Carcinoma of the breast

Malignant tumor – breast carcinoma – is a common oncological pathology.

Such tumors are characterized by relatively late diagnosis, so in many cases the outcome of the disease can be negative. What do you need to know about this disease in order to detect it in the early stages of development? Is it possible to cure the disease, and how? This and much more is in our article.

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Causes breast carcinomas

At present, the possible causes of breast carcinoma have not been sufficiently studied. It is assumed that the risk of developing a malignant tumor is higher in those patients who are exposed to certain provoking factors. These include:

• hereditary predisposition. Experts have proven that in cases where immediate relatives are sick or have had carcinoma, the probability of getting sick increases several times. It's all about the genes that are responsible for the possibility of developing oncology. However, the absence of such genes does not mean that a woman is protected from a malignant disease;
• Previously suffered cancerous tumors. If a woman has already had a tumor, even if it was successfully treated, the risk of it developing in the other breast increases;
• individual features of a woman's sexual function. Risk factors include early puberty (10-11 years), late menopause (at 60 years), pregnancy after 35 years. Women who have never been pregnant or breastfed in their lives are no less at risk;
• the presence of cystic mastopathy or fibroadenoma;
• use of contraceptives for several years without interruption;
• use of hormonal therapy during menopause for 3 years or more;
• exposure to radiation, both in hazardous production and living in radiation-unfavorable zones;
• endocrine diseases such as hypothyroidism, various forms of diabetes, metabolic disorders (in particular, excess weight).

Of course, the factors that provoke the formation of carcinoma are just assumptions. But in order to protect yourself from the insidious malignant disease, it is important to pay attention to these factors and, if possible, try to eliminate them. At least those women who have these factors should most closely monitor their health and regularly consult a doctor.

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Symptoms breast carcinomas

Clinical symptoms of carcinoma may differ depending on the form of oncological pathology (we will talk about the forms below), the phase of development of the process and its scale. Let's highlight the main symptoms of breast carcinoma, having discovered which, a woman should immediately contact a doctor:

• a dense formation of any size can be felt in the chest. Localization is most often under the nipple or on another part of the mammary gland;
• the skin on one of the glands changes, wrinkles appear, the skin may become dense, change in color (redness, yellowness or bluishness of the skin area may appear), ulcers may appear on the surface, most often in the areola area;
• when examining in a mirror, you may notice a discrepancy in the contours of the two glands, that is, one of them may change in size, become convex, or, conversely, retracted;
• enlarged lymph nodes in the armpit area are palpable. In a normal state, the nodes are not palpable. In pathology, they are felt as small, possibly painful, small balls of soft or dense consistency;
• press on the nipple: discharge may appear with carcinoma. Normally, there should be no discharge (except during the prenatal and lactation periods);
• Carcinoma can develop under the guise of mastitis, erysipelas and other inflammatory diseases, so such pathologies should not be treated independently. For any inflammatory processes in the chest, consult a doctor.

Sometimes carcinoma can proceed practically without clinical signs: the insidious disease can be noticed only on ultrasound or mammography. Therefore, preventive visits to the doctor are very important for the timely detection of malignant pathologies.

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Forms

There are two main types of carcinoma: invasive and non-invasive.

Non-invasive carcinoma is the initial stage of the malignant process, which is treated most successfully. At this stage, the tumor is not yet connected to the surrounding tissues, but is located in the milk duct or in a separate lobe of the mammary gland.

Invasive ductal carcinoma of the mammary gland is no longer an isolated element, but a process that has affected other tissues of the gland. Such a process has a special malignant course, it will be more difficult to get rid of it.

