Stages of breast cancer

In clinical medicine, the stages of oncological diseases, including the stage of breast cancer, are clearly defined, as the development of the disease occurs in stages, and the methods of treatment must be adequate to the intensity and nature of the pathological process.

The answer to the question of how many stages of breast cancer the oncologists differentiate is given by the international classification of malignant tumors TNM Classification of Malignant Tumours. According to it, breast cancer has five stages.

[1], [2], [3]

Classification of stages of breast cancer

TNM Classification of Malignant Tumors (last 7th edition, 2009) concerns cancer tumors of any localization, and, thus, this is the classification of stages of breast cancer. It systematizes the main symptoms of cancer: T - Tumor (tumor), N - Nodus (nodes, that is, lymph node involvement) and M - Metastasis (metastases). Depending on the degree of their manifestation determines the stages of the development of the disease.

The designation Tis (Tumor in situ) is used when there is a compact tumor that does not affect the other located in the immediate vicinity of the tissue. The designations T1-T4 refer to the definition of the size of the malignant neoplasm, as well as the level of damage to tissues and organs located next to the tumor. These are stages of breast cancer 1, 2, 3 and 4.

In addition, if the pathological process has not affected the regional lymph nodes, the designation N0 is used. The defeat of lymph nodes - their size, total number and localization - are denoted by N1-N3. And the process of cancer metastasis has the following gradations: Mx (detect metastases is impossible), M0 (distant metastasis absent) and M1 (distant metastasis is).

Accordingly, the 0 stage of breast cancer is a very small tumor that did not have time to hit other tissues and affect the lymph nodes.

If the first stage of breast cancer is diagnosed, it means that the tumor size does not exceed 2 cm in diameter, and its cells have already penetrated into the surrounding tissues, that is, a process of tumor invasion occurs. But the lymph nodes are not affected.

Stage 2 breast cancer is characterized by an increase in neoplasia up to 5 cm and the beginning of its spread to hypodermal cells - the lower (fatty) layer of the skin. This stage has options - 2A and 2B. At 2A, there are no metastases, and at 2B in the armpit region, single metastases are detected from the tumor side, not connected either to each other or to neighboring tissues.

Based on their clinical picture of oncology, 0, 1 and 2A are early stages of breast cancer. 2B, 3 - later, and 4 is considered the latest stage of the disease.

Stage 3 breast cancer also has two "substages" - 3A and 3B. In case 3A, the transverse tumor size is more than 5 cm, there are several metastases (in the axillary region) and an increase in lymph nodes that are welded to each other or nearby tissues. The nipple can be drawn in, it can be serous or spotted.

In stage 3B, the tumor becomes even larger, with hilar lymph nodes and the chest wall. Oncologists distinguish the so-called inflammatory form of breast cancer, which develops very quickly and is often "masked" for mastitis. Characteristic signs of such a cancer - a modification of the skin on the chest, its hyperemia and hyperthermia.

Stage 4 of breast cancer is determined when the lesion covers the entire gland, as well as all lymph nodes (axillary, intrathoracic, subclavian and more distant). The skin and subcutaneous tissues of the breast are ulcerated, and the metastases of the tumor, spread by the lymph flow, can be found in the lungs, adrenals, liver, bone tissues and even in the brain.

[4], [5], [6]

Diagnosis of breast cancer

Diagnosis of breast cancer is carried out using the following methods:

• the clinical analysis of blood (including biochemical and on oncomarkers);
• mammography (mammary gland X-ray);
• Ultrasound of the breast, thorax, abdominal cavity;
• doktografiya (chest X-ray with a contrast agent, is performed during the destruction of the milk ducts, which are associated with serous or spotting from the nipples);
• biopsy (puncture, fine needle aspiration, stereotaxic or surgical) of the mammary gland and lymph nodes;
• histological and immunohistochemical studies of the biopsy specimen;
• magnetic resonance imaging (MRI);

• radiography of the lungs;
• Ultrasound or computed tomography (CT) scan of the chest, abdomen and pelvic organs;
• osteoscintigraphy (radioisotope examination of bones).

It is necessary to emphasize the particular importance for the diagnosis of breast cancer immunohistochemical examination of tumor tissue samples. This is the so-called FISH test, giving the oncologist information on the number of genes in tumor cells that are involved in the synthesis of the HER2 / neu receptor. It was found that with oncological tumors of mammary glands there is a high probability of an increase in the activity of the HER2 gene - the membrane protein-phosphotransferase of the epidermal growth factor receptor. It is the activation of the synthesis of this protein leads to overexpression - an increase in the number of HER2 receptors on the outer shell of tumor cells and their increased multiplication by fission.

By determining the number of HER2 / neu receptors in tumor cells, it is possible to predict further development of neoplasia and to apply the necessary chemotherapeutic drugs to stop the division of pathological cells.

[7], [8], [9]

Treatment of stages of breast cancer

Treatment of stages of breast cancer depends on the results of the examination of patients and the state of her health and should take into account all factors of the development of pathology. For today in oncology of mammary glands such methods of treatment are applied, as:

• chemotherapy;
• surgical removal of the tumor;
• radiotherapy (radiotherapy);
• hormonal therapy;
• target (targeted) therapy;
• combination therapy.

