Breast cancer: symptoms, signs and treatment
Breast cancer is the most common cancer in women. The tumor consists of undifferentiated malignant cells that replace glandular tissue. The relevance of the disease increased in the late seventies of the last century.
The disease was characterized by a primary lesion of women over the age of fifty years. The peculiarity of modern pathogenesis is a disease in the child-bearing age.
How many live with breast cancer?
This question is of interest to all patients admitted to the oncologic dispensary. He is asked to find out the truth, even if it is terrible.
Any doctor knows that the prognosis of the outcome of the disease should be approached carefully. There are examples of inhibition of carcinogenesis of advanced stages and accelerated development of breast cancer detected in the early stages.
However, there are more chances for recovery in a patient with an early operable form of oncology, apart from:
- individual characteristics (age, the presence of comorbidities, support, and understanding of relatives and friends, set to fight for life)
- efficacy and timeliness of treatment.
There are cases of breast preservation in the detection of pathogenesis in the early stages of the disease. Oncologists sometimes decide to remove the breast. This is unpleasant, but not fatal. The support of loved ones is important.
When pathogenesis with metastases to other parts of the body, the prognosis is cautious, it is necessary to fight, because it is possible to suppress the growth of abnormal cells even at this stage.
The first signs of breast cancer
Women often experience breast problems in the form of nodular or extensive seals and other signs that are frighteningly similar to oncology. Fortunately, not all formations are malignant.
Chest pains and seals accompany:
- Mastitis – inflammatory diseases
- Mastopathy – small (nodular), extensive (diffuse) seals
- Fibroadenoma is a benign neoplasm.
Mastitis is an inflammation of a functioning gland of an infectious or traumatic nature. In some cases, find a connection with mastopathy, unrelated to lactation.
General characteristics of mastitis. The first to give birth are women who rarely give birth to young women. The disease is associated with the entry of banal microflora (staphylococcus, streptococcus) through the cracks of the nipples into the gland, hormonal disruptions, hypothermia, injury, improper attachment of the baby. Risk group: primipara women.
Signs of mastitis:
- Constriction in the chest, initially diffuse
- Arching pain aggravated by feeding
- Increase in local and general temperature
- The formation of a purulent cavity and nodular induration is possible
- Discharge from the nipple during lactation (liquid, viscous, purulent, bloody).
It differs from oncology mastitis by a quick debut associated with the above-mentioned reasons, which are determined during the patient’s survey and during the history taking.
Mastopathy is not an inflammatory disease, it is associated with abnormal growth of the alveoli and the ducts of the breast under the influence of hormonal imbalance – increased levels of estrogen, prolactin, decrease in progesterone in the blood and tissues of the gland. There are modular and diffuse forms of mastopathy. Due to tissue proliferation, this disease is called fibrocystic pathology. Risk group: women over 35 years old.
Signs of mastopathy:
- When palpating compaction, resembling grains (nodules) or cords (diffuse lesion).
- Perhaps a combination of pathology with a violation of menstruation or with menopausal changes of the body
- The pain develops gradually with increasing seals
- With prolonged course, symptoms of mastitis may join.
Fibroadenoma is a benign glandular tissue that has an unclear etiology. There are mature fibroadenomas (the shape contours well) and immature (the shape is friable). Some formations have a tendency to rebirth. Risk group: women from 20 years.
Signs of fibroadenoma:
- Single or multiple chest seals
- Pain and other signs are often absent.
It is advisable to contact a mammologist for advice.
The technique includes superficial and deep palpation of the mammary glands with both hands simultaneously.
The reason for the appeal to the mammologist is the identification of:
- Focal or diffuse chest tightness
- Deformations with apparent asymmetry
- Retraction of breast or nipple areas
- Peeling, crusts, nipple erosion and areola
- Pain in the armpit
- Discharges, including bloody
- Swelling of the chest in the form of cellulite – lemon peel
- Redness of the skin.
Other symptoms of breast cancer
In order to clarify the primary symptoms, the doctor conducts an additional examination, starting with a patient survey, examination, and palpation. The main task of a mammologist at the stage of physical examination is to preliminarily determine a benign or malignant course of the disease.
Difficulties in diagnosis are made during the examination of a volumetric organ, seals of less than one centimeter, fibrous adhesions, and inflammations.
The doctor pays attention to:
- The nature of the seals
- The shape, size of the nipples and areola around them
- The presence or nature of the discharge
- Wrinkled skin
- limited intake of skin in the form of the navel
- Resizable regional lymph nodes.
The following description of the seals suggests a malignant course of the disease. Clinical symptoms are necessarily confirmed by instrumental and laboratory tests.
Detect one or several nodes that are clearly contoured, often painless, dense consistency, limited mobility, with wrinkled skin retreats over the tumor site. In the armpit lymph nodes are well palpated. In the later stages, the skin takes on the appearance of lemon peel, ulcerations form, the nipple thickens.
In this case, several sealing options can be detected. In some cases, they resemble the acute form of mastitis or mastopathy.
There are four options for diffuse compaction:
- Puffy. Sometimes develops during pregnancy and breastfeeding. Typical breast seal. The skin is swollen, soaked with infiltrate, hyperemic, resembles a lemon rind. The cause of edema is the compression of the milk ducts by infiltration.
