Breast cancer is one of the common cancers in women all over the world. Even though breast cancer is more common in older women, it also occurs in younger women and even in a small number of men. As women get older, their chances increase. A good understanding of this disease is a must to the patient and their relatives and this helps to avoid many myths and wrong concepts. It also helps detection at an early stage when the lump is very small.
Cancer occurs when, for unknown reasons, cells become abnormal and divide without control or order. The change from normal to cancerous cells requires several separate, different gene alterations. Eventually, altered genes and uncontrolled growth may produce a tumor. Malignant tumors can invade, damage, and destroy nearby tissues and spread to other parts of the body. Cancer cells may be carried in the bloodstream to distant sites in the body. Here they may form new tumours called metastases or “secondaries”.
In the axilla and breast area there are many lymph nodes (glands) that drain fluid from the breast. Breast cancer commonly spreads to these glands. Breasts are made up of fatty tissue containing thousands of tiny glands which produce milk in late pregnancy and after childbirth.
Also read: Surgical management of breast cancer
Types of breast cancer
There are several types of breast cancer. The most common is ductal carcinoma, which begins in the lining of the milk ducts of the breast. Another type, lobular carcinoma, begins in the lobules where breast milk is produced. If a malignant tumor invades nearby tissue, it is known as infiltrating or invasive cancer.
There are specific genes linked to breast cancer and other cancers that run in families. Only a very small number of women have a family history of breast cancer. A woman who has two or more close relatives who developed breast cancer under the age of 60, such as her mother or sister, may have an increased risk. Two genes – BRCA1 and BRCA2 – are now known. If these genetic aberrations are found the risk is increased.
Most breast lumps are benign. Only one in ten of the breast lumps are cancerous. Hence early clinical examination by a surgeon can allay much of the anxiety.
A pill with high levels of oestrogen for more than eight years may slightly increase breast cancer risk in young women. Studies have shown that long-term use of HRT may be associated with a slightly increased risk.
Early menarche and late menopause can increase breast cancer risk. Early and multiple pregnancies reduce the risk of one getting cancer breast.
The breast-screening program helps in early detection of cancer. This involves monthly breast self-examination, annual mammogram past 50 years and annual physical examination
A mammogram is an x-ray of the tissue of the breast. It can reveal changes in the breast before they are detected clinically. An ultrasound scan is a simple test that uses sound waves to build up a picture of the breast. It is very sensitive and can tell the difference between a solid lump and a fluid containing cyst.
Also read: Understanding the genetics of cancer
Biopsy & FNAC
The way to confirm if a breast lump is cancer is by having a biopsy. The suspicious tissue is removed by the surgeon and examined under a microscope by a pathologist who makes the diagnosis. If the biopsy result is positive, it means that the tumor or tissue from the suspicious area contains cancer and you will need treatment. Biopsy can be either FNAC or open biopsy.
FNAC is fine needle aspiration cytology which means taking a sample of cells from a lump using a needle and syringe and examining the cells under a microscope (cytology).
Once breast cancer has been found, more tests will be done to find out the specific pattern (description) of the disease. This important step is called staging. Knowing the exact stage of your disease will help the surgeon plan the treatment.
Stage I is early cancer when the cancerous cells are confined to the breast.
Stage II is when the cancerous cells spread to the axillary lymph nodes.
Stage III is when the tumour spreads beyond the breast to the adjacent area. Stage IV is when the cancer cells spreads to other parts of the body.
In situ cancers are very early cancers. This type of cancer has not spread within or outside the breast.
Most women who are treated for early breast cancer go on to live healthy, active lives. Presently treatments have changed and women who are diagnosed with early breast cancer need not lose the breast.
Once the doctor has determined your specific type and stage of breast cancer, he can begin to plan for your treatment and recovery. The long-term survival is good and it depends on the type and stage of the cancer, speed by which the cancer cells divide, the presence of ER & PR (hormone receptors) in the cells and the age and menopausal status. Breast cancer cure in the post-menopausal woman is very good compared to a young pre menopausal woman.
There are several ways of treating cancer of the breast and the treatment will be planned individually. Surgery has an important role in the treatment of patients with breast cancer. It is the treatment of choice and early cancers are treated by either Breast conservative therapy (removal of lump, axillary gland removal and radiation) or by mastectomy (removal of the breast and some lymph nodes under the arm are removed).
Research suggests that, even if a lump is small, cancer cells may have spread outside the breast. Doctors can use chemotherapy drugs to destroy cancer cells. Most of the chemotherapy drugs work better when combined with other chemotherapy drugs than when used alone. Drugs may be effective against the original tumour in the breast or able to check the growth of cells elsewhere in the body.
Chemotherapy is usually given in cycles. A blood test will be taken at the start of treatment and then at regular intervals during it. The most common short-term side effects that may appear during chemotherapy include: loss of appetite, nausea, vomiting, diarrhea, constipation, fatigue, infections, bleeding, weight change, mouth sores, and throat soreness.
Some drugs cause short-term hair loss. Hair will grow back either during treatment or after treatment is completed. Radiotherapy uses high energy x-rays to kill cancer cells. It is a localised treatment which means it kills cancer cells only in the area of the body to which it is directed. Radiotherapy is usually given using a machine called a linear accelerator. It may be recommended before or after an operation.
Hormones are natural substances that occur in our body and the growth of breast cancer is affected by normal female sex hormones, oestrogen.
Growth of cancer may be slowed down or stopped by blocking the action of this hormone. The most commonly used drugs for this purpose is Tamoxifen. Tamoxifen is taken daily by mouth and usually it is to be taken for 3 – 5 years.
The changing levels of female hormones during pregnancy could encourage the re-growth of breast cancer, but it is advisable waiting one or two years after treatment has finished before thinking of pregnancy. Breast reconstruction is done using a flap (section) of skin, muscle, and fat from another part of the body to the chest area where it is formed to create a breast shape. TRAM flap is when the tissue is taken from abdomen around the navel.
Surgical concepts have changed and big mutilating cancer surgeries are a thing of the past. A cancer diagnosis is by no means a death sentence; it is the necessary first step toward beginning treatment and regaining health. Medical research has made remarkable advances in cancer care, and today, well over half of all people diagnosed with cancer are cured.
While some forms of the disease are difficult to treat, modern therapies can significantly improve quality of life and may extend survival. Early detection and intervention go a long way Talking about their feelings with other women who have had breast cancer helps many women.
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