Cancer is a dreadful disease. 80% to 90% of all cancers are the result of the things we do to ourselves. Breast cancer are common conditions that primarily affected women. When a women discover a breast lump, her 1st responses is often fear, of breast cancer, of losing her breast perhaps of losing her life. Breast cancer also strikes men, althoughly rarely. Breast cancer rarely seen in the client under the age of 40 years.
Breast cancer is the most common malignant means cells that grow harmfully and uncontrollably.
Anatomy of breast tissue
Modified sweat gland.
Lies in the deep pectoral fascia.
- Clavicle superiorly
- Lateral border of the lattismus dorsi muscle laterally.
- The sternum medially.
- Inframammary fold inferiorly.
- Perforating branches of the internal mammary arteries.
- The lateral thoracic arteries.
- Thoracoacromial arteries.
- Posterior intercostal arteries.
Lymph nodes and Lymphatics
75% Axillary nodes 25% internal mammary.
Carcinoma of breast spreads mostly along the lymphatic to the regional lymph nodes.
- Hormonal factors ( when cell come in contact with estrogen)
- Genetic factors like gene mutation
- Starting menopause at a later age.
- Having a 1st child after age 30 or having no children.
- Women with previous history of breast cancer.
- Not breastfeeding
- Using birth control pills
- Being overweight after menopause
- Before age 12 having first menstruation or entering menopause after age 55.
- Driniking alcohol
- Lack of exercise
- Increased age
- Family history
- Dense breast tissue
- Late age of menopause
Signs and symptoms
- New lump in the breast or underarm.
- There will be swelling or thickening of part of the breast.
- Mass which us hard with irregular borders.
- Irritation or dimpling of breast skin.
- Redness or flaky skin in the nipple area ir breast.
- There will be pain in the nipple area & Pulling in the nipple.
- Nipple discharge other than breast milk.
- Any changes can be happen in the size or the shape of the breast.
Types of Breast cancer
- Ductal carcinoma in -situ
- Lobar carcinoma in situ.
- Invasive ductal carcinoma
- Invasive lobar carcinoma
- Inflammatory breast cancer
- Phyllodes tumor
Stages of breast cancer
Staging of breast cancer can be done by using the TNM classification.
Stage 0: Carcinoma in situ or Non-invasive carcinoma.
Stages I and II: Early
Stage III: Advanced
– Tumor >2cm across & spread to underarm LNs or other tissue near breast is extensive in underarm LNs or spread to LNs near breastbone.
Stage IV: Spread beyond breast & underarm LNs to other parts of the body.
- Clinical breast examination
- MR imagining
- Fine needle aspiration and cytology
- Core biopsy
- Excisional biopsy
Breast Self Examination
Breast self exam: manual inspection (reclining)
Breast self examination can be done with fingertips close together, gently probe each breast in one of thses three patterns.
1. Examine your breasts in the shower.
2.Properly examine your breasts in front of mirrior with your arms down, up & on your hips.
3. Stand & press your fingers on your breast, working around the breast in a circular direction.
4. Lie down and repeat step 3.
5. Squeeze your nipples to check for discharge. Check under the nipple last.
– It is a special type of low-powered x-ray technique. It gives the detailed and acurate images of the internal structure of the breast.
– High resolution mammogram films can demonstrate micro calcifications smaller than 100um.
Ultrasound imaging is an adjunct modality that can be used in the assessment of a breast cancer to find proper diagnosis.
- Chemotherapy uses drugs to destroy cancer cells. Sometimes, chemotherapy is given before surgery in women with larger breast tumors. It can be also used in women whose cancer has been already spread to other parts of the body. Treatment of the cancer with one or more cytotoxic anti- neoplastic drugs.
- It can be either curative or palliative.
- It is also used in conjugation with radiation therapy or surgery.
- Chemotherapeutic agents act by killing the cells that rapidly divide – one of the main properties of cancerous cells.
Standard chemotherapy regimens include:
AT: adriamycin and taxotere
AC +- T: Adriamycin and cytoxan, with or without taxol or taxotere.
