Thoracic Lymph Nodes – an overview

1 IMMUNOLOGY AND PATHOLOGY

Sarcoidosis can involve any tissue or organ. However, the finding that 90% of patients have lesions in the lungs, thoracic lymph nodes, or both provides evidence that the disease probably begins in the respiratory tract and associated lymphatic system.² Pulmonary sarcoidosis begins as an alveolitis or an accumulation of inflammatory cells within the alveolus.^3,4 Large numbers of lymphocytes are present within the alveolar interstitium and on alveolar surfaces.^5,6 Most of the cells are T lymphocytes, many of which are activated.^5,7 The majority are T-helper cells.⁷ The increased number of T lymphocytes occurs because of increased replication.^8,11 Enhanced proliferation occurs in part because of synthesis and release by the activated T lymphocytes of interleukin-2, a T-lymphocyte growth factor. ^9,10 In addition, antigen-driven, alveolar macrophage-modulated T-cell proliferation may also be a factor.¹¹ Thus, antigen-pulsed alveolar macrophages from sarcoid patients induce a greater increment in proliferation of T lymphocytes than do cells from normal subjects. On the other hand, patients with sarcoidosis have a deficiency of T lymphocytes in the peripheral circulation.^5,8

In active pulmonary sarcoidosis, activated T lymphocytes spontaneously produce a number of factors in addition to interleukin-2 that are important in the development and maintenance of the inflammatory process: macrophage chemotactic factor,¹² leukocyte inhibitory factor,⁵ γ-interferon,¹³ but not interleukin-1.¹⁴ The macrophages in granulomas are derived from monocytes that originate in bone marrow and reach the site of inflammation by way of the peripheral circulation.¹² By release of monocyte chemotactic factor, the activated alveolar T lymphocytes recruit peripheral monocytes, thereby providing maintenance of granuloma formation. Neutrophils are seldom found, and their absence may be accounted for in part by leukocyte inhibitory factor.⁵ Also, serum lysozyme, an enzyme that inhibits the migration of neutrophils,¹⁵ is increased in sarcoidosis.¹⁶

Enhanced antibody production by pulmonary B-cells in sarcoid lesions apparently accounts for hypergammaglobulinemia that commonly occurs in the disease.¹⁷ In this regard, it was proposed that the activated T lymphocytes stimulated B-cells in the lungs to differentiate into immunoglobulin-producing cells. In patients with active sarcoidosis, the number of pulmonary B lymphocytes that secrete immunoglobulins is markedly increased and there is a significant positive correlation between the percentage of T-cells and percentage of B-cells secreting IgG.¹⁸ These results account for the paradox that circulating lymphocytes of patients with sarcoidosis do not release increased amounts of immunoglobulins despite hypergammaglobulinemia in the peripheral circulation. ¹⁶

Alveolar macrophages from bronchoalveolar lavage of patients with sarcoidosis and hypercalcemia caused by increased circulating 1,25(OH)₂D converted [³H]- 25(OH)D₃ to [³H]-1,25(OH)₂D₃in vitro.^19–22 Production of 1,25(OH)₂D in this system is enhanced in a dose-dependent fashion by γ-interferon.^21,22 γ-Interferon is produced spontaneously by activated T-cells and alveolar macrophages in sarcoidosis,¹³ and the lymphokine evidently plays a key role in the pathogenesis of synthesis of 1,25(OH)₂D in granulomatous disease. First, the concentration of γ-interferon is increased in fluid from pleural effusions of patients with tuberculous pleuritis. Second, the capacity of the fluid to stimulate synthesis of 1,25(OH)₂D by cultured pulmonary alveolar macrophages from patients with sarcoidosis correlates with the concentration of γ-interferon in the fluid. Third, production of 1,25(OH)₂D in response to pleural fluid is prevented by a monoclonal antibody to γ-interferon.²³

Receptors for 1,25(OH)₂D₃ are present in activated peripheral T lymphocytes from normal human subjects,²⁴ and 1,25(OH)₂D₃ inhibits proliferation and suppresses interleukin-2 activity²⁵ and synthesis of γ-interferon²⁶ by phytohemaglutin-stimulated human peripheral lymphocytes. 1,25(OH)₂D₃ inhibits activated T helper-inducer lymphocyte activity from normal human subjects in vitro.²⁷ If receptors for 1,25(OH)₂D are present in activated pulmonary T lymphocytes and if 1,25(OH)₂D₃ inhibits proliferation of activated T-cells and their secretion of interleukin-2 and γ-interferon in sarcoid granulomas, production of 1,25(OH)₂D by alveolar macrophages could provide a compensatory mechanism to inhibit the inflammatory process. Regardless of the role of 1,25(OH)₂D in modification of inflammation, it is evident that nonrenal production of 1,25(OH)₂D is responsible for the abnormal vitamin D and mineral metabolism that occurs in sarcoidosis.²⁸

In sarcoidosis, granulomas consist of collections of inflammatory and immune effector cells. In developing granulomas, loosely arranged epithelioid cells, derived from macrophages, are surrounded by a few lymphocytes and initially the number of macrophages, monocytes, and lymphocytes is greater than the number of epithelioid cells. Later the number of epithelioid cells increases as the number of macrophages, monocytes, and lymphocytes declines.⁴ When alveolitis predominates, few or no granulomas are present. In contrast, when extensive granulomas occur, alveolitis is minimal or absent.^5,29 Alveolitis, therefore, is thought to precede the development of granulomas in sarcoid.^4–17

After formation, granulomas either undergo resolution with little in the way of residual morphological alterations or progress to fibrosis. ^30,31 The fibrotic process begins as a deposition of collagen around the periphery of the granuloma.^3,29 It is assumed but not established that collagen is derived from fibroblasts that surround the granuloma.²⁹ As fibrosis develops, fibroblasts proliferate so that there is eventual destruction of granuloma, fibrosis, and destruction of the normal structures of the lung.^32,33 Thus, pulmonary sarcoidosis either resolves leaving little in the way of impairment of function, as occurs in some 80% of patients, or progresses to fibrosis with the development of pulmonary insufficiency and cor pulmonale, as occurs in the remaining 20% of them.

Lymph Nodes and Lymphadenopathy in Cancer | Allergy and Clinical Immunology | JAMA Oncology

Lymph nodes and the lymphatic system provide a critical filtration process for the body that is important for cancer staging and management.

What Are the Lymphatic System and Lymph Nodes?

Lymph nodes are kidney bean–shaped organs that are arranged in clusters around the body, concentrated around the neck, armpits, groin, and also up and down the middle portions of the chest and abdomen. Lymph nodes are connected to each other by lymphatic channels. Lymphatic fluid drains from all of the tissues of the body through lymphatic channels to nearby lymph nodes that serve as a form of a filter. When the immune system is activated, such as with infections or cancer, immune cells within the lymphatic system known as lymphocytes can multiply. This leads to enlargement of 1 or several lymph nodes, which is known as lymphadenopathy.

Lymph Nodes and Lymphadenopathy in Cancer Diagnosis and Staging

In a person with cancer, lymphadenopathy can occur when cancer cells travel through the filtration system of lymphatic vessels to lymph nodes. Cancer cells can travel through the lymphatic system to a new site of cancer apart from the where the primary cancer first developed. The drainage pathway for a cancer follows a predictable pattern within the body.

Lymphadenopathy can be detected either by being felt during a physical examination, or by imaging studies, such as a computed tomographic (CT) scan. Enlarged lymph nodes may be biopsied to look for cancer cells within them under a microscope.

Staging a cancer is a process of determining the size and extent of spread of a cancer from its initial location. In some cases, lymph nodes from areas that are located near the main cancer may be removed and carefully evaluated under a microscope to look for cancer cells. Detecting cancer cells in the lymph nodes means there is a higher chance that cancer cells may have escaped into the blood stream as well, which means they are more likely to lead to spread of distant metastases to other parts of the body.

Though recommendations depend on the specific type of cancer, in general, when lymph nodes are involved, additional treatment with radiation and/or chemotherapy are often recommended.

Cancer Complications Related to Lymphadenopathy

Enlarged lymph nodes may lead to several complications:

• Pain

• Hoarseness or cough for lymphadenopathy in the chest

• Numbness and tingling for lymphadenopathy affecting the spinal cord or nerves coming out of it

• Compression of blood vessels, leading to an increased risk of a blood clot

• Compression of an airway, leading to difficulty breathing

• Obstruction of lymphatic drainage from a part of the body, leading to swelling of that area

Although systemic therapies can shrink enlarged lymph nodes along with other areas of cancer, radiation therapy to an area of bulky lymphadenopathy will often lead to a more reliable and dramatic shrinkage and improvement of related symptoms.

Box Section Ref ID

Published Online: May 19, 2016. doi:10.1001/jamaoncol.2015.3509.

Conflict of Interest Disclosures: None reported.

Lymph Node Removal in Treating Patients With Stage I or Stage II Non-small Cell Lung Cancer – Full Text View

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Lymph Nodes and Cancer—Common Questions Answered | Fox Chase Cancer Center

What are lymph nodes—and what is their role in the spread of cancer? Knowing how the two are connected can help patients and their loved ones understand more about their diagnosis and treatment options. Here, Jeffrey Farma, MD, FACS, a surgical oncologist at Fox Chase Cancer Center, gives an overview of the basics.

What role do lymph nodes play in the body?

The body has a network of lymphatic channels and lymph nodes that act as a filtration system for fluids, waste, and germs. The vessels are like a highway that circulates lymph—a clear, watery fluid that brings nutrients to cells. The nodes are like hubs or stops along the highway that detoxify the lymph by fighting off harmful substances. As an integral part of the immune system, lymph nodes play a large role in fighting off infection and disease. There are thousands of lymph nodes throughout the body that are found clustered together, connected by lymphatic vessels throughout the body, in areas such as the groin, underarm (axilla), chest, abdomen, etc.

Why do lymph nodes sometimes swell?

Lymph nodes can swell when they’re trying to filter out harmful substances from an injury, infection, or cancer. Even something as simple as a cold or a bug bite can cause lymph nodes to enlarge. That’s important to keep in mind because, even though cancer can cause lymph nodes to swell, it’s not the most common cause of enlarged nodes.  

How does cancer end up in lymph nodes?

Cancer can start in the lymph nodes, like in the case of lymphoma, but it can also spread to lymph nodes from somewhere else in the body. When cancer cells break away from a tumor, they can travel through the lymphatic system and into lymph nodes or through the blood stream and invade tissues and organs in another area of the body. This is called metastasis.   

How is cancer in lymph nodes diagnosed?

When nodes are enlarged, a doctor may opt to perform a biopsy in which just a sample of the node is removed for testing. A pathologist will then look for cancerous cells within that lymph node.

