The first symptoms of breast cancer are usually an area of thickened tissue in the breast, or a lump in the breast or in an armpit. Researchers have identified hormonal, lifestyle and environmental factors that may increase your risk of breast cancer.
Know the basics
1. What is breast cancer?
After puberty, a woman’s breast consists of fat, connective tissue, and thousands of lobules, tiny glands that produce milk for breast-feeding. Tiny tubes, or ducts, carry the milk toward the nipple.
In cancer, the body’s cells multiply uncontrollably. It is the excessive cell growth that causes cancer.
Breast cancer can be:
- Ductal carcinoma: This begins in the milk duct and is the most common type.
- Lobular carcinoma: This starts in the lobules.
Invasive breast cancer is when the cancer cells break out from inside the lobules or ducts and invade nearby tissue, increasing the chance of spreading to other parts of the body.
Non-invasive breast cancer is when the cancer is still inside its place of origin and has not broken out. However, these cells can eventually develop into invasive breast cancer.
Breast cancer is extremely common. In general, it commonly affects more females than males.
The first symptoms of breast cancer are usually an area of thickened tissue in the breast, or a lump in the breast or in an armpit.
Furthermore, other symptoms include:
- A pain in the armpits or breast that does not change with the monthly cycle
- Pitting or redness of the skin of the breast, like the skin of an orange
- A rash around or on one of the nipples
- A discharge from a nipple, possibly containing blood
- A sunken or inverted nipple
- A change in the size or shape of the breast
- Peeling, flaking, or scaling of the skin on the breast or nipple
Most lumps are not cancerous, but women should have them checked by a healthcare professional.
However, there may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
Additionally, you should contact your doctor if you find a lump or other change in your breast — even if a recent mammogram was normal.
Diagnosis & Treatments
1. How is breast cancer diagnosed?
A diagnosis often occurs as the result of routine screening, or when a woman approaches her doctor after detecting symptoms.
Some diagnostic tests and procedures help to confirm a diagnosis.
♦ Breast exam
The physician will check the patient’s breasts for lumps and other symptoms. During this, the patient will be asked to sit or stand with her arms in different positions, such as above her head and by her sides.
♦ Imaging tests
A mammogram is a type of x-ray commonly used for initial breast cancer screening. It produces images that can help detect any lumps or abnormalities.
A suspicious result can be followed up by further diagnosis. However, mammography sometimes shows up a suspicious area that is not cancer. This can lead to unnecessary stress and sometimes interventions.
An ultrasound scan can help differentiate between a solid mass or a fluid-filled cyst.
An MRI scan involves injecting a dye into the patient, so find out how far the cancer has spread.
A sample of tissue is surgically removed for laboratory analysis. This can show whether the cells are cancerous, and, if so, which type of cancer it is, including whether or not the cancer is hormone-sensitive.
More specifically, diagnosis also involves staging the cancer, to establish:
- The size of a tumor
- How far it has spread
- Whether it is invasive or non-invasive
- Whether it has metastasized, or spread to other parts of the body
Moreover, staging will affect the chances of recovery and will help decide on the best treatment options.
2. How is breast cancer treated?
Generally, your doctor determines your breast cancer treatment options based on your type of breast cancer, its stage and grade, size, and whether the cancer cells are sensitive to hormones. Moreover, your doctor also considers your overall health and your own preferences.
In general, most women undergo surgery for breast cancer and also receive additional treatment before or after surgery, such as chemotherapy, hormone therapy or radiation.
As there are many options for breast cancer treatment, you may feel overwhelmed as you make complex decisions about your treatment. Consider seeking a second opinion from a breast specialist in a breast center or clinic. Talk to other women who have faced the same decision.
♦ Breast cancer surgery
In general, operations used to treat breast cancer include:
◊ Removing the breast cancer (lumpectomy)
During lumpectomy, which may be referred to as breast-sparing surgery or wide local excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue. Lumpectomy is typically reserved for smaller tumors.
◊ Removing the entire breast (mastectomy)
Mastectomy is an operation to remove all of your breast tissue. Most mastectomy procedures remove all of the breast tissue — the lobules, ducts, fatty tissue and some skin, including the nipple and areola (simple mastectomy). In a skin-sparing mastectomy, the skin over the breast is left intact to improve reconstruction and appearance. Depending on the location and size of the tumor, the nipple also may be spared.
