Wed. Aug 3rd, 2022
    Breast cancer

    Breast Cancer

    Breast cancer starts in the cells of the breast. Cancerous (malignant) tumor is a group of cancerous cells that can invade and destroy nearby tissue. It can also spread (metastasize) to other parts of the body.

    Breast cells sometimes undergo changes that make the way they grow or behave abnormally. These changes can lead to non-cancerous (benign) breast conditions, such as atypical hyperplasia and cysts. They can also lead to the formation of non-cancerous tumors, including intracanal papillomas.

    In some cases, however, changes in breast cells can cause breast cancer. Breast cancer most often starts in the cells lining the ducts, which are tubes that carry milk from the glands to the nipple. This type of breast cancer is called ductal carcinoma. Cancer can also form in the cells of the lobules, which are the groups of milk-producing glands. This type of cancer is called lobular carcinoma. Ductal carcinoma and lobular carcinoma can be in situ, that is, the cancer remains in its original location and has not invaded surrounding tissue. They can also be infiltrating, or invasive, meaning they have invaded nearby tissue.

    Less common types of breast cancer can also occur. Examples are inflammatory breast cancer, Paget’s disease of the breast, and triple negative breast cancer. Rare types of breast cancer include non-Hodgkin lymphoma and soft tissue sarcoma, among others.

    Breast cancer screening

    Screening is checking to see if the disease is present in a group of people who do not have symptoms of the disease. Screening tests can find this cancer before any symptoms appear. When this cancer is found and treated at an early stage, the chances of successful treatment are better. Follow the guidelines for this cancer screening even when you are feeling good and healthy.

    A mammogram is a low dose x-ray of the breast. It is the most reliable method for detecting early breast cancer in women.

    Women should be aware of the advantages and limitations of screening mammography based on their age and risk factors so that they can decide if it is right for them. Talking with your doctor helps you make a decision.

    If you are between 40 and 49 years old, talk to your doctor about your risk of breast cancer and the benefits and limitations of mammography.

    If you are between 50 and 74 years old, have a mammogram every 2 years.

    If you are 75 or older, ask your doctor if you need to have a mammogram.

    Symptoms of breast cancer

    Breast cancer may not cause any signs or symptoms in the very early stages of the disease. Symptoms appear when the tumor in the breast is large enough that you can feel the lump or when the cancer has spread to nearby tissues and organs. Other medical conditions can cause the same symptoms as breast cancer.

    The most common symptom of ductal carcinoma is a firm or hard lump that is very different from the rest of the breast tissue. It may appear to be attached to the skin or to nearby breast tissue. The lump does not shrink or go away and does not reappear during the menstrual cycle. It can be tender but is usually not painful. (Pain is more often a symptom of a non-cancerous condition.)

    Often, lobular carcinoma does not form a lump. Breast tissue is more like thickening or hardening.

    Other symptoms of ductal or lobular breast cancer can be the following:

    • mass in the armpit (axillary hollow)
    • change in the size or shape of the breast
    • nipple changes, such as a nipple that suddenly starts to point inward (inverted nipple)
    • discharge from the nipple without squeezing it or which is tinged with blood

    Late signs and symptoms are when the cancerous mass grows or spreads to other parts of the body, including other organs:

    • bone pain
    • weightloss
    • nausea
    • loss of appetite
    • jaundice
    • shortness of breath
    • cough
    • headache
    • double vision
    • muscular weakness

    Metastatic breast cancer symptoms

    In addition to the “classic” symptoms of breast cancer (a palpable “lump” in the breast, which is sometimes accompanied by abnormal discharge and / or pain), metastatic breast cancer can cause specific symptoms:

    • In the event of brain metastases, we can observe headaches, loss of balance or dizziness, confusion, memory loss, visual disturbances, speech difficulties…
    • In the event of bone metastases, pain may be observed in the bones, joints and / or back.
    • In the event of pulmonary metastases, it may be a question of chest pain, difficulty in breathing, a dry cough that does not go away or pain in your rib cage…
    • In case of liver metastases, there may be yellowing of the skin and whites of the eyes (jaundice), nausea, vomiting, itching or rash, extreme fatigue…

    Diagnoses

    Diagnosis is a process of identifying the cause of a health problem. It is usually begins when you find a lump in one of your breasts or when a screening mammogram suggests a breast disorder. Your doctor will ask you about your symptoms and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for breast cancer or other health problems.

