Breast Cancer
Signs and Symptoms
Breast cancer begins with abnormal cells developing in breast tissue. It can be confined to the breast or may spread beyond your breast or into other parts of your body. The most common type of breast cancer begins in the ducts designed to carry milk to the nipple. But cancer also may occur in the small sacs that produce milk, called lobules, or in other breast tissue. Breast cancer varies widely and the treatment options are selected to match your individual needs.
Breast cancer may occur in several different forms, such as the five types below:
Breast Cancer in Situ, DCIS and LCIS -- Many breast cancers detected early, typically by mammography, are classified as breast cancer in situ or noninvasive cancer. These early cell changes may develop into invasive breast cancer. Two types of breast cancer in situ are:
DCIS (ductal carcinoma in situ) means that abnormal cells are found only in the lining of a milk duct of the breast. These abnormal cells haven't spread outside the duct. There are several types of DCIS. If not removed, some may change over time and become invasive cancers, while others may not. DCIS is sometimes call intraductal carcinoma.
LCIS (lobular carcinoma in situ) means that abnormal cells are found in the lining of a milk lobule. Although LCIS is not considered to be actual breast cancer at this noninvasive stage, it is a warning sign of an increased risk of developing invasive cancer. LCIS sometimes is found in a biopsy for another lump or unusual change detected on a mammogram.
Invasive Breast Cancer -- These cancer cells form in the ducts or the milk lobules and spread to the breast tissue around them. Tumors can be found during a breast exam or through screening, such as a mammogram. The size of the tumor, what it looks like under the microscope and whether it has spread to the lymph nodes determines the severity of the cancer, the therapies and the difference treatments will make.
Metastatic Breast Cancer -- Metastatic cancer begins in the breast, but spreads outside the breast through the blood or lymph system to other organs. Women usually develop metastatic disease in the months or years following the diagnosis of breast cancer. This cancer most commonly spreads beyond the breast to a patient's bones, lung, liver and brain.
Locally Advanced Breast Cancer -- Inflammatory breast cancer is a rare but very serious and aggressive type of breast cancer. The breast may look red and feel warm. A patient may see ridges, welts or hives on the breast or its skin may look wrinkled. It is sometimes misdiagnosed as an infection.
Recurrent Breast Cancer -- Recurrent disease means that the cancer has come back or recurred after treatment. It may come back in the breast, in the soft tissues of the chest or chest wall, or in another part of the body.
Symptoms
Early breast cancer usually doesn't cause pain. In fact, when breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it may cause changes that you should watch for:
Diagnosis
If cancer is found in your breast, your doctor will want to know the stage or extent of the disease. Staging is a careful attempt to find if the cancer has spread and, if so, to what parts of the body. Your doctor may use blood and imaging tests to learn the stage of the disease. Treatment decisions depend on these findings. Read Staging: Specific Patterns of Breast Cancer to learn more about the staging system.
The first step in the work-up of breast disease is usually a physical exam by a doctor or nurse practitioner. Mammography and ultrasound may be important additions to the physical examination. On the basis of these evaluations, the decision may be made to confirm a clinical impression with a tissue biopsy.
Imaging
Imaging is an important component used to diagnose breast cancer and to evaluate the stage and extent of disease in breast cancer patients. Three major types of imaging are used in this capacity: mammography, ultrasonography and breast magnetic resonance imaging (MRI). Based on these exams, your physician may determine that no treatment is necessary or may recommend further tests or therapy.
Screening Mammography -- A mammogram is a low-dose X-ray of the breast. This is the best test we have to screen women for breast cancer. A Screening Mammogram consists of two "pictures" of each breast. If an area on the mammogram looks suspicious or is not clear, additional mammograms with different views may be needed. Annual screening mammography is recommended for all women over 40 years old.
Diagnostic Mammography -- This is a mammogram used for problem-solving, rather than for screening. For instance, if a patient has a lump in her breast, a directed investigation of that area is performed. This is also done when a particular finding in the breast is being followed over time. A diagnostic mammogram is tailored to the patient's case and is carefully monitored by a radiologist, who interprets the images and determines whether there is any need for further tests.
Ultrasonography -- Using high-frequency sound waves, ultrasonagraphy can often show whether a lump is solid or filled with fluid. This exam may be used along with Diagnostic Mammography or MRI to answer questions about a specific area of the breast. Because it uses sound waves instead of X-Rays, ultrasound provides information that is different and often complementary to the mammogram.
Breast MRI -- Magnetic resonance imaging (MRI) can be used to look specifically at the breast. Each exam produces hundreds of images of the breast, cross-sectional in all three directions (side-to-side, top-to-bottom, front-to-back), which are then read by a radiologist. It is non-invasive and no radioactivity is involved. The technique is believed to have no health hazards in general. The hope is that such non-invasive studies will contribute to our progress in learning how to predict the behavior of tumors, and in selecting proper treatments. Breast MRI is an evolving technology and should not replace standard screening and diagnostic procedures, such as clinical and self-exams, mammogram, fine needle aspiration or biopsy. To learn more about breast MRI, please visit the UCSF Breast MRI Web site.
Biopsy
One way to find out if a breast lump or abnormal tissue is cancer is by having a biopsy. During a biopsy, a surgeon, a pathologist or a radiologist removes a portion or all of the suspicious tissue. The suspicious tissue is examined under a microscope by a pathologist who checks for cancer cells and makes the diagnosis. The following are different types of biopsies as well as how you can best prepare yourself for each of them. The following are different types of biopsies.
