The breast is made up of a set of glands and adipose tissue and is placed between the skin and the chest wall.
In fact it is not a single gland, but a set of glandular structures, called lobules, joined together to form a lobe. In a breast there are 15 to 20 lobes. The milk reaches the nipple from the lobules through small tubes called galactoids (or milkpoxes).
Breast cancer is a potentially serious disease if it is not detected and treated for a long time. It is due to uncontrolled multiplication of some cells in the mammary gland that are transformed into malignant cells.
This means that they have the ability to detach themselves from the tissue that has generated them to invade the surrounding tissues and eventually the other organs of the body. In theory tumors can be formed from all types of breast tissue, but the most common ones are from glandular cells (lobules) or from those forming the walls of the ducts.
There are two types of breast cancer: non-invasive and invasive forms.
Noninvasive forms are the following:
DIN: intraepithelial ductal neoplasia (in situ carcinoma)
Grade 1A (DIN 1A) = flat epithelium attium (according to recent studies this form should be considered precancerous and not a true tumor)
Degree 1B (DIN 1B) = atypical ductal hyperplasia
Grade 1C (DIN 1C) = well differentiated intraepithelial ductal neoplasia (grade 1)
Grade 2 (DIN 2) = moderately differentiated intraepithelial ductal neoplasia (grade 2)
Grade 3 (DIN 3) = poorly differentiated intraepithelial ductal neoplasia (grade 3)
LIN: intraepithelial lobular neoplasia
LIN 1 lobular lobe intraepithelial grade 1
LIN 2 lobular intraepithelial grade 2 lobe
LIN 3 lobular intraepithelial neoplasia in situ
Invasive forms are:
- ductal carcinoma: it is thus called when it crosses the wall of the duct. It accounts for between 70% and 80% of all forms of breast cancer.
- lobular carcinoma: it is called when the tumor passes over the lobule wall. It represents 10-15% of all breast cancers. It can both sneeze at the same time or appear in multiple spots in the same breasts.
- Other forms of less frequent carcinoma are tubular, papillary, mucinous, cribriform carcinoma. They have favorable prognosis.
Breast cancer is classified in five stages.
Stage 0: It is also called in situ cancer. It can be of two types:
- Lobular in situ cancer: It is not an aggressive tumor but may represent a risk factor for the subsequent formation of a malignant lesion.
- In situ duttal carcinoma (DCIS): affects the duct cells and increases the risk of having cancer in the same breast. It is considered a precancerous form rather than a real tumor. In most cases, in fact, it does not evolve towards a true cancer, but spontaneously regresses the body’s defense mechanisms (primarily the action of the immune system).
Stage I: It is an early stage cancer with less than 2 cm in diameter and no involvement of the lymph nodes.
Stage II: is an early stage cancer of less than 2 cm in diameter but has already involved the lymph nodes under the armpit; or is a cancer of more than 2 cm in diameter without the involvement of the lymph nodes.
Stage III: It is a locally advanced tumor of varying size, but it has already involved lymph nodes under the armpit, or that involves tissues close to the breast (eg skin).
Stage IV: It is a metastatic cancer that has involved other organs outside the breast.
If the tumor is identified at stage 0, five years survival in treated women is 98%, although the relapses vary between 9 and 30% of cases, depending on the therapy performed. If lymph nodes are positive, ie they contain cancer cells, five-year survival is 75%.
In metastatic cancer, that is, that which has already affected other organs outside the breast (usually the lungs, liver and bones), the average survival of patients treated with chemotherapy is two years, but this means that there are cases where survival is much longer, even up to ten years.
Generally, the initial forms of breast cancer do not cause pain. A study on nearly a thousand women with breast pain showed that only 0.4% of them had a malignant lesion, whereas 12.3% had benign lesions (such as cysts) and in the rest of the cases there was no any lesion.
The pain was caused only by the natural variations of the hormones during the cycle.
To look for, however, are palpable or even visible nodules, although these are usually signs of an already advanced tumor shape and not of an early-identified form when it is easier to cure. Half of the cases of breast cancer occur in the upper upper quadrant of the breast.
It is also important to report to the physician also nipple abnormalities (out and inside), loss from a single nipple (if the loss is bilateral, most often the cause is hormonal), skin changes (locally stained skin) or of the breast shape.
Most breast cancers, however, do not show signs of self and can only be seen with mammograms (in the young woman, aged 30 to 45, with the help of ultrasound).
Breast cancer is diagnosed with breast mammography and breast ultrasound: Choosing which of the two exams to use depends on age, although in most cases both are used. In some specific cases (eg in the case of very dense breasts or difficult to classify lesions), magnetic resonance imaging can also be used.
