Breast cancer: 9 signs that should alert you

Breast cancer is the most common malignant tumor in women. This type of cancer ranks first in mortality from cancer among the female population. The risk of developing it increases with age. Breast cancer in young girls (under 35 years of age) is rare, but has a worse prognosis.

The most common sign of breast cancer is the presence of a painless lump that a woman notices during a self-examination. Other symptoms are skin changes (orange peel), nipple discharge and breast pain. According to statistics, only 10% of tumors in the mammary glands are malignant.

By the time breast cancer can be felt, the tumor already exceeds 1 cm. Earlier detection of the disease is carried out using mammography.

Treatment for breast cancer depends on the stage of the disease, and the most important information is the size of the tumor and its spread to the lymph nodes. Early detected breast cancer (by chance, on mammography, not yet palpable) has a better prognosis.

Treatment for breast cancer consists of surgery to remove the breast (mastectomy), radiation therapy (radiation therapy), chemotherapy, and hormone therapy. The choice of treatment method depends on the stage of the disease.

Breast structure

The content of the article

The structure of the breast consists of glandular and fatty tissue, as well as nerve and lymphatic tissue. The chest or mammary gland (Latin Mamma, Greek Mastos) lies on the pectoralis major muscle and extends from the 2nd to 6th ribs.

The female breast is a complex gland consisting of 15-20 individual glands. Each of them, together with connective and adipose tissue, forms one lobe. The lobes are separated from each other by connective tissue, and each of them has a drainage channel (duct), which connect and end in a funnel-shaped expansion on the nipple. Around the nipple is a darker pigmented band called the areola.

Breast tumor: benign breast tumors, classification

Benign tumors develop in all breast tissues. The following types of benign neoplasms are found:

Breast cyst.
Fibroadenoma.
Lipoma.
Mastopathy.
Intraductal papilloma.

Mastopathy is a general name for a large number of diseases associated with the proliferation of connective tissue. The type of nodular mastopathy is intraductal papilloma. Fibroids affect young women, the tumor has clear outlines. A lipoma is a fatty tumor, which is predominantly adipose tissue enclosed in a capsule. A breast cyst is a capsule filled with fluid. The classification of benign breast tumors contains six main groups:

Epithelial tumors.
Mixed type of neoplasms.
Another type of neoplasia.
Unclassified benign neoplasms.
Tumor-like formations.
Breast dysplasia.

Breast cancer - incidence

Breast cancer is the most common malignant neoplasm in women (affects one in 100). It is rare in men.

In approximately 80% of new cases, the disease is detected at an early stage, and approximately 20% of patients have advanced disease with metastases at the time of diagnosis.

The incidence of breast cancer has been increasing in recent decades, while mortality in developed countries has been decreasing. This is facilitated by earlier detection of pathology and increased effectiveness of treatment.

It is believed that one in eight women is susceptible to breast cancer.

The disease is rare in women under 40 years of age, and in young girls it is less than 1%.

Breast cancer classification parameters

The main elements of the breast are lobules with glands that produce mother's milk, as well as ducts that deliver it to the nipple. The tissues are penetrated by blood and lymphatic vessels responsible for supplying the mammary gland (MG) with nutrients and removing waste products. The disease begins when normal cells in a woman's body begin to divide uncontrollably, and the process of their death is disrupted. Types of breast cancer are classified according to different criteria.

Based on the location of the primary node, oncological pathologies are divided into neoplasms:

pacifier;
areolas;
axillary area.

Depending on the quadrant of location, malignant nodes are:

upper internal;
upper-outer;
lower internal;
lower outer.

Up to 50% of primary tumors in women are formed in the upper outer quadrant of the mammary gland, about 20% - in the areola or central part of the breast.

Experts classify breast cancer of unspecified location and beyond the boundaries of individual regions into separate groups.

Tumor primary nodes can be ductal or lobular, based on the tissue of which element of the organ structure began to degenerate.

In addition to location, the classification of the disease according to parameters such as:

histological structure;
stage of development;
form;
molecular taxonomy.

Malignant neoplasms are also differentiated by the degree of aggressiveness of the impact and the speed of spread.

Metastasis

Regardless of the location of the primary node, cancer can be:

non-invasive - the tumor grows, but does not leave the borders of the affected part of the organ;
invasive - a malignant neoplasm grows beyond the boundaries of the lobule (or milk duct), its metastases first “capture” healthy parts of the breast, then other organs and systems.

Malignant cells “spread” throughout the body from the gland in two ways:

lymphogenous - through lymphatic vessels;
hematogenous - with the bloodstream.

First, metastases affect regional lymph nodes under the shoulder blades, armpits, sternum or collarbone area. Then they appear in distant areas of the lymphatic system, grow into the skin, soft and bone tissues.

At the terminal stage, malignant cells are found in almost all internal organs of the human body. Metastases from the primary node often spread hematogenously to:

liver;
brain;
spine;
pleura;
lungs;
ovaries;
bones of the pelvis, hips.

