Ductal breast cancer

In the list of female oncological diseases, ductal breast cancer is no less common than other types of breast cancer. However, in recent years, the incidence of this type of cancer has increased significantly.

Ductal carcinoma differs from other types of malignant breast tumors primarily in that it begins its development from the inner walls of the milk ducts, without affecting the lobes and other tissues of the gland.

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Causes of ductal breast cancer

Among the causes and risk factors for the development of ductal breast cancer, the following should be highlighted:

• no history of pregnancy;
• late first pregnancy (if the woman is over 35 years old);
• early puberty;
• delayed onset of menopause;
• cases of breast cancer in close relatives (mother, sister, daughter);
• long-term treatment with female sex hormones (5-6 years);
• the presence of a predisposition to the growth of malignant tumors (abnormal genes).

Ductal breast cancer can also occur in men who carry a mutated BRCA2 gene.

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Symptoms of ductal breast cancer

Early and noninvasive stages of ductal carcinoma are usually discovered by chance, during a routine examination or ultrasound.

Invasive ductal breast cancer may present with some symptoms that the patient can pay attention to on her own:

• dense or lumpy areas are found in the mammary gland that can be felt. Such seals do not disappear, but only increase in size over time;
• areas with changed color and structure appear on the skin of the chest;
• one of the mammary glands takes on a different shape, its form and contours change;
• changes are observed in the area of one of the nipples. This may be the appearance of redness, a change in the shape and retraction of the nipple, the formation of scales and ulcers in the areola area;
• when pressed, or on its own, discharge of various nature appears from the milk ducts (with blood, with pus, or light, depending on the stage of the process);
• a feeling of fullness and pressure appears in one of the breasts.

If a woman discovers at least one of the above symptoms, she should definitely contact a doctor in order to conduct additional diagnostics of the mammary glands in a timely manner. You can make an appointment with a gynecologist, mammologist or ultrasound specialist.

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Forms

Invasive ductal carcinoma of the breast

The invasive form of ductal carcinoma is also called infiltrating cancer or breast carcinoma.

Infiltrating ductal carcinoma of the breast is the most common type of malignant breast tumor. It occurs in 80% of cases of breast cancer.

Infiltrating cancer differs from the usual non-invasive form in that the malignant process is not limited to the walls of the milk duct, but extends beyond it and affects other nearby tissues of the mammary gland.

A characteristic sign of invasive cancer is a fairly dense tumor with "ragged" borders, not fluctuating (as if "glued" to the nearest tissues). The nipple or the entire areola is most often drawn inward.

Often, small, randomly located calcium deposits in the tissue (50 to 600 µm) are found on diagnostic images in the area of the neoplasm. Such deposits are the result of a necrotic process in cells with subsequent impregnation of dead structures with calcium salts.

The neoplasm in invasive ductal breast cancer can have different sizes and development rates, which depends on the characteristics of the malignant cells in each specific case.

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Diagnostics of ductal breast cancer

In order to accurately determine the disease of the mammary gland, it is necessary to undergo a certain series of examinations. Diagnosis of ductal carcinoma of the mammary gland may include the following procedures:

1. Mammography is the most common diagnostic method, which is an X-ray examination of the mammary gland. The accuracy of this examination reaches 90-95%, even in the absence of visual and palpable symptoms of a tumor. The procedure is carried out using a special X-ray machine, which allows you to examine the left and right mammary glands from two angles - frontal and lateral. The latest generation of mammography machines have special stereotactic computer devices, thanks to which an accurate puncture with subsequent biopsy is carried out. The presence of a modern device practically guarantees the recognition of ductal cancer in the initial period of the disease, and also significantly facilitates the course of surgical intervention. However, there are some limitations to the use of this diagnostic method: most specialists do not recommend mammography for young girls and women under 50, since mammography is a type of X-ray procedure during which the mammary gland takes on, albeit small, but still radiation.
2. Thermography is a method for determining the temperature of the skin of the breast. The fact is that healthy tissues and tumor tissues have different temperatures. This is explained by the fact that the tumor contains a greater number of small vessels that emit heat and are easily detected by a thermograph. However, this method is not very popular: its error in determining malignant processes is still very large.
3. The light scanning method is an improved version of diaphanoscopy (examination of tissue lumen). The procedure is based on infrared transillumination of gland tissue. The method is not very common due to its low sensitivity and the difficulty of differentiating diseases.
4. Ultrasound is the second most popular method (after mammography). The procedure is quite fast, harmless and quite informative: it provides comprehensive data on the malignant process, its location, size and shape. Ultrasound is allowed to be used at any age an unlimited number of times.
5. Ductography (galactophorography, or contrast mammography). This procedure is often used when there is discharge from the milk ducts. A special contrast fluid is injected into the milk duct, after which an image is taken that shows changes along the ducts.
6. A biopsy is the removal of a small element of tumor tissue for examination. The tissue is taken using a puncture – a small puncture of the tissue in the area of the suspected tumor location. The removed tissue is then examined under a microscope for the presence of atypical cellular structures. A puncture for a biopsy is not always done: sometimes tissue for examination is taken during the operation to remove the tumor. This is done to make a final diagnosis for the patient.

