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Breast Cancer

  • Overview Symptoms Causes Diagnosis Treatment
Overview

Breast Cancer is most common in women and has the second highest occurrence in India. The average incidence rate varies from 22-28 in urban areas to 6 per lakh women in rural areas. Women above the age of 50 are most susceptible for cancer. In developed countries around one in eight women develop breast cancer at some stage in their life.

It starts as cancerous cells present at the lining of a milk duct or milk gland (lobule) in one of the breasts. This phenomenon is commonly known as lobular breast cancer.  Women should regularly conduct self-examination of the breast and on noticing any lump or change must consult the doctor if necessary. This will help facilitate early stage breast cancer treatment. If the cancer is diagnosed at the first stage, outcomes are better.

TYPES OF BREAST CANCER:

Breast cancer is broadly divided into the following kinds:

  • Non- invasive Cancer ( known as Carcinoma in Situ)
    • Some people are diagnosed when the cancerous cells are still within a duct/lobule. These are known as 'carcinoma in situ' as no cancer cells have grown out from the original site.
    • Ductal Carcinoma in Situ (DCIS) is the most common type of non-invasive breast cancer. The Milk ducts within the breasts are the starting point for this cancer and it is called non-invasive since the cancer doesn’t spread beyond the milk ducts.
  • Invasive cancer
    • In cases where the tumour has grown from within a duct or lobule into the surrounding breast tissue, then it is classified as 'invasive breast cancer’.
    • Invasive breast cancers are also divided into two types. The first type being those where cancer cells have invaded into the local blood or lymphatic vessels and the second type being those where they have not.
    • Another type of invasive breast cancer would be inflammatory breast cancer which can make the skin look red and feel warm. There are treatments available for such rare conditions as well.

Having said this, men are also susceptible to breast cancer. The most common type of breast cancers is carcinomas (cancer in breast tissue), adenocarcinoma (cancer which starts from breast ducts or lobules) and sarcoma (cancer which starts from the connectivity tissues that supports the ducts and lobules)

Here DCIS (Ductal Carcinoma in Situ), LCIS (Lobular Carcinoma in Situ) and Paget disease of the nipple constitute the Stage 0 and Stage 1 of breast cancer.

Carcinoma & Adenocarcinoma:

A cancer is classified as Carcinoma especially when the tumours begin through the epithelial cells that bind organs and tissue in the body.

In the case of Adenocarcinoma, the tumour begins in the milk ducts or the lobules (milk producing glands). Once the duct becomes affected, it is classified as ductal breast cancer.

There are different treatments available in both cases depending on the magnitude and nature of the cancer.

Symptoms

Generally, lumps in the breasts warrant a medical opinion/treatment by breast oncology specialists. Most breast lumps aren't cancerous. The most common symptoms in women are:

  • A painless lump or thickening in the breast
  • A spontaneous discharge of blood from the nipple
  • Retraction or indentation of nipple
  • A change in the size or contours of the breast
  • Redness or pitting of the skin over the breast
  • Mass below the arms
  • Changes in the size or shape of a breast
  • Dimpling or thickening of the skin on a part of a breast

However, it is important to note that:

  • Most breast lumps are not cancerous.
  • Most breast lumps are fluid-filled cysts or fibroadenomas which are benign.

The first place that breast cancer usually spreads to is the lymph nodes (glands) in the armpit. Invasive cancer that spreads to the lymph nodes comes under Stage 2 Metastatic breast cancer. If this occurs, one may develop a swelling or lump in an armpit. In case, the cancer spreads to other parts of the body then it is classified as ‘Stage 4 breast cancer’. A Cancerous tumour in the breast which has spread to other parts of the body can also be termed as ‘Malignant Neoplasm’.

Causes
  • Includes menarche(the 1st occurrence of menstruation), late age at menopause and first childbirth at late stage
  • Shorter duration of breastfeeding
  • A family history of breast cancer increases the risk. If a woman has a mother who has suffered from breast cancer, her risk increases by three times. If a woman has a sister with breast cancer, the risk increases by 2-3 times.
  • Obesity( which contain fat cells called adipocyte, that are susceptible to cancer)

A cancerous tumour starts from one abnormal cell and multiple to many.

