Breast cancer

Breast cancer

Description of breast cancer

Breast cancer is the Czech Republic most common cancer of women. Annually it with us sick around 100 of the 100 000 women. A similar situation but also in other developed countries, where the breast cancer also maintains its front seat next to lung cancer, which in turn is dominant on the contrary in men. During the year worldwide diagnose several million new cases.

We managed to improve the curability of cancer, mainly due to increased trapping in its early stages in relation to the prevention, that is for women over 45 years of compulsory (85% of patients aged over 45 years). More and more, however, we are found even to younger patients, so the discussion about the possibility of introducing mandatory screening for women from 40 years.

Further progress are new treatment options. This applies particularly to continuous improvement and hormone therapyseems very promising as the application of biological therapy.

Interestingly, the breast cancer may occur very rarely and in men (less than 1%).


Risk factors and prevention of breast cancer

There are many factors which are associated with increased risk of breast cancer in women. These include genetic factors, hormonal, nutritional and environmental factors.

The most serious risk factor, however, is age. While over the age of 25 years, these tumors are rare, the incidence begins to rise significantly in the period around the 30th year and tumors occurring in older than 45 years represent the vast majority.

In 75% of women aged not identified except no other known risk factor. For this reason, therefore, we pay attention to women who are over 45 years old and their doctor sends them every two years on a mammogram.

It’s a great achievement in preventive measures covered by insurance, as most other cancer prevention does not like. Of course it plays a role in such a high frequency of breast cancer, but also his good curability when it comes time.

Middle-aged women should therefore not underestimate the possibility of tumor growth and mammography kontoly walk. It is actually just about X-ray examination that does not hurt and is not too demanding.

Younger age if they suspect (eg themselves feel a lump in the breast or have a high incidence of cancer in the family) physician may also request that is sent to investigate, and it’s just as well. In this case, however, recommended rather ultrasound, because it is not excluded that a woman that age could not be pregnant and then it could be harmful X-rays.

Among the other factors that can determine therefore the remaining 25% of women, this includes the long-term effects of female sex hormones – estrogens – at the mammary gland. Especially vulnerable are women after menopause or after surgery of the uterus or ovaries (ie, premature menopause) using hormonal substitution, because of their sexual organs stop producing estrogen, which are important for a variety of other functions in the body, such as preventing osteoporosis.

Post-menopausal women taking hormone replacement also for better mental tuning and wellbeing.On the other hand, hormone replacement therapy is disadvantageous in terms of the risk of breast cancer and thrombosis. Estrogen could also give rise to cancer of the uterus, therefore, to provide hormone replacement and progestins, which decreases the risk and uterus acts favorably.Unfortunately, it was not clearly demonstrated a similar effect in the case of breast cancer.

It is generally recommended not to use hormone replacement therapy in high risk women who still have some of the following factors.

In the development of breast cancer applies as for most other cancers inheritance. These tumors are very often bilateral (or both breasts).

Increased risk is mainly for direct female relatives (mother, sister, daughter) or in families where they accumulate different kinds of tumors within the so-called. Syndromes (Li-Fraumeni syndrome, Cowden syndrome, etc.). There goes that human DNA it is not affected in key areas where it is important for DNA repair genes or start cell death.

These functions of genes are very useful, because if there has been any impairment of DNA in other sections, these genes are not able to fix and thus the tumor growth. Equally important is also cell death, although this may seem remarkable. When it occurs a tumor, it is still desired that the dying tumor cells and the tumor and “disappeared.” However, if the affected gene to cell death in charge, while the opportunity can actually tumor cells continued to proliferate and be essentially immortal.Therefore, the damage to these genes such importance. This way may arise breast cancer and many other cancers.

Other genes that currently play their role not only in breast cancer, but because it was in her diagnosis, the genes BRCA 1 and BRCA second Damage gene BRCA 1 increasingly appears just in breast cancer, ovarian cancer, and to a lesser extent also in men with prostate cancer. Transmitters have a lifetime risk of getting breast cancer (55-85%) or ovarian cancer (15-45%). Failure BCRA 2 gene is associated usually worse prognosis.

Testing for BRCA 1 and BRCA 2 is done in women who have had breast or ovarian have and are less than 35 years of age, in men with breast cancer in women who have both breast and ovary, which does not depend on the age for women whose breast cancer was discovered on the two breasts or in women who have a particular type of cancer (medullary carcinoma of the breast). Then there are the sick women who have family in another female patients with breast or ovarian cancer (sister, mother).

