Breast cancer is a typical female cancer. Unfortunately, the number of deaths from cancer increases every year, because it is a deadly disease, which is usually manifested in the late stages.
The cause of the disease: a combination of environmental and genetic factors. The risk of breast cancer formation is higher in women who have close blood relatives suffering from such an illness. Summer age is also one of the risk factors.
Women over 50 years are more susceptible to developing breast cancer. In the area of risk are also those women who gave birth to the first child after 30 years and those who never gave birth.
The first signs of breast cancer
The first symptoms of breast cancer are relatively visible and obvious. First of all, a woman should be alert to any breaks in the breasts. Need to urgently seek medical attention if swelling or irritation of the breast, nipple pain, skin peeling are observed. These changes may also be signs of infection or cysts. In any case, the intervention of a doctor is extremely necessary.
If the first symptoms of breast cancer are confirmed, you need to undergo several diagnostic tests to diagnose and determine the stage of the disease:
- One of the obligatory tests is a biopsy (collection of tissue or fluid from a suspect area);
- Mammography is a more detailed clinical examination. Mammography helps to see tumors that can be partly hidden by the dense breast tissue;
- For primary diagnosis, appoint an ultrasound. This is a painless and accessible type of diagnosis. Ultrasound allows you to determine the type of suspicious neoplasms, determine the stage of cancer. Determining the stage of the disease is an important key to choosing the optimal method of treatment.
Allocate four stages of breast cancer:
• Zero stage - non-invasive breast cancer. The term "non-invasive" means that there are no cancer cells outside the tumor cell.
• The first stage is invasive cancer, which means that the invasion of cancer cells in adjacent tissues occurred. The first stage is characterized by a tumor up to two centimeters long.
• The second stage of breast cancer occurs when the tumor grows no more than five centimeters. The second stage also means that the cancer has penetrated into the lymph nodes around the mammary gland.
• The third stage of breast cancer is conventionally divided into two subcategories: IIIA and IIIB. The third stage A is invasive breast cancer, with a tumor more than five centimeters, and a significant number of pathological cells in the lymph nodes. Stage IIIB is defined by a tumor in the mammary gland of any size that has spread to the breast, internal lymph nodes and chest wall.
• The fourth stage is a tumor that has spread beyond the breast, the axillary zone, as well as the lymph nodes located at the base of the neck, lungs, and liver.
Stages 0, I, II are considered early. If breast cancer is detected at an early stage, then the probability of survival increases by 70%. Late stages require more aggressive treatment, which means that the percentage of survival falls significantly.
Usually, treatment begins after thoroughly examining the general health of the woman and, usually, a week or later after the biopsy. Treatment is difficult because different types of breast cancer differ significantly in their rate of growth, the tendency for distribution (metastasis), and the response to treatment.
The main types of treatment are surgery, radiotherapy, chemotherapy and the use of sex hormones antagonists.
Radiation therapy destroys malignant cells in the area from which the tumor has been removed, and in surrounding tissues, including lymph nodes.
Chemotherapy (the use of drugs that cause the death of rapidly reproducing cells or inhibit their reproduction) and sex hormones antagonists (drugs that suppress the action of hormones that support the growth of malignant cells) are used to suppress the growth of cancer cells in the body. Often, they prescribe a combination of these therapies.
Since breast cancer is not yet known and none of the remedies is individually effective in all cases, doctors have different points of view regarding the most effective therapy.
A woman with a malignant tumor of the mammary gland has the right to clearly explain to her what is known about her illness and that is unclear, as well as to obtain a complete list of alternatives to treatment. The woman can agree or disagree with the proposed measures.
Treatment for localized breast cancer
In malignant tumors, the spread of which is limited to the mammary gland, treatment almost always involves surgery. This operation is performed shortly after diagnosis and is to remove the maximum possible volume of tumor tissue.
There are several surgical methods. The main question - whether to remove the entire breast (mastectomy is spending) or only the tumor and surrounding normal tissue area (conservative surgery).
Conservative surgery aimed at maximum preservation of healthy breast tissue. It can include the removal of a tumor with a small amount of surrounding normal tissue (removing the node), removing the tumor, and a slightly larger volume of surrounding normal tissue (wide excision or partial mastectomy) or removing a quarter of the mammary gland (removing the affected quadrant).
