Breast malignancies hold the lead in the pattern of cancers among women worldwide. Currently used methods for the instrumental diagnosis of breast cancer (BC) and their related diagnostic procedures are not sophisticated. The common constraint of instrumental techniques is the ambiguity of resultы interpretation that is associated with a diversity of individual characteristics of the structure and morphology of the breast. There is a need to search for novel diagnostic methods and oncomarkers, which are highly specific, highly sensitive, and inexpensive and able to reveal early stages in tumor development. In our opinion, a search for BC biomarkers is a promising and relevant area in oncology. Mass spectrometric methods are used to detect and identify proteomic markers in blood, biological fluids, tumor tissue, lysates, and secretomes of cancer cell lines. State-of-the-art high tech proteomics and mass spectrometric studies are oriented to the analysis of biological fluids and blood in order to identify new biomarkers. It is really that a blood test does not require any material obtained directly from tumor tissue and hence it is independent of the site of a tumor, implies the early detection of primary tumors or secondary foci, and is required by a medical oncologist in current clinical practice. The given review deals with the analysis of current methods to diagnose BC and to evaluate the efficiency of its therapy, by applying proteomic markers and the latest advances in clinical oncoproteomics.

Despite notable progress made in studying breast cancer (BC), the mechanisms of metastases, in view of the classification into molecular subtypes, in patients with BC remain to be fully uninvestigated, in the presence of a good prognosis in particular. To study novel diagnostic and predictive markers in a new way presents current problems in the pathology of BC. This investigation deals with the expression of osteoprotegerin (OPG) in the tumor cells of patients with BC. It enrolled 83 patients with locally advanced BC (T2–4N0–3M0) who had been treated in 2003 to 2010. The inclusion criterion was a histologically verified diagnosis of invasive BC. To study the level of OPG, the investigators conducted an immunohistochemical study of biopsy sections according to the standard protocol. The mean expression of receptor activator of nuclear factor kappa-B (RANK) in the BC cells was 18.7 %; its
median was 5 % (range, 0–90 %). The patients were divided into 2 groups according to the level of RANK expression: 1) high (higher than the median); 2) low (lower than the median). The high RANK group included 39 patients; the low RANK group comprised 44 patients. Analysis of the clinical and pathological characteristics of BC patients with regard RANK expression did not show any statistically significant differences in the presence or absence of affected regional lymph nodes, T category, and Ki-67 index. The analysis of clinical and pathomorphological and immunohistochemical characteristics in patients with breast cancer, taking into consideration RANK expression level, did not show any statistically significant differences with respect to presence or absence of affected regional lymph nodes, age, T category and Ki-67 index (р > 0.05). However, it revealed the following pattern: the high expression of RANK was more common in patients positive for estrogen and progesterone receptors than in those for negative receptors (p = 0.04).

The treatment of breast cancer (BC) is a relevant problem. Surgery is a key treatment method for BC. The volume of its operations varies from radical mastectomies to lumpectomies and, in the areas of regional metastases, from three-level lymphadenectomy to sentinel lymph node biopsy. Objective: to assess whether a displaced TRAM flap may be used for reconstructive operations for BC. The paper presents some experience in treating 11 BC patients in whom a displaced TRAMP flap was employed for reconstruction. At this time, the displaced TRAM flap was applied for delayed reconstruction in 3 patients. The mean age of the patients was 45.5 ± 15.7 years. In 8 BC patients undergoing one-stage reconstruction with a displaced TRAM flap, the treatment schedule was as follows: surgical treatment in 1 patient, combined treatment in 2 patients, and multimodality treatment in 5. The patients received targeted therapy in 3 cases or hormone therapy in 6. A lower abdominal skin-and-fat flap on one vascular pedicle was used in all the 11 patients.
Indications for using a displaced TRAM flap were determined; complications were analyzed. The percentage of complications due to the use of a displaced TRAM flap was 9.1 % in our study.
To reduce the rate of complications after breast reconstruction with a displaced TRAM flap, we carefully selected patients for this choice
of a plastic component. The displaced TRAM flap is one of the variants for delayed breast reconstruction despite its duration and complexity. Corrective surgery is further used to achieve breast symmetry. Corrective operations, namely, breast liposuction and submammary fold formation, were performed in 2 patients. For full breast recovery, the nipple-areolar complex is to be formed following skin-sparing mastectomies and delayed breast reconstructions. The cosmetic effect was evaluated in 11 patients as excellent in 4 (36.4 %) cases, good in 7 (63.6 %). Neither local recurrences nor distant metastases were revealed in the 11 patients during one-year follow-up.

Objective: to assess the nature and frequency of complications due to different types of delayed reconstructive and plastic surgery (DRPS) after radical mastectomy (RME).

