Breast carcinoma

Malignant tumor - carcinoma of the breast is a common oncological pathology.

Such tumors differ relatively late diagnosis, so in many cases the outcome of the disease can be negative. What it is necessary to know about this disease in order to detect it in the initial stages of development? Is it possible to cure the disease, and how? About this and much more - our article.

[1], [2], [3], [4],

Causes of the carcinoma of the breast

At the moment, the possible causes of breast carcinoma have not been sufficiently studied. It is assumed that the risk of malignant formation is higher in those patients who are prone to some provoking factors. These include:

• hereditary predisposition. Experts have proved that in the case when immediate relatives get sick or suffer from carcinoma, the likelihood of getting sick increases several times. It's all about the genes that are responsible for the possibility of developing oncology. However, the absence of such genes does not mean that a woman is protected from a malignant disease;
• cancer tumors transferred earlier. If a woman already had a tumor, even if successfully healed, the risk of its formation on the other breast increases;
• an individual feature of the sexual function of women. The risk includes early puberty (10-11 years), late menopause (at 60 years), pregnancy after 35 years. No less vulnerable are those women who have never been pregnant or never breast-fed in their lives;
• presence of cystic mastopathy or fibroadenoma;
• the use of contraceptives for several years without interruption;
• the use of hormonal therapy during the menopause for 3 years or more;
• exposure to radiation, both in harmful production, and living in radioactive-unfavorable zones;
• endocrine diseases such as decreased thyroid function, various forms of diabetes mellitus, metabolic disorders (in particular, overweight).

Of course, the factors that provoke the formation of carcinoma - these are just assumptions. But in order to protect yourself from an insidious malignant disease, it is important to pay attention to these factors and, if possible, try to eliminate them. At least, those women who have these factors, should most closely monitor their health and regularly undergo a doctor's consultation.

[5], [6], [7], [8]

Symptoms of the carcinoma of the breast

The clinical symptoms of carcinoma may differ depending on the form of oncological pathology (we'll talk about the forms below), the phase of the development of the process and its scale. Let's highlight the main symptoms of breast carcinoma, having found out which, a woman should immediately contact a doctor:

• In the chest, a dense formation of any size is palpable. Localization - more often under a nipple, or on other part of a thoracal gland;
• the skin on one of the glands changes, wrinkles appear, the skin can become dense, change in shade (redness, yellowness or cyanosis of the skin area may appear), ulceration may appear on the surface, more often in the okolososic region;
• when viewed in the mirror, you can see the discrepancy between the contours of the two glands, that is, one of them may change in size, become convex, or vice versa, drawn;
• the enlarged lymph nodes in the underarm zone are probed. In the normal state, the nodes are not probed. In pathology, they are felt as small, perhaps painful small balls, of a soft or dense consistency;
• Press on the nipple: with carcinoma may appear allocation. In the norm they should not be (with the exception of the prenatal and lactation periods);
• carcinoma can form under the guise of mastitis, erysipelas and other inflammatory diseases, so these pathologies should not be treated independently. In case of any inflammation in the chest, consult a doctor.

Sometimes carcinoma can occur practically without clinical signs: an insidious disease can be seen only on ultrasound or mammography. Therefore, preventive visits to the doctor are very important for the timely detection of malignant pathologies.

[9], [10], [11]

Forms

There are two main types of carcinoma: invasive and non-invasive.

Non-invasive carcinoma is the initial stage of a malignant process, which is treated most successfully. At this stage, the tumor is not yet connected to surrounding tissues, but is located in the milky canal or in a separate lobe of the breast.

Invasive ductal carcinoma of the breast is no longer an isolated element, but a process that affects other gland tissues. This process has a special malignant course, getting rid of it will be more difficult.

