Breast Cancer-Diagnosis and Treatment

When an abnormality, such as a lump, is detected in the breast, your doctor will order tests or procedures to further evaluate the problem. These may include a diagnostic mammogram, ultrasound, magnetic resonance imaging (MRI), a needle biopsy or aspiration, or a formal surgical biopsy. These can help to determine if an abnormality is breast cancer, and if so, to characterize the tumor.

Technology has brought about new ways to see into the body, but to date, the mammogram is still the standard of care for screening and is the only screening test shown to decrease the chance of dying of breast cancer. Annual screening mammograms have been shown to decrease mortality by 20 to 30 percent in women over the age of 50. The American Cancer Society recommends that woman have regular mammograms beginning at age 40.

Other imaging technologies are used to complement mammography or to further evaluate an abnormality in the breast. Each offers benefits, but also shortcomings. These include:

• Magnetic resonance imaging (MRI). MRIs are particularly useful to evaluate abnormalities in women with dense breasts. Recently, several cancer organizations have made recommendations that women, who are at very high risk of developing breast cancer, get an annual MRI in addition to a mammogram. However, MRIs aren’t recommended for routine screening. That is because they’re expensive, require an IV injection of a contrast agent, and can lead to additional biopsies and give a high rate of false positives and increased anxiety.

• Ultrasound. Often, this is ordered to determine if a lump or suspicious area found during a breast exam or on a mammogram, is a cyst or a solid mass.

• Digital mammography. The use of this method is on the rise. Digital mammography is slightly better in younger women with dense breast tissue. It can decrease radiation dose and decrease the frequency of repeat images. It has the advantage of decreased waiting time since there’s no time needed to develop the film.

Other tests include computer-aided mammography, nuclear tracers, 3-D mammography, optical imaging, optoacoustic tomography, and microwave imaging.

Chemotherapy

This refers to drugs that kill cancer cells. It’s given alone or as several drugs together. In some cases, it has been found to be of benefit to give chemotherapy prior to surgery (neoadjuvant chemotherapy) to shrink a tumor. It is used for this purpose in women with large tumors. The technique has also been shown to significantly decrease the chance of the cancer returning, and allows women to live longer. Chemotherapy can have significant side effects, so doctors try to individualize treatments.

Genetic markers from the blood can identify which women are likely to have a good response to certain medications. Testing the genetic makeup of the tumor itself can help determine which women are at the highest risk of recurrence and which of those women are more likely to benefit from chemotherapy, while allowing women at very low risk of recurrence to avoid the side effects of unnecessary treatment.

The cancer cells can also be tested for the presence of the human epidermal growth factor receptor 2 (HER-2). HER-2 is a protein found in excessive amounts on the surface of about one out of three breast cancers. Those cancers have always tended to be more aggressive, more likely to spread, and less likely to respond to traditional chemotherapy. However, new treatments — such as the drug trastuzumab (Herceptin) — that directly target the HER-2 protein are now available, greatly improving the outlook for these women. Tratuzumab reduces post-surgical cancer recurrence by up to 50 percent for women with HER-2-positive cancers.

If your cancer is considered “hormone receptor positive,” hormone therapies with the use of estrogen blockers such as tamoxifen, anastrazole (Arimidex), letrazole (Femara) and exenestane (Aromasin), can reduce the rates of recurrence.

Radiation

Studies have shown success in two particular types of therapies — partial breast irradiation and short-course radiation. Both therapies reduce the amount of time you spend at the radiation center. In a traditional radiation course, you’ll spend about five days a week for five to six weeks receiving radiation to the breast.

Partial breast radiation is a new method of radiation that may be considered for those who have had a lumpectomy — a surgical option for small tumors relative to the size of the whole breast. In partial breast irradiation, radiation is focused on just where the tumor was before being removed through surgery.

