• Breast Cancer Symptoms

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    Breast cancer( female breast) belongs to one of the most common forms of cancer in women, which is the proliferation of malignant cells in the chest. In men, it is rare. It occurs not only in the elderly, but not so rarely in young women. The greatest number of diseases falls on the age of 40-50 years. Among the diseased, non-pregnant and non-breast-feeding women predominate. Multiple abortion( abortion) has a predisposing significance. Previous purulent inflammations of the breast( breast) and occasional bruises of the breast in some cases can contribute to the development of the disease. Breast cancer usually develops in the milk ducts, although it can also occur in the lobules of the breast or less frequently in the dense connective tissue of the breast. Breast cancer alone is not life-threatening, but cancer can spread to other organs through the lymph nodes or blood, so its early detection is important. In 90 percent of cases only one breast is affected, although for those who had breast cancer, there is a danger of its development in the second. In any case, detection of cancer at an early stage and appropriate treatment significantly improve the patient's prospects.

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    Numerous observations have established that in the mammary glands of married women who do not give birth or interrupted pregnancy, and also have some deviations from the normal activity of the genital organs, various painful processes often arise, many of which are accompanied by the development of tumor-like seals. Often, benign tumors( fibromas, cysts, etc.) also appear in the mammary gland. Some of them, being completely innocent at first, after many years of existence undergo malignant transformation and become real cancer. To understand each individual case and determine the nature of the existing tumor, only an experienced specialist doctor can.

    The very word "breast cancer" for most sounds like a sentence. In this period it is very important to understand that very much depends on you. These are not empty words. No doctor can cure a patient who does not fight for his life. Modern oncological science has a large arsenal of highly effective drugs, methods of surgical interventions are being improved, and molecular biology data make a huge contribution to the process of cognition of the biological characteristics of the tumor process. Existing diagnostic capabilities now make it possible to detect the disease at the initial stages. Modern surgery makes it possible to preserve the breast or its reconstruction with the help of plastic surgery. The progress of drug therapy led to the creation and widespread introduction of
    drugs directly acting on biological targets. Lovely women, believe me, after the diagnosis is made, life does not end, but simply passes to a new stage. The most important thing is not to shut yourself up and not "go away" into the disease. A woman can and must fully live, regardless of the disease.
    These are not just words. This is a truth based on the modern knowledge of biology, treatment and rehabilitation of breast cancer .

    • The exact cause of the disease is unknown, but the likelihood of breast cancer is related to the following factors:

    • Age. The risk of breast cancer increases with age. Most often it develops after 50 years.

    • Hereditary factors. Approximately 10 percent of women with breast cancer had cases of this disease in the family. Women who have at least second-degree relatives diagnosed with breast cancer before the age of 50 or ovarian cancer at any age can inherit one or two genes that increase the risk of their disease with both breast and ovarian cancers.

    • Birth of children at a late age or lack of children. Women who do not have children whose first child was born at the age of 30 or who have never breast-fed are more likely to have breast cancer.

    • Early onset of menstruation( up to 11 years).

    • Later onset of menopause( failure of menopause at the age of slightly over 50 years).

    • Benign cysts or tumors in the chest.

    • Food with a high content of animal fat.

    • Moderate or severe alcohol use( more than three times a day).

    • There may be toxins in the environment.

    • Long-term( more than 5 years) use of hormone replacement therapy( combination of estrogen and progestin).

    • Long stay under light at night( for example, shift work).

    Breast cancer is a "multifaceted pathology", but most often either the patient herself or the specialist pays attention to a densely boundedly mobile formation. When palpation, you can grope for enlarged axillary lymph nodes. The nodular form of cancer is the most common. It is accompanied by skin symptoms - retraction, deformation, wrinkling.

