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Breast cancer

Breast cancer is the disease that begin when cells in the breast start to grow out of control. This out of control growth can lead to development of tumor which can either be benign or malignant. Benign tumor is the one that is enclosed in one area and cannot spread to other parts of the body while malignant is the one which is not enclosed and can spread to other parts of the body. Malignant tumor is also called cancer. To understand well about breast cancer it is important to have a little bit knowledge on anatomy of breast.


About Breast Cancer
Breasts are the organs located on the chest of both men and women. In women breasts are made of lobes, lobules and ducts. Each breast contains several lobes that may range form 12-20 and in every lobe there are tiny, tube like structures that contain milk secreting glands. These tube like structures are called lobules. Both of these three, lobes, lobules and milk glands are connected by ducts that are responsible for carrying milk to the nipples.In men the breasts are made of ducts but do not contain or have few lobes and lobule. Both men and women breasts contain fatty and fibrous tissues.
In the breast there are also blood and lymph vessels that run through. Blood vessels carry blood that nourishes cells in the breast while lymph vessels are part of immune system. Lymph vessels help to drain fluid from tissues and connect lymph nodes that help to protect the body by fighting infections. Lymph nodes are located throughout the body including at the breastbone, armpits, abdomen, neck and groin. Lymph nodes in the armpits is the first place where breast cancer cells spread to.

Types of breast cancer
Most of breast cancers tend to develop in ducts or lobules. Hence breast cancer is grouped into two groups;
• Ductal carcinoma. This is the one that develop from lining of ducts
• Lobular carcinoma. These develop from lobules.
Depending on whether the disease can spread from there, breast cancer canfurther be divided into either invasive or non-invasive. Invasive breast cancer is the one that tends to spread from ducts or tubules into surrounding breast tissues while non –invasive do not spread. Non-invasive tumors are sometimes called carcinoma in situ while invasive are called infiltrating carcinomas. Most of breast cancer cases are detected when they have already invaded surrounding breast tissues (invasive breast cancers).

RISK FACTORS FOR BREAST CANCER
When it comes to cancer, anything that increases your probability of developing cancer is called a risk factor. Risk factors only influence development of cancer but do not directly cause cancer. Sometimes people with risk factors do not develop the disease while those with no risk factors do develop the disease. Knowing risk factors will help you live your life making some better healthy choices to reduce the risk. Risk factors of breast cancer include the following;
• Gender. Although men can also develop breast cancer, number of women developing breast cancer is very large compared to that of men.
• Age. This cancer is more common to those at older age.
• Family history.Women in families with strong history with the disease especially the first degree relatives (eg; mother and sister) are said to be at an increased risk of developing this disease.
• Inherited genetic mutation.Those born with mutation of BRCA1 and BRCA2 gene are at higher risk of developing breast cancer than others. Normally these genes prevent cells from growing out of control hence mutation of these will increase the risk of breast cancer. Other genetic conditions that increase the risk of breast cancer their effect is less compared to BRCA1 and BRCA2 gene include Li-fraumeni syndrome, lynch syndrome, Ataxia-telangiectasia and hereditary diffuse gastric cancer.
• Personal history of breast cancer. Those with history of having breast cancer in one of the breast, are at risk of developing cancer in the other breast.
• Long term use of hormone replacement therapy. Women using hormone replacement therapy after menopause are said to be at an increased risk of developing breast cancer. It is advised for women to discuss about the side effects of those therapies with their doctors before starting to use them.
• Being overweight. Being overweight will slightly increase your risk of developing breast cancer.
• Alcohol drinking. Some studies suggest that, having more than 1 to 2 drinks per day increases the risk of developing breast cancer at some point in life.
• Socioeconomic factors. Breast cancer is more common to women with good economic status (affluent) than poor ones. The reason for this is not known but it is thought to be variation in diet and environment exposures.
• Oral contraceptives. More research is required regarding this as some studies suggest that oral contraceptives slightly increases chance to develop breast cancer while other studies show no link between the two.

