BREAST CANCER

 

Breast cancer is the most common form women cancers and the most common cause of death among women between 40-44 years old. Breast cancer incidence rate among women reach 32%, it’s mortality rate is 19%. Breast cancer is developing in milk glands or milk ducts cells.

 

Breast anatomy

Mammary glands are located in the front of the chest wall between the 2-6 rib. They are surrounded by skin, pectoralis major muscle and modified apocrine sweat glands, located in the muscle fascia.

Breast tissue consists of 15-20 lobes. The milk ducts (diameter 1-2 mm) drain the breast milk to the nipple.

The nipple contains numerous nerve cell endings, fat cells and sweat glands. It is surrounded by the areola. Pigmentation of the areola circle reaches 15-60 mm in diameter. On the periphery of the areola are found montgomery glands, the sebaceous glands, which can secrete milk.

 

Risk factors

Genetic predisposition: Although the exact cause of breast cancer is unknown, gene mutations increases the risk of its development.

Hormones use: It is known that prolonged exposure to endogenous estrogen affect cancer development Using of oral contraceptives especially prior to first pregnancy, premenopausal and postmenopausal period increases the risk of cancer.

Diet and obesity: Eating food with high fat content as well as obesity can lead to cancer. The risk of breast cancer in obese people is 1.5-2 times higher than in people with standard weight. Obesity not only contributes to the development of breast cancer but also cause resistance to its treatment.

Menopause: Woman entering into menopause after age 55 are 2 times more likely to develop cancer. Menopause caused in surgical way protects women from cancer.

 

Symptoms of breast cancer

Tumor cells are hard with irregular edges and rigid surface, it doesn’t move easily in the breast tissue. If the cancer spreads to distant organs, these metastases are rarely the first symptoms of breast cancer. Breast cancer spreads mostly to hips or ribs bones, lungs and liver. Women by manual examination usually find the tumor not smaller than 1 cm. In most of cases first symptom is swelling or stiffness, rarely secretion from the nipple and regional lymph nodes lesion can be observed.

Sometimes patients may not notice the symptoms, and the cancer is detected using mammography or one of the other imaging methods. Generally about 2 years goes by from the moment of cancer cells formation in breast, till the detection of tumor by doctor.

Following symptoms require immediate treatment in a medical institution:

• palpable tumor in the breast or under the arm (

• discharge from the nipple (from a single duct, bloody or clear)

• inverted, flat nipple or change in breast shape

• changes in the nipple skin texture (peeling, scabbing)

• injury or change in skin color on the breast

• swelling and distinctive dimples on the breast skin (orange peel)

• breast enlargement, deformation, asymmetry or changes in skin color (redness etc.)

Finding and treating cancer at an early stage can save lives, for this reason, all women should know the methods of self-examination and routinely every month control themselves.

 

Physical examination

The best time for breast examination is the time just after menstruation. In the premenstrual period, as a consequence of rise estrogen secretion the blood flow, size and sensitivity of the breast improves. During menstruation, the level of sex hormones rapidly decreases concurrently the secretory activity of epithelium and tissue edema reduces. The minimal volume of the breast is observed within 5-7 days of the menstruation.

 

Imaging methods

Mammography:

One of the most popular breast imaging methods. Mammography is type of breast imaging that uses low-dose x-rays. Mammography detects breast cancer at an early stage. Besides well-known standard methods of mammography different technology, including digital mammography, is available. Digital mammography is the most common imaging method. Mammography increases life expectancy. Some patients are concerned that a mammogram uses too much radiation. This thought is wrong. During normal mammography the radiation dose is less than 0.1 radium. This radiation is similar to the radiation obtained during chest x-ray.

Many of the lesions detected on mammograms may be not recognized by palpation.

The American Cancer Society recommends breast screening every 1–3 years and self-examination every month for women ages 20–40 years. At the age of 40-50 mammography should be done every 1-2 years, at the age over 50 once a year.

During mammography procedure breast is slightly compressed between the image detector and the pressure plate. Routine mammography gives an image of each breast in two different views from the front and from the side.

Mammographic screening increases the ability to detect cancer in situ, the abnormal cells that remain in the place where they first formed, without spread into the underlying tissues. Thanks to mammography cancer’s mortality rate reduces.

 

USG (Ultrasonography)

Ultrasonography (ultrasound) imaging method uses sound waves. This method provides high sensitivity in dense breast tissue.

 

Other methods of cancer evaluation

-Ductography; used to evaluate the serosanguineous or hemorrhagic discharge from the nipple

-MRI (Magnetic Resonance Imaging)

-PAT

-Cytological analysis of nipple discharge

-Biopsy (Method of sampling from cells or body tissues. Method of biopsy depends on the cell or tissue type)

-Tumor markers (CEA, CA-15-3)

-X-ray imaging (to check for metastasis)

- Bone scintigraphy (to check for metastasis)

In the early stage of cancer screening for metastasis can be carried out before or after surgery. However, in the late stages of cancer screening for metastases need to be done before the surgery to choose optimal treatment strategy.

 

BIRADS: Breast Imaging Reporting and Data System.

The system, developed to create a common language of surgeons, radiologists, pathologists, oncologists, radiation oncologists and other specialists. It supports interpretation of mammography and ultrasound results.

BIRADS 0: More research is needed

BIRADS 1: Negative mammography

BIRADS 2: Benign changes

BIRADS 3: Probably benign abnormality; short term observation needed

BIRADS 4: Suspicious abnormality; recommended biopsy

BIRADS 5: The results indicate malignancy; biopsy is necessary

BIRADS 6: Proven malignancy

 

Prognosis

Life expectancy in the untreated breast cancer is 2-3 years. Metastasis is responsible for about 90% of cancer deaths in 5-10 years after mastectomy.

Metastasis of Breast Cancer

49-60% Bones

15-20% Lungs

10-15% Pleura

7-15% Soft tissues

5-15% Liver