BREAST CANCER

Breast Tumors

Description: The most common type of breast cancer begins in the lining of the ducts and is called ductal carcinoma. Another type, called lobular carcinoma, arises in the lobules. When breast cancer spreads outside the breast, cancer cells are often found in the lymph nodes under the arm (axillary lymph nodes). If the cancer has reached these nodes, it may mean that cancer cells have spread to other parts of the body -- other lymph nodes and other organs, such as the bones, liver, or lungs -- via the lymphatic system or the bloodstream.

Cancer that spreads has the same name as the original (primary) cancer. When breast cancer spreads, it is called metastatic breast cancer, even though the secondary tumor is in another organ. Doctors sometimes call this "distant" disease.

Possible Causes:  The risk of breast cancer increases gradually as a woman gets older. This disease is uncommon in women under the age of 35. All women age 40 and older are at risk for breast cancer. However, most breast cancers occur in women over the age of 50, and the risk is especially high for women over age 60. Research has shown that the following conditions place a woman at increased risk for breast cancer:

• Personal history of breast cancer. Women who have had breast cancer face an increased risk of getting breast cancer again.
• Genetic alterations. Changes in certain genes (BRCA1, BRCA2, and others) make women more susceptible to breast cancer. In families in which many women have had the disease, gene testing can show whether a woman has specific genetic changes known to increase the susceptibility to breast cancer. Doctors may suggest ways to try to delay or prevent breast cancer, or improve the detection of breast cancer in women who have the genetic alterations.
• Family history. A woman's risk for developing breast cancer increases if her mother, sister, daughter, or two or more other close relatives, such as cousins, have a history of breast cancer, especially at a young age.
• Certain breast changes. Having a diagnosis of atypical hyperplasia or lobular carcinoma in situ (LCIS) or having had two or more breast biopsies for other benign conditions may increase a woman's risk for developing cancer.

Other factors associated with an increased risk for breast cancer include:

• Breast density. Women age 45 and older whose mammograms show at least 75 percent dense tissue are at increased risk. Dense breasts contain many glands and ligaments, which makes breast tumors difficult to "see," and the dense tissue itself is associated with an increased chance of developing breast cancer.
• Radiation therapy. Women whose breasts were exposed to radiation during their childhood, especially those who were treated with radiation for Hodgkin's disease, are at an increased risk for developing breast cancer throughout their lives. Studies show that the younger a woman was when she received her treatment, the higher her risk for developing breast cancer later in life.
• Late childbearing. Women who had their first child after the age of 30 have a greater chance of developing breast cancer than women who had their children at a younger age.

Also at a somewhat increased risk for developing breast cancer are women who started menstruating at an early age (before age 12), experienced menopause late (after age 55), never had children, or took hormone replacement therapy or birth control pills for long periods of time. Each of these factors increases the amount of time a woman's body is exposed to estrogen. The longer this exposure, the more likely she is to develop breast cancer.

In most cases, doctors cannot explain why a woman develops breast cancer. Studies show that most women who develop breast cancer have none of the risk factors listed above, other than the risk that comes with growing older. Also, most women with known risk factors do not get breast cancer. Scientists are conducting research into the causes of breast cancer to learn more about risk factors and ways of preventing this disease.

Symptoms :  Early breast cancer usually does not cause pain. In fact, when breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for:

1- A lump or thickening in or near the breast or in the underarm area;
2- A change in the size or shape of the breast;
3- Nipple discharge or tenderness, or the nipple pulled back (inversion) into the breast;
4-Ridges or pitting of the breast (the skin looks like the skin of an orange; or
5- A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly).

A woman should see her doctor when symptoms like these appear. Quite often, they are not cancer, but it's important to check with a doctor to diagnose and treat any problems as early as possible.

Diagnoses :  To learn if sn abnormal area on a mammogram, a lump, or other changes in the breast has been caused by cancer or by other, less serious problems a woman's doctor does a careful physical exam and asks about her personal and family medical history. In addition to checking general signs of health, the doctor may do one or more of the following breast exams:

• Palpation. The doctor can tell a lot about a lump (its size, its texture, and whether it moves easily) by palpation, carefully feeling the lump and the tissue around it. Benign lumps often feel different from cancerous ones.
• Mammography. X-rays of the breast can give the doctor important information about a breast lump. If an area on the mammogram looks suspicious or is not clear, additional mammograms may be needed.
• Ultrasonography. Using high-frequency sound waves, ultrasonography can often show whether a lump is solid or filled with fluid. This exam may be used along with mammography.

