What causes your armpit to be swollen
Around one in eight women in Germany will develop breast cancer in their lifetime. This makes breast cancer the most common cancer in women in this country. At the same time, if the diagnosis is made early, the chances of a cure are good compared to other types of cancer.
The term cancer generally stands for malignant tumor diseases, which are accompanied by uncontrolled tissue growth. The malignant disease of the breast is called breast cancer or Breast cancer designated. In total, around 70,000 women develop breast cancer in Germany every year. A swelling of body tissue can be understood as a tumor in the broadest sense. In the narrower sense, it is a tumor that has arisen from the body's own cells growing in an uncontrolled manner. Tumors can benign or malignant be. It is characteristic of malignant tumors that they penetrate the surrounding tissue and destroy the local structures there.
How is the female breast structured?
The female breast consists mainly of adipose, glandular and connective tissue. The milk-producing glandular tissue (Mammary gland) is composed of several glandular lobes. These in turn each consist of a large number of glandular lobules. The milk ducts leading to the nipple also belong to the glandular tissue of the breast, which is surrounded by supporting connective tissue.
In addition to blood vessels, lymph vessels also run through the chest. They belong to the immune system and transport tissue fluid, the so-called lymph. In addition to white blood cells, the lymph also contains breakdown products of the cell metabolism such as proteins and fats. The lymph nodes, in which the lymph vessels converge, serve as guard stations. There the lymph is cleaned and freed from pathogens and cell debris. Important groups of breast lymph nodes are located in the armpits, above and below the collarbone, and behind the breastbone, among others.
Classification of breast cancer types
The origin of breast cancer can either be from the cells of the milk ducts (ductal breast cancer) or from the cells of the glandular lobes (lobular breast cancer) go out. Most often, breast cancer develops from the cells of the milk ducts. Furthermore, one can differentiate between invasive and non-invasive breast cancer: A invasive breast cancer is characterized by the fact that cancer cells have already penetrated the surrounding tissue. At a non-invasive breast cancer on the other hand, it is a localized tumor. Since the affected cells do not grow into their surroundings, the tumor is still completely in the tissue from which it originated.
Non-invasive breast cancers can be divided into the ductal carcinoma in situ (DCIS), that arises from the cells of the milk ducts and into the lobular carcinoma in situ (LCIS), which arises from cells of the glandular lobes. The DCIS already shows many changes typical of breast cancer. The risk of developing invasive breast cancer as a result of DCIS is significantly higher than that of other precancerous stages: In many women, DCIS turns into invasive carcinoma. It is therefore recommended that DCIS be treated in any case, even if this may mean treatment that is not necessary for some women.
Types of breast cancer
- 70-80% of breast cancers arise in the Milk ducts (ductal breast cancer)
- 10-15% of breast cancers develop in the Glandular lobes (lobular breast cancer)
Breast cancer in men
About one percent of all breast cancer diagnoses affect men. According to statistics, around 750 men in Germany are expected to develop breast cancer in 2020. Breast cancer is often a taboo subject for men, as this disease is a typical disease for women. Men often do not pay attention to changes in the breast because they are mostly unaware that they can get breast cancer. A changed or inflamed nipple, lump, or hardening and enlarged lymph nodes in the armpit could be symptoms of breast cancer in men. Changes of this kind should definitely be discussed with your family doctor or a specialist in internal medicine first. Since the examinations and therapies do not differ from those of women, men are often referred to a breast center in the course of treatment. The causes of breast cancer in men are just as unclear as they are in women. An imbalance of the two sex hormones testosterone and estrogen or a hereditary burden are possible factors that play an important role in the development of breast cancer in men. Men can find helpful information and support in the “Men with Breast Cancer” network.
0 men in Germany developed breast cancer in 2016
Causes of Breast Cancer and Chances of a Cure
The root causes of breast cancer are not known. Many factors, such as hormonal changes, lifestyle habits or environmental influences, play a role in the development of the disease. Genetic risk factors are also increasingly in the focus of science. The most important thing for a good chance of recovery is the timely diagnosis and therapy of the tumor. The chances of recovery from breast cancer have improved considerably thanks to a large number of early diagnostic methods and therapeutic options. Breast cancer is also one of the best-studied cancers. The numerous breast centers nationwide are characterized by a high level of quality and enable optimal breast cancer care from diagnosis to follow-up care.
