Hormone-dependent breast cancer

Excess estrogens in women lead to dangerous malignant lesions of the mammary glands.

Consider the signs of cancer, diagnostic methods and treatment options.

[1], [2]

Risk factors

There are risk groups for the development of pathology, consider them in more detail:

• Women with mastitis and uterine myoma
• First pregnancy after 25 years
• Beginning of menstruation up to 13 years
• Periodic disorders of the menstrual cycle
• Abortion before the first birth
• Lack of sexual activity for several years
• Late menopause, after 55 years

Do not forget that lifestyle and nutrition also make up a prediction of predisposition to ailment. According to medical statistics, residents of Japan and the United States have 5-6 times more chances to become owners of cancer.

Allocate the natural prerequisites for the disease, consider them:

• A high level of physiological regeneration, that is, the more new cells are formed, the higher the risk of their mutations.
• The dependence of the gland cells on the hormonal background in certain life cycles from menarche to menopause.

Pathological causes of the disease are associated with genetic and hereditary factors and abnormalities of the hormonal background. Cancer can be caused by internal, that is, endogenous and exogenous, that is, 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, earlier puberty or late menopause. Irregular sexual life, later motherhood or lack of it, abortions, miscarriages and prolonged hormone replacement therapy, can also cause illness.

• Exogenous

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

[3], [4], [5], [6]

Pathogenesis

A tumor is called hormone-dependent if it detects receptors for progesterone and estrogens. These protein molecules are located on the surface of the cancer cell. Medical statistics say 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 to treat it. That is, the presence of receptors in the tumor is a good sign, since such cancers have a softer course and rarely give metastasis.

[7], [8], [9], [10]

Symptoms of the hormone-dependent breast cancer

In order to recognize a malignant neoplasm, the doctor collects an anamnesis. Symptoms of hormone-dependent breast cancer allow you to know about the stage of pathology and its prevalence. Any formation in the chest is an occasion to consult an oncologist. Soreness in the nipples, puffiness, peeling of the skin is not only signs of hormonal failure, but also symptoms of secondary infection, cystic neoplasms.

Symptoms of malignant hormonal lesion of the mammary glands:

• Allocations from the nipples are observed at all stages of the disease. The peculiarity is that they do not depend on the menstrual cycle. Gradually, the intensity of discharge increases, they acquire a yellow-green color and a peculiar smell.
• Seals in the gland - this is the first sign of pathology. As a rule, the tumor can be palpated independently. Often, seals appear after 40 years.
• The increase in axillary lymph nodes - indicates the progression of oncology. This symptom gives you unpleasant sensations when trying to raise your hands.
• Deformation of appearance - in the late stages of cancer, the neoplasm grows into the surrounding tissues and forms spikes that lead to a structural change in the breast. Above the lesion, the skin becomes pink or crimson, flaking and dimples appear. The breast can acquire an elongated or flattened shape, and the nipple can be drawn inwards.

[11], [12]

First signs

The first signs of hormonal cancer, as a rule, are revealed during preventive examinations at the mammalogist. The physician conducts a physical examination and pays special attention to the presence, the nature of the seals and secretions, the skin condition, the size of the regional lymph nodes, the shape of the nipples and areola.

Consider the first signs of the disease, which cause anxiety and require medical care:

• Nodal seals - most often detect several nodules at the same time. They have a clear contour, a dense consistency, painless with limited mobility.
• Lymph nodes - enlarged lymph nodes are palpable in the armpits. In the later stages, the skin peels off and becomes a lemon peel, ulcerations appear.
• Discharge from the nipples - may be colorless or yellow-green. At the last stages, the chest is deformed, and the nipple looks like it has fallen off.
• Diffuse impregnation - there are several types of seals that can be confused with mastitis or an acute form of mastitis. The glands are swollen, tissue infiltration and focal redness are possible.

