Breast Cancer

Overview
Simplified Illustration of a Female Breast
Simplified Illustration of a Female Breast

Women breast is made up of connective tissues, fats, blood vessels, lymph nodes and thousands of tiny glands called lobules.  Lobules produce milk after child birth. This milk is delivered to the nipples via thin tubes called milk ducts. The fatty tissues called stroma surround the lobules and milk ducts.

Normally all cells in our body grow and multiply in a coordinated manner. Old cells die which are replaced by new cells. When something goes wrong in this natural process, multiplication of cells becomes uncontrollable causing cancer.

Breast cancer is one of the most common cancers in women worldwide.

Based on recent estimates, Pakistan has one of the highest incidence of breast cancer in Asia. 1 in every 8 women have a chance to develop breast cancer, 40,000 women die every year.

It could be stopped from spreading to other parts, if diagnosed and treated early.

Nevertheless, most abnormal growths or lumps in breast are benign – that means they are not cancers. But it is very important to get it checked to have peace of mind. Fear will not help, patient should consult the physician as early as possible.

Abnormal growth in breast cancer occurs in cells lining the ducts and lobules. At most occasions, breast cancer starts from cells of ducts therefore called ductal, whereas some develop in lobules called lobular.

Abnormal cells pile up and form a mass called tumour or cyst in breast. The tumour can be benign (non-cancerous) or malignant (cancerous).

Types of Breast Cancer

Mainly breast cancers are classified into invasive and non-invasive types.

Invasive Breast Cancer

Invasive breast cancer cells have the ability to spread to the adjacent tissues and travel to other body organs through blood and lymphatic system. It can start in duct or lobules.  The most common type of breast cancer starts from duct.

Non-invasive Breast Cancer

This type of breast cancer does not have the ability to spread to other organs. Lump formation in non-invasive breast cancer is very rare. They are called carcinoma in situ (meaning: cells are in place and do not spread). Ductal carcinoma-in-situ (DCIS) is the most common type of non-invasive breast cancer affecting the duct.  They are considered as precancerous condition and their presence raises the chances of developing an invasive breast cancer.

Signs and Symptoms

Most noticeable symptom of breast cancer is the presence of a tumour or cyst in the breast. It is very important that women do not ignore these symptoms and have them checked by specialist doctor.

Apart from that, other symptoms are as follows:

  • Changes in shape and size of either one breast or both breasts
  • Fluid discharge from one or both nipple (it could be bloody)
  • Swelling or lump in either one armpit or both
  • Alteration in look of nipple like dipping/ immersing of nipple in breast tissue
  • Change in skin color or rash around nipple
  • Pigmentation or scaling of skin around nipple
  • Pitting and redness of skin around breast, just like that of orange’s peel
  • Pain in nipple or pulling of nipple towards one side
  • Pain in breast
  • Irritation of breast skin
Causes and Risk Factors

No exact cause or risk factor of breast cancer is known but doctors say that family history of breast cancer and presence of certain genes raises the chances of breast cancer development. Additionally, environmental and hormonal factors are also responsible for breast cancer.

Like all other cancers, breast cancer occurs when cells start growing in an uncontrollable manner. In breast cancer, they often begin to divide in ducts or lobules. These cells may spread to lymph nodes or other parts of body.

Hereditary Factor

It is estimated that about 5-10% of breast cancers have some hereditary factor.
Some breast cancers are inherited from one generation to another through genes transfer. There are two genes, BRCA1 and BRCA2; presence of either of the gene greatly increases the possibility of breast cancer development.

Family History

Women with family history of breast cancer (close blood relatives) have higher risk of developing breast cancer. Breast cancer is more common in women whose close relatives had history of breast or ovarian cancer.

Age

With an increase in age, risk of breast cancer increases. It is commonly developed in women above 50 years who have undergone menopause, which is interruption in their monthly period. So therefore, all women of age group 50-70 are recommended to be screened for breast cancer, at least every three years.

History of benign breast cyst or lump

Women who have personal history of benign breast lump are also at elevated risk of development of breast cancer.

Other factors

Apart from them, exposure to estrogen, increased weight, dense breast tissues, alcohol, radiation and hormonal replacement therapy are also some risk factors or causes of development of breast cancer. Women who do not have children or had first child after age 35 years

Diagnosis and Testing

Breast cancer can be satisfactorily treated if detected early. Therefore, it is very important for women who are at risk to discuss it with their doctor.

Breast Self-Exam (BSE)

Women over 30 years should perform BSE once in a month. Perform physical examination using their hands by searching for a lump or cyst and visually looking for any changes in the size and shape of the breast and armpits in the mirror.

Tests carried out in diagnosing breast cancer are as follows:

Clinical Breast Examination

The doctor will examine both of the breasts including armpits and lymph nodes, feeling for lumps.

Mammography

An X-ray of breast is known as mammogram and they are usually used for screening and diagnostic purpose. If an abnormality is found, more tests are carried out for further evaluation.

Ultrasound of Breasts

Sound waves are used in ultrasound for producing images of deep structures in the body. Breast ultrasounds are used to detect whether the cyst or lump is solid mass or contains fluid.

Biopsy (Taking sample of Breast Cells for Testing)

It is used to take sample of the tissues from the lump or the entire lump and send them for microscopic examination Biopsy is also used for evaluating the type and grade of cells involved.

Magnetic Resonance Imaging of Breast

MRI machine uses radio and magnetic waves to produce images of inner structures of breast. To diagnose breast abnormalities, MRI results are usually used with mammography results.

Other procedures or tests used to diagnose or stage the breast cancer are as follows:

• Complete blood count and other blood tests

• Computerized tomography scan (CT scan)

• Positron emission tomography scan (PET scan)

• Bone scan

• Genetic testing for BRCA1 and BRCA2 genes

• Needle biopsy

Not all tests are required in one patient; doctors know which test should be performed in which patient according to their specific situation and symptoms.

Treatment

If breast cancer is treated at an early stage, then there is less chance for it to spread.

Treatment of breast cancer is commonly done by the combination of surgery, radiotherapy and chemotherapy.

Type of treatment and surgery depends on the situation of patient. In most patients, surgery is used to remove the affected part or the complete breast (mastectomy). Type of cancer and grade of cancer are also key factors in determining what kind of surgery should be performed.  Treatment plan should be discussed with the doctor before surgery or any other treatment.

Surgery is often followed by chemotherapy, radiotherapy, hormonal or medicinal therapy.

In chemotherapy, medicines are used to kill or shrink the cancer cells. In radiotherapy, high energy rays are used to kill cancer cells. Hormonal therapy blocks the cancer cells from obtaining hormones which are important for them in order to grow. Biological treatment works with immune system of body in order to control side effects of other treatments given during cancer and to fight cancer as well.

In some women, cancer has spread or metastasized outside the breast. It is also known as metastatic or advanced cancer.  Treatments are used to maintain the quality of life and relief symptoms.

Living with Breast Cancer

Life after breast cancer changes in several ways. Dealing with pain after surgery and side effects of chemotherapy are difficult to handle. Many women suffer with depression.

Breast cancer ribbon-blackbackground (2)It is important to keep the hope alive. Prayers and family support help the patient to cope with it.

Also, it gives strength to the patient to know about women who had breast cancer and how they are dealing with it.

In recent years, many new medicines have been approved for breast cancer. Many of them are quite effective. A significant number of breast cancer patients survive and live reasonably-healthy life for decades.



 

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