Those with early-stage cancer and no lymph node involvement — but who don’t qualify for partial breast radiation, due to factors such as tumor size or location — may be candidates for short-course radiation. A Canadian study released in 2008 concluded that reducing radiation treatments for certain early-stage breast cancer to 16 sessions given over the course of about three weeks appears to be just as effective as the standard treatment series of 25 treatments over five weeks.

Surgical Treatment Options

If a mastectomy is recommended by either a breast surgeon or an oncologist — or is preferred by the patient — there are several types of breast removal. These include:

• Total, or simple, mastectomy. This involves removal of breast tissue, skin, the nipple and the dark skin (areola) around the nipple but not the lymph nodes.

• Modified radical mastectomy. This removes the same tissues as does a total mastectomy, but also includes the lymph nodes under the armpits (axillary lymph node dissection).

• Radical mastectomy. This is the most extensive form of mastectomy. In addition to the removal of breast and lymph nodes, some chest wall muscle, and additional fat and skin also are removed.

• Others. This includes the skin-sparing mastectomy and the subcutaneous (nipple-sparing) mastectomy.

Breast Cancer-Advances in prevention

A number of recent advances will help prevent,detect and treat the disease that women dreaded so much.

The good news is that breast cancer survival rates are among the highest of all cancers. Overall, nearly 89 percent of women diagnosed with breast cancer live for at least five years after treatment.

These lifestyle changes and early detection methods are key that can reduce the risk of developing breast cancer.

• 
  
  Excercise. Aim to excercise 30minutes three to four times a week. Regular excersice may help prevent the disease by boosting immune function,warding off obesity, and lowering levels of estrogen and insulin.
  
  
  

• 
  
  Drink less Alcohol. Research has shown that two drinks a day could increase their risk of 10 percent.
  
  
  

• 
  
  Weight. A study published in the Journal of the American Medical Association in 2006 concluded that women who lost 22 pounds after menopause reduced their risk of developing breast cancer by 45 percent.
  
  
  

• 
  
  Eat your veggies. A low-fat diet can do a lot to reduce women's risk, but for even more protection, add some cruciferous vegetables, such as broccoli to your plate.
  

• Know your family history. "In about 15 percent of breast cancer cases, there is a family history of the disease," Freeman says.If you have one first-degree relative who had breast cancer, your lifetime risk doubles, and if you have two your risk increases five-fold.
  

• Get checked. All women should have a clinical breast exam at least  every three years and annual exams and mammoggrams starting at the age of 40. Women with a family history should begin screening 10 years prior to the family member's age of diagnosis.
  

Stages of Breast Cancer

Staging Your Cancer

Tumor size,lymph node involvement, and whether the cancer has spread to the other parts of your body will determine the stage of your cancer. A key part of staging breast cancer is to determine whether an invasive tumor has spread to regional lymph nodes. To accomplish this, a test called sentinel node biopsy has become the gold standard. The sentinel nodes are the lymph nodes in the underarm area that are usually the one closest to the area of the breast invovled in the cancer. Using the result of the sentinel node biospy, doctors can determine whether additional lymph nodes need to be removed.

A surgeon may use any of the several methods to locate sentinel nodes. These include injecting a blue dye in the area of the breast where the tumor has been indentified, the use of radioactive tracer injected into the breast, or both. Once identified, the surgeon removes the sentinel nodes and a pathologist examines them for cancer cells. If no cancer is seen, then further lymph nodes need to be removed. If the sentinel nodes does not contain cancer, the surgeon will remove additional lymph nodes from the armpit (axillary lymph node dissection) to determine how many lymph nodes are involved as well as to remove the cancer in the area. Properly done. a sentinel node biopsy canaccurately identify the lymph node involvement of the cancer 97 percent of the time.

Sentinel node biopsy has spared many women from the axillary node dissection and its complications, such as swelling (lymphedema).

