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Breast Cancer

  • Posted on- Jun 06, 2017
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Breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumor that can often be seen on an x-ray or felt as a lump. The tumor is malignant (cancer) if the cells can grow into (invade)

Overview of breast cancer-

  • Breast cancer occurs when cell of breast began to grow out of control often from a tumor which can start from a lump.
  • The tumor occurs malignant when the cells grow in the surrounding tissue, i.e spread in the different parts of the body.
  • The cancer can start in all part of the breast, but most cancers start in the inner lining of the milk ducts or globules that supply them with milk, rarely cancer start is the tissue of the breast.
  • Breast cancer is the most common cause of cancer in women, men can also have breast cancer but it's rare (2000 new cases registered every year in US).
  • It accounts for 16% of all female cancers, and 22.4% of invasive cancer worldwide, and 18.2% of all cancer deaths worldwide. One in every eight women in US has breast cancer.


Symptoms

Symptoms of breast cancer-

  • Any women having certain symptoms mentioned below should be consulted with a doctor immediately:
  • A lump in a breast
  • A pain in the armpits or breast that does not seem to be related to the woman's menstrual period
  • 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 swelling (lump) in one of the armpits
  • An area of thickened tissue in a breast
  • One of the nipples has a discharge sometimes it may contain blood
  • The nipple changes in appearance it may become sunken or inverted
  • The size or the shape of the breast changes
  • The nipple-skin or breast-skin may have started to peel, scale or flake

Causes of breast cancer-

  • The cause of breast cancer is still not known.
  • In breast cancer, the normal cells become cancerous through the mutation of cell DNA although some can be inherited but most cases occur that DNA changes related to breasts cancer occur during one's lifetime.
  • Proto-oncogenes can also help, if these cells mutate the growth of any cell goes out of control.So, it can lead to cancer.

Risk factors of breast cancer-

  • Though the causes of breast cancer is not known there are some factors which can increase the chance of getting breast cancer such as:
  • Age: The chances of getting breast cancer increases with the age of a person.
  • Family history: The risk of breast cancer is higher among women who have relatives with the disease. Having a close relative increases the risk to double.
  • Personal history: Women who had a breast cancer before, even a non-invasive one has a higher chance of getting breast cancer in the other breast.
  • Menstruation: Women who started their menstrual cycle at a younger age (before 12) or went through menopause later (after 55) have a slightly increased risk.
  • Breast tissue: Women with dense breast tissue (as documented by mammogram) have a higher risk of getting breast cancer.
  • Race: White women have a higher risk of developing breast cancer. But African-American women have more proliferative and invasive tumors when they have them.
  • Radiation-Exposure to previous chest radiation or use of diethylstilbestrol increases the risk of breast cancer.
  • Having no children or the first child after age 30 increases the risk of breast cancer.
  • Breastfeeding for one and a half to two years might slightly lower the risk of breast cancer.
  • Being overweight or obese increases the risk of breast cancer.
  • High sugar intake can increase the risk of breasts cancer.
  • Use of oral contraceptives in the last 10 years increases the risk of breast cancer.
  • Using combined hormone therapy after menopause increases the risk of breast cancer.
  • Alcohol use increases the risk of breast cancer.
  • Genetic risk factors: The most common causes are mutations in the BRCA1 and BRCA2 genes (breast cancer genes). Inheriting a mutated gene from a parent means that one has a significantly higher risk of developing breast cancer.

Diagnosis of breast cancer-

  • Mammogram-Mammogram is the X-ray of breast which is used to detect any abnormalities or changes in the breast. Women of higher age i.e. above 45 should undergo mammogram annually to detect any risk, or women of lower that age and higher that age must undergo mammogram to fall out the risk.
  • Breast test-A test is done by the physician who looks for lump or any abnormalities in the breast which can indicate cancer.
  • Ultrasound of breast-Ultrasound of a breast is done to look for dense breast tissues, or certain changes in the breast which can be felt but not seen in mammogram.
  • MRI of breast-This technique is useful for women who had already detected with breast cancer. It helps to measure the size of the cancer, other tumors in breast and check for tumor in other breast.
  • Breast biopsy-Biopsy of the breast is done, by taking a small tissue sample from the breast and studies it to find any abnormal or different cells in the breast tissue.


