The mammary glands are a "mirror", which indirectly reflects the entire state of the woman's body. The morphology of this organ is a close object of attention of doctors, because in many diseases it is in the chest that the first changes appear.

This is a group of pathologies that are different in terms of reasons and mechanism of development, encrypted by doctors with special numbers.

What do they mean, and how not to get lost in medical encryption in order to have full information about your health?

ICD 10 diagnosis statistics

ICD 10 (No. 60-64) diseases of the mammary glands are subject to careful statistical analysis. This is one of the reasons why the unified classification was introduced. According to the latest data from the World Health Organization, up to 40% of women suffer from mastopathy among the female population of the world, and more than half of all cases (up to 58%) are combined with gynecological disorders. Of particular interest is the fact that many breast diseases are also precancerous conditions. The incidence and mortality rate from breast cancer is increasing every year, despite the huge advances in medicine in the field of their early diagnosis and effective treatment. The lion's share of cases occurs in developed countries.

The internationally accepted classification of ICD No. 10 is also used in our country. Based on it, there are:

· N 60 - Benign growths of the mammary gland. Mastopathy belongs to this group.

· N 61 - Inflammatory processes. Among them are carbuncle, mastitis, abscess.

· N 62 - Enlargement of the mammary gland.

N 63 - Volumetric processes in the chest, unspecified (knots and nodules).

· N 64 - Other pathologies.

Each of these diseases has its own causes, characteristic clinical picture, methods of diagnosis and treatment. Let's talk about this now.

The definition of the disease was back in 1984 by the experts of the World Health Organization. It characterizes benign dysplasia as a combination of pathological mechanisms, manifested by both regressive and progressive changes in breast tissues with the appearance of abnormal relationships between the epithelium and the connective tissue.

Also, according to the definition, an important sign is the formation of changes in the breast such as fibrosis, cysts and proliferations. But this is not the primary symptom for making a diagnosis, because. it is not always available.

Clinical picture of the diagnosis

The disease can manifest itself in various ways. But the main symptoms can be distinguished:

· Dull pain in the mammary glands, which often tends to increase before the onset of menstruation. After the menstrual bleeding has passed, the pain usually subsides.

Irradiation - the spread of pain outside the breast. Often patients complain that pain is given to the shoulder, shoulder blade or arm.

The presence of education in the breast or compaction of its structure. This symptom can be determined by patients who are attentive to their state of health and regularly palpate.

Diagnostics

The doctor begins the examination with a thorough collection of anamnestic data. The doctor clarifies the patient's onset of menstruation, its nature, cyclicity, soreness, profusion. The gynecological history is also important, which consists in the age of onset of sexual activity, the number of pregnancies, miscarriages, abortions, childbirth. Genealogical data will help to understand whether there were similar diseases in blood relatives in the female line. All this information helps to establish the correct preliminary diagnosis.

An objective examination will help the doctor to identify the asymmetry of the mammary glands, and when they are palpated, to determine the presence or absence of neoplasms. Mammologists pay special attention not only to the consistency and structure of the mammary gland, but also to the color, size and condition of the nipples.

Instrumental methods confirm the correctness of the alleged diagnosis or, conversely, refute it and return the doctor to the beginning of the diagnostic search. Most often resort to mammography and ultrasound of the mammary glands. Additionally, the patient's blood and urine are studied.

Therapy

Treatment of diseases of the mammary glands No. 60 ICD10 is possible in 2 versions. The first is medication, which is used for diffuse growths. A good result can be achieved by hormonal agents, including oral contraceptives.

The second method is surgical, which is indicated for the nodular form. The removed formation is subject to mandatory histological examination to exclude the presence of atypical cancer cells. The prognosis after treatment is favorable.

ICD-10 No. 61 breast diseases included: abscess, carbuncle and mastitis, which is considered the most common pathology in this group.

Mastitis is an inflammatory disease. The defeat of the breast is often unilateral, and only in rare cases (not more than 10%) extends to both mammary glands. The cause of the disease is two main factors that overlap one another:

The first is a violation of the outflow of milk;

The second is the addition of pathogenic or conditionally pathogenic microflora.

Initially, the disease proceeds according to the type of aseptic (sterile) inflammation. However, very quickly, literally in a day, in conditions of stagnation of milk secretion and a favorable temperature, the microflora is activated. Thus begins the stage of bacterial inflammation.

Main symptoms

The clinical picture is almost the same in all women. The first symptom is a sharp rise in temperature to high values ​​​​(38 - 39 ° C). Further, redness of the skin of one of the mammary glands joins, and then severe pain. As time goes by, they only get stronger. With severe inflammation and the absence of timely treatment, sepsis develops very quickly - a deadly complication.

Diagnostics

The diagnosis is established on the basis of anamnestic, objective and laboratory data. From the anamnesis it turns out that the woman is breastfeeding. As a rule, the risks increase if you constantly apply the child in the same position. In this case, incomplete emptying of the gland occurs. An objective examination shows hyperemia of the inflamed gland, its slight increase, as well as sharp pain on palpation. A laboratory study in the blood reveals leukocytosis with high values.

Treatment

In the early stages, conservative (drug) treatment is also effective. The main condition is the thorough expression of milk. For these purposes, a breast pump is not the best solution; it is best to do it by hand. The patient can perform the procedure on her own, but often, due to severe pain, it is necessary to turn to specially trained people. Of the drugs resort to the help of broad-spectrum antibiotics. Usually these measures are enough for a complete recovery and further restoration of breastfeeding.

In severe forms of the disease, before the appointment of an operative method of treatment, attempts are made to temporarily stop lactation with the help of special medicines. If this method was ineffective, then surgeons take up the treatment.

Other inflammatory diseases of the breast

Carbuncles and abscesses of the mammary gland also occur in clinical practice, but are now becoming less and less common. Carbuncle of the mammary gland, as in any other part of the skin, is a purulent inflammation of the hair follicle and sebaceous gland. An abscess is a purulent fusion of the mammary gland limited from healthy tissues.