◊ Removing a limited number of lymph nodes (sentinel node biopsy)
To determine whether cancer has spread to your lymph nodes, your surgeon will discuss with you the role of removing the lymph nodes that are the first to receive the lymph drainage from your tumor. If no cancer is found in those lymph nodes, the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes need to be removed.
◊ Removing several lymph nodes (axillary lymph node dissection)
If cancer is found in the sentinel lymph nodes, your surgeon will discuss with you the role of removing additional lymph nodes in your armpit.
◊ Removing both breasts
Some women with cancer in one breast may choose to have their other (healthy) breast removed (contralateral prophylactic mastectomy) if they have a very increased risk of cancer in the other breast because of a genetic predisposition or strong family history.
Moreover, most women with breast cancer in one breast will never develop cancer in the other breast. Discuss your breast cancer risk with your doctor, along with the benefits and risks of this procedure.
However, complications of breast cancer surgery depend on the procedures you choose. Generally, breast cancer surgery carries a risk of pain, bleeding, infection and arm swelling (lymphedema).
Normally, some women choose to have breast reconstruction after surgery. Discuss your options and preferences with your surgeon.
Consider a referral to a plastic surgeon before your breast cancer surgery. Your options may include reconstruction with a breast implant (silicone or water) or reconstruction using your own tissue. These operations can be performed at the time of your mastectomy or at a later date.
♦ Radiation therapy
Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells. The procedure is typically done using a large machine that aims the energy beams at your body (external beam radiation). However, radiation can also be done by placing radioactive material inside your body (brachytherapy).
More specifically, external beam radiation is commonly used after lumpectomy for early-stage breast cancer. Doctors may also recommend radiation therapy to the chest wall after mastectomy for larger breast cancers or cancers that have spread to the lymph nodes.
In addition, side effects of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Breast tissue may also appear swollen or more firm. Rarely, more-serious problems may occur, such as damage to the heart or lungs or, very rarely, second cancers in the treated area.
Chemotherapy uses drugs to destroy cancer cells. If your cancer has a high risk of returning or spreading to another part of your body, your doctor may recommend chemotherapy to decrease the chance that the cancer will recur. This is known as adjuvant chemotherapy.
Moreover, chemotherapy is sometimes given before surgery in women with larger breast tumors. The goal is to shrink a tumor to a size that makes it easier to remove with surgery.
In addition, chemotherapy is also used in women whose cancer has already spread to other parts of the body. This procedure may be recommended to try to control the cancer and decrease any symptoms the cancer is causing.
Furthermore, chemotherapy side effects depend on the drugs you receive. Common side effects include hair loss, nausea, vomiting, fatigue and an increased risk of developing infection.
Rarely, side effects can include premature menopause, infertility (if premenopausal), damage to the heart and kidneys, nerve damage, and, very rarely, blood cell cancer.
♦ Hormone therapy
Hormone therapy — perhaps more properly termed hormone-blocking therapy — is often used to treat breast cancers that are sensitive to hormones. Sometimes, doctors refer to these cancers as estrogen receptor positive (ER positive) and progesterone receptor positive (PR positive) cancers.
Moreover, hormone therapy can be used before or after surgery or other treatments to decrease the chance of your cancer returning. If the cancer has already spread, hormone therapy may shrink and control it.
More specifically, treatments that can be used in hormone therapy include:
◊ Medications that block hormones from attaching to cancer cells
Selective estrogen receptor modulator (SERM) medications act by blocking estrogen from attaching to the estrogen receptor on the cancer cells, slowing the growth of tumors and killing tumor cells. SERMs include tamoxifen, raloxifene (Evista) and toremifene (Fareston). Possible side effects include hot flashes, night sweats and vaginal dryness. More-significant risks include blood clots, stroke, uterine cancer and cataracts.
◊ Medications that stop the body from making estrogen after menopause
Called aromatase inhibitors, these drugs block the action of an enzyme that converts androgens in the body into estrogen. These drugs are effective only in postmenopausal women. Aromatase inhibitors include anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin). Side effects include hot flashes, night sweats, vaginal dryness, joint and muscle pain, as well as an increased risk of bone thinning (osteoporosis).
◊ A drug that targets estrogen receptors for destruction
The drug fulvestrant (Faslodex) blocks estrogen receptors on cancer cells and signals to the cell to destroy the receptors. Fulvestrant is used in postmenopausal women. Side effects that may occur include hot flashes and joint pain.
