How To Learn The Breast Cancer ? Diagnosis, Treatment

Chapter Orientation

The breast is a modified skin appendage which has functional and social significance in the females but is rudimentary in the males. Onset of its development in females is linked to menarche as a part of developmental milestones in puberty. The breast responds to hormonal changes in reproductive years of a woman's life-during pregnancy, lactation, and post-menopausal and age-related involution. Like in other organs, the breast too is affected by anomalies, inflammatory diseases, and is the site of occurrence of benign and malignant neoplasms. However, the most important purpose of study of diseases of the breast is early detection and diagnosis of breast cancer, a disease that leads other cancers in incidence and mortality in women. Topics for study of breast diseases are discussed in this chapter under following headings:

1) normal structure.

2) inflammatory conditions,

3) benign epithelial proliferations,

4) benign fibroepithelial tumours, and

5) carcinoma in situ and invasive breast cancer

What is Breast Cancer?

Breast cancer is a disease in which the cells in the breast grow out of control. There are different types of breast cancer. The type of breast cancer depends on which cells in the breast become cancerous.

Breast cancer can start in different parts of the breast. The breast consists of three main parts: lobules, ducts and connective tissue. The lobules are the glands that produce milk. Ducts are tubes that bring milk to the nipple. Connective tissue (which consists of fibrous and fatty tissue) surrounds and holds everything together. Most breast cancers start in the ducts or lobules.

Breast cancer can spread outside the breast through blood vessels and lymph vessels. When breast cancer spreads to other parts of the body, it is said to have metastasized.

Kinds of Breast Cancer

Invasive ductal carcinoma. Cancer cells start in the ducts and then grow outside the ducts into other parts of the breast tissue. Invasive cancer cells can also spread or metastasize to other parts of the body.
Invasive lobular carcinoma. Cancer cells start in the lobules and then spread from the lobules to nearby breast tissues. These invasive cancer cells can spread to other parts of the body.

There are several other less common types of breast cancer, such as Paget's disease, outer medullary, mucinous, and inflammatory breast cancer.

Ductal carcinoma in situ (DCIS) is a breast disease that can lead to invasive breast cancer. Cancer cells are only in the lining of the ducts and have not spread to other tissues in the breast.

What are the Symptoms?

Different people have different symptoms of breast cancer. Some people have no signs or symptoms at all.

Some warning signs of breast cancer are:

A new lump in the breast or armpit (armpit).
Thickening or swelling of the breast.
Irritation or dimpling of the breast skin.
Redness or scaly skin in the nipple or breast area.
Nipple retraction or pain in the nipple area.
Nipple discharge other than breast milk, including blood.
Any change in breast size or shape.
Pain in any area of the breast.

Keep in mind that these symptoms can occur with other conditions that aren't cancer.

If you have any signs or symptoms that worry you, see your doctor immediately.

What Is a Normal Breast?

No breast is typical. What is normal for you may not be normal for another woman. Most women say their breasts feel lumpy or uneven. The way your breasts look and feel can be affected by getting your period, having children, losing or gaining weight, and taking certain medications. Breasts also tend to change as you age. For more information, see the National Cancer Institute’s Breast Changes and Conditions.

What Do Lumps in My Breast Mean?

Many conditions can cause breast lumps, including cancer. But most lumps are caused by other medical conditions. The two most common causes of breast lumps are fibrocystic breast condition and cysts. Fibrocystic condition causes non-cancerous changes in the breast that can cause lumps, tenderness and pain. Cysts are small fluid-filled sacs that can develop in the breast.

What Are the Risk Factors?

Studies have shown that your risk of breast cancer is caused by a combination of factors. The main factors that affect your risk include being a woman and getting older. Most breast cancer occurs in women age 50 or older.

Some women develop breast cancer without other known risk factors. Having a risk factor does not mean you will get the disease, and not all risk factors have the same effect. Most women have some risk factors, but most women do not get breast cancer. If you have risk factors for breast cancer, talk to your doctor about ways you can reduce your risk and about breast cancer screening.

Risk Factors You Cannot Change

Age. The risk of breast cancer increases with age. Most breast cancers are diagnosed after the age of 50.
Genetic mutations. Women who have inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2, are at higher risk of breast and ovarian cancer.
Reproductive history. Starting menstruation before age 12 and starting menopause after age 55 exposes women to hormones longer, increasing their risk of breast cancer.
Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it harder to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.
A personal history of breast cancer or certain non-cancerous breast conditions. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast conditions, such as atypical hyperplasia or lobular carcinoma in situ, are associated with a higher risk of breast cancer.
Family history of breast or ovarian cancer. A woman's risk of breast cancer is higher if she has a mother, sister, or daughter (a first-degree relative), or more family members on the mother's or father's side who have had breast or ovarian cancer. Having a first-degree male relative with breast cancer also increases a woman's risk.
Previous treatment with radiation therapy. Women who have had radiation therapy to the chest or breasts (for example, to treat Hodgkin's lymphoma) before age 30 have a higher risk of developing breast cancer later in life.
Exposure to the drug diethylstilbestrol (DES). DES was administered to some pregnant women in the United States between 1940 and 1971 to prevent miscarriage. Women who used DES, or whose mothers used DES when they were pregnant with them, have a higher risk of developing breast cancer.

