Hormone-dependent breast cancer

Excess estrogen in women leads to dangerous malignant lesions of the mammary glands.

Let's look at the signs of cancer, diagnostic methods and treatment options.

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Risk factors

There are risk groups for the development of pathology, let's look at them in more detail:

• Women with mastopathy and uterine fibroids
• First pregnancy after 25 years
• Onset of menstruation before age 13
• Periodic menstrual irregularities
• Abortion before first birth
• Lack of sexual activity for several years
• Late menopause, after 55 years

It is worth remembering that lifestyle and nutrition also make up a prognosis of predisposition to the disease. According to medical statistics, women in Japan and the USA have 5-6 times more chances of becoming cancer patients.

There are natural prerequisites for the disease, let's consider them:

• High level of physiological regeneration, that is, the more new cells are formed, the higher the risk of their mutations.
• Dependence of gland cells on hormonal levels in certain life cycles from menarche to menopause.

Pathological causes of the disease are associated with genetic and hereditary factors and hormonal imbalances. Cancer can be caused by internal, i.e. endogenous and exogenous, i.e. external factors.

• Endogenous

The risk group includes women aged 30-70 years who have a history of: chronic gynecological diseases, hormonal disorders, long-term use of contraceptives, early puberty or late menopause. Irregular sexual life, late motherhood or its absence, abortions, miscarriages and long-term hormone replacement therapy can also cause the disease.

• Exogenous

The causes of this group are a cumulative factor. They have a rather specific effect on the development of cancer, but stimulate oncology in combination with other factors. This category includes: various gland injuries, smoking, alcoholism, ionizing radiation, and the effects of chemicals.

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Pathogenesis

A tumor is called hormone-dependent if it has receptors for progesterone and estrogen. These protein molecules are located on the surface of the cancer cell. Medical statistics state that if more than 10% of tumor cells contain receptors for progesterone and estrogen, then the cancer is hormone-sensitive and hormone therapy is used for treatment. That is, the presence of receptors in a tumor is a good sign, since such cancerous lesions have a milder course and rarely metastasize.

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Symptoms hormone-dependent breast cancer

In order to recognize a malignant neoplasm, the doctor collects anamnesis. Symptoms of hormone-dependent breast cancer allow you to learn about the stage of the pathology and its prevalence. Any formations in the breast are a reason to contact an oncologist. Soreness in the nipples, swelling, peeling skin are not only signs of hormonal imbalance, but also symptoms of secondary infection, cystic neoplasms.

Symptoms of malignant hormonal lesions of the mammary glands:

• Nipple discharge – observed at all stages of the disease. The peculiarity is that it does not depend on the menstrual cycle. Gradually, the intensity of the discharge increases, it acquires a yellow-green color and a peculiar smell.
• Seals in the gland are the first sign of pathology. As a rule, the tumor can be felt independently. Seals often appear after 40 years.
• Enlarged axillary lymph nodes indicate the progression of oncology. This symptom causes discomfort when trying to raise your arms.
• Deformation of appearance – in the late stages of cancer, the tumor grows into the surrounding tissues and forms adhesions, which lead to structural changes in the breast. The skin above the lesion becomes pink or purple, peeling and dimples appear. The breast may become elongated or flattened, and the nipple may be drawn inward.

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First signs

The first signs of hormonal cancer are usually detected during preventive examinations by a mammologist. The doctor conducts a physical examination and pays special attention to the presence and nature of seals and discharge, skin condition, size of regional lymph nodes, shape of nipples and areola.

Let's look at the first signs of the disease that cause concern and require medical attention:

• Nodular seals - most often several nodules are found at the same time. They have a clear outline, dense consistency, are painless with limited mobility.
• Lymph nodes – enlarged lymph nodes are palpated in the armpits. In later stages, the skin peels and takes on the appearance of a lemon peel, ulcers appear.
• Nipple discharge – may be colorless or yellow-green. In the later stages, the breast becomes deformed and the nipple appears sunken.
• Diffuse impregnation - several types of compactions appear, which can be confused with mastopathy or acute mastitis. The glands are edematous, tissue infiltration and focal redness are possible.

