Treatment of breast cancer: modern approaches and methods. Breast Cancer Treatment Methods Cured Breast Cancer

A common cancer among women is breast cancer. The success of treatment and the life expectancy of the patient depends on the timely detection of the disease. The symptoms, stages of development, methods of diagnosis and treatment of breast cancer are described below.

The mammary glands consist of lobules, or glands, channels for transferring milk to the nipples, adipose, connective tissue, blood and lymphatic vessels.

Breast cancer is a lesion of the breast by malignant neoplasms that replace glandular tissue. Most often, carcinoma that develops in the lobules or ducts is detected, but besides it, there are about 20 other types of malignant tumors of the breast.

The frequency of the disease is high among women over the age of 40, and the maximum number of cases of cancer is observed in the period of 60-65 years.

Cancer cells have an abnormal structure and a high rate of division due to the rapid metabolism in them. Appearing in the tissues of the chest, as the disease progresses, they penetrate into nearby lymph nodes, and in the later stages they also affect distant tissues, including bones and internal organs.

In addition, the life cycle of malignant cells is shorter than that of healthy cells, and their decay causes general intoxication of the body.

Doctors see the main cause of breast cancer in. More often, the disease develops in women when hormone production changes dramatically. At the same time, less progesterone and estrogen are produced, which affects the condition of the mammary glands.

Not only a deficiency, but also an excess of female sex hormones is considered unfavorable, for example, the risk of developing breast cancer is increased in nulliparous women after 30 years and as a result of abortions. Pregnancy, childbirth and breastfeeding, on the contrary, significantly reduce the likelihood of malignant cells in the mammary gland.

Stages of breast cancer, symptoms

The international classification of stages of breast cancer identifies four stages in the development of the disease.

1 stage

The pathological focus does not exceed 2 cm in diameter, and the cancer has not yet affected neighboring tissues and lymph nodes. There are no metastases, breast fat and skin are not affected.

On palpation, a painless small lump is felt - this is the only sign of breast cancer at an early stage.

2 stage

The tumor reaches from 2 to 5 cm, does not grow into adjacent tissues. The second stage is divided into two categories:

• IIb - the neoplasm increases in size;
• IIa - penetration of cancer cells into the axillary lymph nodes.

Symptoms of breast cancer in stage 2a are wrinkling of the breast areas and a decrease in the elasticity of the skin over the tumor. After compressing the skin in this place, wrinkles do not straighten out for a long time.

No more than two metastases in the affected gland can be detected, often a symptom of umbilization appears - retraction of the nipple or skin at the location of the tumor.

3 stage

The diameter of the neoplasm exceeds 5 cm, it can affect the subcutaneous fat layer and the dermis. Symptoms of stage 3 breast cancer: the skin resembles a lemon peel, it is pulled in over the tumor, often edematous, if there are metastases, then no more than two.

4 stage

Pathology affects the entire mammary gland, ulcers appear on the skin of the breast. Metastases are multiple and spread to other organs and tissues, primarily affecting the lymph nodes located under the shoulder blades, in the armpits and collarbones.

Distant spread of metastases affects the skin and soft tissues, from the internal organs - the lungs, ovaries, liver, from the bones - the femoral and pelvic.

Symptoms and signs of breast cancer in stages

Breast cancer symptoms and signs can be divided into four groups:

1. The appearance of seals;
2. breast skin changes;
3. Allocations from juices;
4. Enlarged lymph nodes.

At the first stage at small sizes, cancer does not manifest itself actively. It can be detected by chance, when a dense nodule is felt in the mammary gland. If the tumor is malignant, in most cases it is painless to the touch, and the presence of pain during palpation most often indicates a benign formation (mastitis, mastopathy).

The cancer node is very dense, with an uneven surface (lumpy), immobile or slightly displaced upon exposure, often attached to the skin or surrounding tissues, fixed. Seals of large sizes appear at stages 2-4 of breast cancer (from 3 to 10 cm).

Attention! There are forms of breast cancer in which the mammary gland is painful to the touch - these are erysipelatous and pseudo-inflammatory forms of a diffuse tumor. They are characterized by rapid growth, the absence of individual dense nodes, reddening of the skin of the chest, and fever.

With a malignant formation on the chest, skin retraction, folds, wrinkles, localized swelling appear in the place above the tumor. With the further development of cancer on the skin, nipple or areola, small non-healing sores appear, which then merge, bleed, suppuration develops (the last stage).

The next symptom of breast cancer in women is discharge from the nipples. Depending on the form and stage of the disease, they can be cloudy or transparent, whitish or yellowish, contain impurities of pus or blood.

The nipple at the same time is compacted and looks swollen. Any discharge from the mammary gland, especially outside of pregnancy and the period of breastfeeding, should be regarded as an alarming signal and a reason to be examined by a mammologist.

Starting from stage 2 cancer cells penetrate the nearest lymph nodes, which leads to an increase in the latter. If the tumor affects only one mammary gland, then this symptom is observed on one side.

A clear sign of metastatic lesions of the lymph nodes is their large size, density, fusion, more often they are painless. In this case, the armpit area may swell, and in the later stages, the arm also swells due to poor outflow of lymph and blood (lymphostasis).

Breast Cancer Diagnosis

The main methods for diagnosing breast cancer:

• taking a mammogram;
• a blood test for the presence of tumor markers (in women under 30 years of age);
• Ultrasound of the mammary glands;
• biopsy (taking a piece of tissue for examination).

To assess the general condition of the patient and the level of prevalence of cancer cells in the body, the following methods allow:

• blood tests - general and biochemical (to determine the level of formed elements, ESR, cholesterol, amylase, liver tests, glucose, total protein, creatinine);
• CT scan;
• urinalysis to exclude pathology from the urogenital area;
• Ultrasound of internal organs;
• radiography of bones, chest.

Determining the course of the disease, doctors use the TNM system, in the conclusion, next to each letter they put a number:

• T denotes the size of the tumor (from 0 to 4);
• N - the degree of damage to the lymph nodes (from 0 to 3);
• M - the presence or absence of distant metastasis (0 or 1).

self-examination

Since breast cancer does not show up in the early stages of development, regular self-diagnosis is of great importance. It should be carried out on the 5th-7th day of the monthly cycle, in good light, in front of a large mirror, completely removing clothes to the waist.

The mammary glands should be examined with raised and lowered hands, paying attention to their size, skin condition, color, symmetry. After that, you need to carefully feel the chest - any tissue seals (both nodular, focal, and diffuse, affecting evenly the entire gland) should alert.

The self-examination also checks for discharge from the nipples by pressing on them. At the end of the examination, palpation of the axillary, supraclavicular and subclavian lymph nodes is performed - with cancer they are even, dense, enlarged, often painless.

Treatment of breast cancer is aimed at the complete destruction of malignant cells. At a later stage, if full recovery is not possible, symptomatic therapy is prescribed, for example, taking powerful painkillers to alleviate the condition. Treatment includes several directions, which are most often combined with each other.

Radiation therapy

The task of this method is to stop the aggressive development of the tumor, its growth for surgical intervention. It is considered as a preparatory stage before the operation and is carried out after the removal of the neoplasm.

Radiation therapy is also indicated if surgery is not possible, for example, in the presence of brain metastases.

hormone therapy

It is used if receptors sensitive to progesterone and estrogen are found in cancer cells in the laboratory. Sex steroid analogues or antagonists are used to treat breast cancer.

In some cases, in addition to hormone therapy, the ovaries are removed, since they produce hormones that provoke tumor growth.

Targeted Therapy

It is also called aiming. Cancer cells are able to protect themselves from exposure to radiation, chemotherapy and hormone therapy, releasing special substances (EGFR factor). This is a definite barrier to a quick cure.

For immunocorrection, that is, reducing the response of malignant cells to therapeutic agents, the drug Herceptin (Trastuzumab) is used. These are purified monoclonal antibodies specific for the protective factor of cancer cells.

The use of targeted therapy requires the availability of special equipment and highly qualified personnel in the clinic.

Chemotherapy

This method involves the introduction of drugs, is prescribed taking into account the characteristics of the patient and is indicated if:

• The diameter of the neoplasm is more than 2 cm;
• Tumor cells are low differentiated;
• The woman is of childbearing age;
• Cancer cells do not have receptors sensitive to progesterone and estrogen.