The cause of the disease in carbuncle is a blockage of the sebaceous gland, against which the pathogenic microflora has joined. An abscess may develop as a result of hematogenous or lymphogenous infection from other foci.

Both diseases occur with an increase in temperature, an increase in soreness in one of the mammary glands.

Treatment is often performed surgically. The abscess is opened, freed from purulent contents, treated with an antiseptic solution, and then drainage is established for a while. The patient is prescribed a course of broad-spectrum antibiotics. With timely treatment, the prognosis is always favorable.

In this group, it is customary to single out gynecomastia, which occurs only in men. It is characterized by the growth of breast tissue and, accordingly, its increase. In women, this process is called breast hypertrophy, and also belongs to this group.

The risk of hypertrophy increases the consumption of beer, because. This drink contains plant estrogens. They also stimulate active cell division.

It is worth noting that such a diagnosis is established not only in women, but also in men, but their ratio to each other is 1:18. Mostly women aged 20 to 85 are ill, but it is more common in 40-45 years. Mortality from the disease is 0%.

Causes

The etiology of the disease is not fully understood.

Clinical picture

The first time the disease has no symptoms at all, this is the so-called latent phase of the disease. The duration of this period is individual and can vary from several months to a year or more. The first symptom is periodic pain in the breast, which may increase before the onset of menstruation. Pain, as a rule, subsides immediately after the end of menstruation.

The biggest mistake of patients is that they do not pay attention to changes in their own body and do not go to doctors, attributing ailments to hormonal imbalances, the beginning of a new cycle, or the proximity of the menopause. Over time, the pain takes on a constant aching character. With careful self-palpation, the patient can detect a formation in the chest, which often serves as a reason to see a doctor.

Diagnostics

Main research methods:

Collection of complaints

assessment of anamnestic data;

laboratory research methods (general clinical blood test, urinalysis, biochemical blood test or tumor marker test);

instrumental methods (ultrasound, mammography, biopsy).

Treatment

All breast neoplasms are subject to surgical treatment. After removal, the biological material in 100% of cases is sent for histological examination, which establishes an accurate diagnosis and the need for further treatment.

Other diseases of the breast (N64) ICD10

This group includes:

galactocele - a cyst in the thickness of the mammary gland, filled with milk;

involutive change after breastfeeding;

secretion from the nipple outside the lactation period;

Inverted nipple

Mastodynia is a condition that is perceived subjectively. It is characterized by discomfort in the chest. They may be present continuously or intermittently.

Prevention of breast diseases

A priority place in the working tactics among gynecologists and oncologists is propaganda for the prevention of breast diseases. These include social advertising, various medical brochures, preventive conversations with patients at the reception, the increase in the popularity of a healthy lifestyle, as well as the approval of World Breast Cancer Day.

To minimize the risk of developing the disease, as well as not to miss it at an early stage, the following rules should be followed:

Refusal to smoke and drink alcohol;

treatment of acute diseases, as well as prolongation of the remission phase in chronic;

passing preventive examinations, especially over the age of 35 years;

Performing self-palpation of the mammary glands at home at least once every 4-6 months.

Benign breast dysplasia according to ICD-10 or mastopathy

Benign breast dysplasia according to ICD-10 or mastopathy is a disease of the mammary glands (benign tumor). It appears as a result of tissue growth during various hormonal disorders and there are 2 types: nodular (single compaction) anddiffuse mastopathy(with multiple nodes).Mastopathy occurs mainly in women of reproductive age. This phenomenon is easy to explain. Every month, in a young body, periodic changes occur under the influence of the hormones estrogen and progesterone, which affect not only the menstrual cycle, but also breast tissue (stimulation and inhibition of cell division, respectively). Hormonal imbalance, causing an excess of estrogen, leads to tissue proliferation, i.e. to mastitis.Also, the untimely production of prolactin, the hormone of lactation, can lead to the disease (it normally appears during pregnancy and lactation).The development of mastopathy can provoke vitamin deficiency, trauma, abortion, hereditary predisposition, chronic diseases, etc. You can feel the appearance of mastopathy on your own. It causes pain in the mammary gland, accompanied by breast enlargement, swelling and induration. Sometimes there may be discharge from the nipples. If you find such signs, you should immediately contact a specialist.

ICD-10, (No. 60-No. 64) diseases of the mammary glands according to the International Classification of Diseases

Medication mastopathy is treated with hormonal (gestagens, estrogen inhibitors, antiestrogens, androgens used according to the International Classification of Diseases, ICD-10) and non-hormonal drugs Mabusten.Surgical intervention is used for nodular mastopathy and is diagnosed in two types: sectoral resection (in this case, the tumor is removed along with the breast area) and enucleation (only the tumor is removed). Surgery is indicated if breast cancer is suspected, the tumor or single cyst rapidly increases.Lifestyle affects the speedy recovery. During the treatment period, it is better to limit the consumption of tea and coffee, include more vegetables and fruits containing vitamins in the diet, give up bad habits, thermal procedures (for example, in a bath or sauna), and wear comfortable underwear. Diagnostics(mammologist) consists of several stages:palpation of the mammary glands in the supine and standing position, examination of the nipples, palpation of the lymph nodes and the thyroid gland;

Mammography - x-ray of the mammary glands;
. Ultrasound to accurately determine the structure and location of the neoplasm in the breast;
. biopsy - examination of tissue for oncogenes;
. hormonal studies, examination of the liver and consultation of specialists (gynecologist, oncologist).

Descriptions of diseases class=”sprite sprite-diseases” title=”Diseases and Syndromes”>

Medical standards. help with

C50 Malignant neoplasm of breast

Inclusions: connective tissue and mammary glands Excludes: skin of mammary glands (C43.5, C44.5)

C50. 0 Nipple and areolaC50.