Subjects and methods. The investigators analyzed the results of treating 31 patients after RME in 2001 to 2014. DRPS was performed 4 months to 15.5 years (more frequently 1 to 3 years) following RME. To choose an optimal reconstructive method, it should be kept in mind the following factors: breast size and ptosis, the patients’ somatic status, the presence of scars in the donor area, and radiotherapy to the chest. The breast was repaired using a TRAM flap in 22 patients. Eight cases underwent two-step reconstruction, by setting a tissue expander at Step 1 and replacing it by a silicone implant at Step 2. In one patient, a Becker expander/implant was used as a plastic component for delayed breast reconstruction
in order to make a bed with a latissimus dorsi fragment.

Results. Complications were observed in 8 (25.8 %) patients. The largest number of complications occurred in 6 cases after breast reconstruction using a TRAM flap. There were complications, such as inferior epigastric arterial thrombosis; marginal necroses of a displaced TRAM flap; hematoma in the postoperative wound region; implant bed infection; and wound edge diastasis in the donor area. In virtually all complicated cases, the patients received multimodality (75 %) and combined (12.5 %) treatments before DRPS.

Conclusion. Beam radiotherapy and chemotherapy increase the risk of complications after both reconstructive plastic surgery with implants and the use of autologous tissues. Two-step reconstruction applying implants provided a good cosmetic effect and the least rate of complications.

Breast cancer (BC) ranks first in the pattern of female malignancies (20.7 %) and remains the top cancer among women. Paget’s disease (PD) is a rare BC form that occurs in the orifice of the lactiferous tubes and that is characterized by involvement of the nipple, large ducts, often to form a lump in the breast; this rare abnormality is encountered in 0.5–5 % of all BC cases. PD has a number of peculiarities. According to different authors, PD is attended with invasive or noninvasive BC in most cases (90–98 %). The involvement is commonly multifocal. PD has a very high risk for a lump (100 and 96 % for palpable and nonpalpable breast tumors, respectively). Almost 50 % of these patients have palpable breast lumps. Despite the fact that the course of PD has its peculiarities because of the rarity of this abnormality, the approaches to its treatment are not different from those in other histopathological types of BC. As for the surgical treatment of PD, until the present time there have been many unsolved problems that remain a matter of debate. The surgical treatment of PD does not differ from the treatment of BC and is primarily determined by disease stage and tumor subtype. The volume of operations for PD varies: from Madden’s radical mastectomy to lumpectomy and sentinel lymph node biopsy. It should be kept in mind that besides nipple-areole complex involvement, invasive or noninvasive BC is often detected in PD. Organ-sparing surgery for PD is mainly a method of rehabilitation for patients. Whether organsparing surgery can be performed is also determined by breast size. Oncoplaplastic resections may be carried out for PD. If the patient wishes to preserve her breast, the range of both single-stage and delayed reconstructive operations is wide. The assessment of the biological features of a tumor and the more differentiated approach to therapy in this cohort of patents might improve considerable survival rates; the determination of indications for organ-sparing treatment is to improve quality of life in patients and their rehabilitation.

The mainstay of radical treatment for patients with breast cancer (BC) is a surgical intervention: radical mastectomy (RME) of different modifications or organ-sparing operations. In the preoperative period, the tasks of therapeutic exercises (TEs) are psychological preparation of a patient for active participation in his / her treatment, as well as complete breath training. Classes are done in a group of convalescents, by applying dynamic and static breathing exercises. In the early postoperative period, the tasks of TEs are to prevent hypostatic pneumonia, surgical-site shoulder joint stiffness and to improve systemic and regional blood and lymph circulation. Analysis of 1235 patients who had undergone RME and 212 patients who had radical resection showed that restricted shoulder joint motion due to hand immobilization in an adducted position and late initiation of TEs occurred in 44.6 and 33.5 % of the patients, respectively. Individual TEs classes include breathing exercises, position treatment, and special exercises to restore shoulder joint function and to control posture. Lymphadenectomy and failure to ligate intersected lymphatic vessels lead to inevitable lymphorrhea and seroma. Analysis of 1447 patents indicated that early initiation of TEs failed to affect seroma duration and extent and wound dehiscence. In the latter (that, according to the author»s data, occurs in 3.7 % of cases after RME and in 9.2 % after preoperative radiotherapy), TEs are limited by position treatment until the wound heals or secondary sutures are applied. The tasks of the late postoperative period are recovery of the full range of shoulder joint motion, normal posture, cardiovascular and respiratory adjustments to increased physical exercises, and general tonic exposure. The paper gives TEs sets developed for each period.