When the development of breast cancer ends with the abnormal tissues being separated from the “maternal” node and transferred to other parts of the woman’s body, the disease is called metastatic.

If the primary pathogenic node forms again after treatment in the second mammary gland, in the same place, nearby tissues or organs, we are talking about a recurrent type of cancer.

Both forms of pathology are late-stage diseases; metastases can appear months or even years after the end of treatment. Relapse occurs in approximately 30% of women treated in the early stages of the disease. The average time for local “return” of oncology is five years. The risk of reappearance of the tumor is especially high in the first 24 months.

Non-invasive breast cancer can become invasive as the size of the tumor increases. It is very important to monitor the intensity of its growth, start treatment on time, and stop metastasis.

Experts distinguish three degrees of doubling in the size of carcinomas in women:

high – the abnormal primary node grows twice in three months or less;
average – doubles over a period of time from 3 to 12 months;
low – doubling lasts more than a year.

Tumor cells undergo separate differentiation. In medical documents, the parameter is designated by the Latin letter “G”. Doctors distinguish three degrees of danger of breast cancer:

highly differentiated (G1) - malignant cells are similar to natural ones, divide slowly, and have a low potential for metastasis;
moderately differentiated (G2) - pathologically altered structures retain the characteristics of normal ones, multiply at an average speed, and are more prone to spread than the previous group;
low-differentiated (G3) - cells are practically devoid of healthy signs, quickly divide, and have a high potential for the formation of metastases. They are a sign of cancer with an aggressive, rapid, life-threatening course.

Determining the type of malignant cells and the location of the primary tumor helps predict the possible spread of metastases.

Breast cancer - causes (risk factors)

There are a number of risk factors associated with the occurrence and development of breast cancer:

Age.
It is now known that breast cancer can occur at any age, but rarely occurs before age 25. The risk of the disease increases with age, most often occurring after menopause (the last menstrual period in a woman's life).
Hereditary predisposition.
A positive family history (mother, sister or daughter of a breast cancer patient) increases the risk of developing the disease. The overall relative risk of breast cancer in women with a positive first-degree family history (mother, sister, daughter) is 1.7 (the risk is 1.7 times higher or 70% compared with women without a positive family history). Mutations in the BRCA1, BRCA2 and p53 genes are associated with a high risk of developing the disease.
Personal history of a malignant disease.
Women diagnosed with cancer in one breast earlier have a higher risk of developing a tumor in the other. Patients who have previously been treated for endometrial, ovarian, or colon cancer also have a higher risk of developing breast cancer than women without a history of cancer.
Hormonal factors.
Early first menstruation (before age 11) and late menopause (last menstruation after age 55) are associated with a higher risk of breast cancer. A higher incidence is observed in women who have not given birth and in those who had their first birth after 30 years of age. Early first pregnancies and more births reduce the risk of developing breast cancer. It is believed that continued breastfeeding may be a protective factor against developing the disease, while not breastfeeding increases the risk of breast cancer. Studies have shown that hormone replacement therapy and oral contraceptives increase the risk if taken for more than 10 years.
Ionizing radiation.
Its exposure (during diagnostic, therapeutic procedures or radiation exposure) during and after puberty.
Lifestyle.
Eating fatty foods, obesity, smoking and drinking alcohol.

Just because a woman has any of the risk factors does not mean she will get breast cancer. There is usually a balance between cell production and cell death in the body. If the genes that regulate these processes are changed, control over cell division is lost and uncontrolled proliferation (tissue growth) of biologically altered (atypical) cells occurs. Any change in genes does not immediately cause cancer. It is assumed that this is a long-term process, requiring 6-7 such independent events of cellular change.

Professional diagnostics

Only highly qualified specialists can professionally assess the situation and make a diagnosis. Diagnosis of breast cancer is a complex procedure that includes:

Personal examination of the patient with palpation of the breast and examination of the lymph nodes for enlargement. This allows you to determine the presence of compactions, inflammation and make preliminary conclusions.
Mammography. This is one of the key diagnostic methods that allows you to determine the presence, shape and size of a tumor.
Ultrasonography. With its help, the number of tumors is determined, as well as the size and exact location.
Biopsy of the lump with histological examination. This method involves studying the affected tissues for the presence of cancer cells, and if a malignancy is detected, a detailed study of the properties of the tumor.

In some cases, computed tomography or magnetic resonance imaging may be needed. The diagnostic method is chosen by the attending physician depending on the specific situation. For a preventive examination and the absence of symptoms of breast cancer, a personal examination by a specialist and one of the imaging methods (ultrasound or mammography, depending on age) is sufficient. Other examinations are prescribed if lumps and other manifestations of the disease are present.

Breast cancer - types

According to the World Health Organization, breast tumors are divided into two groups:

non-invasive breast cancer, i.e. carcinoma in situ (without basement membrane perforation);
invasive breast cancer (the tumor has penetrated the basement membrane).