Invasive breast carcinoma is divided into several variants of the course:

1. The ductal carcinoma of the mammary gland is formed inside the wall of the milky canal (duct), eventually spreading into nearby breast tissues. The most common is infiltrating ductal carcinoma of the mammary gland (this name is equivalent to the word "invasive" - germinating) - such a tumor can be recognized by a sufficiently dense formation with fuzzy boundaries, which is welded to the nearest tissues. The sucking region often falls inside (retracted). The pictures can detect calcium deposits: they form on the site of dead cells. Infiltrating ductal carcinoma of the mammary gland can have various sizes, and cellular structures may have varying degrees of aggressiveness, which largely determines the rate of spread and growth of cells.
2. Lobular carcinoma of the mammary gland - affects first the glandular tissue, then grabbing newer and newer nearby tissues. Invasive lobular carcinoma of the breast can also be called lobular carcinoma. This name characterizes a tumor that grows directly from the lobular structures of the breast, which are responsible for producing milk from a woman. Often an invasive type of tumor is not detected on a mammogram. Nevertheless, in the upper outer part of the breast can be probed some dense formation. More than in a quarter of cases, the same education appears on the second breast, or in the form of multifocal carcinoma (in several places on one breast). Most clearly the tumor manifests itself in the late stages, when there is a change in the surface of the skin over the lesion. Because of the hormonal nature of the disease, infiltrating lobular carcinoma of the breast can spread to the internal reproductive organs - the uterus and appendages.
3. Tubular carcinoma of the mammary gland - differs penetrating growth in adipose tissue. Such a tumor is never large (up to 2 cm), has a tubular structure with a pronounced lumen. Carcinoma cells are monomorphic, with very little signs of atypicality. Tubular carcinoma contains a fairly large amount of collagen: the tumor is characterized by slow growth and at first can not cause suspicion. This is the reason for frequent incorrect diagnoses, since such manifestations are possible for adenosis of the breast or for radial sclerotic changes.
4. Paget's disease of the nipple  is an intra-cellular carcinoma of the mammary gland, which is manifested by the formation of ulcers or by changing the contours of the nipple and the parasol zone. On the surface of the nipple, there is the appearance of peeling and redness, which sometimes can abruptly disappear on its own. However, the disease itself does not disappear. In the future, it manifests itself with pain, a burning sensation, and discharge from the milk ducts is possible. Often, the initial course of this disease resembles eczema. Paget's disease of the nipple can occur both in women and in men.
5. Carcinoma in situ of the breast is a non-invasive malignant process, that is, not spread to nearby tissues. Literally the combination of "in situ" is translated as "in place". In carcinoma in situ, atypical tumor cells do not germinate in the surrounding gland tissues, but are located on one site. This is the most favorable variant of the tumor, which in some cases is even treated conservatively, without the use of surgery. The danger of non-invasive neoplasm is that at any time it can go into an infiltrating (invasive) form, affecting all nearby tissues and significantly worsening the prognosis of the disease.

Infiltrating carcinoma of the breast, in turn, is divided into several variants of the course:

• pre-invasive ductal carcinoma - when the process has not yet passed to the surrounding tissues, developing in the milk canals, but there is a high probability that it will soon transform into an infiltrative form;
• infiltrative ductal carcinoma of the mammary gland - originates in the milk ducts, gradually expanding, and switching to fatty tissue of the breast. The degenerated cells of such a carcinoma, in contrast to the non-invasive form, are able to penetrate the blood and lymphatic vessels, thereby spreading to other organs and systems.

Infiltrative breast carcinoma is one of the most insidious and prevalent variants of the course of the disease. Such a tumor is diagnosed in 80% of all breast cancers. This malignant form leaves the cavity of the milk canal quickly enough and sprouts into healthy breast tissue.

Of the most characteristic signs of the disease can be called:

• a slight dense section with fuzzy contours, reminiscent of a cone;
• The compaction does not "walk" between the tissues, but is clearly welded to them;
• the parotid region is drawn inward (not always, but very often);
• a mammogram traces a number of small calcium deposits along the perimeter of the tumor.

Infiltrating carcinoma of the breast by international standards is assessed according to the following table:

TX	The initial tumor can not be evaluated
T0	No signs of primary tumor
Tis	Signs of carcinoma in situ
T1	Education with dimensions up to 2 cm
T1mic	The presence of micro-germination - microinvasion, up to 0.1 cm
T1a	Invasion from 0.1 cm to 0.5 cm
T1b	Germination greater than 0.5 cm, but less than 1 cm
T1c	Germination from 1 cm to 2 cm in surrounding tissue
T2	Education from 2 cm to 5 cm
T3	Education more than 5 cm
T4	Any formation that has spread through the thorax and skin
T4a	Germination through the thorax
T4b	Swelling and sores on the skin surface
T4d	Swelling with inflammatory phenomena
NX	Carcinoma, assessment of the nearest lymph nodes is difficult
N0	Metastases in the nearest lymph nodes were not detected
N1	The mobile nearest lymph nodes from the side of the lesion were found
N2	The fixed nearest lymph nodes are found on the side of the lesion
N3	Metastases are found in the inner nearest lymph nodes
MX	It is impossible to estimate the extent of metastasis
M0	Metastases are not detected
M1	Distant metastases were found

