Breast Cancer


General Information

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

Each breast also contains blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter substances in lymph and help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.

The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.

Age and health history can affect the risk of developing breast cancer.
Risk factors include the following:

-A family or personal history of breast cancer.
-Never having given birth.
-Menstruating at an early age.
-Older age.

Breast cancer is sometimes caused by inherited gene mutations (changes).
The genes in cells carry the hereditary information that is received from a person's parents. Hereditary breast cancer makes up approximately 5% to 10% of all breast cancer. Some altered genes related to breast cancer are more common in certain ethnic groups.

Women who have an altered gene related to breast cancer and who have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast. These women also have an increased risk of developing ovarian cancer, and may have an increased risk of developing other cancers. Men who have an altered gene related to breast cancer also have an increased risk of developing this disease. (For more information, refer to Male Breast Cancer.)

Tests have been developed that can detect altered genes. These genetic tests are sometimes done for members of families with a high risk of cancer. (Refer to Screening for Breast Cancer, Prevention of Breast Cancer, and Genetics of Breast and Ovarian Cancer for more information.)

Tests that examine the breasts are used to detect and diagnose breast cancer. A doctor should be seen if changes in the breast are noticed. The following tests and procedures may be used:

Mammogram: An x-ray of the breast that may find tumors that are too small to feel.

Biopsy: The removal of cells, tissues, or fluid to view under a microscope and check for signs of disease. If a lump in the breast is found, the doctor may need to cut out a small piece of the lump and look at it under the microscope to see if there are any cancer cells. Four types of biopsies are as follows:

-Excisional biopsy: The removal of an entire tumor or lesion.
-Incisional biopsy: The removal of part of the tumor or lesion.
-Core biopsy: The removal of a sample of tissue with a wide needle.
-Needle biopsy or fine-needle aspiration biopsy: The removal of a sample of tissue or fluid with a very thin needle.

Estrogen and progesterone receptor tests: If cancer is found, these tests may tell whether estrogen and progesterone (hormones) affect the way the cancer grows. These tests may also give information about the chances of the tumor recurring (coming back). The test results show whether hormone therapy is likely to stop the cancer from growing. To perform these tests, tissue from the tumor is examined in the laboratory, usually at the time of biopsy.

Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether it is in the breast only or has spread to other places in the body), the type of breast cancer, certain characteristics of the cancer cells, and whether the cancer is found in the other breast. A woman's age, menopausal status (whether a woman is still having menstrual periods), and general health can also affect treatment options and prognosis.

Stages of Breast Cancer

After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment.

The following stages are used for breast cancer:

Stage 0 (carcinoma in situ)
There are 2 types of breast carcinoma in situ:

-Ductal carcinoma in situ (DCIS) is a very early breast cancer that may develop into an invasive type of breast cancer (cancer that has spread from the duct into surrounding tissues).
-Lobular carcinoma in situ (LCIS) is not cancer, but rather a marker or indicator that identifies a woman as having an increased risk of developing invasive breast cancer (cancer that has spread into surrounding tissues). It is common for both breasts to be affected.

Stage I
In stage I, the cancer is no larger than 2 centimeters (about 1 inch) and has not spread outside the breast.

Stage IIA
In stage IIA, the cancer is either:

-no larger than 2 centimeters (about 1 inch) but has spread to the axillary lymph nodes (the lymph nodes under the arm); or
-between 2 and 5 centimeters (1 to 2 inches) but has not spread to the axillary lymph nodes.

Stage IIB
In stage IIB, the cancer is either:

-between 2 and 5 centimeters (1 to 2 inches) and has spread to the axillary lymph nodes (the lymph nodes under the arm); or
-larger than 5 centimeters (about 2 inches) but has not spread to the axillary lymph nodes.