“Today we can probably cure 70 to 80 out of 100 women who come with the first illness. The problem is that we cannot promise that to the individual patient. "
Prof. Dr. med. Nadia Harbeck
Early detection and symptoms
Breast monitoring is the best form of breast cancer screening. As part of the Medical check-up the gynecologist can provide guidance on proper palpation. However, not every knot that is felt automatically means breast cancer; harmless cysts can also be the cause of a change. Nevertheless, every palpable lump in the breast should be clarified by the gynecologist.
From the age of 30 every woman is legally entitled to an annual examination for the early detection of breast cancer. The gynecologist palpates the chest and the axillary lymph nodes. However, it is also recommended that all women self-examine their breasts once a month. The ideal period is about a week after the start of the last period, when the breasts are the softest and changes can be felt more easily on these days. Self-examination is learned quickly and works best with a system.
Stand in front of a mirror in good lighting and first look at the shape and appearance of the skin and nipples. With your arms raised, watch both breasts from the front and from both sides and see whether you can discover any abnormalities or irregularities.
Palpate the chest
You can palpate your breasts either in lines from the outside in, in a spiral, or in lines; it is important that you proceed systematically. It is best to use your right hand to examine the left breast and vice versa. Feel along the chest with the flat tips of the three middle fingers. Start standing in the upper quarter of the chest. There the tissue is usually a little denser. It can help if you put your free hand under the breast to be examined for support. Finally, press the nipple lightly between your thumb and forefinger and watch for fluid.
Repeat the palpation while lying down using your preferred method. Extend the arm away from the body on the side to be examined. The lower area of the chest and the armpit can now be easily felt.
Questions for breast self-exam
- Has the size or shape of the breast changed?
- Are the breasts clearly different from each other?
- Can you see any indentations, wrinkles, or bulges?
- Is there any redness or inflammation?
- Is the tissue hardened in certain places?
- Is a nipple puckered, reddened, or leaking?
- Do you have chest pain?
If you notice changes, thickening or lumps when palpating yourself while standing or lying down, you should definitely have them examined by a doctor. The earlier breast cancer is detected, the higher the chance of recovery. You can order a scanning card with instructions for self-examination here.
Breast Lump: Cyst, Benign Tumor, or Cancer?
Most of the changes that you can feel will be a cyst in the breast or benign tumors, such as: B. so-called fibroadenomas. They can be clearly delimited from the surrounding tissue and moved under the skin. Cysts that are filled with fluid often react to pressure and are slightly sensitive to pain. However, if a lump is rather blurred, hardened and feels uneven, the suspicion of breast cancer is more likely. If the bump is located directly under the skin, it can also be noticeable through visible or tangible changes to the skin. If there is a noticeable change in the lymph nodes in the armpit, it could be a sign of breast cancer and a spreading tumor. However, since inflammation can also cause these symptoms, a doctor's visit is necessary for a clear diagnosis. If the doctor finds abnormalities, an imaging procedure, such as mammography, usually follows for further clarification.
An abnormality in the chest is worrying, even if it usually turns out to be harmless. Modern Diagnostic procedures how Mammography, ultrasound and magnetic resonance imaging(Magnetic resonance imaging) enable early detection of malignant tumors. The earlier a tumor is detected, the better the chances of recovery are usually.
0 out of 1,000 women examined received a normal result
Source: Cancer Information Service
Mammography and breast sonography
Women between the ages of 50 and 69 become so-called every two years Mammography screening program, a chest x-ray. Two recordings are made of each breast in different planes. For this purpose, the breast is placed between the recording table and a plexiglass plate. The plates are then briefly pressed together. Two independent radiologists then evaluate the images. If the finding is not clear, the ultrasound examination of the breast follows, the so-called Breast sonography. With the help of sound waves, the doctor examines the location, size and nature of a change in the breast tissue. If the gynecologist or the mammography center has raised a specific suspicion of breast cancer, they will usually receive one biopsyof the breast (taking a tissue sample). Further imaging procedures or the repetition of an examination are only necessary in exceptional cases.
Magnetic resonance imaging
The Magnetic resonance tomography (also magnetic resonance tomography [MRT]) is the most sensitive process. Numerous sectional images of the breast tissue are recorded with the help of magnetic waves. Breast cancer diagnostics only use this method for specific questions or if no clear results can be achieved using other methods.
Imaging tests for suspected metastases
If there is a suspicion of metastasis (formation of daughter tumors), other imaging procedures such as Computed tomography (CT) and the Bone scintigraphy applied. The Computed Tomography uses x-rays. In contrast to mammography screening, a CT scan depicts the entire body in order to also obtain an image of the chest and lungs.
