Breast Cancer

Definition

Cancer is a disease characterized by the uncontrolled growth of abnormal cells. Breast cancer is any type of malignant (cancerous) growth in the breast tissue.

Breast cancer is the most common cancer in women and affects approximately 1 out of every 8 women in the U.S..

Description

There are several types of breast cancer, but the common types are ductal carcinoma (occurring in 85 to - 90 percent of the cases) and lobular carcinoma (occurring in about 8 percent of the cases).

Ductal carcinoma arises in the ducts (a tubelike passage leading from the lobes, lobules and bulbs). Lobular carcinoma arises in the lobules (part of the lobe which ends in dozens of tiny bulbs that can produce milk).

If the cancer spreads outside the breast it is called metastatic breast cancer.

Causes and Risk Factors

No one knows exactly why a normal breast cell becomes a cancerous one, and there is probably no single cause. It is thought, however, that breast cancer results from a combination of risk factors.

The most common risk factors include:

• a family history of breast cancer

• early menstruation

• late menopause

• women who are over 40 years of age when they bear their first child

• women who have not borne children

Speculated risk factors include:

• use of hormones (postmenopausal estrogen therapy and birth control pills)

• diet (high intake of fats and fibers)

• environmental toxins (exposure to electromagnetic fields and pesticides)

• obesity

• existing medical conditions such as diabetes, hypertension, chronic cystic disease of the breast

• women with malignancies in other body sites

• alcohol consumption

Symptoms

Early breast cancer usually does not cause pain. In fact, when it first develops, breast cancer may cause no symptoms at all. But as the cancer grows, it can cause these changes:

• a lump or thickening in the breast or armpit

• a change in the size or shape of the breast

• discharge from the nipple

• a change in the color or texture of the skin of the breast or areola (such as dimpling, puckering, or scaliness).

Note: any changes in the breast should be reported to a doctor without delay. Symptoms can be caused by cancer or by a number of less serious conditions. Early diagnosis is especially important for breast cancer because the disease responds best to treatment before it has spread. The earlier breast cancer is found and treated, the better a woman's chance for complete recovery.

Diagnosis

The diagnosis may be established by a careful physical examination, mammography, ultrasonography and, if needed, a biopsy.

• The doctor will examine the breasts using visual inspection and palpation. Visual inspection looks for changes in breast contour, new dimpling, nipple inversion, discharge, moles, puckering or persistent sores. Palpation is using the pads of the fingers to press down and feel the tissue around the breasts for any unusual lumps. Benign (non-cancerous) lumps often feel different from cancerous ones.

• Mammography is an x-ray of the breast that reveals any suspicious areas.

• Ultrasonography uses high frequency sound waves that enter the breast and bounce back. The pattern of their echoes produce a picture called a sonogram that detects whether the breast lump is solid (possibly cancerous) or filled with fluid (non-cancerous).

• If further tests are needed, the doctor will recommend a biopsy. There are three ways to do breast biopsies: fine needle aspiration, large core breast biopsy and surgical biopsy. Fine needle aspiration (FNA) uses a fine needle, inserted into the breast tissue, to withdraw cells from the suspicious area. Large core breast biopsy uses a large core needle in a spring-loaded device that removes "cores" or plugs of tissue from the suspicious area. Surgical biopsy is the surgical removal of part or all of the lump or suspicious area.

If breast cancer is diagnosed, the doctor will then determine the stage (phase or progression) of the cancer. The following staging system is used:

• Carcinoma in situ is very early breast cancer. Cancer is present only in the immediate area in which it developed.

• Stage I means the tumor is no larger than 2 centimeters (cm)(about 1 inch) and has not spread outside the breast.

• Stage II means the tumor is from 2 to 5 cm (roughly 2 inches) and/or has spread to the lymph nodes under the arm.

• Stage III means the cancer is larger than 5 cm (about 2 inches) involves the underarm lymph nodes to a greater extent, and/or has spread to other lymph nodes or other tissues near the breast.

• Stage IV means the cancer has spread to other organs of the body (metastatic cancer), most often the lungs, bones, liver, or brain.

