ВТОРОЕ МЕДИЦИНСКОЕ ЗАКЛЮЧЕНИЕ
Breast Cancer

Breast cancer, which has a risk of 1 out of every 8 women, is one of the cancer types with the highest death rate worldwide. According to studies, the prevelance of breast cancer, which accounts for 14% of total cancer deaths, is increasing every year.

Since breast cancer is the most common type of cancer seen in women, most women are concerned about whether breast cancer will kill them. As in other types of cancer, early diagnosis and correct treatment methods save lives in breast cancer.

What is Breast Cancer?

Uncontrolled proliferation of cells in the breast tissue, which consists of adipose tissue, blood vessels, milk ducts and glands, in some cases to spread to other parts of the body and to continue to multiply is called breast cancer. Due to structural changes in healthy cells, cells proliferate rapidly and form tumors in the breast region.

What causes Breast Cancer?

Although the causes of breast cancer are not fully known, known breast cancer risk factors may play a role in the development of cancer:

    To have never given birth or to have had the first birth after the age of 30,

    Not breastfeeding for 6 months after giving birth

    Entering the menopause period at an advanced age,

    Entering the menstrual period at an early age,

    Excessive alcohol consumption,

    Overweight or Obesity,

    inactive lifestyle,

    Being a woman,

    Having a first-degree relative with a history of breast cancer

    long-term estrogen therapy

    Exposure to radiation, especially in the chest area,

    Having had breast cancer before.

Especially advanced age, the beginning of the first menstrual bleeding before the age of 12, and the presence of breast cancer in a mother or sibling are primary risk factors that cannot be changed. The risk, which increases after the age of 30 in women, increases more after the age of 50. Approximately half of the female patients with this cancer are individuals over 65. Those with a history of breast cancer among their first-degree relatives have a three times higher risk.

Do men get Breast Cancer?

There are also breast tissue in men as in women. Therefore, although there is a possibility of the disease, the risk of breast cancer in men is much lower than in women. The disease, which is seen in 1 out of every 100 cases, is mostly seen in men over the age of 60-65. However, because the possibility of breast cancer in men is ignored, diagnosis and treatment often start quite late in male patients.

Symptoms of Breast Cancer

The primary symptom of breast cancer is palpable masses around the breast or under the armpit. These swellings or masses are hard tissue and painful in some cases, and soft tissue and painless in some cases. Those who do research on how to understand breast cancer first consider this common symptom.

    Pain around the breast

    Swelling in the breast and armpit areas,

    Discharge or bleeding from the nipple,

    Deformities of the nipple (collapse or retraction),

    Wounds and skin disorders around the breast,

    Edema around the breast,

    Color changes or deformities in the breast.

In some cases, the signs of breast cancer are understood by other symptoms caused by the spreading cells. Breast cancer also causes tissue disorders in organs such as the lung and liver where it metastasizes. In this sense, complaints such as pain in the chest area or shortness of breath can also be a symptom of breast cancer.

How is Self-Breast Cancer Examination performed?

Breast cancer examination is of great importance because there are no obvious symptoms in the early stage. Early diagnosis of breast cancer is mostly possible as a result of the examinations performed by the patients themselves. Breast cancer control by the patients themselves covers the breast area and armpit. In general, these checks, which should be done once a month by women older than 20 years, can be detected early. These controls should be done 4-5 days after the end of the menstrual period when the effect of hormones is less than normal.

Breast examination can be done in front of a mirror, in the shower or in a lying position. In front of the mirror, in an environment with sufficient light, it is necessary to examine the area around and under the breasts, nipples and armpits manually and visually, with the upper body naked. In front of the mirror, first of all, it should be checked from different angles whether there are any abnormalities in the size, symmetry and color of the breasts, collapse of the nipples, redness of the breast skin. Then the same observation should be made with the arms up. At this point, attention should be paid to whether there is swelling, especially under the armpit.