Fine Needle Aspiration (FNA) Biopsy -- FNA samples a woman's lump using a thin small needle that leaves a mark no bigger than a needle stick from a blood test. FNA often allows us to diagnose a lump within two to three days. Read Fine Needle Aspiration Biopsy for Breast Cancer Diagnosis to learn more about the procedure and what to expect.
Stereotactic Core Biopsy -- This procedure was developed as a less invasive way to obtain tissue samples for diagnosis. It involves removing tissue with a biopsy needle while your breast is compressed in a way similar to a mammogram. This biopsy requires less recovery time than surgery and causes no significant scarring. You and your physician and radiologist may consider this procedure if there is an abnormality on a mammogram that cannot be felt. Your radiologist decides if this procedure is technically possible for your condition and your physician decides if it's appropriate for your situation. Read Stereotactic Core Biopsy for Breast Cancer Diagnosis to learn more about the procedure and what to expect.
Needle (Wire) Localization Biopsy -- This type of biopsy involves the use of a needle and wire to locate the abnormal tissue and surgery to remove it. Needle localization is performed when you have an abnormality on a mammogram that cannot be felt. It is an outpatient biopsy that is done in two steps on the same day. Read Needle (Wire) Localization Biopsy for Breast Cancer Diagnosis to learn more about the procedure and what to expect.
Decision Making Consultation
If you are diagnosed with breast cancer, the Collaborative Care services at the UCSF Carol Franc Buck Breast Care Center can help you effectively communicate with your doctors as you navigate through the series of complex decisions surrounding your treatment options. To learn more, please read Decision Making Consultation.
Treatment
Current treatments for women with breast cancer include surgery, radiation therapy, chemotherapy and hormonal therapy. Treatment methods are classified as local or systemic. Local treatments — such as surgery and radiation therapy — remove, destroy or control cancer cells in a specific area. Systemic treatments — such as chemotherapy and hormonal therapy — destroy or control cancer cells throughout the body. Depending on your condition, you may receive a single treatment or a combination of therapies given at the same time or in succession.
Surgery
Surgery is a common treatment for cancer and several types may be used from lumpectomy to breast reconstruction:
Lumpectomy -- In this procedure, a surgeon removes the breast cancer and some normal tissue around it. This procedure usually removes all the cancer with little change in the appearance of your breast. Typically, the surgeon takes out some lymph nodes from under your arm to determine if the cancer has spread. If you have a lumpectomy, you are likely to have radiation therapy as well. Radiation destroys cancer cells that may not have been removed by surgery.
Partial or Segmental Mastectomy -- Depending on the size and location of the cancer, this procedure can conserve much of the breast. The surgeon removes the cancer, some breast tissue, the lining over the chest muscles below the tumor and usually some of lymph nodes under the arm. In most cases, radiation therapy follows.
Sentinel Lymph Node Disection -- One or more of your sentinel lymph nodes are removed in this procedure. To locate a sentinel node, the surgeon injects a blue dye (isosulfan blue) into the skin where the breast cancer is or was. The blue dye is picked up by the lymphatic vessels and travels to a sentinel node. A lymph node is removed and sent to pathology, where it is examined. The sentinel lymph node is believed to most likely contain disease if the cancer has spread from the breast to the lymph nodes. Other lymph nodes may or may not be removed, depending on your situation. This procedure typically takes about an hour.
Modified Radical Mastectomy -- In this procedure, a surgeon removes the breast, some of the lymph nodes under the arm, and the lining over the chest muscles, and sometimes part of the chest wall muscles.
Radical Mastectomy -- The surgeon removes the breast, chest muscles and all the lymph nodes under the arm in a radical mestectomy. This was the standard operation for many years, but now is performed only when a tumor has spread to the chest muscles.
Breast Reconstruction -- Breast reconstruction, or surgery to rebuild a breast, is often an option after the removal of a breast. Health insurance plans in California pay for this surgery, including surgery to make both breasts similar in shape and size. A reconstructed breast will not have natural sensation, but can have a natural appearance. The best cosmetic results are achieved with immediate reconstruction, performed at the same time as the mastectomy. The choice regarding reconstruction is based on personal preferences and will not affect outcome.
Radiation Therapy
Radiation therapy is the use of high-energy rays or particles to treat disease. It works by killing tumor cells or inhibiting their growth and division. Years of study by radiation oncologists have led to the widespread use of effective, tolerable doses of radiation. It is used to treat early stage breast cancer along with surgery. It may be used in more advanced breast cancer to control the disease or to treat symptoms such as pain.
To learn more, read Radiation Therapy for Breast Cancer.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. For breast cancer, it is usually administered as a combination of drugs given orally or by injection. Chemotherapy enters the bloodstream and travels throughout your body. The treatment is most commonly used to decrease the chance that cancer will recur after surgery, shrink breast cancer after surgery when the tumor is large or if it is inflammatory, and to control metastatic breast cancer which has spread to other organs in the body.
Hormonal Therapy
Hormonal therapies change the hormonal environment in your body, which impacts the growth and behavior of some breast cancers. If your breast cancer produces one of the hormone receptors — estrogen receptor (ER) or progesterone receptor (PR) — then hormonal therapy is effective in treating early-stage, metastatic or advanced breast cancer and preventing recurrence.
More Information
For more information, please contact the UCSF Carol Franc Buck Breast Care Center
at (415) 353-7070.
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