Breast cancer

 

Breast cancer

Breast cancer starts when healthy cells change and begin to grow out of control and turn into a tumor. Tumors can begin in different areas of the breast, like the glands that make breast milk, the ducts that carry milk to the nipple, or other tissue regions.

Having a family history of breast cancer, including inherited gene mutations, can increase the risk of developing breast cancer.

 

Stem cell transplants are procedures that restore blood-forming stem cells in people who have had theirs destroyed by the very high doses of chemotherapy or radiation therapy that are used to treat certain cancers. Stem cell transplants are most often used to help people with leukemia and lymphoma. They may also be used for neuroblastoma and multiple myeloma. Stem cell transplants do not usually work against cancer directly. Instead, they help you recover your ability to produce stem cells after treatment with very high doses of radiation therapy, chemotherapy, or both.

Types of stem cell transplants:

• Autologous, which means the stem cells come from you, the patient.
• Allogeneic, which means the stem cells come from someone else. The donor may be a blood relative but can also be someone who is not related.
• Syngeneic, which means the stem cells come from your identical twin, if you have one.

 

What Is Breast Cancer?

Breast cancer is a disease in which cells in the breast grow out of control. There are different kinds of breast cancer. The kind of breast cancer depends on which cells in the breast turn into cancer.

Breast cancer can begin in different parts of the breast. A breast is made up of three main parts: lobules, ducts, and connective tissue. The lobules are the glands that produce milk. The ducts are tubes that carry milk to the nipple. The connective tissue (which consists of fibrous and fatty tissue) surrounds and holds everything together. Most breast cancers begin in the ducts or lobules.

Breast cancer can spread outside the breast through blood vessels and lymph vessels. When breast cancer spreads to other parts of the body, it is said to have metastasized.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Symptoms?

 

 

 

Signs and symptoms of breast cancer may include:

·         A breast lump or thickening that feels different from the surrounding tissue

·         Change in the size, shape or appearance of a breast

·         Changes to the skin over the breast, such as dimpling

·         A newly inverted nipple

·         Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin

·         Redness or pitting of the skin over your breast, like the skin of an orange

 

Different people have different symptoms of breast cancer. Some people do not have any signs or symptoms at all.

Some warning signs of breast cancer are—

• New lump in the breast or underarm (armpit).
• Thickening or swelling of part of the breast.
• Irritation or dimpling of breast skin.
• Redness or flaky skin in the nipple area or the breast.
• Pulling in of the nipple or pain in the nipple area.
• Nipple discharge other than breast milk, including blood.
• Any change in the size or the shape of the breast.
• Pain in any area of the breast.

Keep in mind that these symptoms can happen with other conditions that are not cancer.

If you have any signs or symptoms that worry you, be sure to see your doctor right away.

 

 

 

Causes

Doctors know that breast cancer occurs when some breast cells begin to grow abnormally. These cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass. Cells may spread (metastasize) through your breast to your lymph nodes or to other parts of your body.

Breast cancer most often begins with cells in the milk-producing ducts (invasive ductal carcinoma). Breast cancer may also begin in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells or tissue within the breast.

Researchers have identified hormonal, lifestyle and environmental factors that may increase your risk of breast cancer. But it's not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. It's likely that breast cancer is caused by a complex interaction of your genetic makeup and your environment.

Inherited breast cancer

Doctors estimate that about 5 to 10 percent of breast cancers are linked to gene mutations passed through generations of a family.

A number of inherited mutated genes that can increase the likelihood of breast cancer have been identified. The most well-known are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), both of which significantly increase the risk of both breast and ovarian cancer.

If you have a strong family history of breast cancer or other cancers, your doctor may recommend a blood test to help identify specific mutations in BRCA or other genes that are being passed through your family.

Consider asking your doctor for a referral to a genetic counselor, who can review your family health history. A genetic counselor can also discuss the benefits, risks and limitations of genetic testing to assist you with shared decision-making.

Risk factors

 

A breast cancer risk factor is anything that makes it more likely you'll get breast cancer. But having one or even several breast cancer risk factors doesn't necessarily mean you'll develop breast cancer. Many women who develop breast cancer have no known risk factors other than simply being women.

Factors that are associated with an increased risk of breast cancer include:

·         Being female. Women are much more likely than men are to develop breast cancer.

·         Increasing age. Your risk of breast cancer increases as you age.

·         A personal history of breast conditions. If you've had a breast biopsy that found lobular carcinoma in situ (LCIS) or atypical hyperplasia of the breast, you have an increased risk of breast cancer.

·         A personal history of breast cancer. If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.

·         A family history of breast cancer. If your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of people diagnosed with breast cancer have no family history of the disease.

