Peculiarities of treatment of breast cancer in old and senile age Vitaly Alekseevich pynzar. Breast cancer: causes, signs, diagnosis, how to treat

According to statistics, breast cancer is very common in Russia, and among all cancer diseases it ranks first. This female disease mainly occurs in adult women over 55 years of age. But due to environmental deterioration in cities and poor nutrition, breast tumors began to grow younger, and now cases are already occurring in young girls from 30 to 45 years old. Basically, the tumors themselves are benign and can be quickly treated in the first stages.

Causes

As with any oncology, scientists and doctors still cannot find the exact cause of the development of malignant neoplasms. But there are several factors that increase the chance of this disease occurring.

Of course, the health of the reproductive system is primarily affected. Are there any glitches in menstrual cycle women and how exactly they go through. How many births there were, and how late they began for the woman. And also the duration of breastfeeding during pregnancy.

Like , a malignant tumor of the mammary gland directly depends on the level of the hormone in the blood, as well as exactly how estrogen itself affects the mammary gland. And the higher the level of the hormone itself relative normal value, the higher the chance of getting sick. Let's take a closer look at all the causes of breast cancer.

Genetics

In the last century, scientists discovered two genes that are responsible for the mutation of breast cancer cells. Therefore, having the BRCA1 and BRCA2 genes significantly increases the risk of developing breast cancer.

At the same time, cancer itself appears quite early, from the age of 40. Breast cancer appears in two milk sacs at once. There is a possibility of other tumors appearing in the uterus, intestines or lungs. Several foci and tumors appear throughout the mammary gland.

At what age does cancer most often appear? Typically these are women over 50 who are overweight and have eating problems.

NOTE! Both of these genes also affect male organs and increase the chance of prostate cancer.

Prevention

Typically, many women with these genes turn to drastic measures and resort to surgery. Removing the mammary glands actually reduces the chance by 95%. There are also those who remove the ovaries, since they are also at risk.

External factors

As with other tumors, malignant female formation is affected by the environment, radiation, irradiation, ultraviolet radiation, nutrition and air pollution with carcinogens and mutagens.

Obesity greatly influences the occurrence of cancer, since the fat layer itself produces a lot of female hormone into the blood, which simply falls in nuclei onto the mammary glands.

Radiation, the general radiation background in the city, when exceeding the norm, greatly increases the risk, since all Alpha, Betta and Gamma rays can change the structure of the DNA of cells, and they, in turn, mutate.

There have been cases when, during radiotherapy to treat another oncology, a woman developed breast cancer and small tumors appeared throughout the area. Fortunately, they were immediately removed before entering the metastasis phase, but the fact itself is there.

Other factors influencing the occurrence of breast cancer:

1. Incorrect hormonal therapy, when women self-medicate without the knowledge and without consulting a doctor.
2. If a girl begins menstruation very early before the age of 11.
3. Menopause in old age.
4. Nulliparous women.
5. First pregnancy after 30 years.

As many people know, during menstruation the female body experiences a large influx of estrogen, which puts the mammary gland in danger, but only if menstruation lasts for quite a long time. Simply put, the longer the tarragon peaks, the worse it is.

Do oral contraceptives affect breast cancer? In fact, there is no direct danger or evidence of this. Some doctors say that if not correct use Before age 20, there is a risk of cancer. Some say that together they are dangerous for women. But in some cases these drugs help female body. So, if these drugs are used correctly, there is no danger!

Symptoms

Unfortunately, like other types of oncology, chest symptoms do not manifest themselves at first, and stages 1 and 2 are quiet. Cancer itself in the early stages can only be detected by ultrasound or x-ray mammography. This should be done especially for women over 50 years of age and those who are at risk.

First signs

1. Painful menstruation and sudden mood changes.
2. Nodular compaction in the chest area.
3. The nipples retract.
4. A dimple appears on the chest.
5. Appearance orange peel in one zone.
6. Redness in one place.
7. Ulcers or crusts may appear in one place. This is especially strong in the nipple area.
8. The tumor can deform the breast, and it becomes different from the second one.
9. The lymph nodes in the armpit are enlarged, dense and painless.
10. One breast may be larger than the other.
11. Pain in one breast outside of menstruation.
12. First, the patient experiences pain in the joint, and later the entire limb swells.
13. If malignant neoplasms are close to the surface, then it is easily visible.
14. Discharge of unpleasant-smelling pus or mucus.
15. In later stages, the temperature rises. Redness of the entire chest.

If the first 12 symptoms can characterize other diseases, then the latter definitely indicate cancer.

NOTE! If there is at least one of the signs, then you should contact a mammologist or oncologist. Yes, the disease itself most often proceeds very slowly and the tumor is not aggressive in initial stages, but there are also cases when cancer developed several months before the final fatal stage.

Variety

First of all, the doctor conducts full examination and finds out what he is dealing with: the size of the tumor, the degree of damage to nearby tissues, the classification of lymph nodes, the level of aggressiveness, the presence of metastases in the blood.

1. Non-invasive— to put it simply, it is a tumor that does not go beyond the boundaries of its tissue and structure. With early surgery, there is a chance to save most of the breast.
2. Invasive“This is a different form that occupies an area of ​​several tissues and structures. More aggressive and dangerous look cancer.
3. Squamous cell breast cancer- usually occurs much more often than adenocorcinoma. Mutation of the squamous epithelium occurs.
4. Adenocarcinoma or glandular cancer mammary gland- reborn from glandular epithelium. Most often found in the lower chest.

Nodular breast cancer

This type is currently the most common in women over 40 years of age. The tumor is initially located in the upper outer quadrants of the chest. Then the cells themselves grow and penetrate into nearby tissues, muscles, fat and even skin.

Nipple cancer

In another way, this pathology is also called Paget's disease. First, the nipple itself becomes denser, and then increases in size. Later, jams and dry crusts appear. In general, the disease itself is very slow and metastasizes late.

Diffuse breast cancer

This type of cancer grows much faster than the previous one, the tissues themselves are more aggressive, due to which the tumor quickly spreads throughout the entire mammary gland. The breasts grow in size and have severe redness and swelling. True, it occurs rarely in 5% of cases in all breast oncology.

Hormone sensitivity

As we said, breast cancer tumors usually have greater sensitivity to female hormones:

1. Estrogen -ER+
2. Progesterone - PgR+
3. Epidermal growth factor HER+

This means that if you reduce the amount of hormones, and also use drugs that reduce the sensitivity of the tumor itself, you can reduce the growth rate of malignant tissues or even slightly reduce the tumor itself.

But there are also types of cancer that begin to develop without hormonal support and do not respond in any way to the amount female hormones in blood. Doctors then have to resort to chemotherapy to shrink the tumor. The therapy itself has more side effects.

In general, the stages of breast cancer are very similar to other malignant formations. Let's take a closer look.

Survey

First of all, you will need to pass the General and biochemical analysis blood and in case of any abnormalities, the doctor may require you to donate blood for tumor markers. But this is done extremely rarely, since usually, if a tumor in the mammary gland is directly suspected, the therapist will already send you for examination to an oncologist and mammologist.

