Important Information about Breast Cancer
• Breast cancer (cancer of the breast) is one of the most common cancers in women.
• Most cases occur in women over the age of 50.
• If you notice any lump or change to your normal breast then you should see a doctor promptly.
• If breast cancer is diagnosed at an early stage, there is a good chance of a cure.
• In general, the more advanced the cancer (the more it has grown and spread), the less chance that treatment will be curative. However, treatment can often slow the progress of the cancer.
What is important is that you get to know your own breasts – how they look and feel – and report any changes promptly to a doctor.
• Most cases occur in women over the age of 50.
• If you notice any lump or change to your normal breast then you should see a doctor promptly.
• If breast cancer is diagnosed at an early stage, there is a good chance of a cure.
• In general, the more advanced the cancer (the more it has grown and spread), the less chance that treatment will be curative. However, treatment can often slow the progress of the cancer.
What is important is that you get to know your own breasts – how they look and feel – and report any changes promptly to a doctor.
What is Breast Cancer
• Breast cancer is one of the most common cancers in females
• Around one in eight women develop breast cancer at some stage in their life.
• Most develop in women over the age of 50 but younger women are sometimes affected.
• Breast cancer can also develop in men, although this is rare.
• Breast cancer develops from a cancerous cell which develops in the lining of a milk duct or milk gland (lobule) in one of the breasts.
• There are some ‘sub-types’ of breast cancer which are important to know as the treatment and prognosis (outlook) vary depending on the exact type of the cancer.
Types of Breast Cancer
Broadly it is divided into
• Non-invasive and Carcinoma in situ
Some people are diagnosed when the cancerous cells are still totally within a duct or lobule. These are called ‘carcinoma in situ’ as no cancer cells have grown out from their original site.
Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer
• Invasive cancer
Most breast cancers are diagnosed when a tumor has grown from within a duct or lobule into the surrounding breast tissue. These are called ‘invasive’ breast cancers.
Invasive breast cancers are also divided into those where cancer cells have invaded into local blood or lymphatic vessels and those that have not.
• Breast cancer is one of the most common cancers in females
• Around one in eight women develop breast cancer at some stage in their life.
• Most develop in women over the age of 50 but younger women are sometimes affected.
• Breast cancer can also develop in men, although this is rare.
• Breast cancer develops from a cancerous cell which develops in the lining of a milk duct or milk gland (lobule) in one of the breasts.
• There are some ‘sub-types’ of breast cancer which are important to know as the treatment and prognosis (outlook) vary depending on the exact type of the cancer.
Types of Breast Cancer
Broadly it is divided into
• Non-invasive and Carcinoma in situ
Some people are diagnosed when the cancerous cells are still totally within a duct or lobule. These are called ‘carcinoma in situ’ as no cancer cells have grown out from their original site.
Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer
• Invasive cancer
Most breast cancers are diagnosed when a tumor has grown from within a duct or lobule into the surrounding breast tissue. These are called ‘invasive’ breast cancers.
Invasive breast cancers are also divided into those where cancer cells have invaded into local blood or lymphatic vessels and those that have not.
A carcinoma in situ is easier to treat and has a better outlook than an invasive cancer.
Grade of the cancerous cells
A sample of breast cancer tissue can be looked at under the microscope. As a rough guide, the lower the grade, the better the cancer is likely to respond to treatments such as chemotherapy and radiotherapy.
A sample of breast cancer tissue can be looked at under the microscope. As a rough guide, the lower the grade, the better the cancer is likely to respond to treatments such as chemotherapy and radiotherapy.
• Grade 1 – the cancer cells tend to be slow growing and less ‘aggressive’.
• Grade 2 – is a middle grade.
• Grade 3 – the cancer cells tend to be fast growing and more ‘aggressive’.
• Grade 2 – is a middle grade.
• Grade 3 – the cancer cells tend to be fast growing and more ‘aggressive’.
Presence of receptors
Some breast cancer cells have receptors, which allow certain types of hormones or proteins to attach to the cancer cell. The types of receptor tested for are:
• Hormones
Tests on a sample of breast cancer cells can show if they contain estrogen receptors or progesterone receptors. (Estrogen and Progesterone are female hormones.)
Treatment can block the hormone receptors in these cancers
• Her2
Some breast cancer cells have receptors for a protein known as HER2.
Cancers having high levels of these receptors are called Her2 positive.
