What Should A Person With Stage 4 Breast Cancer Expect From Treatment
Treatment options vary widely depending on where you live, your access to specialists and sub-specialists, and your willingness to try therapies that are still in the experimental phase.
Seek out oncology specialists who specialize in Stage 4 breast cancer. Discuss with your treatment team what clinical trials may be available for your clinical situation.
During this time, be sure to surround yourself with a support system of friends and family.
Paget Disease Is A Rare Type Of Breast Cancer
- Approximately accounts for 1% of all breast cancers
- Cancer starts in the breast ducts, then spreads to the skin of the nipple, and areola
- Usually associated with ductal carcinoma in situ or invasive ductal carcinoma
- Symptoms may consist of the nipple and areola being: Crusted, scaly, red, bleeding, oozing, burning, or itching
National Breast Cancer AssistanceAccess For All
ABCF makes access to breast health care and services easier for everyone. By eliminating barriers for screenings and increasing the availability of other medical resources, we are helping women and men detect breast cancer at its earliest stage.
What Is Ductal Carcinoma In Situ
Ductal carcinoma in situ is a very early form of breast cancer thats confined to the milk ducts, which is why its called ductal. Carcinoma is the name for any cancer that begins in cells that line the inner or outer surfaces of tissues, such as the breast ducts. In situ is a Latin term meaning in its original place. DCIS is the most common form of noninvasive breast cancer.
DCIS is classified as low, intermediate, or high grade. Grades are based on what the cells look like under a microscope. The lower the grade, the more closely DCIS resembles normal breast cells. The higher the grade, the more different it is from normal cells. DCIS can sometimes involve the nipple, causing it to look red and scaly. This is a rare form of cancer known as Pagets disease of the breast .
In some women, DCIS may not progress to invasive cancer in their lifetime. This has fueled debate about DCIS about whether women with low-risk disease need any treatment, or if they could be safely checked with annual mammograms and breast exams to see if the cancer is progressing. Currently, the standard treatment for DCIS includes surgery, often a lumpectomy.
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N Categories For Breast Cancer
N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are involved.
Lymph node staging for breast cancer is based on how the nodes look under the microscope, and has changed as technology has gotten better. Newer methods have made it possible to find smaller and smaller groups of cancer cells, but experts haven’t been sure how much these tiny deposits of cancer cells influence outlook.
Its not yet clear how much cancer in the lymph node is needed to see a change in outlook or treatment. This is still being studied, but for now, a deposit of cancer cells must contain at least 200 cells or be at least 0.2 mm across for it to change the N stage. An area of cancer spread that is smaller than 0.2 mm doesn’t change the stage, but is recorded with abbreviations that indicate the type of special test used to find the spread.
If the area of cancer spread is at least 0.2 mm , but still not larger than 2 mm, it is called a micrometastasis . Micrometastases are counted only if there aren’t any larger areas of cancer spread. Areas of cancer spread larger than 2 mm are known to influence outlook and do change the N stage. These larger areas are sometimes called macrometastases, but are more often just called metastases.
NX: Nearby lymph nodes cannot be assessed .
N0: Cancer has not spread to nearby lymph nodes.
N1c: Both N1a and N1b apply.
N3: Any of the following:
Breast Examination After Treatment For Breast Cancer
The incision line may be thick, raised, red and possibly tender for several months after surgery. Remember to examine the entire incision line.
If there is redness in areas away from the scar, contact your physician. It is not unusual to experience brief discomforts and sensations in the breast or nipple area .
At first, you may not know how to interpret what you feel, but soon you will become familiar with what is now normal for you.
After breast reconstruction
Following breast reconstruction, breast examination for the reconstructed breast is done exactly the same way as for the natural breast. If an implant was used for the reconstruction, press firmly inward at the edges of the implant to feel the ribs beneath. If your own tissue was used for the reconstruction, understand that you may feel some numbness and tightness in your breast. In time, some feeling in your breasts may return.
After radiation therapy
After radiation therapy, you may notice some changes in the breast tissue. The breast may look red or sunburned and may become irritated or inflamed. Once therapy is stopped, the redness will disappear and the breast will become less inflamed or irritated. At times, the skin can become more inflamed for a few days after treatment and then gradually improve after a few weeks. The pores in the skin over the breast also may become larger than usual.
What to do
Paget Disease Of The Breast
up to 4 percent of all breast cancer cases.
Paget disease is a rare cancer that forms in the milk ducts and spreads to the skin of the nipple and areola, the skin around the nipple. According to the National Cancer Institute , this type of breast cancer is usually accompanied by DCIS or an invasive tumor within the breast.
The symptoms of Paget disease are often mistaken at first for skin conditions, like eczema or dermatitis. However, the symptoms wont respond to topical treatments.
