Breast Cancer

Breast cancer is a type of cancer that begins in the cells of the breast. It occurs when abnormal cells in the breast grow and multiply uncontrollably, forming a mass or lump. Breast cancer can occur in both women and men, but it is much more common in women.

Pathophysiology of breast cancer:

Breast cancer is a complex disease that involves a combination of genetic, environmental, and lifestyle factors. The exact pathophysiology of breast cancer is not fully understood, but it is thought to involve a series of changes or mutations in the DNA of breast cells, which can lead to the uncontrolled growth and division of cells.

Breast cancer typically begins in the cells of the milk ducts or lobules, which are the structures that produce and transport milk. Over time, mutations can occur in the DNA of these cells, causing them to grow and divide uncontrollably. As these cells divide, they can form a mass or lump, which can be felt as a breast lump or seen on a mammogram.

Types of breast cancer:

There are several types of breast cancer, including:

• Invasive Ductal Carcinoma (IDC): This is the most common type of breast cancer. It begins in the milk ducts and can spread to other tissues in the breast or to other parts of the body.
• Invasive Lobular Carcinoma (ILC): This type of breast cancer begins in the lobules or milk-producing glands of the breast. It can also spread to other tissues in the breast or to other parts of the body.
• Ductal Carcinoma In Situ (DCIS): This is a non-invasive type of breast cancer that begins in the milk ducts and does not spread to surrounding tissue. However, if left untreated, it can progress to invasive breast cancer.
• Lobular Carcinoma In Situ (LCIS): This is a non-invasive type of breast cancer that begins in the milk-producing glands of the breast. It does not typically become invasive, but having LCIS increases the risk of developing invasive breast cancer in the future.
• Inflammatory Breast Cancer: This is a rare but aggressive type of breast cancer that can cause the breast to appear swollen and red.
• Triple Negative Breast Cancer: This is a type of breast cancer that does not have receptors for estrogen, progesterone, or HER2. It tends to be more aggressive and is often treated with chemotherapy.

HER2-positive Breast Cancer: This is a type of breast cancer that has too much of the HER2 protein, which can promote the growth of cancer cells. It is often treated with targeted therapy.

It’s important to note that there are many other less common types of breast cancer, and each case is unique. A medical professional can provide a more detailed explanation of the specific type of breast cancer a person may have.

Stages of breast cancer:

Breast cancer staging is a way to describe the extent or spread of cancer within the body. The stage of breast cancer is determined by the size of the tumor, whether it has spread to nearby lymph nodes, and whether it has spread to other parts of the body. The most commonly used staging system for breast cancer is the TNM system, which stands for Tumor, Node, and Metastasis.

The stages of breast cancer are:

Stage 0: This is also known as ductal carcinoma in situ (DCIS). It is non-invasive cancer that remains within the milk ducts and has not spread to surrounding tissues.

Stage I: At this stage, the cancer is small and has not spread beyond the breast tissue. It may also involve nearby lymph nodes.

Stage II: This stage is divided into two subcategories: Stage IIA and Stage IIB. In Stage IIA, the cancer is either small and has spread to nearby lymph nodes or is larger but has not spread to lymph nodes. In Stage IIB, cancer may be smaller but has spread to nearby lymph nodes, or it may be larger and has not spread to lymph nodes.

Stage III: This stage is divided into three subcategories: Stage IIIA, Stage IIIB, and Stage IIIC. In Stage IIIA, cancer has spread to lymph nodes near the breastbone or under the arm, and the tumor may be any size. In Stage IIIB, cancer may have spread to the chest wall or skin of the breast, and may or may not have spread to nearby lymph nodes. In Stage IIIC, cancer has spread to lymph nodes above or below the collarbone, as well as to lymph nodes near the breastbone or under the arm.

Stage IV: At this stage, cancer has spread to other parts of the body, such as the bones, liver, or lungs, in a process called metastasis

Risk factors of breast cancer

: There are several factors that can increase a person’s risk of developing breast cancer. Some of the most common risk factors include:

• Age: The risk of breast cancer increases as a person gets older. Most cases of breast cancer are diagnosed in women over the age of 50.
• Gender: Breast cancer is more common in women than men. Men can also develop breast cancer, but it is rare
• Family history: Women who have a mother, sister, or daughter with breast cancer are at a higher risk of developing the disease. The risk increases if the family member was diagnosed at a younger age or if multiple family members have had breast or ovarian cancer.
• Genetic mutations: Certain genetic mutations, such as BRCA1 and BRCA2, can increase the risk of breast cancer. These mutations can be inherited from a parent
• Personal history: Women who have had breast cancer in one breast are at an increased risk of developing cancer in the other breast. Women who have had certain types of benign breast conditions are also at an increased risk.
• Exposure to estrogen: Prolonged exposure to estrogen, such as starting menstruation at an early age, starting menopause at a later age, or taking hormone replacement therapy, can increase the risk of breast cancer.
• Lifestyle factors: Certain lifestyle factors can increase the risk of breast cancer, such as being overweight or obese, not getting enough physical activity, drinking alcohol, and smoking.