    Sometimes a woman complains of spotting from the nipple. However, in some cases, the tumor does not form. The process diffusely spreads through the mammary gland tissue, without forming nodes. In such clinical cases, there is swelling of the skin of the gland, hyperemia, and fever. Such clinical variants of breast cancer
    are called diffuse or inflammatory.
    The similarity of the symptoms of inflammation and the "specific process" sometimes leads to the setting of erroneous diagnoses and, as a consequence, the appointment of an incorrect treatment.
    Paget's cancer is a peculiar symptom, a rare clinical form that accounts for no more than 4% of cases.
    The onset of the disease is very similar to the eczematoid changes on the nipple or areola, often accompanied by itching. When visiting a dermatologist, ointments containing corticosteroids and epithelializing components are prescribed. After their use, it is even possible to improve the condition, but soon the process continues
    to develop, capturing a large part of the areola, there may be nodal formation in various parts of the breast. In this case, there is no doubt that the process is of poor quality, and the woman is sent for a full-fledged examination.

    Generalize the symptoms:

    • Usually painless swelling or swelling in the chest or under the arm( more often in the upper or outer part of the chest).

    • Changing the appearance of the skin of the breast, flattening, indenting, redness or peeling of the breast.

    • Nipple change, including indentation, itching or burning sensation, dark or spotting.

    • Change in size or asymmetric breast development.

    • Pain or discomfort in the chest with severe development of the disease.

    Most often, breast cancer begins as a small nodule or a limited compaction that occurs in the thickness of the gland and often long gone unnoticed by the patient itself. For the most part, accidentally, when washing or dressing, a woman discovers in her breast a tight formation with a cherry or hazelnut size, with unsharp boundaries, moving, painless, sometimes with a slightly pulled over skin.

    Less often breast cancer begins without a clearly tangible tumor node, but in the form of a diffuse compaction spreading in all directions, causing swelling and reddening of the skin.

    Even more rarely, the disease begins with bloody discharge from the nipple or eczema, followed by the formation of a tumor node in the gland thick.

    Having arisen in one form or another, a cancerous tumor swiftly, then slowly, but steadily increases in size, remaining painless and showing no manifestation of itself, except for the knotty hardening in the chest. Meanwhile, the tumor process gradually spreads, which is most often expressed by a slight retraction of the skin over the tumor.

    But the matter is not limited only to the local growth of tissue. Very soon, especially in younger women, the tumor cells penetrate into the lymphatic ways and with the current of the lymph carried away, settling in the nearby lymph glands( armpit, above the clavicle).In the presence of favorable conditions, daughter tumor nodes - metastasis grow out of them, which is manifested by swelling and tightening of the glands, completely painless. Usually by this time, the presence of cancer can be detected even when viewed, in the form of a globular protrusion, more often outward and upward from the nipple, or wrinkled and retracted skin area, respectively, the deep-lying tumor.

    This gradual and painless development of the disease without pronounced external signs lulls the vigilance of patients who are not in a hurry to see a doctor, waiting for the spontaneous disappearance of the tumor. However, this does not happen, the tumor increases in size, is soldered to the skin and ulcerated;at the same time there is a development of new metastatic nodes on the neck, armpits of the other side and in other places. Breaking a tumor into the bloodstream leads to the appearance of multiple tumors in the lungs, liver, bones and other organs and, thus, the entire body is affected by the disease.

    Therefore, it is especially important to detect a tumor in a timely manner, in the first period of its existence, ie, when it still completely fits in the thickness of the gland and does not go beyond it, does not give metastases to the armpit.

    Correctly performed radical treatment in these cases ensures recovery.

    • The presence of a bump in the chest can be detected by examination or mammography.

    Mammogram is a visualization method using X-rays. The radiation load at mammography is insignificant, and diagnostic accuracy is great - 80-95%.Therefore, this study can not be called harmful. With the help of mammography, it is possible not only to see the compaction, but also to determine its localization, to understand the "relationship" of compaction with a healthy tissue. Thus, with the growth of the tumor towards the central part of the mammary gland( nipple and areola), an organ-preserving operation( radical resection) is not always indicated. Small, not reached 1 cm( in the largest dimension) nodes can be diagnosed only on mammograms. The same applies to the accumulation of calcium salts or microcalcinates, often a sign of the earliest( preinvasive) stage of cancer.
    To identify the formations located within the duct with a clinic of serous or bleeding discharge from the nipple, an x-ray examination with the introduction of a contrast agent-doktografia-is the necessary diagnostic method.
    It would seem - an ideal study. Nevertheless, the mammogram has its shortcomings, which can not be ignored. In women under 30, "informative" mammography is reduced because of the dense tissue structure. This does not apply to patients with silicone implants. One can not ignore the discomfort during the procedure associated with squeezing the

    gland. • biopsy of the tubercle is needed to determine if there are cancer cells present in it. From the tubercle a needle or tissue is taken with a needle;A tissue sample can also be taken during a small operation.

