Breast Cancer

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’.

• • Includes menarche(the 1^st 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.

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.

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.