[13], [14]

Stages

There are four stages of pathology, consider each of them:

• 0 stage - non-invasive pathology, concentrated in duct or gland, but does not extend to surrounding tissues. To diagnose it is possible at standard mammography, that is in the course of preventive survey. With adequate treatment, the ten-year survival rate is 98%.
• I stage - the neoplasm does not extend beyond the gland, but is in proximity to the tissues. With timely treatment, a ten-year survival rate is 96%.
• II stage - characterized by the survival of patients in 75-90% of cases and has two sub-stages:
  • 2A - the tumor does not exceed 2 cm and 5 cm in diameter. Does not apply to axillary lymph nodes.
  • 2B - tumor size about 5 cm, extends to the axillary lymph nodes. In some cases, the cancer exceeds the size of 5 cm, but does not affect the lymph nodes.
• III stage - is divided into sub-stages, each of which has its own survival prognosis.
  • 3A - the tumor has infected 4-9 lymph nodes and exceeds the size of 5 cm. In the second variant of development, the lymph nodes are enlarged from the side of the affected gland. The prognosis of survival is 65-75%.
  • 3B - the cancer reached the walls of the chest or skin. This stage is similar to an inflammatory form of cancer. With adequate treatment, the survival rate is 10-40%.
  • 3C - the tumor affected axillary lymph nodes and lymph nodes near the sternum. The survival rate for ten years is 10%.
• IV stage - the neoplasm spread to other organs, which speaks of metastasis. Survival is about 10%.

[15], [16], [17],

Forms

The international classification of diseases of the 10th revision includes cancerous lesions of the mammary glands in the category II Neoplasms (C00-D48), Malignant neoplasms (C00-C97). Let's consider more detailed a code on mb 10:

• C50 Malignant disease of the breast.
  • Nipple and areola.
  • C50.1 The central part of the breast.
  • C50.2 Upper inner quadrant.
  • C50.3 Inside-inner quadrant.
  • C50.4 The upper quadrant.
  • C50.5 Lower unrounded quadrant.
  • C50.6 Axillary region.
  • C50.8 Distribute to more than one of the above areas.
  • C50.9 Localization, unspecified.

If there is a need to determine additional lesions of glands, then an additional encoding is used for this classifier.

[18], [19], [20], [21]

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:

• In the process of growth, the neoplasm compresses and destroys the milk ducts and healthy breast tissue.
• The greatest danger is metastasis, which can affect any organs and systems. In case of lung injury, suffocation and frequent inflammation occur, with metastases to the liver - frequent attacks of vomiting with bile, bone damage - frequent fractures, cracks. If the metastases reach the brain, then there are violations of the thought process, problems with hearing and vision, convulsions, impaired consciousness.

As a hormone-dependent tumor therapy, chemotherapy and radiation therapy are used, which also cause a number of consequences:

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

As a surgical treatment most often used excision of the tumor together with part of healthy tissue and nearby lymph nodes. Negative consequences of the operation:

• Disturbance of lymph drainage - arises from the removal of lymph nodes, can lead to lymphostasis, making it difficult for the hand to function from the side of the remote organ.
• Psychological problems - after surgery, many women become self-absorbed, begin to feel inferior. Therefore, every patient needs professional psychological help.

[22], [23], [24], [25], [26]

Complications

Complications occur during the growth of the tumor and during treatment. The most dangerous is metastasis. Together with the blood flow, cancer cells are carried along all the lymph vessels, affecting vital organs and systems. In breast cancer, there are latent, that is, dormant metastases, the development of which lasts 5-10 years and does not give itself out as any symptomatology.

Late access to medical care and lack of treatment can lead to:

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

[27], [28]

Diagnostics of the hormone-dependent breast cancer

As a rule, these are instrumental methods, that is, ultrasound, CT, MRI, mammography, laboratory tests and a triple test for the determination of oncomarkers.

Consider the most informative research methods:

• Mammography

With the help of a special mammogram apparatus, an x-ray photograph of the glands is made. In the picture, the doctor can recognize any formations, determine their size, localization and character. The procedure takes no more than 10 minutes and is practically painless.

This method allows you to recognize the tumor at an early stage, when other symptoms have not yet appeared.

