Invasive cancer nst. Invasive breast cancer: types of disease and features

Recently, the incidence of breast cancer in women has increased significantly. If the disease is detected in time and treatment is started, the likelihood of a successful outcome increases significantly. Therefore, you need to regularly visit a qualified mammologist. However, if you believe the statistics, in most cases doctors are able to detect stage 3 breast cancer, at which life expectancy is relatively short. Therefore, any woman must take her health very seriously and have a detailed understanding of this terrible disease.

general information

Breast cancer, or carcinoma, is a malignant tumor of an advanced form, in which the disease has entered an aggressive stage and has begun to affect soft tissues and cells of neighboring organs. Stage 3 breast cancer, in which life expectancy in most cases does not exceed ten years, most often occurs in women closer to 65 years of age. With timely diagnosis and initiation of treatment, there is a high probability that the patient will undergo surgery normally and will also live for a fairly long time. However, everything here depends on many nuances.

What factors influence the life expectancy of patients?

The survival rate for this cancer depends not only on the individual characteristics of the organism, but also on the following factors:

• cancer stage;
• histological structure of the tumor;
• hormonal receptor levels;
• accompanying illnesses;
• the patient's condition, etc.

It is also worth noting that life expectancy for any malignant tumor depends on what lifestyle a person adheres to. Therefore, it is very important to get rid of all bad habits.

Types of disease

The severity of the disease of a person who has been diagnosed with stage 3 breast cancer, life expectancy may depend on many factors. The disease is divided into three types:

1. 3A. The size of the tumor does not exceed five centimeters, and its localization extends to a maximum of 3 lymph nodes.
2. 3B. The cancer has begun to affect muscle tissue, and the size of the formation does not exceed 8 cm. At this stage of the disease, there is a great threat to the patient’s life, and in the absence of treatment, the likelihood of death increases greatly.
3. 3C. The size of the tumor exceeds eight centimeters, and the affected area reaches 10 lymph nodes. In this case, there is practically no hope for a cure.

Each stage manifests itself differently and is accompanied by different symptoms.

Classification of the disease

There is no specific classification of breast cancer, however, it can be divided into two types: invasive and non-invasive. The first type is more aggressive and implies that the tumor has begun to affect healthy tissue outside the organ in which it first appeared. A tumor of this form spreads very quickly and, in addition to the lymph nodes, affects fatty and soft tissues, and is also transported along with the blood throughout the body. Non-invasive carcinoma develops very slowly and does not spread beyond one organ.

Forms of invasive carcinoma

Invasive unspecified breast cancer stage 3 is divided into the following forms:

• Invasive ductal carcinoma is one of the most popular forms of the disease, which is accompanied by pain, nonspecific discharge, and changes in the shape and size of the breast.
• Lobular cancer - accompanied by the formation of compactions that appear outside the organ.
• Medullary form - most often diagnosed in younger women. It develops very quickly, but has no clinical manifestations of a malignant tumor.
• Adenoid cystic carcinoma is very rare. The tumor measures no more than three centimeters, does not pose a serious threat to the patient’s life and responds well to treatment.
• Secretory tumor is a very insidious form of cancer that affects both women and men of any age.
• Cystic breast cancer, in which metastases can spread throughout the body, is very rare in medical practice and affects women of middle and older age. The size of the formation can reach ten centimeters.
• Apocrine carcinoma is a very rare form of benign tumor, with which the patient can live throughout his life.
• Crib cancer is one of the mildest forms of the disease, which is highly treatable in the early stages. Very often accompanied by concomitant diseases that can complicate treatment.

It is worth noting that stage 3 breast cancer, during which life expectancy can vary, has many other forms, but those listed above are the most common.

Forms of non-invasive carcinoma

Non-invasive malignant tumors are divided into two types:

• ductal - a very insidious form of the disease, which often makes itself felt after complete recovery;
• lobular - does not metastasize, but can affect two breasts at the same time.

It is worth noting that in medical practice there is another type of this oncological disease, which does not have a scientific term. Its clinical manifestations are very similar to mastitis or some other diseases caused by various infections.

Reasons for the development of the disease

Breast cancer, the prognosis of which is not always grim, can develop for the following reasons:

• Unhealthy Lifestyle;
• improper diet;
• mammary gland injuries;
• hormonal disbalance;
• infertility;
• late birth;
• irregular sex life;
• state of ecology;
• overweight;
• heredity;
• consequences of inflammatory diseases;
• irradiation;
• failure in the stable activity of the endocrine system.

The most common reasons why invasive breast cancer develops are hormonal imbalance and lack of sexual activity.

Clinical manifestations of carcinoma

The disease can make itself felt in completely different ways, and the symptoms depend on the stage and shape of the tumor. The most common signs accompanying stage 3 breast cancer (life expectancy may vary, for example, the five-year survival rate is 55-80%) are:

• severe pain in the area of ​​tumor formation;
• red rashes on the skin;
• discharge of various contents and consistency;
• change in normal breast shape and size;
• the presence of formations that are easily palpable;
• swelling and inflammation of the chest and surrounding areas;
• ulcers;
• poor appetite and sudden weight loss;
• anemia;
• poor health, accompanied by constant weakness.

All these symptoms appear when invasive breast cancer has already begun to progress and developed into an aggressive form. The disease can be recognized in the initial stages by the shape of the nipple. If he wrinkles or retracts, then this is a serious reason to think about it and go to the hospital for examination.

Modern examination methods

Modern diagnostics of breast cancer allows doctors not only to identify the disease itself, but also to obtain comprehensive information about it, allowing them to create the most effective treatment program. This is very important because the clinical manifestations of breast cancer have many similarities with some other diseases.

When visiting a medical facility, the patient is prescribed:

• mammography and consultation with a specialized specialist;
• cellular analysis;
• blood and urine tests;
• computer and magnetic resonance tomography.

Professional diagnosis of breast cancer allows you to detect the disease at the earliest stage, at which it is best treated. Therefore, you should not put off visiting a doctor.

Treatment of carcinoma

Treatment of cancer can be carried out at different stages, but the likelihood of a complete recovery and the patient’s future life largely depends on how timely it was started. Breast cancer, the metastases of which have already begun to grow, can also be treated, however, treatment methods and complete disposal of the tumor depend on the form and severity of the disease.