RISK FACTORS:

Even when breast cancer can develop for no apparent reason, there are certain 'risk factors’ that increase the chances of developing it. These are:

  • Ageing: The risk of developing breast cancer roughly doubles every 10 years.
  • Location: The rate of breast cancer varies between countries, due to environmental factors.
  • HRT (Hormone Replacement Therapy): Taking Hormone Replacement Therapy for several years increases risk of breast cancer.
  • Dense breast tissue: A highly dense tissue can increase the risk too.
  • History of benign diseases: If the person has a history of benign breast diseases, the risk of getting breast cancer increases.
  • Lifestyle factors: Signs such as lack of exercise, obesity after menopause and excess intake of alcohol can also add to the chances of getting breast cancer.
Diagnosis

The first test after physical evaluation may include an X-ray of the breast known as mammography. This could be followed by biopsy and other imaging tests.

INITIAL ASSESSMENT :

If you develop a lump or detect a possible symptom, a doctor will usually examine your breasts and armpits to look for any lump or abnormalities. The various tests can include:

  • Digital mammogram: A Special X-ray which can detect changes in the density of breast tissue indicating tumours
  • Ultrasound scan of the breasts
  • MRI scan of the breasts, more commonly performed on younger women, especially those with a strong family history of breast cancer.

BIOPSY – TO CONFIRM THE DIAGNOSIS:

A biopsy is a small sample of the tissue that is removed from a part of the body, in this case a breast tissue. The sample is then examined under the microscope to look for abnormal cells. A specialist may take a biopsy with a needle inserted into the lump and extract some cells commonly known as FNAC procedure (Fine Needle Aspiration Cytology). Sometimes a mammogram or ultrasound scan guides the doctor in locating the spot for needle insertion. There are cases where a small operation is needed to obtain a biopsy sample. As part of the diagnosis, the cells from a tumor can be assessed and tested to determine their progression levels.

ASSESSING THE EXTENT AND SPREAD (STAGING) :

The aim of staging is to find out:

  • The extent of growth of the tumor (if the cancer has spread to the local lymph nodes in the armpit or other areas of the body).
  • Assessing the grade of the cells and the receptor status of the cancer. This information helps doctors recommend the best surgery for breast cancer and examine any non-surgery options that are available.
Treatment

The treatment can include surgery, radiation therapy, chemotherapy and hormone therapy depending on the stage of the disease. The treatment depends on:

  • The size and shape of the tumour
  • The grade of the cancer cells in the tumour
  • Age of the patient
  • If the patient has reached menopause or not.
  • General health and personal preferences for treatment.

SURGERY FOR BREAST CANCER:

The different types of surgeries that can be considered are:

  • Breast organ preservation surgery is often suggested if the tumour is not too big
  • 'Lumpectomy' (or wide local excision) is a type of surgery where just the tumour and some surrounding tissues of the breast are removed. It is usually followed up with radiotherapy and surgery (to kill any cancer cells that may have been left in the breast tissue).
  • Removal of the affected breast
    • This may be necessary if there is a large tumour or if the tumour is located in the middle of the breast. Surgical removal of the breast (mastectomy) is recommended when the cancer has spread aggressively.
    • The Breast reconstruction surgery can be done immediately after the removal of the cancerous breast also.
  • After the surgery is completed, it is common to remove one or more lymph nodes in the armpit where the cancer originated. The lymph nodes which are removed are examined to see if they contain any cancerous cell and determine the next course of treatment after surgery.
    • Alternatively, a sentinel lymph node biopsy may be performed. This is to assess if the main lymph nodes contain any cancer at all. If they are clear, then the remaining lymph nodes in the armpit need not be removed.

RADIOTHERAPY:

The breast radiation therapy is a treatment which uses high energy beams to kill the cancerous cells or stop them from multiplying. In the case of breast cancer, radiotherapy is mainly used in conjunction to surgery.

CHEMOTHERAPY FOR BREAST CANCER:

Chemotherapy otherwise known as ‘chemo treatment’ is a procedure to where anti-cancer drugs are used against cancer cells to stop them from multiplying. ‘Adjuvant Chemotherapy’ is the treatment recommended after surgery. Chemo may sometimes be given before surgery to shrink the tumour in case it has grown to an abnormal size. There are also new gene tests being developed to help doctors decide ascertain which women will benefit the most from chemotherapy.

Chemotherapy is often a recommended option for metastatic cancers and while treating older patients.

HORMONAL THERAPY FOR BREAST CANCER:

Female hormones such as oestrogen and progesterone stimulate the cancer cells to divide and multiply. The treatments involves thee suppression of these hormones, thereby stopping the growth of cancer cells. Hormonal therapy provides better response amongst patients who have good oestrogen and progesterone receptors.

However, it would be important that the patients must monitor and have constant checks done for effective treatment at an early stage.