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Stages, symptoms, signs and treatment of breast cancer

Breast cancer is the most common cancer in women. The tumor consists of undifferentiated malignant cells that replace the glandular tissue. The relevance of the disease increased in the late seventies of the last century. The disease was characterized by mainly affecting women over the age of fifty years. A feature of the present ecopathogens – a disease of child-bearing age.

How many are living with breast cancer?

This question is interesting for all patients admitted to the Oncology center. Ask him to see the truth, even terrible.

Any doctor knows that the predictions of the outcome of the disease should be treated with caution. Well-known examples of the inhibition of late stages of carcinogenesis and accelerated development of breast cancer identified at an early stage.

However, the more the chances of recovery in a patient with early operable form of cancer, if you ignore the:

  • individual characteristics (age, presence of comorbidities, support and understanding of relatives and friends, the setting for the struggle for life);
  • the effectiveness and timeliness of treatment.

There are known cases of preservation of the breast in the detection of pathogenesis in the early stages of the disease. Oncologists sometimes decide to remove breast cancer. It is unpleasant, but not fatal. Important the support of loved ones.

In the pathogenesis of metastasis in other parts of the body prognosis careful, you need to fight, because it is possible to suppress the growth of abnormal cells even at this stage.


Treatment of breast cancer in "Assuta"

Clinic "Assuta"(Israel) conducts the treatment of breast cancer using the latest medical technologies. The vast majority of patients in this disease, an operation is performed, allowing to keep the chest. The clinic has the opportunity to undergo surgery with renowned surgical oncologist of the country – Professor Shlomo Neubaum. In"Assuta"also takes one of the most experienced Israeli experts in the treatment of cancer – Professor Moshe Inbar. Due to the presence in the clinic of modern linear accelerators Novalis TrueBeam TH, irradiation of the tumor makes it possible to reduce the number of required procedures and the time of exposure, and to avoid damage to the surrounding tissue.

The success of the cancer treatment always due to timely diagnosis. In"Assuta" of the patient due tomilestone will be able to pass the examination in breast cancer in just 4-5 days. Modern diagnostic techniques like PET-CT, allows to define the stage of disease and spread of the tumor.

Save a life and begin the treatment of breast cancer with breast conservation now - http://www.assuta-clinic.org/lechenie-raka-v-izraele/lechenie-raka-molochnoy-zhelezy-v-izraile/


The content of the article:


First signs of breast cancer

Women often face problems of the breast in the form of nodular or extensive seals and other features that are frightening similarities withOncology. Fortunately, not all the formation are malignant.

Pain and breast lump is accompanied by:

Mastitis – inflammation of the functioning of the gland infectious or traumatic nature. In some cases, discovering a connection with people, unrelated to lactation.

General characteristics of mastitis. Usually suffer first rodamia women rarely nulliparous young women. The disease is associated with getting banal microflora (Staphylococcus, Streptococcus) through the cracks of the nipples inside the gland, hormonal failure, hypothermia, injury, improper latch of the baby. Risk group: women aged primiparas.

Signs of mastitis include:

  • A lump in her breast, at first diffuse;

  • Bursting pain, worse when feeding;

  • Increase local and General temperature;

  • The formation of purulent cavity and nodular seal;

  • Discharge from the nipple during lactation (liquid, viscous, purulent, bloody).

From cancer mastitis is rapidly debut associated with the above causes, which are defined in the survey period, the patient and history taking.

Mastitis is not an inflammatory disease, it is associated with abnormal growth of the alveoli and ducts of the Breasts is influenced by hormonal imbalance – increased estrogen, prolactin, decrease of progesterone in the blood and tissues of the gland. Distinguish between nodular and diffuse form of mastitis. Due to the spread of the tissues of the disease called fibrocystic disease. Risk group: women over the age of 35.

Signs of mastitis:

  • When the feeling of the seal, reminiscent of grains (nodules) or strands (diffuse lesion).

  • Perhaps a combination of pathology with menstrual or menopausal rearrangements of the body;

  • The pain develops gradually with increasing of the seals;

  • In the long can join the symptoms of mastitis.

Fibroadenoma – a benign neoplasm of glandular tissue, with unclear etiology. Distinguish Mature fibroadenoma (form well contuinued) and immature form (loose). Some schools have the tendency to degeneration. Risk group: women over 20 years.

Signsfibroadenoma:

  • Single or multiple breast lump;

  • Pain and other symptoms are often absent.

It is advisable to consult a mammologist consultation.

Self-examination

The technique involves superficial and deep palpation of the breast at the same time with two hands.

The reason for the appeal to mammologist is the identification of:

  • Focal or diffuse breast lump;
  • Deformation with obvious asymmetry;
  • Retracting areas of the breast or nipple;
  • Peeling, crusts, erosions of the nipple and areola;
  • Pain in the armpit;
  • Discharge, including bleeding;

  • Swelling of the breast in the form of cellulite – lemon peel;

  • Redness of the skin.

Other symptoms of breast cancer

In order to clarify the primary symptoms, the doctor performs additional tests, starting with questioning the patient, inspection and palpation. The main objective of mammalogy at the stage of physical examination – to determine in advance whether benign or malignant course of the disease.

Difficulties in diagnosis arise in the investigation of the vast body seals less than one centimeter, fibrous adhesions and inflammation.

The doctor pays attention to:

  • The nature of seals;
  • The shape, size, nipples and areolas around them;
  • The presence or character of discharge;
  • Wrinkling of the skin;
  • Umbilical – limited retraction of the skin in the navel;
  • Change the size of regional lymph nodes.

The following description of the seals allows you to assume a malignant course of the disease. The clinical symptoms necessarily confirmed by laboratory and instrumental studies.

