Breast Cancer Treatment

Breast cancer is a major concern for women. Learn about the causes of cancer of the breast, the five stages of this cancer, and breast cancer treatment. Also, learn what are the screening methods for cancer in the breast. This article is meant to increase breast cancer awareness. Consult a doctor for treatment and medication. Don’t do self-medication.

Table of Content

What is breast cancer?

It is a disease in which breast cells grow abnormally and the growth becomes out of control. The breast is made up of different types of parts which are made up of different kinds of cells. Following are the main parts:-

• Milk glands (lobules)
• Nipple
• Areola
• Ducts that connect the lobules to the nipple
• Connective tissue and muscle
• Fatty tissue
• Lymphatic tissue

What exactly is breast cancer?

It is a type of cancer that starts in the breast. Cancer starts when cells begin to grow out of control and crowd out normal cells. This makes it hard for your body to work the way it should. Normal cells in the body divide in an orderly way. The normal cells die when they are worn out or damaged, and new cells take their place. In cancer, the cells keep on growing and making new cells. They crowd out normal cells. This is called cancer. It causes problems in the part of the body where cancer has started. Cancer can also spread to other parts of the body. Some cancers grow slowly. Some cancers grow fast and spread fast.

Male breast cancer

Male and females, both can develop cancer in the breast. Incidences of male breast cancer are less. Only 1 % of cases of cancer in the breast are seen in males. Cancer in a male’s breast is mostly observed in old age. But you need to be careful as it may occur at any age. If you have higher levels of estrogen in your blood, then the chances of cancer are more. Also, if there is any case in your family, then you need to be watchful.

Breast cancer symptoms

You should know what is normal breast. Then only you can judge whether your breast has any abnormality. Remember that no breast is typical. Your breast shape changes during your life. Breast changes when

• You have your regular periods
• During pregnancy
• While breastfeeding
• During weight gain and weight loss
• Breasts tend to change when you age

So you need to monitor regularly and check for early symptoms of breast cancer.

What are the symptoms of breast cancer?

Some of the breast cancer signs are given below:-

• A lump in the breast or the armpit (underarms) may be a symptom of cancer. All lumps are not cancerous. So you need not worry. But you must see your doctor if you notice any lump in the breast or thickening of some area of the breast. Such lumps are hard to touch and may cause pain.
• You may notice a change in the size of the breast. This change may occur in one breast or both breasts.
• There may be abnormal discharge from the nipples. This discharge may be milky white or may have blood in it.
• Changes in the nipple area may occur. There may be a pain in the nipple or pulling in of the nipple.
• There may be redness and swelling in the nipple area.
• Nipple skin may turn dry and scaly.
• Breast skin may get dimpling or roughness like orange peel.
• Lymph nodes in the armpit may get enlarged.
• Swelling or pain in any area of the breast.

These are the commonly observed breast cancer signs. Keep in mind that such symptoms do not mean that you have cancer. It can be any other disease also. Two main causes of a lump in the breast are fibrosis and cysts. Fibrosis is scar-like, rubbery tissue and is non-cancerous. A cyst is usually a fluid-filled sac that that may become cancerous later on.

Breast cancer causes

Doctors have identified several factors as the causes of breast cancer. The causes can be hormonal, environmental, and lifestyle-related. But it is not yet clear why some people develop cancer even though they were not at risk. Following are some general breast cancer risk factors.

• Cancer of the breast occurs when some breast cells begin to grow abnormally. These cells divide more rapidly than healthy cells. So these cells continue to accumulate and form a lump or mass. Such cells may spread (metastasize) through your breast and to your lymph nodes or other parts of your body.
• Cancer in the breast most often begins with cells in the milk-producing ducts.
• It may also begin in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells or tissue within the breast.
• Studies have shown that 5 to 10 percent of such cancers are linked to gene mutations passed through generations of a family.
• If you are female, you are at higher risk. Males also may suffer from cancer of the breast. However, it is observed more in females.
• Genetic history can also cause cancer in the breast. If you have a family history of such cancer, then you are more susceptible to it. Genetic mutations in BRCA1 and BRCA2 genes increase your risk for cancer in the breast.
• If you got your first period earlier than the age of 12, then you are at higher risk.
• If you have delivered your first baby after the age of 35 years, it increases your risk of cancer in the breast. Breast-feed your baby as long as you can. The longer you feed, the better you are protected.
• If you are taking postmenopausal estrogen and progesterone to reduce menopausal symptoms, then also you have a higher risk of cancer.
• If you have had breast cancer earlier, then there are very high chances that you may have it again in the breast or other parts of your body.
• If you have reached menopause after the age of 55, you are more prone to develop cancer of the breast.
• The woman who never got pregnant is more vulnerable to develop cancer of the breast.
• If you are heavyweight or obese or a smoker, you are at higher risk.

