What is breast cancer

Breast cancer is the most common form of cancer affecting women in Malaysia. About one in 19 women in this country are at risk, compared to one in eight in Europe and the United States. Breast cancer is a malignant (cancerous) tumor that starts from cells of the breast.The disease occurs mostly in women, but men can get breast cancer too. The information here refers only to breast cancer in women. Woman’s breast is made up of glands that make breast milk (lobules), ducts (small tubes that carry milk from the lobules to the nipple), fatty and connective tissue, blood vessels, and lymph (pronounced limf) vessels. Most breast cancers begin in the cells that line the ducts (ductal cancer), some begin in the lobules (lobular cancer), and the rest in other tissues.

Type of breast cancer.

1. Carcinoma in situ : This term is used for early stage cancer, when it is confined to the place where it started. In breast cancer, it means that the cancer is confined to the ducts or the lobules.
2. Ductal carcinoma in situ (DCIS): This is the most common type of noninvasive breast cancer. DCIS means that the cancer is confined to the ducts.
3. Lobular carcinoma in situ (LCIS): This condition begins in the milk-making glands but does not go through the wall of the lobules.
4. Invasive (infiltrating) ductal carcinoma (IDC): This is the most common breast cancer. It starts in a milk passage or duct, breaks through the wall of the duct, and invades the tissue of the breast.
5. Invasive (infiltrating) lobular carcinoma (ILC): This cancer starts in the milk glands or lobules. It can spread to other parts of the body.

Causes of breast cancer

Definite cause/s still unknown but certain risk factor has been linked to it.Risk factor is anything that increases the chance of someone getting the illness.Some risk factor are fixed like age, and sex while others can be controlled.

Fixed Risk Factors

• Age-The older you get the more chance you have.Women aged more than 50 years old have 8-10 times fold more chance of getting it compared to younger age.
• Women-women has 100 times more risk than men.
• Family history-if you have family history of breast cancer,you are at a high risk of getting the cancer.
• Past history of Breast cancer-if you were diagnosed with breast cancer before you are prone to get it on the same breast or the other one.
• Menstrual period-the earlier you have your menarche (1st period), the higher the risk of developing breast cancer when you are older.
• Genetic factor-5%-10% linked to mutation of gene and breast cancer. 80% of the involved genes are BRCA1 and BRCA2.

Changeable risk factor

• Breast feeding-women who breast fed their child for 1-2 years have a lower risk of getting breast cancer.
• Alcohol-women who have 2-5 drinks daily have 1.5 times higher chance of getting breast cancer compared to women who do not consume alcohol.
• Exercise-reduce the risk of breast cancer. Studies show that exercising 30 minutes/day for 5 days is adequate.

Symptoms of breast cancer

The most common sign of breast cancer is a new lump or mass. A lump that is painless, hard, and has uneven edges is more likely to be cancer. But some cancers are tender, soft, and rounded. So it’s important to have anything unusual checked by your doctor. Other signs of breast cancer include the following:

1. a swelling of part of the breast
2. skin irritation or dimpling
3. nipple pain or the nipple turning inward
4. redness or scaliness of the nipple or breast skin
5. a nipple discharge other than breast milk
6. lump in the armpit

How is breast cancer detected?

1. Breast self examination – women should do yourself breast examination regularly from the age of 20 years old you need to learn from your nurse or doctor the right way of doing breast self examination. If you notice any lump at your breast, please consult your doctor.
2. Mammogram – A mammogram is an x-ray of the breast. This test is used to look for breast disease in women who appear to have no breast problems. It can also be used when women have symptoms. During a mammogram, the breast is pressed between 2 plates to flatten and spread the tissue. The pressure lasts only for a few seconds. Although this may cause some discomfort, it is needed to get a good picture. Very low levels of radiation are used. While many people are worried about exposure to x-rays, the low level of radiation used for mammograms does not significantly increase the risk of breast cancer.
3. Biopsy – A biopsy is done when other tests show that you might have breast cancer. The only way to know for sure is for you to have a biopsy. During this test, cells from the area of concern are removed so they can be studied in the lab.

Staging

Staging is important to determine if the patient is potentially in a curable early stage or otherwise:

1. Stage 0 – Cancer in Situ
2. Stage I – Cancer is less than 2 cm.
3. Stage II – Cancer is between 2 to 5 cm with or without involvement of the glands in the armpit
4. Stage III – Cancer is larger than 5 cm or there is extensive involvement of the glands in the armpit
5. Stage IV – Cancer has spread outside the breast and involves other organs in the body
6. Stage I & II are considered early and curable.
7. Stage IV disease is not curable.

Treatment

Women who are diagnosed to have Breast Cancer will be given treatment.Method of treatment depends on evaluation by a medical professional.Some patients are operated followed by chemotherapy.This is called adjuvant chemotherapy.If the surgeon think they need to shrink the size of the cancer before surgery,chemotherapy/radiotherapy will be given (Neoadjuvant therapy).

1. Type of surgery – The purpose of surgery is to remove as much breast cancer tissue as much as possible
   • Breast conserving surgery – removal of the removing breast lump and some normal tissue around it.
   • Usually followed by radiation therapy.
   • Mastectomy: This operation involves removing the entire breast.
   • Axillary dissection: This operation is done to find out if the breast cancer has spread to lymph nodes under the arm. Some nodes are removed and looked at under a microscope.
2. Chemotherapy
   • Chemotherapy (commonly called just “chemo”) is the use of cancer-killing drugs injected into a vein or taken as a pill. These drugs enter the bloodstream and reach throughout the body. If chemo is given after surgery it can reduce the chance of breast cancer recurring. Chemo can also be used as the main treatment for a woman whose cancer has already spread outside the breast and underarm area or that has spread widely after the first treatment.
   • Chemo may be given before surgery to shrink the tumor in order to make it easier to remove.
   • Chemo is given in cycles, with each period of treatment followed by a break. The total course of treatment usually lasts 3 to 6 months. Often several drugs are used together rather than a single drug alone.
   • The side effects of chemo depend on the type of drugs used, the amount given, and the length of treatment.
3. Radiation Therapy
   • Radiation therapy is treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in the tumor (brachytherapy).
   • Radiation therapy may be used to destroy cancer cells remaining in the breast, chest wall, or underarm area after surgery or, to reduce the size of a tumor before surgery
   • Treatment is usually given 5 days a week in an outpatient center over a period of about 6 or 7 weeks, beginning about a month after surgery. Each treatment lasts a few minutes.
   • The main side effects of radiation therapy are swelling and heaviness in the breast, sunburn-like changes in the treated area, and fatigue.
4. Hormone Therapy
   • The female hormone estrogen promotes the growth of breast cancer cells in some women. For these women, several methods to block the effect of estrogen or to lower its levels are used to treat breast cancer.
   • A drug such as tamoxifen, which blocks the effects of estrogen. Tamoxifen is taken in pill form, usually daily for 5 years after surgery, to reduce the risk of cancer recurring.
   • Aromatase inhibitors is a type of drug that stops production of estrogen. They only work for women who are menopausal and whose cancers are hormone positive.