    The diagnostic process can seem long and overwhelming. It’s okay to worry, but try to remember that other medical conditions can cause breast cancer-like symptoms. It is important that the healthcare team rule out any other possible cause of the health problem before making a diagnosis of this cancer.

    The following tests are usually used to rule out or diagnose this cancer. Many tests that can diagnose cancer are also used to determine its stage, that is, how far the disease has progressed. Your doctor may also give you other tests to check your general health and help plan your treatment.

    Health history and physical examination

    Your health history consists of a checkup of your symptoms, risk factors, and any medical events and conditions you may have had in the past. Your doctor will ask you questions about your personal history:

    • symptoms that suggest breast cancer
    • breast disease or breast cancer
    • hormone replacement therapy (HRT)
    • radiotherapy to the chest
    • other cancers that increase the risk of breast cancer, including ovarian cancer and colorectal cancer

    Your doctor may also ask you questions about your family history:

    • breast cancer
    • risk factors for breast cancer
    • other cancers that increase the risk of breast cancer, including ovarian cancer and colorectal cancer

    The physical exam allows your doctor to look for any signs of breast cancer. During the physical exam, your doctor may:

    • have a clinical exam of your breasts, which includes the breasts and armpits, looking for lumps, thickening or
    • hardening, and changes in the skin or nipples;
    • feel your abdomen to see if your liver is larger than normal (swollen);
    • listen to your lungs.
    Diagnostic mammogram

    A diagnostic mammogram is an x-ray that uses low-dose radiation to produce images of the breast. It is used to monitor abnormal results seen during a screening mammogram or clinical breast exam. A mammogram can also find an abnormal area during a biopsy.

    Ultrasound

    In an ultrasound, high-frequency sound waves are used to produce images of parts of the body. It can tell if a lump in the breast is a solid tumor or a cyst. Doctors can also use the ultrasound to guide the biopsy needle to the area to be analyzed.

    A woman with advanced breast cancer may have an ultrasound to see if the cancer has spread to the liver (liver metastases).

    Biopsy

    A biopsy is the only way to diagnose breast cancer with certainty. During a biopsy, the doctor removes tissue or cells from the body for analysis in the laboratory. The pathologist’s report confirms whether or not there are cancer cells in the sample.

    The type of biopsy will be chosen according to the mass, namely whether it is palpable, which means that it can be felt by touch, or not palpable, that is to say that it cannot be felt. touch. The doctor may use a mammogram or ultrasound to help find the area to be scanned. Most biopsies are done in the hospital, and you can go home after it’s done.

    In a fine needle biopsy, a very fine needle and syringe are used to remove a small amount of tissue from the lump. Doctors use it to find out if the lump is a cyst or a solid tumor. This cannot be used to determine whether the cancer is non-invasive or invasive. Find out more about a fine needle biopsy.

    Read also: Tubular Breast (Tuberous Breasts) Malformation of Breasts

    In a core biopsy, a special hollow needle is used to remove tissue from the body. Doctors use it to take a sample from a suspicious area of ​​the breast. They may take several samples from the area during the procedure. Doctors may use a special suction device to remove more tissue with the hollow needle. This technique is called aspiration biopsy. Find out more about a core biopsy.

    In a core biopsy under stereotaxic guidance, three-dimensional, or stereotaxic, images are used to find the exact location of the tumor or suspect area in the breast. The doctor uses these images to guide the needle during the biopsy. Stereotaxic guided biopsy is used to remove a mass that can be seen on imaging pictures but cannot be felt by touch. Find out more about stereotaxic guided drilling biopsy.

    In a needle biopsy, a mammogram is used to insert a thin wire into a suspicious area of ​​the breast that cannot be felt by touch. The wire is left in place as it guides the surgeon to the suspect area during a surgical biopsy. Find out more about the needle biopsy.