PREVENTION OF BREAST CANCER
In order to prevent something you need first to know what causes it. Since there is no known specific cause for breast cancer, there are no proven ways of completely preventing development of this cancer. Despite absence of ways to prevent this disease, there are ways of reducing the risk of development of the disease. These include the following;
• Prophylactic mastectomy. For those having mutated BRCA1 and BRCA2 genes may opt to have surgery to remove breasts since there are at more risk of developing breast cancer at some point in life. These women may also have surgery to remove ovaries and fallopian tube (prophylactic salpingo-oophorectomy) to reduce the risk of developing ovarian cancer due to this kind of mutation.
• Changing life style. To reduce the risk of developing breast cancer at some point in life, it is advised to have a healthy life style such as avoiding excessive alcohol drinking, doing physical exercises to avoid being over weigh and avoiding hormone replacement therapies after menopause.
• Chemoprevention. There are drugs that may be used to reduce the risk of breast cancer for those at high risk of developing it. Hormone blocking drugs will help to reduce the risk of developing breast cancer by blocking estrogen hormone.

EARLY DETECTION AND SCREENING OF BREAST CANCER
When it comes to cancer, early detection normally provide better treatment outcome. When breast cancer is found early, chances for better treatment outcome are very high. For most cancers, early detection has been greatly contributed by the presence of screening processes.
Screening is the process of running some tests to someone with no symptoms of the disease with the intention of determining presence or absence of the disease. For breast cancer, screening can be done by using mammogram, MRI tests and ultrasound. Among those three, mammogram is the one which is widely recommended while MRI and Ultrasound are used to those at very high risk of developing breast cancer.
Mammogram involves using low dose x-rays to take pictures of breasts in order to check presence or absence of signs of breast cancer. During the test, each breast is placed between two x-ray plates separately and picture is taken. The test may be uncomfortable but it takes a very short period of time.
In order to reduce the uncertainties and repeat taking the test several times, a new type of mammogram called tomosynthesis is used. Tomosynthesis takes x-ray images of breast tissues from different angles and uses a computer to combine them to form a three –dimensional image (3D-image) which shows a better image than a normal mammogram. By combining the two images (normal mammogram and tomosynthesis), the results will be more clear with low chances of false-positives.
Despite presence of screening tests and various recommendations from different organizations, decisions to do those tests remain individual. It is important for every woman to talk with their doctors on how often she should have the screening tests.

SIGNS AND SYMPTOMS OF BREAST CANCER
People with breast cancer may experience the following signs and symptoms. Sometimes, people with breast cancer do not have any of these changes, or the cause of those symptom may be another medical condition that is not cancer, hence seeing your doctor upon experiencing any of those symptoms is advised. Signs and symptoms of breast cancer include the following;
• Presence of a lump or thickening in the breast
• Changes in the skin of the breast such as scar appearance, unusual redness, dimpling or other color changes
• Nipple discharge that may be clear or bloody
• Changes in size and shape of the breast
• Presence of lump under armpits
• Changes of nipple such as turning inwards or development of sore in a nipple
• Feeling pain in the breast that doesn’t go away. This is normally not a symptom of breast cancer, but it should be reported to a doctor.

DIAGNOSIS OF BREAST CANCER
cancer diagnosis
Medical diagnosis simply means identification of nature of an illness by elimination of the symptoms. Normally people don`t go to hospital knowing they have cancer but during diagnostic procedures is when doctors detect the disease.
Following suspicion of the disease, doctors normally run combination of tests to determine whether there are cancerous cells in the body or not and if there are cancer cells, how far have they spread. Along with thorough medical history and physical examination, doctors normally use combination of the following tests to diagnose cancer.
Laboratory tests.
Laboratory tests are important in ruling out other conditions and confirming diagnosis. For cancer diagnosis laboratory tests normally include blood tests, urine tests, tumor markers and other body fluids tests.
• Blood tests. Blood tests help to reveal level of different substances in the blood which will help doctors to know if there is anything wrong in the body. From blood tests doctors can see complete blood count which indicates number, size and maturity of blood cells. Also from the blood tests doctors can analyze if kidney and liver are working properly.
• Urine tests. Urine tests (urinalysis) involve laboratory examination of urine to check presence of blood, proteins, and other substances such as drugs. For instance, blood in the urine may be an indication of benign condition, infection or other health problem.
• Tumor markers. These are biomarkers (proteins) that can be produced by both cancer cells and normal body cells in response to cancer. Tumor markers are released into the blood or urine. Although studies are still conducted to determine role of these markers in diagnosing cancer because sometimes people with benign condition will have elevated level of these proteins. Also not all tumors have their markers and some markers are not specific to one type of tumor.
• Other body fluids. Despite being rarely used, sometimes body fluids can be tested in the lab during diagnosis of cancer. For instance, the use of cerebral spinal fluid (CSF) and pleural fluid. CSF is used in diagnosis of brain tumors while pleural fluid for lung cancer.

