Breast cancer (breast cancer)


Breast cancer is a disease state, in which her glandular tissue is affected. It is the most common cancer among women and is the second leading cause of death in women. Malignant tumors of the mammary gland in Bulgaria affect approx 3500 sick per year. To a lesser extent (100 times less) seen in men. Early diagnosis of the disease 80% of patients undergo a complete cure or increase their survival after diagnosis.

The good news is, that in five-year survival, which in 1900. it was barely 5%, in 1990. got up 50%, reached levels of 84% – 87% nowadays. This is due to the advent of all modern methods, which are related to the genetic profiling of patients and help to personalize their treatment, maximum improvement and prolongation of their survival.


  • Changes in skin color or texture – flaky skin around the nipple and areola; darkening of the skin around the nipple.
  • Lump or thickening
  • Clear or red liquid from the grains
  • "Orange skin" or bumps on the skin of the chest.
  • Drooping or deformation of the nipple
  • Change in breast size or shape
  • Armpit pain

Diagnostics and screening

There are several basic methods of diagnosis and screening for breast cancer. But experts recommend every woman over 40 years of age without family burden to perform home examinations at least once a month.

The good news is, that in five-year survival, which in 1900. it was barely 5%, in 1990. got up 50%, reached levels of 84% – 87% nowadays. This is due to the advent of all modern methods, which are related to the genetic profiling of patients and help to personalize their treatment, maximum improvement and prolongation of their survival.

Home inspections can be done in several ways:

Under the shower: Place your left hand on the back of your head. Use your fingers to feel your entire breast using circular motions, moving from the armpit to the center of the breast. It is recommended that your hands are soaped. Repeat the same by switching hands.

In front of a mirror: Place your hands next to your body and examine your chest for changes. Repeat with arms raised high.

Lying down: Place a pillow under your right shoulder and raise your right hand behind the back of your head. Using your left hand, rub your right breast in small circular motions. Check your entire breast and armpit area.

Symptoms, to keep an eye out for, when it comes to breast cancer are: chest pains, relaxation, appearance of lumps, veins, bumps, rashes, irregularities, wrinkling of the skin around the nipple, blood or secretion.

If you notice any of the changes, you must contact a specialist.


Mammography is a specific imaging method, in which the structures are visualized with a relatively low dose of X-ray radiation, forming the mammary gland. This is the most common method for diagnosing breast diseases, in women and men.

Screening mammography

This mammography method, widely used for early diagnosis of breast cancer and is carried out in women, who have no complaints or visible breast changes. It usually examines both mammary glands in two mutually perpendicular projections and helps to detect tumor formations, which are not palpable during ordinary examination.

Women over the age of 45 and those at increased risk of breast cancer must undergo a screening mammogram. It is completely free after presenting a referral from a personal physician.

Diagnostic mammography

Diagnostic mammography is an X-ray method, suitable for examination of all women, who have symptoms on the side of their mammary glands like engorging tumor masses, thickening or redness of the breast skin, secretion from the ducts, nipple deformity or pain. With a diagnostic mammogram, all the changes found during the screening test are specified.

Digital mammography

Digital mammography is a digital system, in which the ordinary X-ray film is replaced by detectors, having the ability to convert attenuated X-rays into electrical signals. An image is produced from these electrical signals, in the case of the mammary gland, which can be analyzed on screen or printed on special film, similar to conventional radiography. Digital mammography has a number of advantages such as high resolution, allowing extremely small pathological findings to be visualized, as well as the lower dose of ionizing radiation, administered during the study. The digital three-dimensional (3D) Mammography is the major advance in the diagnosis of breast diseases in recent years 20 years. With it, the device creates three-dimensional images, which help doctors examine hard-to-evaluate areas, especially in women with denser mammary glands. The main advantage of 3D mammography over conventional mammography is the possibility of detecting smaller tumors and the more precise diagnosis of the type of tumor.

3D mammography

Up to now, standard two-dimensional devices take pictures of the breast in two different planes. In 3D mammography, also known as "digital breast tomosynthesis." (DBT)“, are made 9 virtual very thin sections in different planes and we can see carcinomas several millimeters in size, which are lost during standard mammography. The radiation exposure is the same as for a regular mammography. We also have contrast-enhanced mammography capabilities at our hospital, that is, a contrast agent is injected into a vein in the arm, which "stains" the tumor and makes it visible. It is the best in the world for detailed and reliable breast cancer diagnosis.

