Breast Cancer - Symptoms, Diagnosis & Treatment

Tests For Breast Cancer

Diagnosis of breast cancer involves a variety of tests & procedures, including:

• A mammogram. An X-ray of the breast commonly used to screen for breast cancer. If any abnormality is found during a screening mammogram, a diagnostic mammogram may be recommended to further evaluate that abnormality.
• Breast examination. The doctor checks the breasts & armpit lymph nodes, feeling for lumps & any other abnormalities.
• Breast ultrasound – involves using sound waves to generate images from within the body. Ultrasound can help determine whether a breast lump is a solid mass or a fluid-filled cyst.
• Breast tissue biopsy – the benchmark test for breast cancer diagnosis, breast tissue is examined by a laboratory for expert testing. A biopsy can also help ascertain the types of cells causing cancer & the grade.
• Breast magnetic resonance imaging (MRI). An MRI involves using magnetism & radio waves to create images of the breast’s interior.

Staging Breast Cancer

On diagnosis of breast cancer, the extent (stage) of cancer must be established in order to determine the prognosis & create a treatment plan. Full information regarding the stage of cancer may not be available until after breast cancer surgery.

Tests employed in staging breast cancer include:

• Blood tests.
• A Mammogram of the other breast, to ascertain there is also cancer there.
• A breast MRI.
• Bone scanning.
• A computerized tomography (CT) scan.
• A positron emission tomography (PET) scan.

Medcare’s professional health experts will select the appropriate tests based on patient circumstances, taking into account any new symptoms. Breast cancer stages are designated from 0 to IV. Stage 0 suggests cancer that is non-invasive or contained within the milk ducts. Stage IV breast cancer - metastatic breast cancer - is indicative of cancer that has spread.

Breast cancer Treatment

You may be offered one type of treatment or a combination of treatments. The type & combination of treatment offered depend on the cancer diagnosis & stage. Your Medcare health professionals will discuss which options are available & right for you.

Some of the main treatments for breast cancer include:

• Surgery
• Radiotherapy
• Chemotherapy
• Hormone therapy
• Targeted therapy

Choosing breast cancer treatments

Your Medcare team will consider:

• Stage & grade of cancer
• Your general health
• Whether you have undergone menopause

Breast Cancer Surgery

Surgery is commonly the first treatment for breast cancer. Surgery type will vary, depending on breast cancer type. After surgery, chemotherapy, radiotherapy or, in certain cases, hormone or targeted therapies will be offered, again depending on the type of breast cancer. Sometimes, chemotherapy or hormone therapy will be offered first of all. Breast cancer surgery can involve:

• Breast-conserving surgery, which involves removal of a tumor.
• Mastectomy, where the whole breast is removed.

Following mastectomy, reconstructive surgery is often undertaken to reconstruct & replace the removed breast. Studies reveal that breast-conserving surgery followed by radiotherapy is as successful as total mastectomy in treating early-stage breast cancer.

Breast-Conserving Surgery: Breast-conserving surgery encompasses lumpectomy or wide local excision, (where the tumor & some surrounding breast tissue is removed), to partial mastectomy or quadrantectomy, where up to a quarter of the breast is removed. If breast-conserving surgery is performed, the volume of breast tissue removed will depend on:

• The type of cancer.
• The size & location of the tumor.
• The volume of tissue surrounding the tumor that needs to be removed.
• Breast size.

The surgeon will always remove an area of healthy breast tissue around the tumour, which will be tested for traces of cancer. If there's no cancer found in the healthy surrounding tissue sample, there's less chance of it returning. If cancer cells are discovered in the surrounding tissue, more breast tissue may need to be removed. Following breast-conserving surgery, radiotherapy is commonly administered to destroy any remaining cancer cells.

Mastectomy: A mastectomy involves removing the entire breast, including the nipple.

Breast Reconstruction Following Mastectomy: Breast reconstruction is special surgery to make a new breast, which mirrors the remaining breast as closely as possible. It is performed either by breast implant or by using tissue from another part of the body.

Lymph Node Surgery: To ascertain if the cancer has spread, a sentinel lymph node biopsy may be done. Sentinel lymph nodes, found under the arms, are the first lymph nodes that cancer cells reach if they spread. If cancer cells are discovered in the sentinel nodes, further surgery to remove more lymph nodes from under your arm may be required.

Radiotherapy: Radiotherapy involves delivering controlled doses of radiation to kill cancer cells. Usually, radiotherapy is applied after surgery, along with chemotherapy to kill any remaining cancer cells.

Four types of radiotherapy may be used in breast cancer treatment:

• Breast Radiotherapy following breast-conserving surgery, radiation is applied to the whole of the remaining breast.
• Chest-Wall Radiotherapy applied after a mastectomy.
• Breast Boost high-dose radiotherapy in the area where the cancer was.
• Lymph Node Radiotherapy is aimed at the armpit & the inner chest to kill any remaining lymph node cancer.

Chemotherapy: Chemotherapy provides anti-cancer (cytotoxic) medicine to kill cancer cells via a drip, into the arm. It's usually used after surgery to destroy cancer cells that have not been removed, but sometimes before surgery to reduce large tumors.