- Carapace. It is characterized by tissue infiltration. Pathogenesis can spread to the chest wall. The skin is dense, bluish-red, sedentary. Groping for multiple nodules. Ulcerations and crusts in the form of a shell are found, the skin shrinks.
- Similar to erysipelas of the skin. Focal redness is a characteristic feature. The edges of the hyperemic area, swollen with uneven edges, extend to the skin of the chest wall. It proceeds with fever up to 40 ° C. Poor treatment.
- Like mastitis. The affected area is enlarged, the skin is hot, reddened, tense. The tumor is dense, weakly mobile, palpable in large areas. Pathogenesis spreads rapidly, often accompanied by fever.
It looks like psoriasis or eczema. In contrast, they are accompanied by strong redness of the skin, engorgement of the nipple and areola. On the skin of the nipple and areola dry, then weeping crusts and scabs are formed, and under them wet granulations. Carcinogenesis spreads through the milk ducts deep into the body of the gland.
Causes of Breast Cancer
The natural causes of breast cancer are:
- The high rate of physiological regeneration and death (apoptosis) of glandular tissue cells and the subsequent formation of new cells. The more young cells are formed, the higher the risk of mutations – this is the basis of the modern understanding of carcinogenesis;
- High dependence of gland cells on the hormonal background during the life of a woman from menarche to menopause. The number of female sex hormones in the tissues of the mammary gland is many times greater than the level of such steroids in the blood.
Men do not have such a fatal combination – labile hormonal background and a high rate of renewal of glandular cells.
This is probably why breast cancer:
- In men, it is extremely rare, although the histological structure of gland cells in men and women is absolutely identical;
- In women, the frequency of cancer does not depend on the amount of glandular tissue, it can equally often occur in women with small and large breasts, which also indicates the hormonal nature of breast cancer.
Pathological mutations of cells occur every second in every person, regardless of his state of health and gender. Moreover, not all people fall ill with cancer (including breast cancer).
Endogenous causes of breast cancer
The risk of breast cancer are women aged 30-70 years who have a history of:
- Early puberty or late menopause;
- Chronic gynecological diseases;
- Hormonal disorders (diabetes, hypothyroidism, obesity, and others);
- A similar disease in blood relatives;
- Long-term use of birth control pills;
- Long-term hormone replacement therapy;
- Numerous abortions and miscarriages;
- Irregular sex or prolonged lack of relaxation after sex;
- The absence of children or late motherhood.
Exogenous causes of breast cancer
There are still discussions about the influence of external (exogenous) causes. They are probably of concomitant significance and are a cumulative factor of the trigger mechanism of carcinogenesis.
Their specific effect on the development of breast cancer has not been proven, but they accurately stimulate the development of oncology in combination with other causes.
Exogenous causes include:
- Chest injuries;
- Ionizing radiation;
- Chemical substances;
- Smoking and alcohol.
Injury in the area of the mammary gland is a possible cause of cancer at the site of damage to the glandular tissue. It has been proven that ionizing radiation also has a serious impact on the development of this type of disease, like smoking, and alcohol abuse, although the relationship has not been reliably established, it is not rejected.
Chemical substances. In the literature, there are references to the effect of certain chemicals on the production and utilization of female sex hormones – estrogen. It is known that estrogens and their metabolites are involved in breast carcinogenesis. Elevated levels of estrogen in the urine are one of the diagnostic criteria for making a diagnosis of estrogen-dependent cancer.
Caffeine is often cited as a specific stimulant for estrogen-dependent carcinogenesis. Coffee is a common drink, so its effect on the body in cancer is interesting.
Caffeine is part of:
- Natural coffee
- Freshly brewed tea
- Mate – a tonic drink from Argentina and some Latin American countries;
- Guarana – Brazilian tonic.
Caffeine is an alkaloid from the group of methylxanthines. Drugs in this group are used to treat asthma, improve tone in lung diseases and diseases associated with edema, as a diuretic. The anti-cancer effect of theophylline and pentoxifylline is well known – these are drugs from the group of methylxanthines.
A similar anti-cancer effect of caffeine was confirmed by Swedish scientists from the University of Lande and Malmö, who studied the CYP1A2 gene and its alleles – A / A, A / C, C / C. It is established that caffeine with different intensity inhibits the development of breast cancer in all groups of subjects. 15% of women who do not drink coffee have estrogen-independent cancer, which is difficult to treat.
Thus, caffeine is not related to estrogen-dependent forms of breast cancer.
Types of breast cancer
Nosological forms of cancer are divided into precancerous or non-invasive (in situ), invasive ductal and lobular. Breast cancer is associated with the level of estrogen and progesterone in the tissues of the breast, as well as with the presence of a specific tumor protein HER2 / neu.
Hormone-Dependent Breast Cancer
Due to the peculiarities of the physiology, the woman’s body is under hormonal pressure much stronger than the male one. Important functions are hormones, produced primarily by the ovaries – estrogen, progesterone, pituitary – LH, FSH. At the same time, there are regular hormonal changes associated with natural physiological processes.
Against the background of modern life, the number of risks associated with the imbalance of the hormonal status has increased many times. First of all, this is the widespread use of methods for the endocrine regulation of fertility. Some factors were mentioned at the beginning of the article.
It has been observed that in many forms of breast hyperplasia, endocrine disorders are observed, as well as a very high level of estrogen, prolactin against the background of a decrease in progesterone level. This ratio is maintained in the clinical manifestation of breast cancer. Predominantly estrogen-dependent and predominantly progesterone-dependent forms of breast cancer.
