Breast Cancer - Symptoms, Stages, Causes and Treatment

Breast cancer is a disease where abnormal breast cells grow out of control. It can start in different breast parts, like the lobules (a gland that makes milk) or ducts (tubes that carry this milk to the nipple). Cancer can also metastasise or spread outside the breast through blood and lymph vessels.

Breast cancer can develop in various forms, each with specific characteristics and treatment approaches. Common types of this malignancy include: 

1. Invasive Ductal Carcinoma (IDC): The most prevalent form that originates in the milk ducts and can spread to surrounding tissue. 

2. Lobular Breast Cancer: Starts in the lobules, which are the glands that produce milk, and has the potential to spread to nearby breast tissue. 

3. Ductal Carcinoma In Situ (DCIS): Like IDC, this cancer starts in the milk ducts. However, it remains confined to the ducts without spreading.

Some less common types of breast cancer are as follows: 

1. Triple-Negative Breast Cancer (TNBC): This invasive cancer is known for its aggressiveness and tends to spread faster compared to other forms of breast cancer.

2. Inflammatory Breast Cancer (IBC): A rare and aggressive form that results in redness and swelling of the breast.

3. Paget’s Disease of the Breast: It may look like a rash and affects the nipple skin.  

Breast Cancer Stages

Doctors use breast cancer stages to identify the extent of cancer spread within the body. It helps determine the seriousness of cancer and the best course of action. The most common staging method used for this type of malignancy is the TNM system. 

The TNM staging breast cancer system stands for Tumour size (T), Node involvement (N), and Metastasis (M). 

1. T categorises the size and extent of the primary tumour. 

2. N indicates the spread of cancer to nearby lymph nodes and the number of nodes affected.

3. M assesses if the cancer has metastasised to other body parts.

Medical experts may also use the number staging system, which includes stages from 0 to 4:

1. Stage 0: The cancer is non-invasive, i.e., it is localised to the milk ducts and has not spread to other parts of the breast. 

2. Stage 1: Cancerous cells spread in the nearby breast tissue. 

3. Stage 2: Cancerous cells develop into one or more tumours. These tumours might be smaller than 2 centimetres and reach the underarm lymph nodes or be larger than 5 centimetres without spreading to these nodes. 

4. Stage 3: This is a locally advanced breast cancer stage where malignant cells spread to nearby tissue and lymph nodes. 

5. Stage 4: Cancer spreads from the breast to other organs like the liver, lungs, or brain. 

Breast cancer symptoms can vary widely from one person to another. Most individuals may not even experience these in the early stages. When the condition advances, symptoms may include: 

1. A breast lump or thickening different from the surrounding tissue 

2. Inversion or flattening of the nipple 

3. Skin colour changes (breast skin may look pink or red for people with white skin and red or purple for those with dark skin)

4. Changes in the breast shape or size

5. Scaling, peeling, or crusting of the nipple or breast skin 

6. Discharge from the nipple, possibly containing blood

Breast cancer occurs when the DNA inside breast tissue cells changes. Normally, DNA guides cells on how to grow, divide, and die. These instructions are altered in cancer cells, leading to rapid multiplication and prolonged survival. This abnormal growth can form a tumour. 

However, researchers do not know the exact causes of breast cancer as what triggers these DNA changes is unknown. 

Breast Cancer Risk Factors

Although the cause of breast cancer is not known, various factors can increase the chances of developing the condition. The primary risk factors include: 

Modifiable Risk Factors

These are factors within an individual’s control, such as lifestyle choices and environmental exposures. Addressing these can lower the risk: 

1. Smoking and Drinking Alcohol: Tobacco use and alcohol consumption are linked to various types of cancer, including breast cancer. 

2. Obesity: Women who are obese, especially after menopause, have a higher risk of breast cancer. 

3. Pregnancy History: Never getting pregnant or giving birth to the first child after 30 can elevate the risk. 

4. Hormone Replacement Therapy: People who use these medicines to control menopause symptoms have an increased risk of cancer.  

5. Radiation Exposure: Patients who have had radiation therapy, especially to the chest, head, or neck, before 30 years of age are more prone to this type of malignancy. 

Non-Modifiable Risk Factors

These include genetic and biological factors beyond an individual’s control but are important for understanding their overall risk.

1. Age: The risk increases as people get older. About two-thirds of invasive breast cancers are diagnosed in women aged 55 or above. 

2. Gender: Women are more likely to get the condition than men. According to WHO, about 99% of breast cancers occur in women, and only 0.5-1% of cases occur in men. 

3. Family History: A history of breast cancer in parents, siblings, children, or close relatives can increase the risk.

4. Genetics: 5% to 10% of breast malignancies develop due to genetic mutations, including changes in the BRCA1 and BRCA2 genes. 

5. Personal Health History: Individuals with previous breast cancer are three to four times more likely to get a new cancer in the other breast or another part of the same breast. 

6. Reproductive History: Early menstruation before age 12 or late menopause after age 55 elevates the risk.

It may not always be possible to prevent breast cancer. However, people can decrease their risk of developing the condition with the following steps: 

1. Breast Self-Exams: Examining the breasts regularly for changes like lumps, skin changes, or discharge can help detect tumours early. 

2. Healthy Lifestyle Adjustments: A balanced diet of fruits and vegetables and regular exercise contribute to overall health and cancer prevention. Aim for at least 30 minutes of exercise most days of the week. 

3. Limit Alcohol Consumption: To reduce breast cancer risk, it is best to quit alcohol. However, if individuals choose to drink, they should limit the amount to no more than one drink a day. 

