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.
What Will Happen After Treatment
Youll be glad when treatment is over. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of these follow-up visits. You will have exams, blood tests, and maybe other tests to see if the cancer has come back.
At first, your visits may be every few months. Then, the longer youre cancer-free, the less often the visits are needed.
If you still have a breast , youll need to get a mammogram every year. Depending on your treatment, you might need other tests as well, such as yearly pelvic exams or bone density tests.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life making healthy choices and feeling as well as you can.
Calculating Risk Based On Tumor Size
Memorial Sloan Kettering Cancer Center provides a Breast Cancer Nomogram through which you can predict the likelihood that a breast cancer has spread to axillary lymph nodes based on tumor size .
To complete this estimate, you are asked to agree to the conditions, and understand that it is only an estimate.
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How Breast Cancer Spreads
Breast cancer can spread when the cancer cells get into the blood or lymph system and are carried to other parts of the body.
The lymph system is a network of lymph vessels found throughout the body that connects lymph nodes . The clear fluid inside the lymph vessels, called lymph, contains tissue by-products and waste material, as well as immune system cells. The lymph vessels carry lymph fluid away from the breast. In the case of breast cancer, cancer cells can enter those lymph vessels and start to grow in lymph nodes. Most of the lymph vessels of the breast drain into:
- Lymph nodes under the arm
- Lymph nodes around the collar bone
- Lymph nodes inside the chest near the breast bone
If cancer cells have spread to your lymph nodes, there is a higher chance that the cells could have traveled through the lymph system and spread to other parts of your body. The more lymph nodes with breast cancer cells, the more likely it is that the cancer may be found in other organs. Because of this, finding cancer in one or more lymph nodes often affects your treatment plan. Usually, you will need surgery to remove one or more lymph nodes to know whether the cancer has spread.
Still, not all women with cancer cells in their lymph nodes develop metastases, and some women with no cancer cells in their lymph nodes develop metastases later.
Symptoms Of Angiosarcoma Of The Breast
Another rare form of breast cancer, angiosarcoma forms inside the lymph and blood vessels. Only a biopsy may definitively diagnose this type of cancer. Angiosarcoma can cause changes to the skin of your breast, such as the development of purple-colored nodules that resemble a bruise. These nodules, if bumped or scratched, may bleed. Over time, these discolored areas may expand, making your skin appear swollen in that area. You may or may not have breast lumps with angiosarcoma. If you also have lymphedema, which is swelling caused by a buildup of lymphatic fluid, angiosarcoma may occur in the affected arm. Cancer treatment sometimes damages the lymph vessels, which may lead to lymphedema.
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I Shifted To Being Overly Optimistic
Charlotte Conner, 33, had just undergone a breast augmentation when she felt a lump in her breast. When I saw my doctor, they werent concerned, in part because of my young age, says Conner, who was 30 years old at the time. She had a mammogram and ultrasound to check for signs of cancer, but no MRI. Looking back now, I wish I would have asked for that MRI, she says.
At the first check-up six months later, they told her she was fine. At the secondone year after the original lump was foundthe lump had tripled in size. Her doctor ordered a biopsy, and a diagnosis was confirmed: Stage 2A ductal carcinoma, which means the cancer was growing but contained to the breast and surrounding lymph nodes.4
When they told me I had cancer, I was calm, she says. Her mindset immediately shifted from a sinking feeling towards being optimistic about the future. I focused on getting healthy again, says Conner, who started fantasizing about what she would do after treatment.
She remembers thinking, I may be feeling sick and throwing up from chemotherapy, but what restaurants am I going to go to after all this is over? Its an outlook that didnt necessarily come naturally to her, either. Im not even overly optimistic in lifeI think Im a realistbut in this situation, I shifted to being overly optimistic.
Breast Cancer Cell Growth
Cancer begins when a normal breast cell undergoes a number of mutations in genes that control the growth of the cell. These mutations may occur over a long period of time, even decades, before a cancer cell forms.
A cancer cell must divide on average 30 times before it forms a mass that can be felt in the breast. Since tumor cells multiply and divide exponentiallyone cell becomes two, two cells become four, and so ona tumor will increase more rapidly in size the larger it is.
That said, not all cells are dividing at one time, and growth can be different at different stages in the formation of a tumor. Compared with many types of cancer, breast cancer has a “low growth fraction,” meaning that the proportion of cancer cells that are in an active cell cycle is low.
Some tumors, such as some leukemias and lymphomas, have much higher growth fractions .