Non-invasive breast cancer - carcinoma in situ

Non-invasive breast cancer is also called carcinoma in situ and, unlike invasive cancer, does not penetrate the basement membrane of the epithelium (it remains localized and does not spread through the breast stroma).

Ductal carcinoma in situ arises from the epithelial cells of the milk duct and is the most common form of preinvasive breast cancer (80%), and in 10-20% of patients the changes are bilateral. This form of cancer most often occurs in women between 40 and 60 years of age.

In most women, small tumors do not cause visible changes and are not felt when examining the breast (no lump). They are usually discovered incidentally, on mammography or breast biopsy, when fibrocystic changes are suspected.

If the diagnosis is made early and the tumor is surgically removed, the prognosis for recovery is good. If no tumor is found, it is expected that half of women will develop invasive cancer (which penetrates the basement membrane).

Lobular carcinoma in situ

Lobular carcinoma in situ is a rare malignant tumor that is usually diagnosed incidentally during a breast biopsy performed for some other reason.

Lobular carcinoma in situ accounts for about 20% of preinvasive cancers or 3-5% of all breast cancers. This tumor occurs in younger women (breast cancer in young girls).

This tumor is not detected during a breast exam (there is no lump in the breast) and is usually not visible on a mammogram. The diagnosis is made solely on the basis of a breast biopsy.

Invasive breast cancer

Invasive breast cancer can arise from the epithelium of the tubules or lobules and is of two types:

ductal;
lobular.

Most cancers are of ductal origin (about 80%), so the term "invasive breast cancer" has become synonymous with this form of cancer. In 10% of cases it is lobular invasive cancer.

Ductal invasive breast cancer

Ductal invasive breast cancer arises from the epithelium of the excretory ducts. At an early stage, it manifests itself in the form of a compaction because it causes a strong reaction of the connective tissue, as the tumor penetrates into it through the basement membrane. The size of the growths varies, but on average most are diagnosed when they are about 2 cm in diameter.

Most of these tumors are diagnosed during a breast exam or mammogram. In advanced cases, they stick to the front wall of the chest and retract the skin or nipple.

Lobular invasive breast cancer

This tumor is formed by a malignant change of lobular carcinoma in situ. The increase in the number of newly diagnosed women over 50 years of age with this breast cancer is due to an increase in the number of women using hormone replacement therapy.

Most patients experience a lump in the breast, although in some the tumor does not interact with the connective tissue and no noticeable mass is palpable. This breast cancer tends to occur bilaterally (on both breasts).

The remaining 10% of malignant tumors are rare, special forms of breast cancer:

Paget's disease of the breast
(Paget's disease of the nipple, Paget's cancer) - eczema on the nipple of the breast, redness of the nipple with itching of the nipple and retraction of the nipple. This condition resembles dermatitis, but due to the appearance of the nipple, we almost always find ductal carcinoma in the affected breast.
Medullary breast cancer
is a well-confined tumor and has a slightly better prognosis than invasive breast cancer.
Mucinous breast cancer
is a slow-growing tumor, usually found in older women (average age about 60 years), the prognosis is good, and it rarely metastasizes to the axillary lymph nodes.
Tubular breast cancer
is a rare form of invasive breast cancer with a very good prognosis; the tumor is usually small and rarely metastasizes to the axillary lymph nodes. Relapse of the disease is rare.
Invasive papillary breast cancer
- less than 1% of all breast tumors, often manifests as bleeding from the nipple and in this respect resembles benign papillomas.
Inflammatory breast cancer
is a rare type of breast cancer that causes inflammation of the entire breast (mastitis) and enlargement, often without a breast lump. Redness on the chest, chest pain and swollen breasts are visible. This form of cancer is extremely aggressive.

Breast cancer - symptoms

Breast cancer is a slow-growing tumor. It is believed that on average it takes 7 to 8 years for a 1 cm tumor to grow from the first malignant cell.

The most common symptom of breast cancer is a palpable, painless nodule in the breast (70-80%). Other symptoms include skin changes (wrinkled skin like an orange peel), bloody brown breast discharge (2-3%), breast pain (5%). Much less often, enlarged axillary lymph nodes or signs of distant metastases appear as the first symptom.

In Western countries, an increasing number of breast tumors are being detected in asymptomatic patients (women who do not have symptoms) using screening mammography. There is ample evidence that early treatment after screening mammography reduces mortality and improves survival by 30-40%.

Unfortunately, in 70% of cases, breast cancer is detected by the patient herself. Then the disease is often in an advanced stage.