Seal knots

Detect one or more nodes that are clearly contribut, often painless, dense consistency, of limited mobility, with a wrinkled retractions of the skin above the tumor site. In the axilla is well-palpable lymph nodes. In the later stages, the skin turns lemon peel, the formation of ulceration, thickened nipple.

Diffuse permeation

In this case it is possible to detect several variants of the seal. Insome cases they resemble the acute form of mastitis or mastitis.

Four possible variant of diffuse seals:

  • Swollen. Sometimes develops during pregnancy and breastfeeding. Characterized by the seal of the breast. The skin is edematous, soaked infiltrate, hyperemia, reminiscent of lemon peel. The cause of the edema – compression of the milk ducts infiltration.

  • Armored. Is characterized by infiltration of tissues. Pathogenesis may spread to the chest wall. The skin is thick, bluish-red color, inactive. Grope multiple nodules. Found ulcerations and crust in the form of the carapace, the skin shrinks.

  • Similar to the erysipelatous inflammation of the skin. Focal redness is characteristic. The edge of the congested area swollen with jagged edges, apply on the skin of the chest wall. Occurs with fever up to 40°C. is difficult to treat.

  • Like mastitis. The affected area is increased, the skin hot, reddened, tense. Tumor dense, slightly movable, is felt over vast area. Pathogenesis spreads rapidly, often accompanied by fever.

Paget's Disease

Looks like psoriasis or eczema. Unlike them accompanied by severe redness of the skin, engorgement of the nipple and areola. On the skin of the nipple and areola are formed dry, then moist crust and scabs, and under them the wet granulation. Carcinogenesis is distributed through the milk ducts into the body of the pancreas.


The causes of breast cancer

The natural background breast cancer is:

  • High speed physiological regeneration and death (the apoptosis) of cells of glandular tissue and the subsequent formation of new cells. The more formed young cells, the higher the risk of mutations is the basis of the modern understanding of carcinogenesis;
  • The high dependency of cancer cells from the hormones in the period of woman's life from menarche to menopause. The number of female sex hormones in the tissues of the breast is many times greater than the level of such steroids in the blood.

Men do not have a fatal combination – labile hormonal levels and fast update rate of glandular cells.

This is probably why the breast cancer:

  • In men is extremely rare, although histological structure of the gland cells of men and women are absolutely identical;
  • In women the incidence of cancer is not dependent on the volume of glandular tissue, it is equally often can occur in women with small andbig Breasts that also indicates the hormonal nature of breast cancer.

Pathological cell mutations occur every second each person, regardless of his state of health and sex. However, not all people get cancer (including breast cancer).

Endogenous causes of breast cancer

Risk factors for breast cancer are women aged 30-70 years, with a history of:

  • Early puberty or late menopause;
  • Chronic gynecological diseases;

  • Hormonal disorders (diabetes, hypothyroidism, obesity, etc.);

  • Similar to the disease in blood relatives;
  • Long-term use of birth control pills;
  • Long substitutive hormonal therapy;
  • Numerous abortions and miscarriages pregnancies;
  • Irregular sex or prolonged lack of relaxation after sex;
  • The absence of children or after maternity.

Exogenous causes of breast cancer

Still ongoing debate about the influence of external (exogenous) reasons. Probably, they have a connotation and are cumulative factor inrush mechanism of carcinogenesis.

Their specific influence on the development of breast cancer is not proven, but they certainly stimulate the development of cancer in combination with other reasons.

The exogenous reasons include:

  • Chest trauma;
  • Ionizing radiation;
  • Chemical;
  • Smoking and alcohol.

Trauma in the field of breast cancer – a possible cause of cancer in the damage of the glandular tissue. It is proved that ionizing radiation also has serious influence on the development of such diseases as Smoking, alcohol abuse, although the relationship was not significantly determined, but it is not rejected.

Chemical. In the literature there are mentions about the influence of certain chemicals on the development and utilization of female sex hormones – estrogens. It is known that estrogens and their metabolites are involved in carcinogenesis of the breast. Increasing the level of estrogen in the urine is one of the diagnostic criteria for the diagnosis in estrogenzawisimycancer.

Caffeine

As a specific stimulator estrogenzawisimae carcinogenesis often indicate caffeine. Coffee is a common drink, so its effect on the body in cancer is interesting.

Caffeine is part of:

  • Natural coffee;
  • Freshly brewed tea;
  • Cocoa;
  • Mate – a tonic beverage from Argentina and some countries of Latin America;
  • Guarana Brazilian soft drinks.

Caffeine is an alkaloid from the group of methylxanthines. This group of drugs used to treat asthma, improve skin tone with lung diseases and diseases accompanied by edema, as a diuretic. It is well known anti-cancer effects of theophylline and pentoxifylline are drugs from the group of methylxanthines.

Similar anti-cancer effect of caffeine is confirmed by Swedish scientists from the University of Lund and malmö who studied the CYP1A2 gene and its alleles – a/A, A/C, C/C. it is Established that the caffeine with different intensity inhibits the development of breast cancer in all study groups. 15% of women who do not drink coffee, set estrogenzawisimy cancer, difficult to treat.

Thus, caffeine has nothing to do with estrogen-dependent forms of breast cancer.


Types of breast cancer

Nosological forms of cancer are divided into precancerous or non-invasive (in situ), invasive ductal and lobular. Breast cancer is associated with estrogen and progesterone in the breast tissue and with the presence of specific tumor HER2/neu protein.

Hormone-dependent breast cancer

Due to the peculiarities of the physiology of a woman's body is under hormonal pressure is much stronger than the male. Important functions are hormones produced primarily by the ovaries – estrogen, progesterone, pituitary – LH, FSH. When this occurs, the regular hormonal changes associated with natural physiological processes.