In the manual examination, which can be done lying down or standing, it is checked whether there is a mass under the breast, nipples and armpit. In the standing hand examination, the left hand should be used for the right breast and the right hand should be used for the left breast. The breast circumference and armpit should be checked by making circular movements with the index, middle and ring fingers and slightly increasing the pressure.

In manual examination performed in the supine position, the right arm should be raised above the head in the control of the right breast, and the left arm in the control of the left breast. At this point, it is necessary to put a towel or pillow under the shoulders on the side of the examination. Just like standing, it should be checked whether there is a mass around the breast and under the armpit with circular movements. At the same time, the nipple should be squeezed to check for discharge or bleeding. If any lump or mass is encountered during these movements, it is necessary to go to a health institution.

Beginning of Breast Cancer

The beginning of breast cancer is different from other types of cancer when the symptoms are taken into account. The disease, which does not cause many symptoms in the early stage, therefore makes early diagnosis difficult. Since the disease does not show obvious symptoms until the advanced stages, it is necessary for women to undergo regular health screening in order to be diagnosed at the initial stage of the disease. Breast cancer awareness campaigns also emphasize the development of awareness about this disease and the importance of early diagnosis.

Stage of Breast Cancer

Breast cancer stages; It varies according to the location and size of the cancerous cells, the degree of spread to the lymph nodes and whether they metastasize to the surrounding organs and tissues. The five stages and the sub-stages of these stages provide information about the spread of cancer and guide the doctors on the treatment plan.

Stage 0

The cells that form in the milk ducts have not yet spread to the adipose tissue, lymph nodes or other tissues and organs at this stage. Tumor sizes are very small at this stage, which is the earliest stage of breast cancer.

Stage IA

At this stage, cells that do not reach the lymph nodes and surrounding organs are smaller than 2 cm.

Stage IIA

At this stage, the cells can spread to the lymph nodes depending on their size. The tumor, which has dimensions between 2 cm and 5 cm, has not spread to the lymph nodes or surrounding tissues and organs. On the other hand, at this stage, in tumors smaller than 2 cm, a very small amount of spread in the lymph nodes can be observed.

Stage IIB

At this stage, although the tumor, which is between 2 cm and 5 cm in size, has spread to the lymph nodes, it has not reached distant organs and tissues. On the other hand, the mass larger than 5 cm remains only on the chest wall without spreading to the lymph nodes.

Stage IIIA

Although the mass, which is about 5 cm in size, does not spread to the surrounding tissues, it spreads to the axillary lymph nodes. On the other hand, cells larger than 5 cm may spread to the lymph nodes even if they do not involve the chest wall.

Stage IIIB

At this stage, the cells spread in the lymph nodes around the armpit and rib cage or on the chest wall and tissue. Cancer cells vary in size. However, no cancerous cells are found in distant regions.

Stage IIIC

Cancerous cells of varying sizes spread to the lymph nodes above the collarbone or around the rib cage, and to the axillary lymph nodes. In this sense, cancerous cells are found in many lymph nodes around the breast.

Stage IV

In this stage, which is excluded from breast cancer in stage 3, cancerous cells have metastasized to surrounding organs and tissues such as liver, lung, and bone.

Breast Cancer Treatment

Although breast cancer cases increase every year, the disease can be diagnosed early and can be controlled thanks to modern medicine and new treatment methods. Especially in the disease that is noticed at an early stage, the spread of the tumor is intervened and breast losses are minimized. Treatment of advanced breast cancer requiring surgical operation is carried out together with plastic surgery and breast reconstruction is applied to patients.

Breast cancer treatment is performed with chemotherapy, radiotherapy and hormone therapy as well as surgical methods. However, surgical operations constitute the basis of the treatment of the disease, especially in the early stages. The treatment plan is shaped according to the stage of the disease. In stage 0, there is usually no need for adjunctive treatment such as chemotherapy or radiotherapy after surgery. In Stage I and Stage II, where the mass is small, physicians decide whether an adjunctive treatment is needed in addition to surgery. In Stage III, chemotherapy and surgical operation are applied together, while in Stage IV, it is decided whether surgery will be performed according to the spread of cancerous cells. In cases with very advanced metastases, only auxiliary treatment methods are applied in order to increase the quality of life of the patients.

