Breast Cancer is one of the leading causes of cancer death, and also the most common cancer among women. It is a malignant tumour that forms in the lobules or the ducts of the breast. The cancer cells in the breast multiply uncontrollably and affect the healthy breast tissues, and an also affect the lymph nodes present under the arms. These lymph nodes help the cancer move to other parts of the body.
Types of breast cancer
Breast cancer can be broadly divided into two categories: Invasive and Non-invasive (in situ). Invasive cancer is when the cancer cells spread from the breast ducts or glands to other parts of the body, while noninvasive breast cancer is when the cancer is still in its place of origin and hasn’t yet broken out.
The common types of breast cancer belonging to the above two categories are as follows:
- Ductal carcinoma: This originates in the milk ducts of the breast. This can be either
invasive or noninvasive. - Lobular carcinoma: It is a type of cancer that occurs in the milk-producing glands of the breast.
Some of the rarer types of breast cancer are:
- Paget’s disease: This starts in the ducts of the breast and spreads to the nipple and
surrounding areas, affecting the skin and the areola. - Inflammatory breast cancer: This occurs due to the blockage of the lymph nodes by
cancer cells. It makes the breast appear reddish. - Phyllodes tumour: This occurs in the connective tissue of the breast.
- Mucinous carcinoma: These are formed from mucus-producing cancer cells.
- Angiosarcoma: This is a cancer that grows in the blood vessels or lymph vessels of the
breast.
Risk Factors
The factors that increase the chances of getting breast cancer are:
- Age: The chances of getting breast cancer increases as one gets older. Most cases of
invasive breast cancers are found in women over the age of 55. - Family History: If a close relative, like mother, sister, daughter etc. has breast cancer, it doubles your risk of getting this disease.
- Alcohol: Drinking alcohol also increases the risk of breast cancer.
- Breast tissue: Women who have a dense breast tissue, as detected by the mammogram, have a higher risk of breast cancer.
- Early periods: Women who first menstruated before the age of 12 are at a higher risk of getting breast cancer.
- Having children at a later age: Women who have their first child after the age of 35 have ran increased risk of breast cancer.
- Exposure to radiation: If you have been exposed to previous chest radiation, you are at a higher risk of getting affected.
- Medications: Women who consume postmenopausal estrogen and progesterone medications have an increased risk of breast cancer.
- Gender: Women are more likely to get breast cancer than men.
Symptoms
The signs and symptoms vary from woman to woman, but there are some common signs to watch out for. You may notice a change in the way your breast or nipple feels. This may present as a lump or nipple tenderness. Other symptoms can present as a change in how the breast or nipple looks. The frequent symptoms of breast cancer are:
- Change in the size or shape of the breast
- Inward turned nipple
- Changes in the texture of the skin of the breast
- Nipple discharge
- Lump or swelling under the arm
- Breast pain
In many cases, only breast cancer does not cause pain. However, you should always consult your doctor in case of any breast pain or any other persistent and noticeable changes.
Progression and Staging of Breast Cancer
The staging of breast cancer refers to the extent of the disease. The cancer stage is based on several factors, including the size of the tumour, whether any lymph nodes are involved, whether the cancer is invasive or noninvasive, and whether the cancer has spread to areas beyond the breast.
- Stage 0: This is considered a noninvasive breast cancer. In this stage, there is no
evidence that the cancer cells have spread into neighbouring breast tissue, beyond the
duct or lobule. - Stage 1: This is considered an early stage of invasive breast cancer. When measured, the tumour is not more than 2 cm in diameter, and there is no evidence that the cancer cells have spread beyond the breast.
- Stage 2: It is divided into the following subcategories:
1. Stage 2A: It is an invasive breast cancer where the tumour is a maximum of 2 cm
in diameter and has spread to the lymph nodes under the arm, or the tumour is
2-5 cm in diameter but has not spread to any lymph nodes.
2. Stage 2B: It is slightly different, in that the size of the tumour is 2-5 cm, and has
spread to underarm lymph nodes, or, the tumour is larger than 5cm but has not
spread to underarm lymph nodes. - Stage 3: It is considered a locally advanced cancer and is also divided into 3
subcategories:
1. Stage 3A: There are two main scenarios that can occur with stage 3A breast
cancer. One is where the tumour is no larger than 5cm in diameter but has
spread to the underarm lymph nodes that are growing into each other, forming
clumps. The cancer may also have apread to the lymph nodes near the
breastbone. The second scenario is very similar with the exception that the
tumour is larger than 5cm in diameter and that the underarm lymph nodes are
not adhered to one another or other tissues.
