Breast Cancer
　

Breast cancer is one of the most common cancers affecting women. It is a disease where cancer cells are found in the tissue of the breast. An individual breast has 15 to 20 sections, known as lobes, which are in turn subdivided into smaller sections called lobules. Cancer occurs when the cells become abnormal and divide without control. This results in too much tissue and a lump forms. This is called a tumour and can be benign or malignant. Narrow tubes called ducts connect the lobes and lobules. The most common of all breast cancer is ductile cancer, found in the duct cells. Cancer starting in the lobes or lobules is called lobular cancer. If detected early breast cancer is treatable – even curable. Most women who are treated in the early stages remain cancer-free five years on.

Tumours

  • Benign tumours are not cancerous. Once removed, they usually do not reoccur. Cells in benign tumours do not invade the surrounding tissue nor do they spread to other parts of the body. They are not life-threatening
  • Malignant tumours are cancerous. The cells continue to grow out of control, invading and damaging the surrounding tissue and organs. Often they break away entirely and enter the lymphatic system or even the bloodstream which can lead to secondary cancer.

Types of breast cancer

  • Adenocarcinoma starts in the glandular tissues. The two main types are ductile carcinomas and lobular carcinomas
  • Ductile carcinoma or DCIS is the most common type of non-invasive breast cancer. If diagnosed early it can be cured. Usually diagnosed by mammogram.
  • Invasive ductile carcinoma or IDC starts in the milk duct and has spread to the fatty tissue of the breast. Accounts for around 75% of breast cancer.
  • Invasive lobular carcinoma or ILC starts in the milk producing glands. Like IDC, this can spread to the fatty tissue and is more difficult to diagnose by mammogram.
  • Inflammatory breast cancer is a rare form of invasive cancer, accounting for just 1% of all breast cancers. The skin of the breast becomes red, inflamed and pitted in appearance.
  • Lobular carcinoma in situ or LCIS is a non-invasive cancer of the milk glands that does not break through the lobules. Women with this condition have a higher risk of developing an invasive type of cancer.
  • Medullary carcinoma is an invasive cancer and accounts for 5% of breast cancers. Women diagnosed with this have a better chance of survival than with other types of invasive cancers.
  • Mucinous carcinoma also known as Colloid carcinoma. This is a very rare form of invasive breast cancer is formed by mucus-producing cells. Prognosis for recovery is good.
  • Paget’s disease starts in the ducts and spreads to the nipple before reaching the areola. Often associated with in situ carcinoma but it is not always invasive.
  • Phyllods tumour is a very rare form of cancer found in the connective tissue of the breast. Phyllodes are usually benign but occasionally may become malignant.
  • Tubular carcinoma is an unusual type of invasive breast cancer. They have a better than average prognosis than either ductile or lobular carcinomas.

Stages of breast cancer

  • Stage 0 – the earliest form of breast cancer and have not yet become invasive.
  • Stage 1 – the tumour is 2.0 cm and has not spread beyond the breast.
  • Stage 2 – the tumour is 2.0 cm and has reached, or is spreading to, the lymph nodes.
  • Stage 3 – the tumour is larger than 5 cm and has spread to the surrounding tissue.
  • Stage 4 – the cancer has spread throughout the body.

Ways to detect breast cancer

  • Breast self examination should be performed on a regular basis by all women aged 20 or over. This is one of the surest ways of detecting changes in the breast.
  • Clinical breast examination is carried out by your doctor or nurse. Attention is given to the whole breast and the underarm area.
  • Mammography is an x-ray of the breast used to diagnose breast cancer in women who have symptoms.
  • Screening mammography is used as a preventative measure.
  • Breast ultrasound or sonography is when high frequency sound waves are sent into the area of the body suspected of being cancerous.
  • Ductograms diagnose the cause of nipple discharge.
  • Biopsy is usually carried out after a mammogram, ultrasound or physical examination. Biopsy is the only sure way of determining if cancer is present.
  • Fine Needle Aspiration Biopsy or FNAB is when a fine needle is guided into the breast lump.
  • Core needle biopsy is carried out under local anaesthesia. A large needle is used to remove a sample of abnormal tissue.
  • Surgical biopsy is used in cases where some or all of the lump is removed for examination.
  • If the results from any of the above diagnoses are benign, no further treatment will be needed.

