# Saturday, January 24, 2009
                 

When a lump is discovered in the breast, either by the woman or her physician, tests will be ordered to determine whether or not the lump is cancerous. These tests can be used to 'stage' and 'grade' the cancer. These tests will most likely include:

Imaging Studies: This allows tissues, organs and/or bones to be studied in detail. X-rays, ultrasounds, CT scans and/or bone scans give healthcare professionals the opportunity to study pictures of the size of the tumor and to see if it has spread.

Biopsy: This is usually necessary to make a definite diagnosis of cancer; cells are removed and checked under a microscope. These cells can also be studied to determine how fast the cancerous cells are growing. A biopsy can be done by:

   • Fine needle aspiration: this uses a thin needle to remove fluid/cells from the lump.
   • Core needle biopsy: a needle is inserted through a small incision in the breast to remove samples of tissue.
   • Surgical biopsy: local anesthetic is used and part or the entire lump will be removed.

Laboratory Tests: If cancerous cells are found in the biopsy sample these tests can help the physician learn more about the cancer to determine which treatment options are best suited. The hormone receptor status test shows whether the cells have certain hormone receptors. This can help predict how the tumor will behave and whether or not it will respond to hormonal therapy; this is more common in post-menopausal women. The Her2 test looks for the cancer gene that controls the Her2 protein. Her2 positive breast cancers behave differently than other breast cancers and need specific treatment.

Once a definite diagnosis of cancer has been made the cancer will be given a stage and a grade. The cancer stage describes the tumor size as well as whether or not it has spread beyond the place where it began to grow. In the earliest stage of breast cancer the cells are found only in the milk ducts or lobules and are called in situ cancer. If this is diagnosed before these cells have spread to the surrounding tissue there is no risk of them spreading once they have been removed. When breast cancer spreads of the duct or lobule it is called invasive cancer; this is still effectively treated especially if diagnosed early. The five stages of breast cancer are:

Stage 0: There are 2 kinds of stage 0 breast cancer: ductal carcinoma in situ (DCIS), where abnormal cells are in the lining of the milk duct and have not spread outside of the duct. Lobular carcinoma in situ (LCIS), where abnormal cells are in the lining of a lobule.
Stage 1: Where the tumor is 2 cm or smaller and the cancer has not spread outside of the breast.
Stage 2: Where the tumor is 2 to 5 cm, or the cancer has spread to the lymph nodes, or both.
Stage 3: Where the cancer has spread to the lymph nodes and may have also spread to surrounding tissues i.e. the muscle or the skin.
Stage 4: Where the cancer has spread to distant parts of the body.

The biopsy sample is studied to determine the grade of the tumor which is based on how the cancer cells look and behave when compared to the normal cells. There are 3 grades:

Grade 1: This is a low grade; slow growing and less likely to spread.
Grade 2: This is a moderate grade.
Grade 3: This is a high grade that tends to grow quickly and is more likely to spread.

Along with the stage and grade of the breast cancer, the healthcare team will factor in the woman's age, health status and whether or not she has been through menopause in order to determine the best treatment options. The most common treatment methods are:

Surgery: The type of surgery will depend on the size and location of the tumor. A lumpectomy involves the removal of a lump as well as some tissue, but not the whole breast. A mastectomy involves the removal of the whole breast. Many times the doctor will also remove some lymph nodes from the armpit in order to determine whether or not the cancer has spread.

Radiation Therapy: External beam radiation therapy involves a large machine that is used to aim a beam of radiation at the tumor. The radiation damages the cancerous cells as well as healthy cells that are in the path of the beam. This type of radiation therapy is almost always given after breast-conserving therapy (lumpectomy) and is sometimes used after a mastectomy. In certain cases, the lymph node area will also be treated with this therapy. Internal radiation therapy (brachytherapy) involves radioactive material being placed directly into or near the tumor. 

Chemotherapy: This treatment is given either orally (pills) or by injection. Chemotherapy drugs interfere with the ability of cancerous cells to grow and spread; however this treatment does damage healthy cells as well. Side effects from chemotherapy generally include nausea, vomiting, fatigue, hair loss, decreased appetite as well as increased risk of infection. Some chemotherapy drugs can affect the ability to become pregnant as well.