Cancerous nodes can also be found when a patient undergoes surgery to have all or part of a tumor removed. During the procedure, a doctor might remove one or more nearby lymph nodes. The nodes are then examined to see if they’re cancerous. One technique to evaluate lymph nodes is called a sentinel node biopsy. This is commonly used in breast cancer and melanoma.

How is treatment affected if cancer is in the lymph nodes?

It’s different for different patients. Cancers that have moved into the lymph nodes tend to be more advanced. Often, the risk of recurrence is higher in these patients than those without lymph node involvement. The treatment options may include removal of the lymph nodes in this area, or additional treatments such as immunotherapy, chemotherapy, and/or radiation.

Are there any risks to having cancerous lymph nodes removed?

Removing cancerous lymph nodes can help keep a cancer from spreading further or coming back. But it can sometimes result in lymphedema, a condition where lymph fluid backs up in the part of the body where a node used to be. Lymphedema can cause swelling and nerve discomfort or dysfunction, but the good news is that lymphedema can often be managed or even cured. Your doctor can help you weigh the benefits and risks of having cancerous nodes removed.

Everyone’s cancer is different and when there is involvement in the lymph nodes, your doctor will take this into account when presenting you with treatment options.

Lung Cancer | Cedars-Sinai

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Overview

Lung cancer is the number one killer among cancers in both men and women. It accounts for one-third of all cancer-related deaths in the United States. Although the number of men who get lung cancer has slightly decreased recently, the number of women who contract lung cancer has steadily risen. For nearly 40 years, breast cancer was the leading cause of death in women until lung cancer replaced it in 1987. In 1997, 178,000 new cases of lung cancer were diagnosed in the United States.

Lung cancer is divided into two categories: small cell lung cancer and non-small cell lung cancer. These two types behave differently and are, therefore, evaluated and treated differently. Small cell lung cancer, which includes oat cell carcinoma, is a more aggressive disease and is often more advanced at the time of diagnosis. Treatment usually involves chemotherapy and radiation therapy. Non-small cell lung cancer includes adenocarcinoma, squamous cell, and large cell cancer. 

Surgery is the primary treatment for early stage non-small cell lung cancer. Up to 80% of non-small cell lung cancer cases can be cured by surgery, depending upon the size of the tumor and if cancer cells have spread to other parts of the organ or the body.  

Symptoms

Lung cancer may be found as a mass or tumor on the chest X-ray of a patient with no symptoms, but most patients have symptoms when diagnosed. Symptoms may include:

• A new cough, a change in an existing cough and a bloody cough
• Pneumonial
• Rib or shoulder pain
• Hoarseness
• Loss of appetite
• Weight loss
• Facial swelling
• Headaches
• Bone pain

See also thymoma, another type of tumor.

Risk Factors

Ninety percent of lung cancers are related to smoking. The risk of lung cancer is 30 times greater in smokers than in non-smokers and correlates with the total exposure to cigarettes, referred to as pack-years (packs smoked per day times the number of years smoked). One in seven people who smoke at least two packs a day will die of lung cancer. Cigar and pipe smoke double the risk of developing lung cancer, compared to nonsmokers. Approximately 5,000 to 10,000 Americans develop lung cancer per year from secondhand smoke.

Exposure to air pollution, radiation and industrial chemicals, such as arsenic, nickel, chromium and asbestos also increase the risk of lung cancer. Asbestos alone increases by four times the risk of getting lung cancer. The combination of asbestos and smoking increase the risk 90 times. Asbestos exposure is also associated with mesothelioma, a type of cancer that starts in the pleural lining of the chest. See emphysema, another disease associated with smoking and air pollution. See also sarcoidosis, another disease that can affect the lungs.

Diagnosis

Evaluation

A chest X-ray is the first step in evaluating lung cancer. Normal X-ray procedures give a good picture of the chest cavity, but a CT scan (an advanced X-ray system) is usually done to show the lung mass, lymph nodes and the rest of the chest cavity in much greater detail. These X-rays may help evaluate the extent of a lung mass and suggest the likelihood of cancer. A diagnosis of lung cancer, however, requires a biopsy.

An MRI (magnetic resonance imaging) may be part of the evaluation for a lung mass. It is especially useful in evaluating the brain and bones, but it does not visualize the lung well.

A PET scan is a relatively new nuclear medicine technique that may be very helpful in evaluating and identifying the stage of a lung mass. If a lung mass “lights up” on the PET scan, it is a lung cancer most of the time. If the mass does not light up on the PET scan, it is not likely to be a cancer. The test also evaluates the entire body to see search for any evidence that the tumor has spread to lymph nodes or other areas of the body.

Although X-rays may suggest the presence of cancer, a biopsy is needed to make the diagnosis. Biopsy is the removal and examination of biological tissue, cells or fluids. A biopsy may be performed in several ways.

Sputum – A patient can cough up a sputum sample to look for cancer cells. Sputum cytology will diagnose 75% of tumors located in the bronchi (windpipes), but only 25% of tumors located toward the edge of the lung. Most lung cancers are not in the windpipes so most cancers are not diagnosed by sputum tests. If the test does not diagnose cancer, there is no guarantee that cancer is not present.

Needle biopsy – A needle biopsy is a technique in which a radiologist anesthetizes the skin and inserts a needle through the chest into a lung mass. This is usually done in the radiology department with a CT scan to accurately direct the needle. This will diagnose 60 to 90% of lung cancers, depending on the size and location of the cancer. Even under the best circumstances, however, a needle biopsy sometimes fails to diagnose some masses that are actually lung cancers. Therefore, if the test does not diagnose cancer, there is no guarantee that the lung mass is benign (not cancer).

Bronchoscopy – Another method to obtain tissue is flexible bronchoscopy. The bronchoscope is a flexible, hollow tube that is inserted through the mouth or nose and into the bronchi (windpipes). The procedure may be performed under light sedation or a general anesthetic. If a tumor is seen in the windpipe, a tissue sample can be obtained. Light bronchoscopy is a special bronchoscope that uses a special type of light to identify cancers not seen with standard light. Most lung cancers are not visualized with the bronchoscope because they are located toward the edge of the lung, rather than in a major bronchus.

EndoBronchial UltraSound (EBUS) – EBUS is a technique with a special bronchoscope that has an ultrasound on the tip. The ultrasound identifies lymph nodes on the outside of the windpipes. The ultrasound then helps the surgeon pass a needle into the lymph node to determine if there is cancer in the node. This can both make a diagnosis and stage a lung cancer.

Mediastinoscopy – Cervical mediastinoscopy is a surgical procedure that is done under general anesthesia in the operating room. Through a one-inch incision in the neck, the surgeon follows the windpipe into the chest to remove lymph nodes. This procedure can be done on an outpatient basis. It is an important test because it not only can diagnose a lung cancer, but it also indicates the extent of the tumor so it helps determine the proper treatment. This is most often an outpatient procedure. Sadly, in the United States, about half of the mediastinoscopy procedures produce no lymph nodes for biopsy. There should be several nodes removed with this procedure. (Little)

Wedge Resection – A surgical biopsy may be necessary to determine whether or not a lung mass is a cancer. This requires hospital admission and a general anesthetic. Often, the biopsy can be obtained with three small (half-inch) incisions in a procedure called thoracoscopy or video-assisted thoracic surgery (VATS). A camera is placed through one of the incisions, while the pathologist places surgical instruments through the other incisions to remove the lung mass for examination. If cancer is found, then a complete cancer operation is performed while the patient is still asleep.

 
Stages

Small cell cancer accounts for about 25% of all lung cancer. It is staged as either limited disease (confined to the chest) or extensive disease (spread outside the chest). Small cell cancer is usually treated with chemotherapy and radiation therapy. It is rarely treated with surgery because by the time it is diagnosed it has usually spread to other parts of the body, even if the tests do not prove it.

There are four stages of non-small cell lung cancer. This staging system is important for determining the prognosis and treatment for lung cancer.

• Stage I is a cancer confined to the lung and usually treated with an operation.
• Stage II cancer that has spread to lymph nodes near the tumor and within the lung is usually treated with an operation, but may be subsequently treated with chemotherapy and/or radiation.
• Stage III cancer is confined to the chest, but it has spread more widely through the tissues in the chest.
• Stage IV cancer has spread to other parts of the body, such as the brain, liver or bones.

Evaluation and Staging of Lung Cancer

The staging and evaluation of a lung cancer involves a history and physical examination and several other tests.  Knowing the stage of your cancer helps you and your doctor develop a proper treatment plan.  Tests will also determine if you have the lung capacity to undergo treatment.

Pulmonary Function Tests – Pulmonary function tests are done to see if the patient has enough lung function so that an operation can be performed safely. The patient breathes into a machine to determine the lung capacity. If the pulmonary function test is good, then a lobectomy is the usual treatment. If the pulmonary function is not adequate, there are other surgical and non-surgical treatment options.

Brain CT Scan or MR – Lung cancer may travel to the brain so imaging of the brain is performed if the patient has headaches or neurologic symptoms, weight loss, or appears to have a more advanced stage tumor. If there are no symptoms and the tumor appears to be early stage, this is often not done because the chances of finding the tumor in the brain is low.

CT Scans – A CT of the chest is needed to evaluate the tumor. The surgeon needs to look at the tumor to determine the location so the surgeon knows where to resect and the relation of the tumor to surrounding structures to determine the extent of the resection needed to remove the tumor (just the mass, a section of the lung or the entire lung).

PET Scan – Parts of the body with an active metabolism (such as the brain, liver, tumors) absorb more glucose than other parts of the body so Fluorodeoxyglucose is injected to identify these areas. This test is often used to evaluate a mass in the lung and determine if there is spread elsewhere. In general, if a mass in the lung lights up on the PET scan, there is an 80 to 90% chance that it is cancer. A false positive test can occur if the mass is inflammatory or infection. If the lung mass does not light up on the PET, the chances of the mass being cancer are only 5%. False negative tests occur if the mass is small (<1 cm) or a low grade, slow growing tumor, such as broncho-alveolart cancer (BAC, now known as AIS). The PET scan evaluates the mediastinum (middle of the chest) to see if the lymph nodes are involved. False positive tests occur up to 25% of the time; this may be due to infection, inflammation, or anthrocosis. False negative tests occur if the area of tumor on the lymph node is small (<1 cm). Nodes that are positive on the PET generally need to be biopsied to determine if there really is tumor there.

Bone Scan – A bone scan or a brain scan, may be done to see if the tumor has metastasized (traveled) to other parts of the body.

