Does the malignant tumor hurt? All about malignant tumors and cancer treatment
ВreastCare.ru - 2008
What pain is associated with breast cancer?
Understanding the cause of pain helps you better understand and manage it. When you have just started treatment, it can be difficult to understand what is causing the pain - the tumor itself or something else. Pain is always a warning. It can indicate what is happening in the body and how a particular treatment affects. New pain may indicate the appearance of a new tumor or metastasis. An increase in the intensity of pain also indicates a corresponding change. So what is characteristic of cancer pain and what is characteristic of pain of a different origin?
Breast cancer pain can be caused by:
- The breast tumor itself. Sometimes pain can be noted in the tumor. In inflammatory breast cancer, it is mild to moderate because it is associated with skin lesions. This is accompanied by the formation of even sores on the skin.
- Metastases. You already know that metastases are the spread of a cancerous tumor to other areas of the body. Metastases can spread through the lymphatic or bloodstream. They can amaze various bodies: liver, lungs, brain, as well as bone tissue. One of the main signs of metastasis is pain. With metastasis of the spine, pain appears in the back, and with liver damage - in the right half of the abdomen.
- Pain associated with treatment. Occasionally, certain treatments can increase the intensity of the pain. For example, hormonal treatment or radiation exposure to bone metastases can cause burning pains. The reason for this is usually that in response to treatment, swelling of the tumor occurs, which is associated with pain.
- Chest pain. Although breast pain is not cancerous, pain in only one breast is alarming for patients. This is especially true when pain occurs along no clear reason... In this case, your doctor may recommend a biopsy of the area of interest.
Pain not associated with breast swelling
The cause of pain may not only be a tumor:
- Surgical intervention.
- Radiation therapy.
- Chemotherapy.
- The recovery period.
- Changes in the mammary gland of non-cancerous origin.
Postoperative pain and pain after radiation
The pain after surgery is not so bad, but it can be exhausting and disturbing for the patient. This pain is usually associated with the fact that when performing a soft tissue incision, small nerve fibers are damaged. This leads to the fact that in this area the sensitivity is increased. Swelling of the tissues after surgery is also one of the causes of this pain. In addition, during the operation, the surgeon performs various manipulations with tissues, which also causes additional trauma.
After lumpectomy, pain is localized at the site of the removed tumor. The reasons for this are described above. Gradually, this pain goes away as the wound heals and nerve fibers are restored.
After axillary lymphadenectomy, pain is also noted. It can get worse after exposure to radiation. When the lymph nodes are removed, the outflow of lymph from upper limb... This leads to a well-known condition called lymphedema. Lymphedema is soft tissue lymphedema. Moreover, in soft tissues pressure is created, which is also the cause of pain in this area. Lymphedema may be persistent, although it does exist special exercises, which can help alleviate its severity somewhat.
Pain after lymphadenectomy has another source - the nerve plexus in the armpit. During the operation to remove the lymph nodes, these nerves have to be pushed back, which causes additional trauma. Therefore, in some cases, axillary pain can last from several weeks to several months or even years. Simple pain relievers (analgin, ibuprofen, etc.) are ineffective in this case, and usually special drugs that affect the nervous tissue are used - these are anticonvulsants and antidepressants.
Pain after a mastectomy - removal of the entire breast - can be combined with numbness and weakness in the arm and shoulder. In most cases, these symptoms are associated with soft tissue injury: their dissection and stretching.
Pain after radiation exposure
Radiation can cause pain of varying intensity. Sometimes it is paroxysmal, and in some cases, it is significantly pronounced. In most cases, this pain is moderately expressed and gradually disappears after the course radiation therapy... Why does radiation cause pain?
- Nerve irritation
- Swelling around scar tissue and the irradiated area
- Skin lesions (like sunburn)
- Friction of irritated skin areas against each other (for example, when irradiating the armpit).
- Sometimes infection.