Treatment

Treatments of breast cancer-

  • The treatment of breast cancer take into account several factors of patient before starting the treatment such as the stage of the cancer, the health of the patient, the` age of the patient and also the type of the breast cancer.
  • Surgery:
  • Breast-conserving surgery (lumpectomy) - Only the part of the breast containing the cancer is removed along with some surrounding tissue. The removal of the breast tissue size depends on the size and location of the tumor.
  • Mastectomy -In this surgery the entire breast is removed, including all of the breast tissue and sometimes other nearby tissues. Some women may also get a double mastectomy, in which both breasts are removed.
  • If the cancer has passed on to the nearby lymph nodes than certain lymph node surgery is needed for the removal.
  • Sentinel lymph node biopsy (SLNB) - In this method only the lymph nodes under the arm to which the cancer would likely to spread is removed.
  • Axillary lymph node dissection (ALND) -In this method anywhere from about 10 to 40 (though usually less than 20) lymph nodes from under the arm. This technique is avoided as removal of such many lymph nodes can cause serious side effects.
  • Radiation therapy:
  • Breast radiation therapy - after a lumpectomy, radiation is administered to the remaining breast tissue to ensure no return of cancer.
  • Chest wall radiation therapy - this is applied after a mastectomy to the chest walls or places where any drains which excited the body after surgery.
  • Breast boost - a high-dose of radiation therapy is given after lumpectomy to the whole breast.
  • Lymph nodes radiation therapy - the radiation is aimed at the axilla (armpit) and surrounding area to destroy cancer cells that have reached the lymph nodes
  • Breast Brachytheraphy-
  • All the previous radiation methods are external methos, i.e a radiation is provided from outside the body.
  • In brachytherapy small device containing radioactive pellets is placed in the breast tissue for few minutes a radiation is given internally.
  • They ensure targeted radiation to specific cancer cells and removal of them.
  • Side effects of any radiation therapy may include irritation in breast region, redness, infection, fatigue and darkening of breast skin.
  • Chemotherapy:
  • Chemotherapy treatment can be given before or after radiation. Before radiation it is given to shrink the cancer size so less or no radiation is required. And after surgery it is given to remove any cancer cells which are remained back. Drugs used are:
  • Anthracyclines, such as doxorubicin (Adriamycin) and epirubicin (Ellence)
  • Taxanes, such as paclitaxel (Taxol) and docetaxel (Taxotere)
  • 5-fluorouracil (5-FU)
  • Cyclophosphamide (Cytoxan)
  • Carboplatin (Paraplatin)
  • Most often combination of two or three drugs is used.
  • Advanced cancer-Patients with cancer which has spread beyond breast and lymph nodes can be given advanced chemotherapy treatment. Drugs used are-
  • Docetaxel
  • Paclitaxel
  • Platinum agents (cisplatin, carboplatin)
  • Vinorelbine (Navelbine)
  • Capecitabine (Xeloda)
  • Liposomal doxorubicin (Doxil)
  • Gemcitabine (Gemzar)
  • Mitoxantrone (Novantrone)
  • Ixabepilone (Ixempra)
  • Albumin-bound paclitaxel (nab-paclitaxel or Abraxane)
  • Eribulin (Halaven)
  • Hormone therapy: The therapy is used for cancers that are sensitive to the hormones. It blocks certain receptors to lower the cause of cancer. Drugs for such therapy are:
  • Amoxifen - This drug blocks androgen receptor in breast cancer cells. It stops estrogen from binding to the cancer cells and help in dividing them. Side effects may include changes in periods, hot flashes, weight gain, headaches, nausea, vomiting, fatigue, and aching joints.
  • Aromatase inhibitors - this type of medication may be offered to women who have been through the menopause. It blocks aromatase. Aromatase helps estrogen production after the menopause. Before the menopause, a woman's ovaries produce estrogen. Examples of aromatase inhibitors include letrozole, exemestane, and anastrozole. Side effects may include nausea, vomiting, fatigue, skin rashes, headaches, mood swings, bone pain, aching joints, loss of libido, sweats, and hot flashes.
  • Targeted therapy-
  • Trastuzumab (Herceptin) - this monoclonal antibody targets and destroys cancer cells that are HER2-positive. (HER2 is the gene that gets mutated in breast cancer). Possible side effects may include skin rashes, headaches, and/or heart damage.
  • Lapatinib (Tykerb) - this drug targets the HER2 protein. It is also used for the treatment of advanced metastatic breast cancer. Tykerb is used on patients who did not respond well to Herceptin. Side effects include painful hands, painful feet, skin rashes, mouth sores, extreme tiredness, diarrhea, vomiting, and nausea.
  • Breast cancer can be prevented by preventing all the certain risk factors which can increase the rate of this particular cancer.

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