Violation of patient needs in breast cancer. Nursing care for patients with tumor diseases of the mammary gland (mastopathy, breast cancer). Anatomy of the breast

Breast cancer is a malignant tumor that develops from the epithelium of the lobules or their excretory ducts.

Dynamics of morbidity and mortality of the female population of Russia from breast cancer

EPIDEMIOLOGY

  • 50% of all cases of breast cancer occur in the USA, Canada, Western Europe, where about 18% of the female population of the planet lives. Incidence is rising throughout the world, and mortality has begun to decline in some Western countries.
  • The highest mortality rate is in Denmark, the Netherlands, Ireland, and Israel. Low incidence in Asia, Africa, and South America.
  • 7-10% of women develop breast cancer during their lifetime.
  • The best 5-year survival rates are in the USA (84%), Australia (73%), and Japan (74%). In Europe 63-67%, in Russia 55%. In general, the 5-year survival rate in the world is 50-60%.

Breast cancer mortality in various countries world in 2000

Anatomy of the breast

  • The paired organ, located at the level of the III-IV rib, is a modified apocrine gland.
  • Nipple, areola, 4 quadrants, axillary process.
  • It consists of 15-20 lobules, each of which has its own excretory duct, which passes into the “milk sinus”, opening into 8-15 milk openings.
  • Enclosed in a connective tissue sheath formed by layers of the superficial fascia of the chest.
  • Blood supply – a. thoracica int. et axillaris, intercostalis.

Lymphatic system of the mammary gland

  • Intraorgan - lymphatic capillaries, vessels, plexuses of the mammary gland itself and the skin covering it.
  • Extraorgan – abducens lymphatic vessels– collectors and regional The lymph nodes.

Lymphatic network of the mammary gland

1 – paramammary:

a – Bartels knot;

b – Sorgius node;

2 – axillary level 2;

3 – axillary level 1;

4 – subscapular;

5 – axillary level 3

(apical or subclavian);

6 – supraclavicular;

7 – internal (parasternal);

8 – interthoracic (Rotter’s knot);

9 – retrothoracic;

10 – lymphatic vessels heading to the epigastric region

  • Axillary;
  • Subclavian;
  • Parasternal
  • Mediastinal;
  • Intercostal;
  • Cross;
  • Epigastric

(Herot's path)

Risk factors for breast cancer

  • Gender, age
  • Factors of reproductive function
  • Endocrine-metabolic factors
  • Genetic factors
  • Exogenous factors
  • Trauma, inflammation
  • Viral theory
  • Gender, age

Factors of reproductive function

  • Early menarche (before 13 years)
  • Late menopause (after 55 years)
  • Duration of menstrual function
  • Late first birth (after 30 years)
  • Number of pregnancies and abortions
  • Abortion, especially before the first birth
  • Usage hormonal drugs, especially estrogen during pregnancy
  • Duration of lactation
  • Process of evolution

Endocrine-metabolic factors

Genetic factors

  • Blood relatives on the maternal side
  • Overexpression of the BRCA 1 gene, localized on chromosome 17, increases the risk of breast cancer to 50-80%.
  • Overexpression of the BRCA 2 gene, localized on chromosome 13, increases the risk of breast cancer to 40-70%.

Exogenous factors

  • Ionizing radiation
  • Alcohol consumption
  • Excess animal fats in the diet
  • Chemical carcinogens
  • Smoking

Pathogenesis of breast cancer

  • Increased production of estrogens
  • Reducing their disposal
  • Content enhancement:

RE (estrogens receptors)

RP (progestin receptors)

Precancer of the breast

  • Intraductal papilloma;
  • Intraductal immune proliferations;
  • Proliferative forms of fibrocystic disease (especially with cell atypia).