    During the surgical or open biopsy, part or all of the suspicious mass or region is removed. The excisional biopsy removes the entire area with a margin of healthy tissue around it. The incisional biopsy removes only part of the area. Find out more about surgical biopsy.

    In a punch biopsy, a hollow, sharp instrument is used to remove an area of ​​skin and the underlying tissue. It is used to diagnose inflammatory breast cancer, where cancer cells are found in the lymphatics of the skin. Find out more about the punch biopsy.

    Lymph node biopsy

    A lymph node biopsy is a surgical procedure in which lymph nodes are removed for microscopic examination to see if they have cancer.

    This cancer cells can break away from the tumor and travel through the lymphatic system. They can first spread to the lymph nodes in the armpit (axillary nodes). The doctor uses the number of lymph nodes affected by the cancer to help determine the stage of breast cancer.

    A sentinel node biopsy can identify and remove the sentinel node to see if it contains cancer cells. The sentinel node is the first lymph node in a chain or group of lymph nodes that receives lymph from the area around the tumor. The doctor will remove other lymph nodes only if the sentinel node has cancer. This test is offered if the tumor in the breast is less than 5 cm and the axillary nodes cannot be felt by touch on physical examination. Find out more about the sentinel node biopsy.

    Analysis of hormone receptor status

    Estrogen and progesterone are hormones that can stimulate the growth of breast cancer cells. Testing the status of hormone receptors can tell if estrogen receptors (ER) and progesterone receptors (PR) are present in breast cancer cells. This information will help your healthcare team determine which treatments will work best for you.

    HER2 status analysis
    ErbB2 is better known as HER2, or HER2 / neu. HER2 stands for human epidermal growth factor receptor 2. This is a gene that has undergone a change (mutation) and can therefore promote the growth of a tumor, called an oncogene.

    Testing for HER2 status is used to find out if breast cancer cells are producing more HER2 protein than normal (overexpression). This information will help your healthcare team determine which treatments will work best for you.

    Complete blood count

    The complete blood count (CBC) is used to assess the quantity and quality of white blood cells, red blood cells and platelets. The CBC is used to check your general health. Your healthcare team also uses the CBC to obtain baseline values ​​against which to compare the results of future FSCs performed during and after treatment.

    Blood biochemical analyzes

    A blood chemistry test measures the level of chemicals in the blood. It makes it possible to evaluate the quality of functioning of certain organs and also to detect anomalies. Blood chemistry tests used to establish the stage of breast cancer include the following.

    Blood urea nitrogen and creatinine levels can be measured to see how well the kidneys are functioning. The healthcare team assesses kidney function before giving chemotherapy and may also assess it during or after treatment.

    Both alanine aminotransferase (ALT) and aspartate transaminase (AST) can be measured to see how the liver is functioning. If the level of these enzymes is higher than normal, it could mean that the cancer has spread to the liver.

    The level of alkaline phosphatase can be measured to know the function of the liver or to know if cancer is present in the bones. If the level of this enzyme is higher than normal, it could mean that the cancer has spread to the liver or bones.

    Determination of tumor markers

    Tumor markers are substances found in the blood, tissues and fluids taken from the body.

    The healthcare team measures tumor markers in women with advanced or metastatic breast cancer at initial diagnosis. The level of the following tumor markers is used to check response to treatment:

    • tumor antigen 15-3 (CA 15-3)
    • carcinoembryonic antigen (CEA)
    X-ray

    In an x-ray, low-dose radiation is used to produce images of the body’s structures on film. It is used to find out if breast cancer has spread to the lungs.

    Bone scan

    In a bone scan, radioactive materials that attach to the bones (radiopharmaceuticals) and a computer are used to create an image of the bones. A bone scan can tell if the breast cancer has spread to the bones (bone metastases).

    A bone scan is used if the woman experiences bone pain or if the level of alkaline phosphatase is higher than normal. The doctor may also order a bone scan if the tumor in the breast is larger than 5 cm or if he can feel the lymph nodes in the armpit (axillary nodes) when touched. A bone scan is not done in women with stage I breast cancer.

