>> General Info about Breast Cancer
Other than skin cancer, breast cancer is the most common type of cancer among women. Breast cancer mostly occurs in women over the age of 50, and the risk is especially high for women over age 60. Breast cancer is also found to occur more often in white women than African American or Asian women. Each breast has 15 to 20 sections called lobes. Within each lobe are many smaller lobules (milk producing glands). Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules and bulbs are all linked by thin tubes called ducts (milk passages that connect the lobules and the nipple). Fat surrounds the lobules and ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola. There are no muscles in the breast, but muscles lie under each breast and cover the ribs. Each breast also contains blood vessels and lymph vessels. The lymph vessels carry colorless fluid called lymph, and lead to small bean-shaped organs called lymph nodes. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest. Lymph nodes are also found in many other parts of the body. Cancer cells may enter lymph vessels and spread out along these vessels to reach lymph nodes. Cancer cells may also enter blood vessels and spread through the blood stream to other parts of the body, bypassing lymph nodes. When breast cancer cells reach the lymph nodes, they continue to grow, often causing swelling of the lymph nodes. These swollen lymph nodes sometimes can be felt, especially in the armpit. If breast cancer cells have spread to the lymph nodes in the arm pit, there is a greater chance that cancer cells have spread to other organs of the body as well.
>>What are the causes of Breast Cancer ?
There are many factors for developing breast cancers. However, the exact cause is not known. It is suspected that more than one factor is involved. Also the risk of breast cancer increases as a woman gets older. Personal history of breast cancer: Women who have had breast cancer face an increased risk of getting breast cancer in their other breast.
Family history: A woman's risk for developing breast cancer increases if her mother, sister, or daughter had breast cancer, especially at a young age.
Late childbearing: Women who have their first child late (after about age 30) have a greater chance of developing breast cancer than women who have a child at a younger age.
Early Menstruation and Late Menopause: Women who started their menstrual periods early (before age 12) or go through menopause late (after age 55) are at higher risk.
>>What are the causes of Breast Cancer ?
Breast density: Breasts that have a high proportion of lobular and ductal tissue appear dense on mammograms. Making it more difficult for doctors to see abnormal areas on a mammogram. Breast cancers nearly always develop in lobular or ductal tissue (not fatty tissue). That's why cancer is more likely to occur in breasts that have more lobular and ductal tissue (that is, dense tissue) than in breasts with more fatty tissue.
Obesity is a controversial risk factor: Some studies report obesity individuals have a higher risk of breast cancer, possibly associated with higher levels of estrogen production in obese women.
Radiation therapy: Women whose breasts were exposed to radiation before age 30, especially those who were treated with radiation for Hodgkin's disease, are at an increased risk for developing breast cancer. Studies show that the younger a woman is, while receiving radiation treatment, the higher her risk for developing breast cancer later in life.
Alcohol: Some studies suggest a slightly higher risk of breast cancer among women who drink alcohol (more than 3 drinks a day).
Oral Contraceptives (birth control pills): Birth control pills may slightly increase the risk for breast cancer, depending on age, length of use, and other factors.
Hormone Replacement Therapy: More than 5 years of use has been shown to slightly ncrease the risk of breast cancer and it is found to increase with longer periods of usage.
Estrogen pills: Women consuming diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer.
Chemicals: Some studies have pointed to exposure to estrogen - like chemicals that are found in pesticides and other industrial products as a possible increased risk of breast cancer.
>>What are the signs and symptoms of Breast Cancer?
Detection of a breast lump is the most common symptom of breast cancer. But, almost 90% of all breast masses are caused by benign lesions (non cancerous).
* Early breast cancer usually does not cause pain.
* Lump or mass in the armpit.
* Change in the size or shape of the breast should be examined. The breast should be examined in an upright (sitting) position. The breasts should be inspected for difference in size, withdrawal of the skin or nipple, visible patterns and signs of swelling. In breast cancer, the lump is usually single, separate and hard. In some instances, it is fixed to the skin or the muscle.
* Nipple discharge from a breast carcinoma is usually spontaneous, bloody, associated with a mass and localized to a single duct in one breast. The nipple shows tenderness, or the nipple is pulled back (inverted) into the breast. The nipple should be gently squeezed to check for discharge. It is also associated with redness, swelling or oedema and retraction of the nipple.
* Ridges or pitting of the breast (the skin looks like the skin of an orange).
* Pain, swelling or discomfort in the breast.
>>How can Breast Cancer be diagnosed?
Clinical breast exam:A thorough clinical exam, can reveal any lumps, if formed. A self breast examination can also be done on a regular basis.
Mammograms:A low radiation X-ray called screening mammogram is the best tool available for detecting breast cancer early, before symptoms appear. Mammograms can often detect a breast lump before it can be felt. It also shows small deposits of calcium in the breast. Although most calcium deposits are benign, a cluster of very tiny specks of calcium (called microcalcifications) may be an early sign of cancer.
Ultrasonography:Using high-frequency sound waves, ultrasonography can often show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer).
