Swelling and pain in the mammary gland
Breast cancer is the most frequent oncological disease in women in the Russian Federation. It accounts for more than 20% of all malignant tumors.
The disease is almost always detected after 55-60years, although recently breast cancer "younger", meeting in women 30-45 years. Breast tumors are potentially curable and have good predictions, so it is important to identify them at the earliest stages (see self-diagnosis of breast cancer).
Possible Symptoms of Breast Cancer
Any woman should carefully monitorthe condition of his chest, examine and probe it. A compulsory medical consultation is necessary if there are symptoms characteristic of breast cancer:
- Nodal formation in the chest (dense, motile or soldered to the surrounding tissue)
- Sealing and thickening of the nipple
- Nipple Retraction
- Stretching of the skin over the tumor
- Symptom of "lemon peel" above the tumor
- Redness of the skin of the breast
- Sores and crusts in the skin above the tumor
- Deformed mammary gland (change in size, fixation to the chest wall)
- Palpable dense lymph nodes in the axillary and supraclavicular areas (often immobile)
- Pain in the mammary gland (especially without connection to the menstrual cycle)
- Edema and pain in the hand
- Symptoms of distant metastases (pain in the bones, abdomen, jaundice with liver damage)
All of the above characteristics may indicateas a formidable disease, and on benign tumors or inflammation in the chest. Therefore it is very important to visit a specialist on time and clarify the diagnosis.
Types of breast tumors
Statistics of the frequency of malignant diseases in women
Nodular cancer is the most common formtumors of the mammary gland. Usually the cancer node is located in the upper chest quadrants. It grows, capturing surrounding healthy tissues, penetrating into muscles, adipose tissue and skin. The growth rate in tumors of the nodal structure can be different. Rapidly growing and metastasizing cancer in women under 40, during and immediately after pregnancy.
Diffuse cancer is detected much more rarely nodal,grows faster and has a more unfavorable outlook. It is characterized by the defeat of the entire breast, increasing it in size, swelling, ulceration and lymph node involvement.
Paget's disease is a nipple cancer. The disease begins with densification and enlargement of the nipple, appearing on its surface ulcers and crusts. Progresses slowly, but the diagnosis is set rather late (due to the similarity with the eczema of the nipple). In advanced cases, cancer affects the areola, the gland tissue and gives metastases.
Rare forms - malignant tumors of non-cancerousnature. These include sarcomas, lymphomas and metastases of other tumors in the mammary gland. Clarification of the diagnosis is possible after cytological and histological examination.
Most of the tumors found by womenat independent survey and probing of a breast, are good-quality or are not considered at all a pathology. Therefore, the doctor conducts differential diagnosis between all possible formations in the mammary glands:
- Nodular forms of mastopathy
- Acute mastitis
After the examination, mammography, cytological and histological examination, a final diagnosis can be made.
Factors affecting the development of breast cancer
The causes of breast cancer are still not established. There are only special circumstances that increase the risk of a tumor.
- Menstrual function
- Number of births
- Duration of lactation
Long-term studies have proved the relationshipgenital function of a woman and the frequency of malignant tumors in the chest. Since hormone-dependent cancer occurs and progresses against a background of high estrogen levels. then the risks increase significantly under the following conditions:
- early onset of menstruation (earlier than 12 years)
- late menopause (later 55 years)
- absence or only one pregnancy
- late first pregnancy (after 30 years)
- absence or short lactation
- long-term hormone replacement therapy
After the first menstruation and before their termination inMenopause A healthy woman experiences estrogenic peaks every month (during ovulation). The exception is the period of pregnancy and lactation, when ovulation is absent. Therefore, the longer this estrogenic period, the higher the risk of developing breast cancer.
The question of the influence of hormone replacementtherapy and combined oral contraceptives is still open. It is believed that prolonged replacement therapy after menopause may slightly increase the risk of breast cancer. Therefore, it is optimal to prescribe it for a short time, to maintain the balance of bone tissue. There is also evidence that an early onset of OK (up to 20 years) may lead to an increased risk of breast cancer. This information is very contradictory. Since the preventive value of oral contraception for ovarian cancer is proven, the benefits from them exceed the risk.
- Breast cancer in blood relatives
- Syndromes that include breast cancer
In the 90 years of the last century, scientists maderevolutionary discovery in oncomamology. The genes responsible for "family" breast cancer were identified: BRCA1 and BRCA2. Tumors of this origin make up 5-10% of the total number of malignant processes of the breast.
Distinguishing signs of hereditary breast cancer:
- Identification at a young age (usually in 40-45 years)
- High incidence of cancer in both glands
- Frequent combination with tumors of other localizations
- Primary-multiple cancer (many foci in the chest)
Women with a mutation in BRCA1 have a 65% riskTo get breast cancer before the age of 70. The probability of ovarian cancer also reaches 60%. Moreover, with a tumor in the chest in combination with this mutation, every second woman develops cancer in another mammary gland.
The mutation BRCA2 leads to breast cancer in 45% of cases, and to ovarian cancer at 15-30%. Men with this mutant gene are also at risk of breast, prostate and rectal cancer.
