Cancer is the scourge of our time. In 2010, the International Cancer Society conducted monitoring. His data is impressive. So, in the control year, 10 million people fell ill with cancer on the planet, and 8 million died from it. Doctors are worried by the fact that the number of people with cancer is growing year by year, despite all the efforts to combat it.
Oncology of lungs leads in the number of sick and dead. The second position is occupied by breast carcinoma. In Russia, this ailment came out on top among all oncological diseases in women. Counting the number of deaths from breast cancer is most sad for the reason that this disease can be completely cured if it is recognized in the first stages. To help women, now in many clinics they perform mammography. Some patients are even forced to undergo this test. But a frivolous attitude to this problem leads to a logical ending.
This article will consider the mechanism of development of breast carcinoma, the reasons for its occurrence and risk groups are named. We will also talk about diagnostic methods, treatment methods and prognoses.
Breast
In modern society, there is hardly any adult who has never seen a woman’s breast. However, not every woman knows about what structure she has. The mammary glands are located on the chest and attached to the pectoralis major muscle.
Regardless of size, they are surrounded by a fat layer that protects their inner region 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 has 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 units 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.
A large number of lymph vessels are located in the mammary glands, and a pronounced anastomizing connection exists between those located in one and the other glands. Scientists explain this very fact by the fact that a tumor that appears in one mammary gland, as a rule, is detected in another. All lymph vessels are connected to the lymph nodes surrounding the mammary gland. They take on the first “blow” of overgrown cancer cells.
Malignant tumor
Cancer is by no means an indicator of our time. This ailment was ill in ancient Egypt, and the first methods of its treatment were developed by the famous Hippocrates. He believed that it makes no sense to heal from this disease in its last stages, since the patient will die anyway.
Nowadays, 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 not reaching maturity. As a result, they give rise to similar underdeveloped clones, but apoptosis does not apply to them.
As a result of the formation of exorbitant clusters, “irregular” cells break through the membrane and begin to creep into neighboring parts of the body. There is no mistake. It is to creep in, as scientists have discovered in them the formation, similar to amoeba pseudopods (pseudopodia), with the help of which these cells can move independently. This is called invasion, and the disease is called invasive breast carcinoma. This process is already considered life-threatening to the patient, but it can still be stopped.
In the future, cancer cells are separated from a group of their own kind and are carried throughout the body with a blood stream. Where they linger, a new uncontrolled tumor growth begins, and the process itself is called metastasis. Medicine is powerless at this stage to cure the disease. Many cancer cells have a priority for metastases. For invasive breast carcinoma, these are lymph nodes (axillary and subclavian), lungs, skin, and spinal cord. Less commonly, metastases are detected in the spongy bones, brain, ovaries, and liver.
Causes
Scientists have been able to understand that cancer begins due to mutations in the cell. Genetic changes provoke these fatal metamorphoses (malignancies). What makes genes change while in the realm of speculation. It is generally accepted that the following factors influence the occurrence of cancer:
- Dysfunctional ecology.
- Heredity.
- Carcinogens that we inhale with air and consume with food.
- Smoking.
- Alcoholism.
- Individual microorganisms (e.g. cow leukemia virus).
- Radiation.
- Sun rays, if their exposure is too strong or prolonged.
All these factors can cause cancer of any organ, including breast cancer.
Invasive breast carcinoma (non-specific 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 affected by:
- Later (after 55 years) the onset of menopause.
- Smoking in his youth.
- The absence of childbirth and pregnancy throughout life (for middle-aged women).
- Early (up to 12 years) onset of menstruation.
- Cancer of the female organs (which has taken place in the life of the patient).
- Obesity.
- Hypertension.
- Diabetes.
- Long-term use of hormonal contraceptives.
Denua 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) is a carcinoma in the milk duct without invasion.
- Tis (LCIS) - lobular carcinoma without invasion.
- Tis (Paget) - Paget's disease.
- T1 - neoplasm up to 20 mm in size.
- T2 - tumor size from 20 to 50 mm.
- T3 - a value of more than 50 mm.
- T4 - any tumor size, but there are metastases in the skin, chest wall.
2. N - regional lymph nodes:
- Nx - evaluation not available.
- N0 - no metaztases in the lymph nodes.
- N1 - axillary lymph nodes already have metastases (levels I and II), but they are not yet joined together.
- N2 - metastases are already soldered in the lymph nodes, but they are levels I and II so far. 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 lymph system.
- N3 - in the lymph nodes (internal mammary, subclavian, axillary) there are metastases of the III level.
3. M - metastases distant from the chest:
- M0 - not determined.
- M1 - is and is determined.
Histology classification
In medicine, the term "histology" refers to the state of the tissues of the human body, their structure and features that are determined by biopsy or autopsy. Regarding histology, these types of carcinomas are distinguished:
- In situ in the milk duct.
