A type of oncology in which cells that have mutated during the division of normal cells try to grow as far as possible beyond the organ in which they originated is called “invasive cancer.”

During invasive cancer, the beginning of tumor growth is distinguished - the stage of microinvasive cancer (microcarcinoma); it is characterized by growth beyond the boundaries of the basement membrane to a depth of 5 mm. Microinvasion is the stage of cancer development that is most favorable for treatment.

There is a clear connection between invasive cancer and carcinoma - after the basal membrane is ruptured by tumor cells, carcinoma transforms into invasive cancer.

What is invasive breast cancer and the reasons for its formation

Often when breast cancer is not diagnosed at an early stage, many patients are diagnosed with invasive carcinoma. This type of cancerous tumor (BC) rapidly progresses, and once it enters the lymphatic system, it spreads to all internal organs. This is a nonspecific type of invasive cancer. There is also a non-invasive type of carcinoma, which is characterized by the growth of cancer cells into the organ where it formed. with this type of tumors appear later than with the invasive type. If there are metastases, such carcinoma is called metastatic.

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Invasive cancer occurs more often in people with a history of the following diseases and conditions:

• first pregnancy terminated by abortion. During pregnancy, changes occur not only in the genitals, but also in the mammary glands. An abrupt interruption of such a process is a prerequisite for the development of such cancer;
• mastopathy. Cavities in which fluid is present (cysts) and fibrosis (foci of connective tissue) appear due to hormonal imbalance. Being a collection of altered cells, they seem to be a convenient focus for the formation of cancerous tissue;
• fibroadenoma. The presence of elastic nodules of connective tissue, which appear due to hormonal imbalance in the body, can contribute to the development of cancer. To prevent such malignancy from occurring, it is necessary to treat it in a timely manner, without giving it the opportunity to enlarge and transform;
• refusal to breastfeed. In women who do not breastfeed, various lumps may develop in the breasts, which can subsequently develop into invasive ones.

The following types of factors may also contribute to the development of invasive cancer:

• Chronic pathologies of the female reproductive system, as a rule, are those that have led to complete or partial infertility;
• Long absence or irregularity of sexual activity;
• The presence of a similar disease in close relatives.

Types of Invasive Cancer

There are usually three types of such pathology:

• Ductal carcinoma (invasive ductal cancer). With this type of pathology, the first abnormal cells appear in one of the ducts through which milk flows during lactation. This type is considered the most dangerous and most common type of mammary carcinoma. Cancer cells of this carcinoma quickly enter the systemic blood or lymph flow. Cells of this type of cancer contribute to the appearance of various abnormal discharges from the nipple and deform the nipple itself. The age of patients with this pathology is usually over 55 years.

Invasive ductal carcinoma comes in various degrees of differentiation:

1. High degree. The structure of the nuclei of such cancer cells is identical. This is the least malignant grade;
2. Intermediate. The structure of tumor cells and their functions resemble non-invasive low-grade cancer;
3. Low. In this case, the cells are very different in structure from each other and spread very quickly along the duct, penetrating into neighboring structures;

• Preinvasive ductal carcinoma. While it has not yet spread to neighboring tissues, it develops from the cells of the milk ducts. But the chances of this stage turning into an invasive type are very high;
• Invasive lobular cancer. Formed from lobules of gland cells. Among invasive cancers it occurs in 10-15% of cases. This type of cancer can be in the form of a single tumor or in the form of several nodules. With this type of cancer, bilateral damage is possible. It is also difficult to diagnose, due to the fact that there are no obvious manifestations in the form of discharge from the nipples or the presence of lumps.

Unspecified form of invasive cancer

This form of invasive cancer is characterized by its inability to determine the type - ductal or lobular carcinoma. Invasive unspecified mammary cancer can be of the following types:

The common point of all these types of cancer is that for the most part (60-70%) they are hormone-dependent - they have estrogen receptors, that is, hormone therapy is well suited for their treatment. If cancer formed in premenopause, then it does not have such receptors.

It can also be noted that the medullary type of tumor in invasive cancer is the most favorable, in contrast to ductal and lobular carcinoma and Paget's cancer.

Symptoms of Invasive Cancer

Depending on the stage of the disease, invasive cancer manifests itself differently. Before cancer cells spread beyond the boundaries of the structure, many patients do not feel anything; others only complain of discomfort and pain when feeling the mammary glands. Morphological signs of early invasive cancer are practically absent. Only with further development of the tumor do the following symptoms begin to appear:

• nipple pain;
• change in breast shape;
• bloody discharge from the nipples;
• a “bump” or compaction appears without precise boundaries;
• The skin of the breast in some areas becomes red, pale or wrinkled.