Hormonal imbalances with a good effect are treated, on average, in one-third of the patients with both forms of cancer using endocrine therapy. The effectiveness of the sensitive group reaches 75%.
Along with the long-term use of hormones – analogs of gonadotropin-releasing hormone, the regulation of ovarian function can be carried out by physical methods (radiation exposure) and surgical castration.
Negative breast cancer
The most severe form of breast cancer. Clinically proceeds in a pathogenesis similar to other forms of cancer. Differs in the complexity of treatment. To determine this type of cancer can only laboratory molecular genetic studies. The classification was put into practice after 2000. In medical practice, this disease is usually classified as triple negative breast cancer. This form of cancer is detected in every third patient, from 27 to 39% of those examined. Ultrathin studies have established the presence of cancer that has receptors for one of the three proteins in the body:
- specific tumor protein.
Three times negative cancer is characterized by the presence of cells that do not have receptors for all three proteins. As a result, carcinogenesis is reminiscent of a fight with a dragon, which constantly eludes the pursuer. In recent years, doctors have found effective ways to affect the body in this form of the disease.
Luminal breast cancer
It belongs to the group of estrogen-dependent oncological diseases of the mammary gland. There are two forms – type A and type B.
Type A luminal cancer
It occurs in women during menopause. At this age, it is found in 30-40% of the observed cases.
- well perceive estrogen and progesterone cells;
- insensitive to the cell growth marker of oncocytes of the mammary gland Ki67;
- cells of a specific tumor protein are not perceived at all, the histochemical designation is HER2 / neu.
Patients with type luminal cancer respond well to hormone therapy with an estrogen antagonist, tamoxifen, as well as aromatase inhibitors. Aromatase is an adrenal enzyme that is involved in the transformation of testosterone into estrogen. A high survival rate, a low recurrence rate is recorded.
Type B luminal cancer
Diagnosed among young women of childbearing age. Approximately 14-18% of estrogen-dependent cancer patients have type B.
Accompanied by metastases to the lymph nodes, high recurrence rate. The disease is usually difficult to chemotherapy and hormone therapy. Only in some cases, it is possible to suspend the growth of cells with the help of a course of immunotherapy with the drug trastuzumab. Trastuzumab is a human monoclonal antibody to the specific tumor protein HER2 / neu. Thus, under certain indications, specific immunity is stimulated for the antigen of the corresponding clone.
Stages of Breast Cancer
The division of breast cancer into stages, depending on the severity of pathogenesis, is rather arbitrary. Cancer is a multifactorial disease; the degree of damage and tumor volume are not the main criteria for assessing the severity of the disease.
Meanwhile, the stages of breast cancer in the medical literature are referred to as:
- tumor size T 1, T 2, T 3, T 4 ;
- the involvement in the pathogenesis of regional lymph nodes N 0, N 1, N 2, N 3.
- the presence of distant metastases – M 0 , (absent) M 1 (available).
- Designations are also available in early non-invasive tumors, here we will not indicate them.
Stage 1 breast cancer
An initial breast tumor can be described as follows:
- T 1 (size up to 2 cm);
- N 0 ( metastases of regional lymph nodes are absent);
- M 0 (distant metastases are not detected).
Stage 2 breast cancer
A mammary gland tumor in the second stage of pathogenesis can be described as follows:
- T 2 (size from 2 to 5 cm);
- N 1 detect metastases in lymph nodes I, II, damage to one or two lymph nodes on the one hand. Nodes are palpated, as separate educations;
- M 0 or M 1 single distant metastases are possible.
Stage 3 Breast Cancer
A mammary gland tumor in the third stage of pathogenesis can be described as follows:
- T 3 (size over 5 cm);
- N 2 metastases in the lymph nodes of the axillary I, II level are detected, on the one hand as a single package, or the lymph nodes near the mammary gland are enlarged to a detectable size (in the absence of changes in the axillary lymph node).
- M 0 or M 1 are absent or distant metastases exist.
Stage 4 breast cancer
Breast tumor in the fourth stage of pathogenesis can be described as follows:
- T 4 the size of the tumor does not matter, it is determined outside the breast and on the skin of the breast, it is accompanied by ulcerations, nodules;
- N 3 – metastases on both sides of the chest level III, palpable under the mammary gland, in the axillary and supraclavicular space.
- M 1 multiple distant metastases.
Variants of these numerical designations are possible, as well as additional digits to clarify the description.
Breast Cancer Diagnosis
By minimally invasive diagnostic methods include mammography – an option of X-ray, ultrasound diagnosis, elastography, magnetic resonance imaging. Invasive – biopsy and further histological and cytological examination of alveolar cells.
The most common method in our country is a radiograph (mammogram) in two projections. The study is recommended in accordance with the individual menstrual cycle.
In recent years, with the introduction of new methods, doubts arise about the diagnostic value of mammography. This is due to additional X-rays with regular examinations and dubious results in fibrous growths, the presence of breast implants, small tumor size. In some cases, the diagnostic accuracy of the results is reduced to 6-40%.
Meanwhile, using this method, you can get the primary, secondary and indirect symptoms of breast proliferation. The diagnostic value is based on the identification of calcinates (microcalcifications) – calcium salts, which are clearly visible against the background of the alveoli and ducts.
