Breast cancer

Breast cancerDevelops often, about 1 out of 10 women. Risk factors: menopause at the age of 50 years; no birth or first childbirth at the age of 30 years (incidence 3 times more likely); family history indicative of breast cancer in mother, sister (2 times more) or both (6 times more); fibrocystic breast disease (3-5 times more often). Early diagnosis of breast cancer provides a successful treatment for most patients. Five-year survival rate in the treatment of localized forms I-II stage is 90%, in case of locally spread cancer - 60%. The treatment results are much worse in the presence of distant Metastasio. In the diagnosis of breast cancer the importance of systematic self-examination (4 times per year) and medical examinations of women aged 40 years and older (1 year). Mammography is recommended 1 every 2 years after age 40, 1 in every year after 50 years. When detected in the breast solid tumor without clear boundaries diagnosis should be updated immediately (needle biopsy with cytologic analysis, biopsy with histological analysis). Method of dynamic clinical observations instead of clarifying diagnostic procedures should not be used. Often in the mammary glands detect benign conditions (diffuse and nodular breast, intraductal papilloma, fibroadenoma). The development of breast cancer from benign - infrequent situation (for example, from fibroadenoma - 1-1,5%), at the same time, wrong tactics in the differentiation from breast cancer often occurs in practice. In diffuse mastopathy detect diffuse induration and tenderness in the breast, sometimes there are bright discharge from the nipple. When nodal mastopathy defined single or multiple seals of various sizes with indistinct contours that are not associated with skin. Fibroadenoma can be represented by a dense, rounded, bumpy single or multiple different tumor sites. Leaf fibroadenoma are characterized by rapid growth and reach large sizes in a short time. Intraductal papillomas appear bloody discharge from the nipple. The diagnosis is precise cytological analysis and intraductal contrast mammography. Cysts in the breast are rounded, clear boundaries, contain serous fluid. Symptoms. Breast cancer is the development of limited mobile, solid tumor with minor indrawing skin over it. In the late stages of the disease, these symptoms are more pronounced, appear indrawing nipple, infiltration and ulceration of the skin, swelling of the breast in the area of location of the tumor. In addition to this most typical of developing breast cancer, there are other clinical variants. Edematous-infiltrative form is characterized by enlargement of the mammary gland due to the pronounced edema and infiltration, skin sealed and redness, tumour site may not be detected by palpation and mammography (primary-edematous-infiltrative form) or to be of relatively small size (secondary-edematous-infiltrative form). As a variant of this form of breast cancer sometimes develops venerable-like or registeredby cancer manifested bright hyperemia of the skin, fever and rapid progression. On the contrary, cancer type Pejeta arising from the epithelium of the large ducts near the nipple, is characterized with slow development. First, there is thickening, indrawing and ulceration of the nipple, then in the thickness of the breast is formed of a dense tumor site. Classification of breast cancer is made in accordance with the TNM system. The classification is the size of the tumor in the breast and localization of metastases. Spreads breast cancer in the regional lymph nodes and distant organs and tissues. When cancer localization in the outer quadrants involved first of all axillary lymph nodes, in the inner quadrants-and infraclavicular chest. Possible involvement of supraclavicular and axillary nodes on the opposite side. Enlarged lymph nodes does not always mean their metastatic lesions. It may be increased as a manifestation of hyperplasia. The fact neoplastic lesions of the lymph nodes and the number of involved nodes establish the morphological examination after surgery. Distant metastases of breast cancer occur in the bones, lungs, liver, skin, chest wall, brain, etc. To clarify the extent of spread of the disease at the time of diagnosis and in follow up using scintigraphy of the skeleton (if necessary, x-rays of the bones), ultrasound examination of the liver, lung radiography, etc. Important to characterize breast cancer is the determination of estrogen receptor (ER) and progesterone (SPM) in the tumor, which is produced during the removal of the tumor or by biopsy. The tumor is dependent on the endocrine effects when the content of ER and/or RP -10 fmol/mg protein. The contents of hormone receptors in primary tumors and metastases was not significantly different. Therefore, the conclusion about the endocrine dependence of tumor made in the early stages of the disease, can be taken into account when determining treatment strategy during the development of metastases. Treatment. When breast cancer stage I-II optimal method of treatment is surgery with radical mastectomy or lumpectomy with removal of regional lymph nodes. After surgery about early breast cancer additional treatment is administered. When affected axillary lymph nodes should be conducted adjuvant chemotherapy. In stage III disease appoint preoperative radiotherapy and/or chemotherapy and after surgery - adjuvant drug therapy. Adjuvant chemotherapy begin 2-3 weeks after surgery. The most commonly used mode CMP (cyclophosphamide -100 mg/m2 oral, 1-14 th days in combination with methotrexate 40 mg/m2/1 and 8 days and 5-fluorouracil 500 mg/m2/1 and 8 days; the intervals between courses - 2-3 weeks, the number of courses - 6). At high re and/or RP in menopause additionally give tamoxifen (20 mg daily for 2 years), and with preserved menstrual cycle produce oophorectomy, then use tamoxifen (20 mg) or prednisolone (10 mg) long. When menopause is over 10 years old and a high level of re adjuvant therapy may only be performed by tamoxifen. Preoperative therapy in locally distributed common breast cancer.


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