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Breast Cancer

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I. The etiology and prevalence of

  • Morbidity

Among the malignant tumors in women with breast cancer ranks first in incidence (29% of all cases) and the second death (the first - before the age of 55 years).

  • Risk Factors  
    • Age. Risk increases with age, especially after - 50 years.  
    • Breast.  
    • Pregnancy and lactation. At the first birth after age 30 the risk of breast cancer is 2-5 times higher than in the first genus to 18.
    • Exercise, according to the majority of cohort studies, may reduce the risk of breast cancer regardless of age.
    • Ionizing radiation increases the risk of breast cancer.
    • Alcohol - definite risk factor.

II. Pathologic anatomy and flow

  • Ductal cancer is 70-80% of breast cancers in women and almost all the cases in men.
  • Lobular carcinoma was 10% of cases.
  • Other options (less than 10% of cases).
  • Inflammatory carcinoma (1%) manifested by infiltration of lymphatic vessels of the dermis.
  • Paget's cancer of the breast nipple like nipple eczema.
  • Metastasis. Most tumors based on the quadrant verhnenaruzhnogo cancer. Dissemination is associated with local growth, lymphogenous and hematogenous metastasis. Most affected lymph nodes, skin, bone, liver, lungs and brain. The frequency of metastases in the lymph nodes in tumors okologrudinnoy inner quadrant is 25% for tumors of the outer quadrants - 15%. Typically, these metastases are combined with axillary lymph nodes. In rapidly growing tumors, the risk of metastases above.
  • The natural course. Although proTnoz depends on the stage, to predict the course of the disease is very difficult. In the early stages of cancer is curable, but in 10-20% of cases, distant metastases occur, even 10-20 years after surgery. In locally advanced tumors at high risk of hidden distant metastasis. In some cases, the tumor is progressing rapidly, especially in the presence of adverse prognostic factors. Metastatic tumors are incurable and is characterized by stabilization during treatment and further stepwise progression.

III. Diagnosis

  • Physical examination
    • Volume formation in the mammary gland is determined in most patients.
    • Discharge from the nipple - the second most common symptom.
    • Other symptoms include skin changes, an increase in axillary lymph nodes, various manifestations of the local growth and distant metastases.
  • The influence of surgery on the prognosis
    • Removing the primary tumor has little effect on the risk of metastasis.
    • Local recurrence (in the chest wall) in 90% combined with distant metastases.

a. metastases in the axillary lymph nodes the risk of recurrence and distant metastases above, even if the primary tumor and lymph nodes were completely removed.

b. Axillary lymphadenectomy does not reduce the risk of local and systemic recurrence and survival.

a. okologrudinnoy Removing the lymph nodes is associated with significant complications and improves survival.

  • Indications. Chemotherapy shows almost all patients with positive lymph nodes.
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