In last 20 years, breast cancer ranks first among all malignant neoplasms among women in Ukraine. During this time, there is a tendency not only to increase the incidence of breast cancer, but also to an increase in mortality from this pathology among female population. Today, breast cancer is an extremely relevant medical and social problem, because this disease is often diagnosed late and prognosis is unfavorable.
If you have been diagnosed with breast cancer or other oncological disease of this localization – do not give up in any case! Yes, the disease is difficult, but with timely diagnosis and correct modern approach to therapy, it is completely curable. The main thing is to find a qualified specialist who will help you overcome this disease and go through the entire struggle by your side.
Such doctors work in Oncology Department Maimonides Multidisciplinary Medical Center. Our clinic works in close and fruitful cooperation with the best Israeli oncology centers. We chose Israeli medicine as a model of providing medical services, because it is one of the best and most effective in the world. Each individual case of breast cancer is managed jointly by attending oncologist, the head of the department – Dr. Iryna Stefanska and responsible oncologist directly from Israel. Thanks to such coordinated work of a professional team, we manage to achieve success even in the most difficult cases.
Of course, oncological diseases treatment, especially of a malignant nature, is an expensive process, and many patients do not receive the full range of necessary medical care due to financial constraints. Therefore, our clinic works under the patronage of “Keren Or for our Child” the Charitable Foundation, which fully or partially pays the costs of medical services for seriously ill patients.
All our specialists are highly qualified and have extensive experience working in Oncology Department. Most of them have repeatedly completed internships at the best oncology centers in the world. Our medical departments uses only modern and safe medical and diagnostic equipment of expert class.
In their work, our oncologists are guided only by modern treatment protocols and global clinical recommendations, so you can be 100% sure of of medical care quality and its adequacy. At the same time, treatment advantage at Maimonides Center is an individual approach to each patient, because there are no two identical people and two identical tumors. Therefore, making up an examination plan or a treatment scheme, doctor does not use one template for everyone, he takes into account age, type of tumor, its histological and molecular genetic characteristics, patient's general condition, severe concomitant pathologies presence, woman's wishes regarding treatment process and other factors. This approach contributes to significantly better results of complex treatment and significantly improves prognosis.
A whole multidisciplinary team works in Maimonides Oncology Department. Oncologists, surgeons, mammologists, radiation therapists, chemotherapists, plastic surgeons, rehabilitators, psychologists and other specialized doctors provide assistance to a patient with breast cancer. If a certain narrow specialist or rare medical and diagnostic equipment is not available, patient is referred to subsidiary institutions of Maimonides Medical Center or our Israeli partner clinics, where he is guaranteed to receive the full range of necessary medical services, where he is guaranteed to receive the full range of necessary medical services.
Breast tumors causes and symptoms
There are several factors that can give impetus to breast cancer development:
- Age. The most significant risk factor for breast cancer development is age. The average age at the time of diagnosis is about 60 years.
- Family history . The most significant risk factor for breast cancer development is age. The average age at the time of diagnosis is about 60 years.. Relatives of the 1st consanguinity degree presence (mother, sister, daughter) with breast cancer increases the risk of cancer by 2-3 times. But cancer presence in distant relatives has little effect on risk of developing this disease. If more than 2 close relatives of the 1st line have breast cancer, disease risk can increase 5-6 times.
- Breast cancer gene mutations . Between 5 and 10% of women with breast cancer carry a mutation in one of two known breast cancer genes, BRCA1 or BRCA2. The risk of breast cancer developing by age 80 is about 72% with a BRCA1 mutation and about 69% with a BRCA2 mutation.
- Personal medical history . A history of preinvasive breast cancer increases of breast cancer risk. The risk of contralateral breast cancer developing after mastectomy is approximately 0.5–1% for each subsequent year of follow-up.
- Gynecological history . Early menarche, late menopause, late first pregnancy increase breast cancer risk. Women with their first pregnancy after age 30 have a higher risk than those who have never given birth.
- Pathological changes in mammary glands . Benign tumors associated with a small increased risk of invasive breast cancer include complex fibroadenoma, moderate to severe hyperplasia (without atypia), sclerosing adenosis, or intraductal papilloma.