This X-ray examination must be done for all women once a year after 50 years of age, for patients at risk once every six months, especially for those who have the BRCA1 and BRCA2 genes.

Immunohistochemical diagnostics

Doctors are trying to figure out how tumor cells react to female hormones. If breast cancer itself is hormone-dependent, then certain drugs are prescribed that reduce sensitivity and also reduce the amount of estrogen in the blood.

Ultrasound

For older women, this examination is not very suitable, and is usually used in young girls. In the early stages there is a strong error and a chance of not detecting a tumor.

Cytological examination

Using a special device, the doctor takes a tissue sample for examination. Cancer cells have a different structure and based on the study, it is possible to determine how much the tissue differs from normal ones. You can see the aggressiveness and speed of cell growth.

Other studies

It is usually prescribed for later stages of cancer, when metastases occur in other organs, so it is easier for doctors to see the affected area and prescribe a specific type of treatment.

Therapy

Like any treatment for cancer, the disease depends on the stage of breast cancer and the age of the patient. The earlier breast pathology is detected, the easier it is for doctors to treat breast cancer. Therapy is usually aimed at removing the tumor and part mammary gland, or complete removal of the organ. There are quite a few methods of therapy, let's look at everything.

Partial removal surgery

NOTE! The doctor must prescribe additional therapy in the form of radiation in order to kill the remaining cancer cells. When part of a gland or cancer is removed, the healthy halves themselves are stitched together.

Mastectomy

You probably already guessed that this is a complete removal of the mammary gland with lymph nodes.

Irradiation

Radiation therapy is a fairly effective method, after partial removal tumors. The doctor then prescribes radiation therapy to destroy any remaining cancer cells that may later develop into cancer.

Chemotherapy

It is used both before and after surgery. Before surgery, this therapy helps reduce the size and growth rate, and afterward it is used to destroy the remaining lesions.

Hormone therapy

In older women, the ovaries can be removed so that they do not release excess estrogen into the blood, plus blockers are prescribed that reduce the sensitivity of the tumor to the female hormone.

Use: tamoxifen, exemestane, anastrozole, letrozole.

Palliative care

At stage 4, when the tumor has spread to all corners of the body, it is no longer possible to cure the disease, and doctors are faced with the task of improving the patient’s quality of life, reducing pain, intoxication and the impact on organs of the tumor itself. For this purpose, radiation, chemotherapy, narcotic drugs, and painkillers are used.

Treatment of breast cancer at stage 1

Usually a small part of the gland containing the tumor is removed. Since there is no severe damage to nearby tissues, the operation is usually quite successful with few consequences. If the patient is at risk, radiotherapy is additionally prescribed.

Treatment of stage 2 breast cancer

Here, treatment with drugs is added that reduce the growth rate through hormone blockers. Plus there is chemotherapy before and after surgery. The tumor itself and nearby tissues are removed. After the operation, the patient undergoes constant monitoring for relapses.

Treatment of stage 3 breast cancer

Step 1 is chemotherapy, followed by surgery to partially or completely remove the mammary gland. Step 2 - a complex of chemotherapy and radiotherapy is given.

NOTE! Remember - Early detection of cancer leads to a favorable prognosis and easier treatment.

Rules of conduct after surgery

1. After the operation you cannot sleep, so it is better to distract the patient with something.
2. You can get up and walk slowly if possible.
3. Do not touch the bandage or remove it from chest.
4. Be careful with the PVC tube, which carries excess ichor out. It is removed after 8-11 days.
5. If your doctor recommends chemotherapy or radiation, listen to him as this will kill any remaining cancer cells.
6. You cannot swim for 3-4 weeks.
7. The stitches are removed after two weeks.

Postoperative complications

Immediately after surgery

• Bleeding from wounds
• Suppuration
• Lymph secretion
• Limostasis

Late complications

• Poor posture due to removal of 1 breast. For this purpose, exercise therapy and a combination of various exercises that fix this.
• Postmastectomy defect - after one gland is removed, the woman feels uncomfortable. To do this, an internal implant is installed or a special weight is hung, which helps balance the second breast.
• When the nipple and areola are removed, they are usually replaced with similar tissue from the labia or the second nipple. Sometimes the tissues themselves are sewn together and the nipple areola is tattooed.
• Lymphedema of the arm - then the doctor prescribes a series of exercises to reduce swelling and improve blood circulation.

Psychotherapy

After surgery, the woman usually experiences post-mastectomy depression. At the same time, there is a decline in mood, constant blues, sexual problems due to the absence of one breast. During this period, you definitely need to take courses with a psychotherapist who will help you cope with this stage in your life. Later, an implant will need to be inserted so that the woman feels complete.

In men

It may not be strange, but breast cancer can also affect males. The fact is that some have a rudiment in the form of a mammary gland. It's certainly underdeveloped, but it's there. Typically, breast cancer in men occurs due to gynecomastia. This happens with severe obesity, when there is an excess of female hormones or due to some pathologies.

At the same time, the tumor itself grows very quickly and is very aggressive. Mucus and pus may be discharged from the nipple late stages. The treatment of this pathology is very difficult.

Forecast

Carcinoma is detected at stages 2 and 3. The tumor is not aggressive and grows slowly at the very beginning. That is why the survival rate varies from 50 to 70% on average for all cases.

• 1 Degree - 90%
• 2 Degrees – 70%
• 3 Degrees - 35%
• 4 Degrees - 5% of women live another 5 years.

Breast cancer prevention

• Women over 55 years old should see a mammologist every year.

At early detection Breast cancer is successfully treated in 98% of cases. Researchers continue to make impressive progress in diagnosing and treating breast cancer.

However, breast cancer in older adults remains a very common disease, the risks of which will only be minimized if women follow the recommended schedule and get annual mammograms.

Over the past thirty years, the number of new cases of the disease has increased every year, although deaths from breast cancer have decreased slightly. Breast cancer remains the second leading cause of cancer death after lung cancer.

Like all cancers, breast cancer begins with abnormal cell growth. These "bad" cells grow too quickly and spread or metastasize throughout the breast, often entering the lymph nodes located under the armpit or even moving to other parts of the body.

There are several signs of potential breast cancer, including bleeding or nipple retraction; change in breast size or contour; flattening, redness, or pitting of the skin over the breast. The most common sign is a lump on the breast.

If a woman notices hardening of the skin, she should visit a doctor.

Risk factors

Several major risk factors are thought to increase the likelihood of breast cancer. However, it is important to keep in mind that most people with one or more of these risk factors do not have breast cancer.

Main risk factors:

• Age
• Chest trauma in childhood
• Beginning of menarche (first menstruation) before age 12
• Weight gain in adolescence
• Lack of pregnancy or late pregnancy(after 30 years)
• Long-term use of oral contraceptives
• Weight gain after menopause
• Late menopause (after 50 years)
• Increased density breast tissue

Excessive exposure to estrogen, the hormone that promotes female secondary sexual characteristics, is a leading factor in the development of breast cancer. Exposure to a combination of estrogen and progesterone over a four-year period also increases the risk of developing breast cancer. This is especially important because of trends in estrogen therapy to prevent premenopausal syndrome and other diseases. More recent reductions in replacement hormone therapy may have led to a recent small decline in breast cancer cases in women over 50 years of age.