Stages

• Stage 1 (degree) of invasive breast carcinoma – when the tumor is no more than 2 cm, does not have metastases and does not penetrate nearby structures;
• Stage 2 invasive streaming breast cancer has a neoplasm - 2-5 cm, tumor cells are localized in one or several nodes in the axillary fossa, but they are not fused with each other and with nearby tissues, there is no metastasis;
• Stage 3 of invasive unspecified cancer - at this stage, the tumor does not have clear boundaries in a lobular or ductal neoplasm, the lymph nodes have cancer cells that are “glued” together, there are no distant metastases yet;
• Stage 4 - with this carcinoma, the lymph nodes are already affected and metastases are present in distant organs.

What is invasive cervical cancer and the factors behind its occurrence?

is in second place in terms of diagnosis frequency after breast cancer. Depending on the stage of formation, it can be non-invasive or invasive. The transition from one type to another can take a long period.

Invasive uterine cancer usually occurs in females after 40 years of age, with the peak of this disease occurring between the ages of 48-55 years. Before the age of 30, the chance of developing this disease is quite low - 7%, and the risk of getting invasive uterine cancer after crossing the 70-year mark is also low (16%).

The development of the disease can be influenced by many factors. Among them is infection with the HPV virus (human papillomavirus). But even its presence in a woman’s body does not always indicate the necessarily onset of the cancer process. Among the factors influencing the development of invasive cancer, the following should be noted:

• sexually transmitted diseases, also HIV;
• a fickle partner who has a large number of sexual relationships with different partners;
• promiscuous sex life;
• sexual activity started at an early age;
• a large number of births;
• use of hormonal drugs;
• previous oncological disease of the genitourinary system;
• active and passive smoking.

The risk also increases if you have the following diseases:

• cervical erosion;
• dysplasia;
• leukoplakia.

Timely detection of such diseases will help to begin treatment on time and prevent it from developing into cancer.

It is also customary to divide ongoing transformations in the cervix into the following types:

1. Cervical dysplasia (this includes pathologies such as polyps, pseudo-erosions, leukoplakia, condylomas)
2. The precancerous process (this is cervical dysplasia in different stages) is considered a reversible process;
3. Pre-invasive (or non-invasive). This stage is characterized by the completion of epithelial changes and the completion of infiltrative growth;
4. Invasive cancer. Cancer cells spread.

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Symptoms of invasive cervical cancer

The most common signs of invasive cervical cancer are usually bleeding during sexual intercourse, unstable menstruation, watery discharge with an unpleasant odor, pain in the lower abdomen, and problems with urination. These signs usually indicate the presence of a tumor and are specific. But general signs may also occur that characterize the patient’s general health – weakness, dizziness, loss of appetite, increased sweating, etc.

Although this disease is a clinically pronounced cancer, early stage invasion in oncology may not always have pronounced symptoms to give a prognosis for the disease. This disease can be detected by histology and can also be confirmed by biopsy.

Diagnosis

In order to detect invasive breast cancer in a timely manner, it is recommended that once a year (you should start such regular examinations after 20 years of age) you undergo screening tests - X-ray mammography or ultrasound scanning.

If such a study confirms the presence of a tumor, then a more accurate examination is prescribed, which consists of:

But an accurate diagnosis is possible only after examining the cells obtained by puncture; the discharge from the nipples is also examined. Immunohistochemical tests are performed on the resulting cells to determine sensitivity to sex hormones in order to select hormone therapy.

To accurately determine the stage of invasive cancer, tomography of regional lymph nodes, bones, and lungs is performed. If tumor cells are found there, they are also studied by biopsy.

To determine the rate of tumor growth, a Gleason classification is performed, which is based on studying the area of ​​malignancy obtained by biopsy. During the study, undifferentiated chains of cells are counted, and based on the counting results they are assigned to one of the categories:

• G1 – well differentiated cancer;
• G2 – moderately differentiated cancer;
• G3 – low differentiation carcinoma (if this cancer is not a lobular type, but a ductal one, it has the maximum ability to penetrate structures that differ from its own);
• G4 – extremely malignant, undifferentiated;
• Gx – the degree of differentiation cannot be established.

The lower the grade of cancer, the more difficult it is to cure, and the more treatment options will have to be tried to achieve a cure.

Diagnosis of invasive cervical cancer

If histological analysis confirms the presence of a tumor, then the following studies are prescribed:

• Pyelography (a test to detect problems in the urinary system);
• Chest X-ray;
• Cystoscopy;
• Sigmoidoscopy.

Also, additionally prescribed:

• CT, MRI;
• Biopsy.

Treatment of the disease

To treat invasive cancer, both local (radiation therapy, tumor removal) and systemic (chemotherapy, biological and hormonal therapy) methods are used. Combinations of several methods are often used. The choice of treatment is based on:

1. Tumor size;
2. Location of the neoplasm;
3. Stages of the disease;
4. Sensitivity of the tumor to estrogen;
5. Menopause (age of the patient).