1 Central part of the breast C50. 2 Upper inner quadrant of the breast C50.

3 Infero-internal quadrant of the breast C50. 4 Upper outer quadrant of the breast C50.

5 Inferoexternal quadrant of the breast C50. 6 Axillary posterior breast C50.

8 Breast disease extending beyond one or more of the above locationsC50. 9 Mammary gland, part unspecified.

We welcome all readers interested in the topic of breast cancer (BC) to our website. Today it is one of the most studied and studied types of oncology. This serious topic is the subject of our article.

We will consider what the disease is, how it is coded by the international classifier and how the pathological process develops.

The concept of cancer

For breast cancer, the ICD-10 code is C50. This group includes a tumor that develops in the SAH zone (areola of the nipple), in the central part of the gland and in its various quadrants. Including how C50.8 encodes a lesion that goes beyond the specified limits.

Cancer is understood as an exclusively malignant neoplasm that affects the glandular tissue of the breast. According to WHO, this is the most common form of "female" cancer, affecting girls from 13 years of age and developing in adult women up to 90 years of age.

Causes of the disease

Oncological processes in the breast in women are quite common, especially after 40 years or at the time of menopause.

• Etiological factors
• Variety of localization

Worldwide, breast cancer in ICD 10 has the code C50, excluding cancer on the skin of the breast, which refers to skin diseases of the oncological plan (C43.5-C44.5).

The International Classification of Diseases 10 readings is a regulatory document in the diagnosis, treatment and methods of preventing the development of oncological pathology. Statistical data make it possible to analyze regional morbidity, to analyze the implementation of clinical treatment protocols.

Etiological factors

A malignant neoplasm in the mammary gland is usually preceded by a number of predisposing aspects and situations.

So most likely breast cancer will manifest itself in a woman who has the following factors:

• advanced age;
• burdened oncological anamnesis;
• injury;
• propensity to mastopathy;
• smoking;
• alcohol abuse;
• overweight;
• radioactive impact;
• early onset of menstruation;
• late birth.

A neoplasm in the mammary gland, like prostate cancer, has a benign initial form of development of the pathological process. These diseases affect women and men in equal percentages.

Symptoms at an early stage are very meager, having no differences from ordinary inflammation, therefore, it is very problematic to detect stage 1-2 cancer.

Variety of localization

In ICD 10, breast cancer is coded as C50. The number after the dot determines the specific location of the oncology, for example, C50.0 determines the presence of a neoplasm within the nipple and halo, and C50.2 deciphers the location of the tumor in the upper inner quadrant of the gland. In total, 10 official varieties of the possible location of the cancer process have been registered.

Approaches to the classification and treatment of fibrocystic mastopathy

Mastopathy code according to (ICD 10 N60) is a serious pathology that requires qualified treatment.

Fibrocystic mastopathy of the breast (ICD code 10 N60.1) and similar diseases were coded by the International Systematization of Diseases of the tenth revision. This classification is used by experts all over the world. Thanks to her, a unified official statistics is maintained, which also includes cases ending in death.

Titles

Breast cancer in men.

Description

Breast cancer in men accounts for approximately 1% of all breast cancers in women. That is, this disease in men is 100 times less common than in women.

Titles

Russian name: Gemcitabine.
English name: Gemcitabine.

Latin name

Gemcitabinum (Gemcitabini).

chemical name

2-Deoxy-2,2-difluorocytidine (as hydrochloride).

Pharm Group

Antimetabolites.

Pharmacodynamics

Antimetabolites.

Pharmacological action - antitumor. Pharmacodynamics.

An antitumor agent, an antimetabolite of the pyrimidine analog group, inhibits DNA synthesis. It exhibits cycle specificity, acting on cells in the S and G1/S phases.

Oncological processes in the breast in women are quite common, especially after 40 years or at the time of menopause.

Worldwide, breast cancer in ICD 10 has the code C50, excluding cancer on the skin of the breast, which refers to skin diseases of the oncological plan (C43.5-C44.5).

The International Classification of Diseases 10 readings is a regulatory document in the diagnosis, treatment and methods of preventing the development of oncological pathology. Statistical data make it possible to analyze regional morbidity, to analyze the implementation of clinical treatment protocols.

Etiological factors

A malignant neoplasm in the mammary gland is usually preceded by a number of predisposing aspects and situations.

So most likely breast cancer will manifest itself in a woman who has the following factors:

• advanced age;
• burdened oncological anamnesis;
• injury;
• propensity to mastopathy;
• smoking;
• alcohol abuse;
• overweight;
• radioactive impact;
• early onset of menstruation;
• late birth.

A neoplasm in the mammary gland, like prostate cancer, has a benign initial form of development of the pathological process. These diseases affect women and men in equal percentages.

Symptoms at an early stage are very meager, having no differences from ordinary inflammation, therefore, it is very problematic to detect stage 1-2 cancer.

Variety of localization

In ICD 10 breast cancer coded as C50. The number after the dot determines the specific location of the oncology, for example, C50.0 determines the presence of a neoplasm within the nipple and halo, and C50.2 deciphers the location of the tumor in the upper inner quadrant of the gland. In total, 10 official varieties of the possible location of the cancer process have been registered.

ICD-10 CODE
C50 Malignant disease of the breast.
C50.0 Nipple and areola.
C50.1 Central part of the mammary gland.
C50.2 Upper inner quadrant.
C50.3 Lower inner quadrant.
C50.4 Upper outer quadrant.
C50.5 Infero-outer quadrant.
C50.6 Axillary region.
C50.8 Spread over more than one of the above areas.
C50.9 Location, unspecified.
D05.0 Lobular carcinoma in situ
D05.1 Intraductal carcinoma in situ

EPIDEMIOLOGY

Breast cancer is the most common cancer in women. The incidence of breast cancer is steadily growing and at least 1 million new cases are detected annually in the world. In the United States, one in eight women will develop breast cancer during their lifetime. The predicted increase in the number of cases by 2010 is 1.5 million. The incidence of breast cancer in the countries of the European Union is 95-105, and the death rate is 30-40 cases per 100 thousand women per year. In the general structure of the incidence of the female population, neoplasms of the mammary glands account for 30%.