Stage IIIA
In stage IIIA, the cancer is either:

-smaller than 5 centimeters (about 2 inches) and has spread to the axillary lymph nodes (the lymph nodes under the arm), and the lymph nodes are attached to each other or to other structures; or
-larger than 5 centimeters and has spread to the axillary lymph nodes and the lymph nodes may be attached to each other or to other structures.

Stage IIIB
In stage IIIB, the cancer has either:

-spread to tissues near the breast (the skin or chest wall, including the ribs and muscles in the chest); or
-spread to lymph nodes inside the chest wall along the breastbone.

Stage IV
In stage IV, the cancer has either:

-spread to other organs of the body, most often the bones, lungs, liver, or brain; or
-spread to the lymph nodes in the neck, near the collarbone.

Inflammatory Breast Cancer
In inflammatory breast cancer, the breast looks red and swollen and feels warm. The redness and warmth occur because the cancer cells block the lymph vessels in the skin. The skin of the breast may also show the pitted appearance called peau d'orange (like the skin of an orange).

Recurrent Breast Cancer
Recurrent breast cancer is cancer that has recurred (come back) after it has been treated. Recurrent breast cancer may come back in the breast, in the chest wall, or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with breast cancer.
Different types of treatment are available for patients with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Four types of standard treatment are used:

Surgery
Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.

Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following:

-Lumpectomy: Removal of the tumor and a small amount of normal tissue around it. Lumpectomy is usually followed by radiation therapy to the breast. Most doctors also take out some of the lymph nodes under the arm.
-Partial or segmental mastectomy: Removal of the cancer, some of the breast tissue around the tumor, and the lining over the chest muscles below the tumor. Some of the lymph nodes under the arm are usually taken out. In most cases, partial mastectomy is followed by radiation therapy.

Other types of surgery include the following:

-Total or simple mastectomy: Removal of the whole breast. Sometimes lymph nodes under the arm are also taken out.
-Modified radical mastectomy: Removal of the breast, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
-Radical mastectomy (sometimes called the Halsted radical mastectomy): Removal of the breast, chest muscles, and all of the lymph nodes under the arm. This surgery is used only when the tumor has spread to the chest muscles.

Even if the doctor removes all of the cancer that can be seen at the time of surgery, the patient may be given radiation therapy, chemotherapy, or hormone therapy after surgery to try to kill any cancer cells that may be left. Treatment given after surgery to increase the chances of a cure is called adjuvant therapy.

If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast's shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at a future time. The reconstructed breast may be made with the patient's own (nonbreast) tissue or by using implants filled with saline or silicone gel. The Food and Drug Administration (FDA) has decided that breast implants filled with silicone gel may be used only in clinical trials. Before the decision to get an implant is made, patients can call the FDA's Center for Devices and Radiologic Health at 1-888-INFO-FDA (1-888-463-6332) for more information.

Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Radiation may be used after surgery in addition to chemotherapy, and hormone therapy. Breast cancer is treated with external radiation.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Hormone therapy
Hormones are chemicals produced by glands in the body and are circulated in the bloodstream. Estrogen and progesterone are hormones that affect the way some cancers grow. If tests show that the cancer cells have estrogen and progesterone receptors (molecules found in some cancer cells to which estrogen and progesterone will attach), hormone therapy is used to block the way these hormones help the cancer grow. This may be done by using drugs that block the way hormones work or by surgically removing organs that make hormones, such as the ovaries.

Hormone therapy with tamoxifen is often given to patients with early stages of breast cancer and those with metastatic breast cancer (cancer that has spread to other parts of the body). Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase the chance of developing endometrial cancer. Women taking tamoxifen should have a pelvic examination every year to look for any signs of cancer. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.

