Breast cancer

Breast cancer

What is it

The breast or breast is composed of fat, connective tissue and glandular. Each breast has between 10 and 20 sections known as lobes, which in turn are divided into smaller sections, the lobules. The lobules contain the milk-producing glands during lactation . Through the ducts the milk reaches the nipple.

The lobules and the ducts are found in the stroma, an adipose tissue in which the blood and lymphatic vessels are also located, which go to the lymph nodes. These ganglia are responsible for protection against bacteria, tumor cells and other harmful substances.

According to the Spanish Society of Medical Oncology (SEOM), breast cancer occurs when the cells of the glandular epithelium reproduce uncontrollably and very quickly. These cancer cells can travel through the blood and lymphatic vessels and reach other parts of the body, where they can adhere to the organs and form metastases.

Breast cancer can appear in both men and women. However, more than 99 percent of diagnoses occur in women .

 

Causes

As in other cancers, such as osteosarcoma or brain tumors , the cause or causes that cause breast cancer are not known . However, specialists have identified the risk factors that predispose to developing the disease:

  • Age: It is the main risk factor. As a woman gets older, she is more likely to get breast cancer.
  • Genetics: Women with a family history of breast cancer are more at risk. This increases if the relative is the mother, sister or daughter.
  • Reproductive factors: Agents that increase exposure to endogenous estrogens, such as early onset of the first menstrual period , late menopause or the use of hormone replacement therapy after menopause increase the risk of breast cancer. Not having never given birth is also related to this cancer.
  • Previous breast cancer: Those patients who have had invasive breast cancer have a higher risk of suffering from contralateral breast cancer.
  • Breast density: If it is high, it is also related to this cancer.
  • Ionizing radiation: Exposure to this type of radiation, especially during puberty, increases the possibility of breast cancer.
  • Obesity .
  • Consumption of alcohol.

symptoms

The most common manifestation that helps detect cancer is the appearance of a smalllump (palpable nodule) that usually causes no pain. Other common symptoms are changes in the skin of the breast or retraction of the nipple.

Prevention

Self- examination and mammograms are the most useful tools for finding suspicious lumps in the breasts. In general, the mammography technique facilitates the detection of small lumps, difficult to predict by palpation of the chest. This type of test should be repeated annually from age 50 or 45 in the event that a person has a family history of breast cancer first grade.

Types

Not all the lumps that appear in the breast are a symptom of cancer. In fact, nine out of ten packages are benign . These noncancerous lumps may be fibrosis or connective tissue tumors and glandular or cysts or fluid filled sacs.

Benign breast tumors (fibroadenomas) are not life threatening and usually have easy treatment. Specific breast tumors are:

Ductal carcinoma

Ductal carcinoma in situ is located in the mammary ducts or ducts through which the milk reaches the nipple. If left untreated it can cause metastasis. This is why it is very important to detect its presence in time, in order to avoid the progression towards cancer.

This detection can only be done through specific tests, such as a mammogram, since carcinoma in situ does not usually produce any symptoms. Invasive carcinoma is the most frequent of breast cancers and accounts for approximately 80 percent of all those that occur.

Lobular or lobular carcinoma

Lobular carcinoma, also known as invasive lobular neoplasia, follows the same filtering process as invasive ductal carcinoma towards adipose tissue, but from lobules .

Inflammatory breast cancer

It is a quite aggressive cancer that grows fast. It is called inflammatory because the cancer cells block the lymphatic vessels and this manifests itself in the skin, which acquires a thick and hollow appearance, similar to that of an orange peel.

Other types

Other rare types of breast cancer are the mucinous or colloid , in which the cancer cells produce some mucus, and the medullary , an infiltrating tumor, but with a better prognosis than other invasive cancers.

Paget’s cancer

It spreads through the skin of the nipple and areola. In this type of cancer, the skin of the nipple and halo has a scaly, reddish appearance, with occasional blood loss. Paget’s disease may be associated with carcinoma in situ or infiltrating .