Lymphorrhea plays a leading role in the development of post-mastectomy pain syndrome and gives rise to lymphocele, local complications, and delayed adjuvant therapy and it is accompanied by longer hospitalization and a larger number of outpatient visits.
Objective: to evaluate the efficiency of armpit myoplasty in the prevention of lymphorrhea after radical mastectomy. The Department of Mammology, Republican Clinical Oncology Dispensary, Ministry of Health of the Republic of Tatarstan, has developed a procedure to prevent prolonged lymphorrhea via armpit myoplasty using the distal end of the minor pectoral muscle (Patent No. 2385673 dated April 10, 2010), which minimizes the risk of seroma formation in the armpit. The investigation is based on the analysis of the results of radical surgery in 545 patients. All the patients were divided into a study group (n = 256) that had undergone armpit myoplasty and classical Patey’s mastectomy and a control group (n = 289) that had Patey’s mastectomy only. The investigation has revealed that armpit myoplasty using the minor pectoral muscle is an effective technique to prevent seromas in the postmastectomy wound area; in this case, there is a decrease in the volume and duration of lymphorrhea and in the length of hospital stay.

We have studied bone marrow lymphocytes subpopulations in 67 patients with breast cancer and 13 patients with benign processes in the mammary gland. Morphological study of the cellular composition of the bone marrow and immunological analysis of lymphocyte subpopulations have been done. Comparative characterization of lymphocyte subpopulations in the bone marrow of patients with breast cancer and benign breast diseases was done by flow cytometry. The gate of Mature lymphocytes (CD45++) studied subpopulations of T cells (CD3), b cells (CD19), NK cells (CD56+CD3–). Among T lymphocytes (CD3+) was studied TCRγδ and TCRαβ cells, a subpopulation of CD4, CD8, CD4+, CD25+ T-regulatory cells. Within В-lymphocytes (CD19+) was studied subpopulations CD10, CD38, CD5 lymphocytes. We revealed a significant increase of CD5+, CD38+ B-cells in patients with breast cancer compared to benign tumors. Index of maturation of erythrocytes was significantly higher in BC 0.96 in comparison with benign processes 0.92. When comparing immunological data with histological structure of the tumor in the group of breast cancer patients, it was noted that the percent of CD10+ B-lymphocytes was significantly higher in infiltrative ductal cancer in comparison to infiltrative lobular carcinoma (19.3 and 8.0 % accordingly; p = 0.024).

Everyone knows that the surgical treatment of breast cancer is a major step in the combined treatment of breast cancer. One of the problems faced by cancer clinics are large economic costs in the treatment of patients with breast cancer. Thereby significantly affect the budget oncology clinics. In turn, the operations for performing advanced breast cancer significantly increases the time of hospital stay and also increases the cost of treating the patient. The objective of our study is to evaluate the cost-effectiveness of different options for surgical treatment in patients with early breast cancer luminal type A. We analyzed 200 patients with stage T1N0M0 breast cancer with luminal type A follow-up was 5 years. Patients were divided into four groups. The first group included 50 patients who underwent mastectomy with preservation of both pectoral muscles. The second group included 50 patients who had undergone radical resection of the breast. The third group included 50 patients who underwent resection of sectoral with stadiuma lymph node dissection. The fourth group included 50 patients who underwent resection with wide sectoral lymph node biopsy signal. As a result, we found that the implementation of sectoral resection with lymph node biopsy signaling in patients with breast cancer T1N0M0 stage (luminal type A) allows to reduce the duration of inpatient treatment and thus reduce the cost of inpatient care at a comparable overall and disease-free survival.

Breast cancer (ВС) is a common malignant disease of the female reproductive system. Currently we have many treatment strategies given location depending on the clinical data. Radiation therapy is an important component in a comprehensive program of treatment for ВС. Despite the fact that often use a single dose fractionation regime 1.8–2 Gy daily fractions to a total of 50 Gy in 5 weeks, do not run out to try to find new modes of fractionation. According to published research results hypofractionated regimes, we can conclude that the approaches to the value of the dose per fraction,
the number of fractions and the time of treatment differ. Dose per fraction ranged from 2.66 to 3.2 Gy, and more recently have been tested modes with a single dose of 6 Gy. Empirical data from these studies are important, but must also be aware of the possibility of applying mathematical methods for computing the probability of cure of the tumor and the occurrence of radiation complications.
It is necessary for an individual approach to each patient, picking up for some clinical cases the optimal mode of fractionation. In addition, the search continues and improvement fractionation regimes, and the results of clinical trials can tell a lot about how good the chosen model. In work the opportunity of application of the synthesized mathematical model (SM model), intended for description of NTCP, to the description of probability of local treatment of early stages of the ВС.