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Benign Breast Lumps And Future Cancer Risk
- Women who had a history of benign breast disease are more likely to develop breast cancer than those who have never had any breast disease. According to a 2019 study in the International Journal of Cancer, benign breast disease increases the risk of developing breast cancer in the future, in addition to the risk that a woman may already have due to family history, personal breast cancer history, or a genetic mutation.
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A diagnosis of lung cancer naturally causes some overwhelming emotions, but you don’t have to let those emotions get the best of you. Although the percentage of cases in men is much lower than in women, male breast cancer accounts for a por. There are a number of different treatments doctors recommend. Getting a diagnosis of bladder cancer can be a difficult time. But hearing the words can still be scary.
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How Fast Breast Cancer Grows
People may wonder about growth or doubling time when considering how long to wait to begin treatment. This growth is also very important to understand if you have a lump and have been advised to simply observe it over time.
Unless your healthcare provider is extremely confident that a lump is benign, it should be evaluated right away rather than waiting.
In general, the growth of breast cancer can be quite variable, but several studies provide at least an estimate of what may be happening.
How Much Do Tamoxifen And Raloxifene Lower The Risk Of Breast Cancer
Multiple studies have shown that both tamoxifen and raloxifene can reduce the risk of developing estrogen receptor-positive breast cancer in healthy postmenopausal women who are at high risk of developing the disease. Tamoxifen lowered the risk by 50 percent. Raloxifene lowered the risk by 38 percent. Overall, the combined results of these studies showed that taking tamoxifen or raloxifene daily for five years reduced the risk of developing breast cancer by at least one-third. In one trial directly comparing tamoxifen with raloxifene, raloxifene was found to be slightly less effective than tamoxifen for preventing breast cancer.
Both tamoxifen and raloxifene have been approved for use to reduce the risk of developing breast cancer in women at high risk of the disease. Tamoxifen is approved for use in both premenopausal women and postmenopausal women . Raloxifene is approved for use only in postmenopausal women.
Less common but more serious side effects of tamoxifen and raloxifene include blood clots to the lungs or legs. Other serious side effects of tamoxifen are an increased risk for cataracts and endometrial cancers. Other common, less serious shared side effects of tamoxifen and raloxifene include hot flashes, night sweats, and vaginal dryness.
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Factors Associated With More Rapid Spread
Some types of breast cancer, as well as molecular subtypes, are more likely to spread and spread earlier than other types. Ductal carcinoma is more likely to spread than lobular carcinoma, among tumors that are the same size and stage.
While many breast cancers do not spread to lymph nodes until the tumor is at least 2 cm to 3 cm in diameter, some types may spread very early, even when a tumor is less than 1 cm in size.
Questions To Ask The Doctor
- Do you know the stage of the cancer?
- If not, how and when will you find out the stage of the cancer?
- Would you explain to me what the stage means in my case?
- Based on the stage of the cancer, how long do you think Ill live?
- Do you know if my cancer has any of these proteins: estrogen receptor, progesterone receptor, or the HER2 protein?
- What does it mean if my cancer has any of these proteins?
- What will happen next?
There are many ways to treat breast cancer.
Surgery and radiation are used to treat cancer in a specific part of the body . They do not affect the rest of the body.
Chemotherapy, hormone treatment, targeted therapy, and immunotherapy drugs go through the whole body. They can reach cancer cells almost anywhere in the body.
Doctors often use more than one treatment for breast cancer. The treatment plan thats best for you will depend on:
- The cancer’s stage and grade
- If the cancer has specific proteins, like the HER2 protein or hormone receptors
- The chance that a type of treatment will cure the cancer or help in some way
- Your age
- Other health problems you have
- Your feelings about the treatment and the side effects that come with it
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Who Gets Breast Cancer
Breast cancer is the most common cancer among women other than skin cancer. Increasing age is the most common risk factor for developing breast cancer, with 66% of breast cancer patients being diagnosed after the age of 55.
In the US, breast cancer is the second-leading cause of cancer death in women after lung cancer, and it’s the leading cause of cancer death among women ages 35 to 54. Only 5 to 10% of breast cancers occur in women with a clearly defined genetic predisposition for the disease. The majority of breast cancer cases are “sporadic, meaning there is no definitive gene mutation.
Kinds Of Breast Cancer
The most common kinds of breast cancer are
- Invasive ductal carcinoma. The cancer cells grow outside the ducts into other parts of the breast tissue. Invasive cancer cells can also spread, or metastasize, to other parts of the body.
