Breast
cancer occurs when there is a malignant tumor inside
the breast. Each year more than 185,000 women are
diagnosed
with breast cancer, and the incidence of this disease
is rising in developed countries. There are approximately
43,500
deaths from breast cancer annually, making this disease
second to lung cancer as the leading cause of death
by cancer among women.
Orthodox
breast cancer treatment (surgery, radiation &
chemotherapy) has showed, in some cases, potential
in relieving symptoms and improving the patient's
quality of life. But in most other cases, the death
rate of surgery, the side effects of radiation and
chemotherapy are always beyond that patients can tolerate.
The Breasts
Each
breast has 15 to 20 overlapping sections called lobes.
Within each lobe are many smaller lobules, which end
in dozens of tiny bulbs that can produce milk. The
lobes, lobules, and bulbs are all linked by thin tubes
called ducts. These ducts lead to the nipple in the
center of a dark area of skin called the areola. Fat
fills the spaces around the lobules and ducts. There
are no muscles in the breast, but muscles lie under
each breast and cover the ribs.
Each breast also contains blood vessels and vessels
that carry colorless fluid called lymph. The lymph
vessels lead to small bean-shaped organs called lymph
nodes. Clusters of lymph nodes are found near the
breast in the axilla (under the arm), above the collarbone,
and in the chest.
Lymph
nodes are also found in many other parts of the body.
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Benign Breast Lumps
Any noticeable change, thickening or localized swelling
in your breast
that was not there before may be a lump. Eighty-five
percent of all breast lumps found are benign. Some
common benign breast problems that appear as lumps
are:
Cystic
Disease (fibrocystic breast disease) is the most common
cause of breast lumps in women. These lumps or cysts
are fluid-filled sacs that enlarge and become tender
and painful before the menstrual cycle. This condition
is responsible for at least half of all breast biopsies
performed. It tends to involve both breasts. These
lumps are movable, and if large may feel round and
firm. Cystic disease usually disappears after menopause.
Lipomas develop as single, painless lumps. They can
vary in size.
Lipomas consist of fatty tissue and are commonly found
elsewhere in the body.
Fibroadenomas, single solid tumors, appear most often
in young women. These breast lumps are firm, rubbery,
movable, often oval-shaped, and usually painless.
Papillomas are small, wart-like growths in the lining
of a mammary duct
near the nipple. These can produce a bloody discharge
of the nipple.
There
are other, not as common benign breast lumps caused
by a variety of breast problems such as sclerosing
adenosis, etc. TOP
Breast Cancer
The
most common type of breast cancer begins in the lining
of the ducts and is called ductal carcinoma. Another
type, called lobular carcinoma, arises in the lobules.
When breast cancer spreads outside the breast, cancer
cells are often found in the lymph nodes under the
arm (axillary lymph nodes). If the cancer has reached
these nodes, it may mean that cancer cells have spread
to other parts of the body--other lymph nodes and
other organs, such as the bones, liver, or lungs--via
the lymphatic system or the bloodstream. Cancer that
spreads is the same disease and has the same name
as the original (primary) cancer. When breast cancer
spreads, it is called metastatic breast cancer, even
though the secondary tumor is in another organ. Doctors
sometimes call this "distant" disease. TOP
Risk Factors for Breast Cancer
The
risk of breast cancer increases gradually as a woman
gets older.
This disease is uncommon in women under the age of
35. All women age 40 and older are at risk for breast
cancer. However, most breast cancers occur in women
over the age of 50, and the risk is especially high
for women over age 60.
Research has shown that the following conditions place
a woman at
increased risk for breast cancer:
Personal
history of breast cancer. Women who have had breast
cancer face an increased risk of getting breast cancer
again.
Genetic alterations. Changes in certain genes (BRCA1,
BRCA2, and others) make women more susceptible to
breast cancer.
Family history. A woman's risk for developing breast
cancer increases
if her mother, sister, daughter, or two or more other
close relatives, such as cousins, have a history of
breast cancer, especially at a young age. Certain
breast changes. Having a diagnosis of atypical hyperplasia
or lobular carcinoma in situ (LCIS) or having had
two or more breast biopsies for other benign conditions
may increase a woman's risk for developing cancer.
