BREAST CANCER

Breast cancer is when the cells in the breast tissue, most commonly in the milk ducts, start growing uncontrollably and  then forms a tumour.

It is  one of the most common cancers in the world. It affects both men & women (although very rare in men). Most women diagnosed with breast cancer are over the age of 50, but younger women can also get breast cancer.

The breasts are made up of glandular tissue, fat, milk ducts and connective tissue. Younger women normally have more dense breasts than older women. Your breasts usually feel lumpy just before your period or during ovulation and this is why it is advised that the best time to check your breasts is a few days after your period ends a sit will be less dense then.

Types of Breast cancer

There are different types of breast cancer, some which are common and some that are quite rare.

Invasive breast cancer (IDC):

About 80% of all breast  cancers are invasive breast cancer. Invasive means that the cancer has spread into the surrounding breast tissues from the milk ducts in the breast. Most invasive breast cancers are called No Special Type which means they have no special features. Symptoms of this type of cancer  include a lump in the breast, skin irritation , indent or dimpling of the breast, armpit lump or nipple discharge.

Invasive lobular cancer

Also called infiltrating lobular carcinoma, is the second most common type of breast cancer . This type starts from the lobules (milk producing glands) and means it has spread into the surrounding breast tissue. This type of cancer tends to happen in older women than IDC, though it can happen in younger women. Some research have indicated that the use of hormone replacement therapy during or after menopause can increase the risk of ILC. This type of breast cancer is less likely than other forms of breast cancer to cause a firm or distinct breast lump. Symptoms of this type of cancer include a newly inverted nipple, a mass or swelling in the breast, dimpling of the skin.

Ductal Carcinoma in situ (DCIS)

This is like an early form of IDC. It simply means some of the cells lining the ducts have started to become abnormal. This cancer is still confined to the ducts  and not invaded surrounding tissues yet. However, having DCIS can increase your chances of having Invasive breast cancer (IDC) later on. According to the American Cancer Society, new DCIS cases are increasing and this may be because of there are better screening methods which are being detected early. As it’s an early form of breast cancer, there may not be a lot of symptoms and is usually picked up on screening tests. Symptoms may include a lump in the breast or nipple discharge.

Lobular Carcinoma in situ (DCIS)

This means that some cells inside the lobules (glands that make milk) have started becoming abnormal. it is not cancer but having it increased  the risk of invasive cancer in future. It is usually diagnosed in women ages 40-50 who have not been through menopause. LCIS does not cause show up on mammograms and does not present with symptoms. It usually tends to be diagnosed as a result of biopsy done on the breast for some other reason. Your doctor may suggest regular monitoring and have a breast exam every 6- 12 months.

Triple negative breast cancer

This is usually  faster growing type of breast cancer. This type of breast cancer does not have receptors for the hormones, oestrogen and progesterone, and Her2 protein. This means hormonal or targeted treatments will not work for this type of breast cancer. Chemotherapy, radiation and surgery will be the most effective for this type of breast cancer. Basal cell breast cancer is a type of triple negative breast cancer with a clear pattern of changes in proteins in the cells. Symptoms usually include a new lump/thickening in your breast, nipple discharge, change in the nipple position, breast skin changes.

Inflammatory breast cancer

This is a rare type that also develops quickly and makes the breast look warm, swollen and red. This happens when cancer cells block the lymphatic vessels in skin covering the breast, causing the breast to be tender and swollen. It is more common in black women and in younger women too. It is most times mistaken for a breast infection. It is usually diagnosed when it has spread from its  point of origin to nearby lymph nodes. Symptoms of IBC may appear quite quickly and may include quick change in the look of one breast, dimpling of the breast, flattening of the nipple, enlarged lymph nodes.

Angiosarcoma of the breast

They start in the cells that line the lymphatic vessels or blood vessels. They are also very rare. There are two types which are primary and secondary angiosarcoma. Primary angiosarcoma begins in the breast tissue and is usually seen in women ages 30s -40s. Secondary angiosarcoma, on the other hand is seen in older women, start because of having radiation to the breast for a previous breast cancer. Symptoms may include a lump, change in the size of the breast , rash on the breast, armpit lump.

Symptoms of breast cancer

It is important to note that different types of breast cancer can have several symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue.

Other symptoms to look out for include :

• a change in the size or shape of one or both breasts
• discharge from either of your nipples, which may be streaked with blood
• a lump or swelling in either of your armpits
• dimpling on the skin of your breasts
• a rash on or around your nipple
• a change in the appearance of your nipple, such as becoming sunken into your breast

Diagnosis

Breast cancer  screening

The aim of this is to test people with no symptoms in order to catch cancer early, when they have the best chance of being cured. It involves using a test called mammography to take x-rays of the breast to find cancers when they are too small to feel. Most countries run a screening programme that is carried out annually for women aged 40 or over to check for early signs of breast cancer. Women with a higher-than-average risk of developing breast cancer may be offered screening and genetic testing for the condition.

Mammograms are usually used to test in older women because they have less dense tissue. Mammograms are more difficult to read in younger women because their breast tissue is denser. If you have  a higher risk of breast cancer and have dense breast tissue, you may be advised to screen with a breast ultrasound and /or mammogram.