Secondary factors such as smoking, obesity, alcohol, diet and stress are also important. As with reducing the risk of all cancers, it is recommended healthy image life, including a balanced diet, frequent physical exercise and moderate stress.

Genetics can also play a big role in the development of breast cancer. Although less than 10% of breast cancer cases are inherited, women with family history diseases have a much greater risk of breast (and ovarian) cancer.

Breast cancer treatment

Once the cancer is detected, the doctor will determine its stage and publish a report on your disease. This detailed report should include everything from locations and descriptions of each fabric sample to clinical history patient with the disease until modern times.

Treatment for breast cancer varies depending on the stage of the cancer and the number or range of cancer cells. The treatment regimen will also depend on this.

Four traditional methods treatments include:

• Surgery
• Radiation therapy
• Chemotherapy
• Hormone therapy

For more than 100 years, surgery has been considered the mainstay of treatment for breast cancer. Only recently has this approach changed as new first-response techniques have become available and doctors have begun using targeted treatment strategies in many cases. However, surgery remains in an important way treatment.

Lumpectomyis is the least invasive surgical procedure as only the tumor is removed. Lumpectomies are recommended when there is no evidence of cancer spreading to other areas of the breast or body. This is usually followed by five to seven weeks of radiation therapy as a precaution.

There are three levels of mastectomy or breast removal. A total mastectomy results in the complete removal of the breast. A modified radical mastectomy, the most common surgical procedure, involves removal of the breast and supporting lymph nodes. Radical mastectomy, a lengthy and standard procedure that requires removal of the entire breast, axillary lymph nodes and chest wall under the chest. After surgery, doctors examine samples from each tissue group to determine further treatment, although radiation therapy is a common follow-up procedure.

Radiation therapy, the use of intense light rays to kill cancer cells, has a 50-70% chance of reducing recurrence, according to the National Cancer Institute. But most patients realize that radiation not only kills cancer cells, but also healthy cells.

Chemotherapy, which is the use of drugs that kill cancer cells. Chemotherapy quickly attacks cells, both cancerous and healthy cells. Although recent developments have helped reduce the notorious side effects. It is important to note that each chemotherapy treatment regimen is unique and depends on many factors, including the patient's medical history and genetics, current health status, and many other factors.

Hormone therapy, the use of specific hormones that attack cancer cells, is a systematic treatment designed to rid the entire body of cancer. Doctors use special drugs to inhibit estrogen or progesterone from developing breast cancer or, in some cases, turn off ovarian hormone production.

Hormone therapy is usually used when the patient is hormone receptor positive. It can be used to reduce the risk of cancer in women at high risk of cancer, to reduce the risk of recurrence, to shrink a large tumor, or to treat advanced disease.

There is also a recently developed thymimmune targeted treatment regimen that mimics natural antibodies that attack specific characteristics of a cancer cell. Targeted therapy is being added to chemotherapy, although researchers are also developing methods to reduce the intensity of chemotherapy and even potentially eliminate it from the treatment regimen.

Gradually, scientists are developing new methods of treating cancer, and also improving old ones. A combination of high-dose chemotherapy and replacement of destroyed cells with stem cell transplantation is being developed, although the method remains unproven. The use of certain kinase inhibitors, which block signals that are necessary for tumor growth, is also being studied.

Our boarding house will be able to provide you with an annual examination, which will help in diagnosing the early stages of diseases, including breast cancer.

480 rub. | 150 UAH | $7.5 ", MOUSEOFF, FGCOLOR, "#FFFFCC",BGCOLOR, "#393939");" onMouseOut="return nd();"> Dissertation - 480 RUR, delivery 10 minutes, around the clock, seven days a week and holidays

Pynzar Vitaly Alekseevich. Features of the treatment of breast cancer in old and senile age: dissertation... Candidate of Medical Sciences: 14.00.27 / Pynzar Vitaly Alekseevich; [Place of protection: GOUVPO " Russian University Friendship of Peoples"]. - Moscow, 2007. - 0 p.: ill.

Introduction

Chapter 1. Literature Review 9

1.1.Relevance of the problem of breast cancer in older women 9

1 2 Features of cancer in the elderly 10

1 3 Common tactics for treating breast cancer 11

1.4 Types of surgical interventions for breast cancer, their evolution 12

1.5 Non-surgical methods of treatment 18

1 6 Choice of treatment tactics in elderly patients 22

Chapter 2. Materials and methods 30

2 1 Technique of typical surgical interventions performed for cancer

breast 31

2 2 Morphological study of surgical material 38

2.3 Characteristics of the study group of patients 41

Chapter 3. Analysis of the treatment performed and long-term results 50

Chapter 4. Adjuvant treatment of elderly patients, non-renal surgery 95

4.1. Postoperative treatment of patients, treatment algorithm for elderly patients 96

Conclusion 97

References 112

Introduction to the work

Relevance of the topic

Every year, 8 million new cases of malignant neoplasms and more than 5.2 million deaths from them are registered worldwide. In Russia in 2000, 448.6 thousand patients were identified with for the first time in their lives established diagnosis malignant neoplasm.

Life expectancy is increasing in many countries, and along with this the incidence of diseases is increasing malignant tumors elderly people (according to the classification adopted by the WHO European Regional Office (Kyiv, 1963), ages from 60 to 74 years are considered elderly, from 75 to 89 are considered senile, and 90 years and more are considered the age of long-livers). During the period from 1980 to 2000, the incidence increased by almost 70%: from 22.6 to 38.3% 0000.

In Russia, the incidence in age groups after 50 years has increased sharply. At the end of 2004, 408.4 thousand patients with breast cancer were registered, of which 55.1% had been diagnosed for 5 years or more (Davydov M.I., Aksel E.M., 2005).

Breast cancer in Russia ranks third among all causes of death in the female population after diseases of the circulatory system and accidents in all age groups, averaging 2.1%, progressively increasing with age. The total number of deaths from breast cancer increased from 12.5 thousand (1983) to 22.7 thousand (2003), i.e. the increase was 10.2 thousand (85%) (Davydov M.I., Dvoirin V.V., 2005).

Despite the obvious relevance of the problem, until recently, the development of rational methods of treating the elderly has not received sufficient attention. Thus, in international scientific studies, age 65-70 years is often an exclusion criterion. In fact, only recently have special scientific programs appeared on this problem.

As is known, cancer in the elderly has some peculiarities. The health status of such patients differs significantly from patients of other age groups, which is due to the presence of concomitant diseases (Hillen H.F., Maher M.L., Dreyfus H., 2000).

Undoubtedly, there have been certain successes in the combined and complex treatment of breast cancer associated with the introduction into widespread medical practice of new methods of radiation and drug therapy, but surgical intervention continues to play a dominant role, which to this day remains the basis on which all treatment plans are built. events (Ivanov V.M. 1993).

Surgical treatment should always comply with what was formulated in 1960 by A.I. The cancer principle of oncological radicalism, which in case of breast cancer involves the removal of not only the organ with the primary tumor and surrounding tissues, but also wide excision of regional lymph nodes and tissue - the first stage of regional metastasis (Bazhenova A.P., 1983).