Diagnosis

The process of diagnosing breast cancer begins when there is suspicion from a physical examination or a routine mammogram. From that moment the specialist can perform a series of tests that confirm cancer:

  • Mammograms : X-ray images that detect abnormal areas of the breast. These tests are not 100 percent reliable and can offer suspicious images that are not malignant in the end or detect a malignant tumor.
  • Ultrasonography : distinguishes cystic lesions (filled with fluid) from solid lesions. This technique usually completes mammography.
  • Nuclear magnetic resonance (NMR) : It is a radiological exploration that uses the action of an electromagnetic field to obtain images. MRI is used as a complementary test of the previous two or to analyze the brain or spinal cord.

If after carrying out these tests the suspicion continues, the next step that the specialist will give will be the confirmation of the cancer by performing a biopsy .

Pathological anatomy

As explained from SEOM, the definitive diagnosis of cancer is established by the specialist in pathological anatomy by observing the malignant cells obtained in the biopsy under a microscope.

From these cells you will be able to define the tumor, evaluate the prognosis and possible treatments. The factors it evaluates are:

  • Tumor size: The larger the tumor, the greater the risk that it will recur.
  • Histological type: Depends on the cells from which the tumor derives. Ductal carcinoma is the most frequent (80 percent of cases), followed by lobular carcinoma.
  • Histological grade: Provides information on the maturation (growth) of tumor cells. The most differentiated are the most mature, grade I and least aggressive; the least differentiated are those of grade III.
  • Lymph node involvement: The prognosis of the disease is established by the number of nodes that have been affected . The greater the number of lymph nodes, the greater the risk of relapse.

From SEOM they insist that when breast cancer is operated it is important to study the lymph nodes of the axilla (the first place where the tumor spreads). One option to evaluate the lymph nodes is the sentinel lymph node technique that allows the majority of axillary nodes to be preserved.

  • Hormonal receptors: The specialist will analyze if the tumor cells are in the hormones estrogen and progesterone .
  • HER-2 : This is the receptor 2 of human epidermal growth factor, a protein that participates in the growth of cells. HER-2 is present in normal cells and in most tumors. However, in 15-20 percent of breast tumors is found in high concentrations , causing the tumor to be more aggressive.

Treatments

The treatment of breast cancer is based on multiple factors and requires the collaboration of different specialists: surgeons, oncologists, etc.

In the initial stages, treatment usually begins with surgery and continues with radiotherapy . Currently, in some cases the possibility of starting before with neoadjuvant treatment that can facilitate breast conservation is offered .

The therapy applied depends on many factors, including the stage or stage in which the tumor is located, whether or not there is metastasis, the size of the cancer and also how the cancer cells are. The classification made by the doctors establishes the size of the tumor, the affected lymph nodes and the degree of metastasis or spread to other organs, if there is one. The most widely used is the TNM system , created by the American Joint Cancer Committee. Each letter refers to a characteristic that is defined by a number:

  • T (size): Followed by a number from 0 to 4. It refers to the size of the tumor, the larger the cancer, the greater the number.
  • N (nodules) : From 0 to 3. It refers to the lymph nodes that are affected by cancer cells.
  • M (metastasis): Followed by a 0 or 1. Indicates whether the cancer has spread (1) or not (0) to other organs.

Surgery

The surgery is used with the intention of removing the tumor and analyzing the lymph nodes of the axilla . There are two surgery options:

  • Conservative : The specialist will remove the tumor and a small amount of healthy tissue around it. As indicated from SEOM, this option allows the breast to be conserved, although, in general, it requires that after the operation radiotherapy be administered to eliminate the tumor cells that remain in the breast. This option can be performed depending on the size of the tumor, the breast and the patient’s wishes.
  • Mastectomy: The specialist will remove the entire breast . Under these circumstances, patients can rebuild their breast. This option can be done by removing the breast or after finishing all treatments. The right time depends on several factors related to the treatment and the patient’s preferences.

