Cancer is the scourge of our times. In 2010, the International Society for Oncology conducted monitoring. His data is impressive. So, in the control year, 10 million people on the planet fell ill with cancer, and 8 million died from it. Doctors are alarmed by the fact that the number of people who are diagnosed with cancer is growing year by year, despite all the efforts made to combat it.
Lung cancer is the leader in the number of cases and deaths. The second position is occupied by breast carcinoma. In Russia, this disease came out on top among all cancers in women. Counting the number of deaths from breast cancer is the saddest thing for the reason that this disease can be completely cured if it is recognized in the early stages. To help women, mammograms are now performed in many clinics. Some patients are even forced to undergo this analysis. But a frivolous attitude to this problem leads to a natural ending.
This article will discuss the development mechanismbreast carcinomas, the causes of its occurrence and risk groups are named. We will also talk about diagnostic methods, treatment methods and prognosis.
Breast
In today's society, there is hardly a single adult who has never seen a woman's breasts. However, not even every woman knows what kind of structure she has. The mammary glands are located on the chest and are attached to the pectoralis major muscle.
Regardless of size, they are surrounded by a fatty layer that protects their inner area from mechanical damage. The body of the mammary glands consists of lobes located around the nipple. They can be from 15 to 20 units. Each of the large lobes consists of small lobules that are filled with microscopic alveoli. The space between the lobes and lobules is filled with connective tissue. It contains the milk ducts. They originate from the tops of the lobes and go to the nipple. Closer to it, some ducts merge, so only 12-15 of them open at the top of the nipple.
Breast carcinoma can develop in any part of the breast - in the duct, in the lobule, in the connective tissue, even in the alveoli. Depending on the location, the type of disease is determined and treatment is prescribed.
There are a large number of lymphatic vessels in the mammary glands, and there is a clearly defined anastomizing connection between the glands located in one and the other. Scientists use this feature to explain the fact that a tumor that has appeared in one mammary gland, as a rule, is also detected inanother. All lymph vessels are connected with the lymph nodes surrounding the mammary gland. They take the first "strike" of overgrown cancer cells.
Malignant tumor
Cancer is by no means an indicator of our times. This disease was ill in ancient Egypt, and the first methods of its treatment were developed by the famous Hippocrates. He believed that there was no point in healing this disease in its last stages, since the patient would die anyway.
In our time, there is a lot of information about cancer. So, it is now reliably known that a malignant tumor can begin with a single cell, which, as a result of mutations, acquires a kind of immortality. Normal cells during the period of their life carry out a number of divisions and die (natural apoptosis occurs). Cancer cells divide randomly, often before reaching maturity. As a result, they give rise to similar underdeveloped clones, but apoptosis does not apply to them.
As a result of the exorbitant accumulations formed, the “wrong” cells break through the membrane and begin to spread to neighboring areas of the body. There is no error. It is to spread, as scientists have found in them formations similar to amoeba prolegs (pseudopodia), with the help of which these cells are able to move independently. This phenomenon is called invasion, and the disease is called invasive breast carcinoma. This process is already considered dangerous for the patient's life, but it can still be stopped.
In the future, cancer cells are separated from a group of their own kind and with blood flowspread throughout the body. Where they linger, a new uncontrolled growth of the tumor begins, and the process itself is called metastasis. At this stage, medicine is still powerless to cure the disease. Many cancer cells have a priority direction of metastases. For invasive breast carcinoma, these are lymph nodes (axillary and subclavian), lungs, skin, and spinal cord. Less commonly, metastases are found in spongy bones, brain, ovaries, liver.
Reasons
Scientists have managed to understand that cancer begins due to mutations in the cell. These fatal metamorphoses (malignancies) are provoked by genetic changes. What causes genes to change is still a matter of conjecture. It is generally accepted that the following factors influence the occurrence of cancer:
- Unfavorable ecology.
- Heredity.
- Carcinogens that we breathe in the air and consume with food.
- Smoking.
- Alcoholism.
- Individual microorganisms (e.g. bovine leukemia virus).
- Radiation.
- The sun's rays, if their exposure is too strong or prolonged.
All these factors can cause cancer of any organ, including breast cancer.
Invasive breast carcinoma (nonspecific or specific) is diagnosed in women of mature age (after 65 years) about 150 times more often than in young women 25-30 years old. Thus, age-related changes are also a risk factor. In addition, the development of breast cancer is influenced by:
- Later (after 55years) menopause.
