|
| |
|
 |
 General Info about Breast Cancer |
| What are the causes of Breast Cancer ? |
| What are the symptoms of Breast Cancer ? |
| How can we diagnose Breast Cancer ? |
| Types of Breast Cancer |
| More valuable information about Breast Cancer |
| Frequently asked questions about Breast Cancer |
| Glossary |
| |
| General Info about Breast Cancer |
Other than skin cancer, breast cancer is the most common type of cancer among women. Breast cancer mostly occurs in women over the age of 50, and the risk is especially high for women over age 60. Breast cancer is also found to occur more often in white women than African American or Asian women.
Each breast has 15 to 20 sections called lobes. Within each lobe are many smaller lobules (milk producing glands). Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules and bulbs are all linked by thin tubes called ducts (milk passages that connect the lobules and the nipple). Fat surrounds the lobules and ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola. There are no muscles in the breast, but muscles lie under each breast and cover the ribs.
Each breast also contains blood vessels and lymph vessels. The lymph vessels carry colorless fluid called lymph, and lead to small bean-shaped organs called lymph nodes. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest. Lymph nodes are also found in many other parts of the body.
Cancer cells may enter lymph vessels and spread out along these vessels to reach lymph nodes. Cancer cells may also enter blood vessels and spread through the blood stream to other parts of the body, bypassing lymph nodes. When breast cancer cells reach the lymph nodes, they continue to grow, often causing swelling of the lymph nodes. These swollen lymph nodes sometimes can be felt, especially in the armpit. If breast cancer cells have spread to the lymph nodes in the arm pit, there is a greater chance that cancer cells have spread to other organs of the body as well.
The signs of cancer of the breast are, a small abscess begins with the size of a hazel nut or smaller, and then increases in size little by little, with notable hardness, darkness of coloring, round shape, and some warmth to the touch. When it begins to grow larger, green veins appear in it, and it has roots penetrating into the body.
-Theodoric, Bishop of Cervia, 1267
|
|
| What are the causes of Breast Cancer ? |
There are many factors for developing breast cancers. However, the exact cause is not known. It is suspected that more than one factor is involved. Also the risk of breast cancer increases as a woman gets older.
 Personal history of breast cancer : Women who have had breast cancer face an increased risk of getting breast cancer in their other breast.
Family history : A woman's risk for developing breast cancer increases if her mother, sister, or daughter had breast cancer, especially at a young age.
Late childbearing : Women who have their first child late (after about age 30) have a greater chance of developing breast cancer than women who have a child at a younger age.
Early Menstruation and Late Menopause : Women who started their menstrual periods early (before age 12) or go through menopause late (after age 55) are at higher risk.
Alcohol: Some studies suggest a slightly higher risk of breast cancer among women who drink alcohol (more than 3 drinks a day).
Oral Contraceptives (birth control pills): Birth control pills may slightly increase the risk for breast cancer, depending on age, length of use, and other factors.
Hormone Replacement Therapy: More than 5 years of use has been shown to slightly increase the risk of breast cancer and it is found to increase with longer periods of usage.
Estrogen pills: Women consuming diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer.
Chemicals: Some studies have pointed to exposure to estrogen - like chemicals that are found in pesticides and other industrial products as a possible increased risk of breast cancer.
|
|
| What are the symptoms of Breast Cancer ? |
Breast density : Breasts that have a high proportion of lobular and ductal tissue appear dense on mammograms. Making it more difficult for doctors to see abnormal areas on a mammogram. Breast cancers nearly always develop in lobular or ductal tissue (not fatty tissue). That's why cancer is more likely to occur in breasts that have more lobular and ductal tissue (that is, dense tissue) than in breasts with more fatty tissue.
Obesity is a controversial risk factor : Some studies report obesity individuals have a higher risk of breast cancer, possibly associated with higher levels of estrogen production in obese women.
Radiation therapy : Women whose breasts were exposed to radiation before age 30, especially those who were treated with radiation for Hodgkin's disease, are at an increased risk for developing breast cancer. Studies show that the younger a woman is, while receiving radiation treatment, the higher her risk for developing breast cancer later in life.
Detection of a breast lump is the most common symptom of breast cancer. But, almost 90% of all breast masses are caused by benign lesions (non cancerous).
Early breast cancer usually does not cause pain.
Lump or mass in the armpit.
Change in the size or shape of the breast should be examined. The breast should be examined in an upright (sitting) position. The breasts should be inspected for difference in size, withdrawal of the skin or nipple, visible patterns and signs of swelling. In breast cancer, the lump is usually single, separate and hard. In some instances, it is fixed to the skin or the muscle.
