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Untreated Breast Cancer In Elderly

Do Larger Breast Cancer Tumors Always Require A Mastectomy

Mayo Clinic Explains Breast Cancer

No, not always. Tran says some large tumors do not require mastectomy. The surgical decision for lumpectomy versus mastectomy is determined by the tumors size relative to the size of the breast. Lumpectomy would likely be feasible for a 2-centimeter tumor in a person with very large breasts, but mastectomy would be recommended for the same tumor size in a person with small breasts, Tran explains.

Treatment For Physical Symptoms

The American Cancer Society urge that a person should not have to endure pain in the final months and days of life.

Many people find relief with opioid medications, but these can cause side effects such as fatigue and constipation. A person may use opioids in combination with other pain relief medications, such as acetaminophen or ibuprofen.

Other drugs, such as antidepressants and antiseizure medications, can also treat certain types of pain.

Doctors can also prescribe medications for nausea and vomiting. Some drugs for treating nausea can make a person drowsy. However, these drugs may help people eat and drink more or simply make it easier for them to function and interact with other people.

Harms Of Cancer Treatments

Cancer found in its early stages is usually curable by surgery and adjunctive therapy, regardless of the patients age. Therefore, early cancer diagnosis is important also in the elderly. Even though a patient is very old and has other diseases, early-stage cancer can often be operated. Surgery may improve the patients quality of life, even if the aim is not to extend the patients life span. Particular care is placed in evaluating the elderlys eligibility for operations. Radiation and medical treatments provided after surgery reduce the risk of cancer spreading. These adjuvant treatments may cause temporary harms, but in spite of them it is easier for elderly patient to live with other illnesses without metastatic cancer. Many special features are associated with the treatment of cancer in the elderly. Little research exists on antitumor and radiation treatments for the elderly, as most clinical trials have not included patients over the age of 65. Hence for example chemotherapy has been avoided in treating patients that are over 65. In radiotherapy, in turn, smaller dosages than usual may have been used.

Effective chemotherapy should be started in spite of the expected harms in the elderly patients, for example, in the treatment of aggressive lymphoid tissues if healing is possible on the basis of earlier data. Supportive treatments help in carrying out chemotherapy.

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What Investigations Are Necessary For Staging Breast Cancer

Breast cancer staging almost always involves a bone scan, as breast cancer is highly prone to metastasize to the bones.

During this test, medics inject a small amount of a radioactive substance into the bloodstream, where it eventually collects in the bones. A radiation scanner is then able to detect accumulations of tracer substance in the bones.

If breast cancer spreads beyond the breast, 25% of the time it goes into bones first.

Aging Out Of The Mammogram

20 Things to Know About DCIS, or Stage 0 Breast Cancer

For many women, regular breast cancer screening is standard medical protocol. But for older women, should it be?

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By Paula Span

When Janet Halloran last saw her primary care physician, the doctor asked whether she had undergone her annual mammogram. Yes, she replied, she had.

At 76, Ms. Halloran, a real estate broker in Cambridge, Mass., is past the age that most medical guidelines recommend breast cancer screening for someone with no history of the disease. Even for younger women, the guidelines call for a mammogram every other year, not annually.

So Ms. Halloran could consider stopping mammograms, or at least having them less often. But her doctor has never discussed that prospect. She says, These are the things you need to do, Ms. Halloran said. Besides, she added, its an easy test: Go once a year, hold your breath and youre done for another year. Its just routine.

But for older women, should it be?

Theres been a lot of uncertainty, said Dr. Xabier Garcia-Albéniz, an oncologist and epidemiologist at RTI Health Solutions and lead author of a new observational study that tries to answer that question. This is an area with a complete lack of randomized clinical trials.

Yet more than half of women over 75 have had a screening mammogram within the past two years, the Centers for Disease Control and Prevention reported in 2018.

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Role Of Postoperative Rt

Postoperative RT following breast-conserving surgery, combined with appropriate systemic adjuvant treatment, has been shown to significantly reduce both absolute risk for 5-year recurrence and 15-year absolute breast cancer mortality risk. Proportional reductions were found in all patients regardless of age, although absolute risk was lower in older patients.18

No significant increase in RT toxicity has been seen in older women. Therefore, among healthy older women, standard fractionation RT with a boost to the lumpectomy cavity is considered a standard component of breast-conserving therapy.

