Breast Cancer

Breast cancer mostly affects glandular cells in the milk ducts or lobules. Most patients present with a found during an examination or screening mammography, asymptomatic lesion. The diagnosis is confirmed by biopsy. The therapy typically consists of excision, often in combination with radiotherapy, with or without adjuvant chemotherapy, hormonal therapy, or both.

About 247,000 new cases of invasive breast cancer and in about 41,000 deaths are expected in the 2016th In addition, about 61,000 new cases of breast cancer in situ in 2016 are expected. Breast cancer is the second leading cancer-related (after lung cancer) cause of death in women.

Breast cancer mostly affects glandular cells in the milk ducts or lobules. Most patients present with a found during an examination or screening mammography, asymptomatic lesion. The diagnosis is confirmed by biopsy. The therapy typically consists of excision, often in combination with radiotherapy, with or without adjuvant chemotherapy, hormonal therapy, or both. About 247,000 new cases of invasive breast cancer and in about 41,000 deaths are expected in the 2016th In addition, about 61,000 new cases of breast cancer in situ in 2016 are expected. Breast cancer is the second leading cancer-related (after lung cancer) cause of death in women. Male breast cancer accounts for about 1%. Approximately 2,600 new cases of invasive breast cancer and thus> 400 deaths are expected in the 2016th In men manifestation, diagnosis and treatment are the same, even though men tend to later Erstvorstellungen. Risk factors for women in the US is the cumulative risk for the development of breast cancer in 12% (1 of 8) to 95 years of age, and the risk of dying from this disease is approximately 4%. The main part of the risk is acquired after age 60 (see table: risk to get breast cancer, the diagnosis of invasive). These statistics can be misleading, since most patients die before the age of 95. and the cumulative risk of developing this malignancy is considerably lower in any 20-year period. to obtain risk, a diagnosis of invasive breast cancer age (years) 10-year-Risk (%) 20-yr Risk (%) 30-year-Risk (%) lifetime risk (%) lifetime risk (%) of invasive breast cancer to die (%) 30 0.4 1.9 4.1 12.5 2.8 40 1.4 3.7 6.8 12.2 2.8 50 2.3 5.5 8.8 11.1 2.6 60 3.5 6.9 8.9 9.4 2.4 70 3.9 6.2 to 6 7 2.0 Data 2010-12. Based on web site. accessed February 22 2016th Among the factors that may influence the risk of breast cancer include: Age: The strongest risk factor for breast cancer is age. Most breast cancers occur in women> 50th Family history: By 1st degree (mother, sister, daughter) with breast cancer doubled or tripled the risk of breast cancer. The breast cancer disease more distant relative contrast increases one’s risk of disease only slightly. When ? 2 1st degree have breast cancer, their own risk can increase to 5 to 6 times. Brustkrebsgenmutation: About 5% of patients with breast cancer have a mutation in one of the two known breast cancer genes BRCA1 or BRCA2. When relatives of such women also have this mutation is their risk of developing breast cancer during his lifetime, at 50-85%. Moreover, having carriers of a mutation of the BRCA1 gene is a risk of 20-40% that they will develop ovarian cancer during his lifetime. The risk of women with BRCA2 mutations is less increased. Women who have not at least two ill with breast cancer first-degree relatives, do not have this mutation likely and therefore do not require any precautionary testing for BRCA1 and BRCA2 mutations. And male carriers of a BRCA2 mutation have an increased risk of breast cancer. These mutations are particularly prevalent among Ashkenazi Jews. Women with BRCA1 or BRCA2 mutation can closer monitoring or preventive measures, such as taking tamoxifen or raloxifene or bilateral mastectomy need. Own Medical History: A pre-existing conditions with an in-situ or invasive breast cancer increases the risk of disease. The risk of developing a second cancer in the contralateral breast after mastectomy is at 0.5-1% per year follow-up. Gynecological medical history: Increase Early menarche, late menopause or late firstborn risk. Women who are pregnant for the first time after age 30, have a higher disease risk than nulliparous. Breast changes: history of a lesion that was biopsied requires further investigation, increases the risk slightly. Women with multiple lesions of the breast, but without histologic confirmation of risky patterns should not be regarded as patients at high risk. Among the benign lesions, which could increase the risk of breast cancer slightly, there are complex fibroadenomas, moderate or florid hyperplasia (with or without atypia), sclerosing adenosis and papillomas. Atypical ductal or lobular hyperplasia increases the