Breast Cancer

1399/07/21 - 10:30 / 49

 

What Is Breast Cancer?

 

Breast cancer is a type of cancer that starts in the breast. Cancer starts when cells begin to grow out of control. Breast cancer cells usually form a tumor that can often be seen on an x-ray or felt as a lump. Breast cancer occurs almost entirely in women, but men can get breast cancer, too.

It’s important to understand that most breast lumps are benign and not cancer (malignant). Non-cancerous breast tumors are abnormal growths, but they do not spread outside of the breast. They are not life threatening, but some types of benign breast lumps can increase a woman's risk of getting breast cancer. Any breast lump or change needs to be checked by a health care professional to determine if it is benign or malignant (cancer) and if it might affect your future cancer risk.

 

Where breast cancer starts

 

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Breast cancers can start from different parts of the breast.

  • Most breast cancers begin in the ducts that carry milk to the nipple (ductal cancers)
  • Some start in the glands that make breast milk (lobular cancers)
  • There are also other types of breast cancer that are less common like phyllodes tumor and angiosarcoma
  • A small number of cancers start in other tissues in the breast.

These cancers are called sarcomas and lymphomas and are not really thought of as breast cancers.

Although many types of breast cancer can cause a lump in the breast, not all do. See Breast Cancer Signs and Symptoms to learn what you should watch for and report to a health care provider. Many breast cancers are also found on screening mammograms, which can detect cancers at an earlier stage, often before they can be felt, and before symptoms develop.

 

 

Types of breast cancer

 

There are many different types of breast cancer and common ones include ductal carcinoma in situ (DCIS) and invasive carcinoma. Others, like phyllodes tumors and angiosarcoma are less common.

Once a biopsy is done, breast cancer cells are tested for proteins called estrogen receptors, progesterone receptors and HER2. The tumor cells are also closely looked at in the lab to find out what grade it is. The specific proteins found and the tumor grade can help decide treatment options.

To learn more about specific types of breast cancer and tests done on the breast cancer cells, see Understanding a Breast Cancer Diagnosis.

 

How breast cancer spreads

 

Breast cancer can spread when the cancer cells get into the blood or lymph system and are carried to other parts of the body.

The lymph system is a network of lymph (or lymphatic) vessels found throughout the body that connects lymph nodes (small bean-shaped collections of immune system cells). The clear fluid inside the lymph vessels, called lymph, contains tissue by-products and waste material, as well as immune system cells. The lymph vessels carry lymph fluid away from the breast. In the case of breast cancer, cancer cells can enter those lymph vessels and start to grow in lymph nodes. Most of the lymph vessels of the breast drain into:

  • Lymph nodes under the arm (axillary nodes)
  • Lymph nodes around the collar bone (supraclavicular [above the collar bone] and infraclavicular [below the collar bone] lymph nodes)
  • Lymph nodes inside the chest near the breast bone (internal mammary lymph nodes)

If cancer cells have spread to your lymph nodes, there is a higher chance that the cells could have traveled through the lymph system and spread (metastasized) to other parts of your body. The more lymph nodes with breast cancer cells, the more likely it is that the cancer may be found in other organs. Because of this, finding cancer in one or more lymph nodes often affects your treatment plan. Usually, you will need surgery to remove one or more lymph nodes to know whether the cancer has spread.

Still, not all women with cancer cells in their lymph nodes develop metastases, and some women with no cancer cells in their lymph nodes develop metastases later.

 

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How Does Breast Cancer Start?

 

Changes or mutations in DNA can cause normal breast cells to become cancer. Certain DNA changes are passed on from parents (inherited) and can greatly increase your risk for breast cancer. Other lifestyle-related risk factors, such as what you eat and how much you exercise, can increase your chance of developing breast cancer, but it’s not yet known exactly how some of these risk factors cause normal cells to become cancer. Hormones seem to play a role in many cases of breast cancer, but just how this happens is not fully understood.

 

Inherited versus acquired DNA mutations

Normal breast cells become cancer because of changes (mutations) in DNA. DNA is the chemical in our cells that makes up our genes. Genes have the instructions for how our cells function.

 

Some DNA mutations are inherited or passed to you from your parents. This means the mutations are in all your cells when you are born. Some mutations can greatly increase the risk of certain cancers. They cause many of the cancers that run in some families and often cause cancer when people are younger.

 

But most DNA mutations linked to breast cancer are acquired. This means the change takes place in breast cells during a person's life rather than having been inherited or born with them. Acquired DNA mutations take place over time and are only in the breast cancer cells.

 

Mutated DNA can lead to mutated genes. Some genes control when our cells grow, divide into new cells, and die. Changes in these genes can cause the cells to lose normal control and are linked to cancer.

 

Proto-oncogenes

Proto-oncogenes are genes that help cells grow normally. When a proto-oncogene mutates (changes) or there are too many copies of it, it becomes a "bad" gene that can stay turned on or activated when it’s not supposed to be. When this happens, the cell grows out of control and makes more cells that grow out of control. This can lead to cancer. This bad gene is called an oncogene.

 

Think of a cell as a car. For the car to work properly, there need to be ways to control how fast it goes. A proto-oncogene normally functions in a way that’s much like a gas pedal. It helps control how and when the cell grows and divides. An oncogene is like a gas pedal that’s stuck down, which causes the cell to divide out of control.

 

 

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Tumor suppression genes

Tumor suppressor genes are normal genes that slow down cell division (cell growth), repair DNA mistakes, or tell cells when to die (a process known as apoptosis or programmed cell death). When tumor suppressor genes don't work properly, cells can grow out of control, make more cells that grow out of control, and cells don't die when they should, which can lead to cancer.

