Breast Cancer

Breast cancer begins when abnormal cells within the breast tissue start to grow uncontrollably.Generally It primarily affects women, but it can also occur in men. It usually starts in the milk ducts or lobules of the breast and can spread to other parts of the body if not detected and treated early.

Breast cancer can be classified in several ways, based on various factors such as the type of cells involved, the location and size of the tumor, and the presence or absence of certain receptors. Here are some common classifications of breast cancer:

1.Histological Classification: This classification is based on the appearance of the cancer cells under a microscope. The main types of breast cancer based on histology include:

Ductal carcinoma in situ (DCIS): Cancer cells are confined to the milk ducts and have not invaded surrounding tissue.
Invasive ductal carcinoma (IDC): Cancer cells have invaded through the ductal walls into the surrounding breast tissue.
Lobular carcinoma in situ (LCIS): Abnormal cells are found in the lobules of the breast but have not invaded surrounding tissue. LCIS is not considered true cancer but is a risk factor for developing invasive breast cancer.
Invasive lobular carcinoma (ILC): Cancer cells have spread from the lobules into surrounding breast tissue.

2.Hormone Receptor Status: Breast cancer cells may express hormone receptors such as estrogen receptors (ER) and progesterone receptors (PR). These receptors influence the growth of cancer cells. Breast cancers can be classified as:

Hormone receptor-positive (ER+ and/or PR+): Cancer cells have receptors for estrogen and/or progesterone.
Hormone receptor-negative (ER- and PR-): Cancer cells do not have receptors for estrogen and progesterone.

3.HER2 Status: Human epidermal growth factor receptor 2 (HER2) is a protein that can promote the growth of cancer cells. Breast cancers can be classified as:

HER2-positive: Cancer cells produce too much HER2 protein, which can promote the growth of cancer cells.
HER2-negative: Cancer cells do not produce too much HER2 protein.

4.Triple-Negative Breast Cancer (TNBC): This subtype of breast cancer lacks expression of estrogen receptors, progesterone receptors, and HER2 protein.

5.Stage: Breast cancer is also classified based on the stage, which considers factors such as tumor size, lymph node involvement, and metastasis to other parts of the body.

These classifications help guide treatment decisions and provide prognostic information for patients with breast cancer. It’s important for healthcare providers to consider all these factors when determining the most appropriate treatment plan for an individual patient.

Signs and symptoms of breast cancer can vary from person to person, and not everyone with breast cancer experiences the same symptoms. Some common signs and symptoms are:

1.Lump or Mass: A lump or thickening in the breast or underarm area is one of the most common signs of breast cancer. Not all lumps are cancerous, but it’s essential to get any new lump checked by a healthcare professional.

2.Changes in Breast Size or Shape: Breast cancer can cause changes in the size or shape of breast. This may be noticeable as swelling, distortion, or asymmetry between the breasts.

3.Changes in Breast Skin: Changes in the skin texture of the breast, such as dimpling, puckering, redness, or scaliness, may indicate breast cancer.

4.Nipple Changes: Changes in the nipple, such as inversion (turning inward), flattening, or retraction (pulling inward), can be a sign of breast cancer. Discharge from the nipple, especially if it’s bloody, may also indicate breast cancer.

5.Breast Pain: While breast cancer typically does not cause pain in the early stages, some women may experience breast pain or discomfort that is persistent and unrelated to the menstrual cycle.

6.Changes in Breast Sensation: Changes in sensation, such as itching, tingling, or tenderness in the breast or nipple, may occur with breast cancer.

7.Changes in the Appearance of the Areola: Changes in the color or texture of the areola (the darker area surrounding the nipple) may indicate breast cancer.

It’s important to note that many of these signs and symptoms can also be caused by non-cancerous conditions. However, if you notice any changes in your breasts that concern you, it’s essential to see a healthcare provider for evaluation and appropriate testing. Regular breast self-exams, along with clinical breast exams and mammograms as recommended by your healthcare provider, are important for early detection of breast cancer.

The diagnosis of breast cancer typically involves several steps and tests:

1.Clinical Breast Examination (CBE): A healthcare provider examines the breasts and surrounding areas for any abnormalities, such as lumps, changes in skin texture, or nipple discharge.

2.Imaging Tests:

Mammogram: It is an X-ray of breast tissue. It is often the first imaging test done to detect breast cancer or abnormalities.
Ultrasound: Ultrasound uses sound waves to produce images of the breast tissue. It may be used to further evaluate areas of concern found on a mammogram.
MRI (Magnetic Resonance Imaging): MRI uses magnetic fields and radio waves to create detailed images of the breast tissue. It may be recommended in certain cases, such as for high-risk individuals or to further evaluate abnormalities found on mammogram or ultrasound.

3.Biopsy: If an abnormality is found on imaging tests or during a clinical breast exam, a biopsy is usually performed to confirm whether it is cancerous. Types of biopsies include:

Fine Needle Aspiration (FNA): A thin needle is used to withdraw cells or fluid from the breast lump for examination under a microscope.
Core Needle Biopsy: A larger needle is used to remove a small sample of tissue from the breast lump for examination.
Surgical Biopsy (Excisional or Incisional): A surgeon removes part or all of the breast lump for examination.

