Treatment of breast cancer includes the following sections:
Surgical treatment of
Reconstructive and Plastic Surgery
The basis of breast cancer treatment is surgery, but the combination therapy used in conjunction with radiation therapy, and medication (hormonal therapy and chemotherapy).
The choice of method or methods of treatment depends on:
age of the patient;
characteristics of the primary tumor (location, size, presence of metastases in the axillary lymph nodes);
histological structure of the tumor;
Delegation of hormone receptors in the tumor
expression level of epidermal growth factor receptor;
presence of concomitant diseases.
In stage IA (T1N0M0) is usually performed resection of the breast or the actual removal of the tumor with partial or complete removal of axillary lymph nodes. In the future, radiation therapy is carried out for the remainder of the breast and lymph nodes. In patients at high risk of local recurrence and metastasis of the courses of chemotherapy.
In stage IIA is usually carried out by radical mastectomy, or mastectomy for Madden Drink-Daysenu. Sometimes it is possible sparing surgery with removal of lymph nodes and postoperative radiotherapy on the breast. In the postoperative period is held immunoprophylaxis.
In stage IIB (T2N0M0) in addition to radical mastectomy and chemotherapy, radiation therapy is used by the scheme CMF (6 cycles every 3 weeks). Radiation therapy may also in addition to postoperative preoperative irradiation.
In stage III and IV is carried out long-term preoperative radiotherapy to the breast area, and regional metastasis, as well as chemotherapy and hormone therapy. With the positive results of prior treatment (tumor shrinkage of 50% or more) performed radical mastectomy with possible preservation of the pectoralis major muscle.
If there is no possibility of surgical intervention continues radiotherapy and chemotherapy on special schemes.
After a radical mastectomy for stage III-IV is necessary to conduct post-operative radiotherapy to the chest wall and supraclavicular region.
Hormone therapy is a component of comprehensive treatment, which takes place primarily in the common forms of breast cancer. The indication for the use of hormone therapy is currently the presence of high content of estrogen and progesterone receptors in tumor tissue.
To reduce the level of estrogen to stimulate growth of breast cells, used two-way Ovariectomy or castration of radiation or the drug Zoladex, which is similar to the therapeutic effect of ovariectomy. The introduction of anti-estrogens was to displace the other hormones, as gives good results. For example, tamoxifen (nolvadens, zitazonium) which is used for a long time. It blocks estrogen receptors at the level of the tumor. Antiestrogens can be used in menopause, or after the suppression of ovarian function.
In women with preserved menstrual function demonstrates the use of androgens and their analogues, glucocorticoids, progestins, antniestrogenov, aromatase inhibitors, irradiation of the pituitary gland, as well as the use of agonists of hypothalamic releasing factor.
Aromatase inhibitors, such as aminoglyutatimid (orimeten, mammon) inhibit the function of the adrenal cortex and, thus, reduce the level of steroid hormones. They are usually combined with cortisone acetate or hydrocortisone.
Breast reconstruction after mastectomy is usually carried a plastic surgeon or surgeon-oncologist at the hospital. At the same under the skin, or more frequently, even between the layers of the pectoralis major muscle is sewn a special prosthesis, and then produce a reconstruction of the areola and nipple