Breast tumors– neoplasms, which are accumulations of abnormal tissue. There are two types of tumors – benign and malignant.

Female benign breast tumors

Benign tumors usually grow slowly and do not invade other tissues. They respond well to therapy, and relapses are usually observed only if treatment is not started in a timely manner. Such tumors include cysts, fibroadenomas, papillomas, lipomas, etc.

Fibrocystic changes

In some women, fluctuations in hormones during menstrual cycles can lead to fibrocystic changes (dyshormonal dysplasia) in the area mammary glands. Dysplasias are characterized by disruption of the connective tissue and epithelial components. They usually occur in women over 40 years of age and regress in the postmenopausal period (due to the lack of hormonal fluctuations). Pathology can lead to the formation of cysts (capsules with liquid contents that are localized in the milk ducts) and other benign neoplasms.

Fibroadenomas

Lipomas

Lipoma (wen) is a connective tissue tumor that can arise both in the area of ​​the mammary glands and in other places. It has a soft consistency, is easily movable and painless. Treatment is usually not required unless painful growths develop.

Male benign breast tumors

TO benign neoplasms The mammary gland in males includes gynecomastia - a rubber-like or dense seal caused by hypertrophy of glandular and fatty tissues.

Malignant breast tumors in women

Breast cancer is a malignant tumor that forms in glandular tissue breasts This is the most common type of cancer among females. It is a multifactorial disease, the development of which is associated with modification of the cell genome under the influence of external factors and hormones. Used for the treatment of malignant tumors different methods, including surgical intervention, radiation therapy(radiotherapy), chemotherapy, immunotherapy and targeted therapy.

Forms of breast cancer in women

The forms of this cancer include, in particular:

• Invasive cancer. It begins in the lobules of the mammary glands or milk ducts and spreads to other tissues. The most common type of invasive breast cancer is invasive ductal carcinoma (about 80% of cases). Invasive focal (lobular) carcinoma is observed less frequently (10%).
• Inflammatory cancer. This is a rare and aggressive form of pathology, characterized by redness, swelling, itching and other severe symptoms. It has a high spreading speed.
• HER2 positive cancer. Approximately 20% of breast cancers are HER2 positive. This means that cancer cells contain large number a protein called HER2, which stimulates tumor growth and spread. HER2-positive cancer also has a significant risk of recurrence.
• Cancer in situ. The disease begins in the ducts or lobules of the mammary gland, without spreading to surrounding tissues. The frequency of regional metastasis does not exceed 2%.

Breast cancer in men

Malignant tumors of the mammary gland in males are a rare form of cancer (about 1% of the total number of patients suffering from this disease). Breast cancer is most common among older males, but can affect any age category. Types of breast cancer in men include:

• Ductal carcinoma. Tumor formations are localized in the milk ducts. Almost all cases of the disease are ductal carcinomas.
• Lobular carcinoma. The lesion begins with the lobules of the mammary gland. This type of pathology is rarely found in men because they have a small number of such lobules.
• Paget's disease. Rarely male forms Cancers begin in the milk ducts and spread to the nipples, causing ulcerations and eczematous changes.

Diagnosis of breast tumors

To diagnose benign/malignant breast tumors, the following methods are used:

• clinical examination, palpation of the mammary gland;
• mammography;
• ductography (examination of the milk ducts with the injection of a contrast agent);
• biopsy with cytological examination of the material;
• determination of tumor markers.

Surgical pathology
Anatomy	Anal canal Appendix Gallbladder Uterus Mammary glands Rectum Testicles Ovaries
Diseases	Appendicitis Crohn's disease Varicocele Intraductal papilloma Ingrown nail Rectal prolapse Gynecomastia Overactive bladder Hyperhidrosis Hernia Hernia of the linea alba Dyshormonal dysplasia of the mammary glands Gallstone disease Diseases of the spleen Lipoma Uterine fibroids Urinary incontinence in women Breast tumors

A malignant tumor that occurs when normal breast cells undergo cancerous degeneration; In everyday life it is also called breast cancer.

Many women fear it more than any other disease. And in fact, today it is indeed the most common type of cancer in women. According to the American Cancer Society, 1.3 million new cases of breast cancer are diagnosed every year worldwide. However, over the past decade, mortality from breast cancer has decreased as the quality of medical care, which in turn led to more early diagnosis disease at those stages when it can be cured. Moreover, if previously the disease developed mainly in women over 50 years of age, now it has become noticeably “younger” - cases of the disease in forty, thirty and even twenty year olds are not uncommon.

Causes of breast cancer

The exact cause of breast cancer has not yet been established. However, scientists have identified a whole group of risk factors that are highly likely to trigger the disease.

The first is heredity. If there have been cases of breast cancer in the family (blood relatives - mother, grandmother, sister or aunt), the woman should take special care of herself. For more accurate identification genetic predisposition It is necessary to conduct a genetic study for mutation of the BRCA1 and BRCA2 genes. If such a mutation exists, then the likelihood of developing this disease increases. And you need to regularly visit the oncologist so as not to miss the early development of the disease and treat it in time.

The second risk factor is hormonal. It is affected by the absence of childbirth, lack of lactation and feeding of the child, the first pregnancy over the age of 30 years. In this case, the amount of milk does not matter. The very fact of absence of lactation is significant.

There are a number of other factors that increase the risk of this disease:

• too early onset of menstruation or late onset of menopause (after 50 years)
• early (before 16 years) or late (after 30 years) onset of sexual activity
• irregularity of sexual life and dissatisfaction with it
• mastitis or breast injury
• increased levels of female sex hormones estrogen
• termination of pregnancy
• previous history of ovarian cancer
• endocrinological diseases (for example, diseases thyroid gland) and metabolic disorders (including obesity)
• age over 35-40 years - according to statistics, cancer more often attacks women during and after menopause.

But we must understand that those who do not have any of the above factors can also get sick.

What happens with breast cancer?

The mutated cell begins to multiply rapidly, turning into a fast-growing cancerous tumor. Without treatment, it quickly increases in size and grows into the skin, muscles and/or chest wall. Through lymphatic vessels, cancer cells enter the nearest lymph nodes. With the bloodstream, they spread throughout the body, giving rise to the growth of new tumors - metastases.

Most often, breast cancer metastasizes to the lungs, liver, bones, and brain.

How to suspect?