The usual treatment regimen looks like this:

Disease prognosis

The prognosis for this type of cancer depends on several points:

• At what stage was the disease discovered? Started treatment at stage 1 gives a 90% recovery rate, at stage 2 - 66%, stage 3 - only 41%, at stage 4 survival is less than 10%;
• Location of carcinoma (if it is located within the gland tissue on the outside, the prognosis is more favorable);
• Tumor diameter (five-year survival rate for tumors up to 2 cm - 93%, 2-5 cm - 50-70%);
• Degree of tumor differentiation;
• The presence of estrogen and progesterone receptors;
• The presence of other foci of cancer and lymphedema of the breast and arm.

After treatment for cervical cancer, the patient should be seen by a doctor every three months for two years, and later once every six months.

Remember! With cervical cancer, if it is detected during the middle stage, there is a chance to carry a child to term, while detection at the beginning of pregnancy entails an abortion. But in any case, the decision is made taking into account all individual characteristics.

Question - answer

What does the term “Nottingham system” mean in gynecology?

This is one of the ways to determine the degree of malignancy of a cancer tumor.

Often in oncology diagnoses some incomprehensible combinations of Latin letters and numbers are made. What can T4n3m0 or T2н0m0 mean, for example?

T means the size of the tumor, n (or n) is the prevalence in the lymph nodes, m is the presence of metastases. The lower the number (preferably 0), the less advanced the disease.

Oncology is under study. Recently, among scientists there have been more supporters of antipathogenic cancer therapy. Invasiveness (in Latin invasio) is an attack by viruses, protozoa, and bacteria. Invasive (sometimes called "infiltration") cancer that originates from a duct or lobule. It is sometimes called "adenocarcinoma."

In a short time, the tumor leaves the breast duct and begins to metastasize to the liver, lungs, and brain. The prognosis when detected at the initial stage is more favorable. Invasive - of a nonspecific type, the origin of which is difficult to identify.

Species

Invasive unspecified breast cancer has a variety:

• Paget's cancer - affects the nipple and ariola of the breast, symptoms resemble eczema (an allergic disease).
• Erts - tumors occur in premenopause and postmenopause - hormone-dependent, in 65% of cases they have estrogen receptors.
• Medullary breast cancer - characterized by large formations, has low invasiveness - according to statistics, 8% of cases.
• Inflammatory breast cancer - similar to mastitis - according to statistics, 8% of cases. Symptoms: Swelling or redness that affects a third or more of the breasts. The skin may have ridges or pits appear, and the skin color is orange.

These symptoms develop because cancer cells block lymphatic vessels in the skin, preventing the normal flow of lymph through the inflammatory tissue of breast cancer (BC), which progresses rapidly. When diagnosing stage III (tumor spreads to nearby lymph nodes), stage IV (tumor spreads to parts of the body).

Invasive ductal breast cancer, according to statistics in 70% of cases, occurs in the milk ducts mainly in older women. Depending on the composition of cells, it is divided into different types. The degree of cell classification is very important. Poorly identified by touch.

As the disease spreads, the shape or areola changes, and discharge from the nipple varies in consistency and color. Cancer cells start from the milk duct, break through the walls, and invade the breast tissue. It may be localized, close to where the tumor started.

If cancer cells spread throughout the body, the pathological process in this case develops quickly and metastasizes. Invasive begins in the ducts of the breast or glands, grows in the breast tissue. It can then spread to nearby lymph nodes and beyond. Lobular, ductal and Paget's cancers have an unfavorable prognosis. Treatment depends on the stage and extent of the lesion.

Reasons

Menopausal women and older women are at high risk of the disease. Women who are obese, have lumps in the breast, women with a late first pregnancy (after 35 years of age) and women who have not had children are at high risk.

The main causes of breast cancer:

• mastopathy;
• fibroadenomas;
• abortion;
• cessation of lactation.

Symptoms

Invasive breast cancer may not have any symptoms, especially in the early stages. As the tumor grows, you may notice the following symptoms:

• A thickening in or near the breast or armpit area that continues after your monthly menstrual cycle.
• A mass or small lump the size of a pea.
• Changes in the shape, size, or contour of the breast.
• Blood or clear fluid from the nipples.
• Change in skin color on the breast or nipple.
• The skin on the breast and nipple is dimpled, wrinkled, scaly, or inflamed.
• Changing the shape or position of the nipple.
• Lump in the chest area.
• Pain between the shoulder blades.
• Breast asymmetry.
• Itching, redness, dying skin.
• Hardened areas under the skin.

You may notice changes if you do a monthly checkup. If you suddenly find signs of cancer, immediately see a doctor. He can be treated well if doctors come to the rescue in time.

Degree

After surgery, the stage and extent of the tumor is determined. It depends on how different cancer cells are from normal cells when viewed under a microscope. The higher the degree of difference, the more aggressive the disease behaves. To determine this, classification G (from the word Gleason) is used.

Gleason classification.

The doctor also checks the sample for estrogen and progesterone receptors. This test shows how female hormones - estrogen and progesterone - affect malignant cells. If the test is positive, this means that hormones cause the growth of cancer cells.

