Dec 11
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Breast cancer
Breast cancer is the unbridled growth of malignant cells in the breast tissue. There are two main types of breast cancer, ductal carcinoma – the most common – which begins in the ducts that carry milk from the breast to the nipple and carcinoma lobular that begins in parts of the breast, called lobules, which produce breast milk.
Causes
The origin of breast cancer is not known exactly. Factors that can increase a woman’s risk include heredity, early puberty, late pregnancy, obesity and factors related to lifestyle as excessive consumption of alcohol and tobacco. The world’s largest breast cancer risk factor is age, simply aging. Most breast cancers occur in women over 50 and women over 60 years are those that have the highest risk.
The risk of a woman developing breast cancer increases if her mother, sister, daughter or two or more close relatives, as cousins, have a history of breast cancer, especially in youth. However, 85% of women who develop breast cancer does not have a family history of disease.
Diagnosis
The certainty of breast cancer diagnosis requires microscopic examination of a sample of suspicious breast tissue (biopsy). Biopsy, however, is only the latest step in a chain of procedures aimed to separate the mammary studies into two main groups: those who have some degree of suspicion of cancer and which not.
The anamnesis (interrogation) followed by a physical examination and physical examination of the breast is the first step is to identify if there are signs of disease.
Inside the interrogation is extremely important to investigate whether the patient has direct relatives who have had cancer of the breast (mother, sister) if he has had benign tumors in breast, if her menses home early (12 years old or less) and his late menopause (older than 50), if it had taken contraceptive, was if he smokes; Since all of these have been identified in some way as a risk factor for breast cancer. After that, should find out if the patient has had breast pain (mastalgia) or tabled any lesions.
Later still the physical examination to the patient her be auto done each month. A doctor with experience is also should explore at least every 6 months. Look for lumps, deformities in skin, nipple either above or below the collar bone growths or armpit.
Then if it has been possible to obtain any information that justifies it, you resorted to some of the following diagnostic techniques for image:
- Mammography
- Breast ultrasound
- Magnetic resonance imaging or MRI (i. r. M.) or resonance image.
- (T. e. P.), Positron Emission Tomography (or p. e. T.)
Of these the most important, the more specific and the most widely used procedures is mammography, x-rays obtained on a set of rays that was designed specifically to study the breasts. Other techniques, such as the ductogram, the neumoquistografía and neumooncografía, represent variants of the mammogram which are associated with invasive techniques to clarify the study of certain alterations.
Breast ultrasound is an auxiliary, very useful on many occasions, which in some circumstances can become the main diagnostic technique for image. The main usefulness is the distinction of the solid or cystic nature of nodular lesions identified on mammogram. It is also useful in the study of breast with an important glandular component that determines a high density of the image mamogràfica, making discrimination against potential injuries. It allows a very precise measurement of the size of breast nodules and is very useful to guide punctures to obtain cell or tissue material for cytological examination or biópsico to the study and histo-pathological diagnosis.
Magnetic resonance imaging and T. e. P. (or p. e. T.) they are important in specific cases and their job is not currently routine. However, indications of their use will expand more and more. The main indications of the resonance are intense breast cicatrizales changes tracking surgical post, the study of multicecentricidad of breast cancer, the valuation of the local extension to support or contraindicar conservative treatment and study of complications of mammary prosthesis.
When you get a mammogram, the radiologist examines carefully the images looking for certain radiological signs which are known as probable indicators of pathology. The images can be viewed as analog, using as support for mammography x-ray film; either in a digital, using computer systems.
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Symptoms
Various investigations have found a group of factors of risk or circumstances, which make a person more prone to develop the tumor.
• Age: the risk increases with age. Most breast cancers occur on the 50 years; 60 the risk is higher and is rare under age 35, although it is also possible.
• Sex: women are more prone to developing breast cancer. Men may also experience it, but the probability is one for every 100 females.
• Family history: the chances increase if a sister, mother or daughter has suffered this disease. In addition this risk rises if the family that has suffered from cancer has done prior to menopause, or if it has affected the two breasts.
• Having suffered another cancer: the risk of breast cancer increases if it is has been previously another cancer, especially ovarian and colon, or a lobular or ductal carcinoma in situ (two types of malignant tumor that appear in the lobes or the ducts of the breast or mammary ducts). Another possible risk factor is a benign hyperplasia, a kind of not malignant tumor, which alters the tissue of the breast.
• Late menopause (after age 55)
• Not having children, or first birth from the age of 30.