Other factors associated with an increased risk for
breast cancer include:
1. Breast density. Women age 45 and
older whose mammograms show at least 75 percent dense
tissue are at increased risk.
2. Radiation therapy. Women whose
breasts were exposed to radiation during their childhood,
especially those who were treated with radiation for
Hodgkin's disease, are at an increased risk for developing
breast cancer throughout their lives.
3. Late childbearing. Women who had
their first child after the age of 30 have a greater
chance of developing breast cancer than women who
had their children at a younger age.
In
most cases, doctors cannot explain why a woman develops
breast
cancer. Studies show that most women who develop breast
cancer have none of the risk factors listed above,
other than the risk that comes with growing older.
Also, most women with known risk factors do not get
breast cancer.
Scientists are conducting research into the causes
of breast cancer to learn more about risk factors
and ways of preventing this disease. TOP
Early Detection
When
breast cancer is found and treated early, the chances
for survival are better. Women can take an active
part in the early detection of breast cancer by having
regular screening mammograms and clinical breast exams
(breast exams performed by health professionals).
Some women also perform breast self-exams. TOP
Symptoms
Early
breast cancer usually does not cause pain. In fact,
when breast
cancer first develops, there may be no symptoms at
all. But as the cancer grows, it can cause changes
that women should watch for: A lump or thickening
in or near the breast or in the underarm area; A change
in the size or shape of the breast; Nipple discharge
or tenderness, or the nipple pulled back (inversion)
into the breast; Ridges or pitting of the breast (the
skin looks like the skin of an orange; or A change
in the way the skin of the breast, areola, or nipple
looks or feels (for example, warm, swollen, red, or
scaly).
A woman should see her doctor about any symptoms like
these. Most
often, they are not cancer, but it's important to
check with the doctor so that any problems can be
diagnosed and treated as early as possible. TOP
Diagnosis
In
addition to checking general signs of health, a woman's
doctor may
do one or more of the breast exams described on the
following page.
Palpation.
The doctor can tell a lot about a lump (its size,
its texture,
and whether it moves easily) by palpation, carefully
feeling the lump and the tissue around it. Benign
lumps often feel different from cancerous ones.
Mammography. X-rays of the breast can give the doctor
important information about a breast lump. If an area
on the mammogram looks suspicious or is not clear,
additional mammograms may be needed.
Ultrasonography. Using high-frequency sound waves,
ultrasonography can often show whether a lump is solid
or filled with fluid. This exam may be used along
with mammography. Fine needle aspiration. A thin needle
is used to remove fluid from a breast lump. This procedure
may show whether a lump is a fluid-filled cyst (not
cancer) or a solid mass (which may or may not be cancer).
Clear fluid removed from a cyst may not need to be
checked by a lab.
Needle biopsy. Using special techniques, tissue can
be removed with a
needle from an area that is suspicious on a mammogram
but cannot be felt.
Tissue removed in a needle biopsy goes to a lab to
be checked by a
pathologist for cancer cells.
Surgical biopsy. The surgeon cuts out part or all
of a lump or suspicious area. A pathologist examines
the tissue under a microscope to check for cancer
cells. When cancer is found, the pathologist can tell
what kind of cancer it is (whether it began in a duct
or a lobule) and whether it is invasive (has invaded
nearby tissues in the breast).
Special lab tests of the tissue help the doctor learn
more about the
cancer. For example, hormone receptor tests (estrogen
and progesterone receptor tests) can help predict
whether the cancer is sensitive to hormones.
Treatment
The
treatment options for each woman depend on the size
and location of the tumor in her breast, the results
of lab tests (including hormone receptor tests), and
the stage (or extent) of the disease.
Methods
of Treatment
Methods
of treatment for breast cancer are local or systemic.
Local treatments are used to remove, destroy, or control
the cancer cells in
a specific area. Surgery and radiation therapy are
local treatments.