In these cases, treatments are used that suppress and block hormones that cause cancer cells to grow. The cancer will also be tested for a gene called HER2. The dominant oncogene that gives the command to grow. If one is found, additional drugs such as trastuzumab (Herceptin) can be used. If it spreads to other parts of the body, additional tests are performed.

Stage

The TNM system is used to determine the stage of cancer:

Stage I – small tumor.

Stage II - neoplasm 2 - 5 centimeters with or (without) metastases to the lymph nodes.

Stage III is a large tumor with metastases to the lymph nodes, which may have spread to the chest wall.

Stage IV is a tumor that has spread to other organs in the body (metastasis).

Diagnostics

Diagnosis begins with an independent examination, which is carried out in a lying position, standing with a raised hand behind the head, in a tilted position. The surface of the entire palm must be palpated (palpated) for the presence of swelling or lumps in the chest and under the arms. If a change in the color and structure of the skin of the breast or nipples is detected, the nipple is pulled inward or asymmetry appears, this is a reason to do a mammogram.

Basic diagnostic methods:

• Mammography – detects cancer at any stage.
• Blood test for cancer markers.
• Ultrasound – determines the location and size.
• MRI – establishes the characteristics of the tumor.
• Ductography – reveals a tumor measuring 5 mm.
• Biopsy – allows you to take material for laboratory testing to determine the stage and type of tumor.

Invasive breast cancer is life-threatening, but it can be stopped.

Biomarkers

At first, scientists thought there was only one type of breast cancer. Now they know that this is not true. There are different subtypes of breast cancer, and a pathologist determines which subtype a patient has by looking for specific molecular markers and cancer cells. Markers are divided into three categories:

• Those that are used to help determine the prognosis of a particular cancer and how life-threatening they pose.
• Those that are used to predict how a cancer will respond to a certain treatment.
• Those that do both studies.

By classifying a patient's tumor with a molecular marker, the pathologist provides the patient and physician with information that will be used to determine the best treatment options.

Treatment

Invasive breast cancer uses the following treatment methods:

1. A lumpectomy is a surgical procedure in which the surgeon removes the tumor and a small area of ​​healthy tissue around it.
2. A mastectomy, a procedure in which the entire breast is removed, may be performed after chemotherapy.
3. – This drug treatment can be done before surgery to reduce the swelling. Sometimes done after surgery to try to stop the cancer.
4. Radiation therapy is very often given after chemotherapy and surgery to prevent cancer from returning.
5. Hormone therapy is carried out if tumor cells have hormone receptors.
6. Targeted therapy is a drug treatment carried out if cancer cells have the HER2 gene.

During treatment, the doctor uses one or a combination of therapies to achieve a favorable result. The specific procedures and treatment order depend largely on the stage and characteristics of the tumor. The following factors influence the treatment of the disease:

• Laboratory test results for cancer cells.
• General health.
• Location of the tumor.
• Stage and grade of cancer.
• Age.
• Reproductive age or menopause.
• Heredity.
• Test results for gene mutation.

Prevention

No one is immune from cancer, but there are things that can increase your chances of living. Basic preventive measures:

• self-examination – once a month;
• medical examination – once a year;
• limit the use of contraceptives;
• do not stop breast lactation;
• control body weight;
• prevention of diabetes mellitus;
• eliminate alcohol and nicotine;
• active lifestyle.

Taking preventative measures is much easier than spending money on long-term treatment.

Informative video

Content

Breast cancer is considered one of the most common malignant processes. Invasive breast tumors can affect people of different age groups and genders. The disease quickly spreads to nearby tissues and organs, for this reason it is very important to diagnose a breast tumor at an early stage.

Invasive breast carcinoma manifests itself quite aggressively. In a short time, the neoplasm extends beyond the lobule or duct of the breast and begins to metastasize to the lungs, liver, and brain. Invasive cancer can proceed similarly to other malignant processes in stage 4. Advanced forms of pathology are difficult to treat. The prognosis for early detection is generally favorable.

Ductal carcinoma

This type of breast cancer in women is considered the most common. Infiltrative breast cancer of this type begins in the milk ducts and has a large number of variations in structural organization. Diagnosis of ductal cancer is complicated by the fact that the pathology does not manifest itself with any symptoms for a long time. Often, the compaction is detected when the process has already moved to the isola. In this case, deformation of the shape of the nipple and areola may be observed. The species classification of invasive ductal breast cancer includes:

1. Well-differentiated carcinoma - characterized by a high similarity of tumor cells to normal ones.
2. An intermediate degree of differentiation of neoplasms involves the formation of various structures by cancer cells and the presence of intraductal necrosis.
3. Poorly differentiated carcinoma - atypical cells completely line the surface of the duct mucosa. In this case, calcifications and necrotic masses are detected.