This will determine whether sick woman is a carrier and could thus endanger their children (female as well as male), which then as an adult also undergo such testing. Likewise, he will participate in a healthy person with a family someone already tested positive, because even if they are healthy, they may be transmitters (the risk that a carrier reaches the tumor is 85%, thus not 100%!).

But do not worry if you have cancer dog, he will automatically have your daughter. These hereditary forms of breast tumors occur only in 5-7% of all breast cancers. But it is of course good that screening done in the above cases, since there is a greater probability.

Risk factors include the obesity and excess dietary fats (especially saturated fatty acids such as that contained in butter, animal fats, fatty cheeses, mayonnaise, etc.). Other conventional factors are smoking and lack of exercise.

Some hormonal and genetic changes are also responsible for some benign (noncancerous, or not the cancer) breast disease as cysts (cystic dysplasia skin tags). This dysplasia is přednádorovým state with a significantly higher risk of developing cancer. But beware, not all breast cysts belong to the category of skin tags cystic dysplasia!

Less important, but sometimes for doctors alerting factors are: early menstruation, late menopause, childless woman (the woman who has never had no children), higher age at first childbirth, oral contraceptive use and the excessive burden of ionizing radiation (X-ray, gamma).

From the above it follows that a lot predispositions can influence as is the case especially with age, in hereditary tumors or tumors that occur without previous load some other risk factors.

If you want to do everything for your prevention, careful regular mammography checks, or come for the doctor sooner if you are not yet 45 years old and you suspect that you might be ill. She at least once a month, check the breasts that feel no any shape ( breast self-examination). The question of HRT solve with your gynecologist.

Other factors are the subject of your lifestyle, so when you eat healthily and operate a recreational sport, or do not smoke, I’m sure you will benefit in many other directions of your health.

breast self-examination

Woman would not be carried out every month, if still menstruating and preferably between 7 to 8 day after menstruation. When examined lie on your back and breast Investigate fingers opposite hand so that the mammary gland pressing against the wall of the chest and swirl comes to deciding whether you hit the presence of some resistance (resistance) under the fingers.

Proceed from the nipple to the edges of the breast and gradually so-examine the whole. Repeat with the other breast. If you ever felt for anything suspicious as soon as possible rather go to your doctor or to a special clinic for breast disease.


Signs and symptoms of breast cancer

The most common symptom is painless lump that you can Nahm patient herself during self-examination or the physician is found in the investigation (and not only on gynecology, but also as an incidental finding during examination for another purpose). This lump is the first symptom in about ¾ of patients.

In terms of available treatment is optimal when the first appears bearing palpable mammography examination, or a tumor that is at an early stage and still be clinically expressed. This can be achieved only by regular mammography checks, but even so, if the tumor is discovered, for example, soon after the inspection, can grow almost two years to further control and already in the patient and effect.

So not always should be able to early detection, as well as younger patients for which screening is not yet determined. However, it is statistically demonstrated that the introduction of screening and perhaps greater awareness with early detection of breast cancer has increased and thereby to improve the course of its cure.

Additional but less common (as indicated by the actual percentage) symptoms include breast pain(5%), breast (1%), entry of the skin or nipple (5%), discharge from the nipple (2%) or surface changes on the nipple, e.g. popping (1%).

Enlarged lymph nodes in the armpit or above the collarbone is no sign of spread of the tumor. Less than 10% disease manifests symptoms already distant metastases, therefore symptoms in other organs (such as backache metastasis to the bones).


Breast Cancer Treatment

After diagnosis based on mammography or ultrasound dopněné when it is already certain that the patient has breast cancer, is doing histological examination in order to determine the correct course of treatment. Histology sample is sent from the web of tissue called. Biopsy, which is done very thin needle.

Histology demonstrated whether the lobular carcinoma, which is less harmful (non-invasive) orductal carcinoma, which in turn grow into larger size, but again may be due to the fact more easily diagnosed. Harmfulness lies in its dissemination into the environment.

Decisive for treatment is whether or not the patient metastasis in lymph nodes, or in distant organs. For this purpose further examinations of the bodies – eg. Ultrasound (ultrasound) of the liver, chest X-ray and scintigraphy (examination of the nuclear medicine department) bones.

Using ultrasound to investigate and nodes to which the cancer spreads first (in the armpit and above the key).