For chemotherapy in breast cancer, cytostatics are used - antitumor drugs that have a detrimental effect on cancer cells. Examples of drugs are Cyclophosphamide, Adriablastine, Mitoxantrone, Doxorubicin, Fluorouracil.

In oncology, there are three types of such treatment:

1. Adjuvant (prophylactic, additional) therapy is indicated if the tumor is resectable and is applied before and/or after surgery. It prepares the neoplasm for surgical removal.
2. Therapeutic is prescribed for a generalized form of cancer, that is, with metastatic lesions of other tissues and organs. This method is aimed at the destruction or reduction of metastases to a minimum.
3. The induction type of chemotherapy is indicated if the tumor is inoperable, and its size needs to be reduced to the extent possible for surgery.

Cytostatics have a number of side effects that are the negative side of their use. During chemotherapy, some healthy cells inevitably die along with cancer cells.

Side effects may include:

• dyspnea;
• nausea and vomiting, diarrhea;
• coloring of mucous membranes in a yellowish tint, pigmentation of the skin;
• dizziness, clouding of consciousness;
• decreased visual acuity;
• hematuria (urine with an admixture of blood);
• arrhythmia, pronounced palpitations;
• hair loss;
• itching, allergic skin rashes.

These problems are temporary, they disappear after rehabilitation treatment. Before chemotherapy, a detailed consultation and thorough preparation of the woman for the procedures is carried out.

Surgical treatment of breast cancer

The operation to completely remove the mammary gland is called a mastectomy, it is indicated starting from stage 3. Together with the breast, regional lymph nodes are also removed. After surgery for breast cancer, radiation therapy is prescribed, as well as an additional examination of the preserved lymph nodes and nearby tissues.

In the absence of contraindications, simultaneously with the removal of the breast, it is possible to perform a plastic surgery to reconstruct it.

Complications after mastectomy:

• bleeding from a wound;
• temporary restriction of mobility of the shoulder joint;
• swelling of the arms and chest.

At stages 1 and 2 of breast cancer, surgery is often limited to organ-preserving intervention, that is, the removal of only the tumor focus while preserving the mammary gland. In any case, psychological support from loved ones and specialists is important for a woman.

Prognosis and life expectancy

In oncology, the indicator of treatment success is a 5-year survival rate. After breast cancer therapy, slightly more than half of all patients cross this threshold. This is a conditional border, because having overcome it, many women live for many more years.

Life expectancy is affected by the type of cancer, the degree of its aggressiveness (growth rate), as well as the stage at which treatment began.

The worst prognosis for life is a diffuse type of neoplasm and stage 4 breast cancer - of all the sick, no one lives for 5 years.

With breast cancer of the 2nd degree, life expectancy, or rather the achievement of a five-year, and more often a ten-year survival rate, is about 80%. Moreover, more than half of this number of women will live 20 years or more.

The chances are higher with the effective selection and combination of several therapies. If stage 3 cancer is detected, then life expectancy of 5 years or more is reached by 40 to 60% of women, depending on the substage (3A, 3B).

Breast cancer has a tendency to reappear, in most cases this occurs in the first two years after treatment.

Prevention

Effective prevention of breast cancer includes the following measures:

• Attentive attitude to the state of the endocrine system - hormonal correction, taking oral contraceptives;
• Pregnancy and childbirth;
• Absence of abortions, and, accordingly, effective contraception;
• Prevention and timely treatment of benign breast tumors - fibroadenomas;
• Regular mammography examinations - 1-2 times a year;
• Refusal of bad habits, healthy nutrition, active lifestyle, good sleep.

According to the World Health Organization, 1.5 million women are diagnosed with breast cancer each year. Like many other diseases, breast cancer is "getting younger" - in recent decades, it affects more and more young women. Diagnosis of breast cancer in the early stages is the key to successful treatment. This is a very dangerous disease, but it is curable, and the methods of treatment are becoming more perfect every year.

Breast cancer: there is a way out!

The statistics of the incidence of breast cancer in our country is alarming - mammologists detect about 50,000 new cases annually. The average age of the patients is 59, but this does not mean that younger women are not at risk. On the contrary, as already mentioned, this disease is increasingly affecting women in their prime.

The reasons for the development of breast cancer are still unknown to doctors, but it is obvious that genetics and ecology play a key role here. Residents of rural areas get breast cancer 30% less often than urban women.

However, when breast cancer is diagnosed in the early stages, the prognosis is favorable - if the cancer was detected at the first stage, the survival rate for 5 years is 94%, at the second stage - 79%.

Stages of breast cancer

Oncologists distinguish 4 stages of breast cancer:

• On the first - the tumor is small, does not exceed 2 cm in diameter, metastases are absent.
• In the second stage of breast cancer, the size of the tumor is from 2 to 5 cm in diameter. At this stage, cancer cells are present in 4-5 lymph nodes.
• The third stage of cancer is characterized by large tumor sizes, from 5 cm, while the cancer spreads to the base of the organ.
• The fourth is dangerous because the tumor metastasizes to various organs, most often to the liver, lungs, bones and brain.

Breast cancer accounts for 20-25% of all cancers in women.

Methods of treatment of breast cancer

To date, there are several methods of treatment for breast cancer. The choice of the appropriate one depends on many factors: the size of the primary tumor, the condition of the regional lymph nodes, the presence of distant metastases and the receptor status, that is, sensitivity to hormones.

Surgery

During surgery, the main task of the doctor is to preserve the life and health of the patient, even if this means the loss of the mammary gland. However, now doctors are trying not only to remove the tumor, but also to preserve the gland. In cases where this is not possible, breast prosthetics are performed - usually plastic surgery is performed six months after a mastectomy. Although, for example, in Israel, breast reconstruction is carried out as part of one operation: immediately after removal.

If the size of the tumor does not exceed 25 mm, resort to organ-preserving surgery. Often, several nearby lymph nodes are removed, even if no metastases are found - this helps prevent a relapse of the disease.

It should be noted that the surgeons of the advanced countries in the treatment of oncology are armed with unique surgical instruments. For example, in Israeli clinics, the Margin Probe device is successfully used, which, according to doctors, makes it possible to remove absolutely all cancer cells.

Radiotherapy

Radiotherapy, or radiotherapy, is part of the supportive treatment for breast cancer and is given to women before or after the tumor is removed. Radiotherapy reduces the chance of cancer coming back by killing tumor cells. In radiation therapy, the tumor is irradiated with powerful x-rays or gamma rays.

Intrabeam

Innovative technique of intraoperative irradiation. Avoids postoperative radiotherapy and reduces the risk of recurrence. This procedure is carried out during the operation and saves the woman from postoperative treatment. Unlike traditional radiation therapy, the radiation is directed only at those areas where cancer cells are presumably located. The application of the method allows to reduce the duration of treatment by 6 weeks, while reducing the risk of relapses and causing minimal damage to healthy tissues.

Chemotherapy

Chemotherapy, or drug treatment for breast cancer, is used before, after, and even instead of surgery when it is not possible. Chemotherapy is the introduction of specific toxins that affect tumor cells. The course of chemotherapy can last from 3 to 6 months and usually begins immediately after surgery. Various drugs are used for chemotherapy - some destroy proteins that control the development of tumor cells, others are integrated into the genetic apparatus of a cancer cell and cause its death, and others slow down the division of affected cells.

hormone therapy

Hormone therapy is effective, but only in half of the cases, since not all types of breast cancer are sensitive to this treatment.

Targeted Therapy

Or targeted therapy - the most benign type of treatment for breast cancer. Targeted therapies only work on diseased cells, leaving healthy cells unaffected, so the therapy is much better tolerated.

