Breast Cancer

A new or recurrent diagnosis of breast cancer often results in fear and confusion for patients and their family members Understanding treatment options, accessing new and innovative therapies through clinical trials, as well as understanding the role of supportive care and complementary and alternative medicine are essential Cancer screening, genetic testing and prevention are equally relevant to all individuals, especially those related to someone diagnosed with cancer
Breast cancer is a common malignancy, with almost 200,000 new cases diagnosed in the United States each year The disease occurs most frequently in women and rarely, in men The breasts are glands that produce and release milk in women in association with pregnancy Breast cancer develops from cells in the breast

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 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 When cancer is identified in the biopsy specimen, several other tests are performed on the specimen in order to further classify the cancer and determine the optimal treatment strategy These additional laboratory tests should include:
1) Hormone receptor status: Some breast cancer cells express an abundance of hormone receptors, particularly estrogen receptors These cancers–called estrogen receptor or ER-positive cancers–are typically associated with a better prognosis and are treated differently from breast cancers that are ER-negative Patients with ER-positive breast cancer are treated with hormonal therapy
2) HER2-neu status: Approximately 30% of breast cancers overexpress a protein called HER2-neu This protein is involved in regulating cellular growth and may be found on the surface of normal cells However, overexpression of HER2-neu is associated with a poorer prognosis Laboratory tests can determine whether a breast cancer is overexpressing HER2-neu Breast cancers that are HER2-neu-positive are responsive to treatment with the targeted therapy, Herceptin® (trastuzumab) For this reason, HER2-neu status should be accurately measured on all breast cancers
Other laboratory tests are being evaluated to determine whether they may help determine prognosis Genomic testing, which are tests that evaluate the activity of genes involved in cancer, have shown promise for predicting prognosis for select patients
Optimal treatment of breast cancer often requires several different treatment modalities, including surgery, radiation, chemotherapy and hormonal therapy Following a biopsy-proven diagnosis of breast cancer, additional evaluation is necessary to determine if the cancer has spread elsewhere in the body Breast cancers may spread to adjacent skin, local or regional lymph nodes, or through the blood to other locations in the body, such as the liver, bones and lungs In order to effectively plan treatment, it is important to first determine the extent of the spread or the stage of the cancer Determining the stage of the cancer requires a number of procedures, which may include blood tests, chest x-rays, mammography, and occasionally Computerized Tomography/Magnetic Resonance Imaging (CT/MRI) or bone scans
For over 30 years, the standard of practice for breast cancer staging has included an axillary lymph node dissection During this procedure, a surgeon removes lymph nodes under the arm to aid in determining the spread of cancer in the body If cancer spreads from its site of origin, it commonly spreads first to the lymph nodes that initially collect the excess lymph fluid from that area (sentinel lymph nodes) With current standard staging procedures, axillary lymph nodes are removed during surgery and are tested to determine if they contain cancer cells that may have spread from the breast The presence or absence of cancer cells in axillary lymph nodes is an essential factor in defining optimal treatment strategies following surgery Women who have cancer cells present in their axillary lymph nodes are at a higher risk for a cancer recurrence, so they are treated more aggressively following surgery than women who have no cancer cells detected in their axillary lymph nodes
During an axillary lymph node dissection, 20-40 lymph nodes may be removed Unfortunately, this procedure may be associated with chronic side effects including pain, infection, limited shoulder motion, numbness and lymphedema (swelling of the arm due to an accumulation of lymph fluid) Since these complications can become debilitating, a new strategy is currently being evaluated and refined in clinical trials This strategy incorporates the removal of only the sentinel lymph node(s) to determine the extent of cancer spread Because the sentinel lymph node(s) (SLN) receives initial drainage from the cancer, it has the highest probability of containing cancer cells if the cancer actually has spread Therefore, other axillary lymph nodes may be spared from unnecessary removal if no cancer cells are present in the SLN This practice virtually eliminates the development of complications associated with standard axillary node dissection
Patients who have already undergone surgery and lymph node evaluation and know their stage of cancer may select from the options below In order to learn more about surgery and sentinel lymph node dissection, go to Surgical Management of Breast Cancer
Carcinoma In Situ: Approximately 15-20% of breast cancers are very early in their development These are sometimes referred to as carcinoma in situ and consist of two types: ductal carcinoma in situ (DCIS), which originates in the ducts and lobular carcinoma in situ (LCIS), which originates in the lobules DCIS is the precursor to invasive cancer and LCIS is a risk factor for developing cancer
Invasive Breast Cancer: The majority of invasive breast cancers begin in the lining of the ducts in the breast and are referred to as “ductal carcinomas” Other histologic subtypes of invasive breast cancer are lobular, tubular, medullary, mucinous and papillary Currently, all types of breast cancer are treated the same In order to learn more about the most recent information available concerning the treatment of breast cancer, click on the appropriate stage
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 IIA: 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 (3/4-2 inches) and has not spread to the lymph nodes
Stage IIB: Cancer has spread to involve underarm lymph nodes and/or the primary cancer is greater than 5 centimeters (2 inches) in size and does not involve any lymph nodes
Stage IIIA: 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 IIIB: Cancer directly involves the chest wall or has spread to internal lymph nodes on the same side of the chest
Inflammatory: Inflammatory breast cancer is a special class of breast cancer that is rare The breast looks as if it is inflamed because of its red appearance and warmth The skin may show signs of ridges and wheals or it may have a pitted appearance Inflammatory breast cancer tends to spread quickly
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