Definition and Overview

Carcinoma of the breast is the most common type of breast cancer. Carcinoma is cancer that begins in the skin or other tissues that line or cover an internal organ. There are different types of carcinoma of the breast and are named based on their location and how they spread. These include the following:

  • Ductal carcinoma in situ (DCIS) - Breast cancer that starts inside the milk ducts. The term situ means “in its original place.” DCIS does not spread beyond the milk ducts. Thus, it usually has a very high cure rate.

  • Infiltrating ductal carcinoma (IDC) - IDC accounts for about 80% of all breast cancers. Just like DCIS, IDC also begins in the milk ducts. But unlike DCIS, IDC can spread to lymph nodes and other parts of the body. IDC has many subtypes. One of them is tubular carcinoma, which tends to be low-grade and highly responsive to treatment.

  • Invasive lobular carcinoma (ILC) - ILC starts in the lobules. It can spread to lymph nodes and other parts of the body.

Causes of Condition

Breast cancer occurs due to damage to the cell’s DNA. This causes breast cells to grow abnormally. Abnormal cells divide more rapidly than healthy cells. When they accumulate in one area, they form a tumour.

What damages the cell’s DNA is unknown. However, some hormonal, lifestyle, and environmental factors are thought to play a role. Those who have an increased risk of breast cancer are women with close relatives who have the disease. Those with a history of breast cancer and other types of breast lumps are also at risk.

Other risk factors include:

  • Exposure to radiation for the treatment of another type of cancer around the chest area

  • Advancing age

  • Having breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes

  • Being obese or overweight

  • Combined therapy for menopause

  • Alcohol abuse

  • Having never been pregnant

  • Using contraceptives in the last ten years

  • Late menopause

Key Symptoms

Breast cancer usually does not have symptoms in the early stages. Thus, early detection is crucial. Doing regular breast self-exam can help patients catch the disease before it advances. Symptoms below should prompt them to see their doctor:

  • A mass or lump in the breast - Any abnormal mass in the breast, around the collarbone, or under the arm should be checked by a doctor. The sooner it is checked, the better. Prompt diagnosis and treatment greatly improve treatment outcomes.

  • Swelling of a part or the entire breast. This should be brought to the attention of a doctor even if the patient does not have a breast lump.

  • Breast or nipple pain. This symptom is not specific to breast cancer. It can be caused by many factors. These include the fluctuation of hormones during menstruation and extreme stress. But breast pain that does not go away after the monthly menstrual cycle could be a sign of breast cancer.

  • Changes in nipples - Breast cancer can cause nipples to turn inward.

  • Changes in breast skin - These changes may include redness, thickening, and itchiness.

Other symptoms include visible veins on the breast, vaginal pain, and unintentional weight loss.

It is important to note that having these symptoms does not necessarily mean that a person has breast cancer. They can be caused by other less serious breast conditions. These include breast infections and non-cancerous breast lumps.

Who to See and Types of Treatments Available

Early detection and prompt treatment are the keys to cure breast cancer. If the malignant tumour is found and treated early, the prognosis for patients is often excellent.

Tests used to diagnose breast cancer include:

  • Mammogram - A mammogram is an x-ray test used to look for any changes in breast tissue. It can be carried out even when the patient does not have symptoms (screening mammogram). It is also used if a doctor finds a lump or other abnormalities during a breast exam (diagnostic mammogram).

  • Ultrasound - Ultrasound is a noninvasive test that doctors use when a mammogram detects abnormalities. The test creates pictures of structures surrounding the breast. This helps doctors determine if the lump is a solid mass or is filled with fluid.

  • Magnetic resonance imaging (MRI) - A breast MRI is carried out in patients diagnosed with breast cancer. The test is used to measure the size of the tumour and determine if cancer has already spread.

Patients diagnosed with breast cancer have to undergo a series of tests to determine the stage of their condition. This determines their prognosis and best treatment option. Tests to determine the stage of cancer are breast MRI, blood tests, and bone, CT, and PET scans.

Breast cancer stages range from 0 to IV. Stage 0 means that cancer is small and localised. Stage 4, on the other hand, means that cancer cells have spread to different parts of the body.

The standard treatment for breast cancer is surgery. Its goal is to remove the entire tumour as much as possible. Small, localised tumours can be removed without affecting surrounding structures. However, surgical treatment of advanced cases often requires the removal of the entire breast and surrounding lymph nodes. Surgery is often followed by chemotherapy or radiation therapy. These are used to kill cancer cells that were not taken out by surgery.

The prognosis for patients depends on the stage of their condition and how soon they received treatment. In general, the five-year survival rates for breast cancer patients are as follows:

  • Stages 0 and I - Up to 100%

  • Stage II - 93%

  • Stage III - 72%

  • Stage IV - 22

Stage IV breast cancer can be very difficult to treat because cancer cells have already spread to other parts of the body. Its treatment is often supportive in nature. Cancer treatments are often used not to cure the disease but lessen the severity of symptoms to make patients comfortable as much as possible.

References:

  • Townsend CM Jr, et al. Diseases of the breast. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. https://www.clinicalkey.com.

  • Breast cancer prevention — Patient version (PDQ). National Cancer Institute. http://www.cancer.gov/types/breast/patient/breast-prevention-pdq.

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