Features of breast cancer tumor

  • Type of tumor growth
  • Nodal forms (70-75%)
  • Diffuse (20%):

— diffuse-infiltrative;

- edematous-infiltrative;

- armored;

- inflammatory

(mastitis-like and erysipelas-like)

  • Paget's cancer (2-4%)
  • Hidden (1-2%)

Prevalence of the tumor process(TNM, 2002, 6-e edition)
T –primary tumor

N –regional lymphatic
nodes

M –remotemetastases

Mx – insufficient data to determine distant metastases

M0 – no signs of distant metastases

M1 – there are distant metastases

Brain

The lymph nodes

Morphologycancermammary gland

  • Carcinoma in situ:

Intraductal cancer

Intralobular carcinoma

  • Infiltrating:

Infiltrating ductal carcinoma,

Infiltrating lobular carcinoma,

Inflammatory

  • Paget's breast cancer

Tumor grade

Cdegree of tumor differentiation

  • Gx - degree of differentiation cannot be determined
  • G1— high degree differentiation
  • G2— moderate degree differentiation
  • G3 - low degree of differentiation
  • G4 - undifferentiated tumor

Tumor receptor status

  • ER± (“+” - more than 10 fmol / 1 mg protein)
  • Her -2/ neu
  • Transmembrane glycoprotein - receptor
  • Localized on chromosome 17q21
  • Overexpression correlates with poor prognosis

Principles of breast cancer metastasis

  • W. Halsted's hypothesis about staged metastasis of breast cancer (from the primary tumor to lymph nodes of the 1st-2nd-3rd order, then hematogenous dissemination of the tumor).
  • B. Fisher's hypothesis. Breast cancer at the stage of clinical manifestation - systemic disease(lymphogenous and hematogenous dissemination of tumor cells occurs simultaneously).

Diagnosis of breast cancer

  • Clinical
  • Instrumental
  • Diagnosis of metastases

Clinical diagnosis of breast cancer

  • Anamnesis;
  • Inspection;
  • Palpation of the mammary glands.

Anamnesis

  • History of the disease;
  • Previous and concomitant diseases of the genitals, liver, thyroid gland, etc.;
  • Gynecological and reproductive history;
  • Sexual function;
  • Social and everyday characteristics and professional factors;
  • Family diseases: endocrine, metabolic, oncological.

Breast examination

  • Constitutional features;
  • Examination of the mammary glands (size, shape, symmetry, irregularities in configuration, state of juice, condition skin, vasodilation);
  • Inspection of areas of regional metastasis;
  • Condition of the nipple, discharge, sm Krause, sm Pribram.
  • Skin symptoms – umbilication, areas, “lemon peel”.

Site symptom

  • Krause's sign
  • Changes in the shape of the breast
  • Paget's cancer
  • Skin germination and tumor disintegration
  • Inflammatory form of breast cancer

Palpation of the mammary glands

  • 6-14 days of the cycle,
  • Vertical and horizontal position (from Koenig),
  • Superficial indicative palpation;
  • Deep palpation,
  • Characteristics of the tumor node,
  • Palpation of regional lymph nodes,

Instrumental diagnostics

  • X-ray examination: non-contrast mammography ( diagnostic value 75-95%), targeted mammography, axillography, pneumocystography, ductography;
  • Ultrasound (diagnostic value 85%);
  • CT scan;
  • Magnetic resonance imaging;
  • Positron emission tomography;
  • Thermography;
  • Microwave radiothermometry;
  • Scintigraphy (P 32);
  • Fine-needle puncture aspiration biopsy(up to 70-85%);
  • Trephine biopsy;
  • Receptor status – ER, PR, Her-2/neu.
  • Historically – transillumination.

Diagnosis of metastases

  • Ultrasound of regional lymph nodes;
  • Axillary and transthoracic venography;
  • Lymphography, lymphoscintigraphy (Au 198 and Tc 99);
  • Skeletal bone scanning;
  • Scanning and/or ultrasound of the liver;
  • Ultrasound of the pelvic organs;
  • Study of tumor markers – CA 153

Diagnostic efficiency

  • Stage I – 81%,
  • Stage II – 98%,
  • Stage III – 99%.
  • The final stage of diagnosis is a histological examination of the drug removed during surgery.