Treatment

There are two methods of treatment - local or systemic.

Local treatments are used to remove, destroy, or control the cancer cells in a specific area. Surgery and Radiation therapyare local treatments.

Systemic treatments are used to destroy or control cancer cells all over the body. Chemotherapy and hormone therapy are systemic treatments.

The right treatment method, however, depends on the size and location of the breast tumor; the results of lab tests done on the cancer cells; the woman's age, menopausal status, and general health; and the stage of the disease.

Local treatments

Surgery is the most common treatment for breast cancer. There are two types: breast-sparing surgery and mastectomy.

Breast-sparing surgery such as lumpectomy removes the cancerous lump but not the breast. If needed, the doctor will also remove the fat pad from the armpit through a small underarm incision for analysis. This procedure is called axillary node dissection and is usually performed at the same time as the lumpectomy.

There are four types of mastectomy used in the treatment of breast cancer. Partial or segmental mastectomy removes the tumor, some of the normal breast tissue around it and the lining over the chest muscles. Total or simple mastectomy removes the whole breast. Modified radical mastectomy removes the breast, some of the lymph nodes under the arm and the lining over the chest muscles. Radical mastectomy removes the breast, the chest muscles, all of the lymph nodes under the arm, and some additional fat and skin.

Radiation therapy (also called x-ray therapy, radiotherapy, cobalt treatment, or irradiation) uses high-energy rays to damage cancer cells and stop them from growing. Radiation may come from an outside source or from radioactive materials placed directly in the breast, sometimes both are used. The patient receives external radiation treatments as an outpatient, usually 5 days a week for 5 or 6 weeks. At the end of that time, an extra "boost" of radiation is usually given to the treatment site. The boost may be either external (using electron beam therapy) or internal (using an implant). A short hospital stay is required for implant radiation.

Systemic treatments

Chemotherapy uses drugs to stop the growth of cancer cells. Chemotherapy may be given in different ways - by mouth or by injection into a muscle or vein. It can act on cancer cells outside the breast area. Some of these drugs are given in cycles so that treatment periods alternate with rest periods. Depending on the specific drugs, most patients take their chemotherapy as an outpatient at the hospital, at the doctor's office, or at home. Sometimes it may be necessary to stay in the hospital for a period of time so the effects of the treatment can be watched. The drugs most commonly used in chemotherapy are cyclophosphamide, methotrexate, 5-fluorouracil and adriamycin.

Hormone therapy is used to prevent cancer cells from getting the hormones they need to grow. This treatment may include the use of drugs (such as tamoxifen [Nolvadex]) that interfere with hormone activity or surgery that removes hormone-producing organs. Like chemotherapy, hormone therapy can act on cells all over the body.

Staging treatments

Women with carcinoma in situ may have breast sparing surgery or mastectomy. The type of surgery depends mainly on where the cancer has developed (ductal or lobular).

Women with early stage breast cancer (Stage I and Stage II) are most often treated with a combination of surgery and radiation therapy. In addition, some women with Stage I and most with Stage II breast cancer have chemotherapy and/or hormone therapy in addition to their local treatments. This added treatment is called adjuvant therapy. It is given to prevent the cancer from recurring by killing undetected cancer cells that may have begun to spread.

Women with Stage III are treated with both local and systemic treatments.

Women with Stage IV are treated with both local and systemic treatments.

Prevention

Remember:

(A) Examine Your Breasts Every MONTH Beginning At Age 20 (see your doctor for self breast exam instructions),

(B) Have Your Doctor Examine Your Breasts Every Year Or Two Beginning At Age 30

(C) Have A Mammogram Every Year After Age 40

Questions to Ask Your Doctor

What caused the cancer?

What is the usual course of the disease?

Metastasis: If the cancer spreads, where will it go and how will it be detected?

What are the symptoms of recurrence?

What can be done if the treatment doesn't work?

What determines whether the treatment is working or not?

How can the symptoms of cancer, such as pain, fatigue and weight loss be alleviated?

What does remission mean?