Nipple discharge from a breast carcinoma is usually spontaneous, bloody, associated with a mass and localized to a single duct in one breast. The nipple shows tenderness, or the nipple is pulled back (inverted) into the breast. The nipple should be gently squeezed to check for discharge. It is also associated with redness, swelling or oedema and retraction of the nipple.
Ridges or pitting of the breast (the skin looks like the skin of an orange).
Pain, swelling or discomfort in the breast.
|
|
| How can we diagnose Breast Cancer ? |
Clinical breast exam :
A thorough clinical exam, can reveal any lumps, if formed. A self breast examination can also be done on a regular basis.
Mammograms :
A low radiation X-ray called screening mammogram is the best tool available for detecting breast cancer early, before symptoms appear. Mammograms can often detect a breast lump before it can be felt. It also shows small deposits of calcium in the breast. Although most calcium deposits are benign, a cluster of very tiny specks of calcium (called microcalcifications) may be an early sign of cancer.
Ultrasonography :
Using high-frequency sound waves, ultrasonography can often show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer).
Ridges or pitting of the breast (the skin looks like the skin of an orange).
Pain, swelling or discomfort in the breast.
Magnetic Resonance Imaging (MRI) :
MRI is used to define the size and extent of cancer within the breast tissue. It is mostly used in women whose dense breast tissue makes it more difficult to find tumors with a mammogram.
Digital Mammography :
Digital mammography is similar to standard mammography and it uses radiographs to image the breast. The advantage of digital mammography is that images are stored digitally and can be enhanced by modifying the brightness or contrast. These images can be transmitted by telephone lines for remote consultation.
Biopsy :
This procedure takes a tissue sample to be examined under the microscope.
Fine needle aspiration : A thin needle is used to remove fluid and/or cells from a breast lump. If the fluid is clear, it may not need to be checked by a lab.
Needle biopsy: Using special techniques, tissue can be removed with a needle from an area that looks suspicious on a mammogram but cannot be felt. Tissue removed in a needle biopsy goes to a lab to be checked by a pathologist for cancer cells.
Stereotactic needle biopsy: This procedure uses a mammogram-directed technique using computerized mammogram breast images which helps to map the exact location of the breast lump.
Surgical biopsy: In an incisional biopsy, the surgeon cuts out a sample of a lump or suspicious area. In an excisional biopsy, the surgeon removes all of a lump or suspicious area and an area of healthy tissue around the edges. A pathologist then examines the tissue under a microscope to check for cancer cells.
|
|
| Types of Breast Cancer |
Breast cancer is classified based on where the cancer has initiated whether in the ducts or in the lobules, whether the cells have invaded (grown or spread) through the duct or lobule, and the way the cancer cells look under a microscope.
Carcinoma In Situ:
In situ means that the cancer stays inside the ducts or lobules and has not spread into surrounding fatty tissues in the breast or to other organs in the body. About 15% of breast cancers are carcinomas in situ.
There are 2 types of breast
carcinoma in situ:
1. Lobular carcinoma in situ (LCIS):
It begins in the lobules, but does not grow through the lobule walls. Women with LCIS have a higher risk of developing an invasive cancer in either breast sometime in their lifetime. About 25% of women with LCIS develop breast cancer within 30 years.
2. Ductal carcinoma in situ (DCIS):
This is the most common type of non-spreading breast cancer. Cancer cells inside the ducts do not spread through the walls of the ducts into the fatty tissue of the breast.
Invasive Ductal Carcinoma (IDC):
It is an invasive breast cancer that starts in the duct which may break through the walls of the duct and spread into the breast's fatty tissue. It can then "invade" lymphatic channels or blood vessels of the breast and spread to other parts of the body. About 80% to 85% of all breast cancers are infiltrating or invasive ductal carcinoma.
Invasive Lobular Carcinoma (ILC):
This type of cancer starts in the milk-producing glands (lobules) and can spread beyond the breast to other parts of the body. About 10% to 15% of invasive breast cancers are invasive lobular carcinoma.
Medullary Carcinoma:
This is a special type of IDC which has a clear and distinct boundary between tumor tissue and normal breast tissue. The size of the cancer cells are large and immune cells are present at the edge of the tumor. It accounts for about 5% of all breast cancers.
Colloid Carcinoma
This rare type of IDC is also called mucinous carcinoma, is formed by mucus-producing cancer cells. Colloid carcinoma has a slightly better prognosis and a slightly lower chance of metastases (spreading) than invasive ductal cancers.
Tubular Carcinoma
Tubular carcinoma is an invasive ductal breast carcinoma. About 2% of all breast cancers are tubular carcinomas. They have a slightly better prognosis and a slightly lower chance of metastasis than invasive lobular or invasive ductal cancers of the same size.