Treatment

Cedars-Sinai, through its Samuel Oschin Comprehensive Cancer Institute, offers state-of-the-art treatment for all stages of lung cancer, including investigational studies involving new treatments that are not otherwise available. A highly integrated team approach to treating patients is an integral part of our program. Multimodality therapy is often required so the surgeons, pulmonary specialists, oncologists and radiation therapy specialists work together to formulate the best treatment plan for each patient. A tumor board and a lung cancer clinic are options for reviewing lung cancer cases so the specialists can discuss the cases to recommend treatment approaches. We are dedicated to providing the most up-to-date and compassionate care for our patients. As with all cancers, lung cancer may be treated with surgery, chemotherapy, radiation therapy or a combination thereof. The treatment depends on the type and the extent of the cancer.

Surgery for Lung Cancer

Surgery offers the best chance of a cure for lung cancer and is the treatment of choice for early stage non-small cell lung cancer, but it is not very effective for more advanced stage cancers. Operations are performed when the tumor appears to be confined to the lung and when the procedure can be performed safely. The operation involves removing the cancer and lymph nodes from the chest.

The right lung has three lobes (right upper lobe, right middle lobe and right lower lobe) and the left lung has two lobes (left upper lobe and left lower lobe). A segmentectomy or wedge resection is the removal of less than an entire lobe, a lobectomy is the removal of an entire lobe and a pneumonectomy is the removal of the whole lung.

Lobectomy – The most common lung cancer operation is a lobectomy. This has been proven to have a lower chance of cancer recurrence in the lung and to have a higher cure rate than a wedge resection or segmentectomy for a Stage I lung cancer. The cure rate for lung cancer surgery varies from 20 to 80%, depending on the stage of the tumor. For lung cancer surgery, patients are generally admitted to the hospital for three to seven days. The operation is done under general anesthesia. The most common risk is pneumonia, so patients are out of bed on the day of the operation and walking in the halls the day after the operation. During the operation, drainage tubes are placed into the chest cavity. These are connected to a collection system. These tubes are removed from the chest several days after surgery.

VATS Lobectomy – The program for the treatment of lung cancer at Cedars-Sinai Medical Center has led the charge into the 21st Century. In the United States, about 80% of lung surgery is done through large incisions (6-8 inches long) under the arm.  In contrast, the surgeons at Cedars Sinai developed minimally invasive surgery for lung cancer.

At Cedars Sinai, over 90% of lung cancer surgery is performed with small incisions (Usually about 2 inches).  Less than 3% are planned VATS operations converted to thoracotomies.   Using the most advanced surgical technology available, our surgeons perform the same operation that other surgeons perform through the large incisions.  In the US, there are many operation performed in which the nodes are not removed, but that is important for complete removal of the tumor, for prognosis, and to determine if additional treatment is needed. Cedars-Sinai is proud to be one of the few institutions in the world capable of offering patients complete lung cancer operations via minimally invasive surgery, which results in less pain, shorter hospital stays and faster recovery than traditional, invasive, rib-spreading operations. At Cedars Sinai, our surgeons have the largest experience in the world with VATS lobectomies (over 2700 cases).

Segmentectomy – Each lobe has smaller sections called segmentectomies. There are cases where the tumor is small, where the tumor does not require much tissue to be removed (carcinoid or BAC), or where the patient cannot tolerate the removal of an entire lobe so a segmentectomy can be performed. At Cedars Sinai, segmentectomy, when indicated, are also routinely performed by VATS.

Pneumonectomy – In <10% of cases, the entire lung (pneumonectomy) is required due to the extent of the tumor. This also can be performed with VATS.

Thoracotomy – A thoracotomy (big incision under the arm) is still the most common approach in the US for lung surgery. At Cedars Sinai, this is uncommon, but there are still some indications for a thoracotomy: if the tumor is too large to be removed through a small incision, if the tumor is attached to ribs that need to be resected, if the patient underwent chemotherapy and radiation before the operation, or if situation during the operation requires a thoracotomy. At Cedars Sinai, 3% of planned minimally invasive operations are converted to a thoracotomy.

Chemotherapy – Chemotherapy involves the administration of cancer-killing medication, usually via the veins. It may be used to shrink a cancer prior to a resection, to prevent recurrence of cancer after an operation or for patients who have extensive cancer that cannot be resected. There are many different chemotherapy drugs, and the side effects vary with the different medicines. Chemotherapy alone does not cure non-small cell lung cancer, but it is the primary treatment for small cell lung cancer.

Radiation Therapy – Radiation therapy is an X-ray treatment that usually takes a short time and is given every day for several weeks. Like chemotherapy, it may be given prior to surgery, after surgery or instead of surgery. The side effects are usually minimal and may include a tiredness, skin burns similar to sunburn, esophagitis and nausea. Although radiation may cure lung cancer, only 5 to 10% of patients who receive this therapy are considered cured.

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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Lymphadenopathy – Knowledge @ AMBOSS

Last updated: October 27, 2021

Summary

Lymphadenopathy is the enlargement of lymph nodes and most commonly occurs during benign, inflammatory processes. In pediatric patients, lymphadenopathy is usually caused by upper respiratory tract infections (see “Cervical lymphadenopathy”). Painful, enlarged lymph nodes in adults, paired with signs of localized or systemic infection, are generally caused by some type of bacterial or viral infection. Malignancy must be considered in the case of painless, progressive lymph node swelling in the absence of signs of infection, in which case further diagnostic testing (e.g., serology, imaging, biopsy, and histological analysis) is necessary in order to make the diagnosis.

Etiology

References:^[1]

Pathophysiology

To remember the different causes of lymphadenopathy, think “MIAMI”: Malignancy (e.g., lymphomas), Infection (e.g., TB), Autoimmune disease (e.g., SLE), Miscellaneous (e.g., sarcoidosis), and Iatrogenic (medications).

References:^[3]

Diagnostics

• General: assess for both local inflammatory processes (e.g., enlarged neck lymph nodes due to tonsillitis) and signs of systemic disease (e.g., hepatomegaly and splenomegaly)
• Peripheral lymph node examination:
  • Inspection
    • Visible enlargement: Lymph nodes should not be visible in healthy individuals, as they are only a few millimeters in diameter.
    • Local erythema, swelling, or lesion
  • Palpation
    • Gentle palpation using fingertips
    • The area to be examined should be relaxed to facilitate differentiation of the lymph node from the surrounding tissue (e.g., muscles, tendons).
    • Evaluation of size and level of pain consistency, and fixation.
    • Conduct the following :
      • Palpation of head and neck lymph nodes
      • Palpation of the axillary lymph nodes
        • Support the patient’s relaxed arm with your own. Warn the patient that the exam might be uncomfortable.
        • With one hand, palpate high into the axillary region, pressing your fingers against the chest wall behind the pectoralis muscle and sliding downward.
        • Palpate the subclavicular, lateral, pectoral, and central lymph nodes. The central lymph nodes are typically the most palpable.
        • Move on to palpate the supratrochlear nodes, which are located 3 cm above the elbow.
        • A common cause of axillary lymphadenopathy is breast cancer.
      • Palpation of the inguinal lymph nodes

Soft, mobile, and tender lymph nodes are likely benign. Hard, nonmobile, nontender lymph nodes should raise concern for malignancy. Firm, nontender lymph nodes in patients with sarcoidosis or tuberculosis are exceptions.A palpable, firm lymph node in the left supraclavicular area is called a Virchow node and is classically associated with gastric carcinoma.

Further diagnostic testing

• Acute, painful (localized or systemic) lymph node enlargement potentially associated with localized inflammation or infection (e.g., herpes labialis, pharyngitis).
  • In general, no further diagnostic testing is necessary.
  • If diagnosis and treatment decision is unclear, test for:
• Chronic, localized, nonprogressive lymph node enlargement: In general, no further diagnostic testing is necessary.
• Painless, slowly progressing lymph node enlargement (generalized or localized) or in any other case of unexplained lymph node enlargement suggestive of malignant disease

References:^[3][4][5]

Differential diagnoses

Differential diagnoses according to characteristics of enlarged lymph nodes

^[2]

Generalized lymphadenopathy is defined as the enlargement of more than two noncontiguous lymph node groups.

Differential diagnoses according to location of enlarged lymph nodes

See “Lymph node clusters” in “Lymphatic system.”

The differential diagnoses listed here are not exhaustive.

References

1. Gaddey HL, Riegel AM. Unexplained Lymphadenopathy: Evaluation and Differential Diagnosis.. Am Fam Physician. 2016; 94
   (11): p.896-903.

2. Gaddey HL, Riegel AM. Unexplained Lymphadenopathy: Evaluation and Differential Diagnosis. Am Fam Physician. 2016; 94
   (11): p.896-903.

3. Kanwar VS. Lymphadenopathy. Lymphadenopathy. New York, NY: WebMD. http://emedicine.medscape.com/article/956340-overview#showall. Updated: February 14, 2017. Accessed: March 27, 2017.
4. Physical Examinations II. Lymph Node Exam.
   https://www.jove.com/science-education/10061/lymph-node-exam.
   Updated: January 1, 2018.
   Accessed: July 5, 2018.
5. Lymphadenopathy.
   https://www.merckmanuals.com/professional/cardiovascular-disorders/lymphatic-disorders/lymphadenopathy.
   Updated: January 1, 2019.
   Accessed: May 14, 2019.

6. Ferrer R. Lymphadenopathy: differential diagnosis and evaluation.. Am Fam Physician. 1998; 58
   (6): p.1313-20.

7. Lucey BC, Stuhlfaut JW, Soto JA. Mesenteric lymph nodes seen at imaging: causes and significance. Radiographics. 2005; 25
   (2): p.351-365.
   doi: 10.1148/rg.252045108 . | Open in Read by QxMD

Symptoms of Lymphoma: How to Recognize Them Early

Symptoms of lymphoma often depend on the type you have, what organs are involved, and how advanced your disease is.

Some people with lymphoma will experience obvious signs of the disease, while others won’t notice any changes.

Recognizing the symptoms of lymphoma can improve your chances of receiving a timely diagnosis and prompt treatment.

Swollen Lymph Nodes: A Common Symptom

The two main types of lymphoma, non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma, can both cause swollen or enlarged lymph nodes.

Your lymph nodes are part of your immune system and work by helping to circulate lymph fluid, which contains immune cells, throughout your body. (1) There are about 600 lymph nodes in your body. (2)

Enlarged lymph nodes might feel or look like lumps under the skin, which typically don’t cause discomfort.

