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oncology1

Breast Cancer

Breast cancer is the cancer developing from breast tissue.

Signs & Symptoms:

  • Breast Lump
  • Change in Breast Shape
  • Dimpling of overlying skin
  • Red scaly patches on the overlying skin
  • Fluid oozing out from the nipple
  • Orange-peel texture to the skin referred to as peau d’orange
  • Paget’s Disease – presents as skin changes resembling eczema, such as redness, discoloration, or mild flaking of the nipple skin
  • In case of metastasis:
    • Bone Pain
    • Swollen Lymph Nodes
    • Shortness of Breath

Risk Factors:

  • Female gender
  • Age
  • Obesity
  • Lack of physical exercise
  • Smoking Tobacco
  • Alcohol consumption
  • Hormone Replacement Therapy
  • Ionizing Radiation
  • Genetic – BRCA1 & BRCA2 genes

Common Types:

  • Ductal Carcinoma In situ
  • Ductal Carcinoma
  • Lobular Carcinoma

Diagnosis:

  • Physical Examination
  • Mammography
  • Fine Needle Aspiration Cytology (FNAC)
  • Excision Biopsy
  • PET CT Scan

Stages:

  • Stage 0 is a pre-cancerous or marker condition, either ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS)
  • Stages 1–3 are within the breast or regional lymph nodes
  • Stage 4 is ‘metastatic’ cancer that has a less favorable prognosis

Prevention:

  • Healthy Weight
  • Minimize Alcohol Consumption
  • Avoid smoking
  • Prophylactic bilateral mastectomy (as advocated by some for patients having higher genetic predisposition – having BRCA1 & BRCA2 gene mutation)
  • Regular screening

Management:

The management of breast cancer depends on various factors, including the stage of the cancer and the age of the patient. Increasingly aggressive treatments are employed in accordance with the poorer the patient’s prognosis and the higher the risk of recurrence of the cancer following treatment.

Breast cancer is usually treated with surgery, which may be followed by chemotherapy or radiation therapy, or both. A multidisciplinary approach is preferable. Hormone receptor-positive cancers are often treated with hormone-blocking therapy over courses of several years. Monoclonal antibodies, or other immune-modulating treatments, may be administered in certain cases of metastatic and other advanced stages of breast cancer.

Surgery:

Surgery involves removal of the tumor, usually with some surrounding normal tissue. Neighboring lymph nodes may be biopsied during a surgery. Surgical interventions include:

  • Mastectomy: Removal of the whole breast
  • Quadrantectomy: Removal of one quarter of the breast
  • Lumpectomy: Removal of a small part of the breast

Common surgeries performed are:

  • Breast Conservation Surgery: involves wide excision of only the breast lump with removal of the axilliary lymph nodes. Post-surgery, patient has a near normal breast
  • Modified Radical Mastectomy: involves removal of entire breast and axilliary lymph nodes. This is usually performed when cancer is detected in more than one region of the breast

Post surgery, patients can opt to undergo reconstruction surgery, a type of cosmetic surgery to improve the aesthetic appearance of the surgical site. Breast prosthesis are also used by some patients.

Medical Management:

The major groups of medication used in breast cancer treatment include:

  • Hormone blocking agents
    Some breast cancers require estrogen to continue growing. They can be identified by the presence of estrogen receptors (ER+) and progesterone receptors (PR+) on their surface (sometimes referred to together as hormone receptors). These ER+ cancers can be treated with drugs that either block the receptors, or alternatively block the production of estrogen.
  • Chemotherapy
    Chemotherapy is predominantly used for cases of breast cancer in stages 2–4, and is particularly beneficial in estrogen receptor-negative (ER-) disease. The chemotherapy medications are administered in combinations, usually for periods of 3–6 months. Chemotherapy medications work by destroying fast-growing and/or fast-replicating cancer cells, either by causing DNA damage upon replication or by other mechanisms.
  • Monoclonal Antibodies
    Monoclonal antibody to HER2 (a cell receptor that is especially active in some breast cancer cells), has improved the 5-year disease free survival of stage 1–3 HER2-positive breast cancers to about 87% (overall survival 95%). When stimulated by certain growth factors, HER2 causes cellular growth and division; in the absence of stimulation by the growth factor, the cell will normally stop growing.

Radiation Therapy:

Radiotherapy is given after surgery to the region of the tumor bed and regional lymph nodes, to destroy microscopic tumor cells that may have escaped surgery. It may also have a beneficial effect on tumor microenvironment. Radiation therapy can be delivered as external beam radiotherapy or as brachytherapy (internal radiotherapy). Conventionally radiotherapy is given after the operation for breast cancer. Radiation can also be given at the time of operation on the breast cancer- intra-operatively.

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