What Happens In Breast Cancer

Further Tests After Diagnosis

If the biopsy results show there are breast cancer cells, you will need further tests.

You may have the following tests to check your general health:

• Blood test

  You have a blood test to check your general health and how well your kidneys and liver are working

• Chest x-ray

  You will have a chest x-ray to check your lungs and heart.

You may have tests to find out more about the size of the cancer, or if it has spread anywhere else in the body :

• MRI scan

  An MRI scan uses magnetism to build up detailed pictures of your body. It may be done to find out the size of the cancer and help decide on the operation you have.

• CT scan

  A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body.

• Bone scan

  A bone scan shows up abnormal areas of bone. You have a small amount of a radioactive substance injected into a vein and wait for 2 to 3 hours to have the scan.

See also

Getting Back On Track: How Bone Metastases Are Treated

Oncologists have a range of tools that can help alleviate the pain and discomfort of bone metastases as well as treat the cancer itself, including:

Other ways to effectively manage pain and discomfort from bone metastases include using hot and cold compresses practicing relaxation methods like meditation, physical therapy, or yoga and doing other gentle forms of exercise. Ask your health care team about programs that can help keep you safely active. Strong muscles protect bones, stresses Huston, and being active makes you feel better both physically and psychologically.

Choosing To Go Flat After A Mastectomy

You might decide that you dont want to wear a prosthesis or have a breast reconstruction after having a mastectomy. You may choose to be flat.

Women decide to do this for various reasons. It might be because you:

• dont want to have more surgery
• want to get back to everyday life as soon as possible
• dont want to wear prosthesis, or find them uncomfortable

Your surgeon and breast care nurse will talk to you about all your options. They will explain the pros and cons to help you make the right decision for you. You may need time to make your decision. Talking to family and friends about how you feel can help.

A charity called Flat Friends supports ladies living without reconstruction after a mastectomy.

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If Your Breast Cancer Has Spread

Even if your breast cancer has spread to other parts of your body, it does not necessarily mean its not treatable. If the cancer cannot be removed, the goal of treatment is to improve symptoms, improve quality of life and extend survival.

Some women live with breast cancer for several years as they learn to adjust and accept that theyll be on treatment for an indefinite period of time, explains Dr. Roesch. Your cancer team will help you learn and cope with what you can expect on this journey.

Treatment Of Locally Advanced Cancer

For breast cancers that have spread to more lymph nodes, the following may be done:

• Before surgery, drugs, usually chemotherapy, to shrink the tumor

• Breast-conserving surgery or mastectomy if the drug given before surgery makes removing the tumor possible

• After surgery, usually radiation therapy

• After surgery, chemotherapy, hormone therapy, or both

Whether radiation therapy and/or chemotherapy or other drugs are used after surgery depends on many factors, such as the following:

• How large the tumor is

• Whether menopause has occurred

• Whether the tumor has receptors for hormones

• How many lymph nodes contain cancer cells

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Symptoms And Diagnosis Of Metastatic Breast Cancer

The most common parts of the body where breast cancer tends to spread are the bones, lungs, brain, and liver. But metastatic breast cancer can affect other parts of the body, as well.

Metastatic breast cancer symptoms can be very different depending on the cancers location, but may include:

• back, bone, or joint pain that does not go away

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  difficulty urinating , which can be a sign that the cancer is pinching nerves in your back

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  numbness or weakness anywhere in your body

• shortness of breath or difficulty breathing

• abdominal bloating, pain, or tenderness

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  constant nausea, vomiting, or weight loss

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  jaundice

• vision problems

• biopsy of any suspicious area

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  a tap, removal of fluid from the area with symptoms to check for cancer cells a pleural tap removes fluid between the lung and chest wall a spinal tap removes fluid from around the spinal cord and a tap of fluid in the abdomen removes fluid in the abdominal cavity

These tests may also be used if you have no history of breast cancer and your doctor is having trouble determining the cause of your symptoms.

A biopsy may be done to determine these factors that can influence your treatment, which will be listed in your pathology report. Learn more about Understanding Your Pathology Report.

Locally Advanced Breast Cancer

If breast cancer has spread to the chest wall or skin of the breast, or the lymph nodes around the chest, neck and under the breast bone, but has not spread to other areas of the body, its called locally advanced breast cancer. Sometimes breast cancer is locally advanced when it is first diagnosed.

People who have locally advanced breast cancer are thought to have an increased risk of cancer cells spreading to other areas of the body, compared to those with stage 1 or 2 breast cancers.

