Table of Contents
1. Generality
Breast cancer is the most prevalent form of cancer and is diagnosed among women.
It is a condition whose onset can be contributed to by numerous factors, including old age, family history, the presence of inherited mutations in specific genes, obesity, postmenopausal hormone therapy, etc.
Breast cancer is a successfully treatable malignancy; it is essential, however. That diagnosis and treatment are timely.
Breast Anatomy: A Brief Review
To fully understand an important issue such as breast cancer. It is essential to know, at least in broad terms, the anatomy of the breast, especially the female one. Here is a brief review of this anatomical element:
The breast is a skin relief, even and symmetrical, located in the front and upper part of the chest, in correspondence with the pectoralis major muscle.
In the female, the internal structure of the breast substantially includes three different tissues: the glandular tissue, the connective tissue, and adipose tissue; in addition, it includes an important network of channels, called milk ducts. Which connect the glandular tissue to the nipple.
The glandular tissue is made up of small functional units. Called lobules. Which are organized into 15-20 major complexes. Called lobes or mammary glands. Whose shape and arrangement are very reminiscent of that of the petals of a flower.
The function of the glandular tissue is to produce breast milk in the presence of certain hormonal stimuli.
The milk ducts are used to conduct the mother’s milk outside the breast. When they reach the nipple, in fact, they open outwards, allowing the secretion to escape.
The connective tissue surrounds the milk ducts and lobes and has a supporting function.
Finally, the adipose tissue fills the empty spaces between the connective tissue. The glandular tissue and the ducts. The shape and size of the breast depending on its arrangement and quantity.
2. What’s this
Breast Cancer: What is it?
Breast cancer or breast cancer is a malignancy that arises from the uncontrolled proliferation of the cells constituting a tissue or milk ducts of the breast.
In fact, to define this serious condition, it would be more correct to speak of breast cancer, breast cancer, or breast cancer, as the word “tumor” includes both malignant and benign neoplasms.
However, today, the use of the expression “breast cancer” to indicate malignant neoplasm of the breast is now so well rooted in a common language that it is also accepted in popular articles and texts dealing with the subject.
Breast cancer in humans
Breast cancer is known to be a disease of the female sex.
It should be noted, however, that men can also develop forms of breast cancer. This is a rare occurrence, affecting 1 in every 100,000 males.
3. Caues
Breast Cancer: Causes and Risk Factors
Similar to other malignancies, breast cancer is also the consequence of a slow accumulation of genetic mutations by the DNA of one of the cells that make up the organ concerned. These mutations, in fact, are responsible for the phenomenon of uncontrolled proliferation that characterizes the formation and growth of malignant tumors.
Despite the numerous researches on the subject, doctors have not yet identified the precise causes of the genetic mutations that induce breast cancer; however, they noted a correlation between this neoplasm and factors such as:
The ‘ advanced age. Epidemiological studies have shown that breast cancer is more common in the female population over the age of 50.
The family history of breast cancer. Clinical research has shown that women who come from families in which this neoplasm is recurrent are more at risk of breast cancer.
L ‘ heredity for breast cancer. For several years now, cancer medicine has discovered that the presence of some hereditary and heritable mutations in genes such as BRCA1 and BRCA2 predispose to breast cancer.
The early onset of menstruation combined with the late onset of menopause. It emerged that, probably due to hormonal reasons, women who had their first menstruation before the age of 12 and who entered menopause after the age of 55 are more likely to get breast cancer.
The dense breasts. Doctors define dense a breast in which the share of glandular and connective tissue is preponderant, compared to the fat component.
Clinical studies suggest that women with dense breasts are more likely to develop breast cancer.
The presence, in the past, of other breast neoplasms, both benign and malignant in nature.
Having had radiation therapy in the chest area in the past. Women who, at a young age, required radiotherapy to treat tumors in the chest area (e.g. Hodgkin’s tumor) are more at risk of developing cancer in old age.