The evolution of surgical tactics has led to a gradual refusal of oncologist surgeons to perform mutilating operations of the Urban-Holdin type and a preference for organ- and functional-saving interventions in combination with chemotherapy and radiation therapy (Ivanov V.M., 1993). However, constantly emerging reports of the occurrence of various serious complications after external gamma therapy on the part of organs falling into the irradiation zone (Kudryavtsev D.V. 2001), leads to a constant search for new irradiation techniques and the definition of narrower indications for external radiotherapy (EBRT) to areas of regional metastasis in breast cancer, especially in elderly and senile patients.

Thanks to advances in mammography screening and early diagnosis breast cancer, it has become possible to perform smaller surgical interventions, which is of no small importance in the treatment of cancer in the elderly, allows for rapid rehabilitation of operated patients and improves their quality of life.

The change in surgical tactics towards organ-preserving operations is also associated with the emergence of a biological systemic model of breast cancer by B. Fisher (1977), who showed that this disease at the stage of clinical manifestation is a systemic disease, accompanied by latent dissemination of tumor cells. This hypothesis made it necessary to shift the emphasis when choosing treatment tactics towards systemic therapy (Pak D.D., 2001).

Currently, there are a number of unsolved problems associated with optimizing further treatment of elderly patients who have undergone organ-saving surgery. Radiation therapy carries a certain risk, given the presence of concomitant pathology. Drug therapy can be highly effective, although its use is also problematic in most cases, due to increased risk toxicity of drugs. In old age, the role of hormone therapy becomes more significant, which is determined by the more frequent content of estrogen and progesterone receptors in the tumor. At early stages breast cancer in women over 70 years of age with ER+ and/or PR+ treatment can generally be started with the use of tamoxifen (Tyulyandin S.A., 2003).

In fact, there is no clear algorithm for treatment tactics for breast cancer in older patients. As mentioned earlier, in international scientific studies, the age of patients over 65-70 years is usually an exclusion criterion.

All of the above prompted us to undertake this study of the treatment of breast cancer in patients aged 70 years and older.

Goal of the work

To improve the results of treatment of breast cancer in elderly and senile patients through the development of an algorithm for surgical and complex treatment.

Research objectives

To compare the results of treatment of breast cancer patients over 70 years of age with different volumes surgical intervention.

To determine the effectiveness of postoperative treatment in this age group with and without adjuvant therapy.

To identify the peculiarities of the influence of prognostic factors on the overall and disease-free survival of patients in this age group.

To study stage by stage the three- and five-year survival rate of breast cancer patients included in the study group.

To study the causes of death in elderly and senile patients with breast cancer.

Based on the data obtained, develop the scope of surgical intervention and formulate an algorithm for postoperative treatment of patients aged 70 years and older.

Scientific novelty

The results of treatment of elderly patients with breast cancer were studied using our own clinical material. A comparative assessment of treatment results was made depending on the volume of surgical intervention, and an algorithm for combined and complex treatment of breast cancer in this age group was developed.

Practical value

This study allows us to apply recommendations for choosing the volume of surgical intervention and complex treatment of elderly breast cancer patients; the use of adjuvant endocrine therapy, which leads to optimal treatment tactics for elderly and senile patients with breast cancer.

Main provisions submitted for defense

The optimal scope of surgical intervention for breast cancer in stages 1 is radical resection, for stages III-IV - radical mastectomy with preservation of the pectoral muscles.

The need for additional adjuvant treatment in early stages of breast cancer.

For locally advanced cancer, treatment should be comprehensive, but correspond to the general somatic status of the patient.

For breast cancer in elderly patients, factors with high prognostic significance are: age; criteria: T, N, hormonal status, central tumor location.

Performing an open biopsy of parasternal lymph nodes is important element surgery, allowing for proper staging of the disease and prescribing additional therapy.

If there are positive steroid hormone receptors in the tumor, it is necessary to prescribe hormone therapy in the adjuvant mode.

The mortality structure of patients with breast cancer in old and senile age varies depending on the stage of the disease.

Approbation of work

Approbation of the dissertation took place on November 3, 2006 at an interdepartmental scientific conference with the participation of department staff general surgery, employees of the Road Clinical Hospital named after. ON THE. Semashko JSC Russian Railways, employees of the radiosurgery department of the State Institution RORC named after. N.N. Blokhina.

Publications on the topic of the dissertation

Scope and structure of the dissertation

Features of cancer in the elderly

In terms of detection during preventive examinations in Russia, breast cancer ranks 4th (14.9%) after cervical cancer (22.7%), lip (15.6%), and lung (15.2%). Among patients diagnosed for the first time in their lives, stages I-II account for 56.4%, stage III - 29.6% and stage IV - 12.6%. The overall five-year survival rate for breast cancer patients is radical treatment from 41 to 65%.

In terms of life expectancy, older people without cancer have different prospects. So, according to average indicators (taking into account the average age in the population), people aged 70 years have a chance to live another 14 years, at 80 years old - 7.7 years, and at 85 years old - 5.4 years

The condition of elderly patients with malignant tumors differs significantly from other age groups, which is primarily due to the presence of concomitant diseases. Thus, at the age of 65 years and older, only 8% of patients with malignant tumors do not have concomitant diseases, 37% of patients have approximately 2 diseases, 55% of patients usually have 3 or more concomitant pathologies.

In elderly patients, some distinctive characteristics and the tumor itself. Thus, multiple drug resistance is more often detected, leading to a decrease in the effectiveness of some cytostatic drugs. With increasing age, the tumor loses its ability to undergo physiological death (apoptosis); An increase in the Bc1-2 gene, which prevents apoptosis, was detected. On the other hand, the production of vascular epithelial growth factor and tumor neoangiogenesis decrease with age. ! it can impede tumor growth and metastasis.

1.3 Treatment tactics for breast cancer.

Nowadays, when a large number of options can be used for the treatment of breast cancer (BC), therapeutic techniques, there is no other oncological disease on the treatment of which there would be so many conflicting opinions. The entire variety of therapeutic tactics for breast cancer can be divided into 2 conventional types: local exposure, including surgery and radiation therapy, and systemic effects (chemotherapy, hormone therapy). IN last years additional methods of influencing tumor cell, new antitumor agents are being developed, including immunotherapy. The possibilities of using adaptogens, monoclonal antibodies, neoangiogenesis inhibitors are being studied, and active development is underway genetic engineering. However, at present, surgical treatment is considered the main one. The entire treatment plan is based on surgical intervention with additional therapy.

In the last twenty years, oncologists, both in our country and around the world, have been developing alternative approaches to the treatment of patients with breast cancer, which are based on organ-preserving and functional-sparing operations, as a stage of combined and complex treatment. Such operations become especially relevant when treating patients over 70 years of age. This is due, first of all, to their general somatic condition. It is known that randomized clinical trials conducted in Italy, USA, France and England in the 70-80s. at stages I and II A of breast cancer, showed almost the same effectiveness of organ-preserving treatment in the amount of sectoral resection of the breast with axillary lymphadenectomy and radiation therapy of 60 Gy and Halstead mastectomy. In an Italian study, 10-year disease-free survival of patients was similar with breast-conserving treatment (77%) and Halstead mastectomy (76%).

