CONDITIONS
Breast Cancer
What is Cancer?
Cancer is a broad term. It is a disease that results in changes in normal human cells which cause the uncontrolled growth and division of cells. Some types of cancer cause rapid cell growth, while others cause cells to grow and divide slowly. Certain forms of cancer show visible growths called tumours, while others, such as leukemia (blood cancer), do not show growth that is visible. In a normal healthy human being, a cell receives instructions to die so that the body can replace it with a newer cell that functions better. Cancerous cells do not respond to signals instructing them to stop dividing and die. Hence these cancerous cells build up in the body. They use oxygen and other nutrients that would usually nourish normal cells. Cancerous cells can form tumours, impair the immune system and make changes that prevent the body’s normal functioning. Tumours can be benign (noncancerous) or malignant (cancerous). Benign tumours tend to grow slowly and do not spread. Malignant tumours can multiply rapidly, invade and destroy nearby normal tissues, and spread throughout the body.
Cancer is a genetic disease caused by gene changes that control how body cells function, especially how they grow and divide. There are many types of cancer. Types of cancers are usually named by the organs or tissues where the cancers form. For example, breast cancer begins in the breast, lung cancer in the lung, and liver cancer in the liver. The important lifestyle factors that significantly impact the incidence and deaths due to cancer include tobacco, alcohol, diet, obesity, infectious agents, environmental pollutants and radiation. Oncology is the study of cancer and tumours. The term “cancer” is used when a tumour is malignant; a tumour is likely to cause death if not controlled.
Every year in India, over 20,000 new cases of childhood blood cancer are diagnosed – of which nearly 15,000 are cases of leukemia.
The white blood cells in our body play a crucial role in fighting infections, and they grow and divide as needed. However, individuals with leukemia experience an overproduction of abnormal WBC from the bone marrow that do not perform their intended functions. Unlike most other cancers, leukemia generally does not form a visible tumor that imaging tests like X-rays or CT scans can detect.
What is breast cancer?
Breast cancer is a disease that affects the cells within the breast tissue. It is the most common cancer among women in India. It occurs when some breast cells begin to grow abnormally. These cells divide and grow more rapidly than healthy cells and continue to accumulate, forming a lump or mass. These cells may spread to the lymph nodes or other body parts. Breast cancer mostly begins within cells in the milk-producing ducts, in the glandular tissue called lobules or in other cells or tissue within the breast.
Breast cancer most frequently extends to surrounding lymph nodes. In such cases, breast cancer is still considered a local or regional disease. It can also spread further in the body through the blood vessels and lymph nodes to the bones, lungs, liver, brain, and other organs. The process of spreading cancer to distant organs is termed metastatic or stage IV breast cancer and it is the most advanced stage of the disease.
Most breast cancer incidence is in women; however, it may also affect men.
Ductal carcinoma is the most common type of breast cancer.
- Ductal carcinoma in situ (DCIS). It is non-invasive cancer (stage 0), located only in the duct and has not spread outside.
- Invasive or infiltrating ductal carcinoma. This is cancer that has spread outside of the ducts or lobules.
- Invasive lobular carcinoma (ILC) is the second most common type of breast cancer after invasive ductal carcinoma. In this, the cancer cells have broken out of the lobule where they began and can potentially spread to the lymph nodes and other body areas. Approximately 10% of breast cancer cases are ILC.
- Lobular carcinoma in situ is a precancerous condition where abnormal cells are developed inside some of the breast lobules. Women need regular breast examinations and mammograms to monitor their condition.
- Inflammatory breast cancer: A rare and aggressive form of breast cancer that causes the breast to appear swollen and red with pitting and dimpling of the breast skin.
- Triple-negative breast cancer: A type of breast cancer that does not have receptors for estrogen, progesterone, or HER2 protein. Approximately 15% of invasive breast cancers are triple negative and are challenging to treat.
- HER2-positive breast cancer: A type of breast cancer that tests positive for the HER2 protein, which promotes the growth of cancer cells.
What are the risk factors for breast cancer?
Women have a substantially higher risk compared to men
- Advanced age: Age above 55 years
- Family history
- Gene mutations or hereditary conditions
- Delayed pregnancy (after the age of 30 years), or no pregnancy
- No breastfeeding
- Early menstruation (before the age of 11 and 12) and late menopause (after the age of 55 years)
- Use of hormonal contraceptives
- Obesity and lack of physical exercise
- Hormone replacement therapy
Risk for Recurrence
Even after initial treatment for early breast cancer, it is possible that breast cancer can come back (recur). When cancer returns after a period of remission, it is considered a recurrence, either at the same original site or somewhere else in the body.
