Breast cancer
Breast cancer causes serious health problems and can lead to death. It is a diagnosed cancer and millions of women suffer from it every year. If this disease is treated in time, it is possible to get rid of it, but if it is diagnosed at the last stage, its treatment becomes difficult and many patients lose their lives.
Breast cancer is considered to be the main reason for increasing the mortality rate of women around the world.
The highest rate of breast cancer in Asian countries is found in Pakistan. Every year, about 90 thousand new cases are diagnosed, of which 40 thousand women die.
One in nine Pakistani women has become a breast cancer patient. Due to many misconceptions about the etiology of the disease and socioeconomic factors, the rate of early diagnosis of breast cancer among Pakistani women is very low. As a result, their chances of survival decrease.
There is a lack of knowledge about the etiology of breast cancer in Pakistani women.
Lack of knowledge about breast cancer, socio-economic status and lack of modern medical facilities among Pakistani women compared to western women are possible factors preventing breast cancer diagnosis.
Apart from cancer awareness and cultural issues, the majority of patients are from rural areas, often visiting doctors late due to financial constraints. And when they learn that they have breast cancer, they believe that the treatment will be unbearable for them. Therefore, instead of approaching a qualified doctor, a patient suffering from this disease turns to religious companions for spiritual advice and help.
There are many factors that make breast cancer so common in Pakistani women such as Age, body mass index, marital status, oral contraceptives, breastfeeding, smoking, physical activity and menopausal status are significantly associated with increased risk of breast cancer in Pakistani women.
Chances of recovery and survival are higher if one is diagnosed at an early stage, so it is very important to start treatment as soon as cancer is diagnosed.
What is breast cancer?
Breast cancer develops in the cells of the breast. Usually, this cancer forms in either the lobules or ducts of the breast.
The lobules are the glands that produce milk and the ducts are the pathways that transport milk from the glands to the nipple.
Cancer can also occur in fatty tissue or fibrous connective tissue within the breast.
Uncontrolled cancer cells often invade other healthy breast tissue and can travel to the lymph nodes under the arms.
Lymph nodes are the main route that helps cancer cells spread to other parts of the body.
Symptoms of breast cancer
In many cases the tumor may be too small to be felt but if the tumor can be felt the first symptom is usually a new lump in the breast that was not there before.
However, not all lumps are cancerous, there may be other causes.
Each type of breast cancer causes different symptoms. Many of these symptoms may be similar, but some may be different. Common symptoms of breast cancer include:
*A breast lump or thickening of tissue that feels different from the surrounding tissue and has recently formed.
*Changes in the appearance of the skin on the chest.
*A lump or swelling under the arm.
*Appearance of red, raised skin on the breast.
*Bleeding from the nipple.
*A sudden, unexplained change in breast shape or size.
*A peeling, scaling, or flaking of the skin on the breast or nipple.
*Pain in the breast.
*A new nipple appearing on the breast.
*Discomfort in the breasts.
Types of breast cancer
There are several types of breast cancer which are as follows.
* Lobular carcinoma: It starts in the lobules.
* Ductal carcinoma: It starts in the milk duct and is the most common type.
* Non invasive: This cancer occurs when the cancer remains within its original site and has not yet spread.
* Invasive breast cancer: This occurs when cancer cells break through the lobules or ducts and invade nearby tissue. This increases the chances of the cancer spreading to other parts of the body.
Stages of breast cancer
Breast cancer stages are determined by the size of the tumor and whether it has spread to the lymph nodes or other parts of the body.
According to oncologists, breast cancer is generally divided into four stages.
If it is diagnosed in the first or second stage, it does not take a complicated form, but if it is diagnosed in the third or fourth stage, the disease takes a very complicated form.
* Stage 0: Known as ductal carcinoma in situ (DCIS). These cells are confined within the ducts and do not invade surrounding tissues But in some cases, ductal carcinoma can become invasive breast cancer and spread to other tissues.
* Stage 1: In this stage, the tumor grows up to 2 cm. It has not affected any lymph nodes, or there are small groups of cancer cells in the lymph nodes.
* Stage 2: The tumor is 2 cm away and has started to spread to nearby nodes or 2-5 cm away and has not spread to lymph nodes.
* Stage 3: The tumor is up to 5 cm or the tumor is larger than 5 cm. In the third stage of breast cancer, it starts affecting other parts of the body. During this stage its effects reach the lymph nodes. The lymph node is called the neck bone and the area up to the armpit. In the third stage, the effects of breast cancer begin to appear on the outer skin.
* Stage 4: Cancer has spread to distant organs. Often the cancer has spread to bones, liver, brain or lungs.
If breast cancer is diagnosed at this stage, it becomes very difficult to save the patient’s life.
Prevent breast cancer
Creating a healthy lifestyle and taking appropriate health measures can reduce the risk of cancer. Recent studies show that diet is at least partially responsible for thirty to forty percent of all cancers.
* Exercise or jog daily.
* Avoiding smoking.
* Maintaining a healthy weight, keeping a ‘BMI’ below twenty five.
Fat cells make estrogen, which can stimulate the growth and development of certain types of breast cancer. Excess fat cells can also trigger inflammation in the body, which is linked to a higher chance of recurrence.
* Eat foods that prevent breast cancer.
Consume fresh fruits, vegetables, grains, milk and dairy products. Fish, meat and chicken should be used properly and fat should be removed from it. Avoid sugar and alcohol completely.
* Avoid exposure to the sun and other harmful radiation.
Breast cancer diagnosis
To determine whether the symptoms are caused by breast cancer or a benign breast condition, the doctor will perform a complete physical exam in addition to a breast exam. One or more tests will be done to look for these symptoms. This will help them understand what is causing the symptoms in the breast. The most helpful test in diagnosing breast cancer is a mammogram.