Diagnostic imaging
Diagnostic imagings involve tests that create pictures of inside the body that help the doctor to see if there is tumor or not. There are several imaging tests used in cancer diagnosis depending on the type and location of cancer suspected. These imaging tests include;
• Computed tomography (CT) scan. CT scan machine is a donut-shaped scanner that uses x-rays to create series of pictures of body organs from different angles. This machine is linked to a computer where those series of pictures taken will be combined to create a 3D- image of inside the body. During the scanning process patient will lie still on the table which will slide into the scanner. In order to get a clear image, sometimes the doctor will inject the patient with a contrast material before scanning. From the images the doctor will be able to differentiate between healthy and unhealthy tissues.
• Magnetic resonance imaging (MRI). MRI is an imaging technique that uses powerful magnet and radio waves to take series of pictures of body organs and create a 3D image in a computer linked to a machine. Just like in CT, during MRI procedure the patient will lie on a table that will slide into a long round chamber. Also during this procedure, the doctor may inject the patient with a contrast material for clear image view.
• X-ray. This is an imaging technique that is uses low dose of radiation to create pictures of inside your body. Technician will position the patient and direct the x-ray beam to the intended part of the body. • Ultrasound. Ultrasound is a diagnostic imaging procedure that uses high energy sound waves to produce images of organs inside the body. During the examination, a patient will lie on the table while the technician will slowly move a device called transducer on the skin over the part of the body that is being examined.
• PET scan. Positron emission tomography (PET) scan is an imaging test that uses radioactive glucose to create 3-D images of areas inside the body. Radioactive glucose is used for this test because cancer cells tend to absorb more glucose than normal body cells, so the scan will show which areas of the body has more glucose than others. Before the scan, doctor will inject the patient with tracer called radioactive glucose then during imaging the patient will be asked to lie on the table that will be moving back and forth through the scanner.
• Bone scan. Bone scan is used to examine bones. When it comes to cancer, bone scan is used for diagnosis of bone cancer or cancer that has metastasized into the bones. Before the test, patient will be injected with small amount of radioactive material that tends to collect more on abnormal parts of the bones. Then pictures that will be taken by a scan will indicate the distribution of those radioactive materials in the bones throughout the body.

Biopsy
Biopsy is a diagnostic procedure that involves removing a tissue sample from the body and examines it under microscope in the laboratory. Examination in the laboratory is normally done by a pathologist who will check if the cells in the tissue are cancerous or not. In most cancer cases, biopsy is considered to be the confirmatory test. Depending on the location and type of cancer, biopsy can be obtained in different ways. Some of them include;
• Using needle. By using a thin needle, doctors can draw same tissue or fluid for examination under microscope. This method can be used to draw some fluid (spinal tap), bone marrow (bone marrow aspiration), blood or small amount of tumor from the suspected organ such as liver and breast (fine needle aspiration).
• Surgery. Abnormal tissue samples are obtained while the doctor is performing the surgery. Tissues are then sent to the lab for examination during the surgery. If the surgeon removes just a portion of abnormal area, it is called incisional biopsy while when the entire tumor (abnormal site) is removed it is called excisional biopsy.
• Using endoscope. Endoscope is a thin, lighted tube with a camera (focusing telescope) at the end. It is used for viewing inside the body through natural openings like mouth and anus. During an examination if the doctor sees any abnormal tissue, then endoscope can also be used to take sample for that tissue. There are different kinds of endoscopy exams depending on the site of the body being examined. Some of the exams include colonoscopy (for rectum and colon), bronchoscopy (for trachea, bronchi and lungs) and esophagogastroduodenoscopy EGD (for esophagus, stomach and duodenum)
In addition to medical history and physical examination, diagnosis of breast cancer normally involves the use of diagnostic mammograms, MRI scan, chest X-ray, CT scan, bone scan and biopsy.

