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Алябьева Ю.М., Клинг В.И. English listening com...doc
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Introduction

Every family physician is regularly confronted with patients complaining of changes in one or both breasts. Very often the­re is nothing seriously wrong. But on the other hand, in many countries breast cancer has the highest incidence of all tumors in women. That means that on the average primary care physici­ans will be confronted several times a year with a patient who turns out to have breast cancer.

The chance for cure is undoubtedly influenced by the time at which the tumor in the breast is diagnosed. This program deals especially with the early recognition of breast cancer.

Natural History

Primary tumor

Vocabulary:

lump – опухоль,

adjacent – примыкающий, смежный,

retraction – стягивание, втягивание.

Breast cancer can manifest itself in a variety of ways. This is related to the localization and the growth characteristics of the tumor. A superficial lump is easily palpable. A more de­eply lying one is not for example a lump situated in the cen­ter of the breast or adjacent to the thorax wall is difficult or nearly impossible to feel, even in a small breast.

A superficial tumor can, because of shrinking, produce ret­raction of the skin. Even if there is no mass palpable, breast cancer must always be suspected whenever skin retraction is se­en, especially if it has been noticed recently.

The same is true for nipple retraction. Although nipple ret­raction occurs fairly frequently because of other reasons, the possibility of it being caused by tumor infiltration must alwa­ys be considered, even if ho mass is palpable.

Furthermore breast cancer can also be disguised as an inno­cent eczema of the nipple. In every such case, one should think of the possibility of the so-called «Paget’s disease of the nipple». This is an infiltration of the epidermis of the nipple by Paget cells, which are large carcinoma cells filled with clear cytoplasm. .These cells originate from a carcinoma which spreads following the ductal system of the breast. These ductal carcinomas remain ill a noninfiltrating state for rather a long time and are therefore not palpable during this period.

Metastatic spread

Vocabulary:

plexus – сплетение

Lymphatic metastases to the regional lymph nodes, usually in­volve the axillary lymph nodes, and sometimes the parasternal ones. The lateral portion of the breast drains mainly to the lymph nodes in the axilla; the central and medial portions dra­in to the parasternal chain. It is clinically important to dis­tinguish between the lower situated axillary lymph nodes and the higher ones. The lower axillary lymph nodes lie in or under the extension of the mammary tissue in this area. The highest axilla­ry lymph nodes are found next to the arteriovenous plexus under the clavicle.

Haematogenous metastases often manifest themselves in the skeleton, but also in the lungs, liver, skin, brain and other organs.

There is a relationship between the size of the tumor and both lymphatic and haematogenous metastases. The larger the tu­mor, the greater the chance of metastatic disease. The current methods of therapy for breast cancer only allow cure if the tum­or has not spread beyond the first regional lymph nodes. Detec­tion breast cancer at the earliest possible time is therefore absolutely essential.

Complaints and symptoms

The consultation.

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