Breast Cancer - Types, Symptoms, Risk Factors & Treatment
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Breast Cancer - Types, Symptoms, Risk Factors & Treatment

The deterioration in the genetic structure of the cells lining the mammary glands or ducts and their uncontrolled proliferation is called breast cancer. Although the deterioration of cell structures in the breast is not known precisely, research has proven that the risk increases in some cases. In our article, together with these risk factors of breast cancer; We will describe the symptoms, types, and treatment methods.

Due to their different predictive properties, breast cancers are divided into three large groups as early, locally advanced, and metastatic.

1) Early Stage Breast Cancers
 

In the vast majority of early-stage breast cancers, the symptom is a mass in the breast. Other symptoms are nipple discharge, nipple collapse, retraction, and itching. Women may also rarely present with a complaint of swelling in the armpit.

Breast cancers are most common in the upper outer quadrant (45%). The incidence in other quadrants is central (25%), upper inner (15%), lower outer (10%), and lower inner (5 percent), respectively.

In clinical examination, a firm, irregularly circumscribed, painless, non-mobile (but can be moved with breast tissue) mass is palpated. In early-stage breast cancer, mobile and non-adherent lymph nodes in the axilla can be detected.

Diagnostic Methods

 

  • Mammography: Usually not very helpful in diagnosing women under the age of 35. Because the breast parenchyma is dense during this period.
  • Ultrasonography: More information is obtained from mammography in young women. In malignant tumors, blood flow is increased, and the shape of the blood vessels is radial.
  • MRI
  • Cytology: Cytological examination of nipple discharge or cyst fluid may rarely be helpful.
  • Breast biopsy
  • Fine needle aspiration biopsy: It is performed using a 22 g (gauge) fine needle. It has high sensitivity and specificity in diagnosing malignancy.
  • Core needle biopsy: It is superior to fine-needle aspiration biopsy as it allows larger tissue samples to be taken. It also enables advanced pathological tests such as hormone receptor determination.
  • Incisional biopsy: It is the process of taking a small piece from the mass without removing it completely.
  • Excisional biopsy: It is the surgical removal of the entire mass.

Treatment of Early Stage Breast Cancers

Today, the primary treatment for early-stage breast cancer is surgery. Surgical treatment of breast cancer is performed for the breast and armpit. To remove the tumor in the breast, conservative breast surgery (tumorectomy, wide local excision, lumpectomy, quadrantectomy) or mastectomy (removal of the entire mammary gland and pectoral fascia together with the skin) is performed. If axillary curettage is performed together with mastectomy, this procedure is called modified radical mastectomy. Prospective studies have shown that radical surgical resections do not change long-term survival outcomes. For this reason, conservative breast surgery has been preferred more in recent years.

Conservative breast surgery is an accepted approach in the following situations:

  • Unifocal tumors less than 2 cm
  • Breast volume is sufficient to achieve an excellent cosmetic result
  • Extensive local removal of the tumor is possible
  • To reduce the possibility of local recurrence, the patient accepts radiotherapy or does not have a condition that prevents radiotherapy.
  • In the pathological examination of the specimen, the presence of a healthy part without tumor cells at the excision margins
  • Patient's preference for conservative breast surgery
  • The appropriate surgical approach is mastectomy in the following situations:
  • Multifocal (multifocal) or multicentric (multicentric) tumors
  • Centrally located tumors
  • Small breasts without good cosmetic results
  • Extensive microcalcifications around the tumor or malignant alone on mammography
  • Failure to obtain a tumor-free surgical margin despite repeated excisions
  • Collagen tissue disease (relative contraindication)
  • Patient preference

Radiotherapy is applied after conservative breast surgery as it significantly reduces local recurrence rates. Recent studies have shown that 70-80% of patients with early-stage breast cancer do not have axillary lymph node metastases. Therefore, SLN biopsy is a method that prevents unnecessary ALND. The Sentinel lymph node is the first nodule or nodules to drain from the breast.

When recurrence is detected in the breast after BCS, performing a mastectomy is the standard treatment.

2) Locally Advanced Breast Cancers


Approximately one-third of breast cancers, divided into three early, locally advanced, and metastatic groups, occur at locally advanced stages.