Breast cancer, like all other cancers, should be detected as early as possible, while there is still a chance for a complete cure.

A woman who cares about her health should have an annual breast ultrasound and, after age 40, have a mammogram and visit a mammologist, even if nothing worries her.

Cancer is best treated at the earliest stage, when it is impossible to feel the tumor and it does not yet give any symptoms of general malaise.

Why doesn't self-examination work?

Just 5-10 years ago, women were told that breast cancer is a disease in which a woman is able to take care of herself and regularly examine her mammary glands herself.

The rules for such self-examination are quite simple.

In the first week after menstruation - precisely during this period! - you need to stand in front of the mirror, raise your hands, carefully examine your chest. Then put your hands down and look again. Then we feel the left mammary gland in a circle with our right hand, and with our left hand - right gland.

But as we have already said, self-examination is completely ineffective and cannot replace an annual visit to the doctor.

Symptoms that require attention

When should you go to a mammologist?

If the following symptoms appear:

• nodules or multiple nodules, lumps of any size that do not have clear boundaries in the mammary gland
• enlargement of one of the mammary glands, retraction of the skin, changes in skin density and the appearance of the so-called “lemon peel”
• change in nipple shape and position not associated with breastfeeding
• discharge from the nipple outside of lactation, including clear or bloody
• enlargement and pain of the lymph nodes located in the axillary region.

Remember that if changes are noticeable during self-examination, then we are no longer talking about early diagnosis - you should contact a mammologist or oncologist immediately! But treatment at an early stage is effective and recovery is quite possible.

Diagnostic methods

Mammography allows you to suspect something is wrong much earlier than self-examination. And, therefore, the chances of full recovery much more. Mammograms should be performed regularly on all women over 40 years of age. If the menstrual cycle remains intact, it is recommended to do the study on days 5-12.

X-ray mammography is enough exact method diagnostics, but, like most medical techniques, she's imperfect.

The doctor may order additional tests to determine accurate diagnosis and clarifying the stage of the disease. Possible ultrasound examination, magnetic resonance imaging with the introduction of a contrast agent.

Unfortunately, all these methods do not allow us to accurately determine the nature of the tumor or identify the malignancy or benignity of the process. This requires a biopsy.

A biopsy is usually performed on an outpatient basis (in a doctor's office) and involves removing a piece of the tumor and then examining it. Anesthesia is usually used to perform a biopsy. Before performing a biopsy, other research methods are usually prescribed (usually ultrasound and mammography). If the tumor is deep, the biopsy is performed under X-ray or ultrasound guidance.

Types of breast cancer

Breast cancer is most often adenocarcinoma - that is, cancer of the glandular tissue. Breast cancer can be: ductal, when the tumor begins to grow from inside the ducts of the mammary glands, and lobular (lobular, from the Latin lobula - lobule). These forms can be either infiltrative, that is, when the tumor grows into the tissue, or non-infiltrative, that is, when the tumor does not grow into the tissue, but grows into the lumen, for example, of a duct.

Papillary cancer - a tumor grows in the lumen of the breast duct.

Medullary cancer is a large, voluminous tumor that poorly penetrates into neighboring tissues and organs.

Inflammatory cancer - resembles inflammation of the mammary gland (mastitis), the skin of the mammary gland is inflamed, reddened, and there may be an increase in body temperature.

Infiltrating ductal carcinoma is the most common form breast cancer, the tumor grows in neighboring organs.

Paget's cancer (cancer of the nipple and areola of the breast) is a characteristic lesion of the nipple, reminiscent of allergic skin dermatitis.

Hormone-dependent breast tumors: they are characterized by the presence of estrogen receptors and are more common in postmenopausal women. It is very important to determine the hormone dependence of tumors for the correct selection of treatment. Hormone receptors on the surface of a cancer cell are like its ears or antennae, picking up signals in the form of hormone molecules. Estrogens, connecting with these receptors, seem to instruct tumor cells to grow and multiply.

One of important signs The malignancy of a tumor is its ability to grow into neighboring organs and tissues (invasiveness).

In invasive cancer, the tumor extends beyond the breast duct or lobule and grows into normal tissue. Invasiveness often determines treatment tactics, the scope of the upcoming operation, and the effectiveness of therapy. With invasive cancer, tumor metastasis occurs more often through the bloodstream and through lymphatic vessels to other areas of the body. Non-invasive cancer can be limited to the ducts of the mammary glands or lobules, without germinating, but reaching large sizes. Over time, non-invasive cancer can become invasive.

Classification of breast cancer.

• Stage 0 - the tumor does not extend beyond its appearance.
• Stage 1 - invasive cancer, tumor size up to 2 cm, lymph nodes are not affected.
• Stage 2 - stage of invasive breast cancer, the tumor size is from 2 to 5 cm or the lymph nodes in the armpit on the same side as the tumor are affected, they are not fused to each other and to the underlying tissues.
• Stage 3 A - breast tumor more than 5 cm or significant enlargement of lymph nodes that are fused to each other or to underlying tissues
• Stage 3 B - The tumor can be of any size, but it has grown into the skin of the chest, chest wall, or internal chest lymph nodes. Inflammatory cancer belongs to this stage.
• Stage 4 - Tumor has spread beyond the chest, into the axilla and internal mammary lymph nodes, supraclavicular lymph nodes, lungs, liver, bones or brain

There is also an international classification of malignant tumors TNM, based on the following parameters: tumor size, involvement of regional lymph nodes, presence or absence of metastases.

Breast cancer treatment

In recent years, there has been a breakthrough in oncology with new, life-saving cancer treatment techniques.

Treatment for breast cancer currently includes surgery, radiation therapy, hormonal (antiestrogen) therapy, chemotherapy, and immune-targeted therapy. None of these methods is universal and suitable for every patient; combination therapy is usually required. The choice of treatment method depends on many factors - the patient’s age, the presence or absence of menopause, the type of tumor, its stage, the presence or absence of hormonal receptors on the surface of cancer cells.

The treatment plan for breast cancer patients is developed by three specialists. This is a surgeon, chemotherapy and radiation therapy specialist.

Several types are used in the treatment of breast cancer surgical interventions:

• removal of the tumor and a minimum amount of normal tissue around it;
• partial (sectoral) resection of the breast, in which the tumor, part of the normal tissue around it, and the lining of the breast muscles located under the tumor are removed;
• total (simple) mastectomy, in which the entire breast is amputated;
• limited radical mastectomy When the breast, some of the axillary lymph nodes, and the superficial lining of the chest muscles are removed, sometimes the smaller of the two pectoral muscles is removed.