·         Inherited genes that increase cancer risk. Certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most well-known gene mutations are referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast cancer and other cancers, but they don't make cancer inevitable.

·         Radiation exposure. If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.

·         Obesity. Being obese increases your risk of breast cancer.

·         Beginning your period at a younger age. Beginning your period before age 12 increases your risk of breast cancer.

·         Beginning menopause at an older age. If you began menopause at an older age, you're more likely to develop breast cancer.

·         Having your first child at an older age. Women who give birth to their first child after age 30 may have an increased risk of breast cancer.

·         Having never been pregnant.Women who have never been pregnant have a greater risk of breast cancer than do women who have had one or more pregnancies.

·         Postmenopausal hormone therapy. Women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications.

·         Drinking alcohol. Drinking alcohol increases the risk of breast cancer.

 

 

 

Common cancer treatments

Doctors use different kinds of treatments for different types of cancer. Knowing the types of treatment options may help you feel more confident when talking to your doctor about your options.

 

Surgery

 

Surgery, when used to treat cancer, is a procedure in which a surgeon removes cancer from your body. Depending on the type of cancer and how advanced it is, surgery may be used to remove the entire tumor, remove part of a tumor, or remove a tumor to help ease symptoms caused by cancer. Surgeons are medical doctors with special training in surgery. There are many types of surgery. Surgery may be open or minimally invasive.

• In open surgery, the surgeon makes one large cut to remove the tumor, some healthy tissue, and maybe some nearby lymph nodes.
• In minimally invasive surgery, the surgeon makes a few small cuts instead of one large one. She inserts a long, thin tube with a tiny camera into one of the small cuts. This tube is called a laparoscope. The camera projects images from the inside of the body onto a monitor, which allows the surgeon to see what she is doing. She uses special surgery tools that are inserted through the other small cuts to remove the tumor and some healthy tissue. For some patients, it may take less time to recover than open surgery.

Remember, every patient is different, so check with your doctor to see what is the best choice for you.

 

 

 

Chemotherapy

 

Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to kill cancer cells. Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Examples are cells that line your mouth and intestines and those that cause your hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better or go away after you have finished chemotherapy.

Chemotherapy may be given in many ways. Some common ways include:

• Oral: The chemotherapy comes in pills, capsules, or liquids that you swallow.
• Intravenous (IV): The chemotherapy goes directly into a vein.
• Injection: The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly.
• Intrathecal: The chemotherapy is injected into the space between the layers of tissue that cover the brain and spinal cord.
• Intraperitoneal (IP): The chemotherapy goes directly into the peritoneal cavity, which is the area in your body that contains organs such as your intestines, stomach, and liver.
• Intra-arterial (IA): The chemotherapy is injected directly into the artery that leads to the cancer.
• Topical: The chemotherapy comes in a cream that you rub onto your skin.

 

Radiation therapy

 

Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. Radiation therapy can be used to treat cancer or help reduce symptoms when a cure isn’t possible. At low doses, radiation is used as an x-ray to see inside your body and take pictures, such as x-rays of your teeth and broken bones.

Radiation therapy can be external beam or internal:

• External beam radiation therapy comes from a machine that aims radiation at your cancer. The machine is large and may be noisy. It does not touch you, but it can move around you, sending radiation to your body from many directions.
• Internal radiation therapy is a form of treatment in which a source of radiation is put inside your body. One form of internal radiation therapy is called brachytherapy. In brachytherapy, a solid radiation source, such as seeds, ribbons, or capsules, is placed in your body in or near the cancer. Internal radiation can also be in liquid form. You receive liquid radiation by drinking it, swallowing a pill, or getting it through an IV line. Liquid radiation travels throughout your body, seeking out and killing cancer cells.

 

Immunotherapy

 

 

Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. The immune system helps your body fight infections and other diseases. It is made up of white blood cells and organs and tissues of the lymph system.

Several types of immunotherapy are used to treat cancer. These include:

• Immune checkpoint inhibitors, which are drugs that block immune checkpoints. These checkpoints are a normal part of the immune system and keep immune responses from being too strong. By blocking them, these drugs allow immune cells to respond more strongly to cancer.
• T-cell transfer therapy, which is a treatment that boosts the natural ability of your T cells to fight cancer. In this treatment, immune cells are taken from your tumor. Those that are most active against your cancer are selected or changed in the lab to better attack your cancer cells, grown in large batches, and put back into your body through a needle in a vein. T-cell transfer therapy may also be called adoptive cell therapy, adoptive immunotherapy, or immune cell therapy.
• Monoclonal antibodies, which are immune system proteins created in the lab that are designed to bind to specific targets on cancer cells. Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system. Such monoclonal antibodies are a type of immunotherapy. Monoclonal antibodies may also be called therapeutic antibodies.
• Treatment vaccines, which work against cancer by boosting your immune system’s response to cancer cells. Treatment vaccines are different from the ones that help prevent disease.
• Immune system modulators, which enhance the body’s immune response against cancer. Some of these agents affect specific parts of the immune system, whereas others affect the immune system in a more general way.

