Tag Archives: Breast Cancer

Breast cancer

Finding a breast lump or some other change in your breast may stir fears of breast cancer — and understandably so.

Try not to worry. The odds are in your favor. Most breast lumps — as many as four out of five that are biopsied — are noncancerous (benign). But it’s still important to have the breast lump evaluated by a doctor to be certain you don’t have cancer.

If evaluation of the breast lump reveals breast cancer, you’ve taken a vital step toward dealing with the disease. Early detection gives you the best chance for successful treatment.

During a breast self-exam, you’ll feel tissues of varying consistency. Glandular tissue usually feels firm and slightly rope-like, bumpy or lumpy (nodular); it’s primarily felt in the upper, outer region of your breast. Surrounding fat tissue is soft; it’s often felt in the inner and lower portions of your breast. The contrast between these two types of tissue is often more pronounced just before your period due to hormonal influences on the breast.

Besides changes related to your menstrual cycle, breast tissue also changes as you age. In the majority of women, breast tissue becomes more fatty and less dense over time. You may find that Continue reading Breast cancer

Breast cancer – Invasive lobular carcinoma

Invasive lobular carcinoma is a type of breast cancer that begins in the milk-producing glands (lobules) and then invades surrounding tissues. About 20,000 women are diagnosed with this type of breast cancer each year in the United States. Invasive lobular carcinoma makes up about 15 percent to 20 percent of all breast cancers.

Compared to the more common form of invasive breast cancer — invasive ductal carcinoma — invasive lobular carcinoma is less likely to show up on a mammogram. Although invasive lobular carcinoma tends to be larger at diagnosis, it generally has a more favorable outlook than does invasive ductal carcinoma.

Symptoms

Rather than forming a distinct lump you can feel, invasive lobular carcinoma (ILC) may simply feel like a thickened area in your breast. Lobular carcinoma cells tend to break out of the lobule in single file, then invade surrounding breast tissue in a web-like manner. The affected area may have a different textural feel from normal breast tissue, but it is unlikely to be a discrete mass.

As a result, an invasive lobular carcinoma might become fairly large — about 3/4 inch (2 centimeters) to about 2 inches (5 centimeters) or bigger — before any signs or symptoms appear. These might include: Continue reading Breast cancer – Invasive lobular carcinoma

Inflammatory breast cancer

Signs and symptoms Inflammatory breast cancer Causes Risk factors
Medical advice Inflammatory breast cancer diagnosis Inflammatory breast cancer treatment
Coping skills

Inflammatory breast cancer is a rare but aggressive type of breast cancer that develops rapidly, making the affected breast red, swollen and tender. It’s a locally advanced cancer, meaning it has spread from its point of origin to nearby tissue and possibly to nearby lymph nodes.

The early signs of more-common forms of breast cancer a breast lump or suspicious area on a routine, screening mammogram are often absent in inflammatory breast cancer. Instead, the breast may appear normal until tumor cells invade and block lymphatic vessels in the overlying skin. Fluid backs up, and the breast swells and becomes discolored.

Inflammatory breast cancer can easily be confused with a breast infection, but if it’s cancer, symptoms won’t go away with antibiotics. Seek medical attention promptly if you notice skin changes on your breast, to help distinguish a breast infection from other breast disorders.

Inflammatory breast cancer accounts for between 1 percent and 6 percent of all breast cancer cases in the United States. Survival rates are lower than those observed in other locally advanced breast cancers. But new treatment approaches offer greater odds for survival than ever before.

Signs and symptoms

Despite its name, inflammatory breast cancer does not cause inflammation the way an infection does. Signs and symptoms include:

  • Rapid change in the appearance of one breast, over the course of days or weeks
  • Thickness, heaviness or visible enlargement of one breast
  • Discoloration, giving the breast a red, purple, pink or bruised appearance
  • Unusual warmth of the affected breast
  • Dimpling or ridges on the skin of the affected breast, similar to an orange peel
  • Itching
  • Tenderness, pain or aching
  • Enlarged lymph nodes under the arm, above the collarbone or below the collarbone
  • Flattening or turning inward of the nipple
  • Swollen or crusted skin on the nipple
  • Change in color of the skin around the nipple (areola)

Other conditions have symptoms resembling those of inflammatory breast cancer. A breast infection (mastitis) also causes redness, swelling and pain, but breast infections usually develop during breast-feeding. With an infection, you’re likely to have a fever, which is unusual (but not unheard of) in inflammatory breast cancer.

Breast surgery or radiation therapy may block the lymphatic vessels in breast skin, temporarily making the breast swell and become discolored. When caused by surgery or radiation treatments, however, these changes gradually subside.

