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Diagnosis of breast cancer
Last reviewed: 23.04.2024
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Diagnosis of breast cancer is a complex of methods aimed at detecting malignant tumors. From the early detection of this pathology depends the effectiveness of treatment and the prognosis of recovery. Consider the main procedures used to detect malignant lesions.
Breast cancer is the most common form of a tumor in women, it occupies 19% of all malignant tumors. The risk of malignant neoplasms increases in direct proportion to age. The largest percentage of deaths occur in women 40-55 years. In men, breast cancer is diagnosed very rarely. There are a number of risk factors that can cause a malignant neoplasm. The main factors: the period of menopause, fibrocystic mastopathy, the absence of labor or delivery after 30 years, family history and more.
The localization of the tumor in the mammary gland is different. With the same frequency, there is a lesion of both the left and right glands, and in 25% of cases there is a bilateral cancerous lesion. In this case, the node in the second gland can be either an independent tumor or a metastasis. Most often, tumors appear in the upper-outer square or near the axilla. The main symptomatology of the disease, manifested as compaction and retraction of the nipple, bloody discharge from the chest, pain.
In addition to the classical clinical picture, during the diagnosis can be identified such forms of the disease :
- Mastitis-like
A sharp increase in the breast, swelling, tenderness. The skin becomes hot to the touch, becomes red. To identify matistopodobnogo cancer carry out a differential diagnosis with acute mastitis.
- Rozhistopodobnaya form
With an external examination, the first thing that they pay attention to is the red skin, while the redness spreads beyond the chest. In addition to redness of the skin, the patient has a high temperature rise. Diagnosis should be carried out by an experienced doctor, since often this form of malignant neoplasm is confused with the usual erysipelas.
- Brigandine
It appears because of cancer infiltration through the gaps of the skin and lymphatic vessels. The skin thickens and becomes tuberous. On the chest formed a thick skin carapace, which can cover both one and both glands. The disease has a high degree of malignancy.
- Paget's Cancer
It is a plane lesion of nipples and areoles. With early diagnosis, the main symptom of the lesion is damp and flaky nipples, which can be mistaken for eczema. With further development, the cancer grows into the ducts of the gland and forms a node with metastatic lesions of the lymph nodes.
The doctor's task is to identify all the typical symptoms of cancer. The examination is carried out not only on the affected, but also on the healthy breast, in order to detect the presence of metastases. Mandatory is the palpation of the supraclavicular and axillary basins. If the symptoms of malignant neoplasm are clearly expressed, then the diagnosis is not difficult. But with the disease in the initial stages, small size or deep location of the tumor, additional diagnosis is performed.
As an additional diagnosis, a contrastless mammogram, X-ray, aspiration biopsy, puncture with cytological examination is used. Perhaps partial excision of the tumor along with surrounding tissues and carrying out histological examination. If the presence of cancer is confirmed, the operation is expanded to a radical one. To determine the extent of the spread of a malignant tumor in the body, the patient performs scintigraphy of the skeleton, ultrasound examination of the liver, radiography of the bones and lung X-rays.
Early diagnosis of breast cancer
Early diagnosis of breast cancer is a complex approach, which consists of a variety of methods used in both medicine and oncology. The main objectives of early diagnosis:
- Detection of cancer at an early stage (it is during this period that successful treatment can be carried out).
- Choosing the doctor an effective and ideally suitable method of treatment.
- Evaluation of the results of therapy.
Diagnosis should give an answer to such questions as: what type of tumor (invasive or non-invasive), if there are metastases in neighboring lymph nodes, if so, how great is the lesion.
Early diagnosis is divided into primary and clarifying:
- Primary diagnosis
The examination is called screening. Its main task is to reveal the primary changes in the mammary gland. This self-examination of the breast, palpation of the mammary glands, examination by a surgeon, mammologist, oncologist and endocrinologist. Primary diagnosis is performed in women without obvious signs of a change in the breast. Surveys should be of a regular nature, since their goal is early detection of malignant neoplasm.
