Benign tumors of mammary glands — group of the volume, diffusion or mixed new growths which come from breast tissues are not inclined to invasive growth. Sometimes proceed asymptomatically, are more often shown by periodic or constant pains in chest glands, existence of consolidations, and at a number of neoplaziya – allocations from nipples. At diagnosis use ultrasonography of mammary glands, mammography, cytologic researches, the test on onkomarker. Treatment is selected taking into account a type of a tumor, provides purpose of hormonal and non-hormonal therapy which at some new growths is preceded by surgery.
Benign tumors of mammary glands
According to different researches, benign tumors of a breast make from 30 to 70% of all diseases of the mammary glands diagnosed for women of reproductive age. At patients with pathology of the genital sphere such a neoplasia reveal even more often (in 75-95% of cases). The majority of volume processes find in women 40 years are more senior that testifies to a disgormonalny origin of new growths. The fibroadenoma which are usually diagnosed at the age of 15-35 years belong to number of the tumors revealed at younger patients. The most widespread neoplaziya of mammary glands are various options of fibrous and cystous mastopathy, other types of new growths meet much less often.
Reasons of benign tumors of mammary glands
The uniform theory which is clearing up an etiology of emergence of volume new growths of a breast does not exist today. Formation of a benign tumor is considered the polietiologichesky process provoked by a combination internal (hormonal and genetic) and external factors. According to experts in the sphere of a mammology, are the most common causes of a disease:
- Hormonal violations. First of all, it is about the stimulating influence of estrogen. The good-quality new growth can arise as at pathology of ovaries (cysts, ooforita, adneksita, cancer), and at violation of regulation of synthesis of hormones at the gipotalamo-hypophysial level.
- Genetic predisposition. The probability of detection of tumoral education is higher at women whose close relatives suffered from mammarny neoplaziya. The role of a hereditary factor is connected as with violation of proliferation of cells of a mammary gland, and with failures in hormonal and immune regulation.
- Endocrine diseases. Women with diseases of a thyroid gland, adrenal glands, diabetes belong to risk group on development of benign tumors of a breast. In such cases of violation of hormonal regulation influence synthesis of sex hormones, local microcirculation and immunity.
- Mechanical influences. The risk of formation of a benign tumor increases after the postponed injuries of a mammary gland (bruises, the getting wounds). Danger is also constituted by continuous insignificant traumatic impacts on breast tissues because of wearing incorrectly picked up bra with stones.
Except the immediate causes capable to provoke good-quality tumoral process, allocate a number of the contributing (background) factors. Chronic inflammatory diseases of female genitals (endometritises, plastic pelvioperitonit), endometriosis, frequent abortions, abortions and diagnostic a scraping, extra-uterine pregnancies belong to their number. To risk to ache with a benign tumor of a breast women who early began sex life are more subject, often change sexual partners, smoke, abuse alcohol. In development of a neoplasia a part is played by excess weight, violations of a diet, a hypodynamia, stresses, prolonged uncontrollable use of oral contraceptives. All listed factors are capable to lead to disgormonalny frustration or to strengthen them.
Violation of a ratio of concentration of estrogen and progesterone in fabrics of chest glands, especially at influence of the external damaging agents (mechanical, chemical, radiation), leads to strengthening of proliferation of cages. The epithelium, soyedinitelnotkanny Strom, a lipotsita is involved in process that defines type of the formed tumor. Pathological neoplastic changes in mammary glands can be nodal (in the form of the issued volume new growth) or diffusion (at the majority of forms of mastopathies). With a growth of benign tumors there is no their germination in surrounding fabrics.
In clinical practice usually use histologic classification of good-quality new growths of a breast which was developed by specialists of World Health Organization in 1984. It considers features of a cellular structure and growth and a neoplasia. According to this classification allocate six main groups of tumors of mammary glands:
- Epitelialny new growths. This group is presented by adenomas (a pacifier, tubulyarny, lactating) and intra pro-current (intraduktalny) papilloma.
- The mixed tumors. Such a neoplasia are formed by both epitelialny, and connecting fabric. Enter into group a fibroadenoma and a listovidny (filloidny) tumor.