Removing the tumor with some part of the normal tissue gives the greatest chance of preventing recurrence (recurrence) of cancer in the breast.
The probability of survival in women who have undergone the removal of the entire breast and those who have been conservative surgical treatment in combination with radiotherapy is likely to be the same for at least the first 20 years after the operation.
The main advantage of conservative surgical treatment combined with radiotherapy - cosmetic; Such an operation allows you to save the shape of the body. However, this benefit may be insignificant if the tumor is large enough for the mammary gland; in this case removing areas of normal tissue, which is essential for the prevention of relapse actually deletes it most.
Conservative surgical treatment is usually easy to tolerate when the tumor is small. Approximately 15% of women who have undergone such treatment, the amount of removed tissue is so small that after the operation the difference between healthy and damaged mammary glands is invisible. More often, however, the operated mammary gland becomes slightly smaller and with another contour.
Side effects of radiation therapy, which accompany conservative surgical treatment, are usually short-lived and not accompanied by pain. The skin may blush or bubbles appear. In 5% of women who receive radiation therapy, fractures of the ribs occur. In 10-20%, pneumonia develops after 3-6 months after the completion of radiotherapy. Up to 6 weeks, dry cough and shortness of breath can be kept under physical stress.
With a simple mastectomy, the doctor removes all the breast tissue, but leaves unharmed muscle and a lot of skin to close the wound. The mammary gland is restored much easier if the muscles of the chest and other tissues lying under the mammary gland remain intact.
This method is commonly used in the treatment of invasive carcinoma, which is widely distributed in the milk ducts, since this type of tumor often occurs repeatedly in the mammary gland using conservative surgical methods.
Lymph nodes in the axillary region may also be removed to determine whether the cancer cells have spread beyond the breast; This procedure is called a simple mastectomy in conjunction with the removal of lymph nodes, or a modified radical mastectomy.
Further radiotherapy, often performed after surgery, greatly reduces the risk of reappearance of a malignant tumor in the chest wall or adjacent lymph nodes, but apparently does not increase life expectancy as cancer often spreads (metastasises) to other organs.
The life expectancy of women who have undergone a simple mastectomy, and women after the implementation of radical mastectomy, is almost the same. During the operation, it is recommended that adjacent lymph nodes be used for research in order to refine the prognosis.
Some experts believe that in tumors less than 1.3 cm in diameter during surgery, usually all cancer cells are removed, so no additional treatment is required. If the tumor is more than 3 cm in diameter, chemotherapy is usually prescribed after surgery. If the diameter of the tumor is 8 cm or more, then chemotherapy may be performed before surgery. Women who have in situ lumbar carcinoma may be recommended for the observation or immediate removal of both mammary glands (bilateral mastectomy).
As a rule, doctors do not consider lumbar carcinoma in situ as a malignant tumor; They believe that this tumor only indicates that a woman has a high risk of developing breast cancer. Only 25-30% of women with this condition develop invasive breast cancer; Even less deaths from breast cancer, so many women prefer not to undergo any treatment.
If a woman chooses a treatment to reduce the risk of developing breast cancer, both mammary glands need to be removed, since the malignant tumor does not always develop in the same area and in the same breast as the in situ placental carcinoma.
If a woman wants to avoid mastectomy, tamoxifen, a blocking effect of estrogens, is commonly used. In women of reproductive age, ovaries may be removed, but it is not clear whether this procedure is as effective or more effective than the use of sex hormones.
As a rule, in women with duct carcinoma in situ almost never happens relapse after a simple mastectomy.
A woman may prefer that the reconstruction be carried out simultaneously with the mastectomy, but this means that the anesthesia will continue for a longer time and the operation should take place in cooperation between general and plastic surgeons. In other cases, the reconstruction may be performed later, but this will require repeated anesthesia.
Subsequent chemotherapy or the use of drugs that block the activity of hormones, usually begins shortly after surgery in the mammary gland and lasts for several months or years.
Chemotherapy consists in the destruction of cancer cells with the help of medicines. The use of sex hormones antagonists is due to the fact that they inhibit the action of hormones that contribute to the growth of malignant cells. These treatments slow down the reappearance of the tumor and prolong the lives of most women.
