Breast Cancer

Early Stage Breast Cancer - Stage I, II and III

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Breast Cancer is established as one of the nation's most formidable enemies in the healthcare landscape. It is one of the most common cancers amongst Indian women; every year as many as 100,000 women develop breast cancer in the country. This high incidence is poised to rise to an even more unmanageable number.



Overview

Breast cancer is a malignant tumor in which the abnormal cells in the breast divide and multiply uncontrollably. The cells can invade nearby tissue and can spread through the bloodstream and lymphatic system to other parts of the body

There are 3 major subtypes of breast cancer in women. It can be determined by specific tests on the tissue sample.

Subtypes
HR+ve (Hormone receptor-positive)
  • Approx 60-75% of tumors express proteins in and on the cell surface. Tumors that have estrogen receptors are called “ER-positive.” Tumors that have progesterone receptors are called “PR-positive.”
HER2+ve (HER2-positive)
  • About 20% to 25% of breast cancers depend on the gene called human epidermal growth factor receptor 2 (HER2) to grow. These cancers are called “HER2-positive” and have excessive numbers of HER2 receptors or copies of the HER2 gene. The HER2 gene makes a protein that is found on the cancer cell and is important for tumor cell growth.
  • Cancers that do not express the HER2 protein are called as HER2-ve (HER2 negative)
Triple Negative Breast Cancer
  • If a tumor does not express ER, PR, and/or HER2, the tumor is called “triple-negative.” Triple-negative breast cancer makes up about 15% of invasive breast cancers.
  • Triple-negative cancer is also more common in women with a mutation in the breast cancer genes 1 and 2, commonly called BRCA1 and BRCA2 genes. Experts recommend that all people with triple-negative breast cancer be tested for BRCA gene mutations

Ductal/Lobular classification

Most breast cancers start in the ducts or lobes and are called ductal carcinoma or lobular carcinoma. Breast cancer can be invasive or noninvasive. Invasive breast cancer is cancer that spreads into surrounding tissues. Noninvasive breast cancer does not go beyond the milk ducts or lobules in the breast.

Classification Description
Ductal carcinoma These cancers starts in the cells lining the milk ducts and make up the majority of breast cancers.
Ductal carcinoma in situ (DCIS) This is cancer that is located only in the duct. When a cancer spreads outside the ducts, it is called as invasive or infiltrating ductal carcinoma.
Lobular carcinoma. This is cancer that starts in the lobules. Lobular carcinoma in situ (LCIS). LCIS is located only in the lobules. LCIS is not considered cancer. However, LCIS is a risk factor for developing invasive breast cancer in both breasts

Risk Factors

Both exposure (environmental or occupational) to particular agents & an individual’s susceptibility to these agents are thought to contribute to one’s risk of developing breast cancer

Gender Breast cancer is ~100 times more common among women than men
Family History Risk is higher among women whose close blood relatives have this disease
Age Only 12 % of invasive breast cancers are found in women < 45, while 66% of invasive breast cancers are found in women > 55
Race Caucasian women are slightly more likely to develop breast cancer than are African-American women
Density of Breast Tissue Women with denser breast tissue (as seen on a mammogram), which have more glandular tissue and less fatty tissue, have a higher risk of breast cancer (not due to the density, but due to the fact that the density makes imaging difficult)

Symptoms

The following are the common symptoms of breast cancer

Symptoms
Lump in a breast
Pain in the armpits or breast that does not seem to be related to the woman's menstrual period
Pitting or redness of the skin of the breast; like the skin of an orange
Rash around (or on) one of the nipples
Swelling (lump) in one of the armpits
An area of thickened tissue in a breast
One of the nipples has a discharge; sometimes it may contain blood
The nipple changes in appearance; it may become sunken or inverted
Changes in the size and shape of the breast
Peeling of, scaly or flaky skin on breasts and nipples
Bone pain and symptoms of hypercalcemia
Abdominal distention and jaundice

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Diagnosis

Both Imaging and clinical tests are done for diganosis of breast cancer. The most common test is a Mammogram. However, a mammogram is not sufficient to confirm cancer and hence patients usually undergo additional tests like biopsy and other pathological tests to confirm cancer.

Test
X Ray
PET-CT Scan
Mammogram
MRI & Bone Scan
Biopsy

Treatment Options

The biology and behavior of breast cancer affects the treatment plan. Some tumors are smaller but grow fast, while others are larger and grow slowly. Treatment options and recommendations are very personalized and depend on several factors, including:

Stage of the tumor
Factors affecting Treatment of breast cancer
Tumor’s subtype including hormone receptor status (ER, PR) and HER2 status
Genomic markers
Patient’s age, general health, menopausal status, and preferences
Presence of known mutations in inherited breast cancer genes, such as BRCA1 or BRCA2
Treatment Approaches Approach
Surgery

Surgery is one of the most common treatments in breast cancer with partial/complete removal of the affected breast being done as per the disease.


In a few cases, physicians may prescribe hormonal therapy,chemotherapy or systemic therapy before the surgery. This is called as neo-adjuvant surgery

Chemotherapy

Triple-negative breast cancer cells don’t have estrogen or progesterone receptors and also don’t have too much of the protein called HER2. Triple-negative breast cancers grow and spread faster than most other types of breast cancer. Because the cancer cells don’t have hormone receptors, hormone therapy is not helpful in treating these cancers. And because they don’t have much HER2, drugs that target HER2 aren’t helpful, either. Chemotherapy is usually the standard treatment.


Further Reading

There are many resources on the net for reading further about cancer

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