Treatment Of Specific Types Of Breast Cancer
For inflammatory breast cancer, treatment usually consists of both chemotherapy and radiation therapy. Mastectomy is usually done.
For Paget disease of the nipple, treatment is usually similar to that of other types of breast cancer. It often involves simple mastectomy or breast-conserving surgery plus removal of the lymph nodes. Breast-conserving surgery is usually followed by radiation therapy. Less commonly, only the nipple with some surrounding normal tissue is removed. If another breast cancer is also present, treatment is based on that type of breast cancer.
For phyllodes tumors, treatment usually consists of removing the tumor and a large amount of surrounding normal tissue around the tumor)called a wide margin. If the tumor is large in relation to the breast, a simple mastectomy may be done to remove the tumor plus wide margins. Whether phyllodes tumors recur depends on how wide the tumor-free margins are and whether the phyllodes tumor is noncancerous or cancerous. Recurrence rates are
For noncancerous phyllodes tumors: 10 to 17%
For cancerous phyllodes tumors: 21 to 36%
Cancerous phyllodes tumors can metastasize to distant sites such as the lungs, bone, or brain. Recommendations for treatment of metastatic phyllodes tumors are evolving, but radiation therapy and chemotherapy may be useful.
Breast Cancer Gene Mutation
Mutations in two separate genes for breast cancer have been identified. Fewer than 1% of women have these gene mutations. About 5 to 10% of women with breast cancer have one of these gene mutations. If a woman has one of these mutations, her lifetime risk of developing breast cancer is about 50 to 85%. The risk of developiing breast cancer by age 80 is about 72% with a BRCA1 mutation and about 69% with a BRCA2 mutation. However, if such a woman develops breast cancer, her chances of dying of breast cancer are not necessarily greater than those of any other woman with breast cancer.
These mutations are most common among Ashkenazi Jews.
Women likely to have one of these mutations are those who have at least two close, usually first-degree relatives who have had breast or ovarian cancer. For this reason, routine screening for these mutations does not appear necessary, except in women who have such a family history.
Types Of Recurring Breast Cancer
Breast cancer may recur locally, regionally, or distantly:
Local recurring breast cancer occurs when a new tumor develops in the breast that was originally affected. If the breast has been removed, the tumor may grow in the chest wall or nearby skin.
Regional recurring breast cancer happens in the same region as the original cancer. In the case of breast cancer, this may be the lymph nodes above the collarbone or in the armpit.
Distant recurring breast cancer happens when cancer cells travel to a different part of the body. This new location is far away from the original cancer. When cancer recurs distantly, its considered metastatic cancer.
Not everyone with metastatic breast cancer experiences symptoms. When symptoms do occur, they can vary. Symptoms depend on the location of the metastasis and its severity.
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Metastatic Breast Cancer Symptoms
Metastatic breast cancer symptoms depend on the part of the body to which the cancer has spread and its stage. Sometimes, metastatic disease may not cause any symptoms.
- If the breast or chest wall is affected, symptoms may include pain, nipple discharge, or a lump or thickening in the breast or underarm.
- If the bones are affected, symptoms may include pain, fractures, constipation or decreased alertness due to high calcium levels.
- If tumors form in the lungs, symptoms may include shortness of breath or difficulty breathing, coughing, chest wall pain or extreme fatigue.
- If the liver is affected, symptoms may include nausea, extreme fatigue, increased abdominal girth, swelling of the feet and hands due to fluid collection and yellowing or itchy skin.
- If breast cancer spreads to the brain or spinal cord and forms tumors, symptoms may include pain, confusion, memory loss, headache, blurred or double vision, difficulty with speech, difficulty with movement or seizures.
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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Odds Of Tumor Development Within Quadrants
Based on GEE modeling, there was a statistically difference in the estimated odds of tumor development among the four quadrants . Significant differences were found between the proportions of tumors in pairs of quadrants, adjusted for multiple comparisons, indicating that the overall sample size and individual sample sizes in different quadrants provided sufficient power to compare proportions of tumors in the four quadrants .
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.
How Does Cancer Spread Beyond The Breast
Breast cancer can invade through nearby tissue, or spread through the body via the lymphatic system and blood.