TREATMENT OF BREAST CANCER
Following cancer diagnosis, the doctor will break the news and it is normally not very easy to accept that it is cancer. The doctor will be there to help the patient process the news and to help the patient in taking the next steps.
After the patient receives and processes the news that he/she has cancer, one of the most important steps that will follow is decision making. The doctor will present to the patient (relatives/parents/guardians) with all the possible treatment options and explain what they mean. Then with the help of the doctor, the patient (relatives/parents/guardian) will have to choose which treatment option is good depending on benefits of such option.
Despite all the information given by the doctor, sometimes the patient may still be unsatisfied with what he/she has been told. In such situation, the patient is free and advised to seek a second opinion. Second opinion is the opinion that the patient may seek from another specialist (doctor) regarding his/her health problem and in this case it is cancer. Second opinion may include confirmation of the diagnosis, more clarification on your primary doctor recommendations or even reassurances that all the options have been explored.
In addition to standard care treatment options, sometimes there are those new treatments or drugs or combination of treatments that have not been approved yet to be used as standard care treatments for a particular cancer (disease) but have shown some promising results that they may help. These type of treatments are called clinical trials.
If there are some clinical trials for your case, the doctor may present to the patient or the patient may ask if there are any clinical trials for the particular cancer case. Over the years, have improved treatments and led to better outcomes to people diagnosed with various diseases including cancer. If you have decided to take part in clinical trial, you can also withdraw at any time

Treatment options
Treatment of breast cancer requires a team of doctors and other health care professionals. This team work together and it is called multidisciplinary team. Team may vary depending on the treatment option for a particular case. But normally multidisciplinary team for treatment of breast cancer includes, surgical oncologist, medical oncologist, radiation oncologist, radiation therapist, plastic surgeon, pathologist and other health care professionals like oncology nurses, physiotherapist and palliative care team. Treatment options include the following;
Surgery
Surgery is the treatment option that involve the removal of tumor and surrounding healthy tissues by an operation. This treatment option is performed by a specialized doctors known as surgical oncologist and plastic surgeon. For breast cancer, surgery options will depend on the stage of the disease, overall health and other factors. The surgery options include the following;
• Lumpectomy. This is an option that involve removing the tumor and some surrounding tissues while most part of the breast remain intact. Normally after this kind of surgery, radiation therapy is used to destroy (kill) any possible remaining cancer cells. This kind of surgery is also known as breast-conserving surgery.
• Mastectomy. This type of surgery involve removing the entire breast. Depending on the condition of the disease, during this kind of surgery sometimes skin or nipple can be spared (skin sparing mastectomy or nipple sparing mastectomy).
• Axillary surgery. This is a surgery that involves removing axillary nodes (nodes in the armpit) as this is the first place where breast cancer normally spreads to outside the breast.

Breast reconstruction surgery
Breast reconstruction surgery is the type of surgery that involve creating a breast shape by using either tissues from other body parts (tissue flap) or using silicone implants. This kind of surgery is done by a specialized doctor known as plastic surgeon. Tissues flap that is normally used for reconstruction include tissue from thighs, buttocks, abdomen and back.
Reconstructive surgery can either be done at the same time after mastectomy or after several months later depending on the choice of the patient. Some choose to have at the same time after mastectomy while some choose to have several months later while some choose not to have reconstruction at all. So if the patient plans to have reconstructive surgery, he/she should tell the doctors before the mastectomy. This will help doctors to plan well about the surgery.

