Diagnosis of Breast cancer
Breast cancer is usually first noticed as an abnormality on a mammogram before it is felt by a patient or doctor.
The various tests and screenings that help confirm the diagnosis are:
- Clinical breast examination. Here, your doctor examines the breasts and underarm for abnormalities. During this procedure, you may need to sit or stand with your arms in different positions, such as above the head or by the sides.
Mammography: This is a type of X-ray that doctors commonly use to detect breast cancer at its early stage. It produces images that can help the doctor find any lump or abnormalities. Hence, women with high risk should always go for routine mammography screening.
Ultrasonography: This scan uses sound waves to help your doctor differentiate between a solid mass and a fluid-filled cyst.
Magnetic Resonance Imaging (MRI): It combines different images of the breast to help your doctor detect cancer or other abnormalities. It may be recommended as a follow-up to mammography or ultrasonography.
Ultrasound and MRI can easily detect invasive cancer in non-fatty breast than a mammogram.
Biopsy: It is the only way to confirm a breast cancer diagnosis. For this test, the doctor removes tissues or fluid from your breast with image guidance and sends it for laboratory analysis.
This shows whether the cells are cancerous. If they are, a biopsy indicates which cell is affected, and whether or not the cancer is hormone-sensitive
Diagnosis also involves staging cancer to establish:
- the tumor size
- how far the cancer has spread
- whether it is invasive or noninvasive
Staging provides a picture of patient chances of recovery and their ideal course of treatment.
Breast Cancer Treatments
If the tests confirm breast cancer, you and your doctor will develop a treatment plan to remove cancer, to lower chances of recurrence, and to reduce the chance of it spreading outside your breast. Treatment generally proceeds within a few weeks after the diagnosis.
Your treatment will depend on the tumor’s size and location, lab tests result of the cancer cells, and the stage of the disease. Your doctor usually considers your age and general health as well as your emotions about the treatment options.
These control or get rid of cancer cells in a specific area, such as your breast. These include:
Breast-conserving surgery. The surgeon gets rid of the part of the breast with cancer, along with some nearby tissue. How much they take out depends on factors like the tumor’s size and location. You might also hear it called:
- Partial mastectomy
- Segmental mastectomy
Surgery to remove lymph nodes. Your doctor might take lymph nodes from your underarm to find out whether cancer has spread to them. There are two kinds of this surgery:
- Sentinel lymph node biopsy. The doctor removes one or a few lymph nodes where cancer is most likely to spread.
- Axillary lymph node dissection. This involves more nodes, usually less than 20.
Mastectomy. A surgeon removes the whole breast, along with all of the breast tissue and sometimes nearby tissues. The various types of mastectomy are:
- Total or simple mastectomy. The surgeon gets rid of your whole breast, but not your underarm lymph nodes unless they are within the breast tissue.
- Modified radical mastectomy. The surgeon gets rid of your whole breast along with your underarm lymph nodes.
- Radical mastectomy. The surgeon gets rid of your whole breast and underarm lymph nodes and up to your clavicle (collarbone), as well as the chest wall muscles under your breast.
- Partial mastectomy. The surgeon removes the cancerous breast tissue and some nearby tissues – usually more than in a lumpectomy.
- Nipple-sparing mastectomy. The surgeon gets rid of all the breast tissue but leaves your nipple alone.
- Contralateral prophylactic mastectomy. If you have cancer in one breast and a very high risk of getting it in the other breast, you might choose to have both breasts removed.
It uses high-powered beams of energy, such as X-rays and protons, to kill cancerous cells.
This is usually done after surgery to remove the remaining cancer cells and reduce the chances of recurrence.
Side effects of radiotherapy include fatigue and a red, sunburn-like rash where the radiation is directed. The breast tissue may appear firm or swollen.
They control or get rid of cancer cells all over your body. These treatments include:
Chemotherapy. It uses drugs to destroy fast-growing cells. You might take these drugs as pills or get them injected into a vein. If your cancer has a high chance of recurrence or spread to other parts of the body after surgery, your doctor can recommend chemotherapy (adjuvant chemotherapy) to reduce the risk.
Side effects of chemotherapy depend on the drugs you receive.
Common side effects are loss of hair, fatigue, nausea, vomiting, and a high risk of getting an infection.
Less common side effects include infertility in premenopausal women, early menopause, heart and kidney damage, and blood cell cancer which is very rare.
Hormone therapy. Some cancers grow in response to certain hormones. These cancer types are often referred to as estrogen receptor-positive (ER-positive) and progesterone receptor-positive (PR positive) cancers.
ThEse medications stop the hormones from attaching to cancer cells, which stops their growth.
Hormone therapy reduces the chance of cancer recurrence and if the cancer has already spread, it may shrink and control it.
Chemotherapy and hormone therapy are the two main treatments for cancer that has spread to other parts of the body.
Targeted drugs. They stop the changes that make cells grow out of control.
Immunotherapy. These medications help your immune system fight cancer.
Prevention of breast cancer
Lifestyle modifications. You can reduce the risk of breast cancer by maintaining a healthy weight, reducing alcohol intake, increasing physical activity, and breast-feeding
Maintain a healthy diet. A diet high in vegetables, fruits, whole grains, and legumes reduce the risk of breast cancer.
Also, a high consumption of citrus fruits reduces the risk by 10%, and marineomega-3 polyunsaturated fatty acids appear to reduce the risk.
Regular self-breast examination: This can help in the early detection of changes in your breast and prompt treatment.
Limit postmenopausal hormone therapy. To reduce breast cancer risk, the lowest dose of combined hormone therapy should be used for the shortest possible amount of time.
Chemoprevention. Estrogen-blocking drugs, such as selective estrogen receptor modulators and aromatase inhibitors, reduce the risk of breast cancer in high-risk women.
Preventive surgery. Women with a very high risk of breast cancer may decide to have their healthy breasts surgically removed (prophylactic mastectomy). They may also decide to have their healthy ovaries removed (prophylactic oophorectomy) to reduce the chance of both breast cancer and ovarian cancer.
Breast cancer outlook
Your outlook after breast cancer depends on many factors, including your cancer stage and the time you were diagnosed. However, early detection and treatment usually lead to a positive outlook.
Almost 100% of women whose cancer is only in their breast live at least five years after diagnosis. In women whose cancer has spread to nearby tissue, 91% live at least five more years, and 84% live at least ten more years.
If a woman’s breast cancer has spread to nearby lymph nodes, the five-year survival rate is 86%. About 27% of women whose cancer has spread farther in their body live at least five more years.
F.O. Adagbonyin, MB.BS in view, certified content creator at Medblog180 and MedicWord, licensed google writer and contributing writer at WikiMedia Foundation.