After removing the tumor during surgery, the doctor examines the removed area of ​​tissue or organ. All data obtained from tumor histology are important for treatment.

After surgery, a course of hormone therapy, chemotherapy and radiation therapy is usually prescribed. The duration of this course depends on the stage of the disease.

Chemotherapy - medicinal method treatment of malignant tumors using cytostatics (antitumor agents that have a damaging effect on cancer cells).

Radiation therapy – therapeutic effect on cancer cells with ionizing radiation. Clinics use ordinary x-rays very high energy or electron beams.

Hormone therapy- a method of treatment using hormonal and antihormonal drugs. After the tumor is removed, it is examined for hormone receptors. If these receptors are detected on the surface of cancer cells, there is a chance that hormonal therapy will be useful. And what larger number receptors, the better the result. If at the same time there is a large number of both estrogen and progesterone receptors, then the effectiveness of hormonal drugs increases further. If your cancer treatment plan includes multiple treatments, including surgery, chemotherapy, and radiation, hormonal therapy is usually given last.

In some cases, radiation and chemotherapy are given at the very beginning of treatment before surgical intervention, in order to reduce the tumor (with an initial size of more than two centimeters).

Targeted therapy comes from the English target - goal, target. Targeted therapy does not affect normal healthy cells, but only affects tumor cells, or rather certain parameters of cancer cells: proteins and enzymes produced by the tumor or newly formed blood vessels of the tumor. Most of these drugs act like antibodies, which are produced immune system. Therefore, targeted therapy is sometimes called immune targeted therapy.

After surgery to remove the mammary gland, it is possible to reconstructive surgery. In some cases, such an operation is possible immediately after tumor removal. In any case, you can discuss the possibility of such an operation with your doctor and plastic surgeon.

Cancer is a systemic disease, so relapse is possible. The tumor can reappear at the site of the removed gland due to metastases.

Breast cancer is very common in women and its incidence is constantly increasing. This is partly due to improved detection of the disease, but it should be noted that the disease itself has begun to occur more often (approximately 60-70 people per 100,000 women per year). The incidence of morbidity among patients of working age is increasing.

Statistics say that this disease is one of the most common reasons female mortality. Among the regions where there is a fairly high incidence are Moscow, St. Petersburg, the Chechen Republic and the Kaliningrad region.

It is worth noting the successes of healthcare in the fight against breast cancer. In addition to improving the detection of the disease, based on mass preventive studies using mammography, there is a decrease in mortality in the first 12 months after confirmation of the diagnosis. That is, the disease is now detected at more early stages, it is successfully treated, and the life expectancy of patients with this diagnosis increases.

Causes and conditions of development

The immediate cause disease-causing, has not been reliably established, however high probability Breast cancer is associated with mutations in certain genes that are inherited. That is, the risk of getting sick increases significantly if two close relatives have breast cancer, as well as ovarian cancer.

More often, pathology occurs in patients with the following concomitant conditions:

• irregularity, abnormal duration of the menstrual cycle, infertility, absence of childbirth, breastfeeding, onset of menstruation before the age of 12 years, at the age of over 60;
• inflammatory diseases of the uterus and ovaries;
• endometrial hyperplasia (for example);
• obesity, high blood pressure, atherosclerosis;
• liver disease and hypothyroidism;
• the patient has a brain tumor, sarcoma, lung cancer, larynx, leukemia, carcinoma of the adrenal cortex, intestines and other tumors associated with syndromes (for example, Bloom's disease).

To reduce the likelihood of illness, you should avoid some external factors, for example:

• influence of ionizing radiation;
• smoking;
• chemical carcinogens, preservatives;
• a high-calorie diet containing too much animal fat and fried foods.

The role of violation is high hormonal balance V female body. Diseases of the ovaries, adrenal glands, thyroid and hypothalamic-pituitary systems increase the possibility of breast cancer.

Finally, the role has been proven genetic disorders. They can be of two types:

• genetic mutation in genes that are responsible for cell growth and reproduction; when they change, cells begin to divide uncontrollably;
• induction of cell proliferation, that is, intensification of their division in the formed node.

Pathology is also registered in men; their ratio to sick women is 1:100. Their symptoms, diagnosis and treatment principles are the same as for female patients, adjusted for gender characteristics of hormonal levels and anatomical structure.

Preventive measures

Breast cancer prevention is essential healthy women, and in those who have a unilateral tumor, in order to prevent metastasis and spread to the second mammary gland.

Currently, according to foreign and recent domestic recommendations, bilateral breast cancer followed by prosthetics is indicated for the prevention of breast cancer in healthy women. Such an intervention reduces the likelihood of a tumor appearing almost to zero.

However, before surgery for preventive purposes It is recommended to consult a geneticist who will confirm the increased risk of getting the disease, given the presence of the mutated BRCA1 and BRCA2 genes in the woman.

Surgical removal may be offered to patients with certain precancerous signs:

• atypical ductal hyperplasia;
• atypical lobular hyperplasia;
• lobular carcinoma in situ (unspread).

When tissue is removed directly during the intervention, an emergency histological analysis is performed. If cancer cells are detected, the scope of intervention can be expanded depending on the characteristics of the resulting pathological changes.

The same tactics (deleting healthy gland for cancer of the second breast) is also indicated for unilateral lesions, if gene mutations are genetically confirmed or there are precancerous conditions.

It is believed that removal of the mammary glands for preventive purposes is indicated even if a woman’s risk of getting the disease is the same as the average population. However, in our country, mass mastectomy is viewed with caution as a means of preventing breast cancer.

Traditionally, three components of prevention are used to prevent breast cancer in Russia.

Primary prevention is carried out in healthy women and includes educating the population and promoting breastfeeding. It is necessary to explain the benefits of regular sexual relations with a regular partner and the timely birth of a child. A woman should avoid external risk factors - radiation, smoking, carcinogens. When planning a family with a person in whose family there have been repeated cases of this tumor in women, it is better to visit a geneticist.

Secondary prevention is aimed at diagnosing and eliminating diseases that can later cause a malignant tumor:

• endocrine disorders;
• diseases of the female reproductive system;
• liver diseases.

For secondary prevention, you should regularly undergo a medical examination with a therapist and gynecologist.