This group includes Stage IIIA, which includes N2 tumors other than T3N1M0, which can be used at the time of diagnosis; Stage IIIB, which includes T4 tumors; and Stage IIIC, which includes N3 tumors. Large Stage IIA tumors treated with breast-conserving surgery after neoadjuvant chemotherapy are excluded from this definition.

Suppose the patient complies with breast-conserving treatment criteria other than tumor size. In that case, breast-conserving surgery treatment option after neoadjuvant treatment in large stage IIA, IIB, and T3N1M0 tumors become a necessity that should be stated to him.

Locally advanced tumors usually present with signs of infiltration into the skin or chest wall or with fixed lymph nodes in the ipsilateral axilla.

Among the locally advanced breast cancers, inflammatory carcinomas have the fastest course and unfavorable prognosis.

Generally, a combination of neoadjuvant chemotherapy, surgical treatment, adjuvant chemotherapy, radiotherapy, and endocrine therapy according to receptor status is the commonly used sequence.

3) Metastatic (Surgical Approach to Distant Metastases)


The most common distant metastases in breast cancer are bone, lung, brain, liver, and adrenal gland. Rarely, gastrointestinal system metastases are also encountered.

Lung (Thorax) Metastases


The lung is the organ where breast cancer metastasizes most frequently after bone. 17% of breast cancer metastases are lung metastases.

Surgical resection of lung metastases is not standard practice. However, it comes to the fore in selected cases with limited lung metastasis in which local control of the primary tumor is achieved.

One of the most critical problems in patients with breast cancer is malignant pleural effusion. In addition, pericardial metastases can cause pericardial effusion and associated cardiac tamponade.

Central Nervous System (Brain) Metastases


Breast cancer is the second most common type of cancer that metastasizes to the brain after lung cancer. 10-25 percent of breast cancers metastasize to the brain within 3 years of primary tumor diagnosis. The most suitable for surgical treatment is solitary metastasis.

The gold standard in diagnosing parenchymal, leptomeningeal, and spinal metastases is “Gadolinium-enhanced” magnetic resonance imaging. The most appropriate method to confirm the diagnosis is a stereotactic needle biopsy.

Liver Metastases


The presence of liver metastases in breast cancer patients is usually widespread and is a sign of poor prognosis. Survival in the environment is limited to 4-12 months.

Although the indication for surgical treatment is controversial, the most suitable candidates are patients with a single lesion and no metastases other than the liver.

Adrenal Metastases


Adrenal (adrenal) glands are the organs that are exposed to metastasis in the 4th frequency after the lungs, liver, and bones. The cancers that metastasize most to this region are lung and breast cancers.

PET (positron emission tomography) used for metastasis scanning reveals these lesions with 95-100% sensitivity.

Risk Factors in Breast Cancer


According to 2007 statistics, breast cancer is the most common type of cancer in women. It accounts for 26 percent of all cancers. After lung cancer (26 percent), breast cancer (15 percent) takes second place in cancer-related deaths. Although there are many risk factors for breast cancer, 70 percent of women who develop breast cancer do not have any risk factors.