Pre-invasive ductal

Breast cancer in women (in this form) spreads to the external areas and does not extend beyond the milk duct. Preinvasive ductal carcinoma represents the initial stage of disease development. In the absence of adequate therapy, the tumor process can malignize and become invasive. However, in most cases, treatment gives good results, which has a positive effect on the course of the disease.

Invasive lobular

In most cases of this form of cancer, the tumor is located in the upper outer part of the breast. On palpation, small compactions with uneven contours are detected. A characteristic feature of invasive lobular breast cancer is the presence of chains of 4-5 cells. Usually the capsule in this form of oncology is well developed, the presence of trabeculae in the form of strands is noted.

Unspecified cancer

Such a neoplasm is difficult to recognize during morphological examination. Invasive breast cancer with an unspecified pathogenesis has a poor prognosis. To determine the form of oncology, an immunohistochemical study is performed, which determines the lobular or ductal nature of the lesion. The main types of unspecified cancer are:

1. Medullary – has a weak invasive ability, the tumor can reach large sizes.
2. Inflammatory - the clinic of this type completely duplicates mastitis, which complicates the early diagnosis of the oncological process.
3. Paget's breast cancer affects the nipples and areolas.

Causes of breast cancer

Breast adenocarcinoma can develop in anyone, regardless of gender or age. However, women constitute the main risk group for breast cancer. The anatomical features of the mammary gland make the fair sex susceptible to the formation of neoplasms. Provoking factors for the development of glandular cancer in women are:

• absence of pregnancy;
• late onset of menstruation;
• pregnancy after 30 years;
• improperly adjusted lactation;
• heredity;
• long-term hormone therapy;
• chest injuries;
• postmenopause.

Diagnosis of breast diseases

Adenocarcinoma is one of the types of cancer lesions that can be detected by the patient himself. Recently, experts have been paying special attention to teaching women a simple self-examination technique, which makes it possible to diagnose breast cancer at an early stage, when the likelihood of negative consequences is low. You can learn about the scheme for conducting such an inspection from numerous photos and videos available to the general public. The main diagnostic measures used to detect invasive cancer are:

1. mammography;
2. blood test for cancer markers;
3. biopsy;
4. ductography.

Treatment of breast cancer

Therapy for cancer of any location comes down to complex measures to remove atypical cells from the body. Treatment begins with diagnosis of the disease, without which it is impossible to determine the size of the formation, differentiate the tumor and the causes of its occurrence. When choosing one of the treatment methods, the following are taken into account: the patient’s age, a history of severe pathologies, and general health. Along with this, specialists are obliged to listen to the wishes of the patient himself, who for some reason does not want to undergo any course of treatment.

This type of therapy is used for large tumors. Chemotherapy is used in the postoperative period to prevent metastasis and possible recurrence of the tumor. However, this method can also be used to reduce the size of a tumor before surgery. Chemotherapy is carried out in 4-7 cycles. The advantage of this method can be considered a complex effect on the body. Special preparations destroy “buried” atypical cells that cannot be cured by other methods. During the course of chemotherapy the following are used:

1. alkylating agents;
2. antibiotics;
3. antimetabolites;
4. taxanes (interfering with the process of pathogen division).

Surgical treatment of malignant tumors

Early stage invasive cancer can be successfully treated with surgery. Recently, with this kind of intervention, the method of oncological radicalism has prevailed. This approach is accompanied by significant functional damage to the patient. It is worth saying that today new methods of surgical treatment of cancer with immediate reconstruction of the lost organ are being developed. The duration of rehabilitation depends on the volume of intervention performed.

Radiation therapy course

This method is based on the use of ionizing radiation. It is important to say that not all diagnoses of the oncological spectrum are amenable to radiation therapy. The procedure is carried out using iridium, cobalt, cesium. Radiation therapy is prescribed if the doctor has sufficient grounds for it. Treatment of this type has a lot of contraindications and side effects. Radiation therapy can reduce mortality from breast cancer or extend survival in hopeless cases to 5-10 years.

Hormone therapy

ERC-positive hormone-dependent tumors often appear in postmenopausal women. Most neoplasms have estrogen receptors. ERC-negative cancer affects the fair sex during perimenopause. If adenocarcinoma of the mammary gland is suspected, an immunohistochemical study is prescribed, during which the hormonal status of the tumor is determined. If it is positive, the following types of therapy are used:

1. Adjuvant – carried out to prevent relapses.
2. Neoadjuvant – used to reduce the size of large tumors before surgery.
3. Therapeutic – aimed at eliminating the tumor.

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Eighty percent of women whose breast cancer is not diagnosed at an early stage are diagnosed with invasive carcinoma. This means that cells resulting from a mutation during the division of normal cells try to spread beyond the structure in which they originated and grow into fatty and ligamentous tissue. This type of cancer pathology progresses quite quickly, entering the lymphatic system and spreading through the bloodstream to the internal organs. This is what invasive breast cancer of a nonspecific type is.

