What are the early signs of Breast cancer?

What is Breast cancer?

Cancer grows in the cells of the breast.

Carcinoma of the breast is malignant and usually glandular, which arises from epithelial cells of mammary gland lobules. In early signs of carcinoma, edema is one in which excessive fluid accumulates in the skin of the breast.

According to WHO In 2020, there were 2.3 million women diagnosed with breast cancer and 685,000 deaths globally

Risk factors

Factors that enhance the probability of getting the disease. But having some of them doesn’t mean you’ll surely get the disease.

These factors include

• Age and sex: Women over 40 years are more likely to be victims of the disease.
• Family history: One fourth of cases are related to this factor. If one’s mother or sister has a breast cancer, one is prone to this disease.
• Personal history: Women have antecedently had breast lump (non-cancerous) or had cancer, there are more chances of developing bread cancer.
• Hormonal factor: Women, taking birth control pills or hormone therapy medications (estrogen, progesterone or combination of these two) to treat menopause, have an Increased risk of breast cancer.
• Radiation: If someone receives radiation for diagnosis or treatment purposes to chest, she will at high risk of cancer.
• Alcohol consumption: it is coupled to increasing risk of breast and other type of cancer as well.
•  Body weight: After menopause, fat tissues are more involved in secreting estrogen, so obese women are more at risk of having cancer.

Being overweight also increases blood insulin levels in the body that have been linked to some cancers, including breast carcinoma.

• Gene mutation: Mutation in gene BRCA1 and BRCA2 cause increase in risk of breast and other cancers

How it spreads?

It spreads by means of lymphatic vessels which carry cancer cells from the breast to axillary lymph nodes. The cells stick in nodes hence metastasis occurs. There are connections among the lymphatic pathways and among cervical, parasternal and axillary nodes, so it may cause metastasis from the breast to the opposite breast, nodes, and abdomen. Because most lymphatic drainage of the breast is to axillary nodes, so this is the most common site of metastasis.

Enlarged axillary nodes are indications of breast cancer, but not always, these cells may proliferate supraclavicular and infraclavicular or directly into systematic circulation. 

Signs and symptoms

Some people don’t have any signs and symptoms at all, but some patients show pathological indications of this disease. Most commonly are:

• welling or lump in the breast or armpit
• breast discharge fluid other than milk e.g. blood or fluid
• inverting of nipple
• soreness or rash around nipple
• Tenderness in armpit or part of breast.
• scaling, peeling of skin on the breast or nipple
• change in shape, size of breast or position of nipple
• redness and putting on skin

These symptoms can also appear in other conditions rather than cancer.

Types 

Morphologically breast cancer is divided into two categories i.e. non-invasive and invasive. The Carcinoma that remains in the boundary is termed as in situ (non-invasive) while the other one spread beyond its designation. These are mainly classified as follows. A- Non-invasive (in situ) is also called pre-cancerous or 0 stages.                           

• Ductal Carcinoma in situ (DCIS)
• Lobular Carcinoma in situ (LCIS)

They don’t destroy the basement membrane nor invade lymphovascular channels.

B- Invasive (infiltrating) Carcinoma                                                                                    

• Invasive Ductal Carcinoma: produces desmoplastic response in which breast fat eventually convert into hard, palpable irregular mass.
• Invasive Lobular Carcinoma: invades stroma.
• Triple negative Carcinoma: this type accounts 15 % of total breast cancer.

There are the following subtypes of this one.                                                                                                              

1-Mucinous Carcinoma (The tumor usually is gelatinous and soft due to the presence of mucin)                                                     

2-Tubular Carcinoma                                                                                                

3-Carcinoma with medullary feature

• Inflammatory Carcinoma: It may obstructs dermal lymphatic spaces and patients have an erythematous breast without palpable mass.

All these invasive types assign grades 1-3.

• Grade 1 cancers are relatively small and not much proliferated to surrounding area
• Grade 2: these cells are larger than stage 1 or spread to nearby lymph nodes
• Grade 3 tumors are growing and affecting nearby tissues and have proliferated to many lymph nodes        

• GRADE 4: this is metastasis stage and systematic therapy is given in this stage

Diagnosis

To determine whether symptoms are caused by Carcinoma, there are some diagnostic steps and protocols being followed to detect the ailment.

• Physical examination Doctor inspect and palpate the breast for evaluation of causing symptoms.
• Mammography This is radiographic study of the breast. Mammogram, low dose x ray, is usually recommended for initial breast cancer screening.
• Ultrasound It is non-invasive measure of & distinguishing fluid filled cyst from solid masses. It’s also guide a biopsy needle.
• MRI (magnetic resonance imaging) It brings detailed picture of breast to measure the extent of cancer by using radio waves and magnets.  
• Biopsy A tissue sample is taken from suspicious area to do lab analysis. This test explains a number of things like size, origin, spread and type of cancerous cells.

There are more common methods for this process as

•  fine needle aspiration biopsy
•  core needle biopsy
•  excisional biopsy

Treatment

The doctor examines a patient thoroughly and tells her about the treatment method according to stage, severity, type and risk factors of the carcinoma. There are different approaches of treatment used accordingly.                                  

Local treatment

In this plan of treatment, practitioners treat tumors without affecting other regions of the body.

§ Surgery

Many types of surgery are used to remove cancer

1. Mastectomy ( complete removal of breast)
2. Lumpectomy ( incision of tumor only) Contralateral prophylactic mastectomy (this surgery remove healthy breast to prevent the risk of developing carcinoma in further life)
3. Axillary lymph nodes dissection 

§ RADIATION THERAPY                                                                                                             

It is treated with a high-energy beam of radiation to kill cancer cells.

This treatment also is given in addition to other ones: after BCS breast-conserving surgery and mastectomy to reduce the chance of getting cancer again or if cancer is larger or found in lymph nodes.

Systematic treatment

In systematic treatment, drugs are used to eradicate cancer. This treatment is given by mouth or directly into the bloodstream.

§ Chemotherapy

This is of the following types

1. Adjunctive chemotherapy
2. Non adjunctive chemotherapy
3. Hormone therapy: Some cancers are caused by estrogen and progesterone, cancer cells have receptor to attach to these hormones which help cancerous cells to grow. Drugs usually lower estrogen level (such as aromatase inhibitor) or block receptor (such as tamoxifen) on cancer cells.

• Targeted therapy: unlike chemotherapy, It can be used against HER2 – positive, hormone receptor-positive, BRCA gene mutation accordingly. Its side effects are different from than that of chemotherapy as well.

Prevention

There are several things that could be done to reduce the risk of becoming victims of this disease.                                                                                                                                

Life style

Certain decisions in life may reduce the risk of getting this illness. These include:                                                                                                                          

• Maintaining body weight
• Be physically active
• Avoid or limit alcohol consumption

Self-examination

Though this is not much beneficial, women can do a self-examination to identify any change in size, the shape of breast, or position of the nipple.                                                    

Medication

Pre-emptive surgery

Breast cancer awareness

October is breast cancer awareness month. In this month nonprofit organizations and healthcare professionals show their support together and raise funds for research, prevention, treatment, and diagnostic purpose.

Mr. Ali Husnain

Doctor of Physical therapy
Govt. College university Faisalabad