Breast Cancer – What you should know – By Dr. Shelly Sharma

 

Breast Cancer

What you should know?

By Dr. Shelly Sharma

Breast Cancer is cancer that develops in breast cells, it is the most common cancer diagnosed in women, rarely it can occur in men also. It can occur at any age but the risk increases with age. There is a need to increase awareness about this as Breast cancer is mostly diagnosed in advanced stages when curative interventions have lesser chances of succeeding. Every woman should be aware of the risks and should regularly take measures for early detection. Breast cancer causes the greatest number of cancer-related deaths in women with the higher propensity in developed regions, though incidences of Breast Cancer are increasing in developing and underdeveloped regions. Lack of awareness, limited resources, and insufficient health systems pose great challenges for women across the world.


The risk of Breast cancer is higher in some women than others, those who have had breast cancer in blood relation, older women, those who have had radiation to the chest or breast, who had benign breast condition, women who consume a lot of alcohol, women with dense breasts tissue and those who are taking hormones for a longer time. However, having these conditions does not mean that cancer is inevitable or vice versa is also not true.At the same time, it becomes very important to consult a doctor upon noticing these symptoms.

What is Breast Cancer?

Breast Cancer is out of control growth of cells in breast tissue, Cancer can form in Lobules (milk-producing glands) or Ducts (pathways to bring milk from the glands to the nipples). Cancer cells usually form a tumor that can be seen on mammography or felt as a lump. Not all lumps in breasts are cancerous, there are benign lumps which are just abnormal growth. Many cancers form lumps but not all cancers form lumps especially in the early stages.


 

 

Symptoms of Breast cancer

The most common symptoms of breast cancer are

  • Lumps in the breast or Axilla(armpits)
  • Thickening or swelling of a part of the breast.
  • Change in shape or size of Breast.
  • Feeling of tenderness in breasts or nipple area.
  • Nipples moving inwards.
  • Pain in any area of the Breast.
  • Redness or flaky skin in the nipple area or around.
  • Change in texture of breast skin or nipples.
  • Discharge of blood from the nipple.
  • Irritation or dimpling of breast skin.

It is very important for women to consult a Doctor if any of the aforementioned symptoms are visible.


 Self-examination

Breast cancer may occur in a woman at any age though chances increase with age and women aged over 40 years should get annual screening done. Greater awareness needs to be raised amongst women about self-examination which is extremely important for early detection of cancer when it is more likely to be treated successfully. Breast self-examination along with other screening methods increases the chances of early detection. It is a no cost, convenient tool that women can use at any time and at any age on regular basis, together with other screening tests and regular exams by a Doctor.

 

Step-1

Begin by looking at your breasts in the mirror with arms on your hips, look for signs of dimpling, puckering or bulging of skin, change of position of nipple or inverted nipple, redness, tenderness, swelling or rashes.

Step-2

Raise your arms over your head and look for same signs as mentioned in step 1.

Step-3

Look for any signs of fluid discharge from nipples one or both, fluid can be milky, watery, yellowish or blood.

Step-4

Lie down on your back, feel your breast with opposite arms on each breast, ensure to cover the entire breast from top from collarbone to bottom till ribcage and side to side armpits to armpits and cleavage, use light, medium and firm pressure to check presence of any lumps

Step-5

Feel your breasts while sitting or standing or during a shower.

Breast self-examination is recommended to be done at least once in month, after several days of periods when breasts are less likely to be swollen or tender. Making it a routine will help you familiarize more with your breasts and help you see even minor changes.

There is no need to panic if there is lumpiness felt, which is normal and benign due to hormonal changes. Do not hesitate to consult a Doctor if you see any prominent change and even to get a second opinion if you do not get all the answers from one.


Screening Tests

Doctors prescribe a Mammogram and sometimes an ultrasound or both, to evaluate a lump. Further image testing methods are MRI (Magnetic Resonance Imaging), and /or a Biopsy. A further thorough examination may be required by a Breast Specialist or a Breast Surgeon.


What can be done to reduce the risks of Breast Cancer?

Keeping healthy and keeping fit lowers the risk of many diseases including cancer. There are factors on which you have no controls such as getting older and Family history of cancer however risks can be reduced by taking proper care of health such as

  • Staying fit and physically active

Women who are not physically active are at higher risk of getting breast cancer. Regular exercise helps regulate hormone levels in your body, increased levels of certain hormones increase cancer risk. Exercise helps you maintain a healthy weight, being overweight and obese increases the risks of Cancer. In a week 150 minutes of moderate or 75 minutes of vigorous exercise or a combination of both including strength training which increases metabolism is helpful in the prevention of cancer and other chronic diseases.

  • Not Drinking Alcohol – your body breaks down alcohol into acetaldehyde which damages DNA, DNA controls the cells’ normal growth and function, damaged DNA results in cells growing out of controls and become cancerous.

Breastfeeding your children 

decreases the risk of Breast Cancer

 

 

 

 

Ask your Doctor – about the risks of Hormonal replacement therapy or Oral contraceptive pills and whether they are right for you. Non-hormonal symptoms to treat menopausal symptoms should be looked at.


Treatment

Breast cancer treatment options depend on type of breast cancer, its stage and grade, size, and whether the cancer cells are sensitive to hormones. Also taken into account is overall health of the patient.

Most women undergo surgery for breast cancer and many also receive additional treatment after surgery, such as chemotherapy, hormone therapy, or radiation. Chemotherapy might also be used before surgery in certain situations.