Unlike the form under consideration, there is also a non-invasive type of carcinoma. This is a cancer whose cells grow inside the structure where they originated, do not penetrate other tissues, and metastases occur much later. When metastases have already appeared, this carcinoma is called metastatic.

Causes of Invasive Carcinoma

The disease occurs in people with a history of the following diseases and conditions:

• If the first pregnancy ended in abortion

When pregnancy begins to develop, significant changes occur not only in the woman’s genitals, but also in her mammary glands - in preparation for subsequent feeding. A sharp artificial interruption of these processes, which occurs during an abortion, creates the precondition for the formation of invasive cancer.

• Mastopathy

Foci of connective tissue (fibrosis) and small cavities filled with clear fluid (cysts) occur due to hormonal imbalance. They, representing clusters of altered cells, are an excellent substrate for the formation of atypical, cancerous tissue here.

• Lack of breastfeeding

In women who refuse to breastfeed for various reasons, lumps develop in the breast (they cannot always be felt during self-examination), which can develop into invasive cancer.

• Fibroadenoma

This reason is similar to mastopathy. Only in this case can it develop from dense nodules of connective tissue that appear in the chest due to hormonal imbalance. You can prevent malignancy if you start treatment in time so that it does not begin to enlarge and transform.

What increases your chances of developing invasive cancer?

These are the following factors:

• the presence of this disease in close relatives;
• lack of regularity of sexual activity;
• prolonged lack of sexual life;
• chronic pathologies of the female reproductive organs, especially those that lead to partial or complete infertility.

Types of disease

There are three types of pathology.

1. Invasive ductal breast cancer (ductal carcinoma)

Here the first mutated cells appear in one of those ducts through which, under physiological conditions, during lactation, milk, formed in the special glandular structures of the breast, flows to the nipple. This is the most common and most dangerous type of mammary carcinoma. Its cells are able to quickly enter the systemic bloodstream or local lymph flow. Most often it is found in patients over 55 years of age.

Progressing, the cells of this tumor spread to the isola, deforming its appearance, and also causing the appearance of various pathological discharge from the nipple.

Invasive ductal malignant tumor can have varying degrees of differentiation:

• high, when cancer cells still have nuclei and their structure is identical (such tissue is the least malignant);
• intermediate, resembling in structure and “abilities” non-invasive low-grade cancer;
• low: cells that differ in structure from each other spread quite quickly over the surface of the duct and penetrate into neighboring structures.

2. Preinvasive ductal breast cancer

It develops from the cells of the milk ducts, but still (temporarily) does not have a tendency to spread to other, neighboring tissues. If you do not visit a planned one while the disease is at this stage, the likelihood of it transitioning to the previous type is extremely high.

3. Invasive lobular breast cancer

Its development is provided by the cells that form the lobules of the gland. From here it is “convenient” for it to spread to neighboring tissues. In the structure of invasive breast cancers, it occupies only 10-15%. Such a tumor can be multiple, in the form of several nodes. It can lead to bilateral damage. This formation is the most difficult to diagnose, since it is not manifested by the appearance of “bumps” or discharge from the nipples.

Unspecified form

In addition to ductal and lobular, there is also invasive unspecified mammary cancer. The term means that when a biopsy is taken and the material is subsequently examined under a microscope, the doctor who microscopes the material cannot say, even on the basis of special laboratory tests, whether it is ductal or lobular carcinoma.

Unspecified cancer may have the following structure:

• Medullary type. It is the least invasive of all, that is, it penetrates into neighboring tissues not so quickly, but grows quite quickly within its own structure, forming a voluminous tumor. Registered with a frequency of up to 10%.
• Infiltrating ductal tumor. This carcinoma quickly grows into nearby structures and metastasizes. It accounts for 70% of malignant breast tumors.
• Inflammatory carcinoma. Its manifestations are identical: a compaction appears in the gland, over which the integumentary tissue turns red. The frequency of this type is up to 10%.
• . The formation affects the nipple-areolar mass. It looks like the area has developed eczema (chronic inflammation with itching, weeping, blistering).

60-70% of all these tumors, regardless of their structure, have estrogen receptors, that is, hormonal therapy can be used against them. Cancer usually does not have such receptors when the tumor formed in premenopause.

The prognosis for invasive breast cancer is most favorable in the case of the medullary type of tumor. Paget's cancer, ductal and lobular carcinomas are much worse.

Symptoms

Invasive breast cancer manifests itself in different ways. Its symptoms depend on the stage of the disease. So, until the carcinoma cells have spread beyond a certain structure, some women do not feel anything, while some complain of pain and discomfort that arise only when palpating the mammary glands.

• change in the contour of the gland;
• discharge from the nipples is bloody or light;
• pain or burning in the nipples;
• “bump” or compaction without perceptible boundaries, which does not change size and shape during the menstrual cycle;
• the skin of the mammary gland in some area may become red, flaky, pale or just wrinkled.

