Breast cancer is a highly aggressive malignant tumor. In each particular case, it is impossible to say unequivocally why breast cancer occurred. Based on the statistical data obtained from the examination of millions of breast cancer patients, it is only possible to speak with varying degrees of confidence about certain factors. It is known for certain that the cause of the appearance of cancer cells are mutations in normal breast cells. Under the influence of carcinogens, the genetic material in the cells changes. The cells turn into cancer cells. It is also known that the more often a cell divides, the more likely it is that sooner or later, under the influence of carcinogens, it will degenerate into a cancer cell. In the case of breast cancer, there are many factors that play a role in the carcinogenesis that they enhance. Thus, increased levels of estrogens or their relative predominance in comparison with other hormones are often found in women suffering from breast cancer. Other factors that are important in the development of breast cancer include the following: menstrual disorders, abortions and lack of lactation, thyroid disorders, adrenal disorders, etc. Men also have breast cancer, although much less frequently than women. Most often, this disease develops in men against the background of gynecomastia.
Most breast diseases, including those that pose a risk of malignant degeneration, most often begin with the appearance of areas or foci of compaction in the mammary gland, which a woman often discovers herself. This obliges her, without delay, to consult a doctor, since only an oncologist can determine the nature and nature of the disease. Even for him, the solution of this issue in some cases can be very difficult. The most common is the so-called mastopathy. After the age of 30, it is found in more than 1/3 of women. This condition occurs and develops as a result of changes in hormonal influences on the mammary gland. The cause of mastopathy is mainly due to a violation of the physiological function of the breast, caused by artificial termination of pregnancy, refusal to breastfeed the baby. In the mammary gland, connective tissue develops excessively and the formation of multiple, most often small cystic formations occurs, so mastopathy is usually called fibrocystic. Mastopathy is often bilateral, i.e. changes are simultaneously detected in both mammary glands. When feeling the gland, all of it or some part of it turns out to be somewhat denser, a radially located heaviness is determined in the gland, and among the strands, multiple small, the size of a lentil grain or a pea, nodules – cysts are felt. The affected area of the gland usually does not have clear boundaries, the feeling is often painless, sometimes there is a slight sensitivity. In some cases, especially before the onset of menstruation, there are also very severe pains, and often they do not occur independently, but are felt only when touching, touching clothes, etc. In many cases, the diffuse form of mastopathy does not require any special treatment, and the woman is only subject to systematic medical supervision. Mastopathy is characterized by a chronic, long-term course, and for many years the changes found in the mammary gland remain constant. The main attention should be paid to the elimination of the causes that could contribute to the development of mastopathy. Sometimes, with the onset of pregnancy, the birth of a child and breastfeeding, its physiological function of the breast is normalized. In addition to diffuse, there is a nodular form of mastopathy, when the affected area is clearly delineated from the surrounding tissues and is defined as a node. This is often due to the fact that one of the cysts begins to grow, increases in size, reaching the size of a nut, a chicken egg, etc. Nodular forms include the so-called fibroadenomas of the mammary glands. These are well-defined, easily displaced, rounded, rather dense formations with a smooth surface, sometimes reaching significant sizes. Fibroadenomas are sometimes seen in young girls during puberty. They rarely turn into cancer. Breast disease may be indicated by the appearance of discharge from the nipple. Sometimes they are observed in the presence of a seal palpable in the gland, sometimes the seal can not be determined. The discharge may be milky-white (they usually do not indicate any disease), transparent, mucous, cloudy, resembling pus or bloody. If there is a discharge from the nipple, a woman should definitely consult a doctor to determine the cause of them. In some cases, the discharge, especially bloody, depends on the fact that a papilloma begins to grow in the lumen of the milk duct – a benign tumor, which, however, may subsequently undergo malignant degeneration. In the presence of such a papilloma, surgical treatment is usually undertaken. Breast diseases include the so-called Paget’s disease. The disease resembles eczema and initially affects the nipple and areola (periarticular circle). In and around the nipple area
redness and compaction of the skin appear, then a wet surface is formed, periodically covered with scales and crusts. The nipple is constantly deformed: it becomes wrinkled, thickened, and sometimes retracted so much that in its place there is only a wet, bleeding surface. The disease lasts for years, without going beyond the nipple, but in the future it can spread to the ducts and breast tissue and acquire a malignant course. This kind of eczematous lesion of the nipple requires mandatory treatment, since the possibility of cancer is quite real. As I have already said, many diseases of the breast begin with the appearance of limited formations in it – nodes, seals, which a woman often finds when washing, changing clothes, etc. The seal often has quite significant dimensions. If a woman examined herself regularly, maybe she could have discovered this formation much earlier. This is of particular importance when the formation is dangerous in the sense of the possibility of its malignant degeneration. It is difficult to object to the expediency of regular self-examination of women, especially since its methodology is extremely simple.
