What is Breast
Cancer?
Breast cancer is
cancer of the breast tissue, which consists of sections, called lobes, that are arranged
like the petals of a daisy. Each breast has 15 to 20 lobes. Each lobe consists of many
smaller lobules which have dozens of tiny bulbs that can produce milk.
All of these parts of
the breast are connected by thin tubes called ducts. These ducts lead to the nipple in the
center of a dark area of skin called the areola. Fat fills the spaces between lobules and
ducts. The breast tissue does not include muscles, but there are muscles under each
breast, covering the ribs.
Like other organs in the
body, the breasts are made up of many cells. Cells divide in an orderly, controlled way to
produce additional cells when they are needed in the body. When cells divide in an
abnormal, uncontrolled way, they can form either a benign or malignant growth called a
tumor.
Benign growth is not cancerous. Usually, these kinds of tumors can be removed and won't
come back. With benign growth, the cells do not spread to other parts of the body. Benign
breast tumors are not life-threatening.
Malignant growth is
cancerous. The cancer cells can spread to nearby healthy cells and destroy them. The
cancerous cells can also enter the bloodstream or lymph glands. When breast cancer spreads
and forms secondary tumors in other parts of the body the process is called metastasis.
The most common type of
breast cancer is ductal cancer, which occurs in the tiny ducts that connect the lobes and
lobules. Cancer that begins in the lobes or lobules is called lobular carcinoma.
Inflammatory breast cancer is an uncommon type; in this disease, the breast is warm, red
and swollen.
Prevention and Detection of Breast Cancer
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Prevention
and Detection
Early detection is one
of the best defenses against breast cancer. The earlier the disease is detected, the more
treatment options are available. If the disease is detected in its earliest stages, it has
a cure rate of about 90 percent. However, as the tumor grows larger in size and/or spreads
to the lymph nodes, those percentages drop dramatically -- down to the 50 percent range.
Women should begin
performing self-breast exams at age 20, examining themselves monthly and watching for any
change in their breasts. They need to get into the habit of examining themselves at the
same time every month, preferably a few days after their menstrual cycle ends, in order to
recognize what normal breast tissue feels like. Women under 30 rarely develop breast
cancer, but there are a small number who do.
Not every lump is
cancer.
A lump found during a
self-exam, physician exam, or mammogram does not necessarily mean cancer, approximately 80
percent of all breast lumps are benign (free of cancer). However, since cancer is always a
possibility, women should see their doctors immediately when they find lumps themselves.
A woman's first
mammogram, used as a basis against which future tests can be compared, should be performed
by age 40. After age 40, women should obtain a mammogram every year. In addition, a
clinical breast exam by a physician is recommended every three years for women ages 20 to
40, and every year for those over 40 and for all women who are at higher risk.
What is a mammogram?
A mammogram is a special
kind of technique for taking x-rays of the breast. It consists of two x-rays of each
breast, one taken from the side and one from the top. Mammograms can show breast tumors
before they cause symptoms or before they can be felt. Mammograms are done by specialists
who use machines designed just for taking x-rays of the breast. The mammogram is then
"read" by a qualified radiologist.
Mammography
is an excellent tool, but it does not locate every abnormal area in the breast. So another
important step in early detection is for women to have their breasts examined regularly by
a doctor or nurse.
Between visits to the doctor, women should
examine their breasts every month. The best time of the month is 2 or 3 days after your
period ends. At that time of the month, the breasts are least likely to be tender or
swollen. Women who no longer menstruate should pick a certain day, like the last day or
the first day of the month. Here is an easy-to-follow breast self-examination.
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1.
While in the shower, raise your right arm. Use the finger pads of your left hand to
touch every part of your right breast. Feel gently for any lumps or changes under the
skin. Then raise your left arm and use your right hand to examine your left breast.
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2.
Standing before a mirror, place your arms at your sides. Check both breasts for
anything unusual -- discharge, puckering, dimpling or changes in skin texture. Clasp your
hands behind your head and look carefully for any changes in the shape or contour of your
breasts. Gently squeeze both nipples and look for discharge.
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3.
Lie flat on your back, with your left arm over your head and a pillow or towel
under your left shoulder. Put your left hand behind your head. Use your right hand to
begin touching your left breast gently but firmly. |
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4.
Starting at the outer edge of your breast, press the flat part of your fingers in
small circles, gradually spiraling toward the nipple. Be sure to cover the entire breast.