Stage of the cancer
• This does not describe a type of cancer, but describes how much the cancer has grown and whether it has spread.
• As a general rule, the earlier the stage, the greater the chance of a cure
Causes of Breast Cancer
• A cancerous tumor starts from one abnormal cell.
• The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell.
• This makes the cell abnormal and multiplies ‘out of control’
Risk factors
Although breast cancer can develop for no apparent reason, there are certain ‘risk factors’ which increase the chance that breast cancer will develop.
• Ageing – The risk of developing breast cancer roughly doubles for every 10 years of age. Most cases develop in women over the age of 50.
• Where you live – The rate of breast cancer varies between countries. This may reflect genetic or environmental factors.
• Family history – This means if you have close relatives who have or have had breast cancer. In particular, if they were aged under 50 when diagnosed.
• If you have had a previous breast cancer.
• Being childless, or if you had your first child after the age of thirty.
• Early age of starting periods.
• Having a menopause over the age of 55.
• Taking HRT (hormone replacement therapy) for several years (in women over 50 years) leads to a slightly increased risk.
• Having dense breasts.
• A past history of some benign breast diseases.
• Lifestyle factors – little exercise; obesity after the menopause; excess alcohol.
Family history and genetic testing
• About 1-2 in 20 cases of breast cancer are caused by a ‘faulty gene’ which can be inherited.
• Breast cancer which is linked to a faulty gene most commonly affects women in their 30s and 40s.
• The genes BRCA1 and BRCA2 are the commonest faulty genes.
• If you have any of the following in your family, you might want to see to your doctor.
Three close blood relatives (from the same side of the family) who developed breast or ovarian cancer at any age.
Two close relatives (from the same side of the family) who developed breast or ovarian cancer under the age of 60.
One close relative who developed breast cancer under the age of 40.
A case of breast cancer in a male relative.
A relative with cancer in both breasts.
Note: most cases of breast cancer are not due to an inherited faulty gene.
Some breast cancer cells have receptors, which allow certain types of hormones or proteins to attach to the cancer cell. The types of receptor tested for are:
• Hormones
Tests on a sample of breast cancer cells can show if they contain estrogen receptors or progesterone receptors. (Estrogen and Progesterone are female hormones.)
Treatment can block the hormone receptors in these cancers
• Her2
Some breast cancer cells have receptors for a protein known as HER2.
Cancers having high levels of these receptors are called Her2 positive.
Stage of the cancer
• This does not describe a type of cancer, but describes how much the cancer has grown and whether it has spread.
• As a general rule, the earlier the stage, the greater the chance of a cure
Causes of Breast Cancer
• A cancerous tumor starts from one abnormal cell.
• The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell.
• This makes the cell abnormal and multiplies ‘out of control’
Risk factors
Although breast cancer can develop for no apparent reason, there are certain ‘risk factors’ which increase the chance that breast cancer will develop.
• Ageing – The risk of developing breast cancer roughly doubles for every 10 years of age. Most cases develop in women over the age of 50.
• Where you live – The rate of breast cancer varies between countries. This may reflect genetic or environmental factors.
• Family history – This means if you have close relatives who have or have had breast cancer. In particular, if they were aged under 50 when diagnosed.
• If you have had a previous breast cancer.
• Being childless, or if you had your first child after the age of thirty.
• Early age of starting periods.
• Having a menopause over the age of 55.
• Taking HRT (hormone replacement therapy) for several years (in women over 50 years) leads to a slightly increased risk.
• Having dense breasts.
• A past history of some benign breast diseases.
• Lifestyle factors – little exercise; obesity after the menopause; excess alcohol.
Family history and genetic testing
• About 1-2 in 20 cases of breast cancer are caused by a ‘faulty gene’ which can be inherited.
• Breast cancer which is linked to a faulty gene most commonly affects women in their 30s and 40s.
• The genes BRCA1 and BRCA2 are the commonest faulty genes.
• If you have any of the following in your family, you might want to see to your doctor.
Three close blood relatives (from the same side of the family) who developed breast or ovarian cancer at any age.
Two close relatives (from the same side of the family) who developed breast or ovarian cancer under the age of 60.
One close relative who developed breast cancer under the age of 40.
A case of breast cancer in a male relative.
A relative with cancer in both breasts.
Note: most cases of breast cancer are not due to an inherited faulty gene.