If the breast cancer affects the bones (bone metastases), it can be stopped by a Bone scintigraphy or Skeletal scintigraphy represent. To do this, the doctor injects a weakly radioactive substance. This accumulates in the bone and thus accurately depicts the entire skeleton. The radiation exposure is very low and can be compared to an X-ray.
If previous imaging tests have confirmed the suspicion of a malignant tumor, an Breast tissue sample can be removed. The removal of tissue and its subsequent examination under the microscope is called biopsy. The removed tissue is preserved and embedded in paraffin wax. It is then possible to make thin sections from the sample. After the tissue sections have been stained, they are examined microscopically for the presence of tumor cells. This histological (tissue) examination then provides the reliable result.
In many cases, breast tissue can be removed without surgery. Tissue is usually removed using so-called minimally invasive procedures, in which a needle is used to take tissue samples under local anesthesia.
Types of biopsies
In the case of the ultrasound-controlled Punch biopsy tissue is removed from the breast with a hollow needle. Even the computer-controlled Vacuum biopsy the breast is a minimally invasive method. It allows very precise tissue removal. The removal of a palpable lump or suspicious area during an operation and its subsequent examination is called open biopsy. It is used when a minimally invasive procedure is impossible or insufficient. If cancer is found, it can also move on to the final operation.
The tissue sample is used to examine whether the tumor cells have binding sites (Receptors) for the sex hormones estrogen and progesterone. It also determines how high the number of a particular receptor is HER2, is on the tumor cells. In the case of some tumors, an additional examination is carried out to determine whether the tissue sample has a binding site known as “PD-L1”. This examination is important for any targeted therapy that may subsequently be required.
Hormone receptor status
Receptors are proteins in the cell envelope (cell membrane) through which signals are transmitted from the cell surface to the inside of the cell. One type of receptor found on healthy cells in the female breast is the hormone receptor. For example, hormone receptors in the breast tissue bind the female sex hormones estrogen and progesterone. Tumor cells can also have hormone receptors. A tumor is called estrogen receptor positive (ER +) if there are estrogen receptors on the surface of the tumor cells. A tumor is designated as progesterone receptor positive (PR +) as soon as the tumor cells have progesterone receptors. If estrogen or progesterone binds to the receptors, growth signals are passed on to the inside of the cell: The tumor grows depending on the hormone. This is the case in around 80 percent of all breast cancer patients.
With hormone-dependent breast cancer comes a so-called Anti-hormone therapy in question. This therapy was the first targeted therapy for the treatment of breast cancer and was developed as early as the 1970s. The basic principle of this therapy is to reduce the growth-promoting effect of estrogen on the tumor. This can be achieved by lowering the levels of estrogen in the body or by blocking the binding of estrogen to the receptors.
The HER2 receptor is a binding site for growth factors on the cell surface. This receptor transmits growth signals from the surface to the inside of the cell. A normal cell has only a small amount of the HER2 receptor. However, if there is an increased number of these receptors on the surface of a tumor cell, too many signals are transmitted and the growth of the tumor is promoted.
About 20 percent of all breast cancer patients have an increased number of this receptor on their tumor (HER2 positive breast cancer). A special one Antibody therapy specifically attacks these cells and causes them to die.
Triple-negative breast cancer and PD-L1 status
About ten percent of breast cancers are triple negative. This means that there are neither hormone receptors for estrogen and progesterone nor the HER2 receptor on the tumor cells. This makes treatment more difficult, as therapies that target these receptors cannot work here.
For patients with non-operable, triple-negative breast cancer, the Cancer immunotherapy come into question. The prerequisite for this is that the tumor tissue has the PD-L1 binding site. PD-L1 is one of the so-called checkpoints.These are switching points through which the body's own immune system can control and switch off defense cells. PD-L1 in tumor tissue can thus block defense cells that would normally attack the tumor cells. Cancer immunotherapy helps the immune system to recognize and fight cancer again.
Breast Cancer - Causes and Risk Factors
The cause of the development of malignant tumors always lies in the altered genome of a cell. In the course of a lifetime, our genetic material is exposed to many internal and external influences. A change can cause a cell to lose its natural control of division and to multiply unhindered, causing cancer.
Failure to divide cells
During normal cell division in the body, many thousands of errors occur every day, which are repaired by the body's own protective mechanism. If this does not work properly or if too many errors occur, these cells usually die. In rare cases, however, the cells do not perish, but develop into cancer cells. These then pass the errors on to their daughter cells with each division. If the faults are in the genes that regulate and control cell division, the affected cell gets out of hand. It begins to divide indefinitely and cancer develops.