Chemotherapy and hormone therapy

These treatments are used as a supplement because they are not effective on their own. The thing is that even a small tumor can give metastases, which can lead to tumor growth throughout the body and damage to other organs. The use of chemotherapy and hormonal therapy makes it possible to localize the disease and slow down or completely stop its development.

Surgical treatment

Surgery to remove the mammary glands is considered one of the most popular methods of treatment in cases where other measures are completely useless. During the operation, surgeons completely remove the affected areas of soft tissue and organs. To restore the normal shape of the breast, plastic correction is performed, but this is possible after complete completion of treatment and the patient’s completion of a rehabilitation program.

Surgeries for breast cancer are the most radical method, so doctors perform them only in isolated cases. It is important to understand that surgical intervention is not possible in the later stages of the disease.

Radiation exposure

This method is an alternative to chemotherapy and is used in conjunction with other treatments. Radiation therapy has a detrimental effect on the malignant tumor, killing it and preventing further progression of the disease. The full course of therapy takes about six weeks, but the doctor can make adjustments to it depending on the patient’s clinical picture. It is worth noting that during the irradiation process, healthy cells also die, but during the rehabilitation period the body gradually restores them. If we compare radiation with other modern types of therapy, it is one of the safest.

To avoid this terrible disease, women should regularly visit a qualified doctor. You can also do a breast self-examination at home. Take care of your health, and then you will not be afraid of any diseases.

Invasive breast carcinoma is a pathology that can affect absolutely any person - at any age, both men and women. However, most often the disease is found in women of reproductive age.

Unfortunately, patients with carcinoma can live for a long time without knowing that they have a dangerous pathology.

But for successful treatment, it is very important to seek medical help as early as possible: for this it is necessary to understand and distinguish the typical signs of carcinoma.

ICD 10 code

• D 00-D 09 – tumors in situ;
• D 05 – non-invasive breast carcinoma;
• D 05.0 – non-invasive lobular carcinoma;
• D 05.1 – non-invasive intraductal carcinoma;
• D 05.7 – non-invasive breast carcinoma of other localization;
• D 05.9 – non-invasive breast carcinoma, unspecified;
• C 50 – malignant breast tumor.

ICD-10 code

C50 Malignant neoplasm of the breast

Causes of Invasive Breast Carcinoma

The reasons for the appearance of an invasive neoplasm in the mammary gland have not yet been fully established. Experts identify only risk factors that can serve as an impetus for the development of malignant pathology.

• Hereditary predisposition. If immediate relatives have had cancer, the likelihood that other family members will also become ill increases.
• Malignant tumor on one breast. If a patient has a cancerous tumor in one gland, the risk of developing cancer in another gland increases.
• Features of sexual development and reproduction of the patient. The risk of carcinoma increases if a woman experiences premature puberty, late menopause, late first pregnancy or primary infertility, etc.
• Benign neoplasm in the mammary gland. A benign process (cysts, fibroadenomas) can sometimes degenerate or serve as a trigger for the development of a malignant neoplasm.
• Exposure to radiation. Radiation as an environmental factor, or used for medicinal purposes, significantly increases the risk of cancer.
• Endocrine disorders, metabolic disorders. Diseases such as diabetes, thyroid dysfunction, hypertension, and obesity contribute to the growth of atypical cells.
• Hormonal therapy, oral contraceptives. Hormone imbalance can also be an indirect cause of the appearance of tumors in the mammary gland.

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Pathogenesis

The stages of carcinoma progression, such as initiation, promotion and progression, are not fully understood. It is known that pathogenesis is provoked by mutational processes of proto-oncogenes, which are transformed into oncogenes and activate cell growth. Proto-oncogenes also increase the synthesis of mutational growth factors or affect external cellular receptors.

When the integrity of the cell is violated by estrogen hormones, the replication of the destroyed cell is activated even before the process of its regeneration. The intervention of estrogen is one of the prerequisites for the occurrence of breast cancer. In this way, a stage such as promotion is launched. Distant metastasis occurs in the latent period (clinical symptoms are not yet expressed) - usually this occurs when the stage of angiogenesis begins in the lesion.

Symptoms of Invasive Breast Carcinoma

Carcinoma can be hidden for a long period without revealing any symptoms. The first signs of pathology often appear at later stages:

• the appearance of a dense area in the breast, independent of the phase of the monthly cycle;
• visible changes in the outline, volume or shape of one of the glands;
• the appearance of liquid discharge from the milk ducts (usually light or bloody);
• external changes in the skin on the gland (wrinkles, peeling, redness, marbling, etc.);
• the appearance of compactions in the armpits (enlarged lymph nodes).

Later, signs of disease progression can be observed:

• the nipple becomes flat or inverted, the areola swells;
• some areas of the gland take on the appearance of a “lemon peel”;
• the gland is noticeably deformed;
• the skin over the source of pathology retracts (falls in);
• distant metastases are detected.

Pain is not typical for breast carcinoma.

Classifications of invasive breast carcinomas

Invasive breast carcinoma is a cancerous tumor that forms outside the lobular membrane or duct, directly in the breast tissue. Gradually, the process affects the lymph nodes in the axillary region, as well as the skeletal system, brain, respiratory organs and liver.

If cancer cells are found in other organs, then we are talking about metastasis (that is, the spread of metastases).

There are several variations in the course of carcinoma:

• invasive ductal carcinoma of the breast - originates from the milk ducts (ducts), after which the degenerated cellular structures spread through the tissue into the fatty tissue of the breast. Atypical cellular structures penetrate the lymph flow and circulatory system and disperse throughout the body. Invasive ductal carcinoma is considered the most common form of breast cancer;
• preinvasive ductal carcinoma is a condition that precedes the spread of a cancerous tumor deep into the tissue;
• invasive lobular breast carcinoma - occurs in approximately 15% of all cases of breast cancer. Invasive lobular carcinoma develops in the lobular structure of the breast, spreading further according to the principle of the previous two options.

