material and further study it).

When cancer cells are identified as part of one or another biopsy, they are subjected to further research in terms of susceptibility to sex hormones (progesterone, estrogens), characteristics of their reproduction, etc. Due to the methods used, the possibility of selecting adequate treatment is subsequently determined, due to which, in in turn, the possibility of curing patients is allowed. For this purpose, additional research methods may also be prescribed that are not specifically related to the study of the characteristics of the mammary glands, that is, methods in which research is concentrated within other areas.

Treatment

As the main and most effective method of treating breast cancer, only a surgical method is considered, which ensures the removal of an organ affected by cancer. It should be noted that any other treatment options, with the exception of surgery, provide only a temporary effect for patients. Features of surgical intervention include choosing one of the following methods:

• complete removal of the mammary gland, including the lymph nodes of the axillary region and fatty tissue on the affected side (this option is considered the most preferable);
• removal of a certain area of ​​the gland (that is, the area in which the tumor formation is concentrated, as well as the lymph nodes of the axillary region on the same side on which the lesion itself is located);
• if the tumor formation is significant, as well as if it is widespread, the mammary gland, blood vessels, and pectoral muscles are removed (moreover, in some cases, an option is allowed in which the ribs are also removed, everything depends, in particular, on the specified initial feature, based on which is being deleted).

In most cases, additional therapy methods are used after surgery. So, if the disease is not accompanied by metastases, then the treatment is supportive; it uses antihormonal drugs, which are taken over a period of five years, this will eliminate the possibility of preventing the return of the pathology, as well as the formation of metastases.

If metastasis occurred during the pathology, and its spread occurred to the area of ​​the axillary lymph nodes, then chemotherapy and radiation therapy are used. Radiation therapy, in particular, consists of irradiation using a special device at small doses (for a period of 1 month). During chemotherapy, appropriate drugs are administered intravenously.

If metastasis has affected other organs (lungs, liver, etc.), then chemotherapy is mandatory, aimed at reducing the size of metastases or completely destroying them. Let us recall that metastases are specific screenings from the main tumor formation, which have a similar structure and have the ability to subsequently grow when the function of the organs is impaired, under the conditions in which they found themselves and began to develop.

As you can see, breast cancer is a quite serious disease, therefore, if any symptoms appear in the gland area, you should consult a mammologist and an oncologist. In addition, we should not forget about the need for self-examination for the presence of a specific nodule in the glands, as well as the need for a preventive visit to the doctor, even in the absence of symptoms.

Symptoms of breast cancer can be similar to other benign pathologies. Cancer cells can only be reliably identified through a comprehensive examination. But in order not to miss the appearance of the first signs or symptoms of breast cancer, you need to regularly conduct self-examination and medical examination.

Normally, the mammary gland of an adult woman is a convex disc consisting of lobules. The lobule is the functional unit of the mammary gland. There are from 18 to 22 such lobules in one breast. In its structure, each lobule represents a large number of closed alveoli sacs.

It is in these sacs that milk is produced and collected during lactation. Each sac is equipped with small excretory ducts. These ducts merge into larger ones and exit to the nipple of the mammary gland, where separate ducts are present. The number of large ducts in the mammary glands varies (from 4 to 18).

Each of these structural elements of the gland has an individual internal lining. In the alveoli it is represented by lactocytes (secretory cells), in the excretory ducts - by epithelium (cylindrical). Near the nipples, the columnar epithelium turns into a multilayered squamous epithelium. The mammary gland also contains adipose and connective tissue.

If a woman has small breasts, this does not indicate any pathology. Normally, the ratio between adipose tissue and secreting structures is approximately 1:1. This figure may vary depending on the constitution. Thus, with a dense build, there is a preponderance towards the fat part.

When neoplasms (both malignant and benign) appear, the source of the development of pathology can be any of the above tissues and structural units of the mammary gland. Cancer cells can be localized anywhere, but more often the pathological process develops in the upper outer square of the breast.

Symptoms and first signs of breast cancer

A number of specific signs indicate the possible development of cancer. Knowing these signs, you can not only suspect cancer, but also differentiate a malignant tumor from other breast pathologies using additional diagnostics. The main signs of a possible malignant process include:

Lumps in one or both breasts, which are detected by palpation both when the patient is in a horizontal and vertical position.

Disturbances in the shape of the mammary gland, which in no way depend on a woman’s menstrual cycle.

