Breast Cancer

Breast Cancer

Breast cancer is a condition in which abnormal cell growth occurs in the breast. While it can affect men, the disease is more common in women.

Types of Breast Cancer

Breast cancer types can be invasive (moves into the surrounding tissue) or non-invasive (stays in the ducts or lobes). Healthcare providers will often use the term "infiltrating" instead of invasive. Some types can also be named based on where the cancer begins. For example, ductal carcinoma begins in the lining of the milk ducts while another type, lobular carcinoma, begins in the lobules where breast milk is produced.

Invasive Breast Cancer

Invasive breast cancers make up 70 to 80 percent of all breast cancer cases. The most common type of invasive breast cancer is infiltrating ductal carcinoma (also called invasive ductal carcinoma). This type is found in approximately 60 percent of breast cancer cases. The second most common type of breast cancer is infiltrating lobular carcinoma (also called invasive lobular carcinoma), found in approximately 6 percent of breast cancer cases.

Other, less common, invasive types of breast cancer include:

• Infiltrating ductal and lobular carcinoma
• Inflammatory breast cancer
• Medullary carcinoma
• Mucinous carcinoma
• Paget's disease of the nipple
• Papillary carcinoma
• Tubular carcinoma.

Non-Invasive Breast Cancer

Non-invasive breast cancer types have not moved into the surrounding breast tissue. Therefore, the prognosis is good for these types of cancer.

Common non-invasive types of breast cancer include:

• Intraductal carcinoma, also known as ductal carcinoma in situ (DCIS)
• Lobular carcinoma in situ (LCIS).

Breast Cancer Causes

Scientists are not sure of the breast cancer causes in most cases of the disease. In 5 to 10 percent of breast cancer cases, there is a genetic reason for the breast cancer.

Genetic Influences

The genes in cells carry the hereditary information that is received from a person's parents. As mentioned, hereditary breast cancer makes up approximately 5 to 10 percent of all breast cancer patients. Some altered genes related to breast cancer are more common in certain ethnic groups.

Women who have an altered gene related to breast cancer and who have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast. These women also have an increased risk of developing ovarian cancer, and may have an increased risk of developing other cancers. Men who have an altered gene related to breast cancer also have an increased risk of developing this disease.

Tests have been developed that can detect altered genes. These genetic tests are sometimes done for members of families with a high risk of cancer.

Know the Risk Factors

While breast cancer risk factors are not specific breast cancer causes, they can increase the likelihood that a woman will get breast cancer.

Risk factors for breast cancer include the following:

• Older age
• Menstruating at an early age
• Older age at first birth or never having given birth
• A personal history of breast cancer or benign (non-cancerous) breast disease
• A mother or sister with breast cancer
• Treatment with radiation therapy to the breast/chest
• Breast tissue that is dense on a mammogram
• Taking hormones such as estrogen and progesterone
• Excessive drinking of alcoholic beverages
• Being white.

What Else Is Known About the Causes of Breast Cancer?

While all the breast cancer causes are not known, there is a lot that is known. Some things that are known about breast cancer causes include the following:

• Breast cancer is not caused by stress or by an injury to the breast.
• You cannot "catch" breast cancer from other women who have the disease. It is not contagious.
• You should not feel guilty. You haven't done anything wrong in your life that caused breast cancer.
• Most women who develop breast cancer do not have any known risk factors or a history of the disease in their families.

Is Pain a Warning Sign of Breast Cancer?

In its early stage, breast cancer usually does not cause pain. Still, a woman should see her healthcare provider about breast pain or any possible breast cancer symptoms as early as possible so that problems can be diagnosed and treated. Keep in mind that most often, problems in the breast are not actually due to cancer but to other, less serious, health problems.

Common Symptoms of Breast Cancer

Common signs and symptoms of breast cancer include:

• A change in how the breast or nipple feels
• A lump or thickening in or near the breast or in the underarm area
• Nipple tenderness
• A change in how the breast or nipple looks
• A change in the size or shape of the breast
• A nipple turned inward into the breast
• Nipple discharge (fluid).

Symptoms of Inflammatory Breast Cancer

Inflammatory breast cancer is a rare type of breast cancer. In inflammatory breast cancer, the lymph vessels around the breast become blocked. Symptoms of this type of breast cancer include a red, swollen, and warm breast. The skin of the breast may also appear pink, purple, or bruised, and it may have ridges or appear pitted, like the skin of an orange (called peau d'orange). These symptoms often occur quickly over a period of weeks.

Another possible symptom is swollen lymph nodes under the arm, above the collarbone, or in both places. Often, a tumor cannot be felt, and may not be seen on a mammogram.

Diagnosing Breast Cancer

In order to make a breast cancer diagnosis, your doctor may:

• Ask about your personal and family medical history.
• Perform a physical exam.
• Order a mammogram or other imaging procedure. These tests make pictures of tissue inside the breast.

After the tests, your doctor may decide that no other exams are needed, that you have a follow-up exam later on, or that you need to have a biopsy to look for cancer cells. A biopsy is a procedure in which a piece of tissue is removed so that it can be examined further.

Tests Used to Make a Breast Cancer Diagnosis

Certain exams and tests your doctor may use when diagnosing breast cancer include:

• Clinical breast exam
• Diagnostic mammogram
• Ultrasound
• MRI
• Biopsy
• Fine-needle aspiration
• Additional tests.

Breast Cancer Stages

To plan your treatment, your healthcare provider needs to know the extent of the disease. This is called the stage of breast cancer stage. This determination is based on such factors as the size of the tumor and whether the cancer has spread.

The different stages of breast cancer include:

• Stage 0 (including lobular carcinoma in situ and ductal carcinoma in situ)
• Stage I
• Stage II (including IIA and IIB)
• Stage III (including IIIA, IIIB, and IIIC)
• Stage IV
• Recurrent.

