Dr. Aditi Chaturvedi

What is Breast Cancer ?

Breast cancer is a disease that starts in the breast with a malignant tumor. A malignant tumor is a mass of cells that grows out of control. The cancerous cells can also metastasize (restrict to one part), or grow to other tissues or parts of the body. Breast cancer can develop at any age. It mostly affects Women but also affects a small number of men each year. Breasts are made up of lobules and ducts surrounded by fatty and connective tissue. Lobules produce breast milk and ducts carry milk to the nipple. Lobules and ducts are most common sites for initial Brest Cancers. But tumors can also develop in the fibrous and fatty connective tissue that surrounds the lobules and ducts.

There are different types of breast cancer.

Normally Classified into Non Invasive and Invasive:

Invasive : Most breast cancers are diagnosed when a tumour has starts from within a duct or lobule to the surrounding breast tissue.

These are called invasive breast cancers:

Early breast cancer is an invasive breast cancer that is contained in the breast and may or may not have spread to lymph nodes in the breast or armpit.

Locally advanced breast cancer is a form of invasive breast cancer that has spread to areas near the breast, such as the chest wall.

Metastatic breast cancer (also called advanced breast cancer) is an invasive breast cancer that has spread from the breast to other parts of the body.

Paget’s disease of the nipple is an uncommon or rare form of breast cancer that affects the nipple and the area around the nipple

Inflammatory breast cancer is a rare form of invasive breast cancer that affects the lymphatic vessels in the skin of the breast, causing the breast to become red and inflamed.

Non Invasive Some people are diagnosed when the cancerous cells are still totally within a duct or lobule. When the cancer is not grown outside the original site , known as carcinoma in situ (or non-invasive breast cancer).

Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer that is restricted to the ducts of the breast.

Lobular carcinoma in situ (LCIS) is a non-invasive breast cancer that is restricted to the lobules of the breast.

Risk factors

A breast cancer risk factor is anything that makes it more likely you'll get breast cancer. But having one or even several breast cancer risk factors doesn't necessarily mean you'll develop breast cancer. Many women who develop breast cancer have no known risk factors other than simply being women.

Factors that are associated with an increased risk of breast cancer include:

Signs and symptoms of breast cancer may include

Let us begin with the most common question : When should you suspect breast cancer or in fact what should alert you to visit a breast specialist doctor?

How would you notice these changes?

All ladies should perform breast self examination atleast once a month a few days after their period.

First, you should see your breasts and armpits in front of a mirror with your arms by your side, then with your arms above the head (for the under bust area) and lastly with the hands pressed against hips.

The next step should be feeling your breasts systematically (in a circular motion or up and down or radially) covering all areas of the breast and armpit to discover any change. This should be done standing and in lying down position with the opposite hand. So, for example while feeling the left breast, use your right hand and keep the left hand raised above your head.

It is important to know that breast should be examined by the flat of your fingers and not by bunching them together.

The exam should end with pinching your nipples to look for any discharge.

This is a schematic diagram to guide you through the examination and we will be adding a link to a video soon.

If you feel any change in the feel of your breasts or any of the above mentioned changes, do not panic but please visit a doctor preferably a breast specialist.

Every breast lump is not cancer but it is important to get evaluated.

It is also necessary to remember that pain in the breasts is not necessary to indicate cancer, in fact most commonly, the malignant lumps are painless, so do not wait for pain to get alarmed.

Mastalgia or breast pain is quite common and more often that not, indicative of a benign (non cancerous) condition.

If you have undergone a routine mammogram without any symptoms, please visit a breast specialist if the radiologist has reported any suspicious finding. We will discuss whether screening mammograms are routinely indicated in another section.

How Is Breast Cancer Diagnosed?

Treatment

The aim of treatment for breast cancer and the types of treatment recommended depend on a number of things including:

Surgery -The types of operation which may be considered are:

Breast-conserving surgery This is often an option if the tumour is not too big. A lumpectomy (or wide local excision) is one type of operation where just the tumour and some surrounding breast tissue are removed. It is usual to have radiotherapy following this operation. This aims to kill any cancer cells which may have been left in the breast tissue.

Removal of the affected breast (mastectomy) This may be necessary if there is a large tumour or a tumour in the middle of the breast. It is often possible to have breast reconstructive surgery to create a new breast following a mastectomy. This can often be done at the same time as the mastectomy, although it can also be done months or years later. There are now many different types of reconstruction operations available.

A sentinel lymph node biopsy may be performed. This is a way of assessing if the main lymph nodes draining the breast contain cancer. If they are clear then the remaining lymph nodes in the armpit will not need to be removed. If it is not possible to do this, one or more of the lymph nodes in the armpit may be removed. This helps to stage the disease accurately and to guide the specialist as to what treatment to advise following surgery.

Radiotherapy In Radiotherapy High energy beams are used at focused Cancer cells to kill the cancer cells or stop the multiplication of Cells.Usually it is a combination of Breast Surgery with Radiation to affected Breast to prevent the cancer to return back because of some cancer cells lying just near the operating sites.

Hormone treatments Female Hormones Oestrogen and Progesterone produced in Ovaries in female may affect some onset of Breast Cancer. As these hormones increase the division and multiplication of Cancer Cells .Here the Hormone treatments works well to reduce the level of these hormones and stops there growth of Breast Cancer. For Hormone –responsive breast cancer this treatment works best in Women, sometimes it also works in Non-Hormone responsive cancers as well.

Hormone treatments include:

Chemotherapy This is the treatment in which Anti-Cancer medicines are used to kill cancer cells or stop their growth When chemotherapy is used in addition to surgery it is known as adjuvant chemotherapy. Sometimes before operation a chemotherapy is given to reduce or shrink the size of Tumour which makes surgery more success rate .

Breast Cancer