Breast Cancer Treatment

The female breast is designed to produce milk for the nourishment of a baby. So, it has glands to convert blood into milk, ducts to carry the milk to the nipples and openings on the tip of the nipples to allow the milk to flow out when it is sucked.

The Breast Glands: Each breast is divided into 15 – 20 lobes separated from each other by fat. Each lobe is again divided into lobules that are made up of masses of alveoli clustered around tiny tubes known as the ductules. The alveoli synthesizes milk from the blood in the exact proportions that a baby requires for nourishment.

The milk is collected from each alveoli by the ductules which join each other to form a single larger duct called the lactiferous duct. Each lobule is drained by a single lactiferous duct.

Breast tissue starts growing in an embryo in the uterus around 6 to 7 weeks after conception. At about 16 weeks, cells begin grouping together to form the glands of the breasts. After birth, many children are seen with slightly larger breasts - this is due to the stimulation by the hormones received from the mother.

Ductal Carcinoma in Situ is a type of cancer that starts in the cells of the ducts of the breasts and remains contained within the ducts. 'In situ' is a Latin word meaning 'in place'. It is often referred to as a precancerous condition. It is also referred to as 'TIS', which means 'tumor in situ' or 'in the same place'.

Ductal breast cancer is more common than lobular breast cancer. Between 85% and 90% of all breast cancers are ductal.

Because the cancer cells have not as yet broken through the wall of the duct, the cancer cells have no access to the blood stream or the lymph nodes, and have no ability to spread to other parts of the body. As a result, DCIS is completely curable. Women do not die of DCIS.

But once the cells break through the duct wall, it becomes Invasive Ductal Cancer (IDC) and can spread rapidly. So, DCIS needs to be treated aggressively.

Invasive ductal carcinoma (IDC), also called infiltrating ductal carcinoma, is the most common type of breast cancer. It constitutes about 80% of all diagnosed breast cancers.

The breast is an organ designed to manufacture and deliver milk to the infant. The majority of the breast is composed of fatty tissue. Milk glands lie within this fatty tissue and are connected to the nipple via a series of ducts.

Invasive means that the cancer which had originally started in the ducts of the breast (DCIS) has broken through the membrane of the ducts and invaded the surrounding tissue.

Once the cancer cells ahve broken through the ductal membrane, they can invade the lymph and blood systems, and spread further to other parts of the body. This is known as metastasis.

Invasive ductal breast cancer usually occurs in women who are over the age of 55 years. It is basically a postmenopausal condition. It can also occur in older men - that is, men who have crossed 50 years of age.

Lobular Carcinoma In Situ (LCIS) is a type of breast cancer which starts in the cells of a part of the breast known as the'lobules'.

Each breast has about 20 lobules which are drained by ducts which carry the milk to the nipples.

LCIS develops in these lobules but does not break through the basement membrane to spread to the surrounding tissue.

'In situ' is a Latin word meaning 'in place'. It is also referred to as TIS, which means 'tumor in situ' or 'in the same place'.

LCIS is often referred to as a precancerous condition. About 25% of women with LCIS will develop breast cancer over time.

Lobular breast cancer is the second most common type of breast cancer. It is less common than ductal breast cancer and more common than other types of breast cancers like Inflammatory Breast cancer and Paget's Disease of the Breast .

Surgery is usually the first line of treatment in breast cancer. Different types of surgery are carried out depending on the :

• The size and location of the tumor.
• The type of breast cancer
• Whether it is still within the breast or has spread out to the surrounding tissues.
• The woman's personal choice is also important to a certain degree.

Different Types of Breast Cancer Surgery 

Breast Cancer Surgery may be Conservative or Radical -

• Conservative Breast Cancer Surgery In this type of surgery, only the tumor or a part of the breast is removed. The rest of the breast is conserved. There are two types of conservative breast surgery.

   

  • Lumpectomy A lumpectomy is the removal of the breast cancer and a portion of normal tissue around the breast cancer lump. Some of the nearby lymph nodes may also be removed if thee surgeon deems it necessary. Lumpectomy is usually followed by radiotherapy, to ensure that all the cancer cells are dead.

     

  • Partial Mastectomy Also known as Segmental mastectomy, the surgeon, in this operation, removes a larger amount of breast tissue around the tumor, maybe even 1/4th of it. He/she may also remove the lining over the chest muscles below the tumor and some of the lymph nodes under the arm.

Radiotherapy, also called radiation therapy or Xray treatment is a type of treatment procedure for cancers in which special rays called ionizing radiaiton is passed through cancerous cells to kill them.

The ionozing rays destroys the genetic material of the cells making it impossible for them to recover. During therapy, the rays also destroy normal cells, but these cells can usually recover again to function normally since they are healthy cells.

Radiotherapy is generally combined with surgery or chemotherapy. It is done before surgery to help shrink the tumor and improve surgical outcome. It can also be done after surgery to prevent any recurrence of tumors. In certain cases, it is also done during surgery (IORT or Intra-operative radiation therapy)

Types of Radiotherapy: There are different types of radiotherapy and different ways to deliver the rays.

• External Radiotherapy: In this procedure, the rays are delivered from outside the body and targetted carefully at the cancerous area. In breast cancer, external radiotherapy is the type of radiation preferred. This type of radiotherapy is also useful to women whose breast cancer has spread to other organs and who require treatment to decrease the pain and discomfort. The image below shows external radiotherapy to the breast.

Radiotherapy, also called radiation therapy or Xray treatment is a type of treatment procedure for cancers in which special rays called ionizing radiaiton is passed through cancerous cells to kill them.

The ionozing rays destroys the genetic material of the cells making it impossible for them to recover. During therapy, the rays also destroy normal cells, but these cells can usually recover again to function normally since they are healthy cells.

Radiotherapy is generally combined with surgery or chemotherapy. It is done before surgery to help shrink the tumor and improve surgical outcome. It can also be done after surgery to prevent any recurrence of tumors. In certain cases, it is also done during surgery (IORT or Intra-operative radiation therapy)

Types of Radiotherapy: There are different types of radiotherapy and different ways to deliver the rays.

• External Radiotherapy: In this procedure, the rays are delivered from outside the body and targetted carefully at the cancerous area. In breast cancer, external radiotherapy is the type of radiation preferred. This type of radiotherapy is also useful to women whose breast cancer has spread to other organs and who require treatment to decrease the pain and discomfort. The image below shows external radiotherapy to the breast.

Paget's disease of the nipple and/or breast is named after Sir James Paget who discovered that the cells on the nipple in this condition was made of large cancerous cells.

Sir James Paget also discovered a disease of the bone known as Paget's Disease of the Bones or Osteitis Deformans. This is not however a cancerous condition but a chronic disorder that typically results in enlarged and deformed bones.

Paget's disease of the breast is relatively uncommon. It occurs in less than 5% of all women with breast cancers. It is frequently seen in combination with an underlying cancer of the breast ducts like Invasive Ductal Breast Cancer or Invasive Lobular Breast Cancer.

Paget's disease can occur in both men and women. But is is more often misdiagnosed in men and passed off as dermatitis or eczema.