Symptoms of breast cancer
• A breast lump
The usual first symptom is a painless lump in the breast.
Note:
Most breast lumps are not cancerous.
Most breast lumps are fluid filled cysts or fibroadenomas (a clumping of glandular tissue) which are benign.
However, you should always see a doctor if a lump develops as the breast lump may be cancerous.
• Other symptoms
Other symptoms which may be noticed in the affected breast include:
Changes in the size or shape of a breast.
Dimpling or thickening of some of the skin on a part of a breast.
The nipple becomes inverted (turns in).
Rarely, a discharge from a nipple occurs (which may be bloodstained).
A rare type of breast cancer causes a rash around the nipple which can look similar to a small patch of eczema.
Rarely, pain in a breast.
Note: pain is not a usual early symptom. Many women develop painful breasts and this is not usually caused by cancer.
• A breast lump
The usual first symptom is a painless lump in the breast.
Note:
Most breast lumps are not cancerous.
Most breast lumps are fluid filled cysts or fibroadenomas (a clumping of glandular tissue) which are benign.
However, you should always see a doctor if a lump develops as the breast lump may be cancerous.
• Other symptoms
Other symptoms which may be noticed in the affected breast include:
Changes in the size or shape of a breast.
Dimpling or thickening of some of the skin on a part of a breast.
The nipple becomes inverted (turns in).
Rarely, a discharge from a nipple occurs (which may be bloodstained).
A rare type of breast cancer causes a rash around the nipple which can look similar to a small patch of eczema.
Rarely, pain in a breast.
Note: pain is not a usual early symptom. Many women develop painful breasts and this is not usually caused by cancer.
The first place that breast cancer usually spreads to is the lymph nodes (glands) in the armpit. If this occurs you may develop a swelling or lump in an armpit. If the cancer spreads to other parts of the body then various other symptoms can develop.
Diagnosis of breast cancer
• Initial assessment
If you develop a lump or symptoms which may be breast cancer, a doctor will usually examine your breasts and armpits to look for any lumps or other changes.
You will normally be referred to a specialist.
Sometimes a biopsy of an obvious lump is arranged, but other tests may be done first such as:
Mammogram. This is a special X-ray of the breast tissue which can detect changes in the density of breast tissue which may indicate a tumors.
Ultrasound scan of the breast.
MRI scan of the breast. This is more commonly performed on younger women, especially those with a strong family history of breast cancer.
• Biopsy – to confirm the diagnosis
A biopsy is when a small sample of tissue is removed from a part of the body.
The sample is examined under the microscope to look for abnormal cells.
A specialist may take a biopsy with a needle which is inserted into the lump and some cells are withdrawn (FNAC –Fine Needle Aspiration Cytology).
Sometimes the doctor may be guided as to where to insert the needle with the help of a mammogram or ultrasound scan.
Sometimes a small operation is needed to obtain a biopsy sample.
The biopsy sample can confirm or rule out breast cancer. Also the cells from a tumor can be assessed and tested to determine their grade and receptor status.
• Assessing the extent and spread
If you are confirmed to have breast cancer, further tests may be needed to assess if it has spread.
For example, blood tests, an ultrasound scan of the liver, chest X-ray, a bone scan or other types of scan. This assessment is called ‘staging’ of the cancer.
The aim of staging is to find out:
Diagnosis of breast cancer
• Initial assessment
If you develop a lump or symptoms which may be breast cancer, a doctor will usually examine your breasts and armpits to look for any lumps or other changes.
You will normally be referred to a specialist.
Sometimes a biopsy of an obvious lump is arranged, but other tests may be done first such as:
Mammogram. This is a special X-ray of the breast tissue which can detect changes in the density of breast tissue which may indicate a tumors.
Ultrasound scan of the breast.
MRI scan of the breast. This is more commonly performed on younger women, especially those with a strong family history of breast cancer.
• Biopsy – to confirm the diagnosis
A biopsy is when a small sample of tissue is removed from a part of the body.
The sample is examined under the microscope to look for abnormal cells.
A specialist may take a biopsy with a needle which is inserted into the lump and some cells are withdrawn (FNAC –Fine Needle Aspiration Cytology).
Sometimes the doctor may be guided as to where to insert the needle with the help of a mammogram or ultrasound scan.
Sometimes a small operation is needed to obtain a biopsy sample.
The biopsy sample can confirm or rule out breast cancer. Also the cells from a tumor can be assessed and tested to determine their grade and receptor status.
