Breast cancer — first symptoms, diagnosis and treatment
Breast cancer also occurs in men. Many men are not even aware of the possibility of such a disease, which is why they don’t see a doctor immediately — a factor that leads to late diagnosis, delayed onset of treatment and poor therapeutic outcomes.
Risk factors for breast cancer in women include: malignant tumors in the family history (especially if the mother or grandmother have been affected), late onset of menstruation in girls, lack of deliveries or late first birth, failure in breastfeeding, prolonged lack of sex life, or reproductive system diseases leading to hormonal disturbances. The last studies show that diabetes, hypertension and atherosclerosis also play a significant role in breast cancer development.
Breast cancer occurs as a result of active uncontrolled division of atypical cancer cells. Without treatment, the tumor grows rapidly in size — into the skin, muscles and chest. Through lymph vessels, cancer cells spread into the nearest lymph nodes (axillary, supraclavicular, parasternal, or internal mammary) and mostly metastasize into the lungs, liver, bones and brain. Breast cancer can develop on the background of precancerous diseases, which include mastitis and fibroadenoma.
During the initial stage of the disease, external breast cancer symptoms are absent. Women are frequently unaware of the looming health threat. First symptoms may be seen when the disease’s mechanism already runs. It is essential not to waste any more time and seek for a mammologist’s consultation. A correct diagnosis of breast cancer and a timely administered treatment may ensure more than 80% of a five-year survival rate in patients.
The first breast cancer symptoms are relatively visible and obvious:
- Painless, dense formation in the breast. Practice shows that 70-80% of women are able to detect it in early stages. Of course, among all detected tumors, the majority are benign. Due to the sudden rejuvenation of cancer, oncological awareness must be kept at all times.
- Changes in the shape and form of the breast.
- Shrinkage or retraction of the skin on the breast. To be able to observe this, women should raise their hands above their head and pay closer attention to their skin. Distinctive dimples on the breasts, and, in more advanced cases, the so-called “orange peel” are indicative of a problem. Where dimples are absent, the skin may become wrinkled.
- Changes of the skin’s color on the breast. The breast’s skin tone may range from light pink to purple.
- Unusual discomfort or pain in a breast.
- Lumps or swellings around the nipple.
- Retractions of the nipple.
- Bleedings from the nipple.
- Swelling of the underarm lymph nodes on the same side.
If any one of the symptoms is observed, women should be immediately screened. According to statistics, 90% of cases can be cured if detected at stage I, while stage III is treatable only in 40% of cases.
Despite the fact that breasts are easily exposed for inspection, approximately half of hospital patients are identified on the third and fourth stages of the disease. This is often due to women’s lack of self-examining skills, as well as to long-term treatment with home remedies. At other times, women are afraid to see the doctor and face the truth, which leads to late diagnosis and less efficient therapy.
Breast self exam is the first method of diagnosing breast tumor formation and may be performed by any woman without seeing the doctor. This simple procedure must be thoroughly carried out at least once a month, in the period between the 6th and 12th day of the menstrual cycle. Below are the steps to follow:
- using the mirror to observe the breast’s shape and at the appearances of the skin and nipple.
- raising hands and inspecting the breasts, first from the front and then from both sides.
- pushing down on the breast with the hand’s three middle fingers, in a standing position.
- starting with the upper outer quarter, where the tissue is generally more dense, and then going around clockwise.
- gently squeezing the nipple between the thumb and the forefinger to check for nipple discharge.
- continuing the examination in supine position, again going in a circle, each quarter in order.
- feeling the underarm lymph nodes with the fingers.
Today there are numerous diagnostic methods that detect any problem long before it is discovered by breast self exam.
Mammography, or breast X-ray, is perhaps the most reliable method for early diagnosis, allowing to both detect breast cancer and to determine the size of the tumor, its nature and extent, and the involvement of the tumor-surrounding tissue in the process. All women over 45 years in age are advised to return for screening at least every year. This method reduces the death rate by 35% in cases of cancer in older women. Thanks to mammography, they have a better chance to recover, while also preserving the breast. However, in some cases, mammography is insufficient.
Ultrasound breast examination is another method of early breast cancer diagnosis, which often complements mammography. As a result of this safe method of examination, doctors are able to determine a formation’s structure. It is mainly used in the following situations:
- Early detection of breast cancer in young women without symptoms;
- Complete survey of women with dense breast tissue;
- Puncture for diagnosis, which is performed under ultrasound guidance.
Breast MRI using nuclear magnetic resonance is used to refine the size and location of the tumor, to be confirmed by mammography. A further advantage of MRI is the ability to detect cancer at an early stage, as opposed to mammography.
Biopsy is the method that provides definitive diagnosis. Not only can it detect breast cancer, but can also determine its histological type. With the help of biopsy, doctors are able to tell whether the cells are susceptible to sex hormones or to determine the rate of cell proliferation, etc. This information is necessary in choosing the right treatment.
Treatment of breast cancer
The tactics of treatment and the prognosis of the disease are influenced by:
- the size of the tumor, its location and growth characteristics;
- tumor genotype and expression of certain receptors on tumor cells that determine sensitivity to hormonal drugs, chemotherapy drugs and targeted therapy drugs;
- the status of regional lymph nodes;
- the presence of metastases in distant organs and tissues.
Breast cancer treatment involves local and systemic therapy.
In cases of local treatment, malignant cells can be destroyed or removed, or inhibited in their growth. This type of treatment includes radiation therapy and surgery.
In the initial stages of the disease, the main surgical treatment is typical radical mastectomy. In advanced stages, where there are lesions involving the lymphatic system, especially in young women, a more complex treatment that combines surgery and radiation therapy with chemotherapy and hormone therapy is recommended. Comprehensive treatment is designed to eliminate cancer cells that spread throughout the body beyond the breast.
Radiation therapy is conducted in order to destroy cancer cells and prevent their continuous proliferation.
Systemic therapy includes: chemotherapy, hormone therapy and biological therapy. These methods consist of administering specific substances that destroy or reduce cancer cells. Systemic therapy may also be prescribed in order to prevent tumor recurrence.
Chemotherapy, unlike surgery and radiotherapy, kills tumor cells throughout the body. Unfortunately, some chemotherapy drugs are toxic to healthy organs and the body in general.
Hormone therapy can increase the effectiveness of other cancer treatments (e.g. surgery, radiation therapy, chemotherapy) as well as reduce the risk of recurrence. Approx. 65-75% of all breast cancers are hormone-dependent and involve estrogen and progesterone receptors, while about 10% of tumors have progesterone-only receptors. Following successful blockade of these receptors in tumor cells, they gradually decrease in size and die. Determining the number of receptors for estrogen and progesterone in tumor cells can be performed by biopsy. Tamoxifen is a drug of choice in premenopausal women, and aromatase inhibitors are accepted as a standard in postmenopausal women.
Biological therapy provides a new approach in the treatment of breast cancer. Approximately 25% of women with breast cancer have an excess of protein, known as HER2, which stimulates tumor growth. The essence of biological therapy is that it does not allow this protein to further promote tumor growth and makes chemotherapy more effective.
Treatment of breast cancer must be initiated as early as possible — preferably immediately after the moment of diagnosis. Only a comprehensive examination and appropriate treatment in a specialized clinic may account for a radical cure. About half of women with breast cancer undergoing appropriate treatment live more than 5 years tumor detection. Without compulsory treatment, mortality increases, resulting in a five-year survival rate of 12-15%. No less importantly, women should undergo a regular breast exam, so that, in case of breast cancer or other breast diseases, the diagnosis is timely established and treatment is rapidly initiated.