Causes

As with other types of breast cancer, the exact cause of inflammatory breast cancer is unknown. All cancers are characterized by unregulated cell division, starting with one abnormal cell, in this case usually in one of the breast’s ducts. In inflammatory breast cancer, the abnormal cells rapidly infiltrate and clog the lymphatic vessels in the skin over your breast. The blockage in the lymphatic vessels causes red, swollen and dimpled skin a classic sign of inflammatory breast cancer.

Risk factors

Inflammatory breast cancer tends to affect women at an average age of 59 about three to seven years younger than the average age at which other types of breast cancer are diagnosed. Men can develop the disease, but at an older age. Black women are slightly more likely than are white women to have inflammatory breast cancer.

Medical advice

If you have an apparent breast infection that fails to improve despite a week of treatment with antibiotics, ask your doctor to do a further breast evaluation. This may include imaging studies such as ultrasound, mammogram or MRI scan and a biopsy. If test results show no signs of cancer, but your signs and symptoms appear to be getting worse, talk with your doctor about performing another biopsy especially one that includes a skin sample or ask for a referral to a breast specialist.

Diagnosis

A diagnosis of inflammatory breast cancer is based on your medical history, your physical examination and an excisional biopsy taking a small sample of skin and some of the underlying tissue to examine under a microscope. An excisional biopsy that includes the skin is helpful because a hallmark of inflammatory breast cancer is finding tightly packed clumps of cancer cells (tumor emboli) in the lymphatic vessels of the skin. Imaging tests mammogram and breast ultrasound also may be used to confirm the diagnosis by showing areas of skin thickening.

If the biopsy results confirm that you have inflammatory breast cancer, the next step is to determine how advanced your cancer is its stage, or extent and severity. Your doctor may perform additional tests, such as a CT scan of your chest and abdomen, chest X-ray, and bone scan, to check for the presence of cancer cells in other parts of your body (metastases).

Your cancer will also be tested for the presence or absence of receptors for the hormones estrogen and progesterone, and to see if the cancer produces too much of a protein called HER2. Inflammatory breast cancers are often hormone receptor negative and HER2-positive.

Inflammatory breast cancer is classified as stage IIIB or stage IV breast cancer. Stage IIIB is locally advanced cancer meaning it has spread to nearby lymph nodes and to the fibrous connective tissue inside the breast. Stage IV cancer has spread to other parts of your body, such as bones or liver. About one-third of newly diagnosed inflammatory breast cancers are stage IV.

Treatment

Treatment for inflammatory breast cancer starts with chemotherapy, followed by surgery and radiation therapy. This combined-treatment approach has improved the outlook for women with inflammatory breast cancer. About half the women diagnosed with the condition survive five or more years, and nearly one-third are alive 20 years after diagnosis.

Chemotherapy (anti-cancer drugs)

Treatment of inflammatory breast cancer usually begins with several rounds of chemotherapy to kill or control cancer cells. This pre-surgical treatment, referred to as neoadjuvant therapy, is needed to shrink the cancer and resolve skin problems before the operation, since swelling can prevent the surgical incision from healing properly. The exact number of chemotherapy treatments will depend on how well the cancer responds to the treatments.

Surgery

After chemotherapy, women with inflammatory breast cancer usually have an operation to remove the affected breast (mastectomy). Surgery alone without chemotherapy offers a much smaller chance of a cure. Breast-conserving surgery (lumpectomy) isn’t recommended for women with inflammatory breast cancer. Most women receive additional doses of chemotherapy after healing from the operation.

Radiation therapy

After surgery and any further chemotherapy, a course of radiation therapy is given to kill any remaining cancer cells in the breast and under your arm. This can help decrease the chance of cancer coming back in the area. Radiation typically involves about 30 treatments over six weeks.

Further treatments

Even after treatment with chemotherapy, surgery and radiation, recurrence rates remain high for inflammatory breast cancer. Because of this, your doctor may recommend further treatment (adjuvant therapy) to prevent the cancer from returning. This might include more chemotherapy or hormone therapy if your cancer tests positive for estrogen receptors. Hormone therapy, such as tamoxifen or anastrozole (Arimidex), interferes with the effects of the female hormone estrogen, which can promote cancer cell growth.

If your cancer is HER2-positive, your doctor will recommend a course of trastuzumab (Herceptin). You may also be offered the opportunity to participate in a clinical trial to test new treatments for inflammatory breast cancer.

Coping skills

Inflammatory breast cancer is aggressive and difficult to treat. Until recently, the prospects for long-term survival were poor. A further challenge is the relatively high risk that inflammatory breast cancer will return. Fortunately, the outlook has improved but that doesn’t make coping any easier.