- Specific examinations
In this case, methods are used that make it possible to purposefully search for changes in the mammary glands. Diagnosis provides an opportunity to clarify the nature, prevalence and nature of the changes. Surveys are conducted throughout the treatment, to monitor its effectiveness. The main diagnostic methods of this category: MRI, ultrasound, CT, biopsy and others.
Early diagnosis of breast cancer is carried out by a doctor at every visit to a woman's consultation. Standard diagnosis is the palpation of the body to determine the presence of swelling and painful seals. This examination is explained by the fact that the malignant growth of the breast most often manifests itself as a small swelling, which in 90% of cases the woman discovers on her own. During the examination, the examination is carried out in a lighted room, in a vertical and horizontal position, with arms raised and lowered.
During the examination, the doctor draws attention to a number of factors that may indicate the presence of pathology: swelling or thickening of the breast (nipples), redness or swelling of the skin, asymmetry, change in outlines and position of the nipple. Deformation of areoles, discharge from the nipples, chest traction on the chest, peeling of the breast, tumor compaction in the armpit, swelling of the shoulder, pain and discomfort in the chest, also indicate a pathological process.
Very often, obvious signs of cancer are diagnosed in later stages, when the tumor becomes neglected. In this case a dense painful neoplasm grows into the chest wall, which leads to immobilization of the breast. Due to the germination of the tumor on the skin, the mammary gland is ulcerated, deformed, and the nipple retracts. From the nipple may appear spotting. If the tumor sprouts into the lymph nodes, it leads to an increase in axillary lymph nodes, which causes pain and discomfort.
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Differential diagnosis of breast cancer
Differential diagnosis of breast cancer - a survey that allows you to exclude for various factors and symptoms of the disease, which ultimately will diagnose the only possible damage. Differential examination of breast cancer, primarily carried out with fibroadenoma and mastopathy. For example, the lipoma, unlike the malignant neoplasm, is soft to the touch, without seals and has a coarse-lobed structure. If there is a cyst, then it can reach a large size, which greatly complicates the diagnosis. In this case, for the correct diagnosis, a puncture biopsy or breast resection is performed .
- When differential diagnosis of cancer and galactocele, it is necessary to pay attention to the fact that the latter disease develops during lactation. By its structure, the galactoide resembles a cyst and does not change its size over a long period of time.
- In some cases, the presence of an additional mammary gland located at the edge of the large muscle of the breast and substantially increasing in size during the lactation period, resembling a cone, may erroneously resemble a malignant neoplasm.
- With angiomy of the chest, the lesion has no clear boundaries, it decreases with compression and soft to the touch. If the angioma is under the skin, then the skin becomes bluish.
Difficulties arise in the differential diagnosis of breast and mastitis. Mastitis is characterized by a sharp beginning, strong painful sensations, high fever. But if the condition does not improve for several days and the symptomatology appears outside the lactation period or in the woman of advanced age, this may be a sign of breast cancer.
According to statistical data, most women independently detect a tumor, but do not give it proper value. Because of late treatment for medical help, breast cancer takes an irreversible pathological character, which leads to a fatal outcome.
Methods for diagnosing breast cancer
Methods of diagnosis of breast cancer - a set of procedures and studies that allow you to identify pathological changes, determine their nature, the nature of the flow and a number of other indicators. Let's consider the basic methods of research used at diagnosis:
Mammography
To date, mammography is the main and most effective method of early diagnosis of breast cancer. The procedure is a screening examination and is performed on special devices that allow to recognize pathological growth and changes in tissues. The received pictures are compared with pictures of a healthy breast. In the process of mammography, the chest is compressed by plates, in order to take pictures from different angles. The tissue of the organ in the image is white, the fat is transparent, and the seals and pathological areas are clearly delineated.
Mammography provides an opportunity to recognize the primary and secondary signs of a malignant process.
