Breast cancer is very common, and there are many different types of the disease. However, raised awareness about early detection and the advances in treatment options have increased survival rates for breast cancer patients.
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Ductal carcinoma in situ (DCIS) - A non-invasive breast cancer limited to inside the duct of the breast, meaning it hasn't spread, and is classified as Stage 0. It has no symptoms and is usually spotted on a mammogram as microcalcifications. But there are some cases where microcalcifications are an invasive breast cancer.
HER2 Oncogenes - HER2/Neu is a type of oncogene, a gene that can transform a cell into a cancer cell. When an invasive breast cancer is HER2/Neu positive, the tumor is over-producing the HER2/Neu protein and biologic targeted therapy may be recommended.
Hormone Receptor Positive - Two hormones, estrogen and progesterone, may affect cancer growth. When a tumor is estrogen receptor or progesterone receptor positive, it may respond to hormone treatment such as anti-estrogen therapy. A hormone negative tumor may respond to other types of treatments.
Inflammatory breast cancer (IBC) - This type of breast cancer is rare, aggressive and fast-growing. Cancer cells block lymph vessels in the breast, causing a buildup of fluid (lymph) in the breast skin. The breast will often look swollen, red, purple or bruised. The skin may also have ridges or appear pitted, like an orange peel. The disease typically develops quickly and may not create a tumor that can be felt. Immediate care from your health care provider is recommended. If an infection or rash does not clear up after treatment with antibiotics or topical remedies, return promptly to your provider or see a breast surgeon.
Invasive ductal carcinoma (IDC) - This is the most common type of breast cancer. It begins growing in the milk duct and then invades the surrounding tissue. There may be no signs or symptoms or a woman may find a lump or mass during a breast self-exam. A mammogram may also reveal a suspicious mass or microcalcifications, which will lead to further testing.
Invasive lobular carcinoma (ILC) - Although this is the second most common type of breast cancer, it still accounts for only about 10 percent of all cases. It starts in the milk-producing lobules of the breast and invades the surrounding tissue. It may produce no symptoms or there may be a palpable mass or a density that shows up in a mammogram.
Metastatic breast cancer - A diagnosis of metastatic breast cancer means the cancer has spread to other organs in the body and is classified as Stage 4 breast cancer.
Paget's disease of the breast - This rare form of breast cancer causes a skin change in the areola or nipple. Signs include nipple or areola redness, an eczema-like rash, a break in the skin or crusting. Nipple discharge or inversion may also occur. It typically affects women in their 50s but can appear at younger or older ages.
Stages of Breast Cancer
Staging the disease means finding out how far, if at all, the cancer has spread. Staging helps to create an individualized treatment plan for each patient. The stage of a breast cancer is usually determined after surgery, when the tumor and lymph nodes*, if necessary, are examined. Stages are classified based on the size of the largest tumor, lymph node involvement and whether other organs are affected.
Stage 0 - This is noninvasive breast cancer, or ductal carcinoma in situ (DCIS). Cancer cells are limited to the lining of the ducts and have not spread beyond the ducts.
Stage 1 - Considered invasive breast cancer, the tumor is no larger than 2 centimeters but some cancer cells have spread from the ducts or lobules into nearby fatty tissue of the breast.
Stage 2 - Invasive breast cancer with a tumor between 2 and 5 centimeters.
Stage 3 - This stage has three subsets, which differ based on the number of lymph nodes affected and the size of the tumor. Invasive breast cancer may have spread to the chest wall or skin of the breast.
Stage 4 - Invasive breast cancer has spread beyond the breast and nearby lymph nodes to other parts of the body, usually organs such as lungs, brain, liver, skin, or bones and distant lymph nodes. Inflammatory breast cancer is classified as Stage 4 breast cancer.
*Lymph nodes collect and filter cells from fluids before returning the fluid to the bloodstream. When breast cancer has been diagnosed, lymph nodes are tested to determine whether cancer cells have spread to the nodes.
Sentinel lymph node biopsy - The sentinel lymph node is the first lymph node or nodes where breast cancer will spread. It or they are removed during surgery to see whether they contain cancer cells.
Axillary Node Dissection - If it is known before surgery that any nodes contain cancer, the surgeon will remove the axilliary lymph nodes.
Breast Cancer Preventive Care
Some women have a greater chance than others for developing breast cancer but all women are at risk. Early detection provides the greatest possibility of successful treatment and survival.
Lifestyle modifications such as the ones listed below may help reduce the risk of developing breast cancer.
- Minimize the duration of post-menopausal hormone replacement therapy
- Minimize alcohol consumption
- Eat a low-fat diet
- Maintain a lean, steady body weight
Breast Self-Examination (awareness) - Breast self-examinations should be done by all women ages 20 and older to help find breast changes more easily. They should be done at the same time every month after your period if you are still menstruating. Regular exams help you learn how your breasts feel normally so you will be able to detect any changes.
How to do a self exam:
In front of a mirror, inspect your breasts with your arms at your sides. Next, raise your arms. Look for any changes in breast shape, skin or nipple.
Lie down with your fingers flat and move gently all over the breast. Check for lumps, masses or thickening.
If you notice any changes, see your healthcare provider.
Clinical Breast Exam - A clinical breast exam by your healthcare provider should be part of your physical examination. Women between 20 and 39 years old should have a clinical breast examination by a health professional every one to three years and after age 40, every year, according to the National Comprehensive Cancer Network.
Mammography - Mammograms can detect cancer in its early stages, sometimes years before a lump can be felt. The American Cancer Society recommends women should get an annual mammogram starting at age 40, younger if they have a heredity risk for breast cancer. For women with an increased risk based on a strong family history of breast or ovarian cancer, or a personal history of radiation treatment to the chest region for certain cancers, they should also talk to their healthcare providers about having an annual breast MRI in addition to a mammogram.
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