risk of breast cancer to the 4-5-fold; This risk increases to about 10-fold in patients who also have a contracted invasive breast cancer 1st degree. An increased density of the breast tissue in the mammography screening is also associated with an increased risk of breast cancer. Lobular carcinoma in situ (LCIS): A LCIS increases the risk of development of invasive cancer in both breasts by about 25 times; invasive cancers develop annually at about 1 to 2% of patients with LCIS. Use of oral contraceptives: the use of oral contraceptives increases the risk very slightly (by about 5 cases per 100,000 women). The risk is increased in particular while taking years and leveled in the 10 years after completion. The risk is highest in women who began taking before age 20 (although the absolute risk is still very low). Hormone therapy: A postmenopausal hormone therapy (estrogen plus a progestin) seems the risk is only 3-year revenue to increase slightly (1). After 5 years of taking the risk (approximately 24% increase in relative risk) increased by about 7 or 8 cases per 10,000 women per year taking. Sole estrogen administration does not seem to increase breast cancer risk (as in the “Women’s Health Initiative” reports). Selective estrogen receptor modulators (z. B. raloxifene) reduce the risk of breast cancer development. Radiation therapy: Radiation therapy exposure before age 30 increases the risk. A mantle field radiation therapy for Hodgkin’s disease increases the risk of breast cancer over the next 20-30 years to 4 times. Diet: the diet may contribute to the emergence and growth promotion of breast cancer, but reliable evidence for the effect of a particular diet (eg high fat.) Is missing. Obese postmenopausal women have an increased risk, but there is no evidence that a change in diet reduces the risk. In obese women who have longer than usual their rule, the risk decreases if possible. Lifestyle factors: smoking and alcohol can contribute to a higher risk of breast cancer. Women are advised to stop smoking and reduce alcohol consumption. The “Breast Cancer Risk Assessment Tool” (BCRAT) or (Gail model) can be used to calculate developing breast cancer, the 5-year and lifetime risk of a woman (see Breast Cancer Risk Assessment Tool). Note on risk factors 1. Writing Group for the Women’s Health Initiative Investigators: Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 288 (3): 321-333, 2002. Pathology Most malignancies of the breast are epithelial tumors that arise from the milk ducts or lobules cells lining; more rarely, the non-epithelial malignant tumors of the connective tissue (eg. B. angiosarcoma, primary stromal sarcoma, Phylloidtumoren). Breast cancers are divided into carcinoma in situ and invasive carcinoma. A carcinoma in situist a proliferation of malignant cells within the milk ducts or lobules without stromal invasion. There are two forms: Ductal carcinoma in situ (DCIS): about 85% of carcinoma in situ of this type are l DCIS is usually detected only by mammography. It may include a small or large area of ??the chest; if it is a large area, is microscopic invasive foci may develop over time. Lobular carcinoma in situ (LCIS): LCIS is often multifocal and frequently on both sides before. There are 2 types: classic and pleomorphic. A classic LCIS is not malicious, but increases the risk of developing invasive cancer in each breast. These non-palpable lesion is discovered biopsy usually rare it can be represented in the mammogram. Pleomorphic LCIS behaves more like DCIS; it should be cut to negative margins. The invasive carcinomas are primarily adenocarcinomas. About 80% are infiltrating ductal carcinoma, the rest mostly infiltrating lobular carcinomas. Rare forms are medullary, mucinous, metaplastic and tubular carcinoma. A mucinous carcinoma tends to develop in older women and grow slowly. Women with these types of breast cancer have a much better prognosis than women with other types of invasive breast cancer. Inflammatory Brustkrebsist a fast-growing, often deadly cancer. Cancer cells block the lymph vessels in the breast skin, causing the breast appears inflamed and the skin appears swollen and orange (peau d’orange). Normally, inflammatory breast cancer spreads to the lymph nodes of the armpit. The lymph nodes feel like hard lumps. But often no mass will be felt in the chest, because this cancer spread throughout the breast. Paget’s disease of the nipple (not to be confused with the bone metabolic disease of the same name) is a ductal carcinoma in situ, which propagates in the skin over the nipple and areola and with a Hautläsoin (z. B. eczematous or psoriasis-like lesions). Characteristic malignant cells, called Paget cells are found in the epidermis. Women with Paget’s disease of the nipple often have underlying