- Primary symptoms are microcalcinates and a tumor shadow that has a stellate or irregular shape with uneven contours. The tumor can be accompanied by a path to the nipple and cause its retraction, the skin is compacted, has ulceration. If there are microcalcinates on the breast, that is, deposits of calcium salts in the walls of the gland ducts, this indicates a high probability of a malignant process in the chest.
- Secondary signs - characterized by a variety of symptoms, which manifests itself in changes in the skin, nipples and tissues surrounding the neoplasm.
CT scan
CT of mammary glands allows to track the spread of tumor foci and metastasis. It is carried out both in the early diagnosis of breast cancer, and throughout the course of treatment, to monitor the results of therapy.
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Magnetic resonance imaging
MRI of the mammary glands is performed using a powerful magnetic field. The mammary glands are irradiated by electromagnetic waves. As a result, electromagnetic energy is fixed by special sensors and processed by a computer.
Positron Emission Tomography
It is a radionuclide tomography method that quickly and accurately determines the presence of tumor processes. In the process of diagnosis, a radiopharmaceutical containing radionuclides with positron beta decay is introduced into the gland.
PET can detect the presence of a malignant neoplasm, detect metastases, determine whether the cancer cells remained after treatment and distinguish cancer from benign diseases and inflammatory processes.
Biopsy for breast cancer
A biopsy is the taking of an analysis from a tumor followed by a cytological examination. Advantages of the method at its low cost, ease of implementation and painlessness. Very often, a biopsy is performed under the supervision of ultrasound monitoring. A biopsy can be performed by surgery or with the help of a sectoral resection. The procedure is performed in an outpatient setting with anesthesia and does not require special training.
A diagnostic test allows you to identify the type of neoplasm. Biopsy identifies hormone-dependent tumors with immunohistochemical tests. The method of treatment and the prognosis for recovery depends on the hormonal status of the tumor. Using biopsy, it is possible to determine the histogenesis of malignant neoplasm and develop an effective treatment plan, to determine the sensitivity of cancer cells to various types of therapy.
- Fine needle aspiration biopsy is the simplest and fastest method of diagnosis. It is carried out with the help of a thin needle, so it does not require anesthesia.
- Trepan-biopsy - is carried out in ambulatory, but with anesthesia. The needle is inserted into the tissue under the control of ultrasound.
- Surgical biopsy - is used in those cases when the terana-biopsy and fine-needle did not confirm the presence of oncology. The procedure is carried out under the condition of full hospitalization and under general anesthesia. Doctors conduct an operation and examine the distant tumor.
Thermography
Diagnostic method, which involves measuring the temperature of the skin of the breast. The study is based on the difference in temperature values in tumor and healthy tissues. Since the neoplasm has a large number of blood vessels, they radiate heat, which can be detected by thermography.
This method of diagnosis has not gained wide application, as it has a large number of false-negative results.
Light scanning
Refers to the most modern diagnostic methods. The essence of the research is that through the breast tissue pass the infrared color, which allows to determine the presence of tumor nodes and metastases.
The only drawback of this method is hypersensitivity and lack of specificity.
Galactophhorography
It is carried out in the presence of bloody discharge from the nipples. In the milk ducts a contrast substance that reveals multiple and single papillomas and intracapsular cancer.
Pneumocystography
In this diagnostic study, gas is injected into the affected cavity of the breast. The technique makes it possible to identify intra-cystic pathological proliferation.
In addition to the above methods of diagnosing cancer, the patient underwent radiographic examination of the lungs, CT of the abdominal and thoracic organs, ultrasound of the lymph nodes and abdominal organs. Obligatory are general clinical tests and examinations, as well as radioisotope studies of the skeleton, that is, scintigraphy.
Such a diagnosis will help to assess the extent of the spread of a malignant tumor in the body, the presence or absence of metastases in the lymph nodes and other organs. The results of the conducted researches allow to find out the characteristics and features of the pathology, as well as the state of the organism. Please note that the cancer marker CA15-3 is used to monitor the course of the disease, control the treatment and identify relapses.