    Magnetic resonance imaging

    Magnetic resonance imaging (MRI) uses powerful magnetic forces and radio waves to produce cross-sectional images of the body’s organs, tissues, bones, and blood vessels. A computer assembles the images into 3-dimensional snapshots.

    MRI is not routinely used to diagnose this cancer. The doctor may use it to better examine an abnormality seen on the mammogram if the doctor cannot identify it with other tests or if the results of other tests are not clear.

    Scintimammography or PET Scan

    In scintimammography, a radioactive substance called a radioisotope and a special camera are used to produce images of the breast. Scintimammography may be used to look for abnormalities in the breast after a mammogram, especially if there is scar tissue or dense tissue.

    Galactography

    Galactography is a special x-ray that looks at the breast ducts. It is sometimes used to find out what is causing a nipple discharge. It is also used to help diagnose intraductal papilloma, which is a non-cancerous tumor that can cause nipple discharge.

    Chances of Surviving (prognosis and survival)

    If you have breast cancer, you may be wondering about your prognosis. A prognosis is the act by which the doctor best assesses how cancer will affect a person and how they will respond to treatment. The prognosis and survival depend on many factors. Only a doctor who is familiar with your health history, the type of cancer you have, the stage and characteristics of the disease, the treatments chosen and the response to treatment can review all of this data together with the survival statistics for. come to a prognosis.

    A prognostic factor is an aspect of cancer or a characteristic of the person that the doctor takes into account when making a prognosis. A predictor factor influences how cancer responds to a certain treatment. Prognostic and predictor factors are often discussed together and both play a role in the choice of treatment plan and in establishing the prognosis.

    Doctors use different prognostic and predictive factors for newly diagnosed breast cancer and breast cancer recurrence.

    Newly diagnosed breast cancer
    The following are the prognostic or predictive factors for breast cancer first detected and diagnosed.

    Stadium
    Stage is the main prognostic factor for breast cancer. The risk of early-stage breast cancer coming back (recurring) is lower, so it has a better prognosis. Breast cancer diagnosed at a later stage has a higher risk of recurrence, so its prognosis is less favorable.

    Doctors take into account the spread of cancer to the lymph nodes and the size of the tumor when making a prognosis.

    Spread of cancer to the lymph nodes
    The most important prognostic factor for breast cancer is the spread of cancer to the lymph nodes. Breast cancer that has spread to the lymph nodes has a higher risk of recurrence and a poorer prognosis than breast cancer that has not spread to the lymph nodes.

    Also important is the number of lymph nodes that are affected by cancer, called positive nodes. The higher the number of positive nodes, the greater the risk of breast cancer coming back. Breast cancer that has spread to 4 or more lymph nodes has the greatest risk of recurrence.

    Tumor size

    The second most important prognostic factor is tumor size. The size of the tumor affects the prognosis regardless of the number of lymph nodes affected by the cancer.

    A tumor in the breast that is 5 cm or more is more likely to come back after treatment than a smaller tumor. A tumor in the breast that is less than 1 cm and that has not spread to the lymph nodes has a very favorable prognosis.

    Tumor grade

    The grade can affect the prognosis. Low-grade tumor has a better prognosis because it grows slowly and is less likely to spread than high-grade tumor.

    Hormone receptor status

    Tumors in which the hormone receptors are positive usually have a good prognosis. They are often less aggressive, have a lower grade and are less likely to spread than tumors with negative hormone receptors. They usually respond well to hormone therapy.

    HER2 status

    The HER2 gene controls a protein on the surface of cells that promotes their growth. Breast cancer is HER2 positive when cancer cells make too many copies (overexpress) of the HER2 gene.

    HER2 positive breast cancer is more aggressive and more likely to spread than HER2 negative breast cancer. It is also more likely to come back after treatment. This means that HER2 positive breast cancer has a less favorable prognosis than HER2 negative breast cancer.

    Age at diagnosis

    Women under 35 tend to be diagnosed with a more aggressive, higher grade breast tumor. Breast cancer is often more advanced at diagnosis. This means that a young woman is more likely to have her breast cancer recurring and to have a poorer overall prognosis than an older, postmenopausal woman.

    Breast cancer recurrence

    The following factors may affect the prognosis for breast cancer that comes back after treatment.

