Causes, symptoms, stages and treatment of breast cancer
Breast cancer is a malignant transformation and uncontrolled growth of epithelial cells of the mammary gland, one of the most dangerous and widespread diseases of women, rarely detected in men.
The high level of morbidity in women is associated with the role of estrogens, progesterone, and other hormones at the stages from menarche to menopause, pregnancy and lactation. The risk of developing cancer does not depend on breast size
Content:
- Breast cancer symptoms
- Breast Cancer Causes
- Breast cancer stages
- Breast Cancer Diagnosis
- Breast cancer treatment
Breast cancer symptoms
Nonspecific signs of breast cancer, upon detection of which it is advisable not to delay contacting a medical institution for consultation:
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Progressive weight loss. How to determine? Weight loss persisting for more than three months in a row (Attention! The dynamics of weight loss is individual for each person), against the background of habitual physical exertion, without the use of low-calorie diets.
- Persistent and stable eruptions, peeling on the chest.
How to determine? Allergic, infectious, parasitic rashes or peeling, in contrast to rashes of unclear etiology, are characterized by:
- dynamic development of rashes;
- itching;
- different stages of the rash (beginning, mature, healing);
- a decrease or vice versa an increase in their number.
- Changing the shape of the nipple. The norm is only during lactation, during breastfeeding.
- Enlarging moles in the chest area. You should be wary if you find growing moles, combined with nipple discharge.
- Axillary pain. One of the reasons is inflammation of the lymph node, it is advisable to exclude the cause.
Almost always, breast cancer is associated with the development of nodular seals, neoplasms. Indeed it is. However, some forms, accompanied by lumps in the chest, are not oncology, although some are capable of malignancy (malignant transformation). There are forms that are not manifested by neoplasms for a long time.
Earlier, mastitis, nodular, diffuse mastopathy, fibroadenomas were mentioned in which focal or diffuse damage to the breast tissue is formed.
Other pathologies are known, with lesions of the gland, also diagnosed at different stages and periods:
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During the lactation period:
- Galactocele or milk cyst. Formed after blockage of the milk duct, as a result of acute mastitis. Stagnant milk accumulates in the cyst, a jelly-like (fluctuating) swelling forms.
- Injury to the chest. This refers to an insect bite, scratch, or the like. It manifests itself with improper attachment of the baby, infection. It is accompanied by the formation of a hematoma (bruise).
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At any stage of life, more often in the older age group:
- Lipoma or wen. Benign tumor of the subcutaneous connective tissue. There is a low risk of malignancy (malignant transformation).
- Intraductal papilloma. A benign tumor in the form of outgrowths of the epithelium of the milk ducts. When tender papillomas are traumatized, bloody discharge from the nipples is possible; palpation of the breasts is felt in the form of small seals. There is a high risk of malignancy.
See the first signs and other symptoms of breast cancer here
In this article, we will focus on the method of breast self-examination. It should be known and used by women, especially those over the age of 25 (hereditary risk groups), after 40-45 years, all women. The technique has a high diagnostic value at the preclinical (pre-medical) stage of disease detection.
Recommendations for breast self-examination
For women of fertile age, carry out only the first week after the end of the menstrual cycle. Carry out similar studies during pregnancy, menopause at any time.
The sequence of the procedure is not strictly required. However, adherence to it disciplines, increases attentiveness, and reduces the risk of missing dangerous symptoms. There are two consecutive diagnostic stages: inspection, feeling.
I. Inspection is carried out in a standing position, facing the mirror, in two hand positions - up and down:
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Hands straight down. Pay attention to visible deviations:
- symmetry of the glands, nipples of the left and right sides (asymmetry is the norm during breastfeeding);
- deformities (exclude lipomas, unsuccessful mammoplasty);
- focal retraction of the skin (one of the signs of cancer);
- peeling, changes in the structure of the skin (exclude allergies, skin diseases);
- ulcers, erosion, crusts (exclude healing of primary rashes, wounds);
- skin color (exclude rubbing, erysipelas).
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Hands upright. Pay attention to visible deviations in the armpit when the chest is displaced upward, as well as:
- symmetry;
- swelling;
- color of the skin.
Examination of the inside of the bra tissue. It should be alarming if the fabric of linen gets wet with spots of various colors, usually brown, red or colorless, not associated with lactation, sticky, slimy, watery consistency, odorless, with a smell, including fetid.