In the last decade, in-depth study of the biological properties of the tumor and the introduction of effective methods of radiation and chemohormonal therapy have made it possible to begin the widespread use of organ-preserving treatment not only for localized, but also for locally advanced forms of breast cancer.

Non-surgical methods of treatment

From 1998 to 2003 at the clinical sites of the Department of General Surgery, Faculty of Medicine, Moscow State Medical University and in the Department of Radiosurgery of the Russian Oncological Scientific Center named after. N.N. Blokhin Russian Academy of Medical Sciences, more than 300 patients aged 70 years and older received surgical treatment for breast cancer. Our study group included 272 patients who underwent surgical intervention of one kind or another at the first stage of treatment. During the preoperative preparation and examination, a malignant tumor lesion of the mammary gland was cytologically verified in all patients. Taking into account the concomitant somatic pathology, the patients were examined by a therapist and other specialists, and, if necessary, received therapeutic benefits and preoperative preparation. The day before the operation, everyone was examined by an anesthesiologist.

Given that the volume and duration of the surgical intervention are relatively small, general anesthesia is necessary. The likelihood of developing severe, including fatal, complications in such patients is determined not so much by the operation itself as by the invasion and toxicity of anesthesia. Many elderly and senile patients suffer from severe concomitant diseases and syndromes - such as ischemic heart disease, hypertonic disease, severe circulatory failure, atherosclerosis, polytopic arrhythmias, post-infarction cardiosclerosis, condition after stroke, pneumosclerosis and severe forms bronchial asthma, etc. Therefore, due to their advanced age and severe concomitant diseases, they are often denied surgical, and subsequent radiation and chemotherapy treatment. New methods of monitoring and medications for anesthesia, the indications for surgical treatment have been significantly expanded. 2.1 Technique of typical surgical interventions performed for breast cancer.

Anesthetic care. Premedication is important, the dosage of which should be reduced in elderly patients. For antiemetic purposes, dexamethasone (4 mg) and metoclopramide (25 mg) are administered intravenously before anesthesia. To achieve sufficient, and at the same time controlled, anesthesia, it is advisable to use multicomponent combined anesthesia in these patients. The use of a laryngeal mask eliminates the need for tracheal intubation. With minimal invasion, the laryngeal mask provides reliable artificial ventilation and spontaneous breathing. This allows you to avoid depolarizing muscle relaxants. The combination of intravenous and inhalation components using short-acting anesthetics and muscle relaxants (fentanyl, propofol, isoflurane, cisatracurium) allows you to significantly (more than 2 times) reduce their doses and confidently control the depth of anesthesia at various stages of the operation. Of particular note is the property of propofol to rapidly potentiate general anesthesia for a short time, which makes it very convenient for enhancing pain relief at traumatic stages of surgery and at the same time promotes speedy recovery adequate consciousness and independent breathing. The property of propofol to significantly slow down heartbeat usually manifests itself during induction of anesthesia, in most cases it is leveled by slow fractional administration of small doses (10 mg) or the addition of atropine and is not absolute contraindication in patients with initial bradycardia. Anesthesia is maintained using the method of combined neuroleptanalgesia. Breathing is carried out by a ventilator in the ratio N20: 02 - 1: 1. Operation technique. For breast cancer, typical surgical interventions are radical mastectomy with preservation of the pectoral muscles and radical resection of the mammary gland. It should be noted that in the case of radical resection, open biopsy is only possible if the primary tumor is internal or centrally located. The patient's position on the operating table is typical - on her back with her arms outstretched. I. Radical mastectomy.

When performing a mastectomy, two semi-oval incisions are made, bordering the mammary gland in the transverse direction. Rice. 1. View of the surgical field at the beginning of execution radical mastectomy on right. The upper and lower skin flaps are separated for maximum mobility for suturing the surgical wound. Starting from the medial edge, using an electric knife, the mammary gland with fascia is separated from the pectoralis major muscle to the outer edge of the latter. The drug is withdrawn in the lateral direction. The Gerdi fascia is also electrosurgically intersected, after which the axillary vascular bundle. Adipose tissue is isolated from the axillary lymph nodes. Rice. 2 View of the surgical field at the end of the main stage of the operation.

From the outside, the skin flap of the wound is separated to the edge of the latissimus dorsi muscle. The subscapular vessels and nerves are freed from the surrounding tissue. Next, assistants use Farabeuf hooks to lift the edges of the pectoralis major muscle. The interpectoral tissue is highlighted, the pectoralis minor muscle is shifted laterally to facilitate access to the apical group of subclavian lymph nodes In a sharp way All tissue and lymph nodes are removed from the Lisfranc space. Then small and large pectoral muscles retracted upward to remove the lymph nodes of the subclavian region. Small vessels extending from the subclavian vein are coagulated, and the intercostobrachial nerve is transected at the intercostal muscle. The long thoracic nerve is freed from tissue and preserved. Thus, the mammary gland is removed in a single block with the interpectoral, clavicular, axillary and subscapular lymph nodes.

Characteristics of the study group of patients

In 132 cases, surgical intervention was supplemented by open biopsy of parasternal lymph nodes on the side of the affected breast according to a previously described technique. Metastatic lesions of the parasternal lymph nodes, which corresponds to the pN3b criterion, were detected and histologically confirmed only in patients with metastases to the axillary lymph nodes (9 out of 67). In 65 patients, in the absence of metastatic lesions of the axillary lymph nodes, the presence of metastases in the parasternal lymph nodes was not detected.

Patients with the pN3b criterion were distributed in relation to the pT criterion and the number of axillary lymph nodes (criteria N2a, N3a) as follows: T1N1 - 1 case, T2N1 - 3 cases, T2N3a - 1 observation, T3N1 - 2 observations, T3N2a - 1 case, T4N2a - 1 case. According to the location of the primary tumor in the mammary gland, these 9 cases were distributed as follows: in 5 patients the tumor was located in the outer quadrants, in 2 patients it was located in the central quadrant, and in another 2 cases the tumor was located in the inner quadrants.

An interesting observation is that from this distribution it can be seen that in our sample the frequency of metastases in the parasternal zone is in no way related to the number of identified affected axillary lymph nodes.

The influence of open biopsy of the parasternal lymph nodes on the side of the affected breast on the decision on further treatment tactics is visible even in our relatively small sample of patients. In the above-described 9 cases, when metastatic lesions of the parasternal lymph nodes were detected, the stages of the disease in the patients were corrected and appropriate additional treatment was prescribed, taking into account the pN3b indicator, the localization of the primary tumor in the mammary gland, namely: postoperative radiotherapy to areas of regional metastasis was supplemented with a field on area of ​​the parasternal chain. This manipulation turned out to be especially important for those 5 patients whose tumor was located in the outer quadrants, since when the tumor is localized in the central or inner quadrant, DLT is also performed on the parasternal zone, but when the primary tumor is externally localized, it is not. In our case, by performing an open biopsy, we proved the need for postoperative external beam radiation therapy to the parasternal area in these 5 cases.