Features of the treatment of breast cancer at different stages

• Zero stage
  If the disease is diagnosed at this stage, then the chances of recovery tend to be 100%. To cure, a lumpectomy is performed - a sparing operation in which only the neoplasm itself and a small part of the adjacent tissues are removed, although in some cases the removal of the entire gland is indicated, followed by plastic surgery. However, this method of treatment is used less frequently. After the operation, a course of chemotherapy, targeting and hormonal therapy is indicated.
• First stage
  The prognosis is also favorable, with approximately 94–98% of patients recovering completely after lumpectomy followed by chemotherapy, targeting, and hormonal therapy. Sometimes a course of radiotherapy is indicated.
• Second stage
  At this stage, the tumor is already too large, and lumpectomy, most likely, will not work - a complete removal of the mammary gland is indicated - a mastectomy with removal of the axillary lymph nodes and mandatory subsequent radiation therapy. It is worth saying that in foreign clinics, for example, in Israel, this method is resorted to only in extreme cases, making every effort to save the breast.
• Third stage
  At this stage, numerous metastases are formed. For recovery, it is necessary to remove not only the tumor itself, but also metastases. A mastectomy with removal of lymph nodes and radiotherapy is mandatory, as well as hormone therapy, chemotherapy and targeting therapy to destroy all cancer cells.
• Fourth stage
  This is an advanced breast cancer with a large number of metastases. Radiation and chemotherapy are shown, as well as surgery, the purpose of which is not to remove the tumor, but to eliminate life-threatening complications, and also - in some cases - hormone therapy. It is almost impossible to cure cancer completely at this stage, but it is possible to prolong life and improve its quality.

Early diagnosis of breast cancer is the key to effective treatment. Recently, this topic has often been raised in the media, which makes many women think more about their health and regularly visit a mammologist.

October is World Breast Cancer Awareness Month. Why are different types of oncology called breast cancer, how are they treated in Russia, and why do you have to pay for treatment and tests with free medicine? What does the diagnosis of "mastopathy" really mean? When is it really worth removing the breast, like Angelina Jolie, for prevention? Should everyone get genetic tests for cancer or is it not worth spending money on it?

The Village invited the director of the Cancer Prevention Foundation, oncologist Ilya Fomintsev, to ask professional questions to the practicing doctor, Professor Petr Krivorotko, the largest Russian mammologist, head of the Department of Breast Tumors at the N. N. Petrov National Cancer Center.

Ilya Fomintsev: To what extent can oncologists influence mortality from breast cancer? There is an opinion among patients that cancer is an incurable disease, and oncologists, on the contrary, constantly “debunk this myth”.

Petr Krivorotko: I just belong to such oncologists who do not debunk this myth. However, it is precisely with breast cancer that oncologists influence mortality, and they influence very strongly. Yes, cancer is incurable, but we can often bring breast cancer into a state where it won't affect the cause of death. We can put off the cancer story for some pretty decent amount of time. And most often this period is enough for a person to die from some other disease, or, more simply, from old age.

- And to what extent this delay is influenced by the actions of oncologists, and to what extent - the biological properties of breast cancer itself?

Yes, actually, everything affects - both. However, the properties of the tumor influence, probably, more than oncologists. We have now come to understand that breast cancer is not a single diagnosis. This is a mask behind which hides a huge number of different subtypes of cancer. Now we even began to think that we had learned to distinguish between them, although in fact this is not entirely true. And our successes are rather proof of our insufficient understanding of this disease. Oncologists have an idea that we know something about breast cancer. But in this knowledge of ours, we very often encounter situations where our knowledge simply does not work. For example, we know that there is a molecular receptor on the surface of the tumor, we even have a drug that can block this receptor, we know that under ideal circumstances in most of these patients we can influence the size of the tumor. But there is a category of patients who have everything: there is a receptor, there is a molecule, but our influence does not work at all. There can be a huge number of reasons for this: maybe we have identified this receptor incorrectly, maybe the medicine does not work very well. But, most likely, everything is in order with both of them, but there is some third factor that we still cannot influence in any way, since we don’t know anything about it at all. This is exactly what happens with hormone therapy for breast cancer, which has been used for decades. Ideal, it would seem, the situation to cure the patient. The patient has a tumor, the tumor has receptors for sex hormones. We block these receptors, the hormones do not act on the tumor, and for some time the tumor does not grow or reappear. This can take months, maybe years. But at some point, the tumor begins to grow without changing its biology. The tumor is the same, the medicine is the same, but it does not help. Why? Don't know.

Therefore, if we talk about who has more influence on the history of life and death - an oncologist or tumor biology, I would say this: oncologists try to influence, and sometimes they succeed. In breast cancer, in most cases, this succeeds.

I don't want to say that we were shamans but at that time we were not far from them. At the same time, the vast majority of patients received chemotherapy in vain.

- Previously, there were not so many breast cancer treatment regimens, but now there are a great many of them, and they are selected for each patient literally individually. What is it based on?

The history of the evolution of treatment regimens is generally super interesting. Even 10–15 years ago, all methods of systemic cancer therapy were empirical. I do not want to say that we were shamans, but at that time we were not far from them: we then selected the dose, the regimen of drug administration, by and large, not based on the biological characteristics of the tumor. Even 15 years ago, all clinical protocols were based only on statistical data on how this reduces mortality in all patients indiscriminately. And at the same time, the vast majority of patients received this therapy completely in vain: it did not affect their survival in any way. The most striking example of such treatment is adjuvant chemotherapy. It is performed on patients who no longer have any tumor, we surgically removed it. And here the doctor comes up to the patient and says: “You know, Maryivanna, I performed a brilliant operation, you didn’t have a single tumor cell left, but I’ll prescribe you chemotherapy now, from which your hair will come out, you will feel sick, you will hate relatives, and relatives end up hating you. It will last six months and it will help you!”

And you know what's the coolest thing? The doctor said this, absolutely not knowing whether it would help or not. Because if we take the Oxford Meta-Analysis of Breast Cancer Adjuvant Therapy Studies (this is postoperative chemotherapy. - Note by Ilya Fomintsev), according to its results, it really helped. But only 10-12% of all patients helped. The trick is that even 15 years ago, the doctor did not have a single tool to understand in advance who she would help and who not. And so, in order not to lose these 10–12%, it was prescribed to literally everyone!

A lot has changed since then. Breast cancer has been carefully studied by fundamental oncologists, and it turned out that breast cancer is not one disease. These are generally different diseases with different biological characteristics: with a different set of receptors on the cell surface, with different mutations inside the tumor itself. And it turned out that the treatment that was carried out before is effective only for certain subtypes of cancer. And if this treatment is applied to a group of patients for whom it does not help, it will not only not help, it will worsen their condition. Because she will receive very toxic treatment for nothing. Chemotherapy is not a vitamin at all.

Now there are terms such as "personalized therapy" or "individualization of treatment." Behind these words, in fact, is the desire to choose for a particular patient the treatment that - probably - will be effective for him, depending on the biological properties of his particular tumor.

- We are talking now for the most part about breast cancer therapy. But now I want to ask you about surgery. In recent years, the volume of surgical intervention for breast cancer has significantly decreased and continues to decrease. Is there any chance that surgery for breast cancer will soon be avoided altogether?

On the one hand, studies are really underway that there are subtypes of tumors that, most likely, there is no point in operating at all, it will be enough for them to choose a therapeutic treatment regimen. The MD Anderson Cancer Center has been doing this research for a year now, and maybe we will have them too (I really hope that we will find funds for them). However, it is not worth expecting that surgery will disappear altogether from mammology in the next ten years. Maybe someday, in a certain biological subtype of cancer, we will allow ourselves not to have surgery.

- What you are talking about: individualization of therapy, minimally invasive surgery for breast cancer... How common is this in Russia?

Our country is huge ... There are centers where breast cancer is brilliantly treated, and there are centers where medicine has stopped at Halstead (Halstead operation, a large-volume mutilating operation for breast cancer. - Approx. I.F.). I asked in one dispensary: ​​“How many organ-preserving operations do you perform?” They say three. I ask: “Only three percent?!”, - and the answer is: “No, three pieces a year.” And that's how they do Halstead for everyone. You know, my favorite topic is a biopsy of sentinel lymph nodes, which is not just not performed almost anywhere in Russia... 90% of our mammologists think that this is complete nonsense!

- Tell us a little about it, please, let's make readers more educated than 90% of mammologists. Maybe we'll catch the doctors.

In short, this is a test that is needed to reasonably reduce the amount of surgical intervention. The story is as follows: for more than 100 years, in order to cure breast cancer, the primary tumor was removed as widely as possible, and along with it all the lymph nodes, in which cancer most often metastasizes. For the mammary gland, these are the axillary lymph nodes. And so they did: they removed the entire mammary gland and all the axillary lymph nodes. It was believed that this is a medical procedure that has a positive effect on life expectancy. After many studies, it turned out that, in principle, this does not greatly affect life expectancy. The biology of the tumor, systemic therapy affects ... But the removal of lymph nodes has practically no effect on the results of treatment, while most women do not have any metastases in the lymph nodes at the time of surgery.