4.Pathology and Histology: The samples obtained from the biopsy are sent to a pathology laboratory, where they are examined under a microscope by a pathologist to determine whether cancer cells are present. The type of breast cancer and other important characteristics, such as hormone receptor status and HER2 status, are also determined through this analysis.

Once a diagnosis of breast cancer is confirmed, additional tests may be done to determine the stage of the cancer and whether it has spread to other parts of the body (metastasis). This may include imaging tests such as CT scans, PET scans, bone scans, or other tests as needed.

The results of these tests help healthcare providers develop an appropriate treatment plan tailored to the individual’s specific type and stage of breast cancer.

Treatment for breast cancer depends on various factors, including the type and stage of the cancer, as well as the individual’s overall health and personal preferences. Common treatments for breast cancer may include:

1.Surgery:

Lumpectomy (Breast-conserving surgery): Removal of the tumor and a small margin of surrounding healthy tissue. Generally it is followed by radiation therapy.
Mastectomy: Surgical removal of the entire breast. Types of mastectomy include:
>Total mastectomy (simple mastectomy): Removal of the entire breast.
>Modified radical mastectomy: Removal of the entire breast along with some lymph nodes in the underarm area (axillary lymph node dissection).
>Skin-sparing mastectomy: Removal of breast tissue with preserving the skin over the breast.
>Nipple-sparing mastectomy: Removal of breast tissue while preserving the nipple and areola.
Sentinel lymph node biopsy: Removal and examination of a few lymph nodes to determine if cancer has spread beyond the breast.

2.Radiation Therapy: High-energy beams are used to kill cancer cells or prevent their growth. It may be used after lumpectomy or mastectomy to destroy any remaining cancer cells in the breast, chest wall, or lymph nodes.

3.Chemotherapy: Drugs are used to kill cancer cells or stop their growth. Chemotherapy may be given before surgery (neoadjuvant chemotherapy) to shrink tumors, after surgery (adjuvant chemotherapy) to kill any remaining cancer cells, or for metastatic breast cancer to control the spread of the disease.

4.Hormone Therapy: Hormone receptor-positive breast cancers are treated with medications that block the effects of estrogen or lower estrogen levels in the body. This may include drugs such as tamoxifen, aromatase inhibitors (e.g., anastrozole, letrozole, exemestane), or ovarian suppression.

5.Targeted Therapy: Targeted drugs are used to specifically target cancer cells by blocking specific pathways or proteins involved in cancer growth. Examples include trastuzumab (Herceptin) for HER2-positive breast cancer and drugs like palbociclib, ribociclib, and abemaciclib for hormone receptor-positive, HER2-negative breast cancer.

6.Immunotherapy: Immunotherapy drugs help the immune system recognize and attack cancer cells. While not yet a standard treatment for breast cancer, immunotherapy may be used in certain cases, such as triple-negative breast cancer or HER2-positive breast cancer.

Treatment plans are often personalized, and patients may receive a combination of these treatments. The goal is to effectively treat the cancer while minimizing side effects and preserving quality of life. It’s essential for patients to discuss their treatment options with their healthcare team and be actively involved in decision-making.

Breast cancer and its treatments can lead to various complications, which may include:

1.Lymphedema: Lymphedema is swelling that occurs when lymph fluid accumulates in the tissues due to damage to or removal of lymph nodes during breast cancer surgery or radiation therapy.

2.Fatigue: Fatigue is a common side effect of cancer and its treatments, including chemotherapy, radiation therapy, and hormonal therapy.

3.Pain: Breast cancer itself can cause pain, and treatments such as surgery, radiation therapy, and chemotherapy can also lead to pain or discomfort.

4.Menopausal Symptoms: Hormonal therapies used to treat hormone receptor-positive breast cancer can induce menopausal symptoms such as hot flashes, night sweats, and vaginal dryness.

5.Infertility: Some treatments for breast cancer, particularly chemotherapy and hormonal therapy, can affect fertility and may lead to temporary or permanent infertility.

6.Bone Health: Certain breast cancer treatments, such as hormonal therapy and chemotherapy, can affect bone density and increase the risk of osteoporosis or bone fractures.

7.Heart Problems: Some chemotherapy drugs and radiation therapy to the chest area can increase the risk of heart problems, such as cardiomyopathy or heart failure.

8.Cognitive Changes: Some breast cancer survivors may experience cognitive changes, often referred to as “chemo brain,” which can include problems with memory, concentration, and multitasking.

9.Emotional and Psychological Effects: Dealing with a breast cancer diagnosis and undergoing treatment can lead to emotional distress, anxiety, depression, and other psychological challenges.

10.Secondary Cancers: Some breast cancer survivors may develop secondary cancers as a result of cancer treatments or due to genetic predispositions.

It’s essential for breast cancer patients and survivors to discuss potential complications and side effects with their healthcare team. Many supportive care strategies and interventions are available to help manage and minimize these complications, improve quality of life, and support overall well-being during and after treatment.