Pain associated with chemotherapy
Chemotherapy has negative impact not only the tumor, but also the healthy cells of the body, especially those of them that multiply and divide rapidly. These include cells of the epithelium of the gastrointestinal tract, oral cavity, nose, and hair follicles... One of the manifestations of this side effect of chemotherapy is changes in the oral mucosa: stomatitis with the formation of ulcers and erosions. These lesions are painful and react to food and fluid. When an infection is attached to them, inflammation occurs, which aggravates the pain. In this situation, your doctor may prescribe a medication that dentists usually use to relieve oral pain. It is not recommended to use such drugs on your own.
In addition, some of the chemotherapy drugs, such as Taxol and Taxotere, can cause muscle and joint pain. Others side effect of these funds is the so-called polyneuropathy - painful sensations in the hands and feet, which is associated with damage to the peripheral nerves.
Pain in the recovery period
Some patients, after they learn about their diagnosis, remain inactive throughout the course of treatment. As a result, they gain weight, lose their former the physical state, resulting in pain. The way out of this situation is gradual return to the previous level physical activity- Exercise, aerobics, etc.
THE TUMOR DOESN'T HURTBut initial stage breast cancer cannot be missed
Breast cancer has become a real disaster for modern women... According to the American National Alliance of Organizations Against This Disease (NABCO), in 1950, it was found in one patient out of 18-19, in 1960 - in one in 14, today - in one in 11 in the UK, out of 9 in USA and Russia.
TO Every 30-35 years, the number of women with breast cancer doubles. But this is the average on the planet, and in our country, for example, there were two such patients more than once most in 15 years.
Prince Charles seeks the principle of cancer
The UK's National Health Service introduced the world's first universal breast cancer screening program in 1988. For 14 years now, Queen Elizabeth, like each of her subjects, who have exchanged their fifties, receives an invitation to mammography every three years. British doctors examine 1,250,000 women annually.
Heir british crown headed charitable organization Breakthrough Breast Cancer Charity funding method development early diagnosis breast cancer and research into its causes. British scientists have spent a million pounds from the royal fund on a large-scale study, which involved 37 thousand women with breast cancer. After removal of the tumor, all of them underwent a course of chemotherapy, and relapses of the disease in this group occurred 2 times less often compared with patients who were limited to surgery. The authors of the experiment claim: the combination surgical intervention with chemotherapy will save the lives of 20 thousand women worldwide every year.
COMPUTER LOOKS INTO GENES
Another important discovery, made with financial support from the Prince of Wales Foundation, is the computerized DNA diagnosis of breast cancer. More than 15,000 British women die from breast cancer every year. Even a timely operation does not always stop malignant transformation - tissue malignancy.
With active pathological process it is not enough to remove the tumor - radiation or chemotherapy is required. Select correct tactics treatment specialists will help new method diagnostics - computer analysis of DNA for the presence of mutations in the so-called p53 gene, indicating a high oncological risk.
CANCER FIVE BACK
A hundred years ago, breast cancer was several times less common than it is now, but the diagnosis was tantamount to a sentence. V late XIX For centuries, removing a tumor was a risky undertaking, often complicated by suppuration and blood poisoning, since antibiotics did not yet exist. Plastic surgery was also not, which means that it was not necessary to count on the restoration of the mammary gland. In addition, the diagnosis was made too late: after all, with your fingers you can feel a tumor in the chest only the size of a large pea, no less. This means that it appeared at least five years ago, or even earlier. And all these years no one has treated the disease. And the only remedy for this disease in the past was a scalpel.
Today, things are different: the possibilities of diagnosis and treatment have expanded, and the results inspire hope, leaving no room for fear and despair. If cancer is detected at an early stage, the probability that everything will end well is almost one hundred percent.
THREE REASONS FOR ALARM
But those whose process has gone far should not despair. In the arsenal of modern doctors there are many means of combating breast cancer.