- Smoking in youth.
- No lifetime childbirth or pregnancy (for middle-aged women).
- Early (before 12 years) onset of menstruation.
- Cancer of the female organs (occurred in the patient's life).
- Obesity.
- Hypertension.
- Diabetes mellitus.
- Long-term use of hormonal contraceptives.
Denois classification
There are several generally accepted classification systems for determining the type of breast cancer.
One of them is called TNM. Designed by Pierre Denois. The abbreviation means Tumor - Nodus - Metastasis. In Russian, respectively, "tumor - node - displacement." This classification shows the location of the neoplasm, its condition, size, presence and nature of metastases:
1. T - primary tumor:
- Tx - Unavailable for evaluation.
- T0 - no signs of primary neoplasm.
- Tis - the tumor "sits in place" (no invasion). In English it sounds like "pak in situ".
- Tis (DCIS) - carcinoma in the milk duct without invasion.
- Tis (LCIS) - carcinoma in the lobule without invasion.
- Tis (Paget) - Paget's disease.
- T1 - neoplasm up to 20 mm in size.
- T2 - tumor size from 20 to 50 mm.
- T3 - value over 50mm.
- T4 - any tumor size, but there are metastases in the skin, chest wall.
2. N - regional lymph nodes:
- Nx - Unavailable for evaluation.
- N0 -no metastases to lymph nodes.
- N1 - there are already metastases in the axillary lymph nodes (levels I and II), but they are not yet soldered together.
- N2 - metastases are already soldered in the lymph nodes, but they are still I and II levels. Also, category N2 is set if an enlarged mammary internal lymph node is detected, but there are no clinical manifestations of metastases in the axillary lymphatic system.
- N3 - there are level III metastases in the lymph nodes (internal mammary, subclavian, axillary).
3. M - metastases distant from the breast:
- M0 - not defined.
- M1 - available and defined.
Histological classification
In medicine, the term "histology" refers to the state of the tissues of the human body, their structure and features, which are determined by biopsy or autopsy. Regarding histology, the following types of carcinomas are distinguished:
- In situ in the milk duct.
- In situ in slices.
- Invasive in the duct.
- Invasive in the lobule.
- Tubular.
- Papillary.
- Medullary.
- Colloid (mucous cancer).
- With symptoms of inflammation.
- Squamous.
- Adenoid cystic.
- Juvenile (secretory).
- Apocrine.
- Cribrose.
- Cystic.
- Apudoma.
- With osteoclast-like cells.
Molecular taxonomy
This classification was introduced recently. It is based on the study of sets of molecular markers in each case of diagnosis of breast carcinoma. ByIn essence, the subtypes distinguished in this classification are independent diseases that require specific therapeutic measures. This is:
- Subtype A luminal. Diagnosed in 45% of cases. It is considered an estrogen-dependent inactive tumor. Amplification of the HER2 protein is not observed. The outlook is favorable.
- Subtype B luminal. Diagnosed in 18% of cases. It is considered an estrogen-dependent aggressive tumor. There are HER2 amplifications. Forecast moderate.
- HER2 subtype positive. It is observed in 15% of all patients with BC (breast cancer). The tumor is aggressive, estrogen-independent. Protein amplification is present. The prognosis is poor.
- Subtype Triple negative. It is diagnosed in 30-40% of women with breast cancer. The tumor is aggressive, estrogen-independent. Amplification of the HER2 protein. The prognosis is very poor.
Estrogen is a specific female sex hormone. It is needed so that a woman can conceive and give birth to a baby. If this hormone is produced above the norm, estrogen-dependent tumors begin to develop. The vast majority of them are benign, as they develop slowly, and metastases rarely form.
Other classifications
When making a diagnosis of breast cancer, oncologists distinguish the following types of carcinomas:
- Specific type (general history, characteristic features). Such a definition is very rarely indicated in the diagnosis, since the symptoms and manifestations of this type are similar in all types of breast cancer.
- Non-specific type (can combine several histological types). Breast carcinoma of a nonspecific type is characterized by a non-standard pattern of flow, which complicates the diagnosis. The treatment of such breast cancer requires adjustment according to the symptoms and behavior of cancer cells.
- Pre-invasive ("wrong" cells multiply rapidly, but do not go beyond the affected area).
- Invasive (cancer cells spread beyond the original affected area).
Based on the degree of aggressiveness, invasive or infiltrating breast carcinoma is divided into the following types:
- Gx – differential power cannot be determined.
