Breast Cancer

Breast Cancer

Anatomy of the Breast:

The breast consists of fatty tissue, dense tissue, milk-producing glands (lobules), lobes (formed by groups of lobules), small ducts that carry milk to the nipple, and the areola, the darkened area around the nipple. Inside the breast, there are numerous blood vessels and lymphatic vessels. Blood vessels deliver nutrients and oxygen to cells and remove waste and carbon dioxide, while lymph vessels remove waste from cells and direct it to lymph nodes. Lymph nodes, part of the immune system, help combat infections. Clusters of lymph nodes are located throughout the body, including the axillary lymph nodes in the armpit, where the breast’s lymph vessels

Whatis Breast Cancer?

Healthy cells in the breast can grow uncontrollably to form a lump or tumor. This lump may be benign (non-cancerous) or malignant (cancerous).

Types of Breast Cancer:

• Invasive Breast Cancer: Cancer that spreads to other parts of the body. About 80% of breast cancer cases are of this type.
• Non-Invasive Breast Cancer: Cancer that does not spread beyond the ducts or lobes of the breast. It accounts for around 20% of breast cancer cases.

Common Types:

1. Ductal Carcinoma In Situ (DCIS): A non-invasive cancer found only in the milk ducts.
2. Invasive Ductal Carcinoma: The most common invasive breast cancer that spreads beyond the ducts.
3. Invasive Lobular Carcinoma: Cancer that spreads beyond the lobules.

Rare Invasive Cancer Types:

• Medullary
• Mucinous
• Tubular
• Metaplastic
• Papillary
• Micropapillary
• Apocrine
• Inflammatory Breast Cancer

Breast Cancer Subtypes:

• Hormone Receptor-Positive: Breast cancer cells that express estrogen or progesterone receptors. These cancers rely on these hormones for growth and can be treated with hormone therapy.
• HER2 Positive: 15-20% of breast cancers have high levels of the HER2 protein, which causes rapid growth. HER2-positive cancers can be treated with targeted therapies.
• Triple-Negative Breast Cancer: Cancer that does not express estrogen, progesterone, or HER2 receptors, accounting for 10-20% of invasive breast cancers. It is more common in younger women and those with BRCA1 gene mutations.

Statistics:

Breast cancer is the most common cancer worldwide. In India, around 178,361 new cases of breast cancer are diagnosed annually, with 90,408 deaths reported.

Risk Factors:

• Age: The risk increases with age, especially after 50.
• Personal History: Those who have had breast cancer are at a higher risk of developing it again.
• Family History: A family history of breast cancer, ovarian cancer, or other related cancers increases risk.
• Early Menstruation or Late Menopause: Prolonged exposure to estrogen increases breast cancer risk.
• Pregnancy Age: Having the first child after age 35 or never having children increases risk.
• Hormone Replacement Therapy: Increases breast cancer risk.
• Birth Control Pills: Slightly increase the risk.
• Lifestyle: Being overweight, physically inactive, drinking alcohol, and eating a high-fat diet can increase the risk of breast cancer.
• Radiation: Prior radiation treatments to the chest increase the risk.

Prevention:

While breast cancer cannot be entirely prevented, awareness of risk factors and symptoms can help reduce the likelihood of developing the disease.

Breast Cancer Screening:

Screening involves checking for cancer in individuals with no symptoms to detect it at an early stage, improving the chances of successful treatment.

1. Mammography: An X-ray of the breast that can detect small lumps before they can be felt.
2. Self-Breast Examination: Women should examine their breasts monthly to detect any changes in size, shape, or the presence of lumps.

Symptoms of Breast Cancer:

• A lump in the breast or armpit
• Changes in breast shape or size
• Nipple discharge (blood or dark fluid)
• Nipple retraction (inward turning)
• Skin changes (dimpling or orange-peel texture)
• Breast pain

Diagnosis:

• Mammogram: X-ray imaging to detect abnormalities.
• Ultrasound and MRI: Used to examine suspicious areas further.
• Biopsy: Removing a small portion of tissue to examine it for cancer cells.
• Genomic Testing: Tests to check the cancer’s genetic makeup.
• Blood Tests: To check overall health and organ function.

Staging of Breast Cancer (TNM):

• T (Tumor): Describes the size and extent of the primary tumor.
• N (Nodes): Indicates if cancer has spread to lymph nodes.
• M (Metastasis): Shows if cancer has spread to other parts of the body.

Treatment Options:

1. Surgery: Removal of the tumor, which may involve a lumpectomy (removal of the lump) or mastectomy (removal of the entire breast).
2. Radiation Therapy: Using high-energy rays to destroy cancer cells.
3. Chemotherapy: Using drugs to kill cancer cells.
4. Hormonal Therapy: For hormone receptor-positive cancers, medications like Tamoxifen block hormones that fuel cancer growth.
5. Targeted Therapy: For HER2-positive cancers, targeted drugs like Trastuzumab are used.
6. Bone-Modifying Drugs: To strengthen bones and prevent cancer spread to bones.
7. Immunotherapy: Drugs like Pembrolizumab are used for triple-negative breast cancer.

Follow-up Care:

After treatment, regular follow-ups, including physical exams, blood tests, and imaging, are necessary to monitor for any recurrence and manage side effects.

Breast Cancer in Men:

Though rare, men can develop breast cancer. Symptoms include lumps in the chest or changes in the skin or nipples. Diagnosis and treatment are the same as for women.

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