What is Breast Cancer?
Breast cancer is the abnormal growth and uncontrolled
division of cells in the breast. Cancer cells can invade
and destroy nearby healthy tissue and can spread throughout
the body, usually beginning with surrounding lymph nodes
under the armpit and tissue under the breastbone and
collarbone.
According to the American Cancer Society:
- Each year, more than 200,000 women in this country
learn they have breast cancer
- Breast cancer is the most common type of cancer
among American women and the second leading cause
of cancer death in the United States (second to lung
cancer)
- More women are surviving the disease than ever before,
thanks to advances in diagnosis and treatment, and
earlier detection
- Right now, just over 2 million breast cancer survivors
are living in the United States
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Risk Factors
Although the medical community has not determined why
breast cancer occurs, certain factors are known to increase
your risk of developing the disease. You can control
some of your risk factors but not others.
Controllable risk factors
(lifestyle based):
- Diet:Some studies suggest a link between
breast cancer and a diet high in fat
- Physical inactivity: A sedentary lifestyle
increases your risk of developing different diseases,
including breast cancer
- Obesity:If you are severely overweight,
you're at increased risk
- Alcohol consumption
Uncontrollable risk factors:
- Age
- Race: White women are slightly more likely
to develop breast cancer than are African-American
women. But African-American women are more likely
to die of this cancer because their cancers are often
diagnosed later and at an advanced stage when they
are harder to treat and cure. Asian, Hispanic, and
Native American women have a lower risk of developing
breast cancer though all women are at risk.
- Family or personal history of breast cancer
- Early start of menstruation (before age
12)
- Late menopause (after age 55)
- Reproductive history: If you never had children
or delivered your first baby after age 30, you may
face an increased risk of developing breast cancer
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Common Symptoms
As with other types of cancer, breast cancer usually
develops without noticeable symptoms. However, breast
lumps are often an early sign of trouble. You should
see your doctor if you experience any of these warning
signs:
- Change in the size or shape of the breast
- Lump or thickening of tissue in the breast or armpit
- Dimpled or pulling of the skin over the breast
- Nipple discharge
- Retraction of the nipple
- Scaliness of the nipple
- Pain or tenderness
Screening and
Diagnosis
When breast cancer is found and treated early,
the chances for survival increase significantly. You
can take an active part in the early detection of breast
cancer by having regular screening mammograms and clinical
breast exams, and by performing monthly breast self-exams.
- Mammogram - A
mammogram is a procedure that uses x-rays to detect
changes in breast tissues. The American Cancer Society
recommends annual mammograms beginning at age 40 and
earlier if you have a family or personal history of
the disease. Mammograms can detect cancer and other
tumors and cysts long before you would be able to
feel them in your monthly self-exam
- Clinical breast exam
- An examination of the breasts performed by your
healthcare provider
- Breast self-exam
- Breast self-exams are easy to perform. The best
time to perform a breast self-exam is a few days after
your menstrual period, when your breasts are no longer
swollen or tender. Do the exam on the same day each
month to help you remember. Regular breast exams will
help you become familiar with the way your breasts
normally look and feel, making it easier for you to
notice any changes
If a mammogram or breast exam detects a lump or abnormality,
your doctor
may want to conduct a biopsy. In this procedure,
doctors remove a sample of tissue from the suspicious
area and send it to a laboratory for testing to determine
the presence of cancer.
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Stages of Breast Cancer
Once a breast cancer diagnosis is made, doctors conduct
additional tests to stage the cancer, or determine if
the cancer has spread and how far. Staging helps your
doctor develop an appropriate treatment plan.
Stage 0 (Tis)
Early cancer is confined to the breast (noninvasive or in situ breast cancer), such as:
- Ductal carcinoma in situ (DCIS). Cancer cells are located within a duct but are not found in surrounding fatty breast tissue.
- A form of DCIS that only involves the nipple (Paget's disease of the breast).
- Lobular carcinoma in situ (LCIS). Abnormal cells grow within the lobules (milk-producing glands) but do not penetrate through the lobule walls. Most breast specialists do not consider LCIS a true breast cancer. LCIS is also called lobular neoplasia.
Stage I
Tumor measures 2 cm or smaller in diameter and has not spread to lymph nodes in the armpit.
Stage II
Stage II is divided into substages known as IIA and IIB.
- Stage IIA: One of the following characteristics is true of this stage of breast cancer:
- The tumor is smaller than 2 cm in diameter and has spread to 1 to 3 lymph nodes under the arm on the same side as the breast cancer. Lymph nodes are not stuck to one another or to the surrounding tissues.
- The tumor is larger than 2 cm but smaller than 5 cm in diameter and has not spread to the lymph nodes under the arm.
