Breast Cancer

the breast. There are two main types of breast cancer: Ductal  carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple.

Breast cancer symptoms

Perhaps the most recognized symptom of breast cancer is a lump or mass in the breast tissue. While many women go to their doctor after finding a lump, they should also be aware of any other changes to the breast or nipple.

With the different types of breast cancer come a variety of related symptoms. For example, invasive ductal carcinoma (IDC), which forms in the milk ducts, may cause a distinct breast lump that you can feel. Invasive lobular carcinoma (ILC), which forms in the milk-producing glands, may cause a thickening in the breast.

Breast cancer symptoms

Symptoms of breast cancer vary from person to person. Some common breast cancer signs and symptoms include:

Skin changes, such as swelling, redness, or other visible differences in one or both breastsAn increase in size or change in shape of the breast(s)Changes in the appearance of one or both nipplesNipple discharge other than breast milkGeneral pain in/on any part of the breastLumps or nodes felt on or inside of the breast

Symptoms more specific to invasive breast cancer are as follows:

Irritated or itchy breastsChange in breast colorIncrease in breast size or shape (over a short period of time)Changes in touch (may feel hard, tender or warm)Peeling or flaking of the nipple skinA breast lump or thickeningRedness or pitting of the breast skin (like the skin of an orange)

Causes

Over the course of a lifetime, 1 in 8 women will be diagnosed with breast cancer.

Risk factors you cannot change include:

Age and gender -- Your risk of developing breast cancer increases as you get older. Most advanced breast cancer cases are found in women over age 50. Men can also get breast cancer. But they are 100 times less likely than women to get breast cancer.

Family history of breast cancer -- You may also have a higher risk of breast cancer if you have a close relative who has had breast, uterine, ovarian, or colon cancer.

Genes -- The most common gene defects are found in the BRCA1 and BRCA2 genes. These genes normally produce proteins that protect you from cancer. If a parent passes you a defective gene, you have an increased risk of breast cancer. Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life.

Menstrual cycle -- Women who got theirperiods early (before age 12) or went throughmenopause late (after age 55) have an increased risk of breast cancer.

Other risk factors include:

Alcohol use -- Drinking more than 1 to 2 glasses of alcohol a day may increase your risk of breast cancer.

Childbirth -- Women who have never had children or who had their first child after age 30 have an increased risk of breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer.

DES -- Women who took diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer after age 40. This drug was given to the women in the 1940s through the 1960s.

Hormone therapy (HT) -- You have a higher risk of breast cancer if you received hormone therapy with estrogen for several years or more.

Obesity -- Obesity has been linked to breast cancer, although this link is not well understood. Experts think that obese women produce more estrogen. This may fuel the development of breast cancer.

Radiation -- If you received radiation therapy as a child or young adult to treat cancer of thechest area, you have a very high risk of developing breast cancer. The younger you started such radiation and the higher the dose, the higher your risk. This is especially true if the radiation was given during breast development.

Exams and Tests

The doctor will ask about your symptoms and risk factors. Then the doctor will perform a physical exam. The exam includes both breasts, armpits, and the neck and chest area.

Tests used to diagnose and monitor patients with breast cancer may include:

Breast MRI to help better identify the breast lump or evaluate an abnormal change on a mammogram

Breast ultrasound to show whether the lump is solid or fluid-filled

Breast biopsy, using methods such as needle aspiration, ultrasound-guided, stereotactic, or open

 

CT scan to check if the cancer has spread outside the breast 

Mammography to screen for breast cancer or help identify the breast lump

PET scan to check if the cancer has spread

Sentinel lymph node biopsy to check if the cancer has spread to the lymph nodes

If your doctor learns that you do have breast cancer, more tests will be done. This is called staging, which checks if the cancer has spread. Staging helps guide treatment and follow-up. It also gives you an idea of what to expect in the future.

Breast cancer stages range from 0 to IV. The higher the stage, the more advanced the cancer.

Treatment

Treatment is based on many factors, including:

Type and stage of the cancer

Whether the cancer is sensitive to certainhormones

Whether the cancer overproduces (overexpresses) the HER2/neu gene

Cancer treatments may include:

Chemotherapy, which uses medicines to kill cancer cells.

Radiation therapy, which is used to destroy cancerous tissue.

Surgery to remove cancerous tissue: Alumpectomy removes the breast lump;mastectomy removes all or part of the breast and possible nearby structures.

Targeted therapy uses medicine to attack the gene changes in cancer cells. Hormone therapy is an example of targeted therapy. It blocks certain hormones that fuel cancer growth.

Cancer treatment can be local or systemic:

Local treatments involve only the area of disease. Radiation and surgery are forms of local treatment. They are most effective when the cancer has not spread outside the breast.

Systemic treatments affect the entire body. Chemotherapy and hormonal therapy are types of systemic treatment.

Most women receive a combination of treatments. For women with stage I, II, or III breast cancer, the main goal is to treat the cancer and prevent it from returning (curing). For women with stage IV cancer, the goal is to improve symptoms and help them live longer. In most cases, stage IV breast cancer cannot be cured.

Stage 0 and ductal carcinoma -- Lumpectomy plus radiation or mastectomy is the standard treatment.

Stage I and II -- Lumpectomy plus radiation or mastectomy with lymph node removal is the standard treatment. Chemotherapy, hormonaltherapy, and other targeted therapy may also be used after surgery.

Stage III -- Treatment involves surgery, possibly followed by chemotherapy, hormone therapy, and other targeted therapy.

Stage IV -- Treatment may involve surgery, radiation, chemotherapy, hormone therapy, other targeted therapy, or a combination of these treatments.

After treatment, some women continue to take medicines for a time. All women continue to have blood tests, mammograms, and other tests after treatment.

Women who have had a mastectomy may have reconstructive breast surgery. This will be done either at the time of mastectomy or later.