“All you need to know about Breast Cancer”

— Get Well in India

Introduction

This surgery aims to remove the tumor from the breast or lymph nodes in the underarm area (axillary nodes), if cancer cells are detected in that area. Surgery is considered to be the first and most common form of treatment for breast cancer. It involves removing the tumor and surrounding tissues from the nearby areas that might be cancerous.

Whether you want to undergo a surgery or not depends on many factors. Your oncologist will determine the kind of surgery that’s most appropriate for you based on the stage of the cancer.

Head doctors

Dr. Boman Dabur

Dr. Boman Dabur

Oncology Specialist
Dr. Anil Heroor

Dr. Anil Heroor

Oncology Specialist
  • Anatomy

    The breast is most complex part of the human body as it goes through a lot of changes from birth, to puberty, to pregnancy, to breastfeeding till menopause. The changes are mostly related to hormones produced in the breast at different stages in a woman’s life.

    Breast tissue extends from the collarbone, to lower ribs, sternum (breastbone) and armpit. Each breast contains 15-20 glands called lobes, where milk is produced in women for breastfeeding. These lobes are connected to the nipple by 6-8 tubes called ducts which carry milk to the nipple. The breast and armpit also contain lymph nodes and vessels carrying lymph fluid and white blood cells, which are part of the immune system. Much of the rest of the breast is fatty tissue.

    Boys and girls begin life with similar breast tissue. However, at puberty, high testosterone and low estrogen levels stop breast development in men.

  • Signs & Symptoms

    A lump in the breast is typically associated with breast cancer, most of the time such lumps are benign i.e. non-cancerous.

    Common causes of benign breast lumps include:

    • Breast infection
    • Fibrocystic breast disease
    • Fibroadenoma (non-cancerous tumor)
    • Fat necrosis (damaged tissue)

    In fat necrosis, the mass can be differentiated from a cancerous lump only with a biopsy.

    Even though the majority of breast lumps are caused by less severe conditions, new, painless lumps are still the most common symptom of breast cancer.

    Early signs of breast cancer include:

    • Changes in the shape of the nipple
    • Breast pain that doesn’t go away after your next period
    • New lump that doesn’t go away after your next period
    • Nipple discharge from one breast that is clear, red, brown, or yellow
    • Redness, swelling, skin irritation, itchiness, or rash on the breast
    • Swelling or a lump around the collarbone or under the arm

    A lump that is hard with irregular edges is more likely to be cancerous.

    Later signs of breast cancer include:

    • Retraction, or inward turning of the nipple
    • Enlargement of one breast
    • Dimpling of the breast surface
    • Existing lump that gets bigger
    • Orange peel texture to the skin
    • Vaginal pain
    • Unintentional weight loss
    • Enlarged lymph nodes in the armpit
    • Visible veins on the breast

    Having one or more of these symptoms doesn’t necessarily mean you have breast cancer. Nipple discharge can also be caused by an infection. Your doctor will do a complete evaluation after looking at your signs and symptoms and will suggest some diagnostic tests for verification.

  • Diagnosis

    When you visit your doctor with concerns about breast pain, tenderness, or a lump, there are common tests they might perform like:

    • Mammography
    • Ultrasound
    • Biopsy (FNAC)
    • Lymph node biopsy
    • Liver ultrasound
    • Blood chemistry test
    • Bone scan
    • Chest x-ray
    • Complete blood count
    • Magnetic resonance imaging

Stages & Treatment Details

Staging: It is a way of describing the location of the cancer, its growth and its spread. Diagnostic tests are used to find out the cancer’s stage, so staging may not be complete until all the tests are finished. Knowing the stage, helps the doctor to decide what kind of treatment is best and can help determine a patient’s prognosis. There are different stage descriptions for different types of cancer.

TNM staging system: The most commonly used tool that doctors use to describe the stage. Doctors use the results from diagnostic tests and scans to answer these questions:

    • Tumor (T): How large is the primary tumor? Where is it located?
    • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?
    • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person.

There are two types of TNM staging for breast cancer. First, the clinical stage is based on the results of tests done before surgery, which may include physical examination, mammogram, ultrasound, and MRI scans. Then, the pathologic stage is assigned based on the pathology results from the breast tissue and any lymph nodes removed during surgery. It is usually determined several days after surgery. In general, more importance is placed on the pathologic stage than the clinical stage.

