Breast Cancer Treatment

Cancer that forms in the cells of the breasts is known as breast cancer. Breast cancer generally starts in the ducts or lobules of the breast. The breast lobule is the breast gland that is responsible for milk production. This milk is transported from the lobules to the nipples by a thin tube called the ducts of the breast. Breast cancer can also begin in the fibrous breast tissues, known as stromal tissues.

Breast cancer occurs when the cells in the breasts grow and divide uncontrollably, leading to the formation of a mass of tissue known as a tumor. Breast cancer treatment options may include surgery, chemotherapy, radiation therapy, hormone therapy, immunotherapy, and targeted drug therapy.

Types:
Breast cancer can be invasive or non-invasive. Invasive types of breast cancer can spread from the breast glands or ducts to the other parts of the breast, while non-invasive cancer does not spread from the original tissue.The common types of breast cancers are:
1. Ductal carcinoma in situ:
This is a non-invasive type of cancer. The cancer cells are confined to the breast ducts and do not invade the surrounding breast tissue.

2. Invasive ductal carcinoma:
Invasive ductal carcinoma is the most commonly observed type of breast cancer. It begins in the milk ducts of the breast and later invaded the nearby tissue in the breast. It can also spread to nearby tissues and organs.

3. Lobular carcinoma in situ:
The growth of this type of cancer is seen in the milk-producing glands of the breast. The cancer cells generally do not spread to the surrounding tissue.

4. Invasive lobular carcinoma:
This type of cancer first develops in the lobules of the breast. It invades the nearby tissue.

5. Phyllodes tumor:
Phyllodes tumor is a rare type of breast cancer. This cancer grows in the connective tissue of the breast. Most of these tumors are benign (non-cancerous), but some may be malignant (cancerous).

6. Paget’s disease of the nipple:
This type of breast cancer begins in the ducts of the nipple. As cancer grows, it begins affecting the areola and skin of the nipple.

7. Angiosarcoma:
The growth of this type of breast cancer is seen on the lymph vessels or blood vessels in the breast.

Causes:
The precise cause of breast cancer is not known. Breast cancer occurs due to changes or mutations in the breast cells. This results in the growth and multiplication of the cells in an abnormal manner, leading to the formation of a mass or tumor. The mutations can be somatic (not inherited) or genetic (inherited from a parent) in nature. Somatic mutations are the main cause of breast cancer.

Risk factors: Certain factors increase the chances of developing breast cancer and may include:

• More common in women
• Increase in age
• History of breast disorders
• History of breast cancer
• Family history of breast cancer
• Obesity
• Exposure to radiation 
• Inherited genes 
• Starting of menstrual periods at an early age
• Menopause occurs at an older age
• No history of pregnancy
• Having the first child at an older age
• Smoking
• Alcohol consumption
• Hormone therapy (hormonal treatment for menopausal symptoms) 

Symptoms

The symptoms of breast cancer may include:

• Breast lump
• Changes in the appearance, size, or shape of a breast
• Changes on the breast skin, like dimpling
• Pitting or redness of the skin over the breast (like orange skin)
• Inverted nipple
• Scaling, crusting, flaking or peeling of the skin surrounding the nipple (known as areola), or the skin over the breast

Diagnosis

1. Breast examination: The doctor will check both the breasts and the lymph nodes in the armpit, and feel for the presence of any lumps or abnormalities that may be present.
2. Blood tests: These tests help in checking the levels of the vital blood parameters, for the diagnosis of underlying medical conditions like thyroid diseases and diabetes, and check for the presence of tumor markers, which may indicate the presence of cancer.
3. Mammogram: A mammogram is an x-ray of the breast. It is commonly used for the screening of breast cancer. In case of any abnormality that is detected on the screening mammogram, the doctor will recommend a diagnostic mammogram for further evaluation of the abnormality.
4. Breast ultrasound: Sound waves are used to obtain clear images of the breast in this test. It helps in determining whether a breast lump is a solid mass or a cyst (a fluid-filled mass).
5. Breast MRI scan: A strong magnet and radio waves are used to obtain clear images of the breast.
6. Imaging tests: Imaging tests like CT scans, PET scans, MRI scans help in evaluating the stage and severity of breast cancer, by creating clear images of the internal organs of the body.
7. Biopsy: A small sample of the suspected tissue growth is excised or removed by the surgeon and sent to the laboratory to check for the presence of cancer cells and if present, to check for the type of cancer cells present and the severity of the condition.

