Introduction

Cancer of the breast is the most common form of cancer that affects women but is no longer the leading cause of cancer deaths. About 1 in 10 women develop breast cancer every year.

This reference summary will help you understand the diagnosis and treatment options of breast cancer.

Cancer and Its Causes

The body is made up of very small cells. Normal cells in the body grow and die in a controlled way. Sometimes cells keep dividing and growing without normal controls, causing an abnormal growth called a tumor. If the tumor does not invade nearby tissues and body parts, it is called a benign tumor, or non-cancerous growth.

Benign tumors are rarely life threatening. If the tumor invades and destroys nearby cells, it is called a malignant tumor, or cancer. Cancer can sometimes be life threatening.

Cancerous cells may also spread to different parts of the body through blood vessels and lymph channels. Lymph is a nearly clear fluid produced by the body that drains waste from cells. It travels through special vessels and bean-shaped structures called lymph nodes.

Cancer treatments are used to kill or control abnormally growing cancerous cells. Cancers in the body are given names, depending on where the cancer started. Cancer that begins in the breasts will always be called a breast cancer, even if it has spread to another place such as the liver, bones, or brain.

Although health care providers can locate where a cancer started, the cause of a cancer in a patient cannot usually be identified. Cells contain hereditary or genetic materials called chromosomes.

This genetic material controls the growth of the cell. Cancer always arises from changes that happen in these genetic materials. When the genetic material in a cell becomes abnormal, it can lose its ability to control its growth.

These sudden changes in genetic material can happen for a variety of reasons. These changes may be inherited from parents. Changes in genetic materials may also happen because of exposure to infections, drugs, tobacco, chemicals, or other factors.

Breast Cancer

Breast cancer may originate from either the glands or the ducts of the breast. If cancer originates from the glands, it is called lobular carcinoma. The lobules are the special milk-producing glands.

When cancer happens in the ducts of the breast it is known as ductal carcinoma.

When the cancer moves beyond the place where it began, it is known as “infiltrating” or “invasive” cancer. Cancer that has not crossed beyond the involved lobule or tubule is very limited in nature. It is called “in-situ” carcinoma.

Breast cancer may involve more than one member of a family; this is usually called familial breast cancer. There may be some hereditary and genetic cause for this type of breast cancer. Recent genetic advances have allowed the detection of some of these genes.

Women with familial breast cancer can benefit from genetic counseling and possibly genetic testing.

Signs and Symptoms

Early cancer of the breast usually has no symptoms. Later, as the cancer grows, it may cause a lump that can be felt in the breast. Sometimes the skin overlying the tumor becomes coarse and wrinkled.

This is known as “peau d’orange” in French or “orange skin.” Discharge from the nipple can also be a sign of breast cancer. Most breast cancer cases are discovered either by selfexam or a mammogram.

Diagnosis

When breast cancer has been detected, an operation to take the tumor out and to diagnose the cancer usually follows. During such an operation, the surgeon may check the lymph nodes in the axilla for the presence of cancer.

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A health care provider looks at the tissue taken out at the time of surgery and determines whether or not the tumor is cancerous.

Lymph Nodes If the lump is cancerous, other more specialized tests may be done on the tissue. Your surgeon and oncologist may also ask you to have more radiological tests.

Some of the tests can determine how much faster the cancer cells are multiplying than normal breast cells.

Other tests will determine whether the cancer cells are under the influence of normal female hormones such as estrogen and progesterone; this is known as the estrogen progesterone receptor test.

Radiological tests may include a bone scan and different CAT scans to check whether the cancer has spread outside the breast and the axilla area.

Staging

A stage is an indication of how widely spread the cancer is.

Staging involves a surgical procedure to determine the type of cancer and whether it has spread to the lymph nodes. Treatment can be recommended based on the stage of the cancer.

Stages are usually described using the numbers 0 – 4. A lower number indicates an earlier stage of cancer.

Some stages may be divided into sub-stages. These sub-stages are given a letter designation. For example there is a stage 3A and a stage 3B. A stage 3B is more advanced than a stage 3A.

 

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Stage 0

breast cancer is a carcinoma in-situ. When it originates from a lobule it is known as Lobular Carcinoma In Situ or LCIS. When it originates in a tubule it is known as Tubular Carcinoma In Situ or TCIS.

Stage 1 breast cancer measures less than 1 inch in size and has not spread outside the breast.