Thus, when prescribing EBRT, when no metastases were detected in regional lymph nodes, we took into account the pT value, and if they were present, it was the pN indicator that served as the basis for prescribing postoperative EBRT.

To further determine the long-term results of treatment (survival period, recurrence), the observed patients (with the exception of 3 cases of Paget's cancer) were divided into two main groups: the first group of patients after mastectomy, the second group - after radical resection. Within each group, each group was divided according to the presence or absence of metastatic lesions of the axillary lymph nodes.

It should be noted that patients with the pT1-2 primary tumor criterion in the groups with positive and negative axillary lymph nodes underwent both radical resections and mastectomies, and in the presence of pT 3-4 criteria, exclusively radical mastectomies were performed.

According to the purpose of postoperative radiotherapy, the patients were distributed as follows: radiation therapy was performed for metastatically affected axillary lymph nodes in the case of mastectomy - in 7 cases, in case of radical resection - in 21 cases. Prescription of radiotherapy for unaffected axillary lymph nodes after radical mastectomy was not carried out in pT1-2 and in 4 cases was prescribed in pT4 (these cases were included in the group of patients with criterion pT3-4), and in case of radical resection, postoperative external beam radiation therapy was prescribed in 39 cases (Table 15). The distribution of postoperative external beam radiation therapy (EBRT) for various volumes of breast surgery in the presence or absence of metastatic lesions of regional lymph nodes is presented in Table 15.

Postoperative treatment of patients, treatment algorithm for elderly patients

When analyzing the data in the table, it is revealed that in stage I, chemotherapy treatment was not prescribed at all, in 61% of cases hormone therapy was performed, and in 39% the patients did not receive systemic therapy. In stage II, hormonal treatment was prescribed at approximately the same frequency: in 57.4% of cases, no systemic therapy was carried out in 38% of cases, but PCT was already prescribed in 4.7% of cases. In stage III of the disease, hormone therapy was most often used in 54.2% of cases, chemotherapy treatment becomes significant and is prescribed in 27.1% of cases, and only 18.6% of patients were left without systemic therapy. Thus, hormone therapy was most often used for all stages of the disease in this group of patients. Chemotherapy treatment is used more often the higher the stage of the disease. As the stage of the disease increases, the number of patients who have the opportunity to do without systemic therapy decreases.

The most important criterion characterizing the correctness of the treatment is the overall and disease-free survival rates achieved during this therapy (Tables 39 and 40).

When analyzing overall survival, depending on the systemic therapy performed, it is revealed that in stages I and II of breast cancer, systemic therapy did not have a statistically significant effect (p 0.2) on the results of 3- and 5-year overall survival. When analyzing overall survival for PT stage cancer, there is a statistically significant (p=0.009) difference in 3- and 5-year overall survival rates between a group of 11 patients who did not receive additional systemic therapy: 27.3±13.4 and 9.1 ±8.7, respectively, compared with 3- and 5-year survival rates in a group of 32 patients with hormone therapy: 66.3 ± 8.8 and 47.6 ± 10.2, respectively.

And when comparing 3- and 5-year survival rates in a group of 11 patients without systemic therapy with a group of 16 patients who received chemotherapy treatment, there is a statistically insignificant (p = 0.298), but noticeable decrease in 3- and 5-year survival rates overall survival in patients without systemic therapy was 27.3±13.4 and 9.1±8.7, respectively, than in patients who underwent PCT - 43.8±12.4 and 26.3±12.1, respectively.

When analyzing relapse-free survival data stage by stage, depending on the systemic therapy performed, it is revealed that for all stages of breast cancer we studied, systemic therapy did not have a statistically significant effect (all p 0.2) on the results of 3- and 5- summer disease-free survival.

Conclusion: Systemic therapy carried out in the postoperative period does not have a statistically significant effect on the rates of 3- and 5-year overall and relapse-free survival in the study group of patients at stages I and II. However, refusal to carry out systemic therapy for stage 111 breast cancer has a statistically significant effect (p = 0.009) on overall survival and leads to a significant decrease in survival rates. When systemic therapy was abandoned at stage III, the three- and five-year overall survival rates were 27.3 + 13.4 and 9.1 + 8.7, respectively, compared with the 3- and 5-year overall survival rates in the group of patients who hormone therapy was carried out in 66.3±8.8 and 47.6±10.2, respectively.

In the postoperative period, a complex of therapeutic measures is used, including: systemic therapy, and local effects. The distribution of treatments is presented in Table 41.

After the surgical treatment, in most cases (41.5%), patients received exclusively hormone therapy, no additional treatment 26% of patients did not receive it. In terms of combined treatment (surgery + radiotherapy), radiation therapy was used in 7.9% of patients; Chemotherapy as monotherapy was used in 3% of patients. Combined treatment (surgery+EBRT+CT) was received by 1.1% of patients. A combination of EBRT + hormone therapy was used in 16.2% of cases, and systemic treatment in the form of chemotherapy followed by hormone therapy was used in 3% of cases. A full range of treatments, including postoperative radiation therapy. Chemotherapy treatment with further prescription of hormone therapy was used in 1.1% of cases. When analyzing the same treatment, but gradually, the following trends are noted: for all the stages described, the leading method is hormone therapy (on average in 40-43% of cases), combined method treatment (surgery + EBRT) is used in the case of radical resections (stages 1-1) on average in 10.2% of cases. The combination of EBRT + hormone therapy is applicable most often and at all stages (16.2%). Chemotherapy, both as an independent type of treatment and in combination with other types of treatment, is used more often, the higher the stage of the disease. Refusal to carry out any additional treatment was possible in stages I-II only in 28.2% of cases, while in stage III of the disease this was possible much less frequently, only in 18.6% of cases.

Breast cancer surgery in elderly patients: postoperative complications and survival
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3851160/

Old age is associated with comorbidity and decline in performance, which influences treatment decisions in older breast cancer patients. The purpose of this study was to identify risk factors for complications after breast cancer surgery in elderly patients and to assess mortality in patients with postoperative complications.

We retrospectively reviewed all women aged 65 years and older with invasive and in situ breast cancer who were diagnosed and treated between 1997 and 2012 at the Department of General and Geriatric Surgery of the University of Naples “Federico II”.

449 patients received surgery, of whom 18.2% (n = 82) developed one or more postoperative complications. The odds ratio for the presence of postoperative complications increases with age, reaching statistical significance only for patients older than 85 years. Therefore, these factors may influence treatment decisions in older patients with breast cancer. Previous studies have shown that older patients with breast cancer receive less aggressive treatment and have higher mortality from the disease, even though 65% of breast cancer patients over 75 years of age die from causes other than breast cancer.

The most recent guidelines from the International Society of Geriatric Oncology and the European Society of Specialists in Breast Cancer (EUSOMA) advise breast-conserving surgery with whole-body radiation therapy or mastectomy followed by postoperative radiation therapy in selected patients as standard treatment for patients with older cancers. However, in National Councils The Comprehensive Cancer Network indicates that omission of radiation therapy may be considered in patients over 70 years of age with stage I estrogen receptor-resistant breast cancer who undergo negative margin lumpectomy and receive endocrine therapy. This shows that there is still no consensus on how to treat patients with older breast cancer. Additionally, older patients are often not treated as recommended. Comorbid conditions and frailty, in addition to age, patient, and physician preference, are important reasons for deviation from recommendations. Additionally, treatment strategies for older breast cancer patients are largely not evidence-based, as older adults are often excluded from clinical trials due to age restrictions or comorbidity.

