Breast Cancer

Breast cancer is a malignant tumor formed by the rapid and uncontrolled proliferation of mammary gland cells that have been diverted from their normal function and are developing, covering normal tissue.

Usually, breast cancer is adenocarcinoma and occurs in the terminal pores and lobes of the mammary gland.

Primary breast cancer – Metastatic breast cancer

It is cancer that occurs in the breast and originates from the mammary gland.We call it primary breast cancer. Rarely, cancers that develop in other organs can metastasize to the breast.

Cancer that is confined to the breast and has a small diameter is called primary breast cancer.

Breast cancer can metastasize to the corresponding lymph nodes. We call these metastases proximal metastases. They are important in cancer staging, treatment and prognosis.

When breast cancer invades the skin, chest wall, or lymph nodes to form a complex of hard lymph nodes that stick together or in adjacent tissues, then we call it locally advanced breast cancer. Breast cancer can also metastasize to the bones, lungs, liver and brain. We call these metastases distant metastases. Then we refer to it as metastatic or advanced breast cancer.

Does Breast Cancer Only Affect Women?

Breast cancer is not an exclusively female affair. Men can also develop breast cancer. The difference is that the chances are a hundred times less for the male population.

At what age does breast cancer develop?

Breast cancer can occur at any time during a woman’s life, but the chances increase with age. Studies have shown that the chances double every 10 years until menopause and remain high until the age of about 65 years.

Symptoms of breast cancer

We have to remember that not every breast tumor is necessarily malignant. There are many different benign breast tumors, although sometimes the clinical symptoms can confuse us.

The main symptoms of breast cancer are:

  • Palpable tumors in the breast.
  • Swelling and chest pain
  • Bloody discharge from the nipple
  • Changes and lesions in the skin or the shape of the breast
  • Swelling in the lymph nodes of the armpit.

Diagnosis

Mammogram is a basic method for the early diagnosis of breast cancer. The American Cancer Society recommends an annual mammogram for all women over the age of 40. But is mammogram a diagnostic method that always recognizes malignancy? The answer is no.

There is a percentage around 5-7% in which the mammogram gives false negative results. This is due either to the fact that we cannot detect malignancy, such as lobular malignancies, or because the breast is too dense. For this reason, we often need to perform various additional examinations, such as breast ultrasound.

In recent years, the method of digital mammogram has developed significantly, which is slowly beginning to produce better results.

Cure

Successful treatment of breast cancer consists of removing it or controlling it for an extended period of time. However, since breast cancer is characterized by many different cancer cells, their removal may require different treatments. Thus, a treatment plan may include the following:

Surgery is usually the first treatment for breast cancer.We decide on the basis of several factors, such as the stage of the cancer, its particular characteristics and the patient’s personal wishes.

Tumor removal surgery, also called breast preservation surgery, is the removal of the tumor only, as well as a small amount of surrounding tissue.

A mastectomy is the removal of the entire breast. Mastectomy has evolved a lot and is now less invasive than before, as the muscles under the breast are no longer removed.

We may perform a lymph node removal or resection of the lymph nodes at the same time with tumor removal or mastectomy if the biopsy has shown that the cancer has spread beyond the milk ducts. Some patients may undergo less invasive lymph node resection.

Radiation therapy is an extremely effective and targeted method of destroying cancer cells that may have remained in the breast after surgery. Radiation therapy can reduce the risk of breast cancer recurrence by 70%. Although many patients are afraid of it, they tolerate radiotherapy well and its side effects are limited to where it is irradiated.

Radiation therapy is coordinated by the radiotherapist-oncologist.

Chemotherapy is a systemic treatment. This means that it affects the whole body, through the circulatory system. The goal of chemotherapy and other systemic treatments is to kill the cancerous cells that may have spread to other parts of the body besides where they first appeared.

Chemotherapy is effective against cancerous cells, because we use the drugs that are very effective in rapidly dividing cells. The side effects of chemotherapy are due to the fact that cancerous cells are not the only rapidly dividing cells in the body. And the cells of our blood, mouth, gastrointestinal tract, nose, nails, vagina and hair divide constantly and rapidly. Thus, chemotherapy affects them just as much as cancer.

However, patients tolerate chemotherapy much better than they used in the past. And for many women it is a safeguard to prevent cancer recurrence. It is also important to remember that organs that are not made up of rapidly dividing cells, such as the liver and kidneys, are rarely affected by chemotherapy. In addition, your doctors and nurses will closely monitor these side effects to treat them so that you feel better.

And in the case of chemotherapy, we decide on the drugs to be used based on the specific needs of each patient and factors. These factors are lymph node metastasis, tumor size, stage, etc. The doctor is responsible for choosing the most suitable drugs.

We use hormone therapy to treat estrogen receptor-positive breast cancer and works in two ways:

  • Reducing estrogen levels.

  • Inhibiting the action of estrogen.

The ovaries produce most of a woman’s estrogen. Estrogens promote the development of estrogen receptor-positive breast cancer. Thus, reducing the amount of estrogen or inhibiting their action can shrink tumors and reduce the chance of recurrence of these cancers. Hormone therapy is not effective in estrogen receptor negative cancers.

Hormone therapy includes several classes of substances, such as aromatase inhibitors and selective regulators of estrogen receptors. In some cases, the ovaries and fallopian tubes are removed either to treat estrogen receptor-positive cancer or as a preventative measure for women at high risk for breast cancer. Also, the function of the ovaries is temporarily stopped, with the use of appropriate medication.

It should be clarified that hormone therapy is NOT a hormone replacement therapy. We use it to treat unpleasant side effects of menopause, such as hot flashes and mood disorders.

Targeted anti-cancer therapies are therapies that target specific features of cancerous cells, such as proteins that promote their rapid and abnormal growth. In general, targeted therapies affect healthy, normal cells less than chemotherapy. Some targeted therapies are antibodies, which work like the normal antibodies produced by our immune system.

New therapeutic approaches

In an effort to achieve the best possible outcome at the lowest physical and mental cost to the patient, scientists are exploring new methods of treating breast cancer.

Biological therapy (monoclonal antibodies)

Special antibodies bind to cancer cells at specific sites, through which cancer cells receive message molecules that “alert” them to activate and proliferate. Monoclonal antibodies prevent the arrival of these messages and thus inhibit the further growth of the tumor.

Tyrosine kinase inhibitors

It is a targeted treatment that prevents cell communication and the growth of cancer cells. We can use it in combination with other anti-cancer drugs.

Targeted therapy against the HER2 gene

HER2 is a gene that regulates cell growth. For reasons that we do not understand, it is often amplified and leads to rapid cell division and tumor growth. About 25% of breast cancers are HER2-positive, meaning they show enhancement of this gene. In these cases, when we give HER2-specific drugs, survival increases in both early and metastatic breast cancer.