What Happens After The Local Breast Cancer Treatment
Following local breast cancer treatment, the treatment team will determine the likelihood that the cancer will recur outside the breast. This team usually includes a medical oncologist, a specialist trained in using medicines to treat breast cancer. The medical oncologist, who works with the surgeon, may advise the use of the drugs like tamoxifen or anastrozole or possibly chemotherapy. These treatments are used in addition to, but not in place of, local breast cancer treatment with surgery and/or radiation therapy.
After treatment for breast cancer, it is especially important for a woman to continue to do a monthly breast examination. Regular examinations will help you detect local recurrences. Early signs of recurrence can be noted in the incision area itself, the opposite breast, the axilla , or supraclavicular region .
Maintaining your follow-up schedule with your physician is also necessary so problems can be detected when treatment can be most effective. Your health care provider will also be able to answer any questions you may have about breast self-examination after the following procedures.
How Is Inflammatory Breast Cancer Diagnosed
Inflammatory breast cancer can be difficult to diagnose. Often, there is no lump that can be felt during a physical exam or seen in a screening mammogram. In addition, most women diagnosed with inflammatory breast cancer have dense breast tissue, which makes cancer detection in a screening mammogram more difficult. Also, because inflammatory breast cancer is so aggressive, it can arise between scheduled screening mammograms and progress quickly. The symptoms of inflammatory breast cancer may be mistaken for those of mastitis, which is an infection of the breast, or another form of locally advanced breast cancer.
To help prevent delays in diagnosis and in choosing the best course of treatment, an international panel of experts published guidelines on how doctors can diagnose and stage inflammatory breast cancer correctly. Their recommendations are summarized below.
Minimum criteria for a diagnosis of inflammatory breast cancer include the following:
- A rapid onset of erythema , edema , and a peau d’orange appearance and/or abnormal breast warmth, with or without a lump that can be felt.
- The above-mentioned symptoms have been present for less than 6 months.
- The erythema covers at least a third of the breast.
- Initial biopsy samples from the affected breast show invasive carcinoma.
Imaging and staging tests include the following:
What Is Paget Disease Of The Breast
Paget disease of the breast is a rare type of cancer involving the skin of the nipple and, usually, the darker circle of skin around it, which is called the areola. Most people with Paget disease of the breast also have one or more tumors inside the same breast. These breast tumors are either ductal carcinoma in situ or invasive breast cancer .
Paget disease of the breast is named after the 19th century British doctor Sir James Paget, who, in 1874, noted a relationship between changes in the nipple and breast cancer.
Malignant cells known as Paget cells are a telltale sign of Paget disease of the breast. These cells are found in the epidermis of the skin of the nipple and the areola. Paget cells often have a large, round appearance under a microscope they may be found as single cells or as small groups of cells within the epidermis.
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Risk Factors For Breast Cancer
There are several risk factors that increase your chances of getting breast cancer. However, having any of these doesnt mean you will definitely develop the disease.
Some risk factors cant be avoided, such as family history. You can change other risk factors, such as quitting smoking, if you smoke. Risk factors for breast cancer include:
- Age. Your risk for developing breast cancer increases as you age. Most invasive breast cancers are found in women over age 55 years.
- Drinking alcohol. Alcohol use disorder raises your risk.
- Having dense breast tissue. Dense breast tissue makes mammograms hard to read. It also increases your risk for breast cancer.
- Gender. White women are
While there are risk factors you cant control, following a healthy lifestyle, getting regular screenings, and taking any preventive measures your doctor recommends can help reduce your risk for developing breast cancer.
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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Breast Size And Density
One breast is usually smaller than the other. Your breasts may feel different at different times in the month. It is common for breasts to feel lumpy just before your period.
Younger women have more glandular tissue than fat in their breasts, making them dense.
Your breasts also change during pregnancy. You may notice that they become bigger and feel more tender.
After your periods stop fat gradually replaces the glandular tissue, which is less dense.
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
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Paget Disease Of The Breast
Paget disease is frequently misdiagnosed at first, because the first noticeable symptoms can easily be confused with more common skin conditions affecting the nipple.
Paget disease of the breast may cause the following symptoms:
- Crusted, scaly, or red skin of the nipple and areola
- Bleeding or oozing in the breasts
- Burning or itching sensations in the area
According to the American Cancer Society, Paget disease is present in only about 1 percent of all breast cancer cases, but is almost always associated with either DCIS or IDC.
