The breast is made up of glands called lobules than can make milk and thin tubes called ducts that
carry the milk from the lobules to the nipple. Breast tissue also contains fat and connective tissue, lymph nodes, and blood vessels.
What is breast cancer?
Breast cancer is a malignant tumor(a collection of cancer cells) arising from the cells of the breast. Although breast cancer predominantly occurs in women, it can also affect men.
Breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumor that can often be seen on an x-ray or felt as a lump. The tumor is malignant(cancer) if the cells can grow into(invade) surrounding tissues or spread(metastasize) to distant areas of the body.
Breast cancers can start from different parts of the breast. Most breast cancers begin in the ducts that carry milk to the nipple(ductal cancers). some start in the glands that make breast milk(lobular cancers).
A small number of cancers start in other tissues in the breast. These cancers are called sarcomas and lymphomas.
What are the types of breast cancer?
There are many types of breast cancer. Some are more common than others, and there are also combinations of cancers. Some of the most common types of cancer are as follow:
. Ductal carcinoma is situ: the most common type of noninvasive breast cancer. It has not spread and therefore usually has a very high cure rate.
. Invasive ductal carcinoma: this cancer starts in a duct of the breast and grows into the surrounding tissue. It is the most common form of breast cancer. About 80% of invasive breast cancers are of this type.
. Invasive lobular carcinoma: this breast cancer starts in the glands of the breast that produce milk and represents Approximately 10% of invasive breast cancers.
The remainder of breast cancers are much less common and include the following:
. Mucinous carcinoma- are formed from mucus-producing cancer cells. Mixed tumors contain a variety of cell types.
. Medullary carcinoma- is an infiltrating breast cancer that presents with well-defined boundaries between the cancerous and noncancerous tissue.
. Inflammatory breast cancer- this cancer makes the skin of the breast appear red and fell warm(giving it the appearance of an infection). these changes are due to the blockage of lymph vessels by cancer cells.
. Triple-negative breast cancers- this is a subtype of invasive cancer with cells that lack estrogen and progesterone receptors and have no excess of as specific protein(HER2) on their surface.
. Paget’s disease of the nipple- this cancer starts in the ducts of the breast and spreads to the nipple and the are surrounding the nipple. It usually presents with crusting and redness around the nipple.
. Adenoid cystic carcinoma- these cancers have both glandular and cystic features. They tend not to spread aggressively and have a good prognosis.
. Lobular carcinoma in situ- this is not a cancer but an area of abnormal cell growth that can lead to invasive breast cancer later in life.
The following are other uncommon types of breast cancer:
What causes breast cancer?
There are many risk factors that increase the chance of developing breast cancer. Although some of these risk factors are known, it is hard to know the cause of breast cancer or how these factors cause the development of cancer cell.
We know that normal breast cancer become cancerous because of mutations in the DNA, and although some of these are inherited, most DNA changes related to breast cells are acquired during one’s life.
Proto-oncogenes help cells grow. If these cells mutate, they can increase growth of cells without any control. Such mutations are referred to as oncogenes. Such uncontrolled cell growth can lead to cancer.
Some of the breast cancer risk factors can be prevented(alcohol use) while others cannot be influenced(age). several risk factors are inconclusive(deodorants), while in other areas, the risk is being even more clearly defined(radiation).
The following are risk factors for breast cancer:
. Age: the chances of breast cancer increases as one gets older.
. Family history: the risk of breast cancer if higher among women who have relatives with the disease.
. Personal history: having been diagnosed with breast cancer in one breast increases the risk of cancer in the other breast or the chance of an additional cancer in the original affected breast.
. Women diagnosed with certain benign breast conditions have an increased risk of breast cancer. These include atypical hyperplasia, a condition in which there is abnormal proliferation of breast cells but no cancer has developed.
. Menstruation: women who started their menstrual cycle at a younger age(before 12) or went through menopause later(after 55) have a slightly increased risk.
. Breast tissue: women with dense breast tissues have a higher risk of breast cancer.
. Race: white women have a higher risk of developing breast cancer, but for example, African-American women tend to have more aggressive tumors when they do develop breast cancer.
. Exposure to previous chest radiation or use of diethylstilbestrol increases the risk of breast cancer.
. Having no children or the first child after age 30 increases the risk of breast cancer.
. Breastfeeding for one and a half to two years might slightly lower the risk of breast cancer.
. Being overweight or obese increases the risk of breast cancer both in pre- and postmenopausal women but at different rates.
. Use of oral contraceptives in the last 10 years increases the risk of breast cancer slightly.
. Using combines hormone therapy after menopause increases the risk of breast cancer.