Stages of invasive breast carcinoma:

• 0 – the process does not affect nearby tissues;
• I – the malignant lesion is less than 20 mm in size, the lymphatic system is not affected;
• II – tumor size is less than 50 mm, metastases are detected in the axillary lymph nodes on the affected side;
• III – the size of the tumor may be more or less than 50 mm, with adherent metastases in the lymph nodes, or in the lungs or skin;
• IV – there are distant metastases.

Until stage II, carcinoma is considered early. In stage III they speak of local spread of the process. Stage IV is called widespread or metastatic.

The degree of differentiation of the neoplasm (g) is assessed microscopically and can be determined by values ​​from 1 to 3. The higher the g value, the less degree of differentiation the tumor has, and the more unfavorable the prognosis.

• g1 – high degree of differentiation.
• g2 – average degree of differentiation.
• g3 – low degree of differentiation.
• gx – it is not possible to establish the degree of differentiation.
• g4 – undifferentiated tumor (invasive breast carcinoma of a nonspecific type).

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Consequences and complications of invasive breast carcinoma

Invasive carcinoma is a very common pathology, and complications from this disease can occur with or without treatment. A malignant tumor grows directly in the breast tissue or milk ducts. It damages and presses on nearby tissues, nerve endings and blood vessels. The consequences of this situation can be bleeding and pain. An inflammatory reaction may occur if external damage to the skin occurs.

Mastitis can significantly worsen the course of carcinoma and accelerate the malignant process.

With distant metastasis in the affected organs, complications can also occur. The function of the respiratory or skeletal system, liver, and brain is impaired (depending on the spread of metastases). Often there is a constant headache, confusion, problems with bowel movements and urination.

Difficulties may also arise after surgery. For example, complete removal of the gland often provokes the appearance of psychological problems, and surgical resection of the axillary lymph nodes can cause swelling and a decrease in the range of motion in the upper limb.

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Diagnosis of invasive breast carcinoma

External examination and palpation of the breast is the first and main examination when invasive carcinoma is suspected. It is advisable to palpate the gland in the first half of the monthly cycle - this will provide an opportunity to obtain sufficient information about the condition of the breast. Palpation helps to suspect carcinoma, however, in the early stages of development with a small tumor size, this method may be ineffective.

Laboratory tests include tests for cancer markers - this is an understudied diagnostic method that demonstrates the body's tendency to develop cancerous tumors.

Instrumental diagnostics includes:

• mammography;
• ductography;
• pneumocystography;
• ultrasound examination of the mammary glands;
• magnetic resonance and x-ray computed tomography.

Given the unpredictability of the malignant process, most specialists insist on a comprehensive examination of patients. It should include not only instrumental and laboratory diagnostic methods, but also an assessment of the function of the respiratory organs, liver, etc. This may require consultation with specialized specialists such as a pulmonologist, orthopedist, gastroenterologist, gynecologist and surgeon.

Differential diagnosis is carried out with a nodular form of mastopathy, with adenoma, mastitis and erysipelas in the mammary gland.

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Treatment of invasive breast carcinoma

Treatment of carcinoma involves a comprehensive approach, using chemotherapy, hormonal therapy, radiation and, in most cases, surgery.

• Radiation therapy It is always used in combination with other medical procedures, and never on its own. Radiation is prescribed after a course of medication, after surgery, etc. It affects not only the area of ​​the affected breast, but also sites of possible metastasis (for example, the area of ​​the axillary lymph nodes). Sessions are carried out either immediately after resection, or against the background of drug therapy, but no later than six months after surgical treatment.

• Chemotherapy for the treatment of breast carcinoma is prescribed in the vast majority of cases, especially in the presence of metastases or in the late stages of the disease. The choice of medications for this treatment method is very wide. With pronounced tumor progression, medications such as cyclophosphamide, adriamycin, and 5-fluorouracil are usually used, which help prolong the life of patients even in the most advanced cases.

Chemotherapy is often used in the preoperative period to reduce the volume of the tumor, which significantly improves the prognosis of the operation. And the simultaneous use of drugs such as trastuzumab or bevacizumab makes the treatment as effective as possible.

• Hormone therapy it is also rarely used independently - this is allowed only in old age to ensure long-term remission. Hormonal drugs are successfully used in combination with other treatment methods. In this case, medications with estrogen-like effects that control tumor growth or drugs that reduce estrogen synthesis are prescribed. The first drugs include tamoxifen, and the second group includes anastrozole or letrozole. The listed medications are considered the first choice drugs for invasive carcinoma. The regimen for using these medications is strictly individual.

Surgical treatment can be done in several ways:

• the standard method of radical mastectomy involves removal of the mammary gland (while preserving the pectoral muscles for the possibility of mammoplasty);
• partial mastectomy, with the possibility of mammoplasty.

Subsequently, the shape and volume of the gland is restored using endoprosthetics or reconstruction with autogenous tissue.

In particularly severe advanced cases, operations are performed, the purpose of which is to alleviate the patient’s condition and prolong his life. Such surgical interventions are called palliative.

Homeopathy for the treatment of invasive carcinoma- This is a rather controversial issue in medical circles. Most traditional medicine specialists allow the use of homeopathic remedies for the prevention, but not for the treatment of malignant tumors. Of course, each patient decides for himself whether to trust homeopathy or not. The main thing is not to waste time and not to bring the disease to an advanced inoperable stage, when there can no longer be any talk of successful treatment.

The most common homeopathic remedies for gland carcinoma include Conium, Thuja, Sulfuris, Kreosotum.

Traditional treatment can only be used simultaneously with the traditional one, but not instead of it. Here are some of the most popular recipes that help inhibit tumor growth.

• Approximately 150 g of cherry pits are poured with 2 liters of goat milk and placed in the oven on low heat for 6 hours. The resulting medicine is drunk 100 ml three times a day in between meals. The duration of treatment is at least two months.
• Pure propolis is consumed 4-5 times a day, 6 g, in between meals.
• The color of the potatoes is collected, dried in the shade and an infusion is prepared: 1 tsp. raw materials - 0.5 liters of boiling water. Infuse for 3 hours. Take 100 ml three times a day 30 minutes before meals. Duration of treatment is one month.
• Birch mushroom is grated and infused for 2 days in warm boiled water at a rate of one to five. Next, the infusion is filtered and drunk at least three times a day 30 minutes before meals. Store the medicine in the refrigerator for no more than 4 days.