• Assessing the extent and spread
If you are confirmed to have breast cancer, further tests may be needed to assess if it has spread.
For example, blood tests, an ultrasound scan of the liver, chest X-ray, a bone scan or other types of scan. This assessment is called ‘staging’ of the cancer.
The aim of staging is to find out:
- How large the tumor has grown.
- Whether the cancer has spread to local lymph nodes in the armpit.
- Whether the cancer has spread to other areas of the body.
Finding out the stage of the cancer, the grade of the cells and the receptor status of the cancer help doctors to advice on the best treatment options.
It also gives a reasonable indication of outlook.
It also gives a reasonable indication of outlook.
The treatment for breast cancer
• Treatment options which may be considered include surgery, chemotherapy, radiotherapy and hormone treatment.
• Often a combination of two or more of these treatments is used.
• The treatments used depend on:
The cancer itself –
its size and stage (whether it has spread),
the grade of the cancer cells, and
whether it is hormone responsive or contains Her2 receptors, AND
The woman with the cancer –
age,
whether or not she has achieved menopause,
her general health and personal preferences for treatment.
• Often a combination of two or more of these treatments is used.
• The treatments used depend on:
The cancer itself –
its size and stage (whether it has spread),
the grade of the cancer cells, and
whether it is hormone responsive or contains Her2 receptors, AND
The woman with the cancer –
age,
whether or not she has achieved menopause,
her general health and personal preferences for treatment.
Surgery
• The types of operation which may be considered are:
Breast-conserving surgery. This is often an option if the tumor is not too big.
A ‘lumpectomy’ (or wide local excision) is one type of operation where just the tumor and some surrounding breast tissue is removed.
It is usual to have radiotherapy following this operation.
This aims to kill any cancer cells which may have been left in the breast tissue.
Removal of the affected breast (mastectomy).
This may be necessary if there is a large tumor or a tumor in the middle of the breast.
It is often possible to have breast reconstruction surgery to create a new breast following a mastectomy.
This can often be done at the same time as the mastectomy, although it can also be done months or years later.
There now are many different types of reconstruction operations available.
Whatever operation is done it is also usual to remove one or more of the lymph nodes in the armpit. These lymph nodes are where breast cancer usually first spreads to.
The lymph nodes which are removed are examined under the microscope to see if they contain any cancer cells.
This helps to accurately stage the disease and helps to guide the specialist as to what treatment to advice following surgery.
Alternatively, a sentinel lymph node biopsy may be performed.
This is a way of assessing if the main lymph nodes draining the breast cancer contain cancer. If they are clear then the remaining lymph nodes in the armpit will not need to be removed.
Radiotherapy
• Radiotherapy is a treatment which uses high energy beams of radiation which are focused on cancerous tissue.
• This kills cancer cells, or stops cancer cells from multiplying.
For breast cancer, radiotherapy is mainly used in addition to surgery. When radiotherapy is used in addition to surgery it is called ‘adjuvant radiotherapy’.
• New techniques for radiotherapy are currently in use which reduce the toxicity and duration of treatment
Chemotherapy
• Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells, or stop them from multiplying.
• When chemotherapy is used in addition to surgery it is known as ‘adjuvant chemotherapy’.
• Chemotherapy is sometimes given before surgery to shrink a tumor so that surgery may have a better chance of success and also a smaller operation may be performed. This is known as ‘neoadjuvant chemotherapy’.
• The type of chemotherapy given may depend on the type of cancer.
• New gene tests are being developed to help doctors decide which women will benefit the most from chemotherapy.
• Chemotherapy may also be used for some women to treat breast cancer which has spread to other areas of the body.
Hormone treatments
• Some types of breast cancer are affected by the female hormone estrogen (and sometimes progesterone).
• These hormones stimulate the cancer cells to divide and multiply.
• Most estrogen and progesterone is made by the ovaries.
• Treatments which reduce the level of these hormones, or prevent them from working, are commonly used in people with breast cancer.
• This hormone treatment works best in women with ‘hormone responsive’ breast cancer, but they sometimes work in cancers classed as non-hormone responsive.
• Hormone treatments include:
Estrogen blockers.
Tamoxifen has been available for many years and is still widely used.
It works by blocking the estrogen from working on cells. It is usually taken for five years.
Aromatase inhibitors.