Stage 2A breast cancer can be one of the following:

• no tumor is found in the breast, but cancer is found in the axillary lymph nodes (the lymph nodes under the arm); or

• the tumor is 1 inch or smaller and has spread to the axillary lymph nodes; or

• the tumor is between 1 and 2 inches but has not spread to the axillary lymph nodes.

Stage 2B breast cancer can be one of the following:

• between 1 and 2 inches and has spread to the axillary lymph nodes; or

• larger than 2 inches but has not spread to the axillary lymph nodes.

Stage 3A breast cancer can be one of the following:

• no tumor is found in the breast, but cancer is found in axillary lymph nodes that are attached to each other or to other structures; or

• the tumor is 2 inches or smaller and has spread to axillary lymph nodes that are attached to each other or to other structures; or

• the tumor is larger than 2 inches and has spread to axillary lymph nodes that may or may not be attached to each other or to other structures.

Stage 3B breast cancer can be one of the following, the cancer:

• has spread to tissues near the breast (the skin or chest wall, including the ribs and muscles in the chest); and

• may have spread to lymph nodes within the breast or under the arm.

Stage 3C breast cancer can be one of the following, the cancer:

• has spread to lymph nodes beneath the collarbone and near the neck; and

• may have spread to lymph nodes within the breast or under the arm and to tissues near the breast.

Stage 3C breast cancer is divided into operable (can be treated with surgery) and inoperable (cannot be treated by surgery) stage 3C. In operable stage 3C, the cancer:

• is found in 10 or more of the lymph nodes under the arm; or

• is found in the lymph nodes beneath the collarbone and near the neck on the

same side of the body as the breast with cancer; or

• is found in lymph nodes within the breast itself and in lymph nodes under the arm.

In inoperable stage 3C breast cancer, the cancer has spread to the lymph nodes above the collarbone and near the neck on the same side of the body as the breast with cancer.

In stage 4 breast cancer, the cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.

After The Diagnosis

After the diagnosis of breast cancer it is normal for most patients to worry about the prospects and effects of treatment options such as surgery and chemotherapy.

Fortunately, there are several options available to help patients look and feel their best.

Plastic surgery and prostheses are available to make the change in the patient’s appearance as unnoticeable as possible.

In some cases, chemotherapy can lead to temporary loss of hair. Excellent wigs are available. Choosing one that matches your hair and hairstyle ahead of time is an excellent idea.

There are very helpful networks of patient support groups with people who have all experienced similar procedures. Breast cancer survivors in support groups and patient networks are glad to share their experiences and support.

It is often a positive step toward recovery to join a support group and meet people who can understand your feelings.

Proton Therapy for Breast Cancer Treatment

Because proton radiation deposits its highest doses in diseased tissue, nearby organs, such as heart, lungs, and bone, are less likely to receive radiation. This is especially important for breast cancer patients, who may face the risk of secondary cancers, lung injuries and major cardiac events later in life due to previous radiation exposure.

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Breast cancers treated with proton therapy

    • Early stage breast cancer
    • Locally advanced breast cancer (Stage II and III)
    • Ductal carcinoma in-situ
    • Triple-negative breast cancer

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The gantry rotates 360 degrees around the patient to deliver treatment from different angles, allowing physicians to precisely target the tumor site. It is typically used to treat complex cases, such as those found in pediatric patients and hard-to-reach tumors in adult patients

What to expect

Each patient’s therapy is precisely tailored to their needs. Patients and clinicians collaborate closely to create a personalized treatment plan. The number and length of treatments will vary, based on the cancer. How patients respond depends on many factors, including the types of breast cancer treatments they are receiving. Many people tolerate proton therapy well and continue to perform normal activities. However, individual responses vary.

Advantages of Proton Therapy for Breast Cancer

Although proton radiation treatment is relatively new, clinical trials for breast cancer have already shown excellent signs of disease control and minimal side effects compared with traditional forms of treatment. Proton therapy also offers a number of other compelling benefits:

    • Treatment is noninvasive and painless
    • Proton therapy is effective for treating early stage breast cancer
    • Treatment offers quicker recovery times with minimal side effects
    • Causes less cosmetic damage compared with the burn marks caused by regular radiation
    • It is more accurate and precise than other kinds of radiation
    • Treatment is provided in an outpatient setting
    • Proton radiation has little to no impact on patient energy level