BREAST CANCER

One of the most common types of cancer among women all around the world is breast cancer. All women are at risk of getting breast cancer, and the chances of developing it grow high as women age. The good news is simple breast cancer prevention helps to minimise risks. Breast cancer symptoms may be missing in early stages. Breast cancer treatment depends on many factors, such as age, type of breast cancer, overall health, etc. More detailed information about this condition, its symptoms, diagnostic services and breast cancer treatment, is presented below.

The female breast is made up of a core of milk glands and ducts surrounded by stromal tissue and fat. A fully developed female’s breast is made up of fat, connective tissue and thousands of lobules-tiny glands that produce milk. When females’ breastfeed, their milk goes through tiny ducts and exits the nipple. The breast contains billions of microscopic cells and they multiply in an orderly manner to replace the cells that die with new cells.  When the cells lining the ducts and glands grow in an uncontrolled manner, breast cancer is formed as there are too many cells and it continues to grow more and more than there should be.

WHAT IS BREAST CANCER?

It is a malignant tumor. Breast cancer occurs when breast cells become abnormal and divide without control or order. Healthy cells divide and Reproduce in an orderly manner. When this process is disrupted and cells grow and divide out of control, extra tissue is produced to form a mass or lump (tumor). Tumors can be benign (non-cancerous) or malignant (cancerous).

The glands that produce milk in the breast consist of individual cells that normally reproduce under hormonal control. Sometimes the process of reproduction goes out of control, an abnormal glandular structure develops and this marks the beginning of breast cancer. Most breast cancer cases begin in the milk ducts where a small number start in the milk sacks or lobules.

There are two types of breast cancer:

• Ductal carcinoma: The most common type of breast cancer that starts in the lactiferous duct.
• Lobular carcinoma: The less common type of breast cancer that starts in the lobules.

HOW BREAST CANCER IS STAGED?

Stage 0 – ductal carcinoma in situ (precursor of invasive cancer)

Stage 1 – early breast cancer

Stage 2 – early breast cancer

Stage 3 – locally advanced

Stage 4 – metastatic

Breast cancer can also be graded in accordance with its degree of aggressiveness:

Grade 1 – well differentiated

Grade 2 – moderately differentiated

Grade 3 – poorly differentiated – most progressive

RISK FACTORS FOR BREAST CANCER

• Women aged 40 years and above
• Family history (mother, sister) of breast cancer, especially at young age (less than 35 years old)
• Previous personal history of breast cancer
• Previous abnormal breast biopsy (atypical ductal hyperplasia, lobular carcinoma in situ)
• Hormonal factors such as early menarche, late menopause, no children or 1st child after 35 years old
• Unhealthy dietary habits such as high intake of red meat, saturated fat and alcohol
• Obesity and lack of exercise

BREAST CANCER PREVENTION

By minimizing the risk factors, we can reduce our risk of developing cancer. However, some of the risk factors are difficult to change such as onset of menarche, menopause and childbearing. The practical measures are:

• Cut down on red meat and animal fats
• Increase intake of vegetables, fruits and soya products
• Regular exercise
• Avoid obesity
• Reduce alcohol intake

BREAST CANCER SYMPTOMS

A symptom is something that is felt by the patient and is described to the doctor or nurse such as headache or pain.

A sign is something that the patients and other people can detect such as a rash or swelling.

The first signs of breast cancer are normally an area of thickened tissue in the breast or a lump. Most of them are normally benign lumps but it is advised to get them checked by a health care professional.

Signs and symptoms women should look out for and tell their doctor:

• Presence of a lump in your breast
• Pain in the armpits or breast that is not related to the menstrual period
• Redness or pitting on your breast skin; like orange peel
• A rash on or around one of your nipples
• A lump in one of your armpits
• An area of thickened tissue in a breast
• Discharge that may sometimes contain blood in one of your nipples
• Nipple appearance may appear sunken or inverted
• Changes in your breast size and shape
• Peeling, scaling or flaking of the skin on a nipple or breast

BREAST CANCER TREATMENT OPTIONS

Surgery

This is normally the initial treatment for breast cancer. The ultimate goal is to conserve the breast if possible. It involves the removal of the cancer growth with the minimal safest amount of surrounding tissue such as wide local excision.