L ‘ obesity and physical inactivity. Obese women of advanced age are, particularly at risk.
The hormone therapy is taken after menopause. These therapies appear to be dangerous in the context of breast cancer when they last for more than 5 years.
The ‘ substance abuse alcohol. Studies have shown that women who abuse alcohol develop breast cancer more frequently.
It should be noted that clinical investigations have recorded cases of breast cancer not associated with any of the factors listed above and people who, although falling into one or even more of the aforementioned categories. Have never developed any form of breast cancer in life.
Currently, the reason for all this remains a question mark, an unresolved issue that experts still need to fully understand.
To know more:
Risk Factors for Breast Cancer
Breast cancer: the types
Doctors distinguish two types of breast cancer: non-invasive and invasive forms.
The category of non-invasive forms includes ductal intraepithelial neoplasia (also known as DIN ) and lobular intraepithelial neoplasia (also known as LIN ).
As the name suggests, the non-invasive forms are characterized by a malignant proliferation of tumor cells that lack the ability to invade surrounding tissues.
In the category of invasive forms, however, they fall within the ductal carcinoma, a lobular carcinoma, and other decidedly less frequent variants of the foregoing, known as tubular carcinoma, carcinoma papillary, mucinous carcinoma, and cribriform carcinoma.
Unlike non-invasive ones, invasive forms are characterized by a malignant proliferation of tumor cells capable of invading and infiltrating the surrounding tissues.
Intraepithelial Ductal Neoplasia (DIN)
Ductal intraepithelial neoplasia (DIN) is an example of carcinoma in situ; this means that the tumor cells that characterize the neoplasm do not possess the morphological and biological characteristics of the malignant ones, but, unlike the latter, they do not have an infiltrative and invasive power towards neighboring tissues.
Ductal intraepithelial neoplasia is characterized by a proliferation of non-invasive malignant tumor cells limited to the milk ducts.
4. Epidemiology
Spread and Incidence of Breast Cancer
Breast cancer is the most widespread and diagnosed malignant tumor in the female population worldwide.
Reliable statistical studies on a world scale have found that. Once in a lifetime, one in every 7-8 women gets breast cancer. This means that 14% of the female population develops a form of breast cancer in the course of its existence.
As regards the annual incidence rate of breast cancer, research shows that there is a notable difference between the various geographical areas of the world: for example, in Western Europe, the annual incidence on a sample of 100,000 women is almost 90 cases against the 19 recorded in East Africa.
Breast Cancer and Mortality
In 2011, the breast can.
Breast Cancer and Age
As discussed above, breast cancer is strongly correlated with advancing age.
To confirm this, we report the results of some epidemiological studies according to which only 5% of cases of breast cancer concern women under the age of 40.
Breast Cancer and Survival
For breast cancer, the 5-year survival rate from diagnosis is 80-90%, in the most developed countries in the world and 40-60%, in developing countries.
In 2016, breast cancer caused the death of about 12,600 women, ranking first among the causes of cancer death in the Italian female population.
It is interesting to note that breast cancer is the leading cause of cancer death for all age groups of the Italian female population: for women under 50 (28% of deaths), for women between 50 and 69 years ( 21% of deaths), and women over 70 (14% of deaths).
The most recent surveys have shown that the mortality rate for women under the age of 50 is slightly decreasing, thanks to the increasing spread of early diagnosis programs.
Finally, as regards the 5-year survival rate from the diagnosis of breast cancer. This epidemiological data is, in Italy, equal to 87%; this means that 87 out of every 100 Italian women with breast cancer are still alive 5 years after diagnosis.
5. Sysptoms and Complicatioj
Breast Cancer: Symptoms
The most common symptoms and signs of breast cancer are:
Presence of a lump or an area of abnormal thickened tissue in the breast more rarely, near the armpit or collarbone.
Changes in the size, shape, and appearance of the breasts. Formation of skin dimples in the upper part of the breast.
