Breast Cancer

What is Breast cancer?

Breast cancer is the malignant tumor that starts in the cells of the breast. It occurs both in men and women.  It is the most common cancer in Indian women. However male breast cancer is rare.In 2018, 1.6lakh new cases and 0.8lakh deaths were reported for breast cancer in India

Types of  Breast cancer

Non-invasive Breast cancer

The earliest form of breast cancer is called non-invasive or pre-invasie breast cancer. Non-invasive breast cancer is when the abnormal cells haven’t spread from their original location. Some of these start in cells in the ducts (the milk ducts) or the lobules (milk-producing glands).

Invasive Breast cancer (ILC or IDC)

Invasive breast cancer spreads beyond the ducts into other nearby tissues in the breast. Invasive ductal carcinoma accounts for over 80% of all cases. Early breast cancers are often small and frequently do not spread to the lymph nodes. There are different types of invasive breast cancer. The two most common are invasive ductal carcinoma and invasive lobular carcinoma.

  • A new mass or lump in the breast. If you have A hard mass, it is more likely to be cancerous
  • Any change in the breast or nipple appearance
  • Unexplained change in shape or size of the breast
  • Unexplained swelling of the breast, especially on one side only
  • Sunken or inverted nipple
  • Redness or scaling of the skin of the breast, nipple or areola
  • Uneven areas or pores on the skin that resemble an orange peel.
  • Clear or bloody discharge other than breast milk
  • Swelling of lymph nodes/glands in armpits or around collar bone.

Other Breast Cancers - Triple Negaative Breast cancer

Triple-negative breast cancer (TNBC) accounts for about 10-15%  of all breast cancers. The term triple-negative breast cancer refers to the fact that the cancer cells don’t have estrogen or progesterone receptors and also don’t make too much of the protein called HER2. (The cells test "negative" on all 3 tests.) These cancers tend to be more common in women younger than age 40, who have a BRCA1 mutation.

Triple-negative breast cancer differs from other types of invasive breast cancer in that they grow and spread faster, have limited treatment options, and a worse prognosis (outcome).

  • Nasal cavity
  • Paranasal sinuses
  • Nasal congestion and stuffiness that doesn’t get better or even worsens
  • Pain above or below the eyes
  • Blockage of one side of the nose
  • Nasal drainage in the back of the nose and throat
  • Nosebleeds
  • Pus draining from the nose
  • Decreased or loss of sense of smell
  • Numbness or pain in parts of the face
  • Constant watery eyes
  • Headache
  • Enlarging lymph nodes in the neck (seen or felt as lumps under the skin)

Diagnosis of Breast cancer

Self & clincal examination

Breast Self Examination (BSE): It can be done at the comfort of your own home.Women who are menstruating – Every month BSE should be done 7 days/ 1 week after the menses have stopped.Post menopausal – On a fine day every month.

Clinical Breast Examination: A doctor examines your breasts and under arm area for any lumps by palpation. Nipples are examined for any suspected discharge, skin changes and retraction.

Invasive tests

Biopsy: Fine needle aspiration biopsy/cytology (FNAB/FNAC): After a positive physical examination/ ultrasound or mammogram, a small piece of tissue/fluid is taken from an abnormal finding area of the breast and examined for cancer cells using a thin needle and a syringe without using anesthesia.

Core needle breast biopsy: A larger, hollow needle is inserted into the breast lump and cylindrical piece of breast tissue (core) is taken out for histopathological examination to confirm cancer. A core biopsy provides more breast tissue for examination than FNA.

Surgical (open) biopsy: Occasionally, surgery may be recommended to remove a part or whole breast lump to check for cancer. This is performed under anesthesia.Nipple discharge cytology (nipple discharge exam): A sample of fluid or discharge from the nipple is examined under the microscope to look for cancer cells. Even if the nipple discharge cytology result is negative, the surgeon may go in for other tests if there is a clinical suspicion.

Imaging tests

Mammogram: A mammography machine uses low-dose x-rays to take images of your breast. First the machine compresses each breast and takes x-ray images on film. This is commonly used for early detection of breast cancer.

Breast Ultrasound: In this procedure, a device sends high frequency sound waves through your breast. The sound signals received from tissues are converted into pictures on computer screen. These images allow the doctor to look for any abnormality.

MRI Scan: In this procedure, a high-powered magnet and a computer is used to scan and to create detailed images of the breast and surrounding organs. Breast MRIs are recommended only in specific cases where mammogram information is insufficient.

IHC tests

Immunohistochemistry (IHC) for HER2 testing:Immunohistochemistry (IHC) Testing: Tissue sample is taken  from the cancer site and sent to pathology lab to see if a tumor has too much of the HER2 receptor protein on the surface of the cancer cells. With too many HER2 receptors, the cells receive too many signals telling it to grow and divide.

Immunohistochemistry (IHC)  for hormone receptor testing: Tissue sample is taken  from the cancer site and sent to pathology lab to see if there are hormone receptors on breast cancer cells. If hormone receptors are present, this means that the cancer cells’ growth is fueled by the hormones estrogen and/or progesterone.

Immunohistochemistry (IHC)  for PDL1 Testing: Tissue sample from Triple Negative Breast cancer patients is taken and sent to pathology lab to see if the  programmed cell death ligand (PD-L1) is expressed  in their cancer.  Your doctor will recommend to test the biopsy sample to know if your cancer will respond to Immunotherapy.

Omics diagnostic tests

Genomics & Transcriptomics: Tests that can identify DNA-& RNA based changes (point mutations, gene amplification, fusion, deletion, insertion, or nucleotide polymorphisms) leading to abnormality at the gene level and requires personalised medicine approach. Tests can range from single gene test, panel of genes, whole exome sequencing, RNA sequencing etc

The new guidelines recommend that gene testing to include BRCA 1/2 and PALB2 mutations (and other genes as appropriate based on clinical scenario and family history) be made available to all newly diagnosed breast cancer patients.

Treatment of breast cancer

Hormonal
therapy

Chemotherapy

Targeted therapy

Immunotherapy

Radiation therapy

Onco surgery

Cancer care team for Brest cancer

  • A breast surgeon or surgical oncologist,
  • A Radiation oncologist
  • A medical oncologist
  • A plastic surgeon

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