Additional information important to determine treatment includes identifying the cancer's :

• Grade. This is determined with tissue taken at the time of the core biopsy or surgical biopsy. The grade is based on how aggressive individual cancer cells appear under a microscope. There are different systems to grade cells, but a higher number typically means a more aggressive cancer.
• Stage. This refers to the cancer's size and whether it has spread(metastasized) to lymph nodes or other parts of the body. To further determine the stage, a history, physical exam, blood tesr and a bone scan, computerized tomography(CT) imaging position emission tomography (PET) scans, may be obtained.

The various stages are:

• Stage 0: The cancer is contained within the duct- ductal carcinoma in situ(DCIS).

• Stage I: The invasive cancer is two centimeters or kess and is only on the breast.

• Stage II: The invasive cancer is greater than two but less than five centimeters or has spread to the lymph nodes.

• Stage III: Advanced cancer that's 5 centimeters or more in size and has spread to the lymph nodes or has involved the lymph channels and skin of the breast(inflammatory breast changes.) It hasn't spread beyond to the distant organs of the body.

• Stage IV: Advanced cancer that has spread to othre parts of the body such as lungs, liver, bones or brain.

What is breast cancer?

In the Philippines, breast cancer is the most common cancer specific to women. In which an estimated 14,000 new breast cancer cases are diagnosed each year and nearly 6,300 deaths are expected from the disease annually.

That is why it is a must that one should possess adequate knowledge of this disease.

Basics

Breast are primarily composed of fatty and connective tissue called stroma. The muscles covering your ribs underneath the breast and the breast is suspended fron the chest wall ligaments. Within each breast is a network of 15 to 20 lobules. Each small lobule has a bulb. These bulbs produce milk. Thin tubes, or ducts, connect the lobes to the nipple.

There are two main kinds of breast cancer. They are:

• Ductal-meaning it starts in the tubes, or milk ducts.
• Lobular-meaning it starts in the milk-producing glands.

There's an early form of cancer called in situ. These cancers aren't yet invasive and are contained in the milk ducts. However, if left alone, in situ cancers can develop into invasive cancers,which have the capability of spreading outside the breast. With noninvasive cancer(stage 0) and early-stage (stage I and II) invasive varieties, the cancer is confirmed to just the breast. A surgical option for early-stage breast cancer is a lumpectomy, followed by radiation treatment.

TYPES OF BREAST CANCER

Breast cancer is categorized by the appearance of the cancer cells and their cellular origin. The most common types of breast cancer are:

• Invasive ductal carcinoma (IDC). This type starts in a duct and then invades connective or fatty tissue that surrounds the duct. It can travel to the lymph nodes or enter the blood stream and spread to other parts of the body. It is common type of breast cancer, making up 75 percent of all invasive cancers.

• Invasive lobular carcinoma (ILC). This type starts in a milk-producing glans(lobule), and then invades the surrounding connective or fatty tissue. Like ductal carcinoma, ot can spread to other parts of the body. It accounts fr 15 percent of invasive breast cancers. This tumor maybe more difficult to diagnose, as it can first show up as breats thickening rather than a firm mass.

• Other invasive ductal-type cancers. These less common invasive cancers include medullary, mucinous, tubular, and papillary. Combined, these account for about 10 percent of invasive cancers.

• Ductal carcinoma in situ (DCIS). This non-invasive cancer is made up of abnormal cells in ducts that haven't spread to the connective or fatty tissue. It's the most common noninvasive cancer. Unchecked, it could turn into invasive cancer

• Paget's disease. This cancer is associated with the nipple changes such as eczema, itching, and thickening of the dark circle of skin (areola) around the nipple, and can be invasive or noninvasive. About 50 percent of those with the disease have an associated cancerous lump. paget's disease accounts for less than 5 percent of all breast cancers.

• Inflammatory breast cancer. This is an aggressive cancer in which the affected breast looks inflamed, red, and feels warm. The skin can have the appearance of an orange peel, with an engorged look.. It is often in younger women. It accounts for about two percent of all cancers.