Overview

Breast cancer, like all cancers, is made up of abnormal cells that grow out of control. Those cells may also travel to parts of your body where they aren't expected to be. When this occurs, the cancer is referred to as metastatic.

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Breast cancer usually starts in the glands that produce milk (lobular carcinoma) or the ducts that carry it to the nipple (ductal carcinoma) (called ductal carcinoma). It has the potential to grow larger in your breast and spread to nearby lymph nodes or to other organs through your bloodstream. The cancer may spread to surrounding tissue, such as your skin or chest wall. Breast cancer spreads and grows at different rates depending on the type. Others grow and spread quickly, while others take years to spread beyond your breast.

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1. Who is at Risk for Breast Cancer?

Men can develop breast cancer as well, but they account for less than 1% of all cases. Breast cancer is the most common cancer diagnosed in women.

Breast cancer affects one out of every eight women at some point in their lives. Breast cancer affects about two-thirds of women aged 55 and up. The majority of the rest are between the ages of 35 and 54. Breast cancer is, fortunately, very treatable if caught early. Localized cancer (that is, cancer that hasn't spread beyond your breast) is usually treatable before it spreads. Treatment becomes more difficult once the cancer has spread. It can often keep the disease under control for years.

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2. Symptoms of Breast Cancer

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• A lump or thickening in or near your breast or underarm that lasts the duration of your period

 • A lump or mass, even if it appears to be as small as a pea

 • A change in the size, shape, or curve of your breasts

 • A bloody or clear discharge from the nipple

 • Changes in the appearance of your breast or nipple skin. Dimpled, puckered, scaly, or inflamed skin is possible.

 • Breast or nipple skin that is red

 • Changes in your nipple's shape or position

 • A spot on either breast that is distinct from the rest.

 • A hard spot the size of a marble under your skin

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3. Breast Cancer Types

 

The following are some of the most common types of breast cancer:

 

Cancers that have developed in their natural environment. These types haven't progressed beyond the duct or lobule from which they emerged.

 

• In situ ductal carcinoma (DCIS). This is the earliest stage of ductal carcinoma (stage 0). The disease is still present in the milk ducts in this case. However, if this type is not treated, it can become invasive. It's usually treatable.

• In situ lobular carcinoma (LCIS). This can only be found in the lobules that produce breast milk. It isn't a true cancer, but it does increase your chances of developing breast cancer later. Get regular mammograms and breast exams if you have it.

 

Note: Cancers that spread throughout the body. These have spread or invaded the breast tissue around them.

 

• Ductal carcinoma that is invasive or infiltrating (IDC). The milk ducts are where the cancer begins. It penetrates the duct wall and invades the fatty tissue of the breast. It is the most common type of invasive cancer, accounting for 80% of all cases.

• ILC (invasive lobular carcinoma). This cancer begins in the lobules and spreads to the surrounding tissues and other parts of the body. About 10% of invasive breast cancers are caused by it. The following are subtypes of invasive breast cancer:

• Adenoid cystic carcinoma (also known as adenocystic carcinoma). These cells are similar to those found in your salivary glands.

• Adenosquamous carcinoma of low grade (a type of metaplastic carcinoma). This rare tumour grows slowly and is frequently misdiagnosed as another type.

• Carcinoma of the medulla. The tumours in this rare type are a soft, squishy mass that resembles the medulla, a part of the brain.

• Mucinous carcinoma is a type of cancer with a mucus-like Tumors of this uncommon type float in a pool of mucin, a sticky, slimy substance that makes up mucus.

• Papillary carcinoma is a type of cancer that affects the hair folli These tumours are distinguished by their fingerlike projections. This uncommon condition mostly affects women who have gone through menopause.

• Cancer of the tubules. The tumours are tube-shaped and slow-growing.

 

   Types that are less common include:

 

• Breast cancer that is inflammatory. Inflammatory cells in your skin's lymph vessels cause this rare type.

 

    Paget's disease of the nipple is a condition in which the nipple is inflamed. The areola, the thin skin around your nipple, is affected by this type.

 

• Breast tumours caused by Phyllodes. These uncommon tumours form a leaf-like pattern as they grow. They multiply rapidly but rarely spread beyond the breast.

• Breast cancer that has spread to other parts of the body. Cancer that has spread to another part of your body, such as your brain, bones, or lungs, is known as metastatic cancer (Stage IV breast cancer ).

 

4. (a) Causes and Risk Factors for Breast Cancer

Experts aren't sure what causes breast cancer, but certain factors increase your chances of getting it. Age, genetic factors, personal health history, and diet are all factors to consider. Some things you have control over, while others you don't.