. Exercise seems to lower the risk of breast cancer.
. Genetic risk factors: the most common causes are mutations in the BRCA1 and BRCA2 genes(breast cancer and ovarian cancer genes). Inheriting a mutated gene from a parent means that one has a significantly higher risk of developing breast cancer.
What are the symptoms of breast cancer?
The first symptoms of breast cancer are usually an area of thickened tissue in the breast, or a lump in the breast or in an armpit.
Other symptoms include:
. A pain in the armpits or breast that does not change with the monthly cycle
. Pitting or redness of the skin of the breast, like the skin of an orange
. A rash around or on one of the nipples
. A discharge from a nipple, possibly containing blood
. A sunken or inverted nipple
. A change in the size or shape of the breast
. Peeling, flaking, or scaling of the skin on the breast or nipple
Most lumps are not cancerous, but women should have them checked a health care professional.
How is breast cancer diagnosed?
A diagnosis often occurs as the result of routine screening, or when a woman approaches her doctor after detecting symptoms.
Some diagnostic tests and procedures help to confirm a diagnosis.
Breast self-exam is a step-by-step approach a women can use to look at and feel her breasts to check for anything abnormal.
Although, breast self-exam isn’t recommended as a screening tool for breast cancer, it’s important to become familiar with the way your breasts normally look and fell. Knowing what’s normal for you may help notice a change in your breasts.
Once a month: adult women of all ages are encouraged to perform breast self-exams at least once a month.
In the shower: using the pads of fingers, move around your entire breast in a circular pattern moving form the outside to the center, checking the entire breast and armpit area. Check both breasts each month feeling for any lump, thickening or hardened knot. Notice any changes and get lumps evaluated by your health care provider.
In front of a mirror:visually inspect your breasts with your arms at your sides. Next, raise your arms high overhead. Look for any changes in the contour, any swelling, or dimpling of the skin, or changes in the nipples. Next, rest your palms on your hips and press firmly to flex your chest muscles. Left and right breasts will not exactly match-few women’s breasts do, so look for any dimpling, puckering or changes, particularly on the side.
Lying down:when lying down, the breast tissue spreads out evenly along the chest wall. Place a pillow under your right shoulder and your right arm behind your head. Using your left hand, move the pads of your fingers around your right breast gently in small circular motions covering the entire breast area and armpit. Use light, medium, and firm pressure. Squeeze the nipple, check for discharge and lumps. Repeat these steps for your left breast.
Clinical breast exam
The physician will check the patient’s breast for lumps and other symptoms.
The patient will be asked too sit or stand with her arms in different positions, such as above her head and by her sides.
Chest X-ray: it looks for spread of the cancer to the lungs.
Mammography: a mammography is a type of X-ray commonly used for initial breast cancer screening. It produces images that can help detect any lumps or abnormalities.
A suspicious result can be followed up by further diagnosis. However, mammography sometimes shows up a suspicious area that is not cancer.
Ultrasound: it can help differentiate between a solid mass or a fluid-filled cyst.
CT/MRI: it involves injecting a dye into the patient, to find out how far the cancer has spread.
Bone scan: a bone scan determines if the cancer has spread to the bones. Low level radioactive material is injected into the bloodstream, and over a few hours, images are taken to determine if there is uptake in certain bone areas, indicating metastasis.
Positron emission tomography(PET scan): a radioactive material is injected that is absorbed preferentially by rapidly growing cells(cancer cells). the PET scanner then locates these areas in your body.
A simple of tissue is surgically removed for laboratory analysis. This can show whether the cells are cancerous, and, if so, which type of cancer it is, including whether or not the cancer is hormone-sensitive.
The diagnosis also involves staging the cancer, to establish:
. The size of a tumor
. How far it has spread
. Whether it is invasive or non-invasive
. Whether it has metastasized, or spread to other parts of the body
Staging will affect the chances of recovery and will help decide on the best treatment course.
TNM staging system is a widely used staging system. Besides the information gained from the imaging tests, this system also uses the results from surgical procedures. The system uses letters and numbers to describe certain tumor characteristics in a uniform manner.
T- describes the size of the tumor. It is followed by a number from 0 to 4.
N- describes the spread to lymph node near the breast. It is followed by a number from 0 to 3
M- indicates whether the cancer has spread to other organs. It is followed by a 0 or 1.
The table below summarizes the TNM system.
Once the T,N, and M categories have been determined, they are combined into staging groups. There are five major staging groups, stage 0 to stage 4, which are subdivided into A and B, or A and B, and C, depending on the underlying cancer and the T,N, and M scale.
