Most common Types of Cancer - Breast Cancer

Breast cancer
Breast cancer(malignant breast neoplasm) is a cancer that starts in the tissues of the breast either from the inner lining of milk ducts (Ductal carcinoma) or the lobules (Lobular carcinoma) that supply the ducts with milk. there is also rare cases that breast cancer starts in other areas of the breast. In 2010, over 250,000 new cases of breast cancer were expected to be diagnosed in women in the U.S. alone and the risk of getting invasive breast cancer during life time of a women is 1/8.

Signs and Symptom
Breast cancer is first noticed as a painless lump in the breast or armpit and most often discovered by you or your partner may discover the lump or or your doctor during a routine physical exam.
In early case of cancer, symptoms normally include
1. Lump (mass) in the breast
2. Lump in the armpit (lymph nodes)
3. Nipple discharge (clear or bloody)
4. Inverted or retracted nipple
5. Scaly or pitted skin on nipple persistent tenderness of the breast
6. Unusual breast pain or discomfort
7. Etc.

In advance case of cancer as cancer have spread to distance of the body, symptoms include
1. Bone pain (Secondary tumors in bone)
2. Shortness of breath (Secondary tumors in lung)
3. Unintentional weight loss and drop in appetite (Secondary tumors in liver)
4. Headaches, neurological pain or weakness (Secondary tumors in the nervous system)
5. Etc.

A rare case of breast cancer (Inflammatory Breast Cancer (IBC))
Inflammatory breast cancer (IBC), an aggressive cancer can occur in women of any age, grows in sheets instead of lumps invades nearby skin, leading to whole breast may go suddenly red and feel hot, resembling an inflammation and happening only about 1-6% of all breast cancer cases in the USA. It should be treated very promptly. Symptoms include
1. Rapid swelling (a cup size in a few days) sometimes
2. Associated by skin changes (pink, red, or dark-colored areas)
3. Nipple retraction
4. Persistent itching, skin hot to touch
5. Initially resembles mastitis
6. Breast skin ulcers (later stage of IBC)
7. Etc.

Risk factors
1. Gender
If you are women, your chance of getting breast cancer is 99 % higher due to more breast cells and constant exposure to growth hormones that affect the production of estrogen and progesterone.

2. Aging
Breast cancer increases proportional with age. Researchers found that out of 1/8 invasive breast cancers found in women, 2 out of 3 are women age 55 or older.

3. Heredity
About 5% of woman of breast cancer are caused gene mutation inherited from either the parents.

4. Family factor
Researchers found that if one of your direct family have developed breast or ovary cancer, your risk of getting breast cancer is increased.

5. Pregnancy
The r isk of develop breast cancer for women who never get pregnant.

6. Smoking
Researchers found that the risk of women who had smoked cigarettes in their teen years have a high risk of getting breast cancer and women who smoke for 35 years or more have a 59% higher risk of developing breast cancer, compared with those who never smoked

7. BRCA1 and BRCA2
Researchers found that mutation of tumor suppressor gene BRCA1 and BRCA2 are likely to develop breast cancer later in their life.

8. Menstruation
Women who started menstruating at an early age (before age 12) or went through menopause at a later age (after age 55) have a slightly higher risk of breast cancer due to longer lifetime exposed to estrogen and progesterone hormones.

9. Ataxia telangiectasia mutated (ATM)
The alternation of The ATM gene provides instructions for making a protein in controling the rate cells grow and divide and assisting in DNA of cells repa ir by recognizing damaged or broken DNA strands caused by toxic chemicals or radiation. Inheriting one mutated copy of this gene increase the risk of breast cancer.

10. Tumor protein 53 or P53
P53, a tumor suppressor protein in humans encoded by the TP53 gene can cause Li-Fraumeni syndrome, increasing the risk of developing of breast cancer.

11. Dense breast tissue
Women who have denser breast tissue and more glandular tissue and less fatty tissue, have a higher risk of developing of breast cancer.

12. Previous breast lump that had atypical change
A benign breast lump which showed atypical change called atypical hyperplasia increases the risk of developing breast cancer later in their life.

13. Overweight
Overweight and obese women have a higher risk of developing breast cancer compared to women who maintain a healthy weight in BMI index, especially after menopause.

14. Etc.

Factors that re duce the risk of breast cancer
1. Breast feeding
Researchers found that women who breast feeding their babies slightly lower risk of developing of breast cancer.

2. Early age at first full-term pregnancy:
Women who have their first full-term pregnancy at an early age slightly lower the risk of developing breast cancer later in life. Researchers found the women who have a first full-term pregnancy before age 20, the risk of developing breast cancer is about half that of women whose first full-term pregnancy occurs after the age of 30 and only limited to hormone receptor-positive breast cancer.

3. Increasing number of births
The risk of breast cancer declines with the birth of number of children, Researchers found that Women who have given birth to five or more children have half the risk of women who have not given birth and only limited to hormone receptor-positive breast cancer.

4. Preeclampsia
Women who have had pre gnancy conditions of high blood pressure and protein in the urine develop after the 20th week may slightly decrease the risk of developing breast cancer. Researchers suggested that certain hormones and proteins associated with preeclampsia may affect the risk of breast cancer.