Systemic treatments are used to destroy or control
cancer cells throughout the body.
Chemotherapy and hormonal therapy are systemic treatments.
A patient may have just one form of treatment or a
combination. Different forms of treatment may be given
at the same time or one after another.
Surgery is the most common treatment for breast cancer.
Several types of surgery may be used. An operation
to remove the breast (or as much of the breast as
possible) is a mastectomy. Breast reconstruction is
often an option at the same time as the mastectomy,
or later on. An operation to remove the cancer but
not the breast is called breast-sparing surgery or
breast-conserving surgery. Lumpectomy and segmental
mastectomy (also called partial mastectomy) are types
of breast-sparing surgery. They usually are followed
by radiation therapy to destroy any cancer cells that
may remain in the area.
In
lumpectomy, the surgeon removes the breast cancer
and some normal tissue around it. Often, some of the
lymph nodes under the arm are removed.
In
segmental mastectomy, the surgeon removes the cancer
and a larger area of normal breast tissue around it.
Occasionally, some of the lining over the chest muscles
below the tumor is removed as well. Some of the lymph
nodes under the arm may also be removed.
In
total (simple) mastectomy, the surgeon removes the
whole breast.
Some of the lymph nodes under the arm may also be
removed.
In
modified radical mastectomy, the surgeon removes the
whole breast, most of the lymph nodes under the arm,
and often the lining over the chest muscles. The smaller
of the two chest muscles is also taken out to help
in removing the lymph nodes.
In
radical mastectomy (also called Halsted radical mastectomy),
the surgeon removes the breast, the chest muscles,
all of the lymph nodes under the arm, and some additional
fat and skin. Breast reconstruction (surgery to rebuild
a breast's shape) is often an option after mastectomy.
Radiation
therapy (also called radiotherapy) is the use of high-energy
rays to kill cancer cells and stop them from growing.
The rays may come from radioactive material outside
the body and be directed at the breast by a machine
(external radiation). The radiation can also come
from radioactive material placed directly in the breast
in thin plastic tubes (implant radiation). Some women
receive both kinds of radiation therapy.
Radiation therapy, alone or with chemotherapy or hormone
therapy, is
sometimes used before surgery to destroy cancer cells
and shrink tumors.
This approach is most often used in cases in which
the breast tumor is large or not easily removed by
surgery.
Chemotherapy
is the use of drugs to kill cancer cells. Chemotherapy
for breast cancer is usually a combination of drugs.
The drugs may be given by mouth or by injection. Either
way, chemotherapy is a systemic therapy because the
drugs enter the bloodstream and travel throughout
the body.
Chemotherapy is given in cycles: a treatment period
followed by a recovery period, then another treatment,
and so on. Most patients have chemotherapy in an outpatient
part of the hospital, at the doctor's office, or at
home.
Depending on which drugs are given and the woman's
general health,
however, she may need to stay in the hospital during
her treatment.
Hormonal
therapy is used to keep cancer cells from getting
the hormones they need to grow. This treatment may
include the use of drugs that change the way hormones
work or surgery to remove the ovaries, which make
female hormones. Like chemotherapy, hormonal therapy
is a systemic treatment; it can affect cancer cells
throughout the body.
Treatment
decisions are complex. They are often affected by
the judgment of the doctor, by the desires of the
patient and, the most important, the stage of the
disease. The stage is based on the size of the tumor
and whether the cancer has spread.
Side
Effects of Treatment
It
is hard to limit the effects of cancer treatment so
that only cancer
cells are removed or destroyed. Because healthy cells
and tissues may
also be damaged, treatment often causes unwanted side
effects.
The side effects of cancer treatment are different
for each person, and they may even be different from
one treatment to the next.
Surgery
Surgery causes short-term pain and tenderness in the
area of the operation, so women may need to talk with
their doctor about which method of pain control would
be appropriate. Any kind of surgery also carries a
risk of infection, poor wound healing, bleeding, or
a reaction to the anesthesia used in surgery. Removal
of a breast can cause a woman's weight to shift and
be out of balance--especially if she has large breasts.