    Since in the earliest stages of the disease, with the usual methods of examination-examination and feeling-it is not always possible to make an accurate diagnosis, and waiting can be dangerous and lead to the spread of the process, it is often necessary to resort to a trial operation of removing the tumor and ascertaining its nature withusing microscopic examination. Such an urgent study can be performed within a few minutes, and the surgeon will know the results of it in the operating room. Thanks to this, it is possible to perform the necessary intervention without delay, if the tumor is cancerous, and, on the other hand, to avoid large operations where the benign character of the tumor makes them superfluous.

    • Ultrasonic examination, thermography or computed tomography may be performed.

    Ultrasound( AS) also provides maximum information. This method is based on obtaining an image using high-frequency sound oscillations. The greatest informativeness of ultrasound is for examining young( under 35 years) women. With age, by virtue of the involution( fatty degeneration) of tissue, information decreases
    ultrasound more clearly allows you to differentiate cysts and solid formations, very similar in mammograms, as well as intra-cystic enlargement. Color Doppler mapping is a method that visualizes pathological vessels that always accompany tumor growth. Ultrasound allows simultaneous with visualization to carry out a diagnostic thin-needle biopsy of small or deep-lying formations with their subsequent marking. Finally, ultrasound gives insight into the state of regional lymph nodes( hyperplasia, specific lesion).
    Despite all the advantages, ultrasound can not replace mammography, which makes it possible to "see" small calcifications, in other words, to detail the study.

    The method of magnetic resonance imaging( MRI) is based on the use of reflected magnetic field signals. Computer-transformed digital images of the tissues of any organ, including the breast, are clearly visible on the screen. Often when performing MRI, contrast agents are used, the intravenous administration of
    with subsequent selective accumulation allows to see usually non-invasive tissues. Indications for the appointment of MRI in a comprehensive examination of patients with breast pathology usually serve:
    - refinement of the results of mammography and ultrasound in young( under 35 years) women;
    - an estimation of a condition of implants in a prosthetic gland;
    - tumor germination of structures of the chest wall;
    - diagnosis of cancer recurrence in the operated breast( conservation surgery + radiotherapy) of the mammary gland.
    In all other situations the method can be applied, but it has no significant advantages over mammography and ultrasound.
    Histo- or cytological data are a necessary and decisive component of the diagnosis of cancer. Patients who have an operation at the first stage are usually sufficient to perform a fine needle or stereotaxic biopsy. If the tumor is determined well, the biopsy is performed "under the control of the finger."With a deep location of the formation, the ultrasound method is used. Determining a malignant tumor or not before the operation is extremely important.
    Firstly, this is due to the medical institution's ability to perform urgent intraoperative research. If there is no such possibility, the morphologist's answer will be received at least 7-10 days later.
    With the diagnosis of cancer, such an operation can not be considered radical.
    Secondly, this affects the duration of the operation, which is unfavorable for certain concomitant diseases.
    For patients who plan conservative treatment at the first stage, a morphological study is simply necessary. On the one hand, to treat cancer without a histologically confirmed diagnosis is legally incompetent, on the other hand, the results of a biopsy allow us to make correct predictions.
    Most often, for these purposes, use a biopsy, sometimes a biopsy. Both options are performed on an outpatient basis, under local anesthesia.

    • To remove a tumor, surgery is necessary. The patient should be provided with the necessary surgical care in biopsy or during the subsequent operation. Depending on how the disease developed, only a tubercle or tumor, or the entire breast( mastectomy) can be removed. At each operation, adjacent lymph nodes can be removed. If the swelling captures the muscle tissue under the breast, a breast can be removed and the muscle tissue located below it( radical mastectomy).