The main purpose in all advanced surgical operations is to completely clean the cancerous cells and to remove these glands in case of spread to the lymph nodes. The surgical methods used in breast cancer are as follows:

Mastectomy

This method, which includes the removal of lymph nodes in case of spread of breast tissue and cells, is divided into three as simple mastectomy, skin-sparing mastectomy and radical mastectomy.

In simple mastectomy, the entire breast, including adipose tissue, breast skin and nipples, is removed. In this method, which is not preferred much with the development of alternative methods today, lymph nodes are also taken in case of spread of cells. However, the muscle tissues in the lower part of the breast are left.

Although breast tissue is removed in skin-sparing mastectomy, the breast skin is not touched. The breast is reconstructed with the help of silicone prostheses, since most of the skin is left after the operation, in which the nipple and its surroundings are also removed.

In this sense, breast reconstruction can be applied to patients after skin-sparing mastectomy.

Radical mastectomy, which is one of the rarely preferred methods today, involves removing the entire breast, submammary muscles and axillary lymph nodes. This method is generally preferred for cleaning large masses that adhere to the chest wall.

Breast Conserving Surgery (Lumpectomy)

Lumpectomy is a surgical method that involves removing only the cancerous mass and the surrounding tissues instead of the entire breast. Today, this method, which is widely preferred especially in early stage breast cancer cases, is important in terms of both protecting the integrity of the breast and ensuring that patients are less affected psychologically. Radiotherapy is usually applied to patients with this surgical method.

Adjunctive treatment methods for surgery are as follows:

Radiotherapy

Radiotherapy, which is applied as an auxiliary treatment especially after operations in which the entire breast is not removed, includes irradiation to the armpit and breast area. Although the mass is cleared in surgical operations, there is a possibility of remaining cancerous cells. Radiotherapy gives effective results both in destroying the remaining cancerous cells and in protecting the breast tissue that is not removed. This treatment is planned approximately 30 days after the surgery and takes an average of 6-7 weeks.

Chemotherapy

Chemotherapy, which is one of the medicated treatment methods and usually applied after surgical operations, is also among the preventive methods. Chemotherapy is especially effective in cleaning cancerous cells that cannot be detected by examination and scans, but are likely to spread to different parts of the body. For this purpose, chemical drugs are given to patients intravenously.

If there are any remaining cancer cells after breast cancer surgery, it is aimed to clean these cells. At the same time, drug therapy, which aims to eliminate the risk of spreading to surrounding organs and tissues, is planned according to the extent and spread of cancerous cells around the breast and under the armpit.

Chemotherapy, which can also be applied before breast cancer surgery, allows very large cells to shrink.

Hormone Therapy

Hormone therapy; It is applied to clean the remaining cancerous cells after chemotherapy, radiotherapy and surgical operation.  In the treatment, which is one of the protective methods against the recurrence of the disease, it is aimed to reduce the estrogen hormone and to prevent the proliferation of cancerous cells sensitive to this hormone.

Breast Cancer Surgery

Breast cancer surgeries are divided into mastectomy and lumpectomy methods, which aim to remove the entire breast or only the parts where cancerous tissues are seen. For those with early-stage breast cancer, lumpectomy is one of the ideal methods. In some cases, mastectomy operations, which involve removing the entire breast, are performed due to excessive spread of cells.

The duration of the operations performed under general anesthesia varies according to the type of operation. After the operations, which take about 1-3 hours, the patients are discharged after resting for a few days.

No matter how successful the treatment is after breast cancer surgery, there is a risk of recurrence of the disease. Since the disease is less likely to recur in the early stage, patients should definitely undergo regular check-ups after surgery. A control plan should be made every three months for three years after the operation, and every six months and once a year in the following years.

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