In addition, you can use the gifts of nature - herbs, leaves, berries or plant fruits. Herbal treatment involves the use of plants that have the following properties:

• stimulate the immune system in the fight against malignant cells (euphorbia, astragalus, duckweed, red brush, etc.);
• damage tumor cells (natural cytostatics - periwinkle, colchicum, comfrey, meadowsweet, burdock, etc.);
• stabilize the hormonal balance, compensate for the deficiency or excess of one or another hormone, for example, estrogens or prolactin (sparrow, black cohosh, comfrey, black root, etc.);
• accelerate the removal of toxic substances and decay products from the body (milk thistle, dandelion, chicory, yarrow, etc.);
• eliminate pain (larkspur, peony, willow, black root).

Prevention of invasive breast carcinoma

The danger of developing a cancerous tumor haunts almost every woman, especially over 45 years of age. However, do not be alarmed, because there are preventive recommendations that will often help avoid the disease.

Of course, the existing hereditary predisposition cannot be eliminated. If there is one, then the only way out is regular visits to a gynecologist and mammologist, who can monitor the health of the reproductive system in general and the mammary gland in particular.

• do not smoke, do not abuse alcohol;
• promptly treat infectious diseases and inflammatory processes in the genital area;
• avoid stress and excessive loads that can negatively affect hormonal levels;
Forecast

The prognosis for patients with invasive carcinoma depends on a number of conditions:

• from the presence of metastases;
• on the size of the tumor;
• on the degree of penetration into surrounding tissues;
• on the rate of tumor growth.

Unfortunately, in recent years, the incidence of carcinoma in the world has increased by more than 30%. For this reason, preventive programs have become mandatory in many countries to help recognize the disease at an early stage of development.

Invasive breast carcinoma, diagnosed at the first or second stage, ends in recovery in more than 90% of cases. If the malignant pathology was discovered much later, when the process of spreading metastases had already begun, then the prognosis becomes much more unfavorable.

If a woman has been diagnosed with breast cancer, the further course of the disease, as well as its prognosis, depends on the invasiveness of the cancer, in other words, infiltration. The danger of invasive cancer lies in the fact that by infiltrating nearby organs and tissues, the cancerous tumor changes their structure to pathological, then penetrating into the blood and lymphatic channels.

Migrating to all healthy parts of the body, more and more organs and tissues become infected with cancer. The spread can reach a colossal scale even in a fairly short time, since with the flow of lymph, pathogenic cells are carried throughout the lymphatic system, and with the blood, in turn, to the organs.

Classification

Invasive ductal carcinoma

The most common type is invasive ductal carcinoma. Cancer cells, formed from the ducts of the mammary gland, gradually migrate beyond its boundaries and capture the fatty tissue of the gland and its lobules.

The discovery of a small lump in the chest, with jagged edges, may be the first symptom of the disease. This neoplasm is adherent to the surrounding tissues, and the skin and nipple next to it are noticeably retracted. This type of tumor tends not to appear for a long time; even with careful palpation it is difficult to determine.

Invasive lobular cancer

With invasive lobular cancer, palpation of the breast can easily identify a painful lump that has a fairly hard consistency. This type of tumor is the least common and occupies about 15% and can be located in one gland or affect both breasts. It usually occurs in elderly women of retirement age.

Invasive unspecified cancer

Invasive unspecified cancer is diagnosed when its form is not determined by morphology. In this case, additional immunohistochemical research is required, which will help determine the type of neoplasm.

For example, medullary cancer is characterized by low invasiveness and large tumor size. Inflammatory cancer is similar to mastitis, as the symptoms are quite similar. It begins with identifying infiltration, redness of the skin of the chest and increased temperature.

Infiltrating ductal carcinoma

It gives rapid metastases, growing into nearby tissues and organs, forming nests and cords in them. It takes up 70% of cases.

Paget's cancer

Cancer that affects the halos of the breast and nipple (Paget's cancer) also occurs. It can be easily confused with eczema due to the similar symptom of redness. It has a more unfavorable prognosis than the above types of tumors.

Hormone-dependent tumors usually occur in postmenopause and have estrogen receptors, that is, their growth and development largely depend on the production of this hormone.

Treatment regimen

Depending on the degree of development of the disease and its stage, the necessary treatment is determined.

The main method in the treatment of invasive breast cancer is surgery, in which a segment or part of the gland is removed. If invasive cancer has reached the underlying muscles, these also need to be removed. Before the operation, the size and location of the tumor are determined, since if it is in an inoperable location, it will not be possible to remove it.

After removal of the main cancer focus, radiation therapy or chemotherapy follows. It is used to prevent relapse of the disease.

Necessary to prevent the influence of certain female hormones on cancer cells, their growth and division. For this purpose, special drugs are prescribed that suppress the production of certain sex hormones.

If invasive breast cancer has led to extensive metastases, the disease is considered incurable, since it becomes impossible to cope with numerous foci throughout the body. However, treatment still continues and maintenance therapy is used.

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This term refers to a group of malignant tumors of the ductal epithelium that destroy the basement membrane of the ducts and form foci of growth in the surrounding stroma.

Often, in addition to invasion of the basement membrane, invasion of the wall of lymphatic and blood vessels is noted, which creates conditions for the formation of distant metastases.

This is the most common form breast cancer (BC).

According to various sources, invasive ductal cancer accounts for 40 to 70% of all breast cancer cases.

Today it is believed that all epithelial tumors form in the epithelium of the terminal ductal-lobular unit. The concept of a ductal-lobular unit has been formed in recent years based on the results of a study of the histogenesis of the epithelial component of the mammary gland.

The terminal ducts and acini were commonly called the “terminal ductal-lobular unit.” Each of them is surrounded by loose intralobular connective tissue, which differs from the interlobular stroma.

Invasive ductal carcinoma occurs most often in the left breast (ratio approximately 1.7:1). In 40-50% of cases, the tumor is located in the upper outer quadrant of the mammary gland, less often in the central or upper inner quadrant, and very rarely in the lower outer or lower inner quadrant.