Breast cancer treatment methods

  • The main stages in the evolution of surgical treatment of breast cancer
  • before 1867: tumor excision.
  • 1867: removal of the mammary gland and axillary lymph nodes Moore, 1867).
  • 1895: removal in a single block of the mammary gland along with both pectoral muscles and lymph nodes, tissue of the subclavian, axillary, subscapular regions (Halsted W., 1895; Meyer W., 1895). Standard radical mastectomy.
  • 1948: removal of the mammary gland along with the pectoralis minor muscle, lymph nodes and tissue of the subclavian, axillary, subscapular areas (Patey B., Dyson W., 1948). Modified radical mastectomy.
  • 1949: removal in a single block - the mammary gland, pectoral muscles together with the lymph nodes and tissue of the subclavian, axillary, subscapular, parasternal areas (Margottini M., Bucalossi P., 1949; Holdin S.A., 1955; Bazhenova A.P., 1961; Veronesi U., 1962, etc.).Extended radical mastectomy.
  • 1951: removal of the mammary gland, pectoral muscles with lymph nodes, tissue of the subclavian, axillary, subscapular, parasternal, mediastinal, supraclavicular areas (Urban J., 1951; Wangensteen O., 1952, etc.). Superradical mastectomy.
  • 1965 removal of the mammary gland as a single block along with tissue, lymph nodes of the axillary and subscapular areas (Madden, 1965). Modified radical mastectomy.
  • Since the 70s of the 20th century, organ-preserving operations began to be performed; various options radical resections (lumpectomy, tumorectomy) U.Veronesi, l988,1997.
  • 1992: Definition of sentinel lymph node (Morton, 1992).

Reconstructive plastic surgery

  • Primary mammoplasty
  • Delayed mammoplasty
  • There are two main ways to imitate the shape and volume of the mammary gland: endoprosthetics or reconstructive surgery using autogenous tissue

Palliative surgery

  • In patients with locally advanced inoperable or metastatic process according to vital indications (bleeding or abscess formation of a disintegrating tumor), palliative surgical interventions can be performed.
  • Palliative surgery performed in a patient who does not have distant metastases or with remaining prospects for suppressing disseminated disease should, if possible, have all the features of a radical operation.
  • It is absolutely possible that after adjuvant treatment, the first patient will be radically cured, and the second will be given years of life.

Radiation therapy for breast cancer

  • Preoperative (40-45 Gy)
  • Postoperative (40-45 Gy)
  • Radical (60-70 Gy)
  • Palliative (2-24 Gy)

Any "early" clinical point From a biological point of view, cancer is late.

Chemotherapy for breast cancer

  • Neoadjuvant (induction)
  • Adjuvant
  • For disseminated cancer

Neoadjuvant therapy for breast cancer (CT or HT)

  • carried out before surgery;
  • some patients are transferred from an inoperable to an operable state;
  • in some patients it allows performing organ-preserving operations;
  • may reduce the risk of metastases;
  • serves as an indicator of tumor sensitivity to treatment.

Drug treatment

  • adjuvant chemotherapy is used in most cases and the minimum number of courses is considered to be 6. The best combination is the use of anthracyclines with taxanes (AC + taxanes) (C. Hudis, USA, 2005)
  • for elderly patients it is possible to use CMF, AC followed by capecetabine

The evolution of hormone therapy
RMJ

Hormone therapy for breast cancer

  • Antiestrogens

Tamoxifen (Nolvadex, Zitazonium)

Toremifene (Fareston)

raloxifene (Evista)

faslodex (fulvestrant)

  • Aromatase inhibitors

steroids (formestane, exemestane (aromasin))

non-steroidal (fadrazole, letrozole (Femara), aminoglutethemide (Cytadren), anastrazole (arimidex))