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• Your age. Breast cancer is more common in women over 50 than in younger women.

 

• Race: Before menopause, African American women are more likely than white women to develop breast cancer.

 

• Breasts that are dense. It can be difficult to see tumours on a mammogram if your breasts have more connective tissue than fatty tissue.

 

• Personal experience with cancer. If you have certain benign breast conditions, your chances increase slightly. If you've had breast cancer before, they'll rise even faster.

 

• Your ancestors. You're two times more likely to get breast cancer if a first-degree female relative (mother, sister, or daughter) has it. A family history of breast cancer in two or more first-degree relatives increases your risk by at least three times. This is especially true if the cancer occurred before menopause or if both breasts were affected. If your father or brother has been diagnosed with breast cancer, your risk increases.

 

• Genetics BRCA1 and BRCA2 gene mutations are linked to some cases of breast cancer in families. One in every 200 women carries one of these genes. While they increase your chances of getting cancer, they do not guarantee that you will. You have a 7 in 10 chance of being diagnosed with breast cancer by the age of 80 if you have a BRCA1 or BRCA2 mutation. These genes have also been linked to pancreatic cancer and male breast cancer, as well as ovarian cancer. PTEN gene mutations, ATM gene mutations, TP53 gene mutations, CHEK2 gene mutations, CDH1 gene mutations, STK11 gene mutations, and PALB2 gene mutations are all linked to breast cancer risk. These genes have a lower risk of developing breast cancer than the BRCA genes.

 

• Your menstrual cycle. If you have a family history of breast cancer, your chances of developing the disease increase.

 

• Your period begins before the age of twelve.

 

• Your periods don't stop until you're 55 years old.

 

• The dangers of radiation. You have a higher risk of breast cancer if you had treatment for cancers like Hodgkin's lymphoma before the age of 40.

 

• Diethylstilbestrol is a type of diethylstilbestrol (DES). Between 1940 and 1971, doctors used this drug to prevent miscarriage. If you or your mother took it, your chances of developing breast cancer increased.

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4. (b) Controllable Breast Cancer Risk Factors

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• Physical activity is important. The fewer movements you make, the better your chances are.

 

• Diet and weight. Obesity after menopause increases your chances.

 

• Alcoholic beverages. Drinking on a regular basis, especially more than one drink per day, raises the risk of breast cancer.

 

• A history of pregnancy.

 

• You give birth to your first child after the age of 30.

 

• You don't breastfeed your child.

 

• You aren't expecting a full-term baby.

 

• Hormone therapy. If you do the following, your chances will improve:

 

During menopause, take oestrogen and progesterone-containing hormone replacement therapy for at least 5 years. After 5 years of treatment, the increased risk of breast cancer returns to normal.

 

• Use hormone-containing birth control methods such as birth control pills, shots, implants, IUDs, skin patches, or vaginal rings.

 

Despite this, the majority of women who are at high risk for breast cancer do not develop it. 75 percent of women who develop breast cancer, on the other hand, have no known risk factors. Learn more about the breast cancer risk factors.

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5. Diagnosis of Breast Cancer

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Your doctor will start the breast cancer diagnosis process if you feel a lump or if something shows up on a mammogram.

 

They'll inquire about your personal and family history of health. They'll then perform a breast exam and order tests such as:

 

Imaging tests are performed. These will be used by your doctor to learn more about your breast.

 

• The use of ultrasound. This test creates a picture of your breast using sound waves.

 

• Mammogram (mammogram). This detailed X-ray allows doctors to see lumps and other issues more clearly.

 

• MRI stands for magnetic resonance imaging (MRI). This body scan creates detailed images of the insides of your breasts using a magnet connected to a computer.

 

• A biopsy is a procedure in which a sample of tissue is The doctor takes tissue or fluid from your breast for this test. They examine it under a microscope to see if cancer cells are present and, if so, to determine which type they are. The following are examples of common procedures:

 

• Aspiration with fine needles. This is for lumps that are easy to reach or that may be filled with fluid.

 

• Biopsy with a core needle. To remove a piece of tissue, this type uses a larger needle.

 

• Surgical biopsy (open). The entire lump, as well as nearby breast tissue, is removed by a surgeon.

 

• Biopsy of lymph nodes A portion of the lymph nodes under your arm is removed to see if the cancer has spread.

 

• A biopsy that is guided by an image. To guide the needle, the doctor uses imaging.

 

• Your biopsy sample can be tested for: • Tumor characteristics. Is it invasive or non-invasive, ductal or lobular in nature? Have your lymph nodes been affected? The margins or edges of the tumour are also measured, as well as their distance from the edge of the biopsy tissue, which is known as margin width.