Because inflammatory breast cancer progresses rapidly, you may need to start treatment before you’ve had time to process everything. If you feel rushed, try thinking about your treatment as a series of short-term challenges rather than as one long process. At every stage of treatment, someone on your medical team should be available to explain what’s happening and answer your questions. Don’t be afraid to speak up about any issue that arises anxiety, pain or ongoing trouble with treatment side effects.

Don’t try to go it alone. Seek support from your family and friends, and ask your doctor what community and hospital resources may be available.

There’s no “right” way to feel and act when you’re dealing with cancer. Despite often-repeated anecdotes about the power of a positive attitude, research shows that personality and coping style have no consistent effect on cancer outcomes. If you’re feeling sad, anxious or just plain mad, know that these feelings are normal, and try to let go of the added burden of blaming yourself.

Types of breast cancer

The type of breast cancer you have helps determine the best approach to treating the disease. Get the facts on types of breast cancer and how they differ.

Your doctor suspects that you have breast cancer. To confirm the diagnosis, a pathologist analyzes a tissue sample (biopsy) taken from the lump or suspicious area in your breast. This will tell if you have cancer or some other, benign condition. If the biopsy does show cancer, the results provide your doctor with information about the type of breast cancer and help determine treatment options.

The biopsy results appear on a pathology report, which provides detailed information including the type of breast cancer, if it’s invasive or noninvasive, the tumor grade ? how closely the cancer cells resemble normal tissue ? if the cancer is sensitive to hormonal therapies and if it has too much of a protein called HER-2.

Sophisticated lab tests can also analyze breast cancer tissue for molecular and genetic features of breast cancer cells. Understanding all these aspects of a cancer helps your doctor tailor your treatment plan.

Common types of breast cancer

The most common types of breast cancer begin either in your breast’s milk ducts (ductal carcinoma) or in the milk-producing glands (lobular carcinoma). The point of origin is determined by the appearance of the cancer cells under a microscope.

In situ breast cancer
In situ (noninvasive) breast cancer refers to cancer in which the cells have remained within their place of origin ? they haven’t spread to breast tissue around the duct or lobule. The most common type of noninvasive breast cancer is ductal carcinoma in situ (DCIS), which is confined to the lining of the milk ducts. The abnormal cells haven’t spread through the duct walls into surrounding breast tissue. With appropriate treatment, DCIS has an excellent prognosis.

Invasive breast cancer
Invasive (infiltrating) breast cancers spread outside the membrane that lines a duct or lobule, invading the surrounding tissues. The cancer cells can then travel to other parts of your body, such as the lymph nodes.

* Invasive ductal carcinoma (IDC). IDC accounts for about 70 percent of all breast cancers. The cancer cells form in the lining of your milk duct, then break through the ductal wall and invade nearby breast tissue. The cancer cells may remain localized ? staying near the site of origin ? or spread (metastasize) throughout your body, carried by your bloodstream or lymphatic system.
* Invasive lobular carcinoma (ILC). Although less common than IDC, this type of breast cancer invades in a similar way, starting in the milk-producing lobules and then breaking into the surrounding breast tissue. ILC can also spread to more distant parts of your body. With this type of cancer, you typically won’t feel a distinct, firm lump but rather a fullness or area of thickening.

Less common types of breast cancer

Not all types of breast cancer begin in a duct or lobule. Less common types of breast cancer may arise from the breast’s supporting tissue, including the fibrous connective tissue, blood vessels and lymphatic system. In addition, some tumors don’t actually begin in the breast but represent a different type of cancer that has spread (metastasized) from another part of the body, such as the lymphatic system (non-Hodgkin’s lymphoma), skin (melanoma), colon or lungs. These are not called breast cancer but are referred to as cancer from where it started, now metastatic to the breast.

Unusual types of breast cancer include inflammatory breast cancer, phyllodes tumor, angiosarcoma, osteosarcoma, metaplastic breast cancer, adenoid cystic carcinoma and Paget’s disease of the breast. There are also rare subtypes of invasive ductal carcinoma ? tubular, mucinous, medullary and papillary.

Tumor grade
If the cancer is an invasive type, the pathologist assigns it a grade. The grade is based on how closely cells in the sample tissue resemble normal breast tissue under the microscope. The grading information, along with the cell type, helps your doctor determine treatment options.

Breast cancers are graded on a 1 to 3 scale:

* Grade 1. The cells still look fairly normal (well differentiated).
* Grade 2. The cells are somewhat abnormal (moderately differentiated).
* Grade 3. The cells have lost their proper structure and function (poorly differentiated).

