Breast cancer and care

Breast cancer is the second leading cause of cancer death in women. It is characterized by the abnormal growth and uncontrolled division of cells in the breast. Cancer cells form a tumor, that is often felt as a lump in the breast.This tumor can invade and destroy surrounding normal tissue, and can spread(metastasize) cancer cells throughout the body via the bloodstream or lymph system.

Every woman is at risk for breast cancer. If she lives to be 85, there is a one out of nine chance that she will develop the condition sometime during therest of her life. As a woman ages, her risk of developing breast cancer rises dramatically regardless of her family history. The breast cancer risk of a25-year-old woman is only one out of 19,608; by age 45, it is one in 93. In fact, 80% of all breast cancers are found in women over age 50.

There are a number of risk factors for the development of breast cancer, including: family history of breast cancer in mother or sister, early onset of menstruation, late menopause, and history of abnormal breast biopsies. Reproductive history may also be a factor; women who had no children or have childrenlate in life and women who have never breastfed are at increased risk for breast cancer. However, more than 70% of women who get breast cancer have no known risk factors.

The best way to manage breast cancer risk is by doing a breast self-examination (BSE) at the same time each month. The entire breast tissue area (which extends up to the collarbone) and both armpits should be checked visually and by hand for changes. The changes in the breast that may be a sign of breast cancer include: a lump or thickening in breast or armpit, nipple turninginward, unusual discharge from the nipple, dimpled or reddened skin on the breast, and a change in breast size or shape. A woman should see her doctor assoon as possible if she observes any of these signs.

Periodic clinical breast examinations by a health care professional are alsoimportant in early breast cancer detection. Women between 20 and 39 should have an exam performed at least once every three years; women over 40 should beexamined annually.

More than 90% of all breast cancers are detected on a mammogram (x rayof the breast). Screening mammograms should be ordered according to the doctor's guidelines. Despite the controversy about the cost-effectiveness of mammograms for women in their 40s, most doctors agree with the current American Cancer Society guidelines that recommend screening mammograms every year or two for women between 40 and 49, and every year after age 50. Women with a family history of breast cancer may want to have a mammogram every year after age40. A baseline mammogram should be done by age 35, so that a normal x ray can be used to compare future mammograms, even when there is no reason to believe there is a lump or cyst.

If anything irregular is detected on a mammogram, such as a mass, changes from earlier mammograms, abnormalities of the skin, or enlargement of the lymphnodes, further testing may be recommended. This could include an ultrasound of the breast, a biopsy or needle sampling, or consultation with a breast surgeon.

Biopsy of the breast is a removal of suspicious breast tissue for examinationby a pathologist. An excisional biopsy is a surgical procedure in which theentire lump area and some surrounding tissue is removed for examination. If the mass is very large, an incisional biopsy is done where only a portion of the area is removed and analysed. Needle biopsy can be done in two methods. Anaspiration needle biopsy uses a very fine needle to withdraw cells and fluidfrom the mass for analysis. A large core needle biopsy uses a larger diameter needle to remove small pieces of tissue from the mass that can be analyzed.After the tissue sample is removed, a pathologist will examine the cells within it to determine whether the mass is benign (non-cancerous) or malignant (cancerous).

It is important to realize that not all lumps detected in the breast are cancerous. Many are benign and require only the removal of the lump. However, when a malignancy is found, it is important to determine the extent of the disease is so proper treatment can begin as soon as possible.

To find out if the cancer has spread to other parts of the body (metastasized), doctors will also biopsy underarm lymph nodes to test for cancer cells that have spread. Checking to see if there are cancer cells in the lymph nodes is also a way to tell how advanced the cancer is. This is called "staging" cancer. Breast cancer is rated from Stage 0 to Stage IV based on the size of thetumor and if the cancer has spread to surrounding lymph nodes and/or organs.