- Neoplasia of other types. Except an epithelium and a stroma tumoral process can strike soft fabric, epidermis and to a term of mammary glands. At the same time lipomas and new growths of skin are formed.
- Not classified tumors. Such diagnosis is established in cases when the histologic structure of a neoplasia is not defined, however volume process is good-quality.
- Opukholepodobny educations. Volume new growths of this category have not proliferative nature, result from an ektaziya, an inflammation, anomaly of development (gamartom), etc.
- Dysplasia of mammary glands. The disease is also known under the name of mastopathy (a fibrous and cystous disease). Displastichesky process can be diffusion or nodal.
Symptoms of benign tumors of mammary glands
At the initial stages the disease can proceed asymptomatically. Sometimes even tumors, rather big by the sizes, become a casual find at self-inspection, come to light at survey of the mammologist or during the screening research (ultrasonography of a breast, mammography). However more often growth of a neoplasia is followed by pain or other unpleasant subjective feelings in a breast (burning, a raspiraniye, weight). Depending on new growth type the pain syndrome is periodic or constant. Usually pain arises or amplifies in the second half of a menstrual cycle and completely passes from the beginning of monthly. Less often pain disturbs the woman constantly. Pain can irradiate in a nipple, an armpit, a hand or a shovel on the relevant party.
At tumors of large volume the insignificant visual difference between the sizes of the healthy and affected mammary gland is possible. The woman usually probes in a breast volume formation of a dense or elastic consistence, different degree of mobility and morbidity, with a smooth or uneven surface. The size of some types of neoplaziya depends on the period of a monthly cycle. The Filloidny tumors reaching the huge sizes can visually be defined and cause rough deformation of a contour of a mammary gland. Skin changes over the struck area (dryness, thinning) meet seldom.
At women with fibrous and cystous mastopathy, the epitelialny or displaced breast new growths with intra pro-current growth (intraduktalny papillomas, actively functioning prolaktinoma, ektaziya of channels) the allocations from a nipple arising spontaneously or when pressing are possible. More often they are transparent, is more rare — serous, rather turbid and serous, greenish, similar to colostrum, sanious or hemorrhagic. Extremely seldom allocations have yellowish-greenish color, a dense consistence and resemble pus superficially though inflammation signs in the form of reddening of skin and temperature increase are absent.
In the presence of a considerable pain syndrome the main consequence of good-quality neoplaziya of mammary glands is decline in quality of life of the woman. At a part of patients the sleep is interrupted, working capacity decreases, there are emotional frustration in the form of tearfulness, sensitivity, irritability, the lowered mood, kantserofobiya. Good-quality not proliferative new growths ozlokachestvlyatsya less than in 1% of cases. At proliferative forms of nodal mastopathy and rare forms the neoplazy risk of a malignization makes from 2 to 8% and even more. The Listovidny tumor which is diagnosed in 0,3-1% of cases of pathology of chest glands is inclined to rapid growth, achievement of the huge sizes (to 20 and more centimeters) and to a malignant current at every tenth patient.
Given survey, palpations and a considerable part of the subjective symptoms revealed at volume formations of mammary glands are not specific, can meet both at good-quality, and at malignant processes. Therefore the main objective of a diagnostic stage is the exception of an oncopathology and definition like a neoplasia for the choice of adequate tactics of treatment. During diagnostics the following methods are most informative:
- Ultrasonography of chest glands. Sonografiya allows to visualize structure of band and solid new growths, to estimate their sizes, a form, to define a condition of regionarny lymph nodes, if necessary to execute an aim biopsy. During UZDG changes of a blood-groove in the vessels feeding a tumor come to light.
- X-ray analysis of mammary glands. Taking into account features of a new growth survey or aim mammography, a duktografiya, a pnevmokistografiya (is carried out at suspicion of a breast cyst). X-ray methods allow to find even not palpated a neoplasia, to specify their character and prevalence.
- Cytologic researches. For definition of nature of a disease and histologic structure of a tumor use separated from a nipple, dabs prints and tissues of a mammary gland. The intake of material is carried out by means of punktsionny aspiration or is frayed - biopsies, and also during a sectoral resection of a breast.