Magnetic Resonance Imaging (MRI):MRI is used to define the size and extent of cancer within the breast tissue. It is mostly used in women whose dense breast tissue makes it more difficult to find tumors with a mammogram.
Digital Mammography:Digital mammography is similar to standard mammography and it uses radiographs to image the breast. The advantage of digital mammography is that images are stored digitally and can be enhanced by modifying the brightness or contrast. These images can be transmitted by telephone lines for remote consultation.
Biopsy:This procedure takes a tissue sample to be examined under the microscope.
Fine needle aspiration: A thin needle is used to remove fluid and/or cells from a breast lump. If the fluid is clear, it may not need to be checked by a lab.
Needle biopsy:Using special techniques, tissue can be removed with a needle from an area that looks suspicious on a mammogram but cannot be felt. Tissue removed in a needle biopsy goes to a lab to be checked by a pathologist for cancer cells.
Stereotactic needle biopsy: This procedure uses a mammogram-directed technique using computerized mammogram breast images which helps to map the exact location of the breast lump.
Surgical biopsy: In an incisional biopsy, the surgeon cuts out a sample of a lump or suspicious area. In an excisional biopsy, the surgeon removes all of a lump or suspicious area and an area of healthy tissue around the edges. A pathologist then examines the tissue under a microscope to check for cancer cells.
>>Types of Breast Cancer
Breast cancer is classified based on where the cancer has initiated whether in the ducts or in the lobules, whether the cells have invaded (grown or spread) through the duct or lobule, and the way the cancer cells look under a microscope.
Carcinoma In Situ In situ means that the cancer stays inside the ducts or lobules and has not spread into surrounding fatty tissues in the breast or to other organs in the body. About 15% of breast cancers are carcinomas in situ.
There are 2 types of breast carcinoma in situ:
Lobular carcinoma in situ (LCIS): It begins in the lobules, but does not grow through the lobule walls. Women with LCIS have a higher risk of developing an invasive cancer in either breast sometime in their lifetime. About 25% of women with LCIS develop breast cancer within 30 years.
Ductal carcinoma in situ (DCIS): This is the most common type of non-spreading breast cancer. Cancer cells inside the ducts do not spread through the walls of the ducts into the fatty tissue of the breast.
Invasive Ductal Carcinoma (IDC)
It is an invasive breast cancer that starts in the duct which may break through the walls of the duct and spread into the breast's fatty tissue. It can then "invade" lymphatic channels or blood vessels of the breast and spread to other parts of the body. About 80% to 85% of all breast cancers are infiltrating or invasive ductal carcinoma.
Invasive Lobular Carcinoma (ILC):This type of cancer starts in the milk-producing glands (lobules) and can spread beyond the breast to other parts of the body. About 10% to 15% of invasive breast cancers are invasive lobular carcinoma.
Medullary Carcinoma:This is a special type of IDC which has a clear and distinct boundary between tumor tissue and normal breast tissue. The size of the cancer cells are large and immune cells are present at the edge of the tumor. It accounts for about 5% of all breast cancers.
Colloid Carcinoma:This rare type of IDC is also called mucinous carcinoma, is formed by mucus-producing cancer cells. Colloid carcinoma has a slightly better prognosis and a slightly lower chance of metastases (spreading) than invasive ductal cancers.
>>How can Breast Cancer be treated?
The treatment of breast cancer involves local and systematic treatment. Treatment to the whole body involves systematic treatment, and local treatment involves treatment of breast area and the lymph nodes near it. Sometimes treatment may include more than one type of local or systematic treatment. Both systematic and local treatment is given in patients where the cancer has spread to other places beyond the breast. The choice of treatment is based upon many factors which depend upon the extent to which the cancer has spread, characteristics of the cancer, and general health of the patient. The two local treatments for breast cancer are surgery and radiation. Surgery is the most common treatment for breast cancer, and there are several types of surgery.
Breast conserving surgery: An operation to remove the cancer but not the breast is called breast-sparing surgery.
Lumpectomy: In lumpectomy, the surgeon removes the breast cancer and some normal tissue around it.
Segmental mastectomy: In segmental mastectomy, the surgeon removes the cancer and a larger area of normal breast tissue around it. Occasionally, some of the lining over the chest muscles below the tumor is removed as well. Some lymph nodes under the arm may also be removed.
Total mastectomy: In total mastectomy, the surgeon removes the whole breast. Some lymph nodes under the arm may also be removed.
Radical mastectomy: The surgeon removes the breast, both chest muscles, all of the lymph nodes under the arm, and some additional fat and skin. For many years, this operation was considered the standard one for women with breast cancer, but it is almost never used today. In rare cases, radical mastectomy may be suggested if the cancer has spread to the chest muscles.
Radiation therapy: It is the use of high-energy rays to kill cancer cells. Radiation is used to destroy cancer cells left behind in the breast, chest wall or lymph nodes after surgery.
External radiation: Radiation may be directed at the breast by a machine.
Implant radiation: Radiation can also come from radioactive material placed in thin plastic tubes that are placed directly in the breast. Some women have both kinds of radiation therapy.
