Invasive ductal carcinoma is a malignant neoplasm originating from the cells of the glandular epithelium of the inner lining of the milk ducts. In the initial stages, it flows asymptomatically. Subsequently, it is manifested by the presence of a tumor-like formation, discharge from the nipple, a change in the condition of the skin, the size and shape of the breast. With the spread of the process, weakness, hyperthermia and weight loss appear. Symptoms due to the defeat of various organs by distant metastases are added. The diagnosis is made taking into account complaints, examination data and the results of additional studies. Treatment – surgery, radiotherapy, chemotherapy.
General information
Invasive ductal carcinoma is the most common type of breast cancer. It accounts for approximately 80% of the total number of cases of malignant breast tumors. Occurs when ductal cancer spreads in citu beyond the duct. The risk of developing invasive ductal carcinoma increases with age, 2/3 of patients are women over 55 years old. In the later stages, there is a lesion of regional lymph nodes and distant metastasis. The prognosis at stages I-II is quite favorable, with timely treatment, persistent remission is observed in 85% of patients. With metastasis to lymph nodes and distant organs, survival decreases. The treatment is carried out by specialists in the field of oncology and mammology.
Causes
The causes of this pathology have not been precisely clarified. Among the risk factors, experts indicate unfavorable heredity. Women who have close relatives with invasive ductal carcinoma suffer from this disease 2-3 times more often than the average in the population. The probability of carcinoma also increases in the presence of a non-invasive ductal cancer in the anamnesis, while the time interval between the two diseases can vary greatly. Sometimes invasive ductal carcinoma is diagnosed 20-25 years after treatment of non-invasive cancer.
Risk factors include gynecological history and chronic diseases of the mammary glands. Invasive ductal carcinoma is more often detected in women with early menarche, late onset of menopause, late first pregnancy, absence of gestations, childbirth and breastfeeding in the anamnesis. In addition, breast cancer is more common in patients suffering from fibrocystic mastopathy and fibroadenoma of the breast.
The development of invasive ductal carcinoma can be provoked by prolonged (for several years) taking hormonal drugs. In the reproductive age, oral contraceptives can play a negative role, in the menopause period – medications to eliminate the manifestations of menopause. Along with the above factors, high levels of radiation, radiotherapy for other oncological diseases, diabetes mellitus, hypothyroidism, obesity and arterial hypertension are important.
Symptoms
In the early stages, the disease is asymptomatic. Usually, at the initial stage, the neoplasm can be detected only through regular examinations and self-examinations. During palpation, a painless dense knot is determined without clearly defined boundaries. The first obvious sign is often transparent, yellowish-green or bloody discharge from the nipple, appearing regardless of the phase of the menstrual cycle. As invasive ductal carcinoma progresses, the amount of secretions increases, maceration of the skin, the appearance of erosions and ulcers in the areola zone is possible.
The appearance of the breast changes. The skin above the invasive ductal carcinoma initially turns pink, purple or reddish, and then begins to peel off. There may be umbilication (skin retraction in the area of neoplasm), “site symptom” (the presence of an inelastic area that does not straighten after a short-term taking into the fold) and “lemon peel symptom” (excessive porosity of the skin on the area taken into the fold). Gradually, the external deformation becomes more and more noticeable. A diseased breast is different in size, shape and external contours from a healthy one. Possible retraction of the nipple.
With invasive ductal carcinoma, both local and general signs of oncological damage are revealed: weakness, fatigue, loss of appetite, aversion to meat products, anemia, weight loss and hyperthermia. When invasive ductal carcinoma metastasizes to regional lymph nodes, tumor-like formations in the axillary region are palpated. There may be swelling of the upper limb on the side of the lesion, pain and discomfort when trying to raise your arm.
Distant metastases occur as a result of the spread of cancer cells with blood flow. Invasive ductal carcinoma usually metastasizes to the bones, lungs, skin, liver, ovaries and brain. With bone metastases, patients are concerned about back and limb pain. With metastasis to the liver, ascites may develop. Brain metastases are manifested by headaches, epipripadki and various neurological disorders. Lung metastases are often asymptomatic for a long time. Chest pain, shortness of breath, prolonged cough and hemoptysis are possible. Skin lesions resemble a picture of erysipelas.