Tertiary prevention is aimed at timely detection of recurrent development and metastasis of a tumor in a woman who has already undergone treatment about this disease.

Classification

Stages of breast cancer

Depending on how the tumor grows, diffuse and nodular forms of the tumor, as well as atypical cancer (). The rate is characterized by a rapidly growing cancer (the total mass of tumor cells doubles in 3 months), a tumor with an average growth rate (the mass doubles within a year) and a slowly growing tumor (the tumor doubles in size within more than a year) .

The structure of the tumor is determined by its source, therefore, invasive ductal (growing from the ducts of the gland) and invasive lobular (growing from glandular cells) cancer and combinations of these forms are distinguished.

By cellular structure distinguish adenocarcinoma, squamous cell carcinoma and sarcoma. Malignancy also varies depending on the type of cells.

TNM classification

The classification of this malignant neoplasm is carried out according to the TNM system. According to this classification, the stages of breast cancer are characterized by a certain combination of the qualities of the tumor node itself (T), the involvement of lymph nodes (N) and the presence of metastases (M).

• Stage 0 disease

It is characterized by an extremely small volume of damage without the participation of neighboring tissues.

• Stage 1 disease

It does not metastasize to other organs, except for the possible entry of tumor cells into the lymph nodes of the axillary group on the corresponding side. The diameter of the node does not exceed 2 cm; penetration of its cells into the surrounding healthy tissue does not occur.

• Breast cancer stage 2 (stages)

Does not form metastases, with the exception of possible involvement of the axillary lymph nodes of the corresponding side. The main difference is the characteristics of the node. It can grow up to 5 cm and even penetrate the surrounding glandular tissue.

• Breast cancer stage 3 (stages)

It does not cause metastatic damage to distant organs, but can affect axillary lymph nodes. Other groups of regional lymph nodes lying under the scapula, under the collarbone and above it, near the sternum, may also be involved. In this case, the node can be of any diameter, there is germination into the chest wall, and the skin is affected. The third stage also includes inflammatory cancer - a disease in which thickening of the skin with dense edges without a clearly defined tumor area is noted on the mammary gland.

• Breast cancer stage 4 with metastases

Characterized by the spread of tumor cells to the following organs:

- lungs;
- axillary and supraclavicular lymph nodes on the opposite side;
- bones;
- walls pleural cavity, surrounding the lungs;
- peritoneum;
- brain;
- bone marrow;
- leather;
- adrenal glands;
- liver;
- ovaries.

The most common localization of distant lesions is bone tissue(for example, vertebrae), lungs, skin, and also liver.

External signs and symptoms

Types of breast cancer (more precisely, forms):

• nodal;
• diffuse;
• atypical.

The diffuse form includes tumors that affect the entire gland. Externally, diffuse cancer manifests itself:

• swelling and swelling of the gland;
• resembles in features;
• similar to erysipelas;
• causes compaction and reduction of the gland (armored form).

Atypical forms are rarely recorded; they have features of localization and/or origin:

• nipple damage;
• tumor arising from skin appendages;
• two-way education;
• a tumor growing from several centers at once.

Suspicion of breast cancer should appear when a small, dense, painless node forms in the breast. Pay attention to areas of wrinkling skin or nipple retraction. At the onset of the disease, enlarged axillary lymph nodes are often visible. With intraductal forms, discharge from the nipple appears - light, yellowish, sometimes mixed with blood.

The first signs of breast cancer at an early stage, listed above, as the disease progresses, are supplemented by redness of the skin, the formation of a “lemon peel” on it, an increase in tumor, deformation or the appearance of non-healing ulcers. In the axillary region there are conglomerates of immobile lymph nodes, and swelling of the arm develops due to stagnation of lymph in it.

Symptoms for individual types of breast cancer are characterized by their own characteristics.

• Edematous-infiltrative is accompanied by the formation of a large infiltrate - edematous compacted tissue. The gland enlarges significantly, turns red, swells, and the skin becomes marble coloring, a “lemon peel” appears.
• The mastitis-like form is manifested by enlargement and thickening of the gland. An infection occurs, causing tissue breakdown. The temperature rises.
• Erysipelas-like form with external inspection similar to inflammation caused by microflora (erysipelas): bright red lesions on the surface of the gland spreading to the surface of the chest, skin ulcers are often observed.
• Armored is an advanced stage of cancer, in which the gland shrinks, changes shape, and several nodules form in it.
• Paget's cancer is identified as a special variant that primarily damages the nipple and the area around it.

Do breasts hurt with breast cancer?

The pain caused by the tumor itself does not appear at an early stage of the disease. It is associated with swelling of the gland, compression of surrounding tissues, formation skin ulcers. In this case, it is constant, aching, and goes away for some time after taking conventional painkillers.

The pain can also be cyclical, repeating from month to month in women reproductive age. In this case, they are more associated with the existing precancerous disease - mastopathy and are caused by natural fluctuations in hormone levels. If you experience pain in the mammary gland of any nature, you should consult a doctor.

The earlier the disease is detected, the more effective the treatment will be. The prognosis for stage 1 breast cancer, which can be detected with timely diagnosis, is good. 5 years after confirmation of the diagnosis, survival rate is 98%, after 10 years – from 60 to 80%. This means that almost all women who were diagnosed with the disease at an early stage achieve remission of the disease. Of course, they have to monitor their health and regularly see a doctor.

The more advanced breast cancer is, the lower the survival rate. In stage 2 of the disease, the prognosis is satisfactory, 5-year survival rate is up to 80%, after 10 years - up to 60%. At stage 3, the prognosis is worse: 10-50% and up to 30%, respectively. Stage 4 breast cancer is fatal dangerous disease, survival rate for 5 years is only from 0 to 10%, 10-year - from 0 to 5%.

How quickly does breast cancer develop?

The process occurs in each patient at its own speed. Without treatment, the tumor can completely destroy the mammary gland and give distant metastases within a short time - up to a year. In other patients the course is slower. Therefore, at the first signs of trouble, it is necessary to contact a gynecologist or mammologist and undergo the necessary diagnostics.

Diagnostics

Early diagnosis was traditionally based on self-examination of the mammary glands: once a week, a woman carefully felt the glands in front of a mirror, paying attention to discharge from the nipples, skin unevenness, and enlarged lymph nodes. However, in modern guidelines the effectiveness of this technique is questionable. It is believed that a doctor should determine the disease at an early stage using an annual or ultrasound examination (ultrasound).