II. Feel (palpate) the chest while standing. With a large size of the mammary gland, additionally, in the supine position. There are six positions of palpation of the breast on one side
Description of the technique using the example of the right breast:
- Right arm straight down. The palm of the left hand covers the right breast, the nipple rests against the center of the palm. Circular stroking and deep feeling, by squeezing the palm of the left hand, helps to reveal the seals in the body of the gland outside and deep in the tissue.
- Right arm straight up. The palm of the left hand is pressed against the chest wall from below, the fingertips touch its outer side. Deep feeling is carried out by pressing during the period of movement from the bottom up, squeezing the palm.
- Right arm straight down. The position of the palm of the left hand on the upper wall of the chest surface. By squeezing, stroking the palm of your hand, exclude seals, nodes under the skin of the upper chest.
- Right arm straight down. With the fingers of the left hand, feel the breast nipple, determine the formations inside, invagination, swelling, increased, decreased sensitivity to touch, cold, heat, pain, discharge.
- Right arm straight down. The palm of the left hand is in the armpit. Feel with your fingers, thumb outside, the rest from the inside. Using sliding squeezing movements of the fingers, examine the condition of the lymph nodes in the axillary zone (normally axial or axillary lymph nodes are not detected).
- The position of the right hand is arbitrary. Fingers of the left hand in position on the right supraclavicular fossa. Feel, under- and supraclavicular zone, around it, in order to determine the lymph nodes (normally, the subclavian, supraclavicular nodes are not determined).
Research in the prone position is similar. Repeat the self-examination procedure on the other side of the body, since breast cancer can be one and / or two-sided. Any neoplasms, seals, changes in the skin are considered suspicious.
The identified changes are assessed according to the following parameters:
- shape, size of breasts, nipples, areola;
- the size and shape of the package of lymph nodes, seals, defects, neoplasms;
- the nature of the surface of the neoplasm or lymph node is smooth, rough;
- mobility of the tumor and / or lymph node, that is, during examination it is possible to move from the site of the main localization;
- sensitivity, soreness of the lymph node or neoplasms to touch, pinching.
Report them to a mammologist who will assess the diagnostic value of symptoms in terms of the risk of oncology. Earlier we gave a clinical description of indurations, presumably being symptoms of cancer, including: nodular, diffuse forms (see here).
The preclinical suspicions and the results of the clinical examination are confirmed by the methods of instrumental and laboratory diagnostics.
Earlier, it was told in more detail about the symptoms detected by instrumental methods, their diagnostic value (see here), including:
- radiation (mammography, CT);
- ultrasonic and magnetic radiation (ultrasound, MRI).
The main drawback is subjectivity, assessment of the results of X-ray mammography and ultrasound, depending on the qualifications of doctors. The quality of the results on CT is significantly higher - a type of X-ray examination, and MRI - a type of magnetic radiation.
In recent years, it has been reported about the high efficiency of early stage diagnostics by methods:
- contrast MSCT (multislice computed tomography) - 3D image, topographic binding of the tumor to anatomical formations, examination of the whole body, which allows the doctor to choose a treatment program.
- PET-CT (positron emission tomography and computed tomography) - combines the advantages of X-ray examination with topographic referencing and revealing the nature of pathophysiological processes in and around the tumor.
- Infrared mammography - the method is based on the increased sensitivity of cancer cells, in comparison with healthy tissues, to penetrating heat rays, building, on this basis, a three-dimensional image of the breast with foci of cancer cells. High sensitivity of the method is reported, up to 90% of correct diagnoses of the first stage of breast cancer.
The methods have increased diagnostic value in comparison with other methods. They are not painful procedures, have minimal effect on the body, the results of an objective analysis are presented in the form of a three-dimensional image, the results are carried out and formalized within a short time, recorded on any media, including computer ones.
The disadvantage is the relatively high cost of examinations, including those abroad, queues for quotas for free examinations.
Differentiation of breast cancer forms at the cellular and tissue levels. Methods applied:
- cytological (tumor cells) research;
- histological (ultrathin sections of tumor tissue) studies.
Samples are obtained as a result of biopsy - intravital excision of pieces of breast tissue.
Determination of the microscopic characteristics of the tumor is necessary to establish:
- forms of pathology (forms of breast cancer differ in the aggressiveness of growth);
- tactics (programs) of treatment measures (differ in sensitivity to the effects of drugs);
- predicting the likely outcome of the disease (differ in the likelihood of relapse).