    Time before cancer recurs

    The longer it takes for breast cancer to reappear, the better the prognosis. Women whose breast cancer recurs more than 5 years after diagnosis usually have a better outcome than those whose recurrence occurs within 2 years of diagnosis.

    Location of recurrence
    Cancer that comes back in the breast – local recurrence after lumpectomy and radiation therapy – has a more favorable prognosis than cancer that comes back in other organs, called recurrence or distant metastasis.

    If the cancer comes back in the muscles of the chest, there is a higher risk that it has also come back in another part of the body (recurrence at a distance). Therefore, cancer that recurs in the chest muscles has a less favorable prognosis.

    Breast cancer that recurs in the liver, lungs, or brain has a poorer prognosis than cancer that recurs in other parts of the breast, in the muscles of the chest, or in the lymph nodes in the armpit (axillary nodes).

    Breast cancer that recurs in bone has an intermediate prognosis. This means that it has a better prognosis than cancer that has come back in the liver, lungs or brain, but a poorer prognosis than cancer that has come back in the breast area or chest muscles.

    Can men get breast cancer?

    Men also have breasts which, however, are less developed than those of women. Breast cancer in men is rare. Less than 1% of all breast cancers affect men. However, it is important for men to know that they may be affected by this cancer, especially so as not to overlook the symptoms.

    RISK FACTORS

    There are certain factors that can make it more likely that a man will one day develop breast cancer.

    Age

    A man’s risk of developing breast cancer increases with age. Breast cancer is more commonly diagnosed in men over the age of 60.

    A family history of breast cancer

    Men whose close relatives, both male and female, have had breast cancer are at greater risk of developing this disease. The risk increases depending on the number of close relatives affected by this cancer.

    A genetic predisposition

    About 15% of breast cancers in men are linked to an inherited mutation in the BRCA2 gene.

    Klinefelter syndrome

    It is a very rare inherited (genetic) disorder. In men with this syndrome, androgen levels are low and estrogen levels are high: both are linked to an increased risk of breast cancer.

    Radiation exposure

    Previous exposure to radiation, especially to the chest, increases the risk of breast cancer in men.

    Cirrhosis of the liver

    A liver damaged by cirrhosis increases estrogen levels and lowers androgens, both of which are linked to an increased risk of breast cancer.

    OTHER POSSIBLE RISK FACTORS
    The following factors have been linked to some form of breast cancer in men. The lack of studies on these factors, however, does not allow us to say that they are known risk factors.

    Gynecomastia (exaggerated breast development in men).
    Obesity.
    Alcohol consumption.
    Problems with the testicles: undescended testicle (cryptorchidism), removal of one or both testis (orchiectomy), mumps in adulthood.
    Occupational exposure: steelworks, blast furnaces, rolling mills, gasoline vapors and exhaust gases.
    Most men with breast cancer have invasive ductal carcinoma. Other types of breast cancer are very rare.

    Symptoms, disease progression and management of invasive ductal carcinoma (diagnosis, treatment, follow-up) are substantially identical in men and women.


    List of all Cancers

    The word “cancer” is a generic term for a large group of diseases that can affect any part of the body. We also speak of malignant tumors or neoplasms. One of the hallmarks of cancer is the rapid multiplication of abnormal growing cells, which can invade nearby parts of the body and then migrate to other organs. This is called metastasis, which is the main cause of death from cancer. Types of cancer (in alphabetical order of the area concerned):

    Types of Cancer | List all of Cancers | Adult, Children, Head and neck, Digestive and Types of Blood Cancer

    Information: Cleverly Smart is not a substitute for a doctor. Always consult a doctor to treat your health condition.

    Sources: PinterPandai, National Health Service UKAmerican Cancer SocietyWeb MDWorld Health Organization (WHO)

    Photo credit: Wikimedia Commons

    Photo explanations: The largest proportion of breast cancer cases occur in the upper-outer quadrant of the breast, with much smaller proportions in the upper-inner, lower-outer and lower-inner quadrants, and the central portion of the breast (2010-2012).Based on a Cancer Research UK graphic published in 2016.