On the background of modern life has multiplied the number of risks associated with imbalance of hormonal status. In the first place, this broad use of endocrine methods of fertility regulation. Some of the factors mentioned at the beginning of the article.

It is noticed that many forms of hyperplasia of the breast marked with endocrine disorders, and very high levels of estrogen, prolactin amid falling levels of progesterone. This ratio is maintained in the clinical manifestation of breast cancer. Allocateprimarily estrogen-dependent and predominantly progesteronelike forms of breast cancer.

Hormonal imbalance with good effect to treat on average one third of cases of both cancers with the use of endocrine therapy. Efficiency sensitive group reaches 75%.

Along with long-term use of hormones – analogues of gonadotropin-releasing hormone regulation of ovarian function may be carried out by methods of physical (radiation exposure) and surgical castration.

Negative breast cancer

The most severe form of cancer of the breast. Clinically it occurs in similar to other forms of cancer pathogenesis. Is complex treatment. To determine this type of cancer can only laboratory of molecular genetic studies. Classification introduced after 2000. Usually this disease in medical practice is classified as triple negative breast cancer. This form of cancer detected every third patient from 27 to 39% of patients. Ultrathin studies established the presence of a cancer that has receptors to one of the three proteins of the body:

  • estrogen;
  • progesterone;
  • specific tumor protein.

Triple negative cancer is characterized by the presence of cells having receptors for all three proteins. As a result, the carcinogenesis reminiscent of the fight with the dragon, which continually eludes the pursuer. In recent years, doctors find effective ways of influence on the body in this form of the disease.

Luminal breast cancer

Belongs to the group of estrogen-dependent oncological diseases of the breast. There are two forms – type a and type B.

Luminal type A cancer

Occurs in women during menopause. At this age it is detected in 30-40% of cases observed.

Receptors onkokletok:

  • receptive cells of estrogen and progesterone;
  • insensitive to marker of cell growth of onkokletok breast cancer Ki67;
  • absolutely do not accept cells of a specific tumor protein, its histochemical designation HER2/neu.

Patients with luminal type cancer And respond well to hormone therapy with estrogen antagonist is tamoxifen, and aromatase inhibitors. Aromatase is an enzyme of the adrenal glands, involved in transformation of testosterone to estrogen. Record highthe percentage of survival and low rate of recurrence.

Luminal cancer type

Diagnosed among young women of childbearing age. Approximately 14-18% of cancer patients have estrogen-dependent type V.

Accompanied by metastases to lymph nodes, high rate of recurrences. The disease is usually difficult chemotherapy and hormone therapy. Only in some cases could halt the growth of cells through a course of immunotherapy with drug transtuzumab. Trastuzumab is a human monoclonal antibody specific to tumor protein HER2/neu. Thus, in certain indications, stimulation of specific immunity to encountered of the corresponding clone.


Stage breast cancer

The division of breast cancer into stages depending on the severity of pathogenesis is rather arbitrary. Cancer is a multifactorial disease; the degree of damage and the volume of the tumor are the main criteria for assessing the severity of the disease.

Meanwhile, the stage of breast cancer in the medical literature indicate:

  • the size of the tumor T1, T2, T3, T4;

  • involvement in the pathogenesis of regional lymph nodes N 0, N1, N2, N3.

  • the presence of distant metastases M0, (nil) M1 (available).

Symbols are also early non-invasive tumors, here we will not point.

Stage 1 breast cancer

Breast tumor initial stage can be described as follows:

  • T1 (size up to 2 cm);

  • N0 (metastasis to regional lymph nodes do not exist);

  • M0 (distant metastases are not detected).

Stage 2 breast cancer

Breast tumor in the second stage of pathogenesis can be described as follows:

  • T2 (size 2 to 5 cm);

  • N1 identify metastases in the lymph nodes I, II, defeat of one or two lymph nodes from one side. Nodes are palpated as a separate entity;

  • M0 or M1 possible isolated distant metastases.

Stage 3 breast cancer

Breast tumor in the third stage of pathogenesis can be described as follows:

  • T3 (larger than 5 cm);

  • N2 revealed metastases in lymph nodesarmpits I, level II, with one hand in a single batch, or increase to values determined lymph nodes near the breast (usually not defined), in the absence of changes in the axillary lymph node.

  • M0 or M1 missing or there are distant metastases.

Stage 4 breast cancer

Breast tumor in the fourth stage of pathogenesis can be described as follows:

  • T4 tumor size does not matter, it is determined outside of the breast and the breast skin, accompanied by ulceration, nodules;

  • N3 – metastases on both sides of the chest III level, palpable under the breast, axillary and supraclavicular space.

  • M1 multiple distant metastases.

Possible variants of said digital symbols, as well as additional figures to clarify the description.


Diagnosis of breast cancer

To minimally invasive diagnostic methods include mammography – option x-ray studies, ultrasound imaging, elastography, magnetic resonance imaging. To invasive – biopsy and further histological and cytological study of the cells in the alveoli.

The mammogram

The most common in our country method – x-ray (mammogram) in two projections. The study recommended that in accordance with the individual menstrual cycle.

In recent years, with the introduction of new methods is questionable diagnostic value of mammography. This is due to the additional x-rays with regular screening tests and questionable results when fibrous growths, the presence of breast implants, the small size of the tumor. In some cases the diagnostic reliability of results is reduced to 6-40%.

Meanwhile, with the help of this method, you can obtain primary, secondary, and indirect symptoms proliferation of the mammary gland. Diagnostic value based on the detection of calcification (microcalcifications) is of calcium salts, which are clearly visible in the background of the alveoli and ducts.

Primary (important) symptoms:

  • Contrast area on the image;

  • Irregular edges (beams, lumps or calcifications and microcalcifications);

  • The limited accommodations in the form of single formations or clusters;

  • Size from 0.5 mm and below.