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Stages

There are four stages of pathology, let's look at each of them:

• Stage 0 – non-invasive pathology, concentrated in the duct or gland, but does not spread to surrounding tissues. Diagnosis is possible with standard mammography, that is, during a preventive examination. With adequate treatment, the ten-year survival rate is 98%.
• Stage I – the tumor does not spread beyond the gland, but is located close to the tissues. With timely treatment, the ten-year survival rate is 96%.
• Stage II – is characterized by patient survival in 75-90% of cases and has two substages:
  • 2A – the tumor does not exceed 2 cm and 5 cm in diameter. Does not spread to the axillary lymph nodes.
  • 2B – the tumor is about 5 cm in size and spreads to the axillary lymph nodes. In some cases, cancer is larger than 5 cm but does not affect the lymph nodes.
• Stage III is divided into substages, each of which has its own survival prognosis.
  • 3A – the neoplasm has affected 4-9 lymph nodes and exceeds 5 cm in size. In the second variant of development, the lymph nodes are enlarged on the side of the affected gland. The survival prognosis is 65-75%.
  • 3B – cancer has reached the chest wall or skin. This stage is similar to inflammatory cancer. With adequate treatment, survival is 10-40%.
  • 3C – the tumor has spread to the axillary and sternum lymph nodes. The ten-year survival rate is 10%.
• Stage IV – the tumor has spread to other organs, indicating metastasis. Survival rate is about 10%.

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Forms

The International Classification of Diseases, 10th revision, classifies breast cancer in Category II Neoplasms (C00-D48), Malignant neoplasms (C00-C97). Let's take a closer look at the ICD 10 code:

• C50 Malignant disease of mammary gland.
  • C50.0 Nipple and areola.
  • C50.1 Central part of mammary gland.
  • C50.2 Upper inner quadrant.
  • C50.3 Inferior internal quadrant.
  • C50.4 Upper outer quadrant.
  • C50.5 Inferior outer quadrant.
  • C50.6 Axillary region.
  • C50.8 Spread to more than one of the above areas.
  • C50.9 Localization unspecified.

If there is a need to determine additional damage to the glands, then additional coding according to this classifier is used.

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Complications and consequences

The consequences of cancer appear during the development of the pathological process, as well as during and after therapy (radical removal). Cancer of the gland can cause such negative and threatening results as:

• As the tumor grows, it compresses and destroys milk ducts and healthy breast tissue.
• The greatest danger is posed by metastases, which can affect any organs and systems. In case of lung damage, suffocation and frequent inflammations occur, in case of liver metastases - frequent bouts of vomiting with bile, bone damage - frequent fractures, cracks. If metastases reach the brain, then disturbances in the thought process, problems with hearing and vision, convulsions, and disturbances of consciousness are observed.

Chemotherapy and radiation therapy are used as therapy for hormone-dependent tumors, which also cause a number of consequences:

• Complete or partial loss of hair and eyebrows.
• Brittle nails.
• Nausea, vomiting, digestive disorders.
• Redness of the skin, peeling, itching, dryness.
• Dizziness and headaches.

The most common surgical treatment involves excision of the tumor along with some healthy tissue and nearby lymph nodes. Negative consequences of surgery:

• Impaired lymph flow - occurs due to the removal of lymph nodes and can lead to lymphostasis, which makes it difficult for the arm on the side of the removed organ to function.
• Psychological problems – after surgery, many women withdraw into themselves and begin to feel inferior. Therefore, each patient needs professional psychological help.

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Complications

Complications arise during tumor growth and treatment. The most dangerous is metastasis. Together with the blood flow, cancer cells are carried through all the lymphatic vessels, affecting vital organs and systems. In breast cancer, latent, i.e. dormant metastases occur, the development of which lasts 5-10 years and does not reveal itself with any symptoms.

Failure to seek medical help in a timely manner and lack of treatment can lead to:

• Rapid increase in tumor size and its growth into adjacent tissues.
• The spread of cancer cells to other systems and organs.
• Inflammation of the tumor and surrounding tissues.
• Complications caused by metastasis.

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Diagnostics hormone-dependent breast cancer

As a rule, these are instrumental methods, that is, ultrasound, CT, MRI, mammography, laboratory tests and a triple test to determine tumor markers.

Let's consider the most informative research methods:

• Mammography

Using a special mammograph, an X-ray of the glands is taken. In the image, the doctor can recognize any formations, determine their size, location and nature. The procedure takes no more than 10 minutes and is practically painless.

This method allows us to recognize tumors at an early stage, when other symptoms have not yet appeared.

• Ultrasound

Using ultrasound waves, an image of the breast condition is created. Tissues affected by malignant neoplasms or cysts have a different ultrasound signal from normal tissues. Can be used simultaneously with a biopsy to determine the exact location of the tumor when taking tissue or excising.

• MRI

Magnetic resonance imaging is based on the use of radio waves and a magnetic field to create an image of internal organs. It is considered one of the most informative, as it visualizes processes in soft tissues. But compared to other methods, MRI is an expensive procedure.

