Breast cancer is a malignant neoplasm of the breast. Local manifestations: breast shape change, nipple retraction, skin wrinkling, nipple discharge (often bloody), probing of seals, nodules, enlargement of supraclavicular or axillary lymph nodes. Surgical treatment in combination with radiation or chemotherapy in the early stages is most effective. In the later stages, tumor metastasis to various organs is noted. The prognosis of treatment largely depends on the prevalence of the process and the histological structure of the tumor.
C50 Malignant neoplasm of the breast
According to WHO statistics, more than a million new cases of breast cancer are diagnosed worldwide every year. In the USA, this figure reaches 50 thousand. Every eighth American woman gets breast cancer. Mortality from this pathology is about 50% of all cases. The decrease in this indicator is hindered by the absence in many countries of organized preventive screening of the population for early detection of malignant neoplasms of the mammary glands.
The analysis of breast cancer screening methods among the population shows that the mortality rate of women who took part in the preventive program is 30-50 percent lower than in groups where prevention was not carried out. A dynamic decrease in mortality rates from breast malignancies is observed in those countries where preventive measures are carried out (training women in breast self-examination, medical examination) at the national level. In many US states, there is still an increase in the incidence and mortality from breast cancer due to insufficient coverage of the population with preventive measures.
Currently, breast cancer is divided into more than 30 forms. Nodular cancers (unicentric and multicentric) and diffuse cancers (including edematous-infiltrative and mastitis-like forms) are the most common. Rare forms include Paget’s disease and breast cancer in men.
Breast cancer causes
Certain factors contribute to the occurrence and development of breast cancer:
- Paul. The vast majority of breast cancer occurs in women, the occurrence of malignant tumors in men is 100 times less common;
- Age. Most often, breast cancer develops in women after 35 years;
- Complicated gynecological history: menstrual cycle disorders, hyperplastic and inflammatory pathologies of the genitals, infertility, lactation disorders;
- Genetic predisposition: malignancies occurring in close relatives, lactic-ovarian syndrome, cancer-associated genodermatoses, combination of breast cancer with sarcoma, malignant tumors of the lungs, larynx, adrenal glands;
- Endocrine and metabolic disorders: obesity, metabolic syndrome, diabetes mellitus, chronic arterial hypertension, atherosclerosis, pathologies of the liver, pancreas, immunodeficiency.
- Non-specific carcinogenic factors: smoking, chemical poisons, a high-calorie unbalanced diet rich in carbohydrates and poor in proteins, ionizing radiation, work in discrepancy with biorhythms.
It must be remembered that the factors of increased carcinogenic risk that occur do not necessarily lead to the development of a malignant breast tumor.
Breast cancer is classified by stages of development.
- At stage I, the tumor does not exceed 2 centimeters in diameter, does not affect the surrounding tissue of the gland, there are no metastases.
- Stage IIa is characterized by a 2-5 cm tumor that has not sprouted into the fiber, or a smaller tumor that has affected the surrounding tissues (subcutaneous tissue, sometimes skin: wrinkling syndrome). Metastases are also absent at this stage. The tumor becomes 2-5 cm in diameter. It does not germinate into the surrounding subcutaneous fat and breast skin. Another type is a tumor of the same or smaller size, sprouting subcutaneous fat and soldered to the skin (causes symptoms of wrinkling). There are no regional metastases here.
- At stage IIb, metastases appear in the regional lymph nodes in the armpit. Metastasis to the intra-thoracic parasternal lymph nodes is often noted.
- Stage III tumor has a diameter of more than 5 centimeters, or grows into the muscle layer located under the mammary gland. A characteristic symptom of “lemon peel”, swelling, nipple retraction, sometimes ulceration on the skin of the gland and discharge from the nipple. There are no regional metastases.
- Stage III is characterized by multiple metastases of axillary lymph nodes or single supraclavicular (or metastases in parasternal and subclavian nodes).
- Stage IV is terminal. Cancer affects the entire mammary gland, sprouts into the surrounding tissues, spreads to the skin, manifests itself with extensive ulceration. The fourth stage also includes tumors of any size that have metastasized to other organs (as well as to the second mammary gland and lymph nodes of the opposite side), formations firmly fixed to the chest.
Breast cancer symptoms
In the early stages, breast cancer does not manifest itself in any way, with palpation, a dense formation in the gland tissue can be detected. Most often, a woman notices this formation during self-examination, or it is detected during mammography, breast ultrasound, and other diagnostic methods during preventive measures. Without appropriate treatment, the tumor progresses, increases, grows into subcutaneous tissue, skin, and chest muscles. Metastases affect regional lymph nodes. With the blood flow, cancer cells enter other organs and tissues. Breast cancer most often spreads metastases to the lungs, liver and brain. Necrotic disintegration of the tumor, malignant lesion of other organs leads to death.