Definition of symptoms by tumor markers
Early symptoms can be determined long before the clinical manifestations of the disease using immunological methods.
Determination of tumor markers using PCR (polymerase chain reaction) is an in vitro (in vitro) technology for helping to find complementary to each other:
- antibodies - (standardized DNA fragment of a breast tumor molecule - tumor marker, its commercial designation CA 15-3);
- antigens - (native breast cancer cells circulate in the blood of a sick person, have capture receptors for CA 15-3).
As a result of the PC technology, when mixing, in the wells of the device plate containing samples (CA15-3 + human blood), the following results are possible, confirming or excluding the disease:
- Oncology confirmation. An antibody-antigen complex is formed.
- Exclusion of oncology. The antibody-antigen immune complex is not formed.
The results are easily readable with the help of detectors built into the instrument's hardware complex.
Using PCR, tissue tumor markers of tumor growth are also isolated:
- ER - estrogen receptor;
- PR - progesterone receptor;
- HER 1 or HER 2 are receptors for tumor cell growth factors.
The problem is that not all forms of cancer want to obey the simplified laws of immunology - the complementarity of receptors for specific antigens and antibodies. There are reports of false positive and false negative results. Cancer cells successfully fight the sick person's immune system, suppressing it, directing the response in the wrong direction. This is the insidiousness of most forms of cancer.
Breast cancer is classified according to different principles. In this text, we will not specify the forms of cancer.
The main forms of pathology are previously described:
- hormone dependent;
- three times negative;
- luminal cancer;
- infiltrating.
More details here. This is not an exhaustive listing of breast cancers.
It is almost impossible to determine the exact form of oncology by clinical symptoms and morphological description of the tumor.
Symptoms characteristic of different types of oncology are established on the basis of a complex of in-depth studies. However, this is outside the scope of a popular article in the health education series.
Breast Cancer Causes
Hormonal changes in the body are an integral part of female physiology. Starting from menarche, the body is rebuilt monthly. After fertilization of the egg, the woman's body adapts to bearing a fetus, birth, lactation. The influence continues with menopause, menopause. In men, sexual physiology functions much easier.
The cells of the breast of a woman are every second under the influence of various physiological impulses that stimulate the active regeneration of cells of the fatty, glandular, connective tissue of the breast. The greater the load, the greater the likelihood of failures (cancerous cell mutations).
The cells of the mammary gland of men, of course, participate in metabolic processes, but they are not subjected to significant pressure in the form of rhythmic or arrhythmic bursts. Hormonal disruptions of the genital area are mainly characteristic of male menopause. This period, after fifty years, coincides with the peak incidence of breast cancer in men. However, even during this period, the level of male oncology is no more than one percent of that of the opposite sex.
More significant causes of breast cancer, especially in women, are internal and external factors of influence of a pathological nature.
Summarizing the known causes of breast cancer (see here), we will formulate the principles of prevention of breast cancer.
Active prevention:
- increased oncological alertness in groups of oncogenic risk (genetic predisposition to cancer, hormonal diseases, others);
- regular self-examination of the breast for women after 25 years (risk groups);
- screening examinations after 40 years, in women, regardless of the nature of the risks, the minimum recommended examination (mammography, determination of estrogen levels, identification of tumor markers).
Passive prophylaxis:
- respect for the breast (protection from injury, regular wearing of comfortable bras, a positive attitude towards breastfeeding);
- quitting bad habits that are considered the causes of cancer (smoking, alcohol);
- harmonization of sexual relations in stable couples;
- reducing the risks of negative impact of environmental factors on the body, especially exposure to ultraviolet radiation, sunlight, in tanning salons.
Breast cancer stages
Previously, the stages of cancer adopted in mainstream medicine were described using letters and numbers for the stages of cancer. In this publication we will focus on a simplified description of the stages based on the clinical symptoms of the patient, the description of the tumor clinic.
Stage 1 breast cancer
When determining the initial stages of the disease, difficulties arise due to the small size of the tumor (up to 20 mm). It is difficult to find a neoplasm in a large breast. Seals of the transitional form, carcinoma in situ, close to the first stage, are easily confused with diseases, non-oncological etiology or not at all.
This stage is considered to be the initial - non-invasive. The opinion is based on the fact that visible carcinogenesis does not extend beyond the breast. Regional lymph nodes of the thoracic area of the body are in a normal state, that is, they cannot be felt.
