SURGICAL TREATMENT OF CANCER OF MAMMARY GLAND (THE HISTORY AND CONTEMPORARY)

Аннотация

The concern of cancer of mammary gland is problem of today. The surgical treatment still has a priority. The advances in therapeutic radiation and chemotherapy improve the surgical treatment to enrich quality of life of the patients with the introduction of conservative surgery. Key words: mammary gland, cancer, surgical treatment. Over the past decades, breast cancer has rapidly risen to first place in the overall incidence of malignant tumors in women, both in other CIS countries and in the Kyrgyz Republic. According to data from the early 1970s to the present, the average annual growth rate of the number of cases has doubled (I.P. Napalkov et al., 1982, S.V. Koreneva et al., 1994). The standardized incidence rate in our region in 2008 was 8.5 per 100,000 population. Mortality from this disease also continues to grow, although at a lower rate: (4.6 per 100,000) (Davydov M.I., Aksel E.M., 2008). According to the experts of the World Health Organization (WHO), in the coming 2010, up to 1.5 million new cases of breast cancer will be detected in the world (Stoyko Yu. M. et al., 1999). Such disappointing statistics determine the relevance of improving both the prevention and diagnosis of breast cancer, and its treatment. According to V. P. Letyagin (1985), more than 6,000 treatment options for patients with breast cancer have been proposed at present. All treatment measures are divided into local-regional (surgery, radiation therapy) and systemic effects (chemotherapy, hormone therapy, immunotherapy). Certain successes in the treatment of breast cancer, achieved in recent years, are associated, first of all, with the use of various new methods of combined and complex treatment of this disease, with the undoubted successes of drug therapy for breast cancer, the introduction of highly effective cytostatics, hormonal drugs, bisphosphonates into clinical practice. Considering that breast cancer at any stage may be a systemic disease accompanied by latent dissemination of tumor cells throughout the body, the role of adjuvant systemic chemo- and/or hormone therapy as methods of 58 THEORETICAL ASPECTS IN THE FORMATION OF PEDAGOGICAL SCIENCES International scientific-online conference influencing distant metastases is difficult to overestimate. However, the surgical method of treating this disease remains dominant and basic to this day. The radicalism of the operation, depending on compliance with ablastics and antiblastics, is determined mainly by the compliance of the operation with the individual characteristics of local-regional growth and spread (Bazhenova A.L., Ostrovtsev L.D., Khakhanashvili G.N., 1985). Along with this, the surgical method is also the most ancient method of treating breast cancer, which was used in Ancient Egypt 3 thousand years BC (Davydov M.I., Aksel E.M., 2008). The entire history of the development of surgical treatment of breast cancer reflects the search for optimal volumes of surgical intervention. The nature of therapy is always determined by the level of knowledge, prevailing ideas about the disease and the availability of the necessary material and technical support for treatment programs: from a complete rejection of invasive interventions during the time of Hippocrates and symbolic herbal treatment during the Middle Ages to super-extended mutilating operations in the mid-50s of the 20th century (Semiglazov V.F., Vesnin A.G., Moiseenko V.M., 1989). An assessment of the results of treatment of this disease based on available historical documents since the time of Hippocrates shows that it was actually ineffective and, as a rule, symptomatic, that is, it was aimed at alleviating suffering (reducing pain, treating tumor ulcers), but did not prolong the lives of patients. And only at the end of the 19th century was some progress outlined. A qualitative leap in the effectiveness of breast cancer treatment occurred more than 100 years ago. In the late 19th and early 20th centuries, W. Handley (1922) put forward a hypothesis according to which it was believed that breast cancer spreads primarily through the lymphatic pathways and that regional lymph nodes are an ideal barrier to the spread of cancer cells. At the same time, the spread of tumor cells through the bloodstream was clearly underestimated. Based on this theory, Halsted (1889) developed his own mastectomy technique, which involved the removal of the mammary gland with the pectoral muscles, subclavian, axillary and subscapular lymph nodes in one block. This operation was considered the main method of treatment for a long time and was recognized as a standard radical mastectomy. Immediately after the widespread introduction of the Halsted operation into clinical practice, very encouraging results were obtained: the frequency of local and regional relapses decreased from 80 to 26% (Semiglazov V.F., Vesnin A.G., Moiseenko V.M., 1989). It should be noted that before W.S. Halsted, in 1888, N.I. Studensky proposed a radical operation fo