* Mammogram
The most common way to look below the surface of the breast is with an imaging test called a mammogram. If an abnormal spot is seen on the mammogram, the doctor may request additional tests.
* Ultrasound
A breast ultrasound uses sound waves to create images of tissues deep in the breast. Ultrasound can help the doctor distinguish between a tumor and a benign cyst.
* Breast biopsy
If the doctor suspects breast cancer, he will recommend both a mammogram and an ultrasound. If these two tests don’t tell the doctor whether cancer is present, he may do a test called a breast biopsy.
During this test, the doctor will remove a sample of tissue from the suspicious area and examine it. There are several types of breast biopsy. With some of these tests, the doctor uses a needle to take a sample of tissue. With others, they make an incision in the breast and then remove the sample.
If the tissue sample comes back positive for cancer, the lab will test it further and then tell the doctor what type of cancer it is.
Breast cancer treatment
Breast cancer is treated in several ways. It depends on the type of breast cancer and how far it has spread. Breast cancer patients often receive more than one type of treatment.
* Surgery. An operation where doctors cut out cancerous tissue.
* Chemotherapy. Using special drugs to shrink or kill cancer cells. Cancer drugs are given to a patient either orally or intravenously, sometimes both.
* Hormonal therapy. Hormone therapy is a cancer treatment that slows or stops the growth of cancers that use hormones to grow.
* Biological therapy. Works with the patient’s immune system to fight cancer cells or control the side effects of other cancer treatments.
* Radiation therapy. Using high-energy radiation (like X-rays) to kill cancer cells.
Doctors from different specialties often work together to treat breast cancer. Surgeons are doctors who perform operations. Medical oncologists are doctors who treat cancer with medicine. Radiation oncologists are doctors who treat cancer with radiation.
Some of the main treatments for breast cancer are given below.
Surgery
For both Ductal carcinoma in situ (DCIS) and early-stage invasive breast cancer, doctors usually recommend surgery to remove the tumor.
To make sure the entire tumor is removed, the surgeon will also remove a small area of healthy tissue around the tumor, called a margin.
People who may need a mastectomy can have breast-conserving surgery (lumpectomy) if the tumor has shrunk enough before surgery.
After surgery, the next step in managing early-stage breast cancer is to reduce the risk of recurrence and to try to get rid of any remaining cancer cells in the body.
If surgery is not possible to remove the cancer, it is called inoperable. The doctor will then recommend other ways to treat the cancer. Chemotherapy, immunotherapy, targeted therapy, radiation therapy, and hormonal therapy may be given to shrink the cancer.
Radiation therapy
Radiation therapy is the use of high-energy X-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. There are many different types of radiation therapy.
*External beam radiation therapy
This is the most common type of radiation treatment and is given by a machine outside the body.
This includes whole-breast radiation therapy and partial-breast radiation therapy, as well as accelerated breast radiation therapy, which can be done over days rather than weeks.
*Intraoperative radiation therapy
This happens when radiation therapy is given using a probe in the operating room.
*Brachytherapy
This type of radiation therapy is given by placing a radioactive source in the tumor.
*Partial breast irradiation
Partial breast irradiation (PBI) is radiation therapy that is given directly to the tumor area instead of the entire breast. It is more common after treatment (lumpectomy). Targeting radiation directly to the tumor area usually reduces the amount of time that patients need to receive radiation therapy. However, only some patients can undergo PBI. Although early results have been promising, PBI is still being studied.
*Intensity Modulated Radiation Therapy (IMRT)
External beam radiation therapy is an advanced breast procedure.
The intensity of radiation given to the breast is varied to better target the tumor. This allows the radiation to spread more evenly throughout the breast. Using IMRT lower the radiation dose and can reduce potential damage to nearby organs such as the heart and lungs.
*Proton therapy
Proton therapy is a type of radiation therapy – a treatment that uses high-intensity energy to treat cancer and some non-cancerous tumors. Radiation therapy using X-rays has long been used to treat these conditions.
Proton therapy is usually used to shrink solid tumors that have not spread to other parts of the body. This therapy can also reduce the amount of radiation that reaches the heart.
One thing is worth remembering. Radiation therapy is usually given daily for a set number of weeks.
Chemotherapy
Chemotherapy is a cancer treatment where medicine is used to kill cancer cells.
It can be given before surgery to shrink large tumors, make surgery easier, and reduce the risk of recurrence, usually stopping cancer cells from growing, dividing, and making more cells.
When it is given before surgery, it is called neoadjuvant chemotherapy. It may also be given after surgery to reduce the risk of recurrence, called adjuvant chemotherapy.
Numbness and tingling may remain in some people after chemotherapy. Many patients feel well during chemotherapy and remain active in caring for their families, working, and exercising during treatment.
Hormonal therapy
Hormonal therapy also called as endocrine therapy, Is an effective treatment for most tumors that have estrogen and progesterone receptors this is called ER positive or PR positive. This type of tumor uses hormones for its growth. Blocking hormones may help prevent death from breast cancer. Hormonal therapy is used either by itself or after chemotherapy.
Hormonal therapy may be given before surgery to shrink the tumor, make surgery easier, and reduce the risk of recurrence.
Targeted therapy
Targeted therapy is a treatment that targets specific cancer genes, proteins, or tissue environments that contribute to cancer growth and survival. This treatment works differently than chemotherapy. This type of treatment stops the growth and spread of cancer cells and limits the damage to healthy cells.
Not all tumor targets are the same. To find the most effective treatment, doctors perform tests to identify genes, proteins and other factors in a patient’s tumor.
Nabila Ameer
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