Common sites for enlarged lymph nodes include:

• Side of the neck
• Groin
• Underarm area
• Above the collarbone

While enlarged lymph nodes are a symptom of lymphoma, they’re more commonly caused by infection. In other words, swollen lymph nodes don’t necessarily mean you have cancer. (3, 4)

Other Symptoms of Non-Hodgkin Lymphoma

General Symptoms

Other general symptoms of NHL include:

• Fever, sweating, and chills
• Fatigue
• Unexplained weight loss
• Loss of appetite
• Frequent or severe infections
• Easy bleeding or bruising

Symptoms Depending on Cancer Location

NHLs that start in the abdomen can cause your spleen or liver to enlarge, which can lead to swelling or pain in that area. If the cancer affects your stomach or intestines, it can cause nausea or vomiting.

Lymphomas that press on the superior vena cava, a large vein in your upper chest, can cause trouble breathing; a change in consciousness; or swelling in the neck, head, or arms.

NHLs in the chest may cause pain, pressure, coughing, or trouble breathing.

If the lymphoma affects your brain, it can spark headaches, trouble thinking, personality changes, weakness, or seizures. When these cancers travel to areas around the brain or spinal cord, they can trigger many neurologic issues, including double vision, trouble speaking, and facial numbness.

NHLs that start in your skin can cause itchy, red or purple bumps to form. (3)

Other Symptoms of Hodgkin Lymphoma

General Symptoms

Hodgkin lymphoma may cause the following general symptoms:

• Fever
• Night sweats
• Unexplained weight loss
• Itchy skin
• Fatigue
• Loss of appetite

Symptoms Depending on Cancer Location

If a lymphoma affects lymph nodes in your chest, you might experience coughing, chest pain, or trouble breathing, especially when lying down. (4)

B Symptoms

Doctors commonly group specific signs of lymphoma together and label them B symptoms.

B symptoms include the following:

• Fever
• Drenching night sweats (so bad you have to change your clothes or sheets)
• A loss of more than 10 percent of your total body weight over a six-month period

Classifying these symptoms can help physicians give you a more accurate prognosis. (2)

Symptoms That Overlap With Other Conditions

Many symptoms of lymphoma are also present in other, less serious illnesses, such as an infection like the flu or a common cold. These shared symptoms might include swollen lymph nodes, fatigue, fever, tiredness, and other signs.

One important distinction is that symptoms of a less serious problem usually won’t last long. On the other hand, symptoms of lymphoma typically persist. (5)

When There Are No Symptoms at All

Some people with lymphoma don’t experience any bothersome issues, which means they’re asymptomatic. Or they might not recognize their symptoms as being severe.

Individuals with the following types of lymphoma are more likely to be asymptomatic:

• Follicular lymphoma
• Small lymphocytic lymphoma (SLL)
• Marginal zone lymphoma
• Slow-growing subtypes of lymphoma

Having no symptoms of lymphoma can make getting an early diagnosis more challenging. (6)

When Should You See a Doctor for Your Symptoms?

You should see your doctor if you have any unusual symptoms that don’t go away. Your symptoms are most likely caused by something else, but it’s important to get checked out just in case.

Your practitioner will probably perform a physical exam to check for swollen lymph nodes and any other possible signs of the disease. If your physician thinks your symptoms might be lymphoma, he or she will likely order additional tests and may get a biopsy of a lymph node. Depending on the results of these tests, you might be sent to a specialist, such as a hematologist or oncologist.

Regular checkups are especially important for people who are at a greater risk of developing lymphoma, such as those with an autoimmune disease, someone who’s had previous cancer treatment, or an individual with human immunodeficiency virus (HIV). (7)

Questions Your Doc Might Ask During the Appointment

To determine if your symptoms are caused by lymphoma, your healthcare provider might ask you the following questions:

• What are your symptoms?
• When did your symptoms start and how long have they persisted?
• How severe are your symptoms?
• Do your symptoms come and go or are they consistent?
• Does anything you do tend to improve or worsen your symptoms?
• What other medical conditions do you have?
• Have you ever had any type of autoimmune disorder?
• Has anyone in your family ever had cancer? If so, what type?
• Have you or your family members ever been exposed to toxins?
• What medication are you taking?

It’s a good idea to write down your symptoms, any questions you have, and all the medicines you take before seeing your doctor. Sometimes, having a family member or close friend accompany you to your appointment is also helpful. (8)

Why It’s So Important to Spot Symptoms

The best way to identify lymphoma early on is to report any possible symptoms to your doctor.

Just like with other cancers, diagnosing lymphoma in its early stages can lead to a better outcome.

The sooner you can get an accurate diagnosis, the earlier you can start on effective treatments. (7)

90,000 BRA FITTING MASTER’S REFERENCE. PART II

INTIMODA CONTINUES THE CYCLE OF ARTICLES OF THE FAMOUS POLISH BRA-FITTER SALAD CATAGINES.

As a result of the constant pressure of the wrong-style bra on the body, the
the risk of impaired lymph movement, which can lead to the appearance of edema and
inflammatory processes in the mammary gland,
and also cause pain during use
linen.Penetrated with a dense network of blood vessels and strongly innervated mammary glands are especially sensitive to temperature, injury, and above all to prolonged squeezing. Due to this
development of bra-fitting, taking into account knowledge
medicine, as well as attracting attention
clients to aspects of bra-fitting directly related to health, is, in my opinion, extremely important in the work of a bra-fitter.
When I first saw the picture of the lymphatic system of the chest four years ago, I immediately noticed one detail: the shoulder straps, underwire, bridge and bra belt are located exactly where the lymph nodes are located! I then worked with a group of bra-fitters, and we learned how to choose the right underwear for women after mastectomy (removal of one or both breasts) or with sectoral resections.In order to exclude the possibility of impaired lymph movement and to prevent the occurrence of lymphatic edema of the upper extremities from the side of the removed mammary gland, issues related to the work of the lymph nodes and the prevention of excessive pressure of the bra in this area were extremely important to us. Then I realized that preventing excessive squeezing the lymph nodes is extremely important not only for Amazons, but also for women who have not had breast cancer.

BRA-FITTING – HEALTH AND COMFORT
From that moment on, during bra-fitting sessions, I began to ask clients where pain occurs when using the lingerie. It turned out that the most painful are the area directly under the mammary glands, as well as the place on the armpits, where the bones end. I began to analyze what is the reason for this.I watched where the bones and the belt are located and what is the force of their pressure if clients complain of discomfort; at what point does this discomfort arise: when they sit quietly or actively move.
It became clear to me that it was necessary to develop new methods of selection and fitting of bras, which can be guided during bra-fitting, and I began to deepen my knowledge in three areas at the same time. First, I began to observe the structure of the chest and study the characteristic features of the figures: the structure of the ribs, sternum and shoulders, the height of the mammary glands and the distance between them.Secondly, I began to take into account the type of breathing of the client and the change in the volume of the chest during breathing. And finally, she began to study the anatomy of the breast and the structure of the lymphatic system in the chest area.
I wrote about the first two directions in the article in the previous issue (1/2018 Intimoda), and now I would like to dwell on the third in more detail.

LECTURE ON ANATOMY
The structure of the mammary gland
Did you know that a whole class of vertebrates – mammals (lat.Mammalia)? The mammary glands are located symmetrically on the anterior chest wall between the third and sixth or seventh pairs of ribs. The distance between them depends on the individual structure.
Most of the mammary gland is located on the pectoralis major muscle, and only an insignificant lateral part is located on the serratus anterior muscle (Bochenek A., Reicher M. Gruczoł sutkowy. Anatomia człowieka. T V. PZWL 2008).
The chest is located under the collarbone, medially bounded by the edge of the sternum, and laterally by the middle axillary line.
The figure shows that the mammary gland consists of three types of tissue: glandular, located primarily in the area of ​​the areola of the nipple, connective and adipose (subcutaneous adipose and adipose tissue located by the gland and between the glands). The volume of these tissues can be different for different people, so doctors isolate breasts with a predominance of adipose or glandular tissue. According to studies, the ratio of these tissues in humans is genetically determined and can only slightly change depending on hormonal levels or with age.That is why knowledge regarding physiological changes and individual needs of the client will help us in the process of choosing lingerie.

The mammary glands are permeated by a network of lymphatic and blood vessels
(veins and arteries), and in the skin of the chest and armpits are located
sensory nerve endings. This causes an increased reaction to
pathogens in these areas, including any interactions between
the surface of the bra and the body: pressure or friction as a result
movement of material and bra elements.In this regard, when communicating with
the client needs to explain to her the connection between, for example, too
a small cup and discomfort or pain in the armpit
depressions.

Why does the breast have this shape?
The mammary glands have a semicircular or conical shape and are a paired organ, as well as the largest cutaneous gland. For mammary glands without muscles, the natural “rocker” is the skin, ligaments and fascia, consisting of dense connective tissue.The history of the study of the structure of the mammary gland is quite young. I would like to draw your attention to two significant events associated with it.
The first is the classification of Cooper’s ligaments in 1840. The name comes from the surname of the author of their discovery – Astley Cooper. Cooper’s ligaments are strips of fibrous (dense connective) tissue that support the breast from above and below and lift it up. They run from the skin through the mammary glands to the edge of the pectoral muscle.
According to the research of Dr. Joanna Skour of the University of Portsmouth in the UK, in people over 45, the strength of these ligaments is weakened by 65% ​​and elasticity by 40%, compared with young people.

The second and one of the most recent developments in the field of research devoted to the study of the structure of the mammary gland is the discovery in 1996 by the German plastic surgeon Elisabeth Wühringer of the horizontal and lateral supportive ligaments. Wühringer ligaments are the strong connective tissue that holds the mammary glands (like in a U-shaped cradle) and supports the entire structure of the gland (source: https: // clinicalgate.com / the-central- septum-in- breast-reduction-and-mastopexy / 28.06.2018).
Research by Johanna Skur (2009) in breast biomechanics has shown that the mammary gland moves in three directions, with only 44% of the movements occurring vertically. To prevent sprains, improve breast health and reduce the risk of sagging, it is necessary to provide the right support by stabilizing the bra belt and choosing the right cup size to completely cover the breast.The breasts require support and re-fitting of the bra for every event in life that can lead to changes in breast size: puberty, pregnancy, breastfeeding, menopause, weight changes, sports and physical labor, and aging.

Lymphatic system
The lymphatic system encompasses the entire body. If you look at the diagram of the lymphatic system in the chest area, you will notice that the straps, bones and the belt are located exactly in those areas where the lymphatic vessels and lymph nodes pass (axillary axillary, axillary axillary, sternum, supraclavicular and epigastric).
Lymph nodes are located along the lymphatic vessels. They are shaped like a bean seed and range in size from 2 to 20 mm. They participate in the proper functioning of the immune system – they remove bacteria, viruses and fungi, collect lymph with the help of the lymphatic vessels.
Lymph flows through the lymphatic vessels, therefore, if the pressure is too strong in this area, edema and even cysts may occur as a result of injuries or disturbances in the movement of tissue fluid.
Interestingly, the more I talk with clients about the structure of the breasts and the location of the lymph nodes, share with them knowledge and explain the impact of the wrong choice of bra on their health, the more often I notice that such sincere communication maintains mutual trust and promotes building relationships …In addition, I get useful information, for example, what causes discomfort when using a bra, or what is most important about a bra that a client wants to buy.