invasive or in situ cancer. Pathophysiology Breast cancer is growing locally invasive and spreads beyond the regional lymph nodes or hematogenous, or both off. Metastatic breast cancer can affect almost every organ of the body – most commonly the lungs, liver, bones, brain and skin. Most cutaneous metastases occur in the vicinity of the operated area; Metastases to the scalp are also common. Breast cancer metastases often appear years or even decades after the initial diagnosis and treatment. Hormone receptors that are present in some breast cancer estrogen and progestin receptors are nuclear hormone receptors that, when they bind to the appropriate hormones that promote DNA replication and cell division. Therefore, drugs that block these receptors in the treatment of receptor positive tumors may be useful. Approximately two-thirds of postmenopausal patients have estrogen receptor-positive (ER +) tumors. The incidence of ER + tumors is lower in premenopausal patients. Another cellular receptor is the human epidermal growth factor receptor-2 (HER2, HER2 ErbB2 or newly called /); its presence is accompanied in each tumor stage with a worse prognosis. Symptoms and complaints are many breast cancers as a mass by the patient himself or noticed during a physical or mammographic screening. More rarely the first symptom is pain in the chest, breast augmentation or indefinite thickening in the chest. Paget’s disease of the nipple manifests with skin lesions, including erythema, crusting, flaking and secretion; These changes often seem so harmless that they are ignored by the patients and the diagnosis for one year or more is delayed. Approximately 50% of patients with Paget’s disease of the nipple have a palpable mass at first presentation. A few patients with breast cancer face only with evidence of metastatic disease prior to (eg. As pathological fractures, pulmonary disorders). On physical examination, there is often an asymmetrical or dominant mass – a clearly distinguishable from the surrounding breast tissue resistance. Diffuse fibrotic changes in a quadrant of the breast, usually the upper outer quadrant are more typical of benign diseases; a slight thickening firm into one of, but not in the other breast may also be a sign of a malignant disease. In more advanced breast cancers are found characteristically a fixation of the mass to the chest wall or the overlying skin, satellite nodes or skin ulcers, or, by skin edema, caused by invasion of lymphatic vessels of the skin (so-called. Peau d’orange, Oragnenhaut) related overemphasis on the normal skin structures (so-called. peau d’orange, orange peel). Matted or fixed axillary lymph nodes indicate a tumor spread, as well as a supra- or infraclavicular lymphadenopathy. Dasinflammatorische breast is orange with peau d’characterized redness and enlarged breasts, often without that there is a mass, and it takes a particularly aggressive course. Screening All women should be tested for breast cancer (1). All societies and groups agree with this concept, even though they have different opinions when it comes to the recommended age by the screening should be started and as to the exact frequency of screening. Screening modalities include mammography (including digital and 3-dimensional) Clinical Breast Examination (CBE) by healthcare personnel MRT Monthly (in high-risk patients) breast self-examination (BSE) Mammography Mammography be low-dose X-ray images of both breasts in soft Beam Technology in 1 (oblique) or 2 levels created (an angle and craniocaudal). The mammography is more accurate in older women, partly because fibroglanduläres breast tissue is replaced by fat with age and this is more easily distinguished from abnormal tissue. Mammography is less sensitive in women with dense breast tissue; some states mandate that patients be informed that they have dense breast tissue when it is discovered by mammography screening. The mammography screening guidelines for women with an average risk of breast cancer vary, but generally the screening starts at age 40 or 50 and is repeated until the age of 75 or a life expectancy <10 years every year or every other year. (see table: recommendations for breast cancer screening mammography in women at average risk). Physicians should ensure that patients understand what their individual risk of breast cancer, and survey the patients according to their study preferences. Recommendations for breast cancer screening mammography in women at average risk recommendations USPSTF ACS ACP AAFP ACOG ACR NCCN initiation age (years) 50 45 50 * 50 * 40 40 40 Frequency (Year e) 2 annually until age 54, then every 2 years 1-2 2 1 1 1 final age (years) 75 If the life expectancy <10 years 75 75 75 † 75 † 75 † * Women aged 40 to 50: Consulting the risks and benefits of mammography is recommended, and the investigation can Basier take place end at the risk and patient preferences. † women aged ? 