Tests to diagnose

Breast exam:

Your doctor will carry out a manual exam both breasts and feel the lymph nodes in your armpit for any lumps or other concerns.

Mammogram

If your doctor suspects nay abnormalities in your breast or an abnormality is detected  on a screening mammogram, your doctor may recommend a diagnostic mammogram to check further.

Breast ultrasound

It can be used to check dense breast tissue where mammograms are not suitable. Also it can be used to check if a new breast lump is a solid mass or a fluid-filled cyst

Biopsy

The doctor removes a small piece of tissue from the lump to check for cancerous cells. Your doctor may use a specialised needle guided by ultrasound to remove the sample. Sometimes, a small marker is left at the site so the area can be easily identified on future imaging tests.

Breast MRI

It uses magnetism to take detailed pictures of your breast. Unlike other types of imaging tests, an MRI doesn’t use radiation to create the images.

Bone scan

A small amount of radioactive substance may be injected into a vein  and a scan used to check if the cancer has spread to your bones.

Staging of breast cancer

The diagnostic tests used to check the size and extent of the spread will help determine the staging of the breast cancer. Breast cancer can be divided into number stages.

Stage 1

This means the cancer is still small and only in the breast tissue. It means the tumour is 2cm or smaller or that small areas of the cancer cells re found in the lymph nodes close to the breast

Stage 2

This is when the tumour is between 2-5cm and it may not have spread to the lymph nodes under the arm. However sometimes the cancer may not be found in the breast, but the cancer cells have spread to 1-3 lymph nodes in the armpit or near the breast bone.

Stage 3

This is when the cancer has spread to the lymph nodes in the armpit and other lymph nodes nearby the breast, or to the skin of the breast or chest wall.

However sometimes the cancer may not be found in the breast, but the cancer cells have spread to 4-9 lymph nodes in the armpit or near the breast bone.

Stage 4

This is also called metastatic breast cancer and is when the cancer has spread to other parts of the body such as bones, liver and lungs. In this stage , the tumour may be any size, but means the cancer has spread into organs

 

Treatment for breast cancer

Treatment will depend on the type of breast cancer, stage and whether it is hormone receptive. The following are the various treatments offered for breast cancer

Surgery

There are different forms of surgery carried out for breast cancer. They include:

Lumpectomy:

Here, the surgeon removes the tumour and a small margin of healthy tissue around the cancer. It is often used for removing smaller tumours. Sometime chemotherapy may be used to shrink a tumour so that a lumpectomy can be performed.

Mastectomy:

This involves removing all of the breast tissue, including the ducts, ducts, fatty tissue and some skin, including the nipple and areola. Some women may choose to have both breasts removed, even if one is totally healthy. This happens when they believe they have an increased risk of cancer in the other breast because of a  strong family history.

Axillary node dissection:

Your doctor may need to remove several sentinel lymph nodes if cancer is found in them.

Chemotherapy:

This uses cytotoxic drugs to kill fast-growing cancer cells. It can be used when the cancer ha spread to other parts of the body and may be used to control the cancer. It can also be used to shrink the tumour pre-operation to make it easier to remove.

Radiation:

This uses high-energy or proton rays to kill cancer cells. It can be done using a machine that focuses the energy rays on the breast area or done by putting radioactive material inside your body (brachytherapy). It can also be used to the chest wall after a mastectomy for cancer that has spread to the lymph nodes.

Targeted therapy:

This is mainly used to attack specific proteins like human epidermal growth factor receptor 2 (HER2) in breast cancer cells. By doing this, the drugs damage the cancer cells only. Your doctor will test your cancer cells to see if you may be able to benefit from using this therapy.

Immunotherapy:

This is when your immune system is triggered to fight the cancer cells. This may be used if you have triple negative breast cancer which means that the cancer cells do not have hormone receptors.

Hormone therapy:

This can be used to treat breast cancers that are sensitive to hormones like ER positive and PR positive breast cancer cells. It can be used to reduce the likelihood of the cancer returning or to control the spread of the cancer. They include drugs that stop hormones for attaching to cancer cells, to stop hormone productions in the ovaries, to stop the body from making estrogen after menopause.

 

REFERENCES

https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470

https://www.breastcancer.org/

https://www.cancerresearchuk.org/about-cancer/breast-cancer

Coping with breast cancer

How people cope with the diagnosis and treatment varies from person to person because being diagnosed with breast cancer can affect daily life in many ways. Below are suggestions which could help people have a better quality of life after being diagnosed:

• Communicating with family and friends, which can be a powerful support system
• communicating with other people in the same situation
• Research / finding out as much as possible about your condition
• not trying to do too much or overexerting yourself
• making time for yourself

It’s been suggested that regular exercise can reduce your risk of breast cancer by almost as much as a third. Regular exercise and a healthy lifestyle can also improve the outlook for people affected by breast cancer. 

If you’ve been through the menopause, it’s particularly important that you try to get to, and maintain, a healthy weight  because being overweight or obese causes more oestrogen to be produced, which can increase the risk of breast cancer.