• Ultrasound

With the help of ultrasonic waves, an image of the state of the breast is created. Tissues affected by malignant neoplasms or cysts have an ultrasonic signal distinct from normal tissues. Can be used concomitantly with 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 magnetic fields to create images of internal organs. It is considered one of the most informative, as it visualizes the processes in soft tissues. But in comparison with other methods, MRI is an expensive procedure.

• MRI with contrast

Allows to distinguish between benign and malignant neoplasms, to determine the localization of the tumor, its size and shape. With the help of this study, you can recognize the increase in lymph nodes.

• Biopsy

It involves taking tissue from the affected area of the body to study them under a microscope. The most reliable method, allowing to establish the cellular composition of the affected tissues and the presence of oncology. There are several ways to take tissues. Thus, a thin needle or cutting biopsy can be used to study the mammary gland.

[29], [30], [31]

Analyzes

Breast cancer ranks first among women with oncological diseases. Analyzes are used to detect pathology and allow to control the process of treatment and recovery of the patient. There is an analysis of the breast cancer gene, which allows to determine the location of the tumor, the stage of cancer, the presence of metastases and the pathomorphological structure of the pathology.

Let's consider the basic analyzes which women hand over at suspicions on an oncology:

• General blood analysis

The doctor pays special attention to the qualitative and quantitative composition of leukocytes, hemoglobin and ESR. If there is an oncology, the data will differ from the normal indicators. Suspicions for cancer occur with an elevated level of white blood cells.

• Blood chemistry

It is used to confirm malignant process in the body. During the analysis, the doctor determines the presence of oncomarkers, that is, 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 detect tumor growth rates: CA 125 II, CEA, CA 72-4, CYFRA 21-1, CA 15-3.

• Cytological (histological) studies

One of the most common and informative analyzes, due to its simplicity of carrying out and accessibility. For the study take a scraping fluid, which is released from the nipple of the breast.

• 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, the reaction of formation of special antibodies for their blocking begins in the blood. For the analysis used tissue obtained by biopsy or surgical treatment.

[32], [33], [34],

Instrumental diagnostics

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

Doktografiya is used to determine intra-pathological pathologies. It allows to estimate the size of the tumor in the ducts and its distance from the nipple. Using pneumocystography, you can visualize the internal structure of the lesion.

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

Differential diagnosis

In terms of its symptoms, hormone-dependent breast cancer is similar to many other cancers. The revealed seals can have different nature and origin, therefore they are differentiated with mastopathy, cysts, lipoma, fibroadenoma, angioma, galactocele and mastitis.

Differentiation is performed using MRI, biopsy and ultrasound. If an accurate diagnosis is difficult, then a cytological examination is performed. The method involves studying the punctata at the cellular level.

Treatment of the hormone-dependent breast cancer

The prognosis of survival in malignant diseases largely depends on the results of diagnosis and selected therapy. Treatment of hormone-dependent breast cancer is due to a number of factors - the patient's age, stage, structure and growth rate of the tumor. The complex approach, that is, the combination of chemotherapy, surgical intervention and radiotherapy, is effective.

Let's consider the basic methods of treatment:

• Surgical

Choosing the method of surgery, the doctor in advance plans options for restoring the breast. The operation can be performed by such methods: lumpectomy (partial removal) and mastectomy (complete removal). The latter method is used if the tumor is large, spread to the skin and chest wall and if the patient has a small breast.

• Chemotherapeutic

Chemotherapy is carried out both before surgery and after. Its task is to reduce the primary tumor in order to remove the malignant neoplasm with a lumpectomy. After the operation, it is needed to destroy metastases and prevent their appearance.

• Radiation therapy

This method is used as prevention of cancer recurrence after surgery. It is used for symptomatic treatment of distant metastases, which caused complications and a number of painful sensations. Radiation therapy is necessary for palliative action on inoperable tumors.

• Reconstruction of mammary glands

Restoring the shape and volume of the breast can avoid the psychological and aesthetic problems that occur in many patients after surgery. Reconstructive surgery is performed by two methods: delayed (after all stages of therapy) and one-stage (immediately after removal of the tumor).