A delay in the movement of lymph due to prolonged squeezing of the lymphatic vessels or lymph nodes in the area of ​​the mammary glands can occur due to: in relation to the anatomical shape of the breast,
* pressure of the bones on the breast tissue or friction in the armpit,
* incorrect selection of the cup size – too small or too large, which also leads to excessive pressure of the bones, straps and bra belt on the mammary glands and the area underneath,
* incorrect positioning of the bra strap – too high or too much pressure,
* incorrect putting on the bra.

FIVE WAYS TO SELECT AND FIT THE CORRECT BRA
1 Check the fit of the belt. Too low and too loose, it will fall on the diaphragm – the main respiratory muscle – and can weaken it
work, negatively affecting the functioning of the respiratory system and the circulatory system.
2 Train the client to move breast tissue into the bra cup, starting from the shoulder blade.Then the bones will be located around
mammary gland and it can be argued that the cup size and shape of the bones are selected correctly. If the cups are small or large, if the cut does not fit the figure, the bones will dig into the body, exerting constant pressure on the mammary gland and other parts of the body, which can cause pain. 3 Check if the space at the base of the breast between the bone and the breast edge is filled. If there is an empty space,
move the bone up, directly to the base of the breast.This is important in order to avoid excessive compression of the epigastric lymph nodes and other abdominal organs, which in turn can lead to discomfort.
4 Check in three positions that the bones are correctly positioned: in the position opposite the mirror and at the side with the arm raised for the right and left breast. In the case of an asymmetric breast, the bone on the larger mammary gland will be directed forward, and on the smaller one – towards the back. Choose a cut that is optimally positioned around the edge line on both sides of the breasts.
5 Explain to the client that the bra straps that are in line with where they are attached to the cup will reduce the pressure on the sternocleidomastoid and trapezius muscles. Thus, you can avoid the appearance of muscle pain as a result of circulatory disorders, and problems with turning the head and neck in different directions.
Knowledge of the structure of the breast and an understanding of the functions of the lymph nodes will help the client to understand the consequences of the influence of a bra on these areas and to understand the relationship between choosing the right bra and health.
When the client understands the reasons why we choose a different style or size of bra for her, she will listen to our opinion. It is also necessary to talk about the consequences of such a choice: for example, the discomfort in the process of using a bra will disappear, the woman will feel better, or her health will benefit from this.

KATAZHINA SALADA
Katarzyna Salata has been working in the lingerie industry since 2006, and in 2013 she founded the international independent consulting company Dobra Kreacja.She advises teams of designers and design bureaus of lingerie firms. She was the first in bra-fitting to start taking into account the individual anatomical features of the chest when choosing a bra. Katarzyna is a specialist in the field of linen designs, as well as a fitting and sales technician, and conducts trainings for manufacturers, wholesalers and service personnel of stores in the country and abroad. She provides active assistance to “Amazons” (women who underwent breast surgery), conducts professional master classes in bra-fitting (International Brafitting MasterClass), as well as individual seminars for lingerie salons.
www.DobraKreacja.pl facebook.com/DobraKreacja

90,000 Invasive lobular breast cancer – MyPathologyReport.ca

What is invasive lobular carcinoma?

Invasive lobular carcinoma is a type of breast cancer. The tumor develops from specialized epithelial cells that are usually found inside the gland and ducts of the breast. Invasive lobular carcinoma usually begins with a non-cancerous growth of abnormal breast cells called lobular carcinoma in situ (LCIS).Lobular carcinoma in situ can exist for months or years before developing into invasive lobular carcinoma. In addition, patients with a previous diagnosis of lobular carcinoma in situ have a higher risk of developing invasive lobular carcinoma.

Chest

The tissue of the adult breast is made up of small structures called glands that are organized into groups called lobules. Under certain conditions, these glands can produce milk, which is transported to the nipple through a series of small ducts called ducts.

Inside the glands and ducts are specialized cells called epithelial cells that form a barrier called the epithelium. The tissue surrounding the glands and ducts is called the stroma and contains long, thin cells called fibroblasts.

Genetic syndromes associated with invasive lobular carcinoma

Several genetic syndromes are also associated with an increased risk of invasive lobular carcinoma. If you or a member of your family has been diagnosed with Breast Ovarian Cancer Syndrome (BRCA2) or CDh2 Gene Changes Syndrome, you should discuss the risk of breast cancer with your doctor.

How do pathologists make this diagnosis?

Lobular carcinoma is usually diagnosed after a small sample of tissue is removed using a procedure called a biopsy. Then another surgery can be performed to remove the entire tumor. Depending on the amount of breast tissue removed, the procedure may be called a lumpectomy (which means removing the tumor) or mastectomy.

Histological type

There are two different types of lobular carcinoma, depending on how the cancer cells look when examined under a microscope.

1. Classic type – This is the most common type of lobular carcinoma. Cancer cells are small and they travel through the tissue as separate cells (they are not attached to other cancer cells).
2. Pleomorphic type – Cancer cells in the pleomorphic type are larger and more abnormal than cells in the classical type. The cell nucleus (the part of the cell that contains most of the genetic material) is also darker and larger than the classical type nucleus. Compared to the classic type of lobular carcinoma, the pleomorphic type of lobular carcinoma is more likely to spread to the lymph node and other parts of the body.

Histological Grade

Pathologists use the word class to describe the difference between cancer cells and normal epithelial cells, this lineage inside ducts and glands in the breast.

The grade can only be determined after the tumor has been examined under a microscope. Your pathologist will look for the next three microscopic objects to determine the grade.

1. Glands – A score of 1 to 3 is given based on the percentage of cancer cells that form the glands.Tumors consisting mainly of glands receive a score of 1, while tumors consisting of a very small number of glands receive a score of 3. Cells in lobular carcinoma do not form a gland and always get a score of 3 for this feature.
2. Nuclear pleomorphism – The nucleus is the part of the cell that contains most of the cell’s genetic material (DNA). pleomorphism (or pleomorphic) is a word that pathologists use when the nucleus of one tumor cell is very different from the nucleus of another tumor cell.Nuclear pleomorphism scores from 1 to 3. When most cancer cells are small and very similar to each other, tumors are given a score of 1. When cancer cells are very large and look abnormal, tumors are given a score of 3.
3. Mitotic Velocity – The cell that divides to create a new cell is called the mitotic figure. Your pathologist will count the number of mitotic figures in a specific area (called a high power field) and will use that number to give a score from 1 to 3.Tumors with very few mitotic figures receive a score of 1, while tumors with a large number of mitotic figures are assigned a score of 3.

A score from each category is added to determine the overall histological score as follows:

• Grade 1 – Grade 3, 4, or 5.
• Grade 2 – Grade 6 or 7.
• Grade 3 – Grade 8 or 9.

High-grade tumors (grades 2 and 3) grow faster than low-grade tumors (grade 1) and are more likely to spread to the lymph node and other parts of the body.

Estrogen Receptor (ER), Progesterone Receptor (PR) and HER2 Status

Estrogen and progesterone receptors are proteins produced by normal breast cells that allow the cells to respond to the hormones estrogen and progesterone. HER2 is a special type of protein that allows cancer cells to grow faster than normal cells.

Your pathologist will check your tumor to determine if it is causing ER, PR, or HER2. Tumors that cause ER or PR are considered hormone positive, and tumors that produce extra HER2 are called HER2 positive.Tumors that do not produce any of these proteins are termed triple negative.

Most lobular carcinomas cause ER and PR and very few produce additional HER2.

Tumors producing ER, PR, or HER2 are treated with drugs that target the activity of these proteins. After reviewing your pathology report, your doctor will discuss with you the treatment options that are most suitable for you.

What to look for in your report after tumor removal

Tumor size

This is the size of the tumor.A tumor is usually measured in three dimensions, but your report only describes the largest size. For example, if the tumor is 4.0 cm by 2.0 cm by 1.5 cm, your report will describe a tumor that is 4.0 cm. Only the aggressive part of the tumor is included in the size.

The size of the tumor is used to determine the stage of the tumor (see Pathologic Staging below), and large tumors are more likely to spread to the lymph node and other parts of the body. The tumor is size 0.1 cm or less is usually called microinvasive.

Expansion of the tumor

Lobular carcinoma begins inside the breast, but the tumor may spread to the overlying skin or muscles of the chest wall. Finding cancer cells in the skin or chest wall is called tumor spread.

Spread of the tumor increases the stage of the tumor (see Pathological Stage below). It is also associated with a higher risk that a tumor will grow back after treatment or that cancer cells will spread to distant parts of the body, such as the lungs.

Multiple tumors

If more than one tumor is found in your tissue sample, each tumor will be described separately. The stage of the tumor (see “Pathologic Stage” below) is determined by the largest tumor identified.

Lymphovascular invasion

Blood moves through the body through long, thin tubes called blood vessels. Another type of fluid called lymph, which contains waste products and immune cells, travels through the body through the lymphatic channels.

Cancer cells can use blood vessels and lymph vessels to travel from the tumor to other parts of the body. Moving cancer cells from a tumor to another part of the body is called metastasis.

Before cancer cells can metastasize, they must enter a blood or lymph vessel. This is called lymphovascular invasion. Lymphovascular invasion increases the risk of finding cancer cells in a lymph node or distant part of the body, such as the lungs.

Lymph node

The lymph node is a small immune organ located throughout the body. Cancer cells can travel from the tumor to the lymph node through lymphatic ducts located in and around the tumor (see Lymphovascular invasion above). The movement of cancer cells from a tumor to a lymph node is called metastasis.

Your pathologist will carefully examine each lymph node for cancer cells. Lymph nodes that contain cancer cells are often called positive, and those that do not contain cancer cells are often called negative.Most reports indicate the total number of lymph nodes examined and the number of cancer cells, if any.

Three types of lymph nodes can be described in your report:

• Sentinel axillary lymph node – This is the first lymph node in the lymph node chain to drain fluid from the breast. If cancer is found in the armpit, it is usually found first in the sentinel node.
• Nonstasis axillary lymph node – This type of lymph node is located after the sentinel lymph node in the armpit.Cancer cells usually enter these lymph nodes after passing through the sentinel lymph node.
• Internal Breast Lymph Node – This type of lymph node is found in the breast itself. Cancer cells can travel to these lymph nodes if the lymph node is near the tumor.