There are three degrees of contouring in mastitis, the third (heavy)the degree is the transition between good and malignancy:

  • The first (easy) degree. The picture shows a predominance of shadows, characteristic of fatty tissue.
  • The second (medium) degree. The picture shows the same degree of opacity of plots, characteristic of fatty, glandular and connective tissue.
  • The third (severe) degree. The outlines mainly glandular tissue; shading characteristic of adipose tissue do not exist. It should be alerted, perhaps, the tumor in the picture not contuinue.

Analysis of the level of gene expression

Analysis of the level of gene expression provides an opportunity to assess the likelihood of recurrence of the disease. This study will need to pursue in order to solve the question of the necessity of chemotherapy. Disease recurrence occurs on average 10% of women, and the chemotherapy is assigned to the vast majority that negatively affects the health of patients. This analysis will allow the identification of women who chemotherapy is really necessary.

Other types of diagnostics

Physical studies include:

  • Breast ultrasound and elastography
  • MRI of the breast
  • Physical research
  • Screening

The treatment of breast cancer

The treatment of breast cancer is surgical intervention. When the process is localized, freedom from disease involves chemotherapy. Supporting hormonal treatment with drugs such as Tamoxifen and aromatase inhibitors performed with positive estrogenzawisimy cancer.

Consecrated in article treatment of breast cancer developed jointly by various doctors. In this study we used the global protocols for the management of women with similar disease. Treatment depending on the stage of the disease, patient's age, the nature of the tumor will vary. Used immune, radiation therapy and chemotherapy.

For a start, the doctors carry out an assessment as to what stage the disease is. If this is an early stage of the disease, it is possible to carry out local treatment. If the tumor has metastasized and the disease process was involved lymph nodes and other organs, that is, as a rule, only a systemic treatment of cancer.


Surgical treatment of breast cancer

Depending on the nature of the tumor, fromthe prevalence of the process is sufficient to remove only the tumor. Although you may need to eliminate a certain part of the surrounding tissues. Sometimes remove the breast completely. This surgery is called a mastectomy.

Breast-conserving surgery called a lumpectomy. It can be put into practice in the case, if the tumor exceeded in size 4 cm. Its efficiency will be no less than mastectomy. Before surgical intervention, the physician must determine the exact location of the tumor. This is possible through mammography or ultrasound. Another method for detecting and localizing a neoplasm is palpation, which is performed by the surgeon.

However, the lumpectomy to spend is not always possible, in some cases mastectomy is a higher priority method of intervention:

  • Upon detection of multifocal tumors, i.e., tumors located in different areas of the breast.
  • The chest had once received radiation therapy.
  • The tumor has a large size and is equivalent to the size of the Breasts.
  • Radiation therapy is not possible due to scleroderma or other connective tissue diseases.
  • The possibility of realization of radiotherapy is missing due to the fact that the woman lives in remote areas.
  • The patient herself refuses surgery to remove only tumors, as fears of disease recurrence.

The requirement is that during surgery mandatory had completely removed the tumor with capture of healthy tissue of the breast. This gives the maximum assurance that the affected tissue will be removed from the body. Additional intervention will be required in the case when the edges of the excised from the body of material submitted by the tumor. In some cases during the surgery is required to remove not only the breast, but part of a large sternum. It is the main muscle of the anterior chest wall.

Often removed and the lymph nodes located in the armpit. Previously conducted surgery to remove the axillary nodes is often complicated by the lymph edema. We had to cut 10-40 nodes that disrupts the natural lymphatic flow. Modern surgery has the ability to much of the lymph nodes to keep by removing only the signal nodes. So are those lymph nodes that direct the flow of lymph to the cancer cells. In the end, it is possible to reduce the risk of developing lymphedema after surgery in 65-70% women.Methods of detecting the sentinel lymph nodes every year more and more improved. If the use of blueprints as ID watchdog nodes gave an accuracy of 80%, the use of combined methods increases this figure to 92-98%. Fence biopsy of sentinel lymph nodes is performed for all patients, a tumor which does not exceed in size 5 cmat the stage T1 and T2. Modern surgery has adopted tactics gentle removal of lymph nodes, even if the low number of metastases in the signal node.

The examination of surgical material. The tumor tissue is sent to a study aimed at examining the sensitivity of the potential cancer cells to different types of chemotherapy. This so-called "test cell death". To deliver on the diagnosis need samples until until hours passed after their removal from the body of a woman.

Especially effective such testing when the patient had cancer detected in the early stages. Indeed, in this case to quickly assess the effect of chemotherapy is not possible, because the tumor removed from the breast during the surgical intervention completely.

Itself chemotherapy in this case is called adjuvant and is carried out with a supporting goal. However, the treatment protocols of breast cancer test cell death still have not been made because the clinical trials for its effectiveness to date has not been finalized and have evidence.

Lymphoedema (lymphedema). On the background radiation therapy, or for the removal simpaticski nodes in patients may develop lymphedema. Despite the fact that there are recommendations to limit physical activity to women who have had cancer, recent studies prove that a dosed, specially selected and regularly perform exercises, namely, weight lifting can reduce symptoms of lymph edema.

Overall, to improve health after undergoing surgery for removal of breast tumors is possible through the implementation of power exercises. To exercise should start gently, gradually increasing the load. Well, if you have the option of training with a professional trainer. On the background of lymphostasis need to be mandatory to wear a special supportive bra. This is especially true during exercise.


Radiotherapy (radiation therapy) breast cancer

Radiotherapy is a part of maintenance treatment for women who have undergone a lumpectomy, although sometimes it is performed after mastectomy. Its main objective is to reduce the likelihood of relapse. The essence of the procedure is that a tumor or an area that has been exposed to surgery, processed by gamma rays, or the powerful x-ray radiation. This allows you to effectively destroy the abnormal cells which could remain in a woman's body after surgery, and those cells, which could appear again.

