Breast cancer is one of the most commonly diagnosed cancers in women all across the world. According to statistics, approximately 1.7 million new cases were diagnosed in 2012- which makes it the second most common cancer overall after skin cancer. This represents about 12% of all new cancer cases and 25% of all cancers in women. The condition occurs when the abnormal cells in breasts start multiplying at an uncontrolled rate.
The breast is made up of glands, lobules and ducts surrounded by fatty and connective tissue. The role of lobules is to produce breast milk, while the duct carries the milk from lobules to the nipples. The breast also consists of lymph vessels and blood vessels. The cancer in breast develops when abnormal cells start growing in the breast tissue. It can arise from ducts (ductal carcinoma) or lobules (lobular carcinoma). Breast cancer can be invasive or non-invasive. Invasive breast cancer means it has spread from milk duct or lobules to other parts in the breast, whereas noninvasive or ‘in situ’ breast cancer has not spread anywhere else in the breasts.
Breast cancer does not have a particular etiology; however, there are certain risk factors that increase the predisposition to the condition. These include age, family history, genetics, hormones, obesity, exposure to radiation and lifestyle factors. Those having family history of breast, uterine or ovarian cancer have increased risk of developing the disease. Alcohol use, use of hormone replacement therapy and overuse of antiperspirants and underwired bras also contribute to the disease.
Breast cancer develops gradually and does not show any signs and symptoms in the early stages. Therefore, breast screening after the age of 35 is usually recommended by the doctors. As the cancer grows, symptoms may include hard lump in the breast, change in the size and shape of nipple or breast and fluid coming out of the nipple.
Stages of breast cancer:
Staging is defined as a way to categorize cancer on the basis of its extend of spread. On the basis of staging, the treatment plan is designed by the surgeon.
- Stage 0 is defined as ‘carcinoma in situ’ and does not represent a cancer itself.
- Stage 1 is the early stage cancer where the tumor size is less than two cm
- Stage 2 is the early stage cancer where the tumor size is less than 2 cm, but it has spread to lymph nodes; or the size of the tumor is between 2 to 5 cm.
- Stage 3 is a locally advanced breast cancer where the tumor size has increased up to 5 cm and spread to lymph nodes.
- Stage 4 is the metastatic cancer where the cancer cells have invaded the other parts of the body.
A thorough physical examination is the first step to check for the lump in the breast. This includes examination of both breasts, armpits, and the neck and chest area. Additional tests are done to confirm the diagnosis and determine the stage and treatment of cancer. These include breast MRI, breast ultrasound, CT scan, PET scan, breast biopsy, mammography and sentinel lymph node biopsy.
Mammography is the screening of breasts to find early cancer. They usually help in finding whether the lump is due to breast cancer. Ultrasound is done to evaluate the lump. It helps to find out whether the lump is cystic or solid. MRI and CT scan are advanced tests that help in finding the exact location, size and shape, type and characteristics of the cancer cells. Breast biopsy is the definite way to diagnose cancer. During the procedure, the cells are removed from the lump and evaluated in the laboratory.
The treatment depends upon several factors including stage and type of the cancer, health and age of the patient and whether the cancer is sensitive to hormones. Treatment usually involves partial or complete removal of affected breast, and removal of lymph nodes from the arm pit. Radiation, chemotherapy and hormonal therapy may be included in the treatment plan.
The surgeon takes into consideration several factors to find out the prognosis of the condition. A prognosis is the surgeon’s best estimate of how breast cancer will affect a person, and how it will respond to treatment. This depends upon the type and stage of cancer, characteristic of cancer, treatment provided and the response to treatment. Lower stages and grades have less risk and good prognosis, while higher stages have greater risk of recurrence.
People often feel scared, anxious or overwhelmed after a diagnosis of cancer. Well, these are all normal feelings and it’s best to express them to your loved ones. Finding good emotional and mental support is necessary to fight the disease and to speed up the recovery process.