These are the common causes of cancer in the breast. Although there are several breast cancer risk factors, you may get it even if you are not exposed to any of the above causes. Breast cancer is likely caused by a complex interaction of your genetic makeup and your environment.

Breast cancer stages

Doctors describe breast cancer growth using TNM Staging System. T means how large is the primary tumor in the breast. N means Node. Has the tumor spread to the lymph nodes? What is the size of the tumor and how many nodes have been affected? M means Metastasis. Has cancer spread to other parts of the body?

Doctors see the results of diagnostic tests and then decide about the Stage of the Cancer. Five breast cancer stages range from Stage 0 to Stage 4.

Stage 0 of the cancer

This is the very initial stage. It is called carcinoma in situ. It means that the disease is only in the ducts of the breast tissues. It has not spread to surrounding areas of the breast.

Stage 1 of the cancer

This is an invasive stage. The tumor is small but invasive. It has not spread to the lymph nodes. Cancer now attacks the surrounding healthy cells.

• Stage 1A – Cancer spreads to the surrounding fatty breast tissue. There may or may not be the presence of a tumor.  Cancer is still within the breast and has not spread to lymph nodes.
• Stage 1B – In this stage cancer spreads to lymph nodes. Cancer in the nodes is larger than 0.2 MM but smaller than 2 mm in size.

Stage 2 of the cancer

This stage indicates the further spread of cancer.

• Stage 2A – the tumor has spread to lymph nodes and 1-3 tumors of size less than 50 mm are found in axillary lymph nodes.
• Stage 2B – This stage has 2 possible cases. Either the tumors are bigger but are found only in 1- 3 lymph nodes or the tumor is bigger than 5 cm but not in the lymph node.

Stage 3 of the cancer

Cancer has further grown and spread. Tumors will be located in 4-9 lymph nodes If the tumor is larger than 5 cm and is not located in the lymph node, still it will be stage 3.

• Stage 3A – Cancer tumors will be found in 4-9 lymph nodes.
• Stage 3B – Inflammation and swelling are seen. The tumor goes up to the chest and changes the appearance of breast skin.
• Stage 3C – Cancer has spread to 10 or more lymph nodes in the armpit as well as near the collar bone.

Stage 4 of the cancer

This is an aggressive form of cancer and spread to other parts of the body like a distant lymph node, lungs, brain, or liver.

How to check cancer in the breast?

You should know how to examine breast at home. Regular self-check-up of your breasts will help you identify any abnormality at a very early stage. There are high chances of successful treatment if the disease is diagnosed early. Follow the simple steps of self-examination of your breast.

• Observe your breasts in the mirror, keeping your palms on your waist/hips. Look for any change in size, shape, and appearance of the skin.
• Now raise both hands straight above the head. Again, look for any visible changes in your breasts.
• Thereafter, lie down. Using your right palm figures, feel the left breast. Using smooth touch, keeping all fingers together, check the entire breast. Move your fingers in all directions straight as well as in circular motion.
• You need to use light pressure to feel the skin and very superficial breast tissue. Use medium pressure to feel the deeper tissue and firm pressure to feel the deep-seated tissue close to the ribs.
• For the last step, you need to stand and raise your hand. Using the opposite hand do a similar check-up.

Follow these simple self-examination steps every month. You should do this examination preferably a week after your menstrual cycle. If your periods are not regular or you have undergone uterus removal surgery or if in menopause, then you fix a particular day of every month. E.g., Day 1 of every month or last day of the month. This will help you to increase your cancer awareness and identify the breast cancer symptoms at a very early stage

Breast cancer screening methods

Doctors use many tests to diagnose cancer in the breast. They mayalso conduct tests to find if cancer has spread to other parts of the body. Following screening methods are used by doctors to diagnose breast cancer.

Breast examination

Your doctor will check your breasts and armpit for the presence of any lump or any abnormality. It is similar to your self-examination.

