What is cancer - specifically Breast
Cancer
Incidence
Risk Factors
Prevention / Early Detection
Diagnoses
Staging
Cancer Types
Prognosis factors
Treatments
What is cancer - specifically Breast
Cancer
Incidence
Risk Factors
Prevention / Early Detection
Diagnoses
Staging
Cancer Types
Prognosis factors
Treatments
The American Cancer Society estimates that in 1998 some 178,700 new cases of invasive breast cancer will be diagnosed among women and about 43,900 deaths will result from breast cancer in the United States alone. An estimated 1,600 cases will be diagnosed among men with about 400 deaths. Between 1982 and 1987, breast cancer rates for women have increased by about 4% per year. It is believed that this increase is due to mammography.
By the year 2000, nearly 2 million women in the US
are projected to a have a breast cancer diagnosis. There is no known
cure for breast cancer and there are no known causes. It is widely
accepted that the causes may be genetic, hormonal, and/or environmental.
In recent years several factors have been identified that seem to increase
in a womens chance of being diagnosed with breast cancer. These are
known as "risk factors" and include: being
a woman as the primary factor followed closely by aging with 77%
of new cases diagnosed to women are over age 50. A personal history
of cancer (women with breast cancer have a three to
fourfold increase of developing a new cancer in the other breast).
For a women with a relative who developed breast cancer at a young age,
her risk for breast cancer is two to five times greater than for a women
with no close relative with breast cancer. This increased risk may
be
inherited from relatives on the mother's or father's side of the family.
Lesser risks are reproductive factors such as early menarche (before age
12), first birth after age 30, late age menopause (after age 55),
oral contraceptives, and estrogen replacement therapy for relief of menopause
symptoms Also, certain lifestyle choices may influence the risk of breast
cancer. Some studies have shown that the use of alcohol, smoking
(studies show that smoking affects overall health and increases the risk
for many other cancer types), and diets high in fat, especially the saturated
fat in meat and dairy products can also put a women at risk. Environmental
exposures (pesticides containing DDT and/or its derivatives or polychlorinated
biphenyls) can also increase the risk for breast cancer. It is important
to note that 70% of women diagnosed with breast cancer have NO risk factors.
Since there are no known ways to prevent breast cancer.
The American Cancer Society suggests that the "best strategy is the to
reduce the known risk factors when possible and to follow the guidelines
for early detection". This would include a low fat, high fiber diet,
limiting
alcohol consummation, stop smoking and a change in birth control methods.
And starting a age 20 breast self exams monthly, a clinical breast exam
every three years for women 20 to 39 years of age. Women over 40
should have a clinical breast exam annually along with a mammogram.
For those women with genetic factors genetic testing of the BRCA1 and BRCA2
genes may be an option. Chemopreventive agents such as Tamoxifen
may also be
considered. Some women may even choose to have a preventative
mastectomy, however, this procedure is controversial since it cannot guarantee
that cancer will no develop in the small amount of breast tissue remaining
after surgery and may give the patient a "false" sense
of security.
Once a breast mass as been detected
(by either breast exam or with the use of mammography) the physician has
several methods available to make certain that the mass is cancerous and
to help determine what stage the cancer is in. If the mass is palpable
then the physical may choose to do a biopsy either by fine-needle aspiration
where a needle is guided
into the mass and suction is applied. Clear fluid usually indicates
a benign cysts, while bloody or cloudy fluid may be present in cysts or
cancers. A core biopsy is usually done when the mass is relatively large
and is located close to the surface. Here a larger needle is used
to remove a small amount of tissue. The other biopsy method is the
surgical removal of all or a portion of the tumor under local or general
anesthetics. Microscopic examination is performed on all fluids and
tissues to determine if the mass is a cyst, benign or cancerous.
If the mass is cancerous then additional surgeries and test maybe performed
to help the physician determine a treatment best suited for the patient. Microscopic
exam and testing will help classify the
cancer by type, TNM classification (staging) and provide other prognosis
factors such as the presence of estrogen and progesterone receptor proteins
which indicate that the regulatory controls of the mammary epithelium are
functioning. Presence of both receptor proteins is
associated with an improved prognosis, while their absences is indicative
of poorer prognosis. A tumor with a high degree of differentiation
is associated with a better prognosis than a poorly differentiated, anaplastic
tumor. Assessment of a tumor's proliferative rate (S-phase fraction)
and DNA content (ploidy) by flow cytometry may also be a useful indicator.
Tumors classified as diploid (normal DNA content) are associated with a
better prognosis that tumors classified as aneuploid (abnormal DNA content).