  • Progestins

megeis, farlutal, provera

Adjuvant therapy for breast cancer with Herceptin

  • 56% increase in disease-free survival
  • 50% reduction in the risk of developing distant metastases
  • Nonspecific immunotherapy for breast cancer
  • Pre-invasive cancer
    Lobular carcinoma in situ

Outdoor localization

  • Sectoral resection
  • Radiation therapy to the breast

Central and internal localization

  • Sectoral resection
  • Radiation therapy to the breast and regional areas
  • Pre-invasive cancer
    Ductal carcinoma in situ and Paget's cancer
  • Radical breast sparing mastectomy with primary or delayed mammoplasty

Disseminated breast cancer

  • On average⅓ — ½ patients with breast cancer at various times (sometimes 20-30 years) after primary treatment generalization of the disease occurs.
  • Per shareIII-IVArt. in Russia it is necessary∽ 40% of primary cases.
  • The vast majority of patients with disseminated breast cancer require systemic drug therapy.
  • The average life expectancy of patients after generalization of the process varies from 2 to 3.5 years.
  • Basic principles of drug therapy for disseminated breast cancer
  • If there are two methods with the same expected effectiveness, preference should be given to the less toxic one.
  • In the absence of convincing signs of tumor progression, you should not switch to another type of treatment.
  • When planning treatment, the results of previous therapy, as well as subsequent therapeutic measures, should be taken into account.

Indicators of overall 5-year survival of patients with breast cancer depending on the stage of the disease

Breast cancer is the most common form of malignant neoplasm. It should be noted that the incidence of breast cancer and associated mortality in Russia has increased significantly over the past 20 years. Unlike most tumors of other organs, malignant breast tumors belong to the group oncological diseases, in the timely identification of which the decisive role often belongs to the woman herself. Countries, regions or social groups population from high level sanitary culture, receiving modern qualified information in the field of oncology, are characterized by an incomparably lower proportion of advanced cancer cases in general structure morbidity and significantly higher survival rates of treated patients.

Individual and population risk factors contributing to the development of breast cancer:

  • female gender and age over 50 years;
  • personal or family history of breast cancer;
  • atypical proliferative diseases of the mammary gland;
  • impact ionizing radiation;
  • long childbearing period ( early start and late cessation of menstruation);
  • absence of pregnancies and breastfeeding;
  • late first childbirth (after 35 years);
  • substitution hormone therapy estrogens in the postmenopausal period;
  • excess body weight;
  • alcohol abuse;
  • food with high content animal fats.

Breast cancer is a tumor growing from the epithelium of the mammary gland and arising in its ducts or lobules. Depending on the growth characteristics, they are distinguished nodular, diffuse forms And Paget's cancer.

Nodular cancer in the early stage it is a painless, mobile, dense node with relatively clear boundaries (Fig. 11). Subsequently, his mobility becomes limited. IN late period diseases in pathological process skin, areola, nipple, pectoral muscles. Skin damage is manifested by its wrinkling over the tumor, retraction (umbilication symptom), lymphostasis (symptom " orange peel"), ulceration, tumor growth.

At diffuse cancer The mammary gland increases in volume and becomes denser, tumor nodules are not detected in it, the skin has the appearance of an orange peel, the nipple is retracted and fixed. Sometimes this form of cancer occurs with hyperemia and increased temperature of the skin of the breast (resembles erysipelas or mastitis).

Rice. eleven.

It is characterized by an initial lesion of the nipple, which thickens with the appearance of dry and wet crusts (Fig. 12). The latter fall off and reveal a grainy and moist surface. Gradually, the nipple thickens and ulcerates, the process spreads to the areola, skin and deeper into it.

In all forms of breast cancer, the axillary, subclavian and supraclavicular lymph nodes are affected; they are painless and have a dense consistency.

At the beginning of the disease, there may be no complaints. As the tumor grows, pain occurs in the chest, and when it metastasizes to the lungs and pleura, cough and shortness of breath appear.

