Breast Cancer: Symptoms, Staging, Diagnosis & Treatments

Breast cancer affects millions worldwide, with effects that go far beyond the initial diagnosis. 

Knowing the signs, treatment options, and ways to handle side effects can make a big difference in your outcome. 

In this guide, we’ll dive into key aspects of breast cancer—types, risk factors, symptoms, and treatments—to help you stay informed and prepared. 

What is Breast Cancer?

Breast cancer begins when cells in the breast tissue start to grow uncontrollably. Most commonly, it starts in the milk ducts, which carry milk to the nipple, or in the lobules, where milk is produced. 

Over time, these abnormal cells can invade nearby tissues and potentially spread to lymph nodes or other body parts. According to the American Cancer Society, breast cancer is the most frequently diagnosed cancer among women in the U.S., affecting 1 in 8 women during their lifetime. 

Early detection through regular screenings and self-exams significantly increases the chances of successful treatment.

Types of Breast Cancer

Breast cancer has several types, each with its characteristics and treatment responses. Knowing the specific type helps in understanding treatment options and outcomes.

• Ductal Carcinoma In Situ (DCIS): Non-invasive cancer in milk ducts, detected by mammograms. Treated with surgery and possibly radiation, with excellent outcomes.

• Invasive Ductal Carcinoma (IDC): Most common breast cancer (80%), starts in milk ducts and spreads. Early detection allows effective treatment with surgery, chemotherapy, and radiation.

• Invasive Lobular Carcinoma (ILC): Grows slowly in lobules, harder to detect on mammograms. Treated with surgery, chemotherapy, or hormone therapy.

• Triple-Negative Breast Cancer: Aggressive, lacking hormone and HER2 receptors, common in younger women. Treated with chemotherapy and clinical trials due to lack of hormonal options.

• HER2-Positive Breast Cancer: Driven by excess HER2 protein, aggressive but responds to targeted therapies like Herceptin, with surgery and chemotherapy.

• Inflammatory Breast Cancer (IBC): Rare (1-5%) and aggressive, causes swollen, red breasts. Immediate treatment with chemotherapy, surgery, and radiation is needed.

Main Risk Factors for Breast Cancer

Understanding breast cancer risk factors can guide individuals in taking preventive measures. While some factors are unchangeable, others can be modified to lower risk.

• Gender: Women face a much higher risk of breast cancer; male cases are rare.

• Age: Risk increases with age, with most cases in women over 50. Average age at diagnosis is 62.

• Family History: Having a first-degree relative with breast cancer raises risk 2-3 times.

• Genetic Mutations: BRCA1 and BRCA2 mutations can increase lifetime risk to 85%. Genetic counseling helps assess this.

• Hormonal Exposure: Early menstruation, late menopause, and long-term hormone therapy raise risk by increasing estrogen exposure.

• Lifestyle Choices: Obesity, especially post-menopause, heightens risk. Regular exercise, healthy diet, and limiting alcohol to one drink per day reduce risk in this regard.

Early Symptoms of Breast Cancer

The only way to treat breast cancer effectively is to catch it early. Here are the common signs to watch for:

• Lumps or Thickening: A noticeable lump or thickening in the breast or underarm that feels different from surrounding tissue may indicate breast cancer. Regular self-exams are key to detecting these changes early.

• Changes in Breast Shape or Size: Any sudden changes in size or shape, particularly if one breast appears larger than the other, warrant further examination.

• Nipple Discharge: Discharge from the nipple, especially if it is bloody or occurs without squeezing, should be evaluated by a healthcare professional. Normal discharge typically does not contain blood.

• Skin Changes: Redness, dimpling, or changes in the texture of the breast skin can be signs of cancer. Rashes or scaling on the breast may also occur.

• Nipple Inversion or Changes: Sudden changes in the nipple, such as it pulling inward or having an unusual texture, may indicate an underlying issue that needs investigation.

How Breast Cancer is Diagnosed

Doctors employ various methods to diagnose breast cancer accurately. Early diagnosis greatly enhances treatment effectiveness.

• Mammogram: A low-dose X-ray used to detect breast abnormalities. The recommended starting age is 40 for regular screening. Early detection improves outcomes.

• Ultrasound: Provides further detail after mammogram abnormalities, distinguishing solid masses from fluid-filled cysts. Useful for younger women with dense breast tissue.

• Biopsy: Removes tissue for definitive diagnosis. Methods include fine needle aspiration, core needle biopsy, or surgical biopsy, depending on the abnormality.