Based on these exams, the doctor may decide t hat no further tests are needed and no treatment is necessary. (In such cases, the doctor may need to check the woman regularly to watch for any changes.) Usually, however, fluid or tissue must be removed from the breast to make a diagnosis. A woman's doctor may refer her for further evaluation to a surgeon or other health care professional who has experience with breast diseases. These doctors may perform:

• Fine needle aspiration. A thin needle is used to remove fluid from a breast lump. This procedure may show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer). Clear fluid removed from a cyst may not need to be checked by a lab.
• Needle biopsy. Using special techniques, tissue can be removed with a needle from an area that is suspicious on a mammogram but cannot be felt. Tissue removed in a needle biopsy goes to a lab to be checked by a pathologist for cancer cells.
• Surgical biopsy. The surgeon cuts out part or all of a lump or suspicious area. A pathologist examines the tissue under a microscope

Stages : 

Ductal carcinoma in situ, also called intraductal carcinoma or DCIS, refers to cancer cells in an area of abnormal tissue in the lining of a duct that have not invaded the surrounding breast tissue. If DCIS lesions are left untreated, over time cancer cells may break through the duct and spread to nearby tissue, becoming an invasive breast cancer. Patients with DCIS may have a mastectomy or may have breast-sparing surgery followed by radiation therapy. Underarm lymph nodes are not usually removed. Women with DCIS may want to talk with their doctors about the possible usefulness of treatment with tamoxifen.

Stage I and stage II are early stages of breast cancer, but the cancer has invaded nearby tissue. Stage I means that cancer cells have not spread beyond the breast and the tumor is no more than about an inch across. Stage II means one of the following: the tumor in the breast is less than 1 inch across and the cancer has spread to the lymph nodes under the arm; the tumor is between 1 and 2 inches with or without spread to the lymph nodes under the arm; or the tumor is larger than 2 inches but has not spread to the lymph nodes under the arm.

Women with early stage breast cancer may have breast-sparing surgery followed by radiation therapy as their primary local treatment, or they may have a mastectomy, with or without breast reconstruction (plastic surgery) to rebuild the breast. Sometimes radiation therapy is also given to the chest wall after mastectomy. These approaches are equally effective in treating early stage breast cancer. The choice of breast-sparing surgery or mastectomy depends mostly on the size and location of the tumor, the size of the woman's breast, certain features of the cancer, and how the woman feels about preserving her breast. With either approach, lymph nodes under the arm usually are removed.

Many women with stage I and most with stage II breast cancer have chemotherapy and/or hormonal therapy in addition to surgery or surgery and radiation therapy. This added treatment is called adjuvant therapy. It is given to try to destroy any remaining cancer cells and prevent the cancer from recurring, or coming back.

Stage III is also called locally advanced cancer. The tumor in the breast is large (more than 2 inches across), the cancer is extensive in the underarm lymph nodes, or it has spread to other lymph nodes or tissues near the breast. Inflammatory breast cancer is a type of locally advanced breast cancer. Patients with stage III breast cancer usually have both local treatment to remove or destroy the cancer in the breast and systemic treatment to stop the disease from spreading. The local treatment may be surgery and/or radiation therapy to the breast and underarm. The systemic treatment may be chemotherapy, hormonal therapy, or both; it may be given before or after the local treatment.

Stage IV is metastatic cancer. The cancer has spread from the breast to other parts of the body. Women who have stage IV breast cancer receive chemotherapy and/or hormonal therapy to destroy cancer cells and control the disease. They may have surgery or radiation therapy to control the cancer in the breast. Radiation may also be useful to control tumors in other parts of the body.

Recurrent cancer means the disease has come back in spite of the initial treatment. Even when a tumor in the breast seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained in the area after treatment or because the disease had already spread before treatment. Most recurrences appear within the first 2 or 3 years after treatment, but breast cancer can recur many years later.

Cancer that returns only in the area of the surgery is called a local recurrence. If the disease returns in another part of the body, it is called metastatic breast cancer. The patient may have one type of treatment or a combination of treatments.