And now, imagine, you are performing an operation, and the pathologist says to you: “You performed a brilliant operation, removed 30 lymph nodes ... And none of them have metastases!” At this moment you can explain to the head doctor why you did it, explain it to your colleague abdominal surgeon (Abdominal oncologists deal with tumors of the gastrointestinal tract, as a rule, they know less about the biology of the tumor and much more about surgery. - Approx. I.F.). Of course, you can explain this to the patient: patients in general can believe in any nonsense. But try to explain it to yourself! Why did you remove 30 healthy lymph nodes?!

After all, it greatly affects the quality of life, it is a very severe surgical injury. The hand on the side of the operation after that will not be able to function normally, it will be edematous. After all, even disability is given to patients precisely because of this - because the hand does not work well, and not at all because of the lack of a mammary gland!

However, in most cases, this injury is inflicted completely in vain. I will say more, it is most likely performed in vain by everyone. In reality, it is enough for us from the lymph nodes only to know whether they are affected by metastases or not, and there is most likely no need to remove them, even if they are affected. And now there are studies that confirm this.

So, a biopsy of the sentinel lymph nodes is needed to understand what is happening with the lymph nodes - whether they are affected or not. And on the basis of this, it is reasonable to refuse intervention on the lymph nodes in the vast majority of patients in order to preserve their quality of life. And this is not just not done, it is not even understood practically anywhere in Russia.

The coolest thing, from my point of view, is the scientific justification for the possibility of preserving the mammary gland. Even 30 years ago, the mammary gland was not preserved by anyone anywhere

- Absolute horror, of course, but not news. Let's move on to the good, why are we all about the bad. What would you name the main breakthroughs in the treatment of breast cancer over the past 50 years? For what would you give your personal award named after Peter Krivorotko?

The coolest thing, from my point of view, is the scientific justification for the possibility of preserving the mammary gland. Even 30 years ago, no one anywhere preserved the mammary gland. This is not only a consequence of a change in understanding of cancer progression, but also of advances in radiotherapy.

The second breakthrough is actually quite recent. It was not until the 2000s that the first groundbreaking studies emerged that showed that the main factor in prognosis is the biological subtype of cancer, not the stage. And this is the explanation for how this happens when we detect a very small tumor, operate on it, clap our hands for joy, and a year later the patient dies from metastases, or, conversely, when we detect a huge tumor, and the patient then lives for a long time. years.

Over the past ten years, more than 20 molecular subtypes of breast cancer have been identified. And, it seems to me, their number will only increase. And with them our understanding of how to choose the right treatment for the patient. And now most patients fit into our understanding of biological subtypes. Misunderstanding remains only with a relatively small group of people - there we still select treatments at random.

- Is there any technical possibility in Russia to determine all these biological subtypes? Are they evenly distributed across regions?

Yes, of course, there are problems here. You can talk a lot about the great, but if there is no material basis for all this, then nothing will happen. In order to understand the biology of a tumor, it is necessary to conduct a series of tests that allow us to evaluate the biology of the tumor at least surrogately, not at the gene level. These tests are expensive, and they are available, to put it mildly, not everywhere. Although, however, even here over the past ten years the picture has changed. Now, in one form or another, at least basic tests are done in almost all dispensaries in the country, but the problem here is quality and timing. The terms of these studies reach up to five weeks in some dispensaries, although in a normal laboratory this can be done in three days. And all this time, both the patient and the doctor are waiting for the results, without which it is impossible to continue treatment. And time goes by, in five weeks the tumor can grow.

- What do you think, how much money does the patient need to close financial holes in state guarantees? Is it possible to treat breast cancer in Russia completely free of charge and at the same time qualitatively?

I work in a federal institution, there are completely different principles for financing treatment than in the regions. We have excellent opportunities for cancer treatment, here we can do almost everything at the expense of the state, but the state does not pay us for cancer diagnostics until the diagnosis is established. This is how the financing of federal centers is arranged. Patients have to pay for all examinations until the diagnosis is fully established, and if it is cancer, then from that moment on everything is really free for them, well, at least on paper. In reality, there are situations when it is more expedient for patients to pay for something. However, the main part is still covered by the state.

As for the amounts, let's talk step by step: here the patient felt something was wrong in the mammary gland, or during some spontaneous examination, she was diagnosed with breast cancer. In order to make a diagnosis quickly, adequately and correctly, she will need about 50 thousand rubles. That is how much you will have to spend on research that is needed for a correct diagnosis. For residents of large cities, this amount is even more or less affordable, although even here everyone has different opportunities. And this, mind you, is only the diagnosis, which is necessary to prescribe treatment.

Now let's talk about the treatment itself. In fact, oddly enough, but in the Russian Federation, any woman can receive a standard of treatment for free. The only question is what the standard will be. You can perform the removal of the mammary gland with the complete removal of the lymph nodes for free at any dispensary, and it is performed. But here the nuances begin. Firstly, the question is how competently the preoperative examination was carried out. As I said, not everyone does the necessary immunohistochemistry. And, for example, if the standard of our institution is to perform examinations using CT of the chest and abdomen with contrast, then in the regions this, as a rule, is not even mentioned: in most institutions, only fluorography and ultrasound of the abdominal cavity are performed. I'm not even talking about quality now. But fluorography, even in the most experienced hands, does not have any adequate information content for oncologists.

Here's another example: X-rays of the lungs taken over the past three months are widely accepted as confirmation of the absence of lung metastases. I and many of my colleagues believe that this is, to put it mildly, wrong ...

In a word, standard treatment is available free of charge to every citizen of our vast Motherland. The question is only in the standards that are applied. In reality, modern treatment is impossible in very many dispensaries. Well, what is an oncologist to do, who either does not have radiation therapy at all, or has one that it would be better not to have? Of course, he will not be able to perform organ-preserving operations, because then it is impossible for him to properly irradiate the patient. He'll do a well-meaning mastectomy.

And finally, the next stage is the cost of medicines. Medicines are expensive, both here and around the world. And not all regions can afford to buy the entire range of drugs. Therefore, the patient is often offered a "standard" therapy that has been around for a long time and, strictly speaking, is not erroneous. The paradox of chemotherapy is that it offers a huge range of drugs - from cheap schemes to very expensive ones. At the same time, the difference in the result of treatment is not so revolutionary: not two or three times. An expensive one can be 15-40% more efficient.

What does the doctor do in this case? The doctor prescribes a cheap scheme at the expense of the state budget, without being too dishonest: he honestly prescribes what his dispensary has purchased. If he prescribes expensive drugs that his dispensary does not buy, he will certainly get a kick from his superiors. And when a patient comes, for example, for a second opinion to an oncologist who is not related to the situation, and he says that more expensive and effective treatment can be applied, then additional expenses begin. And how many there will be depends on the situation, it happens that there are a lot.

- In Russia, a huge number of women with such a diagnosis as "mastopathy". what do you think about it?

It's just hell! Mastopathy is not a disease. There is no such diagnosis anywhere in the world. And of course, this does not “turn into cancer” - this is complete nonsense ... The worst thing is that it takes time and effort from doctors who are immersed in this story.

I thought a lot about this topic and I don’t even understand where this crap came from. I remember that in 1998, when I came to work at the dispensary, there was already a lot of this stuff there. The mammary gland can hurt not only cancer. Diseases other than cancer can be: there are benign tumors, there are all kinds of conditions associated with the formation of cysts. Sometimes cysts are huge, they become inflamed, hurt. All this can and should be treated. But we again and again run into the question of the qualifications of our doctors: uzists, oncologists, mammologists. It is easier for them to make some incomprehensible diagnosis than to tell a woman that she is doing well.

Very important advice: find a medical center, not a doctor, but a center where you will receive treatment

- And what about the widespread opinion that breast cancer, they say, rejuvenated?

If we talk about dry data, then the incidence among women from 20 to 40 years old has not changed in any way since the 70s. Actually, this is a curious myth! Where did he come from? First, over the past 20 years, the information field has expanded to incredible boundaries. And if there were no social networks before, now we have a huge number of channels in which everyone discusses important and personal topics. If earlier patients with such a diagnosis did not particularly tell anyone about it, sometimes even relatives did not know that a woman was sick, now there are a huge number of patients who openly talk about it and even make something like a show out of treatment. There are even awards on the American and British Facebook for the best blog of a breast cancer patient. They even manage to make money on this. And in the information space more often slip messages that some young pretty woman is suffering from cancer. In fact, 20 years ago, another pretty young woman was also sick, but a) she often simply did not know her diagnosis, b) she was ashamed of it, even if she knew, and c) she had nowhere to spread this information.