When diagnosing ductal or lobular carcinoma, the aggression of the development of education is determined. The degree of aggression can be determined by the probability of germination in the nearest tissues. She is evaluated on the basis of a biopsy, highlighting the following categories:

• GX - a change in the structure of cells is difficult to assess;
• G1 is a highly differentiated process;
• G2 - moderately differentiated process;
• G3 is a low-differentiated process;
• G4 - undifferentiated.

Invasive breast carcinoma G2 and G1 have a lesser degree of germination, and G3 and G4 are the highest.

Low-differentiated breast carcinoma is characterized by a low cell growth rate, with atypical cells quite similar to healthy cells.

A highly differentiated process proceeds with the rapid growth of tumor cells, in which distinctions are clearly observed with healthy cells.

[12], [13]

Diagnostics of the carcinoma of the breast

The first link in the diagnosis of breast carcinoma is  mammography  - a study that resembles radiography. On the mammogram it is possible to see not only a new formation, but also calcium deposits, characteristic for the infiltrative form.

Ultrasound allows to determine the structure of the tumor, which allows to differentiate the carcinoma from the cystic formations of the mammary gland.

A doppler scan is an evaluation of the breast ducts of the breast. In the study, a special fluid is introduced into the channels, after which the woman is given an X-ray. In ductal carcinoma, the area through which the liquid has not passed is clearly identified on the roentgenogram.

If after the above studies failed to determine the nature of the tumor, the doctor prescribes a biopsy - a diagnostic procedure that accurately indicates the structure of the tumor. The biopsy is carried out with a thin needle, which pierce the tissue of the breast in the affected area, select the necessary amount of internal tissues, which are then examined microscopically. The microscope allows you to see what cells are present in the material - healthy or malignant.

Sometimes it is not possible to remove the investigated material with a thin needle. In such cases, use a needle thicker, or resort to surgical incision of tissues.

When malignant cells are detected, the doctor can prescribe a number of additional tests: this is the determination of the susceptibility of these cells to estrogens and progesterone, an estimate of the rate of cell division, etc. A comprehensive examination helps determine the most correct scheme for further treatment.

If the stage of the disease is such that it is possible to suspect the spread of metastases across the body, assign studies to detect them. Such studies include x-rays, examination of internal organs, CT, osteography, etc.

[14], [15], [16], [17], [18],

Treatment of the carcinoma of the breast

To treatment of breast carcinoma should be started immediately after the diagnostic procedures. There are many options for treating the disease, but when choosing a therapeutic effect, the doctor primarily focuses on the neglect of cancer, the extent of its spread in tissues and in the body, and the aggressiveness of the tumor. Let's consider the basic methods of treatment.

1. Operative treatment. This method is used most often, since it is the most effective way. The operation is usually performed using radiation and chemotherapy. Surgery may involve resection of the entire affected breast, or part of it. During the operation, the nearest lymph nodes can also be removed from the side of the lesion in order to avoid the re-development of the disease. Simultaneously with the operation or with additional intervention, the doctor can install implants that eliminate the external defect of the removed breast.
2. Radiotherapy (irradiation) is a method often prescribed after surgery. Radiotherapy is the procedure for irradiating a site affected by neoplasm, and located near the lymph nodes, which can contain atypical cells from the tumor.
3. Drug treatment (chemotherapy). This method of treatment involves the use of special medications that allow the destruction of developing malignant cells, or suspend their division. Chemotherapy is  not used as the only method of therapy, but perfectly complements the effect of surgery and radiation.

As the main drugs recommended for use in breast carcinoma, you can distinguish Epirubicin, Cyclophosphamide, fluorouracil. The agent chooses the doctor, focusing on the effectiveness of the drug and its perceived body of the patient.

