Breast cancer: Difference between revisions
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[[Breast cancer classification#Major Scheme|Major Scheme]] | [[Breast cancer classification#Staging|Staging]] | [[Breast cancer classification#Pathologic Types|Pathologic Types]] | [[Breast cancer classification#Histologic Types|Histologic Types]] | [[Breast cancer classification#Major Scheme|Major Scheme]] | [[Breast cancer classification#Staging|Staging]] | [[Breast cancer classification#Pathologic Types|Pathologic Types]] | [[Breast cancer classification#Histologic Types|Histologic Types]] | ||
== | ==[[Breast cancer epidemiology and demograhics|Epidemiology and Demographics]]== | ||
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==[[Breast cancer physical examination|Physical Examination]]== | ==[[Breast cancer physical examination|Physical Examination]]== | ||
Revision as of 16:44, 29 November 2011
For patient information click here
| Breast cancer | |
| ICD-10 | C50 |
|---|---|
| ICD-9 | 174-175 |
| OMIM | 114480 |
| DiseasesDB | 1598 |
| MedlinePlus | 000913 |
| MeSH | D001943 |
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Breast Cancer Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Breast cancer On the Web |
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American Roentgen Ray Society Images of Breast cancer |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor(s)-In-Chief: Jack Khouri
Overview
Classification
Major Scheme | Staging | Pathologic Types | Histologic Types
Epidemiology and Demographics
Physical Examination
Screening
X Ray Mammography | Breast MRI | Breast Ultrasound | Self Exam | Genetic Testing
Diagnosis
Breast cancer is diagnosed by the examination of surgically removed breast tissue. A number of procedures can obtain tissue or cells prior to definitive treatment for histological or cytological examination. Such procedures include fine-needle aspiration, nipple aspirates, ductal lavage, core needle biopsy, and local surgical excision. These diagnostic steps, when coupled with radiographic imaging, are usually accurate in diagnosing a breast lesion as cancer. Occasionally, pre-surgical procedures such as fine needle aspirate may not yield enough tissue to make a diagnosis, or may miss the cancer entirely. Imaging tests are sometimes used to detect metastasis and include chest X-ray, bone scan, Cat scan, MRI, and PET scanning. While imaging studies are useful in determining the presence of metastatic disease, they are not in and of themselves diagnostic of cancer. Only microscopic evaluation of a biopsy specimen can yield a cancer diagnosis. Ca 15.3 (carbohydrate antigen 15.3, epithelial mucin) is a tumor marker determined in blood which can be used to follow disease activity over time after definitive treatment. Blood tumor marker testing is not routinely performed for the screening of breast cancer, and has poor performance characteristics for this purpose.
Staging
Breast cancer is staged according to the TNM system, updated in the American Joint Committee on Cancer (AJCC) Staging Manual, now on its sixth edition. Prognosis is closely linked to results of staging, and staging is also used to allocate patients to treatments both in clinical trials and clinical practice.
Summary of stages:
- Stage 0 - Carcinoma in situ
- Stage I - Tumor (T) does not involve axillary lymph nodes (N).
- Stage IIA – T 2-5 cm, N negative, or T <2 cm and N positive.
- Stage IIB – T > 5 cm, N negative, or T 2-5 cm and N positive (< 4 axillary nodes).
- Stage IIIA – T > 5 cm, N positive, or T 2-5 cm with 4 or more axillary nodes
- Stage IIIB – T has penetrated chest wall or skin, and may have spread to < 10 axillary N
- Stage IIIC – T has > 10 axillary N, 1 or more supraclavicular or infraclavicular N, or internal mammary N.
- Stage IV – Distant metastasis (M)
Breast lesions are examined for certain markers, notably sex steroid hormone receptors. About two thirds of postmenopausal breast cancers are estrogen receptor positive (ER+) and progesterone receptor positive (PR+).[1] Receptor status modifies the treatment as, for instance, only ER-positive tumors, not ER-negative tumors, are sensitive to hormonal therapy.
