Symptoms, Causes and Treatment options of Breast Cancer
ಸ್ತನದ ಕ್ಯಾನ್ಸರ್ ನ ಬಗ್ಗೆ ತಿಳಿಯಲೇ ಬೇಕಾದ ವಿಷಯಗಳು

What is Breast Cancer ?

Breast cancer is characterized by uncontrolled growth of the breast cells. It is the most common cause of cancer among women in India and worldwide. It is also the leading cause of death in women aged 45 to 55.

Worldwide awareness and research projects have helped in the advancement of breast cancer treatment. It has become possible to detect the disease at an earlier stage due to proper screening and diagnosis; which has resulted in decreasing the number of deaths over the years.

If you feel a lump in your breast, it is recommended to consult your doctor right away. While breast lumps can be caused by conditions other than cancer, it is still a good idea to get the lumps examined for being on the safe side.

Symptoms of Breast Cancer

Breast cancer is characterized by some specific symptoms. These are:

  • A painless lump in the breast (the most common symptom)
  • A painless lump under your armpit (axilla)
  • Swelling in a certain portion of the breast or the full breast
  • Peeling, scaling or flaking of the skin around the nipples
  • Formation of an inverted nipple
  • Bloody discharge from the nipple
  • Redness or pitting of the breast skin which looks like the skin of an orange
  • Sudden changes in the size and shape of the breast

These are some of the basic symptoms and it doesn’t necessarily mean that you have cancer. For example, a breast lump or pain the breast can be due to the presence of a benign cyst. Still, it is advisable to consult a doctor for further examination to ascertain the cause of pain.

Causes of Breast Cancer

Cancer develops in breasts when DNA in the cells of the breast undergoes mutation and proliferates uncontrollably. While the exact cause of breast cancer is still unknown, studies have identified factors that may increase the chances of breast cancer. These include hormonal, environmental and lifestyle factors.

Gene mutations play an important role in increasing the likelihood of breast cancer. These genes are inherited from the previous generation and contribute to the development of cancer.

Facts you should know about Hereditary breast cancer

The most well-known of such genes are BRCA 1 and BRCA 2, both of which are known to increase the risk of developing breast and ovarian cancer.

It is recommended to consult your doctor for blood tests to identify mutations in the BRCA gene if you have a family history of breast cancer.

Stages of Breast Cancer

Staging of breast cancer classifies a cancer based on the extent of cancer in the body.  The tests determine the size of tumour, which part of breast it is first detected and how far it has spread.

The most common system used for staging breast cancer is the TNM system.

T stands for Tumour . It is used to describe the size of the tumour. It also helps to determine whether tumour has grown into other parts of the organ or tissues around the organ. It is represented by a range of 1 to 4. The higher the number means the larger the tumour.

N stands for Lymph Nodes . It helps determine if the cancer has spread to the lymph nodes around the organ. NX means the impact on lymph nodes cannot be determined. N0 means cancer hasn’t spread to nearby lymph nodes while N1, N2 and N3 means cancer has spread to lymph nodes. N1 to N3 also shows the range that how many lymph nodes are affected.

M stands for Metastasis . It is used to determine if the cancer has spread to other parts of body through blood or lymphatic system. MX means the metastasis cannot be determined; M0 means cancer has not spread to other body parts while M1 indicates that it has spread to other body parts.

Sometimes lowercase letters like a, b and c is used to divide the tumour, lymph nodes and metastasis into sub categories. Also lowercase “is” is used to denote carcinoma in situ. For e.g. Tis

For the convenience of grading the extent of spread of cancer, the cancer is classified into 5 broad stages.

Stage 0

Stage 0 is used to describe non-invasive breast cancers such as Ductal carcinoma in situ (DCIS) or Lobular carcinoma in situ (LCIS). In this stage the cancer is detected at their point of origin and no evidence of it spreading to other nearby tissues is observed.

Stage I

Stage I describes the first stage of invasive breast cancer. This is where cancer cells start invading to nearby tissues from their point of origin. It is divided into two categories IA and IB.