The pathologist determines the grade by looking at the size and shape of both the cell and its nucleus and counting how many cells are in the process of dividing. A higher grade suggests a faster growing cancer that’s more likely to spread.

Hormone receptor status
Breast cancers are tested for the presence of estrogen and progesterone receptors. A receptor is a protein on the outside of a cell that can attach to specific chemicals, hormones or drugs traveling through the bloodstream.

Normal breast cells and some breast cancer cells have receptors that bind to the female hormones estrogen and progesterone. The hormones signal the cells to increase or “turn on” cell growth.

Breast cancers can be hormone receptor (HR) positive or HR negative. Tumors found to be HR positive are further categorized as estrogen receptor positive (ER positive) or progesterone receptor positive (PR positive). With ER positive or PR positive breast cancer, hormone-blocking medications, such as tamoxifen, slow the cancer’s growth. Hormone receptor positive cancers typically grow more slowly than do HR negative cancers.

HER-2 status
Knowing if a cancer has too many copies of the HER-2 gene also influences treatment decisions. This gene drives production of the growth-promoting HER-2 protein. About one out of every five breast cancers is HER-2 positive, meaning these cancers have greater than normal amounts of the HER-2 protein. These cancers tend to grow and spread more aggressively than do other cancers.

Two sophisticated lab tests can detect HER-2 in cancer cells:

* Immunohistochemistry. Special antibodies that attach to HER-2 protein are applied to the tissue sample, and cells change color if too many HER-2 protein receptors are present.
* Fluorescent in situ hybridization (FISH). Fluorescent pieces of DNA find extra copies of the HER-2 gene. Chromogenic in situ hybridization (CISH) is a similar technique.

Some laboratories use FISH only, since many breast cancer specialists believe this test is more accurate than is the immunohistochemistry test.

HER-2 positive breast cancers can be treated with drugs that specifically target the HER-2 protein, such as trastuzumab (Herceptin) and lapatinib (Tykerb).

Breast cancers that are HER-2 negative and also lack receptors for estrogen and progesterone are referred to as “triple negative.” This form of the disease tends to be aggressive and may respond better to different treatments. It appears to be more common in young black and Hispanic women.

Emerging ways to classify breast cancer
The goal of much current breast cancer research is to understand the characteristics of cells in individual tumors. By applying the latest in molecular technology, researchers can identify genes associated with breast cancer and measure their activity in tissue samples. Tools called microarray analysis and reverse transcriptase-polymerase chain reaction (RT-PCR) are used to study patterns of behavior, or expression, of large numbers of genes in breast tissue samples. The researchers can then identify a set of genes whose activity provides information about a cancer, such as the likelihood of recurrence. These tests, known as genetic profiling or gene-expression profiling, have so far been used only for a minority of breast cancers.

Some researchers have proposed a new way to classify breast cancers based on molecular features rather than on the cancer’s appearance under a microscope. These types include:

* Luminal A and luminal B. The genetic activity of these cancers is similar to that of normal lumen cells ? those that line the breast ducts and glands. Luminal cancers are estrogen receptor positive and usually grow slowly.
* HER-2. These cancers have extra amounts of HER-2 protein and extra copies of the gene. They tend to grow quickly but respond well to treatment with Herceptin.
* Basal. Basal breast cancers contain normal amounts of HER-2 and lack estrogen and progesterone receptors. This type of cancer grows rapidly.

Most doctors still use the traditional categories when talking about types of breast cancer. But they draw on the latest research about breast cancer features to determine the best course of treatment.

Household Chemicals and Breast Cancer Risk

A chemical found in many plastic products used in households caused accelerated breast development and genetic changes in newborn female lab rats, a condition that might predispose the animals to breast cancer later in life, a new study says.

Butyl benzyl phthalate (BBP) is commonly used to soften polymers and plastics. It’s found in everything from plastic pipes, vinyl floor tiles and carpet backing to lipstick. BBP has also been found to be an endocrine disruptor, which mimics the effect of hormones. Endocrine disruptors are known to damage wildlife and have also been implicated in reduced sperm counts and neurological problems in humans

The findings are important because the researchers are studying the lifetime effect of BBP on the mammary gland, long before it starts developing under the influence of the hormones of puberty, and the potential implications on humans.

To prevent breast cancer in adulthood, it is necessary to protect both the newborn child and the mother from exposure to this compound that has an estrogenic effect and could act as an endocrine disruptor.

The researchers found that BBP affected characteristics of the female offspring of the rats, such as more rapid breast development and changes in the genetic profile of the mammary glands. While these effects wore off after exposure to BBP was stopped, the changes caused by the chemical might have an effect later in life, the researchers said.