Invasive breast carcinoma is divided into several variants of the course:

1. Ductal carcinoma of the mammary gland – forms inside the wall of the milk duct (duct), eventually growing into the nearby breast tissue. The most common is infiltrating ductal carcinoma of the mammary gland (this name is equivalent to the word "invasive" - growing) - such a tumor can be recognized by a fairly dense formation with unclear boundaries, which is fused with nearby tissues. The area around the nipple often falls inward (is drawn in). Calcium deposits can be detected on images: they form in place of dead cells. Infiltrating ductal carcinoma of the mammary gland can have different sizes, and the cellular structures can have different degrees of aggressiveness, which largely determines the rate of spread and growth of cells.
2. Lobular carcinoma of the mammary gland - first affects the glandular tissue, then captures more and more nearby tissues. Invasive lobular carcinoma of the mammary gland can also be called lobular carcinoma. This name characterizes the tumor that grows directly from the lobular structures of the breast, which are responsible for the production of milk in a woman. Often, the invasive type of tumor is not determined on a mammogram. However, a certain dense formation can be felt in the upper outer part of the mammary gland. In more than a quarter of cases, the same formation appears on the second breast, or as a multifocal carcinoma (in several places on one breast). The tumor manifests itself most clearly in the late stages, when there is a change in the skin surface over the lesion. Due to the hormonal nature of the disease, infiltrating lobular carcinoma of the mammary gland can spread to the internal reproductive organs - the uterus and appendages.
3. Tubular carcinoma of the mammary gland is characterized by penetrating growth into adipose tissue. Such a tumor is never large (up to 2 cm), has a tubular structure with a pronounced lumen. Carcinoma cells are monomorphic, with very few signs of atypicality. Tubular carcinoma contains a fairly large amount of collagen: the tumor is characterized by slow growth and may not initially cause suspicion. This is the reason for frequent incorrect diagnoses, since such manifestations are possible with adenosis of the mammary gland or with radial sclerotic changes.
4. Paget's disease of the nipple is an intraductal carcinoma of the mammary gland that manifests itself by the formation of ulcers or changes in the contours of the nipple and areola. On the surface of the nipple, peeling and redness are observed, which can sometimes suddenly disappear on its own. However, the disease itself does not disappear. Later, it manifests itself as pain, a burning sensation, and possible discharge from the milk ducts. Often, the initial course of this disease resembles eczema. Paget's disease of the nipple can occur in both women and men.
5. Carcinoma in situ of the mammary gland is a non-invasive malignant process, that is, it has not spread to nearby tissues. Literally, the combination "in situ" is translated as "in its place". With carcinoma in situ, atypical tumor cells do not grow into the surrounding tissues of the gland, but are located in one area. This is the most favorable tumor variant, which in some cases is even treated conservatively, without surgery. The danger of a non-invasive neoplasm is that it can at any time turn into an infiltrating (invasive) form, affecting all nearby tissues and significantly worsening the prognosis of the disease.

Infiltrating breast carcinoma, in turn, is divided into several course variants:

• preinvasive ductal carcinoma - when the process has not yet spread to the surrounding tissues, developing in the milk ducts, but there is a high probability that it will soon transform into an infiltrative form;
• infiltrative ductal carcinoma of the mammary gland - originates in the milk ducts, gradually expanding, and moving to the fatty tissue of the mammary gland. The degenerated cells of such carcinoma, unlike the non-invasive form, are able to penetrate the blood and lymphatic vessels, thus spreading to other organs and systems.

Infiltrative breast carcinoma is one of the most insidious and common variants of the disease. This tumor is diagnosed in 80% of all breast cancers. This malignant form quickly leaves the milk canal cavity and grows into healthy breast tissue.

The most characteristic signs of the disease include:

• a small, dense area with unclear contours, resembling a bump;
• the seal does not “walk” between the tissues, but is clearly fused with them;
• the areola area seems to be drawn inward (not always, but very often);
• The mammogram shows a series of small calcium deposits around the perimeter of the tumor.

Infiltrating breast carcinoma is graded according to international standards according to the following table:

TX	The original tumor cannot be assessed
T0	There are no signs of the original tumor.
Tis	Signs of carcinoma in situ
T1	Formation with dimensions up to 2 cm
T1mic	Presence of microgermination – microinvasion, up to 0.1 cm
T1a	Invasion from 0.1 cm to 0.5 cm
T1b	Germination is more than 0.5 cm but less than 1 cm
T1c	Penetration from 1 cm to 2 cm into surrounding tissues
T2	Education from 2 cm to 5 cm
T3	Formation larger than 5 cm
T4	Any formation that has spread through the chest and skin
T4a	Growing through the chest
T4b	Swelling and ulcers on the surface of the skin
T4d	Tumor with inflammatory phenomena
NX	Carcinoma, assessment of nearby lymph nodes is difficult
N0	No metastases were found in the nearest lymph nodes.
N1	Mobile nearby lymph nodes were found on the affected side
N2	Fixed nearby lymph nodes were found on the affected side
N3	Metastases were found in the internal nearby lymph nodes
MX	It is impossible to estimate the extent of metastasis
M0	No metastases detected
M1	Distant metastases found

