Breast Cancer

Breast Cancer

Breast cancer is a metastatic breast tissue comprising two different categories of breast cancer i.e. Ductal carcinoma which initiates in the ducts, meant to transfer milk to the nipple and Lobular carcinoma, which initiates in lobules involved in milk production. These are the major tissue that breast cancer can establish although in some cases, it has been noted to start in other breast tissues. Invasive breast cancer spreads from lobule or ducts to the rest of breast tissue while noninvasive breast cancer is restricted to the tissue it initiated also referred to as in situ marked as ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS) (Hunt et al 9 & 10). Breast cancer is responsive to estrogen which facilitates its growth since the tumor contains estrogen receptors on the surface hence called ER-positive cancer.  In other cases, women have HER2 which is a gene that facilitate the growth, division and repair of cells. Therefore cancer cells with various copies of HER2 have a drastic growth causing a more forceful and recurrent disease (Pub Med pr. 1 & 5). Breast cancer was discovered by ancient Egyptians where Edwin Smith recorded details of its management procedure and prevalence of the disease in Egypt on papyrus (Winchester 1).

Risk Factors

One in every eight women shall have a breast cancer diagnosis in life due to various risk factors. Age and gender; the risk factors of acquiring a breast cancer rises with age where women in their fixities have been noted to have a highly advanced breast cancer. Additionally, women are a hundred times more probable to acquire breast cancer as compared to men. Family history is another risk factor associated with breast cancer adding up to 20-30% of women with breast cancer. Genetic composition as a risk factor predisposes some individuals as compared to others. For instance, BRCA1 & BRCA2 are genes whose role is to produce protein, which shield one from cancerous cells. When these genes become defective, which might be inherited from parents, an individual is more prone to cancer. Women who contain one of the defective genes are 80% probable to acquire breast cancer. Women whose menstrual cycle began at an early age of below twelve years or whose menopause came after 55 years have a higher risk of attaining breast cancer (Pub Med pr. 6).

Other minor risk factors include alcoholism where taking over two glasses daily elevate the probability of having breast cancer. Besides, women with no children or whose childbirth happened at the age of thirty or more years have a higher risk while multiple pregnancies especially when young reduce the risks. Moreover, women who ever took the drug diethylstilbestrol to manage miscarriage have higher risk of having breast cancer when they have reached forty years. Finally, radiation exposure or radiotherapy at an early age aimed around the chest predisposes one to breast cancer. If the doses are high and done at an early age i.e. at some stage in breast development, this increases the chances of having breast cancer (Pub Med pr. 7).

Symptoms

During early stages, there are no notable symptoms which emphasize the need to have breast exams regularly. However, when the breast cancer continues to develop, symptoms may involve the following. Hard and painless breast or armpit lump with uneven edges. Modification in texture, shape and size of the nipple or the whole breast e.g. redness dimpling. In other cases, the nipple may produce a fluid which is colored and pus like. Men with breast cancer experience lump, pain and breast tenderness. During advanced stages of breast cancer, the patient may experience bone pain, weight loss, skin ulcers, breast pains, and arm swelling adjacent to the cancerous breast (Pub Med pr. 10 & 11).

Test

The physician evaluates the symptoms in relation to the risk factors. This is followed by a physical exam which involves the breasts, chest cavity, armpits as well as the neck. The tests that are incorporated in diagnosing breast cancer involves first, breast MRI, which aids in identifying the lumps or assess unusual mammogram change. Second, breast ultrasound is done to detect if the lump is filled with fluid or if it is just solid. Third, breast biopsy involves procedures like needle aspiration, stereotactic and ultrasound guided analysis. Forth, a CT scan detects if the cancerous cells have invaded other tissues. Fifth, a mammography aids in screening for cancerous cells or in detecting breast lumps. Finally, other tests involve PET scan and sentinel lymph node biopsy for assessing the spread of the cancer. These procedures that detect spread of cancer cells are referred to as staging which is essential in administering treatment and the future expectations. The stages that breast cancer falls under vary from 0 to IV where the greater the staging the advanced the breast cancer (Pub Med Pr. 15).

Prevention

Tamoxifen is recommended for prevention of breast cancer for women over the age of 35(Pub Med Pr. 16). Additionally, prophylactic mastectomy through surgical removal of both breasts can be undertaken before the cancer is diagnosed especially those with family history and defective genes. It is necessary to have total mastectomy to eliminate the chances of acquiring the cancer (Kasper & Ferguson 39). Moreover, healthy eating habits e.g. moderate calories, whole grain, fruits and vegetables, avoiding red meat and lifestyle changes e.g. controlled alcohol consumption go a long way in preventing breast cancer (Donegan & Spratt 199).

Treatment

Treatment could be local, which target the disease area with radiation or surgical procedures or systemic which affect the whole body such as chemotherapy (Hunt et al 11 & 12).  It varies with stage, hormonal sensitivity and expression of HER2/neu gene of the breast cancer (Pub Med pr. 20). The treatment involves chemotherapy, radiotherapy and surgery. Chemotherapy aims at killing the cancerous cells, radio therapy at destroying the cancerous tissue while surgery aims at removing the cancerous tissue through a surgical procedure which may involve lumpectomy to remove the lump or mastectomy to remove entire breast and nearby tissues (Donegan & Spratt 31). Women who are ER-positive are recommended for hormonal therapy to manage the hormones facilitating the cancer. For instance tamoxifen drug curbs estrogen effects while aromatase inhibitors like exemestane drugs are recommended for postmenopausal women and work by blocking production of estrogen. Other treatment procedures include biologic therapy, which utilize anticancer drugs like trastuzumab and manages cell changes (Pub Med pr. 22). Treatment for stage I, II & III is meant to cure while stage IV is managed through combined treatment to prolong life and not to cure. Follow-up tests are necessary after and in the course of treatment to evaluate the response of the cancerous cells (Hunt et al 14)

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