What happens to the gland tissue
The mammary gland consists of lobules that produce milk and ducts through which it moves to the nipple. The vast majority of malignant tumors grow from cells of the ducts (ductal carcinoma) or lobules (lobular carcinoma). Initially, the altered cells remain inside the duct and do not go beyond its boundaries - this is the “carcinoma in situ” stage (carcinoma in situ, code D05), it does not yet metastasize and is almost completely curable.
The problem begins when cells grow through the wall of the duct and into the surrounding tissue—this is called invasive cancer. From here, the cells can enter the lymphatic vessels and settle in the axillary lymph nodes, and through the bloodstream into the bones, liver, and lungs. Therefore, examination for a confirmed diagnosis always includes not only the gland itself, but also the lymph nodes and organs where metastases most often appear.
First signs: what you can really notice
The most common first sign is a dense knot that a woman accidentally finds herself. It is usually painless, denser than the surrounding tissue, with unclear boundaries and almost does not move. Pain is rarely the first symptom, and that is why “it doesn’t hurt, it means it’s not scary” is a dangerous misconception.
- A lump or nodule in the gland or armpit that persists throughout the cycle
- Retraction of the nipple or area of skin, dimple that appears when raising the arm
- Changes in skin color and texture: redness, thickening, orange peel appearance
- Discharge from the nipple, especially bloody, from one duct, without pressure
- Asymmetry: one gland noticeably changes shape or stops moving when you raise your arms
- Persistent peeling, erosion or crusting on the nipple and areola
Separately, it is worth mentioning the edematous-infiltrative form: the gland quickly turns red, swells, becomes hot and painful. It looks similar to mastitis, and this form is often treated with antibiotics for several weeks. The rule is simple: mastitis in a non-breastfeeding woman is a reason not to continue treatment with antibiotics, but to go to an oncologist-mammologist.
Who is at high risk
Breast cancer also occurs in women without a single risk factor, so their absence does not negate the need for examination. But under the circumstances listed below, it is necessary to start routine monitoring earlier and undergo it more often.
- Age over 40 years is the main and cannot be eliminated factor
- Breast or ovarian cancer in mother, sister, daughter; BRCA1 and BRCA2 mutations
- Early onset of menstruation (before 12 years of age) and late menopause (after 55)
- Absence of childbirth, first birth after 30 years, refusal of breastfeeding
- Long-term hormone replacement therapy during menopause
- Obesity after menopause, inactivity, regular alcohol consumption
- Previous cancer of one gland, atypical hyperplasia in biopsy
How is the diagnosis made?
Breast cancer cannot be diagnosed by examination, ultrasound, or mammography. These methods answer the question “is there a suspicious formation and where is it?”, but the final answer is given only by examining the cells under a microscope. The examination procedure is usually as follows:
- Осмотр онколога-маммолога: пальпация обеих желёз и всех групп лимфоузлов, оценка кожи и соска.
- УЗИ молочных желёз и регионарных лимфоузлов — main метод до 40 лет, когда ткань железы плотная.
- Маммография — рентгеновское исследование, main скрининг после 40 лет; видит микрокальцинаты, которые УЗИ пропускает.
- Биопсия образования с гистологическим исследованием — обязательный этап, который и устанавливает диагноз.
- Определение подтипа опухоли: рецепторы к эстрогену и прогестерону, HER2, индекс Ki-67 — от этого напрямую зависит схема лечения.
- Уточнение распространённости: УЗИ органов брюшной полости, рентген или КТ грудной клетки, при необходимости — исследование костей.
The CA 15-3 tumor marker is often mistakenly perceived as a “breast cancer test.” It is not used to make a diagnosis and may be normal in tumors and elevated in benign conditions. It is prescribed after a confirmed diagnosis - to monitor the dynamics during treatment.
Treatment: what the plan consists of
Treatment is almost always combined, and the sequence of stages is selected individually. Sometimes surgery comes first, sometimes it is preceded by chemotherapy to shrink the tumor and make breast-conserving surgery possible.
- Organ-conserving surgery (radical resection) - removal of the tumor with a reserve of healthy tissue while preserving the gland; During surgery, the resection margins are urgently examined to make sure that there are no tumor cells in them
- Mastectomy - removal of the entire gland when the tumor is large, multinodular or located in such a way that it is impossible to maintain its shape
- Radical mastectomy with lymph node dissection - with removal of axillary lymph nodes if they are affected
- One-stage or delayed reconstruction - installation of implants and expanders, shape correction using lipofilling
- Chemotherapy - courses in a day hospital, including regimens with docetaxel
- Hormone therapy for hormone-dependent tumors - long-term use of drugs in tablets
- Radiation therapy - usually after breast-conserving surgery
Separately, it is worth mentioning the fear of gland removal. Today, mastectomy and reconstruction are often performed together, and the issue of maintaining appearance is discussed with the surgeon before surgery, not after. Refusing treatment for fear of losing your breasts is the most expensive mistake you can make with this diagnosis.
Prognosis and follow-up after treatment
The prognosis is determined primarily by the stage at the time of treatment and the biological subtype of the tumor. For tumors up to 2 cm without lymph node involvement, long-term results are very good, and most women return to normal life and work.
After completion of the main treatment, observation continues for years: examination by a mammologist, ultrasound or mammography of the remaining tissue and the second gland, control of tests. This is not a formality - a second tumor and relapse, found early, are much easier to treat.
What can be done for prevention
- Self-examination once a month on the 5th–10th day of the cycle, in menopause - on a fixed day of the month
- Ultrasound of the mammary glands annually from 25–30 years; Mammography from age 40 at intervals determined by your doctor
- In case of a family history - the start of observation is 10 years earlier than the age at which the relative fell ill
- Childbirth and breastfeeding reduce the risk; long-term feeding is an additional protective factor
- Weight control after menopause, regular physical activity, avoidance of alcohol
- Do not prescribe hormonal drugs and dietary supplements “for the breast” without examination
