Breast cancer - the main symptoms and treatments
 
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Breast cancer

There are certain signs that may indicate the presence of breast cancer. If you have any of the following symptoms, you should see your doctor straight away so they can carry out tests to confirm the presence or absence of cancer.

 

WHAT ARE THE SYMPTOMS OF BREAST CANCER?

  • A firm, immobile lump in the breast
  • Swollen, hard, non-painful lymph nodes in the axilla
  • Spontaneous discharge from one or both nipples
  • Changes in the appearance of the nipple or skin of the breast
  • If the breast cancer has spread to the rest of the body, other symptoms may appear: fatigue, nausea, weight loss, bone pain, or vision problems

 

Stage and extent of breast cancer

Information about the stage and type of breast cancer is used by doctors to plan optimal treatment. The TNM classification (tumor, nodes, metastases) is used for this purpose.

The following criteria are considered to determine the stage of breast cancer :

  • Tumor size
  • The spread of the disease to the lymph nodes
  • The presence or absence of metastases

 

There are 5 stages of breast cancer

– Stage 0: This is the stage in situ, ie non-invasive, when the cancer cells have not spread and do not penetrate deep into the surrounding tissues;

– Stage 1: This refers to a malignant mass up to 2 cm, localized in the breast;

– Stages 2 and 3: The tumor is larger than 2 cm and/or has spread to neighboring lymph nodes. In the case of breast cancer, the axillary or subclavian lymph nodes are most often affected;

– Stage 4: Indicates the presence of metastases;

 

Histological classification of cancer

Grade 1 in the histological classification gives the best prognosis, indicating a slow-growing cancer, and grade 3 gives the worst prognosis, indicating a more aggressive cancer.   Information about the class and type of breast cancer is of primary importance in determining indications for adjuvant treatment: cancer chemotherapy, radiation therapy, and hormone therapy for breast cancer

 

BREAST CANCER DIAGNOSTICS

After an initial consultation with your doctor, radiological and laboratory tests can be ordered if necessary to detect any abnormalities in the breast tissue.

-Breast ultrasound

– Mammography is an X-ray examination of the breasts.  Mammography must be done in the first half of the menstrual cycle, that is, in the first ten days of the cycle

– Magnetic resonance imaging (MRI) of the breast. This examination reveals benign or malignant intraductal lesions

– Biopsy

– Hormone Receptor Analysis (HER2) for diagnosis

 

If the mammogram shows the presence of calcinates in the breast. How dangerous is it?

Breast calcifications are small deposits of calcium that are often found in the breast during a screening mammogram.

What are breast calcinates?

These are calcium deposits that form in the glandular tissues of the breast. It is quite common and has nothing to do with the amount of calcium we get in our diet. Microcalcinates indicate increased activity of certain cells in the glandular tissue of the breast, when the cells are actively growing and dividing and absorbing more calcium.

Calcinates may raise a suspicion of breast cancer or precancerous changes in breast tissue, especially if they are isolated or their accumulation has an irregular shape.

Benign calcinates in the breast, on the other hand, do not increase the risk of developing breast cancer. It is simply a sign of breast activity.

Calcinates are not palpable on normal palpation of the breast. They can be seen on a mammogram as white spots of different sizes. Calcinates larger than 1 mm are considered macrocalcinates, up to 1 mm – microcalcinates.

A biopsy is often prescribed when calcinates are detected for the first time. Biopsy is indicated by the size, shape and location of calcinates. Macrocalcinates often do not require follow-up, microcalcinates need to be monitored. If in doubt, the biopsy is performed immediately after the mammogram, otherwise only a repeat examination after 6 months is indicated. Calcinates cannot be seen on ultrasound or MRI.

 

Nipple discharge. Is it always a sign of cancer or not?

Nipple discharge outside the lactation or postpartum period is a fairly common symptom and reason to see a doctor. Although the discharge can be worrisome, it does not necessarily mean breast cancer.

There are three types of nipple discharge: physiological discharge, benign discharge and abnormal discharge.

Physiological discharge is serous, from both mammary glands, multifocal and scanty. This is perfectly normal, as it is associated with the secretory nature of the mammary gland.