• MRI with contrast

Allows to differentiate between benign and malignant neoplasms, determine the tumor location, its size and shape. With the help of this study, it is possible to recognize enlarged lymph nodes.

• Biopsy

Involves taking tissue from the affected area of the body to examine it under a microscope. The most reliable method that allows you to determine the cellular composition of the affected tissues and the presence of oncology. There are several ways to take tissue. Thus, fine-needle or cutting biopsy can be used to examine the mammary gland.

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Tests

Breast cancer is the leading cancer among women. Tests are used to detect pathology and allow monitoring the treatment and recovery of the patient. There is a breast cancer gene test that allows determining the location of the tumor, the stage of cancer, the presence of metastases and the pathomorphological structure of the pathology.

Let's look at the main tests that women take if they suspect they have cancer:

• Complete blood count

The doctor pays special attention to the qualitative and quantitative composition of leukocytes, hemoglobin and ESR. In the presence of oncology, the data will differ from normal indicators. Suspicions of cancer arise with an increased level of leukocytes.

• Biochemical blood test

It is used to confirm a malignant process in the body. During the analysis, the doctor determines the presence of tumor markers, i.e. proteins produced by cancer cells. Biochemistry allows you to determine the location of the tumor, the stage of cancer and the body's response to pathological processes. To detect a malignant disease, additional blood tests are used to identify tumor growth indicators: CA 125 II, CEA, CA 72-4, CYFRA 21-1, CA 15-3.

• Cytological (histological) examination

One of the most common and informative tests, due to its simplicity and availability. For the study, a scraping of the fluid that is released from the nipple of the mammary gland is taken.

• Immunohistochemical study

Microscopic examination of tissues using special reagents-antibodies. This method is based on the antigen-antibody reaction. That is, when malignant agents enter the body, a reaction of formation of special antibodies to block them begins in the blood. For the analysis, tissues obtained during biopsy or surgical treatment are used.

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Instrumental diagnostics

The most common and accessible method for detecting breast pathologies is mammography. Such instrumental diagnostics allows detecting cancer at an early stage. The sensitivity of mammography is about 95% and allows determining the size of the tumor, detecting damage to the lymph nodes.

Ductography is used to determine intraductal pathologies. It allows us to estimate the size of the tumor in the ducts and its distance from the nipple. Pneumocystography can be used to visualize the internal structure of the neoplasm.

Ultrasound examination provides clear dimensions of cancer, contours, structure, blood supply and information about the state of regional lymph nodes. At the final stage of the study, a morphological method is used, that is, puncture aspiration biopsy with examination of tumor tissue.

Differential diagnosis

In its symptoms, hormone-dependent breast cancer is similar to many other oncological diseases. The detected seals can have different character and origin, so they are differentiated from mastopathy, cysts, lipoma, fibroadenoma, angioma, galactocele and mastitis.

Differentiation is carried out using MRI, biopsy and ultrasound. If it is difficult to establish an accurate diagnosis, then a cytological study is carried out. The method involves studying the puncture at the cellular level.

Treatment hormone-dependent breast cancer

The prognosis for survival in malignant diseases largely depends on the results of diagnostics and selected therapy. Treatment of hormone-dependent breast cancer is determined by a number of factors - the patient's age, stage, structure and growth rate of the tumor. An integrated approach is effective, i.e. a combination of chemotherapy, surgery and radiotherapy.

Let's look at the main treatment methods:

• Surgical

When choosing a surgical method, the doctor plans options for restoring the mammary gland in advance. The surgery can be performed using the following methods: lumpectomy (partial removal) and mastectomy (complete removal). The latter method is used if the tumor is large, has spread to the skin and chest walls, and if the patient has small breasts.

• Chemotherapeutic

Chemotherapy is administered both before and after surgery. Its purpose is to reduce the primary tumor so that the malignant neoplasm can be removed using lumpectomy. After surgery, it is needed to destroy metastases and prevent their occurrence.

• Radiation therapy

This method is used as a preventive measure against cancer recurrence after surgery. It is used for symptomatic treatment of distant metastases that have caused complications and a number of painful sensations. Radiation therapy is necessary for palliative treatment of inoperable tumors.

• Breast reconstruction

Restoring the shape and volume of the mammary gland allows avoiding psychological and aesthetic problems that many patients experience after surgery. Reconstructive surgeries are performed using two methods: delayed (after all stages of therapy) and immediate (immediately after tumor removal).