In addition to these two mutations, there are genetic syndromes that are manifested by breast and other cancers. They are quite rare, so special tests for them are done according to the indications.
Prevention of mutations BRCA1 and 2
- Removal of both mammary glands (reduces risk by 95%)
- Removal of the ovaries
- Anti-estrogen preparations (tamoxifen, raloxifene)
It is the prophylactic removal of mammary glands andOvaries suffered a famous actress Angelina Jolie. Her mother suffered from breast cancer, a defective gene was also isolated from a Hollywood star. In order to reduce the risk of disease, she went to radical measures. Our country's cases of preventive operations are still quite rare. More often than women, women prefer to take anti-estrogens to turn off menstrual function.
- Ionizing radiation
- Chemical carcinogens
- Dietary preferences
A diet rich in fats. is often associated with the risk of developing tumors, including breast cancer. This is due to both the direct effect of fats on cells, and the development of obesity. Obese women have not just a fatty layer, but a whole station for the production of estrogens. Their excess, as already mentioned earlier, increases the risk of developing the tumor at times.
Ionizing radiation is another factor, influencewhich has been proven for a long time. In Japan, after the explosion of atomic bombs in Hiroshima and Nagasaki, the number of cases of breast cancer increased many times. Most often, women fell ill who at the time of the explosion were up to 20 years old, and the disease began 15-25 years after the disaster.
Another proven provoking factoris the irradiation of the thorax for the purpose of treating other oncopathology. Thus, in young women exposed to therapy for lymphogranulomatosis, the risk of breast cancer is slightly increased.
Examinations for breast cancer
When you contact a GP, gynecologist or mammologist, you will need to undergo some tests and take tests. The number of these methods will depend on the expected diagnosis.
- Medical examination
- Radiography of chest organs
- CT of the chest, abdomen and brain
- Ultrasound of mammary glands and regional lymph nodes
- Cytological examination
- Immunohistochemical study of tumor
- Genetic consultation (search for mutations BRCA1 and 2)
- Radioisotopic examination of bones
- Ultrasound of the liver, pelvic organs and other places suspected of metastases
- Consultation of specialists: oncologist, chemotherapist, radiologist
X-ray examination of mammary glands -the only method used as a screening. It is proved that an annual survey of women after 45 years reduces mortality from breast cancer by 15-20%. To obtain all the necessary information, they use images in two projections, using protective screens and pressing down the chest.
Ultrasound is used forthe appearance of tumor symptoms in young women whose breasts consist of a glandular component. For women after 40 this method of screening is not appropriate. But sometimes ultrasound is used in women in menopause, if the tumor has a soft-tissue component, as well as for examining regional lymph nodes.
The cytological method is based on takinga certain number of cells from the tumor / lymph node to assess their structure. Cancer cells have some distinctive features. For better preservation of the material, liquid cytology has recently been used (placing the sample in a liquid medium).
Great importance in the choice of tactics of therapy hasthe biological nature of a cancerous tumor. After removing the neoplasm it is necessary to find out whether there are in the receptors for hormones. If the tumor is hormone-dependent (that is, sensitive to estrogen or progesterone), then treatment should include blockers of the corresponding hormone.
It is equally important to determine the oncogene HER-2 / neu,which is present in 15-30% of breast tumors. It has a prognostic value. The presence of this oncogene reduces disease-free survival and worsens the prognosis for metastases in the lymph nodes. In addition, there is a special medicine (Herceptin), which suppresses this oncogene. Due to the high toxicity of the drug, it is not prescribed to all in a row, but only to patients with a positive reaction to HER-2 / neu.
CT, chest X-ray, radioisotopethe study of bones, ultrasound of the liver and other organs is aimed at finding distant metastases. These are very important procedures, on the basis of which the method of treating the disease depends.
When determining the stage of the disease, take into account the size of the tumor, regional lymph node involvement and distant metastases. Each of these items is denoted by the Latin letter (TNM).
- T0 - undetectable tumor
- T1 - tumor less than 2 cm in diameter
- T2 - tumor from 2 to 5 cm in diameter
- T3 - tumor more than 5 cm in diameter
- T4 - any tumor with spread to the thoracic and wall and skin
- N0 - axillary nodes not probed
- N1 - on the side of the tumor palpable mobile axillary nodes (both nonmetastatic and clearly metastatic nature)
- N2 - On the side of the tumor, lymph nodes that are soldered to surrounding tissues
- N3 - supra- or subclavian lymph nodes (or edema of the hand)
- M0 - no distant metastases were detected
- M1 - distant metastases were detected
Based on the above classification determine the stage of the disease.
Breast cancer with metastases
For breast cancer, the appearance of metastases is typical. The lymph nodes of the axillary, sub- and supraclavicular, subscapular regions are affected first. More than half of the patients get their diagnosis, already having such regional metastases.
Remote foci of the disease arise from the primarytumor and affected lymph nodes. Most often they are localized in bones, ovaries, lungs and liver, as well as in any other organs and tissues. If the metastases are single, then they can be removed surgically. The operation of breast cancer will not cure, but will increase the duration and quality of life.
