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Breast Cancer

Introduction

Breast cancer is a type of cancer that first arises in cells of the breast and can spread to surrounding areas and other parts of the body. Both men and women can develop breast cancer although it is far more common in women than men.

Causes

A female breast comprises a number of lobules that help in producing milk, milk ducts, fat and connective tissues. Ductal carcinoma is cancer that begins in the milk ducts and is the most common type of breast cancer. Another type is lobular carcinoma and begins in the lobules.

In a person suffering from breast cancer, the cells in the ducts, lobules or connective tissue of the breast grow and multiply uncontrollably. These abnormal cells do not die at the proper time, like healthy cells do, resulting in abnormal growth.

The exact cause of breast cancer is not known and may develop in anyone with breast tissue.

 

Risk factors

The identified risk factors associated with breast cancer include increasing age, gender (women are far more likely to get breast cancer than men), family history, high levels of estrogen, early puberty, late menopause, lack of breastfeeding, and geneticfactors (inherited mutation in certain genes).

 

Certain risk factors associated with lifestyle are smoking, obesity and alcohol consumption.

 

Risk factors in males include exposure to the hormone estrogen, having inflamed testicles or surgery to remove testicles, liver disease, radiation exposure, and older age.

 

Clinical presentation

 

In the early stages, breast cancer does not show any symptoms. The first visible sign of breast cancer is a lump in the breast or underarm. Although they are usually painless, in some instances, there may be pain or tenderness in the lumps. Other symptoms include change in size, shape or texture of breasts or nipples, skin puckering or dimpling, a rash or discharge from the nipple, or texture like an orange peel on the breasts.

 

Older women are generally advised to get periodical screening to detect breast cancer before there are any visible symptoms. Such screening can be carried out through mammograms (X-ray of the breasts), physical exams and self-exams.

 

Diagnosis

 

Diagnosis of breast cancer involves a physical examination of the breasts, armpits, neck and surrounding areas. A mammogramis performed to detect lumps or abnormal growths. However, an abnormal finding on a mammogram does not necessarily mean confirmation as most findings turn out to be benign, andneeds further evaluation.

 

An ultrasound may be performed to determine if the lump is a cyst or a solid mass.

 

A diagnosis of breast cancer can be confirmed through a biopsy, i.e. by removing a sample of fluid in the lump and testing it for cancerous cells. This can be carried out without surgery by using a small needle to remove a sample of cells (known as fine needle aspiration) or by using a larger needle where a sample of the breast tissue is removed (core biopsy). A core biopsy may be carried out with the help of an ultrasound or mammograms or an MRI.In some cases, surgical biopsy may be performed. In such biopsy, a portion of the mass or sometimes the entire breast mass is removed through surgery.

 

Once confirmed, the stage of the cancer is determined based on the size of the tumor and the extent to which it has spread. In the first three stages, cancer is limited to the breast and the regional lymph nodes. In the more advanced stage, the cancer may have metastasized(spread) to more distant parts of the body such as lungs, liver and the brain.

 

Treatment

 

The prognosis and treatment options depend on the stage and spread of cancer, age of the patient and overall health. The treatment options include the following:

 

Surgery: A lumpectomy may be performed when the tumor is small and can be easily separated from the surrounding tissue. The procedure involves removal of the tumor and a small portion of tissue around it. Another surgical procedure to treat breast cancer is mastectomy which involves surgical removal of the entire breast. Other treatments include removal of one or more lymph nodes.

 

Chemotherapy: This involves administering drugs orally or intravenouslyto attack the cancer cells. Chemotherapy may be recommended after surgery to prevent recurrence or before surgery to reduce the size of the tumor to ease its removal. It may also be required if the cancer has spread to other parts of the body.

 

Hormone therapy: In some cases, the cancerous cells have receptorsfor the hormones estrogen or progesterone. This implies that the cells get support from these hormones for their growth. Hormone therapy may be recommended in such cases to block the hormones to limit growth of the cancer cells.

 

Radiation: Radiotherapy (use of high energy beams) may be required to eliminate tumor cells that have survived surgery.