In 2002, 45,857 patients with breast cancer were diagnosed in Russia, accounting for 19.3% of the total incidence of malignant neoplasms in women. The maximum incidence rates were registered in Moscow - 49.4 and in St. Petersburg - 48.6 per 100 thousand of the female population. In 2002, 22.1 thousand women in Russia died of breast cancer. Mortality from breast cancer in 2002 was 16.7%. It is the third leading cause of death in the female population after diseases of the circulatory system and accidents.
cases.

BREAST CANCER PREVENTION

Prevention of breast cancer has not been developed. The protective effect of childbirth is known - the risk of developing breast cancer is 2-3 times higher in women who gave birth for the first time over the age of 30 compared to women who gave birth before the age of 20. In some cases, bilateral mastectomy and oophorectomy are performed for genetically proven hereditary breast cancer, which reduces the risk of breast cancer in carriers of BRCA I and II mutations by 89.5–95%.

SCREENING

Screening is the first qualifying stage of a preventive examination of a practically healthy population in order to identify individuals with a latent disease. The main screening methods are mammography, breast examination by a doctor and self-examination. About 90% of breast tumors are self-diagnosed by women.

At the same time, in at least half of them, the process is initially inoperable. Mammography is the leading screening method for breast cancer in women over 40 years of age, since the specificity of the method is at least 95%. Screening is especially important in Russia, where up to 40% of primary breast cancer patients are diagnosed with stage III–IV of the disease. In developed countries, mammography screening reduces breast cancer mortality by 20%. The frequency of mammography after 40 years is once every 2 years, after 50 - once a year.

CLASSIFICATION

Histological forms of breast cancer:

• non-infiltrating tumors:
  ♦intraductal cancer;
  ♦lobular cancer;
• infiltrative cancer:
  ♦infiltrative ductal carcinoma;
  ♦infiltrative lobular cancer;
• rare histological forms:
  ♦mucous;
  ♦ medullary;
  ♦papillary;
  ♦tubular;
  ♦adenocystic;
  ♦secretory;
  ♦apocrine;
  ♦ cancer with metaplasia;
  ♦others.
• Paget's cancer (nipple).

About 85–90% of invasive carcinomas originate from the ductal epithelium.

International Clinical Classification of TNM (2002)

primary tumor:

• Tis - cancer in situ;
• T1 - tumor size up to 2.0 cm;
• T1mic - tumor size up to 0.1 cm.
• T1a - tumor size up to 0.5 cm;
• T1b - tumor size up to 1.0 cm;
• T1c - tumor size from 1.0 to 2.0 cm;
• T2 - tumor size from 2.0 to 5.0 cm;
• T3 - tumor size more than 5.0 cm;
• T4 - spread of the tumor to the chest wall, skin;
• T4a - spread of the tumor to the chest wall;
• T4b - skin edema, ulceration, satellites in the skin;
• T4c - features 4a, 4b;
• T4d - "inflammatory" carcinoma.

Damage to regional lymph nodes:

• Nx - insufficient data to assess the state of regional lymph nodes.
• N0 - no signs of damage to the lymph nodes.
• N1 - displaced axillary lymph nodes on the side of the lesion.
• N2a - axillary lymph nodes fixed with each other.
• N2b - clinically detectable metastases in the parasternal lymph nodes in the absence of clinically
  defined metastases in the axillary lymph nodes.
• N3a - metastases in the subclavian lymph nodes with or without metastases in the axillary lymph nodes.
• N3b - Metastases in the parasternal lymph nodes in the presence of metastases in the axillary lymph nodes
  nodes.
• N3c - metastases in the supraclavicular lymph nodes on the side of the lesion with or without metastases in the axillary or parasternal lymph nodes.

Distant metastases:

• M0 - no clinically detectable distant metastases;
• M1 - clinically detectable distant metastases.

• stage 0: TisN0M0;
• stage I: T1N0M0;
• stage IIA: T1–2N0M0;
• stage IIB: T2N1M0, T3N0M0;
• stage IIIA: T0–2N2M0, T3N1–2M0;
• stage IIIB: T4N0–2M0;
• stage IIIC: T1–4N3M0;
• stage IV: presence of M1.

ETIOLOGY (CAUSES) OF BREAST CANCER

The etiology of the disease is not known, a specific etiological factor has not been identified. The role of lifestyle and environmental factors in the development of breast cancer is noted. However, only 30–50% of breast cancers can be explained by known risk factors.

The following groups are distinguished according to the degree of risk of developing breast cancer:

• low risk (risk is 1–2 times higher than in the population):
  ♦ the use of COCs at an early age, especially before the first birth;
  ♦HRT increases the risk of breast cancer by 35%;
  ♦ a diet rich in fats, especially saturated fats, since in this case the level of free estradiol in the blood plasma is higher;
  ♦ interruption of the first pregnancy;
• medium risk (risk is 2–3 times higher than in the population):
  ♦ early menerche;
  ♦ late menopause;
  ♦first birth after 30 years;
  ♦infertility;
  ♦ a history of ovarian, endometrial or colon cancer;
  ♦alcohol use;
  ♦an increase in the risk of breast cancer occurs when the value of the body mass index is above 30 kg/m2;
  ♦proliferative diseases of the mammary glands;
  ♦obesity in postmenopause;
• high risk (risk higher than in the population by 4 or more times):
  ♦ over 50 years of age;
  ♦ burdened family history of the development of breast cancer in relatives of the 1st line;
  ♦ breast cancer according to history;
  ♦exposure to ionizing radiation according to anamnesis;
  ♦ proliferative diseases of the mammary glands with atypia of the epithelium;
  ♦ mutations in the BRCA1, BRCA2 genes.

