Breast Cancer and Its Treatment

imagesBreast cancer is a cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. It is also called malignant neoplasm of breast. It is the commonest form of cancer in women. It is the second leading cause of death by cancer in women, following only lung cancer.Although breast cancer is primarily a disease of women, almost 1% of breast cancers occur in men. Death rates from breast cancer have been gradually declining due to increased awareness and screening and improved treatment methods. About 80% of the cancer occur in milk ducts and is known as “ductal cancer”. Cancer developing in the lobules is termed lobular cancer

Causes: Many women who develop breast cancer have no risk factors other than age and sex.

1. Gender: It is the biggest risk because breast cancer occurs mostly in women. Risk of breast cancer increases with age. A woman with a personal history of cancer in one breast has a three- to fourfold greater risk of developing a new cancer in the other breast or in another part of the same breast.

2. Genetic Causes: Family history has long been known to be a risk factor for breast cancer. Both maternal and paternal relatives are important. The risk is highest if the affected relative is a closer one and has developed breast cancer at a young age plus in both the breasts. Having relatives with both breast and ovarian cancer also increases a woman’s risk of developing breast cancer.

3. Hormonal Causes: Hormonal influences play a role in the development of breast cancer. Women who start their periods at an early age (11 or younger) or experience a late menopause (55 or older) have a slightly higher risk of developing breast cancer. Having a child before age 30 years may provide some protection, and having no children may increase the risk for developing breast cancer.

Lifestyle and Dietary Causes: Breast cancer seems to occur more frequently in countries with high dietary intake of fat, and being overweight or obese is a known risk factor for breast cancer, particularly in postmenopausal women. The use of alcohol is also an established risk factor for the development of breast cancer. The risk increases with the amount of alcohol consumed. Studies are also showing that regular exercise may actually reduce a woman’s risk of developing breast cancer.

Breast Cancer Symptoms Early breast cancer has no symptoms. It is usually not painful. Most breast cancer is discovered before symptoms are present, either by finding an abnormality on mammography or feeling a breast lump. Other possible symptoms are breast discharge, nipple inversion, or changes in the skin overlying the breast. A)  Breast discharge is a common problem and is rarely a symptom of cancer. Discharge is most concerning if it is from only one breast or if it is bloody. In any case, all breast discharge should be evaluated. B) Nipple inversion is a common variant of normal nipples, but nipple inversion that is a new development can be of concern. C) Changes in the skin of the breast include redness, changes in texture, and puckering. These changes are usually caused by skin diseases but occasionally can be associated with breast cancer.

Diagnosis and Tests Diagnosis of breast cancer usually is comprised of several steps, including examination of the breast, mammography, possibly ultrasonography or MRI, and, finally, biopsy. Biopsy is the only definitive way to diagnose breast cancer.

1. Examination of the Breast A complete breast examination includes visual inspection and careful palpation (feeling) of the breasts, the armpits, and the areas around your collarbone.

2. Mammography Mammograms are x-rays of the breast that may help define the nature of a lump. Mammograms are also recommended for screening to find early cancer. A mammogram alone is often not enough to evaluate a lump.

3. Ultrasound Ultrasound of the breast is often done to evaluate a breast lump. It can demonstrate whether a mass is filled with fluid (cystic) or solid. Cancers are usually solid, while many cysts are benign.

4. MRI MRI is not routine for screening for cancer but may be recommended in special situations.

Biopsy The only way to diagnose breast cancer with certainty is to biopsy the tissue in question. Biopsy means to take a very small piece of tissue from the body for examination and testing by a pathologist to determine if cancer is present. A number of biopsy techniques are available.

Stages of breast cancer:

1. Stage 0 is sometimes used to describe abnormal cells that have not invaded nearby breast tissue or spread outside the duct.

2. Stage I is an early stage of invasive breast cancer. Cancer cells have invaded breast tissue beyond where the cancer started, but the cells have not spread beyond the breast.

• Stage II is if the cancer has spread to the lymph nodes under the arm and less than 2 cms.

• The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer has not spread to the lymph nodes under the arm.

• The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer has spread to the lymph nodes under the arm.

• The tumor is larger than 5 centimeters (2 inches). The cancer has not spread to the lymph nodes under the arm. 3. Stage III is locally advanced cancer. It is divided into Stage IIIA, IIIB, and IIIC.

4. Stage IV is distant metastatic cancer. The cancer has spread to other parts of the body, such as the bones or liver.

Inflammatory Breast Cancer In inflammatory breast cancer, cancer has spread to the skin of the breast and the breast looks red and swollen and feels warm. The redness and warmth occur because the cancer cells block the lymph vessels in the skin. There may not be any lumps in the breast that can be felt. Inflammatory breast cancer may be stage IIIB, stage IIIC, or stage IV.

Treatment: In recent years, there has been an overwhelming explosion of life-saving treatment advances against breast cancer. So, once breast cancer is detected, one should go for the following treatment options:

  1. Surgery
  2. Radiation
  3. Surgery followed by Radiation
  4. Chemotherapy
  5. Combined Therapy
  6. Adjuvant and Neoadjuvant Therapy for Breast Cancer
  7. Hormonal Therapy – Aromatase Inhibitors
  8. Angiogenesis Inhibitors Therapy
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