There are some common clinical features for all histological types of breast cancer:

Palpable lump (breast lump)
– A lump can be felt during a breast self-exam or during a routine physical examination.
Skin changes
– due to the reaction of the tumor with the connective tissue, the skin may retract. The growth of the tumor causes the lymphatic vessels to close and the skin to swell, causing the skin to appear wrinkled and thickened (orange skin). If the tumor affects the main duct, the nipple may become retracted. Some tumors can affect most of the lymphatic vessels of the breast, especially under the skin, and cause swelling, redness and tenderness of the breast, which we call inflammatory breast cancer.
Enlarged lymph nodes
– tumors spread by lymphatic route to regional lymph nodes, and which group of lymph nodes they will spread to depends on the location of the tumor. Most tumors spread to the axillary lymph nodes (axillary lymph nodes), some spread to the lymph nodes along the internal mammary artery, and some spread to the supraclavicular lymph nodes (lymph nodes above the collarbone). Lymph node involvement is one of the most important prognostic factors and predicts a worse prognosis in patients with breast cancer.
Distant metastases
- in addition to the lymphatic system, the tumor can spread through the blood (hematogenously) and give distant metastases. Breast cancer most often metastasizes to the lungs, liver, bones, brain and adrenal glands.

Breast cancer (BC)

HomePatientsAbout cancerYou need to knowCancer and its typesBreast cancer (BC)

Oncology Breast cancer is a foreign tumor that appears in the glandular tissue. The number of subspecies of this disease known today is about twenty. Cancer cells differ from normal cells in their accelerated metabolism and abnormal structure. When breast cancer occurs, these cells constantly grow, and later penetrate into the lymph nodes and other organs.

Modern science believes that the main catalyst for breast cancer is a distortion of hormonal levels, as a result of which all other symptoms of cancer arise. After all, according to statistics, it is discovered more often during menopause. After all, this is a period of sharp changes in the production of various hormones by the female body, affecting the condition of the mammary gland. Both excess and deficiency of sex hormones are considered negative factors. Thus, the incidence in women who have undergone childbirth and lactation is several times lower than in women who have not given birth or who have had abortions. In the latter, signs of breast cancer are more common.

Kinds

Types of breast cancer in women can have different characteristics; we will give the simplest classification that even a non-specialist can easily understand.

Nodular - occurs more often than others and represents the formation of small nodules, which are nothing more than necrotic (affected) areas. At the middle stage, it is easily palpable and has a heterogeneous nodular structure. The tumor is spherical in shape, but may have lateral branches. The gland tissue changes, fusing together. These first signs of oncology are visible to the naked eye when the arms are raised above shoulder level. Visually it can also be diagnosed by a change in the shade of the skin (yellow, red, brown) and nipple discharge. In subsequent stages it leads to inflammation of the lymph nodes, progression of the tumor, and, accordingly, to an increase in breast volume. The characteristic keratinized skin and open ulcers may also appear.
Diffuse - less common than nodular, but much more dangerous. After all, it develops many times faster and is accompanied by relatively early metastasis. Due to damage to the gland, the breasts swell and the skin changes. Diffuse has its own types:
Infiltrative - a dense formation appears, and the skin swells and becomes covered with a characteristic crust. In addition, the lymph nodes are affected, and the disease most clearly manifests itself near the areola of the nipple.
Inflammatory - otherwise can be called mastitis-like and occurs due to improper treatment. Lumps inside the breast are painful, the breasts swell and become bluish. Lymph nodes and capillary vessels suffer.
Armored - the course of the disease is very long, the tumor affects not only the mammary glands, but can also spread further. Instead of the swelling observed in other types, here there is a decrease in the volume of the breast, its pigmentation and the appearance of multiple nodules, which then merge into one large tumor.

Nipple cancer is the least frequently mentioned subtype of this area, affecting only 3% of patients. Involves the ducts of the nipple and the area around the nipple. The first signs of breast cancer in women will be marks on the inner surface of the bra cups. Then swelling occurs, crusts and ulcers appear. As the tumor progresses, it can affect other parts of the breast, but the progression of the disease is extremely slow.

Stages

To understand how to determine the stage of breast cancer, you should know how they differ. The diameter of the tumor, the duration of the disease, how affected the body is, and what the survival prognosis is are considered. There are initial and 4 main stages of the development of the disease:

Initial - tumor cells appeared quite recently, usually detected by chance during a medical examination. This kind of breast cancer in women is low-risk, the chances of successful treatment are incredibly high and are above 98%. Doctors recommend undergoing a medical examination on your own and in a clinic (antenatal clinic) on a regular basis.
The first is a neoplasm up to 2 centimeters in diameter and has not yet affected nearby tissues. The survival rate for stage 1 breast cancer exceeds 96%, which makes the prognosis extremely favorable.
The second - the diameter is more than 2 cm, but has not yet exceeded 5 cm. Survival is due to the vulnerability of the lymphatic system, but the chances of successful disposal are quite high (up to 90%).
Third, the prognosis for successfully getting rid of the disease is not so great - up to 70%, depending on the degree of damage and the distance from the source of the disease to the lymph nodes. But there are no metastases to healthy organs yet.
The fourth is the last stage of oncology, when cells travel through the blood and lymph flow to other organs, creating multiple foci of the disease. The probability of cure is extremely low - up to 10%

Development speed

The question of how quickly the disease develops cannot be answered absolutely precisely. Progress is due to many factors, including:

Patient age
Hormonal background
Living conditions
Accompanying illnesses
Type of cancer

The last factor in order is one of the most important, since there are types of cancer that are more aggressive and less aggressive. Thus, the transition from stage to stage and the overall progress of the disease may take a year for one patient, and 10 years for another.