- Invasive lobular carcinoma. Cancer cells spread from the lobules to the breast tissues that are close by. These invasive cancer cells can also spread to other parts of the body.
Getting A Breast Biopsy
In a breast biopsy, the doctor takes out small pieces of breast tissue to check them for cancer cells. A biopsy is the only way to tell for sure if you have breast cancer.
There are many types of biopsies. Ask your doctor what kind you will need. Each type has risks and benefits. The choice of which type to use depends on your own case.
Sometimes, surgery is needed to take out all or part of the lump to find out if its cancer. This is often done in a hospital using local anesthesia . You might also be given medicine to make you sleepy.
Cytotoxics And Targeted Therapies
are a relatively new class of cancer drugs that can overcome many of the issues seen with the use of cytotoxics. They are divided into two groups: small molecule and antibodies. The massive toxicity seen with the use of cytotoxics is due to the lack of cell specificity of the drugs. They will kill any rapidly dividing cell, tumor or normal. Targeted therapies are designed to affect cellular proteins or processes that are utilised by the cancer cells. This allows a high dose to cancer tissues with a relatively low dose to other tissues. Although the are often less severe than that seen of cytotoxic chemotherapeutics, life-threatening effects can occur. Initially, the targeted therapeutics were supposed to be solely selective for one protein. Now it is clear that there is often a range of protein targets that the drug can bind. An example target for targeted therapy is the BCR-ABL1 protein produced from the , a genetic lesion found commonly in and in some patients with . This has enzyme activity that can be inhibited by , a drug.
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What Is Stage Iv Breast Cancer
Stage IV is the most advanced stage of breast cancer. It has spread to nearby lymph nodes and to distant parts of the body beyond the breast. This means it possibly involves your organs such as the lungs, liver, or brain or your bones.
Breast cancer may be stage IV when it is first diagnosed, or it can be a recurrence of a previous breast cancer that has spread.
What Are The Risk Factors For Breast Cancer
Like many conditions, risk factors for breast cancer fall into the categories of things you can control and things that you cannot control. Risk factors affect your chances of getting a disease, but having a risk factor does not mean that you are guaranteed to get a certain disease.
Controllable risk factors for breast cancer
- Alcohol consumption. The risk of breast cancer increases with the amount of alcohol consumed. For instance, women who consume two or three alcoholic beverages daily have an approximately 20% higher risk of getting breast cancer than women who do not drink at all.
- Body weight. Being obese is a risk factor for breast cancer. It is important to eat a healthy diet and exercise regularly.
- Breast implants. Having silicone breast implants and resulting scar tissue make it harder to distinguish problems on regular mammograms. It is best to have a few more images to improve the examination. There is also a rare cancer called anaplastic large cell lymphoma that is associated with the implants.
- Choosing not to breastfeed. Not breastfeeding can raise the risk.
- Using hormone-based prescriptions. This includes using hormone replacement therapy during menopause for more than five years and taking certain types of birth control pills.
Non-controllable risk factors for breast cancer
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What Are Dense Breasts
Breasts contain glandular, connective and fatty tissue. Breast density is a term used to describe the different proportions of these tissue types as detected by a mammogram. Dense breasts have relatively high amounts of connective and/or glandular tissue and low amounts of fatty tissue. Only a mammogram can show if a woman has dense breasts. Breast density is not related to how the breasts look, feel, their size or firmness.
On a mammogram, connective or fibrous tissue appears white while fatty tissue appears dark. Because breast cancers also appear white, this may make it more difficult for specialists to identify cancer in women with dense breasts. However, even with dense breasts, a screening mammogram is still the most effective method to detect breast cancer early for women over age 50.
Dense breasts also tend to be more common in younger women or women with a lower body mass index. In addition, breast density tends to decrease as women become older.
What Will The Doctor Do
Sometimes a doctor will discover a lump in a woman’s breast during a routine examination or a patient might come to the doctor with questions about a lump she found.
In other cases, a mammogram may find a lump in the breast that can’t be felt. A mammogram is a special kind of X-ray of the breast that helps doctors see what’s going on inside. Sometimes, other kinds of pictures, like an MRI, also can be taken.
When a lump is found, the doctor will want to test it. The best way to do this is usually with a biopsy. In a biopsy, a small amount of breast tissue is removed with a needle or during a small operation. Then, the tissue is examined under a microscope to look for cancer cells.
The biopsy may be benign , which means the lump is not cancer. If the biopsy shows cancer cells, the lump is malignant . If a breast lump does contains cancer cells, the woman, along with her doctor and family, will decide what to do next.
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