- Lobular carcinoma in situ (LCIS) . LCIS presence increases the risk of invasive carcinoma developing approximately 7-12 times for each breast.
- Oral contraceptives application . Some studies have found a small increased risk in those who use them or have recently used them.
- Hormonal therapy . Postmenopausal hormone therapy (estrogen combined with progestin) appears to slightly increase the risk after only 3 years application.
- Radiotherapy . Radiation therapy under the age of 30 increases the risk of breast cancer.
- Dietary patterns may also contribute to breast cancer development, but conclusive data on different dietary patterns effect (for instance, high-fat) on the likelihood of cancer development are lacking. Obese women in postmenopausal period are a group of increased risk.
- Lifestyle factors . Smoking and drinking alcohol can contribute to a higher risk of breast cancer development.
You should consult a doctor if the following alarming symptoms are present:
- Neoplasm or compaction in mammary gland, which is noticeably different in density to touch from other mammary tissues.
- Volumetric neoplasm in mammary gland, which is fixed to skin or to chest wall.
- Long-term enlargement of one breast.
- Lemon peel effect (punctate indentations, wrinkling, redness, thickening or indentations in breast skin).
- A scaly rasharound the nipple.
- Change in breast shape.
- Nipple changes (for example, retraction).
- Unilateral discharge from nipple, especially bloody.
- Axillary or supraclavicular lymph nodes enlargement on one side.
Many cases of breast cancer are detected as volumetric neoplasms in breast tissue by a patient herself, or during a routine objective examination by a gynecologist, mammologist, or during ultrasound, mammography.
Some types of breast cancer are manifested by visible changes in skin:
- Paget's cancer (breast nipple cancer) presents with skin changes, including redness, crusting, scaling, and nipple discharge. Usually, these changes seem benign, so patients ignore them, delaying diagnosis for a year or more. About 50% of patients with Paget's disease have large breast tumors at examination time.
- Edematous-infiltrative breast cancer manifests as redness and breast enlargement, while a tumor-like malformation is often absent. Skin may change color or appear thickened, resembling an orange peel (lemon peel effect). A typical symptom is discharge from nipple.
Types of breast tumors
Most breast cancers are epithelial tumors that develop from cells that line ducts or lobules of mammary glands. Less common are non-epithelial cancer tumors of supporting stroma, for example, angiosarcoma, primary stromal sarcoma, phyllodes tumor, etc.
Cancer in situ (preinvasive cancer ) and invasive cancer are distinguished.
Preinvasive cancer is cancer cells proliferation in ducts or lobules of mammary glands without penetrating the stromal tissue. There are 2 types:
- Ductal carcinoma in situ (DCIS): About 85% of carcinomas in situ are of this type. DCIS carcinomas are usually detected only by mammography.
- Lobular carcinoma in situ (LCIS) : Often multifocal and bilateral. There are 2 types: classical and pleomorphic. Classic lobular neoplasia is not considered malignant, but increases the risk of both mammary glands invasive carcinoma developing. This lesion is not palpable, usually detected by biopsy, it is rarely visualized by mammography.
Invasive cancer is predominantly adenocarcinoma in nature. In approximately 80% of cases, it is infiltrative ductal cancer; in the rest of the cases – mainly lobular cancer.
Rare forms include medullary, mucinous, metaplastic, and tubular carcinomas. Mucinous breast cancer tends to develop in older women and is characterized by slow growth. Most of these rare types of breast cancer are associated with much better prognosis than other types of invasive breast cancer. However, prognosis for women with metaplastic breast cancer is significantly worse than for other types of ductal breast cancer.
Edematous-infiltrative breast cancer is a fast-growing, particularly aggressive type of cancer that often leads to death. Cancer cells block lymphatic vessels in mammary gland skin, causing mammary gland to become inflamed and skin to tighten, resembling an orange peel. Usually, edematous-infiltrative breast cancer metastasizes to axillary lymph nodes. However, in mammary gland, volumatric malformations by themselves can often not be felt.
Paget's disease of nipple is a form of ductal carcinoma in situ that spreads into skin over the nipple and areola, manifesting as a skin lesion (such as an eczematous or psoriatic lesion). Malignant cells in epidermis, called Paget's cells, are characteristic.
