BREAST CANCER

INTRODUCTION: Cancer of the breast is a pathologic entity that starts with a genetic alteration in a single cell and may take several years to become palpable. The most common histologic type of breast cancer is infiltrating ductal carcinoma, whereby tumors arise from the duct system and invade the surrounding tissues. These tumors arise from the lobular epithelium and typically occur as an area of ill-defined thickening in the breast. Infiltrating ductal and lobular carcinomas usually spread to bone, lung, liver, adrenals, pleura, skin, or brain.

CAUSES OF BREAST CANCER: There is no one specific cause of breast cancer; rather, a combination of genetic, hormonal, and possibly environmental events may contribute to its development. If lymph nodes are unaffected, the prognosis is better. The key to improved cure rates is early diagnosis, before metastasis.

RISK FACTORS:

1. Gender and in specific female, and increasing age.

2. Previous breast cancer: The risk of developing cancer in the same or opposite breast is significantly increased.

3. Family history: Having first-degree relative with breast cancer (mother, sister, daughter) increases the risk twofold; having two first-degree relatives increases the risk fivefold.

4. Genetic mutations account for majority of inherited breast cancers.

5. Hormonal factors: early menarche for example before 12 years of age, nulliparity, first birth after 30 years of age, late menopause that is to say; after 55 years of age, and hormone therapy also formerly referred to as hormone replacement therapy.

6. Other factors may include exposure to ionizing radiation during adolescence and early adulthood obesity, alcohol intake.

PROTECTIVE FACTORS: Protective factors may include regular vigorous exercise, pregnancy before age 30 years, and breastfeeding.

PREVENTION STRATEGIES: Patients at high risk for breast cancer may consult with specialists regarding possible or appropriate prevention strategies such as the following:

1. Long-term surveillance consisting of twice-yearly clinical breast examinations starting at age 25 years, yearly mammography, and possibly MRI

2. Chemoprevention to prevent disease before it starts, using tamoxifen and possibly raloxifene

CLINICAL MANIFESTATIONS: Generally, lesions are nontender, fixed, and hard with irregular borders; most occur in the upper outer quadrant. Some women have no symptoms and no palpable lump but have an abnormal mammogram. Advanced signs may include skin dimpling, nipple retraction, or skin ulceration.

ASSESSMENT AND DIAGNOSTICS: Biopsy for example percutaneous or surgical, and histologic examination of cancer cells. Tumor staging and analysis of additional prognostic factors are used to determine the prognosis and optimal treatment regimen. Chest x-rays, CT, MRI, PET scan, bone scans, and blood work, that is, complete blood cell count, comprehensive metabolic panel, tumor markers.

Medical Management: Various management options are available. The patient and physician may decide on surgery, radiation therapy, chemotherapy, or hormonal therapy or a combination of therapies. Modified radical mastectomy involves removal of the entire breast tissue, including the nipple–areola complex and a portion of the axillary lymph nodes. Total mastectomy involves removal of the breast and nipple–areola complex but does not include axillary lymph node dissection.

Chemotherapy to eradicate micrometastatic spread of the disease: cyclophosphamide, methotrexate, fluorouracil, anthracycline-based regimens (eg, doxorubicin, taxanes (paclitaxel, docetaxel).

Hormonal therapy based on the index of estrogen and progesterone receptors: Tamoxifen is the primary hormonal agent used to suppress hormonal-dependent tumors; others are inhibitors anastrazole.

RELATED;

1.  BREAST EXAMINATION

2.  THE ORIGIN OF CANCER

3.  OVULATION AND THE MENSTRAUL CYCLE

4.  OXYTOCIN

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