A tumor suppressor gene is like the brake pedal on a car. It normally keeps the cell from dividing too quickly, just as a brake keeps a car from going too fast. When something goes wrong with the gene, such as a mutation, the “brakes” don’t work and cell division can get out of control.

 

Inherited gene changes

Certain inherited DNA mutations (changes) can dramatically increase the risk for developing certain cancers and are linked to many of the cancers that run in some families. For instance, the BRCA genes (BRCA1 and BRCA2) are tumor suppressor genes. When one of these genes changes, it no longer suppresses abnormal cell growth, and cancer is more likely to develop. A change in one of these genes can be passed from a parent to a child.

 

Women have already begun to benefit from advances in understanding the genetic basis of breast cancer. Genetic testing can identify some women who have inherited mutations in the BRCA1 or BRCA2 tumor suppressor genes (or less commonly in other genes such as PALB2, ATM or CHEK2). These women can then take steps to reduce their risk of breast cancer by increasing awareness of their breasts and following appropriate screening recommendations to help find cancer at an earlier, more treatable stage. Since these mutations in BRCA1 and BRCA2 genes are also associated with other cancers (besides breast), women with these mutations might also consider early screening and preventive actions for other cancers.

Mutations in tumor suppressor genes like the BRCA genes are considered “high penetrance” because they often lead to cancer. And although many women with high penetrance mutations develop cancer, most cases of cancer (including breast cancer) are not caused by this kind of mutation.

More often, low-penetrance mutations or gene variations are a factor in cancer development.

 

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Each of these may have a small effect on cancer occurring in any one person, but the overall effect on the population can be large because the mutations are common, and people often have more than one at the same time. The genes involved can affect things like hormone levels, metabolism, or other factors that impact risk for breast cancer. These genes might also cause much of the risk of breast cancer that runs in families.

 

Acquired gene changes

Most DNA mutations related to breast cancer take place in breast cells during a woman's life rather than having been inherited. These acquired mutations of oncogenes and/or tumor suppressor genes may result from other factors, like radiation or cancer-causing chemicals. But so far, the causes of most acquired mutations that could lead to breast cancer are still unknown. Most breast cancers have several acquired gene mutations.

 

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Breast Cancer Signs and Symptoms


Knowing how your breasts normally look and feel is an important part of breast health. Although having regular screening tests for breast cancer is important, mammograms do not find every breast cancer. This means it's also important for you to be aware of changes in your breasts and to know the signs and symptoms of breast cancer.

The most common symptom of breast cancer is a new lump or mass. A painless, hard mass that has irregular edges is more likely to be cancer, but breast cancers can be tender, soft, or round. They can even be painful. For this reason, it's important to have any new breast mass, lump, or breast change checked by an experienced health care professional.

Other possible symptoms of breast cancer include:

  • Swelling of all or part of a breast (even if no lump is felt)
  • Skin dimpling (sometimes looking like an orange peel)
  • Breast or nipple pain
  • Nipple retraction (turning inward)
  • Nipple or breast skin that is red, dry, flaking or thickened
  • Nipple discharge (other than breast milk)
  • Swollen lymph nodes (Sometimes a breast cancer can spread to lymph nodes under the arm or around the collar bone and cause a lump or swelling there, even before the original tumor in the breast is large enough to be felt.)

Although any of these symptoms can be caused by things other than breast cancer, if you have them, they should be reported to a health care professional so the cause can be found.

Remember that knowing what to look for does not take the place of having regular mammograms and other screening tests. Screening tests can help find breast cancer early, before any symptoms appear. Finding breast cancer early gives you a better chance of successful treatment.

How Is Breast Cancer Treated?


Breast cancer is treated in several ways. It depends on the kind of breast cancer and how far it has spread. People with breast cancer often get more than one kind of treatment.

Surgery. An operation where doctors cut out cancer tissue.
Chemotherapy. Using special medicines to shrink or kill the cancer cells. The drugs can be pills you take or medicines given in your veins, or sometimes both.
Hormonal therapy. Blocks cancer cells from getting the hormones they need to grow.
Biological therapy. Works with your body’s immune system to help it fight cancer cells or to control side effects from other cancer treatments.
Radiation therapy. Using high-energy rays (similar to X-rays) to kill the cancer cells.
Doctors from different specialties often work together to treat breast cancer. Surgeons are doctors who perform operations. Medical oncologists are doctors who treat cancer with medicine. Radiation oncologists are doctors who treat cancer with radiation.

Clinical Trials
Clinical trials use new treatment options to see if they are safe and effective.
Complementary and Alternative Medicine
Complementary and alternative medicine are medicines and health practices that are not standard cancer treatments. Complementary medicine is used in addition to standard treatments, and alternative medicine is used instead of standard treatments. Meditation, yoga, and supplements like vitamins and herbs are some examples.

Many kinds of complementary and alternative medicine have not been tested scientifically and may not be safe. Talk to your doctor about the risks and benefits before you start any kind of complementary or alternative medicine.

 

 

 
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Which Treatment Is Right for Me?


Choosing the treatment that is right for you may be hard. Talk to your cancer doctor about the treatment options available for your type and stage of cancer. Your doctor can explain the risks and benefits of each treatment and their side effects. Side effects are how your body reacts to drugs or other treatments.

Sometimes people get an opinion from more than one cancer doctor. This is called a “second opinion.” Getting a second opinionexternal icon may help you choose the treatment that is right for you.

 

 

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Prepared:
Neshat Khosravi - Microbiologist

Refrence:

https://www.cancer.org/cancer/breast-cancer/treatment.html

 



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