Most cases of breast cancer have clinical manifestations and many women themselves are able to feel the tumor lump in the gland. However, there are cases of asymptomatic breast cancer, so the introduction of screening increases the detection of asymptomatic cancer.

There are no reliable clinical signs that distinguish breast cancer from benign processes. To diagnose cancer, a histological examination of the tumor is necessary. The cytological method helps to identify most morphological variants of cancer, although it is not absolutely reliable for all variants and depends on the quality of the material taken.

When assessing clinical data, it is necessary to remember that benign processes are more typical in young women. The most common symptom is a lump in the breast, which may or may not be accompanied by pain. Changes in the nipple (retraction, deformation or ulceration) are noted less often.

The list of necessary studies includes mammography, ultrasound, and morphological verification. But they begin the study by interviewing and examining the patient. It is advisable to find out the cause and time of occurrence of the lump, evaluate changes in the skin, the shape of the mammary gland and nipple, as well as the condition of the lymph nodes.

Mammography is a method of periodic examination of women over the age of 35 years. Rarely appropriate in young patients, unless there is a strong suspicion of a tumor or obvious signs of cancer.

Mammographic manifestations of invasive ductal breast cancer are varied and include the presence of a well-defined tumor border, foci of calcification, and disruption of the parenchymal structure.

The most common radiographic appearance of breast cancer is a stellate or round tumor mass without calcifications (64%). In 20% of cases, the tumor manifests itself only as calcifications without other visible changes in the parenchyma.

Invasive ductal breast cancer without any specific features (“not otherwise specified”) is the most commonly detected breast cancer. This group is heterogeneous and includes tumors that do not have specific properties that allow them to be classified as a separate group.

The prefix "not otherwise specified" allows you to distinguish these types of cancer from specific ones. In the histological diagnosis, this addition is not mandatory; it is enough to indicate the term “invasive ductal carcinoma.”

The epidemiological features of ductal breast cancer are the same for all histological variants of invasive cancer in general. The ductal variant of invasive breast cancer predominantly affects women over the age of 40 years.

Known risk factors for breast cancer are also characteristic of invasive ductal carcinoma. However, it should be noted that the specific tubular variant of ductal cancer and lobular cancer are more often detected against the background of atypical ductal hyperplasia and lobular neoplasia.

Cases of familial breast carcinoma associated with BRCA1 mutations usually manifest as ductal breast cancer and have some morphological features: the typical picture of ductal cancer is combined with the presence of areas of medullary cancer, a higher level of mitotic index, more “aggressive” tumor margins than in cases of sporadic cancer.

Association with BRCA2 mutations is characterized by a lower rate of mitosis and a weak tendency to form glandular-tubular structures. However, the morphological, immunophenotypic and clinical features of genetically determined breast cancer require more detailed study.

The macroscopic appearance of invasive cancer does not have specific signs characteristic of the ductal variant. As a rule, on the section the tumor appears in the form of a node of various shapes and sizes (less than 10 mm - more than 100 mm). May have an irregular, star-shaped shape or be a clearly defined node (Photo 33).

Photo 33. Appearance of the tumor and metastasis in the axillary area. Primary tumor and metastasis in the form of a lobular node, whitish in color with clear boundaries

Photo 34. Appearance of mucous cancer. A tumor in the form of a gray jelly with small hemorrhages and necrosis in the center, with clear boundaries

In classic cases, ductal carcinoma is firm to palpation or even hard, like cartilage. In cases of cancer arising against the background of precancerous pathology, the edges of the cancer may be unclear (photo 35).

Photo 35. Appearance of the tumor that arose against the background of focal mastopathy. There is no clear boundary between the area of ​​mastopathy and cancer. However, it is clear that due to the high density of the tissue, the cancer has a smooth cut surface and a sharp edge

A characteristic sign of a tumor is the gray color of the cut surface.

The set of signs: a dense gray tumor with a sharp cut edge makes it possible to identify invasive breast cancer with high reliability.

The most difficult cases of diagnosing cancer against the background of a chronic inflammatory process. Lipogranuloma, as a rule, can also be dense and have a sharp cut edge. However, the cut surface of lipogranuloma is yellow with whitish veins intertwined with each other. Cancer against the background of an inflammatory process is extremely difficult to diagnose.

The histological structure of invasive ductal carcinoma often follows the preexisting ductal structure (Figure 36).

Photo 36. Invasive ductal breast cancer G1. The structures of cancer repeat the structure of the mammary gland ducts, however, there are separate complexes of tumor cells in the stroma, which confirms the invasive type of growth. Infiltration of adipose tissue is noted. Hematoxylin-eosin, x 100

In cases of high histological differentiation, tumor cells form predominantly glandular, tubular structures. Moderately differentiated ductal carcinoma of the breast is characterized by the formation of alveolar structures, cords, and trabeculae (photo 37).

Photo 37. Invasive ductal breast cancer G2. Solid alveolar type of structure, invasion of adipose tissue, stromal hyalinosis. Hematoxylin-eosin, x 100

In some cases, fibrous stroma predominates, and tumor cells are represented by individual cells or chains of cells (photo 38, 39).

Photo 38. Invasive ductal breast cancer G2. Scirrhosis type of tumor growth: stromal hyalinosis, cancer cells form chains, small glandular structures, small solid clusters. Hematoxylin-eosin, x 200

Photo 39. Invasive ductal carcinoma of scirrhous structure. Tumor cells form chains against the background of hyalinized stroma, x 200

As cancer differentiation decreases, the volumetric inclusion of stroma decreases, and cancer cells form solid fields. Sometimes relatively isolated glandular complexes predominate (photo 40).

Photo 40. Invasive ductal breast cancer G3. The stroma is preserved in the form of individual collagen fibers and cancer cells displace the stroma, forming bizarre branched structures that in some places resemble glands. Hematoxylin-eosin, x 200

Tumor cells of ductal carcinoma are larger than lobular carcinoma cells, with pronounced cytoplasm. Cellular polymorphism is presented to varying degrees, depending on the degree of histological differentiation (photo 41, 42).