CMF: Cytoxan, methotrexate, and fluorouracil.
CEF: Cytoxan, Ellence, and Fluorouracil.
FAC: Fluorouracil, adriamycin, and cytoxan.
CAF: Cytoxan, adriamycin and fluorouracil.
TAC: Taxotere, adriamycin and cytoxan.
GET: Gemzar, Ellence, and taxol
Common combination of chemotherapy regime include
- 5- Flurouracil
Induction therapy- For curative induction therapy is a purpose as the first line of treatment.
Neoadjunctive – Chemotherapy given 1st priority to the local treatment.
Adjunctive chemotherapy- It is given after a local treatment or when little evidence or suspicion about reoccurrence or subclinical cancer is present.
Maintanance chemotherapy- Maintanance chemotherapy low dosage treatment given repeatedly for prolong remission.
Side effects of chemotherapy
- Immunosuppression and myelosuppression.
- Gastrointestinal distress
- Hair loss
- Peripheral neuropathy
Hormonal therapy is prescribed by a doctor to women with ER- Positive breast cancer to block certain hormones that fuel cancer growth. An E.g of hormonal therapy is the drug tamoxifen. Hormonal therapy blocks the effects of estrogen, which can help breast cancer cells survive & grow. Most of the women with the estrogen-sensitive breast cancer benefit from this drug..
Another class of hormonal therapy medicines called aromatase inhibitors, such as exemestane, have been shown to work just as well or even better than tamoxifen in postmenopausal women with breast cancer.
Aromatase inhibitors block estrogen from being made.
- Radiotherapy involves medical use of ionizing radiation, used in cancer treatment.
- Radiotherapy can be used as a curative, adjunctive or palliative care.
- Ionizing radiation its work by damaging the DNA of cancerous tissues which leading to cellular death.
- Dosage is calculated in uniy Gray (Gy)
- Radiotherapy depends upon the type, stage of cancer being treated.
- For curative purpose typical dose given between 60- 80 Gy
- For preventive or adjunctive dose given between – 45- 60 Gy.
- External beam radiation therapy
- Radioisotopes therapy
Side effects of radiation therapy
- Acute- Nausea, vomiting, damage to epithelial cells, lymphedema or infertility.
- Late- Fibrosis of exposed tissues, hair loss occur with > 30 Gy & may br permanent. May also leads to dryness of mouth and eyes.
- Complete breast tissue
- Pectoral muscles
- Axillary lymph nodes
- Associated skin and subcutaneous tissue
Associated post- operative impairments:
- Incisional pain
- Lymphedema will occur due to removal of axillary lymph nodes, which disrupts the normal circulation of lymph.
- There will be a weakness of horizontal adductors of the shoulder, Serratus anterior.
- Postural asymmetry and dysfunction.
Modified radical mastectomy
- Entire breast tissue
- Fascia over the chest muscles
- Axillary lymph nodes
- Pectoral muscles remain intact.
- Reduces cosmetic deformity
- Upper extremity dysfunction can be prevented.
Simple/ Total mastectomy
- Total mastectomy involves surgical removal of the entire breast tissue, but lymphatic tissue & pectoral muscles are preserved.
- Involves a low the moderate risk of lumphedema due to post- operative radiation therapy.
Breast conserving surgery
In lumpectomy surgical removal of lump, and margin of normal tissue surrounding the lump. May includes sampling or removal of axillary lymph nodes.
In segmental mastectomy excision of mass along with some portion of breast tissue.
Excision of affected quadrant of the breast tissue can be removed.
It is regarded as an integral part of modern day of the breast cancer management.
Various techniques available include:
- Silicon implants
- Lattissimus dorsi myocutaneous flaps (LD)
- Transverse rectus abdominis myocutaneous flaps (TRAM)
- Gluteal free flaps
Prevention of breast cancer
- Get screened for breast cancer regularly.
- Control your weight and do regular exercise.
- Know your family history of breast cancer.
- Limit the amount of alcohol
- Avoid induced abortions
- Avoid unnecessary medical radiation exposures.
- Prevention mastectomy