Best diagnostic test for Breast cancer:

Diagnostic Tests Biopsy is the best initial test. The different methods of biopsy are:

 Fine needle aspiration (FNA): FNA is usually the best initial biopsy. The false positive rate is less than 2%. However, because FNA is a small sample, the disadvantages are a false negative rate of 10%.

 Core needle biopsy: This is a larger sample of the breast. It is more deforming, but you can test for estrogen receptors (ER), progesterone receptors (PR), and HER 2/neu. Difficulties include greater deformity with the procedure and the possibility that the needle will miss the lesion.

Open biopsy: The “most accurate diagnostic test,” open biopsy allows for frozen section to be done while the patient is in the operating room followed by immediate resection of cancer followed by sentinel node biopsy.

Mammography  ;Mammography is indicated to screen for breast cancer in the general population starting at the age of 40.

Other diagnostic test includes:

Breast cancer can be diagnosed through several tests and procedures, including:

• Clinical breast exam: A healthcare professional will examine the breasts and underarms for lumps or other abnormalities.
• Imaging tests: Imaging tests, such as mammograms, ultrasound, and MRI, can help detect abnormalities in the breast tissue.

• Blood tests: Blood tests can be used to check for certain markers that may indicate the presence of breast cancer, such as CA 15-3 and CA 27.29.
• Genetic testing: Genetic testing can identify inherited gene mutations, such as BRCA1 and BRCA2, that increase the risk of breast cancer.
• Breast cancer staging: If breast cancer is diagnosed, staging tests, such as bone scans, CT scans, and PET scans, can help determine the extent of the cancer and whether it has spread to other parts of the body.

Treatment of breast cancer:

The treatment of breast cancer depends on the stage of the cancer, as well as the individual’s overall health and personal preferences. Treatment may involve a combination of different approaches, including:

Surgery: Surgery is often the first line of treatment for breast cancer. Depending on the stage and location of the cancer, different types of surgery may be performed, including lumpectomy (removal of the tumor and a small amount of surrounding tissue) or mastectomy (removal of the entire breast).

Radiation therapy: Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. It may be used after surgery to destroy any remaining cancer cells in the breast or nearby lymph nodes.

Chemotherapy: Chemotherapy uses drugs to kill cancer cells. It may be given before or after surgery, or as the primary treatment for advanced breast cancer.

Hormone therapy: Hormone therapy is used to block the effects of estrogen or progesterone, hormones that can promote the growth of some types of breast cancer. It may be used in combination with other treatments or as the primary treatment for hormone receptor-positive breast cancer.

Targeted therapy: Targeted therapy uses drugs that specifically target cancer cells, while minimizing damage to healthy cells. It may be used in combination with other treatments or as the primary treatment for HER2-positive breast cancer.

Surgical treatment of breast cancer:

Surgical treatment of breast cancer involves removing the cancerous tissue from the breast. The type of surgery performed will depend on several factors, including the size and location of the tumor, the stage of the cancer, and the individual’s overall health and personal preferences.

The main types of surgery for breast cancer include:

Lumpectomy: This is a breast-conserving surgery that involves removing the tumor and a small amount of surrounding tissue, while leaving the rest of the breast intact. It’s usually followed by radiation therapy to destroy any remaining cancer cells.

Mastectomy: This involves removing the entire breast, including the nipple and areola. There are several types of mastectomy, including simple mastectomy (removal of the breast tissue), modified radical mastectomy (removal of the breast tissue and some of the lymph nodes), and radical mastectomy (removal of the breast tissue, lymph nodes, and chest muscles).

Sentinel lymph node biopsy: This is a procedure in which the first few lymph nodes that the cancer is likely to spread to are removed and examined for cancer cells. If no cancer cells are found, it may not be necessary to remove additional lymph nodes.

Axillary lymph node dissection: This involves removing a larger number of lymph nodes from under the arm to determine if the cancer has spread to the lymph nodes.

Preventive Measures :

While there is no surefire way to prevent breast cancer, there are several measures that individuals can take to reduce their risk of developing the disease

• Maintain a healthy lifestyle: Eating a balanced diet, maintaining a healthy weight, and getting regular exercise can help reduce the risk of breast cancer.
• Limit alcohol consumption: Drinking alcohol has been linked to an increased risk of breast cancer, so it’s recommended to limit alcohol consumption to no more than one drink per day.
• Don’t smoke: Smoking has been linked to an increased risk of many types of cancer, including breast cancer.
• Breastfeed: Women who breastfeed their children may have a reduced risk of developing breast cancer.
• Get regular mammograms: Mammograms can help detect breast cancer early, when it’s most treatable. Women at average risk of breast cancer should start getting regular mammograms at age 40.
• Know your family history: Women with a family history of breast cancer may have a higher risk of developing the disease, so it’s important to discuss this with a healthcare provider.

• Consider risk-reducing medications: Women at high risk of breast cancer may benefit from medications that can help reduce the risk of developing the disease

Conclusion: Overall, breast cancer is a complex disease that requires a multidisciplinary approach to diagnosis, treatment, and prevention. With the right care and support, individuals with breast cancer can achieve successful outcomes and go on to lea