If a breast tumor is suspected, certain diagnostic interventions must be performed before starting any treatment.

Diagnosis of breast cancer includes the following steps:

• questioning the patient and her complete external examination;
• blood test;
• biochemical study, including liver parameters (bilirubin, transaminases, alkaline phosphatase);
• mammography on both sides, ultrasound of the glands themselves and surrounding areas, if necessary, clarifying diagnostics - magnetic resonance imaging (MRI) of the glands;
• digital chest radiography, if more accurate diagnosis is necessary - computed tomography(CT) or MRI of the chest;
• Ultrasound of the liver, uterus, ovaries; according to indications - CT/MRI of these areas with contrast;
• if the patient has a widespread process or metastases, she is prescribed a bone examination to identify tumor foci in them: scanning and radiography of areas of radiopharmaceutical accumulation. If the stage of cancer is proven T 0-2 N 0-1, such a study is carried out if there are complaints of bone pain and an increase in the level of alkaline phosphatase in the blood; even during the patient’s initial visit, the probability of having bone micrometastases is 60%;
• biopsy of the suspected tumor with examination of the resulting tissue; with the help of a biopsy taken before the start of any treatment, a pathological diagnosis is determined - the basis of therapy; a biopsy is not performed if a mastectomy is immediately planned - such a study will be performed during it;
• determination of receptors for estrogen and progesterone, as well as HER-2/neu and Ki67 - special proteins that can be considered as tumor markers for breast cancer;
• fine needle biopsy of a lymph node if there is a suspicion that the tumor has spread there;
• fine needle biopsy of a cyst if a tumor is suspected of developing there;
• assessment of ovarian activity by determining the appropriate hormones;
• examination by a geneticist to detect a BRCA1/2 gene mutation (breast cancer test) - when breast cancer is confirmed in two or more close relatives, in women under 35 years of age, as well as in case of primary multiple cancer.

To determine general condition of a woman’s health, she is prescribed the following tests and studies:

• verification of blood group and Rh factor;
• isolation of antibodies to Treponema pallidum (), to hepatitis C virus and human immunodeficiency, determination of hepatitis B virus antigen (HBsAg);
• coagulogram to determine blood clotting;
• urine test;
• electrocardiogram.

Breast cancer treatment

Treatment methods for the disease are varied. The number of their combinations exceeds 6000. The approach to each patient must be individual. A preoperative therapy plan is drawn up to reduce the volume of the tumor, surgical intervention is proposed, and postoperative measures are developed.

Breast cancer treatment methods:

• local (surgery, radiation);
• acting on the entire body (use of chemotherapeutic agents, hormones, immunotropic agents).

Treatment without surgery

It is carried out when the patient refuses more radical measures, her general serious condition, edematous-infiltrative form, but it will never be completely effective and can only temporarily improve the patient’s well-being. This therapy involves radiation.

Radical methods involve complete removal of the tumor and affected lymph nodes. Palliatives are designed to alleviate the patient’s condition. Symptomatic treatment relieves pain, reduces the severity of symptoms of intoxication. Folk recipes are ineffective for this disease.

Surgical intervention

Surgery for breast cancer is the basis of treatment.

The following operations can be performed:

• conventional radical mastectomy - the entire gland, pectoral muscle, lymph nodes under the collarbone, armpit, and under the scapula are removed;
• extended radical mastectomy – additionally, peri-sternal lymph nodes and thoracic vessels, through which metastasis can occur, are removed;
• superradical mastectomy – supraclavicular lymph nodes and tissue between the chest organs are additionally removed;
• modified radical mastectomy preserves pectoral muscles, has better cosmetic results, so it is considered a more gentle operation;
• mastectomy with removal of axillary lymph nodes of only the lower group - performed in the early phase of the disease with the tumor located in the outer parts of the gland in weakened elderly patients;
• simple mastectomy is a palliative operation that involves removing only the gland; such an operation to remove a tumor is carried out in advanced forms of the disease, decaying formation, severe concomitant diseases;
• radical - removal of only a segment of the gland for a small tumor at an early stage; the mammary gland is preserved; After the intervention, an increased risk of recurrence remains, so additional radiation is performed.

Surgical treatment for metastases to regional lymph nodes must be supplemented with other methods, otherwise there is a high risk of distant metastases and relapse of the disease. Radiation is used both before and after surgery to destroy the most active tumor cells. Methods for irradiating tissue directly during surgery have been developed, which makes it possible to reduce the dose and increase the effectiveness of such therapy.

Chemotherapy

Breast cancer is a tumor prone to metastasis, so almost all patients are prescribed antitumor drugs. The use of chemotherapy significantly reduces the likelihood of relapse and death in patients. Chemotherapy drugs can reduce the stage of the disease, allow you to abandon heavy operations or reduce their volume.

The best medications for treating breast cancer are:

• Cyclophosphamide;
• Fluorouracil;
• Methotrexate;
• Doxorubicin.

Especially in combination. Special schemes have been developed that make it possible to select in each case best option for the patient. Consecutive identical courses can be used (up to 10-12 courses of chemotherapy), and in other cases, after several courses, the drug regimen is changed.

Before chemotherapy, the tumor is tested for sensitivity to hormones. With low hormonal sensitivity, the use of polychemotherapy is recommended, since this is a factor in the unfavorable course of the disease.

Systemic therapy is sometimes not given to patients with an initial favorable prognosis - over 35 years of age, with a small tumor, sensitive to hormones and without lymph node involvement.

One of the most common oncological diseases V modern world is breast cancer. In terms of the total number of cases among the entire population (men and women), this type of cancer pathology ranks second after lung cancer, and in women breast cancer is the most common malignant neoplasm. However, does breast cancer always mean a death sentence? Of course not, since modern medicine has developed a lot effective ways treatment of this disease. However, here a lot depends on the woman herself. After all, the ability to recognize the symptoms of an illness in time will make it easier for doctors to heal the patient.

Breast cancer has been known since ancient civilizations. For example, a disease that has a typical set of signs of breast cancer is described in ancient Egyptian papyri. In that era, the disease was considered incurable and leading to rapid death. However, in earlier times this disease was most likely rare. Currently, there is a rapid increase in the number of cases. Statistics say that in developed countries, approximately every tenth woman faces breast cancer. Every year in Russia alone, malignant tumors in this organ are detected in 50 thousand women. And worldwide this number exceeds a million. And the survival statistics are also disappointing so far. Almost half of the cases in women are fatal.

