Jane DoeWhat is Breast Cancer?
Breast cancer is a malignant tumor that starts in the cells of the breast. A malignant tumor is a group of cancer cells that can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body.
The normal breast
To understand breast cancer, it helps to have some basic knowledge about the normal structure of the breasts, shown in the diagram below.
The female breast is made up mainly of lobules (milk-producing glands), ducts (tiny tubes that carry the milk from the lobules to the nipple), and stroma (fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels).
Most breast cancers begin in the cells that line the ducts (ductal cancers). Some begin in the cells that line the lobules (lobular cancers), while a small number start in other tissues.
The lymph (lymphatic) system of the breast
The lymph system is important to understand because it is one way breast cancers can spread. This system has several parts.
Lymph nodes are small, bean-shaped collections of immune system cells (cells that are important in fighting infections) that are connected by lymphatic vessels. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph (instead of blood) away from the breast. Lymph contains tissue fluid and waste products, as well as immune system cells. Breast cancer cells can enter lymphatic vessels and begin to grow in lymph nodes.
Symptoms of Breast Cancer
In its early stages, breast cancer usually has no symptoms. As a tumor develops, you may note the following signs:
- A lump in the breast or underarm that persists after your menstrual cycle. This is often the first apparent symptom of breast cancer. Lumps associated with breast cancer are usually painless, although some may cause a prickly sensation. Lumps are usually visible on a mammogram long before they can be seen or felt.
- Swelling in the armpit.
- Pain or tenderness in the breast. Although lumps are usually painless,pain or tenderness can be a sign of breast cancer.
- A noticeable flattening or indentation on the breast, which may indicate a tumor that cannot be seen or felt.
- Any change in the size, contour, texture, or temperature of the breast. A reddish, pitted surface like the skin of an orange could be a sign of advanced breast cancer.
- A change in the nipple, such as a nipple retraction, dimpling, itching, a burning sensation, or ulceration. A scaly rash of the nipple is symptomatic of Paget's disease, which may be associated with an underlying breast cancer.
- Unusual discharge from the nipple that may be clear, bloody, or another color. It's usually caused by benign conditions but could be due to cancer in some cases.
- A marble-like area under the skin.
- An area that is distinctly different from any other area on either breast.
Types of Breast Cancer
There are many types of breast cancer. Some are more common than others, and there are also combinations of cancers. Some of the most common types of cancer are as follows:
Ductal carcinoma in situ
The most common type of noninvasive breast cancer is ductal carcinoma in situ (DCIS). This type of cancer has not spread and therefore usually has a very high cure rate.
Invasive ductal carcinoma
This cancer starts in a duct of the breast and grows into the surrounding tissue. It is the most common form of breast cancer. About 80% of invasive breast cancers are invasive ductal carcinoma.
Invasive lobular carcinoma
This breast cancer starts in the glands of the breast that produce milk. Approximately 10% of invasive breast cancers are invasive lobular carcinoma.
The remaining breast cancers types are much less common and include the following:
Mucinous carcinomas are formed from mucus-producing cancer cells.
Mixed tumors contain a variety of cell types.
Medullary carcinoma is an infiltrating breast cancer that presents with well-defined boundaries between the cancerous and noncancerous tissue.
Causes of Breast Cancer
The following are risk factors for breast cancer
Causes of Breast Cancer
The following are risk factors for breast cancer
- Age The chances of breast cancer increase as you get older.
- Family history The risk of breast cancer is higher among women who have relatives with the disease. Having a close relative with the disease (sister, mother, or daughter) doubles a woman's risk.
- Personal history Having been diagnosed with breast cancer in one breast increases the risk of cancer in the other breast or the chance of an additional cancer in the original breast.
- Women diagnosed with certain benign breast conditions have an increased risk of breast cancer. These include atypical hyperplasia, a condition in which there is abnormal proliferation of breast cells but no cancer has developed.
- Menstruation: Women who started their menstrual cycle at a younger age (before 12) or went through menopause later (after 55) have a slightly increased risk.
- Breast tissue: Women with dense breast tissue (as documented by mammogram) have a higher risk of breast cancer.
- Race: White women have a higher risk of developing breast cancer, but African-American women tend to have more aggressive tumors when they do develop breast cancer.
- Exposure to previous chest radiation or use of diethylstilbestrol increases the risk of breast cancer.
