Breast Cancer

What is breast cancer?

Breast cancer is the most common form of cancer in women and is the number two killer (after lung cancer) of women age 35 to 54. it can also occur in men, though incidence is rare. The survival rate has improved because of earlier diagnosis and the variety of treatments now available.

Most breast cancer occurs in the upper outer quadrant (the upper part of the breast closest to the arm). Breast cancer may spread by way of the lymphatic system or bloodstream to the lungs, liver, bones and other organs, or directly to the skin or surrounding tissue.

Diagnosis of breast cancer

The earlier breast cancer is found, the better the chances for successful treatment. A reliable way to detect breast cancer is by monthly self-exam, with immediate evaluation of abnormality. Other tests include mammography (an X-ray of the breast) and biopsy (removal of breast tissue)

Sign and symptoms

• Warning signs of breast cancer include:
• A lump or mass in the breast
• Change in symmetry or size of the breast
• Change in the skin, such as thickening or dimpling, scaly skin around the nipple, an orange-peel-like appearance, or ulcers
• Change in skin temperature or color a warm, hot, or pink area
• Unusual drainage or discharge from the breast
• Change in the nipple, such as itching, burning, erosion, or retraction
• Swelling of the arm
• Pain (with an advanced tumor)

Breast Self Examination (BSE)

The best time to perform a self-exam is about one week after your period ends. If you do not have regular periods, perform a self-exam on the same day every month.

1. Stand before a mirror. Compare both breasts, noticing the shape and size. It is not unusual for one breast to be larger than the other. Check for the unusual sign such as discharge from nipples, puckering, dimpling, scaling of skin, or change in size or shape. Look at the same things with your arm in different positions.
2. Raise your left arm. Using the pads of three fingers of your right hand, feel your left breast firmly, carefully and slowly. Begin at the outer edge, pressing in small circles moving slowly around the breast. Be sure to cover the entire breast. Also be sure to examine from your armpit to the collar bone, as well as below your breast.
3. Gently squeeze the nipple and check for any discharge
4. Repeat steps 2 and 3 on your right breast
5. Repeat steps 2 and 3 on both breasts while lying down. You should lie flat on your back, with your arm over your head and a pillow or folded towel under the shoulder of the breast that you are going to examine. This position flattens the breast and makes it easy to check

Mammography

A mammogram is an X-ray taken of the breast. It can detect tumors that are very small, often too small to be detected by a breast self-exam. Every woman should have an initial mammogram between ages 35 and 39. Women ages 40 to 49 should have one every one to two years. Women over age 50, women who have a family history of breast cancer, or women who have had cancer in one breast should have mammogram every year

Biopsy

Biopsy of the breast, which involves obtaining tissue specimens, can be performed on an outpatient basis. After injection of a local anesthetic, a fine needle is directed into the site to be sampled and tissue or fluid is drawn into the needle. This material is then sent to the lab for diagnosis.

Other biopsies are performed in the operating room under general or local anesthesia. The entire lesion is generally removed, and a frozen section and pathologic examination are performed.

Causes of breast cancer

The cause of breast cancer is unknown. But it is higher incidence in women suggests that estrogen is a cause or contributing factor. Women who are at increased risk include those who:

• Have a family history of breast cancer
• Have a long menstrual history (began menstruating at an early age or experienced menopause late)
• Have never been pregnant
• Were first pregnant after age 31
• Have had cancer in one breast
• Have had endometrial or ovarian cancer
• Were exposed to low-level ionizing radiation

Treatment option

There are now several surgical treatment options:

Lumpectomy:

Lumpectomy plus radiation is used for small, well-defined cancers.

Partial mastectomy:

In this operation the surgeon removes the tumor along with a wedge of normal tissue, skin, and connective tissue. The lymph nodes under the arm (axillary nodes) may also be removed.

Total mastectomy

In this procedure, the surgeon removes the entire breast. Typically, this operation is done if the cancer remains confined to the breast tissue and the lymph nodes are not involved.

Modified radical mastectomy

The surgeon removes the entire breast, axillary nodes, and the lining that covers the chest muscles

Despite adequate local therapy with surgery with or without radiation, many women experience recurrence of their breast cancers. For some cases, this may be prevented by the use of chemotherapy or tamoxifen.