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Breast Cancer

Definition


Disease: Breast Cancer Breast Cancer
Category: Breast Diseases
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Disease Definition:

Although breast cancer is far more common in women, however, it can also occur in men. Breast cancer is cancer that forms in the cells of the breasts.
For some unknown reasons, breast cancer rates have fallen in recent years. For many women, the most feared disease is breast cancer.
The diagnosis and treatment of breast cancer has improved with the help of public support for breast cancer awareness and research funding. Thanks to earlier detection, new treatments and a better understanding of the disease, breast cancer survival rates have increased and the number of deaths has been declining.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Some of the signs and symptoms of breast cancer include:

  • Bloody discharge from the nipple
  • Dimpling or other changes to the skin over the breast
  • Redness or pitting of the skin over the breast, like the skin of an orange
  • Change in the size or shape of the breast
  • A breast lump or thickening that feels different from the surrounding tissue
  • Peeling or flaking of the nipple skin
  • Inverted nipple.


A person should contact their doctor in case they find a lump or some other change in their breast, even if a recent mammogram was normal.

Causes:

When some breast cells begin growing abnormally, breast cancer occurs, but the exact cause of this change is still not clear. The abnormal cells divide more rapidly than healthy cells do. These cells accumulate and may spread (metastasize) through the breast to the lymph nodes or to other parts of the body.
Usually, breast cancer begins with cells in the milk-producing ducts. This type is called invasive ductal carcinoma. However, breast cancer could also begin in the lobules and this type is called invasive lobular carcinoma, or it could begin in the cells within the breast.
Some factors have been identified that can increase the risk of breast cancer. However, it is still not clear why some people who have risk factors never develop breast cancer, while people with no risk factors do. The cause of breast cancer is most likely due to a complex combination of a person's genetic makeup and their environment.

Inherited breast cancer:
It has been estimated that 5 – 10% of breast cancers are due to gene mutation passed through generations of a family. A number of inherited defective genes that can increase the likelihood of breast cancer have been identified. The most common are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), both of which increase the risk of both breast and ovarian cancer.
Blood tests could help identify defective BRCA or other genes that are passed through someone's family, in case they have a strong family history of breast cancer or other cancers. A person should ask the doctor to refer them to a genetic counselor that can review their family health history and discuss the benefits, risks and limitations of genetic testing.

Complications

Complications:

None

Treatments:

Treatment options available for a person's breast cancer will be determined based on:

  • The type and stage of the breast cancer
  • Whether the cancer cells are sensitive to hormones
  • The patient's overall health
  • The patient's own preferences.


Most women receive treatments such as hormone therapy, chemotherapy or radiation, in addition to surgery.

Because there are many options for breast cancer treatment, a person should consider seeking a second opinion from a breast specialist in a breast center or clinic, and talk to other women who have faced the same thing.

Some of the operations that are used to treat breast cancer are:

MASTECTOMY (REMOVING THE ENTIRE BREAST):
Mastectomy can be either simple or radical. In case it is simple, only the breast tissue is removed completely, including the lobules, ducts, fatty tissue and skin, along with the nipple and areola. However, if it’s radical, in addition to the breast tissue, the underlying muscle of the chest wall is also removed along with surrounding lymph nodes in the armpit.

LUMPECTOMY (REMOVING THE BREAST CANCER):
This procedure is reserved for smaller tumors that are easily separated from the surrounding tissue. In this procedure, the tumor and a small margin of surrounding healthy tissue is removed.

SENTINEL NODE BIOPSY (REMOVING ONE LYMPH NODE):
Because breast cancer that spreads to the lymph nodes may spread to other areas of the body, which lymph node near the breast tumor receives the lymph drainage from the cancer is determined, and then removed and tested for breast cancer cells. In case no cancer cell is found, the chance is extremely small of finding cancer in any of the remaining nodes, and so no other nodes need to be removed.