Primary (important) symptoms:
- Contrast area in the picture;
- Irregular edges (rays, tubercles or calcinates and microclimates);
- Limited location as single formations or clusters;
- Size from 0.5 mm and below.
There are three degrees of contouring with mastopathy, the third (severe) degree is transitional between benign and malignant:
- The first (easy) degree. In the picture, the prevalence of shadows characteristic of the adipose tissue.
- Second (medium) degree. The picture shows the same degree of shading of areas characteristic of adipose, glandular and connective tissue.
- The third (severe) degree. The contours of the predominantly glandular tissue are visible; no shading characteristic of the adipose tissue. This should be alarming, perhaps the tumor in the picture does not contour.
Analysis of gene expression levels
Analysis of the level of gene expression makes it possible to estimate the probability of a relapse of the disease. This study should be carried out in order to resolve the issue of the need for chemotherapy. Relapse of the disease occurs on average in 10% of women, and chemotherapy is prescribed to the vast majority, which adversely affects the health of patients. This analysis will determine the women for whom chemotherapy is really needed.
Other types of diagnostics
Physical examinations include:
- Breast ultrasound and elastography
- MRI of the breast
- Physical research
Breast Cancer Treatment
Breast cancer treatment comes down to surgery. When the process is localized, getting rid of the disease involves chemotherapy. Hormonal supportive treatment with drugs such as Tamoxifen and aromatase inhibitors is performed with positive estrogen-dependent cancer.
The tactics of treatment of breast cancer, consecrated in the article, was developed by the joint efforts of diversified doctors. The work has been used worldwide protocols for the treatment of women with a similar disease. Treatment, depending on the stage of the disease, the age of the patient, the nature of the tumor will vary. Used immune, radiation and chemotherapy.
To begin with, doctors evaluate what stage the disease is at. If it is an early stage of the disease, then local treatment is possible. In the event that the tumor has metastasized and lymph nodes and other organs have been involved in the pathological process, then, as a rule, only systemic cancer treatment is performed.
Surgical treatment of breast cancer
Depending on the nature of the tumor, on the extent of the process, it is enough to remove only the tumor itself. Although it may be necessary to remove some of the surrounding tissue. Sometimes remove the breast completely. This operation is called a mastectomy.
Breast-preserving surgery is called lumpectomy. It can be implemented in practice in the event that the tumor is not exceeded in size4 cm. At the same time, its effectiveness will be no less than from a mastectomy. Before the start of surgery, the doctor must determine the exact location of the tumor. This is possible through mammography or ultrasound. Another method of detecting the site of neoplasm localization is palpation, which the surgeon performs.
However, it is not always possible to perform the lumpectomy, in some cases, mastectomy is a higher priority intervention method:
- When a multifocal tumor is detected, that is, the neoplasms are located in different places of the mammary gland.
- The chest has already undergone radiation therapy once.
- The tumor is large and is equal to the size of the breast.
- Radiation therapy is not possible due to scleroderma or due to other diseases of the connective tissue.
- The possibility of implementing radiation therapy is absent due to the fact that the woman lives in remote areas.
- The patient herself refuses the surgery to remove only the neoplasm, as she is afraid of a relapse of the disease.
It is imperative that during the operation a tumor should be completely removed with the capture of healthy breast tissue. This gives the maximum guarantee that the affected tissues will be removed from the body. Additional interventions will be required in the case when the edges of the material excised from the body are represented by a tumor. In some cases, during surgery, it is required to remove not only the mammary gland but also part of the large sternum. It is the main muscle of the anterior chest wall.
Often clean and lymph nodes located in the armpit. Previously performed operations to remove the axillary nodes are often complicated by lymphatic edema. After all, it was necessary to cut out 10-40 nodes, which violated the natural lymphatic outflow. Modern surgery has the ability to save most of the lymph nodes by removing only the signal nodes. So-called those lymph nodes, which direct the outflow of lymph to cancer cells. As a result, it is possible to reduce the risk of developing lymphostasis after surgery in 65-70% of women. The method of detection of signaling lymph nodes every year more and more improved. If the use of blue as an identifier of sentinel nodes gave an accuracy of 80%, then the use of combined methods increases this figure to 92-98%.5 cm, at stage T1 and T2. Modern surgery adheres to the tactics of gentle removal of the lymph nodes, even if there are a small number of metastases in the signal node.
Study of operational material. Tissue-infected tissues are sent to a study aimed at studying the sensitivity of their cancer cells to different types of chemotherapy. This is the so-called “cell death test.” It is necessary to deliver the samples to the diagnostics until the day has passed after their removal from the woman’s body.
Such testing is especially effective when the patient has cancer detected in the early stages. Indeed, in this case, it is not possible to quickly assess the effect of chemotherapy, since the tumor was completely removed from the chest during surgery.
The chemotherapy itself is called adjuvant and is carried out with a supporting purpose. However, the cell death test has not yet been included in the protocols for the treatment of a mammary gland tumor, since clinical trials for its effectiveness have not yet been completed and do not have an evidence base.
Lymphatic edema (lymphostasis). On the background of radiation therapy, or due to the removal of lymph nodes, patients may develop lymphostasis. Despite the fact that there are recommendations regarding the limitation of physical activity for women who underwent oncology, recent studies have shown that dosed, specially selected and systematically performed exercises, namely lifting weights, can reduce the symptoms of lymphatic edema.