Radiation therapy is of two types:

  • Contact, which is performed using an external source of rays. To do this, use a linear accelerator, which emits ions.
  • Remote, which is called brachytherapy and is interstitial way. The radioactive substance is delivered directly into the tissue where the tumor. The amount of this substance is accurately dosed and is calculated individually.

With the help of radiotherapy can destroy even the most microscopic tumor cells that might remain after its removal from the body. Thus, the dosage may not be negligible, since the death of pathogenic cells has to be guaranteed. But healthy cells, such exposure also takes its toll. Die and normal cells and those that are similar to cancer. Suffers the whole body. The calculation is what killed the healthy cells are more able to regenerate and the cancer tissues such ability does not possess. In this context, radiation therapy is prolonged, to give the normal tissues to recover in the rest period from radiation.

If irradiation is performed using an external source, you should visit treatments for 5 days a week. Full course radiation therapy will be from 5 to 7 weeks. One procedure time is 15 minutes. To reduce the period of exposure to radioactive rays is possible thanks to modern technique called APBI (accelerated partial breast irradiation). Thanks to this technique, processing is subjected to only the area where was located the tumor. Thus the entire treatment takes no longer than 7 days.

National Institute of malignant tumors located in the United States, indicates that, although possible detrimental impact on cancer cells with radiotherapy, women's lives, it does not extend. On this account were held for at least 6 research and results clearly indicate that extending the life of patients is not observed.

Sowomen after tumor removal or after partial removal of the breast should undergo a consultation with the surgeon that these studies sign. Perhaps he will also take the view that it is enough just one operation, without subsequent radiotherapy.

Indications for radiotherapy

Most often recommended after radiotherapy was carried out organ-preserving operation with removal of only the tumor. Although perhaps the appointment of an irradiation after mastectomy. The number of indications for the procedure of radiation therapy is constantly expanding.

Almost all women who had undergone quadrantectomy and lumpectomy go through radiotherapy. It is not doing the patients with the fourth stage of cancer, except when a woman suffers from severe bone pain, or tissue subjected to necrosis. But in this case, radiation therapy is not the purpose of decrease in risk of cancer recurrence and is performed in the framework of palliative treatment.

So, recommendations to irradiation following:

  • High risk of recurrence of the disease after undergoing a mastectomy (tumor was of large size, or in the pathological process involved lymph nodes).
  • In the complex therapy when the mammary gland was preserved.
  • Multiple tumors.
  • Tumors metastatic to other pathological lesions.
  • Damage to blood vessels, lymphatic vessels of microscopic size.
  • A tumor that has spread beyond the borders of the lymph nodes.
  • Damaging cancer of the skin, areola or nipple, large breast muscles.

Varieties radiotherapy

Linear accelerator represents the most frequently used medical source of radio waves that is used to rid patients of breast cancer. Treatment can be subjected as the whole iron (if lumpectomy) and whole thorax (post mastectomy). Brachytherapy is used in the case when the disease is detected at early stages of development. This technique refers to the more modern and quicker to complete the treatment. Thanks to her, is handled exclusively by the affected area, while healthy cells are not irradiated.

Modern technology has had a positive impact on the development of radiation therapy. For example, one of the latest techniques, it is intensely modulated radiation therapy or IMRT. It is also possible to adjust the intensity of the radioactive rays, change their shape, forming elementary beams, which act at different points of the prostate. Loaddistributed in such a way that the pathological effects on the heart and lungs is not provided. But it should clearly prove the difference between the usual radiotherapy under supervision of computer dosimetry (body burden is calculated in this case less accurately) and IMRT. No data regarding the number of relapses and number of side-effects from IMRT. External irradiation for treatment of breast used for 5-10 weeks 5 days a week.

Another popular technique that is commonly used in the last 10 years – it APBI (UCO, accelerated partial irradiation). This technique is included in the treatment of breast cancer after undergoing lumpectomy. Effects exposed the place where the tumor and also treated with a small amount of surrounding healthy tissue. Perhaps the passage of UCO for only 5 days.

It is possible to use UCO methods with internal and remote irradiation. Especially efficient method for those patients who had a limited mammary gland neoplasm, not gone beyond the breast.

Contact with the irradiation source of radio waves (radiopharmaceutical) is placed in the chest of the patient. This is possible through the use of a balloon, or a simple catheter, or multiple catheters.

Now, studies aimed at comparing the effect of a point exposure and extensive irradiation of the whole breast. They are scientists NSABP – "national project on adjuvant treatment of cancer of the large intestine and breast cancer".

In addition, modern science has given the opportunity to make radiotherapy maneuverable, i.e. can be carried out directly in the operating unit during surgical intervention. This technique is called TARGIT. Its implementation needs a generator, a radiation source of ions "Intrabeam".

You should know that a large-scale study of 2232 patients from 28 different clinics, located in 9 countries. Wore, these studies the name of the TARGIT-A and were controlled clinical trials of a third phase. Eventually managed to establish that the exposure directly in the operating unit with the use of mobile generator in comparison with the standard method of treatment of breast cancer only 1.0% better, and not more than 1.5% worse. That is, the difference is 0.25%. It is possible that running at a given time of the study TARGIT-B will allow to adjust the dose of received radiation during the use of this modern technique.

Side effects from radiotherapy

Side effects from remote exposure will occur immediately, and after a certaintime after its completion. So, after just a few weeks after suffering exposure, women experience fatigue due to the regeneration of healthy cells. In addition, the skin at the site of exposure to radioactive rays may be darker. A few months after the procedure, the skin is restored, although it is possible life change in its color.

Other side effects:

  • The formation of a soft swelling;
  • Muscle rigidity;
  • The development of lymphedema;
  • Pain in the treated area.

