Breast cancer is a cancer of the glandular breast tissue.

Worldwide, breast cancer is the fifth most common cause of cancer death (after lung cancer, stomach cancer, liver cancer, and colon cancer). And among women worldwide, breast cancer is the most common cancer and the most common cause of cancer death. The number of cases has significantly increased since the 1970s, a phenomenon partly blamed on modern lifestyles in the Western world. Because the breast is composed of identical tissues in males and females, breast cancer also occurs in males, though it is less common.

Risk factors:

1. The risk of getting breast cancer increases with age. It is extremely rare below 20 years of age.

2. More common in females

3. Family history

4. Diet rich in fat and high intake of alcohol

5. Gaining weight after menopause

6. Not having children

7. Delaying first childbirth, not breastfeeding, early menarche (the first menstrual period) and late menopause

8. Women who have received high-dose ionizing radiation to the chest (for example, as treatments for other cancers)

Presenting symptoms:

1. Hard lump

2. Indrawing or distortion of nipple

3. Lump in the arm pit

4. Nipple discharge

5. The skin of the breast, areola, or nipple may be scaly, red, or swollen. It may have ridges or pitting so that it looks like the skin of an orange

6. A change in the shape or size of the breast

Diagnosis:

1. Clinical breast exam Your health care provider feels each breast for lumps and looks for other problems. If you have a lump, your doctor will feel its size, shape, and texture.

2. Mammography is still the modality of choice for screening of early breast cancer, since it is relatively fast, reasonably accurate, and widely available in developed countries. Breast cancers detected by mammography are usually much smaller (earlier stage) than those detected by patients or doctors as a breast lump. The US National Cancer Institute recommends screening mammography every one to two years beginning at age 40. In the UK, women are invited for screening once every three years beginning at age 50. Women with one or more first-degree relatives (mother, sister, and daughter) with premenopausal breast cancer should begin screening at an earlier age. It is usually suggested to start screening at an age that is 10 years less than the age at which the relative was diagnosed with breast cancer.

3. Ultrasound is particularly useful in young women with dense and firm breasts in whom mammograms are difficult to interpret. It can be used to localize breast lumps which are not palpable clinically.

4. Biopsy Your doctor may refer you to a surgeon or breast disease specialist for a biopsy. Fluid or tissue is removed from your breast to help find out if there is cancer.

Doctors can remove tissue from the breast in different ways:

Fine-needle aspiration: Your doctor uses a thin needle to remove fluid or cells from a breast lump. A pathologist at a lab checks them for cancer with a microscope.

Core biopsy: Your doctor uses a thick needle to remove breast tissue. A pathologist checks for cancer cells. This procedure is also called a needle biopsy.

Surgical biopsy: Your surgeon removes a sample of tissue. A pathologist checks the tissue for cancer cells.

An incisional biopsy takes a sample of a lump or abnormal area.

An excisional biopsy takes the entire lump or area.

5. MRI: To see recurrence, or patients with breast implants.

Treatment:

Treatment largely depends upon the stage at presentation.

The mainstay of early breast cancer treatment is surgery with or without radiotherapy when the tumour is localized. Chemotherapy (cancer drugs) or hormonal therapy is added if the cancer is higher grade or has spread to the lymph nodes in the armpits. Advanced stage disease is mainly treated by chemotherapy with surgery playing a little role. That is why if you notice a breast lump you should consult the doctor as soon as possible to detect the cancer at an early stage.

Surgery:

Breast-sparing surgery: lumpectomy (removal of lump) or segmental mastectomy (removal of a segment of breast) + Radiotherapy + axillary lymph node dissection (removal of the underarm lymph nodes)

Mastectomy: An operation to remove the breast (or as much of the breast tissue as possible) is a mastectomy. In most cases, the surgeon also removes lymph nodes under the arm. Some women have radiation therapy after surgery.

The surgery can be combined with breast reconstruction (it is a type of plastic surgery to rebuild the shape of breast) or this can be done at a later stage.

Radiotherapy:

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. Most women receive radiation therapy after breast-sparing surgery. Some women receive radiation therapy after a mastectomy. Treatment depends on the size of the tumour and other factors. The radiation destroys breast cancer cells that may remain in the area.

Chemotherapy:

Chemotherapy uses anti-cancer drugs to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs. These drugs can have side effects like hair loss, nausea, vomiting, diarrhea, etc, but these are temporary and usually resolve after chemotherapy finishes.

Hormonal therapy:

Some breast tumours need hormones to grow. Hormone therapy keeps cancer cells from getting or using the natural hormones they need. These hormones are oestrogen and progesterone. Lab tests can show if a breast tumour has hormone receptors. If you have this kind of tumour, you may have hormone therapy. This can be in the form of Tamoxifen. Another form of treatment is biological treatment in the form of Herceptin (to augment the body’s defence mechanism against certain types of breast cancer).

In summary, the treatment of breast cancer is:

Early stage: surgery and/or radiotherapy and/ or chemotherapy

Locally advanced stage: chemotherapy or local radiotherapy, followed by surgery, if the tumour size has shrunk.

Metastatic disease (which has spread in the body): chemotherapy or hormonal therapy.

Follow-up:

Follow-up care after treatment for breast cancer is important. Recovery is different for each woman. Your recovery depends on your treatment, whether the disease has spread, and other factors. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remain somewhere in the body after treatment. Your doctor will monitor your recovery and check for recurrence of the cancer.

Always tell your doctor about the symptoms which are unusual and do not go away like headache, blurring of vision, bowel disturbance, loss of weight, and changes in the operated breast or the other breast, vaginal bleeding, etc.

Follow-up exams usually include the breasts, chest, neck, and underarm areas. Since you are at risk of getting cancer again, you should have mammograms of your preserved breast and your other breast.

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