In general, to improve the state of health after surgery for removing a breast tumor can be achieved through the implementation of strength exercises. Training should start carefully, gradually increasing the load. Well, if you have the opportunity to conduct classes with a professional trainer. Against the background of lymphostasis, you must wear a special supporting underwear. This is especially true during exercise.
Radiotherapy (radiation therapy) of breast cancer
Radiotherapy is an integral part of maintenance treatment for women who have undergone lumpectomy, although sometimes it is also performed after mastectomy. Its main goal is to reduce the likelihood of recurrence of the disease. The essence of the procedure is reduced to the fact that the tumor, or the area that was subjected to surgery, is treated with gamma rays, or a powerful X-ray irradiation. This allows you to effectively destroy the abnormal cells that could remain in the woman’s body after the operation, as well as those cells that could appear again.
Radiation therapy is of two types:
- Contact, which is performed using an external source of rays. For this, a linear accelerator is used, which emits ions.
- Remote, which is called brachytherapy and is performed by the interstitial method. The radioactive substance is delivered directly to those tissues where the tumor was located. The amount of this substance is precisely dosed and calculated individually.
With the help of radiotherapy, even the most microscopic tumor cells can be destroyed, which could remain after its removal from the body. In this case, the dosage cannot be negligible, since the death of pathogenic cells should be guaranteed. But for healthy cells, such exposure also does not pass without a trace. Both normal cells and those that look like cancer die. As a result, the body as a whole suffers. The calculation is based on the fact that dead healthy cells have more opportunities for regeneration, and cancer tissues do not have this ability. In this regard, radiation therapy is carried out prolonged to allow normal tissues to recover during the period of rest from irradiation.
If irradiation is performed using an external source, then it is necessary to attend the procedure for 5 days a week. A full course of radiation therapy will be from 5 to 7 weeks. One procedure in time takes 15 minutes. Reducing the period of exposure to radioactive rays is possible thanks to a modern technique called APBI (accelerated partial irradiation of the mammary gland). Thanks to this technique, only the area where the tumor was located is subjected to processing. Thus, all treatment takes no more than 7 days.
The National Institute of Malignant Tumors, located in the United States, indicates that, although it is possible to have a detrimental effect on cancer cells through radiotherapy, this does not prolong the life of women. At least 6 studies were conducted on this account and the results clearly indicate that there is no extension of the life expectancy of the patients.
Therefore, women after removal of the tumor, or after partial removal of the breast should consult a surgeon who is familiar with these studies. Perhaps he will also be of the opinion that only one operation is enough, without subsequent radiotherapy.
Indications for radiotherapy
Most often, it is recommended to carry out radiotherapy after an organ-preserving operation has been carried out with the removal of the tumor only. Although it is possible the appointment of radiation after mastectomy. The number of indications for radiotherapy is constantly expanding.
Almost all women who have undergone quadrantectomy and lumpectomy undergo radiotherapy. It is not made to patients with stage four cancer, except in cases where the woman suffers from severe bone pain, or tissue undergoes necrosis. But in this case, radiation therapy is aimed not at reducing the risk of cancer recurrence but is carried out as part of palliative treatment.
Thus, the recommendations for exposure are as follows:
- High risk of re-development of the disease after undergoing mastectomy (the tumor was large, or lymph nodes were involved in the pathological process).
- As part of complex therapy, when the mammary gland was preserved.
- Multiple tumors.
- Neoplasms metastasizing to other pathological foci.
- Damage to blood vessels, lymphatic vessels of microscopic size.
- A tumor that has spread beyond the borders of the lymph nodes.
- Damage to skin cancer, areola or nipple, or major sternal muscle.
Varieties of radiotherapy
The linear accelerator is the most commonly used medical source of radio waves used to rid patients of breast cancer. Treatment can be subjected to both the entire gland (during lumpectomy), and the entire chest (with mastectomy). Brachytherapy is used in the case when the disease is detected in the early stages of development. This technique refers to more modern and allows you to quickly complete the treatment. Thanks to it, only the affected area is treated, while healthy cells are practically not irradiated.
Modern technologies have had a positive impact on the development of radiation therapy. For example, one of the newest methods of its implementation is intensively modulated radiation therapy or MRI. At the same time, it is possible to regulate the intensity of radioactive rays, change their shape, form elementary rays that act on different points of the gland. The load is distributed in such a way that there is no pathological effect on the heart and lungs. But it is still necessary to clearly demonstrate the difference between the usual radiotherapy, carried out under the control of computer dosimetry (the load on the body, in this case, is calculated no less accurately) and IMRI. There is also no data regarding the number of relapses of the disease and the number of side effects from MRI.
Another popular technique that has been most actively used in the last 10 years is APBI (AChO, accelerated partial irradiation). This technique is included in the treatment program for breast cancer after lumpectomy. Exposed to the place where the tumor was located, as well as a small amount of healthy tissue surrounding it is processed. Perhaps the passage of the UCHO in just 5 days.
It is possible to use UCO-techniques for both internal and remote irradiation. The method is especially effective in those patients who have a tumor that is limited to the mammary gland and has not left the bounds of the breast.
When exposed to radiation, the source of radio waves (radiopharmaceutical) is placed in the patient’s chest. This is possible through the use of a balloon, or a simple catheter, or several catheters.
Now studies are being conducted that are aimed at comparing the effect of point irradiation and extensive irradiation of the entire breast. They are engaged in the scientists of the NSABP – “National Project on Adjuvant Treatment of Oncology of the Large Intestine and Breast Gland”.