 

• Progesterone receptors (PR) and oestrogen receptors (ER) (PR). This tells your doctor if oestrogen or progesterone are causing your cancer to grow. This has an impact on the likelihood of your cancer returning and the type of treatment that is most likely to prevent it.

 

• HER2 (human epidermal growth factor receptor 2) The human epidermal growth factor receptor 2 gene is searched for in this test. It has the potential to hasten the progression of cancer. If you have HER2-positive cancer, targeted therapy may be an option for you.

 

• The grade. This informs the doctor about how cancer cells differ from healthy cells, as well as whether they appear to be slower or faster growing.

 

• Oncotype Dx is a type of cancer. This test assesses 16 cancer-related genes as well as five reference genes to determine the likelihood of a cancer recurrence within ten years of diagnosis.

 

• Breast Cancer Index (BCI). This test can assist your doctor in determining how much endocrine therapy you require.

 

• MammaPrint is an acronym for MammaPrint, which stands for Mamm This test uses data from 70 genes to predict the likelihood of cancer recurrence.

 

• PAM50 PAM50 PAM50 PAM50 (Prosigna). This test uses data from 50 genes to determine whether the cancer will spread.

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6. Stages of Breast Cancer

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• Breast cancer in its early stages, also known as stage 0 or noninvasive breast cancer. There are no signs that the disease has spread to the lymph nodes because it is only in the breast (your doctor will call this carcinoma in situ).

 

• Breast cancer in the first stage. The cancer is only 2 centimetres in diameter and hasn't spread.

 

• Breast cancer in stage IIA. The tumor's name is:

 

• Less than 2 centimetres in diameter, with lymph node involvement under the arm.

 

• Greater than 2 centimetres in diameter but less than 5 centimetres in diameter, with no lymph node involvement

 

• Breast cancer in stage IIB. A tumour that is characterised by the following characteristics:

 

• Greater than 5 centimetres in diameter, with no involvement of underarm lymph nodes

 

• Greater than 2 centimetres in diameter but less than 5 centimetres in diameter, with lymph node involvement

 

• Breast cancer in stage IIIA or locally advanced breast cancer:

 

• A tumour that has spread to lymph nodes under the arm or near the breastbone and is larger than 5 centimetres.

 

• Any tumour with cancerous lymph nodes that cling to one another or to nearby tissue of any size.

 

• Breast cancer in stage IIIB. A tumour that has spread to the skin or chest wall of any size.

 

• Breast cancer in stage IIIC. Any tumour that has spread to more lymph nodes and has spread to a larger size.

 

• Breast cancer that has progressed to stage IV (metastatic). A tumour that has spread to places other than the breast, such as the bones, lungs, liver, brain, or distant lymph nodes, regardless of size.

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7. Treatment of Breast Cancer

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If the tests reveal breast cancer, you and your doctor will devise a treatment plan to eliminate the cancer, reduce the chances of it returning, and prevent it from spreading outside your breast. Following the diagnosis, treatment usually begins within a few weeks.

 

The size and location of the tumour, the results of lab tests on cancer cells, and the stage of the disease will all influence your treatment. Your doctor will usually take into account your age, general health, and feelings about the treatment options when making a decision.

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8. Treatment of Breast Cancer

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If the tests reveal breast cancer, you and your doctor will devise a treatment plan to eliminate the cancer, reduce the chances of it returning, and prevent it from spreading outside your breast. Following the diagnosis, treatment usually begins within a few weeks.

 

The size and location of the tumour, the results of lab tests on cancer cells, and the stage of the disease will all influence your treatment. Your doctor will usually take into account your age, general health, and feelings about the treatment options when making a decision.

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(a). Treatments carried out on a local level.

(I) Surgery

 

1. A breast-conserving procedure. Only the cancerous portion of the breast, as well as some surrounding tissue, is removed by the surgeon. The amount they take out is determined by factors such as the tumor's size and location. You may also hear it referred to as:

 

• Lumpectomy (removal of a lump)

 

• Quadrantectomy (removal of four quadrants)

 

• Mastectomy (partial)

 

• Mastectomy in segments

 

2. Lymph node removal surgery. Your doctor may remove lymph nodes from beneath your arm to see if cancer has spread there. This surgery is divided into two types:

 

• Biopsy of a sentinel lymph node. One or a few lymph nodes where cancer is most likely to spread are removed by the doctor.

 

• Dissection of the axillary lymph nodes. There are more nodes in this case, but usually fewer than 20.