Treatment

The type of treatment done for breast cancer depends on the type and stage of breast cancer, size of the tumor, and the overall health status of the patient. The following forms of treatments can be done for breast cancer:

1. Surgery:
Surgery is the most common form of treatment for breast cancer and may include the following:

a) Lumpectomy: This procedure involves the surgical removal of the tumor and some part of the surrounding tissue, while the remaining part of the breast is left intact.
b) Mastectomy: The surgical removal of the entire breast is called mastectomy. The surgical removal of both breasts is known as a double mastectomy.
c) Sentinel node biopsy: Some lymph nodes that receive drainage from the tumor are removed, and then sent to the laboratory for testing. If cancer cells are not found, no additional surgery is required to remove the lymph nodes.
d) Axillary lymph node dissection: In the case of lymph nodes that are found to be cancerous, additional lymph nodes may require removal by the surgeon. This procedure is known as axillary lymph node dissection.
e) Contralateral prophylactic mastectomy: The surgical removal of the healthy breast, along with the affected breast is called contralateral prophylactic mastectomy. This is done for reducing any chances of developing breast cancer again.

2. Radiation therapy:
This procedure involves the use of high-powered radiation beams like x-rays and protons for targeting and killing cancer cells.

3. Chemotherapy:
This therapy includes the use of some drugs or medication to destroy the cancer cells. Chemotherapy is often used in conjunction with surgery to remove cancer. Chemotherapy can be performed before surgery to shrink the cancer cells, allowing them to be removed easily.

4. Hormone therapy:
Hormone therapy helps in blocking the production of female sex hormones (progesterone and estrogen) or blocks the hormone receptors on the cancer cells by using certain medications. This therapy helps in slowing or stopping the growth of cancer.

5. Targeted therapy drugs:
This procedure involves the use of drugs that attack specific abnormalities within the cancer cells, ultimately killing the cancer cells.

6. Immunotherapy:
Certain drugs boost the body’s immune system (disease-fighting system of the body) to fight cancer in immunotherapy.

Risks

The risks associated with the various breast cancer treatments include:
1) Surgery:

• Pain and tenderness of the breast
• Swelling 
• Bleeding
• Wound infection
• Scar tissue at the site of incision
• Swelling of the arm due to the removal of the lymph nodes (lymphedema)
• Phantom breast pain, which includes symptoms like pressure, throbbing, the sensation of pins and needles, and itching
• Depression

2) Chemotherapy and other drug therapies:

• Nausea
• Vomiting
• Loss of hair
• Fatigue
• Infection
• Bleeding
• Bruising
• Disturbances in sleep
• Low blood counts
• Infertility
• Premature menopause
• Depression
• Nerve damage
• Damage to kidneys
• Damage to the heart
• Blood cell cancer (rarely)

3) Radiation therapy:

• Skin reactions or burns
• Fatigue
• Discoloration
• Irritation
• Heart damage
• Lung tissue inflammation
• Secondary cancers

4) Hormone therapy:

• Night sweats
• Vaginal dryness
• Hot flashes
• Blood clot formation
• Thinning of bone

After Procedure

• Supportive or palliative is provided by the doctor, the patient’s family, and a group of specialists to provide relief from symptoms associated with a serious illness, like breast cancer.
• Supportive care helps in improving the quality of life of the patient.
• Once your doctor allows, you can start with a mild form of exercise a few times a week.
• Manage stress by yoga, meditation, or other methods.
• You can talk to a counselor if you feel emotionally overwhelmed due to breast cancer treatments.
• It is normal to feel some pain or discomfort following surgery. The doctor will prescribe medications to relieve your pain.
• Some swelling and bruising are normal after a surgical procedure.
• Avoid heavy lifting and strenuous activities following treatment, till your doctor permits you for the same.
• Have regular follow-up appointments with your doctor. The doctor will evaluate your health and check for any recurrence of cancer.