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Definition
Breast cancer is the abnormal growth and uncontrolled division of cells in the breast. Cancer cells can invade and destroy surrounding normal tissue, and can spread throughout the body via blood or lymph fluid (clear fluid bathing body cells) to start a new cancer in aلاher part of the body.
Description
Every woman is at risk for breast cancer. If she lives to be 85, there is a one out of nine chance that she will develop the condition sometime during the rest of her life. As a woman ages, her risk of developing breast cancer rises dramatically regardless of her family history. The breast cancer risk of a 25-year-old woman is only one out of 19,608; by age 45, it is one in 93. In fact, 80% of all breast cancers are found in women over age 50.
Causes & symptoms
There are a number of risk factors for the development of breast cancer, including:
Family history of breast cancer in mother or sister
Early onset of menstruation and late menopause
Reproductive history: women who had no children or have children late in life and women who have never breastfed have increased risk
History of abnormal breast biopsies.
However, more than 70% of women who get breast cancer have no known risk factors. While a breast cancer gene was discovered in 1994, only about 5% of breast cancers are believed to be related to the gene.
In addition, some studies suggest that high fat diets, bottle feeding instead of breastfeeding, or using alcohol may contribute to the risk profile. Some studies have also found that for certain women, hormone replacement therapy may contribute to the development of breast cancer. However, these findings have been criticized.
It is important to realize that لا all lumps detected in the breast are cancerous. Many are benign and require only the removal of the lump. While having several risk factors may boost a woman's chances of having breast cancer, the interplay of factors is complex. The best way to assess breast cancer risk is by doing monthly self examinations to detect any lump at an early stage. The second is to have a regular mammogram, an x ray of the front and side of the breast that will detect cysts or tumors at the earliest possible stage. Seeking risk assessment consultation at one of the many breast cancer centers located throughout the United States is also helpful.
The changes in the breast that may be a sign of breast cancer include:
Lump or thickening in breast or armpit
Changes in a nipple (thickening, pulling in, bleeding or discharge)
Dimpled or reddened skin over the breast
Change in size or shape
Abnormality on a mammogram.
Diagnosis
More than 90% of all breast cancers are detected by mammogram (a low-dose x ray of the breast). Mammograms should be done to evaluate a suspicious lump. Screening mammograms should be ordered according to the doctor's guidelines. Despite the controversy about the cost-effectiveness of mammograms for women in their 40s, most doctors agree with the current American Cancer Society guidelines that recommend screening mammograms every year or two for women between 40 and 49, and every year after age 50. Women with a family history of breast cancer may want to have a mammogram every year after age 40.
A typical mammography screening includes two views of each breast (one from above, and one from the side). Normally, the technician examines the x-ray pictures immediately to make sure no further x rays are needed, or to decide whether an ultrasound may be required.
If anything irregular is detected, such as a mass, changes from earlier mammograms, abnormalities of the skin, or enlargement of the lymph nodes, further testing may be recommended. This could include an ultrasound of the breast, a biopsy or needle sampling, or consultation with a breast surgeon.
Biopsy of the breast is a removal of breast tissue for examination by a pathologist. An excisional biopsy is a surgical procedure in which the entire lump area and some surrounding tissue is removed for examination. If the mass is very large, an incisional biopsy is done where only a portion of the area is removed and analysed. Needle biopsy can be done in two methods. An aspiration needle biopsy uses a very fine needle to withdraw cells and fluid from the mass for analysis. A large core needle biopsy uses a larger diameter needle to remove small pieces of tissue from the mass that can be analyzed. These analyses can determine whether the mass is benign (non-cancerous) or cancerous and therefore, whether further treatment is required.
To find out if the cancer has spread to other parts of the body (metastasized), doctors remove some underarm lymph nodes to test for cancer cells that have spread and to assist in making decisions for treatment. Checking to see if there are cancer cells in the lymph nodes is also a way to tell how advanced the cancer is ("staging" cancer). Breast cancer is rated from Stage 0 to Stage IV. Staging uses the diagnostic information to tell the cancer physician (oncologist) how widespread the disease is and includes:
Stage 1-The cancer is no larger than 2 cm and no cancer cells are found in the lymph nodes.
Stage 2-The cancer is no larger than 2 cm but has spread to the lymph nodes or is larger than 2 cm but has لا spread to the lymph nodes.
Stage 3A-Tumor is larger than 5 cm and has spread to the lymph nodes or is smaller than 5 cm, but has spread to the lymph nodes, which have grown into each other.
Stage 3B-Cancer has spread to tissues near the breast or to lymph nodes inside the chest wall, along the breastbone.
Stage 4-Cancer has spread to skin and lymph nodes near the collarbone or to other organs of the body.
Treatment
The best chance for successful treatment is to find breast cancer early. Treatment options include surgery, chemotherapy and radiation. Breast cancer is treated in two ways, locally to eliminate tumor cells from the breast by surgery and radiation, and to systemically destroy cancer cells that have traveled to other parts of the body. Systemic therapy includes the use of drugs in chemotherapy and hormonal treatments to reduce the amount of estrogen circulating in the blood.
The extent of surgery depends on the type of breast cancer, whether the disease has spread, and the patient's age and health. If the tumor is less than about 1.6 inches or there isn't much chance it will return, the patient and doctor may opt for removal of the tumor alone (lumpectomy) followed by radiation therapy.
Studies have shown that conservative treatment (a lumpectomy or partial mastectomy) offers the same odds of survival as does removal of the entire breast (total mastectomy) in someone with a small breast tumor that has لا spread into the nearby lymph nodes. New studies suggest that after lumpectomy, a combination of chemotherapy and radiation offers the best chance of long-term survival.
If the tumor is larger, a total (or simple) mastectomy may be needed. If the cancer has spread to the chest muscles, most doctors believe a radical mastectomy is the best solution. This operation is now used only when the cancer has spread to the chest muscle.
In a lumpectomy, the doctor removes:
The lump
Some of the tissue around it
Some of the lymph nodes under the arm may be removed (auxillary dissection) and tested to see if the cancer has spread there.
Even if no cancer is found in the nodes, radiation always follows lumpectomy and treatment may include chemotherapy.
In a modified radical mastectomy, the doctor removes:
The entire breast
The underarm lymph nodes
The lining over the chest muscle (but لا the muscles themselves).
A radical mastectomy is almost never done, but if necessary the doctor removes:
The breast
The chest muscles
All of the lymph nodes under the arm.
Surgery can be combined with breast reconstruction (creating a new breast-shaped mound), either right away or later on. Patients who want breast reconstruction should tell the doctor before surgery, since this could change the way the surgeon operates.
Removing the tumor and a border of normal tissue around it will remove the cancer while saving most of the breast tissue. However, the longer a tumor has been growing in the breast, the more likely it will be that the cancer cells have spread to the lymph nodes. These nodes under the arm or in the chest are a common place for breast cancer cells to spread. During surgery, some of the nodes are removed to check for cancer cells.
The presence of cancer cells in the lymph nodes may require more extensive surgery. If the cancer has spread to the nodes, the patient will need either radiation, chemotherapy, hormone therapy, or a combination of all three after surgery. This is called "adjuvant therapy."