Medications

To treat the hormone-dependent form of cancer, hormone (anti-estrogen) therapy is used. Medications affect the production of estrogen (female sex hormone). The purpose of such treatment is to destroy malignant cells after the initial course of therapy. Hormone therapy refers to ancillary methods that are performed concomitantly with surgery, chemotherapy, or radiation treatment.

Hormonal treatment is indicated when:

• High risk of oncology development due to genetic abnormalities, hereditary predisposition or corresponding test results.
• After the operation to remove the malignant neoplasm as a warning of relapse.
• With an invasive tumor to reduce its size, as well as during metastasis.

Before starting therapy, the patient must take a test for the presence of receptors, since the treatment may not be effective. There are several types of hormone therapy. Depending on the specific situation, a woman is picked up with special drugs with a certain mechanism of action. So, some drugs reduce the level of estrogen, others block the possibility of connecting hormones with receptors or disconnect their production. In some cases, resort to such radical methods as ovarian removal.

Popular means for eliminating hormone-dependent oncology - Toremifene, Anastrozole, Letrozole, Aromazine and others. The duration of treatment depends on the effectiveness of the selected drug, its side effects and the state of health of the patient. This type of treatment is not performed for patients with diabetes mellitus, over 55 years old, with heart failure and kidney and liver function disorders. In this case, the survival rate of patients undergoing hormone replacement therapy is increased by 25%.

Alternative treatment

Many methods are used to eliminate malignant diseases. Alternative treatment is popular at the level with conservative therapy. Its advantage is the use of only plant, natural components. But this method requires medical permission. For the patient is selected an individual course, which depends on the course of the disease and the stage of cancer. In addition, the doctor is guided by the presence or absence of metastases, the severity of the patient's condition and involvement in the pathology of internal organs.

Alternative treatment is divided into the following groups:

• Immunomodulators - plant components are involved in the restructuring of the immune system and encourage it to fight it with cancer cells. Such plants are effective for any kind of cancer. This category includes: a red brush, pennies, aconite, hemlock, spurge of Pallas and others.
• Non-poisonous plants for the destruction of cancer cells - labaznik, burdock, sweet clover, black-legged, vorobeynik.
• Improving the functioning of the liver - according to studies, the effectiveness of treatment of breast cancer largely depends on the work of the liver. For therapy use - hodgepodge, immortelle, dandelion, yarrow, calendula, chicory.
• Plants that act on the hormonal background - to lower the level of estrogens apply a sparrow, black-legged, zyuznik.
• Plants with sedative, diuretic and cardiac action - are used in the presence of metastases. Effective plant remedies: willow bark, sabernik, peony, comfrey, blackrock.

[35]

Herbal Treatment

The effectiveness of drugs directly depends on their composition. The most safe and effective are medicines, which contain plant components. Treatment with herbs is quite effective, from them prepare infusions, solutions, special compresses and ointments.

Consider the most popular herbs used in the treatment of breast cancer:

• Burdock is large - contains lignan glycosides and a lignin derivative of arctigenin, which have a powerful antitumor effect. From it prepare broths and oil extract.
• Pistotel is a great anti-cancer agent, it contains phytoncides, essential oils, alkaloids and flavonoids. The plant is poisonous, therefore it has contraindications and is used only by medical instructions.
• Eucalyptus ball - has bacteriostatic and powerful antiseptic properties. For treatment use extracts from leaves.
• Wild strawberry - for the treatment use extracts from the leaves, having a bactericidal effect.

Recipes from herbs:

• Pour goat milk a couple of handfuls of cherry twigs and soak them on low heat for 6 hours. The drug should be taken on ½ cup 3 times a day, the course of treatment is 70 days.
• Grind 500 g of burdock root large and wring out juice from it. Mix the juice of three lemons and 250 grams of buckwheat honey with the juice of burdock. The resulting mixture is poured into a dark jar and take 1 spoonful overnight for 12 days. After a one-week break, the course of treatment can be continued. Since the root of burdock has a choleretic effect, during the therapy it is necessary to observe a diet.
• Grind 100 g of birch and poplar buds, elecampane grass, aloe juice and chaga mushroom. Mix the ingredients, pour a liter of vodka, place in a glass jar and put it in a dark place or bury it in the ground. After a month, the drug must be filtered and taken 1 spoon 2-3 times a day for an hour before meals.
• 10 drops of birch tar dilute in a glass of milk and take 3 times a day for five days. After the first course, you need to take a break in 2-3 days and repeat the treatment. The therapy lasts for 1-2 months.