In addition, modern science has made it possible to make radiation therapy maneuverable, that is, it can be carried out directly in the surgical unit during surgery. This technique is called TARGIT. For its implementation, a generator is needed – the source of radiation of ions “Intrabeam”.
It is worth knowing that large-scale studies of 2232 patients from 28 different clinics located in 9 countries were conducted. These studies were called TARGIT-A and were monitored by clinical trials of the third phase. As a result, it was possible to establish that irradiation directly in the operating unit using a mobile generator as compared with the standard breast cancer treatment method is only 1.0% better and not more than 1.5% worse. That is, the difference is 0.25%. It is possible that the ongoing TARGIT-B studies will allow correcting the dose of radiation received using this modern technique.
Radiotherapy side effects
Side effects from remote exposure will occur both immediately and after a certain time after its completion. So, after a few weeks after radiation, women experience fatigue due to the regeneration of healthy cells. In addition, the skin at the site of exposure to radioactive rays may become darker. A few months after the procedure, the skin is restored, although a lifelong change in its color is possible.
Other side effects:
- The formation of soft edema
- Muscle stiffness
- Development of lymphostasis
- Pain in the treated area.
Also, many patients note that the breast on the side where the exposure was carried out has become smaller in size and wrinkled. Most often this is due to the fact that the gland’s own tissues were removed along with the tumor.
Plastic surgery aimed at restoring the shape of the breast is not always possible after the adjuvant therapy. This is due to the fact that the skin of the chest is prone to fibrosis and becomes less elastic.
Therefore, experts recommend postponing plastic surgery for some time, in case a woman is going to undergo radiotherapy. In addition, it is advisable to use her own tissue, rather than artificial implants, for breast reconstruction.
There is an assumption that the ACh leads to less development of side effects since only part of the mammary gland undergoes treatment. This can be achieved with the use of several catheters, which allow the flow of radiation to be controlled better.
Systemic treatment of breast cancer
Systemic therapy involves the appointment of patient drugs that affect the entire body. Their combinations are different. Immunotherapy, chemotherapy and hormone therapy are included in the treatment regimen.
Chemotherapy for breast cancer
Its use is possible until the moment of surgical intervention, during it and after the operation. Sometimes chemotherapy replaces surgery if there is no possibility of an intervention.
Appointed according to the individual characteristics of the patient who underwent an examination in the case of
- tumor size more than two cm;
- the child-bearing age of the patient;
- the absence of estrogen and progesterone receptors on the cells;
- poorly differentiated cancer cells.
But the use of drugs that can inhibit the growth of cancer cells has the opposite, negative, side – along with the cancer cells, part of the normal cells dies. This side of chemotherapy pushes away many patients. Many drugs are contraindicated in pregnancy and lactation.
The side effects of chemotherapy, felt by the patient, extend to the functions of:
- gastrointestinal tract – nausea, vomiting, diarrhea, jaundice of the mucous membranes;
- respiratory organs – shortness of breath;
- cardiovascular system – palpitations, flushing of the face;
- nervous system – dizziness, decreased vision, confusion;
- urinary – blood in the urine, swelling of the extremities;
- skin – hair, pigmentation disorders, itching, swelling, allergic reactions on the skin.
Violations are usually reversible, after rehabilitation treatment their effect i,s eliminated. The procedure is carried out in the hospital under the laboratory and clinical control of the patient by the medical staff.
Chemotherapy drugs belong to the pharmacological group of cytostatics and cause the necrotic destruction of cancer cells. Common drugs of this group are doxorubicin, cyclophosphamide, fluorouracil, and others.
Chemotherapy is accompanied by risks to the patient’s health, so careful preliminary preparation and consultation with a doctor is required. Unfortunately, chemotherapy is in many cases the only effective method of combating breast cancer in combination with other methods.
Hormone receptor status
It has been established that women who have already undergone breast cancer are at risk for the recurrence of the formation of a primary tumor. Hormone therapy is prescribed immediately after the completion of chemotherapy if a woman has an estrogen-dependent tumor.
Most often, the following hormonal agents are used for this purpose:
- Tamoxifen. Appointed to young women who have not entered into menopause. The drug is necessary for blocking estrogen receptors.
- Analogs of GnRH. The drugs are aimed at suppressing the work of the ovaries in young women who have not entered menopause.
- Aromatase inhibitors. Used in women in the postmenopausal period in order to reduce the amount of estrogen.
So, with the help of estrogen therapy, it is possible to stop the process of growth of the neoplasm and even reduce it somewhat in size, provided that these drugs are used daily. This thesis was voiced at the 31st annual San Antonio symposium. The symposium was called Breast Cancer.
A total of 66 women participated in the study, and a third of them showed positive dynamics. They all had resistance to treatment with anti-estrogens, and breast cancer metastasized. At the same time, while taking estrogen in some women, cancer began to progress and was transferred back to anti-estrogen therapy. What is most surprising, she began to act.
A few months later, the effect of it again disappeared, but again began to work estrogen therapy. So, a part of the observed women was alternately treated with estrogen and aromatase inhibitors. It happened for several years. Before starting treatment with estrogen and a day after its start, images were taken on positron emission tomography.
It was found that hormone-sensitive tumors were saturated with glucose and actively glowed. Why this happens, to explain up to this point in time failed. It is established that the hormone IGF-1, provoking breast cancer suppressed by estrogen.