If cancer cells are found in a lymph node, the size of the area affected by cancer will be measured and described in your report as follows:

• Isolated tumor cells – The area of ​​tumor cells is less than 0.2 millimeters and less than 200 tumor cells.
• Micrometastases – The area of ​​tumor cells is more than 0.2 millimeters, but less than 2 millimeters.
• Macrometastases – The area of ​​tumor cells is more than 2 millimeters.

Finding cancer cells in a lymph node is associated with an increased risk of cancer returning to distant parts of the body, such as the lungs, in the future. This information is also used to determine the nodal stage (see.Pathological stage below).

Fields

A margin is any tissue the surgeon has cut to remove a tumor from your body. Whenever possible, surgeons will try to cut tissue outside the tumor to reduce the risk that any cancer cells will remain after the tumor is removed.

Your pathologist will carefully examine all edges of the tissue sample to see how close the cancer cells are to the edge of the cut tissue. The fields will be described in your report only after the entire tumor has been removed.

Negative margin means there were no cancer cells at the very edge of the cut tissue. If all margins are negative, most pathology reports will indicate how far the nearest cancer cells were to the border. Distance is usually indicated in millimeters.

The limit is considered positive if the cancer cells are at the very edge of the cut tissue. A positive margin is associated with a higher risk of a tumor growing (recurring) in the same area after treatment.

Healing effect

If you have undergone treatment (chemotherapy or radiation therapy) from cancer to tumor removal, your pathologist examines all of the tissue presented to determine how much of the tumor is still alive (viable). Lymph node cancer cells will also be examined for therapeutic effects.

The therapeutic effect is reported as follows:

1. No residual tumor – all cancer cells are dead
2. Probable effect – some cancer cells are dead, but some are still alive
3. No definitive answer – most cancer cells are still alive

Pathological stage

Pathologic stage of lobular carcinoma is based on the TNM staging system, an internationally recognized system originally created by the American Joint Committee on Cancer.

This system uses information about the primary tumor (T), lymph node (N) and distant metastatic disease (M) to determine the complete pathologic stage (pTNM). Your pathologist will examine the tissue presented and assign a number to each part. In general, a higher number means more advanced disease and worse. forecast.

Tumor stage (pT) in invasive lobular carcinoma

Lobar carcinoma is assigned a tumor stage from 1 to 4, depending on the size of the tumor and the presence of cancer cells in the skin or muscles of the chest wall.

Nodal stage (pN) invasive lobular carcinoma

Lobular carcinoma has a nodal stage from 0 to 3, depending on the number of lymph nodes that contain cancer cells, the number of cancer cells found in the lymph node, and the location of the lymph nodes with cancer cells.

Metastatic stage (PM) invasive lobular carcinoma

Lobular carcinoma is assigned metastatic stage 0 or 1, depending on the presence of cancer cells in a distant part of the body (for example, in the lungs).The metastatic stage can only be determined if tissue from a distant site is sent for pathological examination. Because this tissue is rarely dispatched, the metastatic stage cannot be identified and is referred to as pMX.

Jason Wasserman MD, FRCPC (updated Jul 21, 2021)

Diagnostics of breast cancer – clinic “Family Doctor”.

The mammary gland is an organ in which tumors, both benign and malignant, develop very often, and the latter are much more common.

Among all malignant tumors in women, breast cancer is one of the first places. At the same time, according to the majority of modern clinical and statistical studies, the incidence of breast cancer is increasing throughout the world.

The increase in the number of patients with breast cancer cannot be attributed solely to improved early diagnosis, better registration of patients with precancerous conditions, and effective health education.

It is known that the glandular (milk) epithelium, due to neuro-endocrine influences, constantly changes during the periods of the menstrual cycle, pregnancy, menopause. In this case, the activity of the mammary gland is in close hormonal connection with the ovaries, pituitary gland, adrenal glands. The role of hormonal factors in the occurrence of breast cancer is confirmed by clinical and statistical studies. It is known that breast cancer rarely occurs before puberty, i.e.e. up to about 18 years. With age, as a woman’s body ages, the incidence of cancer increases significantly. Finally, breast cancer is more common among non-pregnant and nulliparous women and women who have given birth but did not breastfeed.

The connection of hormonal disorders with the appearance in the mammary gland of various forms of benign tumors, fibrocystic mastopathy is especially noticeable. The latter, as well as fibroadenomas, are dyshormonal precancerous diseases of the breast.The frequency of degeneration of benign dyshormonal tumors into cancer, according to different authors, ranges from 0.8-1.8 to 15-52.4%. Particularly unfavorable neoplasms in this regard include nodal forms of fibrocystic mastopathy and proliferating cystadenomas.

Pathological studies show a variety of forms of breast cancer. Almost all of them, except for Paget’s cancer, arise in the thickness of the organ at different depths, more often along the outer edge of the mammary gland.Gradually increasing in size and growing, the tumor captures the surrounding tissues, primarily the nearby tissue and milk ducts. Over time, muscles, fascia, and skin are involved in the cancer process.

The growth rate of a cancerous tumor is different and depends on many factors.

In young women, tumor growth, spread and metastasis is much faster. There are 2 main directions of the nearest (regional) metastasis: axillary and retrosternal (parasternal).The first of them is the main one, since the axillary lymph nodes allow lymph flowing from all parts of the mammary gland to pass through. Then it follows through the sub- and supraclavicular lymph nodes.

It is these listed collectors that are affected by metastases in the first place, especially when the primary cancerous tumor is localized in the outer quadrants of the mammary gland and when it is centrally (parasilic) located. Tumors growing in the inner sectors of the gland are capable of affecting parasternal lymph nodes with metastases.

There are no uniform rules or laws for metastasis. Both immediate and distant metastases can appear at any time before and after radical treatment. Distant metastases most often affect the lungs, liver, and skeletal bones. Described lesions by distant metastases of almost all, without exception, other organs and systems.

IN BREAST CANCER, in the initial period of its onset, clinical symptoms and complaints, as a rule, are absent.

Most often, a seal in the mammary gland is first discovered by chance by the patient herself or by a doctor, sometimes when examining other organs, conducting an ECG, etc.etc.

It is necessary to take into account the presence in the past of a “bruise of the chest”, since there are many observations when the appearance of a cancerous tumor in the gland was preceded by its trauma.

IF BREAST TUMOR IS DETECTED, SEE YOUR DOCTOR IMMEDIATELY !!!

WHAT SHOULD NOT BE DONE IN NO EVENT:

Never seek advice on a breast tumor from healers, grandmothers and “religious” leaders.Such appeals often, but almost always cost human life.

Despite the abundance of information about treatment centers, now, already in the 21st century, women came to our reception, who, on the advice of, to put it mildly, ignorant people, and in legal terms, criminals brought their disease to incurable stages. Surprisingly, in 2005. a woman came, who had been treating a small tumor of the mammary gland with lard and kerosene for half a year on the advice of a neighbor. When she went to the doctor, all nearby lymph nodes and the spine were affected by metastases.She applied only because the tumor, in spite of the “treatment”, became larger, and “skin allergy” appeared on the “drug”, which, upon examination, turned out to be the involvement of the skin in the cancer process (read – 4th stage). You can’t even bring a neighbor to justice, since she is not even an illegal healer, and the woman died. It must be remembered that cancer is curable BUT if the disease is detected by a doctor at an early stage.

The Church, on the other hand, considers healing to be a godly affair and, as a rule, Orthodox priests always give blessings for surgery and treatment.If this does not happen, then, as they say, something is wrong here.

THE SYMPTOMS LISTED BELOW ARE A FURTHER PROCESS IN DEPARTMENT:

PAIN – there is almost no pain in the early stages of breast cancer. In a number of cases, moderate pain appears for the first time in the axillary region, where a “packet” of dense lymph nodes is determined by palpation.

Severe pain, especially of a stabbing or pulsating nature, is more often accompanied by various benign diseases of the mammary glands, mainly of inflammatory origin.

In advanced cases of breast cancer, squeezing large nerve trunks, intense excruciating pain appears that radiates to the back, shoulder blade, arm. The sharpest debilitating back pains are noted with metastatic lesions of the spine.

CHANGE OF THE BREAST FORM – in breast cancer, as a rule, various kinds of deformities are noted, the more pronounced, the longer and more advanced the disease. So, a decrease in size, wrinkling, blurring of the usual rounded configuration (due to the retraction area) is characteristic of the scirrosive form of cancer.At the same time, the gland is shifted towards the tumor. On the contrary, in diffuse-infiltrative cancers, the affected gland is enlarged (more healthy), edematous, its configuration is disturbed, its lowering is noted below the border of the healthy gland.

SKIN CHANGE – the skin in breast cancer with cancer undergoes pronounced changes, especially with more superficially located tumors. The skin and subcutaneous tissue above the cancer node lose their elasticity and mobility, become denser, and are not so easily captured in folds.Over time, this area becomes flat at first, then acquires a fine folded wrinkle, resembling a “lemon peel” pattern.

Nipple change – changes on the side of the nipple are of a different nature; in the initial phase of tumor development, the nipple may deviate or fall on the side of the lesion. As the tumor grows, the nipple flattens and then retracts. Particular attention should be paid to the presence of bloody discharge from the nipple.

WHAT TO DO IF…

The first is to see a doctor. Many researchers point out that many women avoid breast examinations for fear of losing it.

In the early 1980s, only a quarter of women in the United States knew that their breasts could be restored after a mastectomy (removal of the breast). Today it is more widely known that modern plastic surgery can create a new breast in place of the removed one. Many women argue that if they knew more about the possibility of breast reconstruction, then most of them would undergo an examination at an early stage.Early diagnosis improves prognosis.

Previously, it was believed that a woman should be allowed to grieve over the loss of a breast in order to better evaluate a new one, since the breast was never restored at the same time as the removal of the tumor. And now it is still customary to restore the mammary gland long after surgery to remove the tumor, although studies have shown that 96.6% of women would prefer it done immediately.

WOMAN’S PSYCHE AND MALIGNANT DIAGNOSIS

The very establishment of the diagnosis: breast cancer and its subsequent removal leads to mental disorders in 96.1% of women.In the postoperative period, after removal of the mammary gland and chemotherapy behavior, social maladjustment is observed, which can be expressed in job loss or disability, family breakdown, emotional isolation, joining religious organizations, and the acquisition of addictions. Moreover, the more time passes after the removal of the mammary gland, the more these mental disorders increase.

Therefore, a one-stage operation to remove the tumor and restore the mammary gland is a means of psychological protection for a woman.

BREAST REMOVAL AND POSTURE DISORDER

After removal of the mammary gland, postural disturbance naturally occurs, and the larger the size of the remaining mammary gland, the naturally greater the load on the spine. This disorder leads to pain in the thoracic and cervical spine, often with neurological symptoms in the hands.

