Breast Cancer
What is breast cancer?
Breast cancer is a malignant tumour of the
breast. It starts as a change to the cells in either the milk ducts
or milk sacs of the breast.
There are different types of breast cancer, some grow very slowly
whilst others develop more rapidly.
What are the different
types of breast cancer?
The most common form of breast cancer is invasive
ductal cancer (65 - 80% of all cases). This cancer starts
as a change in the cells of the milk duct but then penetrates
the surrounding breast tissue as cancerous cells.
Invasive lobular cancer (10 - 14% of all cases) is less common.
This cancer starts as a change in the cells of the milk sacs
but then penetrates the surrounding breast tissue as cancerous cells.
Ductal carcinoma in situ (DCIS)
is a change in the cells of the milk duct which is diagnosed as cancerous
(around 11% of all cases). The cancer is confined to the ducts (in
situ), however a woman with DCIS has a high risk of developing an
invasive breast cancer in the same breast if the DCIS area is not
surgically removed. Some increased risk of further breast cancer still
remains even when the area of DCIS has been removed. Pathology tests
after the operation will indicate what additional treatment and follow
up is needed. For further information refer to BreastScreen
Victoria's "Ductal Carcinoma In Situ".
Lobular Carcinoma in Situ (LCIS)
is a change in the cells of the milk sac. This condition is confined
to the sacs (in situ). It is NOT a cancer, rather it is a benign
breast condition, even though the name "carcinoma" usually
refers to a cancer. As LCIS is not a cancer, it does not need any
further treatment. However, it does mean a woman with LCIS has an
increased risk (above the community average) of developing breast
cancer in the future.
Paget’s disease is a form of breast cancer
that shows up in the nipple as an itchiness and scaling that doesn’t
get better. It represents about 2% of all breast cancers. If you notice
a change in your nipple you need to discuss this with your GP.
Also uncommon is Inflammatory carcinoma. This cancer
is characterized by swelling, redness and soreness of the breast giving
the breast an ”orange peel” appearance. This cancer is
usually treated with chemotherapy prior to surgery.
What are the different
phases of breast cancer?
An Early breast cancer is
one where the available test results indicate that the cancer has
not yet spread beyond the breast and axillary lymph nodes (the lymph
nodes of the armpit).
Recurrent breast cancer is when the breast cancer
reappears in the same breast or site as the original cancer.
Advanced breast cancer has spread beyond the breast to other parts of the body, such as the bones and liver. For further
information refer to a booklet produced by The National Breast Cancer Centre (NBCC): A guide for women with metastatic breast cancer.
Also, Breast Cancer Network Australia's (BCNA) website includes
a page of Resources
for Women with Advanced Breast Cancer.
How common is breast
cancer?
About one in eleven Australian women will
develop breast cancer at some stage in their lives. In Victoria,
2,895 women were diagnosed with breast cancer in the year 2000.
Most breast cancer occurs in women over the age of fifty. In rare
cases it occurs in women under 35.
What causes
breast cancer?
The exact cause of breast cancer is not known.
What are the risk
factors?
The risk of getting breast cancer increases:
Having any, or even several, of these risk
factors does not necessarily mean that you will get breast cancer.
Most women with breast cancer have no known risk factors.
Is breast cancer
hereditary?
Breast cancer is hereditary in 5 - 10% of cases.
Because breast cancer is relatively common in the community, many
women will have at least one person in their extended family with
breast cancer. However, that does not necessarily mean you have an
increased risk of contracting breast cancer.
People with a strong family history of breast cancer can be tested
to see if they have inherited a genetic factor. For further information
refer to Genetic Counselling.
The National Breast Cancer Centre (NBCC) has produced a "Breast Cancer
and Family History" information booklet which provides up to date
information including:
- hereditary breast cancer - what it is
- the main risk factors of breast cancer
- how to assess my risk level
Find out how to access this booklet in our
Resources / Booklets section.
If I have a breast implant
am I more likely to develop breast cancer?
There is no evidence that women with breast implants are more likely
to develop breast cancer. For further information refer to Better
Health Channel's "Breast Implants and Mammograms".
Does
breast cancer occur in men?
Although
it is very rare, men can develop breast cancer. In Victoria 23 new
cases were diagnosed in 2000. In
men, the main risk factor is abnormal enlargement of the breasts
(gynaecomastia), due to drug, chemical or hormone treatments, or
because of Klinefelter's syndrome. A man’s risk increases
where there is a family history of male breast cancer or a strong
family history of breast cancer.
