Breast cancer is entirely a women’s disease but in some cases, it can develop in men too. Commonly breast cancer starts in the cells lining the ducts and it is called ductal cancer. Some cancer starts in the cells lining the lobules called lobular cancer.
In cancer, abnormal cells have abnormal growth patterns. Breast cancer is a malignant tumor of the breast tissue. Malignant tumor means that cancer cells spread to the distant areas of the body.
Breast cancer most commonly spread into the lymph nodes of the same side above the collarbone or under the arm. Breast cancer can also spread to the liver, bones, and brain.
The female breast is mainly made up of:
• Glands that produce milk called lobules.
• Tubes carrying milk from lobules to nipples called ducts.
• Stroma (it is a fatty and connective tissue that surrounds the blood vessels, lymphatic vessels and ducts and lobules.)
Breast cancer spreads through the lymphatic system. Anatomy of lymphatic system of the breast is as under:
Lymph nodes are a part of immune system.Lymph nodes are small and bean shaped and are connected by lymphatic vessels. Lymphatic vessels appear as small veins that carry clear fluid away from breast called lymph.
Lymph consists of waste products, tissue fluids and cells of immune system. When breast cancer enters the lymphatic vessels it starts growing in lymph nodes.
Most of the lymphatic vessels connect to the lymph nodes under the arm, called axillary nodes. Some connect inside the chest, called internal mammary nodes. The remaining connects above or below the collarbone, called supraclavicular or infraclavicular nodes.
A spread of cancer to the lymph nodes results in an invasion in the blood stream and metastasis to other parts of the body. Involvement of a large number of lymph nodes results in higher chances of cancer to spreads to other organs.
Most of the lumps found in the breast are not cancers, which mean they are benign tumors.But they need to be properly examined and viewed under a microscope.
Stages of breast cancer:
In stage 0 of breast cancer, there is called non-invasive type.There is no invasion of cancer cells or non-cancerous abnormal cells into neighboring normal tissue.
Stage I It is divided into IA and IB stages.
• IA stage:
The tumor is localized and does not spread outside the breast.It measures up to 2cm. There is no involvement of lymph nodes.
• IB stage:
Some cancer cells are found in the lymph nodes measuring between 0.2 mm and 2 mm. the tumor may or may not be present in the breast tissue measuring less than 2 cm.
It is divided into IIA and IIB stages.
• IIA stage:
Cancer cells are present in the axillary lymph nodes but not in the breast. A tumor that is found in the axillary lymph nodes measures less than 2cm.
• IIB stage: Tumor that has spread to the axillary lymph nodes measures 2 to 5cm.
It is divided into IIIA, IIIB, and IIIC stages.
• IIIA stage: Cancer cells of any size get clumped together are found in the axillary nodes and they stick to other neighboring structures.
• IIIB stage: The cancer cells of any size chest wall and/ or skin of the breast.
• IIIC stage: Cancer has spread to lymph nodes above or below the collarbone; it may have spread to axillary lymph nodes or to lymph nodes near the breastbone. If the tumor is present in the breast it may have spread to the chest wall and/or the skin of the breast.
The spread of the breast cancer occurs beyond the breast, lymph nodes or to other organs of the body, such as the lungs, skin, bones, liver, or brain.
TNM staging system:
TNM system is based on
• The size of the tumor.
• Involvement of nodes.
• Metastasis has occurred or not.
• TX: Tumor can not be found.
• T0: There is no evidence of primary tumor.
• Tis: Tumor has not grown into healthy breast tissue.
• T1, T2, T3, and T4: This numbering depends on the size of the tumor and its spreads to neighboring tissue.
• NX: Lymph nodes cannot be found.
• N0: Lymph nodes do not contain cancer.
• N1, N2, and N3: This numbering depends on how much lymph nodes are involved.
M category:• MX: Metastasis cannot be found.
• M0: Absence of metastasis.
• M1: Presence of metastasis.
Mortality of Breast Cancer
The mortality rate is decreased because of general awareness and better treatment.
• Genetic Causes
People with family history of breast cancer are at more risk of developing the disease. The risk is highest if the patient having breast cancer is a first-degree relative (mother, sister, daughter). If a male develops breast cancer then the risk for all his close relative increases. The risk of having breast cancer also increases if any relative has ovarian cancer.
• Hormonal Causes
– If in a woman periods starts at an early age (12 or younger) or she has a late menopause (55 or older), then they are at a slightly higher risk of developing breast cancer.
– Oral contraceptive pills slightly increase the risk of breast cancer than women who have never used them. This risk decreases and returns to normal with time once the pills are stopped.
– The risk of developing breast cancer increases if the women have no child or deliver the baby after the age of 30.
• Lifestyle and Dietary Causes
– High dietary intake of fat and being overweight or obese is one of the risk factors for acquiring breast cancer, particularly in postmenopausal women.
– Greater the amount of smoking tobacco and the earlier in life smoking begins the higher the risk for breast cancer.
– The use of alcohol also contributes to the development of breast cancer. Women who consume two to five alcoholic beverages per day have a higher risk of breast cancer as compared to the non-drinkers.
• Environmental Causes
If a woman is receiving radiation therapy to the upper body for treatment of disease before 30 years of age they have a higher rate of breast cancer as compared to the general population.
• Discharge of blood from the nipple.
• Size and shape of the breast changes.
• Formation of peeling, scaling or flaking of the nipple or breast skin.
• Skin of the breast becomes red and pitted, appears as the skin of the orange.
• A breast lump or thickening feels different from the surrounding tissue
• Change to the skin over the breast and dimpling occurs.
• Nipple becomes inverted.
• Breast abscess.
• Examination of the Breast.
– Careful palpation of the breasts, the armpits, and the areas around the collarbone.
– Thickening of the lump is palpated.
• Breast-conserving surgery.
• Radiation therapy.
• Hormone therapy.
• Assure the patient about the quality of care.
• Advice changes in lifestyle and dietary changes.
• Regular screening after the treatment.
• Green and black tea.
• Tomatoes contain lycopene that helps to fight against cancer.
• Sweet potatoes.
• Soy products.
• Fruits rich in vitamin C e.g. oranges, lemon, papaya, grapes, etc.
• Garlic enhances the immunity.
• Vegetables like broccoli, cabbage, carrot, and cauliflower.
Improved treatment has increased the life expectancy. There are chances of recurrence, therefore, regular screening is necessary.
• Spread of cancer to other parts of the body.
• Swelling in the breast with pain is a side effect of radiation therapy.
• Breasts sunken, flabby.
• Hard tumor in breasts with stitching or piercing pains at night.
• Feels worse seeing moving objects.
• Bruised feeling all over the body.
• Feels that she must move but moving makes her feel worse
• Breasts very hard and sensitive
• Purple cracks and ulcers around the nipples.
• Burning and stitching pain in the left breast with chilliness all night.
• Thick, yellow offensive pus in the breast.
• Inflammation of nipples.
• Abscess in the breast.
• Fistulous ulcers.
• Painful indurations in breasts.
• Darting pain in the breast.
• Veins appear distended with blue skin.
• The patient is anxious at night.
• Nipples retracted.
• Secretions are thick, ropy and yellowish.
• Indicated in old, easily tired, cachectic individual with great debility.
• Induration of mammary glands.
• Stitching and burning pain in the mammary gland.
• Contractions and boring pains.
• Nipples sore, cracked and blistered.
• Swelling and hardness of breasts.
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