Breast Cancer

About Breast Cancer

The cancer developing in the cells of breast is called as breast cancer. It is the commonest cancer in the females worldwide. It is also seen in males albeit the frequency is very low. With the awareness about the breast cancer and advances in the treatment strategies, the survival has improved significantly.

The risk factors include: Female sex, early age at menarche, late menopause, having children at age more than 30 years or not having children, obesity and alcohol. Apart from these hereditary predisposition is also seen in patients having gene mutations in BRCA1 and BRCA2. A previous history of breast cancer also increases risk of cancer in same or other breast.

The different types of breast cancers are:

• Invasive Ductal Carcinoma
• Lobular Carcinoma in situ
• Ductal Carcinoma in Situ
• Paget’s Disease of Breast

What are the symptoms of Breast Cancer?

The commonest symptom is: Feeling A LUMP IN THE BREAST.

Other symptoms can be :

• Change in the shape and size of breast,
• Changes in nipple like inversion, discharge from the nipple,
• Redness or pitting of the breast skin.

Any of these symptoms should alert the patient and a visit to doctor should be made at the earliest.

How is it diagnosed?

When any of the above symptoms occur, do consult your doctor. The doctor would be examining the breasts by palpation as well as the armpits to look for the lumps and their extension. He may advise following tests:

• Mammogram: It is the Xray of the breast which is done on a special machine after compressing the breasts. It is a tool for breast cancer screening. It is used in diagnsostic evaluation of the breast masses. It can show the lumps in the breast as well as in axilla(lymphnodes)
• Breast Ultrasound: It is used to characterize the lumps in the breast whether it is solid or cystic. It is used as guidance for biopsy of the lumps.
• Biopsy: Taking a tissue from the breast with a needle is called biopsy. Multiple cores are taken and the sample is subjected to pathologic examination to study the type of tumor and Hormonal status and other indices.
• Breast MRI: It is a specialized MRI of the Breasts and is very specific in characterizing the lumps to be malignant or benign.
• PET scan: It may be ordered for staging of the disease.

How the disease is treated?

The treatment is devised according to type, location, hormonal status and stage of the tumors. Patient’s preferences make an important part of the management. It involves

Surgery: There are various options for surgery of breast. Each option takes into consideration the disease and patient’s preferences.

• Breast conserving Surgery/Lumpectomy: It involves removal of the lump along with a rim of normal tissue. The armpit is also addressed (discussed in section 3) to. The startaegy is used for the patients who are willing to preserve their breasts and ready to undergo regular follow up. This strategy incrorporates the Radiotherapy to the breast +/- Axilla compulsorily.
• Mastectomy: Removal of the entire breast is known as Mastectomy. It may be followed by breast reconstruction through plastic surgery. Some patients may opt for no reconstruction. Once again the axilla is addressed to (discussed below).
• Sentinel Lympnode Biopsy: This is the method in which a dye is injected in the main tumor and a small incision is given in the axilla and the nodes (which appear blue if blue dye used or show radioactivity in case of radioactive dye) are removed and subjected to microscopic examination. If there is no node is found to have tumor no axillary dissection is required. If any Lymphnode is found to be carrying tumor, the complete axillary clearance is done.

It is important to understand the complications of breast surgery. There is risk of lymphedema of the arm especially in case of axillary dissection. Patient should discuss all the surgical options and reconstruction methods thoroughly with the operating surgeon.

Radiotherapy: Radiotherapy to breast is always given after lumpectomy. If the stage of the tumor is higher after mastectomy, radiotherapy is given to the chest wall. If the lymphnodal burden is higher radiation may also be given to axilla.

Chemotherapy: Chemotherapy is usually given after radiotherapy. Sometimes it may be used preoperatively to decrease the size of the tumors.

Hormonal Therapy: Hormonal therapy is an important aspect of the breast cancer management. The tumors which are Estrogen Receptor(ER) or Progesterone Receptor(PR) positive are given certain drugs which block these receptors. It may be used before or after the surgery.

Targeted Therapy and Immunotherapy: Targeted therapy is treatment specifically meant to attacks specifics targets on tumor cells, thus leading to minimal harm to normal cells. In breast cancer there is a human epidermal growth factor receptor 2(Her2) against which effective drugs(Trastuzumab) is available. Immunotherapy is meant to modulate the immune e system to increase cancer cell kill. Immunotherapy is usually reserved for advanced spread out tumors. It has been found useful in triple negative (ER-, PR- and Her2-ve ) tumors.

Tags: Breast Cancer , symptoms of Breast Cancer