OPERATION TO SELECT
Cryodestruction. If the tumor is very small, a special cryoprobe is brought to it, frozen five times and then removed. A barely noticeable scar remains in memory of the operation.
Removal of only the tumor every fifth woman suffering from breast cancer is made through a small incision near the nipple, if it was detected in time (the tumor is small, with clear boundaries). Sometimes nearby lymph nodes are also removed. After surgery, radiation therapy is usually given.
Partial breast resection. The tumor is removed along with the corresponding sector of the breast - surrounding tissues, skin, axillary lymph nodes. To destroy cancer cells that could remain in the chest, radiation or chemotherapy is prescribed.
Radical mastectomy. If the tumor is large enough but does not extend beyond the breast and the lymph nodes are not affected, the surgeon removes the entire breast and refers the patient to radiation or chemotherapy. Are there metastases in the lymph nodes? A modified version of the surgical intervention is performed - they are also removed. Today it is the most common operation for breast cancer.
ADDITIONAL PROGRAM
Radiation therapy- effective on early stages when the tumor is small and did not have time to metastasize. The course usually lasts 6 weeks, 5 days a week. Try not to wash off the marks on the gland to which the radiation source is supplied, otherwise it will not reach the desired area. Do not wipe the skin in this place with alcohol, do not lubricate with cream, make sure that the clothes do not rub.
Chemotherapy- cytostatic drugs kill cancer cells, and their decay products cause intoxication - poisoning of the body. Its signs are weakness, nausea, vomiting, lack of appetite. To improve your well-being, you will be given a drip and recommended medications to alleviate the condition.
Hormone therapy- Suppresses the formation of estrogens by the ovaries, which contribute to breast cancer.
AFTER OPERATION
PLUS ASPIRIN - MINUS CANCER
According to oncologists at Columbia University, taking aspirin once a week for six months reduces the likelihood of developing estrogen-dependent breast cancer (it occurs in 60-70 out of 100 patients) by 20 percent, and with daily use - by 28. However, scientists are far from thinking recommend this drug for cancer prevention: aspirin can provoke asthma, stomach bleeding and other complications. But women who take it as directed by a doctor, such as for heart ailments, can count on additional protection against cancer.
DELETE "IN ANY CASE"
In 10-15 percent of cases, breast cancer is hereditary. The tendency to ailment is transmitted through the maternal line along with specific oncogenes. Between 50 and 95 out of a hundred patients in whom they are found during genetic testing are at risk of developing cancer during their lifetime. If you don't have killer genes, your chance of developing cancer is only 2 percent.
But what about those whose breasts are "programmed" for cancer? There are 5 percent of them among us. Foreign doctors set up radically: out of harm's way, they remove healthy mammary glands in women at risk. Imagine seven out of ten American women who have been found to have dangerous genes agree to a preventive mastectomy. By the way, in some distant organs, healthy in appearance, when examined under a microscope, cancer cells are found. But still, isolated histological findings do not justify the mass separation of frightened patients with mammary glands.
The opinion of the Honored Doctor of Russia, Head of the Oncology Department of the Russian clinical hospital, candidate medical sciences Vladimir Ivanovich KOVALEV:
Preventive surgery is the strong point of American surgeons. In the middle of the last century, appendixes were removed for almost the entire US population. The result is sad - the growth of infectious and oncological bowel diseases. After all, the appendix is responsible for immune and anti-cancer protection digestive system, but it only became clear relatively recently.
In the 80s, another fad arose in the States - women were massively removed healthy ovaries and uterus so that they would not develop cancer in the future. It was believed that after the birth of the planned offspring, these organs have served their purpose and are no longer needed. But there is nothing superfluous in the body! Today, every third American woman has undergone this operation, and the incidence of cancer has not decreased at all.