- Determination of level of onkomarker. One of the most exact methods of identification of malignant processes in which sekretiruyushchy cells of alveolar fabric and channels are involved. Blood is investigated most often on the maintenance of a high-molecular glycoprotein of CA 15-3 which concentration increases at a breast carcinoma.
Differential diagnostics is carried out with a functional mastodiniya, abscess and a breast cancer, osteochondrosis, heart diseases, neurologic and mental disorders. According to indications to patients with focal or diffusion neoplastic processes appoint KT, MPT, radio thermometry, a stsintigrafiya of chest glands, electroimpedance mammography. In the plan of the general inspection usually include determination of level of hormones in blood, consultation of the gynecologist, if necessary – survey of the endocrinologist, gastroenterologist, cardiologist, neuropathologist, psychiatrist.
Treatment of benign tumors of mammary glands
Choosing the scheme of the conservative, expeditious and combined treatment, consider education type, its amount and features of growth. The main objective of medicamentous therapy is impact on the reasons which caused a disease, and separate links of pathogenesis, and also reduction or elimination of clinical symptomatology. For this purpose to the patient appoint:
- Hormonal medicines. Hormonal therapy is shown only at those forms of neoplaziya which are combined with changes of a hormonal background (the increased content of estrogen, FSG and LG, surplus or a lack of progestins, a gipoestrogenemiya, giperprolaktinemiy). On the basis of data on type of a tumor apply estrogen, progesteronsoderzhashchy means, selective modulators of receptors of estrogen, anti-Prolactinums, inhibitors of gonadotropny hormones of a hypophysis. Correction of a hormonal background is more effective at treatment of volume formations of an epitelialny origin.
- Non-hormonal means. For removal of the expressed pain syndrome in the postovulyatorny period nonsteroid resolvents, sedative medicines (usually a phytogenesis), small doses diuretic (are recommended at a combination of pains to hypostasis of a mammary gland). Vitamin therapy (especially A and E vitamins with antioxidant effect), the selenium medicines blocking growth of tumor cells in the phase G2 and inhibiting a number of genes is effective. To improve metabolism of steroids in a liver, use gepatoprotektor.
In some cases purpose of basic non-hormonal and hormonal therapy is preceded by carrying out operation. Thanks to modern methods of diagnostics of the indication for surgical treatment are significantly limited, dynamic observation is shown to most of patients. Fibroadenoma, listovidny tumors, pro-current papillomas, nodular educations, as a rule, are subject to removal at focal proliferative mastopathy, large (from 20 mm) cysts with proliferation. Taking into account histologic structure, the sizes and localization carry out a tumor enukleation, removal of skin education or a sectoral resection of a breast with the subsequent histologic research of fabrics. At some forms of pro-current papilloma perhaps selective allocation of a channel, surrounding structures of a subareolyarny zone remain that is especially important for patients of young age. Cysts can be exposed to a sklerozirovaniye.
An essential role in complex treatment of good-quality formations of a breast is played by correction of a diet and way of life. At detection of a tumor in a mammary gland the refusal of smoking and the use of alcoholic drinks, a sufficient night dream (it is not less than 8 hours), physical activity, an exception of stressful situations is recommended. In a diet it is necessary to limit amount of fat meat and the smoked products influencing exchange of the steroid hormones, and also the pickles, chocolate, cocoa, strong tea, coffee, Coca detaining liquid and promoting synthesis of soyedinitelnotkanny fibers. The diet should be added with fruit (in particular a citrus), vegetables (especially rich with carotene), the cereals, products rich with cellulose. In a day it is necessary to drink up to 1,5-2 pure liters.
Forecast and prevention
At the adequate, in due time begun treatment the forecast favorable. Purpose of basic therapy allows to eliminate or reduce clinical symptomatology and to improve quality of life of the patient. The risk of a postoperative recurrence of the majority of tumors (except listovidny) is minimum. Primary prevention is directed to normalization of a way of life and sexual activity, planning of a child-bearing, refusal of abortions, reasonable purpose of hormonal means, competent selection of bras. Secondary prevention assumes self-inspection of mammary glands and regular surveys at the gynecologist, and after 35 years — the mammologist with performing ultrasonography has breasts or mammographies.