Breast Cancer

• Lump- Painless lump in breast which was not present earlier.
• Sudden change in symmetry of breast, fullness or abnormal shrinkage of breast.
• Nipple-blood in nipple discharge, sudden retraction or inversion of nipple
• Skin changes- ulceration, orange peel like dotted appearance
• Arm pit (axilla) - Fullness, lump.

Severe back pain, continuous cough, breathlessness loss of appetite- in advanced stages of cancer patient can present with these symptoms.

Breast is a hormone responsive organ. Most of the causes are related to change in balance of estrogen and progesterone hormone levels, of body.

Non modifiable- causes which cannot be changed

Gender females are at higher risk of getting cancer. About 1% of Males also can get breast cancer

Age Chances of getting breast cancer increases with the age,

Family history

Only 5-10% of breast cancer are inherited .These cancers are related to sudden changes (mutation) in genes controlling normal cell functioning of our body. BRCA 1 and BRCA 2 are most common genes associated with breast cancer .There many other genes which responsible for breast cancer but frequency of mutation is very less.

Estrogen exposure

Early menarche (getting first menses at an early age) and delayed menopause (time when menses stops) it exposes a female to estrogen for prolonged time.
Dense breast: Everybody has different breast texture. Having dense breast is considered a high-risk forgetting cancer. Personal history of having breast cancer.
Some pre-cancerous breast diseases like atypical hyperplasia or lobular carcinoma in sit
Radiation exposure -Radiation exposure of breast while taking treatment for certain cancer in young age can cause breast cancer in future. Although with new radiation therapy technologies radiation exposure can be restricted.

Modifiable

• Obesity: excessive weight I carries higher risk of breast cancer. In postmenopausal ladies’ body fat is source of estrogen hormone
• Sedentary life style- in turn can lead to obesity
• Alcohol consumption
• Excess estrogen exposure- hormone replacement therapy, supplements etc

Life style modification: This is most important strategy to avoid breast cancer. Healthy food habits with adequate physical activity. Controls of habits e.g. avoid excess alcohol consumption.

Screening: Screening is a test done in healthy individuals to detect any abnormality or cancer in early stage. Screening is usually performed by trained medical professionals.

Self-breast examination: Usually after the age of 20 years all the women should start examining there breast at least once a month. Although it is difficult to diagnose any cancer by this method but it is good practice to understand about self-body to notice any changes if happens.

Clinical breast examination: This is examination of breast by experts. It can be started as early as 30 years. It can be performed semiannually or annually.

Imaging:

• Mammogram: In simpler terms, it is an X-ray of the breasts. There are different guidelines for screening mammogram. It can be started after 40 to 50 years of age not before that. Mammogram can detect small breast lumps, abnormal calcification, and architectural distortion in very early stage.
• Breast MRI: For high risk women having strong family history, having confirmed genetic mutation MRI is preferred to rule out any breast cancer.

What If breast lump is detected

Although not all the breast lumps are cancerous but any breast lump should be one examined and evaluated by specialists.

There are three basics way to evaluate breast lump known as triple test-

• Clinical examination by expert
• Imaging -For women younger than 40 years ultrasound of both the breast is preferred investigation. Mammogram should be done after the age of forty years. Although if doubt of malignancy is high it can be done in younger age too
• Biopsy -To confirm the nature of lump biopsy is being performed which is nothing but taking small bit tissue from lump. It is usually an office procedure. Usually it is a pain less procedure and if needed done by using local anesthesia to avoid any discomfort to patient

Once the diagnosis of cancer is confirmed certain investigations are done to know he stage of cancer. Depending on the clinical examination chest X-ray CT scan chest, Ultrasound abdomen or PETCT scan is advised to know the stage of cancer. To plan the treatment staging is very important.

Breast cancer needs essentially multimodality treatment. It is combination following

Surgery It can be done first or sometime after administrating chemotherapy. Surgery is basically directed to remove lump and adjacent lymph nodes in axilla. It can be of different types-

• Mastectomy: Modified radical mastectomy is removal of full breast with axillary lymph nodes.
• Breast conservation surgery (BCS): Removal of cancerous lump along with axillary lymph node dissection. BCS is always combined with radiation therapy in order to avoid recurrence.
• Plastic reconstruction – there are multitude of options available to reconstruct the breast to give a god cosmesis. It can be rotation of tissue, muscle and skin from nearby part known as pedicle flap It can be done as free flap also.
• Chemotherapy - These are the drugs against cancer. Usually given in the form of injections. There are few tolerable side effects which have reduced even more with new forms of chemotherapy. Chemotherapy is very important to control the cancer cells circulating in blood.
• Radiation therapy: It is type of X rays which are given to operated area to avoid any recurrence.
• Hormone therapy: Breast cancer is a hormone driven cancer. For treatment of breast cancer assessment of hormone receptor status is must. Depending on the presence or absence of hormones hormone therapy is offered after completion of all other treatment.
• Targeted therapy: like hormone receptor there is another target known as HER2 Neu is very essential to plan the treatment. If HER2Neu is present treatment against the same gives very good results