It is the same with the removal of healthy breasts. It's very traumatic surgical intervention, after which you will essentially become disabled - you will be out of order for a long time (taking into account the upcoming plastic surgery), you will not be able to breastfeed your baby. If there is at least one in a hundred chance that cancer will bypass you, you cannot remove the mammary glands. But the probability that the disease will not overtake you is much higher - from 5 to 50 percent! Such a spread suggests that scientists cannot yet give an accurate prediction when detecting malignant genes. So is it worth taking drastic measures based on insufficiently verified data?
Do not rush to go under the scalpel - just do breast cancer prevention. Check up with a mammologist regularly and have a mammogram. Try to give birth in young age, breastfeed babies. Avoid abortion, don't take hormonal contraceptives with estrogens. And the chances that the disease will not affect you will increase significantly.
Prepared
Irina BEREZINA, doctor
The swelling hurts usually on later stages development of oncology. This is the insidiousness of the oncological disease. The intensity and localization depends on the type of cancer lesion and the organ in which the malignant neoplasm has formed. For adequate therapy pain syndrome the doctor needs to establish the nature of the pain.
What are cancer pains?
Many people ask themselves: “ Does the tumor hurt at an early stage? ”. For the initial period of the development of pathology, chronic attacks of low intensity are considered typical. The spread of the cancer process outside the affected organ is accompanied by prolonged attacks that require drug therapy.
Acute pain syndrome indicates damage to nerve fibers and blood vessels. These sensations, in the main, can be stopped by traditional analeptics. In some clinical cases, an acute pain attack can turn into a chronic course. Such patients need the introduction of narcotic pain relievers.
Treatment if the tumor hurts. Step-by-step treatment of cancer pain
The World Health Organization has developed the following approach to the treatment of cancer pain:
First stage
The first stage of cupping unpleasant sensations carried out in the presence of moderate pain of moderate intensity. Cancer patients during this period are prescribed the use of non-narcotic analeptics. The main pharmaceuticals in this group are: aspirin, paracetamol, analgin, etc.
Accompanied by chronic pain, in the early stages of progress, it involves taking aspirin at a dose of 1000 mg and paracetamol (500-600 mg) at intervals of every five hours.
Potential side effects should be considered when prescribing these drugs. For aspirin, malfunctions are considered typical complications. gastrointestinal tract, defective blood clotting and allergic reactions slow type. For paracetamol preparations, toxic effects on the liver tissue are typical. The incidence of complications is directly proportional to the age of the patient.
In the case of diagnosing bone metastases high efficiency has the use of a combination of analeptics and non-steroidal anti-inflammatory drugs (Indomethacin, Voltaren, etc.). These drugs have limited opportunities to relieve pain. With an increase in unpleasant sensations, which is due to the fact that the oncology has increased in size, it becomes necessary to proceed to the next phase of therapy.
Second stage
Increased cancer pain involves the use of weak opiates in the form of Codeine and Tramal. V outpatient especially convenient to use is such a drug as Tramal, which is available in the form of capsules, ampoules and drops. The therapeutic dose of this pharmacological agent is 50-100 mg every six hours. When the effectiveness of these funds decreases, there is a transition to the third phase of pain relief therapy.
Third stage
When cancers are in the late stages of the malignant process and at the same time the tumor is very sore, patients are prescribed a course of taking strong opiates. Representatives of this group pharmacological agents are: Morphine and MST-Continus.
- Morphine is produced in 1 ml ampoules for intramuscular injection and in tablet form, 0.2-0.4 mg. The drug has pronounced side effects, which can be manifested by nausea, vomiting, depressive states and hallucinations.
- V recent times such a drug as MST-Continus, which contains morphine and is supplied in tablet form, has become widespread. Anesthetic action this tool lasts about 12 hours.
In this phase of treatment, when the cancer is very sore, great value It has sharing hormonal drugs, antidepressants and drugs that help narrow blood vessels. It is advisable to prescribe these measures in cases of low effectiveness of narcotic analeptics and the occurrence of side effects from analgesic therapy.