Inflammatory Breast Cancer
Inflammatory breast cancer is a type of spreading cancer that causes the skin of the affected breast to become red and swollen in what is sometimes called "peau d'orange" (the appearance of an orange peel). Doctors now know that these changes are not due to inflammation (earlier, it was thought to be an inflammatory breast cancer and hence the name for this type of breast cancer). This type of cancer has a higher chance of spreading and a worse prognosis than typical invasive ductal or lobular cancers. It is classified as stage III-B cancer.
|
|
Treatment of Breast Cancer |
The treatment of breast cancer involves local and systematic treatment. Treatment to the whole body involves systematic treatment, and local treatment involves treatment of breast area and the lymph nodes near it. Sometimes treatment may include more than one type of local or systematic treatment.
Both systematic and local treatment is given in patients where the cancer has spread to other places beyond the breast.
The choice of treatment is based upon many factors which depend upon the extent to which the cancer has spread, characteristics of the cancer, and general health of the patient.
The two local treatments for breast cancer are surgery and radiation.
Surgery is the most common treatment for breast cancer, and there are several types of surgery.
Breast conserving surgery : An operation to remove the cancer but not the breast is called breast-sparing surgery.
Lumpectomy : In lumpectomy, the surgeon removes the breast cancer and some normal tissue around it.
Segmental mastectomy : In segmental mastectomy, the surgeon removes the cancer and a larger area of normal breast tissue around it. Occasionally, some of the lining over the chest muscles below the tumor is removed as well. Some lymph nodes under the arm may also be removed.
Total mastectomy : In total mastectomy, the surgeon removes the whole breast. Some lymph nodes under the arm may also be removed.
Radical mastectomy : The surgeon removes the breast, both chest muscles, all of the lymph nodes under the arm, and some additional fat and skin. For many years, this operation was considered the standard one for women with breast cancer, but it is almost never used today. In rare cases, radical mastectomy may be suggested if the cancer has spread to the chest muscles.
Axillary Lymph node dissection : Removing some or all of the lymph nodes in the arm pit. Usually 10 to 20 lymph nodes in the arm pit are removed.
Radiation therapy : It is the use of high-energy rays to kill cancer cells. Radiation is used to destroy cancer cells left behind in the breast, chest wall or lymph nodes after surgery.
External radiation : Radiation may be directed at the breast by a machine.
Implant radiation : Radiation can also come from radioactive material placed in thin plastic tubes that are placed directly in the breast. Some women have both kinds of radiation therapy.
There are three main kinds of systematic treatments used for the whole body.
Chemotherapy : is the use of drugs to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs. The drugs may be given in a pill or by injection. Either way, the drugs enter the bloodstream and travel throughout the body. Chemotherapy is preferred when the cancer is spread to the lymph nodes; cancer is more than a centimeter. Chemotherapy is not preferred for cancers with a low risk of spreading to other parts. Side effects of chemotherapy are nausea, vomiting, diarrhea, mouth sores, tiredness, susceptibility to infection, hair loss, aches and discomforts.
Hormonal therapy : Estrogen is a hormone which is required for cancer cells to grow. Estrogen binds to these cells and stimulates them to grow and divide. Anti-estrogens prevent the binding of estrogen. This stops the cells from growing and in doing so, prevents or delays breast cancer recurrence. Tamoxifen is the most commonly used Selective Estrogen Receptor Modulators (SERMs). You should take the drug as a pill once a day. Side effects of this therapy can be hot flashes, vaginal dryness or discharge, irregular periods, nausea and cataracts. Serious, but rare, side effects are endometrial cancer, blood clots in lung or brain.
Immune therapy : This treatment enhances the immune system of the body to fight cancer cells. Herceptin is the most commonly used immune treatment for advanced breast cancer. Herceptin works by attaching to HER 2 receptors on breast cancer cells. These receptors are involved in the signaling for growth and spread of cancer cells. Herceptin blocks and masks the HER 2 receptors which help in recognisation of these cells for the immune system to detect and destroy them.
Biological therapy : is a treatment designed to enhance the body's natural defenses against cancer.
|
|
| More Valuable information about Breast Cancer |
Staging of cancer :
STAGE 0: In Situ ("in place") disease in which the cancerous cells are in their original location within normal breast tissue.
STAGE I: Tumor that is less than 2 cm in diameter with no spread beyond the breast.
STAGE II: Tumor that is 2 to 5 cm in size without spread to lymph nodes of axilla or tumor less than 2 cm in size with spread to axillary lymph nodes.
STAGE III: Tumor that is smaller than 5 cm in size with spread to axillary lymph nodes which are attached to each other or to other structures.
STAGE IV: A tumor that is of any size, which spread beyond the region of the breast and chest wall, such as to liver, bone, or lungs.
Prevention
Many risk factors cannot be controlled. Some experts in the field of diet and cancer agree that changes in diet and lifestyle may reduce the incidence of cancer generally. Efforts have focused on early detection since breast cancer is more easily treated and often curable if it is found early.
