Breast cancer

Breast cancer is cancer of breast tissue. Worldwide, it is the most common form of cancer in females, affecting approximately 10% of all women at some stage of their life in the Western world. Although significant efforts are made to achieve early detection and effective treatment, about 20% of all women with breast cancer will die from the disease, and it is the second most common cause of cancer deaths in women.

Diagnosis

Many breast cancers are diagnosed now by mammography before they are large enough to be palpated, but despite screening efforts, many women are diagnosed with breast cancer after they notice a lump or when experiencing symptoms due to metastatic disease.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

Breast cancer can be suspected after a cautious clinical history, physical examination and imaging (either mammography or ultrasound). The diagnosis can only be established when a suspicious lump is biopsied for histological confirmation of whether it is malignant or not. The biopsy is usually performed either with a fine needle guided by ultrasound or with a larger "core" needle. Some cases require an open biopsy after wire localization under x-ray.

Related Topics:
Clinical history - Physical examination - Mammography - Ultrasound - Biopsied

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

A pathology report will usually contain a description of cell type and grade. Other useful information derived from the pathology laboratory include estrogen receptor and progesterone receptors status and HER2Neu status; these can help to guide treatment. The most common invasive breast cancer cell type is infiltrating ductal carcinoma. Other types include ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), infiltrating lobular carcinoma, medullary carcinoma.

Related Topics:
Cell type - Infiltrating ductal carcinoma - Infiltrating lobular carcinoma

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

After diagnosis, the next phase is tumour staging - this aims to assess the extent of the tumour and whether or not it has metastasized (spread to distant sites).

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

Staging

For suspicious, high risk cases, other investigations which include CT scans, nuclear medicine imaging, chest X-rays and blood tests will be done to look for any metastasis or secondary cancer that has spread a long way from the site of the primary tumour.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

The standard way of categorising tumour is by staging it using the TNM (Tumour, Nodes and Metastasis) system, which in turn determines treatment recommendations. The TNM system is specific for each type of cancer. Some biological features of the cancer such as estrogen receptor and HER2-neu oncogene expression are also determined as they also affect treatment recommendations.

Related Topics:
TNM - Estrogen receptor - HER2-neu - Oncogene

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

The TNM classification of breast cancer:

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

• Tumor size:
• T0 no primary tumor found
• Tis in situ
• T1 =< 2 cm
• T1mic ≤ 0.1 cm (microinvasive)
• T1a > 0.1 to 0.5 cm
• T1b > 0.5 to 1 cm
• T1c > 1 to 2 cm
• T2 > 2 to 5 cm
• T3 > 5 cm
• T4 Chest wall /skin
• T4a Chest wall
• T4b Skin oedema (peau d'orange), ulceration, or satellite skin modules
• T4c Both 4a and 4b
• T4d Inflammatory carcinoma
• Lymph nodes:
• N0 No lymph nodes
• N1 Movable axillary
• N2a Fixed axillary
• N2b Internal mammary clinically apparent
• N3a Infraclavicular
• N3b Internal mammary clinically apparent with axillary lymph node involvement
• N3c Supraclavicular lymph nodes
• Distant metastasis:
• M0 No
• M1 Yes

Stage grouping:

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

• Stage 0: Tis
• Stage I: T1,N0,M0
• Stage IIA: T0-1,N1,M0 or T2,N0,M0
• Stage IIB: T2,N1,M0 or T3,N0,M0
• Stage IIIA: T3,N1,M0 or T0-3,N2,M0
• Stage IIIB: T4,any N,M0
• Stage IIIC: any T,N3,M0
• Stage IV: any T,any N,M1

The cancer is staged depending on factors which include the size of the tumour, whether there is lymph node involvement or not and whether there is distant spread of cancer cells. Stages are a composite of the TNM. Stage I is small tumor (T1) without any spread, while stage IV is metastatic disease. Stages correllate with long-term prognosis, and treatment decisions are often made on the basis of the stage.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~