- G1 - the tumor grows rapidly, but does not grow into neighboring tissues. It is highly differential. This means that her cells are little different from normal.
- G2 - "wrong" cells divide quickly, there are small (up to 5 mm) sprouting into neighboring tissues. Differentiality of the middle level. G2 breast carcinoma has a conditionally favorable prognosis, since in this case a cure can be achieved only if drastic measures and long-term treatment are taken.
- G3-cells are low-differential, but have not yet lost all signs of a normal state.
- G4 – cell differentiation is absolute. The prognosis is extremely unfavorable.
Let's take a closer look at some types of carcinomas.
Lobular breast cancer
Statistics reports that lobular carcinoma of the breast is diagnosed in 20% of women. As the name suggests,it develops in lobules. At the first stages, this pathology does not manifest itself in any way. Moreover, it is rarely detected by mammography. Cytological methods to determine this form of tumor is also difficult. Basically, doctors adhere to expectant-observational tactics in relation to such carcinoma. This means that women should have regular check-ups and appropriate diagnostic tests.
The neoplasm develops extremely slowly. While this process is going on, the “wrong” cells do not leave the area of the lobule. Therefore, this form of cancer is recorded as a Tis tumor (LCIS), which means "sitting in place." This can last from 6 to 25 years and is discovered by chance, for example, during the treatment of a breast disease (not cancer) with a surgical method.
Carcinoma in the lobule may initially develop for the following reasons:
- Heredity.
- Bad environment.
- Use of hormonal drugs.
- Abrupt cessation of breastfeeding.
- Breast injury.
- Radiation exposure.
- Late pregnancy.
- Obesity.
- Hypertension.
- Diseases of the organs responsible for the production of hormones.
- Diabetes mellitus.
- Frequent abortions.
- Hormonal disorders (especially with menopause).
All these causes do not necessarily lead to lobular cancer, they are only risk factors.
Gradually developing, the disease reachesstage, called invasive breast carcinoma of a non-specific type. This means that the "wrong" cells are selected outside the lobule. Often they form several foci in one breast or are detected immediately in both mammary glands. The main risk group is women over 45.
The invasive form of carcinoma at first does not manifest with unbearable pain, but it can already manifest itself as seals without clear boundaries, located most often in the upper chest from the side of the armpits. Women can detect them on their own by palpation.
With further development, patients may experience discoloration and wrinkling of the skin in the area of carcinoma, as well as retraction of the skin inward (retraction).
In the later stages, the shape of the diseased breast changes, lymphatic vessels become inflamed, symptoms of metastases in other organs are added. If cancer cells have affected the milk ducts, purulent or bloody discharge appears from the nipple. Women feel weakness, lack of appetite, lose weight, complain of pain in the limbs (with bone metastases), in the back (with metastases to the spine), headaches and neurological disorders (damage to brain cancer cells), shortness of breath, cough with hemoptysis (malignant cells in the lungs).
Often this disease is diagnosed as a non-specific type of breast carcinoma, because it can combine the following forms:
- Alveolar tumor (distinguished by a large number of altered cells).
- Pleomorphic (types"wrong" cells are different).
- Tubular-lobular (forms tubular systems around the ducts and adjacent lobules).
- Lobular.
- Solid (cancer cells are homogeneous).
- Mixed.
Ductal carcinoma of the breast
This disease is diagnosed in 80% of cases of breast cancer. From the name it is clear that this type of pathology is formed in the milk ducts. As with localization in the lobules, at the beginning of its development, the tumor does not manifest itself in any way. It slowly grows in the cells of the inner lining of the duct, without leaving its borders. Therefore, it is classified as a Tis tumor (DCIS) in the TNM classification.
It can develop in women of all ages, including childbearing.
Possible causes may be factors common to all types of breast cancer:
- Heredity.
- Ecology.
- Radiation.
- Late pregnancy.
- Early period.
- Long-term use of hormonal contraception.
Ductal nonspecific breast carcinoma has some risk factors:
- No history of breastfeeding.
- Fibroadenoma of the breast.
- Fibrocystic mastopathy.
After reaching stage G 2, breast carcinoma in the ducts begins to spread to neighboring tissues. At this stage, women may notice discharge from their nipples. They are purulent (yellowish-green) or look like bloody ichor. You can find them by squeezing the nipple with your fingers. Also at this stage more explicitlydense nodules are palpable.
