Breast cancer diagnosis and treatment


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Breast cancer is very common and it usually occurs in ladies past the age of forty years, though cancer has been seen to occur earlier as well. The incidence of breast cancer in our country is reported to be 25 per 100,000 ladies.

In the western countries this disease is very common. Incidence is very high among Parsees in India, while if is very low in Japan. After the uterus, the breast is the commonest site of cancer in Indian ladies. The occurrence of cancer in the breast is rising in most countries, including India.

The cause of the cancer is unknown. There are certain risk factors, but ladies who develop cancer in the breast may not have identifiable risk factors.

RISK FACTORS OF CANCER IN THE BREAST

• It is very common after forty years of age.
• It is very common among ladies who had early menarche, less than the age of twelve or late menopause in the age of fifty years.
• An increased body weight and a high fat diet have been associated with increased risk.
• Spinsters and childless married women have a greater risk of developing cancer.
• Ladies with a history of any of her relations having breast cancer have an increased risk.
• Ladies with shorter duration of lactation and who had their first pregnancy after thirty two years of age may have increased incidence.
• Oral contraceptives have no direct relation to cancer in the breast.

The risk of developing cancer in the other breast is nearly five times higher among ladies who were young when related for first cancer or in case there is a positive family history. Usually, they present three years after the occurrence of the first tumor. Bilateral breast cancer may be present even at the first presentation.

SYMPTOMS OF CANCER IN THE BREAST

Cancer in the breast develops as a slow growing, lump, painless, the upper outer quadrant being the commonest sites. The important feature of cancer is its spread locally inside the breast and the surrounding structures, to regional lymph nodes in the armpit or to the distant lymph nodes, and by way of the blood to the lungs, liver and bones.

In the majority of cases, the presence of a lump in the breast is an accidental discovery by the lady herself. It may have been present for sometime when discovered. Pain is not an initial symptom. But if pain develops in an already existing lump, or if there is a recent rapid increase in size, it could be and a doctor should be consulted. A lymph node in the armpit may sometimes be the initial finding. When symptoms related to its spread appear, the disease is already advanced.

Because of the lump, the shape of the breast will be changing. Pitting of skin like orange peel indicates involvement of the skin and the restricted mobility of the lump within the breast is indicative of cancer. The nipple may be retracted or pulled to one side when the milk ducts are involved.

Blood discharge from the nipple in patients aged over fifty years could be from an undergoing cancer. Ulceration is an indication of an advanced disease. The other breast is always examined for comparison and for the presence of cancer. Any ulcer or eczematous lesion of the nipple must be well investigated. There may be cancer under it.

Nodes above the collar bone, increased girth of the abdomen, bone pains are indicative of the distant spread of cancer and therefore, advanced disease. The liver may not be enlarged with early metastasis.

DIAGNOSIS OF CANCER IN THE BREAST

A tumor in the breast has been discovered through the open biopsy and mammography examination.

Computed tomography, radioisotope scanning of the bone and liver, ultrasound of the liver, and X-ray of the chest provides information about the widespread. They are also helpful to take decision upon the management approach.

In the clinic of breast screening, ladies are often discovered to have abnormal mammograms without any symptoms of cancer or palpable tumor. These lesions on mammograms can be identified by a needle under microscope or under x-ray control.

STAGING OF CANCER IN THE BREAST

It is a system based on clinical examination to assess the extent of the local disease, its local and distant spread and thus the stage of the cancer in the breast. It is essential to note that tumor node and metastasis are independent factors. The following staging system is used for cancer in the breast.

In the initial stage, tumor limited to breast tissue, less than two centimeters in diameter in size. No palpable nodes and no metastasis.

In the second stage, tumor is more than two centimeters in size but less than five centimeters in diameter, may or may not be adherent to the fascia or muscle. Mobile lymph nodes in the armpit of the same side present may or may not have cancer in the nodes. No metastasis.

In the third stage, tumor is more than five centimeters in size in diameter, tethered to the muscle and fascia. Nodes on the same side are present, involved by cancer fixed to each other and other structures. No metastasis.

In the fourth stage, tumor of any size with directs extension to the chest wall and skin. The nodes are palpable on the same side, involved by cancer fixed to each other and other structures. Distant metastasis is present.

The curative surgery is possible only if cancer is limited locally to first stage and second stage. In third stage and fourth stage the disease has spread beyond the breast and elsewhere and is therefore an advanced case of cancer.

COUNSELING OF THE CANCER IN THE BREAST

The diagnosis pf breast cancer will certainly cause shock, anxiety and depression to any lady and the members of her family. The fear mainly is of eventual death. The loss of a breast is psychologically disturbing. Even the successfully treated cases may continue having fears of persisting disease or of recurrence. Any delay in the diagnosis of suspected cancer and the fears of surgery and other methods of treatment, enhances the emotional trauma of the patient.

Presently, the loss of a breast or immediate death is not inevitable, provided the cancer is detected and suitably treated in the early stages. Unfortunately, those relatives or friends who may have died of cancer are more in the memory than those who are successfully treated and leading a normal life.

A truthful discussion with the doctor is essential to understand the management approaches, their long term effects and after care. The treatment in each patient of cancer is individualized. Any recommended approach depends on age, menstrual and fertility status, site and stage of the disease, its kind, and extent – local, regional or elsewhere in body and the judgment of the doctor.

The success of the treatment depends on the confidence and determination of the patient and reassurance provided by the doctor. Support is needed in the case of reappearance. Successful treatment makes productive, happy and normal life.

MANAGEMENT OF CANCER IN THE BREAST

The methods available of treating breast cancer are hormonal treatment, chemotherapy, radiotherapy and surgery.

Surgery, with or without radiotherapy, will control regional and local disease, while hormonal therapy and chemotherapy deal with its distant spread.

RESULTS OF TREATMENT OF CANCER IN THE BREAST

Results of treatment depend on the size, stage of the cancer and its potential to spread at the time of presentation. Young ladies have a poorer prognosis than older patients with cancer of the same stage. There is little doubt that the early detection and adequate treatment of breast cancer where nodes are not involved may provide a care. The cancer with a high potential of spread has poor results in terms of survival. Constant efforts are on to successfully deal with those unsuspected tumor deposits, frequently present even in apparently early cases of breast cancer.


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