SELECTING THE OPERATION

Even a woman’s awareness of the possible restoration of the mammary gland at the diagnostic stage includes the mechanisms of psychological defense

Breast cancer treatment has two conflicting challenges.On the one hand, saving a life and curing a patient from a deadly disease, on the other hand, preserving an aesthetically significant organ. Therefore, the strategy should proceed from the simultaneous solution of two tasks: ensuring maximum cancer radicality and the best aesthetic result.

There are several ways to restore the mammary gland: with the help of implants and with the help of your own displaced tissues. The latter is certainly more traumatic and leaves behind additional scars on the abdomen or back.The choice of operation in each case is strictly individual.

Since breast cancer is a systemic disease, that is, a disease affecting all organs and systems, sometimes mastectomy is not the only operation in the treatment of breast cancer. In some cases, removal of the ovaries is performed laparoscopically (i.e. without an incision). Also, without a crippling incision of the chest, we perform the removal of the retrosternal lymph nodes if they are damaged (thoracoscopic lymph node dissection).

OPERATION

For small breast tumors, RADICAL RESECTION is possible.

The operation consists in removing the breast sector in the same block with the subclavian-axillary-subscapularis lymph nodes.

Chemo-radiation treatment is usually done after the operation.

MASTECTOMY

Depending on the location of the tumor, the size and shape of the breast, and the presence of a prior biopsy, a skin-sparing mastectomy may be performed.

The operation includes the mandatory removal of the nipple-areola complex and the removal of regional lymph nodes.

As the analysis of the socio-psychological status shows, the loss of the mammary gland is a serious psychological trauma for a woman, which has a decisive impact on her behavior in everyday life and in society. About 30% of these women cannot come to terms with the loss of the mammary gland. To overcome these problems, it is possible to perform an operation with ONE-TIME or DELAYED BREAST RECONSTRUCTION.

Cancer prevention: breast self-examination methods

Women’s breasts – beauty and problems …

The breast, as a very vulnerable part of the female body, needs to be treated very anxiously.

Most people drive away from themselves thoughts of terrible diseases, such as breast cancer. But, the more you know about this threat, the more actively you will try to prevent it.

According to statistics, to the question “When was the last time you visited a mammologist?” three quarters of women answer: “Never” Such an attitude towards the most delicate area of ​​the female body is unacceptable.After all, even painful tension in the chest before menstruation, small seals and slight discharge from the nipples are a reason to see a doctor. By the way, problems with the thyroid gland, adrenal glands, stress, taking hormonal drugs and contraceptives can also affect the condition of the bust.

Protect your chest from injury

Even a small bump can lead to serious bust problems. Therefore, be sure to buckle up while driving, cover your chest with your hands if you are in a crowd.After all, a small bruise will go away in a week, and serious problems may appear much later. At the site of the impact, a seal is formed, which easily degenerates into a malignant tumor.

Do not get carried away with tanning

Both the solarium and the sun can provoke the growth of cancerous tumors. Moreover, one or another breast pathology occurs in every fifth woman over 35 years old. If you are depressed by the sight of Snow White, and you are not ready to give up a light tan, cover your chest with your hands in the solarium, and go out in the sun before 12 or after 17 hours, using a protective cream 15 minutes before.

Pay attention to power supply

Healthy breasts require giving up not only cigarettes, but also alcohol. The most you can afford is a glass of red wine. Include in your diet foods rich in vitamin C – lemons, kiwi, bell peppers, cabbage. Do not give up carrots, tomatoes, dill and spinach, which contain vitamin A – it increases anti-tumor resistance. Vegetable oils and cereals, thanks to vitamin E, prevent or inhibit the appearance of tumors and slow down the aging process.Selenium plays an important role in the prevention of breast cancer. It is able to selectively accumulate in tumor cells and prevent their destructive activity. Therefore, include seeds, garlic, shrimp and fish in your diet.

Have a baby

Almost all mammologists say that the birth of a child and breastfeeding have a beneficial effect on the health of the bust. According to the British Foundation Cancer Research, the risk of developing breast cancer decreases by 7 percent with the birth of a baby.Each year of natural feeding reduces the chance of getting sick by an additional 4.3 percent. Therefore, do not postpone your first pregnancy for long.

Buy the right bra

There are a few rules to follow when choosing the right bra. First, the breasts must completely fill the cup. Secondly, do not overuse push-up. This, no doubt, looks spectacular, but inevitably disrupts blood circulation. Finally, avoid tight shoulder straps that can cut into your shoulders, leaving marks.Mammologists say that the wider the straps, the more evenly the weight of the mammary glands is distributed.

Do Self-Investigation

Try to find out if women in your family have had breast problems. If yes – urgently learn the techniques of self-examination. Feel your breasts periodically to check for lumps, nodules, rough skin, or soreness. Self-examination should be done once a month (and on the same days!).If you find something incomprehensible – urgently see a doctor.

Self-examination of the mammary glands is an important and effective method for the early diagnosis of benign tumors and breast cancer. Studies in Sweden, England and Italy have shown that women who regularly perform self-examinations, and who know the correct technique for conducting it, find the slightest changes in themselves.

Self-examination consists of several stages: examination of the mammary glands, examination with raised arms, palpation of the mammary gland, examination of the right and left mammary glands, identification of changes when pressing on the nipple and areola, self-palpation, lying on the back, examination of the state of the lymph nodes.

Inspection begins with the laundry where it touches the skin to make sure there are no stains. Then the mammary glands are carefully examined in front of a mirror, standing straight and lowering their arms along the body, paying attention to changes in the volume and shape of the breast, skin color, nipple and around the nipple cup. It should be noted the absence or presence of edema of the hands, neck, which, as a rule, is associated with a violation of the outflow of lymph. Examination of the supraclavicular, subclavian and axillary regions reveals the appearance of side smoothness, which indicates the presence of an increase in lymph nodes.

Examination with hands up. Raising their hands on their head, they carefully examine the mammary glands from all sides, assessing the shape, volume and any recently appeared asymmetry.

When viewed while standing, with arms raised to the head, it is important to pay attention to:

• change in the outline and shape of one breast in relation to the other;
• Tightening of the gland up or to the side, displacement or fixation;
• the appearance of swelling and redness of the skin in a limited area or throughout the gland;
• the appearance of retractions, seals or nodes in the tissue of the gland and thicker skin;
• peeling of the skin of the mammary gland;
• appearance of crusts, fistulas and skin ulceration;
• the appearance of bloody discharge from the nipple;
• induration, swelling and redness on the nipple;
• “Swelling” of the shoulder or armpit.

Palpation of the breast. In a standing position, the index, middle and ring fingers of the hand should be placed flat on the chest in the area of ​​the areola and nipple, then press on the surface of the gland.

On palpation, pay attention to:

• change in the structure of the mammary gland to the touch;
• the appearance of a sensation of discomfort or unusual pain in the mammary gland.

Examination of the right breast: the right arm is raised up and thrown back behind the head.Having mentally divided the mammary gland into four parts (quadrants), each of them should be examined quadrant by quadrant. It must be remembered that the mammary gland is most developed and dense at the level of the upper outer quadrant.

The right mammary gland is palpated with the pads and two phalanges of three or four fingers of the left hand. The fingers are laid flat, and, starting from the upper outer quadrant, in circular movements clockwise, in forward movements centimeter by centimeter, moving along the mammary gland, they feel all zones.When palpating, it is very important not to grasp the breast tissue with your fingertips, but only to apply your fingers flat. Then, in the same sequence, it is necessary to examine the left breast.

Identification of changes in pressure on the nipple and areola. The nipple is gently felt, then it is squeezed between two fingers and attention is paid to the absence or appearance of discharge from the nipple.

Self-palpation, lying on your back. Putting a pillow or a rolled-up towel on the floor with one of the shoulder blades, you should lie down so that the examined gland is spread out on the chest wall.The hand of the same side is placed under the head or on the forehead.

Gently, with the pads of the 2nd to 4th fingers, touch the outer part of the gland from below with concentric and radial movements of the nipple to the armpit with the opposite hand, paying attention to the area between the gland and the armpit. An examination of both the axillary and supraclavicular regions is mandatory in order to identify changes in the lymph nodes. Also, using the fingertips, they feel the inside of the breast from top to bottom and from the nipple to the middle of the chest.All the same techniques are used after turning in the opposite direction and laying a pillow (roller) under the scapula.

Study of the condition of the lymph nodes. Feeling the armpit, you should try to feel the lymph nodes. If they are palpable, you should see a doctor, especially if the lymph nodes have appeared recently or their shape has changed.

Be sure to pay attention to the size, mobility, degree of enlargement of the axillary lymph nodes from the corresponding side.

Breast self-examination methods are not complicated, but require skill and regularity. It is best to do this every month, 7-10 days after the end of your period, when the breast tissue is soft enough. If a woman is in menopause, it is advisable for her to choose a certain date for such a survey and repeat the procedure on that day every month.

Important

Women who have the following risk factors should be especially careful:

• absence of children;
• birth of the first child over the age of 30;
• many abortions;
• early onset of menses;
• late menopause;
• oncological diseases of the breast in the family;
• the predominance of high-calorie, fatty foods in the diet;
• frequent alcohol consumption;
• long-term treatment with hormonal drugs and the use of contraceptive pills.

According to the information of the Center for Medical Prevention of Ugra

preparation, prices, decoding of the result. Make breast mammography in Moscow – Central Clinical Hospital of the Russian Academy of Sciences

What is it?

Mammography of the mammary glands is an X-ray screening using a special apparatus – a mammography.

The informativeness of the method is quite high – more than 90%.The goal is to identify and diagnose breast pathology, including tumors, in the early stages, about two years before the onset of symptoms.

For whom is breast mammography recommended?

Diagnostics with a prophylactic purpose is indicated for women, age of whom are older than 40 years , since from this age the risk of developing cancer increases.

According to unconditional indications, the examination is prescribed:

• for chest pain;
• if bumps and seals are felt;
• with differences in shape between the mammary glands;
• with nipple discharge;
• if engorgement of the glands is observed in the absence of lactation;
• with redness of the nipples or changes in their shape;
• for preoperative examination and monitoring the success of the treatment.

Contraindications

Since the study is X-ray, and radiation exposure is still there, you should refrain from mammography:

• pregnant and lactating women;
• for damage to the skin on the chest and nipples;
• in the presence of implants;
• when under the age of 35;
• after termination of pregnancy within six months.

What does a mammogram show?

This is the way:

• to identify – benign or malignant tumor is developing;
• determine its size and location;
• to analyze the dynamics of development.

If a lump is detected on one side, both breasts are examined.