75: Screening can be performed when the life expectancy is good or the patient requests it. AAFP = American Academy of Family Physicians; ACOG = American College of Obstetricians and Gynecologists; ACP = American College of Physicians; ACR = American College of Radiology; ACS = American Cancer Society; NCCN = National Comprehensive Cancer Network; USPSTF = US Preventive Services Task Force. The "Breast Cancer Risk Assessment Tool" (BCRAT) or the Gail model can be used to calculate developing breast cancer, the 5-year and lifetime risk of a woman (see Breast Cancer Risk Assessment Tool). A woman is considered at average risk if their lifetime risk for breast cancer is <15%. Clinical Calculator: Gail model for the 5-year risk of breast cancer among black women (2007) Clinical Calculator: Gail model for the 5-year risk of breast cancer (published 1999), concerns about conduct when and how often a screening mammogram. Accuracy risks and costs only about 10 to 15% of the discovered by mammography changes are carcinomas; 85 to 90% of the findings can be false-negative. False-negative results can exceed 15%. Many of the false positives are benign lesions caused (z. B. cysts, fibroadenomas), but there are regarding new concerns. Of detecting lesions that meet the histological definitions of cancer, but not to invasive cancer during a lifetime of patients develop. The significance depends in part on the techniques used and the experience of Befunders. To support the diagnosis, some centers evaluate digitized mammography images (full-field digital mammography) by computer. While such systems seem to increase <50 years by the radiologist, the sensitivity for detection of invasive cancers in women, but probably not for primary interpretation by computer evidence. Although mammography uses low doses of radiation, the radiation exposure is cumulative impact on cancer risk. If radiological screening is started at a young age, the risk of cancer is increased. The costs include not only the cost of the image itself, but also the costs and risks of diagnostic tests that are required to prevent false positive results on image bewerten.Untersuchung chest The value of routine clinical or self breast examination remains controversial. Some companies such as the American Cancer Society and the US Preventive Services Task Force are opposed to each modality for routine screening in women at average risk. Other companies, including the American College of Obstetricians and Gynecologists, step-clinical and breast self-examination as important components of early detection of breast cancer one. The clinical breast examination (CBE) is usually part of the annual routine examination in women> 40 (1). In the US, clinical breast examination complements rather the screening, as she replaces. In some other countries, where mammography is considered too expensive, the clinical examination is the only precautionary measure. The varied reports on their effectiveness in this context. It could not be proven that the breast self-examination alone reduced the mortality rate, the findings regarding their benefits are different; it is however often used. As an unobtrusive self-examination, some women may be tempted to forgo a medical breast examination or mammography, the patients should, if they are instructed to self-examination, be greater insistence on the need for supplementary measures. Patients should examine the breast itself always on the same day of the month. For women in menstruation the investigation for the 2nd or 3rd day after the menses is recommended because the breasts are then believed to be less sensitive to pain and swollen. Breast self-examination (3 methods) var model = {thumbnailUrl: ‘/-/media/manual/professional/images/breast_self_exam_3_methods_high_blausen_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/ – / media / manual / professional / ? images / breast_self_exam_3_methods_high_blausen_de.jpg lang = en & thn = 0 ‘, title:’ breast self-examination (3 methods) ‘description:’ u003Ca id = “v38397038 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eFrauen should be instructed to examine the entire breast. One of several patterns can be applied: u003cdiv class = “”list “” u003e u003cul data-mmanualobjecttype = “”List “” u003e u003c / ul u003e u003c / div u003e u003c / p u003e u003c / div u003e u003cdiv class = “”list “” u003e u003cul data-mmanualobjecttype = “”list “” u003e u003cli u003e u003Ca id = “”v13952726_de “” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eKreise: Move the fingers in small circles around the chest

Health Life Media Team

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