- Tissue: the cancer spreads from the original site and grows into nearby areas .
- Lymphatic system: breast cancer cells break away from the original site and can enter nearby lymph tubes , grow in nearby lymph nodes or travel through lymph vessels to other parts of the body.
- Blood: breast cancer cells break away from the original site and can enter and travel through nearby blood vessels to other parts of the body.
Treatments To Reduce Your Risk
If you have a greatly increased risk of developing breast cancer, for example, a BRCA gene carrier, treatment might be available to reduce your risk. This applies to a very small minority of women.
Your level of risk is determined by factors such as your age, your family’s medical history, and the results of genetic tests.
You will usually be referred to a specialist genetics service if it’s thought you have a significantly increased risk of breast cancer. Healthcare professionals working at these services might discuss treatment options with you.
The 2 main treatments are surgery to remove the breasts or medication. These are described in more detail below.
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Estrogen Exposure And Breastfeeding
Breastfeeding for over 1 year appears to reduce the risk of breast cancer.
Extended exposure to estrogen appears to increase the risk of breast cancer.
This could be due to a person starting their periods earlier or entering menopause at a later than average age. Between these times, estrogen levels are higher.
Breastfeeding, especially for over 1 year, appears to reduce the chance of developing breast cancer. This is possibly due to the drop in estrogen exposure that follows pregnancy and breastfeeding.
Where Is The First Place Breast Cancer Spreads
The first place that breast cancer commonly spreads to outside the breast are the lymph nodes in the armpit . Surgery is usually needed to remove one or more lymph nodes to help check for breast cancer spread. This operation to remove lymph nodes in the armpit is known as axillary surgery.
Breast cancer found in the lymph nodes will impact the breast cancers staging, and the treatment plan will often be affected as well.
If cancer is found in the lymph nodes, there is a higher chance that cells have travelled through the lymphatic system and bloodstream to spread to other parts of the body. In this instance, treatment with systemic therapies, such as chemotherapy, is likely to be recommended.
If cancer is found in a large number of axillary nodes, radiotherapy may also be recommended to kill any breast cancer cells that remain in the armpit but cannot be removed by surgery.
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Breast Examination By A Health Care Practitioner
A breast examination may be part of a routine physical examination. However, as with breast self-examination, a doctor’s examination may miss a cancer. If women need or want screening, a more sensitive test, such as mammography, should be done, even if a doctor’s examination did not detect any abnormalities. Many doctors and medical organizations no longer require an annual breast examination by a doctor.
During the examination, a doctor inspects the breasts for irregularities, dimpling, tightened skin, lumps, and a discharge. The doctor feels each breast with a flat hand and checks for enlarged lymph nodes in the armpitthe area most breast cancers invade firstand above the collarbone. Normal lymph nodes cannot be felt through the skin, so those that can be felt are considered enlarged. However, noncancerous conditions can also cause lymph nodes to enlarge. Lymph nodes that can be felt are checked to see if they are abnormal.
What Is Breast Cancer In Men
Breast cancer occurs mainly in women, but men can get it, too. Many people do not realize that men have breast tissue and that they can develop breast cancer. Cells in nearly any part of the body can become cancer and can spread to other areas.
Breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumor that can often be seen on an x-ray or felt as a lump. The tumor is malignant if the cells can grow into surrounding tissues or spread to distant areas of the body.
To learn more about how cancers start and spread, see Cancer Basics.
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Types Of Invasive Breast Cancer
Figure 4.6 lists the types of invasive breast cancer.
- Invasive ductal carcinoma is the most common type of breast cancer . It may also be called infiltrating ductal carcinoma, invasive carcinoma of no special type or invasive carcinoma not otherwise specified.
- Invasive lobular carcinoma is the next most common type .
|Types of invasive breast cancer||Proportion of all invasive breast cancers||Tumor characteristics|
|Adapted from select sources .|
Cosmetic Implants And Breast Cancer Survival
A 2013 review found that women with cosmetic breast implants who received a diagnosis of breast cancer also had a higher risk of dying from the disease.
