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BREAST CANCER
Cancer of the breast is the most common cancer in women. The incidence
is approximately 200,000 cases per year. The nationwide risk for women
is 1 in 9. Fortunately when the cancer is detected early the cure rate
is between 90 to 100 percent.
Beast cancer can present as follows.
a. Abnormality on mammogram or ultrasound.
b. A breast lump.
c. Thickening in the breast tissue.
d. An area of redness, inflammation or puckering.
e. Excoriation, ulceration of the nipple or nipple discharge.
f. Change in the contour or the size of the breast.
The incidence of breast cancer increases with advancing age. Most
of the breast cancers are diagnosed after the age of 40.
Breast cancers at an earlier age are rare and occur in individuals
with genetic predisposition. These patients may carry genes (BRCA 1
& or BRCA 2), which predispose them to breast cancer and other cancers.
Excessive exposure to hormones due to early onset of menarche, late
menopause, lack of protection by limited childbearing and breast feeding,
prolonged use of hormones in the form of birth control pills and hormone
replacement after menopause, increase the risk of breast cancer development.
Fortunately, majority of women who take hormones will not develop breast
cancer.
A women’s breast consists of milk producing lobules, ducts which
collect and transport the milk to the nipple, connective tissue, blood
vessels, nerves, lymphatic tissue and fatty tissue.
Cancer that arises in the ductal tissue is called Ductal Cancer and
that which arises in the lobules is called Lobular Cancer. These are
the two most common forms of breast cancer. There are other less common
types of breast cancer like Colloid, Medullary, Tubular, Lymphoid and
Metastatic (cancer that starts in other organs and spreads to the breast)
These cancers can either be invasive or non invasive. The invasive
breast cancer can spread to other parts of body by either the lymphatic
channels or the blood stream. The noninvasive cancers generally stay
confined to the breast tissue. This identification plays an important
role in planning the treatment for the individual patient.
The incidence of breast cancer in males is approximately 1 percent.
A positive family history, testicular dysfunction, and Klinefelter’s
syndrome are risk factors. Male breast cancer tends to spread early.
Any lump in the male breast should be investigated to rule out breast
cancer.
Once the cancer starts in the breast tissue it can involve the skin,
muscles and the chest wall. It can also spread to the lymph glands in
the axilla and then to other organs. During the workup, the center will
conduct investigations to establish the extent of spread if any.
Breast cancer is staged from stage 0 to stage 4. The stage of the
breast cancer is dependant upon the size of breast cancer, the final
pathology, the number of lymph nodes involved with breast cancer, involvement
of skin or chest wall with cancer and the spread to other organs.
Breast cancer also varies in its aggressiveness, this is called the
grade of the cancer. This nature is established by its appearance under
the microscope by our pathologist. Breast cancer is classified as low,
intermediate or high grade.
Breast cancer is also tested for the presence or absence of receptors.
The most common receptors utilized in the treatment planning of an individual
are ER (Estrogen receptor), PR (Progesterone receptor) and HER 2 Neu.
In addition to these, there are other measurements, which are of lesser
significance. The new genetic array testing when available may assist
us further in titrating the treatment. We are excited about this research
and will incorporate this in our decision-making process when it becomes
available.
Our pathologist provides the above information. This information plays
an important role in treatment recommendations made by our oncologists.
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