The nature of the disease and its prognosis depend on the size of the primary tumor, the type of skin lesions of the breast, chest, lymph nodes, presence or absence of distant metastases.

Stages of breast cancer:

  • Stage 0 - tumor in situ without invasive growth, damage to lymph nodes and the presence of distant metastases;
  • Stage I - the presence of a tumor no more than 2 cm in diameter in the absence of damage to the lymph nodes and distant metastases;
  • Stage II - the presence of a tumor measuring from 2 to 5 cm in diameter without involvement of lymph nodes in the pathological process and without distant metastases;

Rice. 12.

  • Stage III - the presence of a tumor with a diameter of 5 to 10 cm, damage to the lymph nodes in the absence of distant metastases;
  • Stage IV - the presence of a tumor of any size in combination with (or without) involvement of the lymph nodes and distant metastases.

Diagnostics. An examination to detect breast cancer at an early stage includes examination of the breast, palpation in horizontal and vertical positions, palpation of the cervical, supraclavicular, subclavian and axillary lymph nodes, clinical examination by a specialist mammologist, and mammography. Women should be taught breast self-examination techniques (Figure 13).

Clinical studies: general and biochemical tests blood, determination of the level of tumor markers, fluorography, radioisotope study of skeletal bones, ultrasound of the liver. If there is a palpable formation in the mammary gland, a puncture, targeted or open (surgical) biopsy is performed, followed by cytological examination biopsy.

The American Cancer Society recommends monthly self-examination for all women over 20 years of age, clinical examination by a breast specialist every 3 years from age 20 to 40, and annual mammography after age 40.

Principles of treatment. Currently underway complex therapy breast cancer: surgery (segmental, total, radical mastectomy), radiation, chemo-, hormone- And immunotherapy. Job nurse in the oncology department and hospice is built taking into account the principles of ethics and deontology, requires organization, manifestation special attention and sensitivity towards patients. A woman undergoing surgery for breast cancer receives double mental trauma: firstly, because she has cancer, and secondly, because as a result of the operation her appearance changes. She needs psychological support from medical workers, relatives and friends.

There is often a need symptomatic treatment complications radical therapy(if there is lymphatic edema of the arm, limited mobility in shoulder joint, gross cicatricial changes in the skin and soft tissues, erysipelas on the side of the operation), as well as chronic pain syndrome, heart and pulmonary insufficiency, infectious complications, anemia, etc.



Rice. 13. Techniques for breast self-examination

Visible changes in the mammary gland are better identified:

  • at certain positions of the body and hands:
  • with arms hanging along the body (a);
  • with hands raised and behind the head (b);
  • when lifting mammary gland fingertips up (c);
  • when pressing on the peripapillary area (G)

When turning the body to the right and left in the above positions ( a-d) are visible following signs:

  • changes in the contours (recession, bulging, sagging) and size of the glands;
  • enlargement or reduction of one of the glands;
  • Tightness of the glands to the side or upward;
  • changes in the contractility of the gland, the appearance of its “fixity”;
  • change in skin color, the appearance of swelling, crusts, fistulas, compactions, nodes over any part of the gland and near it;
  • the appearance of discharge from the nipple when pressing on the isola. Self-examination (palpation) of the outer sectors of the mammary glands is carried out by placing the hand behind the head on the side of the examined mammary gland, with the pads of 2-4 fingers from bottom to top in the direction from the nipple to armpit concentric and radial movements (f, g), be sure to capture the supraclavicular, subclavian and axillary area(d). U healthy people in these areas the lymph nodes cannot be palpated. Then, with the pads of 2-4 fingers, the internal (along the sternum) sectors of the mammary gland are felt. After this, the opposite gland is examined using similar techniques.

Nursing assistance. In addition to the usual (routine) activities related to the collection of anamnestic data (determining the presence of risk factors, etc.), identifying problems and needs, clinical examination, physical and psychological support patient, nursing care for breast cancer includes a number of other components.

