Breast cancer treatment

Breast Cancer, Malignant Neoplasm of Breast

Basic Information

What is Breast cancer?

A malignant growth of breast tissue. Breast cancer can spread to nearby lymph glands, lungs, pleura, bone (especially the skull), pelvis and liver. Breast cancer is rare before age 30, the peak ages are from 45 to 65. The incidence increases after menopause.

Breast cancer is a disease in which cancerous cells develop in the tissues of the breast. It is the most commonly diagnosed cancer in women in the US. Approximately 186,000 cases are diagnosed and 45,000 deaths occur annually. The incidence of breast cancer is gradually increasing. The most common type of breast cancer is ductal cancer, originating in the ducts of the breast. A less common type of breast cancer is known as lobular cancer, which begins in the breast lobes and is more likely to spread to both breasts. About fifteen to twenty percent of these breast cancers prove to be carcinoma in situ (CIS) which means that the cancerous cells have not spread outside the breast ducts or lobes. A number of factors have been identified that strongly increase the risk that a woman will develop breast cancer. Having a first-degree relative (mother, sister, or daughter) with a history of breast cancer or having a personal history of breast biopsies that reveal pre-cancerous cells are risk factors. Other strong risk factors include having had a previous personal diagnosis of breast cancer. A small percentage (one to five-percent) of breast cancers will develop in women with a genetic predisposition (genes BRCA1, BRCA2 and other genes to be identified) to the disease. Additional risk factors for breast cancer include young (less than eleven years) age at onset of menstruation, delayed childbirth after the age of 30, having had no children, late age at onset of menopause (greater than fifty years), and a high fat, low fiber diet. There are no known preventive strategies for breast cancer at this time. It is known that breast cancer incidence has a strong association with exposure to estrogen produced by a woman's own body as well as estrogen that is taken in prescription form for symptoms of menopause. Breast cancer risk can be reduced significantly in women who have had one or both ovaries removed, which reduces exposure to estrogen. Diets limited to twenty percent fat and regular exercise may reduce risk of breast cancer.

How is Breast cancer diagnosed?

  • History will be of a lump or thickening in the breast or armpit, a change in the size or shape of the breast, dimpling or puckering of the skin of the breast, a discharge from the nipple, especially if it is bloody, or changes in the color or feel of the skin of the breast or nipple.
  • Physical exam of the breast is done to confirm any of the above findings. The armpits are examined for any evidence of breast mass or enlarged lymph nodes; the neck is also examined for enlarged lymph nodes. A nipple discharge might be produced by gently squeezing the nipples. In early cases, physical examination of the breasts may be negative.
  • Tests: Women with any suspicious breast changes may be referred for more detailed examination by mammography or ultrasound. Mammography can focus on an area of change and help decide if there is suspicion of cancer, and if further evaluation is necessary. Ultrasound can help discriminate between a solid and a fluid-filled lump, with solid lesions more likely to require surgical evaluation and possible biopsy. Biopsies can be either an open, surgical biopsy, which removes the entire lump, or a needle biopsy in which samples of cells are removed from the lesion. In both cases, the biopsy sample is examined microscopically to determine if breast cancer cells are present.

Three screening methods are currently recommended to women eighteen years and older to detect breast cancer in its earliest, most treatable stage. Specifically, monthly self-exams and annual breast exams are recommended for women 18 to 40 years of age. Women aged 40 to 49 are encouraged to continue these exams and to begin having mammograms every year to two years; annual mammography is recommended for women 50 years and older, combined with monthly self exams and annual exams by a health care professional.

Breast cancer signs and symptoms

No symptoms in early stages, but pre-symptom stages may be detected by mammogram.

  • Swelling or lump in the breast.
  • Vague discomfort in the breast without true pain.
  • Retraction of the nipple.
  • Distorted breast contour.
  • Dimpled or pitted skin in the breast.
  • Enlarged nodes under the arm (late stages).
  • Bloody discharge from the nipple (rare).

Causes

Unknown.

Risk increases with

  • Women over 50.
  • Women who have not had children or who conceived in the late fertile years.
  • Family history of breast cancer (especially mother or sister).
  • Previous benign tumors of the breast (fibrocystic disease).
  • Early menstruation; late menopause; first pregnancy after age 30.
  • Previous breast cancer in one breast.
  • Radiation exposure.
  • Patients with endometrial or ovarian cancer.
  • Studies of estrogen replacement therapy are inconsistent and not conclusive regarding their role in increasing breast cancer risk.

Preventive measures

  • Monthly self-examination of breasts for signs of cancer.
  • Obtain professional examinations regularly.
  • Obtain a baseline mammogram between ages 35 to 40. Have mammograms every 1 to 2 years to age 49 and annually after 50.
  • Eat a well-balanced diet that is low in fat. (Studies are inconclusive about a high-fat diet and breast cancer risks in humans).
  • If you are pregnant, consider breast-feeding your baby. Women who have breast-fed have a lower incidence of breast cancer.
  • A drug, such as tamoxifen, may be prescribed for women at high risk for breast cancer.

Expected outcomes

Breast cancer is curable if diagnosed and treated early. The 10-year survival rate is related to the clinical stage of the disease at diagnosis.

Possible complications

  • Spread to vital organs if not treated early.
  • Adverse reactions to anticancer drugs and radiation.
  • Postsurgical complications (wound infection, limited shoulder motion).

Breast cancer treatment

General measures

  • Diagnostic tests include a physical exam, biopsy, and mammogram. After diagnosis, other tests such as ultrasound, bone scan, chest X-ray, and liver scan are performed.
  • The decision for treatment is very complex and often confusing. Be sure all options are explained and that the risks and benefits of each are thoroughly understood. It is important for you to be an informed and participating member of your health care team.
  • Surgery (mastectomy) to remove the lump, or breast, lymph glands, lymphatic channels and muscles under the breast (sometimes).
  • Radiation therapy (sometimes).
  • Hormonal or chemotherapy (sometimes).
  • Additional information available from:

Medications

Arimidex (Anastrozole), Premarin (Conjugated Estrogens), Evista (Raloxifene), Femara (Letrozole)

  • For minor discomfort during treatment, you may use non-prescription drugs such as acetaminophen or aspirin.
  • Other drugs that may be prescribed:
    • Pain relievers.
    • Anticancer drugs, such as fluorouracil, cyclophosphamide, methotrexate, chlorambucil, vincristine, doxorubicin or melphalan.
    • Hormones (male and female).
    • Cortisone drugs.

Activity

  • If surgery is performed, resume normal activities gradually.
  • Exercise for rehabilitation following surgery will depend on how much tissue has been removed and on your general physical condition.

Diet

No special diet. Maintain good nutrition.

Notify your physician if

  • You or a family member discovers a lump or other change in the breast.
  • The following occur after treatment or surgery:
    • Nausea or vomiting, fever, swelling in the arm.
    • Pain that is not controlled by medication.
  • New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

Last updated 8 August 2011


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