What is breast cancer?
Cancer is the uncontrolled growth of cells within the body. Usually, all of our cells have a specific lifespan of days to years that is genetically programmed in our DNA. When our DNA becomes damaged, either through the aging process, exposure to toxins such as radiation or chemicals or through inherited genes, some cells do not die a natural death but continue to grow. As they do, they form new cells with the same genetic misinformation. These extra cells may form masses or tumours that can be either malignant or benign. A benign tumour is a tumour that does not invade the surrounding tissue or spread around the body and stays in one place. A malignant tumour can invade the surrounding tissue or spread via the blood or lymph networks and affects other cells and organs.
Breast cancer is the second most common type of cancer in women but 1% of all cases are men. Invasive and non-invasive breast cancers are diagnosed in their hundreds of thousands every year, yet remission rates are consistently increasing due to advances in treatment, screening and more awareness of symptoms in the general population.
Most breast cancer is first diagnosed when high-risk women and men are screened at local clinics, or come to their general practitioner reporting a small, hard lump in the tissue of the breast. Furthermore, most women are now aware of the BRCA acronym that stands for ‘breast cancer gene’. The presence of variances of this gene can increase one’s chances of developing breast cancer and those with BRCA1 or BRCA2 are usually given the opportunity to visit their local hospital for regular screening by way of a mammogram.
As breast cancer is so common, research abounds, even in the field of screening methods. Only recently, twice-yearly MRI (magnetic resonance imaging) by experienced radiologists has been proposed as a better alternative than annual mammograms, especially in younger, higher-risk women.
Early diagnosis usually happens where breast cancer has run in families or a person has (and feels) a small, localised lump. Treatments for breast cancer are primarily aimed at tumour removal and preventing further growth. Some women at high risk of developing breast cancer may be considering a preventive bilateral mastectomy; however, this route is rarely advised. Whether you have been diagnosed with breast cancer or are in a high-risk group, Remedazo can put you in touch with expert oncologists for up to three free online consultations to discuss your considerable options.
Should you need to have one or both breasts removed, new techniques in reconstructive surgery can help you regain your pre-surgical silhouette; however, current breast surgery techniques look at the cell type and rate of growth of cancerous cells and try to limit the amount of tissue that is removed. A lumpectomy (removal of the tumour) can achieve complete remission in many cases.
Are there different types of breast cancer?
There are various forms of breast cancer and your medical notes may be difficult to understand. Most specific types are based upon the location and type of abnormal cells.
The breast is primarily composed of glandular (milk-producing) and fatty tissues. Each glandular section is divided into lobes, and these lobes are divided into smaller lobules. A lobule produces breast milk. This milk travels through ducts that meet at the nipple which is surrounded in darker tissue known as the areola. The breasts also contain connective tissue, nerves, ligaments, blood vessels, lymph vessels and lymph nodes. Men have no glandular tissue or ducts and their breasts contain primarily fatty deposits. Hormone imbalances in men can cause gynaecomastia or larger breast tissue in men.
The different tissue types and structures can lead to varying breast cancer types. Types are also categorised according to cell type and whether a tumour is invasive or non-invasive, for example. More recently, genomic research categorises breast cancers according to their gene and protein types. The majority are oestrogen-positive, 20% are HER2-positive, and the same percentage accounts for triple-negative breast cancers.
Naturally, it must be said that a great many lumps found in the breasts of women and men are benign. Cysts, fibrous noncancerous tumours, hyperplasia (excess growth of normal cells), papilloma, adenosis, fat necrosis and inflammation can cause similar symptoms and are not malignant. An experienced radiologist will be able to detect discernible differences; however, sometimes a biopsy is the only way of finding out whether a lump is benign or malignant.
Invasive breast cancer
Where breast cancer cells spread into other areas via the blood circulation or lymph, the term invasive breast cancer is used. If invasive breast cancer reaches organs such as the bones, lungs, liver or brain, the term metastatic breast cancer is used.
Non-invasive breast cancer (in-situ breast cancer)
When breast cancer cells remain in a single location in the breast and do not spread beyond that location, either into other lobules or lobes, that cancer is said to be in-situ or non-invasive. Both invasive and non-invasive breast cancer types can also be categorised according to cell type. The following breast cancer types can be both invasive and non-invasive.
Ductal carcinoma
Starting in the linings of the milk ducts, ductal carcinoma is the most common type of breast cancer in both men and women. Ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) make up approximately 80% of all breast cancer types. There are various subtypes of ductal carcinoma.
Medullary carcinoma
Medullary carcinoma is invasive ductal carcinoma that looks soft and grey, just like the brain stem or medulla. This breast cancer type is slow-growing and does not often spread into lymph nodes. It is more common in Asian communities and is more likely to occur in women over 40 years of age with the BRCA1 mutation. Medullary carcinomas do not respond well to hormones and first-line treatment is lumpectomy or mastectomy. This may be enough to remove the cancer due to its slow growth and low likelihood of spreading. Your oncologist may prefer to additionally prescribe chemotherapy, radiation therapy or targeted therapy or a combination of two or all of these.
Tubular carcinoma
Another IDC subtype is the tubular carcinoma that is most likely to develop in women over 50 years of age but is easy to identify on medical imaging results and, in combination with its slow-growing characteristics, is easy to detect in early stages long before a lump forms. A positive prognosis is usually associated with tubular carcinoma after surgery and often radiation therapy. In addition, most tubular carcinomas respond to hormonal therapy. Chemotherapy is rarely used in breast cancer types that are unlikely to spread.
