OVERVIEW
Breast cancer
is a common cancer, with more than
232,000 new cases diagnosed in the
United States each year. The disease
occurs most frequently in women, but
can also occur in men.
The
normal breast has 6 to 9 overlapping
sections called lobes and within
each lobe are several smaller
lobules that contain the cells that
produce milk. The lobes and lobules
are linked by thin tubes called
ducts, which lead to the nipple in
the center of the breast. The spaces
around the lobules and ducts are
filled with fat. Lymph vessels carry
colorless fluid called lymph, which
contains important immune cells. The
lymph vessels lead to small
bean-shaped structures called lymph
nodes. Clusters of lymph nodes are
found in the axilla (under the arm),
above the collarbone, and in the
chest.
The suspicion of
breast cancer often first arises
when a lump is detected in the
breast during breast examination or
a suspicious area is identified
during screening mammography. In
order to diagnose the cause of the
suspicious area or lump in the
breast, a physician will perform a
biopsy. A biopsy can be performed on
an outpatient basis. During a
biopsy, a physician removes cells
for examination in the laboratory to
determine whether cancer is present.
Other information obtained from the
biopsy sample will play an important
role in treatment decisions. If the
biopsy indicates that cancer is
present, additional surgery may be
performed after the patient and
doctor select a course of treatment.
There are many types of breast
tumors. Some breast tumors are
benign (not cancerous). Benign
breast tumors such as fibroadenomas
or papillomas do not spread outside
of the breast and are not life
threatening. Other breast tumors are
malignant (cancerous). The most
common type of breast cancer is
called ductal carcinoma and begins
in the lining of the ducts. Another
type of cancer is called lobular
carcinoma, which arises in the
lobules.
PERSONALIZED CANCER CARE CENTER
When cancer is identified in the
biopsy specimen, several other tests
may be performed on the specimen in
order to further classify the cancer
and determine the optimal treatment
strategy. Based on the stage of the
cancer and the results of these
tests, treatment of breast cancer is
personalized for each individual.
Treatment may involve surgery,
radiation therapy, chemotherapy,
targeted therapy, and/or hormonal
therapy.
Stage:
Stage is a measure of the
extent of the cancer, and is based
on the size of the tumor and the
presence or absence of lymph node
metastases and distant metastases.
Determining the stage of the cancer
may require a number of procedures,
such as blood tests, chest x-rays,
mammography, computed tomography
(CT), or magnetic resonance imaging
(MRI). For patients with early-stage
cancer, the spread of the cancer to
the axillary (under the arm) lymph
nodes may be assessed through either
sentinel lymph node biopsy or
axillary lymph node dissection.
Axillary lymph node dissection
involves the removal of many
axillary lymph nodes; the procedure
can be associated with chronic side
effects such as pain, limited
shoulder motion, numbness, and
swelling. Sentinel lymph node biopsy
is a more recent procedure that
involves the removal of only a small
number of nodes, or even a single
node. If the sentinel lymph nodes
are negative (show no evidence of
cancer), then no further lymph node
surgery is required. Sentinel lymph
node biopsy is becoming more widely
adopted in the clinical setting for
determining whether cancer has
spread to the lymph nodes in women
with localized breast cancer.
HER2 status: Twenty to thirty
percent of breast cancers
overexpress (make too much of) a
protein known as HER2.
Overexpression of this protein leads
to increased growth of cancer cells.
Fortunately, the development of
treatments that specifically target
HER2-positive cells - such as
Herceptin (trastuzumab) and Tykerb
(lapatinib) - has improved outcomes
among women with HER2-positive
breast cancer. For this reason, HER2
status should be accurately measured
on all breast cancers.
Hormone
receptor status: Some breast
cancer cells express an abundance of
receptors for the female hormones
estrogen and/or progesterone. These
cancers- called hormone
receptor-positive -are typically
associated with a better prognosis
and are treated differently from
breast cancers that are hormone
receptor-negative. Patients with
hormone receptor-positive breast
cancer often receive treatment with
hormonal therapy, such as tamoxifen
or an aromatase inhibitor.
Recurrence Score: Among women
with early-stage breast cancer, the
expression, or activity, of certain
genes has been linked with the
likelihood of cancer recurrence.
Oncotype DX is a genomic test that
predicts risk of recurrence among
selected women with early-stage
breast cancer, including women with
ductal carcinoma in situ (DCIS). Use
of the Oncotype DX test may help
guide decisions about whether about
additional treatment with
chemotherapy or radiation therapy is
necessary after surgery.
For
more information about OncotypeDX,
visit
http://www.mytreatmentdecision.com/
LEARN
MORE
Patients who have
already undergone surgery and lymph
node evaluation and know their stage
of cancer may select from the
options below. In order to learn
more about surgery and sentinel
lymph node dissection, go to Surgery
for Breast Cancer.
Carcinoma In Situ: Approximately 15-20% of breast
cancers are very early in their
development. These are sometimes
referred to as carcinoma in situ and
consist of two types: ductal
carcinoma in situ (DCIS), which
originates in the ducts and lobular
carcinoma in situ (LCIS), which
originates in the lobules. DCIS is
the precursor to invasive cancer and
LCIS is a risk factor for developing
cancer.
Stage
I: Cancer is confined to a
single site in the breast, is less
than 2 centimeters (3/4 inch) in
size and has not spread outside the
breast.
Stage
IIA: Cancer has spread to
involve underarm lymph nodes and is
less than 2 centimeters (3/4 inch)
in size or the primary cancer itself
is 2-5 centimeters (3/4-2 inches)
and has not spread to the lymph
nodes.
Stage
IIB: Cancer has spread to
involve underarm lymph nodes and/or
the primary cancer is greater than 5
centimeters (2 inches) in size and
does not involve any lymph nodes.
Stage IIIA: Cancer is smaller
than 5 centimeters (2 inches) and
has spread to the lymph nodes under
the arm or the lymph nodes are
attached to each other or to other
structures or the primary cancer is
larger than 5 centimeters (2 inches)
and has spread to the lymph nodes
under the arm.
Stage
IIIB: Cancer directly
involves the chest wall or has
spread to internal lymph nodes on
the same side of the chest.
Inflammatory: Inflammatory breast
cancer is a special class of breast
cancer that is rare. The breast
looks as if it is inflamed because
of its red appearance and warmth.
The skin may show signs of ridges
and wheals or it may have a pitted
appearance. Inflammatory breast
cancer tends to spread quickly.
Stage IV: Cancer has spread
to distant locations in the body,
which may include the liver, lungs,
bones or other sites.
Recurrent/Relapsed: The breast
cancer has progressed or returned
(recurred/relapsed) following an
initial treatment.
REFERENCES
American
Cancer Society. Cancer Facts &
Figures 2011. Copyright
2012
CancerConsultants Breast Cancer
Information Center. All
Rights Reserved.
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