Breast cancer( breast cancer) - Causes, symptoms and treatment. MF.

Breast cancer is a malignant tumor that originates from the breast tissue, characterized by quite aggressive growth and the ability to actively metastasize.

Causes of breast cancer

The causes of breast cancer are most often hormonal changes in the body: entry into menopause, when the hormonal regulation of the woman's organism is actively restructuring, the ovaries lose their activity, the production of progesterone and estrogens decreases, the body experiences a "hormonal crisis".The mammary gland and endometrium( the uterus of the uterus) most react to these changes, the breast tissue begins to dissolve and be replaced by fat. It is scientifically established that female sex hormones-estrogens, belongs to the leading role in the development of breast cancer. Excess sex hormones in the body creates a favorable background for the development of the disease. The least active hormones estrogens behave during pregnancy and after childbirth - during lactation. It is proved that childbirth and prolonged breastfeeding( more than 1 year) reduce the risk of developing breast cancer. On the other hand, abortion leads to hormonal "explosion" in the body of a woman, which can provoke the development of tumors. Until now, there is no consensus on the impact on the development of tumors taking hormonal contraceptive drugs, but it is believed that these drugs reduce the risk of developing breast cancer, but increase the risk of developing cancers of female genital organs and osteoporosis. In addition, predisposition to the development of breast cancer can cause harmful environmental factors: ecology, as well as previous inflammatory diseases of the breast - mastitis.

In addition, in patients with family members of the closest relatives who have breast cancer( mothers and sisters), the risk of getting the same tumor grows more than twice - family forms of cancer. Benign breast diseases such as fibrocystic mastopathy, fibroadeniasis, or intraprostatic papillomatosis do not in themselves lead to cancer, but at the same time create an unfavorable background for its development.

The cause of development of breast tumors may be radiation exposure, for example, chest irradiation for other diseases( lung tumors, lymphatic system), prolonged and frequent chest X-ray for inflammatory diseases or pulmonary tuberculosis.

Constitutional obesity can lead to the development of breast cancer and the female reproductive system, with an excess of fat tissue in the body, it becomes an independent endocrine organ and begins to actively develop hormone estrogens, the effect of which provokes the development of tumors.

Symptoms of breast cancer

There are several forms of growth of breast cancer:

- the nodular form, the most frequent, characterized by the presence of a dense nodule from 0.5 to 5 or more cm, it is characterized by all of the following features;

- diffuse: pseudo-inflammatory( mastitis-like), rozhistopodobnaya and armored forms. All of them are extremely aggressive, grow very fast, almost instantly, the tumor does not have clear boundaries, it "creeps" over the mammary gland and skin. For the first two forms, signs of an inflammatory reaction are characteristic: breast tenderness, bright red skin color, body temperature rises up to 39 degrees C. In view of these symptoms, diagnostic errors often occur and patients are treated for inflammatory diseases, by whose names the form data are namedbreast cancer. When carcinoma cancer, the tumor covers the mammary gland as a "crust" pulling it together and reducing it in size.

In some cases, breast cancer manifests as metastases in the lymph nodes on the side of the lesion, and often it is not possible to detect the tumor itself - they speak of concealed breast cancer.

With small tumors of the breast, no symptoms appear. The most attentive women or their husbands can detect a tumor node in the gland by chance, but in a large mammary gland it is difficult to detect a knot of small dimensions. The revealed nodule can be painful when pressed, round, even and moving, this speaks for a benign tumor. Symptoms of tumor malignancy are different: the knot is dense as a stone, its surface is uneven, it is immovable or slightly shifted, it can be tightly fixed to the surrounding tissue or skin, often painless, can reach considerable dimensions( more than 3-5 cm, sometimes 10-15cm).

It is necessary to evaluate the surface of the skin above the tumor: in the malignant process, skin retention, wrinkling, wrinkles, a lemon peel symptom - a local swelling of the skin above the tumor, can be direct growth of the tumor to the skin surface, then it acquires a bright red colorand sprouting in the form of "cauliflower".

Skin contraction in breast cancer

The superficial component of the tumor can bleed and become inflamed.

In addition, you should evaluate the condition of the axillary lymph nodes: they can be slightly enlarged, mobile and painless - this should not be feared, but if the nodes are defined as large and dense, and sometimes merging with each other - this indicates their metastatic damage.

Sometimes there may be swelling of the arm on the side of the tumor - this is a bad sign, it speaks of a far-reaching stage and occurs with metastases in the axillary lymph nodes - there is blockage of the outflow of blood and lymph fluid from the upper limb, lymphostasis occurs.