The most common types of breast cancer are:
- adenoid-cystic cancer,
- apocrine cancer,
- ductal carcinoma in situ,
- lobular carcinoma in situ,
- invasive ductal cancer,
- invasive lobular cancer,
- cystic hypersecretory carcinoma,
- colloid cancer (mucosal, sickle cell),
- cribrosis cancer,
- medullary cancer,
- metaplastic cancer,
- papillary cancer,
- carcinoma with osteoclast-like giant cells,
- cancer with signs of inflammation,
- cancer with signs of an endocrine neoplasm,
- secretory carcinoma (juvenile cancer),
- tubular carcinoma.
Diagnostic methods of breast tumors
The basic rule of diagnosis in oncology: the earlier diagnosis of malignant tumor is established, the better prognosis and treatment result. Therefore, high-quality and quick diagnosis is an extremely important stage. Maimonides Clinic uses only modern equipment of an expert class, all our doctors perfectly master all examination methods of a patient with mammary glands malignant neoplasms suspicion. They are able to interpret received data correctly, which helps them to create a modern, individual and effective treatment plan.
The first stage in diagnosis is a clinical examination of mammary glands. It is usually part of routine annual examination of all women over the age of 40.
Mammography is a mandatory method of medical imaging. This examination gives more accurate results in women over 50 years old. Because with age, fibro-glandular tissue of mammary glands tends to be replaced by fatty tissue, which is easier to distinguish from neoplasms pathological tissue. Mammography is less sensitive in women of childbearing age with dense breast tissue. Women with dense breast tissue may need additional methods of imaging diagnostics, for example, breast tomosynthesis, MRI.
Breast tomosynthesis application (3-dimensional mammography) with digital mammography slightly increases cancer detection frequency and reduces the speed of image visualization. This test is useful for women with dense breast tissue. However, test exposes women to almost twice radiation dose compared to traditional mammography.
MRI has a higher sensitivity, but may be a less specific examination.
Ultrasound is used in young women as a screening method, if a neoplasm is detected by ultrasound, a mammogram must be performed.
Biopsy is the main method of diagnosis verifying. As a rule, a percutaneous needle biopsy under palpation control or ultrasound is used. In our clinic, to improve manipulation accuracy, we use stereotaxic biopsy (puncture biopsy under mammography control, carried out in 2 planes and analyzed with the help of a computer to obtain a three-dimensional image) or biopsy under ultrasound control.
We send all biopsy specimens obtained after procedure to the world's best pathogistological laboratories (Israel, Germany, USA). Thanks to such double checks, we are absolutely sure of diagnosis correctness and selected treatment tactics effectiveness.
Innovative molecular genetic tests are also available to our patients after biopsy. This is a mandatory part of oncological diseases modern diagnosis. Thanks to molecular genetic diagnostics, we can choose the most effective treatment regimens, because the response to certain drugs action depends on the type of malignant changes. An example of such modern diagnostics are test systems for molecular genetic testing. Such as the Foundation One and Caris Molecular Testing. Biopsy specimens is also examined for estrogen and progesterone receptors presence and HER2 protein.
To determine the stage of the desease and tumor process spread, such modern diagnostic methods as MRI, CT of chest cavity, abdominal cavity, and pelvis are used. To scan the whole body in search of distant metastases, bone scintigraphy, PET-CT, PET-MRI are widely used.
Based on obtained data during examination, doctor makes an accurate diagnosis indicating the stage of malignant process and formulates a treatment scheme, according to patient’s individual characteristics and modern clinical recommendations. All necessary diagnostic procedures can be performed directly in clinic, without leaving Ukraine.
Fertility preservation
Breast cancer patients should not become pregnant during treatment. However, all patients who wish to preserve fertility are referred to a reproductive specialist to discuss fertility preservation before starting systemic therapy.
Fertility preservation options include:
Assisted reproductive technologies (ART) with ovarian stimulation and cryopreservation of eggs and embryos.
Cryopreservation of ovarian tissue.
In our department, every patient receives a consultation from a qualified reproductive specialist regarding possibilities of preserving reproductive function. All options, their advantages and disadvantages are discussed. The decision is made jointly by patient, her partner and reproductive doctor.