- Having no children or the first child after age 30 increases the risk of breast cancer.
- Breastfeeding for 1 ½ to 2 years might slightly lower the risk of breast cancer.
- Being overweight or obese increases the risk of breast cancer.
- Use of oral contraceptives in the last 10 years increases the risk of breast cancer.
- Using combined hormone therapy after menopause increases the risk of breast cancer.
- Alcohol use increases the risk of breast cancer, and this seems to be proportional to the amount of alcohol used.
- Exercise seems to lower the risk of breast cance
Treatment for Breast Cancer
Patients with breast cancer have many treatment options. Most treatments are adjusted specifically to the type of cancer and the staging group. Treatment options should be discussed with your health care team. Below you will find the basic treatment modalities used in the treatment of breast cancer. Treatment modalities are always changing and developing. It is important that you discuss the different options with your health care team.
Surgery
Most women with breast cancer will require surgery. Broadly, the surgical therapies for breast cancer can be divided into breast conserving surgery and mastectomy.
Breast-conserving surgery
This surgery will only remove part of the breast (sometimes referred to as partial mastectomy). The extent of the surgery is determined by the size and location of the tumor.
In a lumpectomy, only the breast lump and some surrounding tissue are removed. The surrounding tissue (margins) is inspected for cancer cells. If no cancer cells are found, this is called "negative" or "clear margins." Frequently, radiation therapy is given after lumpectomies.
Mastectomy
During a mastectomy (sometimes also referred to as a simple mastectomy), all the breast tissue is removed. If immediate reconstruction is considered, a skin-sparing mastectomy is sometimes performed. In this surgery, all the breast tissue is removed as well but the overlying skin is preserved.
Radical mastectomy
During this surgery, the surgeon removes the axillary lymph nodes as well as the chest wall muscle in addition to the breast. This procedure is done much less frequently than in the past, as in most cases a modified radical mastectomy is as effective.
Modified radical mastectomy
This surgery removes the axillary lymph nodes in addition to the breast tissue.
Depending on the stage of the cancer, your health care team might give you a choice between a lumpectomy and a mastectomy. Lumpectomy allows sparing of the breast but usually requires radiation therapy afterward. If lumpectomy is indicated, long-term follow-up shows no advantage of a mastectomy over the lumpectomy.
Radiation therapy
Radiation therapy destroys cancer cells with high energy rays. There are two ways to administer radiation therapy:
External beam radiation
This is the usual way radiation therapy is given for breast cancer. A beam of radiation is focused onto the affected area by an external machine. The extent of the treatment is determined by your health care team and is based on the surgical procedure performed and whether lymph nodes were affected or not.
The local area will usually be marked after the radiation team has determined the exact location for the treatments. Usually the treatment is given 5 days a week for 5 to 6 weeks.
Brachytherapy
This form of delivering radiation uses radioactive seeds or pellets. Instead of a beam from the outside delivering the radiation, these seeds are implanted into the breast next to the cancer.
Chemotherapy
Chemotherapy is treatment of cancers with medications that travel through the bloodstream to the cancer cells. These medications are given either by intravenous injection or by mouth.
Chemotherapy can have different indications and may be performed in different settings as follows:
- Adjuvant chemotherapy: If surgery has removed all the visible cancer, there is still the possibility that cancer cells have broken off or are left behind. If chemotherapy is given to assure that these small amounts of cells are killed as well, it is called adjunct chemotherapy.
- Neoadjuvant chemotherapy: If chemotherapy is given before surgery it is referred to as neoadjuvant chemotherapy. Although there seems to be no advantage to long-term survival whether the therapy is given before or after surgery, there are advantages to see if the cancer responds to the therapy and by shrinking the cancer before surgical removal.
- Chemotherapy for advanced cancer: If the cancer has metastasized to distant sites in the body, chemotherapy can be used for treatment. In this case, the health care team will need to determine the most appropriate length of treatment.
There are many different chemotherapeutic agents that are either given alone or in combination. Usually these drugs are given in cycles with certain treatment intervals followed by a rest period. The cycle length and rest intervals differ from drug to drug.
Hormone therapy
This therapy is often used to help reduce the risk of cancer reoccurrence after surgery, but it can also be used as adjunct treatment.