Stage 0 Breast Cancer

Stage 0 is carcinoma in situ. (In situ means "in place.") There are two types:

• Lobular carcinoma in situ (LCIS)
• Ductal carcinoma in situ (DCIS).

Lobular Carcinoma in Situ (LCIS)

In this type of breast cancer, abnormal cells are in the lining of a lobule. LCIS seldom becomes invasive cancer. However, having LCIS in one breast increases the risk of cancer in both breasts.

Ductal Carcinoma in Situ (DCIS)

With this cancer, abnormal cells are in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not spread outside the duct. They have not invaded the nearby breast tissue. DCIS sometimes becomes invasive cancer if not treated.

Stage I Breast Cancer

This stage of breast cancer is an early form of invasive breast cancer. In this case:

• The tumor is no more than 2 centimeters (three-quarters of an inch) across
• Cancer cells have not spread beyond the breast.
  
  

Stage II Breast Cancer

There are two types of stage II breast cancer:

• Stage IIA
• Stage IIB.

Stage IIA Breast Cancer

In stage IIA breast cancer:

• No tumor is found in the breast, but cancer is found in the axillary lymph nodes (the lymph nodes under the arm)
• The tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes
• The tumor is larger than 2 centimeters but no larger than 5 centimeters and has not spread to the axillary lymph nodes.

Stage IIB Breast Cancer

In stage IIB breast cancer, the tumor is either:

• Larger than 2 centimeters but no larger than 5 centimeters and has spread to the axillary lymph nodes
• Larger than 5 centimeters but has not spread to the axillary lymph nodes.

Stage III Breast Cancer

This form of breast cancer may be a large tumor, but the cancer has not spread beyond the breast and into nearby lymph nodes. It is locally advanced cancer. There are three types:

• Stage IIIA
• Stage IIIB
• Stage IIIC.

Stage IIIA Breast Cancer

Stage IIIA breast cancer is one of the following:

• The tumor in the breast is smaller than 5 centimeters (2 inches) across. The cancer has spread to underarm lymph nodes that are attached to each other or to other structures.
• The tumor is more than 5 centimeters across. The cancer has spread to the underarm lymph nodes.

Stage IIIB Breast Cancer

Stage IIIB breast cancer is one of the following:

• The tumor has grown into the chest wall or the skin of the breast
• The cancer has spread to lymph nodes behind the breastbone.

Stage IIIC Breast Cancer

This breast cancer stage refers to a tumor of any size. It has spread in one of the following ways:

• The cancer has spread to the lymph nodes behind the breastbone and under the arm
• The cancer has spread to the lymph nodes under or above the collarbone.

Stage IV Breast Cancer

Stage IV breast cancer is distant metastatic cancer. The cancer has spread to other parts of the body.

Breast Cancer Treatment

Different types of treatment are available for people with breast cancer. Treatment options vary based on:

• The stage of the cancer
• The breast cancer type
• Estrogen-receptor and progesterone-receptor levels in the tumor tissue
• A person's age, general health, and menopausal status (whether a woman is still having menstrual periods)
• Whether the cancer has just been diagnosed or has recurred (come back).

Treatment of breast cancer consists of either local therapy or systemic therapy:

Local Therapy

Surgery or radiation therapy is local breast cancer treatment. These types of treatments remove or destroy cancer in the breast. When breast cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.

Systemic Therapy

Chemotherapy, hormone therapy, and biological therapy are types of systemic breast cancer treatment. They enter the bloodstream and destroy or control cancer throughout the body. Some women with breast cancer have systemic therapy to shrink the tumor before surgery or radiation. Others have systemic therapy after surgery and/or radiation to prevent the cancer from coming back. Systemic breast cancer treatment is also used for cancer that has spread.

Your doctor can describe your treatment choices and the expected results of each. You and your doctor can work together to develop a treatment plan that meets your medical needs and personal values. Choosing the most appropriate treatment is a decision that ideally involves the patient, family, and healthcare team.

Remembering Questions and Answers

Many people with breast cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and breast cancer treatment choices. Knowing more about breast cancer helps many women cope.

Shock and stress after the breast cancer diagnosis can make it hard to think of everything you want to ask your doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor -- to take part in the discussion, to take notes, or just to listen. You do not need to ask all your questions at once. You will have other chances to ask your doctor or nurse to explain things that are not clear and to ask for more details.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat breast cancer include surgeons, medical oncologists, and radiation oncologists. You also may be referred to a plastic surgeon.

Possible Side Effects of Breast Cancer Treatment

Because treatment for breast cancer often damages healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next.

Before treatment starts, your breast cancer healthcare team will explain possible side effects and suggest ways to help you manage them. Also, at any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of the treatment, and to ease emotional concerns.

Getting a Second Opinion

Before starting treatment for breast cancer, you might want a second opinion about your diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather medical records and arrange to see another doctor. You may have to gather your mammogram films, biopsy slides, pathology reports, and proposed breast cancer treatment plan. Usually, it is not a problem to take several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some women with breast cancer need treatment right away.

Follow-up Care

Follow-up care after treatment for breast cancer is important. Even when there are no longer any signs of cancer, the disease sometimes returns because undetected cancer cells remain somewhere in the body after breast cancer treatment.

During follow-up for breast cancer treatment, your doctor will monitor recovery and check for recurrence of the cancer. Checkups help ensure that any changes in your health are noted and treated if needed. Between scheduled visits, you should contact the doctor if you have any health problems.

Breast Cancer Research

Scientists conducting research on breast cancer are actively looking for new ways to prevent, diagnose, detect, and treat the disease. This research has led to new advances in surgery, new medications, and possible new early-detection methods. Research is also focused on lessening the side effects from current treatments for breast cancer.