Ductal carcinoma of the breast

One of the most common forms of noninvasive or invasive breast cancer is ductal carcinoma of the breast.

What are the characteristics of this tumor:

• malignant degeneration originates in the lumen of the milk ducts of the gland;
• cancer cells originate directly from the tissues of the gland duct;
• Ductal carcinoma is usually a noninvasive form of cancer, meaning it does not grow into tissue other than the milk duct. However, in some cases, surrounding healthy tissue may also be affected.

Let's look at this disease in more detail.

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Causes ductal carcinoma of the breast

Women have many more glandular cells than men. If we take into account the degree of influence of hormones on these cells, it becomes clear that the risk of developing breast cancer is higher in women. Men can also get sick, but their chances are estimated to be about a hundred times lower.

The risk of developing carcinoma may increase with age, especially after age 50.

Those patients who have cases of this disease in their family are at a greater risk of developing carcinoma. Moreover, the closer the sick relative (mother, sister), the greater the risk of developing the disease.

One of the risk factors for developing carcinoma is the absence of pregnancies, or infertility. A successful pregnancy and birth reduces this risk.

Long-term treatment with hormonal drugs and long-term use of oral contraceptives increase the risk of developing carcinoma.

Regular consumption of alcoholic beverages significantly increases the chances of developing cancer, including breast cancer. For this reason, women, especially after 40, are advised to abstain from alcohol.

Obesity is a proven risk factor, as excess weight in most cases implies an increased amount of estrogen in the body, which can cause the development of a cancerous tumor.

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Symptoms ductal carcinoma of the breast

Ductal carcinoma may not cause any symptoms for a long time. Breast pain or other sensations are not typical for this disease. Some patients have symptoms, but few pay attention to them at first.

Symptoms of early stage ductal carcinoma of the breast include:

• the skin around the nipple or the nipple itself is drawn inward;
• discharge from the milk duct, possibly mixed with blood;
• enlargement and compaction of the lymph nodes on the affected side, most often in the axillary region.

With extensive spread of the process, the signs of the disease appear more pronounced:

• the mammary gland swells, and with infiltration a “lemon peel” appearance appears;
• the affected gland may change shape, which is more noticeable when comparing the two glands;
• the appearance of ulcers in the nipple area;
• the appearance of metastases, mainly in the lymph nodes of the supraclavicular and axillary regions.

General symptoms of cancer may appear: a feeling of fatigue, weakness, loss of appetite, headaches, irritability.

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Forms

Invasive ductal carcinoma of the breast

Invasive ductal carcinoma of the mammary gland (synonym – infiltrative, infiltrating) is the most common type of breast cancer. This name denotes widespread growth of the neoplasm beyond the milk duct.

Infiltrating ductal carcinoma of the breast begins in the epithelial cells that are located inside the milk ducts. The process then spreads to other surrounding tissues of the gland, outside the milk duct.

The causes of this disease are the same as those of non-invasive cancer. Symptoms of the disease may appear already at the initial stages, or only when intraductal cancer goes beyond the milk ducts. In this case, a characteristic sign of infiltrating carcinoma can be detected: the appearance of a hard swelling with uneven outlines in the nipple area, fused with the nearest tissues. The nipple or areola, as a rule, is drawn inward.

In invasive carcinoma, diagnostics reveal microcalcifications in the mammary gland: this is explained by the death of tumor cells with their subsequent calcification.

Invasive carcinoma is not limited in size and speed of development: the tumor can reach large volumes in different times, depending on the aggressiveness of the tumor.

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Diagnostics ductal carcinoma of the breast

There are many different methods used to diagnose ductal carcinoma of the breast. We will tell you about the most frequently used procedures.

• External examination and palpation – should be performed from the seventh to the tenth day of the monthly cycle. If there is a suspicion of carcinoma, the day of the procedure does not matter. This is a preliminary examination method, which must be followed by laboratory and instrumental diagnostic procedures.
• Mammography is an informative method that helps to detect carcinoma even with undetectable tumors. It is not recommended for use at a young age.
• Ductography is an X-ray procedure with the introduction of a contrast agent, a special substance that allows the milk duct to be shaded and its patency, contours, tortuosity, etc. to be assessed.
• Ultrasound examination (possibly with Dopplerography) – can be used at any age. The effectiveness of the method is equal to mammography, however, ultrasound does not always allow to detect microcalcifications in the gland.
• Thermography is the use of infrared radiation, which helps to identify areas with poor blood circulation and slow metabolism. This method is inferior in information content to mammography and ultrasound, so it is rarely used.
• MRI (magnetic resonance imaging). Can assess the condition of tissues even without using contrast. A highly accurate method, which, however, is less popular due to its high cost.
• Cytology is a method for identifying malignant cells in gland secretions, in a puncture (material taken directly from the gland tissue by puncture).