Analyzes for breast cancer
Analyzes for breast cancer provide an opportunity to learn the characteristics of a pathological disease. According to the results of the study, the doctor diagnoses this or that form of breast cancer and the stage of the tumor process. For the analysis, the patient takes blood and tissue from the affected area.
- Timely diagnosis and delivery of tests allows you to identify and prevent relapses of malignant neoplasm, check the body for the presence of cancer cells after surgery or therapy.
- Analyzes can detect a tumor at the earliest stages, and determine whether a person is at risk.
When analyzing blood, tumor markers are to be studied: CA 15-3, CA 125 II, CYFRA 21-1, CA 72-4 and cancer embryonic antigen (CEA). If these indicators are higher than normal, then this can indicate both malignant and benign education.
Mucin-like cancer antigen CA 15-3 is found in the membranes of cancer cells. The normal values are from 0 to 26.9 units / ml. Blood tests are given in dynamics, it allows to determine the rate of tumor growth, the risk of metastasis and relapses of malignant neoplasm. Additional confirmatory analysis is alpha-fetoprotein. The normal AFP is considered to be from 0 to 7.51 U / ml. With deviations from the norm, we can talk about pathological processes in the body.
In the study of tissues, an immunohistochemical analysis is performed for breast cancer. To carry it out, special reagents are used that contain antibodies with special substances and breast tissue that are taken with a biopsy. The assay is based on an antigen-antibody reaction. So, when you get into the body of external agents in the blood, a reaction takes place that blocks them. Immunohistochemical analysis allows you to identify the desired antigen of a cancerous tumor, so its conduct is very important for the preparation of a treatment plan.
Oncomarkers for breast cancer
Oncomarkers in breast cancer are proteins that circulate in the blood. The level of proteins increases with cancer. But an increased concentration can be observed in the body of a healthy person. That is why oncomarkers are used as an auxiliary diagnostic method, which allows to identify relapses of the disease and evaluate the effectiveness of treatment.
For example, the cancer marker CA 15-3 is a marker of breast and ovarian cancer, and CA 125 is a marker indicating a relapse of the tumor processes in the breast and ovaries. For diagnosis, TRU-QUANT and CA 27-29 markers are also used.
The elevated level of this marker indicates a cancer process. So, in the diagnosis of carcinoma, the level of specificity of CA 15-3 is 95%, in contrast to benign neoplasms. CA 15-3 is directly proportional to the size of the tumor lesion. That is, increased values may indicate the involvement of lymph nodes in the oncoprocess. If the oncomarker increases by 25%, then this indicates a progression of the malignant neoplasm. If the level decreases, then the treatment is effective and the cancer recedes.
CA 15-3 allows you to know about the presence of metastases and the recurrence of the disease. If breast cancer has been treated with chemotherapy or radiotherapy, CA 15-3 values may temporarily rise. This indicates that the tumor is being destroyed, that is, the therapy is effective. But cases were recorded when CA 15-3 had elevated values in pregnant women, but this was not a sign of a malignant neoplasm.
- Oncology markers CA 15-3 and CEA
These oncomarkers allow you to track the development of the tumor. Very often, CA 15-3 is administered concomitantly with a cancer-embryonic agent, that is, CEA, which refers to oncology markers of the rectum.
The normal value of CA 15-3 is from 0-27 U / ml. If the value of the cancer marker is higher than the specified norm, then this indicates a metastasizing process. Norm of CEA from 0-5 U / ml. Decoding of oncomarkers should be performed only by a doctor. Cancer is not diagnosed only at the elevated level of CA 15-3 or another oncomarker. Complex diagnosis is carried out to confirm the disease.
Diagnosis of breast cancer is an integrated approach to detecting malignant neoplasm, determining its type and other characteristics of the course of the disease. The timing of the diagnosis and its effectiveness depends on the choice of treatment methods. The earlier the cancer is detected, the better the prognosis and the higher the chances of recovery.