Breast cancer is one of the most common cancers in women in the United States. It’s the second most common cause of cancer death in women, and the main cause in women 45 to 55 years old. The death rate has decreased in the past 20 years, partly because better screening catches the disease earlier, so chances of recovery and cure are higher.
Early breast cancer usually causes no pain and usually no other symptoms.
As a breast tumor grows, certain changes may occur. These include a lump or thickening (mass, swelling, skin irritation, or distortion) in or near the breast or under the arms or changes in breast size or shape. The color or feel of the skin of the breast, areola, or nipple (dimpled, puckered, or scaly) can change. Women can also have discharge, erosion, inversion, or tenderness of nipples.
Many women (or doctors during the physical exam) feel a lump or finds breast changes. An abnormal mammogram can suggest breast cancer. Some women at high risk of getting breast cancer may get magnetic resonance imaging (MRI) for screening.
A lump shouldn’t be ignored. Mammograms may not show breast cancers in nearly 20% of cases.
When cancer is suspected, the doctor will remove (biopsy) a small piece of abnormal area for study.
The doctor must stage the cancer. Staging determines how far it has spread, to decide on treatment and prognosis. The stage of the cancer is based on tumor size, whether skin, chest wall, and local lymph nodes (glands) are involved, and whether cancer has spread to other organs (metastasis). The biology of the cancer is based on the look of the cancer under the microscope and the tumor’s protein and gene markers.
These things help doctors choose the treatment: surgery, radiotherapy, and medical therapies, such as antiestrogens, chemotherapy, or other biological or targeted therapies.
Most women have surgery to remove the cancer, such as lumpectomy (removing only the lump). Operations to remove the breast, part or whole, include partial (segmental), modified radical, radical, or total (simple) mastectomies. Lymph nodes and muscles may be removed. Radiation therapy, chemotherapy, or hormone therapy can be used before or after surgery. Breasts can be rebuilt after surgery.
Radiotherapy uses high-energy x-rays to kill cancer cells. Radioactive substances in needles, devices known as "seeds," wires, or catheters can be put into or near the cancer.
Chemotherapy uses drugs to kill cancer cells or stop them from dividing. Drugs can be taken by mouth, injected into veins or muscles, or placed near cancer cells.
Hormone therapy (tamoxifen and aromatase inhibitors) stops hormones, especially estrogen, from helping cancer cells grow. Biological therapy works by using the body’s immune (infection-fighting) system to kill cancer cells.
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Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.
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