Also, many patients say that the breast with the side where was carried out the effects have become smaller in size, wrinkled. Most often it is due to the fact that along with the tumor was removed and your own breast tissue.

Plastic surgery aims to restore shape of the breast is not always possible after conducting of adjuvant therapy. This is because the skin of the chest is prone to fibrosis and becomes less elastic.

Therefore, experts recommend that you wait for some time plastic surgery, if a woman is radiotherapy. In addition, it is desirable for breast reconstruction to use her own tissue rather than artificial implants.

There is speculation about what UCO leads to less development of side effects, since the processing is subjected to only part of the breast. This can be achieved when multiple catheters, which allow the flow of radiation to control better.


Systemic treatment of breast cancer

Systemic therapy involves the appointment to the patient of drugs that affect the entire body. The combination of their different. Included in the treatment regimen immunotherapy, chemotherapy, hormonal therapy.

Chemotherapy in breast cancer

May her use until the time of surgery, during it and after the surgery. Sometimes chemotherapy replace surgery if the possibility of interference is missing.

Is assigned based on the individual characteristics of the patient, previous examinations, if:

  • the size of the tumor more than two cm;
  • of childbearing age of the patient;
  • the lack on the cells receptors to estrogens and progesterone;
  • nizkoeffektivnyj cancer cells.

But the use of medicines that inhibit the growth of cancer cells, has the opposite, negative, direction – along with the cancer dies and the part of normal cells. This side pushes many chemotherapy patients. Many drugs are contraindicated in pregnancy and breastfeeding.

The side effects of chemotherapy experienced by a patient, apply to the functions:

  • gastrointestinal tract – nausea, vomiting, diarrhoea, yellowness of the mucous membranes;

  • respiratory – shortness of breath;
  • cardiovascular system – palpitations, tides blood to a person;

  • nervous system – dizziness, reduced vision, confusion;

  • urinary blood in urine, swelling of limbs;

  • the skin – temporary hair loss, pigmentation disorders, itching, swelling, allergic reactions on the skin.

Disorders are usually reversible, after rehabilitation treatment, their influence is eliminated. The procedure is performed in hospital under laboratory and clinical control of the patient from the medical staff.

Chemotherapy drugs belong to the pharmacological group of cytostatics and cause necrotic destruction of cancer cells. Common drugs in this group: doxorubicin, cyclophosphamide, fluorouracil and others.

Chemotherapy is accompanied by risks for the health of the patient, therefore requires careful prior preparation and consultation with the doctor. Unfortunately, chemotherapy in many cases, still the only effective method of combating breast cancer in combination with other methods.

The status of hormone receptors

Found that women who has had breast cancer are at risk for recurrence of the formation of the primary tumor. Hormonal therapy is appointed immediately after the completion of chemotherapy, if a woman has been removed estrogenzawisimaya tumor.

Most often for this purpose use the following hormonal agents:

  • Tamoxifen. Intended for young women not yet in menopause. The drug is required to block the estrogen receptors.
  • Analogues of GnRH. Drugs have their purpose inhibition of the functioning of the ovaries in young women not yet in menopause.
  • The aromatase inhibitors. Used in women in postmenopauzalny period in order to lower the amount of estrogen.

So,through the use of estrogen therapy, it is possible to stop the growth of tumors and even to reduce it in size, provided daily application of the drugs in this group. This thesis was presented at the 31st annual Symposium in San Antonio. The Symposium had the title "breast Cancer".

In total, the study involved 66 women, and positive dynamics was observed in one third of them. They all had a resistance to treatment with antiestrogens and breast cancer has metastasized. Thus during the reception of estrogen in some women the cancer has started to progress and transferred back to antiestrogen therapy. Most surprisingly, she began to act.

A few months later, the effect of it was again lost, but again started to work estrogen therapy. So, part of seeing women alternately received treatment with estrogens and aromatase inhibitors. This occurred for several years. Before starting treatment with estrogens and a day after its launch, was made images for positron emission tomography.

It was found that the tumor is sensitive to hormones, saturated with glucose and actively glowed. Why is this happening, explain to the present time failed. Found that the hormone IGF-1 provokes breast cancer is suppressed by estrogens.

Targeted therapy

Some women have a tumor that's causing the expression of the HER2 gene, so they show treatment with the monoclonal antibody trastuzumab is Trastuzumab, Herpectin. Its action is aimed at suppression of the activity of HER2 in tumor cells, thereby stopping its growth. Maybe the drug in combination with chemotherapy.

Found that this combination tends to slow down the growth of tumors and increases life expectancy of women. There are clinical trials relative positive effect in the treatment method of trastuzumab adjuvant therapy held throughout the year. The risks of recurrence of the tumor decreased, the survival rate of women increased.

There are also other options for targeted therapy, which at this time is not fully understood, among them:

  • Inhibitors of signal transduction. The use of these antibodies enables one to halt the transmission of nerve impulses within atypical cells, provokes their division and stop tumor growth.
  • Inhibitors angiogenesis. These antibodies aim to stop the growth of new blood vessels, which makes the tumor to obtain food and oxygen.
  • Antagonists other hormones orreceptors, including the receptors of prolactin and androgens. They in considerable quantities found in the tumor.

So as a kind of targeted therapy a lot, it gives the opportunity for experts for every woman to choose for her effective method of treatment.

Anti-angiogenic therapy. Randomized trials was a drug like Bevacizumab (a monoclonal antibody aimed at blocking receptors of vascular growth or VEGF receptors). It can now be easily obtained.

Data regarding studies of this therapeutic agent were published in the announcement in 2005 by the National cancer Institute. There are indications that compared with standard chemotherapy, Bevacizumab slows the growth of tumors at 5 months or more. But while the survival of women does not change.