Mammography

Mammography is a type of X-Ray. The image produced is called a mammogram. The mammogram can show even small tumors and lumps which can’t be felt during examination. Screening Mammograms and Diagnostic Mammograms are two types of mammograms. Digital Mammography can take 3-D images of the breast.

FAQ about Mammography

Question 1 – What is a Screening Mammogram?

Answer – This is taken for cancer in the breast when there are no symptoms. A Screening Mammogram shows a suspicious area. The aim is to detect the disease early. Early detection makes treatment easy.

Question 2 – What is a Diagnostic Mammogram?

Answer – It is taken to learn about a specific symptom. More images are taken than Screening Mammogram.

Question 3 – Who does my Mammogram?

Answer – The images are taken by a mammographer. He or she is a trained mammogram technologist. A doctor reads these images and reviews the mammograms. This type of doctor is known as a Radiologist.

Question 4 – What will happen during a mammogram test?

Answer – The process is painless and noninvasive. You will be required to change your clothes. After that, you will stand in front of the mammography machine. The mammographer will place your breast between two plates. The plates will be pressed together to flatten the breast. Now X-Ray is taken which takes few seconds only. After the test, you can go back to your home or office.

Breast ultrasound imaging

This procedure uses sound waves to capture images of deep-seated tissues of the breast. It can detect a solid mass like a lump or a fluid-filled cyst. An ultrasound technologist performs this test with an ultrasound machine.

MRI

An MRI uses a magnetic field and not an X-Ray or sound waves. MRI produces detailed images of the body. A special dye is given to the person before the scan. This dye is called a contrast medium. A breast MRI is generally done after a woman has been diagnosed with cancer. MRI is done to find out how much the disease has grown throughout the breast. It is also done to check the other breast for cancer. MRI is also used as a surveillance method following a breast cancer diagnosis and treatment.

Biopsy

The doctor removes a small amount of suspected tissue. This tissue is examined under a microscope to check for the presence of cancer. A pathologist analyzes the tissue sample. A biopsy can diagnose the stage of cancer and the presence of hormonal or other receptors. Based on the reports of biopsy, your doctor will decide the treatment plan. There are different types of biopsies. The type of biopsy depends on the technique and size of the needle used to collect the tissue samples. Following are types of biopsy:-

• Fine needle aspiration biopsy
• Core needle biopsy
• Surgical biopsy
• Image-guided biopsy
• Sentinel lymph node biopsy

Breast cancer treatment

Your breast surgeon or oncologist will decide the best course of breast cancer treatment based on the stage of your cancer and the receptor (Estrogen, progesterone, and HER2) status of tumor cells. Following are some of the breast cancer treatment options:-

Breast cancer surgery

There are different types of surgery. It will depend on the situation.

• The surgeon will remove the whole breast (Mastectomy), or only the tumors and tissues around them (Lumpectomy or breast-conserving surgery).
• Surgery may be done to find out whether cancer has spread to lymph nodes under the arm.
• There are two main types of surgery to remove lymph nodes. These are Sentinel lymph node biopsy (SLNB) and Axillary lymph node dissection (ALND).
• Your surgeon may also suggest breast It is done to restore the breast’s shape after the cancer is removed. Breast reconstruction can be done at a later time also. It is called delayed reconstruction.

Radiation therapy for the Cancer

This procedure uses high-energy rays to kill cancer cells. Sometimes radiation therapy is used in addition to other types of treatment.

• Radiation therapy may be given after breast-conserving surgery.
• Radiation may be given after Mastectomy if the cancer was larger than 5 Cms.
• The most common type of radiation therapy is External Beam Radiation.
• The deep inspiration breath-hold (DIBH) technique is used if the radiation therapy is to be given for the left breast. If the cancer is in your left breast, your heart needs to be protected from radiation exposure. So, your therapist will guide you to inhale deeply and hold your breath for 20 seconds. A radiation dose will be given while you are holding your breath. When your lungs are filled with air, it keeps your heart away from the radiation dose.

Chemotherapy for Breast Cancer Treatment

During chemotherapy treatment, you will be given anti-cancer drugs. It is given either orally or by intravenous injection. The drug travels through the bloodstream. It reaches cancer cells in most parts of the body. Everyone does not need chemotherapy. It may be given after surgery (adjuvant chemotherapy) or before surgery (neoadjuvant chemotherapy). The doctor will prescribe you a combination of 2-3 drugs. These drugs may be doxorubicin and epirubicin, paclitaxel, docetaxel, 5-fluorouracil, capecitabine, cyclophosphamide, or carboplatin.  However, the doctor is the best person to decide which drug to use. Don’t take any treatment or medication without the doctor’s advice and supervision.