Benign discharge is greenish or whitish, thick and scanty. Most often they indicate a benign breast disease, such as ductal ectasia or galactophoritis, both of inflammatory nature. Ductal ectasia accounts for 15 to 20% of benign discharge. This disease is characterized by an enlargement of the ducts that transport milk, the ducts become thicker and fluid accumulates in them, which is never a sign of cancer. Ductal ectasia is not a precancerous condition, but a natural aging of the gland. It bothers women, but is fairly benign and common.

Benign greenish discharge can also be associated with fibroadenomas, benign tumors of the breast, which are rarely associated with breast cancer.

Abnormal discharge can be bloody or serous, unilateral and unifocal. In about 50% of cases, they are associated with papillomas, small benign neoplasms that need to be operated on because they can become cancerous. They can also result from atypical intraepithelial lesions (precancerous lesions).

Finally, on average, in 11-15% of cases, abnormal discharge is a sign of in situ cancer or invasive breast cancer.

In the case of physiological or benign discharge no treatment is required. In the case of fibroadenoma a simple observation can be necessary. It can also be removed surgically if the mass is growing or bothersome.

In the case of abnormal discharge, surgical treatment is needed to remove the malignant or precancerous lesion.

 

Abnormal discharge from the breast : Galactorrhea

Galactorrhea is an abnormal discharge of milk from the nipple that occurs outside of pregnancy or breastfeeding. These secretions are bilateral (from both mammary glands) and from several pores of the nipple.

Galactorrhea occurs mostly in women (from puberty to menopause), but less frequently can affect men as well. This discharge can be provoked or spontaneous.

In many cases, the cause of galactorrhea is unknown; the discharge may disappear spontaneously after some time.

But in some cases, galactorrhea may be a sign of certain disorders.

Galactorrhea is caused by excess production of prolactin, a hormone that stimulates milk production in the mammary glands. This hormone is secreted by the pituitary gland, an endocrine gland located in the brain. Galactorrhea may therefore be a sign of a benign pituitary tumor which nevertheless needs an appropriate treatment; – It could also be a side effect of certain drugs (antidepressants, antihistamines, neuroleptics, antipsychotics, antibiotics, sedative antihypertensives, etc.). Opiates, such as heroin, can also cause milk discharge from nipples. So can birth control pills that contain estrogen;

– Galactorrhea may indicate thyroid dysfunction (hypothyroidism or hyperthyroidism)

– Galactorrhea can also lead to irregularities in the cycle, ovulation, and libido in women, as well as erectile dysfunction in men. In general, it can cause fertility problems in both women and men. Therefore, it is important not to delay in seeing a doctor.

 

Nipple discharge in men

In about one in 100 cases, nipple discharge can occur in men as well. However, unlike women, nipple discharge in men is almost always a sign of malignancy.

 

PROGNOSIS FOR BREAST CANCER

The survival rate after being diagnosed with breast cancer is 85-90%, making it one of the cancers with the best survival rates.

If the breast cancer is invasive and the patient is not treated, the cancer cells gradually fill the entire breast and then migrate to the axillary lymph nodes and further into the bloodstream to then multiply in the liver, lungs, bones, brain, etc. These secondary tumors are called “metastases.”

 

Certain elements can determine the prognosis:

  • Patient’s age: breast cancer is treated worse in younger patients than in older patients
  • Tumor size: a large tumor is more difficult to treat
  • The histological characteristics of the tumor
  • The presence of inflammatory signs, or involvement of axillary lymph nodes, or the presence of metastases to other organs are worsening prognosis
  • Activation of the HER2 gene is also a sign of disease severity
  • Hormone-dependent breast cancer has a better prognosis

 

Inflammatory breast cancer:

A rare but aggressive type of cancer

Among the different types of cancer, inflammatory breast cancer is one of the most aggressive. What are the signs? How is it treated?

Inflammatory breast cancer, also known as carcinomatous mastitis, is less common than hormone-dependent cancer, accounting for only 1% to 4% of breast cancers, but it is often much more aggressive, so it should be treated quickly. The numbers speak for themselves: the 5-year survival rate ranges from 30 to 50%, compared to 85-90% for hormone-dependent cancers.

Distinctive clinical signs of inflammatory breast cancer :

Swelling, redness on part or all of the breast, thickening that looks like orange peel, fever throughout the breast or even burning, changes in the appearance of the nipple, increased breast volume… all these atypical clinical signs can indicate inflammatory breast cancer.