Additional studies may include MRI, computed tomography, bone scans, etc.

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Treatment of ductal breast cancer

Treatment of ductal breast cancer will be more effective when using a comprehensive approach using surgery, medication, hormonal therapy and radiation.

The methods of treatment and the treatment regimen are prescribed by the attending physician, as a rule, after a consultation with the participation of multidisciplinary specialists: a mammologist, a surgical oncologist, a chemotherapist and a radiologist.

The complexity of treatment depends on the size of the tumor, the degree of invasiveness (penetration into surrounding tissues), the presence of metastases, as well as the age and well-being of the patient.

1. Surgical intervention. A radical (complete removal of the tumor) or palliative (aimed at prolonging the patient's life if it is impossible to completely get rid of the tumor) operation is performed. Surgical intervention can have different degrees and volumes. This can be a lumpectomy (partial removal of the gland), quadrantectomy (removal of most of the gland) and mastectomy (complete removal of the mammary gland with nearby lymph nodes). Plastic surgery to restore the mammary gland is often performed at the same time as mastectomy, or 12 months after the end of treatment after undergoing a final examination.
2. Radiation therapy. It is used when surgical treatment is impossible, as well as after surgery to prevent tumor recurrence. Such therapy is not performed in cases of cardiac decompensation, cerebral circulation disorders, severe metabolic disorders and liver diseases. In some cases, radiation therapy is prescribed before surgery to localize the malignant lesion.
3. Chemotherapy. Preliminary treatment with chemotherapy drugs helps stop the growth of a malignant neoplasm, which subsequently facilitates organ-preserving surgery. Chemotherapy either slows down or restrains tumor growth, which improves the prognosis of the disease and increases patient survival. Doctors rarely resort to prescribing any one chemotherapy drug. Most often, combined treatment is used, especially in the presence of regional metastases. Anthracyclines, taxanes, including monoclonal drugs (trastuzumab, herceptin) are used.
4. Hormonal treatment. For some breast tumors, drugs are used that lower the level of estrogens in the body, which helps slow tumor growth. Tamoxifen is most often the drug of choice.

By combining the listed therapeutic methods, specialists strive to achieve positive results and even completely defeat ductal breast cancer.

Prevention

The best prevention of ductal cancer is a periodic medical examination at a gynecologist's appointment. It is also important to treat any diseases of the reproductive system in a timely manner, not allowing them to become chronic. It is necessary to monitor the regularity of the menstrual cycle, and in case of failures and menstrual disorders, be sure to consult a doctor.

Regular self-examination (inspection and palpation) of the mammary glands allows you to detect suspicious symptoms in time and undergo a thorough comprehensive diagnosis.

If possible, pregnancy should not be postponed until the age of 35. Abortions are also undesirable. Regular sexual activity is recommended.

It is essential to keep the baby on breastfeeding for at least 1 year.

Watch your diet, protect your breasts from injury, avoid drinking alcohol and smoking.

Stress puts a lot of strain on the hormonal system, so you should try to avoid it.

And the most important thing: at the slightest suspicion and symptoms, you must immediately consult a doctor. Very often, timely intervention of a doctor allows you to save not only the patient's health, but also his life.

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Forecast

If you see a doctor in a timely manner and in the early stages of tumor development, the prognosis can be favorable.

A less optimistic forecast can be discussed in the following cases:

• if the neoplasm is large;
• in the presence of metastases in the nearest lymph nodes;
• in the absence of receptors for female sex hormones;
• at a young age of the patient;
• with poorly differentiated tumors;
• in invasive ductal carcinoma.

However, first of all, the quality of the prognosis depends on the time interval from the moment the tumor develops to the beginning of diagnostic and therapeutic measures. Therefore, in order to protect your body from this disease and prevent relapses, you should conduct a self-examination of the mammary glands once a month and, if necessary, do not hesitate to contact a doctor.

Ductal breast cancer is not a death sentence, but success in fighting the disease depends entirely on your serious attitude to the problem. Follow your doctor's recommendations, change your lifestyle in the right direction, and the disease will definitely recede soon.

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