    The decisive factors for such a surgical intervention are the stage of the tumor process and the localization of the neoplasm in the mammary gland. Age of the woman does not matter. The volume of tissue to be removed includes a sector of breast tissue with a tumor and all levels of lymph nodes. During the operation, urgent research is conducted on the remote sector. If the morphologist on the edge finds tumor cells, an extended operation is needed. There are situations when the doctor does not even discuss the scope of the operation. This means that a particular patient has absolute contraindications for preserving the breast. Modern
    contraindications for performing radical resection are as follows:

    - location of the tumor in the subclavian( central) part of the breast;
    - several tumors located in different parts of the breast;
    - edematous and inflammatory( for example, mastitis-like) forms of the tumor process;
    - expected poor cosmetic result( very small gland size).

    • After surgery, radiation therapy may be required to prevent further spread of cancer, especially if lymph nodes have been affected.

    Chemotherapy - the main and effective option of drug treatment of malignant tumors.
    As a result of the impact of chemotherapy on the tumor tissue, the size of the primary formation( and possibly the available metastases) is reduced, and in addition to
    , active prophylaxis of metastatic development takes place.
    In breast cancer, chemotherapy can be performed before surgery to reduce the size of the tumor and affect regional lymph nodes. In the process, the so-called immediate effect of treatment is realized, indicating:
    - the adequacy and effectiveness of the selected scheme;
    - tumor sensitivity;
    - the achievement of an operable state.
    Usually, several( average 4-6) cycles of chemotherapy are used.
    The need to prescribe chemotherapy after surgery is dictated by the results of a histological examination of the removed tumor and lymph nodes. In addition, the content of receptors for estrogens and progesterone, as well as HER-2 / neu status, is studied( depending on the specificity of the tumor, the treatment is selected in the postoperative period).The main task in this case is the prevention of the emergence of distant metastases( prevention of metastatic disease).If it is necessary to conduct chemotherapy, the standard is 4-6 courses with an interval of 3-4 weeks.
    In some cases, chemotherapy is prescribed before and after the operation. In this situation, the attending physician explains in detail the woman the need for such a combination. Chemotherapy can be used as the main method of treatment without surgery, when the tumor process is already common and there are distant metastases.
    Modern chemotherapy regimens usually include drugs of either multidirectional action, or mutually reinforcing each other. The most effective of them are anthracyclines( adriamycin, adriablastin, doxorubicin, pharmarubicin, etc.) and taxanes( Taxotere®, paclitaxel).
    Taxotere® is currently one of the most effective chemotherapeutic drugs used to treat breast cancer.
    Depending on the characteristics of breast cancer and the patient's condition, choose one or another mode of Taxotere®.
    Taxotere® can be administered both with anthracyclines( simultaneously or sequentially) and in combined chemotherapy without anthracyclines, in monoregime( alone), and also used in conjunction with trastuzumab for overexpression of HER-2 / neu.
    As you know, when using any medications, there may be undesirable phenomena and chemotherapy is no exception. The most common - nausea, vomiting. This is due to the fact that antineoplastic agents damage not only tumoral, but also normal cells of the gastrointestinal tract. Some people start dehydration, anorexia. In this case, the interval between courses should be increased, or completely abandon this method of treatment. However, there are patients who do not have similar effects at all.
    There are a number of recommendations that allow not only to reduce, but sometimes completely avoid side effects. It should be borne in mind that in some patients, in addition to the true( acute or delayed), nausea and vomiting are psychogenic and begin only from one type of treatment room or a diluted drug.
    Modern antiemetic therapy offers a wide range of drugs, thanks to which in 90% of patients these phenomena can be prevented in advance. The most commonly used are: nawoban, zofran, kitril, emend.
    In addition, the patient should give practical advice on the dietary regime during chemotherapy:
    - eat more often, in small portions;
    - exclude cloying-sweet and spicy dishes, preferring products with acidic and slightly salty taste;
    - do not eat heavy, difficult digestible food, go for 2-3 days to light, but with enough calories.
    In the intervals between chemotherapy courses, it is possible to use hepatoprotectors( heptral, essential, carpel, etc.) that promote the restoration of the hepatic parenchyma.
    Many patients are concerned about loss or loss of hair( alopecia) - one of the most frequent side effects. As soon as it begins and stops, depends on the specific situation. Usually within a year the hair is completely restored, and sometimes it gets even better.
    It is extremely important in the conduct of chemotherapy to monitor blood levels, in particular, leukocytes.
    The study is conducted in dynamics, always before each next introduction. With a sharp fall in leukocytes( below 2.5 thousand), the free interval can be prolonged, or treatment includes support for colony-stimulating factors. It is believed that contribute to this walnuts, liver, red caviar, red dry wine,
    grenades and their juice. A special diet that increases the number of white blood cells, no. In any case, each specific situation should be discussed with the attending physician