Survival

The answer to the question of how long people live with breast cancer lies in the extent to which the cancer has spread to the breast. For a more precise definition, medicine uses the term “five-year survival rate” - the probability of living more than 5 years after diagnosing cancer at a specific stage.

At the initial stage, as mentioned above, the average life expectancy for breast cancer is practically no different from the usual one, because it is successfully cured in most patients. But the problem is that at least half of patients are diagnosed with stage 3-4 cancer.

Stage	Five-year survival rate
First	Up to 95%
Second	Up to 80%
Third	Up to 40%
Fourth	To 10%

In addition to survival, the issue of relapse is also relevant. Modern medical treatments do not guarantee 100% killing of cancer cells. Therefore, after some time, the disease may return with renewed vigor and affect other important elements of the patient’s body. The more cancer cells have grown before the start of therapy or surgery, the greater the likelihood of recurrence of breast cancer. Moreover, the most dangerous are the first 5 years after seemingly successful therapy. Therefore, cancer patients should be monitored regularly even after treatment. This will make the prognosis for breast cancer more favorable.

Diagnostics

Of all the methods for early diagnosis of breast cancer, self-examination is the most important, because it is extremely important to notice the symptoms early. Doctors insist on monthly self-examination for all women over 35 and those at risk. You need to start with a simple examination of your breasts using a mirror. If one of them is enlarged in relation to the other, deformation is observed, or the skin gradually turns into lemon peel, you should immediately contact a specialist. This is the simplest initial diagnosis of breast cancer.

It is more likely to detect breast cancer on your own in the second week after the start of the menstrual cycle. It is easier to recognize it if, when examining, standing or lying down, you put one hand behind your head and the other to help with the inspection. In addition to the visual examination, it is necessary to check the breast by touch for tumor nodes. If you feel discomfort or pain when palpating, a visit to the mammologist cannot be postponed. Abnormal discharge from the nipples is determined by gently squeezing them. Rapid detection of the disease is a guarantee of absolute cure, so it is vitally important.

How to identify breast cancer in a clinical setting

The range of tools and techniques for detecting breast cancer among doctors is quite wide. The main ones:

Mammography
Thermography
Magnetic resonance therapy
Ultrasonography
Biopsy
Cytological examination
Radioisotope scanning
Scintimammography

These modern techniques not only make it possible to make an accurate diagnosis, differentiating it from, for example, mastopathy, but also give a specific idea of the position, size of the tumor and its malignancy.

Symptoms and signs

Signs of breast cancer in the first stage appear little at all or are barely noticeable. For example, small nodules appear that appear when palpated. It is curious that painful neoplasms more often indicate a benign tumor, but malignant tumors do not bring pain in the initial stages. The nodule may be stationary, or it may move slightly under finger pressure. Other signs of breast cancer include changes in the texture of the skin; folds, wrinkles, swelling, or an orange-like peel may appear on it. Small ulcers may also appear, which in the later stages fester and bleed.

If the disease affects the nipple, this is signaled by pathological discharge, as well as changes in the skin of the nipple and areola around it. This should not be confused with discharge during lactation (feeding). Symptoms of breast cancer also include the proliferation of lymph nodes, which is typical for stage 2. Moreover, the nearby nodes located under the arms suffer first.

Treatment

If you are extremely concerned about whether breast cancer can be treated, then we are confidently ready to give a positive answer. During treatment, it is necessary to completely remove all tumor cells. Naturally, this is easier to do, the earlier the tumor is detected.

Modern methods of treating breast cancer include many different therapies, but the most effective method has been and remains surgical, in which it is possible to completely remove the breast or remove only the tumor if it is small.

Mastectomy is the removal of one of the patient’s breasts and is indicated in the later stages of cancer. At the current level of development of plastic surgery, such operations are often performed together with reconstructive ones. That is, immediately after breast removal, an implant is implanted that externally imitates the organ. After a mastectomy, usually prescribed for the third stage of cancer, a thorough examination of nearby tissues and lymph nodes is carried out to exclude possible relapses.

Other treatments for the disease include the following:

Radiation - slows down the growth of tumor cells. Relevant when surgical treatment is impossible or tumor growth is aggressive.
Hormonal - a number of oncological tumors are vulnerable to certain sex hormones, so doctors can use their artificial analogues or antagonists, but only after a thorough histological examination in the laboratory.
Targeted - since cancer cells develop their own protection from drugs and hormones that destroy them, agents have been developed that reduce this protection and act selectively only on malignant cells.
Chemical - involves the use of drugs that are destructive to cancer cells. It is usually prescribed for the second stage of the disease, and also if hormone therapy is ineffective. In this case, chemotherapy can, firstly, prepare the foreign formation for surgical intervention, secondly, help neutralize metastases that have spread throughout the body, and, finally, reduce the malignant formation to an operable size.