Admission of these drugs may have led to cancer treatment in some women, but this has not yet been proven. Combination treatment with several agents and chemotherapy suppresses relapses more effectively than treatment with a single drug.
However, without surgery or radiation therapy, chemotherapeutic agents can not lead to cure. Depending on which chemotherapy agents a woman takes, vomiting, fatigue may occur, pain in the oral cavity ulcers, and occasionally temporary hair loss.
Vomiting is currently relatively rare due to the use of special medications, such as tropiscrete (newborn). If these drugs are not used, vomiting may occur 1-6 times in 1-3 days after chemotherapy. The severity and duration of vomiting depend on the chemotherapy performed and the individual characteristics of the woman. There may also be increased susceptibility to infection and a tendency to bleeding within a few months. As a rule, these side effects are gradually dwindling, although infectious complications and bleeding can lead to fatal outcome in 1-2 out of every 1,000 women receiving chemotherapy.
Tamoxifen is a blocking activity of a hormonal drug that is prescribed after a woman has undergone a breast cancer surgery. In women over 50, tamoxifen increases the likelihood of survival in the first 10 years after diagnosis by about 20-25%.
Treatment of breast cancer that spread beyond its borders
Breast cancer can give metastases to any part of the body, most often in the lungs, liver, bones, lymph nodes, brain and skin. An malignant tumor sometimes appears in these organs in years or even decades after the detection of breast cancer.
If the cancer has spread to one organ, it is likely that it will appear in others, even if it does not immediately manifest itself. Treatment for breast cancer that has passed beyond the breast is impossible; However, the life expectancy of such patients, as a rule, is at least 2 years, and some of them live up to 20 years.
Drug treatment, in addition to the operation, goes somewhat longer, but the main meaning of the treatment is that the medication, even with its unpleasant side effects, usually reduces the symptoms and improves the quality of life.
When choosing a doctor, the doctor takes into account the following: whether the growth of a malignant tumor is stimulated by estrogens, how much time has elapsed since it was detected, how many organs were affected, whether menopause occurred or not. If a malignant tumor with metastases is not accompanied by appropriate symptoms, then the therapy usually does not succeed because of a delayed diagnosis. Therefore, treatment, especially if it causes unwanted side effects, is often postponed until women develop symptoms (pain or other discomfort) or the tumor begins to grow rapidly.
A woman whose cancer causes pain or other severe symptoms is usually prescribed by sex hormones antagonists or chemotherapy to suppress the growth of malignant cells in the body.
However, there are exceptions. For example, if only one site of cancer growth is detected in bone tissue, after a long relapse period, there can be enough exposure to this bone to treat it. Radiation therapy, as a rule, is effective in bone cancer; Sometimes it has suppressed cancer for many years; Irradiation is also used to treat metastatic malignant tumors in the brain (brain cancer). Antagonists of sex hormones are prescribed more often than chemotherapy, women who have cancer development supported by estrogens, patients without manifestations of the disease for 2 years after diagnosis or in which the malignant tumor does not pose a direct threat to life.
These drugs are especially effective for women between the ages of 40 and 50 who continue to have menstruation and produce a lot of estrogen, as well as for those who have been at least 5 years after menopause; However none of these conditions is absolute. Since tamoxifen causes little side effects, it is commonly used as the first drug that blocks the activity of estrogen.
For the treatment of breast cancer, new drugs that are similar to aminoglutethymide have recently been approved but do not require the use of hydrocortisone; They are probably as effective as aminoglutethymide.
The most effective regimens of chemotherapy include cyclophosphamide, doxorubicin, docetaxel, vinorelbine and mitomycin. These drugs are often used in addition to sex hormones antagonists.
For the treatment of breast cancer, the so-called modifiers of biological response are sometimes used. These drugs are natural substances or slightly modified variations of natural substances that are part of the body's immune system. These include interferons, interleukin-2, activated lymphocytes-killer cells, tumor necrosis factor and monoclonal antibodies. These drugs are used before chemotherapy, but their role in the treatment of malignant tumors of the mammary gland is not finally established.