Breast cancer surgery

A variety of operations/ surgical procedures are used to treat breast cancer, these include:

Lumpectomy (removing the breast cancer lump) –  During a lumpectomy, which may be referred to as breast-conserving surgery or wide local excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue. It may be recommended for removing smaller tumors. Some people with larger tumors may undergo chemotherapy before surgery to shrink the tumor and that makes it possible to remove completely with a lumpectomy procedure.


Mastectomy (removing the entire breast)-. – A mastectomy is an operation to remove all of the breast tissue. Most mastectomy procedures remove all of the breast tissue — the lobules, ducts, fatty tissue, and some skin, including the nipple and areola (total or simple mastectomy ). Newer surgical techniques may be an option in selected cases to improve the appearance of the breast. Skin-sparing mastectomy and nipple-sparing mastectomy are increasingly common operations for breast cancer.


Removing Lymph Nodes-

Sentinel node biopsy (removing a limited number of lymph nodes)- To determine whether cancer has spread to lymph nodes, the surgeon may remove the lymph nodes that are the first to receive the lymph drainage from the tumor.If no cancer is found in those lymph nodes, the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes need to be removed.

Axillary lymph node clearance- If cancer is found in the sentinel lymph nodes, the surgeon may remove additional lymph nodes in the armpit area.

Complications of breast cancer surgery depend on the type of procedures. Breast cancer surgery carries a risk of pain, bleeding, infection and arm swelling, and edema (lymphedema).


Breast reconstruction 

Reconstruction with a breast implant (silicone or water) or reconstruction using the body’s own tissue is some possibilities. These operations can be performed at the time of mastectomy or at a later date.


Radiation therapy

Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells. Radiation therapy is typically done using a large machine that aims the energy beams at the body (external beam radiation). But radiation can also be done by placing radioactive material inside the body (brachytherapy). External beam radiation of the whole breast is commonly used after a lumpectomy. Breast brachytherapy may be an option after a lumpectomy if there is a low risk of cancer recurrence.

Doctors may also recommend radiation therapy to the chest wall after a mastectomy for larger breast cancers or cancers that have spread to the lymph nodes. Breast cancer radiation can last from three days to six weeks, depending on the treatment. A doctor who uses radiation to treat cancer (radiation oncologist) determines which treatment is best for you based on your situation, your cancer type, and the location of your tumor.


Side effects of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Breast tissue may also appear swollen or more firm. Rarely, more-serious problems may occur, such as damage to the heart or lungs or, very rarely, second cancers in the treated area may occur.


Chemotherapy

Chemotherapy uses drugs to destroy fast-growing cells, such as cancer cells. If cancer has a high risk of returning or spreading to other parts of the body, then the doctor may recommend chemotherapy after surgery to decrease the chance of cancer recurrence.

Chemotherapy is sometimes given before surgery in women with larger breast tumors. The goal is to shrink a tumor to a size that makes it easier to remove with surgery. Chemotherapy is also used in women whose cancer has already spread to other parts of the body. Chemotherapy may be recommended to try to control cancer and decrease any symptoms the cancer is causing.

Chemotherapy side effects depend on the drugs used. Common side effects include hair loss, nausea, vomiting, fatigue, and an increased risk of developing an infection. Rare side effects can include premature menopause, infertility (if premenopausal), damage to the heart and kidneys, nerve damage, and, very rarely, blood cell cancer.


Hormone therapy

Hormone therapy — perhaps more properly termed hormone-blocking therapy — is used to treat breast cancers that are sensitive to hormones. Doctors refer to these cancers as estrogen receptor-positive (ER-positive) and progesterone receptor-positive (PR positive) cancers. Hormone therapy can be used before or after surgery or other treatments to decrease the chances of cancer recurrence. If cancer has already spread, hormone therapy may shrink and control it.


Treatments that can be used in hormone therapy include:


Selective estrogen receptor modulators- Medications that block hormones from attaching to cancer cells.

Aromatase inhibitors- Medications that stop the body from making estrogen after menopause.

Surgery or medications to stop hormone production in the ovaries.

Hormone therapy side effects depend on the specific treatment but may include hot flashes, night sweats, and vaginal dryness. More serious side effects include a risk of bone thinning and blood clots.


Targeted therapy drugs

 

Targeted drug treatments attack specific abnormalities within cancer cells. As an example, several targeted therapy drugs focus on a protein that some breast cancer cells overproduce called human epidermal growth factor receptor 2 (HER2). The protein helps breast cancer cells grow and survive. By targeting cells that make too much HER2, the drugs can damage cancer cells while sparing healthy cells. Targeted therapy drugs that focus on other abnormalities within cancer cells are available. And targeted therapy is an active area of cancer research.

 


The cancer cells may be tested to see whether one will benefit from targeted therapy drugs. Some medications are used after surgery to reduce the risk that the cancer will return. Others are used in cases of advanced breast cancer to slow the growth of the tumor.


Immunotherapy

Immunotherapy uses the body’s immune system to fight cancer. The body’s disease-fighting immune system may not attack cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process.

Immunotherapy might be an option in cases of triple-negative breast cancer, which means that the cancer cells don’t have receptors for estrogen, progesterone or HER2. For triple-negative breast cancer, immunotherapy is combined with chemotherapy to treat advanced cancer that has spread to other parts of the body.


Supportive (palliative) care

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with the patient and their families and other doctors to provide an extra layer of support that complements ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy, or radiation therapy. When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.

Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments one may be receiving.

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