The criteria for establishing a genetic diagnosis of hereditary breast cancer are the presence in the family of one or more relatives of the 1st or 2nd degree of kinship suffering from breast cancer, the early age of the manifestation of the disease, bilateral lesions of the mammary glands, the primary multiplicity of neoplasms in the proband (and (or) his relatives). ), specific tumor associations. To date, at least 4 genes have been identified that are responsible for predisposition to breast cancer (p53, BRCA1, BRCA2, PTEN). Among them are p53 and PTEN
are responsible for the development of a specific individual and family predisposition to Li-Fraumeni and Cowden syndromes. Studies have shown that mutations in BRCA1 and BRCA2 (breast cancer associated) are responsible for 40–70% of cases of hereditary breast cancer. At the same time, it was found that in carriers of these gene mutations, the risk of primary breast cancer reaches 80%, and the risk of developing second breast cancer is 50–60% (in the general population, 2 and 4.8%, respectively). The peak incidence of breast cancer in BRCA1 carriers corresponds to the age of 35–39 years, in BRCA2 carriers - to the age of 43–54 years.

The prognosis in BRCA2 mutation carriers is more favorable than in BRCA1 mutation carriers and in sporadic breast cancer.

In carriers of BRCA1 and BRCA2 mutations, early birth is not protective. Carriers of mutations of these genes who have given birth are much more likely (by 1.71 times) to develop breast cancer before the age of 40 than those who have not given birth. Each subsequent pregnancy increases this probability.

Therapeutic tactics in carriers of mutations of these genes should be reconsidered. For these patients, you should:

• recommend prophylactic mastectomy;
• refuse organ-preserving operations;
• recommend prophylactic removal of the other breast;
• expand indications for chemotherapy;
• recommend prophylactic oophorectomy (for BRCA1 mutation).

At the moment, general information about breast cancer is presented by the postulates of B. Fisher:

• tumor dissemination is chaotic (there is no mandatory order of dispersion of tumor cells);
• tumor cells enter the regional lymph nodes by embolization and this barrier is not effective;
• the spread of tumor cells in the bloodstream is essential for tumor dissemination;
• operable breast cancer is a systemic disease;
• it is unlikely that surgical options significantly affect survival;
• 75% of patients with lesions of regional lymph nodes and 25% of patients with unaffected lymph nodes die from distant metastases after 10 years;
• the need for additional, systemic therapeutic interventions in breast cancer is obvious.

To date, when choosing tactics for the treatment of breast cancer, the following biological prognostic factors are taken into account:

• the size of the tumor node;
• the presence of metastases in regional lymph nodes;
• degree of malignancy according to histological examination;
• tumor receptor status (ER, PR): the presence of ER and (or) PR in tumor cells can be considered as a biochemical sign of a high degree of differentiation. The individual sensitivity of breast cancer cells to hormone therapy, and hence the effectiveness of the latter, largely depends on the expression of ER and PR on the cell membrane. The content of ER and PR in different age groups (pre and postmenopausal) is different: in 45% of premenopausal patients and 63% of postmenopausal patients, tumor cells contain ER and PR. The role of all known methods of hormone therapy is ultimately reduced to a decrease in the effect of estrogens on tumor cells, which in the case of hormone-dependent breast cancer leads to a slowdown in the growth of the neoplasm;
• indicators of the activity of the synthesis of deoxyribonucleic acid (DNA) - the amount of DNA of aneuploid tumors; the proportion of cells in the S phase of the cell cycle; overexpression of Ki67, ploidy, thymidine kinase activity, etc.: Ki67 is a tumor marker that characterizes the proliferative activity of a tumor. This nuclear Ag is expressed in all phases of the cell cycle (G1, S, G2, M) except for G0, which makes it a marker of cell population growth;
• receptors for growth factors or regulators (epidermal growth factor receptors - EGFR; HER2/neu): HER2/neu is a transmembrane glycoprotein (a product of the cerbB2/neu gene), which is a tyrosine kinase receptor. Stimulation of this receptor leads to the launch of transcriptional mechanisms, which accelerates cell proliferation and growth. On the example of experimental models, it was shown that Her2/neu can cause tumor resistance to chemotherapy and endocrine therapy. VEGF, vascular endothelial growth factor, induces proliferation and migration of endothelial cells while inhibiting their apoptosis (tumor progression and metastasis are considered to be angiogenesis-dependent processes). Thymidine phosphorylase is identical in structure and function to platelet-derived endothelial growth factor (PDECGF) and is an enzyme that catalyzes the reverse dephosphorylation of thymidine to thymine and 2deoxyribose1phosphate. Hyperexpression of thymidine phosphorylase accelerates tumor growth and also provides cells with resistance to apoptosis induced by hypopsia;
• oncogenes BRCA1, BRCA2.
  New biological factors are being studied: Bcl2, p53, PTEN, CDH1, MS H2, ML H1, ALCAM/CD166.
  The Bcl2 protein family is quite heterogeneous. Some of its representatives (Bcl2, BclXI) inhibit apoptosis (cell death) by inhibiting the release of cytochrome C and apoptosis-inducing factor from mitochondria (regulated by p53), while others (Bax, Bad), on the contrary, are considered apoptosis activators. p53 is a nuclear protein that, when DNA is damaged, triggers the apoptosis mechanism, which makes it possible to avoid the reproduction of cells with a modified genetic apparatus. Normal p53 is rapidly degraded and its presence in the nucleus is practically
  indefinable. The appearance of mutant p53 blocks apoptosis, which predetermines the resistance of the cell to chemotherapy and radiotherapy.

PATHOGENESIS

The stages of development of neoplasms are not fully understood. The process of carcinogenesis includes the stage of initiation, promotion and progression. The process of carcinogenesis is initiated by the mutation of proto-oncogenes that turn into oncogenes and stimulate cell growth (increasing the production of mutagenic growth factors or affecting surface cell receptors - for example, HER2 / neu).