The breast cancer is also usually tested for the presence of human epidermal growth factor receptor 2, a protein also known as HER2, neu or erbB2. HER2 is a cell-surface protein involved in cell development. In normal cells, HER2 controls aspects of cell growth and division. When activated in cancer cells, HER2 accelerates tumor formation. About 20-30% of breast cancers overexpress HER2. Those patients may be candidates for the drug trastuzumab, both in the postsurgical setting (so-called "adjuvant" therapy), and in the metastatic setting.[2]
Treatment
The mainstay of breast cancer treatment is surgery when the tumor is localized, with possible adjuvant hormonal therapy (with tamoxifen or an aromatase inhibitor), chemotherapy, and/or radiotherapy. At present, the treatment recommendations after surgery (adjuvant therapy) follow a pattern. This pattern is subject to change, as every two years, a worldwide conference takes place in St. Gallen, Switzerland, to discuss the actual results of worldwide multi-center studies. Depending on clinical criteria (age, type of cancer, size, metastasis) patients are roughly divided to high risk and low risk cases, with each risk category following different rules for therapy. Treatment possibilities include radiation therapy, chemotherapy, hormone therapy, and immune therapy.
In planning treatment, doctors can also use PCR tests like Oncotype DX or microarray tests like MammaPrint that predict breast cancer recurrence risk based on gene expression. In February 2007, the MammaPrint test became the first breast cancer predictor to win formal approval from the Food and Drug Administration. This is a new gene test to help predict whether women with early-stage breast cancer will relapse in 5 or 10 years, this could help influence how aggressively the initial tumor is treated.[3]
Primary Prevention
Phytoestrogens and Soy | Folic Acid (Folate) | Oophorectomy and Mastectomy | Medications
Prognosis
There are several prognostic factors associated with breast cancer. Stage is the most important, as it takes into consideration local involvement, lymph node status and whether metastatic disease is present. The higher the stage at diagnosis, the worse the prognosis. Breast cancer patients whose lymph nodes are cancer-free have a much better prognosis than those whose lymph nodes are positive for cancer.
The presence of estrogen and progesterone receptors in the cancer cell is another important prognostic factor which may guide treatment. Hormone receptor positive breast cancer is usually associated with much better prognosis compared to hormone negative breast cancer.
HER2/neu status has also been described as a prognostic factor. Patients whose cancer cells are positive for HER2/neu have more aggressive disease and may be treated with trastuzumab, a monoclonal antibody that targets this protein.
Psychological aspects of diagnosis and treatment
The emotional impact of cancer diagnosis, symptoms, treatment, and related issues can be severe. Most larger hospitals are associated with cancer support groups which can help patients cope with the many issues that come up in a supportive environment with other people with experience with similar issues. Online cancer support groups are also very beneficial to cancer patients, especially in dealing with uncertainty and body-image problems inherent in cancer treatment.
Metastasis
Most people understand breast cancer as something that happens in the breast. However it can metastasise (spread) via lymphatics to nearby lymph nodes, usually those under the arm. That is why surgery for breast cancer always involves some type of surgery for the glands under the arm — either axillary clearance, sampling, or sentinel node biopsy.
Breast cancer can also spread to other parts of the body via blood vessels. So it can spread to the lungs, pleura (the lining of the lungs), liver, brain, and most commonly to the bones. Seventy percent of the time that breast cancer spreads to other locations, it spreads to bone, especially the vertebrae and the long bones of the arms, legs, and ribs. Breast cancer cells "set up house" in the bones and form tumors. Usually when breast cancer spreads to bone, it eats away healthy bone, causing weak spots, where the bones can break easily. That is why breast cancer patients are often seen wearing braces or using a wheelchair, and why they complain about aching bones.
When breast cancer is found in bones, it has usually spread to more than one site. At this stage, it is treatable, often for many years, but it is not curable. Like normal breast cells, these tumors in the bone often thrive on female hormones, especially estrogen. Therefore, the doctor often treats the patient with medicines that lower her estrogen levels.