Side effects of surgery
Side effects of surgery depend on type and extent of surgery. Some of the possible side effects of surgery include the following;
• Risk of infection.
• Pain around the area of surgery
• Shoulder stiffness as a result of axillar surgery
• Excess bleeding.
• Numbness and tingling as a result of bruising or injury to nerves
• Seroma (collection of fluid around the surgical scar)
• Reaction from anesthesia
• Lymphoedema.

Radiation therapy
Radiation therapy is a treatment of cancer by using high energy x-rays or other radiation particles to destroy cancer cells. Radiation therapy is given by a specialized doctor known as radiation oncologist. There are two main types of radiation therapy, internal radiation therapy (brachytherapy) and external beam radiation therapy.
• External beam radiation therapy. Involve directing beam of radiation to the tumor from the source (machine) which is positioned outside the body. External beam radiation therapy can be delivered in different ways, including intensity-modulated radiation therapy (IMRT) and 3D conformal radiation therapy (3D-CRT). These techniques deliver high radiation dose to the tumor site while causing minimum damage to the surrounding tissues. These improvements have reduced the side effects from radiotherapy
• Internal radiation therapy (brachytherapy). This delivers radiotherapy to the tumor from inside your body. It is a type of targeted internal radiation therapy wherethe radiation source is placed directly into the tumor. This allows higher doses of radiation to be given, whilethe effects on nearby tissuesare highly minimized.
For treatment of breast cancer, external radiation therapy is the one that is commonly used.

Side effects of radiation
Side effects of radiation therapy depend on the dose of radiation therapy given. These side effects normally go away soon after completion of treatment but also there are some medications that may help to relieve if they become too severe. Some of the possible side effects include the following;
• Fatigue
• Mild skin reactions at the site of irradiation
• Loss of hair around treatment site (armpits and chest)
• Swelling. Some people develop fluid in the breast while radiation to the armpits may lead to lymphedema in the arm.
• Feeling some shooting pains

Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells or stop its growth and division. This treatment is given by a specialized doctor known as medical oncologist. Chemotherapy is the treatment option that is normally used for early and locally advanced cases of breast cancer.Type of chemotherapy used for treatment of such cases is known as systemic chemotherapy.
It is systemic because the drug enters the bloodstream to reach cancer cells throughout the body. It is normally given through a tube placed into a vein using a needle (intravenously), as a pill or capsule that is swallowed (orally). Chemotherapy can be given before surgery to shrink the tumor or after surgery to destroy remaining tumor cells or given in combination with radiation therapy.

Side effects of chemotherapy
Possible side effects of chemotherapy depends on the dose given, type of drug used and periodic time by which it has been used. These side effects include the following;
• Hair loss
• Mouth sores
• Nausea and/or vomiting
• Loss of appetite
• Feeling tired due to low red blood cells count
• Risk of infection due to decreased white blood cells
• Easily bruising and bleeding due to low blood platelets.
• Changed bowel habits such as constipation or diarrhea

Hormonal therapy
Hormone therapy is the treatment option that involves using hormone-blocking drugs to treat cancer. The drugs will slow or stop the growth of tumor cells. This treatment option can be used for those with hormone receptor positive cancers. It can also be used in combination with other treatment options (after radiation therapy, chemotherapy or surgery). Common hormone therapy treatments include the use of Tamoxifen and Aromatase inhibitors.This kind of therapy is different to that used for post menopause symptoms.
• Using tamoxifen. Tamoxifen is also known as ant-estrogen drug. It helps to prevent cancer cells from responding to estrogen hormone. This will help slow the growth. This drug can be harmful to a baby, so during treatment your doctor will ask you to use contraceptives to prevent pregnancy.
• Aromatase inhibitors. This work by reducing the amount of estrogen that the body produces which will prevent growth of hormone sensitive cancer cells. This kind of treatment is normally recommended to those postmenopausal women as they are already producing lower amount of estrogen hormone.

Side effects of hormone therapy
The common side effects of hormone treatment depend on the type of drug used and dose given. Some of the possible side effects includes, hot flushes, tiredness, risk of osteoporosis and broken bones as a result of aromatase inhibitor, vaginal dryness and improved bone health as a result of tamoxifen.

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