In spite of all of modern medicine»s advances, ovarian cancer (OC) mortality remains to be incommensurably high and to hold the lead among gynecological cancers. The initial cause of this deplorable statistics is the absence of a clear concept of the pathogenesis of OC and hence the justified prevention and methodology of early diagnosis of the disease; in this connection, therapy that proves to be ineffective is frequently used by medical oncologists in their daily practice. As a consequence, there is a high proportion of its further progression: the rates of early and late recurrences were about 30 and 60–65 %, respectively; most of which are drug resistant to further chemotherapy cycles. By taking into account these strikingly modest statistics, it becomes apparent that oncologists desire to make changes in the existing treatment regimen to achieve meaningful results. To use target drugs is one of these promising areas owing to new views on the concept of the pathogenesis of OC.
Nevertheless, considering a wide variety of the signaling cascades and molecules, which are involved in the process of carcinogenesis, even target compounds, if they have only one point of application, cannot always produce their desirable therapeutic effect and their co-administration is responsible for high toxicity. In this light, the most effective drugs are indole-3-carbinol and epigallocathechin-3-gallate, which virtually cause no adverse reactions and can block various molecular targets at different levels of the mechanism of malignant transformation. Based on L. A. Ashrafyan, s concept of two pathogenetic variants of sporadic OC (2009) and on the recent findings in molecular biology and epigenetics, the incorporation of the above medications into the standard treatment regimen for OC should increase survival rates and change the nature of recurrence by that of more locally advanced forms. On this basis, a clinical trial was carried out to study the efficiency of using antitumor drugs based on indole-3-carbinol and epigallocathechin-3-gallate as part of combination therapy for OC. The results of the clinical trial performed are suggestive of considerably higher survival rates in the groups receiving the above drugs than in the control groups. In addition, the multitarget effect of indole-3-carbinol and epigallocathechin-3-gallate can effectively remodel the function of a cancer stem cell, the main source of recurrences and metastases, and may be considered as an important adjunct to the existing strategy of antitumor therapy.

Background. Current complex ultrasound diagnosis using novel imaging techniques can assess, to a high accuracy, different tumor parameters during neoadjuvant chemotherapy (NCT) for locally advanced cervical cancer (CC) (Stages IIB–IIB). This assessment is very important and necessary to define further treatment policy.

Materials and methods. A total of 199 patients diagnosed with Stages IIB–IIIB CC, including 60 patients with Stage IIB (T2bN0M0), 4 with Stage IIIА (T3aN0M0), and 135 with Stage IIIВ (T2bN1M0, T3aN1M0, T3bN0–1M0) (according to the International Federation
of Gynecology and Obstetrics (FIGO) classification), who received NCT at Stage 1 of treatment, were examined. Complex ultrasound study was conducted before treatment initiation and after each NCT cycle. The therapeutic pathomorphism of a tumor was evaluated in surgically treated patients.

Results. The criteria have been determined for evaluating the efficiency of NCT for locally advanced CC, which are based on current ultrasonographic techniques including B-mode, Doppler ultrasound (power, spectral, three-dimensional ones), as well as on the results of therapeutic pathomorphism.

Conclusion. The criteria for evaluating the efficiency of NCT for CC should be based on current complex ultrasonographic techniques.

Today, the common term metabolic syndrome encompasses visceral (abdominal) obesity, glucose intolerance, type 2 diabetes mellitus (DM), hypertension, and dyslipidemia. In Europe, the rate of obesity mong the women ranges from 6 to 36 %. In the USA, 65 % of the adult population is overweight and 30 % is obese. High estrogen production in adipose tissue in patients with obesity has been established to increase the risk of cancer of the corpus uteri (CCU) by 4 times as compared to that in normal weight female patients. Furthermore, obese patients are at increased risk for DM that is also a risk factor for CCU. A rise in the number of obese patients leads to the population redistribution of gynecological cancer. The increasing number of patients with gynecological cancer is overweight. This patient group has an increased risk from surgery and anesthesia, a higher incidence of postoperative complications, and delayed recovery. Laparotomy increases the duration of hospital stay and the rate of wound complications. The frequency of urologic injuries in obese patients varies between 2 and 4 %. In this patient category, the rate of damage to the large vessels or bowels has also statistically significant differences. The literature highlights a number of complications specific to patients with obesity: trocar damage to anterior abdominal wall vessels, particularly to the inferior epigastric artery, urinary bladder, as well as trocar site hernia. The authors describe their experience in treating CCU patients with metabolic syndrome at the Department of Surgery for Female Reproductive System Tumors, N. N. Blokhin Russian Cancer Research Center. They demonstrate that laparoscopic extirpation of the uterus and its appendages can be performed in patients with third-degree obesity (weighing 174 kg) in Stage I CCU. It should be noted that this weight was previously regarded as an absolute contraindication to surgical treatment. Today, the active introduction of laparoscopic techniques into gynecological oncology and the improvement of anesthetic maintenance make it possible to virtually level off a contraindication to surgery, such as obesity, and to transfer it to a class of indications. An examination algorithm and the clinical features of the disease are given.