The presence of neurological pain is relieved with a single dose of Amitriptyline at a dose of 25 mg. Acute shooting pain implies a combined medication course of treatment that includes pain relievers and anticonvulsants.
The tumor hurts - the principles of prescribing anesthetic therapy
The best result of analgesia can be achieved if used strictly according to the hours of admission (as opposed to the use of analeptics when absolutely necessary). This scheme of therapy allows you to reduce the daily need for narcotic drugs.
Another fundamental principle for the relief of cancer pain is considered to be the bottom-up method of analgesia, which consists in a gradual transition from conservative pain relievers to narcotic drugs.
As practice shows, the most convenient form analeptics are considered a tablet form, which involves the oral route of taking medications. Pharmaceuticals in the form of tablets and capsules are the most readily available form of outpatient therapy.
Pathological formations that have developed for no apparent reason by cell multiplication. They differ in structure polymorphism and isolation of growth. True tumors have a number of features that distinguish them from formations similar in external signs. So, they should be distinguished from swellings, which are a symptom of diseases such as a cyst, goiter, etc., there are also hematomas, dropsies, various inflammatory processes and injuries. Reactive swelling of tissues of the body disappears after elimination of the causes. The beginning development of a tumor always continues, as if getting out of the regulatory action of the body, since it has "autonomy" of growth.
Tumor qualities can occur in the cells of any tissues of the body that are capable of reproduction. Having become a tumor cell, the original cell transfers new properties to its direct cellular descendants, which become similar to it in their morphological and chemical characteristics, manifesting a number of regularities.
According to the characteristics of growth and clinical course, benign and malignant formations are distinguished.
Benign tumors grow slowly, surrounded by a capsule, do not germinate, but move apart adjacent tissues and organs. Depending on the localization, such a tumor in some cases can (exist throughout the patient's life without causing him much harm. In other cases, as it grows, it puts pressure on a nearby organ, causes its atrophy, squeezing blood vessels and nerves. A benign tumor does not give metastases and after its radical removal comes a cure (does not recur).
Malignant tumors
They are distinguished by rapid infiltrating growth, they are not delimited from neighboring tissues by a capsule and, germinating, destroy them.
The cells of malignant tumors, growing into the lymphatic and blood vessels, can be torn off and carried by a stream of fluid (blood, lymph) to other organs, causing the development of new tumors - metastases. The growth of a cancerous tumor in the body alters the metabolism, causing a deterioration general condition, severe exhaustion and dystrophy. The onset of its development is often asymptomatic, which leads to late treatment patients and delayed diagnosis. The infiltrating ability to spread creates difficulties in establishing the boundaries of the lesion / which makes it necessary to remove during the operation not only the tumor, but also the surrounding healthy tissues, in which there may be cancer cells. However, even after that, a relapse may occur again in the same place.
The division of tumors into benign and malignant is conditional and is permissible only for clinical assessment of the disease. Since benign, but located near vital organs and disrupting their function, they can lead to the death of the patient (tumors of the brain, mediastinum, etc.).
Examination of a patient with a suspicion of a tumor should answer, first of all, the following questions: 1) does this large have a true tumor or the formation taken for it is a symptom of another disease; 2) benign or malignant tumor, whether there are metastases; 3) is it possible to remove the tumor, i.e. whether there is technical (anatomical) and functional operability. Answers to these questions are received after a detailed clarification of complaints, history of the development of the disease and clinical, endoscopic, radiological, pathophysiological and other special methods survey.
Symptoms and course. Benign tumors usually do not cause complaints and are often found by chance, on the internal organs they appear only as symptoms of a mechanical disturbance of their activity. The general condition of the patient, as a rule, does not suffer. When examining a superficially located formation, attention is drawn to the roundness of its shape or lobularity of the structure. The tumor is mobile, not adhered to the surrounding tissues, its consistency may be different, regional lymph nodes are not enlarged, palpation is painless.