Components nursing care:

  • educational work - informing the patient about the disease, methods of its diagnosis, prevention and treatment in an accessible form;
  • training women in self-examination of mammary glands;
  • regular treatment of the wound (ulcer) at the site of the disintegrating tumor: application of aseptic dressings, topical use of metronidazole powder to eliminate odors;
  • caring for the wound and drainage system after surgery, teaching the patient how to carry out these activities;
  • prevention of infectious complications in the wound area, infections of the respiratory, urinary and other systems;
  • prevention and treatment lymphedema using hand massage, teaching self-massage techniques, etc.;
  • relief of chronic pain syndrome (internal and parenteral use of analgesics);
  • treatment of depression caused by loss of external attractiveness, financial independence, family troubles (conversations with a nurse, psychotherapist, relatives, priest);
  • informing about the possibility of fulfillment plastic surgery, wearing a special corset;
  • dynamic monitoring of the patient’s condition and compliance with doctor’s orders;
  • encouragement of reasonable physical activity, assistance in performing physical therapy exercises.

About 25,000 new cases of breast cancer are diagnosed each year, and approximately 15,000 women die from it each year - more than from any other cancer. Over the past decade, the incidence of breast cancer among women in Belarus has increased by 26.3%. Thus, the problem under consideration is one of the most acute in modern clinical oncology.
The nursing process is the method by which nurses carry out their responsibilities in providing care to patients, scientifically based and carried out in practice. In practical healthcare, a nurse is required not only to have good technical training, but also the ability to creatively relate to patient care, the ability to work with the patient as an individual.
First stage nursing process when caring for a patient with breast cancer - examination of the patient. This is a targeted questioning, examination of the patient, assessment of her condition. Having determined the cause of a person's anxiety, the nurse identifies specific factors that causing disturbance adaptation.
The second step in the nursing process is to identify the patient's current problems and potential problems that may arise over time. The nurse should help the woman adapt to this situation, if possible eliminate irritants by establishing nursing diagnosis. For example, severe pain in the area of ​​the right breast due to breast surgery; stressful condition caused by past operation; increase in body temperature due to the presence of inflammatory process in the area of ​​the right breast, manifested by dry lips, fever, general weakness; decreased muscle tone due to the residual effect of previously administered anesthetic drugs, manifested by inactive behavior in bed; headache, due to the presence inflammatory reaction, manifested by a deterioration in general well-being.
The third stage of the nursing process involves planning nursing care. After identifying stimuli that cause inappropriate reactions in the client, the nurse works with the client to determine short-term and long-term goals of care.
Having planned activities to care for the patient, the nurse carries them out. This will be the fourth stage of the nursing process - implementation of the nursing intervention plan. Its purpose is to provide appropriate care to the patient, that is, to assist the patient in meeting the needs of life, education and counseling, if necessary, to the patient and his family members.
There are 3 categories of nursing intervention: independent - actions carried out by the nurse on her own initiative; dependent - performed on the basis of written instructions from a doctor and under his supervision; interdependent - involves joint activities nurse with a doctor and other specialists.
The fifth stage of the nursing process is assessing the effectiveness of nursing interventions. Its purpose is to assess the patient's response to nursing care, analyze the quality of care provided, evaluate the results obtained and summarize. Nursing intervention is effective only if the goal is achieved in the final adaptive ways. It is also necessary to assess the psychological and behavioral systems, the degree to which the patient has achieved the ability to self-care.

LECTURE PLAN:

1. DEFINITION OF BREAST CANCER.

2. ETIOLOGY.

3. PATHOGENESIS.

4. CLINICAL MANIFESTATIONS.

5. INSPECTION AND DIAGNOSTICS.

6. TREATMENT AND REHABILITATION.

Breast cancer belongs to the group of diseases that includes mastopathy (hormonal hyperplasia).

Mastopathy– a large group of different morphological structure hyperplastic conditions, obviously with the same pathogenesis, but different etiologies. Common link for all mastopathy is a violation hormonal balance. A relationship has been established between dysfunction of the gonads and the development of mastopathy in the mammary glands.