Risk Factors You Can Change

Not being physically active. Women who are not physically active have a higher risk of developing breast cancer.
Overweight or obesity after menopause. Older women who are overweight or obese have a higher risk of developing breast cancer than women of normal weight.
Taking hormones. Some forms of hormone replacement therapy (those that include both estrogen and progesterone) taken during menopause may increase the risk of breast cancer if taken for more than five years. Some oral contraceptives (birth control pills) have also been found to increase the risk of breast cancer.
Reproductive history. First pregnancy after 30 years, not breastfeeding and never having a full-term pregnancy can increase the risk of breast cancer.
Drinking alcohol. Studies show that a woman's risk of breast cancer increases with the more alcohol she drinks.

Research suggests that other factors such as smoking, exposure to chemicals that can cause cancer, and changes in other hormones due to night shift work may also increase the risk of breast cancer.

Who Is at High Risk for Breast Cancer?

If you have a strong family history of breast cancer or inherited changes in the BRCA1 and BRCA2 genes, you may be at high risk for breast cancer. You may also have a high risk of ovarian cancer.

Talk to your doctor about ways to reduce your risk, such as medications that block or reduce estrogen in your body or surgery.

What Can I Do to Reduce My Risk?

Many factors over the course of a lifetime can affect the risk of breast cancer. You can't change some factors, such as aging or family history, but you can help reduce your risk of breast cancer by looking after your health in the following ways:

Maintain a healthy weight.
Exercise regularly.
Do not drink alcohol or limit alcoholic beverages.
If you are taking or have been told to take hormone replacement therapy or oral contraceptives (birth control pills), ask your doctor about the risks and see if this is right for you.
Breastfeed your babies if possible.
If you have a family history of breast cancer or inherited changes in the BRCA1 and BRCA2 genes, talk to your doctor about other ways to reduce your risk.

Staying healthy throughout your life will reduce your risk of developing cancer and improve your chances of surviving cancer if it does occur.

How Is Breast Cancer Diagnosed?

Doctors often use other tests to find or diagnose breast cancer. They can refer women to a breast specialist or surgeon. This does not mean that he has cancer or that he needs surgery. These doctors are experts in diagnosing breast problems.

Breast ultrasound.

A machine that uses sound waves to create images, called sonograms, of areas inside the breast.

Diagnostic mammogram.

If you have a problem with your breasts, such as lumps, or if an area of your breast looks abnormal on a screening mammogram, your doctor may order a diagnostic mammogram. This is a more detailed X-ray image of the breast.

Magnetic resonance imaging (MRI) of the breast.

A type of body scan that uses a magnet connected to a computer. An MRI scan creates detailed images of areas inside the breast.

Biopsy.

This is a test that removes tissue or fluid from the breast to look at under a microscope for further testing. There are different types of biopsies (for example, fine needle aspiration, core biopsy or open biopsy).

Production

If breast cancer is diagnosed, further tests are done to see if the cancer cells have spread in the breast or to other parts of the body. This process is called staging. Whether the cancer is only in the breast, is in the lymph nodes under the arm, or has spread outside the breast determines your stage of breast cancer. The type and stage of breast cancer tells doctors what kind of treatment you need. For more information, visit Breast Cancer Stages.

How is breast cancer treated?

Breast cancer is treated in several ways. It depends on the type of breast cancer and how far it has spread. People with breast cancer often receive more than one type of treatment.

Surgery.

Surgery where doctors cut out cancerous tissue.

Chemotherapy.

Using special drugs to shrink or kill cancer cells. Medicines can be pills that you take or medicines given into your veins, or sometimes both.

Hormonal therapy.

It blocks cancer cells from getting the hormones they need to grow.

Biological therapy.

It works with your body's immune system to help it fight cancer cells or control the side effects of other cancer treatments.

Radiation therapy.

Using high-energy beams (similar to X-rays) to kill cancer cells.

Doctors from different specialties often work together to treat breast cancer. Surgeons are doctors who perform operations. Medical oncologists are doctors who treat cancer with drugs. Radiation oncologists are doctors who treat cancer with radiation.

For more information, see the National Cancer Institute's overview of breast cancer treatment options. This site can also help you find health care services.

Clinical trials

Clinical trials use new treatment options to see if they are safe and effective. If you have cancer, you may want to participate.

Which Treatment Is Right for Me?

Choosing the right treatment for you can be difficult. Talk to your oncologist about the treatment options available for your type and stage of cancer. Your doctor can explain the risks and benefits of each treatment and its side effects. Side effects are how your body reacts to drugs or other treatments.