Breast Cancer Overview: Stages, Types, Symptoms and Treatment 2023
Breast cancer is the second leading cause of cancer deaths among women. In 2020, 2.3 million women got diagnosed with breast cancer, and in the same year, 685,000 patients lost their battle against the same fatal disease. In a report by the Centers for Disease Control and Prevention, cancer is the second leading cause of death among women of all races.
How Does Breast Cancer Happen?
Breast cancer happens when the cells in your breast grow and divide abnormally, forming tumors in the breast. The type and stage of breast cancer depend on the size and aggressiveness of the tumors.
Stages of Breast Cancer
The five stages of breast cancer are:
Stage 0: Non-invasive
Stage I: Invasive Breast Cancer
Stage II: Tumor is between 2 to 5 centimeters
Stage III: Tumor is over 5 centimeters
Stage IV: Metastatic or Last Stage of Breast Cancer
Breast Anatomy
Breasts are made up of three main parts: lobules, ducts, and connective tissue. The lobules are glands that produce milk. The ducts work like passageways that help that milk reach the nipple. And connective tissue, comprising fibrous and fatty tissues, surrounds and holds everything together. Ducts and lobules are more prone to cancer than connective tissue.
Types of breast cancer
The type of breast cancer depends on the cells in the breast that changed into cancer. Most types of breast cancer are invasive, which means cancer has the potential to travel to other body parts by leaving off its birth location.
Invasive Ductal Carcinoma
Invasive or Infiltrating Ductal Carcinoma is the most common type of breast cancer. According to The American Cancer Society, almost 80% of breast cancer cases are Invasive Ductal Carcinoma (IDC).
It begins in the ducts (a thin tube in the breast that carries milk to the nipple) and can travel outside the ducts, attacking other breast tissues. Once this happens, the cancerous cells can break into your lymph nodes or bloodstream from where they can advance towards other body organs.
Remember that late diagnosis or treatment can cause metastatic breast cancer, which is the last (incurable) stage of breast cancer. So many women find out that they have cancer when it becomes really hard to cure. So, it is better to do a self-examination after every two weeks.
What are the symptoms of Invasive Ductal Carcinoma?
1. Lump In the breast
2. Thickening or reddening of breast skin
3. Nipple discharge other than the breast milk
4. A change in the breast shape
5. Breast getting swelled
6. Unusual breast pain
7. Lumps forming in the underarm areas
8. Unusual changes in your breast or nipple
9. Breast dimpling
Diagnosis
1. Physical Examination: Before conducting other tests, your doctor will examine your breast. If they notice any lump or other symptoms, they will recommend further tests.
2. Mammography Screening: An abnormal mammograph confirms that you have breast cancer.
3. Computed Tomography (CT scan): It’s a diagnostic tool or machine that takes detailed pictures of your body from different angles.
4. Magnetic Resonance Imaging (MRI): It’s used to notice abnormalities in the breast by capturing multiple images.
5. Positron Emission Tomography (PET): An imaging test that uses a radioactive substance called a tracer for looking at how much cancer has spread into your breast and outside it. This tracer helps to identify affected areas a CT scan might not show.
6. Biopsy: It involves taking a sample of breast tissues that can be affected by cancer. After taking the sample, your doctor will send it for a microscopic examination by a pathologist.
Treatment
The treatment of IDC depends on the stage of cancer. If the IDC is in its advanced stage, you’ll have to go for surgical treatment. Otherwise, non-surgical methods will help.
The conventional treatment options are:
- Lumpectomy: Also known as breast-conserving surgery is a surgery in which the tumor and surrounding tissues are removed from the breast.
2. Mastectomy: It’s a surgical operation, also known as breast reconstruction, through which doctors remove an entire breast if the tumor is aggressive.
Non-surgical methods include:
1. Radiotherapy: Radiotherapy or radiation involves high doses of radiation to destroy breast cancer cells.
2. Chemotherapy: In chemotherapy, doctors use different drugs for killing cancer cells in the breast.
3. Hormone therapy: Your doctor will recommend hormone therapy if you are hormone-receptor-positive. It means estrogen helps the cancer cells to grow. This treatment prevents estrogen from growing in your body.
4. Targeted (Biology)therapy: Targeted therapy is used to target genes and proteins that help the cancer cells grow.
2. Invasive Lobular Carcinoma
Invasive Lobular Carcinoma or Infiltrating Lobular Carcinoma is the second most common type of breast cancer. It begins in the lobules (glands that produce milk) and can attack nearby breast tissues. This type of cancer, like Invasive Ductal Carcinoma, can also metastasize.
What are the symptoms of Invasive Lobular Carcinoma?
1. A swelled area in your breast
2. Change in the appearance or texture of your breast
3. Nipple retraction
4. Discharge from nipple that isn’t milk
5. Uncommon breast pain
6. A lump in or near your armpit
7. Thickening of breast
8. Breast dimpling
Diagnosis
For diagnosing Invasive Lobular Carcinoma, almost the same medical patterns are used as that for Invasive Ductal Carcinoma.
1. Physical Examination: If you or your doctor notices any of the above symptoms, then you are likely to have breast cancer. Once it’s confirmed, your doctor will conduct more tests to determine which type of breast cancer it is.
2. Magnetic Resonance Imaging (MRI): After the mammographic screening test, your doctor will recommend an MRI (It captures multiple images of the breast).