Swelling of the arm on the side of the breast tumor

As can be seen from the above, it is necessary to begin treatment immediately after the detection of the tumor, and it is very important to detect pathological changes as early as possible, self-examination techniques will help.

Breast self-examination

Why self-examination?

It is very important to carry out the techniques of self-examination for the purpose of revealing pathological tumors at an early stage, as it is not always possible to go to a medical institution. The more often you examine the mammary gland, the faster you will notice the appearance of changes in it.

How is self-examination carried out correctly?

The method of self-examination of the mammary glands consists in the following: first you need to evaluate the visual changes in the organ - we stand in front of the mirror and compare the symmetry in size, skin color, the contours of the mammary glands, the color and size of the nipples. The next moment is a feeling: alternately, with both hands, we squeeze the mammary glands from top to bottom on each side, after which we pay attention to the axillary cavities. If you find any changes - soreness, tumors, nodules, skin retraction and so on, you should immediately consult a doctor. It is desirable to conduct self-examination at least once a month.

Breast examination

If you have a tumor in the breast, the first step is to perform a mammogram( x-ray study of the breast), for patients under 45, an alternative to mammography is ultrasound. This study allows to reveal minimal changes in the gland tissue, to characterize them as benign or malignant for certain radiographic signs.

The next step in detecting a tumor pathology is, a tumor biopsy - taking a small piece of a thin needle for examination under a microscope. After that, it is possible to judge more reliably the nature of the tumor, but an exhaustive answer is possible only after removal of the tumor node.

In some cases, it is necessary to take a doktografiya( from the Latin "duktus" - a duct) - an x-ray of the breast with the preliminary introduction of radiopaque substance into the ducts. This study is used to identify intra-flow papilloma - a benign tumor of the milk ducts, which is manifested by bloody discharge from the nipple and degenerates into cancer.

If the cancer is suspected or with confirmed( radiologically and biopsy-related) breast cancer, the following minimum research is performed: ultrasound examination of the axillary lymph nodes to detect metastases in them;X-ray examination of the chest and ultrasound examination of the abdominal cavity in order to exclude the presence of distant metastases in other organs.

In some cases, so-called oncomarkers are used - a blood test for proteins produced only by a tumor and absent in a healthy body. For breast cancer, it is Ca 15.3, it has low diagnostic value and is used routinely in treated patients to detect metastasis at the earliest possible date.

Another new mass study was the analysis of tumor on the receptors for hormones - estrogen and progesterone( ER, PR).Patients with positive sample results are subject to additional treatment - antihormonal.

Recently studied a new receptor-oncomarker: Her2neu, its presence in tumor tissue is a very bad sign and indicates its high aggressiveness.

In case of detection of pathological formations of the mammary glands, you should immediately consult a doctor, this may be a gynecologist or surgeon, but if possible, it is better to consult an oncologist.

It is very important that all women after 50 years of age( or at the onset of menopause) need to perform an annual mammogram to detect cancer at an early stage.

Video for diagnosing breast diseases

Treatment of breast cancer

The most important in the treatment of breast cancer is certainly the surgical method - removal of a tumor-affected organ. Any other treatment gives a supportive, temporary effect.

Different variants of the operation are possible:

- removal of the entire breast with fatty tissue and lymph nodes of the axillary region from the same side( most preferably);
- removal of a site of a mammary gland with a tumor and lymphonoduses of an axillary area from the same party or side, with the subsequent radial therapy on a zone of operation;
- removal of the mammary gland, pectoral muscles, vessels, and in some cases, ribs - at large sizes and prevalence of the tumor.

Often, the operation is supplemented with some special anti-tumor treatment:

- in the absence of metastases, a maintenance treatment - anti-hormonal drug( tamoxifen) is used for 5 years, in order to prevent the return of the disease and the appearance of metastases.
- in the presence of confirmed metastases in the axillary lymph nodes, the use of radiation and chemotherapy is mandatory. Radiation treatment is the irradiation on a special device in a small dose daily for 1 month. Chemotherapy - intravenous administration of chemotherapy.
- in detecting metastases in other organs( liver, lungs, bones, etc.), it is mandatory to use chemotherapy, designed to reduce the size of metastases or completely destroy them.

