According to the World Cancer Research Fund International (2018), breast cancer is recorded to be the most occurring cancer in women worldwide. Not only that, it is also found to be the second most common cancer among both men and women globally. Besides, research also showed that over an 80-year lifespan, women have an average of 1-in-8 chance of contracting breast cancer (Breastcancer.org, 2016). That being said, it is extremely vital for us to be well-informed of this disease as it has robbed many people of their lives.
While regular screening and mammograms can help detect breast cancer in its early stages, there are also several symptoms that one has to watch out for. A lump or swelling may appear near the collar bone or under the arm as breast cancer can occasionally spread to the lymph nodes there, even before the original breast tumour is large enough to be felt (American Cancer Society, 2017). As it progresses, breast cancer can also be detected by the formation of a new lump or mass at the breast area. A hard, painless, irregular-edged mass is most likely to be cancer, although breast cancer can also be soft, tender and round. Moreover, abnormalities in the breast area like swelling, skin irritation or dimpling, nipple or breast pain, nipple retraction, scaliness or thickening accompanied by redness of the breast skin and nipple discharge (with the exception of breast milk) are also some of the common symptoms of breast cancer in its early stages (American Cancer Society, 2017).
With the emergence of these symptoms, a variety of diagnostic tests, such as breast ultrasounds and MRI scans will be performed to determine the best treatment option to tackle the onset of cancer, depending on the stage of the cancer (Breastcancer. org, 2018, Feb 1). Breast cancer can be divided into five stages based on several factors, which include the size of the tumor, the presence of cancer in the lymph nodes, the estrogen-receptor status, the progesterone-receptor status, the HER2 status and the tumor grade (American Cancer Society, 2017b).
To start off, Stage 0 is a form of non-invasive breast cancer, such as the ductal carcinoma in situ (DCIS) and the lobular carcinoma in situ (LCIS). The term ‘In Situ’ means that the cancer is in its early stage which makes it highly treatable. However, the cancer can spread to the surrounding breast tissue if it is not detected or treated. During stage 0 of breast cancer, abnormal cells are usually found in the breast ducts and lobules, but have not spread out of these areas into the surrounding breast tissue (Breastcancer.org, 2018, Oct 16; National Breast Cancer Foundation, 2018a).
Breast cancer gets invasive in Stage 1, where it starts to spread to the surrounding breast tissue. This stage is generally divided into two subcategories, which are stage IA and stage IB; determined by the size of the tumor and the presence of cancer in the lymph nodes. In Stage IA, the size of the tumor is less than 2 cm and has not spread to the lymph nodes. On the other hand, in Stage IB, there are small clusters of cancer cells between the sizes of 0.2 mm and 2 mm. The breast tumor, however, may or may not be present. At this stage, evidence of cancer is already present in the lymph nodes (Breastcancer.org, 2018, Oct 16; National Breast Cancer Foundation, 2018a)
Like Stage 1, Stage II breast cancer is also classified under two subcategories- Stage IIA and Stage IIB. For Stage IIA, the breast tumor has grown in between the sizes of 2 cm to 5 cm. However, cancer cells are not yet present in the axillary lymph nodes. Stage IIA breast cancer also comprises tumors measuring less than 2cm, but in this case, the cancer cells have spread to no more than three axillary lymph nodes. If no tumor is found, the presence of cancer cells larger than 2 mm in the axillary lymph nodes or in the lymph nodes near the breast bone are also categorized as Stage IIA. Stage IIB describes breast cancer in which the breast tumor has already grown larger than 5cm, but have not spread to any axillary lymph nodes. During this stage, the tumor can also measure in between 2cm to 5cm, and cancer cells no larger than 2mm are present in less than four axillary lymph nodes (Breastcancer.org, 2018, Oct 16; National Breast Cancer Foundation, 2018b).