• Environmental factors: it is investigating the possible influence of pesticides, contaminants or electromagnetic fields in food and water.
• Lifestyle: some studies have found a possible link between alcohol consumption and the development of breast cancer.
• Obesity : despite not having any definitive scientific observation, many researchers suggest that follow a diet low in fat and rich in fruits and vegetables, as well as physical exercise on a regular basis may help prevent the onset of breast cancer.
• Stress: an active lifestyle to excessive limits is not convenient or beneficial. A stressful life is harmful to health and as a result, it can favour the appearance of diseases
• HRT: some researchers indicate that from the age 10 with therapy hormone replacement (HRT) may increase the risk of cancer, while others emphasize that no matter how time has taken in the past, as there is the risk of cancer among the following hormone therapy, not between that followed her in the past.
Treatment
There are different treatments available to patients with cancer of breast. Some treatments are standard (the currently used treatment) and others are in assessment in clinical trials. A clinical trial of treatments consists of a research study which seeks to improve current treatments or get information about new treatments for cancer patients. When clinical trials show that a new treatment is better than standard treatment, the new treatment may become the standard treatment. Patients should consider participating in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
We use four types of standard treatment.
1 Surgery
The majority of patients with breast cancer undergo surgery to remove the cancer of the breast. Are generally removed some lymph nodes from the bottom of the arm and can be seen under a microscope to check whether they contain cancer cells
Conservative surgery of the breast, an operation to remove the cancer, but not the same breast. It includes the following procedures:
• Lumpectomy: surgery to remove the tumor (mass) and a small amount of normal tissue around it.
• Partial mastectomy: surgery to remove part of the breast cancer and some of normal tissue around it. This procedure is also called segmental mastectomy.
Patients treated with conservative breast surgery, also they cannot be removed some lymph from the bottom of the arm for biopsy. This procedure is called lymph node dissection. Are you can make at the same time as conservative surgery of the breast or later. Lymph node dissection is done through a separate incision.
Other types of surgery include the following:
• Total mastectomy: surgery to remove the entire breast containing cancer. Also can be some lymph nodes from the bottom of the arm to observe them under a microscope and check for signs of cancer. This procedure is also called total mastectomy. This is done through a separate incision.
• Modified radical mastectomy: surgery to remove the entire breast has cancer, the majority of lymph nodes from the bottom of the arm, the lining of the pectoral muscles and sometimes part of the chest wall muscles.
• Radical mastectomy: surgery to remove the breast that contains cancer, the muscles in the wall of the chest below the breast and all lymph nodes below the arm. This procedure is sometimes called Halsted radical mastectomy.
Even if your doctor removes all cancer seen at the time of surgery, some patients may receive radiation therapy, chemotherapy or hormone therapy after surgery to kill all cancer cells remaining. The treatment given after surgery to increase the chances of curing is called adjuvant therapy.
If the patient is going to have a mastectomy, reconstruction of the breast (surgery to reconstruct the shape of a breast after mastectomy) can be considered. Breast reconstruction can be done at the time of mastectomy or later. Reconstruction can be done with the own (not the breast tissue) of the patient or through the use of implants filled with a saline gel or silicone.
2 Radiation therapy
Radiation therapy is a treatment for cancer using high energy x-rays or other types of radiation to destroy cancer cells or to prevent them growing. There are two types of radiation therapy. External radiotherapy uses a machine outside the body that sends radiation to the area where the cancer is found. Internal radiotherapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into cancer or near the same. The way in which radiation therapy is administered depends on the type and stage of cancer that is being treated.
3 Chemotherapy
Chemotherapy is a treatment for cancer drugs are used to interrupt the growth of cancer cells, either by their destruction or preventing their proliferation. When chemotherapy is administered by mouth or injected into a vein or muscle, drugs enter the bloodstream and affect cancer cells of the body (systemic chemotherapy). When chemotherapy is placed directly in the spine, a body or a body cavity such as the abdomen, the drugs mainly affect cancer cells of these areas (regional chemotherapy). The way in which chemotherapy is administered depends on the type and stage of cancer which is trying to.
4. Hormone therapy
Hormone therapy is a treatment for cancer that are extracted hormones or blocking its action, and prevents the growth of cancer cells. Hormones are substances produced by the glands of the body that circulate through the bloodstream. Some hormones can grow certain cancers. If the tests show that cancer cells offer sites where cannot join hormones (receivers) are used medications, surgery or radiotherapy to reduce the production of hormones or prevent it from functioning. The hormone estrogen, which increases some breast cancers, is made mostly by the ovaries. Treatment to prevent that the ovaries produce estrogen is called ovarian ablation.