 

3. Mastectomy (removal of the breasts). The entire breast, as well as all of the breast tissue and sometimes nearby tissues, is removed by a surgeon. Mastectomies come in a variety of forms:

 

• Mastectomy, either partial or total. The surgeon will remove your entire breast, but not the lymph nodes under your arm unless they are located within breast tissue.

 

• Radical mastectomy with modifications. Your entire breast, as well as lymph nodes under your arm, is removed by the surgeon.

 

• Mastectomy with a radical resection. Your entire breast, lymph nodes under your arm and up to your collarbone, as well as the chest wall muscles under your breast, are removed by the surgeon.

 

• Mastectomy with a portion of the breast removed. The cancerous breast tissue and some surrounding tissue are removed by the surgeon – usually more than in a lumpectomy.

 

• Mastectomy with a nipple-sparing technique. The surgeon removes all of your breast tissue except your nipple.

 

• Prophylactic mastectomy on the contralateral side. If you have cancer in one breast and are at a high risk of developing cancer in the other, you may want both breasts removed.

 

Radiation is number two. The type of surgery you had, whether your cancer has spread to your lymph nodes or elsewhere in your body, the size of your tumour, and sometimes your age all play a role in whether or not you get it. You could have one type or a mix of them:

 

• Radiation from an external beam. This type is generated by a machine that is external to your body. It's usually delivered 5 days a week for 5 to 6 weeks. The following are examples of external beam radiation:

 

• Radiation therapy that is hypofractionated. Larger doses are obtained with fewer treatments, usually only three weeks.

 

• Radiation therapy administered during surgery (IORT). This method involves receiving a single large dose of radiation in the operating room immediately following breast conservation surgery (before the wound is closed).

 

• Conformal radiotherapy in three dimensions. You receive radiation from special machines that can better target it at the tumor's location. Treatments will be given twice a day for five days.

 

• Radiation from within (brachytherapy). In this type, your doctor injects a radioactive substance into your body for a short period of time.

 

• Brachytherapy in the interstices. The doctor places several small, hollow tubes known as catheters into the breast near the cancerous area. They remain in place for a few days. Every day, doctors inject them with radioactive pellets for a short time.

 

Intracavitary brachytherapy is a type of intracavitary brachytherapy. For women with breast cancer, this is the most common type of brachytherapy. A small catheter is used by the doctor to insert a device into your breast. The device is widened and remains in place throughout the procedure. The other end of the cord protrudes from the breast. The doctor inserts radiation sources (usually pellets) into the device using a tube. As an outpatient, you'll usually get this twice a day for five days. The doctor collapses and removes the device after the final treatment.

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(b). Treatments that affect the whole body

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They eliminate or control cancer cells throughout your body. The following treatments are available:

 

1) Chemotherapy. These medications can be taken as pills or injected into a vein. If you have advanced breast cancer, it may be your only option. You can get it either before or after surgery (neoadjuvant chemotherapy) (adjuvant chemotherapy).

 

In stage III breast cancer, NNCN guidelines recommend neoadjuvant chemotherapy, while in stages I and II, upfront surgery is recommended.

 

2) Hormone replacement therapy. Certain hormones stimulate the growth of some cancers. These drugs prevent hormones from binding to cancer cells, halting their growth.

 

• Tamoxifen is a drug that is used to treat breast cancer (Nolvadex, Soltamox, Tamoxen)

 

• Fulvestrant (fulvestrant) (Faslodex)

 

• Aromatase inhibitors (Aromatase Inhibitors):

 

• Anastrozole is a type of anabolic steroids (Arimidex)

 

• Exemestane is a type of exemestane (Aromasin)

 

• Letrozole is a drug that is used to treat cancer (Femara)

 

Learn more about hormone therapy in the treatment of breast cancer.

 

3) Medications with a specific target. These drugs halt the changes that cause cells to proliferate uncontrollably.

 

• Abemaciclib is an abbreviation for "abemaciclib (Verzenio)

 

• Everolimus is a type of plant (Afinitor)

 

• Lapatinib is a drug that is used to treat cancer (Tykerb)

 

• Neratinib is a drug that is used to treat cancer (Nerlynx)

 

• Olaparib is a name given to a group of people (Lynparza)

 

• Palbociclib is a type of palbociclib (Ibrance)

 

• Pertuzumab is a type of antibody (Perjeta)

 

• Ribociclib is a type of ribociclib (Kisquali)

 

• Talazoparib is a drug that is used to treat cancer (Talzenna)

 

• Trastuzumab is a type of antibody (Herceptin)

 

• Kadcyla (trastuzumab emtansine)

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