Breast Cancer

Breast cancer

What happens?

Healthy body cells continuously undergo division, growth and replacement in an orderly way. But some things can go wrong in the body and these cells grow too fast and carelessly and become abnormal, thus forming a tumour. When the breast cells are involved in this abnormal growth, the condition is termed breast cancer.

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Initially, these cancer cells remain in the particular part of the breast where they are formed. After sometime, they may begin to spread into other parts of the breast, and thus are termed invasive breast cancer. From there the cancer can spread around the body. Early breast cancer is cancer that is still within the breast. If the tumour is large or has spread to the skin or the front of the chest, this is locally advanced breast cancer.

What causes breast cancer?

Breast cancer is more common in developed, western countries, however it is more aggressive in African-American women. It is one of the commonest cancers in females. Breast cancer may run in families in up to five percent of cases. A few women get it by inheriting a gene that makes it much more likely.

It is more common in women who have never given birth and those who had their first child births after the age of 35 years. The risk is also higher in people who started menstruating early or who had a late menopause. Breastfeeding reduces the chances of developing breast cancer, and obese people are more likely to develop it. The condition is also more common in individuals who have been on oral contraceptive pills for more than five years.

What are the symptoms?

The commonest symptom of breast cancer is a lump in the breast which is hard and painless, but may be painful in very few cases. A discharge from the nipple, which may be bloody, is the second commonest presentation. The area of the tumour may start to get sore. Lumps may be noticed in the armpits and at the base of the neck. You may feel chest pain and cough out blood. Bone pains may also be present and fractures may occur easily. You may feel breathless and cough a lot especially while lying down, and may notice your abdomen is increasing in size.

Some women may not feel any symptom at the time they are diagnosed of breast cancer due to early screening with a mammography.

What treatments are available?

Treatment of breast cancer is usually a combined approach involving surgery, radiotherapy, chemotherapy and hormone therapy.

Surgery

There are several options in surgery for breast cancer. There is the total (simple) mastectomy, which involves the complete removal of the breast only. The total mastectomy with axillary clearance involves complete removal of the breast alongside some affected lymph nodes in the armpit. There are other options available, and the surgeon should determine which is most suitable for your condition.

Removing the breast does not guarantee total cure as the cancer could rarely return in the scar. There are also risks associated with the surgery.

Many women are emotionally troubled by losing a breast, so there are options for breast reconstruction during the same operation.

Breast-conserving surgery may also be an option. Here, the surgeon removes the tumour but leaves the breast intact. But this isn’t applicable to every case, because the cancer may have spread so far that it is safest to remove the entire breast.

Radiotherapy

Radiotherapy is used when:

  • A patient has undergone a breast-conservative surgery
  • After total mastectomy
  • Patients with high risk of cancer recurrence after surgery
  • When the cancer has spread to bones or lymph nodes
  • In very advanced stages of breast cancer
  • To reduce the size of the tumour before surgery is done

The irradiated skin may itch or change colour after radiotherapy, and the involved breast may feel tender. Some women feel more tired than usual. These problems are usually mild and go away after a few weeks.

Chemotherapy (cancer drugs)

This is used in:

  • All patients with spread of cancer to lymph nodes
  • Large tumour sizes
  • Presence of signs suggestive of poor outcome, such as involvement of blood vessels
  • Advanced breast cancers as a palliative treatment
  • Late stage cancer after simple mastectomy has been done
  • Late stage breast cancer with spread to bone, lungs and liver
  • Women of child-bearing age with aggressive tumours.

Chemotherapy can have unpleasant side effects. You may feel sick and vomit during or after your treatment. You may also lose your hair, put on weight, and get symptoms of the menopause. A lot of women feel very tired during chemotherapy, and it can continue after you stop treatment.

Hormone therapy

Some women have hormone treatment after chemotherapy or radiation. It is mostly used in selected cases where the breast cancer cells are being controlled by hormones like oestrogen and progesterone.

It involves the use of anti-oestrogen drugs like tamoxifen or raloxifen; medical or surgical removal of the ovaries, which is the source of oestrogen, and the use of anti-progesterone drugs. These treatments stop oestrogen from working in the body. The aim is to reduce the chance that your cancer will come back.

It is relatively safe and easy to administer, and gives protection against cancer in the opposite breast. Hormone therapy is useful in breast cancer in the elderly after surgery or occasionally as tamoxifen alone. It reduces the chances of the cancer coming back and so probably improves the life span and quality of life.

What will happen to me?

The outcome of breast cancer is usually determined by the following factors:

  • Age: The younger the age, the worse the likely outcome
  • Sex: Cancer in men is worse than that in women
  • Stage: Early stages have better outcomes
  • The type of breast cancer
  • Tumour size: The larger the size, the poorer the outcome
  • The extent of spread of the cancer cells.
  • How well the individual responds to treatment.

Even after a seemingly successful treatment, breast cancer can sometimes come back, so you will always need to be watchful for symptoms and have regular check-ups as advised by your doctor. However, if breast cancer is going to come back, it’s most likely to do so within the first two years.