Risk factors for breast cancer
There are many factors that have been linked to the development of breast cancer cells. Some of them we can influence through our way of life, others not. An important factor is the sex hormone Estrogen. About 80 percent of all breast cancer cells respond to estrogen with increased growth (more hormone dependent or. hormone receptor positive Breast cancer). If our diet consists of too many animal fats and sugary foods or if we suffer from a lack of exercise, this is often the cause Obesity. This in turn causes the estrogen level to rise, so that hormone-dependent breast cancer is favored. That is why doctors recommend a healthy, varied diet and sufficient exercise.
Lower the risk of breast cancer through exercise
According to a study by the German Cancer Research Center (DKFZ), moderate exercise can lower the risk of breast cancer. Bicycling, brisk walking and swimming all have positive effects: those who are active for more than three hours a week can reduce their risk of breast cancer by around 20 percent. An active lifestyle with regular exercise strengthens the immune system and prevents diseases. Extreme physical exertion or high-performance sports are not necessary.
Source: German Cancer Research Center
Smoking and increased alcohol consumption are particularly harmful. Smoking is blamed for 25 to 30 percent of all cancer deaths. In addition, a woman who drinks 0.3 liters of wine or 0.6 liters of beer per day increases her risk of breast cancer by around 30 percent in the long term. A healthy lifestyle therefore lowers the risk of developing breast cancer. But there is no guarantee that you will stay healthy through enough exercise and a balanced diet. It is impossible to predict whether a woman will develop breast cancer or not. In general, several circumstances and influences must come together for breast cancer to develop.
“We don't know where the disease comes from. The living conditions in the western world are certainly a problem. After all, breast cancer is much more common here. "
Prof. Dr. med. Ulrike Nitz
Factors that can be influenced
- Unhealthy diet and obesity
- Increased Alcohol consumption
- Low Lactation periods (voluntary decision)
- Environmental factors (e.g. radiation)
Factors that cannot be influenced
- Early onset Menstruation (first period before the age of 13)
- Late menopause (Menopause after age 52)
- Childlessness or late birth of the first child (motherhood at 30 years of age and later)
- Low Lactation periods (involuntary decision)
- General Old age risk (from the age of 50)
- Own previous Breast cancer
- Treatment with Hormone replacement therapy after menopause
- Diabetes mellitus
- Genetic predisposition
Familial breast cancer
Five to ten percent of all breast cancers are familial breast cancer: One Change in the genetic material (mutation) is transmitted from mother or father to children and increases the likelihood of developing the disease in the course of life. There may be a risk of genetically determined breast cancer if one of the following constellations applies in a family line, i.e. either on the paternal or maternal side:
- at least three women are or have had breast cancer (regardless of age)
- at least two women are or have had breast cancer (one of them before the age of 51)
- at least one woman has or has had breast cancer and one woman has ovarian cancer
- at least two women have or have had ovarian cancer
- at least one woman has or has had breast and ovarian cancer
- at least one woman has or was diagnosed with breast cancer when she was 35 years of age or younger
- at least one woman aged 50 or younger is or has had bilateral breast cancer
- at least one man has or has had breast cancer and one woman has breast or ovarian cancer
Source: German Consortium for Familial Breast and Ovarian Cancer
Breast cancer genes: BRCA1 and BRCA2
A change in the genes can be seen in about 25 percent of women with familial breast cancer BRCA1 and BRCA2 prove. BRCA stands for "breast cancer", the English word for breast cancer. For both women and men, if one of these genetic changes is present, the likelihood of developing breast cancer increases significantly (ten-fold). The women are also significantly younger at the time of their illness: the mean age at diagnosis is 40 years. They fall ill on average 20 years earlier than women without a genetic risk (60 years). Women with an altered BRCA gene are also more likely to develop ovarian cancer. Those affected can find helpful information and addresses for familial breast cancer on the website of the German consortium for familial breast and ovarian cancer: www.konsortium-familiaerer-brustkrebs.de.
Advice from specialized centers
If a family is suspected of having a genetic risk of developing breast and ovarian cancer, the family should contact a specialized center. After a detailed consultation, a genetic test can be carried out there. With this gene changes are detected. All that is required for the test is a small blood sample and the result is available after a few weeks. The result then always affects the whole family, since the children can also be carriers of the mutation. If they also decide to take a test and it turns out positive, they will be included in an intensified early detection program. Preventive removal of the ovaries may also be considered after a certain age or if the patient has breast cancer to reduce the risk of ovarian cancer.
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