Metastasis (M): It describes whether the cancer has spread to a different part of the body.

M0 means that there is no sign that the cancer has spread.

cMo(i+) means there is no sign of the cancer on physical examination, scans or x-rays. But cancer cells are present in blood, bone marrow, or lymph nodes far away from the breast cancer, the cells are found by laboratory tests

M1 means the cancer has spread to another part of the body.

Treatment: Surgery is the first and the most common treatment.

  • Breast  conserving therapy and radiation therapy:  This is also called a lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy. This is a surgical procedure in which the part of the breast and surrounding tissues containing the cancer are removed. How much of the breast is removed depends on the size and location of the tumor and other factors.

Radiotherapy uses controlled doses of radiation to kill cancer cells. It is generally given after surgery and chemotherapy to kill any remaining cancer cells. If you need radiotherapy, your treatment will begin about a month after your surgery or chemotherapy to give your body a chance to recover.

  • Modified  radical mastectomy: A modified radical mastectomy is a surgical procedure in which the entire breast is removed, including the skin, areola, nipple, and most axillary lymph nodes. The pectoralis major muscle is spared. Earlier, modified radical mastectomy was the primary method of treatment of breast cancer. As the treatment of breast cancer evolved, breast conservation has become more widely used. However, mastectomy still remains a viable option for women with breast cancer.
  • Axillary lymph node dissection: There are three levels of axillary lymph nodes.

Level I is the bottom level, below the lower edge of the pectoralis minor muscle. Level II is lying underneath the pectoralis minor muscle. Level III is above the pectoralis minor muscle.

A traditional axillary lymph node dissection usually removes nodes in levels I and II. For women with invasive breast cancer, this procedure accompanies a mastectomy. It may be done at the same time as, or after, a lumpectomy (through a separate incision).

  • Chemotherapy: It involves using cytotoxic drugs to kill the cancer cells. Chemotherapy is usually used after surgery to destroy any cancer cells that have not been removed. This is called adjuvant chemotherapy. In some cases, you may have chemotherapy before surgery, which is generally used to shrink a large tumor. This is called neoadjuvant chemotherapy.
  • Sentinel lymph node dissection: Sentinel lymph node dissection is an alternative to traditional axillary lymph node dissection and has less side-effects. However, the sentinel node procedure is not appropriate for everyone. Research shows that even after the sentinel node procedure, more surgery may be necessary thus having its own limitations.
  • Hormonal therapy: It may help curb the growth, spread or recurrence of some type of cancer. It helps shrink or slow the growth of tumor in advanced-stage. It reaches for cancer cells almost anywhere in the body and not just in the breast. It’s recommended for women with hormone receptor-positive (ER-positive and/or PR-positive) breast cancers, and it does not help women whose tumors are hormone receptor-negative (both ER- and PR-negative).
  • Biological therapy: It uses the body immune system to curb the cancer. It involves using substances derived from living organisms, or laboratory-produced versions of such substances to treat cancer. Some biological therapies for cancer use vaccines or bacteria to stimulate the body’s immune system to act against cancer cells.
  • Bisphosphonates: These are the drugs that slow down or prevent bone damage. This treatment is done when cancer has spread to the bone from another part of the body
  • Doctor visits: Initially, your follow-up doctor visits will be scheduled in every few months. The longer you have been free of cancer, the less often you need to visit the doctor. After 5 years, they are typically done about once a year.
  • Mammograms: If you had breast-conserving surgery, you will get a mammogram about 6-12 months after surgery and radiation are completed, and then at least every year after that.
  • Pelvic exams: If your medications involves hormone drugs, you should have pelvic exams every year because these drugs can increase your risk of uterine cancer.
  • Bone density tests: If you are taking an aromatase inhibitor for early stage breast cancer, or if you go through menopause as a result of treatment, these tests are important to monitor your bone health.
  • Other tests: Other tests such as blood tests and imaging tests (like bone scans and chest x-rays) will be needed if you have symptoms or findings that suggest that the cancer might have come back.

It’s important to know that women who have had breast cancer are at higher risk for certain other cancers.

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