Pathological discharge from one or both nipples, not associated with pregnancy and lactation. The color and consistency of the discharge may vary.

Scales near the nipple that peel off and leave behind small ulcers and erosions.

Spots of red and even purple hue in the skin of the gland. Areas of redness may gradually grow, then they begin to peel off and become the cause of severe itching. In their projection, the skin noticeably thickens. After peeling begins, the color of the spot becomes more intense. Moisture is noted in the spots, they are subject to erosion and ulceration, and hemorrhages occur.

The appearance of retractions in the chest. They become noticeable during movements, for example, when the patient slowly raises and lowers her arm.

Abnormal nipple shape. The nipple may become tight, retracted, or deviate to the side.

Reduction of the pigmented area around the nipple with a violation of its consistency.

Wrinkling of the skin of the chest. If the skin is compressed into a small fold, then wrinkles will appear on it, perpendicular to this fold.

Painful sensations in the gland of various types. They can occur both as a result of movement and at rest. The intensity of the pain varies. In the initial stages of the disease, patients find it difficult to indicate the exact location of the pain. Discomfort occurs even from light touches. It also happens that pain appears spontaneously.

Swelling of the affected breast, the appearance of the so-called “lemon peel” in a certain area. In some cases, the lemon peel completely covers the chest.

Increased vascular pattern on the skin of the chest. Previously invisible vessels are well contoured, their lumen is expanded. In such places, the skin is sore.

Impaired elasticity of the skin in certain areas. The surface of such areas becomes smooth, they have a denser consistency.

The appearance of enlarged lymph nodes in the supraclavicular and axillary areas.

Swelling of one arm of unknown etiology.

How to properly perform a breast self-examination, read the article on our website.
The symptoms of breast cancer in men will be the same as in women.

If you find the symptoms described above, you need to contact a mammologist or oncologist and perform additional diagnostic methods. The causes, treatment and prognosis for breast cancer are covered in our other article.

Symptoms of malignant breast cancer

The following types of lumps may indicate the presence of cancer cells.

Seals in the form of nodules in the mammary gland

Symptoms of breast cancer at an early stage are a single nodule or multiple nodules with clear contours of a dense consistency that are painless on palpation, the mobility of the nodules is limited, and wrinkled retractions of the skin are determined over the location of the tumor. Enlarged lymph nodes can be felt under the arms.

At a later stage, the nipple thickens, the skin becomes ulcerated and becomes like an orange peel.

Diffuse saturation of the mammary gland

Cancerous signs of lumps may resemble acute forms of mastitis or mastopathy:

1. Edema diffuse compaction.

May develop during pregnancy and breastfeeding. The skin is in the form of an orange peel, swollen, hyperemic (reddened), saturated with infiltrate. The infiltrate compresses the milk ducts causing pain and swelling.

2. Armor diffuse seal.

Symptoms of breast cancer in women are manifested by tissue infiltration. The tumor can spread to the chest, multiple nodules can be palpated. The skin becomes dense, bluish-red in color, immobile, ulcerations and crusts appear in the form of a shell.

3. A thickening similar to erysipelas of the skin.

Signs of breast cancer appear as focal redness. The lump is hyperemic, its edges are uneven and swollen, the tumor can spread to the chest. Body temperature rises to 40°C.

4. A lump similar to mastitis.

With this type of diffuse compaction, an enlargement of the mammary gland is observed, the tumor is dense, inactive, and can be easily palpated. The skin is red, tense, and there is a local and general increase in temperature.

Paget's disease

The first symptoms of breast cancer are similar to those of psoriasis or eczema. But the difference lies in the bright hyperemia of the skin, engorgement of the areola and nipple, on which first dry, and then weeping crusts and scabs are formed, under which there is wet granulation. Cancer cells spread through the milk ducts deep into the body of the gland.

The classification of breast cancer will give you an idea of ​​stages 1, 2, 3 and 4. The symptoms of which may be the same.

Comparison of similar symptoms with other breast diseases

If you find a lump in your breast, do not immediately think that these are cancer cells. There are many common breast diseases with similar symptoms.

Pain and lumps in the chest can occur with:

Mastitis (inflammation of the mammary gland);

- Mastopathy of the mammary glands (small nodular or extensive diffuse compactions);

Fibroadenoma (benign neoplasm).