    Endocrinotherapy , as a method of treatment, has more than a century of history. G. O. Beatson performed ovariectomy( removal of the ovaries) for the first time in patients with advanced breast cancer. As a result, out of 10 operated, in 3 cases, all manifestations of the disease completely disappeared. Later, the main steroid hormones were discovered and their interrelations in the female body between themselves and target tissues were described.
    This experience has not become the property of history. Ovariectomy is the most frequent method of endocrine therapy for women of reproductive age. An alternative to surgical intervention now is the use of releasing hormone agonists( zoladex) in combination with anti-ET.
    In the 1970s, hormone receptors were found on the surface of the tumor cell. It is thanks to them that the cell is able to perceive hormonal stimulation, responding to it with a specific action( division, maturation, etc.). For "female" breast cancer, the positive status of the tumor by the receptors for estrogen and progesterone( RE +, RP +) is very important. Only in the presence of receptors, it makes sense to use endocrine therapy. About 2/3 of breast tumors differ in receptorpositivity, so in this group hormone therapy is one of the most effective treatment options.
    It should be noted that in different age groups different methods of endocrine therapy are used, because the ways of hormones formation in menopausal patients and patients with a preserved menstrual function are not the same.
    For a long time, the "gold standard", regardless of age, was anti-estrogenic drugs, widely used since the 1970s. The main mechanism of their action is the competitive binding of estrogen receptors with a blockade of possible signals, which led to the removal of estrogen stimulation of cell proliferation. The most widely and frequently used tamoxifen and its analogs( zitazonium, nolvadex, toremifene).These drugs still remain
    basic in hormone therapy of patients of reproductive age.
    With a preserved menstrual function, circulating estrogens are actively produced by the ovaries. Stimulation of them is carried out by hormones of the central link( follicle-stimulating, luteinizing).Therefore, in addition to receptor binding, it is necessary to achieve the maximum reduction in the level of circulating female
    hormones. To do this, now use: surgical removal of the ovaries( ovariectomy), radiation exposure to their tissue, or the so-called "chemical castration".The latter is carried out by the introduction of drugs that inhibit the production of "central" hormones-follicle-stimulating and luteinizing. After the procedure
    there is a sharp decrease in the functional activity of the ovaries, the level of circulating estrogens is approaching, in absolute terms, to the menopausal state. The attractiveness of this method of ovariectomy is its reversibility, i.e.when the drug is canceled, the menstrual cycle and the reproductive status of the woman are restored. The combination of zoladex and tamoxifen is the most commonly used version of endocrine therapy, which allows a 50% reduction in the likelihood of recurrent disease and a 25% mortality rate from breast cancer.
    Duration of taking tamoxifen in a dose of 20 mg / day.- not less than 5 years.
    Naturally, any woman who is recommended endocrine therapy, will be concerned with the question: what are the most frequent side effects that can arise during the treatment?
    In relation to zoladeks, the most common side effects are: hot flashes, mood changes( castration syndrome), dryness of the vaginal mucosa. Tamoxifen induces the development of atypical hyperplasia of the endometrium, accompanied by dysfunctional uterine bleeding, up to the carcinoma of the endometrium.
    In this case, the drug is canceled!
    When taking hormonal therapy, a woman should consult at least once a half a year with a gynecologist and regularly perform ultrasound examination of the pelvic organs, in addition to the standard examination.
    Speaking about anti-estrogens, in the 21st century one can not but say a few words about the prospect of this class of compounds, which is primarily connected with faslodex( ICI 182, 780. Fulvestrant).
    The drug, unlike tamoxifen, does not have those side effects that sometimes lead to the elimination of the latter. Fazlodex not only blocks, it completely destroys estrogen receptors, and this leads to a stop of proliferation. In experimental studies it was shown that fulvestrant inhibits the development of non-
    only breast tumors resistant to tamoxifen, but also tumors of the uterus.
    Fazlodex is generally well tolerated. Adverse effects are rarely recorded( less than 1%).Approximately 5% of patients have joint pains, disorders in the blood coagulation system and local( injection injected) reactions. Gastrointestinal disturbances, tides( about 20%) were registered more often.
    The expected increase in the risk of vascular reactions and osteoporosis has not been observed, which is why the drug is especially recommended for a group of menopausal patients.
    The combination of good tolerability and pronounced efficacy promotes the ever wider introduction of fulvestrant into clinical practice, especially with progression against the background of previous treatment.
    Recently, studies have been conducted on the use of Fazlodex instead of tamoxifen in conjunction with zoladex as a post-operative treatment of young patients with receptor-positive tumors.
    Most likely, all the available positive qualities in the very near future will make fulvestrant "gold standard" endocrine therapy of the XXI century, which in the XX century was tamoxifen.
    In menopausal women, the source of estrogens is not the ovaries, but the adrenal glands and adipose tissue. In these organs, aromatase( the key enzyme of the aromatization reaction) produces estrogens. Therefore, now the appointment of antiestrogens in receptor-positive breast cancer in women of menopausal age is considered less correct than the use of aromatase inhibitors. The classical representatives of this group are the femar( letrozole) and arimidex( anastrozole).
    Aromatase inhibitors should not be given to young women, since a decrease in the production of estrogen, particularly in adipose tissue, will inevitably lead to an increase in functioning ovaries( feedback effect).
    Numerous studies have shown that the use of aromatase inhibitors reliably reduces the risk of recurrence of the disease and a 12% mortality risk.
    The incidence of contralateral breast cancer with anastrozole is approximately 4 times lower than with tamoxifen.
    Preparations of this group are practically devoid of those side effects and complications that develop when taking tamoxifen: there is no pathology of the endometrium, coagulation system( coagulation), and castration syndrome.
    Aromatase inhibitors are now used as a post-operative treatment for intolerance or progression against the background of anti-estrogens, and also before the surgical stage with inoperable tumors.
    Modern endocrine therapy is the most sparing and effective method of drug therapy for breast cancer patients with a hormone sensitive tumor.
    Having a pronounced antitumor effect, hormone therapy maintains a good level of quality of life, does not cause side effects characteristic of chemotherapy - nausea, vomiting, hair loss, anemia and leukopenia( decrease in the number of leukocytes.)