Metastases are cuttings from the main tumor, having its structure and capable of growing, disrupting the function of those organs where they develop. The appearance of metastases is associated with the regular growth of the tumor: the tissue grows quickly, the nutrition does not suffice for all its elements, some cells lose contact with the rest, it breaks away from the tumor and enters the blood vessels, spreads through the body and enters the organs with a shallow and developed vascular network, lungs, brain, bones), settles in them from the bloodstream and begins to grow, forming colonies - metastases. In some cases, metastases can reach huge sizes( more than 10 cm) and lead to the death of patients from poisoning with the products of the tumor's vital activity and disruption of the organ's functioning.

Breast cancer most often metastasizes to nearby lymph nodes - axillary and retrosternal depending on the location of the tumor;from distant organs, the first place in terms of the frequency of damage is the bones( most often - pelvic bones and spine), but any can be affected;in the lungs and pleura( cover lining of the lungs), in the liver, brain, ovaries, skin and other organs. If metastases are single, it is possible to remove them - this gives a better chance of recovery. If they are multiple, only maintenance chemotherapy is possible. Great problems are brought to the patients pleurisy - metastatic damage to the lining of the lungs, which leads to a violation of its permeability and accumulation of fluid in the lung cavity, leading to compression of the organs - lungs, heart, and causing dyspnea, heaviness in the chest and exhaustion of patients.

Treatment of breast cancer in Assuta

The Israeli private clinic "Assuta" offers treatment for breast cancer using all the modern developments of Western medicine. First of all, these are organ-preserving surgeries that allow the breast to be preserved with complete removal of the tumor "with clean edges".At advanced stages of the disease, a mastectomy with simultaneous plastic surgery for breast reconstruction can be performed. The operation is performed by the leading Israeli surgeon Professor ShlomoShinebaum. Patients of the clinic are also diagnosed and treated by the famous Israeli oncologist - Professor MosheInbar.
"Assuta" is equipped with the latest equipment, such as the TrueBeam system, which reduces the duration and number of radiotherapy sessions for breast cancer. Such equipment allows to avoid damage to healthy tissues when the tumor is irradiated.

Get the treatment program and the exact price for breast cancer treatment in the Israeli Assuta clinic & gt; & gt;

Complications of breast cancer

Complications of breast tumors can be: bleeding from large tumors, inflammation of the tumor and surrounding tissues, complications associated with metastasis: pathological( in the metastasis zone) bone fractures, pleurisy with rapid fluid accumulation and shortness of breath, dyspnea at multiplemetastases to the lungs, hepatic insufficiency with multiple metastases to the liver and others.

Complications associated with the operation can be the following: inflammation in the area of ​​a postoperative wound, prolonged lymphorrhea( lymph flow - the light part of the blood), associated with the removal of the axillary lymph nodes and tightening the healing of the postoperative wound;lymphatic edema of the hand, associated with an outflow disturbance due to the removal of a large number of nodes and slowing the flow of lymph fluid.

And of course it should be said that without treatment, patients suffering from breast cancer die very quickly within 1-2 years from the time of detection of the tumor. It is always more effective to fight with a small, initial tumor than with a tumor that has metastasized.

Treatment with folk remedies in this case is unacceptable: you can not apply any lotions, decoctions or tinctures, in some cases they can accelerate the growth of the tumor.

The very period of treatment for breast cancer can range from several weeks( under the condition of surgery) to several years( in the case of maintenance chemotherapy).After the treatment, it is possible to wear a prosthesis after removing the sutures and healing the wound or reconstructing the breast( plastic surgery).It is not recommended to sunbathe, any physical exercises, hot baths, baths and saunas are categorically contraindicated, as they provoke a tumor return.

Prognosis and survival in breast cancer.

Breast cancer ranks first in the frequency of development and mortality from cancer in women. Annually, up to 1.5 million new cases of cancer development of this organ are registered in the world. He is leading in terms of the number of female deaths( more than 400 thousand deaths per year).At the time of diagnosis, 11.5% of women have distant metastases, and 10.3% of women die within the first year from the steady progression of the disease. In Russia, the incidence of breast cancer varies from 33.7 to 40 cases per 100,000 women per year. In the structure of the incidence of malignant tumors in women, breast cancer is about 19%.About 10 women in Russia have a risk of getting sick.

Despite the improvement in diagnostic and treatment results, mortality from breast cancer in Russia is not reduced due to the detection of diseases in later periods.

Breast cancer is diagnosed in the following ratios: 1-2 stage is detected in 61% of cases, 3 stages - 26% and 4 stages - 12%.

The incidence of breast cancer increases with age: growth begins after 40 years and reaches a peak at 60-65 years. The highest mortality rate in the age groups is 75-79 and 80-84 years.