The likelihood of developing breast cancer is close connection with the constitution of the woman, the time of onset of menstruation, rhythm and duration menstrual cycle, intensity and character menstrual bleeding, the onset of sexual activity and its nature, the use of drugs to prevent pregnancy, the time of menopause and menopausal disorders of the vegetative, metabolic-endocrine and neuropsychic order. An important role is played by the number of births and abortions, the number of lactations, their intensity and duration, diseases of the female reproductive system, primarily the breast, and the presence of breast cancer in the past.

Currently, the incidence and mortality of women from breast cancer ranks high among all cancer diseases. Despite the development and improvement of surgical, radiation, medicinal, and immunological treatment methods, the mortality rate from breast cancer can only be reduced by improving the condition early diagnosis.

The development of breast cancer, like tumors of other localizations, is subject to general laws that influence the growth rate of the tumor.

Clinical forms Breast cancers are diverse. Depending on the nature of growth, all breast cancers are divided into two main groups - nodular, growing in the form of a more or less delimited node, and diffuse, growing infiltratively. The following independent forms are distinguished:

1) mast-like cancer, in which reactive inflammation dominates with hyperemia, infiltration and swelling of the skin, local and general increase temperature;

2) erysipelas-like cancer, characterized by extensive hyperemia of the skin;

3) armored cancer, in which the skin over a significant area turns into a thick layer;

4) Paget's cancer (cancer of the nipple and areola);

5) cancer of the excretory ducts (intraductal cancer, comedocarcinoma).

In 1956, the Ministry of Health proposed clinical classification, providing for four stages of disease development. International TNM classification, based on clinical assessment local spread of the tumor (T), damage to regional lymph nodes (N) and the presence of distant metastases.

Mammary cancer long time develops asymptomatically. Pain is not typical for the initial period. Small and deeply located tumors do not cause changes appearance mammary gland.

When the tumor is located in the superficial layers, especially with infiltrative growth, due to lymphangitis and lymphostasis, swelling of the skin develops, in which it takes on the appearance of a “lemon peel”. The skin over the tumor becomes dry, flaky and dull. As cancer progresses, it leads to deformation of the breast, nipple and areola.

A cancerous tumor, as a rule, is palpated in the form of a node, an irregularly shaped compaction with unclear contours and a bumpy surface. The consistency of the tumor is very dense, sometimes reaching the density of cartilage. Characteristic is an increase in density from the periphery to the center. Disintegrating cancerous tumors have a soft consistency.

In areas of regional metastasis (axillary, subclavian and supraclavicular areas), the lymph nodes enlarge, become very dense, and take on a rounded shape.

The examination must be carried out correctly. Women are examined in a standing position (hands on head) and lying on their back. Attention is paid to the symmetry of the mammary glands, their size, shape, the presence of deformations, the condition of the skin and its color, the condition of the areolas and nipples (is there any discharge), and check for retractions, ulcerations, and swelling. First, one mammary gland is palpated, then the other, comparing symmetrical areas. When a compaction is identified, its size, shape, consistency, mobility, and connection with the skin are determined. Next, bilateral palpation of the muscular, sub- and supraclavicular lymph nodes is performed.

The most optimal and timely diagnostic complex examination of patients with suspected breast cancer is palpation - mammography - puncture. Thermography and echography methods have also gained great recognition.

The choice of treatment method depends primarily on the stage of the disease. In stages I and partially II it is shown surgical intervention without the use of any additional specific treatment methods.

The main operation for breast cancer is radical mastectomy. In older women, the Patey procedure can be used to preserve the pectoralis major muscle.

In more late stages combined treatment is used - radical mastectomy with preoperative radiation therapy or with chemotherapy with cytostatics, hormone therapy.

For stage IV breast cancer, especially in the presence of multiple metastases, treatment includes hormonal and chemotherapy with cytostatics.