Digging, which was engaged in the development of this drug applied in the Management of quality control of medicines and foods, to be able to use this drug to slow the growth of metastasized breast tumors.

Preclinical trials

  • Protein tyrosine phosphatase 1B (rtr1v). Was successfully tested on mice with drugs that aim to block protein tyrosine phosphatase 1B, which causes the development of approximately 40% of breast tumors. The results were published in the journal "Nature genetics" from March 2007. The study was conducted at McGill University located in Canada.

    This same protein in excess amounts found in people with diabetes and obesity. The drug is aimed at suppressing the activity of tyrosine phosphatase 1B can slow the development of cancer not only breast cancer. but lung cancer. At this point in time it is engaged in the development Merck. They continue to test on mice with tumors expressing HER2, which are sensitive to the Herceptin. If the experiments are successful, it will save the lives of many women with similar tumors.

  • Blockers cholesterol – Ro48-8071. It is likely that the drug PRIMA-1, which is the disastrous effect on abnormal cells, can inhibit the production of cholesterol. Found that Ro 48-8071, is able to suppressthe synthesis of cholesterol. Scientists suggest that it can also be used to kill cancer cells, similar to the drug PRIMA-1. But healthy cells will not be damaged.

  • Glucose-lowering drugs. The study of the properties of Metformin in combination with Doxorubicin (a cancer drug) were graduate students Herc H. and D. Eliopulos. The experiments were held over in the test tubes cells that are identical to breast cancer cells.

    Found that in mice with breast tumor receiving antidiabetic drugs is able to prevent tumor formation by cancer cells. 2 groups of mice with breast cancer, which was formed in ten days, double dose of metamorphine with Doxorubicin delayed the recurrence of the disease and reduce tumor size. This is in comparison with the intake of only one Doxorubicin. Two months after completion of treatment, Oncology in animals who received only the cancer drug, recurred. In mice that had been in therapy for glucose-lowering means of recurrence did not happen. However, the reception solely of Metformin on breast cancer has no effect.

  • Thermotherapy. It is possible that hyperthermia in the near future will also be used to treat breast cancer in conjunction with the introduction of antitumor vaccines. This assumption allows to do modern discoveries in this field. In addition, MRI imaging of cancer, are sensitive to hyperthermia, is used more often. The use of hyperthermia is gaining such wide popularity that in America the organization, "General national cancer network" included hyperthermia in the treatment Protocols of breast cancer, as a method aimed at dealing with relapses.

    One of the largest centres in Europe, where using the method of hyperthermia is in the Netherlands. It's called "Medicinski center name of Erasmus". There is a patented tool – Thermodox, which is represented liposome capsule with its member Doxorubicin. Capsule is administered intravenously and aktiviziruyutsya under the influence of high temperatures on it. The heating is done by local effects. This allows you to control the growth of cancer cells and improve the quality of life of patients. The local heating of tissue does not exceed 42 degrees, but capable of dissolving the liposomal capsule and release the medicinal substance, there are. In the end, it in high concentrations delivered directly into the tumor tissue.

  • Len. In rats, a study was conducted regarding the positive effects of flax seedin terms of combating the disease. The results showed that the tumor size became smaller. Then in the experiment with the control of the placebo effect involved 32 women who were in postmenopausal. They daily took 25 g of flax seeds. Managed to establish that this dose increases the growth of cancer cells responsible for self-destruction. In turn, the gene c-erb25 responsible for the growth of cancer cells, to be expressed fewer. There are preliminary indications that flax seed contributes to tumor growth and metastasis, and also increases the effect of Tamoxifen.

Immunotherapy in breast cancer

The human immune system helps the body to resist the development of tumors.

  • Therapy by dendritic cells. Own dendritic human cells processed using oncofetal antigens and three times a month are introduced to a woman by injection. There is an assumption that these cells are returned back to the body, will teach T cells to recognize oncofetal antigens on the surface of abnormal cells and cause a global immune response. Eventually, the cancer cells will be destroyed by his own immune system and the disease will get back to normal.
  • Stevemax - gormonalnozawisimae cancer treatment (phase 3 trials). At this time the vaccine is being developed Stevemax, which would stimulate the immune response to abnormal cells with antigen glycoprotein mucin-1. It is often found in various types of tumors. It Express tumors of the rectum, breast, lung, prostate. The vaccine is supposed to "teach" the immune system these cells to find and destroy.

During the second phase of the trial, which involved 171 patients with inoperable lung tumor at stage 3B, were obtained positive results. Managed to extend the lives of people from 13.3 months (patients on maintenance therapy) to 30.6 months for inclusion in the treatment regimen Stevemax. Side effects were minor – a small discomfort in the digestive tract, local reactions and mild or moderate severity of symptoms resembling the flu.

Chemoimmunotherapy in breast cancer

Getting rid of breast tumor using its own immune system – the treatment is very attractive and promising. Immunization has many advantages over other methods of therapy and allows the cells of the immune systemremember the tactics of struggle with atypical cells, which makes re-treatment is not needed.

Chemoimmunotherapy has as its goal to enhance T-cell response to any cancer antigen and play a new T-cell response with cytotoxic drugs. Some of these drugs, such as Paclitaxel, Cyclophosphamide, Doxorubicin in combination with immunized by dendritic cells capable of destroying cancer cells much more efficient. While in past years there was a consensus that immunotherapy to chemotherapy would be ineffective, since T-cells are depleted. It is now clear that after the depletion phase begins active growth.

IMP321 increases the number and improve the functioning of immune cells, natural killer cells and cytotoxic T-lymphocytes. At the stage of clinical trials the success was registered in 90% of cases, while cancer has progressed in only 3 patients for six months. It is assumed that chemoimmunotherapy will be included in the treatment protocols of breast cancer with chemotherapy.

