October has several observed medical conditions, 9 of which run for the entire month. I have chosen to write about National Breast Cancer Awareness.
According to the American Cancer Society (ACS) almost 193,000 new cases of invasive breast cancer are expected to be diagnosed in women this year in the United States alone. This dreaded disease is the second leading cause of cancer death in women. Statistics reveal that African American women have a greater incidence of breast cancer before the age of 40, but a minimally lower incidence after that age than do Caucasian women. Breast cancer is much less common in males of any ethnic background at any age but about 2,000 cases will be confirmed this year in men.
There are different types of breast cancer, divided into two main categories. The first is non-invasive, either ductal carcinoma in situ (DCIS), or lobular carcinoma in situ (LCIS). These forms are not considered cancer, per se, because they are benign tumors and there is very little risk that they will spread. They are confined to the milk ducts in women. If left untreated, however, DCIS may progress to invasive cancer. With LCIS, abnormal cells are found in the lobules of the breast. LCIS is considered a warning of an increased risk for the development of cancer in either breast.
The second category is the invasive form of breast cancer that penetrates through normal breast tissue and invades surrounding tissues. The most common type, invasive ductal carcinoma, accounts for almost 80% of all breast cancer cases.
There are different stages of breast cancer, depending on the size of the tumor and whether or not it has spread to the lymph nodes and organs, a term referred to as metastases. Once all information is obtained, staging can be designated as I, II, III and IV. Generally speaking, the lower the number, the less a cancer has spread. The stages also have subcategories for advancement (A, B, C). For the sake of simplicity, I will use a numbering system of 0 through 4.
Stage 0 is the earliest phase, indicating that confinement is restricted to the ducts or lobules, depending on the place of origin.
Stage 1 indicates the cancer cells have spread from the point of origin, but not beyond the breast and the tumor is 2 centimeters (¾ of an inch across) or less in size.
Stage 2 is where things become tricky. There are 4 situations in which stage 2 can be diagnosed. Situation 1 indicates the tumor is 2 centimeters or less, but the cancer has spread to the underarm lymph nodes. Situations 2 and 3 indicate the tumor is between 2 and 5 centimeters (up to 2 inches) and the cancer has (situation 3) or has not (situation 2) spread to the underarm lymph nodes. Situation 4 indicates the tumor is larger than 5 centimeters but the cancer has not spread to the underarm lymph nodes.
Stage 3 has several variations. This is also where the subcategories I mentioned above come in to play. Stage 3A indicates 1 of 2 situations. First is that the tumor is 5 centimeters or less in size and the cancer has spread to the attached underarm lymph nodes or the lymph nodes behind the breast bone. Second is that the tumor is 5 centimeters or larger in size and the cancer has spread to the singular or attached underarm lymph nodes or those located behind the breast bone.
Stage 3B indicates that a tumor of any size has grown into the chest wall or breast skin. The cancer may have spread to the attached underarm lymph nodes or to those behind the breast bone. Rarely, inflammatory breast cancer is diagnosed and is at least stage 3B or higher and this causes a red, swollen breast due to cancer cells that block the lymph vessels.
Stage 3C indicates a tumor of any size that has spread the lymph nodes under the arm and behind the breastbone or the lymph nodes above and below the collarbone.
Stage 4 implies the cancer has spread far beyond the breast to other parts of the body such as the liver or bones.
Chemotherapy may be recommended prior to surgery if there is lymph node enlargement, if the tumor is large, or if it is attached to the muscles of the chest wall. It may also be prescribed following a surgical procedure and before receiving radiation. Chemotherapy uses drugs that will kill cancer cells, while radiation is designed to kill cancer cells and shrink a tumor. Hormone therapy might also be considered. It uses drugs to either block estrogen from reaching cancer breast cells or to reduce the amount of estrogen the body produces to help reduce the possibility of a recurrence of cancer. Hormone therapy is most effective for patients whose tumor cells produce the estrogen receptor and is not recommended for those who have tumors that are estrogen negative. Should surgical intervention be appropriate, it might include lumpectomy, a modified radical mastectomy, nipple-sparing mastectomy, lymph node biopsy, or simple/total/skin-sparing mastectomy. Should mastectomy be performed, breast reconstruction can be considered.
Enormous strides have been made over the last few years that can go a long way toward bringing this frightening disease under control and eradicated. Through biopsy and other testing, your physician will be able to garner critical information regarding the stage which will assist him in determining the best method of treatment.