What are the symptoms of breast cancer?
Many women with breast cancer do not exhibit any physical changes (signs and symptoms) at their initial diagnosis. However, the following signs and symptoms may appear in advanced stages and vary widely.
- Solid non-painful lump or node in the breast or the armpit region.
- Breast tenderness and swelling.
- Fluid leaking from the nipple.
- Change in the breast size, shape, or appearance of wrinkles in the breast skin.
- An inverted nipple.
- Itching, crusting, or scaling of the skin surrounding the breast.
- In most cases, the patient does not feel any pain.
Breast lumps do not necessarily mean that cancer is present; some lumps form due to cysts or infections in and around the breast region.
Men with breast cancer commonly experience the following symptoms:
- Breast lump or swelling
- Flaky or red skin on the breast
- Dimpling or irritation of the breast skin
- Nipple discharge
- Nipple pain or inversion
How is breast cancer diagnosed?
- Breast self-examination: Women above 40 years of age should do breast self-examination routinely every month after their menstrual cycle and look for any lumps or discharge.
- Breast examination by a clinician: A breast examination conducted by a trained healthcare provider and super-specialists in the hospital or clinic. If there is a family history of breast cancer, the healthcare provider will immediately recommend a mammogram.
- Mammography: Mammography is an X-ray imaging method used to examine the breast. It is the most accurate way of early detection of breast cancer, even if the size is small. This early detection could lead to early treatment and faster recovery.
- Biopsy – A biopsy is the removal of a tiny sample of tissue for microscopic examination. The tests mentioned above can indicate that cancer is present, but only a biopsy can provide a conclusive diagnosis of cancer.
What are the treatment options?
Treatment options depend on the diagnosis (type of tumour, stage, size) and the health status of the patient:
- Surgery: The first choice is typically surgery.
- A lumpectomy is a procedure where only the tumour and part of the breast tissue around it are removed. Usually, radiotherapy is offered after this operation.
- Mastectomy is the removal of a diseased breast.
- Sentinel lymph node biopsy determines whether cancer has progressed to the lymph nodes beneath the arm.
- Chemotherapy: It is frequently a combination of a number of different medications designed to stop cancer cells from growing. It can be used both before and after surgery, as well as in conjunction with other forms of treatment.
- Radiation therapy: Radiation uses high-energy beams to kill cancer cells. Radiation can also be used to shrink tumours and relieve pain.
- Hormone therapy: Certain hormone treatments for breast cancer function by preventing hormones from adhering to receptors on cancer cells. Some work by decreasing the body’s production of hormones which can help prevent recurrence and death.
- Targeted Drug Therapy: Special medications target gene mutations (changes in a gene’s DNA sequence) to slow down or destroy cancer cells.
The course of treatment for males with breast cancer relies on the size and extent of the tumour, just like it does for women. Surgery, chemotherapy, radiation therapy, hormone therapy, and targeted therapy are all possible forms of treatment.
Individuals diagnosed with early-stage breast cancer often can manage their condition effectively with treatment. Many people with a breast cancer diagnosis can live long, fulfilling lives. Late-stage breast cancer is more challenging to treat and can be life-threatening.
When to see a healthcare provider?
- If you notice a persistent and solid breast lump
- If the breast lump does not disappear in 6 weeks
- If you see a discharge from the nipple (usually blood)
- If a nipple gets inverted
- Upon noticing a change in the size of the lymph nodes in the armpit (lump in the armpit)
What are the ways to reduce the risk of breast cancer?
- Breast self-examination – All women should become familiar with the look and feel of their breasts and notify any changes promptly to their healthcare provider. If a lump or other symptoms develop, women should contact a healthcare provider immediately, even after a recent normal mammogram.
- Clinical breast examination: Women between the ages of 25 and 39 should get a clinical breast exam every one to three years, while those above 40 should have one every year.
- Get routine mammograms: The American Cancer Society advises starting screening mammograms at age 35 and every year after age 40.
- Maintaining a healthy lifestyle includes nutritious food, physical activity, and a healthy weight.
- Limit post-menopausal hormone therapy: Some women experience bothersome signs and symptoms during the post-menopausal period and may need hormonal treatment to relieve their symptoms. Minimizing the duration and dosage of hormone therapy is recommended to lower the risk of breast cancer.
