Breast Cancer

Breast Cancer

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Overview

Breast cancer is a condition where cells in the breast grow out of control. The breast has three main parts: lobule, duct, and connective tissues. Cancer cells can grow in different parts of the breast.

What are the types of breast cancer?

Most common type of breast cancer are listed below:

  • Invasive ductal carcinoma: When cancer cells grow beyond the ducts of the breast into other parts of breast tissue, it is known as invasive ductal carcinoma. Invasive cancer cells have a tendency to grow and metastasize to other parts of the body as well.
  • Invasive lobular carcinoma: In this type of cancer, there is a spread of cancer cells from lobules to nearby breast tissues. As this is also invasive cancer, it can also spread to different parts of the body.

What are symptoms of breast cancer?

Some common symptoms of breast cancer include:

  • Lump in the breast
  • Flat, inverted, or retracted nipple
  • Change in colour of the nipple
  • Change in size and shape of the breast
  • Redness, rashes, or swelling on the breast
  • Persistent itching
  • Tenderness
  • Discharge from the nipple
  • Dimpling, ulceration, or nodules on breast
  • A marble-like hardened area under the skin

Symptoms at advanced stage:

When there is delay in diagnosis of breast cancer at early stage, it may spread to other organs and may lead to following symptoms:

  • Pain in bone
  • Headache
  • Trouble breathing
  • Swollen belly
  • Double vision
  • Changes in brain function
  • Jaundice
  • Muscle weakness
  • Loss of appetite or weight loss.

Symptoms of male breast cancer

Breast cancer in male is rare. However, you may have to pay attention to the following symptoms:

  • A thick spot or lump in the breast area or armpit.
  • Changes in the skin of the nipple or breast, like scaling, redness or discharge.

What causes breast cancer?

There is still no clarity on how cells in the breast start growing abnormally. However, environmental factors or hormonal changes may cause genetic mutation in the tumor suppressor genes.

Breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) are the genes found in every human and they are helpful in protecting you from the various tumors. However, certain mutations happening in these genes prevent them from working properly, thereby increasing the chances of cancer. When one of these genes mutates, cells grow abnormally leading to the mass formation which results in breast cancer.

Who is at risk of breast cancer?

There are many factors which increase the chance of the development of breast cancer in women. Some of the common risk factors are:

  • Family history of breast cancer
  • Age above 50 years
  • Early menstruation and/or late menopause
  • Obesity
  • Lack of physical activity
  • Dense breast tissue
  • Chronic use of oral contraceptives
  • Hormonal replacement therapy post-menopause
  • Women who cannot conceive
  • Consumption of alcohol
  • Use of tobacco

Women who are working have a higher risk due to factors like:

  • Late pregnancy (after 30 years)
  • Stress
  • Not breastfeeding
  • Air pollution exposure
  • Sleep deprivation

How is breast cancer diagnosed?

The most common methods performed to diagnose breast cancer are breast examination and mammography. Self-examination is the main key to early detection of breast cancer.

  • Physical examination: On a visit to your doctor, they will initially perform a physical examination of the breast to look for any change in the colour, shape, size, tenderness, and presence of lumps.

After examination, the doctor may advise you to go for certain tests that confirm the tumor and also give information about the stage of the cancer.

  • Breast ultrasound: This test is done using the sound waves to make a detailed picture, it not only covers your breast area, but also checks for any lump in the armpit area.
  • Diagnostic mammogram: Mammogram uses the low-energy X-rays to examine the breast. It helps in the process of diagnosing and screening for breast cancer. Mammograms sometimes help in detecting the tumor up to 3 years before it can be felt.
  • Magnetic resonance imaging (MRI): MRI is a kind of body scan that uses magnetic fields and provides detailed pictures of the areas inside the body. This helps in accessing the size of the tumor.
  • Biopsy: It is the diagnostic procedure that helps to confirm the diagnosis of breast cancer. Needle biopsy is a procedure done to take out a small sample of cells from the affected site with the help of a small needle. In some cases, lump excisional biopsy can also be performed where the entire lump is removed along with some surrounding tissue.