Thermochemotherapy for cancer of the breast

Chemotherapy helps to reduce the size of tumors in 58.8% of cases, while combination therapy this figure increases to 88.4%. The tumor became smaller in size by 80% in 80% of cases. The same effect was observed only in 20% of cases in patients who received only chemotherapy.


Evaluation of the effectiveness of treatment

Standard imaging techniques and physical examination are essential to assess the effect of the ongoing neoadjuvant therapy. The only possibility of evaluation that is recognized around the world.

However, such modern diagnostic methods as CT, MRI, PET can detect residual effects of the tumor, to identify residual formation of metastases.

  • The effectiveness of chemotherapy can be assessed by CT or PET.
  • Localization of residual cancer can be determined using MRI.
  • The sensitivity of the cancer to therapy can be assessed by diffusion-weighted MRI.
  • The sensitivity of the tumor in the early stage of development to chemotherapy can be identified using biomarkers sk18.
  • To see a larger number of malignant tumors of the breast compared to ultrasound and mammogra allows 3T MRI.

A blood test

The search technology of circulating cancer cells in the fragments of blood is an alternative method of diagnosis, FDA approved. While women take a tablespoon of blood and send it for analysis beforethe beginning of the treatment. Then the study was repeated after a month. The amount available in the blood, atypical cells will indicate whether there is an effect of the therapy.


The treatment of breast cancer in Israel

Israel is recognized worldwide as a country that has the ability to treat even the most severe cancer patients from around the world. Here are the most well-known clinics specializing in cancer:

  • MC Assuta. This clinic has the experience for over 80 years. Patients relieve cancer chemotherapy method, using nuclear and biological treatment may undergo radiotherapy. Surgery patients only by highly skilled surgeons.
  • Ichilov MC, located in tel Aviv. This center is recognized as one of the best in the country. Approach to the treatment of cancer is complex, each patient involved the oncologist, the surgeon, the haematologist, radiologist and diagnostician. In addition to conducting surgeries in a hospital it is possible to perform chemotherapy, radiotherapy and cell therapy.
  • MTS Chaim Sheba. The facility is equipped with the latest technology. It includes linear accelerators, CT and MRI devices, PET scanners. This center not only treats cancer, but also holds on its database of clinical trial. Individual approach to each patient is a prerequisite of treatment.
  • The cancer center Assaf Ha-Rofé is a research centre operating at the University of tel Aviv. Here, the passage of modern disease diagnosis. Treatment is carried out using the latest techniques, for example, using laser radiation.
  • Center Hadassah. The clinic successfully conducted the treatment of malignant tumors with the use of hormonal, immunotherapy and cytotoxic therapy.
  • The Medical Center Herzliya. The clinic has 120 branches, each of which has its own focus. The facility of the world level with modern equipment. Here it is possible to conduct contact and remote irradiation, performed organ transplants and other complex operations.

It is possible to deliver the patient from almost anywhere in the world in any of the medical centers in Israel. Care and treatment will be provided at the highest level.

The price of treating breast cancer in Israel varies within the following limits:

  • 500 dollars for implementation of laboratory diagnosis, determination of tumor markers;
  • From 400 dollars per testbiopsy taken earlier;
  • From $ 650 for a mammogram and ultrasound followed by a consultation with a specialist;
  • From $ 1600 for performing imaging for diagnostic purposes;
  • From $ 2,000 for the biopsy and examination of biopsy material;
  • From $ 10,000 for removal of the tumor with preservation of the breast tissue;
  • 12000 dollars for a mastectomy.

As for the cost of chemotherapy, it depends on the size of the tumor, its sensitivity to hormonal agents. There is a possibility of chemotherapy in the home country with subsequent control of results in the clinic of Israel.

Breast surgery there will cost from 30,000 to 50,000 dollars.

Naturally, the prices offered are indicative, for more accurate information need to contact their medical centre.

Video review: breast cancer 3rd stage, full cure is 4 years


The nutrition in breast cancer

The food in the hospital is organized on the basis of scientifically based medical guidelines. However, patients seem to offer a lean diet, and they would still have the hunger after meals. Be patient, after some time the quantity of food on offer will be enough to saturate and reduce weight.

If there are no forces to abandon the usual diet, and the relatives provide food gifts, follow the recommendations and give preference to:

  • Low-calorie fruit and vegetables, ideal if they are grown on the plot where guaranteed low content of chemical additives;

  • Natural (not konservirovannoy) meat, stewed white meat – breast of chicken and rabbit, boiled beef instead of sausage and boiled beef tongue, boiled lamb. Eliminate pork in any form;

  • Vegetable products and bread, preferably made of roughly milled grain;

  • Natural juices and compotes made from local berries;

  • Perhaps the additional use of fish oil, other products containing vitamin D, Omega 3, omega 6.

Refrain or abstain from eating:

  • Products containing soy (add in sausage, sausage, and some vegetable products);

  • Canned, smoked meat of any kind (ham, ham);

  • Moderate consumption of sugar, salt;

  • Canned juices.

Useful information: Few people know that ordinary beta-carotene (provitamin A) decreases the risk of mastitis and breast cancer by 40%! What foods most beta-carotene?


Disability in breast cancer

The duration of treatment breast cancer – about four months, then the issue of disability. A favorable factor for rehabilitation is the most complete elimination of symptoms, confirmed by all studies.

The extension of the term disability available after passing mediko-social examination. According to her results, in respect of the patient solves a question on assignment of a disability.

Distinguish disability by degrees of vitality:

  • III degree – the smallest loss;
  • Grade II – moderate loss;
  • I degree – the expressed restriction.

For each degree of disability, there are objective criteria, confirmed using the clinical, laboratory, and hardware research. In the case of extremely hopeless condition of the patient the woman is prescribed palliative care.