Breast cancer — symptoms, stages and treatment options

• Signs and symptoms
• Diagnostics
• Stages of breast cancer
• Breast cancer treatment options
• Treatment according to stages
• Prognosis and survival rate

Breast cancer is a malignant tumor of the glandular tissue in the woman’s breast, which can spread (metastasize) or grow into (invade) distant areas of the body. It is the most common malignant female disease. The tumor takes the 2nd place among all oncological diseases in the world.

How does breast cancer spread?

Breast cancer spreads fast and asymptotically. Women often visit a doctor only in the advanced stages (III-IV), when the tumor has metastasized and grown into the healthy tissues. Cancer gets into the blood, lymph or other parts of the body.

World’s prevalence of breast cancer

The incidence of breast cancer increases by 0.3% per year in white people in comparison with American-African women or other races. The highest level of the disease incidence is in North America, West Europe, and Oceania.

Breast cancer incidence worldwide is given in the graphic below. It shows the age-standardized rate per 100,000 women. Age-standardization is a statistical method that removes the effect of age on the calculated rate.

White women suffer from breast cancer 100 times more frequently than white men. Black women have breast tumors 70 times more often in comparison with black men.

White women face breast cancer in 13% of all cases, black — in 11%, Asian people — in 11%, Hispanics — in 10% of cases.

The disease is the most frequently diagnosed cancer in 140 countries of 189 globally. Breast cancer incidence is lower in less developed countries and higher in more advanced states.

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Causes of breast cancer

Age

Breast malignancy is not an age-related disease. Women at 13-90 years old can be affected by it. Only 5% of all breast tumors occur in women under 40. The risk of cancer development increases with age.

Breast cancer statistics by age shows that risk grows by:

• 0.5% in 40-aged women
• 4% at the age of 40-60 years
• 7% at 60-80 year profile.

Gender

The disease commonly occurs in women, but men can get it too. 1 in 1,000 men has breast cancer.Genetics

Сarcinoma affects not only those people who have a genetic predisposition. 70% of women with breast cancer had no hereditary predisposition to the disease. Women whose family members have suffered from this disease are at risk. They should undergo regular breast check-ups.

Genetics play a significant role in less than 5% of cases. BRCA1 and BRC2 gene mutations are the main reason for hereditary breast cancer. These mutations cause 90% of genetic tumors according to the Journal of Surgical Oncology report. Specific gene mutations are passed from parents to children.

Lifestyle

Bad habits and wrong lifestyle can also lead to breast cancer. They are called modified risk factors because people can change these things themselves.

• obesity — high cholesterol level is a bad influence on the body and turns on the formation of the malignant cells
• alcohol — oncology of breast is more constant among heavy drinkers according to Alcoholism Clinical and Experimental Research
• smoking tobacco — breast cancer risk is 35-50% higher in long-term smokers according to Canadian experts report
• radiation — a lot of radiation diagnostics can lead to the formation of malignant neoplasms in the chest
• sitting regularly — women with lack of physical activities face the disease 10% more frequently. Sitting for a long time increases breast cancer mortality rate.

Personal features

• early periods (under 12 years)
• late menopause
• late 1st child — means having a baby in 35+ years old
• having never been pregnant
• previous breast conditions
• postmenopausal hormone therapy.

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How to prevent breast cancer?

Breast cancer won’t be 100% prevented. But every woman can reduce the risk of its development. How?

• Provide self-examinations monthly
• visit a breast physician annually
• build healthy intimacy
• keep in fit
• quit smoking
• limit drinking and eating of junk food
• wear comfortable bra that does not compress the breast.

Types of breast cancer

Oncologists classify breast tumors according to their extension, types of cells, and molecular structure. Statistics of breast cancer types given below has been represented by American Cancer Society and National Breast Cancer Foundation.

According to tumor extension, breast cancer is divided into:

• invasive — the malignant tumor that extends beyond the milk duct or lobule, and grows into the healthy tissues
• non-invasive (in situ) — cancer is located in one place and does not spread in surrounding tissues.

According to the type of cancerous cells, breast cancer is distinguished into:

1. carcinoma

It is a malignant tumor developed from the epithelial cells, which lines organs, tissues, and glands in the human body. It is the most common type of breast cancer and occurs in 80% of cases.

There are such types of breast carcinoma:

• ductal carcinoma

It is a malignancy of the breast milk duct. 2 kinds of ductal carcinoma exists. Ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC). The former one means that breast cancer is still situated in the milk ducts.

In case of the latter one, the tumor begins to invade the surrounding tissues.

• lobular carcinoma

Such a kind of the disease describes the neoplasm in the milk-producing glands (lobules). It also can be of 2 types. Lobular carcinoma in situ (LCIS) or lobular neoplasia is not considered to be cancer. It is a breast change that looks like the tumor in the lobules.

LCIS can lead to invasive lobular carcinoma (ILC), which metastases to other body tissues. If a woman has LCIS, the risk of invasive carcinoma development is 7-12 times higher.