Targeted cancer

 

 

Targeted cancer therapy is a type of treatment that interferes with specific proteins that control the growth, division, and spread of cancer. Targeted cancer therapies are sometimes called “molecularly targeted drugs,” “molecularly targeted therapies,” “precision medicines,” or similar names.

 

 

Hormone Therapy

 

Hormone therapy is a cancer treatment that slows or stops the growth of cancer that uses hormones to grow. Hormone therapy is also called hormonal therapy, hormone treatment, or endocrine therapy.

Hormone therapy may be given in many ways. Some common ways include:

• Oral – Hormone therapy comes in a pill that you swallow.
• Injection – The hormone therapy is given by a shot in the muscle in your arm, thigh, or hip or right under the skin in the fatty part of your arm, leg, or belly.
• Surgery – You may have surgery to remove organs that produce hormones. In women, the ovaries are removed. In men, the testicles are removed.

 

Stem cell transplants

Stem cell transplants are procedures that restore blood-forming stem cells in people who have had theirs destroyed by the very high doses of chemotherapy or radiation therapy that are used to treat certain cancers. Stem cell transplants are most often used to help people with leukemia and lymphoma. They may also be used for neuroblastoma and multiple myeloma. Stem cell transplants do not usually work against cancer directly. Instead, they help you recover your ability to produce stem cells after treatment with very high doses of radiation therapy, chemotherapy, or both.

Types of stem cell transplants:

• Autologous, which means the stem cells come from you, the patient.
• Allogeneic, which means the stem cells come from someone else. The donor may be a blood relative but can also be someone who is not related.
• Syngeneic, which means the stem cells come from your identical twin, if you have one.

 

 

Prevention

 

Breast cancer risk reduction for women with an average risk

 

Making changes in your daily life may help reduce your risk of breast cancer. Try to:

·         Ask your doctor about breast cancer screening. Discuss with your doctor when to begin breast cancer screening exams and tests, such as clinical breast exams and mammograms.

Talk to your doctor about the benefits and risks of screening. Together, you can decide what breast cancer screening strategies are right for you.

·         Become familiar with your breasts through breast self-exam for breast awareness. Women may choose to become familiar with their breasts by occasionally inspecting their breasts during a breast self-exam for breast awareness. If there is a new change, lumps or other unusual signs in your breasts, talk to your doctor promptly.

Breast awareness can't prevent breast cancer, but it may help you to better understand the normal changes that your breasts undergo and identify any unusual signs and symptoms.

·         Drink alcohol in moderation, if at all. Limit the amount of alcohol you drink to no more than one drink a day, if you choose to drink.

·         Exercise most days of the week.Aim for at least 30 minutes of exercise on most days of the week. If you haven't been active lately, ask your doctor whether it's OK and start slowly.

·         Limit postmenopausal hormone therapy. Combination hormone therapy may increase the risk of breast cancer. Talk with your doctor about the benefits and risks of hormone therapy.

Some women experience bothersome signs and symptoms during menopause and, for these women, the increased risk of breast cancer may be acceptable in order to relieve menopause signs and symptoms.

To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for the shortest amount of time.

·         Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If you need to lose weight, ask your doctor about healthy strategies to accomplish this. Reduce the number of calories you eat each day and slowly increase the amount of exercise.

·         Choose a healthy diet. Women who eat a Mediterranean diet supplemented with extra-virgin olive oil and mixed nuts may have a reduced risk of breast cancer. The Mediterranean diet focuses mostly on plant-based foods, such as fruits and vegetables, whole grains, legumes, and nuts. People who follow the Mediterranean diet choose healthy fats, such as olive oil, over butter and fish instead of red meat.

Breast cancer risk reduction for women with a high risk

If your doctor has assessed your family history and determined that you have other factors, such as a precancerous breast condition, that increase your risk of breast cancer, you may discuss options to reduce your risk, such as:

·         Preventive medications (chemoprevention). Estrogen-blocking medications, such as selective estrogen receptor modulators and aromatase inhibitors, reduce the risk of breast cancer in women with a high risk of the disease.

These medications carry a risk of side effects, so doctors reserve these medications for women who have a very high risk of breast cancer. Discuss the benefits and risks with your doctor.

·         Preventive surgery. Women with a very high risk of breast cancer may choose to have their healthy breasts surgically removed (prophylactic mastectomy). They may also choose to have their healthy ovaries removed (prophylactic oophorectomy) to reduce the risk of both breast cancer and ovarian cancer.