Treatment should be carried out comprehensively under the constant supervision of a specialist, including after recovery. Note that a number of methods have their own complications and side effects, which can be eliminated with other drugs and other medical devices.

Causes

Scientists believe that the key factor in the occurrence of a tumor focus is hormonal. But there are other causes of breast cancer in women. Let's consider what increases the likelihood of disease:

Cases of similar diseases in relatives
Previously discovered non-oncological diseases of the mammary glands
Elderly age
There was no pregnancy and (or) childbirth
The period of feeding the baby with breast milk is too short (less than a year)
Childbirth at a late age (over 35 years old)
Early menstruation or late menopause
Use of hormonal contraceptives
Excess weight
Abuse of alcohol and tobacco products
A small percentage of adipose tissue in the breast structure

The number of factors is quite large and they all play a role in the occurrence of this cancer.

How to avoid

Let us immediately emphasize that it is impossible to insure yourself 100% against breast cancer. However, you can significantly reduce the likelihood of illness (alcohol, tobacco, excess weight) and realize what nature has prepared the female body for. We are talking here, first of all, about childbirth and breastfeeding. Long-term lactation and childbirth (preferably not alone) during an active age significantly reduce the risk of breast cancer.

The modern world dictates certain fashion trends for girls, not all of which are safe. For example, topless tanning or extreme sports with periodic injuries in the chest area carry an additional risk of cancer. Stress also plays an important role, so a calm lifestyle, proper nutrition and moderate exercise will help you stay healthy for many years!

Association "Hello!" together with oncology specialists, she has developed a series of brochures from which patients and their loved ones can receive up-to-date information about modern diagnostics and treatment: head and neck tumors, kidney cancer, lung cancer, breast cancer, melanoma, immuno-oncology options, as well as about psychological and legal support. Recommendations for lifestyle during treatment. Targeted therapy for skin melanoma edition

Breast cancer - diagnosis

To diagnose cancer:

An anamnesis is collected, and by interviewing the patient, the symptoms and duration of their action are found out. The doctor asks about the existence of possible risk factors, such as a family history of breast cancer, year of first and last menstruation, time of first birth and number of births, use of oral contraceptives or hormonal medications.
The breast and lymph nodes (supraclavicular and axillary) are examined by inspection and palpation. During the examination, attention is paid to the size, shape and symmetry of the breasts, as well as possible changes in pigmentation, indentations in the skin or nipples. You should also pay attention to possible discharge from the nipple. Palpation determines the location of any changes, size, consistency (hard or soft), sensitivity, mobility to the surface and skin, as well as possible pain with suspicious changes in the breast.
Mammography is an x-ray diagnostic examination of the breast. It is still the most accurate and widely used non-invasive method. Mammography is used for early detection and confirmation of diagnosis. In addition, mammography identifies possible multicentric tumors and clusters of microcalcifications specific to breast cancer. Today it is recommended that a woman have her first mammogram at age 40 (with a positive family history at age 35). Then mammograms are done every two years.
Breast ultrasound is very often used to diagnose cancer. It is less sensitive and specific than mammography, especially in postmenopausal women. This method is indicated for young women in whom glandular tissue predominates in the breast and is very helpful in distinguishing breast cysts from solid tumors. The results of breast ultrasound depend on the phase of the menstrual cycle.
Any suspicious breast changes require a biopsy. A breast biopsy is the removal of a tissue sample for pathological analysis, which means viewing under a microscope. The pathohistological result is the only reliable evidence of a malignant disease, such as breast cancer.
In addition to a breast biopsy, it is necessary to determine the involvement of the lymph node draining the breast area (sentinel node). Determination of lymph node involvement is necessary to assess the stage of the disease.

Diagnostics

After an external examination, a preliminary diagnosis is made, which must be confirmed by laboratory and instrumental examination. The same procedures will help distinguish cancer from benign formations. For this purpose the following is carried out:

Blood test - determines special substances produced in the presence of tumors. The same examination shows hormone ratios as a possible causative factor.
CT scan with contrast - shows the condition of the parenchyma, gives indirect ideas about the presence of compactions.
Ultrasound and MRI of the breast - these methods diagnose the condition of soft tissues and can detect the smallest lumps. Indispensable for fibrocystic mastopathy.
Biopsy is the removal of material for microscopic examination. It has high accuracy in differentiating the nature of the tumor.

Breast cancer - stage of disease

The stage of the disease is one of the main parameters for determining the treatment method and prognosis of the disease. This is expressed according to the TNM classification (T = tumor size, N = lymph node involvement, M = distant metastases.