Hormone Therapy as Cancer Treatment

The doctor may prescribe you hormonal drugs if receptors for estrogen or progesterone are present on cancer cells. Examples are tamoxifen, toremifene, fulvestrant, letrozole, etc.

Immunotherapy

Intravenous infusion atezolizumab or pembrolizumab may be given to shrink the tumor.

Triple-Negative Breast Cancer

It is also known as TNBC. Almost 10 to 15% of such cancer cases are triple-negative types. Triple-Negative stands for the absence of 3 receptors on the cancer cells. Receptors for estrogen, progesterone, and HER2 (Human epidermal growth factor receptor 2) are absent on the cells. Therefore, triple-negative breast cancer (TNBC) does not respond to hormone-based medicines and drugs that act on HER2. This cancer spreads very fast. People with an age less than the age of 50 have more chances of having TNBC.  Diagnosis is made using analysis of cancer cells from biopsy samples. The doctors look for the presence of these receptors.

Doctors treat TNBC with a combination of surgery, radiation therapy, and chemotherapy.

Surgery is carried out after the chemotherapy. Neoadjuvant Chemotherapy shrinks the size of the tumor. Your doctor may prescribe a chemotherapy drug for 3 to 4 months. Thereafter surgery may be done. After surgery also, the doctor may ask you to continue with chemotherapy. This reduces the risk of cancer reappearing.

If the TNBC is in stage 4, which means it has spread to other organs of the body. In such cases, common chemotherapy drugs will be prescribed. Immunotherapy drugs are prescribed for the advanced stage of TNBC.

How to prevent breast cancer?

If you follow a healthy nutritive diet and healthy lifestyle, you can reduce the risk of breast cancer.

• Do regular self-breast examination. Become familiar with breast cancer awareness.
• Get your breasts checked by doctors for clinical breast examination and mammography.
• Do not smoke and do not drink alcohol.
• Stay physically active and maintain your body weight in the normal range. A regular exercise of 30 min. every day should be followed.
• Combination hormonal replacement therapy increases your risk of cancer. So consult your doctor to know more about it.

What is deep inspiration breath-hold?

This technique is followed when the cancer is in your left breast and you are undergoing radiation therapy. As your heart is also on the left side, and being a very vital organ, you need to protect it from radiation exposure. Therefore, the radiation therapist will tell you to inhale deeply once and exhale completely. Then inhale deeply for the second time and fill your lungs with air and hold your breath.  You need to hold the breath for 20 seconds, during which radiation treatment will be given. Since your lungs are filled with air, it creates a space between your heart and the radiation dose.

Breast cancer awareness

Breast cancer is the biggest cause of cancer deaths in India. Many women in low and middle-income groups are not aware of clinical examination and self-examination of breasts. A large number of women can’t afford mammography due to its cost. Breast cancers in low and middle-income countries are generally detected when it reaches advanced stages. Consequently, more than half the global deaths from breast cancer occur in countries that are in the low and middle-income group.

Breast examination is as good as mammography, for detecting tumors in the breast. So do not underestimate the importance of examination of breasts by a trained health worker. Tata Memorial Hospital has conducted a study for over 20 years. As per this report, clinical examination of breasts is very effective in checking breast cancer. This research has been published in BMJ of the UK.

This study began in 1998. It covered 150000 women. The clinical examination helped avoid 1500 breast cancer deaths in India. The study also helped avoid 40000 deaths in low and middle-income countries.

This clinical breast examination should be done by trained health workers. The process takes only about 15 to 20 minutes. This clinical examination leads to the early detection of breast cancer. Early detection reduces the mortality rate by 30% in women who are above 50 years of age.

The incidence of breast cancer per year in India is 30 per 1,00,000 population. The death rate per year is 15 per 1,00,000 population. This death rate can be reduced if a clinical examination of the breast is done regularly. This is a simple and inexpensive technique. Mammography scans are not available in India at the taluka level. The cost of a scan is high and a large number of women can’t afford it. Hence clinical breast examination is better than no screening at all.

References

Early symptoms

Causes of cancer

Self examination of breast

Tests, Procedures and Scans

Biopsy

Stage of cancer

Surgery for cancer

Chemotherapy