After cell damage, estrogens stimulate the damaged cell to replicate before the damage is repaired. The presence of estrogens is a mandatory factor in the development of breast cancer, providing a stage of promotion. Distant metastases occur long before the clinical manifestation of the tumor process - during the first 20 doublings, with the onset of angiogenesis in the tumor.

CLINICAL PICTURE / SYMPTOMS OF BREAST CANCER

The clinical picture is quite diverse and depends on the prevalence of the process: from its complete absence (with non-palpable tumors) to the classic picture of breast cancer (see Physical examination).

DIAGNOSTICS OF BREAST CANCER

ANAMNESIS

When collecting an anamnesis, it is necessary to pay attention to the timing of the onset of the first symptoms of the disease, the sequence of development of the tumor process (the dynamics of tumor growth, changes in the skin, nipple and areola, the appearance of enlarged lymph nodes in the armpit, discharge from the nipple); whether operations were performed on the mammary glands, their injuries; whether the treatment of diseases of the lungs, skeletal system, liver was carried out in the last 6–8 months (typical localization of distant metastases in breast cancer).

PHYSICAL EXAMINATION

Inspection and palpation play an important role in the diagnosis of breast cancer (Fig. 30-3). Attention should be paid to the violation of the shape of the mammary glands (deformity), the condition of the nipple and areola (retraction, ulceration), the condition of the skin (hyperemia, edema, the presence of intradermal metastases). Of the skin symptoms, the symptom of “lemon peel” (lymphatic edema of the papillary dermis), the symptom of “platform” (rigidity of the skin over the tumor), the symptom of “umbilization” (skin retraction due to infiltration of Cooper's ligaments) are most often observed.

Rice. 30-3. Clinical picture of infiltrative-ulcerative form of breast cancer.

Palpation (recommended in the first phase of the menstrual cycle) allows not only to establish the diagnosis of breast cancer, but also to determine the size of the primary tumor and the condition of the regional lymph nodes, which gives an idea of ​​the stage of the disease.

In the later stages of the disease, when infiltration of the breast tissue and skin edema are observed, the germination of the skin of the breast by a tumor, examination is considered almost the most reliable diagnostic method. When the tumor is localized in the region of the transitional fold, the seal is often inaccessible for x-ray examination, in such cases, examination and palpation play a significant role in the diagnosis of this disease. Examination of patients and palpation of the mammary glands in women of reproductive age is best done in the first phase of the menstrual cycle (5-10 days).

However, inspection and palpation are obviously not effective in diagnosing non-palpable tumors (less than 1.0 cm in diameter), and also do not fully provide information about the state of regional lymph nodes.

LABORATORY RESEARCH

The study of tumor markers CA 153 (Carbohydrate antigen), cancer embryonic Ag, tissue polypeptide Ag - oncofetal polypeptide and some others should be used for dynamic monitoring. The use of this method is recommended.

INSTRUMENTAL STUDIES

The main diagnostic method, the value of which becomes higher with increasing age of patients, is mammography (Fig. 30-4). The sensitivity of mammography is up to 95%. On mammograms, it is possible to more accurately assess the size of the tumor node and, in some cases, axillary lymph nodes, to identify non-palpable malignant tumors of the breast.

Rice. 30-4. Breast cancer with metastases to the axillary lymph nodes.

With intraductal neoplasms of the mammary gland, ductography is considered an indispensable method for their diagnosis, with the help of which it is possible to assess not only the size of the tumor in the duct, but also at what distance from the nipple it is located. Pneumocystography allows you to visualize the internal structure of the cavity formation.

Ultrasound is considered to be no less informative, not competing with mammography, for diagnosing diseases of the mammary glands (Fig. 30-5). This method allows you to more clearly determine the size of the primary tumor, contours, structure, the presence of an intensive blood supply to the tumor and, most importantly, the state of the regional lymph nodes, which, along with the above data, allows you to establish a more accurate diagnosis.

Rice. 30-5. Cancer in the cyst.

MRI and X-ray CT are used much less often in the diagnosis of breast cancer due to the high cost of research and lower specificity and accuracy.

The morphological method is considered the final stage in the diagnosis of breast cancer. Before starting treatment, morphological confirmation of the diagnosis is necessary. As a rule, a puncture aspiration biopsy of the tumor is performed, followed by a study of the morphological and biological parameters of the cells. The sensitivity of the cytological diagnostic method reaches 98%.

Using all diagnostic techniques among 215,000 cases of breast cancer in the United States, 50,000 were diagnosed with cancer in situ.

Taking into account the systematic nature of the tumor process, it is mandatory to consider a comprehensive examination of patients, including the study of the lungs, liver, skeletal system, etc.

DIFFERENTIAL DIAGNOSIS

Nodular forms of breast cancer must be differentiated primarily with nodular mastopathy, Paget's cancer - with adenoma of the nipple, edematous-infiltrative forms of breast cancer - with mastitis, erysipelas.

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

When planning treatment approaches, it is advisable to discuss them at a consultation of specialists consisting of a surgeon, a chemotherapist and a radiation therapist. At the initial examination of the patient, a consultation with a gynecologist is mandatory (to exclude metastases of breast cancer in the ovaries, to perform oophorectomy in complex treatment).

EXAMPLE FORMULATION OF THE DIAGNOSIS

When formulating a diagnosis, it is necessary to take into account the side of the lesion, the quadrant of the mammary gland, the growth form of the tumor process (nodular, diffuse), the size of the tumor node, the condition of the surrounding tissues and skin, the condition of the regional lymph nodes, the presence of clinically detectable distant metastases. Example: T2N1M0 (IIB st.)
- tumor node up to 5.0 cm in diameter, there are single metastases (no more than 3) in the armpit,
no distant metastases.