Cute the breast that takes on the appearance of orange peel.
Breast skin irritation and redness.
Pain in the breast or nipple area.
It should be noted that, for breast cancer, it is difficult to outline a classic symptomatological picture, as each patient represents a case in its own right.
However, it is also correct to point out that there are more common manifestations than others: this is the case, for example, of nodules and abnormal tissue thickenings, which can be considered to all intents and purposes the most characteristic signs of breast cancer.
Did you know that?
The appearance and texture of the breasts vary from woman to woman and are affected by factors such as menstruation, pregnancy, breastfeeding, weight gain, age, and medication.
Breast Cancer: Initial Symptoms
In most cases, the first symptom of breast cancer is the formation of an abnormal lump or thickening in or around the breast (armpit or collarbone).
Are Breast Lumps Always Malignant Tumors?
Nodules are the most characteristic signs not only of breast cancer. But also of the most common benign neoplasms of the breast.
Complications of Breast Cancer
If diagnosis and treatment are late, breast cancer can infiltrate neighboring tissues. Moreover, it can reach nearby and distant lymph nodes, and spread its malignant cells in the blood. Triggering the phenomenon of metastases.
Metastases resulting from breast cancer can affect various organs and tissues in the body: first of all, bone tissue, followed by the lungs, liver, and brain.
The spread of metastases to various parts of the body is indicative of a serious health condition, usually fatal for the patient.
Breast cancer: when to see a doctor?
A woman should always consult her doctor if she feels a new lump in her breast or any of the other symptoms and signs listed above.
6. Diagnosis
Breast Cancer Diagnosis: How To Recognize It?
Normally, the diagnosis of breast cancer begins with a physical examination and anamnesis; he continues. Therefore, with diagnostic imaging, in particular with breast ultrasound, a mammogram, and sometimes even with an MRI scan. Finally, it ends with a biopsy.
Any other investigations, such as blood tests, a bone scan, a PET scan, and a CT scan, are used for in-depth study or when. In the presence of metastatic tumors, there is a need to clarify which organs of the body are cancer cells that are widespread.
A fundamental objective of diagnostic research for breast cancer is to establish the stage of advancement of the malignant neoplasm and its degree: these data, in fact, define the severity of the condition and help the doctor to plan the most appropriate therapy.
Breast Cancer and Breast Ultrasound
L ‘ ultrasound breast is an instrumental examination, completely non-invasive, which uses ultrasound to provide images related to the soft tissue present in a specific area of the body.
Breast ultrasound detects the presence of suspicious lumps and clarifies their consistency (whether they are solid or soft).
Breast cancer and mammography
Mammography is a very effective X-ray examination in identifying suspicious areas or nodules, which could be the result of a neoplastic process.
Mammography is also an important screening test for the early detection of breast cancer.
Breast Cancer and MRI
MRI is a non-invasive instrumental test. Which provides detailed images of the soft and hard tissues of the human body.
MRI allows the identification and description of suspicious thickenings or nodules.
Breast Cancer and Biopsy
The biopsy is the examination that allows us to establish whether the lump or area of suspicious tissue identified during the previous investigations is breast cancer or not.
In fact, it is the investigation that is needed to have a diagnostic confirmation of what up until that moment was only a hypothesis.
The biopsy involves two procedural steps:
The sampling, using a special needle, of a portion of suspicious tissue Generally, to accurately trace the tissue area in which to take the sample, the diagnostician uses a guide tool such as X-rays or another diagnostic imaging test.
Laboratory tests on the collected tissue sample. These investigations allow us to establish whether it is actually a malignant tumor and, if it is, to establish its stage and degree.
Breast Cancer Stage.
The staging of a malignant tumor includes all the information, collected during the biopsy, concerning the size of the tumor mass, its infiltrating power, and its metastasizing capacity.