Hormone Treatment: Certain breast cancers are stimulated by the hormones oestrogen or progesterone. These are known as hormone receptor-positive cancers. Hormone therapy lowers oestrogen or progesterone levels, stopping their effects. Hormone therapy is often given after surgery & chemotherapy, but sometimes before surgery to help shrink a tumor - making it easier to remove. Hormone therapy may be the only treatment recommended for breast cancer if your general health prevents you from having surgery, chemotherapy or radiotherapy.

Targeted Therapies: Targeted therapies alter cell function, helping stop cancers from growing & spreading. Not all breast cancers can be treated with targeted therapies. Some targeted therapies are given via drip into a vein. Others come as tablets.

Complementary Therapies: Complementary therapies may improve physical & emotional wellbeing. Often offered alongside conventional treatments, they include:

• Stress reduction techniques, such as breathing exercises
• Massage
• Aromatherapy
• Acupuncture

Please speak to your Medcare professional about any complementary therapy to ensure it does not interfere with your conventional treatment.

Secondary Breast Cancer: While most breast cancers are discovered at an early stage, a small number of women discover breast cancer after it has metastasized - spread to other parts of the body. This so-called secondary cancer, also called "advanced" or "metastatic" cancer, is incurable. In this case, treatment may be different, to achieve remission, where cancer shrinks or disappears.

Chemotherapy for secondary Breast Cancer: In cases when breast cancer has spread beyond the breast & lymph nodes, chemotherapy will not cure it, but may shrink the tumor, relieve symptoms & help extend life.

Risk Factors of Breast Cancer?

A combination of breast size, personal medical history, & family medical history can put an individual at risk of developing breast cancer. Doctors advise at-home breast checking as part of a woman’s personal-care routine. Detecting a symptom early can be a critical part of recovery.

Risk factors for breast cancers may include:

• Age
• Genetic mutations
• Reproductive history
• Breast density
• A personal history of breast cancer
• Family history of breast or ovarian cancer
• Previous radiation therapy treatment

On top of these unavoidable risk factors, there are many lifestyle risk factors, which can be avoided, including:

• Lack of Exercise: A small amount of daily exercise increases overall health & helps avoid cancers.
• Weight: Being overweight or obese after menopause increases risk.
• Taking hormones
• Drinking Alcohol: Risk for breast cancer increases with greater alcohol consumption.
• Smoking: The risk increases slightly among those who smoke.
• Chemicals: Exposure to toxic chemicals.
• Hormonal Changes: Such as those brought on by night shift working may increase breast cancer risk.

Breast Cancer Complications

In cases of advanced breast cancer, there are a number of complications relating to pain in the

• Bones
• Lungs
• Liver
• Brain

There can also be treatment-related complications.

Cancer-Related Pain: Cancer tumors can put pressure on organs, nerves, & bones, causing significant escalating intractable pain.

Bone Complications: Breast cancer often spreads to the bones, which can cause significant pain. Breast cancer that spreads to the bone can cause the following complications:

• Bone pain resorption can cause bone thinning & weakening, often leading to fractures.
• Spinal compression, cancer cells in or near the spine can put pressure on the spinal cord & adjacent nerves, bringing pain to the back or neck, numbness or tingling, & difficulty walking.
• Hypercalcemia is a bone complication which means elevated levels of calcium in the blood. This can cause: Kidney stones, Kidney failure, Irregular heartbeat, Neurological problems including confusion, dementia or coma.

Lung Complications: Breast cancer that has spread to the lungs doesn’t always lead to symptoms & complications, but may cause:

• Shortness of breath
• Wheezing
• Chest pain
• Continual, persistent cough
• Effusion - cancer cells producing fluid that surrounds your lungs

Liver Complications: Around half of those with metastatic breast cancer may have spread to the liver. Early signs include:

• Pain
• Stomach fullness
• Sudden weight loss
• Vomiting
• Jaundice
• Blockage of bile ducts, which help the liver remove waste

Brain Complications: If breast cancer spreads to the brain, it may cause vision, memory, or behavioral problems. Symptoms can include:

• Headaches
• Dizziness
• Nausea
• Vomiting
• Seizures

Cancer Treatment-Related Complications: Cancer treatment means removal of both abnormal & normal cells from the body, so unpleasant side effects are fairly common. Cancer treatments can cause pain, sickness, & hair loss. Chemotherapy treatments may also result in:

• Mouth sores
• Nausea
• Nerve damage
• Diarrhea

Radiation therapy can cause burning pain & scarring, while surgery can be painful & may require significant time for recovery. Removing lymph nodes to check for cancer cells disrupts the flow of lymph fluid. If there aren’t enough lymph nodes to properly drain fluid from a certain part of the body, a form of painful swelling called lymphedema can occur.

Breast Cancer Prevention

While everyone has a certain degree of susceptibility to breast cancer, there are some straightforward lifestyle factors we can all undertake to lessen & avoid the risks, includi

• Diet: Eat a healthy diet, rich in vegetables, fruit & natural, high fibre whole foods. Avoid bad fats, too much red meat & highly processed & junk foods.
• Weight: Maintain healthy weight, especially as you approach old age.
• Chemicals: Avoid toxic chemicals both at home & work.
• Exercise & Activity: Undertaking a regular exercise regime will certainly benefit overall health. Studies show that moderate weekly physical activity reduces the risk of breast cancer by around 20%.