Stages of the disease

Stage	Peculiarities
Stage I	Tumor less than 2 cm in diameter (T), axillary lymph nodes not affected (N), no distant metastases (M)
Stage II	Tumor less than 5 cm in diameter (T), with involvement of mobile regional lymph nodes (N), without distant metastases (M)
Stage III	Tumor of any size, with skin involvement or fixation along the chest wall (T), metastases in fixed axillary lymph nodes (N), without distant metastases (M)
Stage IV	Tumor of any size (T) with distant metastases (eg, liver, bone, or distant lymph nodes) (N) and (M)

Breast cancer - treatment

In the treatment of breast cancer the following is used:

surgery;
radiation therapy;
chemotherapy;
hormone therapy;
immunotherapy.

Surgery -

main treatment for breast cancer. Its goal is to remove tumor tissue and affected lymph nodes.

The type of surgery depends on the stage of the disease and can be:

A simple mastectomy
is a surgical procedure that removes all breast tissue (glandular and fatty tissue) and the nipples, but not the lymph nodes in the armpit. This operation is performed in cases where the cancer has not spread to the lymph nodes.
Radical mastectomy
- removal of the breast as in a simple mastectomy with removal of the lymph nodes in the armpit.
A reserve mastectomy
is a procedure in which only the part of the breast around the tumor is removed. When choosing a surgical intervention, it is always difficult to perform a sparing mastectomy. Unfortunately, this is not always possible due to the size and location of the tumor.

Radiation therapy

may be performed before or after surgery. It is performed before surgery to reduce swelling and the risk of local recurrence. The purpose of postoperative radiation is to destroy residual cancer cells and prevent recurrence of the disease. After gentle procedures, radiation therapy should always be carried out.

Adjuvant chemotherapy (chemotherapy after surgery) is given to women with diseased lymph nodes and to women at high risk (tumor larger than 1 cm).

Hormone therapy

used if the tumor is hormonally dependent. In 60–70% of cases, breast tumor growth is stimulated by sex hormones (estrogen and progesterone). Hormone-dependent tumors primarily occur in older women and are often less aggressive and well differentiated. Patients with a positive heart rate have better survival and the possibility of treatment with hormonal therapy, for example, the use of antiestrogen - tamoxifen.

Symptoms

The initial stages of the disease have virtually no symptoms. Often the disease is accidentally discovered during preventive procedures.

An alarming signal is a formation that can be palpated, or discharge from the nipple: bloody, purulent, serous. But there is no pain. It appears later, when distant metastases occur.

One of the signs of the disease is a modification of the pathological gland, breast deformation.

The tumor can affect skin changes by penetrating the subcutaneous tissue. Flattening, wrinkling, a “lemon peel” effect, marbling, redness, and ulceration occur.

Typical symptoms of the disease manifest themselves in the following forms:

Edematous-infiltrative – change in the size of the gland, change in skin color to marble, hyperemia;
Mastitis-like – breast hardening, body temperature rises;
Erysipelas - the appearance of foci similar to erysipelas;
Armored - wrinkling of the gland;
Paget's cancer - the nipple thickens, the skin becomes reddened, thickened, and scales and crusts are present.

Breast reconstruction after mastectomy (breast removal)

There are several breast reconstruction techniques, and the choice depends on the underlying disease and the age of the patient.

Primary breast reconstruction is performed simultaneously with the operation of the underlying disease, and secondary reconstruction means a subsequent operation after some time.

Indications for primary breast reconstruction are highly motivated patients in the first and second stages of the disease with an appropriate ratio of tumor size to breast size.

Contraindications to primary breast reconstruction include diabetes, obesity, smoking, cardiovascular disease and mental disorders. Chemotherapy and radiation therapy are not contraindications for primary breast reconstruction.

Breast reconstruction can be performed with a silicone implant, a tissue expander, or using your own tissue.

Relationship between cancer and age

There is a myth that breast cancer occurs only at a certain age. Alas, this is not true. Perhaps this opinion arose due to the difference in the results of diagnostic methods for different age groups. For example, the older the patient, the easier it is to see a tumor during mammography. With ultrasound diagnostics, everything is exactly the opposite: this method has proven to be most effective for people under 35 years of age.

It is safe to say that all age groups are at risk for breast cancer, and concomitant factors are more important than age. According to Woods' confirmed hypothesis, the tumor appeared more often in young women with two or more full-term pregnancies than in women without children. Also, the development of the tumor is influenced by changes in hormonal levels, which explains the high percentage of detected diseases in postmenopausal age and in cases where menstruation began before 12 years.

The age of the patient is of great importance for carrying out preventive measures related to ovarian cancer. According to research from the University of Carolina, if breast cancer was detected at age 50 or younger, this increases the risk of ovarian cancer by 4.3 times. However, in women over 50 years of age, this risk tends to zero.

Breast cancer - mortality and cureability

The percentage of women who survive five years or more after diagnosis depends on the stage of the disease as follows:

Stage	% of women surviving up to 5 years after surgery	% of women who do not survive 5 years after surgery
Ductal carcinoma in situ	95%	5%
Breast cancer stage I	87%	13%
Stage II breast cancer	75%	25%
Stage III breast cancer	45%	55%
Stage IV breast cancer	13%	87%

These percentages represent only the average value of the statistics, and no one can say which group (whether she will survive or not survive) a particular patient belongs to. The fight against breast cancer is long-term and depends on the initial stage of detection of the tumor, as well as other concomitant diseases and the condition of the body.