Mammograms will show the presence of:

• calcifications – the accumulation of calcium salts accompanies cancer processes;
• fibroadenomas – benign formations that tend to increase;

90,113 cysts are fluid-filled cavities not related to cancer.

Types of mammography

Today, several options for mammography are used.Traditional diagnostics are performed using film. In modern medical institutions, it is practically not used, since it gives the highest percentage of errors.

Digital diagnostics is the latest advancement in this field, replacing X-ray film with fixed detectors that convert radiation into an electrical signal. The resulting image can be viewed on a monitor or printed.

Benefits of using:

• high quality images with a low proportion of radiation;
• the ability to see the smallest changes in one picture;
• reduction of examination time;
• no need for consumables and space for storing reagents and boxes with films;
• the ability to create an electronic archive.

Computed mammography

An automated system uses a digital image to search for pathological changes:

• by mass of sites;
• in terms of tissue density;
• for the presence of calcium deposits.

The program highlights these areas and gives a message about the need for further diagnostics.

In diagnostics, the importance of using the technique is of secondary importance, since:

• no drill-down option;
• pathology is difficult to determine, especially with mastopathy;
• insufficiently high efficiency for a different kind of formations.

You can use computed mammography to diagnose:

• nodes in areas inaccessible for palpation;
• for cancer with a high density of formation;
• if it is necessary to identify bone metastases.

Ultrasound

Mammography is highly effective, but in some cases the results may be unreliable:

• when examining young women with dense breast tissue;
• with diffuse mastopathy;
• for changes due to inflammatory processes.

How is ultrasound different? The ultrasound technique has certain advantages:

• This is an additional method if it is difficult to make a diagnosis after mammography;
• method is simple and safe, it can be repeated with the desired frequency;
• is used to examine women during pregnancy and lactation;
• for imaging tumors close to bones;
• Allows you to distinguish – where is the seal, and where is the cyst;
• May be used for inflammation or injury.
• The condition of the lymph nodes can be examined.
• Used as a control study after operations and implantation.

MRI mammography

The most accurate technique that does not use radiation. Its only drawback is its high cost. The study can be carried out with the introduction of a contrast agent.

Electrical impedance mammography

A modern technique based on the properties of current conductivity in various tissues.The degree of conductivity shown by healthy and diseased areas varies significantly.

How do I prepare for a mammogram?

Patients are concerned about the question: when is the best time to do the examination?

To do the research as efficiently as possible, you need to take into account some rules and know on which day of the cycle you should be examined:

• when making an appointment, please note that the study should be performed one week after menstruation or later;
• Bring your previous research results with you;
• two days before the procedure, exclude coffee, caffeine and energy drinks;
• do not use cosmetics on the day of the procedure – the breasts and armpits should simply be washed;
• Let the radiologist know what is bothering you.

How is breast mammography performed?

Diagnostics is carried out on an outpatient basis. The patient’s chest is placed on the platform and fixed. Several projections are performed in different positions.

For the results to be clear, you must hold your breath, as with fluorography.

During examination, the chest is slightly compressed:

• to equalize its thickness;
• get a clear photo:
• distribute soft evenly;
• reduce the radiation dose.

Interpretation of results

Based on the results of the study, the doctor writes a conclusion.

The photo shows the structure of the organ, blood vessels, lymph nodes and ducts. If it is uniform, without darkening and seals, then there is no pathology.

The image should clearly show the vessels, and the lymph nodes should not be enlarged.

In the presence of pathology, the normal structure changes, the lymph nodes increase.Then the specialist determines the number of foci of the disease, their shape, size, uniformity and location.

In the presence of a tumor, irregularities and a lack of clarity of formation characterize cancer.

Calcifications can be seen, which occur with any formations.

In any case, a mammogram is only the initial stage of examining a woman’s mammary glands and additional studies and a doctor’s consultation are required.

Is mammography harmful?

For the development of neoplasms, the radiation received is small. In the study, where the latest devices are involved, the proportion of radiation is significantly reduced. It is important to understand that despite the disadvantages, this procedure is necessary. The results have saved many lives.

Where to get a mammogram?

You can undergo mammography in Moscow at the Central Clinical Hospital of the Russian Academy of Sciences – this is a medical center equipped with the most efficient equipment, where experienced specialists, the best in the capital, are engaged in examinations and decoding.

Find out the price of the procedure, the time of possible carrying out and other information by phone (499) 400-47-33. Doctors of the Central Clinical Hospital of the Russian Academy of Sciences remind: timely diagnosis will allow treatment with minimal surgical intervention and preserve the organ!

National Medical Research Center of Oncology. N.N. Blokhin

For almost 70 years, the Oncology Center has been a unique symbiosis of science and clinical practice, a multidisciplinary approach to the treatment of cancer patients, a surgical school known far beyond the borders of Russia.Morphological, immunological and genetic diagnostic methods are studied and improved here.

Blokhin’s specialists are the authors of clinical guidelines for oncology.

More than 35 thousand patients of all ages undergo anticancer treatment at the Oncology Center annually. Almost 6,000 more Russian citizens receive assistance remotely – through telemedicine consultations.

Oncology center is:

• Combined treatment of patients
• Own production of chemopharmaceutical and radiopharmaceuticals
• Proprietary methods of tumor immunotherapy
• Advanced technologies for the rehabilitation of cancer patients
• “Competence centers” for various nosologies, including the first center of competence in Russia for the treatment of patients with tumors without an identified primary focus
• Own blood transfusion department, whose donors supply blood and blood components exclusively to patients of the Oncology Center
• The first and only cancer center with a specialized rehabilitation department for cancer patients
• The largest pedagogical school in the field of oncology in Russia

For many years, the Cancer Center has been a member of the International Union Against Cancer (UICC) at the World Health Organization (WHO) and a member of the Association of European Cancer Institutes (OECI) in Geneva.

In 2019, the Research Institute of Pediatric Oncology and Hematology of the N.N. N.N. Blokhin became a full member of the leading world organization that unites transplant centers in Europe and the world – the European Group for Blood and Bone Marrow Transplantation (EBMT).

National Medical Research Center of Oncology. N.N. Blokhin:

• World-class cancer care accessible to everyone
• Innovations in Oncology
• Unique experience for colleagues

Operations to remove melanoma surgically at the Helena Clinic

Early melanoma can be completely cured.

Ongoing research is developing new drugs that provide the basis for better prognosis, even in advanced melanoma.

Helena Clinic offers the best modern methods for the treatment of melanoma.

Melanoma comes from melanocytes – the so-called skin cells that produce dark pigment. In Western countries, melanoma, along with breast cancer, is more and more common.

Melanoma on the lateral surface of the body

The main risk factors for melanoma are skin burns caused by UV radiation from the sun.Pale and freckled skin is most easily burned. Therefore, it is highly recommended on sunny days to apply sunscreen with a protection factor (SPF) of at least 20 to the skin.

Melanoma arises in a pre-existing mole on the skin only in a third of cases; in two thirds of cases, melanoma appears on an unchanged area of ​​the skin.

It is very important in all cases when there is a change in the color or size of a mole (age spot / nevus), redness appears around it or cracks or non-healing crust appear on its surface, examine this mole at a doctor and take a biopsy.

Such a mole is removed for examination completely, and also, if possible, with the capture of a small amount of normal skin around.

All removed moles must be examined under a microscope to obtain a histological diagnosis.

Melanoma treatment

The first step in the treatment of melanoma is surgical removal. How far you need to remove the melanoma depends on its thickness. The thickness of the melanoma is determined by biopsy examination and is measured in millimeters according to the Breslow scale.If there is ulceration on the surface of the mole, then the thickness assessment becomes more difficult, and, as a rule, the true thickness of the tumor is greater than that determined by the biopsy study. Melanoma spreads rapidly to the surrounding tissues, forming so-called satellite metastases. The remoteness of these metastases from the primary melanoma also depends on its thickness. Therefore, the amount of healthy tissue to be removed around the primary melanoma is determined on the basis of its thickness on the Breslow scale.

Melanoma thickness less than 1 mm on the Breslow scale is classified as a superficial tumor in the initial stage and has a good prognosis. In this case, around the melanoma or around the scar from the previous resection, the surrounding externally unchanged tissues are removed at a distance of 1 cm.

A melanoma thickness of 1 to 2 mm is also considered superficial with a relatively good prognosis, while removal of the surrounding tissue around the tumor at a distance of 2 cm is considered sufficient.

Melanoma with a thickness of more than 2 mm is excised with the capture of the surrounding tissues at a distance of 2-3 cm.Wider excision is not warranted, and the previously practiced extended tissue excision within 5 cm is no longer used.

Study of sentinel lymph nodes in the treatment of melanoma

The first step in the treatment of melanoma is the surgical removal of the tumor. Surgical treatment of melanoma more than 1 mm thick always includes a sentinel lymph node biopsy.

On the day before surgery, technetium radioisotope injections are made around the melanoma biopsy scar and lymph nodes are mapped (i.e.e. determine their location). “Sentinel” lymph nodes, capturing the radioisotope, are removed simultaneously with excision of the surrounding tissue around the scar from a melanoma biopsy.

If, upon further examination of the remote “sentinel” lymph nodes, melanoma cells are found in them, then all other lymph nodes in this area are removed.

The operation to remove the remaining lymph nodes can be performed under local anesthesia, but if there are many lymph nodes, then the operation is performed under general anesthesia.The patient can stay in the recovery room overnight if required.

In our clinic, such surgeries are performed by a plastic surgeon using oncoplastic methods. Various methods are available, such as local skin graft, free graft tissue graft and, if necessary, microneurovascular tissue graft.

The cost of surgical interventions depends on the duration of the operation and is calculated after the consultation of the surgeon.

Adjuvant treatment of melanoma

If the melanoma is more than 1 mm thick, oncologist Dr. Esa Männistö advises our patients and gives recommendations for adjuvant (postoperative) therapy.

To comprehensively assess the stage of the disease, radiological studies of the lungs and liver are performed. For patients with metastasis to the lymph nodes, computed tomography of the whole body and osteoscintigraphy (examination of the skeletal system) are additionally performed.

In recent years, drug therapy for melanoma has advanced significantly. As a result of studying the role of mitogen-activated protein kinases (MAPKs) in the regulation of gene expression, as well as regulation of cell growth and survival, a new marker of melanoma has been identified. To detect it, a genetic analysis is performed for the BRAF mutation.

This analysis helps in the selection of new drugs for the treatment of metastatic melanoma. The disadvantage of new drugs is their high cost.

Our oncologist, Dr. Esa Männistö, individually prescribes the best therapy for the patient. Some drugs that have long been used to treat melanoma, such as interferon alpha (IFN-α), are still used effectively in selected cases to prevent relapse.