Photo 41. Invasive ductal breast cancer G3. Cancer consists of large cells that have lost the layered distribution of epithelium characteristic of ducts, but have retained the tendency to adhesion. The cells have a wide cytoplasm and large polymorphic nuclei. Hematoxylin-eosin, x 400

Photo 42. Invasive undifferentiated breast cancer, probably from the G4 ductal epithelium. Cancer cells are large with a light, large nucleus and abundant eosinophilic cytoplasm. Hematoxylin-eosin, x 400

The diagnosis of “invasive ductal breast cancer” is valid when more than 50% of the tumor area has a tubular, glandular or ductal structure. If the characteristic ductal component of a tumor occupies 49% or less, and the rest of the tumor volume consists of other forms of cancer, then the term “mixed type cancer” should be used.

Examples of such tumors are mixed ductal-lobular cancer (photo 43-45), and special forms of cancer include pleomorphic cancer, cancer with giant cells of the osteoclast type, cancer with signs of chorionic carcinoma, cancer with melanocytic characteristics.

Photo 43. Invasive mixed lobular-ductal breast cancer G2. In the upper right corner there is a section of ductal cancer, the rest of the tumor is represented by lobular cancer of a scirrhous structure. Hematoxylin-eosin, x 200

Photo 44. Invasive mixed lobular-ductal breast cancer G2. In the center there are three areas of ductal (acne-like, comedo-) cancer, around areas of lobular cancer. Hematoxylin-eosin, x 200

Photo 44a. Invasive mixed lobular-ductal breast cancer G2. Hematoxylin-eosin, x 200

Photo 45. Pleomorphic breast cancer. A tumor consists of cells of different sizes and shapes. Hematoxylin-eosin, x 200

In the case of pleomorphic cancer, >50% of the tumor mass is occupied by large polymorphic, spindle-shaped cells, as well as giant multinucleated cells or cells with differentiation of pleomorphic rhabdomyosarcoma.

This variant is always assessed as poorly differentiated (G3), characterized by a tendency to an aggressive course (50% of patients have >3 affected lymph nodes at the time of diagnosis). The average age of patients is about 50 years. The tumor reacts positively to cytokeratins, epithelial membrane antigen (EMA), a negative reaction with progesterone and estrogen receptors.

Cancer with giant cells such as osteoclasts

The histological structure of the tumor is similar to invasive ductal carcinoma, but the presence of individual multinucleated giant cells or their clusters in the form of foci is noted (photo 46). There are options with other forms of cancer, such as mucinous, papillary and others.

Photo 46. Invasive cancer with the presence of giant cells such as osteoclasts. Cancer cells are glandular structures, but against this background giant multinucleated cells are visible. Hematoxylin-eosin, x 200

According to the results of immunohistochemical and electron microscopic studies, it is generally accepted that giant cells originate from histiocytes - macrophages (the cells have a negative reaction to cytokeratins, a positive reaction to CD68).

The average age of patients with this pathology is 51 years. In addition to the presence of giant cells in the stroma, signs of inflammation are noted: cellular infiltration of lymphocytes, monocytes, mononuclear and stromal histiocytes, including binucleate ones, extravascular arrangement of erythrocytes, as well as proliferation of fibroblasts. Giant cells are usually found near the epithelial component or within the ducts.

Moreover, such structural features are noted in tumor relapses and metastases. The epithelial component is usually represented by highly differentiated infiltrating ductal carcinoma. However, cribriform, lobular, mucinous, and tubular areas of carcinoma are possible.

The five-year survival rate of patients with this type of cancer is slightly higher than that of patients with invasive ductal cancer, averaging 70%. However, some authors believe that the presence of osteoclasts in the tumor has no prognostic significance.

CD68+, S100- cells are large, they lack expression of cytokeratins, epithelial antigen membranes, smooth muscle actin, estrogen and progesterone receptors. However, acid phosphagase, nonspecific esterase, lysozyme are contained, and alkaline phosphatase is absent.

Ultrastructural and immunohistochemical evidence suggests that these cells are histiocytes with osteoclastic differentiation.

In vitro studies suggest that osteoclasts may be derived directly from monocytes and macrophages. This phenomenon is extremely important in bone metastasis, when tumor-associated macrophages, differentiating into multinucleated cells, cause bone resorption.

The stroma contains a large number of vessels, polymorphic cellular infiltration with the presence of lymphocytes, monocytes, plasma cells, and histiocytes. Around the cancer structures there are a large number of large multinucleated cells such as osteoclasts, CD68+, and cytokeratin-negative. Estrogen and progesterone receptors have been identified in the nuclei of cancer cells.

It should be noted that multinucleated giant cells of the osteoclast type are detected not only in cancer, but also in malignant leaf-shaped tumor and osteogenic sarcoma of the mammary gland.

When carrying out differential diagnosis of these tumors, the following signs must be taken into account. A malignant leaf-shaped tumor with areas such as osteogenic sarcoma is characterized by a clearer boundary between the tumor and breast tissue than with osteogenic sarcoma, the presence of leaf-shaped tumor structures, other types of sarcomas are often detected, more than 10 mitoses in one field of view, a more favorable clinical course, such as usually no effect of hormonal therapy.

Osteogenic sarcoma of the breast is characterized by an infiltrative type of growth, the absence of other types of sarcomas and the absence of an epithelial component in the tumor. This tumor is more prone to hematogenous metastases and does not have estrogen and progesterone receptors.

Unlike stromal tumors with the presence of osteogenic differentiation, in breast carcinoma multinucleated giant cells are not tumorous, but reactive, and an immune reaction is possible.

Their prognostic value remains to be studied. A detailed study of the epithelial component in the tumor allows us to differentiate this type of carcinoma from a malignant leaf-shaped tumor with the presence of osteoclasts.

An extremely rare variant of ductal cancer is cancer with signs of chorionic carcinoma. With this type of cancer, cells containing 6-chorionic gonadotropin are detected. An increased level of this hormone is determined in the blood of such patients. The histological structure of cancer is indeed similar to chorionic carcinoma.

Cancer with melanocytic characteristics

Photo 47. Cancer with melanocytic characteristics. Breast cancer infiltrates the epidermis, creating a picture characteristic of melanoma. The similarity with melanoma is enhanced by the presence of individual cells containing brown pigment in the cytoplasm (in the upper right corner). Hematoxylin-eosin, x 200

Photo 48. Cancer with melanocytic characteristics. The tumor consists of small cells such as melanocytes. Hematoxylin-eosin, x 200

When diagnosing this form of cancer, it is necessary to exclude primary melanoma of the breast skin (especially if the skin is affected by cancer) (photo 49-51).