Moving on, Stage 3 breast cancer can be divided into Stage IIIA, IIIB and IIIC. In Stage IIIA, the size of the tumor is bigger than 5cm and small clusters of cancer cells are found in lymph nodes. For some individuals, Stage IIIA breast cancer comes in the form of a tumor over 5cm, with cancer cells spreading to less than four lymph nodes near the breastbone and under the arm. If there is no tumor present during this stage, the presence of cancer cells in 4 to 9 lymph nodes classifies the breast cancer to be in Stage IIIA. For breast cancer in Stage IIIB, the tumor can be of any size and the cancer cells are found to have spread to the skin of the breast and to the chest wall, with evidences of an ulcer and swelling. The cancer may also extend to nine axillary lymph nodes and breastbone lymph nodes. For Stage IIIC breast cancer, the cancer cells have already spread to the breast skin and chest wall, causing inflammation, swelling and ulcers, even though the breast tumor may or may not be found. At this stage, the cancer has also extended to more than 10 axillary lymph nodes, as well as lymph nodes below and above the collarbone (Breastcancer.org, 2018, Oct 16; National Breast Cancer Foundation, 2018c).
The last stage of breast cancer- Stage IV, is the advanced and metastatic stage of breast cancer. When breast cancer reaches Stage IV, it basically means that the cancer has spread beyond the breast, underarm and internal mammary lymph nodes to other parts of the body, such as the lungs, bones, brain and liver (Breastcancer.org, 2018, Oct 16; National Breast Cancer Foundation, 2018d).
There are two ways to approach breast cancer, which are through local treatments and systemic treatments. Local treatments mean that the tumor is treated without affecting the rest of the body. This form of treatment includes surgery and radiation.
Breast cancer surgery can be divided into lumpectomy and mastectomy, depending on how advanced the cancer is. Lumpectomy, also known as breast conserving surgery, involves the removal of the cancerous part of the breast; while mastectomy involves the removal of the whole breast, including the nearby breast tissues surrounding it (American Cancer Society, 2018c).
On the other hand, treatment in the form of radiation involves high-energy rays, such as X-rays to kill cancer cells at targeted parts of the body. Radiation therapy is generally categorized into two main types, which are the external beam radiation and the internal radiation. The external beam radiation is delivered through cancer-killing rays outside the body, while the internal radiation involves injecting a radioactive substance into the body for a short period of time (National Breast Cancer Foundation, 2018f).
Meanwhile, systemic treatments are different from local treatments in a way that it can reach cancer cells almost anywhere in the body. This form of treatment includes chemotherapy, hormone therapy and targeted therapy.
Treatment in the form of chemotherapy consists of a combination of drugs that functions to stop cancer cells in its tracks or to destroy them altogether. Cytotoxic drugs are a form of chemotherapy, which can be given either orally or intravenously to kill cancer cells. In some cases, chemotherapy is given before a surgery in order to shrink a large tumor before operating on it. Treating cancer with chemotherapy brings many adverse side effects, which include nausea, fatigue, hair loss, early menopause and appetite loss (National Breast Cancer Foundation, 2018g).
Tamoxifen, the most common hormone therapy, is usually prescribed with the aim to prevent the further growth of cancer cells. This drug functions to stun the growth of estrogen-fueled cancer cells by blocking their estrogen-shaped openings. As time passes, the drug eventually starves the cancer cells and causes them to die (National Breast Cancer Foundation, 2018e).
Another form of systemic treatment is targeted therapy. It is mainly used to treat HER2-positive breast cancers, which tend to grow and spread more aggressively. Targeted therapy, as its name suggests, functions to target breast cancer cells that have high levels of HER2 protein, a cancer growth-promoting protein. A number of drugs developed to target this protein include pertuzumab, trastuzumab, lapatinib and neratinib (American Cancer Society, 2018d).
To sum up, breast cancer can be a really scary thing to many people. Nevertheless, with the early detection of the onset of breast cancer, the chances of curing it is fairly high. Therefore, it is really important to take note of the signs and symptoms of breast cancer, as well as performing breast screening and mammograms regularly. With that,