The first part of the self-examination is that a woman in the nude examines her mammary glands in a mirror, first with her hands down, then with her hands on her head. At the same time, an unequal size of the mammary glands can be detected, which happens with completely normal, healthy glands, but may also depend on the presence of a cyst, a tumor node, etc. in the gland. There may be an asymmetry in the contours of one of the glands due to a sinking or bulge in any of its parts, a change in the shape or retraction of the nipple of one breast compared to the other, etc.
The second, most essential part of self – examination is groping. The glands are felt alternately in the supine position. First, the inner half of the gland is felt, while the hand of the examined side is placed behind the head; the feeling is performed by the hand of the opposite side. The feeling is carried out from the middle of the gland to the outside. First, the lower parts of the gland are felt in this way, then the middle and upper parts. The examination is completed by feeling the axillary fossa. Self-examination is carried out once a month, preferably during the first week after the end of menstruation.
Breast cancer is a disease of middle-aged and elderly women. Symptoms of cancer of this organ are various degrees of severity of breast asymmetry, retracted nipple with serous and bloody discharge, as well as hyperemia and swelling of the skin above the tumor. When palpation is determined by different sizes of the tumor; in shape, it can be nodular and non-uniform consistency, but with fairly clear boundaries. A rare form is Paget’s cancer, which begins with a change in the shape of the nipple, the appearance of redness and compaction of the skin, the formation of scales, wet crusts, ulceration. Later, a tumor node is found under the nipple in the gland tissue. The radiological method of investigation – contrast-free mammography-has become very important in the diagnosis of breast cancer. The latter is carried out in order to clarify the size, nature of tumor growth, and identify the infiltrative component of cancer. Mammography is also necessary to obtain information about the condition of the second breast in terms of detecting palpable tumors. The mammograph has small stands on which to place the mammary gland. From above, the mammary gland is pressed down with a special plate, after which a picture of the breast is taken. The image is usually taken in two projections, in order to accurately determine the location of the pathological formation. Mammography is a low-pain study. If there is pain in the mammary glands during mammography, there may be unpleasant sensations associated with compression of the mammary glands. A puncture biopsy has a great diagnostic informative value.
Recently, the accuracy of cytological diagnostics has significantly increased – up to 98 % of cases of correct answers with a characteristic of the degree of differentiation of a malignant tumor. The technique of thick needle biopsy has even greater diagnostic capabilities. However, it should be remembered that these techniques are used after breast irradiation, especially in the infiltrative form of cancer (focal dose 4-6 Gy) in order to prevent the possible spread of the cancer process. Information about the state of regional lymph nodes is of great importance for the preparation of a treatment plan and prognosis of the disease. In addition to palpation and biopsy of anatomical areas, direct lymphography is used to identify enlarged axillary, less often supra– and subclavian nodes. These studies are particularly relevant in obese women, when palpation nodes are not determined. No less important are studies that clarify the state of the lungs, bone systems, and liver. The frequency of covert metastases, as is known, is quite high: almost 1/3 of the sick women revealed asymptomatic bone metastases by scanning, which is further confirmed by clinical and radiological data.