Cancer cells remain inside the breast duct, without invasion into normal adjacent breast tissue
The tumor measures up to 2cm and the cancer has not spread outside the breast, no lymph nodes are involved
There is no tumor in the breast, instead, small groups of cancer cells-larger than 0.2 mm but not larger than 2mm- are found in the lymph nodes OR there is a tumor in the breast that is not larger than 2 cm, and there are small groups of cancer cells-larger than 0.2 mm but not larger than 2 mm- in the lymph nodes.
No tumor can be found in the breast, but cancer cells are found in the axillary(under the arm) lymph nodes OR the tumor measures 2 cm or smaller and has spread to the axillary lymph nodes OR the tumor is larger than 2 but no larger than 5 cm and has not spread to the axillary lymph nodes.
The tumor is larger than 2cm but not larger than 5 cm and has spread to the axillary lymph nodes OR the tumor is larger than 5 cm but has not spread to the axillary lymph nodes.
No tumor is found in the breast. Cancer is found in axillary lymph nodes that are stickiing together or to other structures, or cancer may be found in lymph nodes near the breastbone OR the tumor is any size. Cancer has spread to the axillary lymph nodes, which are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone.
The tumor may be any size and has spread to the chest wall and/or skin of the breast AND may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone.
Inflammatory breast cancer is considered at least stage 3B.
There may either be no sign of cancer in the breast or a tumor may be any size and may have spread to the chest wall and/or the skin of the breast AND the cancer has spread to lymph nodes either above or below the collarbone AND the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone.
The cancer has spread-or metastasized- to other parts of the body.
What is the treatment for breast cancer?
Treatment will depend on:
. The type of breast cancer
. The stage of the cancer
. Sensitivity to hormones
. The patient’s age, overall health, and preferences.
The main option include:
. Radiation therapy
. Biological therapy, or targeted drug therapy
. Hormone therapy
Surgery: If surgery is needed, the choice will depend on the diagnosis and the individual.
Lumpectomy: removing the tumor and a small margin of healthy tissue around it can help prevent the spread of the cancer. This may be an option if the tumor is small and likely to be easy to separate from the surrounding tissue.
Mastectomy: simple mastectomy involves removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. Radical mastectomy removes muscle from the chest wall and the lymph nodes in the armpit as well.
Sentinel node biopsy: removing one lymph node can stop the cancer spreading, because if breast reaches a lymph node, it can spread further through the lymphatic system into other parts of the body.
Axillary lymph node dissection: if there are cancer cells on a node called the sentinel node, the surgeon may recommend removing several lymph nodes in the armpit to prevent the spread of disease.
Reconstruction: following breast surgery, reconstruction can recreate the breast so that it looks similar to the other breast. This can be done at the same time as a mastectomy, or at a later date. The surgeon may use a breast implant, or tissue from another part of the patient’s body.
Controlled doses of radiation are targeted at the tumor to destroy the cancer cells. Used after surgery, along with chemotherapy, It can kill any remaining cancer cells.
Medications known as cytotoxic drugs may be used to kill cancer cells, if there is a high risk of recurrence or spread. This is called adjuvant chemotherapy.
If the tumor is large, chemotherapy may be administered before surgery to shrink the tumor and make its removal easier. This is called neo-adjuvant chemotherapy.
It may be used to reduce estrogen production, as estrogen can encourage the growth of some breast cancers.
Hormone blocking therapy
Hormone blocking therapy is used to prevent recurrence in hormone-sensitive breast cancers. These are often referred to as estrogen receptive(ER) positive and progesterone receptor(PR) positive cancers.
Hormone blocking therapy is normally used after surgery, but it may sometimes be used beforehand to shrink the tumor.
It may be the only option for patients who cannot undergo surgery, radiotherapy or chemotherapy.
Targeted drugs destroy specific types of breast cancer. The drugs are all used for different purposes.
Treatments for breast and other cancers can have severe adverse effects.
The patients should discuss with a doctor the risks involved and ways to minimize the negative effects, when deciding on treatment.
How to prevent of breast cancer?
There is no sure ways to prevent breast cancer, but some lifestyle decisions can significantly reduce the risk of breast and other types of cancer.
. Avoiding excess alcohol consumption
. Following a healthy diet with plenty of fresh fruit and vegetables
. Getting enough exercise
. Maintaining a healthy body mass index
Carefully thinking about breastfeeding options and use of HRT following menopause, is essential, as these can affect risk of breast cancer.
Preventive surgery is an option for women at high risk.
The above article serves only as reference. Kindly refer to your primary care provider for complete consultation and treatment.
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