Breast Cancer Treatment in India

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What is Breast Cancer?

Breast cancer refers to a gathering of cancerous cells originating from breast cells. While it predominantly occurs in women, it can also affect men, albeit infrequently. The initiation of breast cancer typically involves the development of calcium deposits or the formation of a localized small tumor. These cancer cells can then disseminate through the bloodstream to various organs or channels within the breast, including the lymph nodes. The rate of spread and growth varies, and breast cancer has the potential to extend beyond the confines of the breast itself.

Symptoms of Breast Cancer

Breast cancer, during its initial stages, often manifests without noticeable symptoms. Nevertheless, as the condition progresses, certain symptoms may emerge :

  • Nipple discharge associated with breast cancer may present in various colors such as green, bloody, or clear to yellow, resembling pus.
  • A lump in the armpit or breast characterized by irregular edges and hardness typically does not cause pain.
  • Alterations in the size or shape of the nipple or breast.

Male breast cancer often presents with common symptoms such as tenderness, breast lumps, and breast pain.

Advanced Breast Cancer Symptoms

  • Welling in the armpit
  • Weight loss
  • Bone pain
  • Discomfort or breast pain
  • Skin ulcers

Types of Breast Cancer

Invasive Breast Cancer : Invasive breast cancer occurs when cancer cells extend beyond the lining of lobules or ducts, infiltrating the surrounding breast tissue. This form of breast cancer can be classified into various types:

  • Triple Negative Breast Cancer : This type of cancer lacks receptors for the HER2 protein, estrogen, or progesterone.

  • Inflammatory Breast Cancer : This is deemed a relatively uncommon form of breast cancer. It arises when cancer cells obstruct the lymph vessels of the breast skin, potentially leading to swelling or inflammation of the breast.

  • Invasive Ductal Breast Cancer : The occurrence of invasive ductal breast cancer is marked by the spread of cancer cells from the lining of the duct into the surrounding breast tissue.

  • Paget’s disease of the Breast : The presence of a scaly or red rash on the skin of the nipple characterizes this type of breast cancer. Women affected by this may also have invasive breast cancer or ductal carcinoma in situ (DCIS).

  • Invasive Lobular Breast Cancer : This type originates from the cells lining the breast lobes and is challenging to diagnose through a mammogram.

Ductal carcinoma in situ (DCIS) : This is regarded as one of the earliest forms of breast cancer. The cancer cells are confined to the breast ducts and have not spread to the surrounding breast tissue.

HER2 positive breast cancer : HER2 positive breast cancer occurs when there is an elevated presence of a protein called HER2 on the surface of breast cancer cells.

Rarer Type of Breast Cancer

  • Medullary breast cancer
  • Malignant phyllodes tumor
  • Mucinous breast cancer
  • Tubular breast cancer

Stages of Breast Cancer

Stages of breast cancer depends on four things :

  • The spread of the cancer in different parts of the body beyond the breast.
  • Size of the cancer.
  • Whether cancer is present in the lymph nodes.
  • Whether cancer is non-invasive or invasive.

Different stages include :

Stage 0 : This stage encompasses non-invasive breast cancers, including ductal carcinoma in situ (DCIS).

Stage I : In the classification of breast cancers, Stage 1 delineates invasive cancers. Stage 1 is further divided into 1A and 1B. In Stage 1A, the cancer remains confined within the breast without spreading, and the tumor size is approximately 2 cm. In Stage 1B, the tumor is also less than 2 cm, and it involves small clusters of cancer cells.

Stage II : Stage IIA and IIB are the two subcategories within this stage. Invasive breast cancer is characterized in Stage IIA, where:

  • The tumor size in Stage IIA is larger than 2 cm but does not exceed 5 cm, and it has not spread to the axillary lymph nodes.
  • Even though there is no tumor in the breast, cancer is present in 1 to 3 axillary lymph nodes or in the lymph nodes surrounding the breast bone in Stage IIA.
  • In Stage IIA, a tumor, which can be 2 cm or even smaller, has extended its presence to the axillary lymph nodes.

Invasive Breast Cancer is delineated in Stage IIB, where:

  • In Stage IIB, the tumor size exceeds 5 cm, but it has not spread to the axillary lymph nodes.
  • In Stage IIB, the tumor measures more than 2 cm but not larger than 5 cm. Additionally, small groups of breast cancer cells, ranging from larger than 0.2 millimeter to not more than 2 millimeters, can be observed in the lymph nodes.
  • In Stage IIB, the tumor is larger than 2 cm but not exceeding 5 cm, and cancer has spread to 1-3 lymph nodes surrounding the breast bone.

Stage III : In Stage IIIA, one of the sub-categories of Stage 3, invasive breast cancer is characterized by :

  • In Stage IIIA, the tumor size exceeds 5 cm, and cancer has spread to 1-3 lymph nodes surrounding the breast bone.
  • In Stage IIIA, a tumor can be of any size, or there may be no tumor at all. However, cancer is present in 4-9 lymph nodes surrounding the breast bone.
  • In Stage IIIA, a tumor is larger than 5 cm, and small groups of breast cancer cells can be observed in the lymph nodes.

In Stage IIIB, a sub-category of Stage 3, invasive breast cancer is characterized by:

  • In Stage IIIB, cancer has spread to the lymph nodes surrounding the breast bone.
  • In Stage IIIB, the tumor does not have a specific size but has spread to the breast skin or chest wall, leading to the development of an ulcer or swelling.
  • In Stage IIIB, the cancer has spread to approximately 9 axillary lymph nodes.

In Stage IIIC, a sub-category of Stage 3, invasive breast cancer is characterized by :

  • In Stage IIIC, cancer has spread to lymph nodes or axillary lymph nodes surrounding the breast bone.
  • In Stage IIIC, there is no indication of cancer in the breast, and if there is a tumor, it could be of any size. This tumor has spread to the breast skin or chest wall.
  • In Stage IIIC, the cancer has spread either below or above the collarbone or to lymph nodes.
  • In Stage IIIC, the cancer has spread to a significant number of axillary nodes.

Stage IV : In Stage IV, the invasive breast cancer has extended its reach beyond the breast, spreading to surrounding lymph nodes and distant organs such as bones, brain, lungs, and skin.

Diagnosis of Breast Cancer

During a physical examination of a patient, areas such as the armpits, chest, breasts, and neck are thoroughly assessed. Several tests are conducted to diagnose breast cancer, including:

  • A sentinel lymph node biopsy is conducted to assess whether cancer has spread to the lymph nodes.
  • A breast ultrasound is performed to visualize the presence of a lump, whether it is in a fluid-filled or solid form.
  • Mammography is also carried out to identify breast lumps or for screening purposes to detect breast cancer.
  • A CT scan is conducted to assess the extent of cancer spread.
  • A breast biopsy is conducted using various methods, including stereotactic, needle aspiration, or ultrasound-guided techniques.
  • A PET scan is utilized to examine the extent of cancer spread.

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