What is breast cancer?
Breast cancer. The breast or sinus is made up of fat, connective and glandular tissue. Each breast has between 10 and 20 sections known as lobes, which in turn are divided into smaller sections, the lobules. Lobules contain milk-producing glands in lactation. Through the ducts the milk reaches the nipple.
The lobules and ducts are found in the stroma, a adipose tissue in which the blood and lymphatic vessels are also located, which go to the lymph nodes. These ganglia are responsible for protection against bacteria, tumour cells and other harmful substances.
These cancer cells can travel through the blood and lymphatic vessels and reach other parts of the body, where they can adhere to the organs and form the metastases.
Breast cancer can appear in both men and women. However, more than 99 percent of the diagnoses occur in women.(1)
Causes of the breast cancer
As with other cancers, such as osteosarcoma or brain tumors, the cause or causes of breast cancer are not known. However, specialists have identified the risk factors that predispose to develop the disease:
» Age: It is the main risk factor. As the woman gets older she is more likely to have breast cancer.
» Genetics: Women with a family history of breast cancer are at greater risk. It increases if the relative is the mother, sister or daughter.
» Reproductive factors: those agents that increase exposure to endogenous estrogens, such as early onset of first rule, late menopause, or use of hormonal replacement therapy after menopause increase the risk of breast cancer. Not having given birth is never also related to this cancer.
» Anterior breast cancer: patients who have had invasive breast cancer are more likely to have contralateral breast cancer.
» Breast density: If high, it also relates to this cancer.
Ionizing radiation: Exposure to this type of radiation, especially during puberty, increases the chance of breast cancer.
» Alcohol consumption.
Breast Cancer Symptoms
The most common manifestation that helps detect cancer is the emergence of a bump (palpable nodule) that usually does not cause pain. Other frequent symptoms include alterations of the breast skin or nipple retraction.
Prevention of breast Cancer
Self-Examination and mammography are the most useful tools for finding suspicious breast lumps. In general, the mammography technique facilitates the detection of small lumps, difficult to predict through palpation of the chest. This type of test should be repeated annually from 50 years, or 45 in the event that a person has a family history of first-degree breast cancer.
Types of breast Cancer
Not all the lumps that appear in the breasts are a symptom of cancer. In fact, nine out of ten lumps are benign. These non-cancerous lumps can be fibrosis or tumors of connective and glandular tissue, or cysts or fluid-filled pouches.
Benign breast tumors (fibroadenoma) are not a life-threatening and are often easily treated. Specific breast tumors are:
Ductal carcinoma in situ is located in the mammary ducts or ducts through which the milk reaches the nipple. If it is not treated it can cause metastasis. This is why it is very important to detect in time its presence, in order to avoid the progression towards the cancer.
This detection can only be done through specific tests, such as mammography, because in situ carcinoma does not usually produce any symptoms. Invasive carcinoma is the most common breast cancer and accounts for about 80 percent of all those that occur.
Lobular or lobular carcinoma
Lobular carcinoma, also known as invasive lobular neoplasia, follows the same filtering process as invading ductal carcinoma towards adipose tissue, but from lobules.
Inflammatory breast cancer
It’s a pretty aggressive cancer that grows fast. It is called inflammatory because the cancer cells block the lymphatic vessels and this is manifested in the skin, which acquires a thick and hollow appearance, similar to that of an orange peel.
Diagnosing the breast Cancer
The breast cancer diagnostic process begins when there is a suspicion of physical examination or routine mammogram. From that moment on, the specialist can perform a series of tests that confirm the cancer:
» Mammograms: X-ray images that detect abnormal areas of the breast. These tests are not 100% reliable and can offer suspicious images that in the end are not malignant or do not detect a malignant tumor.
» Ultrasound: Distinguish cystic lesions (fluid filled) from solid lesions. This technique usually completes mammography.
» Nuclear magnetic resonance (NMR): It is a radiological scan that uses the action of an electromagnetic field to obtain images. MRI is used as a complementary test of the anterior two or to analyze the brain or spinal cord.