Early detection and timely treatment of this type of cancer is especially important.

Generally, treatment of this type of cancer involves a combination of treatments. Most often, treatment begins with chemotherapy, then usually a complete mastectomy, since the entire mammary gland may be affected. In this type of breast cancer, immediate reconstructive surgery is not possible because of the high risk of recurrence.

To reduce the risk of recurrence, radiation therapy and even hormone therapy (in case the tumor responds to hormone receptors) can be offered. And yet, even this combination of treatments does not eliminate the risk of metastases, both immediately and subsequently, as well as the risk of recurrence.

Mainly young women (from 35 till 50 years) suffer from inflammatory breast cancer. The reasons for this age distribution are not yet clear.

Metastatic breast cancer

In the vast majority of cases, breast cancer is found and treated while it is still localized. But sometimes it happens that cancer cells migrate to other parts of the body through the blood and lymph, forming metastases.

Metastases may be detected at initial diagnosis, but most often they occur later, usually within the first 5 years of diagnosis. In rarer cases, metastatic recurrence may occur even later, 10 to 20 years after initial diagnosis.

All 3 major cancer types – Her2+, RH+, and triple negative – are potential sources of metastasis.

Signs of metastasis

Although metastatic breast cancer may remain silent for a long time, metastases can still give certain signs or symptoms in some cases. Detecting them early allows the disease to be treated more quickly and effectively.

Signs depend on the location of the metastases. Each type of breast cancer has its own tendency to develop. Breast cancer predominantly metastasizes to the bones, lungs, liver, or brain.

– Metastases to the bones can cause nighttime pain and even fractures;

– Metastases in the lungs can cause shortness of breath;

– Metastases in the liver can cause jaundice;

– Metastases to the brain can cause severe headaches;

 

Treatment of metastatic breast cancer

Treating metastatic breast cancer is different from treating localized cancer: It is no longer curative. It has two goals: to slow the progression of the disease and to control its symptoms so that the patient can live with it as long as possible and in the best conditions.

Treatment depends on several factors: the type of original tumor (HER2+, HR, triple-negative), presence of recurrences, the rate of metastases spread, the patient’s general condition, etc. Further treatment is regularly adjusted depending on the body’s response to treatment and possible side effects.

Hormone therapy

Hormone therapy is given to original cancerous tumors that are hormone-sensitive. Because the growth of this type of tumor is stimulated in the presence of female hormones, the goal of hormone therapy is to block their action.

The type of hormone therapy offered for breast cancer varies depending on whether or not the patient is in menopause.

Chemotherapy

Chemotherapy is the only treatment for metastatic triple-negative cancer.

Chemotherapy for breast cancer may also be indicated for other types of metastatic breast cancer (HR+ and HER2+), especially when symptoms are present. Chemotherapy may be given in addition to hormone therapy and/or targeted therapy or as a replacement for them.

Chemotherapy treatment for cancer with metastases is not curative; it is aimed at limiting the progression of the disease.

Implantable Chemotherapy Chamber

The implantable chamber, also called the implantable catheter chamber (ICC or PAC from “port-a-cath”), appeared in the early 1980s, simultaneously with the first chemotherapy drugs.

This device is now widely offered to breast cancer patients who have to undergo intravenous chemotherapy to reduce vein trauma during repeated chemotherapy sessions. The catheter is placed in a large vein, usually at the top of the chest. Today, this device is almost systematically offered to patients before chemotherapy begins, and patients generally like it.

The catheter is regularly monitored by doctors, for which X-rays are taken to make sure it is functioning properly. Patients can wear such catheters for a very long time, especially if the disease has metastasized, resulting in the need for continuous treatment for several years without complications.

Targeted therapy

Targeted therapy with new drugs has revolutionized the treatment of HR+ and Her 2+ breast cancer. The goal of targeted therapies is to block specific mechanisms of cancer cells. They are mostly prescribed as pills and are usually well tolerated and have little or no effect on a patient’s quality of life. These drugs can be taken alone or in combination with chemotherapy. Treatment may last for several years, but as a rule, after a certain period of time the cancer cell develops a mechanism of resistance, which makes it necessary to change the treatment strategy.

– In the case of triple-negative breast cancer, immunotherapy is also used in some cases, even these drugs are not very effective for the therapy of this type of breast cancer.