Hormonal therapy with tamoxifen is often supplied to patients with early stage breast cancer and cancer patients with metastatic breast (cancer that has spread to other parts of the body). Hormonal therapy with tamoxifen or estrogen can act on all the body’s cells and can increase the chance of developing cancer of the endometrium. Women who take tamoxifen should undergo a pelvic exam every year to check for signs of cancer. All vaginal bleeding that is not bleeding menstrual be reported to a doctor as soon as possible.
Hormonal therapy with an aromatase inhibitor is administered to some postmenopausal women suffering from breast hormonodependiente cancer. Hormonodependiente breast cancer need the hormone estrogen to grow. Aromatase inhibitors lower estrogen in the body because they prevent an enzyme called aromatase to turn the androgen into estrogen.
Certain aromatase inhibitors can be used for the treatment of breast cancer in a stadium early as adjuvant therapy or after two years or more of tamoxifen. Aromatase inhibitors are being tested in clinical trials to compare with hormonal therapy with tamoxifen in the treatment of the metastatic breast cancer.
New types of treatment in clinical trials are testing.
This section of the summary refers to treatments assessment in clinical trials, but perhaps not mentioned all new treatments that are being considered. For more information in English about clinical trials, visit the NCI Web site.
Followed by surgery Sentinel lymph node biopsy.
Sentinel lymph node biopsy is a procedure to remove the Sentinel lymph node during surgery. Sentinel lymph node is the first node that receives the lymphatic drainage of a tumor and the first lymph node where it is possible that the cancer spreads from the tumor. Inject a radioactive substance or a blue tint near the tumor. The substance or dye flows through the lymph ducts into the lymph nodes. The first node that receives the substance or the dye is extracted. A pathologist observes the tissue under a microscope to check for cancer cells. When cancerous cells are not detected, it may not be necessary to extract more lymph nodes. After the Sentinel lymph node biopsy, the surgeon removes the tumor (conservative surgery of the breast or mastectomy).
High-dose chemotherapy with stem cell transplantation.
High-dose dose chemotherapy with stem cell transplantation is a way to administer chemotherapy high dose and replace blood cells destroyed by cancer treatment. (Immature blood cells) mother cells are extracted from the blood or bone marrow of the patient or a donor, and are frozen and stored. After finishing chemotherapy, stored stem cells be thawed and re-inject the patient through an infusion. These reinyectadas stem cells grow (and restore) the blood cells in the body.
Some studies have shown that with high doses of chemotherapy followed by a cell transplantation mother are not obtained better results than with standard chemotherapy in the treatment of breast cancer. The doctors have decided that, for now, high doses of chemotherapy alone must prove in clinical trials. Prior to participating in a study of its kind, women should consult with their doctors about serious side effects, even death, which can cause high doses of chemotherapy.
As adjunctive therapy monoclonal antibodies
Monoclonal antibody therapy is a treatment for cancer that uses antibodies produced in the laboratory from a single type of cells of the immune system
These antibodies can identify substances in cancer cells or normal substances of the body may help cancer cells grow. Antibodies adhere to substances and destroy cancer cells, preventing its growth or prevent it from spreading. Monoclonal antibodies are administered by infusion. They can be used alone or to take drugs, toxins or radioactive material directly to cancer cells. Monoclonal antibodies can also be used in combination with chemotherapy as adjuvant therapy.
Trastuzumab (Herceptin) is a monoclonal antibody that blocks the effects of the growth factor of the HER2 protein, which transmits growth signals cancer cells of the breast. Nearly a quarter of patients with breast cancer have tumors that can be treated with trastuzumab combined with chemotherapy.
Inhibitors of tyrosine kinase such as adjuvant therapy
Tyrosine kinase inhibitors are targeted therapy drugs that block the signals that tumors need to grow. Inhibitors of tyrosine kinase combined with other drugs as adjuvant therapy can be used.
The lapatinib is an inhibitor of tyrosine kinase that blocks the effects of the HER2 protein and other proteins in the interior of the tumor cells. It can be used to treat patients with positive breast cancer to the HER2 which has worsened after treatment with trastuzumab.
Patients should consider participating in a clinical trial.
For some patients, perhaps the best choice of treatment is to participate in a clinical trial. Clinical trials are part of the process of cancer research. Clinical trials are carried out to determine whether new treatments for cancer are safe and effective, or better than standard treatment.