- In situ in segments.
- Invasive in the duct.
- Invasive lobule.
- Tubular.
- Papillary.
- Medullary.
- Colloid (mucous cancer).
- With symptoms of inflammation.
- Squamous cell.
- Adenoid cystic.
- Juvenile (secretory).
- Apocrine.
- Kribroznaya.
- Cystic
- Apudoma.
- With osteoclast-like cells.
Molecular taxonomy
This classification has been recently introduced. It is based on the study of sets of molecular markers in each case of diagnosis of breast carcinoma. In essence, the subtypes distinguished in this classification are independent diseases that require specific therapeutic measures. It:
- Subtype A is luminal. Diagnosed in 45% of cases. It is considered an estrogen-dependent inactive tumor. Amplification of the HER2 protein is not observed. The forecast is favorable.
- Subtype B luminal. It is diagnosed in 18% of cases. It is considered an estrogen-dependent aggressive tumor. Amplification HER2 is. The prognosis is moderately unfavorable.
- The HER2 subtype is positive. It is observed in 15% of all breast cancer patients (breast cancer). The tumor is aggressive, estrogen-independent. Amplification of the protein is. The forecast is unfavorable.
- Subtype Triple negative. Diagnosed in 30-40% of women with breast cancer. The tumor is aggressive, estrogen-independent. Amplifications of the HER2 protein. The forecast is very unfavorable.
Estrogen is a specific female sex hormone. He is needed so that a woman can conceive and give birth to a baby. If this hormone is produced above normal, estrogen-dependent tumors begin to develop. The vast majority of them are benign, as they develop slowly, and rarely form metastases.
Other classifications
When making a diagnosis of breast cancer, oncologists distinguish these types of carcinomas:
- Specific type (general history, characteristic signs). Such a definition is very rarely indicated in the diagnosis, since the symptoms and nature of the manifestation of this type are similar for all types of breast cancer.
- Nonspecific type (may combine several histological species). Non-specific breast carcinoma is characterized by a non-standard course 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).
According to the degree of aggressiveness, invasive or infiltrating carcinoma of the mammary gland is divided into the following types:
- Gx - it is impossible to determine the differential degree.
- G1 - the tumor grows rapidly, but does not grow into neighboring tissues. It is highly differential. This means that its cells differ little from normal.
- G2 - “wrong” cells divide quickly, there are small (up to 5 mm) sprouts in neighboring tissues. Differentiality of the average level. Breast carcinoma G2 has a conditionally favorable prognosis, since in this case it is possible to achieve cure only if radical measures are taken and long-term treatment is taken.
- G3 cells are low-differential, but have not yet lost all the signs of a normal state.
- G4 - absolute cell differential. The forecast is extremely unfavorable.
Consider in detail some types of carcinomas.
Lobular breast cancer
Statistics report that lobular carcinoma of the breast is diagnosed in 20% of women. As the name implies, it develops in segments. At the first stages, this pathology does not manifest itself in any way. Moreover, it is rarely detected by performing a mammogram. Cytological methods to determine this form of the tumor is also difficult. Basically, doctors adhere to wait-and-see tactics in relation to such a carcinoma. This means that women should be regularly examined and carry out appropriate diagnostic tests.
The neoplasm is developing extremely slowly. While this process is in progress, the “wrong” cells do not leave the lobule region. Therefore, this form of cancer is recorded as a Tis tumor (LCIS), which means "sitting still." This can last from 6 to 25 years and is discovered by chance, for example, when treating a disease of the breast (not cancer) with a surgical method.
Initially, carcinoma in the lobule may develop for the following reasons:
- Heredity.
- Bad ecology.
- The use of hormonal drugs.
- Abrupt cessation of breastfeeding.
- Breast injuries.
- Radiation exposure.
- Late pregnancy.
- Obesity.
- Hypertension.
- Diseases of the organs responsible for the production of hormones.
- Diabetes.
- Frequent abortions.
- Hormonal disorders (especially with menopause).
All these reasons do not necessarily lead to lobular cancer, they are only risk factors.
Gradually developing, the disease reaches a stage called non-specific invasive breast carcinoma. 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 older than 45 years.
At first, the invasive form of carcinoma does not manifest intolerable pains, but it can already manifest itself as seals without clear boundaries, most often located in the upper chest from the armpits. Women can independently detect them on palpation.
With further development, patients may experience discoloration and wrinkling of the skin in the area of carcinoma, as well as dropping of the skin inside (retraction).
At later stages, the shape of the diseased breast changes, the lymph vessels become inflamed, and symptoms of damage to other organs by metastases 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 extremities (with metastases in the bone), in the back (with metastases in 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 (characterized by a large number of altered cells).
- Pleomorphic (types of "irregular" cells are different).
- Tubular lobular (forms tubular systems around the ducts and adjacent lobules).