2. Stage 3B: Unlike the other stages, in this stage, the tumour may be of any size
and has spread to the skin of the breast or chest wall. This stage may also include
lumps in the skin of the breast or swelling.
3. Stage 3C: The tumour may be of any size, but it has also spread to the lymph
node areas above or below the clavicle, chest wall and/or the skin of the breast. - Stage 4: It is considered distant, medistatic cancer, meaning it has spread to other
organs and parts of the body.
Diagnosis
Breast cancer is usually diagnosed by routine screening when the woman approaches a doctor with the symptoms. Some common diagnostic tests and procedures used to detect breast cancer are:
- Mammogram: This procedure uses low dose x-rays to detect changes in breast tissue. If an abnormality is detected, the doctor may opt for additional tests. After the procedure, the radiologist reviews the x-rays and additional pictures may need to be taken. Since mammogram is a simple, out-patient procedure, the person will be able to go home immediately following the test.
- Ultrasound: An ultrasound creates a picture of the breast tissue using sound waves, and can help distinguish between a cancerous mass and a fluid-filled cyst, which is not
cancer. - MRI: The Magnetic Resonance Imaging procedure uses magnetic fields to produce a
detailed image of the breast tissue. Before this procedure, the patient is injected with a
a dye.
Biopsy: It is used to find out if an abnormal lump in the breast is cancerous. It involves removing a tissue sample from the area of concern in order to be examined by a pathologist. It consists of three techniques: Fine Needle Aspiration biopsy, Core needle
biopsy or Surgical biopsy. In a Fine Needle aspiration biopsy, the doctor inserts a needle
into the breast, which will be guided using an ultrasound probe to the correct area and a
sample will be extracted. A core needle biopsy is done to remove several small pieces of
tissue, or cores of tissue from the breast. These two techniques involve removing samll
samples of tissue or fluid using a needle. However, if the area of concern is not accessible via needle, a surgical biopsy may be recommended. There are two techniques of surgical biopsy: Excisional and Incisional biopsy. In the former, the surgeon makes an incision in the breast and removes the entire mass. The latter is done if only a small part of the area of concern needs to be removed, usually to make a diagnosis.
Treatment
The kind of treatment depends on the stage of the cancer, the extent to which it has spread, and the size of the tumour. The common treatment options are:
1. Surgery: The different types of surgery are:
- Lumpectomy: In this procedure, the cancerous part is removed and the
surrounding tissue is left in place. - Mastectomy: It involves removing the entire breast.
- Sentinel node biopsy: The surgeon will remove the lymph nodes that are the first to receive the lymph drainage from the tumour.
- Axillary lymph node dissection: If the sentinel lymph nodes are found to be affected by cancer, then additional lymph nodes may be removed.
- Contralateral prophylactic mastectomy: The surgeon removes the healthy breat to minimize the risk of getting breast cancer again.
2. Radiation Therapy: The patient is subjected to powerful bursts of radiation to kill the cancer cells. In an external beam radiation, a large machine directs high-powered energy beams at the patient’s body. In a brachytherapy, the radioactive material is placed inside the body.
3. Chemotherapy: It is a drug treatment used to kill cancer cells. It is advised after the
surgery if there is a high risk of the cancer occurring again. Some side-effects of
chemotherapy are: hair-loss, nausea, vomiting and reduced immunity.
4. Hormone Therapy: In this method, the body’s production of estrogen and progesterone hormones is blocked as these can stimulate the growth of the tumours.
5. Medications: Many therapy drugs target the cancer cells that overproduce a protein
called Human Epidermal Growth Factor Receptor 2 (HER2) and damage them, while
sparing the healthy cells.
The exact causes of breast cancer are not yet known. Therefore, a healthy lifestyle, regular check-ups etc. are some preemptive measures that can be taken or followed to prevent the occurrence. This includes reducing the intake of alcohol or eliminating it altogether, exercising regularly and having generally healthy eating habits.
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