Modern treatment of breast tumors
One of the most important advantages of breast cancer treatment at Maimonides Medical Center is a comprehensive approach to each individual clinical case. In the fight against tumor, doctor uses the entire available arsenal of methods. Therapy is always a combination of two, three, or even more methods. Typically, treatment regimen includes tumor surgical removal in combination with chemotherapy, hormone therapy, and/or radiation therapy. In some cases, certain innovative treatment methods are added to treatment program (targeted drugs, immunobiological drugs, etc.).
Tumor surgical removal is the main treatment method of breast cancer. Methods of breast cancer surgical treatment include various variants of lumpectomy and mastectomy.
Mastectomy is mammary gland complete removal and includes the following types:
- Skin-sparing mastectomy: preserves pectoral muscles and enough skin to close the wound, which facilitates breast reconstruction and preserves axillary lymph nodes.
- Nipple-sparing mastectomy : Same as skin-sparing mastectomy plus nipple and areola-sparing.
- Simple mastectomy : preserves pectoral muscles and axillary lymph nodes.
- Modified radical mastectomy : preserves pectoral muscles and removes some axillary lymph nodes.
- Radical mastectomy: removal of axillary lymph nodes and pectoral muscles.
Radical mastectomy is performed rarely, if there was no tumor invasion of pectoral muscles.
Breast-conserving surgery includes different terms, for example, lumpectomy, wide excision, quadrantectomy. They are used to describe how much breast tissue is removed.
The main advantages of organ-sparing surgery are less extensive surgical intervention and possibility of mammary gland preserving. Importantly! Necessity to completely tumor removal within healthy tissue should outweigh any cosmetic considerations.
All patients after mastectomy are recommended to consult a plastic surgeon regarding reconstructive surgery.
Reconstructive procedures include:
- Reconstruction with a prosthesis : silicone or saline implant installation.
- Autologous reconstruction : transfer of a muscle flap graft (the broadest back muscle, buttock musle, or straight abdominal muscles) or muscle-free flap transfer.
Breast reconstruction can be performed during initial mastectomy or organ-sparing surgery or later as a separate surgical procedure. Surgery terms depends on patient's choice, as well as adjuvant therapy necessity (chemotherapy, radiation).
Breast reconstructive plastic surgery benefits include improved mental health in mastectomy patients.
Hormonal therapy for breast cancer is indicated estrogen receptors presence on neoplasm cells, which contribute to neoplasm’s growth. Drugs actively block estrogen receptors. Groups of drugs that suppress aromatase synthesis are also used, an enzyme involved in estrogen production, and suppress ovary work, which produce female sex hormones.
Radiation therapy after radical surgery significantly reduces local recurrence incidence in breast and regional lymph nodes and can improve overall survival.
Radiation therapy is indicated after mastectomy if any of following factors are present:
- Primary tumor larger than 5 cm.
- Affected axillary lymph nodes.
- The edges of removed tissues contain cancer cells.
In such cases, radiation therapy after mastectomy significantly reduces the rate of local recurrence in chest wall and regional lymph nodes and improves overall survival.
To reduce radiation therapy side effects, radiation oncologists of our clinic use modern types of radiation therapy, in particular radiation treatment with adjustable radiation intensity (IMRT). This method of cancer treatment involves point impact on neoplasms and healthy organs and tissues preservation. Radiation duration and volume with IMRT method is significantly less than with standard radiotherapy.
Chemotherapy in our clinic, following the example of the best oncology centers in Israel, is prescribed only in case of proven effectiveness. This is due to the fact that studies conducted in recent decades have shown that in more than 70% of patients such therapy is useless. In order to determine chemotherapy effectiveness, Oncotype DX testis performed. In case of ineffective application of traditional chemo drugs, safer and gentler biological methods of treatment are resorted to.
Targeted therapy – breast cancer treatment is performed using drugs that act exclusively on malignant cells. Thus, drugs based on monoclonal antibodies to HER2 protein detected on oncogenic cells surface demonstrated high efficiency.
In each individual case, the decision on certain treatment methods combination is made jointly by a team of specialists. Every woman and her disease is different, so our doctors, based on their experience in breast cancer treatment, often go beyond the standard protocols, changing treatment regimens and doses of necessary drugs, radiation method in order to get the best possible results for their patients.