- Is it psychologically more difficult to work with young people?

Yes, but it's hard to say for everyone. There are young people who are already well and truly familiar with the disease. And they are so well versed in the topic that sometimes you even hesitate to give some advice. I don't know if this is good or bad.

There are other patients who have read a lot of information about breast cancer, but it is completely wrong - false. And sometimes it is simply impossible to convince them. There is a third type - those who are resigned to the end. Most often they have an example of older relatives - grandmothers, mothers, whose illness was very difficult.

And it happens, on the contrary, that after a course of treatment, patients are transformed, they begin some completely new life, a fire lights up in their eyes. But there are few of them, and they, as a rule, are already older. Basically, it's a tragedy.

Yes, it's probably harder to work with young people.

If we talk about those who had bad examples with serious illnesses before their eyes. This is hereditary breast cancer.

As a rule, these are women with oncogenic mutations. Now, by the way, genetic testing is needed not only to assess the risk of getting cancer. This is also necessary in order to determine the tactics for those who are already sick.

- And who needs to do these genetic tests anyway?

I would tell everyone, but I'm afraid I'll get kicked out by the entire oncology community. True, not everyone should do this. Let's start with the fact that it's not cheap. It is worth getting tested if we are talking about hereditary cancer. Here, in any case, we have some kind of family history: if both grandmother and mother were sick, then the daughter is at risk. If there were cases of ovarian cancer in the family, and it was a close relative. This test is enough to do once in a lifetime.

- But what to do if you find a mutation?

This is a huge headache not only for the patient, but also for me. That's what I can say. First, "forewarned is forearmed". We know that genetic predisposition increases the chance of getting cancer, but this does not mean that it will happen tomorrow or even happen. Secondly, you can undergo examinations more actively - do an MRI of the breast every year, and this does not mean at all that you need to stop living - you can continue to give birth to children, raise them, enjoy life. And when the issue with the children is closed, come to the oncologist and ask for a prophylactic mastectomy. But the fact is that even the complete removal of the gland does not guarantee that the woman will not get sick. This is rare, but we cannot help but warn the patient about it. Still, testing should be done: this knowledge can reduce the risk of death from breast cancer.

- What advice would you give to women who have recently learned about their diagnosis of breast cancer?

Don't despair. And don't panic. This is the thing that cures in most cases. And even if there are already metastases, this is not a disaster. This is a disease that oncologists are trying to turn into a state of chronic disease. We may not be able to cure her completely, but it is in our power to make life go on, and this is very important. This is the first tip.

The second very important advice: find a medical center, not a doctor, but a center where you will receive treatment.

- And how to choose them?

It's very hard, very hard. Firstly, this center must have the appropriate equipment. But for the average person it is hard to understand what equipment is good and what is not. For example, radiation therapy must be in principle, it happens that it is not at all. The pathological laboratory must be one that can do any molecular tests. Should have its own chemotherapy department.

- Now, if, let's say, a woman comes to the doctor and asks: "What percentage of organ-preserving operations do you perform?" Is this a criterion?

You know, most doctors will just send her and won't even talk. However, if a woman comes to me and asks what percentage, I will answer her - I am not ashamed to answer. It seems to me that this is the most important criterion: any self-respecting center should own the entire spectrum of surgical interventions for breast cancer. It should do mastectomy, organ-preserving operations, all types of reconstructions: with transplanted flaps, with implants, with expanders, with a combination of techniques. And if the center does not own at least one technique, this is wrong. It means that something is wrong with them there in the Danish kingdom.

What else? It is important that in the center you choose for treatment, the doctors speak English. At least some. And everyone else was reading. But it is either difficult or impossible to verify this.

And finally, the repair still needs to be normal. Chambers should be clean and beautiful. Well, I don't believe that normal treatment is provided in the 12-bed ward. If there is a mess in the department, then there is a mess in their heads. If the head physician has enough time and energy to create banal things, then there is a chance that he will have enough time and energy to do a normal pathomorphology. I do not remember that there was a chic pathomorphology, but around devastation. Usually it's the other way around.

But now, in fact, there are many dispensaries in the country that are more than decent.

- Can you name five pieces at once?

Kazan. Generally great guys. Samara are great guys. Lipetsk is gorgeous. By the way, this is my hometown, and there is a good service, there is good equipment.

You know, Tyumen pleasantly surprises. Irkutsk! But Irkutsk, one must understand, is "the role of the individual in history" (V. V. Dvornichenko, legendary among oncologists, has been working in Irkutsk for many years as the chief physician of the oncology dispensary. - Approx. I. F.). Irkutsk is a very strong office. Novosibirsk yet. In Yekaterinburg, Professor Demidov has a strong center in the 40th hospital.

- And here's a provocative question for you. If you take all the mammologists in the Russian Federation, what percentage of them would you offhand call good?

I don't quite understand when they say "good doctor" in our profession. Of course, Dr. Aibolit must be good. But modern oncology and the treatment of breast cancer in particular is a team. Therefore, instead of "a good doctor" it is necessary to say "a good center". And the doctor with whom you will communicate depends on your psychotype. If you need to cry into your vest, find a doctor to whom you will cry into your vest. If you need a strict military-style tone with you, find one for yourself. But look for them in a good center.

- Okay, then I'll rephrase the question. In total, there are about a hundred centers in the country that deal with breast cancer: one each in the regions, more federal centers, private clinics. What percentage of them are good?

I haven't been everywhere. But I think that 30 percent is normal. Again, when we visit colleagues, we see positive aspects. It is clear that this may be a "survivor's mistake", because I visit the centers to which they are invited, and, therefore, these are, in any case, active people. But I hope that at least 30% of all centers in the country are good.

The risk group is supplemented by patients suffering from nodular mastopathy, hypertension, diabetes mellitus, and obesity.

Features of the course of breast cancer in stage 2

The second stage of breast cancer is considered an early form of manifestation of the disease. But in the case of damage to the pathology of several lymph nodes, experts talk about its relationship to late forms. Cancer, which occurs in a diffuse invasive form, in some patients requires excision of blood vessels, pectoral muscles and ribs.

The presence of a neoplasm, or tumor, ranging in size from 2 to 5 cm;

Affected lymph nodes located in the armpit and adjacent to the tumor.

In substage 2B, the size of the tumor varies from 2 to 5 cm with the spread of the process to the lymph nodes of the whole body.

How to be treated for stage 2 breast cancer?

Surgery as a treatment for breast cancer involves a mastectomy, or complete amputation of the diseased breast. Some patients may be offered organ-preserving surgery - the choice is made on the basis of the results of a comprehensive diagnosis.

Can breast cancer be cured? What is the chance for a successful recovery?

Can breast cancer be completely cured? This question daily worries the female half of the population, whose representatives are faced with a terrible diagnosis: breast cancer. This is not surprising, because breast cancer is one of the most serious diseases, the victims of which are women of various age categories and social strata every year.

The cancer factor does not choose a woman with any specific signs, but all the sick people live with one question throughout the treatment process: is breast cancer treated? Of course, I always want to reassure the patient, and say only kind warm words about a speedy recovery, and her further return to her usual way of life. In practice, unfortunately, there are not always positive forecasts for survival, and this also needs to be discussed.

Can breast cancer be cured

The statistics of the treatment of this oncological disease says that cancer is curable, but getting rid of this disease depends not only on the professionalism of doctors and the right cancer center, within the walls of which treatment will be carried out, but also on a number of factors. It is worth considering the basic aspects that affect the healing of this serious illness:

• Timely appeal of a woman to a specialized doctor in case of detection of primary symptoms of breast cancer. This is a key factor that has a tremendous impact on the prospect of the entire treatment process. The sooner treatment begins, the higher the chances of survival of the patient.
• Regular scheduled medical examinations. Independent palpation of the chest to detect foreign formations.
• Healthy lifestyle. The absence of bad habits, both before the illness and during the treatment itself.
• Passage of therapy in a specialized center for the fight against oncological diseases of this category.
• High-quality medicines designed to suppress tumor cells.
• Professional approach to treatment by medical staff.
• A balanced diet, the steady implementation of all instructions that come from the attending physician.
• Support of relatives and friends.

