Breast cancer is second only to lung cancer as a
cause of cancer deaths in women.
Cancer that has not spread is called in situ,
meaning “in place.”
Cancer that has spread is called invasive or
Breast cancer, like other cancers, occurs because of an
interaction between an environmental (external) factor
and a genetically susceptible host.
About 90% of breast cancers are due to genetic
abnormalities that happen as a result of the aging process
and the “wear and tear” of life in general.
The etiology of breast cancer is still poorly understood
with known cancer risk factors explaining only a small
proportion of cases.
Breast tissues consist mainly of fatty tissue interspersed
with connective tissue. Each tissue has 15 to 20 sections
that are termed as Lobes. Inside each lobe are many
smaller structures called Lobules/Ducts that contain
Oxygen, nutrients, and other life-sustaining nourishment
are delivered to breast tissue by the blood in the arteries
Lymph ducts: Drain fluid that carries white blood cells
(that fight disease) from the breast tissues into lymph
nodes under the armpit.
Lymph nodes: Filter harmful bacteria and play a key role
in fighting off infection.
Three Types of Vessels
MilkLobules Ducts Nipple
90% of cases are reported with ductal carcinoma. Lobular
carcinoma is very rare. If cancer confines to duct it is
benign or in situ but if move beyond duct, termed as
malignant or invasive.
Genetic abnormality due to any mutation allows the cells to
divide more rapidly than healthy cells do and may spread
through the breast, to the lymph or to other parts of the
body (metastasize) e.g. lungs or liver.
It has also been observed that breast stromal cells can
modulate the growth of normal and neoplastic breast
epithelial cells and can secrete growth factors following
stimulation by endogenous hormones. The adipose tissues
contain aromatase enzyme, which produces oestradiol
from circulating cholesterol. Because of the higher
proportion of these fat cells in breasts of older women, the
levels of oestradiol in are much greater than their plasma
levels. This probably accounts for the rising incidence of
breast cancer with ageing and supports the role of steroid
hormones in the pathogenesis of breast cancer.
Hormone Replacement Therapy
Having Children late or not at all
History of Cancer
Genetics (BRCA1, BRCA2, HER-2)
Lump in the breast tissue
Dimpling of skin
Red Scaly Patch on Skin
Swollen Lymph Nodes
Constant Pain in breast and armpit area
A mammogram is a special type of X-ray taken to look for
abnormal growths or changes in breast tissue.
An ultrasound can distinguish between a solid mass, which
may be cancer, and a fluid-filled cyst, which is usually not
MRI may be used to find out how much the disease has
grown throughout the breast the tissue.
Removal of cells from a suspicious mass to see if it’s cancer
Positron Emission Tomography:
PET may also be used to find out whether the cancer has
spread to organs.
Molecular Testing of Tumor:
The standard tests to further evaluate the cancer include
estrogen receptor (ER), HER-2 tests. The presence of these
receptors helps determine the type of treatment that is
most likely to lower the risk of recurrence. Generally,
hormonal therapy works well for ER-positive cancers, also
called hormone receptor-positive cancers. If a person’s
tumor does not have ER, the tumor is categorized as
negative tumor type. This type of cancer usually grows and
spreads more quickly than hormone receptor-positive
The American Joint Committee on Cancer (AJCC) and
the International Union against Cancer (UICC)
recommend TNM staging. Their TNM system, which they
now develop jointly, classifies cancer by several
factors, T for tumor, N for nodes, M for metastasis and
helpful to some extent in treatment approaches.
T describes the size of the original (primary) tumor and
whether it has invaded nearby tissue,
N describes nearby (regional) lymph nodes that are
M describes distant metastasis (spread of cancer from one
part of the body to another).
The management of breast cancer depends on various
factors, including the stage of the cancer and the age of the
patient. Breast cancer is usually treated with surgery,
which may be followed by chemotherapy or radiation
therapy, or both. A multidisciplinary approach is
preferable. Hormone receptor-positive cancers are often
treated with hormone-blocking therapy over courses of
several years. Monoclonal antibodies, or other immune-
modulating treatments, may be administered in certain
cases of metastatic and other advanced stages of breast
Mastectomy: Removal of the whole tissue.
Lumpectomy: Removal of a small part of the tissue.
There are currently three main groups of medications used
for adjuvant breast cancer treatment after surgery.
Hormone Blocking Therapy: Some breast cancers
require estrogen to continue growing. These ER+ cancers
can be treated with drugs that either block the receptors,
e.g. Tamoxifen, or alternatively block the production of
estrogen with an Aromatase inhibitor, e.g. Anastrozole
or Letrozole. The use of tamoxifen is recommended for 10
Chemotherapy: Chemotherapy is predominantly used for
cases of breast cancer estrogen receptor-negative (ER-)
disease. The chemotherapy medications are administered
in combinations, usually for periods of 3–6 months.
One of the most common regimens, known as "AC",
combines Adriamycin(Doxorubicin)+ Cyclophosphamide.
Another common treatment is Cyclophosphamide+
Methotrexate+ Fluorouracil (or "CMF").
Monoclonal Antibodies: Trastuzumab, a monoclonal
antibody to HER2 which is only effective in patients with
Bevacizumab (Avastin): Blocks angiogenesis (the
formation of new blood vessels) and is under evaluation in
Lapatinib: Tyrosine Kinase Inhibitor only used to treat
HER2 positive metastatic breast cancer.
Radiotherapy is given after surgery to the region of the tumor
bed and regional lymph nodes, to destroy microscopic
tumor cells that may have escaped surgery.