Photo 49. Cancer with melanocytic characteristics. Expression of Cytokeratin pak (clone AE1/AE3, produced by DAKO). Immunohistochemical staining, EnVision imaging system, DAB chromogen. Staining of the cytoplasm of tumor cells is positive, which is typical for cancer, and not for melanoma, x 200

Photo 50. Cancer with melanocytic characteristics. Estrogen receptor expression (clone 1D5, produced by DAKO). Immunohistochemical staining, EnVision imaging system, DAB chromogen. There is positive staining of the nucleus of tumor cells, which is typical for breast cancer, x 200

Photo 51. Cancer with melanocytic characteristics. Estrogen receptor expression (clone 1D5, produced by DAKO). Immunohistochemical staining, EnVision imaging system, DAB chromogen. There is positive staining of the nucleus of tumor cells, which is typical for breast cancer, x 400

It is also necessary to exclude Paget's disease, in which cells containing melanin can be detected (photo 88, 89).

Photo 88. Paget's cancer. Hematoxylin-eosin, x 100

Photo 89. Paget's cancer. Hematoxylin-eosin, x 200

L.M. Zakhartseva, M.V. Woodpecker, A.V. Grigoruk

A type of oncology in which cells that have mutated during the division of normal cells try to grow as far as possible beyond the organ in which they originated is called “invasive cancer.”

During invasive cancer, the beginning of tumor growth is distinguished - the stage of microinvasive cancer (microcarcinoma); it is characterized by growth beyond the boundaries of the basement membrane to a depth of 5 mm. Microinvasion is the stage of cancer development that is most favorable for treatment.

There is a clear connection between invasive cancer and carcinoma - after the basal membrane is ruptured by tumor cells, carcinoma transforms into invasive cancer.

What is invasive breast cancer and the reasons for its formation

Often when breast cancer is not diagnosed at an early stage, many patients are diagnosed with invasive carcinoma. This type of cancerous tumor (BC) rapidly progresses, and once it enters the lymphatic system, it spreads to all internal organs. This is a nonspecific type of invasive cancer. There is also a non-invasive type of carcinoma, which is characterized by the growth of cancer cells into the organ where it formed. with this type of tumors appear later than with the invasive type. If there are metastases, such carcinoma is called metastatic.

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Invasive cancer occurs more often in people with a history of the following diseases and conditions:

• first pregnancy terminated by abortion. During pregnancy, changes occur not only in the genitals, but also in the mammary glands. An abrupt interruption of such a process is a prerequisite for the development of such cancer;
• mastopathy. Cavities in which fluid is present (cysts) and fibrosis (foci of connective tissue) appear due to hormonal imbalance. Being a collection of altered cells, they seem to be a convenient focus for the formation of cancerous tissue;
• fibroadenoma. The presence of elastic nodules of connective tissue, which appear due to hormonal imbalance in the body, can contribute to the development of cancer. To prevent such malignancy from occurring, it is necessary to treat it in a timely manner, without giving it the opportunity to enlarge and transform;
• refusal to breastfeed. In women who do not breastfeed, various lumps may develop in the breasts, which can subsequently develop into invasive ones.

The following types of factors may also contribute to the development of invasive cancer:

• Chronic pathologies of the female reproductive system, as a rule, are those that have led to complete or partial infertility;
• Long absence or irregularity of sexual activity;
• The presence of a similar disease in close relatives.

Types of Invasive Cancer

There are usually three types of such pathology:

• Ductal carcinoma (invasive ductal cancer). With this type of pathology, the first abnormal cells appear in one of the ducts through which milk flows during lactation. This type is considered the most dangerous and most common type of mammary carcinoma. Cancer cells of this carcinoma quickly enter the systemic blood or lymph flow. Cells of this type of cancer contribute to the appearance of various abnormal discharges from the nipple and deform the nipple itself. The age of patients with this pathology is usually over 55 years.

Invasive ductal carcinoma comes in various degrees of differentiation:

1. High degree. The structure of the nuclei of such cancer cells is identical. This is the least malignant grade;
2. Intermediate. The structure of tumor cells and their functions resemble non-invasive low-grade cancer;
3. Low. In this case, the cells are very different in structure from each other and spread very quickly along the duct, penetrating into neighboring structures;

• Preinvasive ductal carcinoma. While it has not yet spread to neighboring tissues, it develops from the cells of the milk ducts. But the chances of this stage turning into an invasive type are very high;
• Invasive lobular cancer. Formed from lobules of gland cells. Among invasive cancers it occurs in 10-15% of cases. This type of cancer can be in the form of a single tumor or in the form of several nodules. With this type of cancer, bilateral damage is possible. It is also difficult to diagnose, due to the fact that there are no obvious manifestations in the form of discharge from the nipples or the presence of lumps.

Unspecified form of invasive cancer

This form of invasive cancer is characterized by its inability to determine the type - ductal or lobular carcinoma. Invasive unspecified mammary cancer can be of the following types:

The common point of all these types of cancer is that for the most part (60-70%) they are hormone-dependent - they have estrogen receptors, that is, hormone therapy is well suited for their treatment. If cancer formed in premenopause, then it does not have such receptors.

It can also be noted that the medullary type of tumor in invasive cancer is the most favorable, in contrast to ductal and lobular carcinoma and Paget's cancer.

Symptoms of Invasive Cancer

Depending on the stage of the disease, invasive cancer manifests itself differently. Before cancer cells spread beyond the boundaries of the structure, many patients do not feel anything; some complain only of discomfort and pain when feeling the mammary glands. Morphological signs of early invasive cancer are practically absent. Only with further development of the tumor do the following symptoms begin to appear:

• nipple pain;
• change in breast shape;
• bloody discharge from the nipples;
• a “bump” or compaction appears without precise boundaries;
• The skin of the breast in some areas becomes red, pale or wrinkled.