On average, 85% of women diagnosed with breast cancer are out of the fight with the tumor - the winner. The main thing to remember is that everyone is responsible for their own health and timely seeking medical help.

Breast cancer diagnosis, prevention, surgery and other treatments

Breast cancer is very common in women and the incidence is constantly increasing. This is partly due to the improvement in the detection of the disease, but it should be noted that the disease itself began to occur more often (approximately one person per woman per year). The incidence of patients of working age is increasing.

Statistics show that this disease is one of the most common causes of female death. Among the regions where there is a rather high incidence are Moscow, St. Petersburg, the Chechen Republic and the Kaliningrad Region.

It is worth noting the success of public health in the fight against breast cancer. In addition to improving the detection of the disease, based on mass preventive studies using a mammograph, there is a decrease in mortality in the first 12 months after confirmation of the diagnosis. That is, the disease is now detected at earlier stages, it is successfully treated, and the life expectancy of patients with this diagnosis is increasing.

Causes and conditions of development

The direct cause of the disease has not been reliably established, but breast cancer is most likely associated with mutations in certain genes that are inherited. That is, the risk of getting sick increases significantly if two close relatives have breast cancer, as well as ovarian cancer.

More often, pathology occurs in patients with such concomitant conditions:

• irregularity, abnormal length of the menstrual cycle, infertility, lack of childbirth, breastfeeding, onset of menstruation before the age of 12, menopausal period over the age of 60;
• inflammatory diseases of the uterus and ovaries;
• endometrial hyperplasia (for example, polyps);
• obesity, high blood pressure, atherosclerosis;
• liver disease and hypothyroidism;
• the patient has a brain tumor, sarcoma, lung cancer, larynx, leukemia, carcinoma of the adrenal cortex, intestines and other tumors associated with syndromes (for example, Bloom's disease).

To reduce the likelihood of illness, some external factors should also be avoided, for example:

• influence of ionizing radiation;
• smoking;
• chemical carcinogens, preservatives;
• high-calorie diet containing too many animal fats and fried foods.

The role of hormonal imbalance in the female body is high. Diseases of the ovaries, adrenal glands, thyroid and hypothalamic-pituitary system increase the possibility of breast cancer.

Finally, the role of genetic disorders has been proven. They can be of two types:

• a genetic mutation in the genes that are responsible for the growth and reproduction of cells; when they change, cells begin to divide uncontrollably;
• induction of cell proliferation, that is, an increase in their division in the formed node.

Pathology is also registered in men, their ratio with sick women is 1:100. Symptoms, diagnosis and principles of treatment are the same as in female patients, adjusted for the sex characteristics of the hormonal background and anatomical structure.

Preventive actions

Breast cancer prophylaxis is necessary in both healthy women and those with a unilateral tumor to prevent metastasis and spread to a second breast.

Currently, according to foreign and recent domestic recommendations, for the prevention of breast cancer in healthy women, bilateral mastectomy is indicated, followed by prosthetics. Such an intervention reduces the likelihood of a neoplasm to almost zero.

However, before a prophylactic operation, it is recommended to consult a geneticist who will confirm the increased risk of getting sick, given the presence of mutated BRCA1 and BRCA2 genes in a woman.

Surgical removal may be offered to patients with some precancerous features:

• atypical ductal hyperplasia;
• atypical lobular hyperplasia;
• lobular carcinoma in situ (non-common).

When tissues are removed directly during the intervention, an emergency histological analysis is performed. When cancer cells are detected, the scope of intervention can be expanded depending on the characteristics of the resulting pathological changes.

The same tactics (removal of a healthy gland in case of cancer of the second breast) is also indicated for unilateral lesions, if gene mutations are genetically confirmed or there are precancerous conditions.

It is believed that the removal of the mammary glands with a preventive purpose is indicated even if the risk of getting sick in a woman is the same as the average for the population. However, in our country, mass mastectomy as a means of preventing breast cancer is treated with caution.

Traditionally, three components of prevention are used to prevent breast cancer in Russia.

Primary prevention is carried out in healthy women and includes education of the population, promotion of breastfeeding. It is necessary to explain the benefits of regular sexual relations with a regular partner, the timely birth of a child. A woman should avoid external risk factors - radiation, smoking, carcinogens. When planning a family with a person in whose family there have been repeated cases of this tumor in women, it is better to visit a geneticist.

Secondary prevention is aimed at diagnosing and eliminating diseases that can later cause a malignant tumor:

• mastopathy;
• endocrine disorders;
• diseases of the female reproductive system;
• liver disease.

For secondary prevention, you should regularly undergo a dispensary examination by a general practitioner and a gynecologist.

Tertiary prevention is aimed at timely detection of tumor recurrence and metastasis in a woman who has already been treated for this disease.

Classification

Stages of breast cancer

Depending on how the tumor grows, there are diffuse and nodular forms of the neoplasm, as well as atypical cancer (Paget's disease). The rate is characterized by rapidly growing cancer (the total mass of tumor cells becomes 2 times greater in 3 months), a tumor with an average growth rate (an increase in mass by a factor of two occurs within a year) and a slowly growing one (a tumor increase by a factor of 2 occurs in more than a year) .

The structure of the tumor is determined by its source, therefore, invasive ductal (growing from glandular ducts) and invasive lobular (growing from glandular cells) cancer and combinations of these forms are distinguished.

According to the cellular structure, adenocarcinoma, squamous cell carcinoma and sarcoma are distinguished. Depending on the type of cells, malignancy also varies.

TNM classification

The classification of this malignant neoplasm is carried out according to the TNM system. According to this classification, the stages of breast cancer are characterized by a certain combination of the qualities of the tumor node itself (T), the involvement of lymph nodes (N) and the presence of metastases (M).

It is characterized by an extremely small amount of damage without the participation of neighboring tissues.

It does not metastasize to other organs, except for the possible entry of tumor cells into the lymph nodes of the axillary group on the corresponding side. The diameter of the node does not exceed 2 cm, the penetration of its cells into the surrounding healthy tissues does not occur.

Does not form metastases, except for the possible involvement of the axillary lymph nodes of the corresponding side. The main difference is the characteristic of the node. It can grow up to 5 cm and even penetrate the surrounding glandular tissue.

Does not cause metastatic lesions of distant organs, but may affect the axillary lymph nodes. Other groups of regional lymph nodes may also be involved, lying under the scapula, under the collarbone and above it, near the sternum. In this case, the node can be of any diameter, there is germination in the chest wall, the skin is affected. The third stage includes inflammatory cancer, a disease in which thickening of the skin with dense edges is noted on the breast without a clearly defined tumor area.

It is characterized by the spread of tumor cells to the following organs:

Axillary and supraclavicular lymph nodes on the opposite side;

The walls of the pleural cavity surrounding the lungs;

The most common localization of distant foci is bone tissue (for example, vertebrae), lungs, skin, and also the liver.

External signs and symptoms

Types of breast cancer (to be more precise - forms):

The diffuse form includes tumors that affect the entire gland. Externally, diffuse cancer manifests itself:

• swelling and swelling of the gland;
• on signs resembles mastitis;
• similar to erysipelas;
• causes compaction and reduction of the gland (shell form).

Atypical forms are rarely recorded, they have features of localization and / or origin:

• nipple damage;
• a tumor originating from the appendages of the skin;
• bilateral education;
• a tumor growing from several centers at once.

Breast cancer is suspected when a small, firm, painless nodule forms in the breast. Pay attention to areas of wrinkling of the skin or retraction of the nipple. Enlarged axillary lymph nodes are often seen early in the disease. With intraductal forms, discharge from the nipple appears - light, yellowish, sometimes with an admixture of blood.

The first signs of breast cancer at an early stage, listed above, with the progression of the disease, are supplemented by reddening of the skin, the formation of a “lemon peel” on it, an increase in the tumor, deformity, or the appearance of non-healing ulcers. In the axillary region there are conglomerates of immobile lymph nodes, swelling of the arm develops due to stagnation of lymph in it.

Symptoms in individual variants of breast cancer are characterized by their own characteristics.