Treatment of breast cancer
The treatment of the disease is determined by the attending oncologist together with a chemotherapy specialist and a radiation therapist. The scope and appropriateness of these or other methods depends on:
- Tumor localization and its prevalence
- The age of the patient and the state of her menstrual and genital function
- Concomitant chronic diseases (liver, heart, pancreas and other organs)
- Previous treatment
The whole therapy of the disease is divided into three types: surgical, medicinal and radiation. Usually, two or even three approaches are used at once.
Complete removal of the mammary gland and underlyingtissues, practiced before the 90s of the last century, was a crippling and difficult method of treatment. Currently, with a common form of the disease, a modified version of the operation is used, which is better tolerated. At the same time, the mammary gland, fascia (membrane) of the large pectoral muscle, and regional lymph nodes are removed. After the operation is completed, the plastic of the breast is performed, which allows solving the patient's psychological problems.
Radical resection is a gentle operation, in which the mammary gland sector is removed, the fascia of the large pectoral muscle, lymph nodes.
Contraindications to radical resection:
- location of the tumor in the center of the breast
- breast cancer in men
- tumor growth in several places at once
- diffuse form of cancer
After the operation, the mammary gland is formed from the remaining tissue. In addition to the gentle method, the remaining portion of the breast is irradiated.
- Age under 35 years
- High malignant cancer (determined by histological examination of the removed tumor)
- Sprouting tumor capsules of the regional lymph node
- Absence of receptors for estrogen and progesterone
- High activity of the oncogene HER-2 / neu
When these factors are detected, extended operations and additional drugs are usually used.
Irradiation of the breast is recommended to allwomen after an organ-preserving operation. This significantly reduces the risk of relapse in the rest of the breast. With common tumors of the third and fourth stage, irradiation is performed even after the operation with complete removal of the breast.
Chemotherapy (doxorubicin, cyclophosphamide, docetaxel, paclitaxel)
Chemotherapy can be applied right aftersurgery (in the early stages of the disease), as well as before surgery to reduce the tumor in volume. With distant metastases, such treatment is aimed at improving the quality of life, rather than on full recovery.
If a sensitivity to estrogen is detected in the study of a distant tumor, then treatment involves blocking this hormone. Among the ways of such blocking are:
- removal of ovaries (more often in elderly women)
- anti-estrogen drugs (tamoxifen)
- aromatase inhibitors (letrozole, anastrozole, exemestane)
With increased activity of HER-2 / neu, its inhibitor-herceptin or analogues is used.
With far-reaching disease with distantmetastases, speech about cure, alas, does not go. But modern medicine can increase life expectancy and improve its quality. In palliative care, all of the above methods are used. They help to eliminate the immediate threat of life (bleeding, infection during the decay of the tumor), reduce the intensity of pain. Often in conjunction with chemotherapy, painkillers (non-narcotic drugs and narcotic drugs) are used.
Algorithms for the treatment of breast cancer
After the termination of treatment the woman becomes on a prophylactic medical examination for the purpose of the further supervision.
- Regular self-examination of the breast
- Examination at the doctor (in the first year every three months, in the 2nd and 3rd years - every six months, then once a year)
- The annual mammography of both glands or the opposite (after mastectomy)
- If you suspect a relapse or metastasis -a thorough examination (CT, oncomarkers and other methods). It is proved that routine in-depth examination without symptoms does not increase life expectancy.
Breast cancer in men
The mammary gland in the representatives of the stronger sex -this is a rudiment. In it in a very small volume remained the remains of glandular, adipose and connective tissue. In cases of obesity, the size of the mammary glands can be increased. But the true hypertrophy (proliferation of glandular tissue) is called gynecomastia. Men with this pathology often turn to therapists and endocrinologists.
Breast cancer occurs in men not only withgynecomastia, but also in perfectly healthy organs. The cause of this extremely rare condition is an excess of female and a lack of male hormones. Such a tumor rides itself more aggressively than in women, is less treatable. Signs of cancer are soreness, discharge from the nipple and extraneous education.
Prognosis for breast cancer
- The average 5-year survival rate for breast cancer is 50-60%
- Thus, at the first stage of the disease, a five-year period without recurrences is overstepped by more than 90% of women
- and at III and IV stages of a cancer of a mammary gland this percent decreases up to 35%
Prevention of breast cancer
There are no ways, giving 100% protection from malignant breast tumors. But every woman has the opportunity to reduce the risks of this ailment, and also to prevent the spread of the disease in the early stages.
- Women over 40 years - mammography once in 2 years, after 50 - every year, with breast cancer from relatives - every year from 35 years.
- Regular self-examination of the breast
- Seeking a doctor if you have any possible symptoms of cancer
- Pregnancy planning, full breastfeeding
- Weight control, correction of diabetes mellitus and other endocrine diseases
- Special control in women with relatives with breast and ovarian tumors
- Reception of oral contraceptives and hormone replacement therapy only after consulting a doctor and examination (see unsafe birth control pills).
- Reception tamoxifen, preventive mastectomy and removal of the ovaries with confirmed hereditary cancer.
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