- Lobular
- Solid (homogeneous cancer cells).
- Mixed.
Breast ductal carcinoma
This disease is diagnosed in 80% of breast cancers. From the name it is clear that this type of pathology is formed in the milk ducts. As with localization in lobules, the tumor does not manifest itself at the beginning of its development. It slowly grows in the cells of the internal lining of the duct, without leaving its borders. Therefore, according to the classification of TNM, it is recorded as a Tis type tumor (DCIS).
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 periods.
- Prolonged use of hormonal contraception.
Non-specific ductal carcinoma of the mammary gland has certain risk factors:
- Lack of history of breastfeeding.
- Breast fibroadenoma.
- Fibrocystic mastopathy.
Having reached stage G 2, breast carcinoma in the ducts begins to spread to neighboring tissues. At this stage, women may notice discharge from the nipples. They are purulent in nature (yellowish-green) or similar to a bloody succession. You can detect them by squeezing the nipple with your fingers. Also, at this stage, dense nodules are more clearly felt.
Subsequently, 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. At this point, peeling begins. Upon examination, the doctor discovers the so-called site syndrome. This means that the skin in the area of the carcinoma, taken by the fingers into the crease, spreads too slowly when it returns to its previous position.
At the 3rd stage, the nipple is retracted, the sore chest swells, is deformed. Metastases to the lymph nodes can provoke swelling of the hand, pain when performing actions.
The 4th stage is characterized by the presence of many metastases. The patient experiences discomfort and pronounced pain in organs affected by cancer cells.
The prognosis of non-specific invasive breast carcinoma at this stage is extremely poor. As a rule, patients undergo symptomatic treatment, maintenance therapy, analgesia with strong analgesics.
Diagnostics
Regarding breast cancer, the fate of women largely depends on themselves. Each doctor advises all women, starting from the age of 20, not to be lazy and to independently examine their mammary glands by palpation. Any seal, any nodule should cause an alarm. Also, women themselves can notice in themselves:
- Swelling of the lymph nodes in the armpits.
- Changing the shape and size of one breast compared to another.
- Nipple dropping.
- Sensation of unexplained 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 treatment at the clinic in the presence of at least one of the above symptoms.
To clarify the diagnosis are assigned:
- Mammography (survey, sighting).
- Ultrasound of the mammary gland.
- MRI
- If there is discharge from the nipple, take a smear.
- Blood test for tumor marker CA 15-3.
- Histological examination of the biopsy.
- Ultrasound and x-rays of other organs (with suspected metastasis).
Treatment features
After mutation, the cancer cells become similar to intelligent living creatures inventing ways to preserve their population. So, 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 of 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 surrounding tissue areas. Such surgeries have been performed for many years. In recent years, lumpectomy (removal of only a tumor) began to be introduced in some clinics. But this method has not yet proven itself.
The newest direction is cryomammectomy. It consists in exposing the tumor to very low temperatures, freezing it and removing it with a cryoprobe.
After the operation, chemotherapy (medication) and radiation therapy are usually prescribed. The first is designed to kill all the tumor cells in the body. The second is intended to affect areas of the body located near a remote organ.
If the patient has not yet developed invasive breast carcinoma of the non-specific type G2 and the tumor "sits in place", surgery can be replaced by hormone therapy. This is justified only in the presence of a luminal tumor of subtype A. Among the prescribed drugs:
- Tamoxifen.
- "Retrosol".
- Anastrozole.
- Exemestane.
The course of admission is from 5 to 10 years.
If the expressing HER 2 gene is detected in the tumor, targeted therapy is prescribed to patients. In this case, the drugs are prescribed:
- Trastuzumab.
- Pertuzumab.
- Lapatinib.
- CDK 4/6 path blockers.
For the treatment of bone metastases, bisphosphonate therapy is used. 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 down the growth of a cancerous tumor. Among them are broccoli, bell pepper, mint, caraway seeds, rosemary, soy, garlic, brown seaweed, green tea.
Breast Cancer: Predictions and Hopes
The statistics are somewhat ambiguous. So, at stage I of 5 years, 70-94% of patients live. With stage II - 51-79%. With III - 10-50%, and with IV - up to 11%. The difference in numbers is large, but after all, these percentages are the lives of people. But from these statistics, it can be concluded that during treatment in the early stages, survival is much higher.
Other information shows how treatment methods affect the outcome. So, after a mastectomy for 5 years, 85% live, and 10 years - 72% of patients, and after treatment in the complex (surgery, chemotherapy, radiation), these figures are 93% and 68%, respectively.
In 2018, Stanford University researchers tested a new cancer cure for 87 mice. The survival rate was 100%. The new drug, as it were, “wakes up” T-killers, which begin to respond to cancer cells and destroy them. Now the new drug is being tested in humans.