Pathological changes at the subclinical level, characteristic of the first stage of oncology, can be determined exclusively by modern diagnostic methods. The most informative is a comprehensive examination, which includes several complementary methods in the course of a screening examination.
Stage 2 breast cancer
The size of the tumor does not increase much in comparison with the first stage of the disease. It is generally accepted to consider the size of the second stage neoplasm in the range of 20 - 50 mm.
A characteristic feature of this stage is the probing of one or two lymph nodes in the axillary (axillary), supraclavicular, and other areas near the chest. Normally, the sentinel lymph nodes of the breast are not palpable.
Self-diagnosis is becoming an increasingly important method for detecting signs of disease. In order to increase the effectiveness of the examination, let us pay attention to the signs of lymph node involvement, which are available during an independent breast examination.
Signs of lymph node involvement:
- Pain. Usually in the axillary (axillary) zone, this is the earliest possible sign.
- Hyperplasia. Enlargement of the lymph nodes up to the size of the palpable skin surface;
- Lymphadenitis. Inflammation of the lymph nodes.
The names of the packets of sentinel lymph nodes located near the breast, which are part of the system of lymphatic vessels draining from the breast.
It is easy to independently determine their location by the name of well-known anatomical landmarks:
- axillary (axillary), usually affected first, and then;
- subclavian, supraclavicular;
- periosternal (prerasternal) - the center of the chest in the hollow between the glands.
The most common method for detecting oncology in the lymph nodes is a biopsy in order to study pathological material under a microscope.
Stage 3 breast cancer
The size of the tumor reaches a diameter of more than 50 mm.
A characteristic feature is the definition of the lymph nodes of the axillary, clavicular zones in the form of packages (groups). It feels like a bunch of small to medium sized berries. It is possible to damage the lymph nodes of the parasternal zone, without affecting the nodes in other zones.
At this stage, the likelihood of distant metastasis increases significantly. The greatest likelihood of distant metastases is localized in bone structures. The probability of bone metastasis is up to 90%. Bone metastases, according to the latest scientific data, can be detected even in the first stage of the disease. However, it does not exceed 5% when the disease is detected at the first stage.
Stage 4 breast cancer
It is accompanied by moderate and severe clinical symptoms localized in the chest area (ulcers, erosion, crusts), manifested by signs of bone damage (aches, pain). Clinical indicators of the body, the patient's well-being, in the absence of a therapeutic effect, steadily regresses.
During this period, the size of the tumor does not matter. Lymph nodes are palpated with packages from both sides, possibly affecting distant groups of lymph nodes. Multiple metastases in the bones and liver are characteristic.
Breast Cancer Diagnosis
Various diagnostic programs are offered. One of them includes physical examinations, including screening and follow-up examinations. When signs of oncology are detected, their differentiation is carried out. The last stage of diagnosis is a specialized consultation. (See here for more details).
In addition, we list the standard research methods used in clinical practice for the diagnosis of breast cancer, namely:
- initial registration of the patient, collection of anamnesis of life and illness, traditional examination methods (examination, palpation, percussion, auscultation, thermometry);
- X-rays (mammography and chest x-ray);
- Ultrasound of the mammary glands in various modifications with additional examination (liver);
- Scincigraphy is a method of radioisotope visual diagnostics of metastases in bone tissue; it is known to use the technique for other medical purposes;
Other diagnostic techniques are prescribed according to indications, taking into account the technical capabilities of the medical institution. Laboratory studies of biological fluids (whole, stabilized blood, serum, etc.) for morphological, biochemical, and other indicators are of an auxiliary nature, mainly to clarify the state of the patient's body.
Breast cancer treatment
The most promising treatment for the early stages of the disease. During this period, it is possible to predict a complete recovery.
The likelihood of metastasis and return of the disease is possible in the later stages:
- Surgical treatment in the form of total, partial resection with the possibility of breast plastic surgery.
- Hormone therapy
- Chemotherapy - adjuvant (enhanced) and non-adjuvant.
- Radiation therapy.
- Targeted (targeted) therapy.
Also see: Other cancer treatments
The author of the article: Bykov Evgeny Pavlovich | Oncologist, surgeon
Education: graduated from residency at the Russian Scientific Oncological Center. N. N. Blokhin "and received a diploma in the specialty" Oncologist"
