Breast Cancer Signs and Symptoms: (HealthLine): Cancer occurs when changes called mutations take place in genes that regulate cell growth. The mutations let the cells divide and multiply in an uncontrolled way.
Breast cancer is cancer that develops in breast cells. Typically, the cancer forms in either the lobules or the ducts of the breast. Lobules are the glands that produce milk, and ducts are the pathways that bring the milk from the glands to the nipple. Cancer can also occur in the fatty tissue or the fibrous connective tissue within your breast.
The uncontrolled cancer cells often invade other healthy breast tissue and can travel to the lymph nodes under the arms. The lymph nodes are a primary pathway that help the cancer cells move to other parts of the body.
Breast cancer symptoms
In its early stages, breast cancer may not cause any symptoms. In many cases, a tumor may be too small to be felt, but an abnormality can still be seen on a mammogram. If a tumor can be felt, the first sign is usually a new lump in the breast that was not there before. However, not all lumps are cancer.
Each type of breast cancer can cause a variety of symptoms. Many of these symptoms are similar, but some can be different. Symptoms for the most common breast cancers include:
a breast lump or tissue thickening that feels different than surrounding tissue and has developed recently
red, pitted skin over your entire breast
swelling in all or part of your breast
a nipple discharge other than breast milk
bloody discharge from your nipple
peeling, scaling, or flaking of skin on your nipple or breast
a sudden, unexplained change in the shape or size of your breast
changes to the appearance of the skin on your breasts
a lump or swelling under your arm
If you have any of these symptoms, it doesn’t necessarily mean you have breast cancer. For instance, pain in your breast or a breast lump can be caused by a benign cyst. Still, if you find a lump in your breast or have other symptoms, you should see your doctor for further examination and testing.
Types of breast cancer
There are several types of breast cancer, and they are broken into two main categories: “invasive” and “noninvasive,” or in situ. While invasive cancer has spread from the breast ducts or glands to other parts of the breast, noninvasive cancer has not spread from the original tissue.
These two categories are used to describe the most common types of breast cancer, which include:
Ductal carcinoma in situ. Ductal carcinoma in situ (DCIS) is a noninvasive condition. With DCIS, the cancer cells are confined to the ducts in your breast and haven’t invaded the surrounding breast tissue.
Lobular carcinoma in situ. Lobular carcinoma in situ (LCIS) is cancer that grows in the milk-producing glands of your breast. Like DCIS, the cancer cells haven’t invaded the surrounding tissue.
Invasive ductal carcinoma. Invasive ductal carcinoma (IDC) is the most common type of breast cancer. This type of breast cancer begins in your breast’s milk ducts and then invades nearby tissue in the breast. Once the breast cancer has spread to the tissue outside your milk ducts, it can begin to spread to other nearby organs and tissue.
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Invasive lobular carcinoma. Invasive lobular carcinoma (ILC) first develops in your breast’s lobules and has invaded nearby tissue.
Other, less common types of breast cancer include:
Paget disease of the nipple. This type of breast cancer begins in the ducts of the nipple, but as it grows, it begins to affect the skin and areola of the nipple.
Phyllodes tumor. This very rare type of breast cancer grows in the connective tissue of the breast. Most of these tumors are benign, but some are cancerous.
Angiosarcoma. This is cancer that grows on the blood vessels or lymph vessels in the breast.
The type of cancer you have determines your treatment options, as well as your likely long-term outcome.
Inflammatory breast cancer
Inflammatory breast cancer (IBC) is a rare but aggressive type of breast cancer. IBC makes up only between 1 and 5 percentTrusted Source of all breast cancer cases.
With this condition, cells block the lymph nodes near the breasts, so the lymph vessels in the breast can’t properly drain. Instead of creating a tumor, IBC causes your breast to swell, look red, and feel very warm. A cancerous breast may appear pitted and thick, like an orange peel.
IBC can be very aggressive and can progress quickly. For this reason, it’s important to call your doctor right away if you notice any symptoms.