When Paget disease appears on the nipple, one or more tumors are most likely present inside the same breast. A mastectomy is often required.
If no lump can be felt in the breast tissue, and a biopsy shows DCIS but no invasive cancer, the outlook is good.
However, if invasive cancer is present, the cancer will need to be treated more aggressively.
Types Of Invasive Breast Cancer
Most breast cancers are invasive, meaning the cancer has spread from the original site to other areas, like nearby breast tissue, lymph nodes or elsewhere in the body. Invasive breast cancer cells break through normal breast tissue barriers and spread to other parts of the body through the bloodstream and lymph nodes. The two most common types of invasive breast cancer are invasive ductal carcinoma and invasive lobular carcinoma.
Invasive ductal carcinoma
The most common type of breast canceraccounting for roughly 70 to 80 percent of all casesis called invasive ductal carcinoma . IDC is a cancer that starts in a milk duct and grows into other parts of the breast. With time, it may spread further, or metastasize, to other parts of the body.
Invasive lobular carcinoma
Invasive lobular carcinoma is the second most common type, accounting for roughly 5 to 10 percent of all breast cancers. ILC starts in lobules and then spreads into nearby breast tissue. Like IDC, it may metastasize. However, this cancer is harder to detect on mammograms and other exams than IDC. One in five women with ILC have both breasts affected.
Inflammatory breast cancer
Pagets disease of the breast
Angiosarcoma of the breast
Other, even more rare, types of invasive breast cancer include adenoid cystic carcinoma, low-grade adenosquamous carcinoma, medullary carcinoma, mucinous carcinoma, papillary carcinoma and tubular carcinoma.
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What Are The Types Of Breast Cancer
The most common types of breast cancer are:
- Infiltrating ductal carcinoma. This cancer starts in the milk ducts of the breast. It then breaks through the wall of the duct and invades the surrounding tissue in the breast. This is the most common form of breast cancer, accounting for 80% of cases.
- Ductal carcinoma in situ is ductal carcinoma in its earliest stage, or precancerous . In situ refers to the fact that the cancer hasn’t spread beyond its point of origin. In this case, the disease is confined to the milk ducts and has not invaded nearby breast tissue. If untreated, ductal carcinoma in situ may become invasive cancer. It is almost always curable.
- Infiltrating lobular carcinoma. This cancer begins in the lobules of the breast where breast milk is produced, but has spread to surrounding tissues in the breast. It accounts for 10 to 15% of breast cancers. This cancer can be more difficult to diagnose with mammograms.
- Lobular carcinoma in situ is a marker for cancer that is only in the lobules of the breast. It isn’t a true cancer, but serves as a marker for the increased risk of developing breast cancer later, possibly in both or either breasts. Thus, it is important for women with lobular carcinoma in situ to have regular clinical breast exams and mammograms.
Can I Be Screened For Breast Cancer
BreastScreen Australia offers a free screening program for women at risk of breast cancer:
- If youre aged between 50 and 74 years, youll be invited to access a free mammograms every 2 years. This is because nearly 4 in 5 breast cancers occur in women aged over 50.
- If youre aged between 40 and 49 years or over 75 years, you are also eligible but wont be contacted about it.
- Women under 40 years of age are usually not offered breast screening because the density of their breast tissue makes it harder to detect cancers on mammograms.
Younger women with a strong family history of breast or ovarian cancer, or women with breast cancer diagnosed in the last 5 years may also benefit from breast screening. For more details, call BreastScreen Australia on 13 20 50 or visit their website.
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Dilemmas Of Stage Iv Breast Cancer
Indeed, there are many serious and personal questions involving stage IV breast cancer. So, overall survival is less likely, and gains from intensive breast cancer treatment are unfortunately rather modest. A serious consideration is, therefore, quality of life during the course of treatment.
These decisions tend to be a dynamic process, based on individual cases, between patients and physicians. Respect needs to be given to the expectations for treatment, the status of the disease and the patient wishes.
Evaluation After Cancer Diagnosis
After cancer is diagnosed, doctors usually consult a team of cancer specialists , including surgeons, cancer drug treatment specialists, and radiologists , to determine which tests should be done and to plan treatment.
If cancer cells are detected, the biopsy sample is analyzed to determine the characteristics of the cancer cells, such as
Whether the cancer cells have estrogen or progesterone receptors
How many HER2 receptors are present
How quickly the cancer cells are dividing
For some types of breast cancer, genetic testing of the cancer cells
This information helps doctors estimate how rapidly the cancer may spread and which treatments are more likely to be effective.