Studies in older women have found no important increase in RT toxicity. The SIOG panel recommends that RT after breast-conserving surgery and adjuvant systemic treatment should be considered in all older women with breast cancer. Factors that should be taken into account include life expectancy, patient health and functional status, mortality risk from comorbidities , and risk for local recurrence.19

Since absolute risk for local recurrence is lower in older women, the benefits of RT may decline with age. In addition, the schedule and duration of conventional RT may be challenging for older women who have limited mobility or transportation. Alternatives that demonstrate promising early results include hypofractionated RT schedules, more rapid fractionation, and partial-breast rather than whole-breast irradiation.20

What Are The Breast Cancer Stages

Staging helps describe how much cancer is in your body. Its determined by several factors, including the size and location of the tumor and whether the cancer has spread to other areas of your body. The basic breast cancer stages are:

  • Stage 0. The disease is non-invasive. This means it hasnt broken out of your breast ducts.
  • Stage I. The cancer cells have spread to the nearby breast tissue.
  • Stage II. The tumor is either smaller than 2 centimeters across and has spread to underarm lymph nodes or larger than 5 centimeters across but hasnt spread to underarm lymph nodes. Tumors at this stage can measure anywhere between 2 to 5 centimeters across, and may or may not affect the nearby lymph nodes.
  • Stage III. At this stage, the cancer has spread beyond the point of origin. It may have invaded nearby tissue and lymph nodes, but it hasnt spread to distant organs. Stage III is usually referred to as locally advanced breast cancer.
  • Stage IV. The cancer has spread to areas away from your breast, such as your bones, liver, lungs or brain. Stage IV breast cancer is also called metastatic breast cancer.

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Mammograms May Not Always Be Recommended

Women who are not at an elevated risk of breast cancer should receive mammograms annually or every two years after age 50. However, the age to stop mammograms is less clear. Older women with other serious medical issues should discuss the benefits of mammography with their physician, as it may make sense to stop mammography at some point and monitor risk through physical exams. Patients should develop a personalized plan for screening and surveillance with their doctors based on their current health and medical history.

Life Is Prolonged Cancers Increase

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In Finland, already more than 32 000 new cancers were found in 2013. The amount is threefold compared to the incidence rates in the 1970s. The main reason for the increase in the incidence of cancer is that people live longer than before.

A persons average lifespan has continuously extended. Life expectancy is most affected by deaths in childhood or during working age. In particular decreases in infant mortality extend the life expectancy of the entire population. In Finland, the health of the population began to improve rapidly after the war, as education and income increased.

The life expectancy for Finnish men is currently 79 years and for women 84 years. The maximum age in humans is thought to be between 115 and 125 years.

Many of the elderly are independent and in good condition, and have an active life. Falling ill with cancer is a shocking experience regardless of age, and most of the elderly wish for active treatment, if such is available.

The most common cancers in older men are prostate, lung, and gastrointestinal cancers. The most common cancers in older women are breast, gastrointestinal, lung, and gynecological cancers.

Figure 2. Trends in cancer mortality in persons aged 75 or older in 19542013.

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If Im 70 Or Older Will Invasive Breast Cancer Be Fatal

Though a cancer diagnosis is scary at any age, older adults may feel more vulnerable. But Tran says there are reasons not to panic.

In patients 70 years old or older, most of the time, the invasive cancer is hormone receptor positive, which means it is a slower-growing cancer.

Most patients treated for invasive breast cancer survive, she says. Even when you are diagnosed at an older age, you can successfully complete your therapy, go on living and eventually die from causes other than breast cancer.

This is especially true for those who are in good general health at the time of their diagnosis and who are able to care for themselves.

Will I Have To Have Chemo If I Have Breast Cancer

Tran says chemotherapy can be an effective way to reduce the size of a tumor, but admits the regimen can be tough. Depending on your individual situation, chemo is not always necessary.

For postmenopausal patients with invasive cancer where the tumor is greater than 1 centimeter and hormone receptor positive, the information we get from the oncotype genetic profile of cancer can help predict if chemotherapy will be beneficial, she says.

If tests come back with a low score for certain factors, even if theres cancer in lymph nodes, the patient may be able to skip chemotherapy and instead receive hormone-blocking treatment, which is easier to take and involves fewer side effects. Tran says hormone therapy is given over five years, and can be administered in pill form.

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Treatment Options May Change With Age

While younger patients often require a combination of chemotherapy, surgery, and radiation to treat breast cancer, older women are less likely to require chemotherapy and radiation to treat their disease because of the more favorable types of cancers they tend to develop.

For example, studies have shown that women aged 70 or older with small, estrogen-sensitive tumors may not require radiation following a lumpectomy and can do well without this treatment. Women with these types of tumors often do not require chemotherapy either.

In some cases, older women may be recommended for chemotherapy, which can cause more significant physical side effects than in younger women. The impact of potential side effects on a womans daily life should be taken into account when weighing the risks and benefits of any treatment plan.

Survival For All Stages Of Breast Cancer

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Generally for women with breast cancer in England:

  • Around 95 out of every 100 women survive their cancer for 1 year or more after diagnosis
  • Around 85 out of every 100 women will survive their cancer for 5 years or more after diagnosis
  • Around 75 out of every 100 women will survive their cancer for 10 years or more after diagnosis

Cancer survival by stage at diagnosis for England, 2019Office for National Statistics

These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer.