When diagnosing ductal or lobular carcinoma, the aggressiveness of the tumor's development is determined. The degree of aggression can be determined by the probability of invasion into nearby tissues. It is assessed based on a biopsy, identifying the following categories:

• GX – changes in cell structure are difficult to assess;
• G1 – highly differentiated process;
• G2 – moderately differentiated process;
• G3 – low differentiated process;
• G4 – undifferentiated.

Invasive breast carcinoma G2 and G1 have a lower degree of invasion, while G3 and G4 have the highest degree of invasion.

Poorly differentiated breast carcinoma is characterized by a slow rate of cell growth, while atypical cells are quite similar to healthy ones.

The highly differentiated process occurs with rapid growth of tumor cells, in which differences from healthy cells are clearly visible.

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Diagnostics breast carcinomas

The first link in diagnosing breast carcinoma is mammography, a test similar to X-ray. A mammogram can show not only the tumor, but also calcium deposits, which are typical for the infiltrative form.

Ultrasound examination allows us to determine the structure of the tumor, which allows us to differentiate carcinoma from cystic formations of the mammary gland.

A ductographic examination is an assessment of the milk ducts of the mammary gland. During the examination, a special liquid is injected into the ducts, after which the woman is given an X-ray. In the case of ductal carcinoma, the X-ray will clearly show the area through which the liquid did not pass.

If after conducting the above studies it was not possible to determine the nature of the tumor, the doctor prescribes a biopsy - a diagnostic procedure that will accurately indicate the structure of the neoplasm. A biopsy is performed using a thin needle, which punctures the breast tissue in the affected area, the required amount of internal tissue is taken, which is then examined microscopically. The microscope allows you to see which cells are present in the material - healthy or malignant.

Sometimes it is not possible to remove the material being examined with a thin needle. In such cases, a thicker needle is used, or a surgical incision of the tissue is resorted to.

If malignant cells are detected, the doctor may prescribe a number of additional tests: this includes determining the susceptibility of these cells to estrogens and progesterone, assessing the rate of cell division, etc. A comprehensive examination allows you to determine the most correct scheme for further treatment.

If the stage of the disease is such that one can suspect the spread of metastases throughout the body, studies are prescribed to detect them. Such studies include radiography, examination of internal organs, CT, osteography, etc.

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Treatment breast carcinomas

Treatment of breast carcinoma should be started immediately after diagnostic procedures. There are many known treatment options for the disease, but when choosing a therapeutic intervention, the doctor is primarily guided by the advanced stage of the cancer, the extent of its spread in tissues and in the body, and the aggressiveness of the tumor. Let's consider the main treatment methods.

1. Surgical treatment. This method is used most often, as it is the most effective. The operation is usually performed using radiation and chemotherapy. Surgery may involve resection of the entire affected mammary gland or part of it. During the operation, the nearest lymph nodes on the affected side may also be removed to prevent the disease from recurring. Simultaneously with the operation or with additional intervention, the doctor may install implants that eliminate the external defect of the removed mammary gland.
2. Radiotherapy (irradiation) is a method often prescribed after surgery. Radiotherapy is a procedure that irradiates the area affected by the tumor and nearby lymph nodes that may contain abnormal cells from the tumor.
3. Drug treatment (chemotherapy). This method of treatment involves the use of special medications that allow the destruction of developing malignant cells or the suspension of their division. Chemotherapy is not used as the only method of therapy, but it perfectly complements the effect of surgery and radiation.

The main drugs recommended for use in breast carcinoma include Epirubicin, Cyclophosphamide, and Fluorouracil. The doctor selects the drug based on the effectiveness of the drug and its acceptance by the patient's body.