Tests may include
A chest x-ray to determine whether the cancer has spread
Blood tests, including a complete blood count , liver tests, and measurement of calcium, also to determine whether the cancer has spread
When cancer is diagnosed, a stage Staging Cancer Cancer is suspected based on a person’s symptoms, the results of a physical examination, and sometimes the results of screening tests. Occasionally, x-rays obtained for other reasons, such as… read more is assigned to it. The stage is a number from 0 to IV that reflects how extensive and aggressive the cancer is:
Staging the cancer helps doctors determine the appropriate treatment and the prognosis.
Many factors go into determining the stage of breast cancer, such as the TNM classification system.
The TNM classification is based on the following:
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Are There Complications Of Breast Cancer
Possible complications from breast cancer treatment include:
- Lymphoedema in some cases, removing your lymph nodes may cause swelling, discomfort and pain in the arm, shoulder and upper body.
- Early menopause certain treatments, especially chemotherapy and hormone therapy, can cause menopause symptoms, such as hot flushes, joint pain, or a change in sex drive, to occur earlier than usual.
- Anxiety and depression research shows that anxiety and depression are common among women with breast cancer. One study found that up to 50 per cent of women with early breast cancer may experience anxiety and/or depression in the year after diagnosis.
Does Breast Cancer Affect Women Of All Races Equally
All women, especially as they age, are at some risk for developing breast cancer. The risks for breast cancer in general arent evenly spread among ethnic groups, and the risk varies among ethnic groups for different types of breast cancer. Breast cancer mortality rates in the United States have declined by 40% since 1989, but disparities persist and are widening between non-Hispanic Black women and non-Hispanic white women.
Statistics show that, overall, non-Hispanic white women have a slightly higher chance of developing breast cancer than women of any other race/ethnicity. The incidence rate for non-Hispanic Black women is almost as high.
Non-Hispanic Black women in the U.S. have a 39% higher risk of dying from breast cancer at any age. They are twice as likely to get triple-negative breast cancer as white women. This type of cancer is especially aggressive and difficult to treat. However, it’s really among women with hormone positive disease where Black women have worse clinical outcomes despite comparable systemic therapy. Non-Hispanic Black women are less likely to receive standard treatments. Additionally, there is increasing data on discontinuation of adjuvant hormonal therapy by those who are poor and underinsured.
In women under the age of 45, breast cancer is found more often in non-Hispanic Black women than in non-Hispanic white women.
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Research And Clinical Trials
Doctors and researchers are carrying out trials to find better tests and treatments for Paget’s disease, ductal carcinoma in situ and breast cancer.
National Institute for Health and Care Excellence June 2018
Breastconserving surgery in patients with Pagets diseaseS Helme and othersBritish Journal of Surgery, 2015, Sept:102
Mammary and extramammary Pagets diseaseL Filho and othersBrazilian Annals of Dermatology, 2015: 90 pages 225-31
Pagets Breast Disease: A Case Report and Review of the LiteratureS Dubar and othersFrontiers in surgery, 2017. Volume 4
Practical consensus recommendations for Paget’s disease in breast cancerA Gaurav and others
Genomic Tests To Predict Recurrence Risk
Doctors use genomic tests to look for specific genes or proteins, which are substances made by the genes, that are found in or on cancer cells. These tests help doctors better understand the unique features of each patients breast cancer. Genomic tests can also help estimate the risk of the cancer coming back after treatment. Knowing this information helps doctors and patients make decisions about specific treatments and can help some patients avoid unwanted side effects from a treatment that may not be needed.
The genomic tests listed below can be done on a sample of the tumor that was already removed during biopsy or surgery. Most patients will not need an extra biopsy or more surgery for these tests.
For patients age 50 or younger
Recurrence score less than 16: Hormonal therapy is usually recommended, but chemotherapy is generally not needed
Recurrence score of 16 to 30: Chemotherapy may be recommended before hormonal therapy is given
Recurrence score of 31 or higher: Chemotherapy is usually recommended before hormonal therapy is given
For patients older than 50
The tests listed above have not been shown to be useful to predict risk of recurrence for people with HER2-positive or triple-negative breast cancer. Therefore, none of these tests are currently recommended for breast cancer that is HER2 positive or triple negative. Your doctor will use other factors to help recommend treatment options for you.
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