Breast surgery is generally regarded as a low morbidity procedure. However, various complications can arise with serious consequences. For example, surgical site infections can lead to increased morbidity, additional costs, and delays in postoperative adjuvant therapies.

In order to develop evidence-based guidelines for individualized care of breast cancer in older adults, it is important to investigate the occurrence of surgical complications in this specific group. There have been only a few studies examining postoperative complications in older patients with breast cancer, often with limited numbers of patients. Therefore, the purpose of this study was to identify risk factors for postoperative complications in older patients with breast cancer and to evaluate overall survival in patients with postoperative complications compared with patients without postoperative complications.

We reviewed all consecutive female patients aged 65 years or older with invasive and in situ breast cancer who were diagnosed and treated between 1997 and 2012 at the Department of General and Geriatric Surgery of the University of Naples “Federico II”.

We reviewed the charts of these patients and collected information on specific treatments, comorbidities, adverse events, geriatric parameters, body mass index (BMI), smoking, and mortality.

For this study, all patients with stage I-IV cancer breast and in situ of all histological subtypes that were treated with breast conserving surgery or mastectomy. If patients received breast-conserving surgery (BCS) followed by a mastectomy, the most extensive surgery was used for analyses. Stage was described using the pathologic tumor-node-metastasis (TNM) classification, which was valid in the year of diagnosis. If pathological stage was not available, clinical stage was used. Axillary surgery was defined as a sentinel node procedure or axillary lymph node dissection. Again, the most extensive axillary surgery was used for analysis.

To compare different age groups, patients were divided into five groups: 65-69, 70-74, 75-79, 80-84 and 85 years and older.

The number of comorbidities was classified into four groups: no comorbidity, 1 comorbidity, 2 comorbidities, and 3 or more comorbidities. BMI was analyzed in three groups: 25.

In case of missing data, patients were not excluded from the analysis but were analyzed in a separate group (unknown).

Possible postoperative complications were wound infections(including abscesses), bleeding, hematoma, seroma, anemia, cardiovascular complications, thromboembolic and other complications. The primary outcome was defined as the presence of one or more of these complications.

All statistical analyzes were two-sided. A p value less than 0.05 was considered significant.

The following risk factors for at least one postoperative complication were assessed in univariate logistic regression models: age (in 5-year groups), TNM stage, most extensive surgery, most extensive axillary operation, number of comorbidities (5 or more types of medications per day), neoadjuvant treatment, BMI, and smoking during surgery.

A total of 449 patients aged 65 years or older with invasive and in situ breast cancer underwent BCS or mastectomy and were included for analysis. Patient characteristics are shown in Table 1.

Patient characteristics.

Most patients (72%) received mastectomy. The majority of patients (74.8%) had at least one concomitant disease. Few patients (3.0%) received neoadjuvant treatment. 21% of patients used 5 or more types of medications per day. BMI values ​​were missing for 224 patients (49.8%), and smoking status was missing for 142 patients (31.6%). Median follow-up was 7.5 years (range 0.01 -15.0).

Overall, 18.2% of patients developed 1 or more postoperative complications (Table 2). Most frequent complications were seroma (n = 21) and wound infection (n = 17).

Complications in different age groups.

As shown in Table 3, the odds ratio (OR) for developing a postoperative complication increased with age (OR for patients aged >85 years was 5.75 (95% confidence interval 2.38–14.04, p

Association between patient, tumor characteristics, treatment and occurrence of postoperative complications.

More high number comorbidities were associated with a higher risk of postoperative complications (patients without comorbidity performed as controls, OR 1.67 (95% CI 0.74-3.80), 1.79 (95% CI 0.80-4.07 ) and 2.51 (95% CI 1.17–5.45; p = 0.01) in patients with 1, 2, and 3 or more comorbidities, respectively).

Similarly, polypharmacy was strongly associated with the risk of complications (OR 16.7 (95% CI 9.12-30.58), p

In addition, patients treated with mastectomy and patients treated with axillary lymph node dissection had more complications than patients treated with breast-conserving surgery and less extensive axillary surgery.

Smoking increased the odds of developing complications with an OR of 2.75 (95% CI 1.14–6.54, p

There was no significant association between BMI and postoperative complications.

Overall survival was worse in patients with postoperative complications.

Regarding the influence of comorbidity on the development of postoperative complications, Houterman et al. concluded from an observational study that comorbidities and age do not influence the occurrence of complications after treatment. The study included only 154 patients aged 70 years or older and examined complications of all treatments in the first year after diagnosis. In addition, patients who did not receive surgery were included in this study. Therefore, this study differs significantly from the current study, which may explain the differences in outcome. Another study by Janssen-Heijnen et al. also found no association between comorbidities and postoperative complications. Again, this study included only 490 breast cancer patients, of whom only 192 were over 65 years of age. Because the impact of comorbidities is highest in older adults, this may explain the differences in the current study.

A recent Danish study found that higher age and mastectomy increase the risk of reoperation due to bleeding in breast cancer surgery. These results were confirmed in the current study.

Another study found that BMI >25, diabetes, and smoking were predictors of wound complications. In the current study, BMI was not associated with the risk of postoperative complications, which may be explained by missing values ​​in approximately 50% of patients because recording of BMI in the chart may be missing by chance.

Because older patients are rarely included in clinical trials, large cohort studies have great importance in this population. These studies are in a good way studying complications of treatment, since the data are objective and studies usually contain more patients.

This study also has some limitations. Due to retrospective data collection, there may have been an underestimation of the number of complications. However, in these data, 18.2% of patients developed at least one complication, and this is even higher than a recent study in a large US cohort that reported a 30-day incidence for all breast cancer procedures of 5.6%. The most common complications were wound infections. Therefore, these data appear to accurately reflect general practice and are consistent with previous studies.

A meta-analysis confirmed that hormonal treatment as monotherapy is inferior to surgery (with or without hormonal treatment) for local control and progression-free survival of breast cancer in healthy women older age.

However, in Italy, older patients receive fewer surgeries and more hormonal therapy as monotherapy than younger patients, even at lower stages of the disease.

This suggests that patients may receive treatment due to fear of morbidity and mortality in breast cancer surgery. Although older patients with comorbidities have a higher risk of postoperative complications, the relative mortality in this group was not higher and therefore suggests that avoidance of surgery due to fear of treatment-related mortality is warranted only in vulnerable older patients. The question remains as to how to define this particular group. Therefore, future prospective studies are needed to identify patients at risk for postoperative complications and to develop specialized care for older patients with breast cancer.

N.R, C.R: concept and design, interpretation of data, subject to final approval of the version to be published.