The typical symptoms of Paget disease include:
- redness, flaking or crusting around the nipple and areola
- a tingling or itching sensation around the nipple area
- thickened skin on or near the nipple
- a flattened nipple
Concern For Displacement With Bi Rads Category 5 Lesions
Some experts express concern about biopsies for category 5 lesions, feeling that the epithelial displacement of tumor cells might accelerate growth. Once removed from the body cancer cells degenerate and die.
However, surgeons prefer that the mass site is disturbed as little as possible. So, a surgeon will obtain a minimal amount of large biopsy using core needle biopsy.
The surgeon will then wish to establish the histologic grade of the tumor, evaluate the sentinel node , and sample hormonal levels. Some physicians prefer the use of a Fine Needle Aspiration biopsy rather than large core samples when the lesion is solid and with high cellular content. But, an FNA biopsy is insufficient to distinguish between DCIS and infiltrating ductal carcinoma
The main goal of any biopsy with BI-RADS category 5 is to confirm the diagnosis and extent of an obviously malignant lesion. Additional diagnostic procedures, particularly imaging and possibly biopsy of the axillary lymph nodes, will almost always be necessary. Many surgeons will remove the breast lesion in a one-step therapeutic surgery and will thus seek to disturb the site, and the patient, as little as possible.
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Ductal Carcinoma In Situ
If the cancer is hormone receptor positive, it may be treated with tamoxifen or an aromatase inhibitor for 5 years after surgery. This treatment is thought to lower the risk of DCIS recurrence or invasive cancer developing in either breast.
Types Of Breast Cancer And Related Conditions
Read about the different types of breast cancer and conditions related to breast cancer.
Paget’s disease is a rare skin condition of the nipple that is associated with some breast cancers. Find out what it is and how it is diagnosed and treated.
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Phyllodes Tumors Of The Breast
A phyllodes tumor is a very rare type of breast cancer that accounts for less than
75 percent of cases, phyllodes tumors arent cancerous, so they usually dont spread beyond the breast. But they can grow quickly and some can be considered borderline, which means they have properties that could make them cancerous at a later stage.
Phyllodes tumors form in the connective tissue of the breast. The most common symptoms include:
- a smooth lump in or around the breast
- a lump that grows quickly and stretches the skin
- breast skin that looks red and feels warm
Can Cancer Form In Other Parts Of The Breast
Cancers can also form in other parts of the breast, but these types of cancer are less common. These can include:
- Angiosarcomas. This type of cancer begins in the cells that make up the lining of blood or lymph vessels. These cancers can start in breast tissue or breast skin. They are rare.
- Inflammatory breast cancer. This type of cancer is rare and different from other types of breast cancer. It is caused by obstructive cancer cells in the skins lymph vessels.
- Paget disease of the breast, also known as Paget disease of the nipple. This cancer affects the skin of the nipple and areola .
- Phyllodes tumors. These are rare, and most of these masses are not cancer. However, some are cancerous. These tumors begin in the breasts connective tissue, which is called the stroma.
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What To Know About Breast Cancer Symptoms
The symptoms of breast cancer can vary widely and some types of breast cancer may not have any noticeable symptoms.
Sometimes a lump may be too small to be felt or to cause any changes to your breast or surrounding area. In these cases, cancerous cells are often first detected through screening techniques like a mammogram.
When there are symptoms, they can include:
- a lump or thickening of breast tissue that you can feel with your fingers
- breast swelling or changes to your breast size or shape
- changes to the skin on your breast, such as dimpling, redness, or skin irritation
- the nipple turning inward or nipple pain
- a lump in your underarm area
- nipple discharge other than breast milk
Its important to be familiar with how your breasts usually look and feel. This will help you notice any changes and to follow up with your healthcare professional promptly if anything looks or feels different.
Noninvasive breast cancer develops in the cells of a duct or lobule and remains in that location. Its also referred to as in situ which means in the original place.
There are two types of noninvasive breast cancer:
- ductal carcinoma in situ
- lobular carcinoma in situ
Lets take a closer look at each type.
Does A Benign Breast Condition Mean That I Have A Higher Risk Of Getting Breast Cancer
Benign breast conditions rarely increase your risk of breast cancer. Some women have biopsies that show a condition called hyperplasia . This condition increases your risk only slightly.
When the biopsy shows hyperplasia and abnormal cells, which is a condition called atypical hyperplasia, your risk of breast cancer increases somewhat more. Atypical hyperplasia occurs in about 5% of benign breast biopsies.
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What Are The Warning Signs Of Breast Cancer
- A lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.
- A mass or lump, which may feel as small as a pea.
- A change in the size, shape, or contour of the breast.