Estrogen (a hormone produced by the ovaries) promotes the growth of a few breast cancers, specifically those containing receptors for estrogen (ER positive) or progesterone (PR positive).
The following drugs are used in hormone therapy:
- Tamoxifen (Nolvadex): This drug prevents estrogen from binding to estrogen receptors on breast cells.
- Fulvestrant (Faslodex): This drug eliminates the estrogen receptor and can be used even if tamoxifen is no longer useful.
- Aromatase inhibitors: They stop estrogen production in postmenopausal women. Examples are letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin).
Targeted therapy
As we are learning more about gene changes and their involvement in causing cancer, drugs are being developed that specifically target the cancer cells. They tend to have fewer side effects then chemotherapy (as they target only the cancer cells) but usually are still used in adjunct with chemotherapy.
Drugs that target new tumor blood vessels
Tumors need new blood vessels to grow. The process of blood vessel growth is known medically as angiogenesis. New drugs are being developed to target this growth and fight certain cancers, including breast cancer.
Bevacizumab is a monoclonal antibody directed against blood vessel cells. Newer study results seem to indicate that this drug slows the cancer growth in some patients but did not improve survival. The use of this medication should be discussed with your health care team.
Alternative treatments
Whenever a disease has the potential for much harm and death we search for alternative treatments. As a patient or the loved one of a patient you want to try everything and leave no option unexplored. The danger in this approach is usually found in the fact that the patient might not avail themselves of existing, proven therapies. You should discuss your interest in alternative treatments with your health care team and together explore the different options.
Pregnancy after Breast Cancer
The research was specific to women who were diagnosed with estrogen-receptor positive tumors, which have protein molecules that need estrogen to grow. About 60 percent of all breast cancers are ER-positive, according to the National Institutes of Health.
Despite the fear that high hormone levels that occur during pregnancy might stimulate breast cancer growth, data overwhelming showed that it does not, experts said.
The study included 333 women ages 21 to 48 who became pregnant after a breast cancer diagnosis and 874 women with similar breast cancer diagnoses who did not become pregnant. About five years after pregnancy, researchers found about 30 percent of all the women had a recurrence of the cancer.
In the past, some women who became pregnant were advised to get abortions because of the potential dangers of recurrence, but researchers said this recommendation might be unnecessary in most cases.
Lifestyle changes after Breast Cancer
You can't change the fact that you have had cancer. What you can change is how you live the rest of your life -- making choices to help you stay healthy and feel as well as you can. This can be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even start during cancer treatment.
Making healthier choices
For many people, a diagnosis of cancer helps them focus on their health in ways they may not have thought much about in the past. Are there things you could do that might make you healthier? Maybe you could try to eat better or get more exercise. Maybe you could cut down on the alcohol, or give up tobacco. Even things like keeping your stress level under control may help. Now is a good time to think about making changes that can have positive effects for the rest of your life. You will feel better and you will also be healthier.
Eating better
If treatment caused weight changes or eating or taste problems, do the best you can and keep in mind that these problems usually get better over time. You may find it helps to eat small portions every 2 to 3 hours until you feel better. You may also want to ask your cancer team about seeing a dietitian, an expert in nutrition who can give you ideas on how to deal with these treatment side effects.
One of the best things you can do after cancer treatment is put healthy eating habits into place. You may be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight, eating a healthy diet, and limiting your alcohol intake may lower your risk for a number of types of cancer, as well as having many other health benefits.
Rest, fatigue, and exercise
If you were sick and not very active during treatment, it is normal for your fitness, endurance, and muscle strength to decline. Any plan for physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis twice a week. If you haven't exercised in a few years, you will have to start slowly – maybe just by taking short walks.
If you are very tired, you will need to balance activity with rest. It is OK to rest when you need to. Sometimes it's really hard for people to allow themselves to rest when they are used to working all day or taking care of a household, but this is not the time to push yourself too hard. Listen to your body and rest when you need to. (For more information on dealing with fatigue, please see Fatigue in People With Cancer and Anemia in People With Cancer.)
Keep in mind exercise can improve your physical and emotional health.
- It improves your cardiovascular (heart and circulation) fitness.
- Along with a good diet, it will help you get to and stay at a healthy weight.
- It makes your muscles stronger.
- It reduces fatigue and helps you have more energy.
- It can help lower anxiety and depression.
- It can make you feel happier.
- It helps you feel better about yourself.