Treatments

  • Local therapy treats the tumour where it is found without affecting the rest of the body. This includes surgery or radiation therapies.
  • Systematic therapy is given orally or directly fed into the bloodstream. This is used when the cancer has spread beyond the breast. Includes chemotherapy, hormonal therapy and immunotherapy.
  • Lumpectomy removes only the lump and some of the surrounding normal tissue. If the cancer has spread, further surgery will be required.
  • Mastectomy is divided into three areas:
    • Simple or total mastectomy where the whole breast is removed, but not the lymph nodes or muscle tissue.
    • Modified radical mastectomy where the whole breast is removed along with some of the lymph nodes.
    • Radical mastectomy where the whole breast, the lymph nodes and the pectoral muscles are removed.

Surgery

  • You will find out within a few days of a biopsy if you have cancer.
  • The extent of the breast cancer will not be known until after the local surgery.
  • You will meet with your surgeon beforehand. Ask as many questions as you like
  • You will be asked to sign a consent form. Read it carefully.
  • You may be asked to donate your own blood in case of a blood transfusion.
  • You will be asked if you are taking any medication.
  • You will also meet with your anaesthesiologist and post-operative nurse.
  • Depending on the surgery required you may become an outpatient or you may be admitted to hospital.
  • If you are admitted to hospital your length of stay will be determined by the extent of the surgery, your overall health and any complications that may arise.
  • The length of the operation will depend on how complicated the surgery is. A mastectomy can take between two and four hours.

After surgery

  • After surgery you will have a dressing and some form of drainage from the breast.
  • The drainage tubes usually remain in place for up to three weeks.
  • You will be asked to move your arm about to prevent stiffness.
  • Most women do not suffer much pain but there may be numbness or a stretching feeling.

Chemotherapy

  • Anti-cancer drugs may be given orally (by mouth) or intravenously. The drugs are designed to fight cancer in any part of the body. Chemotherapy significantly reduces the recurrence of breast cancer.
  • The side effects, if there any, depend on the type of drugs used and the length of treatment.
  • Temporary side effects include fatigue, nausea and vomiting, loss of appetite, hair loss and occasionally mouth ulcers.
  • There may also be an increased risk of infection or bruising.

Radiation therapy

  • This is a post-surgery treatment using high-energy rays to destroy cancer cells. It is effective in destroying any remaining cancer cells after surgery.
  • Side effects include swelling in the breast area, sunburn and tiredness. These changes will go away within 5-12 months.

Hormone therapy

Because Oestrogen is thought to promote certain breast cancers, anti-oestrogen drugs are used to lower the natural oestrogen produced by the ovaries. The most common one is Tamoxifen and it is usually taken for up to five years.

Alternative or complimentary medicines

You should consult a qualified herbalist or homeopath regarding alternative treatments. Many of them can be taken with standard medication.

Emotional reactions to breast cancer

  • Both before and after surgery you should take time to consider your psychological, emotional and spiritual needs. It is important that you recognise that this is a very difficult time and that you will have a range of emotional reactions. Do not be afraid to talk them over with someone you trust.
  • The treatment you receive will influence the image you have of yourself. Your body will undergo many changes and these can be difficult to come to terms with.
  • You will have genuine concerns for your future and the outcome of any treatment you are receiving.
  • Concerns about sexuality are often foremost after surgery, especially after radical surgery.
  • Involving your partner, if you have one, is important.
  • Seek professional counselling if you have problems coming to terms with things.

Reconstructive and breast implant surgery

  • This is not a treatment for cancer. It is used to restore the breast’s appearance after surgery.
You should discuss reconstruction with your surgeon before surgery, as breast reconstruction may be done as the same time as the mastectomy. 		　

　

　

　

   

圖書館首頁 婦產科首頁  

Department of Obstetrics and Gynecology  ,   Chia-Yi Chang Gung Memorial Hospital