Breast Cancer
OVERVIEW:
Breast cancer develops in either the lobules or the ducts of the breast. Lobules produce milk, and ducts bring the milk from the glands to the nipple. Cancer can also occur in the fatty tissue or the fibrous connective tissue within your breast. The lymph nodes are a primary pathway that helps the cancer cells move to other parts of the body such as under the arms.
One should also know that most breast lumps are benign and not cancer (malignant).
Non-cancerous breast tumours are just abnormal growths that are not life-threatening but may increase the risk of breast cancer. Different types of breast cancer grow and spread at different rates. Some take years to spread beyond your breast, while others grow and spread quickly.
TYPES
Breast Cancer can be of two main categories: “invasive” and “noninvasive,” or in situ. Invasive cancer spreads from the breast ducts or glands to other parts of the breast and noninvasive cancer does not spread from the original tissue. These two categories are used to describe the most common types of breast cancer, which include:
1)Ductal carcinoma in situ. The cancer cells are confined to the ducts in the breasts.
2)Lobular carcinoma in situ. Lobular carcinoma grows in the milk-producing glands
of the breast.
3)Invasive ductal carcinoma. It is one of the most common type of breast cancer. This type of breast cancer begins in your breast’s milk ducts and then invades nearby tissue in the breast.
4)Invasive lobular carcinoma. It develops in the breast’s lobules and has invaded nearby tissue.
5)Paget disease of the nipple. This type of breast cancer begins in the ducts of the nipple, but as it grows, it begins to affect the skin and areola of the nipple.
6)Phyllodes tumor. This is a very rare type of breast cancer that grows in the connective tissue of the breast. Most of these tumors are benign, but some are cancerous.
7)Angiosarcoma. This is cancer that grows on the blood vessels or lymph vessels in the breast.
SYMPTOMS
The symptoms of breast cancer include:
1)A lump or thickened area in or near your breast or underarm that lasts through your period
2)Nipple discharge that can be bloody or clear
3)A mass or lump in the breast or underarm (armpit).
4)A change in your breast’s size, shape, or curve
5)Changes in the skin of breast or nipple like; dimpled, puckered, scaly, or inflamed.
6)Red skin on your breast or nipple
7)A hard, marble-sized spot under your skin
8)Thickening or swelling of part of the breast.
9)Irritation or dimpling of breast skin.
10)Pain in the breast
11)Redness or flaky skin in the nipple area or the breast.
12) Any change in the size or the shape of the breast.
RISK FACTORS
Most breast cancers are diagnosed after age 50.
1)Inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2 are at higher risk
2)Women with early menarche and late menopause are exposed to hormones longer, that raises their risk of getting breast cancer.
3)Nulliparous women and women who have not breast fed their children are at a higher risk.
4)Previous history of breast cancer can lead to breast cancer again.
5)Family history of breast or ovarian cancer.
6)Women who had radiation therapy before the age of 30 have a higher risk of getting breast cancer later in life.
7)Artificial hormones replacement therapy like estrogen and progesterone during menopause can raise risk for breast cancer.
DIAGNOSIS
1)Clinical Examination: by a trained surgical oncologist is necessary to diagnose the lump
2)Mammography: is the most important single investigation which defines the nature of the tumour.
3)Biopsy: A blind biopsy or a sonography guided biopsy is the most important investigtion which confirms the prescence of cancer. It also provides tissue for Immuno-histo-chemistry (IHC) which is helpful in deciding the type of therapy
4)PETCT scan: with a single scan which is done from head to toe, the extent of spread of the disease is defined. In non affording patients,a Xray chest, USG abdomen and pelvis and a bone scan can provide some information egarding the spread of the disease
5)CA 15.3 : this is a tumour marker (blood test) which is useful in moniotoring patient on therapy and for prognosis
TREATMENT
Breast Cancer treatment depends on the size and location of the tumor, age, and the stage of
the disease.
The treatment options for Breast Cancer:
Surgery
Breast-conserving surgery: This removes the part of the breast with the cancer, and some nearby tissue.
Mastectomy: removes the entire breast, along with all of the breast tissue and sometimes nearby tissues.
Surgery to remove lymph nodes. This removes some lymph nodes from under arm to find out whether cancer has spread to them.
1)Sentinel lymph node biopsy removes one or a few lymph nodes where cancer is most likely to spread
2)Axillary lymph node dissection that removes lymph nodes from all stations of axilla
Radiation
There are variety of options for Radiations too
External beam radiation. This is a radiation therapy that happens 5 days a week for 5 to 6 weeks. Some types of external beam radiation include:
Hypofractionated radiation therapy lasts for 3 weeks with larger doses.
Intraoperative radiation therapy (IORT) is a single large dose of radiation in the operating room right after breast conservation surgery (before the wound is closed).
Internal radiation (brachytherapy) In this type, the doctor puts radioactive pellets or needles inside the body to do the job.
Interstitial brachytherapy. The doctor inserts catheters into the breast around the area of cancer. They stay in place for several days. Doctors put radioactive pellets into them for short periods every day.
Intracavitary brachytherapy. The doctor uses a small catheter to put inside the breast. The device is widened and stays in place during the treatment while the other end sticks out of the breast.
Systemic treatments/Chemotherapy and newer therapies
They destroy or control cancer cells all over the body. These treatments include:
Chemotherapy. One might take these drugs as pills or get them injected into a vein. This can be the only treatment or before the surgery depending upon the stage.
Hormone therapy. The cancers that grow in esponse to certain hormones. The medications stop the hormones from attaching to cancer cells, which stops their growth.
Targeted therapy. These work against specific genetic targets eg. Trastuzumab against HER2NEU
Immunotherapy and others: newer drugs like immnunotherapy, PARP inhibitors, CDK inhibitors etc can also be used and have beneficial effect on the survival