Breast cancer can start in the lobules (glands in
the breast that produce milk), the ducts (small passages connecting the
lobules to the nipple), fatty, connective and lymphatic tissue. There
are many kinds of breast tumors. Most are benign, staying in one
place, with limited
growth and are not life threatening. Others are malignant (cancerous)
and may become life threatening if left untreated. The most diagnosed
breast cancers are Adenocarcinoma, Comedocarcinoma, Ductal carcinoma in
situ (DCIS), Infiltrating (or invasive)
ductal carcinoma (IDC), Infiltrating lobular carcinoma (ILC), Inflammatory
breast cancer, In situ, Lubular carcinoma in situ (LCIS), Medullary carcinomas,
Mircocalcifications. Others cancer types are mucinous carcinoma,
Paget's disease of the nipple, Phyllodes tumor, Scirrhous cancer, Tubular
carcinomas (click here for descriptive
glossary). Metastases are satellite tumors that indicate a breast
cancer has spread from the breast to a lymph node or an organ. Node-positive
(or negative) - means that the cancer has spread to the lymph nodes under
the arm on the same side or has not.
The most widely used staging system for breast cancer is the TNM system developed by the American Joint Committee on Cancer. In this system, the stage is based on tumor size (T), node involvement (N), and evidence of metastasis (M). The TNM stage can be applied in a process called stage grouping which ranges from Stage 0, the least serious or earliest stage of cancer, to Stage IV, the most serious or advanced stage. The best chance for survival is when tumors are found in the earliest stages of 0 and 1.
Treatment of breast Cancer consists of both local
management (surgery and/or radiation therapy)
and systemic treatment (chemo and/or hormonal therapy). Today, most
women are treated with combinations surgery, radiation, and chemo.
Surgery is used to remove the tumor and varying amounts of surrounding
tissue and to take samples of the axillary lymph nodes under the arms.
This surgical procedure can take place in several forms - from Lumpectomy
(remove of only lump and a rim of normal tissue) to Radical mastectomy
(removal of entire breast, axillary lymph nodes, and the chest wall muscles
under the breast) with several modifications of the two (partial, simple,
total, modified). Chemotherapy consists of powerful anticancer drugs
that maybe given intravenously or by mouth. Treatments can last 2
to 8 hours and are given about 3 weeks apart. This allows for
a recovery period. Treatments are cyclic
usually lasting from 6 to 9 months. Chemotherapy regimens combine
several chemotherapeutic agents to increase cell kill and the minimize
drug resistance. The mostly widely used chemo agents are Cyclophosphamide(C)
also known as Cytoxan, Adriamycin, Methotrexate and 5
- Fluorouracil. When a patient is diagnosed at Stage 2, 3 or
4, then she may choose to participate in a clinical trial (click here
for my results with a clinical trial) of high-dose chemotherapy with stem
cell or bone marrow transplant. The drugs used are Cytoxan and Adriamycin
but the dosages increased dramatically. If the womans tumor tested
positive for the presence of the estogen and/or progestrone receptor proteins
then hormonal therapy may be given in conjunction with chemo. This
therapy could include the removal of endocrine glands that produce the
hormones (ovary, pituitary, or adrenal glands) for which the cancer is
dependent on. The women may also take Tamoxifen followed by progestins
and
aminogluethimide.
Radiation treatment maybe used to reduce the size of the tumor before
surgery or to destroy cancer cells remaining after surgery. The objective
of radiation treatments are to conserve the breast, decrease the
chance of recurrence, and eradicate residual cancer. External beam
radiation using a linear accelerator delivering photons is given daily
over a at least a 4 1/2 week period to the entire breast region.
In addition, a concentrated radiation dose or "boost" is given to the primary
tumor site (this can include the peripheral lymphatics if there was node
involvement) via electrons on a daily bases for about 6 days. The "boost"
usually runs concurrent with the other radiation treatment.
Currently research is being done regarding monoclonal antibodies that
are engineered to carry drugs or radiation directly to the tumor and that
may offer a way to treat micromestastes, the on going search for oncogenes
and the proteins they produce as a way to help diagnose or
prevent breast cancer and many other research projects to numerous
to list. The America Cancer Society alone provides funding to over
70 research projects related to breast cancer at a cost of $13.3 million.
Since 1972 the ACS has funded over $92 million in breast cancer research
grants.
The ASC has shown that when cancer tumors are found in the very
earliest (in situ) stage, the survival rates are excellent, Stage 0 -survival
rate approaches 100%. Stage I - survival rate (5 years) approaches 97%.
Stage II - survival rate (5 years) drops to 76%. Stage III - survival rate
(5 years) is at 21%. The best protection both women and men have
against breast cancer is to beware of their individual risk factors, and
to perform monthly breast exams.
Glossary
Key words used to describe various types of breast cancers.
Adenocarcinoma is a general type of carcinoma that starts in
glandular tissues anywhere in the body. This accounts for nearly all
breast cancer.
Comedocarcinoma is a ductal carcinoma in situ (DCIS), some of the
cancer cells within ducts spontaneously begin to degenerate.
This type
of DCIS is more likely to recur locally after lumpectomy and may have
a
higher risk for being associated with invasive ductal carcimoma than
other forms of DCIS.
Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer.
Cancer cells fill the ducts but do not spread through the walls of
the
ducts into the fatty tissue of the breast. Nearly 100% of women
diagnosed at this early stage of breast cancer may be cured.
Only in the
rarest circumstances can DCIS be detected by breast self-exam or clinical
breast exam. The changes causes by DCIS usually can be seen by
means of
mammography. With more women getting mammograms each year, the
diagnosis
of DCIS is becoming more common.