If after carrying out these tests the suspicion continues, the next step that will be given by the specialist will be the confirmation of the cancer performing a biopsy.
The definitive diagnosis of cancer is established by the specialist in pathological anatomy when observing the malignant cells obtained in the biopsy under the microscope.
From these cells will be able to define the tumor, evaluate the prognosis and possible treatments. The factors you evaluate are:
» Tumor size: The greater the tumor, the greater the risk of it reappearing.
Histological type: It depends on the cells from which the tumor derives. Ductal carcinoma is the most frequent (80 percent of the cases), followed by lobular carcinoma.
» Histological Grade: Provides information on the maturation (growth) of tumor cells. The most differentiated are the most mature, Grade I and least aggressive; The least differentiated are Grade III.
» Lymph node involvement: The prognosis of the disease is established by the number of nodes that have been affected. The greater the number of nodes, the greater the risk of relapse.
» Hormonal receptors: The specialist will examine whether the tumour cells are estrogen and progesterone hormones.
» Her-2: It is the receptor 2 of the human epidermal growth factor, a protein that participates in the growth of cells. The Her-2 is present in normal cells and in most tumors. However, in 15-20 percent of breast tumours are at elevated concentrations, enabling the tumor to become more aggressive.
Breast Cancer Treatments
The treatment of breast cancer is based on multiple factors and requires the collaboration of different specialists: surgeons, oncologists, etc.
In the initial stages treatment usually starts with surgery and continues with radiation therapy. At present, in some cases the possibility of starting with neoadjuvant treatment that can facilitate the conservation of the breast is offered.
The therapy that is applied depends on many factors, including the stage or phase in which the tumor is found, whether or not there is metastasis, the size of the cancer and also how the cancerous cells are.
The classification made by physicians establishes the size of the tumor, the affected lymph nodes and the degree of metastasis or propagation to other organs, if any. The most widely used is the TNM system, created by the Joint American Cancer Committee.
Each letter refers to a feature that is defined by a number:
- T (size): followed by a number from 0 to 4. It refers to the size of the tumor, the bigger the cancer, the greater the number.
- N (nodules): 0 to 3. It refers to the lymph nodes that are affected by cancer cells.
- M (metastasis): followed by a 0 or 1. Indicates whether the cancer has spread (1) or not (0) to other organs.
The surgery is used with the intent to remove the tumor and to analyze the lymph nodes. There are two options for surgery:
» Preservative: The specialist will remove the tumor and a small amount of the healthy tissue around it. As they point from seom, this option allows to preserve the breast, although it usually requires that after the operation radiation therapy is administered to eliminate the tumor cells that remain in the breast. This option can be done depending on the size of the tumor, the breast and the patient’s wishes.
» Mastectomy: The specialist removes the entire breast. In these circumstances, patients can rebuild their breast. This option can be done by removing the breast or after completing all the treatments. The right time depends on a number of factors related to the patient’s treatment and preferences.
Sentinel ganglion biopsy
The Sentinel ganglion is the first lymph node where the tumor may be spread. To locate it, the specialist will inject a blue dye near the tumor that flows through the lymphatic vessels into the lymph nodes.
The procedure that the professional will follow is to remove the first lymph node that receives the substance and check if the tumor has arrived. If the tumor has spread to the ganglion, the lymph nodes will have to be removed.
This technique is not indicated in all circumstances.
Radiotherapy is used to prevent tumor cells from growing and/or destroying them. Can be used as:
» Adjuvant Therapy: Specialists may recommend it as a local treatment to eliminate possible tumor cells that remain after surgery.
» Palliative therapy: To relieve symptoms of bone or lymph node involvement.
Unlike surgery or radiotherapy, systemic therapy does not act locally, this treatment affects the entire body.
It is administered by mouth or intravenously and distributed to all organs. The aim of this treatment is to reduce the risk of relapse in sickness and death.
The three types of systemic therapies most commonly used today are chemotherapy, hormone therapy and targeted therapies. The use of each option depends on the type of breast cancer and the risk of relapse of the patient.
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