It makes and biochemical tests (the blood test) for determination of tumor markers, which are so to say a molecule specific for the tumor, which is secreted into the blood (in breast cancer is mainly CEA). Another thing that biochemistry determines the presence of certain receptors, which are important for hormonal treatment to substance lodges in tablet form, to the receptor not followed. Some breast cancers have these receptors, so then we can not treat hormonal therapy, but must choose a different approach.

Selecting therapeutic strategies thus depends on the age, hormonal status (presence / absence of the receptors), the overall shape and the presence and number of metastases.

The basic method of treatment of early cancer is surgery, which is taken either whole breast or part thereof (in this case usually followed by another irradiation). For reducing the tumor it is also better to remove and lymph nodes in the armpit, because in many cases there is already tumor spread and may be even not detectable.

At present, however, there is a possibility to do during operation scintigraphy (by radioisotope)called. sentinel node, which is actually the first nodule, which could be affected and when this examination would be negative, might not be at all nodes removed because the tumor to them yet fortunately arrived.

After surgery the patients that were affected by the tumor and lymph nodes, chemotherapy treatment. It is because of the fact that during the operation may cause the so-called. Mikrometastázám, thus seeding even a few tumor cells in the blood, so that these cells are destroyed, and thus completely destroyed tumor.

If the patient has affected nodes, but has a further increased risk of tumor seeding (tumor is too large, not present estrogen receptors, or the nature of the tumor cells histologically very severe), and is also recommended chemotherapy. It depends of course on the age because elderly nemocněných could be chemotherapy unnecessarily burdensome.

In postmenopausal women with positive estrogen receptors after surgery gives long-term tamoxifen(Tamoxifen Tamoplex, Nolvadex, Tamifen, Zitazonium), which has the advantage that in some tissues act against estrogen (in breast cancer) and other supports estrogen (in bone – preventing osteoporosis in metabolism Lipis – favorably affects cholesterol). In one tissue, where estrogen supports, but it is negative – in the uterus, where the tumor may occur. This risk, however, given the current disease secondary.

Tamoxifen reduced the incidence of relapses (flare further tumor) by 47%. It is precisely due to the complete eradication of tumor cells which may enter the bloodstream during surgery and which have estrogen receptors, which is the condition of the whole hormone treatment.

Today the forefront receiving hormone treatments other than medication tamoxifen. It isanastrozole (Arimidex), letrozole (Femara), or formestane. These are substances that block the production of estrogen in the adrenal glands and ovaries.

New treatment options are antibodies against HER2 in HER2 positive tumors. It is a biological therapy, which is very specifically directed against a certain molecular structure in the tumor, and can therefore very effectively impress without without causing many side effects. It is expected that its effect especially in tumors, which tend to increased cell proliferation and metastasis (ie those which have a worse prognosis).

Tumors that are intermediate (not early, but still metastasize), it is better to first “shrink” by the doctor chooses one of the chemotherapeutic procedures before resorting to surgery. This is because after all, already a tumor larger dimensions. When reduced due to chemotherapy, it is then more likely that the operation goes well. All but assuming that really takes chemotherapy and demonstrating tumor shrinkage. If it were to shrink tumor failed, it means that it is already too late to surgery and better tumor and irradiate retry chemotherapy.

After the slash-and-burn surgery gives back additional chemotherapy or hormonal therapy because mikrometastázám.

Treatment of metastatic carcinoma is already precarious. Basically not cure cancer, but smaller and smaller by the difficulties that may already be in other organs through metastasis. The patients are given chemotherapy or hormonal therapy with tamoxifen. It is again preferred for patients who have estrogen receptors and occupies especially if metastases in bone or soft tissue.

Under these circumstances, it is also good radiation (for bone metastases, which manifest severe backache or metastasis in the brain). Chemotherapy is reserved for patients with liver metastases, with the rapid spread of the tumor and those that do not have estrogen receptors.

Overall, the better chance for a cure breast cancer have tumors with as few lymph node involvement (ideally zero) and those with positive estrogen receptors and can therefore treat hormonal therapies.Another indicator of the different histological forms of cancer, and according to recent findings HER2 protein (associated with a worse prognosis), against which the receptor was found but antibody (called trastuzumab).

Breast tumors are very heterogeneous and each patient’s situation may vary considerably. Thus it is unfortunately pigeonholed, who will definitely heal and for whom the disease after surgery a few years back. Curability, however, compared to other cancers very promising.

Other names: breast cancer, breast cancer, malignant breast cancer, breast cancer

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