Differential diagnosis

Lump in the breast may also be associated with different health problems like fibroadenomas, benign breast masses, lipoma, etc. It is always recommended to visit a right specialist and they will suggest certain tests and based on the proper diagnosis; he may guide you to the right specialist like an oncologist in case of breast cancer.

What are the next steps after confirmation of cancer?

After confirmation of cancer, your doctor may ask you to go for additional tests to determine the tumor spread to the lymph nodes or to other areas of your body. Doctor recommends positron emission tomography (PET) scan to know about the spread of the tumor. Once the detailed information of the cancer is available with the doctor, he will start planning the treatment protocol.

What are the stages of breast cancer?

  • Stage 0: There is no proof of cancer cells and no invasion of neighbouring tissue.
  • Stage 1: Cancer cells break through or invade the neighbouring tissues.
  • Stage 2: Cancer is not found in the breast but in axillary lymph nodes or in the lymph node near the breast bone.
  • Stage 3: Cancer is found in 4-9 axillary lymph nodes or in the lymph nodes near the breastbone. Cancer cells might have spread to the chest wall or to the skin of the breast. Tumor size is > 5 cm
  • Stage 4: This is the advanced or metastatic stage where cancer has spread beyond the breast and nearby lymph nodes to different organs of the body, like distant lymph nodes, lungs, skin, bones, brain, or liver.

How is breast cancer treated?

There are different treatment options available which are used in combination depending upon the patient’s age, overall health, and stage of cancer.

  • Surgery: Surgery involves excision of the tumor and below are the types of surgery:
    • Breast-conserving surgery: It is an operative procedure done to remove the tumor and some normal tissue around it. In cases, where cancer is near the chest wall, a part of the chest wall lining may also be removed. This kind of surgery may also be called lumpectomy, partial and segmental mastectomy, quadrantectomy, or breast-sparing surgery.
    • Total mastectomy: This is a surgical procedure where the whole affected breast is removed. In certain cases, some of the lymph nodes under the arm may also be removed and checked for any sign of cancer.
    • Modified radical mastectomy (MRM): MRM involves the removal of the whole affected breast along with many lymph nodes of the underarm, the lining over chest muscles, and occasionally part of the chest all muscles.
  • Radiation therapy: Radiation therapy utilises high-energy x-rays or other types of radiation to kill the cancer cells and also keeps them from growing.
    • External radiotherapy: External machine is used to send radiations to the affected part of the body.
    • Internal radiotherapy: Certain devices such as seeds, wires, needles, etc are placed on or near the affected area where they emit radiation.
  • Systemic therapy: This treatment involves the use of medications to fight against cancer cells present throughout the body.
    • Chemotherapy: Chemotherapy utilises drugs to prevent cancer cells from growing, either by killing the cancer cells or by inhibiting them from multiplying. Chemotherapy is an option for treating cancers that are not responding to hormone therapy.
    • Hormone therapy: It works by removing hormones or blocking their action that inhibits the growth of cancer cells. Estrogen is majorly made by ovaries that can make some breast cancer cells grow. Medications are prescribed to inhibit hormone production.
    • Targeted therapy: This treatment uses drugs and other substances that identify and attack the cancer cells. As this treatment focuses on cancer cells, it is less harmful in comparison to radiation and chemotherapy.
Treatment depending on the stage of the cancer
  • Stage 0: At this stage, following treatment is considered:
    • Surgery like lumpectomy or simple mastectomy is done.
    • Radiation therapy after surgery.
    • Hormone therapy
  • Stage 1: At this stage, following treatment is considered:
    • Surgery like lumpectomy or simple mastectomy is done.
    • Radiation therapy after surgery.
    • Hormone therapy
    • Chemotherapy is not usually started in early stages of breast cancer.
  • Stage 2: At this stage, combination of various treatment is considered:
    • Surgery like lumpectomy, simple or modified radical mastectomy are done.
    • Radiation therapy after surgery.
    • Chemotherapy.
    • Oral hormonal therapy may be continued for 5 years in patients who have hormone positive breast cancer.
  • Stage 3: At this stage, combination of various treatment is considered:
    • Surgery like lumpectomy, simple or modified radical mastectomy is done.
    • Radiation therapy after surgery.
    • Chemotherapy.
    • Oral hormonal therapy may be continued for 5 years in patients who have hormone positive breast cancer.
  • Stage 4: At this stage, following treatment is considered
    • Surgery is not usually the first option considered at this stage.
    • Chemotherapy and radiation therapy are used to stop the spread of the cancer to the lymph nodes.
    • Surgery may be performed to treat broken bones, spinal cord compression and single masses resulting due to spread of the cancer.
    • Pain medications and anti-depressant may also be started.