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Stages Of Breast Cancer: Stage Iiib

A stage IIIb breast cancer is one in which the tumor may be of any size but it has grown into the chest wall or the skin of the breast. A stage IIIb designation also applies if there is evidence of either

• axillary lymph node metastasis
• internal mammary node metastasis

presenting in such a way as to suggest that total surgical removal is not possible.

There is a unique type of breast cancer, inflammatory breast cancer, that causes the breast to appear red and swollen. This is because the cancer cells block some of the lymphatic vessels. Inflammatory breast cancers tend to have a poorer prognosis and are generally stage IIIb at least.

Stage 4 Breast Cancer

Stage 4 breast cancer can have a tumor of any size, and its cancer cells have spread to nearby and distant lymph nodes as well as distant organs.

The testing your doctor does will determine the stage of your breast cancer, which will affect your treatment.

Although they generally have less of it, men have breast tissue just like women do. Men can develop breast cancer too, but its much rarer.

According to the ACS , breast cancer is 100 times less common in white men than in white women. Its 70 times less common in black men than in black women.

That said, the breast cancer that men develop is just as serious as the breast cancer women are diagnosed with. It also has the same symptoms.

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How Is Metastatic Breast Cancer Treated

The main treatment for metastatic breast cancer is systemic therapy. These therapies treat the entire body. Systemic treatments may include a combination of:

Your care team will plan your treatment based on:

• Body parts cancer has reached.
• Past breast cancer treatments.
• Tumor biology, or how the cancer cells look and behave.

Getting Used To Changes

Research has shown that the sooner you confront the physical changes to your body, the easier you may find it to gain confidence in the way you look. However, some people wont have had the chance or courage to do this early on.

If you have a partner, letting them see the surgical scars and changes to your body sooner may also make being intimate easier in the long term.

The first few times you look at yourself might make you feel unhappy and shocked, and you may want to avoid looking at yourself again. However, the initial intense feelings you may have will lessen over time as you get more used to how you look now.

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How Breast Cancer Starts

The breast is a highly complex part of the human body. The female breast goes through many changes over a lifetime from birth, puberty, pregnancy and breastfeeding, right through to menopause.

If you have been diagnosed with breast cancer, understanding the anatomy of the breast and the role each part has to play can be helpful to understand your diagnosis. It can also help you talk to your doctor about surgery and other treatment options.

In this piece we cover:-Understanding Breast Anatomy-Normal Breast Changes Through Life-How Does Cancer Start in the Breast?-How Does Cancer Spread Beyond the Breast?-Symptoms of Breast Cancer

Where Breast Cancer Starts

Breast cancers can start from different parts of the breast. The breast is an organ that sits on top of the upper ribs and chest muscles. There is a left and right breast and each one has mainly glands, ducts, and fatty tissue. In women, the breast makes and delivers milk to feed newborns and infants. The amount of fatty tissue in the breast determines the size of each breast.

The breast has different parts:

• Lobules are the glands that make breast milk. Cancers that start here are called lobular cancers.
• Ducts are small canals that come out from the lobules and carry the milk to the nipple. This is the most common place for breast cancer to start. Cancers that start here are called ductal cancers.
• The nipple is the opening in the skin of the breast where the ducts come together and turn into larger ducts so the milk can leave the breast. The nipple is surrounded by slightly darker thicker skin called the areola. A less common type of breast cancer called Paget disease of the breast can start in the nipple.
• The fat and connective tissue surround the ducts and lobules and help keep them in place. A less common type of breast cancer called phyllodes tumor can start in the stroma.
• Blood vessels and lymph vessels are also found in each breast. Angiosarcoma is a less common type of breast cancer that can start in the lining of these vessels. The lymph system is described below.

To learn more, see Types of Breast Cancer.

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External Beam Radiation Therapy

The following three sections refer to treatment using x-rays.

Conventional external beam radiation therapy

Historically conventional external beam radiation therapy was delivered via two-dimensional beams using kilovoltage therapy x-ray units, medical linear accelerators that generate high-energy x-rays, or with machines that were similar to a linear accelerator in appearance, but used a sealed radioactive source like the one shown above. 2DXRT mainly consists of a single beam of radiation delivered to the patient from several directions: often front or back, and both sides.

Conventional refers to the way the treatment is planned or simulated on a specially calibrated diagnostic x-ray machine known as a simulator because it recreates the linear accelerator actions , and to the usually well-established arrangements of the radiation beams to achieve a desired plan. The aim of simulation is to accurately target or localize the volume which is to be treated. This technique is well established and is generally quick and reliable. The worry is that some high-dose treatments may be limited by the radiation toxicity capacity of healthy tissues which lie close to the target tumor volume.