Targeted therapy for HER2-positive breast cancer

Almost one in five breast cancers is HER-positive. Treatment for this type of cancer has benefited greatly from improved cancer therapies. Chemotherapy combined with targeted therapies have changed the prognosis of breast cancer.

What is HER2+ breast cancer ?

HER2 is a protein that occurs naturally in the body. It is a transmembrane receptor involved in the regulation of cell proliferation. When a cell becomes malignant (most often in breast cancer, but also in gastric, ovarian, bladder, lung, etc.), the number of these receptors increases abnormally. As a result, the growth of cancer cells is accelerated. This type of breast cancer is called HER2-positive or HER2+. This is a particularly aggressive form of cancer, where the risk of recurrence is higher and mortality in this type of breast cancer is higher, especially because these cells respond worse to certain types of chemotherapy. Since the late 1990s, however, targeted therapies have been used on these tumors, which, when combined with chemotherapy, have changed the prognosis.

Mechanism of action of targeted therapy for HER2+ cancer

Targeted therapy is a treatment that specifically blocks certain mechanisms in cancer cells, most commonly proteins present on the surface or inside cancer cells. Two classes of therapies are used to treat HER2+ cancer:

– Monoclonal antibodies: these drugs block the membrane receptor and thus block the development of cancer cells while sparing healthy cells

– Tyrosine kinase inhibitors: these molecules will be able to penetrate the cancer cell to block a specific mechanism.

The purpose of these drugs is to stop the growth and spread of breast cancer cells and reduce the risk of recurrence.

HER2 status can change (over time or as a result of treatment), so it is possible to have the test repeated in case of recurrence or metastasis.

 

Radiation therapy

Radiation therapy is systematically indicated for localized breast cancer, and less frequently for metastatic breast cancer.

In recent years great progress has been made in oncology, especially in the treatment of breast cancer, which has greatly improved the prognosis for the disease even at the metastatic stage. The disease can now be controlled for many years, preserving a very good quality of life for patients.

 

New ways to treat triple negative breast cancer

Of all breast cancers, triple negative breast cancer is the most aggressive. Triple-negative breast cancers get their name because they lack estrogen, progesterone (hormone-dependent breast cancer), and HER-2 receptors. This means that hormonal and targeted therapies cannot be used to treat them.

This type of cancer has a much higher risk of metastasis than other types of breast cancer, with a poor prognosis because it is very likely to recur and metastasize to other organs. The liver and lungs are more likely to metastasize, because they spread more through the bloodstream than through the lymphatic system.

There has been little recent progress in therapy for this type of cancer.

 

Breast cancer in men

Breast cancer is usually associated with women. Rarely, however, breast cancer also occurs in men. Men account for about 1% of cases of the disease. It is because men do not believe they are at risk of developing breast cancer and do not seek medical advice that the tumor has time to reach an advanced stage before diagnosis. Lack of awareness of the disease, combined with the absence of obvious symptoms in the patient, and as a result, men’s five-year survival rate is lower than that of women (69% for men, compared with 80-85% for women). Men also have a higher risk of metastases.

In most cases, men are affected by infiltrating ductal carcinoma.

Causes of breast cancer in men, as in women, is a mutation in the BRCA1 or BRCA2 genes. About 15% of breast cancers in men are due to an inherited mutation in these genes.

Symptoms of breast cancer in men

The symptoms of ductal carcinoma are basically the same in men and women. Listed below are signs that are a reason to see a doctor urgently :

– A lump (even painless) in the breast area that can be palpated on self-examination

– Retraction or deviation of the nipple

– Redness, swelling, and warmth in the breast area

– Localized pain

– Palpable nodes in the armpits

– Greenish or bloody discharge

 

Risk factors for breast cancer in men:

– Heredity: having breast cancer in close relatives, both men and women

– Age: a man’s risk of developing breast cancer increases with age

– Men with Klinefelter syndrome have low levels of androgens and high levels of estrogens, which increases the risk of developing breast cancer

– Radiation therapy to the chest in the past

– Liver cirrhosis: it causes high estrogen levels and low androgen levels

 

At our Health and Prevention Center, you may be screened for :

– Breast cancer

Comprehensive medical checkup for women over 40

Rehabilitation program for oncology and cancer prevention

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