With hormone-dependent tumors that differ in the presence of receptors sensitive to estrogens and progesterone, the doctor prescribes drugs that inhibit the production of hormones. It is proved that with such carcinomas, preparations that block hormonal synthesis are of great help. The most commonly prescribed drug is Tamoxifen. It is used for a long time, sometimes for several years.

Drugs containing monoclonal antibodies are another medication that is detrimental to malignant cells. These drugs include Herceptin. The scheme of reception of Herceptin is painted exclusively by a specialist.

An oncologist, together with a nutritionist, can prescribe a  diet for breast cancer.

Prevention

What can be done to prevent the development of carcinoma in the mammary gland? Really, every woman needs to know and fulfill the basic principles, allowing to protect her as much as possible from insidious disease.

Women in almost any life period can be prone to mammary gland diseases. What should I do to reduce the risk of injury?

1. Watch your own weight. It is proved that women with a large body weight are more prone to breast pathologies. With obesity, not only the hormonal balance of a woman is disturbed, but excessive workload is also created on the organs. Revise your diet and, if you can not cope, you can consult a dietician's advice.
2. Forget about drinking alcohol. Scientists have proved that women who drink alcohol often increase the risk of carcinoma by more than 20%. Perhaps the reason for this - all the same hormonal changes that occur against the background of alcohol intake. If you can not completely abandon alcoholic beverages, reduce their use to a minimum.
3. Lead an active lifestyle, go in for sports. Physical culture helps to keep itself in shape, strengthens immunity, stabilizes the hormonal background.
4. If in your family (on your line) there are women who have ever had malignant diseases of the breast, then the danger is higher for you than for others. What can I advise? It is often to visit a doctor and do a prophylactic ultrasound to monitor the condition of the mammary glands.
5. After the birth of the baby, do not ignore breastfeeding. Feed your baby for at least 1 year. Thus, you not only strengthen the body of the newborn, but also reduce the risk of carcinoma formation.
6. Vitamin D has a good preventive effect. It is proved that this vitamin can even inhibit the growth of malignant cells in the body.
7. Pay attention to your diet. Meat products from beef and pork are best replaced with white chicken or turkey meat. Experts argue that instead of meat in most cases it is better to use sea fish and seafood. In addition, the number of vegetables, berries, herbs and fruits, legumes and nuts, as well as vegetable oils, the so-called diet against cancer should be increased in the menu  .
8. Periodically examine the mammary glands. Develop a habit: monthly after the end of menstruation (for 5-6 days) after taking a shower, check the glands for any changes: seals, nodules, maceration, soreness, discharge from the nipples, etc. If you find anything suspicious, necessarily descend or go on reception to the gynecologist or  mammologu,  make US.

Do not forget to treat any diseases of the mammary glands and the genital area in a timely manner. If you follow all the rules listed above, you will be able to save not only your beauty, but also your health.

[19], [20], [21], [22], [23],

Forecast

Undoubtedly, with the constant development of world medicine and professional development of specialists, as well as with the emergence of modern technical medical equipment, the forecast of breast carcinoma can be successful in 95% of cases. However, one should not forget that the timeliness of contacting a doctor and finding a tumor at early, asymptomatic stages of development play a huge role in the effectiveness of treatment.

Also in the prognosis of the disease, the presence and prevalence of metastases is important. Carcinoma, whose success depends on the presence of metastasis, is much more difficult to respond to therapeutic effects if more than four metastases are present in the lymph nodes. At the same time, the farther from the primary tumor metastases are found, the worse the prognosis becomes.

According to statistics, carcinoma with dimensions up to 20 mm spreads metastases to 15% of cases; carcinoma with dimensions up to 50 mm - up to 60% of cases; a tumor that has a size of more than 50 mm metastasizes in almost 80%.

Specialists from different countries have determined that the prognosis of the disease may be worse in hormone-independent tumors, that is, those that do not have sensitive receptors for sex hormones.

Important for assessing the prognosis of carcinoma is the definition of oncomarkers. Such a blood test can now be taken in almost any laboratory. Indicators of oncomarkers, indicating an excess of the norm of 1.5-2 times, worsen the prognosis and increase the risk of the formation of repeated carcinoma or the spread of metastases.

Do not be shy on any suspicious occasion to see a doctor. Carcinoma of the breast can become too serious a payment for carelessness, so do not let it develop and love yourself!

[24], [25], [26], [27],