IA is the stage where a) primary tumour measures up to 2 cm and b) cancer has not spread outside breast and no lymph nodes are involved.

IB describes invasive breast cancer in which there can be either no tumour in breast along with small group of cancer cells larger than 0.2 mm but not larger than 2 mm are found in lymph nodes or there is a tumour in breast no larger than 2 cm along with small group of cancer cells in lymph nodes.

Stage II

Stage II is divided into two sub categories known as IIA and IIB

Stage IIA describes cancer in which either of the following can happen

  • There is no evidence of tumour in breast, but cancer has spread to 1 to 3 axillary lymph nodes. It has not spread to other parts of the body(T0,N1,M0)
  • The tumor is 20 mm or smaller and has spread to the axillary lymph nodes (T1,N1,M0)
  • The tumour is larger than 20 mm but not larger than 50 mm and has not spread to axillary lymph nodes (T2, N0,M0)

Stage IIB comprises of either of these conditions

  • The tumour is larger than 20 mm but not larger than 50 mm and has spread to 1 to 3 axillary lymph nodes (T2,N1,M0)
  • The tumour is larger than 50 mm but and has not spread to the axillary lymph nodes. (T3, N0,M0)

Stage III

Stage III can be further sub-divided into three categories

  • Stage IIIA : In this stage the cancer has spread to around 4 to 9 axillary lymph nodes or to internal mammary lymph nodes, it has not spread to other parts of body. (T3, N2, M0) or it can be a tumour larger than 50 mm that has spread to 1 to 3 axillary lymph nodes. (T3, N1, M0)
  • Stage IIIB: The tumour at this stage has spread to the chest wall and may cause swelling or ulceration of breast or is diagnosed as inflammatory breast cancer. It may or may not have spread to the axillary or internal mammary lymph nodes and it has not spread to other body parts. (T4, N1 or N2, M0)
  • Stage IIIC: The tumour at this stage has spread to 10 or more axillary lymph nodes, the internal mammary lymph nodes or to lymph nodes under the collarbone; it has not spread to other body parts. (T1-T4,N3,M0)

Stage IV

Stage IV is known as metastatic because the tumour can be of any size and has spread from its point of origin to other organs such as bones, brain, liver, lungs, distant lymph nodes, or chest wall. (T1-T4, N1-N3, M1)

Recurrent

It refers to the cancer that has come back after the treatment. It can be described as local, regional or distant. A round of tests is conducted to learn about the extent of recurrence.

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Breast Cancer

Risk Factors

Risk factors are those factors that increase the chance of getting breast cancer. But having one or more of the risk factor does not mean that you will be getting breast cancer. It is seen that some women develop breast cancer that have no known risk factors.

Factors that are known to increase the risk of breast cancer are:

Age

With increasing age the chances of developing cancer increases.

Alcohol

It is found that the consumption of an excessive amount of alcohol can increase the risk of breast cancer.

Dense breast tissue

It makes breast readings by mammogram harder and is known to increase the chances of having breast cancer.

Genes

Women who have a mutation in the BRCA gene have an increased likelihood of developing breast cancer.

Early periods

Women who have experienced their first period before the age of 12 have an increased risk of breast cancer.

Family History

If there is a case of breast cancer in the family especially to someone in the young age, then there is a chance that other females may get cancer.

Late Pregnancy

Women who gave birth to first children after 35 have an increased risk.

Hormone therapy

Women undergoing estrogen and progesterone therapy to counter menopause symptoms are at increased risk of developing breast cancer.

Delayed Menopause

Women who have menopause after 55 are more likely to be having breast cancer in the next 10 years.

No pregnancy

Women who have never been pregnant are more likely to develop cancer of the breast.

Types of Breast Cancer

Breast cancer can be of several types but all these are categorized into two main groups namely invasive and non-invasive or in-situ. While invasive cancer can spread from the breast to other organs in-situ cancer remains localized in the breast tissue.

The following are some of the types of breast cancer

Ductal Carcinoma In-Situ (DCIS)

It is the presence of abnormal cell growth in the ducts that carry milk in the breast. It is the earliest form of breast cancer, it is non-invasive.