Description of the disease

The mammary gland is paired organ, which is a distinctive feature of the class of mammals, to which humans also belong. The ability to feed their offspring with milk containing easily digestible nutrients has given mammals a huge competitive advantage before other branches of the animal kingdom. However, you have to pay for everything. The mammary glands are also complex organs, whose work depends on the influence of sex hormones. The slightest deviations in the biochemical processes occurring in the body affect the mammary gland.

This organ consists of many alveoli collected into lobes, in which milk is produced. Through special ducts, milk flows to the nipple, where it is released during lactation. There is also a lot of fatty and connective tissue in the chest, and there are blood and lymphatic vessels.

Women know very well that their breasts are susceptible to various diseases– mastitis and mastopathy. Not uncommon benign tumors mammary glands, for example, adenomas. Under certain circumstances, they can degenerate into malignant ones. However, breast cancer can appear on its own, without connection with other diseases. A tumor, in fact, is a conglomerate of overgrown glandular cells, constantly growing and spreading its pathogenic influence to other organs.

It should be noted that mammary glands are by no means a female privilege, unlike other female genital organs. Hidden under a man's nipples are glands that are physiologically the same as those in women, although many men are unaware of this. However, unlike women, the glands in men are in a “dormant” state and are not active, since female hormones are needed to activate the glands. However, the similarity of male breasts to female breasts means that men can also suffer from breast tumors. Cancer of this organ, however, is observed approximately 100 times less often in the stronger sex than in women.

Nosologically, malignant breast tumors are represented by two main types: ductal carcinoma and lobular carcinoma. In total, there are more than 20 types of tumors that form in the tissues of the mammary glands. Tumors can be invasive, that is, they can spread very quickly to other tissues and non-invasive. Also cancerous tumors divided into those that are susceptible to female hormones and actively respond to them, and those that are not susceptible to hormones. The last category of breast tumors is considered the most difficult to cure.

Reasons

As with many other cancers, the exact causes of breast cancer are still unknown. However, there is an assumption that cancer of this organ is largely associated with a hormonal imbalance in the body, primarily with an increase in estrogen levels above normal. According to this theory, women at risk include:

• have never given birth to children,
• who did not feed their children with their milk,
• have repeatedly had abortions,
• who took long time estrogens,
• who started menstruating early,
• who experienced menopause late (at 50 years of age and older).

The significance of these factors is easily explained - the more menstrual cycles a woman has had, the more exposure her body is exposed to estrogen throughout her life. Estrogens stimulate the regeneration of tissues of many organs, including the mammary glands, which means that the likelihood of mutations in these tissues increases.

Also, in some cases, breast cancer is a genetically determined disease. Genes have been discovered whose damage is 50% likely to cause disease in their carriers. However, genetically determined cancer accounts for only a small proportion of all cases of the disease.

Women also appear to be at risk:

• elderly people who have entered menopause;
• suffering from cancer of other organs;
• had benign tumors of the mammary glands;
• suffering from obesity, diabetes mellitus, arterial hypertension, atherosclerosis;
• having bad habits– users of nicotine and alcohol;
• had contact with carcinogenic substances or were frequently exposed to radiation;
• consuming large amounts of animal fats.

There is also a theory linking many cases of breast tumors to negative impact some viruses.

Sometimes there is an opinion that malignant tumors of the mammary glands can lead to mechanical injuries breasts However, in fact, there is no substantiated evidence of such a connection.

Most cases of malignant breast tumors occur in older women. The peak of the disease occurs at 60-65 years of age. The proportion of women under 30 years of age diagnosed with this disease is small. And in most cases, their tumor is not particularly aggressive. And in teenage girls, the disease occurs only in isolated cases.

Diagnostics

Malignant breast tumors are one of the few cancer diseases where self-diagnosis is extremely effective. This means that a woman can often detect a tumor herself when examining her mammary glands. In this case, you only need to know the set of symptoms that accompany this disease. Indeed, in approximately 70% of cases of breast tumors, suspicious formations were initially discovered by the patients themselves, and not identified during a medical examination.

Therefore, any woman should make it a rule to conduct an independent examination of her mammary glands. This procedure is simple and should be performed every month after the end of menstruation.

During the examination, priority attention should be paid to the following parameters:

• breast symmetry,
• their size,
• skin color,
• skin condition.

If a suspicious symptom or formation of unknown nature is detected, you should consult a mammologist. He will conduct a manual examination of the breast and may prescribe additional procedures, such as ultrasound, mammography (x-ray of the breast area), ductography (mammography with a contrast agent). If suspicions about the malignancy of the formation still remain, then a biopsy is performed followed by examination of the cellular material. A blood test for tumor markers is also performed.

Symptoms

As mentioned above, a woman can often determine for herself whether everything is okay with her breasts during a self-examination. However, to do this you need to know the set of symptoms that accompany cancer.

It is worth keeping in mind that pain is not the defining symptom in this case. In most cases, breast tumors develop in the early stages almost painlessly. If a woman, during self-examination, discovers painful lump, then in most cases it is a benign formation.

However, there are exceptions to this rule. Symptoms of erysipelas, armored and inflammatory diffuse tumors usually include severe chest pain. These forms of the disease are often also characterized by a set of symptoms such as high fever and inflammation, which is why they can be confused with some other infectious diseases. Sign similar tumors– lack of clear boundaries and rapid spread over a large area. In the armored form of cancer, the tumor can compress the surface of the breast, causing it to decrease in size.

The main signs of breast cancer are a hard surface and uneven contours tumors. Smooth and round tumors, as a rule, are benign formations. Typically, a malignant tumor is immobile and only moves slightly when pressed. Another symptom of a tumor is a change in the appearance of the skin located above it. The skin may retract and wrinkles and folds may form.

As the disease progresses, cancer cells can travel to the lymph nodes, causing them to increase in size. These signs - enlarged lymph nodes, their uneven surface, should also be alarming. In most cases, lymph nodes affected by cancer cells remain painless.

Besides, common symptom gland tumors – discharge from the nipples not associated with lactation. These discharges are usually pathological in nature and contain blood or pus.

