A woman's breasts are made of specialised tissues supplied by blood vessels, lymph nodes and nerves. Breast cancer is the uncontrolled growth of cells in the breast. This mass of abnormal tissue is called a tumour. Breast cancer can develop in both men and women, although female breast cancer is more common.
Over a period of time, the malignant tumour cells can invade the nearby healthy tissues such as the axillary lymph nodes (found in the underarm) and slowly move to other parts of the body. Breast cancer is divided into different stages based on how far the cancer cells have spread beyond the site of the original tumour.
- Stage 0:
- Cancer cells in breast duct only (Ductal carcinoma in situ)
- Have not invaded into other normal tissues
- Stage IA:
- Tumour measures up to 2 cm
- Has not spread
- No lymph nodes are involved
- Stage IB:
- No tumour or tumour of up to 2 cm in breast tissue
- Developing cancer cells in the lymph nodes measuring 0.2 to 2 mm
- Stage IIA: One of the below cases
- No tumour in breast, but cancer cells in lymph nodes under the arm (axillary lymph nodes)
- Tumour up to 2 cm with spread to the axillary lymph nodes
- Tumour of 2 to 5 cm but has not spread to the axillary lymph nodes
- Stage IIB: One of the below cases
- Tumour of 2 to 5 cm has spread to 1-3 axillary lymph nodes
- Tumour of 2 to 5 cm but has spread to 1-3 axillary lymph nodes or lymph nodes near the breast bone
- Tumour greater than 5 cm with no lymph node involvement
- Stage IIIA:
- Tumour may (of any size) or may not be present in breast. Cancer has spread to >4 lymph nodes near the breast bone or under the arm (axillary lymph nodes).
- Tumour greater than 5 cm with 1-3 lymph nodes involved
- Stage IIIB: Cancer has spread to the chest wall and the skin of the breast and up to 9 lymph nodes under the arm or near the breast bone. (Inflammatory breast cancer is Stage IIIB).
- Stage IIIC: Cancer has spread to the chest wall and skin of the breast and the lymph nodes above and below the collar bone, near the breast bone or under the arm.
- Stage IV: Cancer has spread to various other parts of the body.
Cancer occurs due to mutations or changes in the genes responsible for regulating the normal growth of cells and keeping them in a healthy condition. These mutated genes may be inherited from parents, or may result from external influences of radiation or cancer-causing chemicals, or wear and tear during the aging process. Hormones also play a major role in the development of breast cancer.
There are many other factors that could increase the risk of developing breast cancer. Some of these factors include:
- Being a woman
- Family or previous history of breast cancer
- Dense breast tissue
- Early menstruation (before age 12) and late menopause (after age 55)
- Use of birth control pill and Hormone replacement therapy (HRT)
- Heavy smoking and alcohol consumption
- Being overweight or obese
- Not breastfeeding after child birth
Initially, breast cancer may or may not cause any symptoms. The 1st sign of cancer is a lump or mass in the breast. The lump is usually painless and hard, with an uneven edge, but may be tender and soft at times. Any unusual signs such as swelling of the breast, skin irritation, pain in the breast or nipple, nipple turning inwards, redness or thickening of nipple or breast skin, nipple discharge, or lump in the underarm area may indicate breast cancer.
Breast cancer diagnosis is done by the triple test. Breast examination is the first step followed by breast imaging and biopsy. Some of these tests include:
- Mammography: A skilled technician places and compresses your breast between 2 plates attached to a highly specialized camera. The camera takes 2 pictures of the breast from different directions. The breast is compressed to reduce its thickness in order to obtain a clear X-ray image.
- Ultrasound scan: High frequency sound waves are emitted onto your breast and converted into images of the breast tissue.
- Biopsy: A small sample of breast tissue is removed from the area of concern and examined under a microscope to ascertain whether it is cancerous tissue and to determine the characteristics of the cancerous tissue.
- FNA (fine needle aspirate) - a needle is used to remove a few cells from the abnormality in question. The cells are then examined under a microscope to give a diagnosis of benign or malignant cells.
The early detection of cancer makes treatment easier and more successful.
Your doctor will plan your treatment based on multiple factors including the stage of your cancer and the biology of the cancer. Treatment will not only target and destroy the cancer cells, but also ensure that it does not recur. There are several steps in the treatment of breast cancer and the order in which they are undertaken will be discussed with you before they start and will be designed to maximize the cure of the breast cancer. Treatments include:
- Surgery: Your doctor may choose between many types of surgeries. These include the removal of the tumour and a small margin of healthy tissue, the entire breast tissue and sometimes, even the neighbouring lymph nodes. After mastectomy your breast can also be reconstructed in an immediate or later procedure.
- Chemotherapy: This treatment includes the administration of medicine through the bloodstream to weaken and destroy the cancer cells in the body. Chemotherapy may be given after surgery, to kill any cancer cells that have been left behind in the body or before surgery, to shrink the cancer.
- Radiation therapy: In this therapy, high-energy radiations are used to destroy cancer cells. This is a highly targeted and effective way to destroy breast cancer cells. This therapy is easy to tolerate and the side effects are limited to only the treated area. It also prevents the recurrence of breast cancer.
- Hormonal therapy: This therapy blocks the female hormone oestrogen from stimulating breast cells both normal and cancerous. These medications help to shrink or slow the growth of cancer cells.