Sentinel node biopsy

The sentinel node is the first lymph node where it is possible for the tumor to spread . To locate it, the specialist will inject a blue dye near the tumor that will flow through the lymphatic vessels until it reaches the lymph nodes.

The procedure that the professional will follow is to remove the first lymph node that receives the substance and check if the tumor has arrived. If the tumor has spread to the lymph node, the lymph nodes will have to be removed.

This technique is not indicated in all circumstances.

Radiotherapy

Radiation therapy is used to prevent tumor cells from growing and / or destroying them . It can be used as:

  • Adjuvant therapy : The specialists can recommend it as a local treatment to eliminate possible tumor cells that remain after performing the surgery.
  • Palliative therapy : To relieve the symptoms of bone or lymph node involvement.

Systemic therapy

Unlike surgery or radiotherapy, systemic therapy does not act locally, this treatment affects the entire body .

It is administered orally or intravenously and is distributed to all organs. The goal of this treatment is to reduce the risk of relapse in the disease and death.

The three types of systemic therapies most used today are chemotherapy , hormone therapy and targeted therapies . The use of each option depends on the type of breast cancer and the risk of relapse of the patient.

Side effects of treatment

Some of the side effects of systemic therapy are:

  • Nausea and vomiting : Anti-emetic medications (against vomiting) may be required to avoid them. The doctor will tell you not only what to take before the chemo session, but also what you will have to take at home. Try to drink a lot of liquid, it is useful against nausea. They will be remitted when a few days pass after receiving the treatment.
  • Hair loss : Although it is not a serious effect, it is a source of anguish and dissatisfaction for most patients, as it influences the perception of their own image . Generally, hair loss begins two or three weeks after the first therapy cycle and remits after the treatment ends. The hair grows back at its normal speed.
  • Irritations in the mouth : mucosistis or oral irritations are common with chemotherapy. It is a disorder more annoying than worrying, because it produces burning in the mouth . To reduce this alteration is recommended extreme oral hygiene and use toothbrushes with soft bristles, which do not damage the gums. Antiseptic rinses also help.
  • Anemia : One of the most important side effects in chemotherapy is the reduction of the number of red blood cells in the blood. Anemia manifests itself through fatigue , weakness and extreme pallor . Sometimes it may require a blood transfusion. Plaquetopenia or excessive platelet depletion (the blood cells that clot blood in case of wounds) may also occur . This effect produces an increase in bruises (bruises) or bleeding in the gums and nose.
  • Neutropenia : It is another effect more monitored by doctors due to the severity. It consists of the reduction of white blood cells or leukocytes (cells that defend against the intrusion of pathogenic elements, such as viruses or bacteria). Neutropenia favors the appearance of infections (fever, urine infection , sore throat, etc.).

Other data

Incidence

According to SEOM data, breast cancer is the most frequent in Spanish women and accounts for 29 percent of all cancers.

Mortality of this type of cancer has declined significantly in recent years due to advances in screening programs and treatments. Despite this, it remains the leading cause of cancer death in Spain among women .

The age of maximum incidence is over 50 years but, approximately 10 percent is diagnosed in women under 40 years.

The median survival of breast cancer after five years was 89.2 percent, standing at more than 98 percent in stage I and 24 percent in stage III.

Breast cancer in men

One in 100 cases of breast cancer occurs in a male . Although the frequency is lower than among women, men who suffer from breast cancer usually have a worse prognosis of the disease. This difference is not due to the fact that the breast tumor in men is of a worse type, but simply because it is diagnosed much later than among women, especially due to misinformation.

The risk of a man developing breast cancer increases if someone has suffered in his direct family and also if he has suffered the so-called Klinefelter syndrome , an alteration that does not produce testosterone .

Other risk factors are having suffered testicular diseases or being overweight. The treatments that a man affected by this tumor receives are the same as those applied to women.