Classic Staging System
According to the classic staging system, there are 5 stages of breast cancer, identified with numbers from 0 to 4:
Stage 0. Corresponds to the forms of carcinoma in situ. Typically, it refers to intraepithelial ductal neoplasia and intraepithelial lobular neoplasia.
Stage 1 . Non-metastatic breast tumors, less than.
Stage 2 . Non-metastatic breast tumors, 2 to 5 centimeters in size.
Which have reached the nearby lymph nodes in the armpit are the stage.
Stage 3 . Non-metastatic breast tumors, 2 to 5 centimeters in size. Which have infiltrated other and surrounding breast tissues, and have reached the lymph nodes of the armpit, are the stage.
Stage 4 . Breast tumors of any size that have spread metastases to other parts of the body belong to stage.
Please note: the above is a simplified version of the classic staging system; in fact, there are also substages.
TNM system
There is the possibility of describing the stage of breast cancer by another system: the so-called TNM system.
The TNM system evaluates:
The size of the tumor. It is indicated by the letter T and is described by a scale of values from 1 to 4, where 1 indicates the smallest tumors. While 4 is the largest tumor.
The involvement of the lymph nodes. It is indicated by the letter N and is described by a scale of values from 0 to 3, where 0 indicates the absence of lymph node involvement, while 1, 2, and 3 indicate an increasing lymph node involvement.
The presence of metastases. It is indicated by the letter M and is described by the values 0 and 1, where 0 indicates the absence of metastases, while 1 indicates the presence.
Breast Cancer Grade.
The degree of a malignant tumor includes all those data, emerged during the biopsy examination, concerning the extent of transformation of the malignant tumor cells, compared to their healthy counterparts.
Grade 1 . Slow-growing breast cancers are grade 1, the cells of which have only mildly malignant features.
Grade 2 . Breast tumors whose cells have more relevant malignant characteristics than the previous.
7. Therapy
Breast Cancer: The Cures
There are various therapeutic approaches for the treatment of breast cancer. The implementation of one rather than another or their combination depends on specific factors, which are:
The site of the tumor mass.
The staging and the degree of the neoplasm. In general, an early stage and low-grade breast cancer allow the therapist to resort to non-bloody treatments, while an advanced and high-grade breast cancer obliges the therapist to use very invasive treatments.
The general state of health of the patient. A patient in good health can tolerate even a very invasive treatment very well; on the contrary, a patient in precarious health conditions is not strong enough to resist the most “cruel” therapies.
Currently, treatment options for breast cancer include:
Surgery;
The chemotherapy ;
Radiotherapy;
Antitumor hormone therapy;
Targeted therapy;
L ‘ immunotherapy.
Breast Cancer Surgery
Surgical treatment for breast cancer consists of the removal of the tumor mass and, if affected by malignant neoplastic cells, of the lymph nodes in the armpit.
Surgery is particularly useful and indicated when breast cancer is in its early stages. That is when the neoplasm is quite limited.
Currently, there are two main surgery options: lumpectomy and total mastectomy.
Lumpectomy
Also known as breast-conserving surgery or partial mastectomy, lumpectomy aims at eliminating the tumor mass without excessively removing the surrounding tissue.
Total mastectomy
Total mastectomy, on the other hand, involves the complete removal of all the tissues that make up the diseased breast.
It should be noted that, as a rule, total mastectomy is followed by breast reconstruction.
To know more:
Breast Cancer: Surgical Therapy
Chemotherapy, Radiotherapy and Hormone Therapy for Breast Cancer
In the presence of breast cancer. Chemotherapy can be used in at least three situations: before surgery, to facilitate subsequent removal; after surgery, to optimize the results of the removal (adjuvant chemotherapy); when the neoplasm is metastatic.
Examples of chemotherapy: cyclophosphamide, doxorubicin, methotrexate fluorouracil.
In the presence of breast cancer. Radiotherapy is a treatment generally used after surgery, to optimize the results.
