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 DEFINITION
The breast cancer is an illness in which cancerous cells develop in the textiles of the breast. The mammary gland consists of several lobes bunches and lobulillos connected by means of a few thin conduits, as branches of a tree, in these conduits there develops the most frequent breast cancer that is the cancer ductal, another type of breast cancer is the lobar carcinoma.
CAUSES
There exists a familiar predisposition that is transmitted across the genes (in the chromosomes), being 5 % to 10 % of all the cases of the cancer of hereditary broadcast. Another factor that it predisposes to the breast cancer is the use of the contraceptive hormonal ones.
I DIAGNOSE
The most effective prevention of the breast cancer is the precocious detection and for it the self-examination of the breasts, of periodic form, is fundamental. Also from 50 years and earlier if familiar predisposing factors exist, an exploration must be realized of periodic form (every 2 years) called mamografía. East exploration detects small tumors that can happen unnoticed in the self-examination
The appearance of some suspicious nodule indicates the achievement of a biopsy of the same one, this supposes taking a small piece of the nodule and analyzing it to the microscope to determine the presence of cancerous cells. Normally the capture of the sample is realized by means of a needle that gets in the mammary textile and by aspiration there is gathered part of the suspicious textile.
If the analysis detects cancerous cells other studies will be realized to see the sensibility of these cells with the feminine hormones (estrogen and progestágenos). According to the sensibility to these hormones we will be able to extract conclusions on the most correct treatment, since the hormones of the growth will be used of different form as the answer to the feminine hormones of every cancer, and the recidivar probability will be different in a few cases and in others.
The healing of the breast cancer will depend on the extension stadium at the moment of the diagnosis as well as the general health of the affected person.
EXTENSION STAGES
- Breast cancer stage 0 (in situ).
The cancerous cells only spread on the part of the textile ductal or lobar of the breast. The lobar in situ although it is not a real cancer supposes a predisposition to develop it, the ductal in situ if or it is. - Stage I
The size of the cancerous nodule is less than 2 centimeters and without extension to other textiles. - Stage II
If the size of the cancer is a 2 cm minor and has spread to the ganglions of the armpit, or when the cancerous nodule is major than 2 cm and 5 cm minor with or without dissemination than the ganglions of the armpit. - Stage III
- The stage III To
The cancerous nodule is a 5 cm minor but it has spread to the ganglions of the armpit that are multicolored and clingings between themselves or to other structures. Or if it is major than 5 cm with dissemination axilar. - The stage III B
The cancerous nodule spreads over the textiles near to the breast, the skin, the ribs, the muscles of the thorax or to the lymphatic ganglions of the thoracic wall.
- Stage IV
When the cancerous cells have been spread to other textiles of the body (bones, lungs, liver or brain), and also locally to the skin and to the lymphatic ganglions of the neck and clavicle. - Inflammatory cancer of the breast
It is a concrete and rare type of breast cancer, the breast has aspect inflamed shyly and heat with modifications of the surface of the skin. It is very aggressive and it is spread quickly. - Appellant
When the cancer has talked each other and cancerous cells appear again in the breast, the thoracic wall or in other parts of the body.
TREATMENT
In the treatment of the breast cancer four types of treatment are used:
- surgery
- radiotherapy
- chemotherapy
- hormonal therapy
Clinical studies are realized with biological therapy and with the transplant of bone marrow.
First of all the surgery is used to extract the cancerous nodule of the breast, also axilares extract the lymphatic ganglions to themselves for his analysis in the microscope and to detect the extension of cancerous cells.
Types of surgery for the breast cancer.
- Conservative surgery:
- Lumpectomía (escisional biopsy or wide split) consists of the extraction of the cancerous tumor and a safety area around him and sometimes some ganglion axilar. It collaborates later with the radiotherapy.
- Partial mastectomy, in her the cancer is extracted with part of the textile of about the same one and the recovering of the muscles of the thorax under the tumor, with the lymphatic ganglions axilares. Also the radiotherapy is applied later.
- Aggressive or radical surgery
- Radical mastectomy is the extraction of the whole breast the breast and the recovering of the muscles of the thorax and of the thoracic wall placed under the tumor, with the lymphatic ganglions axilares. In the modified partial mastectomy it departs from the muscles of the wall of the thorax they survive.
- The radiotherapy can be external or or across applied radioisotopes locally (internal radiotherapy).
- The chemotherapy is applied of form endovenosa.
- The hormonal therapy is applied if the analyzed cancerous cells it has recipients for estrogen or progesterone. The tamoxifeno is used like hormonal therapy, is administered for 5 years in the breast cancer without extension to the lymphatic ganglions. The problem is that there increases the probability of appearance of the cancer of womb.
TREATMENT FOR EXTENSION STAGES
Stage 0 BREAST CANCER IN SITU
1. Surgery to extract the whole breast (entire mastectomy).
2. Surgery to extract only the cancer (lumpectomía) more radiotherapy.
3. Clinical studies with lumpectomía more radiotherapy with or without hormonal therapy.
In little occasions there will be realized an extraction of the ganglions of the armpit.
In the lobar carcinoma in situ can be chosen for:
1. Diagnostic biopsy continued for mamografías annual
2. The hormonal therapy with tamoxifeno
3. Surgery to extract both breasts (entire mastectomy)
STAGE I
1. Surgery of lumpectomía or partial mastectomy with ganglions cleanliness axilares, with later radiotherapy.
This rule has levels of healing similar to the modified radical mastectomy.
2. Modified radical mastectomy, with the lymphatic ganglions axilares.
In addition to an adjuvant therapy:
a) Chemotherapy.
b) Hormonal therapy (tamoxifeno for 5 years).
c) Clinical studies with diverse rules.
STAGE II
1. Lumpectomía or the partial mastectomy, with some lymphatic ganglions axilares. The later radiotherapy produces similar healing indexes to to the radical mastectomy.
2. Modified radical mastectomy, with lymphatic ganglions axilares.
In addition to an adjuvant therapy:
a) Chemotherapy.
b) Hormonal therapy (tamoxifeno for 5 years).
c) Clinical studies with diverse rules.
STAGE III
- Breast cancer stage IIIA:
1. Modified radical mastectomy ó the radical (with lymphatic ganglions axilares).
2. Radiotherapy administered after the surgery.
3. Chemotherapy with or without hormonal therapy in addition to the surgery and the radiotherapy.
4. Clinical studies with diverse rules.
- Breast cancer stage IIIB:
1. Chemotherapy to diminish the size of the tumor, later realizes the surgery and/or the radiotherapy.
2. Hormonal therapy in addition to the rest.
3. Clinical studies with diverse rules.
STAGE IV
1. Radiotherapy or a mastectomy to reduce the symptoms.
2. Hormonal therapy with or without surgery to extract the ovaries.
3. Chemotherapy.
4. Clinical studies with diverse rules.
INFLAMMATORY CANCER OF THE BREAST
There are used the same rules as for the breast cancer in stage IIIB or IV.
CANCER APPELLANT
1. Hormonal therapy with or without surgery to extract the ovaries.
2. If the tumor appellant is isolated the surgery and/or the radiotherapy is applied.
3. Palliative radiotherapy of the pain
4. Chemotherapy.
5. Clinical studies with diverse rules.
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