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What Is Breast Cancer?




Breast cancer is a malignant tumor that starts from cells of the breast. A malignant tumor is a group of cancer cells that may grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. The disease occurs almost entirely in women, but men can get it, too.

Breast cancer is a vicious adversary.

There’s no getting around it. Breast cancer is the leading cause of death for women 35 to 50. And it hits women of limited means especially hard.

  • Women die of breast cancer at the rate of one every 12 minutes.
  • One in eight women will be diagnosed with breast cancer in her lifetime.
  • Breast cancer is the leading cause of cancer deaths among African American women
  • Woman of low socioeconomic status are more likely to be diagnosed with late-stage disease and die of the disease.

But there is hope.

Thanks in great part to early detection, more than 1.6 million breast cancer survivors are alive in America today. The earlier breast cancer is detected, the less the cancer has a chance to spread. That means more treatment options are available, and the chances for survival are much greater. In fact, the five year survival rate after early-stage diagnosis and treatment is over 90 percent.

What are the types of breast cancer?

There are several types of breast cancer, although some of them are quite rare. In some cases a single breast tumor can have a combination of these types or have a mixture of invasive and in situ cancer.
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Ductal carcinoma in situ

Ductal carcinoma in situ (DCIS; also known as intraductal carcinoma) is the most common type of non-invasive breast cancer. DCIS means that the cancer cells are inside the ducts but have not spread through the walls of the ducts into the surrounding breast tissue.

About 1 in 5 new breast cancer cases will be DCIS. Nearly all women diagnosed at this early stage of breast cancer can be cured. A mammogram is often the best way to find DCIS early.
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Lobular carcinoma in situ

Although it is not a true cancer, lobular carcinoma in situ (LCIS; also called lobular neoplasia) is sometimes classified as a type of non-invasive breast cancer, which is why it is included here. It begins in the milk-producing glands but does not grow through the wall of the lobules.

Most breast cancer specialists think that LCIS itself does not become an invasive cancer very often, but women with this condition do have a higher risk of developing an invasive breast cancer in the same breast or in the opposite breast. For this reason, women with LCIS should make sure they have regular mammograms and doctor visits.
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Invasive (or infiltrating) ductal carcinoma

This is the most common type of breast cancer. Invasive (or infiltrating) ductal carcinoma (IDC) starts in a milk passage (duct) of the breast, breaks through the wall of the duct, and grows into the fatty tissue of the breast. At this point, it may be able to spread (metastasize) to other parts of the body through the lymphatic system and bloodstream. About 8 of 10 invasive breast cancers are infiltrating ductal carcinomas.
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Invasive (or infiltrating) lobular carcinoma

Invasive lobular carcinoma (ILC) starts in the milk-producing glands (lobules). Like IDC, it can spread (metastasize) to other parts of the body. About 1 out of 10 invasive breast cancers is an ILC. Invasive lobular carcinoma may be harder to detect by a mammogram than invasive ductal carcinoma.
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Less common types of breast cancer

Inflammatory breast cancer: This uncommon type of invasive breast cancer accounts for about 1% to 3% of all breast cancers. Usually there is no single lump or tumor. Instead, inflammatory breast cancer (IBC) makes the skin of the breast look red and feel warm. It also gives the breast skin a thick, pitted appearance that looks a lot like an orange peel. Doctors now know that these changes are not caused by inflammation or infection, but by cancer cells blocking lymph vessels in the skin. The affected breast may become larger or firmer, tender, or itchy. In its early stages, inflammatory breast cancer is often mistaken for an infection in the breast (called mastitis). Often this cancer is first treated as an infection with antibiotics. If the symptoms are caused by cancer, they will not improve, and the skin may be biopsied to look for cancer cells. Because there is no actual lump, it may not show up on a mammogram, which may make it even harder to find it early. This type of breast cancer tends to have a higher chance of spreading and a worse outlook than typical invasive ductal or lobular cancer.