AXILLARY LYMPH NODE DISSECTION (REMOVING SEVERAL NODES):
The additional lymph nodes in the armpit are removed in case cancer is found in the sentinel node. To help determine the best course of treatment, including whether the patient will need radiation therapy or chemotherapy, the doctor should know if cancer has spread to the lymph nodes or not.
Generally, surgery carries a risk of bleeding and infection. Complications of breast cancer surgery depend on the procedures that the patient chooses; for instance, surgery to remove your lymph nodes increases the risk of lymphedema (arm swelling).
In case a woman chooses to have breast reconstruction after surgery, which could be performed at the time of the mastectomy or at a later date, she should discuss her options and preferences with her surgeon. She should also consider referral to a plastic surgeon before her breast cancer surgery. Breast reconstruction has these options:

  • Reconstruction with a synthetic breast implant
  • Reconstruction using the patient's own tissue.


RADIATION THERAPY:
X-rays or other beams of high-energy particles are used in radiation therapy in order to kill cancer cells. Although in some rare cases radiation is placed inside the body (brachytherapy), but usually radiation therapy comes from a machine outside the body (external beam radiation).
Although radiation therapy might be recommended after mastectomy for larger breast cancers, but usually, it is recommended after lumpectomy for early-stage breast cancer.

Fatigue and a red, sunburn-like rash where the radiation is aimed are some of the side effects of radiation therapy. Breast tissue might also appear swollen or more firm. However, in some rare cases, more serious problems might occur, such as lymphedema (arm swelling), damage to the lungs or nerves and broken ribs.

CHEMOTHERAPY:
In chemotherapy, drugs are used to kill cancer cells. Chemotherapy will be recommended after surgery in case a person's cancer has a high chance of returning or spreading to another part of the body. In this case, chemotherapy drugs are used to decrease the chance of cancer’s recurrence. This method is called adjuvant systemic chemotherapy.
For women whose cancer has already spread to other parts of the body chemotherapy is recommended in order to try to control the cancer and decrease any symptoms the cancer is causing.
Neoadjuvant chemotherapy is a method in which chemotherapy drugs are given before surgery to women with larger breast tumors in order to shrink the tumor to a size that makes it easier to remove with surgery. This method increases the chance of a cure.
In order to determine exactly who could benefit from this treatment, researches are still ongoing.
Vomiting, hair loss, frequent infections, fever and nausea are some of the side effects of chemotherapy, which usually depend on the drugs that the patient is taking.

HORMONE THERAPY:
To treat estrogen and progesterone receptor positive cancers, which are cancers that are sensitive to hormones, hormone blocking therapy is used.

To decrease the chance of the cancer returning, a person can use hormone therapy after surgery. Hormone therapy could also shrink and control the cancer if it has already spread.

Some of the treatments that may be used in hormone therapy are:

Medications or surgery to stop hormone production in the ovaries:
The hormone production could be shut down in some premenopausal women due to surgery or medications.
Menopausal symptoms, such as vaginal dryness, hot flashes, mood changes and decreased sex drive are some of the common side effects of hormone therapy, but they usually vary depending on the medication that the patient is receiving.

Medications that block hormones from attaching to cancer cells.
SERMs (selective estrogen receptor modulators) act by preventing the estrogen present in the body from attaching to the estrogen receptor on the cancer cells, which slows the growth of tumors and kills tumor cells. An example of SERM is tamoxifen, which could be used in both pre- and postmenopausal women.

Medications that stop the body from making estrogen after menopause:
These drugs are called aromatase inhibitors and include letrozole , exemestane  and anastrozole . The action of an enzyme that converts androgens in the body into estrogen is blocked by these medications. These medications are only effective in postmenopausal women. An increased risk of bone thinning (osteoporosis) and joint and muscle pain are some of the side effects of aromatase inhibitors.


TARGETED DRUGS:
Some of the targeted drugs that attack specific abnormalities within cancer cells, and that are approved to treat breast cancer include:

Bevacizumab :
The signals that cancer cells use to attract new blood vessels are stopped by this medication, which is designed especially for this task. The cancer cells die without new vessels to bring oxygen and other nutrients to the tumor. This medication is usually approved for breast cancers that have spread to other areas of the body.

Trastuzumab :
HER2 proteins are targeted by this medication that helps some breast cancer cells to grow and survive. Trastuzumab might help block HER2, in case breast cancer cells make too much of it, which will cause the cancer cells to die.

Lapatinib :
This medication is approved for use in advanced breast cancer, which targets HER2 protein. This medication is reserved for women who tried trastuzumab and their cancer progressed nonetheless.

Usually, the side effects of targeted drugs depend on the drug that the patient is receiving.

Prognosis:

Not Available

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