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 me.
Breast Cancer signs and symptoms include:
- a lump in the breast or armpit,
- bloody nipple discharge,
- inverted nipple,
- orange-peel texture or dimpling of the breast’s skin,
- breast pain or sore nipple,
- swollen lymph nodes in the neck or armpit, and
- a change in the size or shape of the breast or nipple.
Breast cancer is diagnosed during a physical exam, by a self-exam of the breasts, mammography, ultrasound testing, and biopsy.
Treatment of breast cancer depends on the type of cancer and its stage (0-IV) and may involve surgery, radiation, or chemotherapy.
Types of Breast Cancer:
- Ductal carcinoma in situ: The most common type of non-invasive breast cancer is ductal carcinoma in situ (DCIS). This early-stage breast cancer has not spread and therefore usually has a very high cure rate.
- Invasive ductal carcinoma: This cancer starts in the milk ducts of the breast and grows into other parts of the surrounding tissue. It is the most common form of breast cancer. About 80% of invasive breast cancers are invasive ductal carcinoma.
- Invasive lobular carcinoma: This breast cancer starts in the milk-producing glands of the breast. Approximately 10% of invasive breast cancers are invasive lobular carcinoma.
- 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 feel 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 a specific protein (HER2) on their surface. It tends to appear more often in younger women and African-American women.
- Paget’s disease of the nipple: This cancer starts in the ducts of the breast and spreads to the nipple and the area 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. This pre-cancer can lead to invasive breast cancer later in life.
Uncommon types of Breast Cancer:
- Papillary carcinoma
- Phyllodes tumor
- Tubular carcinoma
Diagnosis of Breast Cancer:
Although breast cancer can be diagnosed by the above signs and symptoms, the use of screening mammography has made it possible to detect many of the cancers early before they cause any symptoms.
Women should have the choice to begin annual screening between 40-44 years of age. Women age 45 and older should have a screening mammogram every year until age 54. Women 55 years of age and older should have biennial screening or have the opportunity to continue screening annually. Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer.
Staging is the process of determining the extent of the cancer and its spread in the body. Together with the type of cancer, staging is used to determine the appropriate therapy and to predict chances for survival.
To determine if the cancer has spread, several different imaging techniques can be used.
- Chest X-ray: It looks for spread of the cancer to the lung.
- Mammograms: More detailed and additional mammograms provide more images of the breast and may locate other abnormalities.
- Computerized tomography (CT scan): These specialized X-rays are used to look at different parts of your body to determine if the breast cancer has spread. It could include a CT of the brain, lungs, or any other area of concern.
- Bone scan: A bone scan determines if the cancer has spread (metastasized) 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 (such as cancer cells). The PET scanner then locates these areas in your body.
Many women with breast cancer will require surgery. Broadly, the surgical therapies for breast cancer can be divided into breast-conserving surgery and mastectomy.
This surgery will only remove part of the breast (sometimes referred to as partial mastectomy). The extent of the surgery is determined by the size and location of the tumor.
In a lumpectomy, only the breast lump and some surrounding tissue is removed. The surrounding tissue (surgical margins) are inspected for cancer cells. If no cancer cells are found, this is called “negative” or “clear margins.” Frequently, radiation therapy is given after lumpectomies.
During a mastectomy (sometimes also referred to as a simple mastectomy), all the breast tissue is removed. If immediate reconstruction is considered, a skin-sparing mastectomy is sometimes performed. In this surgery, all the breast tissue is removed as well, but the overlying skin is preserved. A nipple-sparing mastectomy keeps the skin of the breast, as well as the areola and nipple.
During this surgery, the surgeon removes the axillary lymph nodes as well as the chest wall muscle in addition to the breast. This procedure is done much less frequently than in the past, as in most cases, a modified radical mastectomy is as effective.
Modified radical mastectomy:
This surgery removes the axillary lymph nodes in addition to the breast tissue. Depending on the stage of the cancer, a health care team might give someone a choice between a lumpectomy and a mastectomy. Lumpectomy allows sparing of the breast but usually requires radiation therapy afterward. If lumpectomy is indicated, long-term follow-up shows no advantage of a mastectomy over the lumpectomy.
Radiation therapy destroys cancer cells with high energy rays. There are two ways to administer radiation therapy.
External beam radiation:
This is the usual way radiation therapy is given for breast cancer. A beam of radiation is focused onto the affected area by an external machine. The extent of the treatment is determined by a health care team and is based on the surgical procedure performed and whether lymph nodes were affected or not.
The local area will usually be marked after the radiation team has determined the exact location for the treatments. Usually, the treatment is given five days a week for five to six weeks.
This form of delivering radiation uses radioactive seeds or pellets. Instead of a beam from the outside delivering the radiation, these seeds are implanted into the breast next to the cancer.
Chemotherapy is treatment of cancers with medications that travel through the bloodstream to the cancer cells. These medications are given either by intravenous injection or by mouth.
- Adjuvant chemotherapy: If surgery has removed all the visible cancer, there is still the possibility that cancer cells have broken off or are left behind. If chemotherapy is given to assure that these small amounts of cells are killed as well, it is called adjunct chemotherapy. Chemotherapy is not given in all cases, since some women have a very low risk of recurrence even without chemotherapy, depending upon the tumor type and characteristics.
- Neoadjuvant chemotherapy: If chemotherapy is given before surgery, it is referred to as neoadjuvant chemotherapy. Although there seems to be no advantage to long-term survival whether the therapy is given before or after surgery, there are advantages to see if the cancer responds to the therapy and by shrinking the cancer before surgical removal.
- Chemotherapy for advanced cancer: If the cancer has metastasized to distant sites in the body, chemotherapy can be used for treatment. With cases of metastatic breast cancer, the health care team will need to determine the most appropriate length of treatment.
There are many different chemotherapeutic agents that are either given alone or in combination. Usually, these drugs are given in cycles with certain treatment intervals followed by a rest period. The cycle length and rest intervals differ from drug to drug.
This therapy is often used to help reduce the risk of cancer reoccurrence after surgery, but it can also be used as adjunct treatment.
Estrogen (a hormone produced by the ovaries) promotes the growth of a few breast cancers, specifically those containing receptors for estrogen (ER positive) or progesterone (PR positive)
The following drugs are used in hormone therapy:
Tamoxifen (Nolvadex): Toremifene (Fareston) Fulvestrant (Faslodex): Aromatase inhibitors: letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin).