Testing For Proteins And Genes
The breast cancer cells will be tested for certain proteins called estrogen and progesterone receptors. If the cancer has these proteins, it’s called a hormone receptor positive breast cancer. The cells are also tested to see if the cancer makes too much of the HER2 protein. If it does, it’s called a HER2-positive cancer. These cancers are sometimes easier to treat. If the cancer doesn’t test positive for any of these proteins, it’s called a triple-negative breast cancer.
The cells might also be tested for certain genes, which can help decide if chemo might be helpful and how likely it is that the cancer will come back. Ask your doctor to explain the tests they plan to do, and what the results might mean.
Breast Lumps: Why Size Movability And Pain Matter
Your breasts are made up of fat, nerves, blood vessels, fibrous connective tissue, and glandular tissue, as well as an intricate system of milk-producing lobules , and ducts . This anatomy in and of itself creates a lumpy, uneven terrain.
A lump in the breast distinguishes itself from this background of normal irregularities. Harmless breast lumps can be solid and unmovable, like a dried bean; or movable, soft, and fluid-filled you can roll it between your fingers like a grape. A lump may be pea-size, smaller than a pea, or even several inches across, although this larger size is rare.
What typically differentiates a benign breast lump from a cancerous breast lump is movement. That is, a fluid-filled lump that rolls between the fingers is less likely to be cancerous than a hard lump in your breast that feels rooted in place.
Another rule of thumb has to do with pain. Breast cancer does not usually cause pain. Benign conditions sometimes do, although there are exceptions to this rule as well. For instance, a rare form of breast cancer, inflammatory breast cancer, may cause symptoms such as aching, tenderness, pain, or burning in the breast.
The only way to know the status of a lump for sure is through medical tests, such as;an ultrasound, a mammogram, or a fine needle aspiration , in which your doctor uses a tiny needle to extract a bit of the lump for laboratory examination.
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Types Of Breast Cancer
There are several different types of breast cancer, which develop in different parts of the breast.
Breast cancer is often divided into either:
- non-invasive breast cancer ;;found in the ducts of the breast which has not spread into the breast tissue surrounding the ducts. Non-invasive breast cancer is usually found during a mammogram and rarely shows as a breast lump.
- invasive breast cancer where the cancer cells have spread through the lining of the ducts into the surrounding breast tissue. This is the most common type of breast cancer.
Other, less common types of breast cancer include:
- invasive lobular breast cancer
- inflammatory breast cancer
It’s possible for breast cancer to spread to other parts of the body, usually through the blood or the axillary lymph nodes. These;are small lymphatic glands that filter bacteria and cells from the mammary gland.
If this happens, it’s known as secondary, or metastatic, breast cancer.
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How Common Is Breast Cancer Recurrence
Most local recurrences of breast cancer occur within five years of a lumpectomy. You can lower your risk by getting radiation therapy afterward. You have a 3% to 15% chance of breast cancer recurrence within 10 years with this combined treatment. Based on genetic testing, your provider may recommend additional treatments to further reduce your risk.
Recurrence rates for people who have mastectomies vary:
- There is a 6% chance of cancer returning within five years if the healthcare providers didnt find cancer in axillary lymph nodes during the original surgery.
- There is a one in four chance of cancer recurrence if axillary lymph nodes are cancerous. This risk drops to 6% if you get radiation therapy after the mastectomy.
Breast Hematomas Present Some Risks For Secondary Health Complications
Physicians and specialists need to keep a very close eye on;hematomas because they can be a risk for secondary health complications.
Whilst hematomas have nothing to do with cancer or anything of that nature they do pose a risk for infection. Bacteria can sometimes infect the blood underneath the tissue. Symptoms of infection include swelling, pain and fever.
Skin discoloration is also a common side-effect. A special concern is for women with any medical history of hemopathy and coagulation disorders, or those taking anticoagulant drugs.
Some doctors might even suggest a patient keep away from certain pain killers which have been known to hinder the blood-clotting process.
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What Should I Ask My Healthcare Provider About Metastatic Breast Cancer
If youve been diagnosed with metastatic breast cancer, ask your provider:
- What are my treatment options?
- What is my prognosis?
- What side effects can I expect?
- Will complementary therapy help me feel better?
- What if I want to stop treatment?
- How can I feel my best during treatment?
A note from Cleveland Clinic
Metastatic breast cancer is advanced breast cancer. Providers classify it as stage 4 breast cancer. It happens when cancer cells, often left behind after previous breast cancer treatment, start to spread to other parts of the body. While there is no cure for metastatic breast cancer, treatment can prolong your life and help you feel better. There are many medications available, so if one treatment isnt working, your care team can try a different approach. If you notice any symptoms or dont feel your best, especially if youve undergone breast cancer treatment in the past, talk to your healthcare provider.
Last reviewed by a Cleveland Clinic medical professional on 04/14/2021.
Symptoms Of Secondary Breast Cancer
The symptoms of secondary breast cancer depend on the part of the body the cancer has spread to. In this section we explain the general symptoms, and some of the more specific symptoms you may experience.;
All the symptoms mentioned here can be caused by other conditions. But if you have any of these symptoms it’s important to get them checked out by your doctor or specialist nurse. Always let them know if you develop any new symptoms, especially if they last more than a week or two.
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Breast Lumps Or Lumpiness
Many womens breasts feel lumpy. Breast tissue naturally has a bumpy texture.
Some women have lumpier breasts than others. In most cases, this lumpiness is no cause to worry.
If the lumpiness can be felt throughout the breast and feels like your other breast, then its probably normal breast tissue.
Lumps that feel harder or different from the rest of the breast or that feel like a change are a concern and should be checked. This type of lump may be a sign of breast cancer or a benign breast condition .
See a health care provider if you:
- Find a new lump that feels different from the rest of your breast
- Find a new lump that feels different from your other breast
- Feel something thats different from what you felt before
If youre not sure whether you should have a lump checked, see your provider.
It may be helpful to download and print Susan G. Komen®s Questions to Ask Your Doctor If You Find a Lump or Change in Your Breast resource and take it with you to your doctor appointment. Theres plenty of space to;write down the answers to these questions, which you can refer to later.
There are other;Questions to Ask Your Doctor resources on many different breast cancer topics you may wish to download.
Symptoms Elsewhere In The Body
Sometimes breast cancer cells can spread from the breast to other parts of the body. This is known as secondary breast cancer.;
Some symptoms to be aware of include:
- unexpected weight loss and a loss of appetite
- severe or ongoing headaches
Find out more about the symptoms of secondary breast cancer.
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How Does The Doctor Know I Have Breast Cancer
A change seen on your mammogram may be the first sign of breast cancer. Or you may have found a lump or other change in your breast.
The doctor will ask you questions about your health and will do a physical exam. A breast exam is done to look for changes in the nipples or the skin of your breasts. The doctor will also check the lymph nodes under your arm and above your collarbone. Swollen or hard lymph nodes might mean breast cancer has spread there.
If signs are pointing to breast cancer, more tests will be done. Here are some of the tests you may need:
Mammogram: This is an x-ray of the breast. Mammograms are mostly used to find breast cancer early. But another mammogram might be done to look more closely at the breast problem you might have.
MRI scan: MRIs use radio waves and strong magnets instead of x-rays to make detailed pictures. MRIs can be used to learn more about the size of the cancer and look for other tumors in the breast.
Breast ultrasound: For this test, a small wand is moved around on your skin. It gives off sound waves and picks up the echoes as they bounce off tissues. The echoes are made into a picture that you can see on a computer screen. Ultrasound can help the doctor see if a lump is a fluid-filled cyst , or if it’s a tumor that could be cancer.
Nipple discharge exam: If you have fluid coming from your nipple, some of it may be sent to a lab. There, it will be checked to see if there are cancer cells in it.
Breast Pain And Breast Cancer In Men
As with breast cancer in women, breast cancer in men;is often painless.;That said, it tends to push on nearby structures more rapidly than a tumor would in most women. In addition, hormone-induced breast pain is also, of course, less likely to occur in men. If you are a man experiencing breast pain, play it safe.;Breast cancer can and does occur in men, and though only one in 100 breast cancers occurs in men, that’s still far too frequent.
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How To Perform A Male Self
A person can perform the following steps:
When To Seek Medical Attention
Pain, discomfort, and minor changes to the breasts arent always an indication of IBC. Sometimes, they can be due to another underlying condition.
However, since IBC is aggressive, early diagnosis and treatment are important. If you have any of the symptoms mentioned above or have noticed any abnormal changes to your breasts, consult with a doctor as soon as possible.
One of the most important ways to prepare for your appointment is by keeping track of symptoms youre concerned about. If possible, write down notes about:
- when the symptoms began
- how the symptoms feel
- anything else your doctor might need to know
After you and your doctor have reviewed your symptoms, they will likely perform a physical exam and review of your medical history to determine if there are other reasons for your symptoms.
Its likely that your doctor will also want to perform diagnostic testing, which may include:
If you have been diagnosed with IBC, treatment will begin right away and usually includes chemotherapy to reduce the size of the tumor, followed by surgery and radiation therapy.
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Family Members Loved Ones And Caregivers
You may worry about how your illness and care will affect your family and loved ones. This is a very tough journey to travel alone, and everyone needs help and support from those close to them. It can be hard to know how to start who to talk to and what to say. You may want to read Telling Others About Your Cancer. If there are children in your family, you may also want to read Helping Children With Cancer in the Family: Dealing With Recurrence or Progressive Illness.
If youre part of a couple, your partner may step up and offer to help you get back and forth to treatment, go with you to appointments, and help you deal with treatment side effects. Singles may need to find a friend or family member who can help in these ways. Whether its your spouse, partner, friend, or other relative, the person who helps you get your cancer treatments and manage side effects is called a caregiver. This is someone who wants to help and support you, but in order to do that they will need their own support and help. They can start by reading What It Takes to Be a Caregiver or call us for more information.
Surgery For Breast Cancer
Most women with breast cancer have some type of surgery. Common types of breast surgery are lumpectomy, mastectomy, and taking out lymph nodes from the underarm. Women who have a mastectomy may also decide to have the breast shape rebuilt, either at the same time or later on.
Choosing between lumpectomy and mastectomy
Lumpectomy only takes out the lump and a little bit around it. It lets you keep most of your breast. The downside is that youll most likely need radiation treatment after surgery. But some women who have a mastectomy also need radiation afterward.
When choosing between a lumpectomy and mastectomy, be sure to get all the facts. At first you may think that a mastectomy is the best way to get it all out. Some women tend to choose mastectomy because of this. But in most cases, lumpectomy is just as good as mastectomy. Talk to your cancer care team. Learn as much as you can to make the right choice for you.
If you have a mastectomy, you may want to think about having your breast shape rebuilt. This is called breast reconstruction. Its not done to treat the cancer. Its done to build a breast shape that looks a lot like your natural breast.
If youre going to have a mastectomy and are thinking about having reconstruction, you should talk to a plastic surgeon before the mastectomy is done. Your breast can be rebuilt at the same time the mastectomy is done or later on.
Side effects of surgery
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What Is Hospice Care
If at some point treatment can no longer control the cancer or the benefits no longer outweigh the side effects, you may feel better with hospice care. The hospice philosophy accepts death as the final stage of life and does not try to stop it or speed it up. The goal of hospice is to help patients live as alertly and comfortably as possible during their last days. Most of the time, hospice care is given at home. It can also be given in hospitals, nursing homes, and hospice houses. Your cancer may cause symptoms or problems that need attention, and hospice focuses on your comfort. If youd like to learn more about this, see Hospice Care.
What Is The Goal Of This Treatment
Radiation therapy for breast cancer is typically given after a lumpectomy;and sometimes after a mastectomy to decrease the risk of local cancer recurrence. The treatments typically start several weeks after surgery so the area has time to heal. Radiation therapy may be used:
- As a primary treatment to destroy cancer cells
- Before another treatment to shrink a tumor
- After another treatment to stop the growth of any remaining cancer cells
- In combination with other treatments to stop cancer cell growth
- To relieve symptoms of advanced cancer
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Breast Exam By Your Doctor
The same guidelines for self-exams provided above are true for breast exams done by your doctor or other healthcare professional. They wont hurt you, and your doctor may do a breast exam during your annual visit.
If youre having symptoms that concern you, its a good idea to have your doctor do a breast exam. During the exam, your doctor will check both of your breasts for abnormal spots or signs of breast cancer.
Your doctor may also check other parts of your body to see if the symptoms youre having could be related to another condition.
How Breast Cancer Pain May Feel
If breast cancer is the cause of breast pain, it will often be present in only one breast, whereas benign breast pain is often on both sides.;;
Breast cancer pain can be persistent and very specific, usually hurting in just one spot. But, breast cancer can be present in your breast before it causes pain. If you have other symptoms of breast cancer, such as nipple retraction, sudden swelling of your breast, or sudden skin changes, consult your doctor for a clinical breast exam.
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Why Does My Provider Need To Test The Metastatic Tumor
Your care team will test the metastases to figure out the biology of the tumor, which can help guide your treatment plan. Providers may test tumors for:
- Hormone receptor status: If the cancer is hormone receptor-positive, hormonal therapy may be your first treatment.
- HER2 status: Human epidermal growth factor receptor 2 is a protein that is overexpressed on some breast cancer cells. HER2-positive cancer responds to specific HER2-targeted therapies.
- PIK3CA gene mutation: If a tumor is hormone receptor-positive and HER2-negative, your provider may test for this gene mutation. Specific targeted therapies can be used to treat tumors with this mutation.
- PD-L1 status: Tumors that are hormone receptive-negative and HER2-negative may be tested for PD-L1 status. If the PD-L1 test is positive, you may be recommended to receive a combination of immunotherapy and chemotherapy.