If the diagnosis of ductal carcinoma of the breast is confirmed as a result of diagnostics, the next step should be to check for metastases in the body. Most often, CT scan is used for this purpose.

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Treatment ductal carcinoma of the breast

The most radical type of treatment for ductal carcinoma of the breast is removal of the tumor followed by a course of radiation. However, this is far from the only method of treating cancer.

• Organ-preserving removal. When agreeing to have a tumor removed, women certainly want to preserve the affected mammary gland as an organ. In some early cases, this is indeed possible. The surgeon removes the tumor directly, without affecting the gland as a whole. After such an operation, subsequent radiation therapy is mandatory.
• Surgical treatment of ductal carcinoma of the breast can be performed in several ways: the lumpectomy method (removal of the entire area of cancerous degeneration) and the excision method (usually a repeat operation after lumpectomy when residual cancer cells are found). The excision method is often performed under ultrasound or mammography control to help clarify the location of the tumor.

• Radiation therapy – often prescribed after surgery to completely eliminate the recurrence of cancer. Radiation therapy can be performed on the entire affected gland or on a limited area. The device for radiation therapy is called a linear particle accelerator. The course of irradiation with the device is usually carried out five days on and two days off for five weeks. The use of radiation therapy can reduce the risk of recurrence of cancer by 50-75%.
• Complete excision of the affected gland is a mastectomy. Such a radical operation is prescribed for carcinoma of significant size, as well as for a clear hereditary tendency to breast cancer. After complete excision of the gland, plastic surgery is performed to replace the missing breast. Often, such a procedure is performed simultaneously with the excision.
• Chemotherapy. This treatment method can improve the outcome of surgery. What drugs can be used to treat carcinoma:
  • tamoxifen is an estrogen receptor blocker that inhibits the growth of malignant cells in hormone-dependent oncology;
  • aromatase inhibitors (arimidex, femara, aromasin) – inhibit the production of hormones, thereby suppressing the biosynthesis of estrogens in tumor tissue;
  • other chemotherapy drugs (cyclophosphamide, epirubicin, doxorubicin, methotrexate, fluorouracil) are quite toxic drugs that kill cancer cells, but in some cases they also damage healthy tissue. The effect of such drugs on the bone marrow and digestive system is especially pronounced.

The choice of one or another method of treatment remains with the doctor: it can depend on many factors, so therapy is selected individually.

Prevention

Preventive measures include timely treatment of mammary gland diseases, prevention of abortions, and adherence to the physiological period of breastfeeding. Every woman without exception is recommended to independently examine her mammary glands for the appearance of lumps, nodules, discharge, etc. A routine examination by a mammologist or gynecologist should be performed annually. After the age of 40, it is advisable to undergo periodic mammography.

If someone in the family has had breast cancer, then all other immediate family members are at risk and must be examined by a mammologist annually without fail.

It is advisable not to forget about the general rules for the prevention of oncological diseases:

• give up bad habits (smoking, drinking alcohol);
• avoid stress;
• avoid chest trauma;
• treat diseases of the genital area, hormonal imbalances, and infectious diseases in the body (including chronic ones) in a timely manner.

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Forecast

The prognosis for ductal carcinoma of the breast can depend on several factors:

• from the size of the malignant tumor;
• from detection of metastases in the lymphatic system;
• from the degree of malignancy based on the results of histology;
• from the hormone dependence of the tumor;
• from the level of the tumor marker CA 15-3;
• from the timeliness and quality of the treatment provided.

Qualified and competently selected treatment measures guarantee patients considerable chances for a favorable prognosis. Ductal carcinoma of the mammary gland is treatable: currently, most medical institutions have all types of necessary equipment for the treatment of this pathology.

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