Chemotherapy is carried out with the help of cytotoxic (cytostatic) drugs, which violate the mechanism of dividing pathological cells and thereby lead to the cessation of their proliferation. These drugs include: platinum preparations (Cytoplatin, Cisplatin, Carboplatin, Triplatin, etc.); preparations of the group of taxa (Paclitaxel, Taxan, Paklitax, Paksen, etc.); preparations of the vinca alkaloid group (Vinkristin Vinorelbin, Vinblastine, Mawerex); derivatives of oxazaphosphorines (Endoxane, Mafosfamide, Trophosphamide, etc.); derivatives of fluoropyrimidine carbamate (Capecitabine, Xeloda), etc.

In this case, chemotherapy for breast cancer can be carried out as the only method of treatment, as well as to reduce the size of the tumor before surgical removal and stop the formation of metastases after surgery.

Surgical intervention - removal of the tumor and parts of surrounding tissues (lumpectomy) or removal of the entire mammary gland (mastectomy) - is performed in the majority of clinical cases of breast oncology, especially if early stages of breast cancer are diagnosed.

Radiation therapy for breast cancer, as in the case of tumors of other localization, is designed to cause mutation and death of cancer cells under the influence of radioactive irradiation. Radiation therapy can complement chemotherapy and surgical removal of the breast tumor.

According to experts, it is advisable to carry out hormone therapy for breast tumors after their removal only to patients with hormone-dependent neoplasms, that is, if cancer cells have receptors for estrogens and progesterone. In this case, medicinal preparations of the group of aromatase inhibitors (cytochrome P450-dependent enzyme) - Anastrozole, Letrozole or Exemestane.

Target therapy targeting the tumor and its metastases is based on the ability of recombinant IgG1 class monoclonal antibodies (like those produced by human immune cells) to selectively bind to the molecular HER2 / neu receptors on the outer shell of cancer cells and stop their growth. Among the most widely used drugs of this group, oncologists are called Trastuzumab and Epratuzumab.

Combined treatment of stages of breast cancer involves individual selection and simultaneous or sequential use of all the methods listed above.

Treatment of stage 0 breast cancer

In the treatment of stage 0 breast cancer, removal of the affected breast sector sectoral sectoral resection or lumpectomy (see above) is applied. These operations can be accompanied by lymphodissection - the removal of nearby lymph nodes.

In addition, it is necessary to prescribe a course of radiation therapy, and with increased tumor expression of HER2 - targeted therapy with the help of recombinant monoclonal antibodies.

Treatment of Stage 1 Breast Cancer

In the treatment of stage 1 breast cancer, lumpectomy is performed with removal of the axillary lymph node. To eliminate the remaining tumor cells and to avoid its re-emergence, after surgery, adjuvant (postoperative) radiation, hormonal or chemotherapy is prescribed. And in the case of tumor overexpression of HER2, adjuvant targeted therapy should be used.

Treatment of Stage 2 Breast Cancer

The obligatory stage of treatment of the 2nd stage of breast cancer is the partial removal of the tissues of the affected organ (lumpectomy) or complete removal of the gland (mastectomy), which depends on the individual clinical picture of the disease. In this case, the affected regional lymph nodes are also removed. The course of chemotherapy of a patient with tumors greater than 5 cm is repeated twice: before and after surgery.

According to the indications, postoperative courses of radiotherapy or hormone therapy are conducted.

In the case of mastectomy, endoprosthetic plastic surgery of the breast is performed with time.

Treatment of Stage 3 Breast Cancer

The beginning of treatment of stage 3 breast cancer is a complex attack on cancer cells with the help of cytotoxic drugs (chemotherapy) and oncologic hormone therapy. And only after positive results the decision is made to conduct the operation. Positive result of surgeons is fixed by a repeated course of chemotherapy or targeted ionized irradiation.

However, with tumor necrosis, bleeding, or abscess formation, treatment starts with surgery (palliative radical mastectomy). And after that chemo-and radiation therapy is applied.

With hormone-dependent neoplasms, long-term administration of aromatase inhibitors (hormone therapy) is shown, and in case of tumor overexpression of HER2 receptors (for more details, see Diagnosis of breast cancer), use of monoclonal antibodies.

Treatment of Stage 4 Breast Cancer

Admittedly oncologists, the treatment of stage 4 breast cancer - a recurrent and metastatic tumor process - is in most cases palliative, that is, aimed at alleviating the condition of patients. However, complete complex therapy at this stage of the disease can prolong life.

First of all, in order to reduce the level of intoxication of the body, sanation mastectomy is necessary, which consists in the maximum complete removal of necrosis and ulcerated tissues. And to fight metastases, the whole arsenal of anti-cancer methods is used: complex chemotherapy, radiation and hormone therapy.

In addition, the compulsory treatment of accompanying pathological processes must be mandatory. Thus, in case of anemia and thrombocytopenia, reception of appropriate medications and blood transfusion are indicated; with metastases in the bone - the appointment of preparations of the group of bisphosphonates, etc.

The development of the disease goes through several stages, and the stages of breast cancer are clearly defined. Therefore, it is necessary to apply for medical help on time and not to allow non-treatable stages of oncological diseases.