Medicines

Hormonal (anti-estrogen) therapy is used to treat hormone-dependent cancer. The drugs affect the production of estrogen (female sex hormone). The goal of such treatment is to destroy malignant cells after the initial course of therapy. Hormonal therapy is an adjuvant method that is performed simultaneously with surgery, chemotherapy or radiation therapy.

Hormonal treatment is indicated for:

• High risk of developing cancer due to genetic abnormalities, hereditary predisposition or corresponding test results.
• After surgery to remove a malignant tumor as a preventative measure against recurrence.
• In case of invasive tumor to reduce its size, as well as in case of metastasis.

Before starting therapy, the patient must undergo a test for the presence of receptors, since the treatment may be ineffective. There are several types of hormone therapy. Depending on the specific situation, a woman is given special drugs with a specific mechanism of action. Thus, some drugs reduce the level of estrogen, others block the ability of hormones to bind to receptors or turn off their production. In some cases, they resort to such radical methods as removal of the ovaries.

Popular means for eliminating hormone-dependent oncology are Toremifene, Anastrozole, Letrozole, Aromasin and others. The duration of treatment depends on the effectiveness of the chosen drug, its side effects and the health condition of the patient. This type of treatment is not carried out for patients with diabetes, over 55 years old, with heart failure and impaired renal and hepatic function. At the same time, the survival rate of patients who underwent hormone therapy increases by 25%.

Folk remedies

Many methods are used to eliminate malignant diseases. Traditional medicine is popular along with conservative therapy. Its advantage is the use of only herbal, natural components. But this method requires medical permission. An individual course is selected for the patient, which depends on the course of the disease and the stage of cancer. In addition, the doctor focuses on the presence or absence of metastases, the severity of the patient's condition and the involvement of internal organs in the pathology.

Traditional medicine is divided into the following groups:

• Immunomodulators – plant components participate in the restructuring of the immune system and encourage it to fight cancer cells. Such plants are effective for any type of cancer. This category includes: red brush, kopecky, aconite, hemlock, Pallas's spurge and others.
• Non-poisonous plants for destroying cancer cells are meadowsweet, burdock, sweet clover, black root, and saxifrage.
• Improving liver function – according to research, the effectiveness of breast cancer treatment largely depends on liver function. For therapy, use – saltwort, immortelle, dandelion, yarrow, calendula, chicory.
• Plants that affect hormonal levels - to reduce estrogen levels, use comfrey, blackroot, and lycanthropus.
• Plants with sedative, diuretic and cardiac effects are used in the presence of metastases. Effective herbal remedies: willow bark, meadowsweet, peony, comfrey, black root.

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Herbal treatment

The effectiveness of drugs directly depends on their composition. The safest and most effective are considered to be medications that contain herbal components. Herbal treatment is quite effective, they are used to prepare infusions, solutions, special compresses and ointments.

Let's look at the most popular herbs used in the treatment of breast cancer:

• Burdock contains lignan glycosides and the lignan derivative arctigenin, which have a powerful antitumor effect. Decoctions and oil extracts are prepared from it.
• Greater celandine is an anti-cancer agent, contains phytoncides, essential oils, alkaloids and flavonoids. The plant is poisonous, therefore it has contraindications and is used only according to medical indications.
• Eucalyptus globulus – has bacteriostatic and powerful antiseptic properties. Extracts from leaves are used for treatment.
• Wild strawberry - extracts from leaves, which have a bactericidal effect, are used for treatment.

Recipes from medicinal herbs:

• Pour goat milk over a couple of handfuls of cherry branches and simmer them over low heat for 6 hours. The remedy should be taken ½ cup 3 times a day, the course of treatment is 70 days.
• Grind 500 g of burdock root and squeeze the juice out of it. Mix the juice of three lemons and 250 g of buckwheat honey with burdock juice. Pour the resulting mixture into a dark jar and take 1 spoon at night for 12 days. After a week's break, the course of treatment can be continued. Since burdock root has a choleretic effect, a diet must be followed during therapy.
• Grind 100 g of birch and poplar buds, elecampane herb, aloe juice and chaga mushroom. Mix the ingredients, pour in a liter of vodka, place in a glass jar and put in a dark place or bury in the ground. After a month, strain the remedy and take 1 spoon 2-3 times a day an hour before meals.
• Dilute 10 drops of birch tar in a glass of milk and take 3 times a day for five days. After the first course, take a break of 2-3 days and repeat the treatment. The therapy lasts for 1-2 months.

