Mammary cancer

Mammary cancer. Develops often, about 1 in 10 women. Risk factors: menopause at the age of 50 years; no delivery or first birth over the age of 30 years (the incidence is 3 times more often); family history indicative of breast cancer in the mother and sisters (2 times more often), or both (6 times more often); fibrocystic breast disease (3-5 times more). Early diagnosis of breast cancer provides successful treatment of most patients. The five-year survival rate in the treatment of localized forms of stage I-II was 90%, with mestnorasprostranannom cancer - 60%. The results of treatment are much worse in the presence of distant metastaeov.

In the diagnosis of breast cancer are important systematic independent examination of cancer (4 times a year) and medical examinations of women over the age of 40 years (1 per year). Mammography is recommended 1 time in 2 years after the age of 40 years, 1 time per year - after 50 years. Upon detection in breast solid tumor without clear boundaries diagnosis should be updated immediately (needle biopsy with cytological analysis with histological analysis of the biopsy). dynamic clinical observation method instead of specifying diagnostic procedures should not be used.

Most mammary detect benign (diffuse and nodular breast disease, intraductal papilloma, fibroadenoma). The development of breast cancer from benign - uncommon situation (eg, fibroadenoma - 1-1.5%), while the wrong tactics in the differentiation of breast cancer often occurs in practice. In diffuse mastitis exhibit diffuse seal and breast tenderness, sometimes there are bright, discharge from the nipple. When nodal mastopathy defined single or multiple seals in different sizes with indistinct contours, not related to the skin. Fibroadenomas can be presented dense, rounded, lumpy single or multiple tumor nodes of various sizes. Fibroadenoma leaf-characterized by rapid growth and reach a large size in a short time. Intraductal papilloma appear bloody discharge from the nipple. The diagnosis specify when cytology and intraductal contrast mammography. Breast cysts are rounded, clear boundaries, containing serous fluid.

Symptoms. Breast cancer development appears limited mobility, a solid tumor with a slight indrawing of the skin over it. In the later stages of the disease, these symptoms are more pronounced appear retraction of the nipple, infiltration and ulceration of the skin, swelling of the breast in the tumor area. In addition to this most typical of developing breast cancer, there are other clinical options. Edematous infiltrative form is characterized by an increase in breast cancer due to pronounced edema and infiltration, the skin is sealed and hyperemic, tumor node can not be detected by palpation and mammography (primary edematous infiltrate Nye form) or be relatively small (secondary otechno- infiltrative form). As a variant of this form of breast cancer sometimes develops mastitis-like or rozhistopodobny cancer manifested brighter skin flushing, fever and a rapid course of the disease. On the contrary, such as Paget's cancer arising from the epithelium of the large ducts near the nipple, characterized by slow development. First, there is thickening, ulceration and retraction of the nipple, then formed a dense tumor site in the breast thickness.

Classification of breast cancer carried out in accordance with TNM system. The classification - the size of the tumor in the breast and localization of metastases. Metastatic breast cancer to regional lymph nodes and distant organs and tissues. If cancer is in the outer quadrants involved primarily the axillary lymph nodes, the internal quadrants, retrosternal and subclavian. Perhaps the involvement of supraclavicular and axillary nodes on the opposite side. Swollen lymph nodes does not always mean their metastases. Perhaps their increase as a manifestation of hyperplasia. Fact tumor lymph nodes and the number of involved nodes was set at morphological examination after surgery. Distant metastases of breast cancer arise in the bone, lung, liver, skin, chest wall, brain and t. D. To verify the extent of the disease at the time of diagnosis and the further observation using skeletal scintigraphy (if necessary radiography of bones), ultrasonography of the liver , the light and X-rays. d.

Important for the characterization of breast cancer is defined as the content of estrogen receptor (ER) and progesterone (PR) in the tumor, which is produced by removing the tumor or biopsy. Tumor considered dependent endocrine influences in the RE content and / or RP -10 fmol / mg protein. The content of hormone receptors in primary tumors and metastases is not significantly different. Therefore, depending on the conclusion of endocrine tumors, done in the early stages of the disease, it can be taken into account in determining treatment strategy during the development of metastases.

Treatment. In breast cancer, stage I-II the best treatment is surgery - radical mastectomy or sectoral resection with removal of regional lymph nodes. After surgery for early breast cancer, additional treatment is not indicated. When involved axillary lymph nodes should be performed adjuvant chemotherapy. In stage III disease prescribe preoperative radiotherapy and / or chemotherapy and after surgery - adjuvant drug therapy.

Adjuvant chemotherapy begin within 2-3 weeks after surgery. The most commonly used mode CMF (cyclophosphamide -100 mg / m2 orally on days 1-14 in combination with methotrexate - 40 mg / m2 / w, s 1 and 8 days and 5-fluorouracil scrap - 500 mg / m2 / per 1 s and 8 days; the intervals between courses - 2-3 weeks, the number of courses - 6). At a high content of ER and / or ER menopause additionally give tamoxifen (20 mg daily for 2 years), and saving the menstrual cycle produces ovariectomy, then use tamorsifen (20 mg) or prednisolone (10 mg) for a long time. When menopause more than 10 years and a high level RE adjuvant therapy can be carried out only with tamoxifen.

Preoperative therapy is carried out in locally-propagation-lence of breast cancer. Effective mode CMF or various combinations to include adriamycin, radiation therapy (course dose 40 Gy) can be assigned simultaneously. At a high level, RE, RP used tamoxifen, ovarian function. The operation is performed 2-3 weeks after the radiation therapy.

With the development of distant metastasis at various stages of the disease has important therapeutic value of drug therapy. chemotherapy regimens should include adriamycin:

  1. Adriamycin (20 mg / m2 / w, s 1, 8, and 15 days) in combination with methotrexate (20 mg / m2 / w, 1st day), 5-fluorouracil (500 mg / m2 w / w, day 8) and cyclophosphamide (400 mg / m2 / 15 th day);
  2. Adriamycin (40 mg / m2 / w, day 1) in combination with cyclophosphamide (600 mg / m2 / w, 1st day);
  3. Adriamycin (30 mg / m2 / in the 1st and 8th days) in combination with 5-fluorouracil (500 mg / m2. 1st and 8th days) and cyclophosphamide (100 mg / m2 orally 1 -14 th days);
  4. Adriamycin (60 mg / m2 / w, 1st day) and vincristine (1,2 mg / m2,1 th and 8 th day).

The course of treatment is carried out every 4 weeks. No clear evidence of differences in the effectiveness of these modes are not available.

When CMP and resistance to adriamycin partial response may be obtained using mitomycin C, cisplatin, vinblastine. Separate importance tiofosfamida (20 mg / m 3 times per week for 3 weeks), but this treatment substantially reduces the hematopoietic reserves. Most tiofosfamid injected into the pleural cavity (30-50 mg) after removal of the exudate.

Tamoksifon occupies a leading place in the endocrine therapy for breast cancer. Assign it with positive or unknown receptor orally at 20 mg / day for a long time. With little effect of tamoxifen is advisable to use aminoglyutetemida (orimetena) - 500 mg / day with cortisone acetate - 50 mg / day every day for a long time. Keep medicinal value androgens (testosterone or medrotestrona propionate 100 mg / m daily or every other day; omnadren, proloteston - 3 times per month). At a high-level ER drug therapy may be initiated endocrine drugs, and further supplemented with cytostatic drugs.

Radiation therapy used in bone metastases, brain, skin, as well as in cases of primary tumor disseminated form of disease.