Many of the current standard treatments are based on previous clinical trials. Patients participating in a clinical trial may receive standard treatment or be among the first to receive the new treatment.
Patients participating in clinical trials also help to improve the way in which the cancer in the future will be. Although clinical trials do not lead to effective new treatments, often respond to important questions and help to make progress in the research.
Patients can enter a part of clinical trials before, during or after starting his treatment for cancer.
Some clinical trials only included patients who still did not receive treatment. Other trials tested treatments for patients whose cancer has not improved. There are also clinical trials that test new ways of preventing cancer resort (again) or reduce the side effects of cancer treatment.
Clinical trials take place in many parts of the country. See the section on treatment options to find links in English to the clinical trials that are currently performed. These have been recovered from the NCI clinical trials database.
Follow-up tests may be needed.
Some of the tests used to diagnose cancer or to determine the stage of the cancer may recur. Some tests are repeated to ensure that treatment is effective. Decisions regarding continuing, changing or stopping treatment can be based on the results of these tests. This is sometimes called reestadificicación.
Some of the tests will continue repeating sporadically after completing treatment. The results of these tests may show if your condition has changed or if cancer has resorted (again). These tests are sometimes called follow-up tests or examinations.
Treatment options for breast cancer recurrent
The treatment of recurrent (cancer returned after finishing treatment) breast cancer in the breast or chest wall may include the following:
• Surgery (modified radical or radical mastectomy), radiation therapy, or both.
• Systemic chemotherapy or hormonal therapy.
• Participation in a clinical trial of trastuzumab (Herceptin) combined with systemic chemotherapy.
Treatment options for breast cancer (breast) inflammatory
The treatment of inflammatory breast cancer may include the following:
• Systemic chemotherapy.
• Systemic chemotherapy followed by surgery (conservative surgery of the breast or total mastectomy) with lymph node dissection followed by radiotherapy. You can manage additional systemic therapy (chemotherapy, hormonal or both therapies).
• Participation in clinical trials evaluating new cancer drugs, new combinations of drugs and new ways to administer treatments.
Prevention
• Take care of your health. It is essential.
Medical terms explained in a simple way:
The fat cells produce a hormone called estrogen. Prior to menopause, the greater part of estrogens are secreted (removed) by the ovaries. But after menopause, the ovaries cease to exercise such functions making it easier to get to have an excess of estrogen after menopause. Logically to higher level of fat in the body, the greater the possibility that we have excess estrogen. Excess estrogen (produced by cells excess fat) significantly increases the risk of breast cancer.
Excess belly fat represents an increased risk of breast cancer compared with that of the hips or limbs.
Therefore:
or Try to be thin, but not spent, never with a thinness below normal.
or avoid sedentary life. The sedentary lifestyle increases the risk of breast cancer. To reduce the risk of cancer are needed every day, for at least 5 days a week, between 35 minutes and an hour of physical activity.
or that doesn’t lack vitamin D. Vitamin D deficiency increases the risk of breast cancer. To prevent breast cancer eat foods rich in vitamin D and exposed to the Sun a few minutes a day, preferably in the morning. Beware, overexposure to the Sun may be worse.
or eating food with less fat. Speaking of fat we refer to the animal fats (red meat, eggs, butter, piglet, creamy milk, sausage, fish fatty, etc.) Fatty foods should not exceed 25 to 30% of calories in our diet. Fiber-rich foods help to protect us. Vitamins A, C and E also help.
• Avoid taking more than one alcoholic beverage per day.
If decision-making, which is not more than one drink (a drink). The risk increases when it takes over.
• Beware of oral contraceptives.
Studies suggest that oral contraceptives may increase the risk of breast cancer. Similarly, once ceases the use of birth control pills decreases the risk. Other contraceptive methods, especially if you are in known risk are to be considered.
• Breastfeeding helps.
Breastfeed their babies for at least six months, and very recomendablemente at least one year. Studies seem to be quite convincing in the fact that breastfeeding women reduce their risk of breast cancer.
• Beware of hormone replacement (HRT) treatments, more and more common to avoid the symptoms of menopause, can increase your risk of breast cancer.
• Periodically undergo preventive medical examinations. Usually have a long “quiet” period between the stage of the initiation of breast cancer and the emergence of symptoms, the preventive examinations are trying to find cancer at this stage, when it is easier to treat it successfully. Once a year make a mammogram, and learn how to make a monthly self-exam.