In some women, the tumor causes the expression of the HER2 gene; therefore, they have been shown treatment with trastuzumab monoclonal antibodies – Trastuzumab, Herceptin. Its action is aimed at suppressing the activity of HER2 in tumor cells, which helps to stop its growth. Perhaps the appointment of this drug in combination with chemotherapy.
It has been established that such a combination leads to a slower growth of the neoplasm and contributes to an increase in the life expectancy of women. There are clinical trials of the relative positive effect obtained with the treatment of trastuzumab with the adjuvant therapy technique, carried out throughout the year. The risk of re-development of the tumor has decreased, the survival rate of women has increased.
- There are also other options for targeted therapy, which are currently not fully studied, among them:
- Signal transduction inhibitors. The use of these antibodies allows you to stop the transmission of nerve impulses within atypical cells, provokes their division and stops the growth of the tumor.
- Inhibitors of angiogenesis. These antibodies are aimed at stopping the growth of new blood vessels, which prevents the tumor from getting food and oxygen.
- Antagonists of other hormones or receptors, including prolactin and androgen receptors. They are found in significant quantities in the tumor.
Since there are a lot of varieties of targeted therapy, it enables specialists for each woman to choose an effective treatment for her.
Antiangiogenic therapy. A randomized trial has passed a drug such as Bevacizumab (monoclonal antibodies aimed at blocking vascular growth receptors or VEGF receptors). It is currently available for purchase.
Data on the study of this therapeutic agent were published in the announcement in 2005 by the US National Institute of Oncology. There is evidence that compared with standard chemotherapy, Bevacizumab slows tumor growth by 5 months or more. But at the same time, the survival rate of women does not change.
A company that has been developing this drug has submitted an application to the Office of Quality Control of Drugs and Food to be able to use this drug to slow the growth of metastatic breast tumors.
Protein tyrosine phosphatase 1B (PTP1B). Successful trials have been conducted in mice with drugs that are aimed at blocking the protein tyrosine phosphatase 1B, which causes the development of approximately 40% of breast tumors. The results were published in the journal Nature of Genetics in March 2007. The study was conducted at McGill University, located in Canada.
The same protein in excess is found in people with diabetes and obesity. A drug aimed at suppressing the activity of tyrosine phosphatase 1B is able to slow the development of cancer, not only the mammary gland. but also lung cancer. Currently, Merck is developing it. They continue to test mice with HER2 expressing tumors that are sensitive to Herceptin. If the experiments are successful, it will save the lives of many women with similar tumors.
Cholesterol blockers – Ro48-8071. It is likely that PRIMA-1, which has a detrimental effect on abnormal cells, can suppress cholesterol production. It has been established that Ro 48-8071 is capable of suppressing cholesterol synthesis. Scientists suggest that it can also be used to destroy cancer cells, similar to the drug PRIMA-1. But at the same time, healthy cells will not be damaged.
Sugar-lowering drugs. The study of the properties of metformin in combination with doxorubicin (an oncologic drug) was done by graduate students H. Herch and D. Liopulus. Experiments were performed on cells in test tubes that are identical to breast cancer cells.
It was established that in mice with a mammary gland tumor, the use of hypoglycemic drugs prevents the formation of a tumor by cancer cells. In 2 groups of mice with breast cancer, which was formed in ten days, a double dose of metamorphize with doxorubicin delayed the relapse of the disease and contributed to a decrease in the size of the tumor. This is compared to taking only one doxorubicin. Two months after the completion of the treatment, the oncology of the animals that received only the oncological preparation recurred. In mice that were treated with a hypoglycemic agent, relapse did not occur. However, taking metformin exclusively on breast cancer has no effect.
Thermotherapy. It is possible that hyperthermia in the near future will also be used for the treatment of breast cancer in combination with the introduction of anticancer vaccines. This assumption allows us to make modern discoveries in this area. In addition, MRI imaging of hyperthermia sensitive cancer is being used more and more. The use of hyperthermia is gaining such widespread popularity that, in America, the Universal National Oncological Network has included hyperthermia in the Protocols for the treatment of breast cancer, as a method aimed at combating recurrence of the disease.
One of the largest centers in Europe where the use of the method of hyperthermia is located in the Netherlands. It is called the Erasmus Medical Center. There is a patented remedy – ThermoDox, which is represented by a liposomal capsule with its Doxorubicin. The capsule is injected intravenously and is activated under the influence of high temperatures on it. Heating is carried out by local exposure. This allows you to control the growth of cancer cells and improve the quality of life of patients. At the same time, local heating of the tissues does not exceed 42 degrees but is capable of dissolving the liposomal capsule and releasing the medicinal substance in it. As a result, it comes in high concentrations directly into the tumor tissue.
Linen. A study was conducted on rats about the positive effects of flaxseed in terms of combating the disease. As a result, it was found that the size of the tumor became smaller. Then, 32 women who were in the post-menopausal period took part in the experiment with the control of the placebo effect. They took daily 25 g flax seed. It was possible to establish that this does contribute to an increase in the growth of cancer cells responsible for independent elimination. In turn, the c-erb25 gene, which is responsible for the growth of cancer cells, became less expressed. There is preliminary evidence that flaxseed helps to slow tumor growth and metastasis, and also enhances the effect of taking Tamoxifen.