- A blood-stained or clear fluid discharge from the nipple.
- A change in the look or feel of the skin on the breast or nipple .
- Redness of the skin on the breast or nipple.
- An area that is distinctly different from any other area on either breast.
- A marble-like hardened area under the skin.
These changes may be found when performing monthly breast self-exams. By performing breast self-exams, you can become familiar with the normal monthly changes in your breasts.
Breast self-examination should be performed at the same time each month, three to five days after your menstrual period ends. If you have stopped menstruating, perform the exam on the same day of each month.
What Are The Different Types Of Breast Cancer
Roughly 12 percent of women in the United States will develop breast cancer in their lifetime. Breast cancer affects an estimated 600,000 women per year. Men also can develop breast cancer, although it is rare.
Did you know there many different types of breast cancer? Heres what you need to know about the types and how to recognize symptoms.
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Examples Using The Full Staging System
Because there are so many factors that go into stage grouping for breast cancer, it’s not possible to describe here every combination that might be included in each stage. The many different possible combinations mean that two women who have the same stage of breast cancer might have different factors that make up their stage.
Here are 3 examples of how all of the factors listed above are used to determine the pathologic breast cancer stage:
Types Of Breast Cancer
Cancer clinicians currently classify breast cancer into three basic therapeutic groups: oestrogen receptor positive, HER2 , and triple negative, or basal-like, breast cancer. Each group varies in prevalence, and has different treatment options and predicted outcomes.
A recent study in the journal Nature described four main breast cancer classes, or subtypes, breaking down these three groups even further. Each subtype is caused by different subsets of genetic and epigenetic abnormalities.
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Types Based On Where Cancer Starts Or Spreads
One of the ways doctors describe breast cancer is based on where in your body it starts or spreads.
Breast cancers are often a type of carcinoma called an adenocarcinoma. These cancers start in the cells lining the milk ducts or the glands that produce milk .
Ductal Carcinoma. Ductal carcinoma is cancer of the cells that line the milk ducts in your breast.
Ductal carcinoma in situ is the earliest form of ductal carcinoma. “In situ” means it’s only in the milk ducts, and isn’t likely to spread to other parts of your body. About 1 in 5 people who are newly diagnosed with breast cancer have DCIS. This type is very curable.
Invasive ductal carcinoma is the most common type of breast cancer, affecting about 80% of people who are diagnosed. “Invasive” means the cancer is able to spread outside of the milk duct where it started.
There are several subtypes of invasive ductal carcinoma:
You might also hear about lobular carcinoma in situ . But LCIS isn’t really cancer, and won’t spread outside of the lobule. Doctors usually find it when they do a breast biopsy.
Phyllodes Tumor of the Breast. These rare tumors grow in the breast’s connective tissue. They’re more common in women who have an inherited condition called Li-Fraumeni syndrome. Only 1 in 4 phyllodes tumors are cancer. The rest are noncancerous .
M Categories For Breast Cancer
M followed by a 0 or 1 indicates whether the cancer has spread to distant organs — for example, the lungs, liver, or bones.
M0: No distant spread is found on x-rays or by physical exam.
cM0: Small numbers of cancer cells are found in blood or bone marrow , or tiny areas of cancer spread are found in lymph nodes away from the underarm, collarbone, or internal mammary areas.
M1: Cancer has spread to distant organs as seen on imaging tests or by physical exam, and/or a biopsy of one of these areas proves cancer has spread and is larger than 0.2mm.
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What Is Stage 1 Breast Cancer
This breast cancer is the earliest stage of invasive breast cancer. In stage 1, the tumor measures up to 2 cm and no lymph nodes are involved. At this stage, the cancer cells have spread beyond the original location and into the surrounding breast tissue.
Because a stage 1 tumor is small, it may be difficult to detect. However, breast self-exams and routine screening are always important and can often lead to early diagnosis, when the cancer is most treatable.Stage 1 breast cancer is divided into two categories:
Stage 1A: The tumor measures 2 cm or smaller and has not spread outside the breast.
Stage 1B: Small clusters of cancer cells measuring no more than 2 mm, are found in the lymph nodes, and either there is no tumor inside the breast, or the tumor is small, measuring 2 cm or less.
At stage 1, TNM designations help describe the extent of the disease. For example, there may or may not be cancer cells in the lymph nodes, and the size of the tumor may range from 1 cm to 2 cm. Most commonly, stage 1 breast cancer is described as:
- T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor
- N0: Usually, cancer has not spread to the lymph nodes.
- M0: The disease has not spread to other sites in the body.
Stage 1 breast cancer survival rate
The survival rate for stage 1A breast cancer may be slightly higher than for stage 1B. However, all women with stage 1 breast cancer are considered to have a good prognosis.