The possible identification of suspected nodules or formations usually leads the doctor to advise a biopsy, which can be performed directly in the operating room or in the outpatient clinic with a needle inserted into the nodule allowing a cytological or microstological examination. In the first case (cytological examination) cells are examined, in the second (microstological) tissue: these examinations allow both to determine the nature of the disease and, with microistology, to evaluate its biological characteristics.
A particular form of biopsy is the so-called liquid biopsy or washing of the ducts. It consists of the introduction of liquid into the galtofori ducts through the forelins on the nipple. The liquid collected after this “washing” contains some of the cell walls of the ducts themselves that can be studied by the microscope in search of any atipie. In this way it is possible to evaluate the presence of atypical cells in a larger area of the breast than the one that is covered with classical biopsy.
How to care
Almost all women with a breast cancer, regardless of stage, undergo surgery to remove diseased tissues.
Where this is possible, conservative surgery is used, ie, it saves the breast, but it draws the entire part of the lesion. This technique is also called quadrantectomy (or extensive breast resection) and consists in the removal of the breast tissue that surrounds the neoplasm. It should be followed by a radiotherapy, which aims to protect the remaining breast glands from both the risk of local recurrence and the onset of a new breast cancer.
During surgery, the surgeon can also remove the anus lymph nodes. To know if they are involved, we use the sentinel lymph node technique, that is to identify the lymph node that drains the lymph from the area where the tumor is located. If microscopic analysis shows that the sentinel lymph node is free of tumor cells or has a small aggregate (micro metastasis), they do not touch others, otherwise the axillary cable is removed, ie the removal of all axillary lymph nodes.
Sometimes it is necessary to remove more than one breast dial: in this case we talk about partial or segmental mastectomy, and it is also followed by radiotherapy. In the initial forms of cancer (stage I and II), quadrantectomy followed by radiotherapy is equally effective for breast augmentation. Most patients with intraepithelial neoplasia follow the same route.
More advanced forms of cancer are treated with the removal of the entire breast, according to a technique called modified radical mastectomy, which involves the removal of the gland, the sentinel lymph node and / or all the lymph nodes under the armpit, rarely partially or all of the pectoral muscle and often also of the overlying skin. In many cases today it is possible to save the nipple and most of the skin with the technique of mastectomy that conserves the nipple sparing mastectomy. The areular area is protected with a targeted radiotherapy dose that can be delivered directly to the operating room in the following days.
Both with conservative surgery and in the case of mastectomy, breast reconstruction is carried out: in rare cases, if the woman is to undergo radiation therapy, tends to wait for the end of therapy, which may interfere with cicatrization, otherwise breast plastic during the intervention itself.
After the surgery, accurate histological and biological evaluation is the basis for defining precautionary medical therapies to minimize the risk that the disease may affect other organs (remote metastases).
For this reason most patients are offered anticancer therapy.
Chemotherapy is useful but not always necessary and should be prescribed after a personal assessment of each case. It is also prescribed in the initial forms (stage I and II) for precautionary purposes and the gain, in terms of years of survival, is greater than the more advanced forms of cancer. In recent years, the use of neoadjuvant chemotherapy has also been spread, ie administered prior to surgery to reduce the size and aggressiveness of the tumor.
Radiotherapy lasts for a few minutes and is repeated for five days a week, up to five to six weeks later. Generally, radiotherapy treatment can be combined with the use of drugs.
When a breast cancer is removed, it is sent to the laboratory to study the biological characteristics, in particular the state of the receptors, estrogen and progesterone, two of the female hormones. Patients whose cancer is positive for estrogen receptors can use estrogen blocking drugs such as tamoxifen, which is prescribed in pills for five years after surgery. In women of childbearing age, this drug is often associated with an analogue LH-RH inhibitor that induces temporary menopause.
Other medicines with the same function, called aromatase inhibitors, are now being used, now reserved for women who are already in menopause. The tumor is examined by the pathologist anus also to detect the presence of a receptor called HER-2 / neu. If this is present significantly, there is a greater risk of falling into a relapse. For this reason, it has been proposed for a few years for positive women for this examination to take a biological drug called trastuzumab, a substance that blocks receptors and prevents the tumor from growing. Other biological drugs are being studied.
Who is at risk
There are several risk factors for breast cancer, although only a few of them can be prevented.
Age: More than 75% of cases of breast cancer affect women over the age of 50.
Familiarity: About 5-7% of women with breast cancer have more than one close family member (especially in juvenile cases).
There are also some genes that predispose to this type of cancer: BRCA1 and BRCA2. The mutations of these genes are responsible for about 50 percent of hereditary and ovarian cancer hereditary forms.