Symptoms of invasive ductal carcinoma, taking into account the stages:
- Stage I – the diameter of the tumor does not exceed 2 cm. There is no germination of the skin and subcutaneous fat.
- Stage IIa – the diameter of invasive ductal carcinoma is 2-5 cm . There is a positive “site symptom” and wrinkling of the skin when taken into the fold.
- Stage IIb – the diameter of the tumor is 2-5 cm . An indistinctly expressed umbilication may be determined. No more than 2 metastases are detected.
- Stage III – the diameter of invasive ductal carcinoma is more than 5 cm. Umbilication, breast swelling and “lemon peel symptom” are detected. Possible retraction of the nipple. No more than 2 metastases are detected.
- Stage IV is a large tumor affecting a significant part of the breast. Numerous metastases are detected.
Diagnosis and treatment
The diagnosis is made taking into account complaints, anamnesis, results of external examination and data from additional studies. In the presence of at least one alarming symptom, an extended examination is indicated. Patients with suspected invasive ductal carcinoma are referred for an overview mammography in three projections, targeted mammography, ductography, MRI and ultrasound of the breast with regional lymph nodes. A smear from the nipple of the breast is examined. The determination of the cancer marker CA 15-3 in the blood is carried out. A biopsy of invasive ductal carcinoma, histological, immunohistochemical and cytological examination of the biopsy are performed. To exclude metastases, lung x-ray, limb bone radiography, ultrasound of internal organs and other studies are prescribed.
Therapeutic tactics are determined taking into account the stage of the process, the hormonal status of invasive ductal carcinoma (hormone-dependent or hormone-independent) and the HER2 status of the tumor. In the initial stages, radical breast resection or subcutaneous mastectomy is performed. In case of widespread invasive ductal carcinoma, radical mastectomy or mastectomy with simultaneous irradiation is performed. If possible, reconstruction or simultaneous prosthetics of the breast are carried out. In the presence of contraindications to large-scale surgical intervention (old age, the presence of severe somatic pathology), ablation with lymphadenectomy is used.
In the postoperative period, radiation therapy and chemotherapy are prescribed. In invasive ductal carcinoma of stage III and IV, treatment begins with chemotherapy. When detecting the HER-2 gene, lapatinib and its analogues are used. Hormonal preparations are used for hormone-dependent neoplasms. After surgical intervention, patients are referred for psychological rehabilitation, in the long term, if necessary, reconstructive operations are performed to eliminate the cosmetic defect.
Prognosis and prevention
The prognosis for invasive ductal carcinoma is determined by the stage, the prevalence of the process, the degree of malignancy of the neoplasm, the number of metastases and some other factors. At stage I, the five–year survival rate according to various data ranges from 85-95%, at stage II – 66-80%, at stage III – 41-60%. The average life expectancy of patients with stage IV tumor is 2-3.5 years, 25-35% of patients manage to live more than 5 years, 10% – more than 10 years.
The main means of preventing invasive ductal carcinoma are regular examinations and self-examinations. All women of childbearing age should visit a mammologist annually and undergo breast ultrasound. Patients over the age of 35 years are prescribed an overview mammography once every 2 years, and over the age of 50 years – annually. If calcification foci are detected in the mammary gland, patients are referred for a biopsy. At will or according to indications, a study is carried out for the presence of genetic mutations that increase the risk of developing invasive ductal carcinoma.
Self-examinations are recommended to be carried out on the 8th – 12th day of the menstrual cycle. It is necessary to carefully examine both mammary glands in the mirror, paying attention to the symmetry of size and shape, changes in the structure or color of the skin. Then you should consistently probe both mammary glands and axillary lymph nodes and press on the nipple to make sure there is no discharge. The presence of at least one symptom characteristic of invasive ductal carcinoma is a reason for immediate treatment by a mammologist or oncologist.