• MRI: Offers detailed imaging, often used for high-risk women or to assess cancer's extent post-diagnosis.

• Genetic Testing: Identifies BRCA mutations in women with a strong family history.

Breast Cancer Stages and Grading Score

Staging and grading help determine the extent of breast cancer and inform treatment decisions.

• Stage 0: Cancer is confined to the ducts, treatable with surgery and radiation, with a high survival rate.

• Stage I: Tumor is less than 2 cm, possibly in nearby lymph nodes. Surgery and radiation are common, with a good prognosis.

• Stage II: Tumor is 2-5 cm and may involve several lymph nodes. Treatment includes surgery and chemotherapy.

• Stage III: Cancer spreads to multiple lymph nodes or nearby tissues like the chest wall. Treatment combines chemotherapy, surgery, and radiation.

• Stage IV: Cancer has metastasized to distant organs like the liver, bones, or lungs. Treatment focuses on relieving symptoms and improving quality of life.

Grading assesses how abnormal the cancer cells appear under a microscope.

• Grade 1 (Low Grade): These cells closely resemble normal cells and grow slowly, leading to a better prognosis.

• Grade 2 (Intermediate Grade): These cells have more abnormal features and grow faster than low-grade cancers, which may require more aggressive treatment.

• Grade 3 (High Grade): High-grade cancers appear significantly abnormal and tend to grow quickly, often necessitating aggressive treatment strategies.

Treatment Options for Breast Cancer

Doctors create treatment plans based on the type and stage of cancer, along with personal factors. A team of specialists works together to develop a plan tailored to the patient's needs.

• Surgery: Lumpectomy removes the tumor; mastectomy removes one or both breasts. Lymph nodes may also be tested.

• Radiation Therapy: High-energy rays target remaining cancer cells after surgery over several weeks to lower recurrence risk.

• Chemotherapy: Drugs kill rapidly dividing cancer cells, used before surgery (neoadjuvant) to shrink tumors or after (adjuvant) to eliminate residual cells.

• Hormone Therapy: Blocks estrogen in hormone receptor-positive cancers using drugs like fulvestrant or ribociclib.

• Targeted Therapy: Targets specific cancer traits. HER2-positive cancers respond to lapatinib. Olaparib inhibits DNA repair in BRCA-mutated cancers.

• Immunotherapy: Engages the immune system to combat cancer, such as pembrolizumab for aggressive types like triple-negative breast cancer.

Medications for Breast Cancer

These medications help treat advanced or specific types of breast cancer. Keep in mind, that they’re not the only options available. Your doctor might prescribe something different if you have interactions.

• Everolimus (Afinitor): Slows disease progression when combined with hormone therapy for hormone receptor-positive, HER2-negative metastatic breast cancer.

• Fulvestrant (Faslodex): Blocks estrogen receptors, used in postmenopausal women with hormone receptor-positive cancer that has progressed.

• Palbociclib (Ibrance): Interrupts cell division in hormone receptor-positive cancers, used with hormone therapy for advanced cases.

• Lapatinib (Tykerb): Targets HER2 and EGFR, used with chemotherapy to slow tumor growth in HER2-positive breast cancer.

• Ribociclib (Kisqali): Inhibits cancer cell division, combined with hormone therapy for advanced hormone receptor-positive breast cancer.

• Olaparib (Lynparza): A PARP inhibitor for BRCA-mutated breast cancer, blocking cancer cell DNA repair, leading to cell death.

• Pembrolizumab (Keytruda): An immunotherapy that boosts the immune system to fight cancer, effective in aggressive types like triple-negative breast cancer.

• Gemcitabine: A chemotherapy drug that treats various cancers including Pancreatic and Lung Cancer by inhibiting DNA synthesis and tumor growth.

Managing Breast Cancer Treatment Side Effects

Here are some common side effects and doctor’s advice for handling them:

• To manage fatigue, stay active, rest, and maintain a balanced diet.

• To reduce nausea, use antiemetics, eat small meals, and stay hydrated.

• To relieve skin irritation, moisturize regularly and avoid sun exposure.

• To address anxiety or depression, seek therapy or join support groups.

• To control swelling, use compression garments and do gentle exercises.

Conclusion

Breast cancer presents challenges, but there is hope. Advances in research and treatment options allow many women to thrive despite a diagnosis. By staying informed and proactive, you can make informed decisions that enhance your health and well-being.