This could be due to the implants masking cancer during screening or because the implants bring about changes in breast tissue.
However, a published in Aesthetic Surgery Journal found that having cosmetic breast implant surgery did not increase the risk of breast cancer.
Scientists need to carry out more research to confirm the link.
There are several different types of breast cancer, including:
- Ductal carcinoma: This begins in the milk duct and is the most common type.
- Lobular carcinoma: This starts in the lobules.
Invasive breast cancer occurs when the cancer cells break out from inside the lobules or ducts and invade nearby tissue. This increases the chance of cancer spreading to other parts of the body.
Noninvasive breast cancer develops when the cancer remains inside its place of origin and has not yet spread. However, these cells can sometimes progress to invasive breast cancer.
A doctor often diagnoses breast cancer as the result of routine screening or when a woman approaches her doctor after detecting symptoms.
Several diagnostic tests and procedures help to confirm a diagnosis.
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Mammography Density By Breast Quadrant Not Associated With Breast Cancer
Multiple studies have shown that women with mammographically dense breasts are at a higher risk of developing breast cancer and that the upper outer quadrant of the breast is the most frequent site where breast cancer is located. There is no association, according to findings of a study published in BMC Cancer. However, the study did reconfirm that breast cancer was most likely to occur in the upper outer quadrant of the breast in a patient cohort of 110 women.
Research to investigate the relationship between quadrant density and tumors occurring in a specific quadrant location has been limited by lack of a reliable method to measure quantitative density on mammography as well as by lack of a standardized method to divide a breast into four well-defined quadrants. A multinational research team from the Department of Radiological Sciences at the University of California in Irvine and hospitals in Taiwan developed a computer algorithm-based segmentation method to quantitively analyze breast density. They used this with an established method to divide a breast into four quadrants based on craniocaudal and mediolateral oblique mammography using the nipple and the chest wall as references.
The upper outer quadrant had the highest breast area and the highest dense area, with a 20% density. The lower outer quadrant had the majority of cancer , followed by the lower inner quadrant , the upper inner quadrant , and the lower outer quadrant .
What Is Stage Iii Breast Cancer
In stage III breast cancer, the cancer has spread further into the breast or the tumor is a larger size than earlier stages. It is divided into three subcategories.
Stage IIIA is based on one of the following:
- With or without a tumor in the breast, cancer is found in four to nine nearby lymph nodes.
- A breast tumor is larger than 50 millimeters, and the cancer has spread to between one and three nearby lymph nodes.
In stage IIIB, a tumor has spread to the chest wall behind the breast. In addition, these factors contribute to assigning this stage:
- Cancer may also have spread to the skin, causing swelling or inflammation.
- It may have broken through the skin, causing an ulcerated area or wound.
- It may have spread to as many as nine underarm lymph nodes or to nodes near the breastbone.
In stage IIIC, there may be a tumor of any size in the breast, or no tumor present at all. But either way, the cancer has spread to one of the following places:
- ten or more underarm lymph nodes
- lymph nodes near the collarbone
- some underarm lymph nodes and lymph nodes near the breastbone
- the skin
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Breast Cancer Risk Factors You Can Control
- Physical activity. The less you move, the higher your chances.
- Weight and diet. Being overweight after menopause raises your odds.
- Alcohol. Regular drinking — especially more than one drink a day — increases the risk of breast cancer.
- Reproductive history.
- You donât have a full-term pregnancy.
Still, most women who are at high risk for breast cancer donât get it. On the other hand, 75% of women who develop breast cancer have no known risk factors. Learn more about the risk factors for breast cancer.
How Are Fibroadenomas Diagnosed And Treated
Your healthcare provider may diagnose this type of lump simply by feeling it. But, he or she will want to confirm the diagnosis with a mammogram or ultrasound and fine-needle aspiration. Sometimes, in very young women, the fibroadenoma is not removed. However, since sometimes these tumors enlarge with pregnancy and breastfeeding, your provider may suggest having it surgically removed.
While most fibroadenomas do not lead to cancer, there is a type of fibroadenoma that has been linked to an increased risk of cancer, particularly in women with a family history of the disease.
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