Stages

• Stage 1 (degree) of invasive breast carcinoma – when the tumor is no more than 2 cm, does not have metastases and does not penetrate nearby structures;
• Stage 2 invasive streaming breast cancer has a neoplasm - 2-5 cm, tumor cells are localized in one or several nodes in the axillary fossa, but they are not fused with each other and with nearby tissues, there is no metastasis;
• Stage 3 of invasive unspecified cancer - at this stage the tumor does not have clear boundaries in a lobular or ductal neoplasm, the lymph nodes have cancer cells that are “glued” together, there are no distant metastases yet;
• Stage 4 - with this carcinoma, the lymph nodes are already affected and metastases are present in distant organs.

What is invasive cervical cancer and the factors behind its occurrence?

is in second place in terms of diagnosis frequency after breast cancer. Depending on the stage of formation, it can be non-invasive or invasive. The transition from one type to another can take a long period.

Invasive uterine cancer usually occurs in females after 40 years of age, with the peak of this disease occurring between the ages of 48-55 years. Before the age of 30, the chance of developing this disease is quite low - 7%, and the risk of getting invasive uterine cancer after crossing the 70-year mark is also low (16%).

The development of the disease can be influenced by many factors. Among them is infection with the HPV virus (human papillomavirus). But even its presence in a woman’s body does not always indicate the necessarily onset of the cancer process. Among the factors influencing the development of invasive cancer, the following should be noted:

• sexually transmitted diseases, also HIV;
• a fickle partner who has a large number of sexual relationships with different partners;
• promiscuous sex life;
• sexual activity started at an early age;
• a large number of births;
• use of hormonal drugs;
• previous oncological disease of the genitourinary system;
• active and passive smoking.

The risk also increases if you have the following diseases:

• cervical erosion;
• dysplasia;
• leukoplakia.

Timely detection of such diseases will help to begin treatment on time and prevent it from developing into cancer.

It is also customary to divide ongoing transformations in the cervix into the following types:

1. Cervical dysplasia (this includes pathologies such as polyps, pseudo-erosions, leukoplakia, condylomas)
2. The precancerous process (this is cervical dysplasia in different stages) is considered a reversible process;
3. Pre-invasive (or non-invasive). This stage is characterized by the completion of epithelial changes and the completion of infiltrative growth;
4. Invasive cancer. Cancer cells spread.

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Symptoms of invasive cervical cancer

The most common signs of invasive cervical cancer are usually bleeding during sexual intercourse, unstable menstruation, watery discharge with an unpleasant odor, pain in the lower abdomen, and problems with urination. These signs usually indicate the presence of a tumor and are specific. But general signs may also occur that characterize the patient’s general health – weakness, dizziness, loss of appetite, increased sweating, etc.

Although this disease is a clinically pronounced cancer, early stage invasion in oncology may not always have pronounced symptoms to give a prognosis for the disease. This disease can be detected by histology and can also be confirmed by biopsy.

Diagnosis

In order to detect invasive breast cancer in a timely manner, it is recommended that once a year (you should start such regular examinations after 20 years of age) you undergo screening tests - X-ray mammography or ultrasound scanning.

If such a study confirms the presence of a tumor, then a more accurate examination is prescribed, which consists of:

But an accurate diagnosis is possible only after examining the cells obtained by puncture; the discharge from the nipples is also examined. Immunohistochemical tests are performed on the resulting cells to determine sensitivity to sex hormones in order to select hormone therapy.

To accurately determine the stage of invasive cancer, tomography of regional lymph nodes, bones, and lungs is performed. If tumor cells are found there, they are also studied by biopsy.

To determine the rate of tumor growth, a Gleason classification is performed, which is based on the study of the area of ​​malignancy obtained by biopsy. During the study, undifferentiated chains of cells are counted, and based on the counting results they are assigned to one of the categories:

• G1 – well differentiated cancer;
• G2 – moderately differentiated cancer;
• G3 – low differentiation carcinoma (if this cancer is not a lobular type, but a ductal one, it has the maximum ability to penetrate structures that differ from its own);
• G4 – extremely malignant, undifferentiated;
• Gx – the degree of differentiation cannot be established.

The lower the grade of cancer, the more difficult it is to cure, and the more treatment options will have to be tried to achieve a cure.

Diagnosis of invasive cervical cancer

If histological analysis confirms the presence of a tumor, then the following studies are prescribed:

• Pyelography (a test to detect problems in the urinary system);
• Chest X-ray;
• Cystoscopy;
• Sigmoidoscopy.

Also, additionally prescribed:

• CT, MRI;
• Biopsy.

Treatment of the disease

To treat invasive cancer, both local (radiation therapy, tumor removal) and systemic (chemotherapy, biological and hormonal therapy) methods are used. Combinations of several methods are often used. The choice of treatment is based on:

1. Tumor size;
2. Location of the neoplasm;
3. Stages of the disease;
4. Sensitivity of the tumor to estrogen;
5. Menopause (age of the patient).

The usual treatment regimen looks like this:

Disease prognosis

The prognosis for this type of cancer depends on several points:

• At what stage was the disease discovered? Started treatment at stage 1 gives a 90% recovery rate, at stage 2 - 66%, stage 3 - only 41%, at stage 4 survival is less than 10%;
• Location of carcinoma (if it is located within the gland tissue on the outside, the prognosis is more favorable);
• Tumor diameter (five-year survival rate for tumors up to 2 cm - 93%, 2-5 cm - 50-70%);
• Degree of tumor differentiation;
• The presence of estrogen and progesterone receptors;
• The presence of other foci of cancer and lymphedema of the breast and arm.

After treatment for cervical cancer, the patient should be observed by a doctor every three months for two years, and later once every six months.

Remember! With cervical cancer, if it is detected during the middle stage, there is a chance to carry a child to term, while detection at the beginning of pregnancy entails an abortion. But in any case, the decision is made taking into account all individual characteristics.

Question answer

What does the term “Nottingham system” mean in gynecology?

This is one of the ways to determine the degree of malignancy of a cancer tumor.

Often in oncology diagnoses some incomprehensible combinations of Latin letters and numbers are made. What can T4n3m0 or T2н0m0 mean, for example?

T means the size of the tumor, n (or n) is the prevalence in the lymph nodes, m is the presence of metastases. The lower the number (preferably 0), the less advanced the disease.