Lobular Carcinoma In-situ (LCIS)

It is the condition where abnormal cell growth is observed in the milk glands (lobules). Women diagnosed with LCIS have an increased risk of developing invasive breast cancer.

Invasive Ductal Carcinoma (IDC)

It usually starts in the milk ducts and then spreads to nearby tissues. It continues to grow to organs outside the breast once it breaches the milk duct. It is the most common form of breast cancer that affects women.

Invasive Lobular Carcinoma(ILC)

It starts with abnormal growth in breast lobules and then to the surrounding tissues and organs as the disease progresses.

Paget disease of the nipple

This is cancer that begins in the duct of the nipple, and as it grows, it begins to affect the skin and areola. Paget's disease of the breast is found to occur mostly in women older than 50 years.

Inflammatory Breast Cancer

Inflammatory breast cancer is a rare form of cancer that grows rapidly. The breasts appear red, swollen and tender. It occurs as cancer cells block the lymphatic vessels covering the skin of the breast.

Angiosarcoma

Angiosarcoma is a rare type of cancer that occurs in the blood vessels or the lymph vessels in the breast.

Diagnosis of Breast Cancer

These are the various tests to diagnose breast cancer:

  • Mammogram: Mammogram is the X-Ray of the breast. It is the most common method of detecting breast cancer.
  • Breast Ultrasound: It uses sound waves to determine whether the breast lump is a solid mass or fluid-filled mass.
  • Breast Biopsy: This involves extracting a part of the tissue from the suspected area of the breast for determining cancer. It also helps determine the stage of cancer, the involvement of hormone receptors.
  • Breast MRI: Magnetic Resonance Imaging (MRI) uses different images of the breast that helps a doctor identify the abnormalities. It is used in conjunction with Mammogram and Ultrasound.

Treatment of Breast Cancer

There are many breast cancer treatment options available, but the course of treatment will be determined by the stage of cancer, how far it has spread and how big is the tumor.

The most common procedure for breast cancer treatment is surgery. There are additional treatments such as chemotherapy, radiation, and hormone therapy.

The most common surgical procedures are:

Lumpectomy

Known as the breast conserving surgery, in this procedure, the tumor and surrounding tissues are removed, keeping the breast intact. It should be followed up with radiation therapy.

Mastectomy

This procedure removes the entire breasts.

Sentinel Node Biopsy

In this procedure to selective removal of lymph nodes affected by the tumor.

Axillary lymph nodes dissection

This procedure is used when cancer is found in sentinel node; it involves removal of axillary node from the armpit.

Contralateral prophylactic mastectomy

It is a surgical procedure where the healthy breast is also removed to minimize the risk of developing breast cancer again.

Chemotherapy

In this treatment drugs are used to destroy cancer cells. Sometimes chemotherapy is given before surgery to women who have a big tumor to shrink it to make the surgery easy.

Radiation Therapy

This therapy used high powered beams of energy to kill cancer cells, mostly it is done externally, and some of the recent developments allow the doctor to irradiate cancer cells from inside the body which is known as brachytherapy.

Hormone therapy

Hormones such as estrogen and progesterone stimulate the growth of cancer cells. This form of treatment blocks the production of these hormones or blocking hormone receptors on cancer cells.

Recovery Rate

Recovery rate of a breast cancer is based on the stage at which it is detected. In India the survival rates will determined by the stage at which the cancer gets detected.

  • If detected at Stage I the survival rate is about 90%
  • If detected at Stage II, the survival rates are about 70-80%
  • If detected in Stage III, the survival rates are around 60-70%
  • In stage IV, it is not curable.

Prevention

Some risk factors are there that cannot be controlled. But those which can be controlled should be adopted to reduce the chance of developing breast cancer. These include leading a healthy lifestyle, getting more exercise and eating a healthy diet, resist drinking alcohol. Performing regular screenings and following the preventive measures will go a long way in minimizing the risks of breast cancer.

Resist the urge to indulge in smoking and drinking, it will help you lead a healthy life.