The average five-year survival rate for all patients (at all stages of the disease) in developed countries is about 75%.

The most important factors for breast cancer in terms of prognosis for treatment success are:

tumor size (large tumor – worse prognosis);
degree of malignancy and differentiation of the tumor (a higher degree and weaker differentiation means a worse prognosis);
damage to the axillary lymph nodes (the more affected lymph nodes, the worse the prognosis);
hormonal receptor status (negativity – worst prognosis);
age – younger patients (breast cancer in young girls – worse prognosis).

Thus, the success of treatment depends on at what stage of the disease the cancer is diagnosed (as with any other human malignant tumor). If the tumor is small, present in only one location, and has not spread to the lymph nodes, there is a high chance that only surgery will be required for a complete immediate cure. However, even such patients have a chance of recurrence because only one malignant cell that travels beyond the removed part of the breast through the blood is needed to further multiply and form a new tumor in the same or another breast.

That is why today a malignant tumor is spoken of as a chronic disease that is unpredictable and can always return. For the same reason, long-term regular examinations are necessary to monitor the patient's condition.

Stages of the disease

Classification of breast cancer by stage of development is carried out in accordance with the international system, which takes into account the size, condition of the primary malignant focus, the presence of immediate and distant metastases.

There are 4 stages in total:

0—node cells do not extend beyond the boundaries of the affected organ. This category includes non-infiltrating ductal, lobular carcinomas, as well as Paget's disease before signs of a tumor appear;
1 - the size of the tumor is no more than 2 cm, there are no metastases;
2 - the formation grows up to 5 cm, damage to the nearest lymph nodes (mammary or axillary) is possible with smaller node sizes;
3 - the size of the primary malignant lesion exceeds 5 cm, regional metastases are detected, the neoplasm grows into the skin, chest wall, and dermatological signs of cancer appear. Sometimes solitary distant lesions are present;

4 - the size of the tumor at this stage does not matter. It is easily palpated beyond the boundaries of the breast neoplasm, and ulcerations appear on the body. Metastases affect not only distant lymph nodes, but also various internal organs, where secondary malignant neoplasms are formed, consisting of cells from primary nodes.

When determining the stage of the disease, not only the size of the primary lesion of breast cancer is taken into account, but also the characteristics of its growth and localization. Thus, microinvasion is considered to be the penetration of abnormal cells into the basement membrane of the breast by a maximum of 2 mm. Multicentric cancer involves multiple compactions in one gland, bilateral - in both.

Breast cancer - support

The diagnosis of breast cancer will not leave anyone indifferent. As a woman tries to cope with shock and fear for her future, she is asked to make important decisions about treatment.

A psychological attitude in the fight against a cancerous tumor will help the body and doctors together defeat the malignant neoplasm.

Everyone finds their own way to cope with a cancer diagnosis. The following tips may help:

It's important to know everything you need to know about your form of cancer. Ask your doctor for details - type of cancer, degree of disease, hormonal receptor status. Find reliable sources of information about treatment options and don't trust publicist ploys. If the patient has high-quality and truthful information, it will be easier for her to make the right decision about treatment. However, some people do not want to know the details of their illness.
Talk to other women with the same diagnosis or visit breast cancer forums. You are not alone.
Keep your friends and family close, don't isolate yourself. When a woman tells her loved ones about the diagnosis, she will most likely receive many offers of help. Think of things you could use help with and don't be shy to ask. This communication makes us stronger.
Maintain intimacy with your partner. Talk to him about your feelings and insecurities.
Take care of your body. Get enough sleep every day. Eat plenty of fruits and vegetables. Make time for light exercise. Take more walks in the fresh air.
Avoid bad habits. Remove cigarettes and alcohol from your life. Avoid foods high in fat.

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Possible complications

Breast cancer in women is a dangerous disease, which is complicated by rapid progression and the occurrence of metastases to other organs and systems. This pathology can lead to complete removal of the organ, and in advanced cases, death.

Damage to the lymphatic system leads to the fact that, along with the lymph, pathological cells move further into the chest. The process, in rare cases, can affect the breasts on both sides. Ulcers and inflammation affect the skin, which can lead to infection.

In the absence of adequate treatment, the oncological process affects all organs. In this case, even surgical treatment will not give a positive result.

Possible postoperative complications:

soft tissue swelling;
curvature of the spine as a result of changes in load due to breast removal on one side;
motor dysfunction of the shoulder joint;
disruption of the immune system due to the removal of part of the lymph nodes.

All these painful conditions after surgery are corrected by drug treatment, exercise therapy and compliance with the doctor’s recommendations.

Modern treatment methods help to cope with the disease, provided that you consult a specialist in a timely manner.