Mucinous or colloid carcinoma
This rare invasive ductal carcinoma subtype develops in mucus and usually occurs five to ten years after the menopause. It responds well to treatment and does not easily spread to other lymph nodes or organs. Mixed mucinous carcinoma forms are trickier to treat as they are composed of different cell types but when not mixed are relatively easy to treat when detected in early to mid stages.
Inflammatory breast cancer (IBC)
Extremely rare but also extremely aggressive, inflammatory breast cancer begins in the lymph vessels just under the skin. Cancerous tumours block off the flow of lymph and cause inflammation; the breast looks red and swollen. While IBC can be caused by ductal carcinomas that spread (IDC), this type has been given its own category. It is more common in obese, heavier-breasted younger women and rarely responds to hormone therapy. Typical symptoms are orange-peel type skin that is red and warm, rapidly growing breast, a burning sensation or an inwardly turning nipple. A lump is not always present. Treatment begins with at least 6 cycles of chemotherapy, then surgery (radical mastectomy), then radiation treatment. Additionally, IBC responds to targeted therapy in the form of trastuzumab.
Metaplastic breast carcinoma
Another rarer form of breast cancer is the metaplastic breast carcinoma (MpBC). MpBC is also aggressive and begins in immature breast cells. These immature cells, instead of becoming glandular cells, turn into connective tissue cells and form masses that often look benign. Because of this, early detection is difficult (but certainly possible). This type of cancer does not respond well to hormone therapy but can be fairly successfully treated with mastectomy and chemotherapy, especially in earlier stages. The tyrosine kinase inhibitor cetuximab also seems to make a difference in many cases.
Mammary Paget’s disease
Paget’s disease of the nipple is another rare form of breast cancer and, as its name suggests, begins in the cells that surround the nipple and form its ducts. The areola can become itchy and red in the presence of Paget’s disease.
If Paget’s disease is diagnosed, you will be sent for an MRI of both breasts, as it rarely occurs alone; a ductal carcinoma is usually detected in the same breast. The first-line treatment for Paget’s disease is usually breast-conserving surgery, although the location and size of the accompanying ductal carcinoma may require a radical mastectomy. Radiation therapy usually follows, especially in breast-conserving procedures. As the oncologist must deal with two cancer locations, a combination of chemotherapy, targeted therapy and perhaps hormonal therapy is recommended
Sarcoma
Breast sarcomas are very rare and begin in the connective tissue of the breast. They can develop on their own (de-novo), after radiation treatment (RT sarcoma) or where lymphedema or the arm or breast exists (therapy-related sarcoma). As with all types of breast cancer, first-line treatment is surgery and larger tumours will usually require complete breast removal or mastectomy. Additional radiation and chemotherapy is common. Angiosarcoma is a subtype that either occurs de-novo (usually women aged 30 – 50) or about 10 years after radiation treatment.
Phyllodes tumour
Phyllodes means leaf-like in Greek and relates to the leaf-like cells that form this rare but quickly-growing type of breast cancer. Phyllodes tumours can be benign, borderline or malignant and are removed surgically. They rarely spread to the lymph nodes but postoperative radiotherapy is possible. Borderline Phyllodes tumours rarely recur.
Oestrogen-positive breast cancer
Some types of mutated cells that cause breast cancer have receptors on their outer surfaces that some hormones or other substances can attach to. When these substances attach, they encourage the breast cancer cells to multiply at a faster rate. New scientific discoveries allow oncologists to block these receptors and slow down cancer growth.
Oestrogen-positive breast cancers grow more quickly in the presence of oestrogen. Women taking hormone replacement therapy during or after the menopause sometimes have a higher risk of developing breast cancer because the hormones they take contain oestrogen. This may also apply to the hormone progesterone. Approximately 70% of all breast cancers are oestrogen-positive and so respond to treatment that limits oestrogen and progesterone in the body.
Progesteron positive breast cancer
When breast cancer cells have progesteron receptors, either in combination with or without oestrogen and/or HER2 receptors, treatment is adjusted to tackle these cell types. Together, ER+ (oestrogen positive) and PR+ (progesterone positive) breast cancers make up the group of hormone receptor positive (HR+) cancers. Depending on the hormone receptors your breast cancer cells have, hormone therapy may or may not be added to your treatment plan. If a cancer cell has receptors for only one type of hormone receptor, such as ER negative and PR positive, it is still considered an HR+ type cancer but only hormone treatment with progesterone inhibition is given. This is a useful and cumulative addition to other treatment forms.
HER2-positive breast cancer
Some types of mutated cells that cause breast cancer have receptors on their outer surfaces that some hormones or other substances such as certain proteins can attach to. When these substances attach, they encourage the breast cancer cells to multiply at a faster rate. New scientific discoveries allow oncologists to block these receptors and slow down cancer growth.
One protein that encourages breast cancer growth is called HER2. Approximately 15% of breast cancers have HER2 receptors. If you are prescribed trastuzumab, your breast cancer is HER2-positive.
Triple negative breast cancer
Some types of mutated cells that cause breast cancer have receptors on their outer surfaces that some hormones or other substances such as certain proteins can attach to. When these substances attach, they encourage the breast cancer cells to multiply at a faster rate. New scientific discoveries allow oncologists to block these receptors and slow down cancer growth.
When breast cancer cells do not have receptors for either oestrogen, progesterone or the HER2 protein, they are known as triple-negative cancers. Perhaps 15% of women (usually younger women) with breast cancer have this type that does not respond to either hormone therapy or HER2 therapy. In this case, other treatments are used.
Alternatively, triple positive breast cancers can be treated with both hormones and HER2 targeted drugs.
Comments