Intensity-modulated radiation therapy

How Does Cancer Start In The Breast

To understand how cancer can originate, it can be helpful to understand how regular cells and tissues function and develop.

Healthy cells are the basic building blocks of all tissues and organs in the body. The body is constantly making new cells to replace worn out tissue or to heal injuries. Normal cells are programmed to grow and divide in an orderly and controlled manner, so that each new cell replaces ones that are lost.

Sometimes cells become abnormal and keep growing. As they grow, they can form a mass or lump called a tumour. However, not all tumours are cancer. Some tumours are benign , which means they tend to grow slowly and usually do not invade surrounding tissue or other parts of the body. Tumours that are malignant have the potential to invade and spread to other parts of the body.

Breast cancer starts when cells in the breast begin to grow abnormally. These cells have the potential to grow out of control and invade the surrounding tissue. When this occurs, this is called invasive breast cancer. If the cancer cells continue to grow, they may spread beyond the breast to other parts of body, which could become life-threatening.

There are different types of breast conditions which are named after the areas of the breast where they start:

Non-invasive breast conditions

Invasive breast cancers

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Causes And Risk Factors

The lifetime risk for New Zealand women for developing breast cancer is 1 in 9. There are risk factors that women can and cant change. The main risk factors for developing breast cancer that you cannot change are:

• Increasing age breast cancer is not common in individuals under 50
• Having a history of close family members with breast cancer
• Having had breast cancer previously.
• Having had a biopsy showing an “at risk” breast lump or thickening
• Having a genetic risk, such the BRCA1 or BRCA2 gene mutations.

Risk factors that you can change are:

• Being overweight or obese, especially after menopause
• Having a low level of physical activity
• Alcohol consumption
• A diet high in fat and a reduced intake of fibre, fruits, and vegetables
• Certain medications such as oral contraceptives may increase risk in individuals with a history of breast cancer or known gene mutations.

There are also some popular myths that are not risk factors for developing breast cancer:

• Trauma to the breast sometimes people may discover a lump due to a blow or injury to the breast, but this is not associated with cancer
• Underwire bras
• Mobile phones
• Deodorants/antiperspirants
• Breast implants .
• Abortion.

Treatment Options For Metastatic Breast Cancer

Treatment for metastatic breast cancer often is based on systemic therapies, which use drugs rather than surgery or radiation. Metastases treatments are designed to shrink tumors and slow their growth, help ease symptoms and improve quality of life. Treatment may change, such as when one therapy stops working, or the side effects become too uncomfortable. Rather than having only one treatment, most patients undergo several treatments combined to help fight the cancer.

The four broad categories of drug-based treatments are:

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Can Exercise Help Reduce My Risk Of Developing Breast Cancer

Exercise is a big part of a healthy lifestyle. It can also be a useful way to reduce your risk of developing breast cancer in your postmenopausal years. Women often gain weight and body fat during menopause. People with higher amounts of body fat can be at a higher risk of breast cancer. However, by reducing your body fat through exercise, you may be able to lower your risk of developing breast cancer.

The general recommendation for regular exercise is about 150 minutes each week. This would mean that you work out for about 30 minutes, five days each week. However, doubling the amount of weekly exercise to 300 minutes can greatly benefit postmenopausal women. The longer duration of exercise allows for you to burn more fat and improve your heart and lung function.

The type of exercise you do can vary the main goal is get your heart rate up as you exercise. Its recommended that your heart rate is raised about 65 to 75% of your maximum heart rate during exercise. You can figure out your maximum heart rate by subtracting your current age from 220. If you are 65, for example, your maximum heart rate is 155.

Aerobic exercise is a great way to improve your heart and lung function, as well as burn fat. Some aerobic exercises you can try include:

• Walking.
• Dancing.
• Hiking.

Remember, there are many benefits to working more exercise into your weekly routine. Some benefits of aerobic exercise can include:

Possible Changes In Breathing

• Breathing may speed up and slow down due to less blood circulation and build-up of waste products in the body
• Patient may grunt while breathing
• Neck muscles may look tight to help breathe
• Mucus in the back of the throat may cause rattling or gurgling with each breath
• The patient may not breathe for periods of up 10 to 30 seconds

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When Do People Get A Metastatic Breast Cancer Diagnosis

Metastatic breast cancer can occur at different points:

• De novo metastatic breast cancer: About 6% of women and 9% of men have metastatic breast cancer when theyre first diagnosed with breast cancer.
• Distant recurrence: Most commonly, metastatic breast cancer is diagnosed after the original breast cancer treatment. A recurrence refers to the cancer coming back and spreading to a different part of the body, which can happen even years after the original diagnosis and treatment.

What About Other Treatments That I Hear About

When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.

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