What happens after the surgery?

After the breast mastectomy, you may have to stay in hospital for 3 days or less. Your vitals like body, temperature, heart rate, blood pressure, etc., will be monitored throughout your stay. In case you have pain or nausea due to anesthesia, inform the doctor and they will provide you mediation to subside it. Physiotherapist will visit you and teach you the exercises that you may have to practice to avoid shoulder and arm stiffness.

Once you are discharged, please follow the below mentioned guidelines:

  • Rest: Allow yourself to have extra rest for the first few weeks after the surgery.
  • Medicine: Take all the medications on time as suggested by the doctor. This will help you to recover well.
  • Sponge bath: Till all your drains are removed and sutures healed, take a sponge bath. Once your doctor approves a regular bath, you may go for it.
  • Exercise: Regularly do exercises taught to you by your physiotherapist. In case you experience pain or difficulty doing it, get in touch with a physiotherapist

What are the advances in the treatment of breast cancer?

Several preclinical and clinical studies suggest that immune therapy improves the clinical outcome of patients suffering from breast cancer. It acts by blocking the specific antibodies that makes it difficult for the immune system to fight the cancer. However, this has not been approved by the FDA yet, treatment is mostly available through clinical trials.

What is the survival rate of breast cancer?

The survival rate of the patient depends on the factors like type and stage of cancer.

  • 5-year survival rate for patients with Stage 0 breast cancer is 100%.
  • 5-year survival rate for patients with Stage 1 breast cancer is 100%.
  • 5-year survival rate for patients with Stage 2 breast cancer is 93%.
  • 5-year survival rate for patients with Stage 3 breast cancer is 72%.
  • 5-year survival rate for patients with Stage 4 breast cancer is 22%.

Treatments for all stages are available. Also, survival rates don’t always predict your future. It is always advisable to discuss with your doctor about the diagnosis and best treatment option available.

How to keep check on reoccurrence?

Breast cancer can reoccur long after the treatment. Your doctor may like to keep you on active surveillance where you may need to go frequent testing to keep a check on recurrence. He may advise you to look for:

  • Change is shape, size or texture of breast, nipple or skin.
  • A new lump in the breast.
  • Lumps on the skin of the chest wall.
  • Thickening on or near the scar where surgery was done.

What are the complications associated with breast cancer?

  • Breakdown and swelling of the skin.
  • Mastitis (inflammation of the breasts).
  • Lymphatic channel invasion.
  • Metastasis to other organs such as lungs, liver, bone, etc.
  • Bone complications such as fractures and osteoporosis.

Tips for prevention

  • Maintain normal weight and exercise regularly.
  • Doing self-examination of breasts every month. If any change is noticed, consult your doctor.
  • Undergoing routine screening tests for cancer.
  • Reduce stress and practice meditation or yoga.
  • Avoid smoking and alcohol consumption.

Dietary and lifestyle modifications

  • Reduce intake of processed food, pickled foods, etc.
  • Prefer taking baked or boiled foods instead of fried foods.
  • Take meals at frequent intervals rather than 3 large meals.
  • Have a high fiber diet which includes vegetables like green leafy vegetables, legumes, etc.
  • Try consuming foods like garlic, green tea, turmeric, and flax seeds as they have anti-cancerous properties.
  • Consumption of grapes decreases estrogen production, thereby keeping a check at breast cancer.
  • Limit alcohol consumption.
  • Prefer using organic food and beauty products.
  • Yoga and meditation also help in speedy recovery.
  • Take iron and vitamin D supplements.

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