BREAST CANCER

Signs and symptoms

The first symptom, or subjective sign, of breast cancer is typically a lump that feels different from the surrounding breast tissue. According to the The Merck Manual, more than 80% of breast cancer cases are discovered when the woman feels a lump. According to the American Cancer Society, the first medical sign, or objective indication of breast cancer as detected by a physician, is discovered by mammogram. Lumps found in lymph nodes located in the armpits can also indicate breast cancer.

Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. Pain ("mastodynia") is an unreliable tool in determining the presence or absence of breast cancer, but may be indicative of other breast health issues.

When breast cancer cells invade the dermal lymphatics—small lymph vessels in the skin of the breast—its presentation can resemble skin inflammation and thus is known as inflammatory breast cancer (IBC). Symptoms of inflammatory breast cancer include pain, swelling, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d'orange.

Another reported symptom complex of breast cancer is paget’s disease of the breast. This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. As Paget's advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget's also have a lump in the breast.

Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain. Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are "non-specific", meaning they can also be manifestations of many other illnesses.

Most symptoms of breast disorder do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. The appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.

Causes

The primary risk factors that have been identified are sex, age, childbearing, hormones, a high-fat diet, alcohol intake, obesity, and environmental factors such as tobacco use, radiation and shiftwork. However, studies of environmental and lifestyle factors only attribute a small increase in breast cancer to each factor. Furthermore, these studies are not randomized, controlled trials, and so they may associate breast cancer with factors that don't actually cause breast cancer.

No cause is known for 95% of breast cancer cases, while approximately 5% of new breast cancers are attributable to hereditary syndromes. In particular, carriers of the breast cancer susceptibility genes, BRCA1 and BRCA2, are at a 30-40% increased risk for breast and ovarian cancer, depending on in which portion of the protein the mutation occurs.

• Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
• Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk.
• Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.
• Race: Breast cancer is diagnosed more often in Caucasian women than Latina, Asian, or African American women.
• No physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help decrease risk.
• Tamoxifen may interact unfavorably with certain antidepressants when used for prevention of breast cancer recurrence.
• Abortion-breast cancer hypothesis: The mainstream medical community has concluded there is no proven link between induced abortion and breast cancer.

Tests

If a lump is found, a mammogram or ultrasound will be done. A

biopsy is often done to check if the lump is cancer and if so, what

type. A biopsy is a procedure to remove tiny pieces of tissue. The

samples are then checked by a doctor. If the biopsy finds cancer, more

tests may be done to see if the cancer has spread to other parts of your

body.

Types of Treatment

Based on your biopsy results and the type of cancer, you and your

doctor will decide the best treatment for your breast cancer. Here are

the treatments that may be done:

Surgery

Surgery is done to remove as much of the cancer as possible. Either

the whole breast is removed, called mastectomy, or a part of the

breast is removed, called lumpectomy. With either surgery, lymph

nodes under the arm are checked for cancer. You and your doctor may

also talk about reconstruction surgery. This surgery is done to create

the look of a normal breast.

You may still need to have more treatment. Having a mastectomy or

lumpectomy does not guarantee that the breast cancer is gone from the

entire body. Small cancer cells that are too small to detect may remain

in the body.

Radiation Therapy

When a lumpectomy is done, it is often followed by radiation

therapy. Radiation therapy is done to treat the entire breast. Radiation

therapy often begins 4 to 6 weeks after surgery.

Hormone Therapy and Chemotherapy

Treatment may be needed to target cancer cells that may be remaining

in the body. It may be done before surgery to shrink a tumor or after

surgery to kill cancer cells that may have spread or that remain in the

body.

• Hormone therapy is medicine in pill form taken to work against

estrogen in the body. The most common side effect is signs of

menopause.

• Chemotherapy is medicine given in an IV (intravenous) tube in a

vein or as a pill. The medicine kills cancer cells. Common side

effects include feeling tired, hair loss and nausea. These side

effects are often temporary.

Talk to your doctor or nurse if you have any questions or

concerns.