• Edema-infiltrative is accompanied by the formation of a large infiltrate - edematous compacted tissue. The gland is significantly enlarged, reddens, swells, the skin acquires a marble color, a "lemon peel" appears.
• The mastitis-like form is manifested by an increase and compaction of the gland. Attached infection, causing tissue breakdown. The temperature rises.
• The erysipelas-like form, on external examination, is similar to inflammation caused by microflora (erysipelas): bright red foci on the surface of the gland with spread to the surface of the chest, skin ulcers are often noted.
• Shell - an advanced stage of cancer, in which the gland decreases, changes shape, several nodules form in it.
• Paget's cancer is singled out as a special variant, primarily affecting the nipple and the area around it.

Do breasts hurt with breast cancer?

The pain caused by the tumor itself does not appear at an early stage of the disease. It is associated with swelling of the gland, compression of surrounding tissues, and the formation of skin ulcers. In this case, it is constant, aching, passing for a while after taking conventional painkillers.

Pain can also be cyclical, recurring from month to month in women of reproductive age. In this case, they are more associated with the existing precancerous disease - mastopathy and are caused by natural fluctuations in hormone levels. If you experience pain in the breast of any nature, you should consult a doctor.

The earlier the disease is detected, the more effective the treatment will be. The prognosis for stage 1 breast cancer, which can be detected with timely diagnosis, is good. After 5 years after confirmation of the diagnosis, the survival rate is 98%, after 10 years - from 60 to 80%. This means that almost all women who have been diagnosed with the disease at an early stage achieve remission of the disease. Of course, they have to monitor their health and regularly see a doctor.

The more advanced breast cancer, the lower the survival rate. At the 2nd stage of the disease, the prognosis is satisfactory, 5-year survival is up to 80%, after 10 years - up to 60%. At stage 3, the forecasts are worse: 10-50% and up to 30%, respectively. Stage 4 breast cancer is a deadly disease, with a 5-year survival rate of only 0 to 10%, and a 10-year survival rate of 0 to 5%.

How fast does breast cancer develop?

The process proceeds for each patient at its own pace. Without treatment, the tumor can completely destroy the mammary gland and give distant metastases within a short time - up to a year. In other patients, the course is slower. Therefore, it is necessary at the first signs of trouble to contact a gynecologist or mammologist and undergo the necessary diagnostics.

Diagnostics

Early diagnosis was traditionally based on self-examination of the mammary glands: once a week, a woman carefully probed the glands in front of a mirror, paying attention to discharge from the nipples, skin irregularities, and swollen lymph nodes. However, in modern guidelines, the effectiveness of this technique is questionable. It is believed that a doctor should determine the disease at an early stage with the help of an annual mammogram or ultrasound (ultrasound).

If a breast tumor is suspected, it is necessary to perform certain diagnostic interventions before starting any treatment.

Diagnosis of breast cancer includes the following steps:

• questioning the patient and her complete external examination;
• blood analysis;
• biochemical study, including liver parameters (bilirubin, transaminases, alkaline phosphatase);
• mammography on both sides, ultrasound of the glands themselves and surrounding areas, if necessary, clarifying diagnostics - magnetic resonance imaging (MRI) of the glands;
• digital chest x-ray, if necessary, more accurate diagnosis - computed tomography (CT) or chest MRI;
• Ultrasound of the liver, uterus, ovaries; according to indications - CT / MRI of these areas with contrast;
• if the patient has a widespread process or metastases, she is prescribed a study of the bones to identify tumor foci in them: scanning and radiography of the zones of accumulation of the radiopharmaceutical. If the stage of cancer T 0-2 N 0-1 is proven, such a study is carried out with complaints of pain in the bones and with an increase in the level of alkaline phosphatase in the blood; even during the initial treatment of the patient, the probability of having bone micrometastases in her is 60%;
• biopsy of the alleged tumor with a study of the resulting tissue; with the help of a biopsy taken before the start of any treatment, a pathomorphological diagnosis is determined - the basis of therapy; a biopsy is not performed if a mastectomy is immediately assumed - during it such a study will be carried out;
• determination of estrogen and progesterone receptors, as well as HER-2 / neu and Ki67 - specific proteins that can be considered as tumor markers for breast cancer;
• a biopsy with a thin needle of a lymph node with suspicion of the spread of a tumor there;
• a biopsy with a thin needle of a cyst if a tumor is suspected to develop there;
• assessment of ovarian activity by determining the appropriate hormones;
• examination by a geneticist to detect a mutation of the BRCA1 / 2 gene (breast cancer test) - when cancer of the breast is confirmed in two or more close relatives, in women under 35 years of age, as well as in primary multiple cancer.

To determine the general health of a woman, she is prescribed the following tests and studies:

• verification of blood group and Rh factor;
• isolation of antibodies to pale treponema (test for syphilis), hepatitis C virus and human immunodeficiency, determination of hepatitis B virus antigen (HBsAg);
• coagulogram to determine blood clotting;
• Analysis of urine;
• electrocardiogram.

Breast Cancer Treatment

Methods of treatment of the disease are varied. The number of their combinations exceeds 6000. The approach to each patient should be individual. A plan of preoperative therapy is drawn up to reduce the volume of the tumor, surgical intervention is proposed and postoperative measures are developed.

Breast cancer treatment methods:

• local (surgery, radiation);
• acting on the whole body (the use of chemotherapeutic agents, hormones, immunotropic agents).

Treatment without surgery

It is carried out when the patient refuses more radical measures, her general serious condition, edematous-infiltrative form, but it will never be fully effective and can only temporarily improve the patient's well-being. This therapy involves radiation.

Radical methods involve the complete removal of the tumor and affected lymph nodes. Palliative care is designed to alleviate the patient's condition. Symptomatic treatment relieves pain, reduces the severity of symptoms of intoxication. Folk recipes for this disease are ineffective.

Surgical intervention

Surgery for breast cancer is the basis of treatment.

The following operations can be performed:

• conventional radical mastectomy - the entire gland, pectoral muscle, lymph nodes under the collarbone, armpit, under the shoulder blade are removed;
• extended radical mastectomy - the peristernal lymph nodes and thoracic vessels are additionally removed, through which metastasis can occur;
• superradical mastectomy - additionally remove the supraclavicular lymph nodes and fiber between the organs of the chest;
• modified radical mastectomy preserves the pectoral muscles, has better cosmetic results, so it is considered a more gentle operation;
• mastectomy with removal of the axillary lymph nodes of only the lower group - performed in the early phase of the disease with the location of the tumor in the outer sections of the gland in debilitated elderly patients;
• simple mastectomy - a palliative operation that involves the removal of only the gland; such an operation to remove the tumor is carried out with advanced forms of the disease, decaying formation, severe concomitant diseases;
• radical sectoral resection - removal of only a segment of the gland with a small tumor at an early stage; while the mammary gland is preserved; after the intervention, an increased risk of recurrence remains, therefore, radiation is additionally performed.

Surgical treatment for metastases to regional lymph nodes should be supplemented with other methods, otherwise there is a high risk of distant metastases and recurrence of the disease. Irradiation is applied both before and after surgery to destroy the most active tumor cells. Techniques have been developed for irradiating tissues directly during surgery, which makes it possible to reduce the dose and increase the effectiveness of such therapy.

Chemotherapy

Breast cancer is a tumor prone to metastasis, so almost all patients are prescribed anticancer drugs. The use of chemotherapy significantly reduces the likelihood of relapse and death of patients. Chemotherapy drugs are able to reduce the stage of the disease, allow you to abandon major operations or reduce their volume.

The following medications are best for treating breast cancer:

Especially in combination. Special schemes have been developed that allow in each case to choose the best option for the patient. Sequential identical courses (pre-courses of chemotherapy) can be used, and in other cases, after several courses, the drug regimen is changed.

Before chemotherapy, the tumor is examined for hormone sensitivity. With low hormonal sensitivity, the use of polychemotherapy is recommended, since this is a factor in the unfavorable course of the disease.

Systemic therapy is sometimes not given to patients with an initial favorable prognosis - older than 35 years, with a small tumor that is sensitive to hormones and without involvement of the lymph nodes.

hormone therapy

Hormone therapy involves the suppression of the ovaries, which contributes to the inhibition of the growth of tumor cells. Previously, surgical or radiation castration was widely used. Now, gonadotropin-releasing hormone agonists (Buserelin, Goserelin) are often prescribed for this purpose. In addition, antiestrogen drugs are additionally used, for example, the drug Tamoxifen.