These are drugs which work by blocking the production of estrogen in body tissues.
They are used in women who have gone through the menopause.
GnRH (gonadotrophin releasing hormone) analogues.
These drugs work by greatly reducing the amount of oestrogen that you make in the ovaries.
They are usually given by injection and may be used for women who have not yet reached the menopause.
An alternative which may be considered for women before the menopause is to remove the ovaries (or to destroy them with radiotherapy). This stops estrogen from being made.
Trastuzumab
• Trastuzumab (also known as Herceptin) is a treatment that may be given to women who have a large number of HER2 receptors in their cancer.
• It is a type of drug called a monoclonal antibody.
• It works by attaching to HER2 receptors on the surface of breast cancer cells and thereby stopping the cancer cells from dividing and growing.
• The types of operation which may be considered are:
Breast-conserving surgery. This is often an option if the tumor is not too big.
A ‘lumpectomy’ (or wide local excision) is one type of operation where just the tumor and some surrounding breast tissue is removed.
It is usual to have radiotherapy following this operation.
This aims to kill any cancer cells which may have been left in the breast tissue.
Removal of the affected breast (mastectomy).
This may be necessary if there is a large tumor or a tumor in the middle of the breast.
It is often possible to have breast reconstruction surgery to create a new breast following a mastectomy.
This can often be done at the same time as the mastectomy, although it can also be done months or years later.
There now are many different types of reconstruction operations available.
Whatever operation is done it is also usual to remove one or more of the lymph nodes in the armpit. These lymph nodes are where breast cancer usually first spreads to.
The lymph nodes which are removed are examined under the microscope to see if they contain any cancer cells.
This helps to accurately stage the disease and helps to guide the specialist as to what treatment to advice following surgery.
Alternatively, a sentinel lymph node biopsy may be performed.
This is a way of assessing if the main lymph nodes draining the breast cancer contain cancer. If they are clear then the remaining lymph nodes in the armpit will not need to be removed.
Radiotherapy
• Radiotherapy is a treatment which uses high energy beams of radiation which are focused on cancerous tissue.
• This kills cancer cells, or stops cancer cells from multiplying.
For breast cancer, radiotherapy is mainly used in addition to surgery. When radiotherapy is used in addition to surgery it is called ‘adjuvant radiotherapy’.
• New techniques for radiotherapy are currently in use which reduce the toxicity and duration of treatment
Chemotherapy
• Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells, or stop them from multiplying.
• When chemotherapy is used in addition to surgery it is known as ‘adjuvant chemotherapy’.
• Chemotherapy is sometimes given before surgery to shrink a tumor so that surgery may have a better chance of success and also a smaller operation may be performed. This is known as ‘neoadjuvant chemotherapy’.
• The type of chemotherapy given may depend on the type of cancer.
• New gene tests are being developed to help doctors decide which women will benefit the most from chemotherapy.
• Chemotherapy may also be used for some women to treat breast cancer which has spread to other areas of the body.
Hormone treatments
• Some types of breast cancer are affected by the female hormone estrogen (and sometimes progesterone).
• These hormones stimulate the cancer cells to divide and multiply.
• Most estrogen and progesterone is made by the ovaries.
• Treatments which reduce the level of these hormones, or prevent them from working, are commonly used in people with breast cancer.
• This hormone treatment works best in women with ‘hormone responsive’ breast cancer, but they sometimes work in cancers classed as non-hormone responsive.
• Hormone treatments include:
Estrogen blockers.
Tamoxifen has been available for many years and is still widely used.
It works by blocking the estrogen from working on cells. It is usually taken for five years.
Aromatase inhibitors.
These are drugs which work by blocking the production of estrogen in body tissues.
They are used in women who have gone through the menopause.
GnRH (gonadotrophin releasing hormone) analogues.
These drugs work by greatly reducing the amount of oestrogen that you make in the ovaries.
They are usually given by injection and may be used for women who have not yet reached the menopause.
An alternative which may be considered for women before the menopause is to remove the ovaries (or to destroy them with radiotherapy). This stops estrogen from being made.
Trastuzumab
• Trastuzumab (also known as Herceptin) is a treatment that may be given to women who have a large number of HER2 receptors in their cancer.
• It is a type of drug called a monoclonal antibody.
• It works by attaching to HER2 receptors on the surface of breast cancer cells and thereby stopping the cancer cells from dividing and growing.
No comments:
Post a Comment