Repeat this exam on your right breast.
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5.
Finally, rest your arm on a firm surface and use the same circular motion to
examine the area between the breast and the underarm itself. All of this is breast tissue
too.
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Symptoms
Anytime a woman (or a
man) notices a lump, a discharge, or any other change -- whether or not it is during a
breast self-examination -- she should contact her doctor.
Early breast cancer
usually is not painful. In fact, breast cancer may cause no symptoms at all when it is
first developing. But as the cancer grows, it can cause these noticeable symptoms:
A lump or thickening
in or near the breast or in the underarm area
A change in the size
or shape of the breast
A discharge from the
nipple
A change in the color
or feel of the skin of the breast or nipple
Diagnosis
An abnormal area shown
on a mammogram, a lump, or other changes in the breast can be caused by cancer or by
other, less serious problems. To determine the cause of any of these signs or symptoms, a
doctor does a physical exam and asks about the medical history of the patient and the
family.
A physician can tell a
lot about a lump by carefully feeling it and the tissue around it. Benign lumps often feel
different from cancerous ones. A mammogram also gives the physician important information
about the lump. If an area on the mammogram looks suspicious or is not clear, additional
views may be needed.
The physican may also
order ultrasonography, a test that uses high-frequency sound waves, which people cannot
hear, to show whether a lump is solid or filled with fluid.
These exams may indicate
to the physician that no further tests are needed and no treatment is necessary. However,
often the physician must remove fluid or tissue from the breast to make a diagnosis. This
is called a biopsy. There are two main types of biopsies.
Aspiration
or needle biopsy, in which the physician uses a needle to remove fluid or a small amount
of tissue from the lump. This procedure may show that the lump is a non-cancerous
fluid-filled cyst. Or it may show that the lump is a solid mass, which may or may not be
cancer.
Surgical
biopsy, in which the physician cuts out part or all of a lump or suspicious area. The
tissue removed during the biopsy is sent to a lab where a pathologist examines it under a
microscope to check for the presence of cancer cells. If cancer is detected, the
pathologist can tell what kind of cancer it is (whether it began in a duct or a lobule)
and whether it is invasive (has invaded nearby tissues in the breast).
Special laboratory tests
of the tissue can be done to help the physician learn more about the characteristics of
the cancer, whether it is likely to grow slowly or quickly, and whether the cancer has
spread. At this point, the doctor may refer the patient to a specialist, and treatment
generally starts within a few weeks after the diagnosis. Specialists in the treatment of
breast cancer include medical oncologists, surgeons, and radiation oncologists. |
Treatment for Breast Cancer
There are many
ways to treat breast cancer, depending on the size and location of the tumor, the results
from the lab tests and the stage of the disease.
To develop a treatment
plan that fits the patient's needs, the doctor may order x-rays of the lungs and special
tests to check the liver, lungs, or bones because breast cancer can spread to these areas.
The doctor will consider the patient's age and general health as well as the patient's
opinions and concerns about the treatment options. The physician is the best person to
answer questions about treatments, how successful each treatment might be, and how much it
is likely to cost.
You might want to
consider making a list of questions before seeing the doctor and taking notes when you
talk to him or her. It may help to have a family member or friend with you -- to take part
in the discussion, to take notes, or just to listen.
The most common
treatment is surgery. Mastectomy is surgery to remove the breast. Surgery
that removes only the cancer and a small amount of surrounding tissue, but not the entire
breast, is called a lumpectomy or breast-sparing surgery.
A partial mastectomy
includes removal of the tumor and some of the normal breast tissue, as well as the lining
between the chest muscles and the tumor.
In a total mastectomy,
the whole breast is removed. When a surgeon does a modified radical mastectomy, the
breast, some of the lymph nodes under the arm, the lining over the chest muscles, and
sometimes the smaller of the two chest muscles are removed.
A type of treatment that
is seldom used now is a radical mastectomy, in which the breast, the chest muscles,
all of the lymph nodes under the arm, and some additional fat and skin are all surgically
removed.
A new technique to avoid
unnecessary axillary dissections in selected breast cancer patients is Sentinel Node
Biopsy. This procedure is used to identify and examine the "sentinel" node, the
first lymph node that receives cancer cells from the primary tumor. If this node is
positive for cancer cells, additional positive nodes may be found upstream, and an
axillary dissection is necessary. But if the sentinel node is negative, the nodes upstream
are likely to be negative as well, and need not be removed.