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How Is Breast Cancer Treated

There are several breast cancer treatment options, including surgery, chemotherapy, radiation therapy, hormone therapy, immunotherapy and targeted drug therapy. Whats right for you depends on many factors, including the location and size of the tumor, the results of your lab tests and whether the cancer has spread to other parts of your body. Your healthcare provider will tailor your treatment plan according to your unique needs. Its not uncommon to receive a combination of different treatments, too.

Breast cancer surgery

Breast cancer surgery involves removing the cancerous portion of your breast and an area of normal tissue surrounding the tumor. There are different types of surgery depending on your situation, including:

Chemotherapy for breast cancer

Your healthcare provider may recommend chemotherapy for breast cancer before a lumpectomy in an effort to shrink the tumor. Sometimes, its given after surgery to kill any remaining cancer cells and reduce the risk of recurrence . If the cancer has spread beyond your breast to other parts of your body, then your healthcare provider may recommend chemotherapy as a primary treatment.

Radiation therapy for breast cancer

Radiation therapy for breast cancer is typically given after a lumpectomy or mastectomy to kill remaining cancer cells. It can also be used to treat individual metastatic tumors that are causing pain or other problems.

Hormone therapy for breast cancer

Immunotherapy for breast cancer

An Update In Breast Cancer Management For Elderly Patients

Domenico Fusco1, Elena Allocca1, Emanuele Rocco Villani1, Laura Franza1, Alice Laudisio2, Giuseppe Colloca1

1 Geriatrics Department, Fondazione Policlinico Universitario A. Gemelli , Università Cattolica del Sacro Cuore , Campus Bio Medico University and Teaching Hospital , , Italy

Contributions: Conception and design: D Fusco, E Allocca, ER Villani Administrative support: None Provision of study materials or patients: None Collection and assembly of data: E Allocca, ER Villani Data analysis and interpretation: D Fusco, G Colloca, A Laudisio, L Franza Manuscript writing: All authors Final approval of manuscript: All authors.

Correspondence to:

Keywords: Breast cancer elderly tailored personalized treatment

Submitted Jul 01, 2017. Accepted for publication Feb 07, 2018.

doi: 10.21037/tcr.2018.03.21

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What Are The Early Signs Of Breast Cancer

Breast cancer symptoms can vary for each person. Possible signs of breast cancer include:

  • A change in the size, shape or contour of your breast.
  • A mass or lump, which may feel as small as a pea.
  • A lump or thickening in or near your breast or in your underarm that persists through your menstrual cycle.
  • A change in the look or feel of your skin on your breast or nipple .
  • Redness of your skin on your breast or nipple.
  • An area thats distinctly different from any other area on either breast.
  • A marble-like hardened area under your skin.
  • A blood-stained or clear fluid discharge from your nipple.

Some people dont notice any signs of breast cancer at all. Thats why routine mammograms and are so important.

Emotional And Spiritual Care

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End-of-life care also includes emotional, mental, and spiritual therapy. A personâs healthcare team may include social workers, counselors, mental health professionals, and religious or spiritual advisors.

According to the Anxiety and Depression Association of America, up to 40 percent of people with cancer experience serious mental distress. This may include anxiety, depression, panic attacks, and post-traumatic stress disorder .

Medications, therapy, religious or spiritual rituals, and support groups can help a person cope with mental health issues and stress during this difficult time.

Caregivers may also need help with stress, anxiety, and depression. The palliative care team can usually also provide support and advice to caregivers for their emotional needs.

The Breast Cancer Healthline app provides people with access to an online breast cancer community, where users can connect with others and gain advice and support through group discussions.

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The Stages Of Breast Cancer

NOTE: Although a lot of this information is still valid, The American Joint Committee on Cancer has recently updated their classifications for staging breast tumors.

We will be updating all our articles on staging in the near future. In the meantime, please click HERE for a brief summary of the major changes in January 2018.

If a breast biopsy confirms that breast cancer is indeed the diagnosis, the staging process begins.

The stages of breast cancer are really the extent of breast cancer. So, in order to choose and begin the best treatment, it is necessary to stage breast cancer. The staging process shows the progression of breast cancer.

Breast cancer progresses in relatively predictable and consistent ways, so it is possible to categorize breast cancer in terms of stages.

There are basically five stages of breast cancer, with some subcategories .

Management Of The Primary Lesion In Frail Patients Or Those With Advanced Locoregional Disease

For patients with life expectancies of 5 years or more and resectable lesions, surgery remains the key to successful control of the primary tumor. A Cochrane analysis has shown that for older patients, primary endocrine therapy with tamoxifen was associated with survival outcomes similar to those of women treated with surgery, with or without endocrine therapy. However, the majority of women given tamoxifen alone had breast tumor progression by 5 years. Although aromatase inhibitors might prove superior to tamoxifen in this setting, they are not likely to change these results greatly, and we recommend surgery for patients with life expectancies of more than 5 years. For older women with hormone receptorpositive locally advanced breast cancer who are not candidates for tumor resection or who wish to increase their odds of breast preservation, neoadjuvant endocrine therapy can be of major benefit and makes many older patients candidates for breast-preserving surgery.

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