Author: Alaa Belmokhtar
Breast cancer is a common disease in which the breast cells begin to grow uncontrollably and rapidly. This type of cancer is especially prominent in women, and typically begins in either the lobules or ducts of the breast. Breast cancer can result in various symptoms, some of the most common being: lumps in the breast or underarm, irritation of the breast skin, and pain or change in any area of the breast. In order to properly diagnose breast cancer a visit to the doctor is necessary.
Diagnosis and Staging
Firstly, the doctor will review your symptoms and discuss your personal medical history to gauge if it’s possible to be diagnosed with breast cancer. They use your personal and hereditary history to determine if there are any genetic possibilities or indicators of breast cancer. After the initial questioning and physical exam, the doctor may order lab tests and imaging to find any signs of breast cancer. Some of these tests include: mammograms, breast MRIs, and breast ultrasounds; these tests are used to screen for abnormalities and create images of the interior of the breasts. Another way to diagnose breast cancer would be through a biopsy, which is the removal of cells or tissue from the breasts to determine if the cancer is present. A biopsy is the ultimate test that is used to diagnose breast cancer, as it determines which cells are cancerous or not.
The next step in the diagnosis is the staging of the cancer. The stages of breast cancer are identified through the TNM system, created by the American Joint Committee on Cancer (AJCC). The AJCC revolutionized the classification of cancer depending on its stage. This standardizes the diagnosis and allows doctors to confirm a treatment. Originally, the TNM system consulted only three characteristics to determine the appropriate stage for breast cancer. T is used to represent the size of the tumor and how it has spread from its original site to other tissue. N represents whether the cancer has spread to the lymph nodes, and M conveys whether the cancer has spread past the breast and to the rest of the body. More recently, in 2018, the AJCC added more characteristics to the staging, including a tumor grade, which measures how similar the cancer cells look to normal cells, as well as the estrogen and progesterone-receptor status, which determines if the cancer cells have receptors for the mentioned hormones. Other guidelines include the HER2 status which determines if the cancer cells are making an excess of HER2 protein, and the Oncotype DX score.The Oncotype DX score adds up the HER2 status, the estrogen-receptor status, and the N characteristic. All of these characteristics are used in relation to each other to figure out the correct stage of cancer more accurately.
Stages
There are five stages of breast cancer: Stages 0 through IV. Stage 0 is the stage in which the cancer is non-invasive; this means that the abnormal cells have remained in their original site. Stage I is used to describe when the cancer cells begin invading nearby tissue. This stage is divided into two categories: Stage IA, in which the cancer has spread into the fatty breast tissue and IB, in which some cancer cells have invaded the lymph nodes. In Stage II, the cancer begins to spread and grow; Stage IIA indicates that the tumor is still small or non-existing, while in Stage IIB, there are indications of a breast tumor growing in size. In Stage III, the cancer becomes more complex and is harder to treat, but it still hasn’t spread to bones or organs. In IIIA, the cancer is in up to 9 lymph nodes, while in IIIB, the tumor begins moving into the skin around the breast, and, in IIIC, the breast cancer has spread to over 10 lymph nodes. In the final stage, Stage IV, the breast cancer cells begin metastasizing, or spread to the rest of the body.
Types of Treatments
Treatments for breast cancer vary from case to case, depending on the type of breast cancer and which stage it has reached, as well as individual circumstances. The two primary types of treatment are known as local treatments and systemic treatments. Local treatments focus on directly treating the cancer or tumor; this can include surgeries to remove the cancer or radiation. The two main surgeries are lumpectomies and mastectomies; a lumpectomy is a procedure that removes only the tumor from the breast and is typically followed up with radiation therapy, while a mastectomy removes the breast itself. For systemic treatments, however, the patient is given drug treatments that treat the cancer. Some examples of this include chemotherapy, immunotherapy, and targeted therapy for breast cancer which all work to treat the entire body, rather than just treating the individual spot.
Making a Treatment Decision
People who are diagnosed with breast cancer, along with their doctors, encounter the difficult decision of which treatment will work best for them. The decision comes down to each patient’s circumstance and situation. Lumpectomies are less aggressive and can preserve the breasts while removing the cancer. However, there is a longer period of radiation therapy necessary to ensure the cancer is gone, thus, incurring a slightly higher risk of the cancer recurring after a lumpectomy than a mastectomy. On the other hand, a mastectomy is more invasive and removes the entire breast and is less likely to have a recurrence of the cancer, but it takes longer to recover from and includes more postoperative side effects. For people with metastatic breast cancer, systemic treatments are also necessary as they work to fight the cancer throughout the body by stunting the growth of the cancer cells. To make the right decision, a person should consider all of the benefits and risks of the different treatments, as well as discuss with their doctor how intense their treatment should be and what they think is best for their situation.
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