Stage classification of invasive cancer

To determine the stage, we focus on the following parameters:

1. Dimensions of carcinoma.
2. Damage to regional lymph nodes (these are axillary, sub- and supraclavicular lymph nodes).
3. The presence of metastases to internal organs (lungs, brain, liver) and bones.

Stage 1 invasive breast carcinoma– this is a non-metastasized neoplasm with a diameter of up to 2 cm, which does not penetrate nearby structures.

Invasive ductal breast cancer stage 2 (grade) characterized by the following parameters:

• the neoplasm has a diameter of 2-5 cm;
• cancer cells are “collected” in one or more lymph nodes in the axillary fossa on the same side, while they have not fused with each other or with nearby tissues;
• There is no metastasis to bones or abdominal organs.

Invasive unspecified breast cancer stage 3 (grade)– does not have the clear properties of a lobular or ductal neoplasm, in which the lymph nodes are “glued” together and with adjacent tissues, affected not only in the axillary fossae, but also further, but there are no distant metastases.

Invasive cancer stage 4 (grades)– this is carcinoma of more than 5%, affected lymph nodes and metastases in distant organs.

Diagnostics

The presence of a tumor can be suspected by ultrasound scanning of the mammary glands or X-ray mammography. These are screening studies that should be carried out regularly, once a year, after 20 years.

If ultrasound or X-ray mammography confirms the presence of a tumor, a more targeted and accurate study is needed. It includes:

• MRI of the mammary glands.
• Ductography is an x-ray of the glands, performed after filling the ducts with a contrast agent for X-rays.
• Positron emission tomography.

An accurate diagnosis that this is invasive cancer is made after studying cells obtained from the tumor by puncture. If there is discharge from the nipple, this is also examined.

Immunohistochemical tests are performed on the resulting cells to determine their sensitivity to female sex hormones (this will allow selection).

To establish the stage of oncological pathology (for example, to say that there is invasive unspecified breast cancer of the 2nd degree), a tomographic examination of regional lymph nodes, liver, bones, and lungs is performed. If tumor-like foci are found there, they also require histological examination, which involves a biopsy.

To predict how quickly the tumor will grow and whether it will penetrate other structures (this will help determine treatment), the Gleason classification is used. It is based on examination under a microscope of an area of ​​malignant growth taken during a biopsy. There, undifferentiated chains of cells are counted. As a result, they get a figure that is assigned to one of three categories:

1. G1 (G for Gleason). The cancer is highly differentiated.
2. G2. The cancer is moderately differentiated.
3. G3. The carcinoma is poorly differentiated. If the cancer is ductal rather than lobular, it has the greatest ability to invade structures other than its own.
4. G4. The cancer is undifferentiated, extremely malignant.
5. Gx. The study does not make it possible to establish the degree of differentiation.

The lower the degree of differentiation, the more difficult it is to cope with the cancer, the more combinations may have to be tried in order to be cured.

How to treat this disease

To treat invasive breast cancer, an oncologist can use local (tumor removal and radiation therapy) or systemic (biological or hormonal therapy) methods. Either one method of treatment or a combination of methods can be used. The choice of therapy is based on:

• localization of the tumor;
• tumor size;
• sensitivity of tumor tissue to estrogen;
• stage of cancer;

The informed choice of the patient is also taken into account.

The usual treatment regimen is as follows:

• first, hormone therapy is carried out to reduce the volume of the tumor and its adhesion to neighboring structures;
• the tumor is then surgically removed. To do this, a mastectomy (removal of the entire gland) or lumpectomy (removal of the tumor, healthy tissue around the perimeter and axillary lymph nodes) is performed;
• Afterwards chemotherapy and to prevent tumor recurrence are carried out.

What is the prognosis for invasive carcinoma?

The prognosis for invasive ductal breast cancer is based on several parameters:

• Depending on the stage at which the process is detected, after which treatment is started:

— if carcinoma was diagnosed at stage 1, the treatment started ensures a 90% recovery;
— detected at stage 2, survival rate is 66%;
- if the diagnosis was established only when the disease moved to stage 3, after which treatment was started, the survival rate does not exceed 41%;
- at stage 4, 5-year survival is recorded in less than 10% of people.

• Localization of carcinoma within the gland tissue. It is most favorable if it is located on the outside, least favorable if the formation is localized in the center or in internal structures. This is due to the rate of metastasis.
• Tumor diameter:

- if it is up to 2 cm, the probability of surviving another 5 years is 93%;
- 2-5 cm in diameter reduces survival rate to 50-70%.

• The more differentiated the tumor, the better the prognosis.
• The presence of estrogen and progesterone receptors in carcinoma further increases survival.
• The presence of several cancer foci, as well as lymphatic edema of the breast and arms on its side, reduce survival.