3. Ultrasound of the Breast: It involves painless sound waves that help to detect the tumors in your breast.
4. Breast Needle Biopsy: A radiologist will remove some of your breast tissues by numbing the breast area using a needle. Your doctor will then send the sample to the laboratory, where the pathologist will examine it using a microscope.
Sometimes treatment of ILC depends on different factors. For instance, your overall health, preference, and most importantly, how aggressive breast cancer is. Your doctor might suggest breast-conserving surgery or breast-reconstruction.
Treatment
1. Adjuvant therapy (radiation and chemotherapy): The chief purpose of adjuvant therapy is to kill the remaining cancerous cells that were left untreated during surgical procedures. It combines radiation and chemotherapy along with the surgery. The tumors of ILC are like branches, which make it difficult for surgeons to remove cancer from the breast.
2. Endocrine therapy (hormonal blockade): If estrogen hormones are involved in the growth or survival of breast cancer cells, your doctor will most definitely recommend getting Endocrine Therapy.
3. Paget’s Disease of the Breast
Paget’s disease of the breast is a rare type of breast cancer among women, and 1% to 4% of women develop this disease. Paget’s disease of the breast can also be found in men, which is rare. This type of cancer begins in the nipple's skin, causing changes to it and the areola (the darker skin surrounding the nipple). This type of cancer usually attacks only one breast.
What are the symptoms of Paget’s disease of the breast?
1. Nipple or areola turning red or itchy.
2. Thickness of skin around the nipple.
3. Nipple becoming crusty or flaky.
4. Flatness of nipple
5. Yellow or bloody discharge from the nipple
Diagnosis
A nipple biopsy is necessary to diagnose Paget’s disease of the nipple accurately.
Your doctor might recommend doing:
1. Surface Biopsy: It removes cells from the surface of your nipple.
2. Shave Biopsy: a tool like a razor that is used to shave off the cells from the top layer of your skin.
3. Wedge Biopsy: your doctor will use a scalpel to remove a small amount of tissue.
4. Punch Biopsy: a cutting tool that removes a disk-shaped tissue.
For many years, the standard surgical process for treating Paget’s disease of the breast was Mastectomy. It included both removal and non-removal of lymph nodes. Patients suffering from this type of breast cancer usually have more than one tumor in the same breast. Even if there was only one tumor present, the surgery was difficult to perform due to the distance between the nipple and the tumor.
With time, studies have shown that a better way to treat Paget’s disease of the breast is the surgical removal of the nipple and areola along with radiation therapy of the whole breast.
4. Triple-negative breast cancer
Triple-negative breast cancer is an aggressive type of invasive breast cancer. This type of cancer grows and spreads rapidly in and out of the breast tissues and is harder to cure. Almost 10% to 15% of breast cancer cases involve patients diagnosed with Triple-negative Breast Cancer.
Cancer cells of this type neither have estrogen/progesterone (ER or PR) or protein.
What are the symptoms of Triple-negative breast cancer?
1. Dimpled skin
2. Swelling of breast
3. A change in size or shape
4. Unusual pain in the breast
5. Nipple retraction
6. Nipple discharge that isn’t milk
Diagnosis
The first thing is to confirm whether you have breast cancer. Once it is determined, your doctor will check estrogen or progesterone receptors (ER or PR) and HER2 protein (Human Epidermal Protein) for triple-negative breast cancer.
Patients diagnosed with triple-negative breast cancer have relatively fewer options. The reason is that their bodies don’t make estrogen, progesterone receptors (ER and PR), or human epidermal protein (HER2) to get other available therapies.
Most of the time, women battling triple-negative cancer go through chemotherapy. Doctors might also suggest surgical operation if the cancer has not spread to other regions. Once you are operated on, you will go through chemotherapy to reduce the chances of cancer coming back.
If, unfortunately, cancer is on stage five, platinum chemotherapy, PARP inhibitor or antibody-drug conjugate, or immunotherapy with chemotherapy might serve.
There are some more types of breast cancer, but they are rare.
1. Angiosarcoma
Angiosarcoma is a rare type of breast cancer that begins in the cells that line blood or lymph vessels. It grows and spreads quickly without getting diagnosed. Angiosarcoma usually happens because of complications from breast radiation therapy. Women who have had breast radiation treatment therapy may not notice angiosarcoma until 8–10 years after it.
2. Phyllodes Tumor
Phyllodes or Phylloides tumor is another rare type of breast cancer that can be found in the connective tissue of breasts. This type of cancer is more common among women in their 40s, but women of any age can develop phyllodes tumors. Women with a rare genetic condition called Li-Fraumeni Syndrome are at high risk for phyllodes tumors. Not all phyllodes tumors are cancerous, but approximately 25% of these tumors are.
Phyllodes tumors can often be divided into three separate groups.
1. Benign: tumors are non-cancerous and account for more than half of phyllodes tumors. There are relatively low chances of their growing.
2. Borderline: Includes features between benign and malignant tumors.
3. Malignant: tumors are cancerous and account for 1 in 4 phyllodes tumors. They can grow fast and spread. Treatment for this group of phyllodes tumors might not be effective as they usually come back.
3. Adenoid Cystic Carcinoma
Adenoid Cystic Carcinoma or Adenocystic carcinoma is a rare type of breast cancer. This type of cancer can start in the salivary glands or other areas of the head and neck. Only 1% of cases out of 100% are Adenoid Cystic Carcinoma. Unlike aggressive types of cancer, Adenoid Cystic Carcinoma tends to grow gradually. Moreover, the chances of it getting back are few.