◊ Surgery or medications to stop hormone production in the ovaries
In premenopausal women, surgery to remove the ovaries or medications to stop the ovaries from making estrogen can be an effective hormonal treatment.
♦ Targeted drugs
Targeted drug treatments attack specific abnormalities within cancer cells. The drug used to treat breast cancer include:
◊ Trastuzumab (Herceptin)
Some breast cancers make excessive amounts of a protein called human epidermal growth factor receptor 2 (HER2), which helps breast cancer cells grow and survive. If your breast cancer cells make too much HER2, trastuzumab may help block that protein and cause the cancer cells to die. Side effects may include headaches, diarrhea and heart problems.
◊ Pertuzumab (Perjeta)
Pertuzumab targets HER2 and is approved for use in metastatic breast cancer in combination with trastuzumab and chemotherapy. This combination of treatments is reserved for women who haven’t yet received other drug treatments for their cancer. However, side effects of pertuzumab may include diarrhea, hair loss and heart problems.
◊ Ado-trastuzumab (Kadcyla)
This drug combines trastuzumab with a cell-killing drug. When the combination drug enters the body, the trastuzumab helps it find the cancer cells because it is attracted to HER2. The cell-killing drug is then released into the cancer cells. Moreover, Ado-trastuzumab may be an option for women with metastatic breast cancer who’ve already tried trastuzumab and chemotherapy.
◊ Lapatinib (Tykerb)
Lapatinib targets HER2 is approved for use in advanced or metastatic breast cancer. This drug can be used in combination with chemotherapy or hormone therapy. However, potential side effects include diarrhea, painful hands and feet, nausea, and heart problems.
◊ Palbociclib (Ibrance)
Palbociclib is used with aromatase inhibitors in women with advanced hormone receptor positive breast cancer. In addition, side effects may include increased risk of infections, fatigue and nausea.
◊ Everolimus (Afinitor)
Everolimus targets a pathway that plays a role in the growth of cancer cells. It’s used in combination with exemestane in women with advanced breast cancer. However, side effects may include mouth sores, increased risk of infections, rash and lung problems.
♦ Supportive (palliative) care
Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. The specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. This can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.
When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.
Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.
Unfortunately, it’s still not clear what causes breast cancer., However, doctors know that breast cancer occurs when some breast cells begin growing abnormally. These cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass. The cells may spread (metastasize) through your breast to your lymph nodes or to other parts of your body.
Moreover, breast cancer most often begins with cells in the milk-producing ducts (invasive ductal carcinoma). Breast cancer may also begin in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells or tissue within the breast.
Furthermore, researchers have identified hormonal, lifestyle and environmental factors that may increase your risk of breast cancer. But it’s not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. It’s likely that breast cancer is caused by a complex interaction of your genetic makeup and your environment.
2. Risk factors
Generally, there are many risk factors for breast cancer, such as:
Women are much more likely than men are to develop breast cancer.
Your risk of breast cancer increases as you age.
A personal history of breast cancer
If you’ve had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
- A family history of breast cancer
If your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of people diagnosed with breast cancer have no family history of the disease.
Inherited genes that increase cancer risk
In general, certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most common gene mutations are referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast cancer and other cancers, but they don’t make cancer inevitable.
If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer will increase.
In general, being obese increases your risk of breast cancer.
Beginning your period at a younger age
Generally, if your period begins before age 12, this increases your risk of breast cancer.
Having menopause at an older age
If you began menopause at an older age, you’re more likely to develop breast cancer.
Having your first child at an older age
Women who give birth to their first child after age 30 may have an increased risk of breast cancer.
Never been pregnant
Generally, women who have never been pregnant have a greater risk of breast cancer than do women who have had one or more pregnancies.
Postmenopausal hormone therapy
In general, women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications.
Generally, drinking alcohol increases the risk of breast cancer.
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GO.CARE does not provide medical advice, diagnosis or treatment.
|Breast cancer. https://www.webmd.com/breast-cancer/guide/stages-breast-cancer#1. Accessed November 7, 2017.
Breast cancer. https://www.mayoclinic.org/diseases-conditions/breast-cancer/diagnosis-treatment/drc-20352475. Accessed November 7, 2017.
Breast cancer. https://www.medicalnewstoday.com/articles/37136.php. Accessed November 7, 2017.