- Stage IIB: Either of the following characteristics is true of this stage of breast cancer:
- The tumor is larger than 2 cm but smaller than 5 cm in diameter and has spread to 1 to 3 lymph nodes under the arm on the same side as the breast cancer. Lymph nodes are not stuck to one another or to the surrounding tissues.
- The tumor is larger than 5 cm in diameter but has not spread to the lymph nodes under the arm.
Stage III
Stage III is divided into substages known as IIIA, IIIB, and IIIC.
- Stage IIIA: Either the tumor or tumors measure larger than 5 cm in diameter with any spread to lymph nodes or the lymph nodes are stuck to one another or surrounding tissue.
- The tumor is smaller than 5 cm in diameter and has spread to 4 to 9 lymph nodes under the arm on the same side as the breast cancer or has spread to the lymph nodes under the breast bone (internal mammary nodes) but not under the arm.
- The tumor is smaller than 5 cm in diameter and has spread to 4 to 9 lymph nodes under the arm, which are matted or stuck to one another or surrounding tissue.
- The tumor is larger than 5 cm in diameter and has spread to fewer than 10 lymph nodes under the arm or has spread to the lymph nodes under the breast bone but not under the arm.
- The tumor is larger than 5 cm in diameter and has spread to fewer than 10 lymph nodes under the arm, which are matted or stuck to one another or surrounding tissue.
- Stage IIIB: Breast cancers of any size have spread to the skin or chest wall.
- Stage IIIC: Breast cancers of any size have one of the following characteristics.
- Breast cancer cells have spread to 10 or more lymph nodes under the arm.
- Breast cancer cells are found in the lymph nodes under the arm and beneath the breast bone (internal mammary nodes).
- Breast cancer cells are found in the lymph nodes above the collarbone (supraclavicular) or below the collarbone (infraclavicular).
Stage IV
Cancer of any size has spread (metastasized) to distant sites, such as the bones or lungs, or to lymph nodes not near the breast.
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Common Treatment
Options
Learning you have breast cancer can be devastating
news, but life-saving medical advances have armed patients
with more treatment options than ever before. Breast
cancer, in particular, is very treatable, with high
survival rates.
Treatment for breast cancer is based on the type, stage,
and size of the tumor, as well as your personal preferences,
general health, and ability to tolerate certain medical
procedures or medications. The goal of treatment is
to preserve healthy tissue while destroying the tumor
at its point of origin, as well as any cancer cells
that have spread throughout the body.
Treatment options include:
Surgery
Most patients with breast cancer undergo surgery to
remove the cancerous tissue in the breast. Some axillary
lymph nodes (lymph nodes in the armpit) are removed
as well to see if the breast cancer has spread. Types
of surgery include:
Wide Excision Lumpectomy - A wide excision
or lumpectomy is surgery to remove the breast tumor
and a small amount of surrounding normal tissue.
Mastectomy - A mastectomy is the surgical removal
of the entire breast. There are three different types
of mastectomies:
- Simple or total mastectomy - surgeons do
not cut away any lymph nodes or muscle tissue
- Modified radical mastectomy - surgeons remove
the breast and some armpit lymph nodes
- Radical mastectomy - surgeons remove the
breast, axillary lymph nodes and chest wall muscles
under the breast
Patients may want to consider breast reconstruction
surgery to rebuild the breast after a mastectomy. A
breast implant or your own tissue may be used to reconstruct
the breast. Reconstruction can be done at the same time
as the mastectomy or any time later.
Even if a patient undergoes surgery to remove the cancer,
radiation therapy, chemotherapy, or hormone therapy
may be recommended to kill any cancer cells that may
be left.
Radiation
Therapy
Radiation therapy is a non-surgical method of treatment
of cancer and other diseases using penetrating beams
of high-energy waves called x-rays or gamma rays. Radiation
injures or destroys tumor cells by damaging their genetic
material, making it impossible for these cells to continue
to grow. There are two types of radiation therapy:
- External beam radiation therapy:- Specialized
medical equipment is used to deliver radiation to
the tumor site from outside the body.
- Internal radiation therapy: Radioactive
material is placed in the body near the cancer cells
(also called implant radiation or brachytherapy)
The way the radiation therapy is given depends on the
type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a type of treatment that uses drugs
to stop the growth of cancer cells, either by killing
the cells or by stopping the cells from dividing. Chemotherapy
drugs can be taken orally or by injection depending
on the type and stage of the cancer and the type of
drug protocol your doctor has prescribed. It is important
to discuss your treatment protocol with your treatment
team so you are aware of any possible side effects.
Hormone
Therapy
Hormone therapy is a cancer treatment that removes hormones
or blocks their action and stops cancer cells from growing.
Hormones are substances produced by glands in the body
and circulated in the bloodstream. The presence of some
hormones can cause certain cancers to grow. If tests
show that the cancer cells have places where hormones
can attach (receptors), drugs, surgery, or radiation
therapy are used to reduce the production of hormones
or block them from working.
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