Triple-negative breast cancer: This term is used to describe breast cancers (usually invasive ductal carcinomas) whose cells lack estrogen receptors and progesterone receptors, and do not have an excess of the HER2 protein on their surfaces. Breast cancers with these characteristics tend to occur more often in younger women and in African-American women. Triple-negative breast cancers tend to grow and spread more quickly than most other types of breast cancer. Because the tumor cells lack these certain receptors, neither hormone therapy nor drugs that target HER2 are effective against these cancers (although chemotherapy can still be useful if needed).

Mixed tumors: Mixed tumors contain a variety of cell types, such as invasive ductal cancer combined with invasive lobular breast cancer. In this situation, the tumor is treated as if it were an invasive ductal cancer.

Medullary carcinoma: This special type of infiltrating breast cancer has a rather well-defined boundary between tumor tissue and normal tissue. It also has some other special features, including the large size of the cancer cells and the presence of immune system cells at the edges of the tumor. Medullary carcinoma accounts for about 3% to 5% of breast cancers. The outlook (prognosis) for this kind of breast cancer is generally better than for the more common types of invasive breast cancer. Most cancer specialists think that true medullary cancer is very rare, and that cancers that are called medullary cancer should be treated as the usual invasive ductal breast cancer.

Metaplastic carcinoma: Metaplastic carcinoma (also known as carcinoma with metaplasia) is a very rare type of invasive ductal cancer. These tumors include cells that are normally not found in the breast, such as cells that look like skin cells (squamous cells) or cells that make bone. These tumors are treated like invasive ductal cancer.

Mucinous carcinoma: Also known as colloid carcinoma, this rare type of invasive breast cancer is formed by mucus-producing cancer cells. The prognosis for mucinous carcinoma is usually better than for the more common types of invasive breast cancer. Still, it is treated like invasive ductal carcinoma.

Paget disease of the nipple: This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple and then to the areola, the dark circle around the nipple. It is rare, accounting for only about 1% of all cases of breast cancer. The skin of the nipple and areola often appears crusted, scaly, and red, with areas of bleeding or oozing. The woman may notice burning or itching.

Paget disease is almost always associated with either ductal carcinoma in situ (DCIS) or, more often, with infiltrating ductal carcinoma. Treatment often requires mastectomy. If only DCIS is found (with no invasive cancer) when the breast is removed, the prognosis is excellent.

Tubular carcinoma: Tubular carcinomas are another special type of invasive ductal breast carcinoma. They are called tubular because of the way the cells are arranged when seen under the microscope. Tubular carcinomas account for about 2% of all breast cancers. They are treated like invasive ductal carcinomas, but tend to have a better prognosis than most breast cancers.

Papillary carcinoma: The cells of these cancers tend to be arranged in small, finger-like projections when viewed under the microscope. These tumors can be separated into non-invasive and invasive types. Intraductal papillary carcinoma or papillary carcinoma in situ is non-invasive. It is often considered a subtype of ductal carcinoma in situ (DCIS), and is treated as such. In rare cases, the tumor is invasive, in which case it is treated like invasive ductal carcinoma, although the outlook is likely to be better. These cancers tend to be diagnosed in older women, and they make up no more than 1% or 2% of all breast cancers.

Adenoid cystic carcinoma (adenocystic carcinoma): These cancers have both glandular (adenoid) and cylinder-like (cystic) features when seen under the microscope. They make up less than 1% of breast cancers. They rarely spread to the lymph nodes or distant areas, and they tend to have a very good prognosis.

Phyllodes tumor: This very rare breast tumor develops in the stroma (connective tissue) of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Other names for these tumors include phylloides tumor and cystosarcoma phyllodes. These tumors are usually benign but on rare occasions may be malignant.

Benign phyllodes tumors are treated by removing the tumor along with a margin of normal breast tissue. A malignant phyllodes tumor is treated by removing it along with a wider margin of normal tissue, or by mastectomy. Although surgery is often all that is needed, these cancers may not respond as well to the other treatments used for more common breast cancers. When a malignant phyllodes tumor has spread, it may be treated with the chemotherapy given for soft-tissue sarcomas.

