View Surgical Options For Breast Cancer

What is Breast Cancer or Carcinoma of the Breast:

Human breasts are highly lobular milk producing glands made up of fibrous and fatty tissues. The lobules are connected to ducts, which drain the milk produced in the glands to the nipples.

The breast also contains a dense network of lymph vessels that mostly connects to the lymph nodes located under the arms.

Carcinoma of the breast is characterized by the uncontrolled and abnormal growth of the breast cells in the milk ducts, in the milk producing lobules or even in the tissue in between.

In essence, breast cancer is not one condition but rather it can manifest in different forms depending on the affected breast tissue.

The dynamics of breast cancer cell growth and behaviour is entirely dependent on the type of tissue affected and this also influences the effectiveness of the treatment interventions in the later stages.

Types of breast cancer:

1. Ductal carcinoma in situ (DCIS): This type of carcinoma appears early and the condition is characterized by multiplication of the cancer cells within the milk ducts. Though non-invasive in nature initially, lack of immediate and time-sensitive intervention can make it invasive and the cancer can spread to the surrounding tissues.
2. Invasive ductal carcinoma: As it is evident from the name itself, this form of cancer is invasive in nature and can rapidly spread to surrounding tissues. This is the commonest form of breast cancer originating in the milk ducts and may spread rapidly to the surrounding breast fatty tissues. The extent of proliferation of this cancer can be far-reaching, through the lymph ducts and the blood stream into distant organs, and the condition can turn very serious.
3. Invasive lobular carcinoma: This is another form of breast cancer that can spread to surrounding body tissues. The invasive lobular carcinoma starts in the milk-producing breast lobules and its detection through a standard mammogram is challenging compared to invasive ductal carcinoma.

Some other forms of breast cancer that are not very common are Inflammatory breast cancer, Paget’s disease of the nipple, Phyllodes tumor and angiosarcoma.

What treatments are most effective:

The treatment for breast cancer can vary significantly from one patient to another but the following are the primary ways in which it can be treated. Usually, more than one method is used, and as described earlier, this will always be tailored to the individual patient.

1. Surgical intervention: For those patients who are suffering from Ductal carcinoma in situ (DCIS) and the more serious invasive forms, surgical intervention to remove the malignant tumour is essential. To prevent metastasis, surgeons routinely remove the cancer with a segment of healthy tissue around the affected region. In the event that the spread of the cancer is more extensive and the tumour size is large, hormonal therapy or chemotherapy may be given before carrying out any surgical intervention.
2. Radiation: Radiation therapy is another form of treatment for breast cancer where high energy beams such as x-rays are used to destroy the malignant cells. Radiation therapy is external when rays are given to the patient from a system outside the body. Radiation therapy can also be internal in nature where a radioactive substance is placed inside the body for a short period of time.
3. Systemic interventions: Treatment strategies that involve oral or intravenous administration of targeted drugs against the cancer cells are called systemic treatments because the drugs can target the cancer cells located anywhere in the body. Systemic interventions include chemotherapy, hormonal therapy and targeted therapy where cancer genes and proteins are specifically targeted.

Breast Cancer Statistics:

In Australia, 15,166 new cases of breast cancer were reported in 2012 and it is anticipated that the number will rise to 16,084 by the end of 2016. This is on the rise and it is estimated that by 2020, around 17,200 new cases of breast cancer among Australian women will be reported.

The incidence of breast cancer is reported to be 115 cancers per 100,000 female population for the year 2016. Health statistics state that breast cancer was the second most common form of malignancy in Australia in 2012 and by the end of 2016 it’s going to go down to the third position.

It is also estimated that in 2016, the risk of an female getting diagnosed with breast cancer by the time she turns 85 is 1 in 8.

Risk Factors for Breast Cancer:

The following are some of the most important risk factors for breast cancer:

1. Gender: The condition is at least 100 times more common in women than men.
2. Age: Risk of breast cancer increases with age
3. Genes: Mutations in the BRCA1 and BRCA2 genes that are inheritable in nature can lead to breast cancer
4. Family history of breast cancer: An individual (primarily women) who has close blood relatives suffering from breast cancer are highly predisposed to the condition, especially if the relatives were male or pre-menopausal when diagnosed.
5. Personal history: Having had a previous breast cancer, or other conditions that increase the risk like DCIS and Lobular Carcinoma In Situ (LCIS)
6. Hormonal factors: Child-bearing, lifestyle and personal factors

Progression of Breast Cancer:

The progression of breast cancer can be categorized into following stages according to the degree of severity:

• Stage 0 & 1: This is the earliest stage of the cancer. During this stage the progression of the cancer is very limited and is localised to a specific region.
• Stage 2 & 2A: This stage is also very early in the development of the condition but compared to its preceding stage, the cancer has started to grow and may involve spread to lymph nodes. Treatment at this stage is highly effective.
• Stage 3A, 3B and 3C: The stage 3 forms are more advanced in nature and are characterized by spread of the cancer to the surrounding tissues around the breasts and lymph nodes.
• Stage 4: This stage is the most advanced form characterized by the extensive spread of the cancer to distant organs. Stage 4 is considered incurable but given the level of development in modern medical science, women with stage 4 breast cancer can expect to live longer while the condition persists in chronic form ie, not cured, but controlled enough to lead a normalish life.

How is Breast Cancer Diagnosed:

Breast cancer can be diagnosed through the following approaches:

1. Medical history of the patient and physical examination of the breasts and axillary (armpit) lymph nodes.
2. Use of different imaging procedures such as mammograms, ultrasound of the breasts and breast MRIs
3. Biopsy of the affected breast tissue.

Breast Cancer Prognosis:

When breast cancer is detected at an early stage, the treatment interventions is usually highly successful. In the recent years, the prognosis from breast cancer has been very positive because of the massive improvements in medical knowledge, both from a diagnostic as well as a treatment perspective.

The 5-year survival rate of patients with stage 0 & 1 breast cancer is almost 100% and for stage 2 patients, the survival rate is around 93%. For stage 3 patients, the 5-year survival rate is almost 72% and for stage 4 patients, the survival rate percentage is 22%.