The difference between mastitis and cancerous tumors

Mastitis occurs as a result of injury or infection entering the mammary gland through cracks in the nipple. Most often it occurs in primiparous women who are breastfeeding. Unlike oncology, mastitis develops very quickly literally in the first day after infection or injury.

Mastitis is characterized by:

Diffuse thickening in the chest;

Sharp bursting pain, aggravated by feeding;

An increase in temperature, both local and general;

Purulent cavities and nodular compactions may appear;

Pathological purulent or bloody discharge may be released from the nipple during lactation.

The difference between mastopapia and cancerous tumors

Mastopathy is a disease of non-inflammatory origin; it is a pathological proliferation of the alveoli and ducts of the mammary gland under the influence of hormonal imbalance (increased levels of estrogen, prolactin, decreased progesterone in the blood and gland tissues).
There may be nodular and diffuse forms of mastopathy. Fibrocystic breast changes can develop into cancer. Read more about the diagnosis and treatment of breast cysts in a special article on our website. Upon examination and palpation, it is impossible to reliably distinguish mastopathy from cancer; additional diagnostics must be carried out.

Mastopathy is characterized by:

On palpation, compactions are determined in the form of nodules (like grains) or strands in case of diffuse damage;

Often accompanied by menstrual irregularities and the onset of menopause;

The pain appears gradually as the compactions increase;

In the future, symptoms of mastitis may appear.

The difference between fibroadenoma and cancerous tumors

Fibroadenoma is a benign neoplasm of glandular tissue, the causes of its occurrence are unknown. There can be two forms of fibroadenoma: mature with clear contours and immature - loose. There is a possibility of degeneration into cancer cells. Differential diagnosis of cancer and fibroadenoma is difficult; additional diagnostic methods are required.

Fibroadenoma manifests itself:

Single or multiple lumps in the mammary gland;

There is often no pain;

The skin is usually not changed.

conclusions

Do breast self-exams regularly. It is better to do this in the first week after menstruation, so the results will be more accurate, because the condition of the mammary glands changes on different days of the cycle. If you notice any changes in the skin or feel a lump, do not panic right away; you need to make an appointment with a mammologist. He will give you a referral for examination (mammography and breast ultrasound). And depending on the results, he may refer you to an oncologist or home until your next scheduled examination.

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

• 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;

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

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.

• 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?

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

Visual inspection

• 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

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.

• 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.

Consultation with an oncologist for the treatment of breast cancer

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

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

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

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 testing. 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

Breast cancer treatment

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

Surgery

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

• 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

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.

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

Hormone therapy

Hormone therapy methods:

How does a doctor choose breast cancer treatment tactics?

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?

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.

According to the World Health Organization, every year one and a half million women are diagnosed with breast cancer. Like many other diseases, breast cancer is “getting younger” - in recent decades it has affected increasingly younger women. Diagnosing breast cancer in the early stages is the key to successful treatment. This is a very dangerous disease, but it is curable, and treatment methods are becoming more perfect every year.

Breast cancer: there is a way out!

The statistics on the incidence of breast cancer in our country are alarming - mammologists identify about 50,000 new cases every year. The average age of patients is 59 years, but this does not mean that younger women are not at risk. On the contrary, as already mentioned, this disease increasingly affects women in the prime of life.

The reasons for the development of breast cancer are still unknown to doctors, but it is obvious that genetics and ecology play a key role here. Residents of rural areas suffer from breast cancer 30% less often than urban women.

However, when breast cancer is diagnosed in the early stages, the prognosis is favorable - if the cancer was detected at the first stage, the 5-year survival rate is 94%, at the second stage - 79%.

Stages of breast cancer

Oncologists distinguish 4 stages of breast cancer:

• On the first, the tumor is small, does not exceed 2 cm in diameter, there are no metastases.
• At the second stage of breast cancer, the size of the tumor is from 2 to 5 cm in diameter. At this stage, cancer cells are present in 4-5 lymph nodes.
• The third stage of cancer is characterized by large tumor sizes, from 5 cm, and the cancer spreads to the base of the organ.
• The fourth is dangerous because the tumor metastasizes to different organs, most often to the liver, lungs, bones and brain.

Breast cancer accounts for 20-25% of all cancer cases in women.

