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| Breast cancer |
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| Introduction |
| Breast cancer is a malignant tumor that has
developed from cells of the breast. The disease occurs mostly in women, but does occur
rarely in men. back to top |
| Normal
breast structure |
The main components of the female breast are lobules
(milk-producing glands), ducts (milk passages that connect the lobules and the nipple),
and stroma (fatty tissue and ligaments surrounding the ducts and lobules, blood vessels,
and lymphatic vessels). Lymphatic vessels are similar to veins, except that they carry
lymph instead of blood. Lymph is a clear fluid that contains tissue waste products and
immune system cells that are on their way from areas of infection. Cancer cells can enter
lymph vessels. Most lymphatic vessels of the breast lead to axillary (armpit) lymph nodes.
Lymph nodes are small bean-shaped collections of immune system cells that
are important in fighting infections. When breast cancer cells reach the axillary lymph
nodes, they can continue to grow, often causing swelling of the lymph nodes in the
underarm area. If breast cancer cells have grown in the axillary lymph nodes, they are
more likely to have spread to other organs of the body as well. This is why finding out
whether breast cancer has spread to axillary lymph nodes is important in selecting the
best mode of treatment.
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| Benign breast
lumps |
| Most breast lumps are benign, that is, not
cancerous. Most lumps are caused by fibrocystic changes. Cysts are fluid-filled sacs and
fibrosis refers to connective tissue or scar tissue formation. Breast swelling and pain
can be caused by fibrocystic changes. The breasts may feel nodular, or lumpy, and
sometimes a clear or slightly cloudy nipple discharge is present. Benign breast tumors
such as fibroadenomas or papillomas are abnormal growths, but they cannot spread outside
of the breast to other organs. They are not life threatening. back
to top |
| Number of women suffering from breast
cancer |
Breast cancer is the most common cancer in women.
The following data can show the number of cases:
 |
| Incidence in the developed world |
494 |
| Incidence in the developing world |
416 |
| Mortality worldwide |
376 |
| 5 years prevalence worldwide |
2810 |
(all figures in 1,000) |
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| Geographical surveys done show that USA
(Connecticut) showed the maximum number of cases, that is 71.4 per 1,00,000 women. Japan
showed least number of cases, that is 13.0 per 1,00,000 women. India also showed few
cases, that is 20.1 per 1,00,000 women. back to top |
| Risk factors: |
| There are a number of factors, which increase the
risk of having this cancer. Some of them are: |
- Age - Breast cancer is uncommon below the age of 35. The incidence
sharply increases between the age of 35 and 50. It has also been noticed that cases sharply
decrease at the time of menopause, though the cases have been noted to rise after the age
of 65. Also the women who have had breast cancer before the age of 40, had three times the
risk of developing a second breast cancer than those who developed the breast cancer after
the age of 40.
- Family History - the risk is high in those with a positive family
history of breast cancer, especially if the mother or sister developed breast cancer when
premenopausal.
- Parity - an international case study done shows that breast cancer is
directly related to the age at which the women bear their first child. An early first
pregnancy seemed to have a protective effect. Those women who delayed their first
pregnancy to their late thirties are at a higher risk than multiparous women.
- Hormonal factors - the association of breast cancer with early menarche
and the late menopause suggests that ovary appears to play a crucial role in the
development of breast cancer. Recent evidence suggests that both elevated oestrogen as
well as progesterone, are important factors in increasing breast cancer risks.
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| Types of
breast cancers |
| Understanding some of the key words used to describe
different types of breast cancer is important because these types vary in their prognosis
(outlook for survival or cure) and their treatment options. An alphabetical list of terms,
including the most common types of breast cancer, is given below: |
Adenocarcinoma:
This is a general type of cancer that starts in glandular tissues anywhere in the body.
