Breast Cancer
Breast Cancer
2022-05-20 09:12:41/ Kategori : General Surgery, Gynecology and Obstetrics
Breast Cancer
Breast Cancer ranks first among the cancers seen in women in our country as well as all over the world. According to statistics made in our country, one of every four women’s cancer is breast cancer. Considering women all over the world, one in eight women has a lifetime risk of developing breast cancer, and this risk increases every 10 years after the age of 40.
Female gender is the single most important risk factor for breast cancer. Other risk factors are the early age of the first menstrual period, which increases the risk due to longer exposure to estrogen hormone, for the same reason, the age of late menopause, the first birth after 30 years of age, the long-term use of birth control pills, the long-term postmenopausal hormone drug treatment, postmenopausal high-fat diet and excessive weight gain, smoking and excessive alcohol consumption.
The most common type is the “ductal” type originating from the breast ducts, the second most common subtype is the “lobular” type originating from the mammary glands. There are also subtypes originating from other tissues of the breast. It has been suggested that some genetic factors and some changes brought about by normal aging play a role in the development of cancer. Familial breast cancer due to gene mutation is valid only in 7-9% of cases. Having breast cancer at a young age on the mother’s side, having breast cancer in more than one woman in the family under the age of 40, individuals with concomitant breast and ovarian cancer, having both-sided breast cancer and having male breast cancer in the family suggest that breast cancer may be genetic and there is a gene for women in the family. may require analysis.
The most common symptom of breast cancer is the feeling of a painless, growing mass in the breast. A few patients may experience pain in relation to factors such as the location of the mass and the size of the breast. In the advanced stages of cancer, recessions in the breast or nipple, thickening of the breast skin, swelling, deterioration of the skin or open wounds, and inversion of the nipple can be seen. Contrary to popular belief, bloody nipple discharge is usually seen in the advanced stages of cancer, and bloody discharges that do not cause symptoms are often caused by structures that we call papillomas that develop in the ducts near the nipple, which are actually benign but may develop cancer in a long time. A doctor should be consulted to reveal the name of this.
The formation of breast cancer is actually a slow process, it takes about 5-7 years for the cancerous mass in the breast to reach 1 cm. Its spread firstly to the armpit of the breast related to the lymphatic ways and then to distant organs such as liver, bone and brain via blood.
Early diagnosis of breast cancer has resulted in a decrease in both the number of surgeries that are completely removed and the deaths due to breast cancer. Studies have shown that there is a 30% decrease in breast cancer-related deaths with breast examinations every 2 years between the ages of 20 and 40, and once a year after the age of 40. The most important factor for early diagnosis is raising awareness of people on this issue. Early diagnosis increases the success of the treatment of the disease and the chance of survival from this disease. Today, diagnosis of the disease at an early stage reduces the size and severity of interventions to the patient and the patient’s breast.
Diagnosis of breast cancer at an early stage is based on three basic methods. The first is manual breast examination by women, the second is annual physician control, and the third is annual mammography scans for certain groups of patients. Breast Cancer National Screening Program recommendations of the Ministry of Health’s Cancer Department are between the ages of 20-40, 7-10 days after the start of menstruation each month. These are self-examination on days and physician examination every 2 years, monthly self-examination between the ages of 40-69, clinical physician examination once a year and mammography every two years. Due to the increase in breast cancer cases in advanced and very young ages in recent years, it is appropriate to apply patient-based follow-up programs in relation to risk factors by the physician.
The process after the diagnosis of breast cancer must be carried out by a team of experts in the field. In the light of technological and biological developments, this team consisting of breast surgeon, medical oncologist and radiation oncologist makes the treatment plan by evaluating the patient-based, tumor stage, subtype, response to drugs and deciding on the order in surgery, chemotherapy (drug therapy) and radiotherapy (radiation therapy). . In small tumors in the early stage, surgical intervention is usually performed first and, if possible, breast-conserving surgery (removal of the cancerous part of the breast with a healthy border in the environment and a sentinel lymph node biopsy, which we call SLNB to understand the spread in the armpit), after the main pathology result, chemotherapy is applied first, and then radiotherapy, if necessary. . In advanced stage disease, sometimes surgical treatment is performed after controlling the disease with chemotherapy. As a surgical treatment, breast-conserving surgery, if possible, or mastectomy, where the entire breast is removed, is added to the cleaning of the lymph nodes in the armpit, called axillary dissection, if necessary. Depending on the extent of the disease in the breast and armpit, some patients may require radiotherapy after this procedure. In cases where there is spread to distant organs other than the breast tissue, first of all, we decide on the treatment method according to the breast and the organ to which it has spread, and then surgical treatment is performed, if possible, according to the response received. If not, the process of cleaning the lymph nodes in the armpit, called axillary dissection, is added to the mastectomy operation, where the entire breast is removed. Depending on the extent of the disease in the breast and armpit, some patients may require radiotherapy after this procedure. In cases where there is spread to distant organs other than the breast tissue, first of all, we decide on the treatment method according to the breast and the organ to which it has spread, and then surgical treatment is performed, if possible, according to the response received. If not, the process of cleaning the lymph nodes in the armpit, called axillary dissection, is added to the mastectomy operation, where the entire breast is removed. Depending on the extent of the disease in the breast and armpit, some patients may require radiotherapy after this procedure. In cases where there is spread to distant organs other than the breast tissue, first of all, we decide on the treatment method according to the breast and the organ to which it has spread, and then surgical treatment is performed, if possible, according to the response received.
Generally, after diagnosis, all these treatment processes last for about 6 months, and at the end of this, the patient is followed up with controls every 3 months for the first two years, every 6 months between 2-5 years, and annually after 5 years. In some patients, treatment is continued with a preventive pill to be taken orally every day for 5 to 10 years, depending on the pathological sub-characteristics of the cancer type and hormone sensitivity characteristics.