5. Longer duration of breastfeeding:
Researchers found that Breastfeeding for an extended period of over a year) reduces the risk of developing of breast cancer later in their life in both hormone receptor-positive and hormone receptor-negative breast cancer.

6. Drinking more Coffee
In a new study, published in the journal Breast Cancer Research, women who drink five cups of coffee a day or more can reduce the risk of getting certain types of breast cancer. (How many women can do that without developing nervous tension)

7. Etc.

Diagnosis
1. Clinical Breast Exam (CBE)
The purpose of the clinical breast examination (CBE) is to detect early b reast abnormalities or evaluate patient reports of symptoms of breast cancers at an earlier stage for more more effective treatment. In most case, cancer caught in early stage can be cured completely. In U. S. the American Cancer Society (ACS) recommended that women between the age of 20 to 39 should have a CBE once every three years and women 40 and older to get CBE annually.

2. Mammograms
If you have any symptoms is mentioned above, the first test which your doctor order is a mammogram to screen and detect any breast tissue abnormally and any sign of tumor. mammograms can detect between 85 to 90 percent of all abnormalities, including breast cancer, cysts, fibroadenomas, tumors, etc. even before you can feel a lump.

3. Breast Magnetic Resonance Imaging (MRI)
Breast magnetic resonance imaging (MRI) is a medical test that helps physicians diagnose the breast conditions of a patient by using powerful magnetic f ield, radio frequency pulses to produce detailed pictures of soft tissues and internal structures of the breast. It reveals different details about many breast conditions that cannot be obtained by mammography, ultrasound, etc.

4. Elastography
Elastography, a new technology for imaging breast tissue, is a non-invasive method used to detect or classify the stage of the tumors. In a study comparing ultrasound with breast elastography measurement, researchers found that breast elastography was highly effective in distinguishing benign from malignant breast tumor.

5. Ductal Lavage (Pap smear for the breast)
Ductal lavage also known as Pap smear for the breast, is one of fluid test used in addition to CBE and mammography to detect breast cancer by with drawing fluid which contains breast cells from the breast ducts with the use of a tiny catheter inserted into the nipple.

6. Breast Biopsy
In a breast biopsy, a ver y small tissue sample is extracted and examined under a microscope for the presence of cancer cells by using a medical instrument (fine needle aspiration cytology (FNAC), Core needle biopsy (CNB) and Stereotactic biopsy) or cutting out by a surgical procedure.

7. Etc.

Factors that influence treatment options
A. Stages of breast cancer
The stages of breast cancer are classified depending to
1. Size of the cancer
2. Invasive or not
3. whether cancer has spread to the lymph nodes
4. whether the cancer has spread to the distance parts or organs of the body.
There are 4 stages of breast cancer in TNM rating (where T is referred for tumor size, N is referred for Lymph Node status, M is referred for invasive or not)
# T: Tumor Size is divided into four classes: T-1 is between 0 - 2 cms, T-2 is between 2 - 5 cms, T-3 is > 5cms, and T-4 is a tumor of any size growing into the chest wall or skin, includ ing inflammatory breast cancer.
#N: No swollen nodes: N-0, some swelling but negative node (not cancerous): N-1a, swelling nodes and positive node (cancerous): N-1b, quite swollen and bunched together: N-2, quite swollen and near the collarbone:N-3.
# M: if no cancer cell is found: M-0, cancer cells found: M-1.

a. Stage 1
T-1 tumor and clear lymph nodes with no evidence of spreading (M-0), or T-1N-0M-0.
b. Stage 2
Stage 2 is the combination of combination of T-1, T-2, or T-3 tumor, N-0. N-1a and N-1b but no spreading (M-0)
c. Stage 3
Stage 3 is the combination of all T or N but no spreading(M-0)
d. Stage 4
Stage 4 is the combination of T, N-1a, N-1b, N-2, N-3 and M-1

B. Hormone receptors sites and HER2 (Human Epidermal growth factor Receptor 2)
1. Hormone receptors
A hormone receptor is a receptor protein on the surface of a cell wi th the function of binding to a specific hormone in its interior. Estrogen receptors are that bind estrogen hormone and progesterone receptors are cells with the same.
Estrogen and progesterone receptor status tests
They are the tests to determine whether the tumor's growth is influenced by the hormones estrogen and/or progesterone by taking a sample of breast cancer tissue obtained during a biopsy.
a. Cancer with hormones sensitive is always slower growing
b. Reponses well to hormones suppression treatment
c. If there is negative found in both tests (ER- and PgR-), hormone suppression treatments are not required (tuomor is not driven by hormones). Further testings are required to determine the best options.
d.
# ER-0, PgR-0 is no estrogen and progesterone receptor found
#Er-1+, PgR-2+ small numbers of estrogen and progesterone receptors found accordingly
#ER-2+, PgR-2+ a medium numbers of estrogen and progesterone receptors found accordingly
# ER-3+, PgR-3+ large numbers of estrogen and progesterone receptors found accordingly.

2. Testing HER2 (human epidermal growth factor receptor 2)
About 30% of breast cancers are caused by over expression of its protein product or HER2.