Stages of breast cancer

It is usually customary to distinguish 4 stages of the disease. Each of them is characterized by a set of specific symptoms, the intensity of which increases as the disease progresses.

The first stage is the initial stage. At this stage, the size of the tumor is very small, it does not exceed 2 cm in diameter. Adjacent tissues and lymph nodes are not affected by the pathological process.

The second stage is characterized by a tumor diameter of 2-5 cm. At this stage, cancer cells can begin to penetrate the lymph nodes. At the third stage, the tumor exceeds 5 cm in size. Individual metastases may be detected in the gland itself. At the fourth stage, the entire gland is affected by the process; metastases may be detected in other organs.

TNM Breast Cancer Staging System

Also, the stages of breast cancer are often designated using the TNM system, in which the T index determines the size of the tumor, N is the degree of lymph node involvement, and M is the presence of distant metastases.

Index T can take values ​​from 1 to 4:

• Stage T1 – tumor size up to 2 cm,
• Stage T2 – tumor size from 2-5 cm,
• Stage T3 – tumor size more than 5 cm,
• Stage T4 – the tumor has spread to the chest wall and skin.

Index M takes values ​​from 0 to 3:

• N0 – no metastases in lymph nodes;
• Stage N1 – metastases to axillary lymph nodes Levels 1 and 2, not soldered together;
• Stage N2 – metastases in the axillary lymph nodes of levels 1 and 2, fused together, or damage to the internal mammary lymph node;
• Stage N3 – metastases in subclavian lymph nodes of the 3rd level or metastases in internal mammary and axillary lymph nodes, metastases in supraclavicular lymph nodes.

Index M can take only two values ​​– 0 and 1 M0 – no distant metastases detected, M1 – distant metastases detected.

Treatment

Treating breast cancer is a difficult process. Its success largely depends on how aggressive the tumor is and how far the disease has progressed.

Treatment involves several methods, but the main one is surgical. Previously, in the presence of even a small tumor, surgery to completely remove the gland (radical mastectomy) was practiced. Needless to say, this practice is the reason that many women are afraid of surgery and often refuse this method of treatment, which leads to a worsening of the condition. And in the case of an operation, a woman left without breasts experiences psychological discomfort and stress, which is also undesirable, since a positive moral attitude of the patient is one of the conditions for a successful fight against cancer.

Currently, breast cancer treatment is carried out slightly differently. In most cases, in the early stages of the disease there is no need to remove the entire breast. In an operation called lumpectomy, only the part of the breast affected by the tumor is removed. During treatment, lymph nodes close to the tumor are also removed. Complete breast removal is practiced only from the third stage. But here a lot depends on the characteristics of the disease in each specific case.
However, if the gland is not completely removed, there is a possibility of recurrence of the disease. To prevent this from happening, treatment with chemotherapy and radiotherapy is used. Many breast tumors respond well to treatment with hormones that reduce estrogen levels in the body. This feature is based on the fact that many cancer cells have estrogen receptors, and when these receptors are exposed, the cells accelerate their reproduction.

Hormone therapy, chemotherapy and radiotherapy can also be used as independent treatments for breast cancer if surgery is not possible for some reason. A treatment approach can also be used in which exposure to the tumor with drugs and radiation is practiced before surgery in order to reduce the size of the tumor. Similar method Treatment of breast tumors is called neoadjuvant. In contrast, adjuvant therapy is designed to reinforce results surgery and prevent relapses of the disease.

Of the cytostatic drugs used in chemotherapy for breast cancer, the most widely used are:

• fluorouracil,
• methotrexate,
• cyclophosphamide,
• paclitaxel,
• doxorubicin.

A special form of drug therapy for breast cancer is targeted therapy. This type of treatment is aimed at increasing the sensitivity of tumor cells to chemotherapy drugs, as well as to radiation therapy. Targeted drugs contain special antibodies that neutralize substances secreted by tumor cells of the mammary glands.

Forecast

The chances of recovery from breast cancer are relatively high in the early stages of the disease. If treatment is started at stages 1-2, then 80% of patients live 5 years or more. For stage three cancer, this figure is 40%. For stage IV breast cancer, the five-year survival rate is only a few percent. Much also depends on the patient’s age, her concomitant diseases, and the degree of aggressiveness of the cancer. For erysipelas and armored forms of breast cancer, the five-year survival rate does not exceed 10%.

It must be remembered that even if the patient has had a successful operation to remove a breast tumor, then after some time, sometimes years later, relapses are possible. Therefore, the patient must be under constant supervision of an oncologist.

Prevention

One hundred percent guarantee that a woman will not have malignant tumor breasts, of course, cannot be. However, regular self-examination, visiting a mammologist, and undergoing mammograms at least once a year allows you to identify the disease at an early stage. Childbirth, lactation, and absence of diseases also reduce the likelihood of the disease occurring. female organs and mammary glands, control of hormonal balance in the body, especially during menopause. Of course, not the least role in the prevention of breast cancer is played by good nutrition, body weight control, healthy image life, giving up bad habits.

- develops frequently, affecting approximately 1 in 10 women. Risk factors: menopause over 50 years of age; absence of childbirth or first birth over the age of 30 years (incidence is 3 times more common); family history indicating breast cancer in the mother, sister (2 times more often) or both of them (6 times more often); fibrocystic mastopathy (3-5 times more often).

Early diagnosis of breast cancer ensures successful treatment most patients. 5-year survival rate when treated for localized forms I-II stage is 90%, with locally advanced cancer - 60%. Treatment results are much worse in the presence of distant metastases. In the diagnosis of breast cancer important have systematic self-examinations (4 times a year) and medical examinations of women over 40 years of age (once a year).

Mammography is recommended once every 2 years after the age of 40, once a year after 50 years. If a dense tumor without clear boundaries is detected in the mammary gland, the diagnosis should be clarified immediately (puncture biopsy with cytological analysis, biopsy with histological analysis). Method of dynamic clinical observation instead of clarifying diagnostic procedures should not be used. Benign formations of the mammary glands are more often found - diffuse and nodular mastopathy, intraductal papilloma, fibroadenoma. Development of breast cancer from benign formations- an uncommon situation (for example, from fibroadenoma - 1-1.5%), at the same time, erroneous tactics when differentiating from breast cancer are often encountered in practice.

At diffuse mastopathy detect diffuse thickening and tenderness of the mammary glands, sometimes there are light discharge from the nipple.