Triple-negative breast cancer
Triple-negative breast cancer is another rare disease type, affecting only about 10 to 20 percent of people with breast cancer. To be diagnosed as triple-negative breast cancer, a tumor must have all three of the following characteristics:
It lacks estrogen receptors. These are receptors on the cells that bind, or attach, to the hormone estrogen. If a tumor has estrogen receptors, estrogen can stimulate the cancer to grow.
It lacks progesterone receptors. These receptors are cells that bind to the hormone progesterone. If a tumor has progesterone receptors, progesterone can stimulate the cancer to grow.
It doesn’t have additional HER2 proteins on its surface. HER2 is a protein that fuels breast cancer growth.
If a tumor meets these three criteria, it’s labeled a triple-negative breast cancer. This type of breast cancer has a tendency to grow and spread more quickly than other types of breast cancer.
Triple-negative breast cancers are difficult to treat because hormonal therapy for breast cancer is not effective.
Metastatic breast cancer
Metastatic breast cancer is another name for stage 4 breast cancer. It’s breast cancer that has spread from your breast to other parts of your body, such as your bones, lungs, or liver.
This is an advanced stage of breast cancer. Your oncologist (cancer doctor) will create a treatment plan with the goal of stopping the growth and spread of the tumor or tumors.
Male breast cancer
Although they generally have less of it, men have breast tissue just like women do. Men can get breast cancer too, but it’s much rarer. According to the American Cancer Society (ACS), breast cancer is 100 times less common in white men than in white women, and 70 times less common in black men than in black women.
That said, the breast cancer that men get is just as serious as the breast cancer women get. It also has the same symptoms.
Breast cancer stages
Breast cancer can be divided into stages based on how large the tumor or tumors are and how much it has spread. Cancers that are large and/or have invaded nearby tissues or organs are at a higher stage than cancers that are small and/or still contained in the breast. In order to stage a breast cancer, doctors need to know:
if the cancer is invasive or noninvasive
how large the tumor is
whether the lymph nodes are involved
if the cancer has spread to nearby tissue or organs.
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Breast cancer has five main stages: stages 0 to 5.
Stage 0 breast cancer
Stage 0 is DCIS. Cancer cells in DCIS remain confined to the ducts in the breast and have not spread into nearby tissue.
Stage 1 breast cancer
Stage 1A: The primary tumor is 2 centimeters wide or less and the lymph nodes are not affected.
Stage 1B: Cancer is found in nearby lymph nodes, and either there is no tumor in the breast, or the tumor is smaller than 2 cm.
Stage 2 breast cancer
Stage 2A: The tumor is smaller than 2 cm and has spread to 1–3 nearby lymph nodes, or it’s between 2 and 5 cm and hasn’t spread to any lymph nodes.
Stage 2B: The tumor is between 2 and 5 cm and has spread to 1–3 axillary (armpit) lymph nodes, or it’s larger than 5 cm and hasn’t spread to any lymph nodes.
Stage 3 breast cancer
The cancer has spread to 4–9 axillary lymph nodes or has enlarged the internal mammary lymph nodes, and the primary tumor can be any size.
Tumors are greater than 5 cm and the cancer has spread to 1–3 axillary lymph nodes or any breastbone nodes.
Stage 3B: A tumor has invaded the chest wall or skin and may or may not have invaded up to 9 lymph nodes.
Stage 3C: Cancer is found in 10 or more axillary lymph nodes, lymph nodes near the collarbone, or internal mammary nodes.
Stage 4 breast cancer
Stage 4 breast cancer can have a tumor of any size, and its cancer cells have spread to nearby and distant lymph nodes as well as distant organs.
The testing your doctor does will determine the stage of your breast cancer, which will affect your treatment.
Diagnosis of breast cancer
To determine if your symptoms are caused by breast cancer or a benign breast condition, your doctor will do a thorough physical exam in addition to a breast exam. They may also request one or more diagnostic tests to help understand what’s causing your symptoms.
