Breast Cancer

Overview

Even though breast cancer may be the most common type of cancer diagnosed today, your diagnosis is as unique as you are. Know that there are things you can do to prepare for the path ahead.

First, find a skilled medical team that has experience treating your type of breast cancer. The relationship you have with your doctor, nurse navigator and other members of the team will last for some time, and feeling comfortable with them is essential. You’ll be partners, so being confident in their abilities and trusting their recommendations is important. In turn, it’s equally important for you to feel valued and respected. After all, being diagnosed with breast cancer is a highly intimate experience. You’ll share delicate information with the team members and ask for their help as you move forward with your treatment.

Next, adopt the mindset that knowledge is power, and learn as much as you can about your particular type, subtype and stage of breast cancer to determine your goals of treatment. Surgical oncologist Charles M. Balch, MD, FACS, is passionate about ensuring patients are informed. He feels an educated patient is more likely to get better care and is always better equipped emotionally to cope.

“As physicians, when we talk with our patients and their families, we want them to feel they are active participants in their own care. We don’t want to simply tell them how we plan to treat their disease. Instead, we talk about our shared treatment goals and their expectations for their own quality of life. The more they understand, the more comfortable they are making decisions and following their personalized treatment plan.”

Understanding the basics of cancer may help you process your diagnosis. Cells typically divide in an orderly fashion. When worn out or damaged, they die, and new cells replace them. Cancer develops when genes begin to change, or mutate, within the structure of normal cells. These cells – now called cancer cells – grow and push against normal cells.

Breast cancer develops when malignant cells that originate in breast ductal or lobular structures spread to the surrounding breast tissue. It may be noninvasive or invasive, and knowing the difference will help guide your treatment (see Types of Breast Cancer, below).

Noninvasive breast cancer cannot spread beyond the ductal or lobular walls. The most common form of noninvasive breast cancer is ductal carcinoma in situ (DCIS). Most DCIS cases require therapy (surgery and possibly radiation therapy) to remove and/or treat the abnormal breast tissue and to prevent the development of invasive cancer. When detected in the absence of invasive cancer, DCIS is not life-threatening because it is not biologically capable of metastatic spread to other organs of the body. These are considered by some to be “pre-cancers.”

When cancer cells spread into surrounding fatty and fibrous breast tissue, the breast cancer is considered invasive.

A diagnosis of “advanced breast cancer” means the cancer has metastasized, or spread, beyond the breast and nearby lymph nodes to other organs. Although a cure for advanced breast cancer is not yet available, progress in research is enabling many people to live longer with a better quality of life. Your doctor may use multiple therapies on an ongoing basis to achieve the goal of treatment, which is to control the growth of the cancer while minimizing side effects.

Table 1. Types of Breast Cancer

Type Characteristics
Non-invasive
Ductal carcinoma in situ (DCIS) Cancer cells remain confined to the milk ductal units.
Paget disease Begins in the ducts of the nipple; can be in situ or invasive.
Invasive
Cribriform Cancer in connective tissue featuring "holes" within the histologic pattern.
Ductal Cancer cells that arise from the milk ducts and spread beyond ductal walls into surrounding fatty tissue, connective tissue, lymphatics and/or vascular structures within the breast.
Inflammatory Breast Cancer (IBC) Cancer that is always staged as either Stage III or Stage IV disease, associated with redness and swelling of the breast. Breast skin may look pitted, resembling an orange peel. IBC may be difficult to diagnose because people often report atypical symptoms. IBC may not form lumps like other breast cancers or show up on a mammogram. Often misdiagnosed as mastitis(an infection of breast tissue).
Lobular Cancer cells that arise from the lobules (milk-producing glands) and spread into surrounding fatty tissue, connective tissue, lymphatics and/or vascular structures within the breast.
Medullary Soft, fleshy tumor, often associated with inflammatory cells called lymphocytes; usually has a better prognosis (outlook) than invasive ductal or invasive lobular cancers of the same size.
Metaplastic Rapidly growing tumor, contains a mixture of cell types, including epithelial (glandular) cells and mesenchymal (bone, skin and muscular) cells.
Mucinous (colloid) Mucus is primary component of the tumor; less likely to spread to lymph nodes.
Papillary Tumor with small, finger-like projections; often occurs with DCIS.
Tubular Typically low grade, ER+, less likely to spread beyond breast.
Receptor subtypes
Hormone receptor (ER+ and/or PR+) Tumor positive for estrogen and/or progesterone.
HER2-positive (HER2+) Tumor overexpresses the HER2 oncogene, includes any ER or PR status.
Triple-negative (ER-/PR-/HER2-) Tumor negative for ER and PR and does not overexpress HER2. Triple negative breast cancer (TNBC) tends to be more aggressive and is more likely to have microscopic cancer cells hiding in other organs (micrometatstases). Treatment options are limited because therapies that target ER, PR and HER2 will not be effective; however, recent FDA drug approvals offer more treatment options.

 

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