Breast cancer is prone to rapid metastasis to regional lymph nodes: axillary, subclavian, parasternal. Further, with the flow of lymph, cancer cells spread along the supraclavicular, scapular, mediastinal and cervical nodes. The lymph system of the opposite side may also be affected, and the cancer may pass to the second breast. Hematogenically, metastases spread to the lungs, liver, bones, and brain.
One of the most important methods of early detection of breast cancer is regular and thorough self-examination of women. Self-examination for women at risk for breast cancer, as well as for all women over 35-40 years of age, is desirable to be performed every month. The first stage is breast examination in front of a mirror. They reveal deformities, a noticeable increase in one breast compared to the other. The definition of the symptom of “lemon peel” (skin retraction) is an indication for immediate treatment by a mammologist.
After the examination, a thorough feeling is performed, noting the consistency of the gland, discomfort and soreness. They press on the nipples to detect pathological secretions. In the diagnosis of breast cancer, examination and palpation can detect a neoplasm in the gland tissue. Instrumental diagnostic methods make it possible to examine the tumor in detail and draw conclusions about its size, shape, degree of damage to the gland and surrounding tissues. if a breast cancer is suspected , it is carried out:
- X-ray examination: mammography, ductography, if necessary – digital tomosynthesis.
- Breast ultrasound. Ultrasound examination is supplemented by examination of regional lymph nodes and Dopplerography.
- MRI of the breast.
- Breast biopsy. Subsequent cytological examination of tumor tissues shows the presence of malignant growth.
- Additional diagnostics. Among the latest methods of examination of the mammary glands, it is also possible to note scintiomammography, microwave-RTS.
Breast cancer treatment
Breast cancer is one of the most treatable dense malignancies. Small tumors localized in the tissues of the gland are removed, and, often, cases of recurrence of non-metastasized removed cancer are not noted.
Breast cancer treatment is surgical. The choice of surgery depends on the size of the tumor, the degree of damage to the surrounding tissues and lymph nodes.
- Mastectomy. For a long time, almost all women with a detected malignant breast tumor underwent radical mastectomy (complete removal of the gland, adjacent lymph nodes and chest muscles located under it). Now, a modified analogue of the operation is being performed more and more often, when the pectoral muscles are preserved (if they are not affected by the malignant process).
- Breast resection. In cases of early stages of the disease and small tumor sizes, partial mastectomy is currently performed: only the area of the gland affected by the tumor with a small amount of surrounding tissue is removed. Partial mastectomy is usually combined with radiotherapy and shows quite comparable results with radical surgery.
Removal of lymph nodes helps to reduce the likelihood of recurrence of the disease. After removal, they are examined for the presence of cancer cells. If metastases are found in the lymph nodes removed during surgery, women undergo radiation therapy. Among other things, chemotherapeutic treatment is prescribed to patients with a high risk of malignant cells entering the bloodstream.
Currently, there is a way to detect estrogen receptors in breast cancer cells. They are detected in about two thirds of patients. In such cases, it is possible to stop the development of the tumor by using breast cancer hormone therapy.
Prognosis and prevention
After surgical removal of a malignant breast tumor, women are registered with a mammologist-oncologist, are regularly monitored and examined to detect recurrence or metastases to other organs. Most often, metastases are detected in the first 3-5 years, then the risk of developing a new tumor decreases.
The most reliable measure of breast cancer prevention is a regular examination of women by a mammologist, monitoring of the state of the reproductive system, monthly self-examination. All women over the age of 35 need to have a mammogram.
Timely detection of genital pathologies, hormonal balance disorders, metabolic diseases, avoidance of carcinogenic factors contribute to reducing the risk of breast cancer.
- Balazs I Bodai; Phillip Tuso. Breast Cancer Survivorship: A Comprehensive Review of Long-Term Medical Issues and Lifestyle Recommendations. Perm J. 2015 Spring; 19(2): 48–79 link
- V Craig Jordan. The New Biology of Estrogen-induced Apoptosis Applied to Treat and Prevent Breast Cancer. Endocr Relat Cancer. 2015 Feb; 22(1): R1–31 link
- Suzanne A Eccles et al. Critical research gaps and translational priorities for the successful prevention and treatment of breast cancer. Breast Cancer Res. 2013; 15(5): R92 link