Altai herbs for hormone-dependent breast cancer

Cytostatic herbs are especially effective in breast cancer. The plants interrupt the chain of the disease and slow down the growth of the tumor. These are poisonous herbs: mistletoe, figwort, aconite, periwinkles. Altai herbs are safe and no less effective. In hormone-dependent breast cancer, natural immunostimulants are used that affect the patient's immune system.

For the treatment of external manifestations of oncology, a special ointment prepared on the basis of Altai hemlock is used. The composition of the product includes propolis, beeswax, seeds and inflorescences of hemlock. The ointment relieves pain and swelling, disinfects damaged skin.

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Homeopathy

Many methods and means are used to treat hormone-dependent breast cancer. Homeopathy is also used to eliminate oncology. Let's consider popular homeopathic remedies:

• Alumen – used for seals and ulcers.
• Arsenicum album is a palliative remedy that reduces painful sensations.
• Arsenicum Iodatum – slows the growth and progression of tumors, minimizes painful symptoms and reduces the severity of ulcers.
• Arsenicum Sulfuratum Flavum – helps to restore damaged areas of the skin. It is used to eliminate dryness, peeling and pigmentation of gland tissue.

It is important to remember that any homeopathic medicine can only be taken after consultation with a homeopath and his approval. Self-administration of drugs causes many side effects and worsens the course of cancer.

Surgical treatment

One of the radical methods of cancer therapy is surgery. Surgical treatment allows to remove the tumor, preventing its growth and progression. Thanks to modern diagnostic methods, malignant neoplasms can be detected at early stages. This increases the success of treatment and allows to choose the optimal method of surgery.

Main types of operations:

1. Organ-preserving lumpectomy involves removing only the tumor.
2. Mastectomy is the removal of the entire gland, followed by a course of radiation.

Before the operation, the patient must undergo a number of tests and examinations. This will allow the tumor condition to be assessed and the surgical intervention method to be chosen.

After the operation, the removed tissues are sent for histology and cytology. Often, removal of the gland leads to complications, let's consider them:

• Infectious complications – inflammation occurs in the wound area. This occurs due to failure to observe asepsis during and after surgery or poor wound care. Antibiotics are taken to eliminate the infection.
• Formation of hematomas – blood accumulates in the cavities formed after the operation. This occurs due to technical errors in the operation and increased bleeding in the patient. The wound heals slowly and there is a slight swelling. In addition, seroma may appear, that is, an accumulation of serous fluid (blood plasma). To eliminate the complication, the wound is opened and an outflow for the fluid is created.
• Excessive bleeding is a fairly rare complication that can occur both during and after surgery. To prevent it, doctors prepare donor blood and autologous blood for transfusion.

Prevention

Breast cancer is the leading cancer among women. Prevention helps prevent malignant lesions. More than 1 million cases of the disease are registered worldwide every year. WHO statistics indicate that 30% of women with cancer are over 45 years old. Timely medical attention helps cure the disease in 95% of cases.

Prevention begins with self-diagnosis, which every woman should be able to perform:

• Carefully examine your breasts in front of the mirror, pay attention to their shape.
• Lift and palpate each breast one by one. Place your hands behind your neck one by one and examine the glands again.
• Use the fingers of your right hand to feel your left breast and vice versa. There should be no hardening, lumps or painful sensations in the gland.

If pathological changes are detected after examination, you should consult a mammologist or gynecologist.

In addition to self-examination, there are a number of other preventive methods, let's consider them:

1. Choosing underwear – a poorly chosen bra can injure the mammary glands and irritate the nerve endings located there. Underwear should be the right size and not disrupt the anatomical position of the breast. Strapless bras are especially dangerous.
2. Healthy eating – the main cause of cancer is free radicals found in food. Therefore, the diet should include food rich in antioxidants. Products containing lycopene, flavonoids and choline, which neutralize the action of radicals, help maintain health.
3. Lactation – special hormones are produced during feeding. If lactation is interrupted, the synthesis of hormones is disrupted, which leads to hormonal imbalance.
4. Physical activity – it is recommended to perform special exercises to develop the pectoral muscles.

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Forecast

The success of treatment and the chances of recovery depend entirely on early diagnosis of the pathological process. The prognosis is based on the results of complex therapy, which allows achieving stable remission. There is such a term as five-year survival, modern methods of therapy allow achieving it for every woman with malignant diseases.

Hormone-dependent breast cancer of the first stage has a high survival rate - 84%, with the second 71%, with the third 48% and with the fourth 18%. Non-hormone-dependent oncology has a more negative prognosis and chances of survival. Regular self-examination and adherence to preventive measures are the best way to avoid breast cancer.

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