BREAST CANCER TREATMENT

GOALS OF TREATMENT

Comprehensive treatment of breast cancer includes a combination of various therapeutic approaches: locoregional treatment - surgical and radiation therapy, systemic - chemotherapy and hormonal therapy, which makes it possible to cure the patient or, in some cases, achieve a stable and long-term remission of NCII

Nodular formation in the mammary gland or any of the above symptoms, which do not allow to exclude breast cancer, are an absolute indication for hospitalization.

NON-DRUG TREATMENT

Radiation therapy as an independent method of treatment is rarely used. As a rule, radiation therapy is a stage of complex treatment of breast cancer in terms of adjuvant or neoadjuvant treatment. As an adjuvant treatment, radiotherapy is used after various types of conservative surgery with or without drug therapy, or after radical mastectomy with poor prognostic factors. Be sure to conduct a course of radiation therapy on the parasternal region with internal localization of the tumor. Irradiation of regional zones of the lymphatic outflow is carried out with pronounced lymphogenous metastasis (damage to 4 or more lymph nodes). The timing of the start of radiation therapy can vary: immediately after surgery followed by drug therapy; simultaneously and after drug therapy, but not later than 6 months after surgery.

Conservative treatment of breast cancer is based on radiation therapy and may be supplemented with hormonal and/or chemotherapy. Conservative treatment of breast cancer cannot be considered an alternative to complex treatment with the inclusion of surgical treatment, since 5 and 10-year overall and recurrence-free survival are significantly
higher when using complex treatment. However, in the elderly and with severe comorbidity, when the risk of surgery may be unreasonably high, this approach to treatment is acceptable.

Modern approaches to treatment should be comprehensive, taking into account the nature and spread of the pathological process. All treatments complement each other. The choice of treatment methods should always be individual and take into account not only the prevalence of the process and the biological characteristics of the tumor, but also the age and comorbidities of the patients.

MEDICAL TREATMENT

Chemotherapy, as an option for systemic treatment of breast cancer, is considered an integral step in most treatment programs. Chemotherapy is due not only to the stage of the disease, but also to unfavorable prognostic factors:

• metastases in the lymph nodes;
• tumor more than 2.0 cm in diameter;
• young age of the patient (less than 35 years);
• grades II–IV of malignancy of the tumor;
• tumor receptor negativity;
• overexpression of HER2/neu.

The choice of chemotherapy is very wide. For patients with a high risk of progression, it is reasonable to use the following chemotherapy regimens: CMF (cyclophosphamide, methotrexate, 5fluorouracil ©), AC (adriamycin ©, cyclophosphamide ©), FAC (5fluorouracil ©, adriamycin ©, cyclophosphamide ©) or a combination of anthracyclines with taxanes (AT) . Chemotherapy in such cases significantly increases the survival rates of patients. It has been proven that preoperative chemotherapy for resectable breast cancer does not improve treatment outcomes compared with adjuvant chemotherapy. However, preoperative chemotherapy at the same time makes it possible to reduce the size of the primary tumor node and perform an organ-preserving operation, including in the case of a locally advanced process.

The use of drugs such as trastuzumab and bevacizumab in combination with chemotherapy significantly increases the effectiveness of treatment.

Hormone therapy as an independent method of treatment is used less often, although in elderly people with receptor-positive tumors it can achieve long-term remission. Hormone therapy is very effective in the combined and complex treatment of patients of any age group with tumors containing steroid hormone receptors. In breast cancer, there are 2 directions of hormone therapy:

• hormone therapy, in which drugs are used that compete with estrogens for control of the tumor cell;
• hormone therapy aimed at reducing the production of estrogen.

According to the mechanism of action, antiestrogenic drugs belong to the first group of drugs. In systemic adjuvant treatment of breast cancer from antiestrogen drugs, tamoxifen is considered the drug of choice. Tamoxifen competes with estrogens for receptors in cells, and also reduces the number of cells in the S phase and increases their number in
G1 phase. The second group of drugs includes aromatase inhibitors, the key mechanism of action of which is to reduce the level of endogenous estrogen due to direct inhibition of the enzymes responsible for the synthesis of estrogens. Anastrozole and letrozole are considered the most specific of this group of drugs. These drugs inhibit the conversion
androstenedione to estrone and testosterone to estradiol. Antiestrogen drugs and aromatase inhibitors are comparable in their effectiveness and can be prescribed as first-line hormone therapy for breast cancer.

SURGERY

For breast cancer, the following surgical options are possible:

• radical mastectomy (standard intervention) with preservation of the pectoral muscles with a possible subsequent primary mammoplasty;
• areola-preserving mastectomy with possible subsequent primary mammoplasty;
• organ-preserving operations followed by radiation therapy;
• tumorectomy in combination with radiation and drug therapy (for intraductal carcinoma in situ (DCIS). In this case, the "sentinel" lymph node (SLN) must be examined).

Perhaps intraoperative irradiation of the tumor bed at a dose of 20 Gy.

Over the past decades, it has been convincingly proven in practice that an increase in the volume of surgical intervention does not lead to an increase in the survival rates of patients.

Radical mastectomy with preservation of the pectoral muscles is performed in patients with locally advanced forms of breast cancer (after preoperative treatment) or in the central location of the tumor in the early stages of the disease. While preserving the pectoral muscles, the axillary, intermuscular, subclavian and subscapular tissue are removed in a single block. Low invasiveness of surgical intervention reduces the risk of such complications as lymphostasis, venous insufficiency, neuralgia, radiating postoperative pain in the area
surgical intervention, etc. Simultaneous mammoplasty in patients undergoing radical mastectomy with preservation of the pectoral muscles significantly reduces psychological trauma. In stages I-IIA, in some cases and in stage III (after neoadjuvant treatment: chemotherapy, radiation therapy, their combination), it is possible to perform organ-preserving operations, which naturally affects the psychological status of women and quality of life (Fig. 30-6) .

Rice. 30-6. Cosmetic effect after organ-preserving surgery.