Immunotherapy for breast cancer
Human immunity helps the body resist the development of a tumor.
Therapy with dendritic cells. Human own dendritic cells are processed with oncofetal antigens and administered three times a month to the woman as injections. There is an assumption that such cells, returning back into the body, will teach T-lymphocytes to recognize oncofetal antigens on the surface of atypical cells, which will trigger a global immune response. As a result, cancer cells will be destroyed by their own immunity, and the disease will reverse development.
Stivumax – treatment of hormone-dependent cancer (phase 3 of the trial). At this point in time, the vaccine Stevumax is being developed, which will have to stimulate the immune response to abnormal cells with the antigen glycoprotein mucin-1. It is often found in a wide variety of types of tumors. It is expressed by tumors of the rectum, breast, lung, prostate. The vaccine should “teach” the immune system to find and destroy these cells.
During the second phase of the trial, in which 171 patients with inoperable lung tumors took part in stage 3B, positive results were obtained. It was possible to extend the life of people from 13.3 months (patients on maintenance therapy) to 30.6 months when included in the treatment regimen of Stevumax. The side effects were minor, with slight discomfort in the gastrointestinal tract, local reactions, and mild or moderate flu-like symptoms.
Chemoimmunotherapy for breast cancer
Getting rid of a breast tumor with the help of our own immunity is a very attractive and promising treatment. Immunization has many advantages over other methods of therapy, and also allows immune cells to memorize the tactics of dealing with atypical cells, which makes repeated treatment unnecessary.
Chemoimmunotherapy is aimed at enhancing the T-cell response to any cancer antigen and reproducing new T-cell responses using cytotoxic drugs. Some of these drugs, for example, Paclitaxel, Cyclophosphamide, Doxorubicin in combination with immunized dendritic cells are able to destroy cancer cells much more effectively. While in past years there was an opinion that immunotherapy during chemotherapy would be ineffective, as T-cells are depleted. Now it became clear that after their exhaustion, the phase of their active growth begins.
IMP321 allows you to increase the number and improve the functioning of immune cells, natural killer cells and cytotoxic T-lymphocytes. At the clinical trial stage, success was recorded in 90% of cases, and cancer progressed only in 3 patients in six months. It is assumed that chemoimmunotherapy will be included in the protocols for the treatment of breast cancer with chemotherapy.
Thermochemotherapy for breast cancer
Chemotherapy helps to reduce the size of the tumor in 58.8% of cases, while its combination with thermotherapy, this figure increases to 88.4%. At the same time, the tumor became smaller in size by 80% in 80% of cases. The same effect was observed in only 20% of cases in patients who received only chemotherapy.
Evaluation of the effectiveness of breast cancer treatment
Standard imaging techniques and physical examinations are essential to assess the effect of neoadjuvant therapy being administered. Moreover, this is the only assessment that is recognized worldwide.
Nevertheless, such modern diagnostic methods as CT, MRI, PET help detect the residual effects of the tumor, reveal residual formations, metastases.
- The effectiveness of chemotherapy can be assessed using CT or PET.
- Localization of residual cancer can be determined by MRI.
- The sensitivity of cancer to therapy can be assessed using diffuse-weighted MRI.
- The sensitivity of a tumor at an early stage of development to chemotherapy can be determined using the C18 biomarkers.
- Seeing a greater number of malignant tumors of the breast compared with ultrasound and mammography allows 3T MRI.
The technology of searching for circulating cancer cells in human blood fragments is an alternative diagnostic method approved by the FDA. In this case, a woman takes a tablespoon of blood and sends her for analysis before starting treatment. Then the study is repeated in a month. The number of atypical cells present in the blood will indicate whether there is an effect from the therapy being administered.
Nutrition for breast cancer
Meals at the medical institution are organized on the basis of scientifically grounded medical recommendations. However, it seems to patients that the proposed diet is poor and they still have hunger after meals. Be patient, after some time the amount of food offered will be enough to saturate and reduce weight.
If you do not have the strength to abandon the usual diet, and relatives supply grocery gifts, follow the recommendations and give preference to:
Low-calorie fruits and vegetables, ideally, if they are grown in the garden, where a low content of chemical additives is guaranteed
Natural (not canned) meat, stewed white meat – chicken breast, as well as rabbit, boiled beef instead of sausage, and boiled beef tongue, boiled mutton. Eliminate pork in any form;
Vegetable products and bread, preferably made from coarsely ground grain;
- Natural juices and compotes of local berries;
- Perhaps the additional use of fish oil, other products containing vitamin D, Omega3, Omega 6.
- Refrain or refuse to use:
- Products containing soy (added to sausages, sausages, some vegetable products);
- Canned, smoked meat of any kind (ham, ham);
- Moderate intake of sugar, salt;
- Canned juices.
Breast Cancer Disability
The duration of breast cancer treatment is about four months, then the issue of disability is solved. A favorable factor for rehabilitation is the fullest elimination of the symptoms of the disease, confirmed by all studies.
Extension of the period of incapacity for work is possible after passing a medical and social examination. According to its results in relation to the patient the question of the assignment of disability.
There are disabilities according to the degrees of preservation of viability:
- Grade III – the smallest loss;
- Grade II – moderate loss;
- I degree – a pronounced limitation.
For each degree of disability, there are objective criteria confirmed by clinical, laboratory and hardware research. In the case of an extremely hopeless condition, the patient is prescribed palliative care.