The Health Care for All – Breast Cancer

Article by Engr. Ghassan Jaber

The breast Anatomy

The breast is a collection of glands and fatty tissue that lies between the skin and the chest wall. The glands inside the breast produce milk after a woman has a baby. Each gland is also called a lobule, and many lobules make up a lobe. There are 15 to 20 lobes in each breast. The milk gets to the nipple from the glands by way of tubes called ducts. The glands and ducts get bigger when a breast is filled with milk, but the tissue that is most responsible for the size and shape the breast is the fatty tissue. There are also blood vessels and lymph vessels in the breast. Lymph is a clear liquid waste product that gets drained out of the breast into lymph nodes. Lymph nodes are small, pea-sized pieces of tissue that filter and clean the lymph. Most lymph nodes that drain the breast are under the arm in what is called the axilla.

What is breast cancer?

Collections of cells that are growing abnormally or without control are called tumors. Tumors that do not have the ability to spread throughout the body may be referred to as “benign” and are not thought of as cancerous. Tumors that have the ability to grow into other tissues or spread to distant parts of the body are referred to as “malignant.” Malignant tumors within the breast are called “breast cancer”. Theoretically, any of the types of tissue in the breast can form a cancer, cancer cells are most likely to develop from either the ducts or the glands. These tumors may be referred to as “invasive ductal carcinoma” (cancer cells developing from ducts), or “invasive lobular carcinoma” (cancer cells developing from lobes).

Sometimes, precancerous cells may be found within breast tissue, and are referred to as ductal carcinoma in-situ (DCIS) or lobular carcinoma in-situ (LCIS). DCIS and LCIS are diseases in which cancerous cells are present within breast tissue, but are not able to spread or invade other tissues. DCIS represents about 20% of all breast cancers. Because DCIS cells may become capable of invading breast tissue, treatment for DCIS is usually recommended. In contrast, treatment is usually not needed for LCIS.

How can I prevent breast cancer?

The most important risk factors for the development of breast cancer, such as age and family history, cannot be controlled by the individual. Some risk factors may be in a woman’s control; however. These include things like avoiding long-term hormone replacement therapy, having children before age 30, breastfeeding, avoiding weight gain through exercise and proper diet, and limiting alcohol consumption to 1 drink a day or less. For women already at very high risk due to family history, risk of developing breast cancer can be reduced by about 50% by taking a drug called Tamoxifen for five years. Tamoxifen has some common side effects (like hot flashes and vaginal discharge), which are not serious and some uncommon side effects (like blood clots, pulmonary embolus, stroke, and uterine cancer) which are life threatening.

The most important risk factors for the development of breast cancer, such as age and family history, cannot be controlled by the individual. Some risk factors may be in a woman’s control; however. These include things like avoiding long-term hormone replacement therapy, having children before age 30, breastfeeding, avoiding weight gain through exercise and proper diet, and limiting alcohol consumption to 1 drink a day or less. For women already at very high risk due to family history, risk of developing breast cancer can be reduced by about 50% by taking a drug called Tamoxifen for five years. Tamoxifen has some common side effects (like hot flashes and vaginal discharge), which are not serious and some uncommon side effects (like blood clots, pulmonary embolus, stroke, and uterine cancer) which are life threatening. Tamoxifen isn’t widely used for prevention, but may be useful in some cases. Use of Tamoxifen for prophylactic reasons should be considered carefully by an individual and her doctor, as its use is very individualized. For more information on breast cancer prevention, Isn’t widely used for prevention, but may be useful in some cases. Use of Tamoxifen for prophylactic reasons should be considered carefully by an individual and her doctor, as its use is very individualized. For more information on breast cancer prevention,

Breast Cancer Facts

Simply stated, breast cancer is an uncontrolled growth of breast cells. Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. It differs by individual, age group, and even the kinds of cells within the tumors themselves.

How Does Breast Cancer Occur?

Cancer is a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can “turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.

Breast Cancer is caused by a Genetic Abnormality

According to cancer societies, only 5 to 10% of cancers are due to an abnormality inherited from your mother or father. About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the strain of life in general.

Did you know that Not All Tumors are Cancerous?

A tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumors are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumors are cancerous

The Term “Breast Cancer” Refers to a Malignant Tumor that has developed from Cells in the Breast.
Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast.

Stages of Breast Cancer

Determining the stage of your breast cancer is fundamental for planning your treatment and understanding the most likely outcome. If you have been diagnosed with breast cancer, your doctor will decide what additional tests may be helpful to find out if the disease has spread outside the breast.

About Stages

o The cancer stage — shown as a number from O to IV — is based on the size of the tumor and whether the cancer has spread to the lymph nodes.
o To determine your cancer stage, your doctor will ask questions about your medical history, perform a careful physical examination and review all prior tests as well as the results from the biopsy of the tumor or suspected area.
o Additional tests, such as X-rays and blood work, may be needed. In general, the stage isn’t fully known until after the operation to remove the tumor in your breast and sample the lymph nodes under your arm.
o Breast cancer staging is complicated, and the classification system sometimes changes as doctors learn more about breast cancer.

Stages 0 to IV: What They Mean

Once the surgery is completed, your doctor can determine the stage of your cancer. Breast cancer stages range from 0 to IV, with many subcategories. Lower numbers indicate earlier stages of cancer, while higher numbers reflect a late-stage cancer.

Stage 0

This stage describes noninvasive breast cancer. It hasn’t spread within the breast or to other parts of the body.

Stage I

This stage is an early stage of invasive breast cancer in which:
o The tumor measures no more than 2 centimeters or about ¾ an inch in diameter
o No lymph nodes are involved — the cancer hasn’t spread outside the breast

Stage II

This stage, subdivided into IIA and IIB, describes invasive breast cancers in which one of the following is true:
o The tumor measures less than 2 cm but has spread to lymph nodes under the arm
o No tumor is found in the breast but cancer is found in the axillary lymph nodes
o The tumor is between 2 cm and 5 cm (about 1 to 2 inches) and may have spread to lymph nodes under the arm
o The tumor is larger than 5 cm but hasn’t spread to any lymph nodes

Stage III

Stage III breast cancers are subdivided into three categories — IIIA, IIIB and IIIC — based on a number of different criteria. By definition, stage III cancers haven’t spread (metastasized) to distant sites
For example, a stage IIIA tumor is larger than 5 cm and has spread to one to three lymph nodes under the arm. Other stage IIIA tumors may be any size and have spread into multiple lymph nodes. The lymph nodes clump together and attach to one another or to the surrounding tissue.
In stage IIIB breast cancer, a tumor of any size has spread to tissues near the breast — the skin and chest muscles — and may have spread to lymph nodes within the breast or under the arm. Stage IIIB also includes inflammatory breast cancer, an uncommon but aggressive type of breast cancer.
Stage IIIC cancer is a tumor of any size that has spread:
o To 10 or more lymph nodes under the arm
o To lymph nodes above or beneath the collarbone and near the neck
o To lymph nodes within the breast itself and to lymph nodes under the arm

Stage IV

Stage IV breast cancer has spread to other, distant parts of the body, such as the lungs, liver, bones or brain.