Anti-cancer hormonal therapy is the administration of specific hormones or hormone antagonists able to stop the growth mechanisms of cancer.
In the presence of breast cancer, anticancer hormone therapy can be useful before or after surgery, after chemotherapy, in the presence of metastases, or when the patient’s health does not allow for surgery, chemotherapy, and radiotherapy.
Examples of anticancer hormone therapy drugs: tamoxifen and aromatase inhibitors.
Chemotherapy, radiotherapy, and hormone therapy have various side effects, some of which are also very relevant from a clinical point of view.
To know more:
Radiotherapy, Chemotherapy and Hormone Therapy
Targeted Therapy and Immunotherapy for Breast Cancer
The targeted therapy is based on the use of medicines that can counter anything that promotes the growth and development of cancer cells.
As part of the treatment of breast cancer. Targeted therapy can be used after surgery. To avoid recurrence, or when the neoplasm is at an advanced stage, to slow down its course.
Example of targeted therapy drugs: trastuzumab.
L ‘ immunotherapy is based on the use of cells or proteins of the immune system human being able to recognize cancer cells and attack them to destruction.
As part of the treatment of breast cancer. Immunotherapy can be used in combination with chemotherapy. In the presence of advanced neoplastic forms, metastatic, and that have not responded effectively to other treatments.
Examples of immunotherapy drugs: monoclonal antibodies.
8. Prognosis
Is Breast Cancer Treatable?
The prognosis for breast cancer strictly depends on the stage of cancer: the chances of cure, in fact, are high for carcinomas in situ and stage 1 cancers, while they tend to gradually become smaller as the staging of the disease progresses.
Breast cancer, therefore, is a neoplasm that can be successfully treated. Provided however that diagnosis and treatment are early.
For stage 0 breast cancers and stage 1 breast cancers, the prognosis tends to be excellent; in such circumstances, treatment generally involves lumpectomy and radiation therapy.
For stage 2 and 3 breast cancers, the prognosis becomes progressively less benevolent, complicated above all by an important risk of recurrence (ie, the re-emergence of the neoplasm); in such situations, treatment includes surgery (lumpectomy or mastectomy with or without removal of lymph nodes), chemotherapy combined with targeted therapy, and sometimes even radiation therapy.
For stage 4 breast cancers, the prognosis is poor; in such circumstances, the treatment plan includes all possible treatments, in order to alleviate the patient’s suffering as much as possible.
Breast Cancer and Follow-Up.
For women who have overcome a disease such as breast cancer, there is a program of periodic breast checks, useful for monitoring the outcome of the therapies and the state of health of the patients.
This monitoring – which in health terms is called follow-up – is essential to identify any relapses in time.
Breast cancer: how long do you live?
- 100% for stage 0 neoplasms;
- 98% for stage 1 neoplasms;
- 90% for stage 2 malignancies;
- 70% for stage 3 malignancies;
- 25% for stage 4 cancer.
Breast Cancer: How to Prevent It?
As reported, breast cancer is associated with various risk factors.
Unfortunately. Some of these factors can not be modified. Others, however, are and it is on these that women should act to reduce the chances of developing breast cancer.
Specifically, here’s what can help prevent breast cancer:
Practice regular exercise. Stick to a balanced and healthy diet, all with the aim of avoiding overweight and obesity.
Do not drink alcohol. At least, take it in moderate quantities.
Regularly perform breast self-examination. This practice does not reduce the risk of breast cancer; however, it is important because it allows women to know their breasts and promptly identify any anomalies that may develop at a certain stage of life.
Undergo the exam screening for early detection of breast cancer. Given the excellent prognosis of non-invasive breast cancers. The early diagnosis of these neoplastic forms. Their treatment can be considered a kind of preventive measure against much more serious cancers.
Undergo a preventive mastectomy in the presence of mutations in the BRCA1 or BRCA2 genes.
Breastfeed. Statistical studies have shown that women who breastfeed their children are less likely to develop breast cancer.
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