    It is very likely that in the remainder of the breast tissue there may be micro-tumors, a zone of microcalcinates, from which malignant formation will subsequently develop again. Such a doubt sometimes leads to the patient's refusal from this operation. In this connection, the question arises: is not the radical mastectomy,
    , at which the whole breast tissue is removed, the correct and radical operation? We are ready to agree with this statement if, after an organ-preserving operation, radiation therapy is not offered for the remainder of the breast, sometimes with the inclusion of regional lymph drainage zones in the field of irradiation.
    In this case, radiation therapy solves the main task-prevention of the occurrence of local recurrence of the disease.
    And its use is necessary even for palpation of undetectable before surgery formations. In the absence of postoperative irradiation, the number of patients who may develop a relapse in the rumen increases by two or more times.
    Modern methods of irradiation, individual calculation of irradiation fields for each patient allow almost completely to avoid post-radial changes. As a rule, each woman is given advice on skin care during treatment, blood control. Modern preparations of topical use in the form of ointments: actovegin, methyluracil, solcoseryl-gel, balsam "Rescuer", panthenol, dimexide are very effective. Usually the patient is observed at the treating surgeon and radiological specialist, who collect the necessary treatment together. Due to this significant deformations of the preserved breast, radiation therapy does not cause.
    There is another option when breast irradiation of the regional lymph drainage zones is a component of the curative program - induction therapy of locally advanced cancer.
    In this case, the task of radiotherapy is to reduce the volume of the primary tumor for the subsequent execution of the surgical stage.