Nearly all breast cancers start in glandular tissue of the breast and therefore are
adenocarcinomas. The two main types of breast adenocarcinomas are ductal carcinomas and
lobular carcinomas. There are also several subtypes of adenocarcinoma, some of which have
important implications for prognosis and treatment. |
Ductal Carcinoma In Situ (DCIS)
Ductal carcinoma in situ is the most common type of noninvasive breast cancer. There are
cancer cells inside the ducts but they have not spread through the walls of the ducts into
the fatty tissue of the breast. Nearly 100% of women diagnosed at this early stage of
breast cancer can be cured. The best way to find DCIS is with a mammogram. With more women
getting mammograms each year, a diagnosis of DCIS is becoming more common. DCIS is
sometimes sub classified based on its grade and type, in order to help predict the risk of
cancer returning after treatment and to help select the most appropriate treatment. Grade
refers to how aggressive cancer cells appear under a microscope. There are several types
of DCIS, but the most important distinction among them is whether or not tumor cell
necrosis (areas of dead or degenerating cancer cells) is present. The term comedocarcinoma
is often used to describe a type of DCIS with necrosis. |
| Infiltrating (or invasive) Ductal Carcinoma
(IDC): |
| Starting in a milk passage or duct of the breast,
this cancer has broken through the wall of the duct and invades the fatty tissue of the
breast. At this point, it has the potential to metastasize, or spread to the other parts
of the body through the lymphatic system and bloodstream. Infiltrating ductal carcinoma
accounts for about 80% of breast cancers. |
| Infiltrating (or invasive) Lobular Carcinoma
(ILC): |
| ILC starts in the milk-producing glands. Similar to
IDC, this cancer has the potential to spread (metastasize) elsewhere in the body. About
10% to 15% of invasive breast cancers are invasive lobular carcinomas. ILC may be more
difficult to detect by mammogram than IDC. |
| Inflammatory Breast Cancer: |
| This rare type of invasive breast cancer accounts
for about 1% of all breast cancers. It is an aggressive and a fast-growing cancer.
Inflammatory breast cancer makes the skin of the breast look red and feel warm, as if it
was infected. The skin has a thick, pitted appearance that doctors often describe as
resembling an orange peel. Sometimes the skin develops ridges and small bumps that look
like hives. Cancer cells blocking lymph vessels or channels in the skin over the breast
cause these symptoms. |
| In Situ: |
| This term is used for an early stage of cancer in
which a tumor is confined to the immediate area where it began. Specifically in breast
cancer, in situ means that the cancer remains confined to ducts (ductal carcinoma in situ)
or lobules (lobular carcinoma in situ). It has not invaded surrounding fatty tissues in
the breast nor spread to other organs in the body. |
| Lobular Carcinoma In Situ (LCIS): |
| While not a true cancer, LCIS (also called lobular
neoplasia) is sometimes classified as a type of noninvasive breast cancer. It begins in
the milk-producing glands, but does not penetrate through the wall of the lobules. Most
researchers think that LCIS itself does not usually become an invasive cancer, but women
with this condition have a higher risk of developing an invasive breast cancer in the same
breast, or in the opposite breast. For this reason, it's important for women with LCIS to
have a physical exam two or three times a year, as well as an annual mammogram. |
| Medullary Carcinoma: |
| This special type of infiltrating breast cancer has
a relatively well defined, distinct boundary between tumor tissue and normal tissue. It
accounts for about 5% of breast cancers. The outlook or prognosis for this kind of breast
cancer is better than for other types of invasive breast cancer. |
| Mucinous Carcinoma: |
| This rare type of invasive breast cancer is formed
by mucus-producing cancer cells. The prognosis for mucinous carcinoma is better than for
the more common types of invasive breast cancer. Colloid carcinoma is another name for
this type of breast cancer. |
| Paget's Disease of the Nipple: |
| This type of breast cancer starts in the breast
ducts and spreads to the skin of the nipple and the areola, the dark circle around the
nipple. It is a rare type of breast cancer, occurring in only 1% of all cases. The skin of
the nipple and areola often appears crusted, scaly and red, with areas of bleeding or
oozing. The woman may notice burning or itching. Paget's disease may be associated with in
situ carcinoma, or with infiltrating breast carcinoma. If no lump can be felt in the
breast tissue and the biopsy shows DCIS but no invasive cancer, the prognosis is
excellent. |
| Phyllodes Tumor |
| This very rare type of breast tumor, which forms
from the stroma (connective tissue) of the breast, in contrast to carcinomas which
develops in the ducts or lobules. Phyllodes (also spelled phylloides) tumors are usually
benign but on rare occasions may be malignant (having the potential to metastasize).
Nevertheless, malignant phyllodes tumors are very rare and less than 10 women per year in
the US die of this disease. Benign phyllodes tumors are successfully treated by removing
the mass and a narrow margin of normal breast tissue. A malignant phyllodes tumor is
treated by removing it along with a wider margin of normal tissue, or by mastectomy. These
cancers do not respond to hormonal therapy and are less likely than most breast cancers to
respond to chemotherapy or radiation therapy. In the past, both benign and malignant
phyllodes tumors were referred to as cystosarcoma phyllodes. |
| Tubular Carcinoma: |
| Accounting for about 2% of all breast cancers,
tubular carcinomas are a special type of infiltrating breast carcinoma. They have a better
prognosis than usual infiltrating ductal or lobular carcinomas. |
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