Breast Cancer Treatment

What is Breast Cancer? 

Breast cancer is a disease in which the cells in the breast grow out of control. 

What are the different types of Breast Cancer? 

The commonest type of breast cancer is called infiltrating ductal carcinoma (IDC) and develops in the milk ducts before spreading into the nearby breast tissue. If the changes are contained within the milk ducts, it is known as Ductal Carcinoma In Situ (DCIS) and does not have the ability to spread further. 

If the cell changes start in the milk-producing lobules in the breast, this is called invasive lobular carcinoma (ILC). 

Rarer types of breast cancer include tubular and papillary carcinomas and usually have a good long-term outcome with treatment.  

Inflammatory breast cancer is a rare type which grows rapidly. The cancer cells block the lymph channels causing inflammation which shows as discoloration of the breast skin. 

Within the different types of breast cancer are the subtypes, which refer to receptor cell status. These receptors are present or absent on the surface of the cancer cell and determine which treatments are effective in different cases: 

• ER = Estrogen Receptor  

• PR = Progesterone Receptor  

• HER2 = ErbB2 Growth Receptor 

If a receptor is present on the cancer cell surface, this is known as receptor positive. 

If a receptor is not present on the cancer cell surface, this is known as receptor negative. 

What are the symptoms of Breast Cancer? 

These are common symptoms associated with invasive breast cancer, but having one does not mean that you have breast cancer, as there is overlap with benign breast conditions: 

• Breast lump which is new or feels different to before 

• Change in shape, contour or size of your breast 

• Thickening of the breast tissue, especially persisting through your menstrual cycle 

• Blood stained nipple discharge 

• Breast skin dimpling or puckering, sometimes associated with redness or change in colour of the skin 

• Lump in the armpit (axilla) 

• Nipple changes or inpulling (inversion) which does not easily come out  

What are the causes of Breast Cancer? 

It is not clear exactly what causes some breast cells to change into cancer cells. There are some factors which can increase your risk of this happening: 

• Increasing age 

• Female Sex 

• Family History: if you have a close relative with breast cancer, you are at risk of developing the disease 

• Genetics: About 10 to 15% of people who develop breast cancer have an inherited genetic mutation, the commonest being the BRCA 1 and 2 genes 

• Smoking has been linked to breast cancer 

• Alcohol has been linked to breast cancer 

• Obesity increases the risk of developing certain types of breast cancer 

• Radiation exposure to your chest wall under the age of 30 

• Hormone Replacement Therapy (HRT) may slightly increase the risk of developing breast cancer, but is related to the type of HRT you are taking.

How is Breast Cancer diagnosed? 

A full breast assessment includes clinical examination, breast imaging, and a tissue sample to confirm the diagnosis and provide information about the subtype characteristics of the cancer cells. These subtype characteristics direct management decisions by showing which treatment options work best in each case. 

What is staging in Breast Cancer? 

Breast Cancer Staging helps to establish treatment plans and enhances communication between Healthcare Professionals. It is based on different factors, such as tumour size, location, and involvement of other parts of the body. However, most of these systems do not incorporate more recent information such as tumour characteristics or modern treatment methods. 

Stage 0 = non-invasive disease, meaning the disease remains in the breast only. 

Stage 1 = cancerous cells are in the breast tissue over a small area. 

Stage 2 = cancerous cells are present in a small ball (<2cm) with cancer cells found in the nearby lymph nodes in the armpit (axilla), or there is a large ball (more than 2cm but less then 5cm) of cancer cells within the breast with or without cancer cells in the nearby lymph nodes in the armpit (axilla) 

Stage 3 = cancer cells are found in the breast and extending beyond into the nearby lymph nodes in greater numbers. 

Stage 4 = cancer cells have spread from the breast tissue into other areas of the body, such as the bones, lungs, or liver. 

What are the treatment options for Breast Cancer? 

Surgery is the primary treatment for breast cancer, but other treatments are often recommended alongside an operation.  

Surgical procedures include: 

Lumpectomy: Also known as Breast Conserving Surgery (BCS) or Wide Local Excision (WLE), a lumpectomy is a procedure that involves removing part of the breast containing the cancer with a rim of normal breast tissue, known as a margin. Most people who have this type of surgery will follow it with Radiation therapy to reduce the chance of the cancer cells returning. 

Mastectomy: This involves the removal of the entire breast tissue on one side. It may or may not involve removing the nipple. Breast reconstruction can be performed at the same time or at a later date and your Healthcare Provider will discuss this with you before your mastectomy surgery. 

Surgery is usually combined with one or more of the following treatments: 

Chemotherapy: Chemotherapy is the use of medication to kill cancerous cells in the breast or that have spread outside the breast tissue. This can be administered before and/or after breast surgery and your Oncologist can advise you on what is recommended for you. 

Radiation therapy: This involves the use of high-energy x-rays to destroy cancerous cells. Your Radiation Oncologist will be able to provide you with an individualised plan related to your treatment recommendations. 

Hormone therapy: Also known as Endocrine Therapy, this is a common treatment for ER (Estrogen Receptor) and/or PR (Progesterone Receptor) positive breast cancers. A high number of breast cancer cells rely on estrogen or progesterone to grow, so this medication works by blocking the cancer cells’ access to the hormones and lowering estrogen levels. This is a different type of hormone therapy to that used when women are going through the menopause. 

Targeted therapy: This treatment targets specific genetic changes in your cells which turn normal cells into cancer cells. By targeting the change, the treatment aims to identify a way of destroying the cancer cell before it can grow. 

Immunotherapy: This involves boosting your natural immune system so it can kill the cancerous cells. These treatments are used for some cancer types and your Oncologist will be able to discuss if any of these treatments are suitable for you.