Hormones: Various studies have shown that excessive use of estrogen (female hormones par excellence) facilitates the onset of breast cancer. That is why all the factors that increase their presence have a negative effect and vice versa (for example, pregnancies that reduce the production of estrogen by the body, they have a protective effect).
Breast changes, cysts and fibroadenomas that can be detected with a breast examination do not increase the risk of cancer. On the other hand, the breasts that are in the first mammograms show a very dense tissue or even a benign form of cell growth called breast hyperplasia.
Obesity and smoking also have negative effects.
If the disorder is benign
Many women aged between 30 and 50 show signs of breast dysplasia, a benign breast tissue alteration that has nothing to do with tumor but which can cause some concern at the time of diagnosis. There are several forms of dysplasia, the most common of which is fibrocystic disease.
Small, cystic fibrocystic dysplasia, most commonly between 30 and 40 years, has small, filled liquid cysts, more evident during the premenstrual period. Pain can be present. In large cysts dysplasia, more common in women between the ages of 40 and 50, there is the presence of one or more large, circular, liquid liquid cysts.
The most common benign tumor is, instead, fibroadenoma, which appears mostly between 25 and 30 years. It looks like a single nodule, hard and very mobile, generally painful.
Symptoms that accompany dysplasia and fibroadenomas are:
• sense of breast tension;
• breast pain;
• nodule appearance that woman can “feel” with her hand.
Breast cancer affects 1 woman out of 8 in life. It is the most common cancer in the female and accounts for 29% of all tumors affecting women.
It is the first cause of cancer mortality in women, with a mortality rate of 17% of all deaths due to female oncology.
You can reduce your risk of getting sick with a careful behavior and with a few check tests listed below. It’s good to exercise and feed with a few fat and many vegetables (fruit and vegetables, especially broccoli and cabbage, onions, green tea and tomatoes).
Even breastfeeding helps to combat breast cancer because breastfeeding allows the breast cell to complete its ripening and therefore be more resistant to any neoplastic changes.
Mammography is the most effective method for early diagnosis. The Ministry of Health’s guidelines suggest mammography every two years, 50 to 69 years of age, but the rate may vary depending on the doctor’s views on each woman’s personal history. In women who have had a sick mother or sister usually start first, in the age of 40-45. In recent years, discussion of the utility of mammography (which identifies many cancers, such as ductal carcinoma in situ, that would probably not require aggressive treatments) has led many physicians to consider the possibility of suggesting early onset and frequency of mammography on the basis of the characteristics of the individual patient rather than on the basis of guidelines and screening equal for all.
Ultrasound is a very useful exam for examining the young breast, as in this case mammography is not suitable. It is recommended that you resort to a nodule appearance at the doctor’s advice.
Magnetic resonance is reserved for very dense breasts or diagnostic doubts, although it can be of great help in specific cases.
Visit: It is good practice to have a breast examination at a gynecologist or experienced doctor at least once a year, regardless of age.
Self-climbing: It is a technique that allows the woman to identify early changes in her breasts. Its effectiveness in screening is, however, very low: this means that it is more than just visiting and mammography from the recommended age but can not replace them (go to self-help).
Gene genetic tests for BRCA1 and 2 genes responsible for some hereditary forms of breast cancer are useful prevention tools in particular situations, where the genealogy study of a person highlights the specific characteristics of transmission of the disease. Before undergoing genetic testing, you must contact an experienced genetist who will confirm or deny the usefulness of the exam. In the case of positivity, it is possible to strengthen the control measures with very close mammograms and ultrasound to identify the tumor at an early stage if it occurs or it is possible to resort to ovariectomy and / or preventive mammography in particular.
The Preventive Diet
Several scientific studies have shown the utility of a particular diet in preventing breast cancer relapses in women who have already been affected. Now, the utility of the same diet is being considered in primary prevention, or in those who have not yet developed the disease. At the base of this diet there is a high intake of phytoestrogens (plant hormones similar to female estrogens that are mainly contained in soy and its derivatives, but also in algae, flaxseed, cabbage, legumes, fruits of forest, in wholegrain cereals). In addition, refined sugars that have the effect of raising insulin in the blood and thus inducing diabetes in favor of raw sugars and starches should be limited.
Still: it is advisable to consume many crucifixes (strawberries, mustard, rocket, cauliflower, Brussels sprouts, radishes, cabbage) because they act positively against hormone metabolism.
Lastly, it is good to have the fish in comparison to other animal proteins, accompanied by large quantities of fiber (through the consumption of fruit, cereals, vegetables, legumes). To limit the intake of dairy products and eggs, however, keep in mind the total amount of calcium to prevent osteoporosis.