Contraindications to chemotherapy: leukopenia below 3000, thrombocytopenia below 100,000, sharply weakened general condition of the patient, cachexia, pronounced violation liver and kidney functions in connection with concomitant diseases or massive metastasis. During the drug treatment You should remember the myelosuppressive properties of most antitumor drugs; systematically, at least 2 times a week, monitor the number of leukocytes (especially lymphocytes) and blood platelets.

Of particular importance is maximum use therapeutic measures aimed at improving general condition sick and increase the body's defenses. Medications that normalize hematopoiesis, a complex of vitamins, blood transfusions and, if necessary, antibiotics are prescribed. In addition to conventional treatments, immunotherapy may be used.

It can be said without exaggeration that the treatment of breast cancer, like other malignant tumors- this is a problem of early diagnosis, because a very clear dependence of the long-term prognosis on the duration of the disease and the degree of its prevalence has been established.

For breast cancer, the prognosis depends on the stage of the disease, the morphological type of tumor growth and on histological structure. Infiltrative and poorly differentiated tumors give worse treatment results. According to the St. Petersburg Institute of Oncology, with stage I, about 65% lived 10 years after treatment, with stage II - about 35%, with Stage III 10%. The use of combination therapy including hormonal and chemotherapy treatment in advanced conditions gave up to 65% of the objectively recorded effect (reduction or disappearance of the tumor or metastases). In half of the treated patients, the average life expectancy is about 2 years. The effectiveness of breast cancer treatment in last years increases due to the widespread use of the complex method.

Breast cancer is one of the main problems of modern oncology. This is due not only to the widespread prevalence of this type of pathology, but also to the high social significance diseases for women, because it’s no secret that female breast is one of the main symbols of femininity and motherhood.

According to WHO statistics, more than a million new cases of breast cancer are registered annually, of which over 50 thousand are in Russia. Women over 40 years of age are especially susceptible to breast cancer, although in recent years many experts have noted a significant increase in the incidence among young girls and women. It is difficult to say with certainty what this is connected with. Presumably the provoking factor is early onset of sexual activity, sexually transmitted infections, artificial termination of pregnancy, especially repeated ones or those performed at an early age.

Problems associated with breast cancer can be divided into several groups:

1) Psychological. A woman who has learned of such a serious diagnosis as cancer experiences severe stress associated with fear of pain, upcoming treatment, death and possible consequences for your appearance, social status, personal life, etc. The stress is greater the less the patient is informed about current state cases in oncology, so the doctor must talk in detail about modern capabilities medicine, mentioning that breast cancer is one of the most favorable options malignant diseases. With timely consultation with a doctor and radical therapy, the recovery rate is 95%.

2) Social. Breast cancer primarily affects women of working age, many of whom become disabled. Unfortunately, the mortality rate for this type of pathology still remains quite high, which is associated not so much with the difficulties of therapy, but with the late presentation of women for treatment. medical care. In recent years, the incidence among girls of childbearing age has been increasing, which significantly affects their ability to start a family and give birth to a child.

3) Medical. Scientific progress does not stand still. Methods for diagnosing cancer of all locations, including breast cancer, continue to be improved. At the same time, the emphasis is on the development of methods and technologies that make it possible to identify not only an already developed disease at the most early stages, but also a predisposition to this species pathology, which would allow targeted prevention in risk groups. In recent years, it has become possible to perform organ-conserving operations in the early stages of cancer, which significantly facilitates the rehabilitation process for patients. It was possible to achieve high survival rates and even recovery of women diagnosed with breast cancer, which for many centuries was considered a death sentence. When diagnosing the disease at stage 1, the percentage of recovery (we emphasize recovery, not survival) reaches 95%. In the absence of distant metastases (stage 2-3), the five-year survival rate is more than 70%.

Tatyana Shitova for the project White Clinic of Doctor Vdovin. Date of writing: 07/19/11.

Original article on the customer's website

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