    • Before and after surgery, chemotherapy may be required to prevent further spread of cancer. Such treatment usually lasts from six months to a year.

    • After surgery, tumors with a positive reaction to estrogen may require hormone therapy.

    • Women who have a portion of the breast or all of their breasts removed can benefit from plastic surgery. A plastic surgery can be performed during an operation to remove the breast or later.

    Modern exoprosthesis takes into account all the anatomical and topographical features of the performed operation. The kit, which is offered to a woman, includes aesthetic linens, tops, swimsuits.
    All this makes the defect virtually invisible.
    Experienced consultants select for each woman the appropriate for her in the form, color, size and weight of the exoprosthesis. Properly selected prosthesis should not only meet aesthetic goals, but also be a curative and prophylactic device that provides the most rapid postoperative adaptation and healing of
    tissues. Such a denture prevents disruption of posture, curvature of the spine, lowering of the shoulders, etc.
    Basic rules for choosing an exoprosthesis:
    1. The mass of the prosthesis should correspond to the mass of the other mammary gland;
    2. The size of the exoprosthesis is selected according to the cup of the bra;
    3. The exoprosthesis should compensate as much as possible the malfunction arising after the mastectomy;
    4. during the fitting of a woman, it is better not to take the prosthesis in hand. If she is still curious, then you need to immediately explain that his weight is only visible. In fact, the breast weighs exactly the same amount;
    5. The shape of the exoprosthesis should correspond to the shape of the mammary gland.
    Modern prosthetics are diverse in form - oval, triangular, drop-shaped. They are very similar in their properties to the female breast. Exoprostheses have a soft and delicate structure, quickly take body temperature.
    The latest models of exoprostheses provide a fixation system directly to the surface of the chest. The prosthesis fits better, with greater accuracy corrects defects. However, wear it for more than 12 hours.per day is not recommended.
    In addition, modern exoprosthesis is also developed taking into account their functional tasks. Postoperative prostheses are easy, not injuring wounds. They can be worn almost immediately after removal of the drainage.
    Lite - with a large mammary gland, with lymphatic edema on the side of the operation. These prostheses are especially convenient in hot weather.
    Special prostheses designed for swimming and gym visits.
    Exoprosthesis does not give a woman a lot of trouble hygienically. They are recommended to be washed daily in warm water with soap and then wipe with a soft towel. At night they store in a special package to keep the form unchanged. After visiting the pool, where the water can be chlorinated or sea, you need to thoroughly clean the denture. If possible, it must be protected from pins and long nails, since a prosthetic injury is possible.
    And yet in some women a full psychological rehabilitation is possible only after performing a reconstructive-plastic surgery.

    Depending on what "material" is used in plastic surgery, the techniques are:
    1. Using only silicone material - expander-prosthesis.
    2. Using a combination of silicone material and its own tissues, a thoraco-dorsal flap( donor zone-the widest back muscle) and a silicone endoprosthesis;
    Silicone prostheses are mainly used.
    3. Reconstruction with own tissues - various types of musculocutaneous flaps.
    No doubt, each of the techniques may be accompanied by postoperative complications. The patient is also warned about this.
    The most frequent of them: formation around the implant of a fibrous( constrictive) capsule, rejection of a prosthesis, cutaneous necrosis.
    The final, final stage of any reconstruction is the creation of a nipple-areola complex, related to secondary reconstructive procedures. Its implementation is also largely addressed by the patient, as well as the recovery technique.
    Thus, the restoration of the lost breast during treatment is not at all a cloudy prospect, but a very real step that many women can do.