Most recommend breast self-examinations (BSE) once a month, the week following your menstrual period if you are age 20 or older.
Regular check up by a health professional between ages 20 and 39 at least every 3 years and after age 40, women should have a check up by a health professional every year.
|
|
| Frequently asked questions about Breast Cancer |
Which specialist should I see if I have Breast cancer ?
Any surgeon who has an interest in treating breast cancer can help you. However, if the cancer has spread, an Oncologist is the best person to be approached.
What should I do to prevent breast cancer ?
a. Regular self breast examination after the age of 30.
b. If there is a strong family history of breast cancer, one should have a regular mammogram after the age of 35.
c. Leading a healthy lifestyle will help prevent breast cancer.
Who is the best doctor to treat my disease ?
Any surgeon who has an interest in treating breast cancer can help you. However, if the cancer has spread, an Oncologist is the best person to be approached.
When is chemotherapy used as treatment option?
Chemotherapy will be used anytime once cancer cells are diagnosed in the body's circulation. Chemotherapy would be used to keep the cancer from spreading. It would not cure the cancer all together, but it can keep the cancer "in remission" for a period of time. Also, chemotherapy is used to prevent symptoms from occurring and is used to help one feel more "comfortable" although the cancer may still be in progress.
How does chemotherapy work?
Chemotherapy is a "systemic" therapy. This means that the drugs will go throughout your body and theoretically kill all cancer cells within your body. But certain chemotherapy drugs are known to kill certain types of cancer cells, therefore, the chemotherapy drugs are selected according to the type of cancer one is affected with.
How is chemotherapy given?
Most chemotherapy is given intravenously (IV) so that it reaches directly into the blood system. This allows the drugs to be rapidly absorbed and destroys the cancer fast. Sometimes chemotherapy can be given in a pill form.
What are the effects of radiation treatment?
External radiation therapy does not cause one's body to become radioactive. There is no need to avoid being with other people because of treatment. Even hugging, kissing, or having sexual relations poses no risk of radiation exposure. Approximately 2-3 weeks after the first radiation treatment, one may experience changes to skin areas of the chest wall and breast. These changes are an expected part of the therapy and are temporary.
Are all breast lumps cancerous?
Most breast lumps are benign (not cancerous). They cannot spread outside of the breast to other organs. Fibrocystic changes usually cause most of these lumps. Fibrosis refers to excessive formation of scar-like connective tissue; cysts are fluid-filled sacs. Women with fibrocystic changes often experience breast swelling and pain. The breasts may feel lumpy and the nipple may discharge a clear or slightly cloudy green or gray fluid. Fibroadenomas or papillomas are common breast lumps.
|
|
| Glossary |
Areola - The area of dark-colored skin on the breast that surrounds the nipple.
Aspirate - Fluid withdrawn from a lump, often a cyst, or a nipple
Axilla - The underarm or armpit.
Axillary - Pertaining to the armpit area, including the lymph nodes that are located there.
Axillary lymph node dissection - Surgery to remove lymph nodes found in the armpit region. Also called axillary dissection.
Benign - Not cancerous; does not invade nearby tissue or spread to other parts of the body.
Biological therapy - Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy.
Biopsy - The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire tumor or lesion is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration.
Bone marrow - The soft, sponge-like tissue in the center of bones that produces white blood cells, red blood cells, and platelets.
Cancer - A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread through the bloodstream and lymphatic system to other parts of the body.
Clear margins- the normal tissue around the tumor, which is free of cancer cells.
Cyst - A sac or capsule filled with fluid.
Estrogen - Female sex hormone produced primarily by ovaries and in smaller amounts by conversion of male hormone made in the adrenal gland. In breast cancer, estrogen may promote the growth of cancer cells.
HER 2- a gene that helps control the growth and repair of cells.
Hormone- Chemical substance produced in the body by glands. Hormone travels through the blood stream and sets in motion various body functions.
Immune system- Body's own system for fighting diseases.
Lymph node - A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph).
Lymphatic system - The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body.
Menarche - Age of attaining puberty.
Menopause - Age when menses stops.
Nulliparous- Women who have no children.
Progesterone- Female sex hormone released by the ovaries during every menstrual cycle to prepare the uterus for pregnancy and the breasts for milk production.
Reconstructive Surgery- Women who had mastectomy (removal of breast) reconstruct their breast by rebuilding it in two ways.
a. with implants filled with fluid or gel (or)
b. with tissue taken from the belly or back.
SERMs (Selective estrogen receptor modulators)-drugs that blocks estrogen by filling up its receptors on breast cancer cells. This can help stop or slow down the growth of hormone-receptor-positive breast cancer.
Stage - The extent of a cancer, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.
|
|
|
|
|
|
|
|
|
|