At nodular mastopathy single or multiple compactions of various sizes with unclear contours, not associated with the skin, are determined.

Fibroadenomas can be presented as dense, round, lumpy single or multiple various sizes tumor nodes.

Leaf-shaped fibroadenomas are characterized rapid growth and reach large sizes in a short time.

Intraductal papillomas appear bloody discharge from the nipple.

Diagnosis clarified by cytological examination and intraductal contrast mammography. Breast cysts are round in shape, have clear boundaries, and contain serous fluid.

Symptoms Breast cancer is manifested by the development of a limitedly mobile, dense tumor with slight retraction of the skin above it. IN late stages disease, these symptoms are more pronounced, nipple retraction, infiltration and ulceration of the skin, and swelling of the mammary gland in the area of ​​the tumor appear. In addition to this most typical development of breast cancer, other clinical variants are observed. The edematous-infiltrative form is characterized by an enlargement of the mammary gland due to pronounced edema and infiltration, the skin is thickened and hyperemic, the tumor node may not be detected by palpation and mammography (primary edematous-infiltrative form) or be relatively small in size (secondary edematous-infiltrative form ).

A variant of this form of breast cancer sometimes develops mastitis-like or erysipelas-like cancer, manifested by bright hyperemia of the skin, increased temperature and rapid progression of the disease. Vice versa, Paget's type cancer, arising from the epithelium of large ducts near the nipple, is characterized by slow development. First, thickening, retraction and ulceration of the nipple appears, then a dense tumor node forms in the thickness of the mammary gland.

Breast cancer is classified according to the TNM system. The classification is based on the size of the tumor in the mammary gland and the location of metastases. Metastasizes breast cancer to regional lymph nodes and distant organs and tissues. When cancer is localized in the outer quadrants, the axillary lymph nodes are primarily involved; in the inner quadrants, the substernal and subclavian lymph nodes are involved. Possible involvement of supraclavicular and axillary nodes from the opposite side.

Enlarged lymph nodes do not always mean they are metastatic. Their increase is possible as a manifestation of hyperplasia. The fact of tumor involvement of the lymph nodes and the number of involved nodes is determined by morphological examination after surgery.

Distant metastases of breast cancer occur in the bones, lungs, liver, skin chest wall, brain, etc. To clarify the extent of the spread of the disease at the time of diagnosis and during further observation, skeletal scintigraphy (if necessary, bone radiography), liver ultrasound, lung radiography, etc. are used.

Important for characterizing breast cancer is the determination of the content of estrogen receptors (ER) and progesterone receptors (PR) in the tumor, which is performed during tumor removal or by biopsy. The tumor is considered dependent on endocrine influences when the content of RE and/or RP is 10 fmol/mg protein. The content of hormone receptors in the primary tumor and metastases does not differ significantly. Therefore, the conclusion about the endocrine dependence of the tumor, made in the first stages of the disease, can be taken into account when determining therapeutic tactics during the development of metastases.

Treatment. For breast cancer stage I-II optimal method Treatment is surgical - radical mastectomy or sectoral resection with removal of regional lymph nodes. After surgery for early cancer mammary gland additional treatment not prescribed. For affected axillary lymph nodes adjuvant chemotherapy should be performed.

In stage III of the disease, preoperative radiation and/or chemotherapy is prescribed, and after surgery, adjuvant drug therapy. Adjuvant chemotherapy begins 2-3 weeks after surgery. The most commonly used regimen is CMF (cyclophosphamide - 100 mg/m² orally, days 1-14 in combination with methotrexate - 40 mg/m2 IV, days 1 and 8 and 5-fluorouracil - 500 mg/ m² IV, days 1 and 8; intervals between courses - 2-3 weeks, number of courses - 6).

At high content RE and/or RP during menopause are additionally given tamoxifen (20 mg daily for 2 years), and if the menstrual cycle is preserved, oophorectomy is performed, then tamorsifen (20 mg) or prednisolone (10 mg) is used for a long time.

If menopause is more than 10 years and high level RE adjuvant therapy can be carried out only with tamoxifen.

Preoperative therapy is carried out for locally advanced breast cancer. The CMF regimen or various combinations with the inclusion of Adriamycin are effective; radiation therapy can be prescribed at the same time (course dose 40 Gy). At high levels of RE and RP, tamoxifen is used to turn off ovarian function. The operation is performed 2 to 3 weeks after the end of radiation therapy.

With the development of distant metastases at various stages of the disease, the main therapeutic value is drug therapy. Chemotherapy regimens should include adriamycin: 1) adriamycin (20 mg/m² IV, days 1, 8 and 15) in combination with methotrexate (20 mg/m² IV, day 1 ), 5-fluorouracil (500 mg/m² IV, day 8) and cyclophosphamide (400 mg/m² IV on day 15); 2) adriamycin (40 mg/m² IV, day 1) in combination with cyclophosphamide (600 mg/m² IV, day 1); 3) adriamycin (30 mg/m² IV, days 1 and 8) in combination with 5-fluorouracil (500 mg/m², days 1 and 8) and cyclophosphamide (100 mg/m², days 1 and 8) m² orally, days 1-14); 4) adriamycin (60 mg/m², IV, day 1) and vincristine (1.2 mg/m², days 1 and 8). Courses of treatment are carried out every 4 weeks.

There is no clear evidence of differences in the effectiveness of these regimens.

With resistance to CMF and Adriamycin, partial regression can be obtained using mitomycin C, cisplatin, vinblastine. The use of thiophosphamide (20 mg IM 3 times a week for 3 weeks) is of independent importance; however, such treatment significantly reduces hematopoietic reserves. More often, thiophosphamide is injected into the pleural cavity (30-50 mg) after removal of exudate.

Tamoxifon occupies a leading position in endocrine therapy for breast cancer. It is prescribed for positive or unknown receptors orally at 20 mg/day. for a long time. If the effect of tamoxifen is insufficient, it is advisable to use aminoglutethemide (orimethene) - 500 mg/day. with cortisone acetate - 50 mg/day. daily for a long time. Androgens retain their therapeutic value (testosterone or medrotestron propionate - 100 mg IM daily or every other day; omnadren, proloteston - 3 times a month).

With a high level of ER, drug therapy can be started with endocrine drugs, and later supplemented with cytostatic drugs.

Radiation therapy is used for metastases to the bones, brain, skin, as well as for the primary tumor in cases of disseminated form of the disease.