Hormone Therapy: This treatment removes hormones from the body and/or blocks their actions which can stop cancer cells from growing. Tumors that are hormone receptor positive can be treated with this therapy. Drugs, surgery or radiation therapy can be used to change hormone levels. Hormonal drugs are given as either injections or oral medications. This can cause menopause-like symptoms, i.e. irregular periods, hot flashes. These side effects can be reduced and/or controlled and usually go away once treatment has been concluded; however menopause may be permanent. Surgically removing the ovaries from pre-menopausal women is also a treatment option. This causes immediate onset of menopause.

Biological Therapy: This method of treatment uses drugs to interfere with how the cancer cells grow as well as using the body’s immune system to destroy the cancerous cells. This treatment is often used for women whose breast cancer has too much of the Her2 protein.

Early detection plays a large role in the successful treatment of breast cancer. Women aged 40-49 should have a clinical breast examination at least every 2 years. Women aged 50-69 should have a clinical breast examination every 2 years as well as a mammogram during the same time period. Women over this age should talk to their physician regarding how often testing should occur. For more information regarding breast cancer, please visit the Canadian Cancer Society.

posted on Saturday, January 24, 2009 4:20:55 PM (GMT Standard Time, UTC+00:00)  #   
# Monday, January 12, 2009
                 

Breast cancer is the most common type of cancer found in Canadian women. It is estimated that in 2008 over 22,000 women were diagnosed with breast cancer, and over 5,000 will ultimately lose their life due to this disease. Over 400 women are diagnosed with breast cancer every week in Canada on average; as well an average of 100 women die due to this illness every week. Men are also at risk for breast cancer, with an estimated 170 diagnosed cases in 2008 with 50 fatalities.

Early detection is crucial for successful treatment and survival for women who have breast cancer. Every woman, regardless of age and medical history should regularly examine their breasts in order to detect any abnormalities. Breast cancer is most often detected when a lump is found in the breast and/or armpit. These lumps are usually painless. Other signs of potential breast cancer may include:

   • Changes in breast size and/or shape;
   • Dimpling and/or puckering of the skin that resembles an orange peel;
   • Thickening of the breast skin;
   • Redness, swelling, and/or increased warmth in the affected breast;
   • Inversion of the nipple;
   • Crusting and/or scaling of the nipple.

Women of all ages should be aware of their breasts in order to be able to detect any changes. This can be achieved through looking at your breasts as well as touching them in order to detect any changes. Some women may experience changes that are due to their menstrual cycle; these are important to note in order to determine if anything unusual is happening. Breast tissue may also change with a woman's age. When doing self breast examinations, remember that breast tissue covers not only the breast, but extends up to the collarbone as well as from the armpit across to the breastbone in the centre of the chest. It is recommended to do breast self-examinations monthly for all women, even those who are having regular screening tests.

The majority of women who develop breast cancer have no risk factors other than being a women as well as aging (especially for women 50 and older). However, your risk factor can be higher if:

   • You have already had breast cancer;
   • You have a family history of breast cancer, especially if your mother, sister and/or daughter have been diagnosed before menopause;
   • You have a family history of ovarian cancer;
   • You have an above average exposure to estrogen (which your body naturally produces). This could be due to:

  • Not having given birth for the first time before the age of 30;
  • Menstrual cycle starting at an early age;
  • Beginning menopause later than the average age;
  • Have taken hormone replacement therapy for more than 5 years;
  • Having dense breast tissue;
  • Having a history of breast biopsies that show certain breast changes, i.e. increased number of abnormal cells that are not cancerous (atypical hyperplasia);
  • Having had radiation treatment to the chest area, especially before the age of 30.

Women who may have a slightly higher risk of breast cancer include:

   • Women who are obese, especially after menopause;
   • Women who regularly drink alcohol;
   • Women who have regularly taken birth control pills.


It is important to remember that most women who develop breast cancer do not have a family history of the disease; as well, some women may develop breast cancer without having any of these risk factors present in their lives.

The next blog that will be posted will give in-depth information regarding diagnosis, staging and treatment. Please post in the comment section if you have any questions regarding this or any other health related topic. We would like to invite all our readers to suggest ideas that they would find informative!

posted on Monday, January 12, 2009 4:39:54 PM (GMT Standard Time, UTC+00:00)  #   
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