A Journey With Breast Cancer A Journey with Breast Cancer What is Cancer? The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This is an orderly process which keeps the body healthy. Sometimes cells keep dividing when new cells are not needed. They may form a mass of extra tissue called a growth or tumor. Benign tumors are not a threat to life but malignant tumors are cancer.
Cells in these tumors can invade and damage nearby tissues and organs. The fear is that cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. That is how breast cancer spreads and forms other tumors in the body. The spread of cancer is called metastisis. (Dollinger, Rosenbaum and Cable, 1991).
Understanding the breasts Each breast has 15 to 20 overlapping sections called lobes. There are many smaller lobules, which end in dozens of tiny bulbs that can produce milk. The lobes, lobules and bulbs are all linked by thin tubes called ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola. Fat fills the spaces around the lobules and ducts.
The breast does not have muscles tissue but muscles lie under each breast and cover the ribs. Each breast contains blood vessels and vessels that contain lymph. The lymph vessels lead to small bean shaped organs called lymph nodes. Clusters of lymph nodes are found near the breast under the arm, above the collarbone and in the chest. They are also found in other parts of the body.
(Dollinger, Rosenbaum and Cable, 1991). Types of breast cancer According to Dollinger, Rosenbaum and Cable (1991), the most common type of breast cancer begins in the lining of the ducts It is called ductal carcinoma. Lobular carcinoma arises in the lobules. They explain that when breast cancer spreads outside of the breast, cancer cells are often found in the lymph nodes under the arm. If it reaches these nodes it may mean that cancer cells have spread to other parts of the body, other lymph nodes or other organs. It may have spread to the bones, liver or lungs.
When cancer spreads, it is called metastatic breast cancer. The median duration of survival for women with metastatic disease is two to three years. Malignant cells are transported via the lymphatic system. Distant metastasis occurs when the cancerous tumor cells break away from the primary tumor and spread to other sites in the body. (McEvilly and Hassey, 1998).
Risk factors for breast cancer According to the National Cancer Institute (1999), research has shown that the following conditions place a woman at increased risk for breast cancer: Personal history of breast cancer – Women who have had breast cancer face an increased risk of getting breast cancer again. Genetic alterations – Changes in certain genes (BRCA1, BRCA2, and others) make women more susceptible to breast cancer. In families in which many women have had the disease, gene testing can show whether a woman has specific genetic changes known to increase the susceptibility to breast cancer. Family history- A woman’s risk for developing breast cancer increases if her mother, sister, daughter or two or more other close relatives, such as cousins, have a history of breast cancer, especially at a young age. Certain breast changes – Having a diagnosis of atypical hyerplasia or lobular carcinoma in situ (LCIS) or having had two or more breast biopsies for benign conditions may increase a woman’s risk for developing cancer.
Breast density – Women age 45 and older whose mammograms show at least 75 per cent dense tissue are at increased risk. Dense breasts contain many glands and ligaments, which makes breast tumors difficult to see and the dense tissue itself is associated with developing breast cancer. Radiation therapy – Women whose breasts were exposed to radiation during their childhood, especially those who were treated with radiation for Hodgkin’s disease, are at an increased risk. Late childbearing – Women who had their first child after the age of 30 have a greater chance of developing breast cancer than women who had their children at a younger age. Early menstruation – Women who started menstruating at an early age (before age 12), experienced menopause late (after age 55), never had children, or took hormone replacement therapy or birth control pills for long periods of time. Each of these factors increases the amount of time a woman’s body is exposed to estrogen. The longer this exposure, the more likely she is to develop breast cancer.
In most cases, doctors cannot explain why a woman develops breast cancer. Studies show that most women who develop breast cancer have none of the risk factors listed above. Also, women with known risk factors may never develop breast cancer (Dollinger, Rosenbaum and Cable, 1991). Early detection When breast cancer is found and treated early, the chances for survival are better. Women can take an active part in the early detection by having regular mammograms and breast exams. Self examination is also very important. Mammograms can often detect cancer before it is felt.
It can also show calcium deposits which may be an early sign of cancer. There are some limitations because a mammogram may miss some cancers or may find things that turn out not to be cancer at all. Detecting a tumor early does not guarantee that a woman’s life will be saved. Some fast growing cancers may have already spread to other parts of the body before being detected. (Dollinger, Rosenbaum and Cable, 1991). The National Cancer Institute recommends that women in their forties and older have mammograms on a regular basis, every one to two years. Symptoms Early breast cancer does not cause pain as a rule. In fact, when breast cancer first develops, there may be no symptoms at all. According to Dollinger, Rosenbaum and Cable, 1991), as cancer grows it can cause many changes that women should watch for: A lump or thickening in or near the breast or in the underarm area; A change in the size or shape of the breast; Nipple discharge or tenderness, or the nipple pulled back into the breast; Ridges or pitting of the breast (looks the skin of an orange); A change in the way the skin of the breast, areola or nipple looks or feels.
Diagnosis The physician is able to tell a lot about a lump by its size, texture and whether is moves easily. He/she does this by feeling the lump and the tissues around it. Apparently, benign tumors have a different feel. The physician finds out a lot of information by reading the mammogram. Ultrasonography is also used to tell whether a lump is solid or fluid filled. The following procedures may be performed to make a diagnosis according to Dollinger, Rosenbaum and Cable, (1991): Fine needle aspiration.
A thin needle is used to remove fluid from a lump. If it is fluid filled it is not cancer. If it is solid it may or may not be cancer. Needle biopsy. Tissue can be removed with a needle from an area that is suspicious on a mammogram and cannot be felt. Surgical biopsy.
The surgeon cuts out part or all of a lump or suspicious area. When cancer is found The pathologist can tell what kind of cancer it is, if it is invasive, whether the cancer is sensitive to hormones, if it grows slowly or rapidly. The patient will be referred to an oncologist who specializes in the treatment of cancer. Generally, treatment will begin within a few weeks after diagnosis. This is the time to get a second opinion, prepare self and loved ones. Treatment There are more treatment options and hope for survival than ever before.
The options depend on the size and location of the tumor, the results of lab test and hormone receptor tests, and the stage of the disease. The women’s age, menopausal status, general health and size of her breasts are considered. This is the time to learn all that is possible about the disease, the treatment choices and to take an active part in decisions about medical care and options. There are many.