Ultrasound examination of the mammary glands

Any pathological condition of the breast may require further clarification with the help of an ultrasound examination. It is carried out with a high-resolution device by a qualified doctor, and the information obtained complements this one, obtained during mammography. Ultrasound examination of the mammary glands is indicated in patients of childbearing age due to the lack of ionizing radiation.

Magnetic resonance examination of the mammary glands

Magnetic resonance imaging has established itself as an extremely reliable method in the diagnosis of some diseases of the mammary glands. During the examination, the patient lies on her stomach, and the two mammary glands are placed in a special attachment. In this way, after the introduction of contrast material into the vein of the arm, an image of both breasts is obtained at the same time. This is the most modern method for diagnosing unspecified formations in the mammary glands, for early diagnosis of patients at increased risk of breast cancer, in the diagnosis of recurrence of treated breast cancer or in women with implants in the mammary glands. Due to the absence of ionizing radiation, the method is suitable for young patients.

Risk factors

A risk factor increases the risk of cancer. Even in the presence of several risk factors, some people never get cancer, and in others the disease manifests itself even without risk factors.

Most malignant tumors, affecting the chest, are sporadic, ie. develop from accidental damage to a gene after the person is born.

The most common risk factors are::

  • Age - As you get older, the chance of developing breast cancer increases.
    Genetic predisposition – there are several inherited genes, which are associated with an increased risk of developing breast cancer, as well as other types of carcinomas. BRCA1 and BRCA2 are the most common mutations. In men, who have these mutations, the risk of breast cancer and prostate cancer is high.
  • Past breast cancer – this factor predisposes to a greater risk of developing a new tumor.
  • Family history of breast cancer - in hereditary breast cancer in families of close first-line relatives (mother, sister and children). If you have had close relatives diagnosed with ovarian cancer, this can also be considered a risk factor.
  • Of course, lifestyle is also important for the development of cancer. Increased alcohol use, unhealthy diet and insufficient physical activity can also be considered risk factors, which cause the development of carcinoma.



What are the treatment options for breast cancer??

The most appropriate treatment depends on the size and location of the breast tumor, the results of laboratory tests of cancer cells, as well as the stage or extent of the disease.

Breast cancer treatment can be local or systemic.

Local procedures are used to remove or control cancer cells in a specific area. The possibilities, related to surgery and radiation therapy, are local. In the initial stages of breast cancer, surgery is the first step, with subsequent treatment based on surgical findings, the extent of disease and pathology.

Systemic treatments such as chemotherapy are used to kill or control cancer cells throughout the body. A patient may receive only one or a combination of several different forms of treatment.


Surgery is the most important element of breast cancer treatment. It is often followed by radiotherapy, aimed at reducing the risk of local recurrence in the breast, chest wall and/or nearby lymph nodes.

The lumpectomy is the removal of the cancerous lump with some healthy tissue around it. Quadrantectomy is an older surgical procedure, in which that quarter of the breast is removed, in which the cancerous lump is. Lumpectomy and quadrantectomy are usually followed by radiation therapy to nearby tissues—the area around the removed tissue and sometimes to nearby lymph nodes. The goal of radiotherapy is to prevent recurrence. Radiation therapy is always part of the treatment package, including lumpectomy/quadrantectomy, as its role is to increase the chances of saving the breast. Unfortunately, this is not always possible.

The mastectomy is the surgical removal of the entire breast. Sometimes it is possible to restore it with a silicone implant or with your own tissue. Although less often, radiotherapy may also be required after a mastectomy.

Breast cancer often affects nearby lymph nodes. Usually the ones in the armpit are the first, in which we can detect cancer cells. When such a development of the disease is detected, surgery is undertaken, called lymphatic dissection. The modern approach is to remove one or more lymph nodes initially, in which the cancer would potentially metastasize first, and only if cancer cells are found in them, to complete the operation by dissection of the entire axilla. This limited surgery is called a sentinel lymph node biopsy. Sentinel lymph node biopsy and axillary dissection are usually done at the time of breast surgery, but in rare cases they may be done as a separate procedure.

And the lumpectomy, followed by radiation therapy, and mastectomy give the patient a similar chance of curing the cancer. The advantages and disadvantages of the two approaches in the particular case should be discussed with the surgeon and radiation therapist. Radiotherapy after surgery is prescribed, to reduce the risk of local recurrence in the breast, on the chest wall and in the area of ​​nearby lymph nodes. In some high-risk forms of breast cancer, radiotherapy also improves survival after diagnosis.