2. Inflammatory breast cancer (IBC)

IBC is an uncommon type of breast tumors which is characterized with redness or swelling. This cancer is atypical. There are no lumps, and it isn’t shown on the mammogram. It occurs in young women. African people are at higher risk of IBS than the white ones.

3. Paget's disease

It is the nipples cancer. The tumor begins its grows in the milk duct and then spreads to the nipple and areola (the dark circle part of the nipple). 1-3% of breast malignancies are Paget's disease.

4. Phyllodes tumors

Phyllodes neoplasms are rare. They develop in the stroma (connective tissue). Most of them are benign, but malignant can occur as well. 1 of 4 phyllodes tumors is cancerous.

5. Angiosarcoma

Sarcomas of the breast make less than 1%. It is called angiosarcoma. This type of cancer develops in the line of blood and lymph vessels.

According to Hormone Receptor Status, breast cancer can be:

Hormone receptor test (immunohistochemistry or IH) is performed for detecting specific proteins (estrogen and progesterone hormones) that make cancer grows. Cells that include estrogen are called ER-positive, those that contain progesterone — PR-positive. 2 of 3 breast cancers have at least one of these hormones.

According to the test results, oncologists determine such type of breast tumors:

• Hormone-positive — cancerous cells contain both estrogen and progesterone. This kind of neoplasm grows more slowly in comparison with hormone-negative ones. That’s why treatment is easier. Hormone therapy is the best treatment option in this case.

• Hormone-negative — malignant cells do not include estrogen or progesterone. The tumor develops faster than in the former case. Cancer may come back in several days after the treatment.

• Triple-negative — cells do not have these hormones and do not produce enough protein called HER2 (grows-promoting protein in the outside of the breast cells). African-American and Hispanic women have this kind of breast cancer. Triple-negative breast cancer grows and spreads faster than other types. Chemotherapy helps to treat this tumor.

• Triple-positive — malignancy is ER-, PR-, and HER2-positive. Hormone therapy is the best treatment option for women with triple-positive cancer.

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Breast cancer signs and symptoms

There are signs of the disease that should alarm women. Due to these signs, 60% of breast neoplasms are diagnosed in the early stages (I-II). Among breast cancer symptoms in women are:

• painless lump in the gland
• changing of the breast shape
• wrinkling or retracting of the breast skin
• discomfort or pain in one of the bust
• swelling on the nipple
• bloody discharges from the nipples
• enlargement of axillary lymph nodes.

Each of these early breast cancer symptoms is a reason to visit a doctor immediately.

Best breast cancer hospitals

Germany Best physician for breast cancer treatment

Israel Highest success rate of breast cancer therapy

Turkey All treatments are available

Diagnostics

• Clinical breast exam

The exam is performed with a qualified doctor. Durig the examiation, a physician checks breast for lumps or other physical changes sliding with fingers over the breast. A doctor also checks out medical records of a woman. The primary aim of such a diagnostics is early detection of cancer.

Additional diagnostic methods are prescribed if a doctor has found some abnormalities of the breast during the clinical breast exam.

• Mammogram

It is an X-ray standard diagnostic breast cancer screening. The breast is exposed with a small dose of radiation, which produces the image of the breast tissue. The mammogram helps to detect the tumor before its first signs and establish its exact size.

• Ultrasound

When a doctor has found a suspicious lump with the mammogram, it is essential to investigate whether it is benign or malignant. That’s why a physician prescribes ultrasound. It is an additional scan test. Ultrasound can also detect malignancies, which haven’t been found by mammogram.

• Biopsy

If a solid mass appears on the ultrasound, a radiologist may recommend a biopsy. During the procedure, a doctor removes cells from the suspicious area with a needle to check the presence of cancer. Biopsy does not mean the presence of the disease. 80% of women who have undergone biopsy do not have breast cancer.

• MRI

Magnetic Resonance Therapy or MRI for breast cancer is recommended to observe the disease extent. It is a scan of the body with radio waves to view organs and tissues of the body.

• Lab tests

Blood test for breast cancer and breast cancer markers test are necessary. Specialists expose pathologies which characterise the disease.

If a woman has been diagnosed with breast malignancy, a doctor prescribes lab tests. They usually include hormone receptor test and HER2 test. These tests help to determine the type of breast cancer and to specify the best treatment option in each particular case. Learn more about breast cancer types according to hormone and HER2 testshere.

• CT and PET-CT

CT helps to detect metastases. Specialists conduct PET-CT screening to catch cancer at its 0 stage. This kind of diagnostics can identify the smallest tumors up to 1mm (about the size of a pea).

Stages of breast cancer

Stage of the disease shows the tumor size and its grows into the surrounding organs and tissues of the body.

Breast cancer stages:

• stage 0

Cancer is non-invasive. Malignant cells do not spread to the healthy ones.

• stage 1

The tumor becomes invasive. Cancerous cells appear in the surrounding tissues. The lump is up to 2cm in size and is hardly diagnosed during the clinical breast exam.