G.P, G.R, R.C, M.D: acquisition of data, drafting of manuscript, final approval of version to be published

A.A, B.A: critical revision, interpretation of data, subject to final approval of version to be published

NR: PhD in thoracic surgery at the University of Milan.

CR: Specialist in General Surgery, Cardinale Asscalesi Hospital in Naples.

GP: Resident in Geriatrics at the University Federico II of Naples.

GR: Resident in Cardiology at the University Federico II of Naples.

R.C.: Doctorate in Surgery from the University Federico II of Naples.

MD: General Professor of Surgery at the University “Federico II” of Naples.

A.A.: Specialist in General Surgery, University Federico II of Naples.

Postoperative complications after coronary artery bypass surgery in patients with chronic...

Breast cancer is an insidious disease that may not manifest itself for a long time. Women usually learn about it in the later stages of development. Breast cancer in advanced forms is rarely treatable and causes death. Every year, about 1.5 million new cases of malignant pathology and 400 thousand deaths are recorded.

Over time, the neoplasm grows depending on the individual characteristics of the patient - some may live 10 years, while others may not even have a year.

Reliable reasons influencing the rate of development of the tumor process have not yet been identified. However, there are a number of circumstances that provoke pathology.

Reasons for the development of the disease

According to statistics, most often the disease affects women who have noticed problems:

Some negative factors help accelerate the development of the disease:

• the patient is in an area with increased radiation;
• smoking;
• abuse of food containing chemical dyes and preservatives;
• eating fatty and high-calorie foods.

Dysfunction thyroid gland, ovaries and adrenal glands also increase the likelihood of developing a malignant tumor.

Factors that provoke the disease affect the likelihood of its occurrence and the speed of spread, but are not the causes of the pathology itself. Most women have several factors that predispose them to the appearance of a tumor, but these ladies may never encounter the disease. And in patients who do not have a predisposition to cancer pathologies, doctors detect malignant tumors.

Despite this, everyone needs to know about predisposing factors.

1. Age. The older the patient, the higher the risk of pathology: 65% of all cases of the disease were diagnosed in women whose age exceeded 55 years.
2. Heredity. A malignant node in 10% of cases appears due to a mutation process in genes. The most well-known types of mutations are BRCA1 and BRCA2. Their presence indicates that the risk of breast cancer is 50%. Changes in genes are associated with an unfavorable family history - if close relatives on the maternal side were identified cancer, then for the patient the risk of encountering the disease increases by 2 times.
3. Benign breast pathologies.
4. Insufficient or excessive levels of hormones in the female body. The more estrogen in a patient’s blood, the higher the risk of cancer. In addition, hormones can accelerate the proliferation of already existing abnormal cells.

Some factors that accelerate the inflammatory process are associated with the lifestyle of the fair sex:

There are a number of factors that do not in any way affect the likelihood of pathology, despite numerous discussions: the use of antiperspirants, wearing push-up underwear, silicone implants, medical abortions.

Development of the disease depending on the stage

How successful will undergo treatment the disease depends on the degree of its neglect. There are 5 stages of breast cancer development.

How does the disease progress?

Cancer cells can develop anywhere in the breast. In this case, the probability of damage to the left and right breast is the same. In some cases, the breasts are affected on both sides (2.5% of all diseases). A pathological neoplasm in the initial stages may look like a single tumor (stage 1 disease) or a node with metastases, which already corresponds to stage 2 cancer.

In 50% of cases, the tumor appears in the upper outer quadrant of the breast, in in rare cases at the extreme points adjacent to the armpits. But the patient feels obvious symptoms of the disease only when later stages its development. More often clinical picture It is represented by dense, painless nodules on palpation, concentrated in the chest area.

The tumor becomes motionless when the inflammatory process reaches the chest wall. If the lesion has spread only to the upper layers of the skin, the tumor will become deformed. At the same time, irregularities are noticeable on the surface of the epidermis, the nipple lengthens or, on the contrary, retracts.

Symptoms of late stages of the disease include:

• discharge from the nipple containing blood;
• pain if the pathology has spread to the lymph nodes.

Pain from stage 3 – 4 breast cancer can be acute, piercing or constant.

Tumor development depending on the type of disease

The clinical picture depends on the form of breast cancer.

The disease can occur in a special form called Paget's cancer, in which tumor process captures the nipples themselves and their areolas. At the beginning of the pathology, peeling of the nipples occurs, and then they begin to get wet. For this reason, the disease is often confused with eczema of the mammary glands. Then characteristic nodules form in the tissues, and metastasis spreads to the axillary lymph nodes. The pathology can develop over a long period of time, so patients with Paget's cancer live for several decades, unaware of health problems.

The course of cancer depends not only on its forms, but also on other external factors - the woman’s age and her hormonal state. Many girls who are faced with cancer during pregnancy and lactation note its rapid progression and early metastasis.

In elderly patients, the tumor process can develop for 8-10 years without a predisposition to deterioration.

In order to start treatment on time, you should pay attention to the early symptoms accompanying the pathology:

In the initial stages of cancer development, the resulting tumor is mobile and small in size. When pressed, the seal moves quickly from side to side. As the disease progresses, the mobility of the neoplasm decreases as it penetrates into the deeper layers of the dermis.

Survival prognosis and possible relapses

About a third of all breast cancer cases result in death. How many years can a woman with breast cancer live? This depends on the rate of progression of the disease. With the rapid spread of abnormal cells death may come after a year.

50% of all patients learn about cancer at stages 2-3. Upon receipt timely treatment, most patients live more than 5 years. The favorable prognosis depends not only on individual indications and external factors, but also on the stage of development of the pathology:

Several years after successful treatment, re-inflammation may occur. Cancer cells appear in the same place or distant tissues. Relapse occurs because even the most modern methods of therapy are unable to overcome all abnormal cells. With the blood flow, they enter nearby areas of the skin and gradually progress there.

In case of relapse, skeletal bones, liver, abdomen, lungs. Recurrence of the disease can be assumed if:

Recurrence of the tumor can occur at any time. But according to statistics, relapse most often occurs in the first 3-5 years after the end of the first course of therapy.

Disease prevention

To prevent the cancer process and its relapses, only an annual examination will not be enough. It is important to follow preventive recommendations.

1. Lead a healthy lifestyle– refuse abortions and the birth of more than 3 children, normalize body weight, give preference breastfeeding, avoid stress, engage in active sports.

Check yourself regularly. Experts advise checking the condition of the mammary glands yourself by palpation. This should be done for every patient over 20 years of age, 3–5 days after the end of menstruation.

Self-examination is carried out as follows: a woman undresses to the waist and stands in front of a mirror, paying attention to the shape of her breasts. Then turning in profile, the lady examines each of the mammary glands more carefully. At the end of the procedure, she must palpate each breast in order to find lumps. The left mammary gland is palpated right hand and vice versa.

2. Stick to a diet. It has been scientifically proven that eating certain foods reduces the likelihood of pathology:

   • green tea;
   • carrot;
   • blueberry;
   • apples;
   • cabbage;
   • broccoli;
   • tomatoes;
   • chilli.

Prevention is necessary for all representatives of the fair sex, regardless of age. Both girls and older women should reconsider their habits and lifestyle in order to ensure a healthy future.