New in the treatment of breast cancer is associated with the emergence of drugs: estrogen receptor modulators (Raloxifene), 3rd generation aromatase inhibitors (non-steroidal Anastrozole, Letrozole, Fulvestrant and steroidal Exemestane).

Treatment often begins with surgery - a modified mastectomy or radical resection, supplemented by radiation therapy. In prognostically unfavorable cases, chemotherapy drugs are additionally prescribed. If the tumor is sensitive to estrogens, hormonal therapy is performed.

Complications

The most common complications in women undergoing such an operation are swelling of the upper limb (100%), limited mobility in the shoulder (65%), muscle weakness of the arm (50%), skin sensitivity disorders (40%).

All these changes have one cause - a traumatic lesion during surgery and radiation exposure of the lymphatic and blood vessels, nerve plexuses, so they are combined in the concept of "post-mastectomy syndrome". Its treatment is carried out throughout the life of the patient after surgery with the help of drugs, laser therapy, physiotherapy exercises.

Recovery and forecast

A patient who underwent surgery for such a serious illness cannot be considered cured. She needs further rehabilitation to improve her quality of life. It includes both full-fledged breast prosthetics, and treatment of post-mastectomy syndrome, compression massage, and physiotherapy exercises. Goals of rehabilitation:

• if possible, return to work, although many patients remain disabled;
• maintaining the ability to self-service and normal everyday life;
• relief of pain and care of the patient with the progression of the disease.

The recurrence of breast cancer usually manifests itself after a few years, in the same place where the neoplasm was or in nearby lymph nodes. Risk factors for a recurrent course include those that worsen the prognosis (large tumor size, and so on). It is important to see an oncologist regularly, as well as the first unusual symptoms after treatment for breast cancer, immediately consult a doctor.

Metastatic breast cancer also occurs after 3-5 years, it is associated with the entry of tumor particles into distant organs and their growth. This is how new foci are formed in the liver, bones, and brain. The course of this form of neoplasm is malignant, it progresses rapidly, the prognosis is unfavorable.

To avoid recurrence of the tumor, you need to follow the entire treatment regimen proposed by the doctor after the operation, do not refuse radiation and chemotherapy, if necessary. In many cases, a complete treatment will destroy the cancer cells and save the patient's life in the future.

Breast cancer is not a death sentence

How long do people live with breast cancer? This question is being asked by more and more people all over the planet, because this form of oncology is one of the most common. Not only women suffer from it, contrary to popular belief, malignant tumors of the mammary gland are also found in men, however, several times less than in the fair sex.

The reasons for the increase in the number of cases have not yet been fully elucidated, among the prerequisites for the occurrence of this form of cancer, scientists name both a genetic predisposition, hormonal imbalance in the body, and wearing tight bras, and even the use of antiperspirants. Not to mention bad habits, living in a polluted environment, malnutrition, which generally reduces life expectancy.

Survival for breast cancer can vary widely and depends on many factors, the prognosis can be quite optimistic if the disease was diagnosed at an early stage.

Survival prognosis depending on the stage of breast cancer

Can breast cancer be cured? This question is asked even by those who have never encountered this diagnosis, because the probability of being among the sick is too high.

Modern oncologists answer in the affirmative to this question, but then they make a reservation: the best prognosis can only be when you contact a doctor at an early stage of the disease.

When metastases have not yet had time to spread and cancer can be cured solely with the help of surgery, then both the survival rate and life expectancy are quite high. Here are the statistics regarding survival depending on the stage of this form of cancer:

1. The first stage: the tumor is small (up to 2 cm), there are no metastases, cancer cells did not have time to hit the nearby lymph nodes. The percentage of survival with timely treatment in this case is 75-95%.
2. Second stage: the size of the tumor increases to 5 cm, but there are still no metastases, another option is possible - the tumor itself is no more than 2 cm, but there are metastases in the nearest lymph nodes, they are absent in the bones and vital organs. Survive in such cases from 50 to 85% of patients.
3. The third stage: this is a rather advanced oncological process, the prognosis of doctors can be unfavorable. The size of the tumor in the third stage is more than 5 cm, multiple metastases are observed in the lymph nodes, bones, and nearby organs. Life expectancy with late access to medical care is short. The percentage of survival is also, it ranges from 0 to 30%.
4. Fourth stage: the tumor process progresses uncontrollably, the malignant neoplasm reaches an impressive size, metastases penetrate into nearby and distant internal organs, skin, bones.

It is important to note that with timely treatment (at the first, second stages), the frequency of relapses of the disease is significantly reduced, which in general also prolongs the life of patients.

There is also a direct dependence of the duration and quality of life in breast cancer on the level of medical care. Thus, in Russia, the average life expectancy after the detection of breast cancer with metastases, including in the bones, is from 2 to 4 years, while in European countries and Israel it averages about 12 years.

How does life expectancy depend on the type of tumor?

If a woman has been diagnosed with breast cancer, then before answering the question: is it curable, doctors conduct a comprehensive examination of the tumor. First of all, its dimensions, the presence (absence) of metastases in the bones, lymph nodes and other internal organs are established. The nature of the tumor is also established; the prognosis and further course of treatment largely depend on its nature.

1. Hormone dependent breast tumors. This kind of malignant neoplasm occurs in approximately 30% of all affected women. This form of cancer is relatively easy to treat, and accordingly, the prognosis when this form of cancer is detected will be more favorable, and life expectancy will be higher. It is these tumors that in most cases develop against the background of hormonal imbalance: the level of estrogen and prolactin significantly exceeds the progesterone level. Accordingly, the progress of the tumor process depends on the level of these hormones, on the surface of the tumor itself there are special receptors that are sensitive to these biologically active substances. With the help of special drugs, the hormonal background is corrected, the tumor slows down or stops its growth. Hormone therapy is also supplemented with a standard set of procedures that are prescribed for oncological diseases - radiation therapy, chemotherapy, which generally gives a high percentage of complete recovery, reduces the risk of metastases, including in the bones.
2. Negative breast cancer. One of the most severe forms of cancer. It is difficult to treat, since it is not a hormone-dependent form, doctors give a low chance of survival after the discovery of this type of cancer. It is extremely aggressive, metastases spread rapidly, including in the bones.
3. Luminal cancer, type A is a tumor that has hormonal sensitivity. Her growth is stimulated by the high level of estrogen in the patient's blood. It most often occurs in women of the older age group (after 50 years), but in most cases it responds well to treatment, rarely recurs, with early detection, the prognosis is favorable.
4. Luminal cancer, type B. One of the varieties of the above described tumor is also dependent on estrogen, but it is much more difficult to treat, often recurs, after which it quickly metastasizes to the bones and the nearest internal organs, lymph nodes. Most often affects young women. The prognosis is that without surgery, the survival rate is low.

Breast cancer is curable

The question of whether breast cancer is curable worries many women. It is worth saying that although, in general, every year the number of women with this form of cancer increases, nevertheless, modern doctors have learned how to deal with this formidable disease. In the arsenal of doctors there are methods such as chemotherapy, radiation, targeted therapy, hormone therapy, minimally invasive surgery. If you seek medical help immediately after the first symptoms are detected, then it is quite possible to avoid surgery to remove the mammary gland.

However, much is in the hands of the patients themselves. It is known that such diseases as diabetes mellitus, hypertension and obesity are the most common companions of breast cancer. They are also considered provoking factors in the issue of the recurrence of a cancerous tumor.

A rational healthy diet and moderate physical activity will help to significantly improve the situation - reduce blood sugar, blood pressure, and normalize weight after a course of cancer treatment. Here are the most common recommendations from doctors regarding diet for breast cancer:

1. Avoid foods that contain soy, because soy is a natural source of estrogens, the excess of which stimulates the development of a tumor, the spread of metastases.
2. Give preference to lean meats.
3. Most of the diet should be vegetables.
4. Avoid products with an excess of chemical dyes, flavors, margarine.
5. The diet should contain seafood and fish containing polyunsaturated fatty acids.

How long do people live with breast cancer? This question remains open at the moment, it depends on too many factors. Perhaps even the most experienced doctor will not be able to give an answer. On the part of the patient, strict adherence to all medical recommendations and prescriptions is required, only then can one hope for a full recovery.