Breast Cancer

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What is breast cancer?
Breast cancer starts when cells in the breast usually form a tumorthat is malignant and can invade surrounding tissues or spread to distant areas of the body.

How to diagnose breast Cancer?

  • Breast physical examination
  • Mammogram
  • Breast ultrasound
  • Biopsy
  • MRI
  • CT scan

What are the types of breast cancer?
There are two types of breast cancer tumors: those that are non-cancerous, or ‘benign’, and those that are cancerous, which are ‘malignant’.

Benign Tumour
When a tumor is diagnosed as benign, doctors usually don’t remove it. Even though these tumors are not generally aggressive toward surrounding tissue, occasionally they may continue to grow, pressing on organs and causing pain or other problems. In these situations, the tumor is removed, allowing pain or complications to subside.

Malignant Tumour
Malignant tumors are cancerous and aggressive because they invade and damage surrounding tissue. When a tumor is suspected to be malignant, the doctor will perform a biopsy to determine the severity or aggressiveness of the tumor.

Metastatic Cancer
Metastatic Cancer is when cancer cells of a malignant tumor spread to other parts of the body, usually through the lymph system, and form a secondary tumor.

What are the grades of tumour?
The tumor cells are graded based on a scale of one to three which represents how aggressive the cancerous cells are:

  • Low grade - Well-differentiated
  • Intermediate grade - Moderately differentiated
  • High grade - Poorly differentiated

Low grade tumors look like normal tissue and high grade tumors look abnormal under the microscope and tend to be aggressive.

What are the treatment procedures and the recent advances?
Local treatments: Some treatments are called local therapies.In this, they treat the tumor without affecting the rest of the body. Types of local therapy used for breast cancer include:

  • Surgery
  • Radiation therapy

They are more useful for earlier stage cancers.These treatments are more likely to be useful for earlier stage (less advanced) cancers, although they might also be used in some other situations.

Systemic treatments: Breast cancer can also be treated using drugs, which can be given by mouth or directly into the bloodstream.They can reach cancer cells anywhere in the body, so called as systemic therapies. Depending on the type of breast cancer, several different types of drugs might be used, including:
The main breast cancer treatment options may include:

  • Radiation therapy (radiotherapy)
  • Surgery
  • Biological therapy (targeted drug therapy)
  • Hormone therapy
  • Chemotherapy

Surgery

  • Lumpectomy– Removal of tumor and a small margin of healthy tissue around it surgically.It isoften known as breast sparing surgery in breast cancer.
  • Mastectomy - surgically removing the breast. Simple mastectomy involves removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. Radical mastectomy means also removing muscle of the chest wall and the lymph nodes in the armpit.
  • Sentinel node biopsy - one lymph node is surgically removed.
  • Axillary lymph node dissection - if the sentinel node was found to have cancer cells, the surgeon may recommend removing several nymph nodes in the armpit.
  • Breast reconstruction surgery - a series of surgical procedures aimed at recreating a breast so that it looks as much as possible like the other breast. This procedure may be carried out at the same time as a mastectomy. The surgeon may use a breast implant, or tissue from another part of the patient's body.

Radiation therapy (radiotherapy)
After one month of surgery or chemotherapy,radiotherapy occurs. The patient may require three to five sessions per week for three to five session per week for three to six weeks.

The type of breast cancer the woman has will decide what type of radiation therapy she may have to undergo. In some cases, radiotherapy is not needed.

Radiation therapy types include:

  • Breast radiation therapy - after a lumpectomy, radiation is administered to the remaining breast tissue
  • Chest wall radiation therapy - this is applied after a mastectomy
  • Breast boost - a high-dose of radiation therapy is applied to where the tumor was surgically removed.
  • Lymph nodes radiation therapy - the radiation is aimed at the axilla (armpit) and surrounding area to destroy cancer cells that have reached the lymph nodes
  • Breast brachytherapy - patients with early-stage breast cancer in the milk ducts which has not spread, seem to benefit from undergoing breast brachytherapy with a strut-based applicator.

Chemotherapy
Medications are used to kill the cancer cells - these are called cytotoxic drugs. The oncologist may recommend chemotherapy if there is a high risk of cancer recurrence, or the cancer spreading elsewhere in the body. This is called adjuvant chemotherapy.If the tumors are large, chemotherapy may be administered before surgery. The aim is to shrink the tumor, making its removal easier. This is called neo-adjuvant chemotherapy.

Chemotherapy may also be administered if the cancer has metastasized.It is also useful in reducing some of the symptoms caused by cancer.

Chemotherapy may help stop estrogen production. It encourages the growth of breast cancers.

Protecting female fertility – An arsenic-based chemo medication,which is very gentle on the ovaries are used for attacking cancer.
Hormone therapy (hormone blocking therapy)
Hormone therapy is used for breast cancers that are sensitive to hormones. These types of cancer are often referred to as ER positive (estrogen receptor positive) and PR positive (progesterone receptor positive) cancers. The aim is to prevent cancer recurrence. This therapy is used after surgery or may be used before to shrink the tumor.
If for health reasons, the patient cannot undergo surgery, chemotherapy or radiotherapy, hormone therapy may be the only treatment she receives.

The following hormone therapy medications may be used:

  • Tamoxifen.
  • Aromatase inhibitors

Biological treatment (targeted drugs)
Some drugs are given to the patient to deastroy the cancer cells

Bone-directed treatments
When breast cancer spreads, it often goes to the bones. Some drugs can help treat the spread of cancer to the bones, and might even help prevent it. Newer drugs are introduced to treat breast cancer that has spread to the bones. They are also looking for ways to identify and target the markers that affect bone turnover.

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