Infiltrating (or invasive) ductal carcinoma (IDC) starts in the ducts
and breaks through the wall of the duct and invades the fatty tissue
of
the breast. At this point, it has the potential to metastasize
(spread)
to other parts of the body through the bloodstream and lymphatic system.
Infiltrating ductal carcinoma is the most common type of breast cancer,
accounting for about 80% of breast malignancies.
Infiltrating lobular carcinoma (ILC) starts in the milk producing
glands and is invasive to the breast's fatty tissue. This cancer
has the
potential to spread. This type accounts for about 10% to 15%
of breast
cancer.
Inflammatory breast cancer is a rare invasive cancer and accounts for
about 1% of all breast cancer. It is an aggressive cancer that
usually
spreads rapidly to other parts of the body.
In situ is a term used to indicate an early stage of cancer in which
a tumor is confined to the immediate area where it began. This
means
that the cancer remains confined to ducts or lobules and has not spread
to the surrounding fatty tissues.
Lubular carcinoma in situ (LCIS) begins the glands but does not
penetrate through the wall of the lobules. It is not a cancer
but is
classified as a non-invasive breast cancer because of the increased
risk
of developing an invasive breast cancer over the long term.
Medullary carcinomas comprise is an infiltrating cancer that grows in
a capsule inside the duct. These tumors can become large but are slow
to
expand and have obvious boundaries between tumor and normal tissue.
It
accounts for about 5% of breast cancers.
Mircocalcifications are calcium deposits and are not cancerous.
AJCC STAGING SYSTEM FOR BREAST CANCER
STAGE DESCRIPTION
T0 No evidence of primary tumor
T1 Tumors 2 cm or less in greatest
dimension
T2 Tumors more than 2 cm but no
more than 5cm in greatest dimension
T3 Tumors more than 5cm in greatest
dimension
T4 Tumors of any size with direct
extension to chest wall or skin
N0 No regional lymph node metastasis
N1 Metastasis to one or more movable
ipsilateral axillary nodes
N2 Metastasis to one or more movable
ipsilateral axillary nodes
fixed to one or another
or to other structures
N3 Metastasis to ipsilateral internal
mammary lymph nodes
M0 No distance metastasis
M1 Distant metastasis (including
metastases to one or more
ipsilateral supraclavicular
nodes)
When a woman chooses to participate in High Dose Chemo clinical trials
peripheral blood stem cells are mobilized using a product manufactured
from Amgen, Inc. called Filgrastim (Nuprogen) given in . The
cells are
then harvested using the Baxter CS3000 Plus Blood Cell Separator.
This
is to help combat one of the side effects of the chemo - lowered white
blood cell counts. Below are actual blood test showing Filgrastim
effects on stem cell production by monitoring WBC. Normal values
range
from 4.8 to 10.8. (For a complete research details see Appendix D)
Test
Dates Count (WBC x 103)
REMARKS
9-12
* injections of Filgrastim begins
9-16
48.9
Day 1 of cell harvesting begins
9-17
50.9
Day 2 of cell harvesting completed
9-20
11.6
9-23
7.7
Cycle 1-High Dose chemo treatment
9-25
4.7
Refusion of harvested cells
9-27
21.5
9-30
.4
10-2
.5
Stop taking antibiotics
10-4
9.3
10-8
56.6
10-9
71.5
10-11
19.7
10-14
6.8
Cycle 2-High Dose chemo treatment
10-16
4.2
Refusion of harvested cells
10-18
31.1
10-21
.6
10-23
.3
10-25
9.4
Stop taking antibiotics
10-28
53.6
10-29
71.1
10-30
39.1
Below is are the recommend dosages for standard and high dose chemo.
DRUG STANDARD DOSAGES RESEARCH STUDY DOSAGES
Cyclophosphamide (Cytoxan)
800 mg
5070 mg
Adriamycin
80 mg
127 mg
Methotrexate
unknown
not used
5 - Fluorouracil
800 mg
not used
This is from my actual lab report
Patient name: Janet Blue
Age: 34
Dignosis - Poorly Differentiated Infiltrating Adenocarcinoma,
Ductual
Type
Stage - III/IV
Estrogen/Progesteron Receptors - Negative
DNA Index - Aneuploid
S-Phase Fraction - 27.5
Tumor Size - 8 x 6 x 3 cm
Nodes - 3 of 19 removed cancerous
My risk factors are:
* Woman
* Had a Paternal grandmother, aunt and cousin all diagnosed
with breast cancer
* I have no children
* Overweight
* Since I now have a personal history of breast cancer this
puts my right at the top of the risks.
How was I diagnosed?
A lump was found in June of 1996 and a sonagram was done and the radiologist
diagnosed it was a hemotoma (blood clot) or cyst.
On August 9, 1996 the lump was removed and test result showed that it was cancerous. On August 16, 1996 I lost my right breast to cancer thru a radical mastectomy.
Treatment - Radical Mastectomy, 2 High DoseChemo
Cycles, 4 regular Dose
Chemo Cycles, Radiation of Mastectomy Site.
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