Angiosarcoma: This is a form of cancer that starts from cells that line blood vessels or lymph vessels. It rarely occurs in the breasts. When it does, it usually develops as a complication of previous radiation treatments. This is an extremely rare complication of breast radiation therapy that can develop about 5 to 10 years after radiation. Angiosarcoma can also occur in the arm of women who develop lymphedema as a result of lymph node surgery or radiation therapy to treat breast cancer. These cancers tend to grow and spread quickly. Treatment is generally the same as for other sarcomas.
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What are the stages of breast cancer?

The stage describes the extent of the cancer in the body. It is based on whether the cancer is invasive or non-invasive, the size of the tumor, how many lymph nodes are involved, and if it has spread to other parts of the body. The stage of a cancer is one of the most important factors in determining prognosis and treatment options.

Stage 0: This is ductal carcinoma in situ (DCIS), the earliest form of breast cancer. In DCIS, cancer cells are still within a duct and have not invaded deeper into the surrounding fatty breast tissue.

Stage IA: Considered “early stage” cancer, the tumor is 2 cm or less in diameter and does not appear to have spread beyond the breast.

Stage IB: The tumor is 2 cm or less with micrometasteses in 1 to 3 axillary lymph nodes (the cancer in the lymph nodes is great than 0.2 mm across but is not larger than 2 mm). The cancer has not spread to distant sites.

Stage IIA: One of the following applies:

  • The tumor is 2 cm or less and has spread to 1 to 3 axillary lymph nodes, with the cancer in the lymph nodes larger than 2 mm across.
  • The tumor is 2 cm or less and tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy.
  • The tumor is 2 cm or less and has spread to 1 to 3 axillary lymph nodes under the arm and to internal mammary lymph nodes.
  • The tumor is larger than 2 cm and less than 5 cm but hasn’t spread to the lymph nodes.

The cancer hasn’t spread to distant sites.

Stage IIB: One of the following applies:

  • The tumor is larger than 2 cm and less than 5 cm. It has spread to 1 to 3 axillary lymph nodes and/or tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy.
  • The tumor is larger than 5 cm across but does not grow into the chest wall or skin and has not spread to lymph nodes.

The cancer hasn’t spread to distant sites.

Stage IIIA: One of the following applies:

  • The tumor is not more than 5 cm. It has spread to 4 to 9 axillary lymph nodes, or it has enlarged the internal mammary lymph nodes.
  • The tumor is larger than 5 cm but does not grow into the chest wall or skin. It has spread to 1 to 9 axillary nodes, or to internal mammary nodes.

The cancer has not spread to distant sites.

Stage IIIB: The tumor has grown into the chest wall or skin, and one of the following applies:

  • It has not spread to the lymph nodes.
  • It has spread to 1 to 3 axillary lymph nodes and/or tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy.
  • It has spread to 4 to 9 axillary lymph nodes, or it has enlarged the internal mammary lymph nodes.

The cancer hasn’t spread to distant sites (M0).

Inflammatory breast cancer is stage IIIB unless it has spread to distant lymph nodes or organs, in which case it would be stage IV.

Stage IIIC: The tumor is any size, and one of the following applies:

  • Cancer has spread to 10 or more axillary lymph nodes.
  • Cancer has spread to the lymph nodes under the clavicle (collar bone).
  • Cancer has spread to the lymph nodes above the clavicle.
  • Cancer involves axillary lymph nodes and has enlarged the internal mammary lymph nodes.
  • Cancer has spread to 4 or more axillary lymph nodes, and tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy.

The cancer hasn’t spread to distant sites (M0).

Stage IV: The cancer can be any size and may or may not have spread to nearby lymph nodes. It has spread to distant organs or to lymph nodes far from the breast. The most common sites of spread are the bone, liver, brain or lung.
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Source: The American Cancer Society