Infiltrative (invasive) breast cancer includes tumors that grow beyond the duct or lobule in which they formed. Accordingly, invasive breast cancer can be ductal or lobular.

Features of ductal infiltrative breast cancer

This type of malignant breast tumor is the most common. It is diagnosed in 80% of cases. When examining biopsy material obtained from the tissues of such a tumor under a microscope, specialists most often do not identify any specific features of cancer cells. In this case, we talk about invasive breast cancer without signs of specificity (NST - No Special Type). In the description of such neoplasms you can also find the abbreviation NOS (not otherwise specified).

Initially, the cancer focus is localized in the epithelial tissue lining one of the ducts through which human milk flows to the nipple during lactation. Until the carcinoma grows into other tissues, i.e. no infiltration occurs, it is not an invasive cancer and is classified as in situ (“in situ”). Unfortunately, in most cases, such “stationary” tumors transform into invasive ones after 5-10 years.

Ductal infiltrative cancer grows quickly, begins to metastasize early, and is prone to relapse. At the same time, competent comprehensive treatment makes it possible to put the vast majority of women with this diagnosis into stable remission.

Features of lobular invasive breast cancer

Lobular carcinomas in situ grow and develop more slowly than ductal carcinomas, some of them may never develop into an infiltrative form.

Therefore, when such a neoplasm is detected in some situations, oncologists adhere to the so-called “active surveillance tactics.” However, its presence is a prognostically unfavorable sign, so the patient can independently make a choice in favor of breast removal.

If, during histological examination, receptors for sex hormones or special proteins are detected in the cells of a “fixed” lobular tumor, the patient may be prescribed courses of anastrozole, tamoxifen and other drugs, the action of which leads to disruption of the vital processes of cancer cells or to inhibition of their growth, reproduction and migration into surrounding tissues. In some cases, this treatment is enough to stabilize a woman’s condition for a long time.

Invasive lobular cancer is rare and accounts for 3 to 10% of all reported cases. Such a lesion is not always determined in the form of a solid node: sometimes there is an enlargement of part of the mammary gland without local compactions.

Lobular infiltrative cancer has other differences from ductal cancer. For example, tumors often appear simultaneously not in one, but in several lobules, and in approximately 20% of women, tumors are found in both mammary glands.

Treatment

Treatment for infiltrative breast cancer is always complex. Depending on the histological type of tumor and the stage of the process, it may include:

• Partial or complete removal of the organ, in case of bilateral damage - both glands. As a rule, the axillary lymph nodes on the affected side are removed along with the mammary gland.

• Chemotherapy – neoadjuvant (before surgery) and/or adjuvant (after surgery). In the first case, chemotherapy is aimed at reducing the size of the lesion and inhibiting the vital activity of tumor cells, which facilitates the surgeon’s tasks and improves the prognosis. Adjuvant chemotherapy is used to prevent metastasis and consolidate the results of surgery.
• Radiation treatment, which is usually prescribed in the postoperative period. Modern radiotherapy systems allow radiologists to achieve maximum effect with minimal risk of complications. After total removal of the mammary gland, the chest wall is usually irradiated, as well as the locations of groups of lymph nodes - axillary, supra- and subclavian, parasternal areas. The duration and intensity of radiotherapy is determined on an individual basis.
• Hormone therapy - if the analysis of biopsy material reveals the hormone-dependent nature of the neoplasms.
• Targeted therapy. This method may be highly effective in the treatment of HER2-positive invasive cancer.

At the end of the 20th century, after deciphering the human genome, a paradigm of personalized evidence-based medicine arose, which is aimed at developing individual approaches to therapy taking into account the genetic basis of the disease and based on large-scale multicenter studies.

In 2018, at the meeting of the American Society of Clinical Oncology, results from TAILORx, the largest breast cancer study, were presented, which showed that adjuvant chemotherapy is not justified in average-risk women (RS 11-25 oncotype DX®) with HR+ breast cancer. HER2-, without spread to lymph nodes.

After 9 years of follow-up of 10,000 patients, it was found that postoperative monohormonal therapy and combined hormonal/chemotherapy had similar disease-free and overall survival results (83.3%/84.3% and 93.9%/93.8%, respectively).

“Thanks to the results of this groundbreaking study, we can now safely avoid chemotherapy in approximately 70% of patients diagnosed with the most common form of breast cancer,” said K. Albain, MD, co-author of the study. “For many women and their doctors, the times of uncertainty are over.”

Reconstructive surgery after total organ removal for invasive breast cancer

One of the serious psychological problems that women face after breast removal is the feeling of loss of physical attractiveness. This problem can be solved with breast reconstruction using:

• tissue of the patient’s abdomen or back;
• implants;
• combinations of implants and body tissues.

Whatever method is chosen, after restoration the breasts have a smooth shape. Therefore, the plastic surgeon also reconstructs the nipple. The use of modern implants makes it possible to create a dummy organ that does not require replacement for a long time and does not lose its shape and elasticity.