Treatment methods for breast cancer

Today, there are several methods of treating breast cancer. The choice of the appropriate one depends on many factors: the size of the primary tumor, the condition of the regional lymph nodes, the presence of distant metastases and receptor status, that is, sensitivity to hormones.

Surgery

During surgery, the doctor’s main task is to preserve the life and health of the patient, even if this means the loss of the mammary gland. However, now doctors are trying not only to remove the tumor, but also to preserve the gland. In cases where this is not possible, breast prosthetics are performed - usually plastic surgery is performed six months after the mastectomy. Although, for example, in Israel, breast reconstruction is carried out in one operation: immediately after removal.

If the size of the tumor does not exceed 25 mm, organ-preserving surgery is used. Often several nearby lymph nodes are removed, even if no metastases are found - this helps prevent relapse of the disease.

It should be noted that surgeons in advanced countries in the treatment of oncology have unique surgical instruments. For example, Israeli clinics successfully use the Margin Probe device, which, according to doctors, makes it possible to remove absolutely all cancer cells.

Radiotherapy

Radiotherapy, or radiation therapy, is part of the supportive treatment for breast cancer and is given to women before or after tumor removal. Radiation therapy reduces the chance of cancer coming back by killing tumor cells. In radiation therapy, the tumor is irradiated using powerful X-rays or gamma radiation.

Intrabeam

Innovative technique of intraoperative irradiation. Allows you to avoid postoperative radiotherapy and reduce the risk of relapse. This procedure is performed during surgery and relieves the woman of postoperative treatment. Unlike traditional radiation therapy, radiation is directed only to the areas where cancer cells are thought to be located. The use of the method allows you to reduce the duration of treatment by 6 weeks, while reducing the risk of relapses and causing minimal harm to healthy tissues.

Chemotherapy

Chemotherapy, or drug treatment for breast cancer, is used before, after, and even instead of surgery in cases where surgery is not possible. Chemotherapy is the introduction of special toxins that affect tumor cells. The course of chemotherapy can last from 3 to 6 months and usually begins immediately after surgery. Various drugs are used for chemotherapy - some destroy proteins that control the development of tumor cells, others are integrated into the genetic apparatus of the cancer cell and cause its death, and others slow down the division of affected cells.

Hormone therapy

Hormone therapy is effective, but only in half of the cases, since not all types of breast cancer are sensitive to this treatment.

Targeted therapy

Or targeted therapy is the most gentle type of treatment for breast cancer. Drugs for targeted therapy affect only the affected cells, without affecting healthy ones, so such therapy is much better tolerated.

Features of treatment of breast cancer at different stages

• Zero stage
  If the disease is diagnosed at this stage, then the chances of recovery tend to 100%. To cure, a lumpectomy is performed - a gentle operation in which only the neoplasm itself and a small part of the adjacent tissue are removed, although in some cases removal of the entire gland followed by plastic surgery is indicated. However, this method of treatment is used less frequently. After surgery, a course of chemotherapy, targeted and hormonal therapy is indicated.
• First stage
  The prognosis is also good: approximately 94–98% of patients recover completely after lumpectomy followed by chemotherapy, targeted therapy, and hormonal therapy. Sometimes a course of radiotherapy is indicated.
• Second stage
  At this stage, the tumor is already too large, and a lumpectomy will most likely not be possible - complete removal of the mammary gland is indicated - mastectomy with removal of the axillary lymph nodes and mandatory subsequent radiation therapy. It is worth saying that in foreign clinics, for example Israeli ones, they resort to this method only in extreme cases, making every effort to preserve the breast.
• Third stage
  At this stage, numerous metastases form. For recovery, it is necessary to remove not only the tumor itself, but also the metastases. A mastectomy with removal of lymph nodes and radiotherapy is required, as well as hormone therapy, chemotherapy and targeted therapy to destroy all cancer cells.
• Fourth stage
  This is advanced breast cancer with a large number of metastases. Radiation and chemotherapy are indicated, as well as surgery, the purpose of which is not to remove the tumor, but to eliminate life-threatening complications, as well as, in some cases, hormonal therapy. It is almost impossible to cure cancer completely at this stage, but you can prolong life and improve its quality.

Early diagnosis of breast cancer is the key to effective treatment. Recently, this topic has often been raised in the media, which makes many women think more often about their health and regularly visit a mammologist.

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:

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 for 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 make recommendations for treatment based on the individual characteristics of a particular patient.