What follows after the operation

After certain surgical interventions for breast cancer, an examination of the removed cancerous tissue is performed. This helps the medical team determine the likelihood of recurrence and the best additional treatment, which may include radiotherapy, chemotherapy, anti-estrogen therapy and/or targeted (aimed) therapy. If patients are eligible, application of certain new treatments through inclusion in clinical trials is possible.

Radiation therapy

Breast radiotherapy after lumpectomy/quadrantectomy.

After the cancerous lump is removed, the operated breast is usually irradiated, and sometimes the adjacent lymph nodes. The radiation comes from an apparatus, called a linear accelerator. These rays are similar to X-rays. They are completely painless. The irradiation itself is a short procedure, usually lasts 5-10 minutes and is done once a day from Monday to Friday. The full course of radiotherapy is between 3 and 6 weeks.

A few days before the radiation starts, you will be called for a special CT scan. It is necessary for the precise planning of radiotherapy. At this visit, several small points are also placed on the patient's body, which then help to position the body correctly during radiation treatment.

Radiotherapy of the chest wall after mastectomy

Sometimes radiation therapy is also recommended in cases, when the entire breast is removed. It depends on the size of the tumor, the presence of tumor cells near the edge of the excised breast and the presence of affected lymph nodes. The practical aspects of radiotherapy are very similar to those following a lumpectomy.

Take care of yourself during radiation therapy:

  • Rest more. The body feels tired.
  • Discuss any additional medications with your doctor, which you take.
  • Eat a balanced diet and drink plenty of fluids. (Our nutritionist can help you choose the optimal diet)
  • Be careful with the skin of the breast and chest wall
  • Use only ointments and salves, recommended by your doctor.
  • Coping with the stress of diagnosis and treatment can be challenging. (See our oncology psychologist)
  • Don't be afraid to ask relatives for help, friends and acquaintances.

Potential side effects of radiotherapy:

Generally, radiotherapy to the breast or chest wall is very well tolerated. However, you may experience some side effects.

They include:

  • Fatigue easier, which usually starts in the third week, and may last up to a month or two after the radiation is completed. Just rest more.
  • Redness of the skin. It also starts in the third week and may take a week or two after radiotherapy to disappear. It looks like a sunburn. In rare cases, a blister may appear, which will heal quickly. The doctor will recommend the most suitable preparations for you.
  • The breast may swell slightly and change its consistency. To recover from this side effect, it will take several months.

Lymphedema is swelling of the arm on the same side. It is a rare side effect of modern radiotherapy methods. It is usually the result of previous armpit surgery, relapse or infection.

Sometimes radiation therapy can cause a sore throat, slight pains when breathing, mild nausea. All these side effects are usually mild and go away without special treatment.

Minimal risk (under 1%) from secondary tumors. This risk is quite low 1%, and your doctor can assess how this risk can be reduced specifically for you. Stopping smoking, if you smoke, is one way.

Drug therapy

Drug therapy is most often included in the therapeutic plan after surgery, and significantly less often before it. The goal is to destroy any remaining cancer cells or reduce the volume of the tumor. The doctors, who assess the need for such therapy and make the specific appointments, are medical oncologists.

Chemotherapy destroys cancer cells. A combination of several drugs is often used, which are determined depending on the type and stage of the disease, and are infused intravenously. There are different application schemes, but most often chemotherapy is infused through 2 to 3 weeks for several months. If considered, that radiotherapy is also needed, usually it takes place after the course of chemotherapy has finished.

Breast cancer is often dependent on the levels of female hormones in the body. Hormone therapy blocks the effect of these hormones on cancer cells. It is usually a pill, which is taken every day, but some of the hormonal preparations are in the form of an injection. Hormone therapy is usually given after chemotherapy and during radiation therapy.

Immunotherapy stimulates the own immune system to attack cancer cells. Its use depends on the type of cancer. It is only an option in certain types of cancer. The medical oncologist will explain to you how relevant it is in your case.

When chemotherapy is given?

When breast cancer is localized only to the breast or lymph nodes, chemotherapy may be given after a lumpectomy or mastectomy. This application is known as adjuvant treatment and helps reduce the risk of relapse.

Chemotherapy treatment is sometimes given before surgery (called neoadjuvant treatment), to shrink the tumor so, that it can be removed more easily or removed by a lumpectomy instead of a mastectomy. Chemotherapy may also be used as the main treatment in women, whose cancer has spread to other parts of the body beyond the breast and lymph nodes. This spread is known as metastatic breast cancer.

Source: Bulgarian Oncological Scientific Society (BOND)






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