Health Awareness blog

Breast carcinoma occurs commonly in females. It doesn’t mean that it would occur in males, only rare. Frequency ratio to breast cancer in male to female is 1:125.

No other cancer is more feared by women and for a good reason too. In the United States it is estimated by the American Cancer Society that in 1996 over 185,000 new breast cancers were discovered in women and caused 44:500 deaths, making this score second to lung cancer as a cause of cancer deaths.

Breast cancer can be classified into 5 classes:
• Fibro adenoma
• Phyllodes tumor
• Papilloma
• Papillary carcinoma
• Breast carcinoma
RISK FACTORS FOR BREAST CANCER
• Geographic factors (higher n North America and Northern Europe than Asia and Africa)
• Age (>30 years old)
• Menstrual history (age at menarche <12 years old)
• Pregnancy (late first live birth)
• Genetic and family history (5%-10% of breast cancers are thought to be related to specific inherited mutations).
• Exogenous estrogens
• Oral contraceptive pills
• Obesity
• High fat diet
• Alcohol consumption
• Cigarette smoking
SYMPTOMS AND SIGNS

• Painless lump in the breast
• Nipple retraction or discharge
• Skin dimpling
• Peau d’orange
• Breast asymmetry
• Erythema over skin or nipple
SYMPTOMS OF MATASTASES

• Bone pain
• Headache
• Breathlessness
• Jaundice

INVESTIGATIONS

• Full blood count – to rule out anaemia
• Liver function tests- to look for liver metastases
• Serum calcium – this will increase in advanced disease
• Mammography – for diagnostic
• Ultrasound scan of the breast – this is less helpful inn comparison to mammography
• Fine needle aspiration cytology – this technique is very accurate
• Bone scan – to look for bone metastases
• Ultrasound scan of liver – to look for liver secondaries
• CT scan of brain
CLINICAL STAGING

Manchester classification (modified) 

 TNM classification 

MANAGEMENT & TREATMENT
There are 4 options noted:

1. Surgery
2. Radiation therapy
3. Chemotherapy
4. Hormonal therapy

The patient might be offer, either 1 option or even all 4 options depend on the stage and extend of the disease.
SURGERY

This type of treatment is suitable for early stage of breast cancer. This is consist of wide local incision, simple mastectomy (removal of breast) and modified radical mastectomy (removal of the breast, pectoralis minor muscle and the axillary contents)

Aims:
• Remove tumor
• Relieve the pain
• Correct the obstruction
• Alleviate pressure
Side effects:
• Disfigurement
• Wound seromas
• Arm oedema (swelling)
• Stiffness of the shoulder
• Losing of breast always become an issue
• Patient usually prefer less radical surgery
RADIATION THERAPY
This is use for palliative treatment. For example for fungating lesions and to localized bony metastases.

Aims:
• To destroy rapid dividing cancer cells (minimized normal cells damage)
• Shrink visible tumor (psychological lift to patient)
Side effects:
• Fatigue and weakness
• Pain
• Nausea and vomiting
• Anemia
• Diarrhea
• Dysuria (painful urination)
• Loss appetite
• Possible anorexia
• Pruritus (itchiness)
CHEMOTHERAPY
This treatment is use in patients who are unlikely to respond to hormonal treatment or who has been offered hormonal treatment but fail to respond well. If the right chemotherapy is chosen correctly, it can provide good quality palliation and prolongation of life.

Aims:
• Induce tumor regression and its metastasis adjunct to surgery and radiotherapy
• Palliative measures (relieve pain and other symptoms)
Side effects:
• Marrow suppression (anemia and leucopenia)
• Gastrointestinal tract irritation
• Nausea and vomiting
• Loss of hair
• Alopecia
• Dermatitis
HORMONAL THERAPY
This treatment is offered for patients with established metastatic disease. Women who have high level of oestrogen receptors in the tumours are likely to respond to hormonal treatments. 
OTHER THINGS THAT YOU NEED TO KNOW
Recurrent disease may be treated with radiotherapy, hormonal manipulation and chemotherapy.

Routine follow up to breast clinic is needed to monitor the progress and recurrence of the disease. Patients are encouraged to do self examination of both breast, either at the operation site or other breast that not yet affected. Minimum 5 years follow up is needed and repeat mammography to the breast is highly recommended.

Breast reconstruction might be offered to the patient but many patients are comfortable with prosthesis.
PROGNOSIS
• Stage I : 80% 5-Year survival
• Stage II: 50% 5-year survival
• Stage III: 15% 5-year survival
• Stage IV: 5% 5-year survival
SUMMARY
Breast carcinoma is so far the most common malignancy in female. Annually, about 13 000 women die in UK for this disease. Surprisingly, the incidence appears to be rising. The cause still remains a mystery. Although the 5-year survival rate had increased, the overall mortality has changed very little in the past 25 years.

I am seriously recommending routine self examination at home. Breast screening is very important based on the fact that early detection can improve the prognosis.
Reference:
1. Clinical medicine by Kumar and Clark. 4th edition. 1998.
2. Churchill’s Pocketbook of Surgery by Andrew T Raftery. 2nd edition. 2001.
3. British medical journal 1997.
4. European Journal of Cancer 1997.
5. Journal of Clinical Oncology 1998.
6. Primary management of breast cancer alternatives to mastectomy. 1st edition. Edward Arnold Ltd. 1985.
7. Early breast cancer, its history ad results of treatment. 1st ed. Basel: S Karger, 1976.
8. Basic Pathology. 6th ed. Bangalore: Prism Books PVT Ltd, 1997.

Tags: breast cancer, health, management, prognosis, staging, symptoms, treatment, womens health

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