Other types of treatment are being tested in clinical trials. These include the following:

-Sentinel lymph node biopsy followed by surgery
Sentinel lymph node biopsy is a procedure in which the doctor injects a radioactive substance and/or blue dye near the tumor. The substance or dye flows through lymph ducts to the sentinel node or nodes (the first lymph node or nodes where cancer cells are likely to have spread). The surgeon removes only nodes with the radioactive substance or dye. A pathologist then checks the sentinel lymph nodes for cancer cells. If no cancer cells are detected, it may not be necessary to remove additional nodes. After the sentinel lymph node biopsy, the surgeon removes the tumor (breast-conserving surgery or mastectomy).
-High-dose chemotherapy with bone marrow transplantation and peripheral blood stem cell transplantation
Chemotherapy can reduce the ability of bone marrow to make blood cells. Bone marrow transplantation and peripheral blood stem cell transplantation have been tested as ways to help the blood recover so that higher than standard doses of chemotherapy can be given.

The use of high-dose chemotherapy followed by bone marrow transplantation or peripheral blood stem cell transplantation has not been shown to work better than standard chemotherapy in the treatment of breast cancer. Doctors have decided that, for now, high-dose chemotherapy should only be tested in clinical trials. Before taking part in such a trial, women should talk with their doctors about the serious side effects caused by high-dose chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options by Stage

Ductal Carcinoma In Situ (DCIS)
Treatment of ductal carcinoma in situ (DCIS) may include the following:

-Breast-conserving surgery with or without radiation therapy or hormone therapy.
-Total mastectomy (surgery to remove the whole breast), with or without hormone therapy.

Lobular Carcinoma In Situ (LCIS)
Treatment of lobular carcinoma in situ (LCIS) may include the following:

-Biopsy to diagnose the LCIS followed by regular examinations and regular mammograms to find any changes as early as possible. This is referred to as observation.
-Tamoxifen to reduce the risk of developing breast cancer.
-Bilateral prophylactic total mastectomy (surgery to remove all of both breasts before disease develops). This treatment choice is sometimes used in women who have a high risk of getting breast cancer. Most surgeons believe that this is a more aggressive treatment than is needed.

Stage I, Stage II, and Stage IIIA Breast Cancer
Treatment of stage I, stage II, and stage IIIA breast cancer that is confined to the breast and lymph nodes under the arm may include the following:

-Breast-conserving surgery to remove only the cancer and some surrounding breast tissue, followed by radiation therapy. Some of the lymph nodes under the arm are also removed.
-Modified radical mastectomy (surgery to remove the whole breast and the lining over the chest muscles, as well as some of the lymph nodes under the arm), with or without breast reconstruction surgery.
-A clinical trial evaluating sentinel lymph node biopsy (removal of the first lymph node(s) to which cancer is likely to spread from the tumor) followed by surgery.
-Adjuvant therapy (treatment given after surgery to increase the chances of a cure) may include:

1.Radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy.
2.Systemic chemotherapy, with or without hormone therapy.
3.Hormone therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage IIIB, Stage IV, and Metastatic Breast Cancer
Treatment of stage IIIB breast cancer may include the following:

-Systemic chemotherapy.
-Systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node removal followed by radiation therapy. Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.
-Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment of stage IV or metastatic breast cancer may include the following:

-Hormone therapy and/or chemotherapy with or without trastuzumab (Herceptin).
-Radiation therapy and/or surgery for relief of pain and other symptoms.
-Clinical trials testing new chemotherapy and/or hormone therapy. Clinical trials are also studying new combinations of trastuzumab (Herceptin) with anticancer drugs.
-Clinical trials testing other approaches, including high-dose chemotherapy with bone marrow transplantation or peripheral stem cell transplantation.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Inflammatory Breast Cancer

Treatment of inflammatory breast cancer may include the following:

-Systemic chemotherapy.
-Systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node removal followed by radiation therapy. Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.
-Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Recurrent Breast Cancer

Treatment of recurrent breast cancer (cancer that has come back after treatment) in the breast or chest wall may be:

-Surgery (radical or modified radical mastectomy), radiation therapy, or both.
-Systemic chemotherapy or hormone therapy.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.





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