What do my pathology
results tell me about my breast cancer?
The results of the pathology tests which
you have during the course of a diagnosis help you and your doctor
plan the best treatment for your particular cancer.
Some of these tests occur early in the diagnostic period. Others
occur during your treatment, such as the tests which occur as part
of your surgical treatment.
You may want to ask your doctor for information about the following:
Tumour grade
The information from your pathology tests is used by the pathologist
to 'grade' your cancer. There are 3 grades of tumours:
Grade 1: Cancer cells are similar to normal
cells. They are growing
slowly.
Grade 2: Cancer cells are larger and have different shapes. They
grow
at a moderate rate.
Grade 3: Cancer cells are not similar to normal cells. They are
very
abnormal and are growing rapidly.
Lymph Node involvement
When breast cancer spreads, it may travel to other parts of the
body through the lymph system. The lymph system is made up of
tiny vessels that carry fluid around your body. The fluid, known
as lymph, is made up of cells, bacteria and material from ordinary
blood vessels. Along the lymph system are lymph nodes which filter
the lymph fluid and get rid of bacteria.
If cancer cells move into the lymph system, they are carried to
the lymph nodes. The closest lymph nodes to the breasts are under
the arms in the axilla. This is usually the first place breast
cancer spreads outside the breast.
Your surgeon usually removes some of the lymph nodes under your
arm (axillary dissection) during your operation. Pathology examines
the removed lymph nodes to see if they are affected by cancer.
A technique called sentinel lymph node biopsy is being
tested as an alternative to axillary dissection. This technique
tests the first lymph node of the axilla – this lymph node
sounds the warning if the cancer has spread further. Sentinel
lymph node biopsy is not currently being used in any of the treating
hospitals in the Loddon Mallee region.
If there are no signs of cancer in the lymph nodes, it is less
likely that cancer has spread to other parts of your body. If
all the lymph nodes have cancer then the chances of the cancer
having spread are higher.
Information about lymph node involvement helps your medical treatment
team decide if any additional treatment, such as chemotherapy,
would be useful.
Clear margins
The pathology report indicates if the edges of the tissue removed
during your operation are free from cancer.
If there is any sign of cancer at the edges, it may mean that
some cancer cells are still in your breast. The surgeon will probably
recommend another operation to make sure all the cancer cells
are removed and/or recommend radiation therapy.
Staging
The information from your pathology tests is also used by the
pathologist to 'stage' your cancer. The most common system used
to stage cancer uses the TNM classification system.
T refers to the size of the cancer
N refers to whether the lymph nodes under your arm contain cancer
cells
M refers to whether the cancer has spread to other parts of
your body
All this information is then combined into stage
numbers (I, II, III and IV). Your doctor needs to know the stage
of your cancer to plan your treatment.
Women with Stage I or II cancer are said to have early breast
cancer.
Women with Stage III or IV cancer are said to have more advanced
breast cancer. They may need different treatment to women with
early breast cancer.
Oestrogen receptors
Oestrogen is a hormone produced by women. The growth of some cancers
is accelerated by oestrogen. These oestrogen sensitive cancers
are known as hormone receptor positive cancers.
The information from your pathology tests tell your doctor if
your cancer is hormone receptor positive. This helps your doctor
plan your treatment.
Generally, cancers that are hormone receptor positive respond
well to medications such as Tamoxifen which block the effect of
hormones on the cancer. For more information refer to Hormone
Treatment.
What should I ask
my doctor about my test results?
Ask your doctor:
- the size and stage of your tumour
- the grade of your tumour
- if your lymph nodes are clear of cancer
- if the edges of the removed tissue are free
of cancer
- if your tumour is oestrogen receptor positive
or negative
Is there just one treatment
care pathway for breast cancer?
Each woman who presents with breast cancer
is unique and the medical treatment team will consider all the information
they have gathered about your cancer and lifestyle before they make
recommendations about your particular Treatment
Care Pathway. If appropriate, they will provide more than one
treatment option for you to consider. Ultimately the decision about
your treatment is YOURS to make.
As your treatment progresses and additional test results become available
your medical treatment team may suggest refinements to your treatment
care pathway.
Is
there another website which gives further information?
For further information refer to The
Cancer Council's "Tell Me More About Breast Cancer".
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