The beginning of the development of a malignant tumor is hidden for the patient himself, and meanwhile, it is precisely equal diagnosis that is important. In this regard, when examining people, especially over 35 years old, about vague complaints, starting weight loss, long-term continuous and increasing symptoms of the disease for no apparent reason, oncological alertness should appear. This concept includes: 1) suspicion of the presence of cancer, 2) a thorough history taking, 3) the use of general and special research methods; 4) deep analysis and generalization of the received materials for the diagnosis.
Often patients with malignant neoplasm complain of a violation of the general condition: loss of normal tone at work, apathy, lack of appetite; nausea in the morning, weight loss, etc. More local symptoms can also join this - the presence of a chronic disease of the stomach, rectum, the appearance of a seal in the mammary gland, etc. At first, these phenomena may not be accompanied by pain, but then, when the tumor begins to grow into the nervous trunks, pains appear, taking on more and more painful character. The cancerous tumor grows rapidly. Substances for nutrition of cells come from the whole organism, causing their deficiency in other tissues and organs. Moreover, despite a large number of blood vessels in a cancerous tumor, their inferiority often leads to malnutrition in some of its parts and their decay. The products of necrosis are absorbed into the body, leading to intoxication, progressive emaciation, exhaustion, cachexia.
Recognition. In the anamnesis, attention is paid to chronic diseases, the profession of the patient, bad habits... After a general examination of the patient, the size of the tumor (if available), its nature, consistency and relation to the surrounding tissues are established by palpation. Determine the presence of ulceration, distant metastases, an increase in regional lymph nodes.
When examining hollow organs (intestines, bile, Bladder etc.) endoscopy is widely used, which is performed by endofiberscopes with an optical system and illumination. It makes it possible not only to inspect a suspicious area of the organ, but also to take a piece for histological examination. Biopsy (excision) followed by microscopic examination is a very valuable method of oncological diagnostics. In case of illness internal organs, when, despite all the research methods used, the diagnosis of the disease remains unclear, and the suspicion of a tumor process is not removed, they resort to a diagnostic operation (gluttony, thoracotomy, etc.) to determine the nature or extent of the spread of the process.
Prevention. It has now been established that some of the tumors develop on the basis of various long-term inflammatory and other diseases of organs. For example, with chronic anacid gastritis, chronic callous ulcers and stomach polyps, stomach cancer can develop over time. Chronic bronchitis and long-term recurrent interstitial pneumonia precede lung cancer. Prolonged non-healing cracks and ulcers that grow dark spots, growing warts, papillomas and hyperkeratosis precede skin cancer. All this made it possible to create the doctrine of precancerous, precancerous diseases, the detection and treatment of which is the basis for the prevention of cancer.
Treatment benign tumor operative: excision together with the capsule, followed by histological examination. With small and superficially located, not disturbing the patient, waiting is possible. Absolute indications for its removal are: 1) the presence of a symptom of organ compression, obstruction caused by a neoplasm; 2) constant trauma from clothing to a superficially located tumor; 3) accelerated growth and suspicion of malignant degeneration.
Treatment of malignant tumors depends on the stage of development of the disease. The formed focus of tumor growth is initially limited by an organ or tissue, but later, due to the invasion of the surrounding tissues and metastasis of tumor cells, the process is generalized. In this regard, four stages of the development of the disease are distinguished: Stage I - a localized process; Stage II - damage to nearby (organ) lymph nodes; Stage III - damage to regional lymph nodes; Stage IV - the presence of distant metastases.
Malignant tumors are subject to immediate radical surgical treatment... The operation consists in complete or partial excision of a tissue or organ along with a developed tumor and tissue with regional lymph nodes. However, the opportunity to perform such a radical operation appears only in patients with stages I and II of the development of the process, less often in patients with Stage III due to the presence of distant metastases and their germination into vital organs.
V last years operational method it is widely combined with X-ray and radium irradiation, with hormone therapy. They began to use chemical and biological methods of treatment.