  • Age: Breast cancer is more common in the postmenopausal period. The incidence of breast cancer doubles every 10 years until menopause. Women over the age of 65 are 6 times more at risk than younger women.
  • Genetic factors: BRCA1 and BRCA2, defined as genes for breast and ovarian cancer susceptibility, are located on chromosomes 17 and 13. Women with the BRCA1 gene have a 60-85 percent lifetime risk of developing breast cancer and a 10-40 percent risk of developing ovarian (ovarian) cancer. The BRCA2 gene is a gene that plays a role in the occurrence and bilateral (bilateral) formation of breast cancer in familial cases. Those who carry this gene have an 87 percent risk of developing breast cancer.
  • Family history: Having a family history of breast cancer is a significant risk factor. This risk is higher if first-degree relatives (mother, sister, child) have breast cancer. This risk increases as the number of breast cancer patients in the family increases. Mothers of breast cancer patients have twice the risk of developing breast cancer than the average population, and their sisters have 2.5 times the risk of developing breast cancer. Bilateral cancer increases the risk of breast cancer 5 times. The risk increase in the relatives of a patient with premenopausal bilateral cancer is 9 times more.  A young woman whose mother and sister have breast cancer has a 50 percent lifetime risk of developing breast cancer.
  • Age at menarche and menopause: Early first menstruation and late menopause also increase the risk of breast cancer, as they increase the amount of time women are exposed to hormones. Each year of a missed period, the risk of breast cancer decreases by 20 percent. Women who go through menopause after age 55 are twice as likely to develop breast cancer as those who go through menopause after age 45.
  • Age at first pregnancy-first birth: While nulliparity and having the first birth at a late age increase the risk of breast cancer, a pregnancy terminated at an early age reduces the risk of breast cancer by 10-13 percent. Women who gave birth after the age of 30 have twice the risk of cancer compared to women who gave birth before the age of 20. Paradoxically, as a different approach, the risk in pregnancy after the age of 35 is higher than in women who have never given birth. Second birth at an early age provides additional reduction in breast cancer.
  • Lactation (milk period): Some studies suggest that lactation reduces the risk of breast cancer.
  • Previous breast cancer: In patients diagnosed with breast cancer, the risk of developing breast cancer for the other side is 0.5-1 percent per year. This risk varies according to the age at which breast cancer is diagnosed.
  • Benign breast disease: Benign lesions that do not increase in cells such as simple cyst, fibrosis, simple fibroadenoma, duct ectasia do not increase the risk. The risk increases 4.5 times in women with atypical hyperplasia, and 9 times in those with a first-degree relative with breast cancer in addition to atypical hyperplasia.
  • Oral contraceptives (OCS): The relationship between the use of OCS and breast cancer is controversial.
  • Hormone replacement therapy (HRT): There is an association with long-term use of HRT and an increased risk of breast cancer. The risk increase is mostly with combined preparations. The use of estrogen and progesterone combinations for 5 years causes a 26 percent increase in risk.
  • Obesity: Although obesity doubles the risk in postmenopausal patients, obesity appears to be protective in premenopausal women.
  • Alcohol: Studies show that alcohol intake increases the risk of breast cancer. Drinking 15 grams or more of alcohol per day increases the risk by 50 percent compared to non-drinkers.
  • Diet: There are opposing views that eating a diet rich in fat increases the risk of breast cancer. Intake of vitamins A, C and E may reduce the incidence of premenopausal breast cancer.
  • Cigarette
  • Physical activity: Women under the age of 40 who exercise 4 hours or more per week have a 60 percent lower risk of breast cancer than women who do not exercise at all.
  • Radiation: The development of radiation-induced breast cancer is related to the duration of radiation exposure and develops over a long period of time. After the age of 40, the increased risk of mammography is not significant and screening is associated with a decrease in mortality.

You can read more about cancer in the articles below:

What is Cancer? - Causes, Symptoms & Treatment

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Stomach Cancer - Types, Symptoms, Diagnosis & Treatment

Colon (Intestinal) Cancer - Symptoms, Diagnosis & Treatment

Brain Cancer - Causes, Symptoms, Diagnosis & Treatment

Lung Cancer - Symptoms, Causes, Diagnosis & Treatment

Skin Cancer - Causes, Types, Symptoms & Treatment

Ovarian Cancer - Symptoms, Diagnosis, Stages & Treatment

Prostate Cancer - Symptoms, Diagnosis & Treatment

Liver Cancer - Risk Factors, Symptoms, Stages & Treatment

Kidney Cancer - Causes, Symptoms, Stages & Treatment

Pancreatic Cancer - Symptoms, Diagnoses, Stages & Treatment

Uterine (Endometrial) Cancer - Symptoms, Diagnosis & Treatment

Laryngeal & Hypopharyngeal Cancers - Symptoms, Causes & Treatment

Lip Cancer - Causes, Diagnosis, Risk Factors & Treatment

Salivary Gland Cancer - Causes, Symptoms & Treatment

Biliary Tract Cancer - Causes, Risk Factors, Symptoms & Treatment

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