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Breast Cancer

Breast Cancer is one of the leading cancers for women; it is the second most common cancer for women, next to Skin Cancer and the second most common cause of deaths for women, next to Lung Cancer.

The probability of a women having cancer increases as the age increases. Every year there is approximately 200,000 new cases and over 40,000 deaths per year.

Mortality rates have been slowing in recent years due to early detection and new treatments. This is important and points to both self-examinations, self-awareness, and professional exams.

There are different types of Breast Cancer with some that are related to genetics and other complexities. Others may be related to Estrogen where estrogen binds to receptors on cancer cells, stimulating their growth, development, and progression.

Women have three or four times the risk if a mother or sister has breast cancer. Other risks of cancer can be a previous breast cancer diagnosis.

In the U.S  breast cancer is more common in white women – but incidence is rising in non-whites.

Routine Breast Cancer screening is essential for early diagnosis.

Paget’s Disease is also a type of breast cancer. Metastatic disease which is when cancer spreads from the original location to another area in the body can be seen in some types of breast cancer.

Risk factors:

–  Age of first child (after 35)
–  Genetic mutations: BRCA1 and BRCA2
–  Family History – having a close relative with cancer (mother, sister, daughter or aunt)
–  Smoking, Alcohol
–  Obesity
–  Physical inactivity
–  Dense breast tissue
–  Never having a child
–  Early menarche
–  Late natural menopause
–  Alcohol
–  Exposure to radiation and other chemicals
–  And More

Symptoms:

–  Lumps in breast
–  Lumps in lymph nodes
–  Changes in breast size
–  Changes in breast shape
–  Pain in breast
–  Pain in lymph node
–  Skin dimpling
–  Nipple inversion
–  Nipple Discharge
–  Weight loss
–  Fatigue
–  Fever
–  Chills
–  Peau d’orange – Skin Inflammation, redness, warmth, swelling, and pain.

Screening

Breast cancer screening can be done by:

1.)  X-ray
2.)  Mammography
3.)  MRI
4.)  Breast self-examination
5.)  Lump Biopsy

Staging

Depending on the type of cancer – staging may be important to understand treatment options, progression, survival, and more.

TX –  cannot be assessed
TO – No evidence of tumor
T1 – Size of Tumor is less then 2cm.
T2 – Size of Tumor is greater then 2cm, less then 5cm
T3 – Size of Tumor is greater then 5cm
T4 – Tumor of any size found in chest wall or skin

Nx – nearby lymph nodes cannot be assessed
NO – Cancer is not found in lymph nodes
N1 – Cancer is found in 1-3 axillary [arm-pit] lymph nodes or one mammary lymph node
N2 – Cancer spread to 4-9 axillary [arm-pit] lymph nodes
N3 – 10+ lymph nodes or cancer found in lymph node under clavicle (collar bone) or above clavicle or others

MX –  No Metastasis can be assessed
MO –  No distant spread
M1 – Spread to distant organs is found

Some inherited breast cancers have been found on chromosomes 17 and 13

BRACA1 and BRAC2 are known genes and mutations of p53 have been seen in young women.

Early detection, mammograms, and especially Self-Examination are extremely important.

Treatment Options

1.) Surgery

–  Lumpectomy: Removal of a small tumor and small margin of healthy tissue.
–  Mastectomy: Removal of entire breast
–  Modified Radical Mastectomy: Removes the breast, nipple, and some lymph nodes
–  Nipple-sparing Mastectomy: Removes the breast tissue but preserves the nipple
–  Axillary Lymph Node Dissection: Removes Lymph nodes from the armpit to check for cancer spread
–  Sentinel Lymph Node Biopsy: Dye is injected then Lymph node is removed.

2.) Hormonal therapy

.     Tamoxifen
.     Aromatase
.     Anastrozole – Aromatase inhibitors
.     Letrozole – Aromatase inhibitors
.     Exemestane – Aromatase inhibitors
.     Fulvestrant – Newer hormone therapy that blocks the estrogen receptor. Used for advanced or Metastatic HR+ breast cancer.

3.) Chemotherapy

.     Adriamycin (Doxorubicin)
.     Cytoxan (Cyclophosphamide)
.     Taxol (Paclitaxel)
.     Gemcitabine
.     Epirubicin

4.) Radiotherapy

Men:

Breast cancer is 100x less common in men then women