History
Breast cancer may be one of the oldest known forms of cancer tumors in humans. The oldest description of cancer (although the term cancer was not used) was discovered in Egypt and dates back to approximately 1600 BC. The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were treated by cauterization.The writing says about the disease, "There is no treatment."[4] For centuries, physicians described similar cases in their practises, with the same sad conclusion. It wasn't until doctors achieved greater understanding of the circulatory system in the 17th century that they could establish a link between breast cancer and the lymph nodes in the armpit. The French surgeon Jean Louis Petit (1674-1750) and later the Scottish surgeon Benjamin Bell (1749-1806) were the first to remove the lymph nodes, breast tissue, and underlying chest muscle. Their successful work was carried on by William Stewart Halsted who started performing mastectomies in 1882. He became known for his Halsted radical mastectomy, a surgical procedure that remained popular up to the 1970s.
Cultural references
In the month of October, breast cancer is recognized by survivors, family and friends of survivors and/or victims of the disease. A pink ribbon is worn to recognize the struggle that sufferers face when battling the cancer.
Pink for October is an initiative started by Matthew Oliphant, which asks that any sites willing to help make people aware of breast cancer, change their template or layout to include the color pink, so that when visitors view the site, they see that the majority of the site is pink. Then after reading a short amount of information about breast cancer, or being redirected to another site, they are aware of the disease itself.
The patron saint of breast cancer is Saint Agatha of Sicily.
Related Chapters
- List of breast carcinogenic substances
- Mammary tumor for breast cancer in other animals
- Breast reconstruction
- Alcohol and cancer
- Mammography Quality Standards Act
- National Breast Cancer Coalition
- National Comprehensive Cancer Network
- Breast Cancer Action
- Breakthrough Breast Cancer
- Barron Lerner (Physician)
- William Stewart Halsted (Radical Mastectomy)
- International Agency for Research on Cancer
- The Hormone Foundation
- Susan G. Komen for the Cure
References
- ↑ Rusiecki JA, Holford TR, Zahm SH, Zheng T. Breast cancer risk factors according to joint estrogen receptor and progesterone receptor status. Cancer Detect Prev 2005;29:419-26
- ↑ accessed 1/30/07 cancer.gov
- ↑ "FDA Approves New Breast Cancer Test". Associated Press, February 6, 2007.
- ↑ "The History of Cancer". American Cancer Society. 2002-03-25. Retrieved 2006-10-09.
External links
- Breast localisation and excision: Operation Script on Wikisurgery.
- Breast localisation and excision : Information for patients on Wikisurgery.
- Breast subareolar excision : Operation Script on Wikisurgery.
- Breast subareolar excision daycase : Information for patients on Wikisurgery.
- Breast wide excision: Operation Script on Wikisurgery.
- Breast wide excision: Information for patients on Wikisurgery.
- Fine needle aspiration: Operation Script on Wikisurgery.
- Mastectomy: Operation Script on Wikisurgery.
- Mastectomy: Information for patients on Wikisurgery.
- Mastectomy subcutaneous male daycase: Information for patients on Wikisurgery.
- Trucut needle biopsy: Operation Script on Wikisurgery.
General
- American Cancer Society - Learn About Breast Cancer Page
- National Cancer Institute: Breast Cancer
- Imaginis -Award winning Breast Cancer site
Research and statistics
- eMaxHealth Breast Cancer Publishes Research News on Breast Cancer from Research Institutions and Universities
Clinical
- RadiologyInfo - The radiology information resource for patients: Breast Cancer
- Surgery Choices for Women with Early-Stage Breast Cancer, National Cancer Institute
- Mastectomy vs.n Lumpectomy: Who Decides?, National Research Center for Women & Families
- Australia: Cancer Control Bulletin Alcohol and cancer risk
Videos
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