• stage 2

The malignancy is 5cm in size. It is meant to be the size of hotel bar soap. Cancer has grown into the axillary lymph nodes (under the arm).

• stage 3

Malignancy can be of 2 types: IIIA and IIIB breast cancer. IIIA tumor is invasive, its size is up to 5 cm neoplasm which has mostly spread to the axillary lymph nodes. IIIB breast cancer may be of any size. In this case the tumor has invaded the breast skin, the axillary lymph nodes, and the chest wall.

• stage 4

Сancer has expanded beyond the breast and has spread to the lymph nodes near the neck, lungs, and liver.

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Breast cancer prognosis

Breast cancer stages 0, 1, and 2 are considered the early ones. It means that women with these stages have high chances for recovery. The success rate in the stages 3 and 4 is lower.

Breast cancer treatment options

An oncologist prescribes treatment method for breast cancer according to diagnostics results. Usually, it is affected with the tumor size, stage, number of metastases, woman’s age, and pregnancy planning.

There are such breast cancer treatment options as:

1. cryoablation
2. surgery
3. chemotherapy
4. hormone therapy
5. targeted therapy
6. radiation therapy
7. immunotherapy.

Cryoablation for breast cancer treatment

Oncologists perform cryotherapy for treatment of 0 and I breast cancer stages. During the procedure, a doctor

damages the cancerous cells with the liquid nitrogen, which is administered in the tumor.

Surgery as primary method for breast cancer therapy

Surgery is a primary method for breast cancer treatment. Oncologists remove the tumor and in some cases the invaded lymph nodes in the early stages. There are 2 kinds of surgical intervention:

Lumpectomy is an organ-preserving operation. Specialists remove only the cancerous part of the breast and some surrounding healthy tissues. Doctors determine the organ part they should resect according to the size and location of the neoplasm. There are other names of this procedure: quadrantectomy, partial mastectomy, or segmental mastectomy.

Mastectomy is a radical procedure. Oncologists remove the entire breast and some surrounding tissues. Some women undergo the double mastectomy when both breasts are removed. After the operation, surgeons perform breast reconstruction procedures to rebuild the breast’s appearance.

Breast cancer therapy with chemotherapy

It is a method for breast cancer treating with the cancer-killing drugs. Oncologists prescribe chemo medications taking intravenously or by mouth. Through the bloodstream, drugs reach the cancerous cells, damage them, and stop the neoplasm development. Doctors recommend chemo if the tumor is over 1cm in size and has invaded at least 1 lymph node.

There are several types of chemotherapy:

• adjuvant chemo (after the surgery) is performed to prevent cancer relapse and kill malignant cells which could remain in the breast.

• neoadjuvant (before the surgery) is conducted to reduce the tumor size before the intervention. Oncologists use it to eliminate large neoplasms.

• palliative (for advanced stages) is applied when cancer has metastasized to other organs and tissues. In this case, breast tumor cannot be removed by the surgical method, and palliative chemo only reduces the symptoms of the disease.

Radiation therapy for breast cancer treatment

Radiotherapy is a treatment with highly-energy rays for malignant cells destroying. The need for radiation depends on previous surgical method, level of the tumor spread, and patient’s age (in some cases).

• External beam radiation (rays affect the lump from the particular device) is the most common radiation method. External radiotherapy is performed 5 days a week for 5-6 weeks.

• Internal beam radiation or brachytherapy (source of radiation is put into the body for a short time) is used as a type of accelerated partial breast irradiation. The method is not suitable for each woman. It depends on the tumor size and location.

Treatment for breast cancer applying hormone therapy

Physicians use this type to treat cancer caused by hormones in the blood. To know about cancer types according to hormones you may here. Hormonal therapy is a systematic kind of the treatment which:

• reduces cancer risk
• slow down the tumor development (if cancer has spread to the nearby tissues)
• reduce the risk of relapse after the surgery in the initial stages.

Targeted therapy for breast cancer therapy

Targeted therapy is applied to stop cancer cells spread. It is the best treatment option for the treatment of breast cancer caused by genes mutation. In some cases targeted medication work better than chemotherapy or can help other treatment methods work better.

Targeted therapy may be provided before and after the surgery. Targeted medications eliminate the tumor before the surgery and destroy remaining malignant cells after the operation.

Immunotherapy for breast cancer treatment

It is a treatment method that helps the immune system to fight cancer itself. Immunotherapy is a type of biological treatment methods that use the substances for cancer treatment.

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Best treatment for breast cancer according to stages

Breast cancer stage	The most appropriate treatment options
0 - I stage	cryoablation, lumpectomy, hormonal therapy
II stage	radical or partial surgery, chemo-, radio-, and hormone therapies
III stage	mastectomy, hormone therapy, chemo-, targeted, and immunotherapies
IV stage	radio-, chemo-, -immuno-, targeted therapies (reduce the symptoms and maintain the standard of living in women with this stage)

Each breast cancer treatment option can be used as independent and additional method. Usually, oncologists prescribe each therapy in combination with the other one to achieve the best effect of the treatment.