Tumorectomy followed by radiation and hormone therapy in elderly patients reduces the risk of surgery and does not significantly affect disease-free and overall survival.

Reconstructive plastic surgery for breast cancer in many clinics is considered a stage of complex treatment aimed at leveling the psycho-emotional and social discomfort of a woman. According to the timing of their implementation, they are distinguished:

• primary mammoplasty;
• delayed mammoplasty.

There are 2 main ways to restore the shape and volume of the breast:

• endoprosthesis;
• reconstructive surgery using autogenous tissues.

In patients with locally advanced inoperable tumors or a metastatic process for vital indications (bleeding or tumor decay), palliative surgical interventions are performed. In their implementation, it is necessary to strive to comply with the following principles:

• palliative surgery in a patient who does not have distant metastases or with remaining prospects for therapy, if possible, should be performed in accordance with the rules of radical surgery;
• it is possible that after adjuvant treatment, a patient with a locally advanced inoperable tumor will be radically cured, and a patient with a metastatic process will be given additional years of life.

APPROXIMATE TIMES OF INABILITY TO WORK

Depend on the volume of therapeutic effects: the volume of surgical intervention, the scheme and number of courses of polychemotherapy, radiation therapy. The minimum hospital stay for surgical treatment is 18–21 days. Carrying out other methods of treatment is permissible on an outpatient basis. The decision on disability is made by the attending physician, depending on the tolerance of the treatment by the patient. On average, disability is 4-6 months.

FURTHER MANAGEMENT

After the end of treatment, patients are subject to a comprehensive examination every 6 months during the first 2 years and annually thereafter.

INFORMATION FOR THE PATIENT

Patients should be informed about the nature, prevalence and prognosis of the disease, the prospects for treatment, and the timing and frequency of follow-up.

FORECAST

Despite advances in the treatment of breast cancer, the best results can be obtained in the early stages of the disease (5-year survival rates for stage I reach 95%). In this regard, the detection of this disease in the early stages is considered the most important favorable prognostic factor.

BIBLIOGRAPHY
Davydov M.I., Axel E.M. Malignant diseases in Russia and CIS countries. - M., 2004.
Garin A.M. The contribution of drug therapy to improving the overall survival of cancer patients: Proceedings of the IX Russian Cancer Congress. - M., 2005.
Letyagin V.P. Strategy for the treatment of patients with early breast cancer (According to the European School of Oncology, Moscow, 2005) // Mammology. - 2006. - No. 1. - S. 86–87.
Mouridsen H., PerezCarrion R., Becquart D. et al. Letrozole (Femara) versus tamoxifen: preliminary data of a firstline clinical trial in postmenopausal women with locally advanced or metastatic breast cancerer // Eur. J. Cancer. - 2000. - Vol. 36.
Venturini M., Del Mastro L., Aitini E., et al. Djsedense adjuvant chemotherapy in early breast cancer patients: results from a randomized trial // J. Natl Cancer Inst. - 2005. - Vol. 97. - R. 1712–1714.
Veronesi U. Changing therapeutics in breast cancer the breast primary therapy of early breast cancer. IX International Conference. - 2005.

ICD 10, or the 10th Revision International Classification of Diseases, was coined as a shorthand for diseases of any type. In order not to constantly write long names of diagnoses, you should use a short coding.

breast carcinoma

Breast cancer (BC) has a designation or code according to ICD 10 - C50.

Also in breast oncology there are subgroups that define the area in which a malignant tumor is identified and diagnosed. Subgroups are denoted by an additional degree after the dot:

• C50.0 Breast areola and nipples.
• C50.1 - Central localization.
• C50.2 Upper quadrant inside.
• C50.3 - Lower part inside.
• C50.4 - Upper zone outside.
• C50.5 - Lower zone outside.
• C50.8 - The neoplasm is not within the zones C50.2-C50.6.
• C50.9 - Zone not defined.

Description

A malignant tumor of the mammary gland is a neoplasm that develops from the cells of this organ as a result of a mutation. According to statistics in women, this disease is in the first place. Cancer is hormone-dependent, which is why a certain type of treatment is selected.

Symptoms, signs and abnormalities

• Menstrual disorders.
• Subfebrile temperature.
• Seals in the chest in the form of nodules.
• When pressed on the lumps, they hurt.
• The nipples become red and may retract.
• Pits, redness, dry crust at the site of the neoplasm.
• Visual deformation of the chest bag. It may become larger or have an irregular shape.
• The lymph nodes in the armpits are enlarged and hurt when pressed.
• Discharge of blood, pus, or foul-smelling mucus from the nipples.

For self-diagnosis, it is enough to pay attention to the morphological signs of the tumor by conducting a self-examination at home. To do this, you regularly need to feel the chest for the presence of nodules, lumps and other suspicious formations.

stages

• Stage 1 - the tumor is small and practically indistinguishable on x-rays and mammograms. There are no specific signs.
• Stage 2 - the neoplasm begins to go beyond the tissue area, but is still within the same zone.
• Stage 3 - The tumor begins to grow into neighboring tissues and may affect the lymph nodes.
• Stage 4 - there is a complete defeat of the nearest lymphatic system. Cancer can grow into neighboring organs and metastasize to distant ones through the lymphatic system or the circulatory system.

Influencing factors

• Ecology
• Use of alcohol and cigarettes.
• Misuse of contraceptives and other estrogenic drugs, without a doctor's prescription.
• Obesity and overweight.
• Wrong nutrition.
• Genetic predisposition to breast cancer. Maybe if the patient had a family of patients with this type of oncology.
• Work in the hazardous chemical industry.

Treatment

For treatment, they mainly use the complete removal of organs at 2 and subsequent stages. Also, as an additional therapy, they use: chemotherapy and radiotherapy. These types of treatment are used to reduce the chance of recurrence and to destroy the remnants of metastases after surgery. For hormone-dependent cancer, hormone therapy is used to reduce the sensitivity of the organ to the female hormone.