Breast cancer: Treatment, Stages, Types, and More

Breast cancer: Treatment, Stages, Types, and More

Breast cancer is the most common cancer in Indian Women. The normal breast has 6 to 9 overlapping sections called lobes and within each lobe are several smaller lobules that contain the cells that produce milk. The lobes and lobules are linked by thin tubes called ducts, which lead to the nipple in the center of the breast. The spaces around the lobules and ducts are filled with fat. Lymph vessels carry colorless fluid called lymph, which contains important immune cells. The lymph vessels lead to small bean-shaped structures called lymph nodes. Clusters of lymph nodes are found in the axilla (under the arm), above the collarbone, and in the chest.

The suspicion of breast cancer often first arises when a lump is detected in the breast during breast examination or a suspicious area is identified during screening mammography. In order to diagnose the cause of the suspicious area or lump in the breast, a physician will perform a biopsy. A biopsy can be performed on an outpatient basis. During a biopsy, a physician removes cells for examination in the laboratory to determine whether cancer is present. Other information obtained from the biopsy sample will play an important role in treatment decisions. If the biopsy indicates that cancer is present, additional surgery may be performed after the patient and doctor select a course of treatment.

There are many types of breast tumors. Some breast tumors are benign (not cancerous). Benign breast tumors such as fibroadenomas or papillomas do not spread outside of the breast and are not life threatening. Other breast tumors are malignant (cancerous). The most common type of breast cancer is called ductal carcinoma and begins in the lining of the ducts. Another type of cancer is called lobular carcinoma, which arises in the lobules.

PERSONALIZED CANCER TREATMENT

When cancer is identified in the biopsy specimen, several other tests may be performed on the specimen in order to further classify the cancer and determine the optimal treatment strategy. Based on the stage of the cancer and the results of these tests, treatment of breast cancer is personalized for each individual. Treatment may involve surgery, radiation therapy, chemotherapy, targeted therapy, and/or hormonal therapy.

Stage: Determining the stage of the cancer may require a number of procedures, such as blood tests, chest x-rays, mammography, computed tomography (CT), or magnetic resonance imaging (MRI).

HER2 status: Twenty to thirty percent of breast cancers over express (make too much of) a protein known as HER2. Overexpression of this protein leads to increased growth of cancer cells. Fortunately, the development of treatments that specifically target HER2-positive cells – (trastuzumab) and (lapatinib) — has improved outcomes among women with HER2-positive breast cancer. For this reason, HER2 status should be accurately measured on all breast cancers.

Hormone receptor status: Some breast cancer cells express an abundance of receptors for the female hormones estrogen and/or progesterone.  These cancers– called hormone receptor-positive –are typically associated with a better prognosis and are treated differently from breast cancers that are hormone receptor-negative.  Patients with hormone receptor-positive breast cancer often receive treatment with hormonal therapy, such as tamoxifen or an aromatase inhibitor. For more information, go to Hormonal Therapy.

Recurrence Score: Oncotype DX is a genomic test that predicts risk of recurrence among selected women with early-stage breast cancer, including women with ductal carcinoma in situ (DCIS). Use of the Oncotype DX test may help guide decisions about whether about additional treatment with chemotherapy or radiation therapy is necessary after surgery. 

Stage I: Cancer is confined to a single site in the breast, is less than 2 centimeters (3/4 inch) in size and has not spread outside the breast.

Stage II: Cancer has spread to involve underarm lymph nodes and is less than 2 centimeters (3/4 inch) in size or the primary cancer itself is 2-5 centimeters.

Stage III: Cancer is smaller than 5 centimeters (2 inches) and has spread to the lymph nodes under the arm or the lymph nodes are attached to each other or to other structures or the primary cancer is larger than 5 centimeters (2 inches) and has spread to the lymph nodes under the arm.

Stage IV: Cancer has spread to distant locations in the body, which may include the liver, lungs, bones or other sites.

Recurrent/Relapsed: The breast cancer has progressed or returned (recurred/relapsed) following an initial treatment.