4. Regular Screening: Early detection of small tumours through mammograms can increase treatment success.

Diagnosing breast cancer involves several steps to identify and evaluate the presence and extent of cancer. Here’s a general approach:

1. Clinical Breast Exam: A doctor examines the breasts and underarm areas for lumps, skin changes, or other signs of cancer.

2. Imaging Tests: Mammography is the most common screening tool. Other tests may include ultrasound and MRI to examine abnormalities or assess breast density.

3. Biopsy: It is a definitive way to diagnose cancer. A small tissue specimen is removed from the breast area and examined under a microscope to check for cancer cells.

4. Lab Tests: If cancer is found, additional tests on the tissue are performed to help guide treatment decisions. These include hormone (oestrogen and progesterone) receptor tests and HER2 (a protein involved with cell growth) tests. 

5. Genetic Testing: Evaluations for BRCA1, BRCA2, and other gene mutations may be recommended for individuals with a family history of breast cancer.

Note: The tests advised for breast cancer diagnosis can vary from one person to another based on their condition. 

How to prepare for the doctor’s consultation? 

In raising breast cancer awareness, preparing for a doctor’s consultation involves several key steps. These help the patients better understand their condition and the next steps. Here’s how they can prepare: 

1. Secure a prior appointment with the doctor to avoid long wait hours. 

2. Keep a detailed record of any signs of breast cancer they have noticed.

3. Gather previous mammograms or biopsies and list medications they are currently taking.

4. Record any history of breast cancer or other types of cancer in the family.

Questions to Ask the Doctor

When consulting a doctor about breast cancer, it is important to ask questions that will give the patient a clear understanding of their diagnosis and treatment options. The following are some essential questions to consider: 

1. What type of breast cancer do I have? 

2. What stage is my breast cancer, and what does that mean? 

3. What are the available treatment options, and what do you recommend? 

4. What are the potential side effects of each treatment? 

5. Are there any clinical trials to consider? 

Breast cancer treatment involves consultation with a multidisciplinary team of doctors specialising in cancer care. Generally, a combination of treatments is used to achieve the best outcome. Some common approaches include: 

Local Therapies

These treatments target the tumour and its surrounding area to remove or destroy cancerous cells without affecting the rest of the body.  

1. Surgery: Breast cancer lumps are physically removed in this method. It may include the following techniques: 

1. Lumpectomy: The tumour and some of the surrounding tissue is removed.

2. Mastectomy: Removes one or both breasts, partially or completely. 

2. Radiation Therapy: Uses high-energy x-rays to target and kill cancer cells. It is generally used after surgery to eliminate any remaining cancer cells. 

Systemic Therapies

These involve drugs given through the bloodstream, affecting cells all over the body. 

1. Chemotherapy: Kills cancer cells or stops them from growing and dividing. The drugs can be injected into a vein or given orally. Chemotherapy for breast cancer is often administered after surgery (adjuvant chemotherapy). 

2. Hormone Therapy: It is used for cancers that are hormone receptor-positive. The treatment blocks the natural hormones (oestrogen and progesterone) in the body from supporting the growth of cancer cells.

3. Targeted Therapy: These medicines focus on specific chemicals associated with cancer. By blocking these chemicals, it prevents cancer cells from growing and spreading.

4. Immunotherapy: It helps boost the immune system to fight cancer. Immunotherapy is a treatment option for triple-negative breast cancer. 

Note: The choice of treatment depends on several factors. These include the characteristics of the cancer, the patient’s age, general health, personal preferences, and the doctor’s opinion. 

Estimated Cost of Breast Cancer Treatment 

The cost of breast cancer surgery in India varies widely depending on the stage of the cancer and the hospital where the treatment is performed. The following table shows the estimated expenses: 

Note: These are approximate prices. For up-to-date pricing information, patients should consult HexaHealth experts.  

Delaying treatment for breast cancer can allow it to spread or metastasise to other parts of the body, making it more difficult to manage. Metastatic breast cancer can cause the following complications: 

1. Blood clots 

2. Muscle and joint aches or nerve damage 

3. Cachexia (extreme weight and muscle loss) 

If the cancer spreads to bone, lungs, liver, and brain, it may cause complications like: 

1. Hypercalcemia (high calcium levels in blood)

2. Fractures

3. Haemoptysis (coughing up blood from the lungs)

4. Jaundice

5. Seizures 

6. Stroke

For individuals with breast cancer, adhering to a nutritious diet can be crucial in managing the condition and enhancing overall health. 

Certain food options are good for individuals with breast cancer or at risk of developing the condition. These include:

1. Fruits like berries and peaches and Vegetables like kale and broccoli are rich in flavonoids and carotenoids, which help fight cancer.

2. Whole grains, such as brown rice, quinoa, and oats, contain fibre and antioxidants that can decrease waste substances produced naturally by the body. 

3. Healthy fats like avocados, nuts, and olive oil can reduce inflammation and lower breast cancer risk.

Breast cancer, a prevalent condition affecting many women worldwide, requires early detection. Various treatment options, including surgery, chemotherapy, and targeted therapies, offer hope for managing and potentially overcoming this disease. Raising awareness, understanding the symptoms, and undergoing regular screenings are crucial steps in the fight against breast cancer.

For those experiencing breast cancer symptoms, HexaHealth offers a comprehensive solution. We connect you with the leading oncologists and breast cancer specialists. Moreover, with us, you can find dedicated support throughout your treatment, from hospital admissions to post-operative care.

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