Altai herbs with hormone-dependent breast cancer

Herbs-cytostatics are especially effective in cancerous lesions of the breast. Plants interrupt the chain of the disease and slow the growth of the tumor. These are poisonous herbs: mistletoe white, norichnik, aconite, periwinkle. Altaic herbs are safe and not less effective. With hormone-dependent breast cancer, natural immunostimulants are used that affect the immune system of the patient.

For the therapy 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. Ointment relieves pain and swelling, disinfects damaged skin.

[36], [37], [38], [39]

Homeopathy

Many methods and means are used to treat hormone-dependent breast cancer. Homeopathy is also used to eliminate oncology. Consider the popular homeopathic remedies:

• Alumen - is used for seals and ulcers.
• Arsenicum album is a palliative agent that reduces painful sensations.
• Arsenicum Iodatum - slows the growth and progression of the tumor, minimizes painful symptoms and reduces the severity of ulceration.
• Arsenicum Sulfuratum Flavum - helps repair damaged skin areas. Used to eliminate dryness, flaking and pigmentation of the gland tissues.

Do not forget that you can take any homeopathic remedy only after consultation with the homeopath and its approval. Self-administration of drugs causes many side effects and aggravates the course of cancer.

Operative treatment

One of the radical methods of cancer therapy is surgical. Surgical treatment allows you to remove the tumor, preventing its growth and progression. Thanks to modern methods of diagnosis, malignant neoplasm can be identified even in the early stages. This increases the success of treatment and allows you to choose the optimal method of surgery.

The main types of operation:

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

Before the operation, the patient must pass many analyzes and studies. This will allow us to assess the condition of the tumor and choose the technique of surgical intervention.

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

• Infectious complications - in the wound area there is inflammation. This is due to non-compliance with asepsis during and after surgery or poor care of the wound. To eliminate the infection, antibiotics are taken.
• Education hematomas - in the cavity formed after the operation, blood accumulates. This occurs with technical errors in the operation and with increased bleeding in the patient. The wound heals slowly and there is a slight swelling. In addition, the appearance of seroma, that is, the accumulation of serous fluid (blood plasma). To eliminate complications, the wound is opened and an outflow is created for the liquid.
• Abundant bleeding is a rare complication, which can occur both during and after the operation. To prevent it, doctors prepare donor blood and autograft for transfusion.

Prevention

Breast cancer occupies a leading position among women with oncological diseases. Prevention prevents malignant damage. 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 children. Timely appeal for medical help can cure the disease in 95% of cases.

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

• Carefully inspect the breasts in front of the mirror, pay attention to their shape.
• Alternately, lift and palpate each breast. Put hands alternately behind your neck and examine the glands once more.
• With your right hand, palpate your left breast and vice versa. In the gland, there should be no hardening, seals and painful sensations.

If after the examination pathological changes were revealed, then it is worth turning to a mammalogist or gynecologist.

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

1. Choosing underwear - a badly selected bra traumatizes the mammary glands and irritates the nerve endings located in it. Linen should be in size and not break the anatomical position of the breast. In this case, a special danger is represented by the models of the strapless bodice.
2. Healthy eating - the main cause of cancer are free radicals, which are in the foods. Therefore, the diet should be food rich in antioxidants. Support the health of products that contain lycopene, flavonoids and choline, neutralizing the action of radicals.
3. Lactation - during the production of special hormones are produced. If lactation is interrupted, the synthesis of hormones is disrupted, which leads to hormonal failure.
4. Physical exercise - it is recommended to perform special exercises for the development of pectoral muscles.

[40], [41], [42], [43]

Forecast

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

The hormone-dependent breast cancer of the first stage has a high level of 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 compliance with preventive measures is the best way to avoid breast cancer.

[44], [45], [46], [47], [48], [49], [50]