The highest rates of morbidity and mortality from breast cancer are registered in economically developed countries - the USA and France( 86 cases per 100 thousand population), the lowest in Africa and Asia( 10-14 cases per 100 thousand).Russia occupies an intermediate position.

The indicator of the effectiveness of treatment is the so-called, five-year survival rate, that is, the number of surviving patients within 5 years from the time of detection of the tumor. For breast cancer, it is 55%, that is, slightly more than half of the sick women live 5 years after the tumor was detected, without treatment this figure is no more than 10%.

Survival in breast cancer is affected by a number of factors: hormone sensitivity of the tumor is a favorable factor( the presence of the receptors of progesterone and estrogen in the tumor), but the presence of the Her2neu marker is considered a very bad factor, in this case they speak of high tumor aggressiveness.

In view of the size of the tumor, the stages( stages) of development of breast cancer are distinguished:

Each of the stages is divided into A, B and C.

Stage 1: small tumor size( up to 2 cm), no metastases in the axillary lymph nodes;the most favorable stage in terms of prognosis and survival;
Stage 2: tumor in sizes from 2 to 5 cm, lymph nodes not affected or tumor size up to 2 cm, there are metastases in no more than 4 l / nodes;
The 5-year survival rate for the first two stages averages about 78- 89%.These stages are the most favorable.
Stage 3: tumor more than 5 cm with metastases in the lymph nodes or with skin germination;survival is about 40-60%.
Stage 4: a tumor of any size in the presence of metastases in other organs( bones, lungs, liver, skin, etc.).

Diffusive forms of cancer( mastitopodnye, rozhistopodobnye, armor) from the time of detection are no less than 3 stages.
The last stage, as well as diffuse forms of cancer have a very poor prognosis and little chance of survival of about 10%, 5 years does not live any of the sick. Survival in breast tumors is enhanced by the combination of several treatments: surgery, radiation and chemotherapy.

Prevention of breast cancer

Prevention of breast cancer, first of all, reduces to timely correction of the hormonal background of the body: elimination of painful sensations in menopause( hot flashes, weakness and others), use of hormonal drugs if necessary( contraceptives in small dosages).Prevention of mastopathy, benign breast changes - fibroadenoma, cystic disease, in the form of special preparations, timely removal of benign tumors.

Natural prevention of tumors of the female reproductive system is pregnancy and childbirth, the risk of cancer increases in women of late age( after 30 years) and in nulliparous women. It is necessary to avoid abortion, use contraception. In addition to operational risk: the threat of rupture of the uterus( with scraping) and bleeding, the risk of anesthesia, abortion cause a hormonal "explosion" in the woman's body, which can lead to fatal consequences. Patients who have a family history of cancer, especially breast cancer, must undergo an X-ray examination of the mammary glands every year - mammography.

Epidemiological data indicate that women working in the night shifts have flight attendants( stewardesses, dispatchers), radio and telegraph operators, an increased risk of developing breast cancer, while in women who are primarily blind( i.e., having light deprivation), this risk in2 times less. These data reliably confirm the antitumor activity of the hormone melatonin, produced by the body of a healthy person in the dark. Thus, an important measure of cancer prevention is also a full-fledged sleep in total darkness at night.

Breast cancer is also found in men. Initially, its development is preceded by the phenomenon of gynecomastia - the increase in the breast size and the development of glandular tissue in it. It is treated by the same methods as in women: surgery followed by chemotherapy or radiotherapy. Cancer in men is characterized by no less aggressive current, as in women: it can give multiple screenings.

Consultation of a doctor on breast cancer:

Question: What is the risk of breast cancer?
Answer: First of all, cancer is dangerous progressive progressive growth and damage to nearby tissues. In addition, malignant breast tumors are prone to multiple metastasis, even in the initial stages, and their metastasis is usually poorly sensitive to chemotherapy and quickly leads the patients to death.

Question: Is breast cancer always mandatory or are there other treatments?
Answer: Yes, the operation is always necessary. If the patient categorically refuses surgery, radiation and chemotherapy may be used, but the effect of treatment will be much worse.

Question: How to identify cancer at an early stage?
Answer: This can only be done with the help of an annual dynamic examination: mammography and ultrasound examination of mammary glands, as well as frequent self-examination and prompt treatment. More advanced methods of examination have not yet been developed, recently oncomarkers are studied - protein substances of blood, but their effectiveness is extremely low.

Barinova Natalya Yurievna, oncologist-doctor