This imbalance can cause discomfort in a woman's neck
and back. Also, the skin in the breast area may be
tight, and the muscles of the arm and shoulder may
feel stiff. After a mastectomy, some women have some
permanent loss of strength in these muscles.
Because nerves may be injured or cut during surgery,
a woman may have numbness and tingling in the chest,
underarm, shoulder, and arm. These feelings usually
go away within a few weeks or months, but some women
may have permanent numbness.
Removing the lymph nodes under the arm slows the flow
of lymph. In some women, this fluid builds up in the
arm and hand and causes swelling (lymphedema). Women
need to protect the arm and hand on the treated side
from injury, even long after surgery.
The radiation may cause side effects that involve
the heart, lungs, and ribs. One of the common side
effects is fatigue, especially in the
later weeks of treatment and for sometime afterward.
It is also common for the skin in the treated area
to become red, dry, tender, and itchy. Toward the
end of treatment, the skin may become moist and "weepy."
Exposing this area to air as much as possible will
help the skin heal. Because bras and some types of
clothing may rub the skin and cause irritation, patients
may want to wear loose-fitting cotton clothes. These
effects of radiation therapy on the skin are temporary,
and the area gradually heals once treatment is over.
However, there may be a permanent change in the color
of the
skin.For most women, the breast will look and feel
about the same after radiation therapy. Occasionally,
the treated breast may be firmer.
Also, it may be larger (due to fluid buildup) or smaller
(because of tissue changes) than it was before. For
some women, the breast skin is more sensitive after
radiation treatment; for others, it is less sensitive.
Chemotherapy
The side effects of chemotherapy depend mainly on
the drugs the patient receives. As with other types
of treatment, side effects vary from person to person.
In general, anticancer drugs affect rapidly dividing
cells.
These include blood cells, which fight infection,
cause the blood to clot, and carry oxygen to all parts
of the body. When blood cells are affected by anticancer
drugs, patients are more likely to get infections,
bruise or bleed easily, and may have less energy during
treatment and for some time afterward. Cells in hair
follicles and cells that line the digestive tract
also divide rapidly. As a result of chemotherapy,
patients may lose their hair and may have other side
effects, such as loss of appetite, nausea, vomiting,
diarrhea, or mouth sores. There are cases in which
the heart is weakened, and second cancers such as
leukemia (cancer of the blood cells) have occurred.
Also, some anticancer drugs can damage the ovaries.
If the ovaries fail to produce hormones, the woman
may have symptoms of menopause, such as hot flashes
and vaginal dryness. Her periods may become irregular
or may stop, and she may not be able to become pregnant.
However, some women may still be able to get pregnant
during treatment. Because the effects of chemotherapy
on an unborn child are not known, it is important
for a woman to talk to her doctor about birth control
before treatment begins. After treatment, some women
regain their ability to become pregnant, but in women
over the age of 35 or 40, infertility is likely to
be permanent.
Hormonal Therapy
Hormonal therapy can cause a number of side effects.
They depend largely on the specific drug or type of
treatment, and they vary from patient to patient.
Tamoxifen is the most common hormonal treatment. This
drug blocks the body's use of estrogen but does not
stop estrogen production.
Tamoxifen may cause hot flashes, vaginal discharge
or irritation, and irregular periods. Any unusual
bleeding should be reported to the doctor. Younger
women taking tamoxifen may become pregnant more easily
and should discuss birth control methods with their
doctor.
Serious side effects of tamoxifen are rare, but this
drug can cause blood clots in the veins, especially
in the legs. In a very small number of women, tamoxifen
has caused cancer of the lining of the uterus. The
doctor may do a pelvic exam, as well as biopsies or
other tests of the lining of the uterus, to monitor
for this condition. (This does not apply to women
who have had a hysterectomy, surgery to remove the
uterus.) Young women whose ovaries are removed to
deprive the cancer cells of estrogen experience menopause
immediately. The side effects they have are likely
to be more severe than the effects of natural menopause.