Tests that can help diagnose breast cancer include:
Mammogram. The most common way to see below the surface of your breast is with an imaging test called a mammogram. Many women aged 40 and older get annual mammograms to check for breast cancer. If your doctor suspects you may have a tumor or suspicious spot, they will also request a mammogram. If an abnormal area is seen on your mammogram, your doctor may request additional tests.
Ultrasound. A breast ultrasound uses sound waves to create a picture of the tissues deep in your breast. An ultrasound can help your doctor distinguish between a solid mass, such as a tumor, and a benign cyst.
Your doctor may also suggest tests such as an MRI or a breast biopsy.
If your doctor suspects breast cancer, they may order both a mammogram and an ultrasound. If both of these tests can’t tell your doctor if you have cancer, your doctor may do a test called a breast biopsy.
During this test, your doctor will remove a tissue sample from the suspicious area to have it tested. There are several types of breast biopsies. With some of these tests, your doctor uses a needle to take the tissue sample. With others, they make an incision in your breast and then remove the sample.
Your doctor will send the tissue sample to a laboratory. If the sample tests positive for cancer, the lab can test it further to tell your doctor what type of cancer you have.
Breast cancer treatment
Your breast cancer’s stage, how far it has invaded (if it has), and how big the tumor has grown all play a large part in determining what kind of treatment you’ll need.
To start, your doctor will determine your cancer’s size, stage, and grade (how likely it is to grow and spread). After that, you can discuss your treatment options. Surgery is the most common treatment for breast cancer. Many women have additional treatments, such as chemotherapy, targeted therapy, radiation, or hormone therapy.
Several types of surgery may be used to remove breast cancer, including:
Lumpectomy. This procedure removes the tumor and some surrounding tissue, leaving the rest of the breast intact.
Mastectomy. In this procedure, a surgeon removes an entire breast.In a double mastectomy, both breasts are removed.
Sentinel node biopsy. This surgery removes a few of the lymph nodes that receive drainage from the tumor. These lymph nodes will be tested. If they don’t have cancer, you may not need additional surgery to remove more lymph nodes.
Axillary lymph node dissection. If lymph nodes removed during a sentinel node biopsy contain cancer cells, your doctor may remove additional lymph nodes.
Contralateral prophylactic mastectomy. Even though breast cancer may be present in only one breast, some women elect to have a contralateral prophylactic mastectomy. This surgery removes your healthy breast to reduce your risk of developing breast cancer again.
With radiation therapy, high-powered beams of radiation are used to target and kill cancer cells. Most radiation treatments use external beam radiation. This technique uses a large machine on the outside of the body.
Advances in cancer treatment have also enabled doctors to irradiate cancer from inside the body. This type of radiation treatment is called brachytherapy. To conduct brachytherapy, surgeons place radioactive seeds, or pellets, inside the body near the tumor site. The seeds stay there for a short period of time and work to destroy cancer cells.
Chemotherapy is a drug treatment used to destroy cancer cells. Some people may undergo chemotherapy on its own, but this type of treatment is often used along with other treatments, especially surgery.
In some cases, doctors prefer to give patients chemotherapy before surgery. The hope is that the treatment will shrink the tumor, and then the surgery will not need to be as invasive. Chemotherapy has many unwanted side effects, so discuss your concerns with your doctor before starting treatment.
If your type of breast cancer is sensitive to hormones, your doctor may start you on hormone therapy. Estrogen and progesterone, two female hormones, can stimulate the growth of breast cancer tumors. Hormone therapy works by blocking your body’s production of these hormones, or by blocking the hormone receptors on the cancer cells. This action can help slow and possibly stop the growth of your cancer.
Certain treatments are designed to attack specific abnormalities or mutations within cancer cells. For example, Herceptin (trastuzumab) can block your body’s production of the HER2 protein. HER2 helps breast cancer cells grow, so taking a medication to slow the production of this protein may help slow cancer growth.
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