It is not possible for some patients and they require the total removal of the affected breast and the underlying muscles (mastectomy). During surgery, the lymph glands may also be removed entirely (axillary clearance) or, as an alternate, the region of the primary tumor is injected with a dye to determine the most informative single gland to be removed (sentinel mode sampling). This is essential when it comes to predicting the possibility of cancer recurrence.

Radiotherapy

This may be recommended after surgery to treat the cancer cells in the remaining tissue as a measure to prevent cancer recurrence (local recurrence). Chest radiotherapy is normally spread out over 5 weeks. This is almost always recommended only if a wide excision of the cancer is performed.

Chemotherapy

The purpose of this method of treatment is to prevent cancer recurrence in tissues near the breast. It is normally given to younger women and goes for over three to six months. It may cause mild nausea, vomiting, hair loss, lethargy, tiredness and loss of appetite. Most women are able to continue working during this period. Your doctor will decide which specific drugs are most suitable for your case depending on your general health and other medical problems as well as the stage of cancer and other risk factors.

Special protein receptors on cancer cells like oestrogen, progesterone and HER2/neu receptors can be found in some breast cancer patients. Patients who have oestrogen and progesterone receptors are more likely to benefit from additional hormonal treatment.

An antibody for patients with HER2/neu receptors (advanced breast cancer) has been developed for therapeutic use. Studies are still being carried out. Because of the possible damage it can cause the heart, it is not considered as standard therapy in the adjuvant (prophylactic) setting yet.

Chemotherapy is sometimes administered before surgery to shrink the tumor. This is normally the case if the breast cancer is especially large.

Chemotherapy may not be always necessary in older women who have reached menopause. Only hormones such as tamoxifen may be administered. This normally the case if the cancer is oestrogen or progesterone receptor positive.

Advanced Breast Cancer

The lungs, liver, bones or brain may become affected by cancer at the time of diagnosis or years after the initial breast tumor has been removed. The treatment options include hormone treatment, chemotherapy or radiotherapy.

DIAGNOSING BREAST CANCER

• History taking and physical examination: Your doctor will ask you questions about your overall health, symptoms you have and family medical history, as those, who have a family history of cancers are assumed to be more predisposed to have the same condition. Then your doctor will perform a physical examination of your body to look for any visible symptoms.
• Ultrasound Breast: The waves penetrate the skin and images of the inside of the body structures and tissues are produced. This imaging test can help to discover any lumps or nodules in the breasts which may be early stage breast cancer.



• Mammogram and needle biopsy: A mammogram (X-ray) is an examination that helps to define the extent of the lump. Sometimes, it is combined with a breast ultrasound to determine if the lump is mainly solid or cystic (filled with liquid only). The examination is slightly uncomfortable as the breast is compressed against a metal surface. This is useful for screening rather than evaluation of symptomatic masses.When there is a suspicious breast lump, an X-ray examination (mammogram) and a needle biopsy is necessary. A needle biopsy may still be needed even if the mammogram results are normal.

  A needle biopsy involves using a core or skinny needle or syringe to remove tissue from the breast lump. This can be done at the clinic and the sample is sent for lab testing. The doctor will then be able to determine if the tissue is cancerous.

• Mammotome breast biopsy: This new technology is a minimally invasive procedure compared to an open surgical biopsy and is performed as an outpatient procedure. It involves using vacuum-assisted device to get a biopsy from non-palpable lesions. An X-ray or ultrasound can be used to guide this device. A hollow needle is used to precisely perform the removal of tissue from the suspicious lesion via mammogram. This device can sample tiny X-ray abnormalities (microcalcifications) which allow early diagnosis of breast cancer. It is completed under local anaesthesia and takes about 45 minutes to finish.

Once it is diagnosed, other tests such as chest X-ray and ultrasound may be used to scan the liver and a bone scan may be required to determine if the cancer has spread to other partss

REHABILITATION AFTER TREATMENT

Mental rehabilitation involves close support of spouse, family, friends and support group. A woman will also feel reassured by knowing her chances of survival and attending her review regularly. Physical rehabilitation involves:

• Shoulder exercise after surgery
• Care of arm to avoid lymphoedema
• Lifestyle changes to avoid recurrence