Surgery is often
followed by radiation therapy in which high-energy rays damage cancer cells and
stop them from growing. Radiation may come from an external source, or it can come from
radioactive materials placed directly in the breast in thin plastic tubes.
After a mastectomy, some
women decide to have breast reconstruction surgery, either at the time of the
masectomy or later on. Others decide to wear a breast prosthesis. This is an
individual choice; what is right for one woman may not be right for another. Patients may
wish to talk to a plastic surgeon before the mastectomy, but reconstructive surgery is
still possible years later.
In chemotherapy,
drugs are used to kill cancer cells. Breast cancer is treated with a combination of drugs
that can be given by mouth or by injection. This type of therapy is given in cycles. A
chemotherapy period is followed by a recovery period, then another chemotherapy cycle.
Most people have
chemotherapy as an outpatient, but this depends on the patient's health and other factors.
With hormone therapy, cancer cells are deprived of the hormones they need to grow.
Drugs can be used to change the way hormones work or surgery may be performed to remove
the ovaries, which make hormones.
Follow-up care is very
important after treatment. When a woman has had cancer in one breast, she has a
higher-than-average risk of cancer developing in the other breast. She should continue to
practice breast self-examination, and she should get regular physical examinations,
including exams of the chest, underarm, and neck, as well as blood and urine lab tests,
mammograms, and chest x-rays. The doctor may order other tests, too.
General Questions
1. Are
there any warning signs of breast cancer?
Answer: The
most common sign is a lump or thickening in the breast. Other signs are a change in the
size or shape of the breast, Discharge from the nipple, or a change in the color or
texture of the skin of the breast or areola (skin around the nipple).
However, often there
aren't any tangible signs of breast cancer until the disease has progressed into its
advanced stages. That is why mammogram, which can detect breast cancer before it can
be seen or felt, is so important.
2. I
found a lump in my breast, what should I do?
Answer: See
your doctor.
3. What
is the procedure if a lump is found?
Answer: In some
cases, the physician my order aspiration biopsy (removal of fluid) of a breast lump. In
other cases a tissue biopsy is recommended. This surgical removal and microscopic
examination of the lump is the only way to determine whether cancer cells are present. If
the biopsy indicates the presence of cancer cells, then you and your physician will confer
about treatment options.
4. What's
a biopsy?
Answer: A
biopsy is the surgical removal of a small piece of tissue for microscopic examination to
determine if cancer cells are present. A biopsy is the most important procedure in
diagnosing cancer.
5. What
are calcifications?
Answer:
Calcifications are small calcium deposits in the breast that are found by mammography.
Microcalcifications are
tiny specks of calcium which may be found in an area of rapidly dividing cells. Whey many
of these are seen in one area, they are referred to as a cluster and may indicate a small
cancer. About half of the cancers detected by mammography appears as a cluster of
microcalcifications, the other half appear as lumps.
Macrocalcifications are
coarse calcium deposits, that are found in about half of all women over age 50 and are
associated with benign conditions. They are often seen in both breasts and are most likely
due to aging or old injuries.
6. What
are my risks for breast cancer?
Answer: Simply
getting older and being a woman puts one at risk. The risk is also increased if a woman
has a history of breast cancer in her family; has never had children; had her first child
after age 30; began menstruating before age 12; or completed menopause after age 55.
7. When
should I start having mammograms done?
Answer: Begin
having annual mammograms at age 40. Women with a family history of breast cancer or other
personal risk factors may need to start earlier, and should consult their physician.
8. Will
the mammogram hurt?
Answer: The
pressure caused by flattening the breast may be slightly uncomfortable, but it should not
be painful. If it is, however, women should tell the technologist taking the x-rays and he
or she will ease the pressure.
9. Is
there any risk in getting a mammogram?
Answer: The
radiation exposure from modern low-dose mammography equipment is minimal and the medical
benefit to the patient far outweighs any potential risk.
10. What
are the treatments options for breast cancer?
Answer: There
are four standard ways to treat breast cancer: surgery, radiation therapy, hormonal
therapy, and chemotherapy. Several treatments may be combined, and specific treatment
recommendations depend on the type and location of the tumor, the stage at which it has
been detected, and the patient's age and general health.
Clinical Trials are the
state-of-the-art new treatments available to patients. They also my consist of a
combination of treatment modalities. Speak with your physician regarding the best
treatment option for you.
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