In case of hormone-dependent tumors, which are characterized by the presence of receptors sensitive to estrogens and progesterone, the doctor prescribes drugs that suppress hormone production. It has been proven that drugs that block hormonal synthesis are very helpful in such carcinomas. The most commonly prescribed drug is the well-known drug Tamoxifen. It is used for a long time, sometimes for several years.

Drugs containing monoclonal antibodies are another medication that has a destructive effect on malignant cells. Herceptin is one of these drugs. The Herceptin regimen is prescribed exclusively by a specialist.

An oncologist, together with a nutritionist, can prescribe a diet for breast cancer.

Prevention

What can be done to prevent the development of carcinoma in the mammary gland? Indeed, every woman needs to know and follow the basic principles that allow her to protect herself from this insidious disease as much as possible.

Women at almost any stage of life can be susceptible to breast diseases. What can be done to reduce the risk of damage?

1. Watch your weight. It has been proven that women with a large body mass are more susceptible to breast pathologies. Obesity not only disrupts a woman's hormonal balance, but also creates an excessive load on the organs. Review your diet and, if you can't cope on your own, you can seek advice from a nutritionist.
2. Forget about drinking alcohol. Scientists have proven that women who frequently drink alcohol increase the risk of developing carcinoma by more than 20%. Perhaps the reason for this is the same hormonal changes that occur against the background of alcohol consumption. If you cannot completely give up alcohol, reduce its consumption to a minimum.
3. Lead an active lifestyle, play sports. Physical culture helps you stay in shape, strengthens your immune system, and stabilizes your hormonal balance.
4. If there are women in your family (on your side) who have ever been diagnosed with malignant breast disease, then you are at higher risk of getting sick than others. What can you advise? Visit your doctor more often and have preventive ultrasound to monitor the condition of your mammary glands.
5. After the birth of the baby, do not ignore breastfeeding. Feed the child at least until 1 year. In this way, you will not only strengthen the newborn's body, but also reduce the risk of developing carcinoma for yourself.
6. Vitamin D has a good preventive effect. It has been proven that this vitamin can even inhibit the growth of malignant cells in the body.
7. Pay attention to your diet. It is better to replace beef and pork meat products with white chicken or turkey meat. Experts say that in most cases it is better to eat sea fish and seafood instead of meat. In addition, you should increase the amount of vegetables, berries, greens and fruits, legumes and nuts, as well as vegetable oils in the menu, the so-called anti-cancer diet.
8. Examine your mammary glands periodically. Develop a habit: monthly after your period (on the 5th-6th day) after taking a shower, check your glands for any changes: lumps, nodules, macerations, soreness, discharge from the nipples, etc. If you find anything suspicious, be sure to visit a gynecologist or mammologist, have an ultrasound.

Do not forget to promptly treat any diseases of the mammary glands and genital area. If you follow all the above rules, you will be able to preserve not only your beauty, but also your health.

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Forecast

Of course, with the constant development of world medicine and the improvement of specialists' qualifications, as well as with the advent of modern technical medical equipment, the prognosis of breast carcinoma can be successful in 95% of cases. However, we should not forget that the timeliness of contacting a doctor and detecting a tumor at early, asymptomatic stages of development play a huge role in the effectiveness of treatment.

The presence and prevalence of metastases are also important in the prognosis of the disease. Carcinoma, the success of treatment of which depends on the presence of metastases, reacts much more severely to therapeutic effects if there are more than four metastases in the lymph nodes. Moreover, the further from the primary tumor the metastases are detected, the worse the prognosis becomes.

According to statistics, carcinoma up to 20 mm in size spreads metastases in up to 15% of cases; carcinoma up to 50 mm in size – up to 60% of cases; a tumor larger than 50 mm metastasizes in almost 80%.

Experts from different countries have determined that the prognosis for the disease may be worse in hormone-independent tumors, that is, those that lack sensitive receptors to sex hormones.

Determination of tumor markers is important for assessing the prognosis of carcinoma. Such a blood test can now be taken in almost any laboratory. Tumor marker values that indicate an excess of the norm by 1.5-2 times worsen the prognosis and increase the risk of recurrent carcinoma or the spread of metastases.

Don't hesitate to see a doctor for any suspicious reason. Breast cancer can be too serious a price to pay for carelessness, so don't let it develop and love yourself!

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