Breast cancer treatment is prescribed and administered by an oncologist (cancer specialist). Treatment options include surgery, chemotherapy, and radiation. Breast cancer is treated in two ways, locally to eliminate tumor cells from the breast by surgery and radiation, and systemically to destroy cancer cells that have traveled to other parts of the body. Systemic therapy includes chemotherapy and hormonal treatments.

The extent of surgery depends on the type of breast cancer, whether the disease has spread, and the patient's age and health. If the tumor is less than about 1.6 inches or there isn't much chance it will return, the patient and doctor may opt for removal of the tumor alone (lumpectomy) followed by radiationtherapy. In a lumpectomy, the doctor removes the lump and an area of tissuesurrounding it. Some of the lymph nodes under the arm may be removed (axillary dissection) and tested to see if the cancer has spread there.

If the tumor is larger, mastectomy may be needed. In a modified radical mastectomy, the doctor removes the entire breast, the underarm (axillary) lymph nodes, and the lining over the chest muscle (but not the muscles themselves. Aradical mastectomy is used only when the cancer has invaded the chest muscles; the surgeon removes the breast, the chest muscles, and all of the lymph nodes under the arm.

Surgery can also be combined with breast reconstruction. Breast reconstruction is a series of surgical procedures performed to recreate a breast which looks and feels as natural as possible. It can be performed at the time of masectomy surgery, or at a later date. A breast mound is formed by using artificial materials called breast implants, or by using tissues from other parts of the woman's body, and the nipple and areolar complex (darker area around the nipple) are recreated. Other procedures may be necessary, such as lifting theopposite breast (mastopexy), or making it larger or smaller to match the reconstructed breast.

The presence of cancer cells in the lymph nodes may require more extensive surgery. If the cancer has spread to the nodes, the patient will need either radiation, chemotherapy, hormone therapy, or a combination of all three after surgery. This is called "adjuvant therapy."

Radiation stops the cancer cells from dividing. It works especially well on fast-growing tumors. Unfortunately, it also stops some types of healthycells from dividing. Healthy cells that divide quickly, like those of the skin and hair, are affected the most. This is why radiation can cause fatigue,skin problems, and hair loss.

Breast cancer surgery may be followed by chemotherapy in even the earliest stages. Chemotherapy drugs are administered either orally or by injection into a blood vessel. Chemotherapy is usually given in cycles, with a courseof drugs followed by a period of time for recovery before another course ofdrugs. Chemotherapy treatment time may range between four to nine months.

There may be significant side effects with some types of chemotherapy, including nausea and vomiting, temporary hair loss, mouth or vaginal sores, fatigue, weakened immune system, and infertility. However, chemotherapy for early breast cancer uses medications that cause few side effects.

The growth of some breast cancer cells may be slowed or stopped with the drugtamoxifen, an anti-estrogen medication. Research suggests that tamoxifen may lower the chance that a breast cancer can return by between 25% and 35%. It can also prevent the recurrence of new cancer in the opposite breast.Other hormone treatments include the use of progestins, estrogens, andandrogens. In rare cases, the surgeon may suggest removal of the ovaries (oophorectomy) in pre-menopausal women as a way of eliminating the main source of estrogen, which can boost the growth of some breast tumors.

Stem cell treatment is used to treat advanced breast cancer. By firstremoving a woman's stem cells from her bone marrow or blood, the doctor can use very high doses of chemotherapy or radiation to kill cancer cells. Becausethis also kills healthy white blood cells, leaving the woman vulnerable to infection, the stem cells are then replaced, where they restore the body's ability to fight infection.

It is normal to be depressed or moody, to cry, or to be less interested in sex after breast cancer treatment. Many women have found that joining a supportgroup of breast cancer survivors can help them work through their emotions.

The prognosis for breast cancer depends on the type and stage of cancer. Mostpatients can return to a normal lifestyle within a month or so after surgery. Exercises can help the patient regain strength and flexibility. Regular follow-up with a physician is important to look for any recurrence of the cancer.

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