Overview:
- It is growing of some breast cells in an abnormal way that cannot be controlled, which leads to formation of a non-functional mass in the breast grows over time and then spread to near lymph nodes and may give local or distant metastasis later
- Breast cancer happens in both males and females , but is much more common in women
- Breast cancer is second most common cancer in women
- Survival rates in breast cancer patients have recently improved significantly due to :
- screening campaigns that led to early detection of breast cancer
- updated technologies in diagnostics
- ongoing Pharmaceutical Research
- Types of breast cancer:
- In situ tumor: ductal DCIS or lobular LCIS
- Invasive tumor: intraductal carcinoma IDC (which is the most common) and intralobular carcinoma ILC
- inflammatory cancer
- Paget’s disease
- phyllodes tumor is essentially benign but may develop into cancer
- angiosarcoma
Etiology:
cancer happened when some breast cells begin to grow out abnormally under influence of hormonal and lifestyle factors.
Cancer usually happens at milk-producing ducts (ductal carcinoma), but sometimes it develops at lobules (lobular carcinoma) or at other tissues such as angiosarcoma
Symptoms:
- A lump in breast that causes pressure or pain
- Change in breast size and shape
- Changes in the skin of breast:
Dimpling, puckering, bulging, redness, soreness, rash, or swelling
- Changes in nipple
- Nipple discharge
- armpit node
- general systemic symptoms of cancer (weakness, fatigue, pallor, fever and night sweating)
Causes:
predisposing factors of breast cancer are:
- Gender: breast cancer is much more common in women
- Getting older: mammograms are recommended every year after age 45
- Family history: 5-10% of breast cancer is genetic
- BRCA1 and BRCA2 are responsible genetic mutations of breast and ovarian cancer, so these mutations should be investigated when there is a family history of breast cancer
- breast cancer in corresponding breast
- Obesity
- radiation
- Reproductive history: Starting menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.
- Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can raise breast cancer risk
- Hormone replacement therapy
- Alcohol
Diagnosis:
- Breast self-examination and mammogram annually after age 45 (or younger when there is a family history) is cornerstone of early diagnosis and therefore treatment it quickly before develops
- clinical examination with detailed history
- A comprehensive laboratory test to assess blood counts, liver and kidney function
- Mammogram: reveals lumps and calcifications in breast tissue
- Breast ultrasound is a primary diagnostic procedure in young ages, revealing breast lumps and cysts
- MRI
- DEXA scan and PET scan to investigate metastases
- Breast cancer is finally diagnosed by breast biopsy (biopsy can be done by fine needle aspiration FNA, but core biopsy better)
Treatment:
As in most tumors, breast cancer is classified into four stages depending on type, size, involved lymph nodes and its metastasis
In breast cancer, additional factors affecting treatment plan must also be considered:
- is the tumor positive or negative Estrogen receptor ER
- is the tumor positive or negative Progesterone receptor PR
- is the tumor positive or negative human epidermal growth factor receptor 2 (HER2)
treatment depends on comprehensive doctors discussion to approach best treatment plan for each case ( oncologist, surgeon , radiologist , pathologist, geneticist and plastic surgeon )
- Breast cancer surgery includes:
- conservative surgery: lumpectomy with safe margins of normal breast tissue
- sentinel lymph node biopsy (sentinel node is first lymph node to which lymph comes from site of injury)
- total mastectomy:
nipple can be preserved in some cases
skin can be preserved in many cases
- axillary lymph nodes clearance: when tumor arrived axilla lymph nodes, we have to dissect all lymph nodes groups in the armpit.
arm lymphedema is common after this procedure, so you should pay close attention not to injure hand, and wear appropriate braces with regular lymph massages.
- Bilateral mastectomy: we perform this procedure when have a breast cancer with a large genetic cancerous factor.
- breast reconstruction: usually done by artificial implants or by free abdominal flap
- Chemotherapy: there are many chemotherapy protocols.
Pre surgery to decrease tumor size in large tumors
post-surgery to kill any cancer cells remaining as adjuvant treatment
- Radiotherapy:
- Post conservative lumpectomy: radiation of lump site
- Post mastectomy in large or metastatic cancer: radiation of chest wall
- Hormone therapy: Tamoxifen
treatment of hormone-sensitive cancers (ER and PR)
Can be started before or after surgery
- Aromatase inhibitors: Femara
To stop Estrogen producing in body (Oophorectomy may be done in some cases)
- Herceptin: in HER2 positive cases
- stem cell therapy: in triple-negative cases (ER – , PR – , HER2 -)