    1. The size of the tumor in the mammary gland.
    2. The number of regional lymph nodes affected by metastases.
    It is of fundamental importance:
    • their absence;
    • metastases in 1-3 lymph nodes;
    • metastases in 4 or more lymph nodes.
    Quality of life, its duration, ongoing treatment - everything is in direct dependence. The smaller the diameter of the tumor, the longer the life span. The less lymph nodes are affected, the less aggressive the therapy will be.
    3. Receptors for steroid hormones in the tumor.
    Female sex hormones( estrogens and progesterone) can stimulate growth and development of the tumor population. However, this does not happen with all tumors. To achieve this effect, it is necessary that on the surface of the tumor cell there is a "lock" or receptive hormone stimulation apparatus - a receptor to the corresponding hormone. Such receptors are found in almost 2/3 of mammary gland tumors. Determine their biochemical or immunohistochemical method. The latter is most preferable. And the material can serve as a tumor tissue, and "ready-made postoperative( paraffin) blocks."In the process of studying receptor-positive tumors, they found out that they are usually highly differentiated and respond well to one of the variants of drug treatment-endocrine therapy. Hormonal drugs used in this case are able to block the corresponding receptors, making their communication with circulating hormones impossible.
    4. Epidermal growth factor receptor HER2.
    About 30% of women with breast cancer have HER2-positive tumors. In addition to hormones, the behavior of cells in the body is also influenced by so-called growth factors.
    The HER2 receptor present on the cell surface determines its response to growth factors. And it is expressed by any cell, but in different amounts. In some tumors, there are so many that it leads to an acceleration of the already rapid division and proliferation. Now the HER2 receptor can be determined by three methods:
    - immunohistochemistry;
    - fluorescent in situ hybridization;
    - chromogenic in situ hybridization

    It is believed that HER2-positive tumors are a special form of cancer characterized by an unfavorable prognosis, requiring more aggressive treatment. In these cases, the use of targeted therapy, or therapy of targets, is mandatory. The use of monoclonal antibodies-HER2-receptor blockers in such patients significantly intensifies systemic drug treatment and increases the disease-free interval.
    One of the main drugs of this group is herceptin( trastuzumab).The drug blocks the HER2 receptor, reduces the ability of cells to actively proliferate, increases the sensitivity to chemotherapy. It is used in all cases of established overexpression or amplification of HER-2 / neu( ie, with HER2-positive
    tumors).Modern science is actively developing this direction.
    Now there are medicinal forms of blockers HER1 and HER2 - lapatinib, and also VEGF( tumor growth factor) - avastin( bevacizumab).Against the background of avastin reception, tumor angiogenesis ceases, i.e.the tumor does not receive nutrients and dies.
    In recent years, the combined use of Herceptin and Avastin, which results in a multidirectional effect on the tumor tissue, leading to greater effectiveness of the curative program.

    • Very small tumors that can not be felt can be determined by mammography. Women over the age of 50 should undergo mammography every year, and women between the ages of 40 and 50 should discuss their own risks with the doctor to determine when to start mammography.

    • The examination should be performed by a radiologist specializing in mammography or at a mammological center.

    • Women should undergo an annual breast examination with a doctor.

    • Women should examine their breasts monthly( best two to three days after menstruation).The breast tissue is usually a bit bumpy and uneven, so it's important to get used to the normal contour and texture of the breast. Then it will be easier to determine the changes in texture and appearance.

    • Regular exercise and maintaining a normal weight can reduce the risk of breast cancer after menopause.

    • Women who have a high risk of breast cancer can resort to chemical disease prevention by taking tamoxifen for five years. The decision to take tamoxifen should be taken after discussing the risk of the disease and the prospects for treatment with the doctor.

    • Women who have cases of breast cancer in the family can undergo a genetic test for the presence of breast cancer genes. Women with a positive test result should be under intensive surveillance to identify both breast cancer and ovarian cancer, or consider the possibility of preventive removal of breasts or ovaries.

    • Consult your doctor if you find a bulge anywhere on your chest or under your arm. Most of the tubercles are not carcinogenic, but a biopsy is necessary to make the final diagnosis.

    • Contact your doctor if you notice any changes in the size, shape or appearance of your breasts, or if you have any discharge from the nipple.