Breast Cancer Treatment

Q 1 What is breast cancer? 

Breast cancer is cancer that develops in breast cells. Typically, the cancer forms in either the lobules or the ducts of the breast.  Breast cancer can occur in women and rarely in men. 

Q 2 What causes breast cancer? 

  • Age: 80% of the cases of breast cancer occur in women over 50 years of age. 
  • Beginning to menstruate at an early age.
  • Late menopause 
  • In post-menopausal women: obesity and physical inactivity.
  • No full-term pregnancies or having a full-term first pregnancy after age 30.
  • Alcohol use
  • Previous breast disorders with biopsies showing abnormal cell
  • A family history of breast cancer, especially in a mother, sister, or daughter diagnosed before menopause, or if a mutation on the BRCA1 or BRCA2 genes is present.

Prevention: 

Screening for breast cancer

Screening is done in a normal person and is used to look for cancer before you have any symptoms or signs

  • Average-risk women (less than 15 percent lifetime risk) Start screening from age 50 till 74 with mammography done typically every two years.
  • For high-risk women (greater than 20 percent lifetime risk)
  • Start screening beginning at age 25, or earlier depending on the earliest age of breast cancer in the family with MRI and mammography 

Q 3 What are the types of breast cancer?

Invasive breast cancer

cells have penetrated the epithelial lining (basement membrane) of the ducts.

  • Invasive ductal breast cancers begin in one of the ducts of the breast 
  • Invasive lobular breast cancers begin in one of the lobes (milk-producing glands ) of the breast

Carcinoma in situ 

Cancer cells in carcinoma of in situ have not yet penetrated the epithelial lining (basement membrane) of the ducts. It is an early form of breast cancer.

  • Ductal carcinoma in situ (DCIS) begin in one of the ducts of the breast
  • Lobular carcinoma in situ (LCIS)  begins in one of the lobes (milk-producing glands ) of the breast

Q 4 What are the symptoms of breast cancer

  • Breast mass: The usual first sign is a painless lump/mass in the breast
  • Changes in the size or shape of a breast.
  • Dimpling or thickening of some of the skin on a part of a breast.
  • The nipple turning in (becoming inverted).
  • Rarely, a discharge occurring from a nipple (which may be bloodstained)
  • A swelling or lump in an armpit
  • Advanced disease may present with symptoms such as back or leg pain, abdominal pain, nausea, jaundice, and shortness of breath or cough

A word of caution 

Most breast lumps are not cancerous (malignant). Most breast lumps are fluid-filled cysts or fibroadenomas which are non-cancerous (benign). However, you should always see a doctor if a lump/mass develops in the breast. 

Q 5 How is breast cancer diagnosed? 

  • X-ray Mammography with sonography:  Mammography is an x-ray of the breast used to find out any mass and its location within the breast 
  • Core biopsy: Once a mass in the breast or lymph node in the axilla (armpit) is identified then core biopsy is done. Core biopsy is a procedure where a needle is passed through the skin to take a sample of tissue from a mass.

A word of caution 

  • There is a common myth that taking biopsy leads to the spread of cancer cells in body. This is not true. Taking a biopsy does not lead to the spread of cancer cells in the body.
  • Biopsy confirms that it is cancer and not infection and also helps in knowing the type of cancer so that further treatment can be planned accordingly.

Further testing

If the results of the biopsy confirmed breast cancer, then the doctor may advise having additional tests to assess how widespread the cancer is. These tests may include:

  • Blood tests – To assess the state of liver, kidneys and bone marrow
  • CT/MRI scan – To find out the local spread of disease 
  • Chest X-ray – To check if cancer has spread to the lungs or not 
  • Bone scan – To check if cancer has spread to bone or not
  • Sometimes a PET scan – To know the distant spread of disease 

Q 6 What is breast cancer staging?

Staging is a measurement of how far cancer has spread.

After all the tests have been completed and the results are known, it should be possible to predict what stage the cancer is. The higher the stage, further cancer has spread

  • Stage 0: Non-invasive breast cancer, e.g. DCIS.
  • Stage 1: The cancer is found only in your breast.
  • Stage 2: The cancer is found in your breast and nearby lymph nodes.
  • Stage 3: Cancer has spread to more lymph nodes and involved chest wall or the skin around your breast
  • Stage 4: Cancer has spread to other organs in your body. This is called metastatic breast cancer. The most common sites are bones, lungs, liver, and brain

A word of caution 

The above staging is a simplified version for your basic understanding. The reader is advised to follow the TNM staging system developed by the American Joint Committee on Cancer (AJCC) in which 

  • T stands for the size and location of the primary tumor
  • N stands for nodes. It tells whether cancer has spread to the nearby lymph nodes
  • M stands for metastasis. It tells whether cancer has spread to distant parts of the body

Q 7 How is breast cancer treated? 

When deciding treatment options for a particular patient, the doctor will consider the following factors and will decide the individual treatment plan:

  • The size of the cancer
  • The stage of the cancer
  • The location of the cancer
  • Your overall health and ability to recover from surgery, radiation therapy or chemotherapy
  • How a treatment will affect your breast appearance  
  • Your personal preferences

Following are the general guidelines but treatment may vary from patient to patient:  

Three main categories for treatment purpose are: 

Early-stage breast cancer undergoes primary surgery (lumpectomy or mastectomy) to the breast and regional nodes followed by radiation therapy (RT) and chemotherapy depending upon the final pathology report after the operation. Hormonal therapy depending on the hormonal status of cancer (ER/PR/Her 2)

Locally advanced breast cancer undergo chemotherapy first followed by surgery followed by radiation therapy and chemotherapy. Hormonal therapy depending on the hormonal status of cancer (ER/PR/Her 2)

Advanced disease (metastatic disease) Options include chemotherapy/hormonal therapy/Targeted therapy. The choice of treatment depends upon the organ involved and the biological characteristics of cancer. 

Surgery

Patient with discussion with the surgeon can choose between 2 types of surgery 

  • Mastectomy is the surgery to remove the whole breast. 
  • Lumpectomy (Breast-conserving surgery) is the surgery to remove cancer and a section of healthy tissue around it. People who choose this option keep their breasts. 

Whether you opt for mastectomy or lumpectomy, survival is the same.