Later, some women develop sores in the areola of the nipple.
By the end of the 2nd stage, the breast skin changes color from flesh to pink, then red and burgundy. This is where peeling starts. On examination, the doctor discovers the so-called platform syndrome. This means that the skin in the area of the carcinoma, taken in a fold with fingers, straightens out too slowly when it returns to its previous position.
At the 3rd stage, the nipple is retracted, the diseased breast swells, deforms. Metastases in the lymph nodes can provoke swelling of the arm, pain when performing actions.
4th stage is characterized by the presence of many metastases. The patient experiences discomfort and pronounced pain in the organs affected by cancer cells.
The prognosis of non-specific invasive breast carcinoma at this stage is extremely unfavorable. As a rule, patients receive symptomatic treatment, supportive care, pain relief with strong analgesics.
Diagnosis
With regard to breast cancer, the fate of women largely depends on themselves. Each doctor advises all females, starting from the age of 20, not to be lazy and independently examine their mammary glands by palpation. Any seal, any knot should cause alarm. Also, women themselves can notice in themselves:
- Swollen lymph nodes in the armpits.
- Changing the shape and size of one breast from another.
- Sinkingnipple.
- Feeling of inexplicable discomfort in the mammary glands.
These phenomena may indicate the onset of the disease. The prognosis of breast carcinoma in the vast majority of cases depends on the woman's early visit to the clinic in the presence of at least one of the above symptoms.
To clarify the diagnosis are assigned:
- Mammography (overview, sighting).
- Breast ultrasound.
- MRI.
- If there is discharge from the nipple, take a swab.
- Blood test for oncomarker CA 15-3.
- Histological examination of the biopsy.
- Ultrasound and X-ray of other organs (if metastasis is suspected).
Features of treatment
After a mutation, cancer cells become like intelligent living beings, inventing ways to maintain their population. Thus, cancer cells produce substances that block anti-cancer immunity, develop mechanisms that allow them to elude killer cells.
Taking into account all these features, in most cases, the main method of treatment for invasive non-specific breast carcinoma (G2 category and above) is a mastectomy. This concept means the removal of the problematic mammary gland together with the tissue surrounding it. Similar surgeries have been performed for many years. In recent years, some clinics have begun to introduce lumpectomy (removal of only the tumor). But this method has not justified itself yet.
The newest direction iscryomammoctomy. It consists in exposing the tumor to very low temperatures, freezing it and removing it with a cryoprobe.
After the operation, as a rule, chemotherapy (treatment with medicines) and radiation therapy are prescribed. The first is designed to kill all tumor cells in the body. The second is designed to affect parts of the body that are close to the remote organ.
If the patient has not yet developed invasive non-specific breast carcinoma G2 and the tumor is "sitting in place", surgery can be replaced by hormonal therapy. This is justified only in the presence of a subtype A luminal tumor. Among the prescribed drugs:
- Tamoxifen.
- Retrozol.
- "Anastrozole".
- Exemestane.
The admission course is from 5 to 10 years.
If a tumor expressing the HER 2 gene is found, patients are given targeted therapy. In this case, drugs are prescribed:
- Trastuzumab.
- Pertuzumab.
- Lapatinib.
- CDK 4/6 path blockers.
Bisphosphonate therapy is used to treat bone metastases. The main drug is Clodronate. You need to take it from 2 to 3 years. The daily dose is 1600 mg.
In parallel, many patients use traditional medicine methods. There are many herbs and foods that slow the growth of cancerous tumors. Among them are broccoli, bell pepper, mint, cumin, rosemary, soy, garlic, kelp, green tea.
Breast carcinoma:predictions and hopes
The data of the extras is somewhat ambiguous. Thus, 70-94% of patients live at stage I for 5 years. At stage II - 51-79%. With III - 10-50%, and with IV - up to 11%. The gap in numbers is large, but behind these percentages are the lives of people. But from these statistics, we can conclude that with treatment in the early stages, the survival rate is much higher.
Other information shows how the treatment methods affect the result. So, after a mastectomy, 85% live for 5 years, and 72% for 10 years, and after complex treatment (surgery, chemotherapy, radiation), these figures are 93% and 68%, respectively.
In 2018, Stanford University researchers tested a new cancer drug on 87 mice. Survival was 100%. The new drug, as it were, “wakes up” T-killers, which begin to react to cancer cells and destroy them. The new drug is now being tested in humans.
