Breast Cancer The term breast cancer refers to a malignant tumor that has developed from cells in the

breast. Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast. Two Main Types Invasive Breast Cancer Invasive, or infiltrating, breast cancer is diagnosed when cancer cells that started in your milk ducts or lobes spread to, or invade, healthy surrounding tissue. Invasive breast cancer has the potential to travel to other parts of your body through your bloodstream and lymph system. Subtypes: Invasive ductal carcinoma (IDC) - This is the most common type of breast cancer. It starts in your milk ducts, then breaks out and invades nearby breast tissue. Here are some subtypes of invasive ductal carcinoma: Inflammatory breast cancer (IBC) - This is an advanced, aggressive form of cancer, which starts out in the milk ducts and proceeds to invade the skin and lymph system. IBC does not signal its presence with a breast lump, but with breast pain and skin changes and is often mistaken for other breast conditions. Most cases of IBC can be detected by a mammogram or an ultrasound. Medullary carcinoma - named for its resemblance to brain (medulla) tissue, this subtype of IDC is generally good. Metaplastic breast cancer - a rare form of breast cancer that is often treated aggressively and has uncertain prognosis. Paget's disease of the nipple - shows up in and around the nipple and usually signals the presence of breast cancer beneath the skin. Tubular carcinoma - a rare type of breast cancer, it takes its name from its microscopic appearance and has a better prognosis than most forms of invasive breast cancer. Invasive lobular carcinoma (ILC) - Lobular breast cancer begins in your milk-producing glands or lobes. When it leaves your lobes and infiltrates fatty tissue and other breast tissues close to the lobes, it becomes invasive. Papillary Carcinoma - This is a type of ductal carcinoma in situ (DCIS). This type of breast cancer is rarely invasive and usually stays within the milk ducts of your breast. Less Common Invasive Breast Cancer Types Each of these types of breast cancer occurs in less than 5% of all cases that are diagnosed. Adenoid cystic carcinoma - Named for their microscopic appearance, these cancer cells resemble glandular and cystic cells. Usually not aggressive, this type of breast cancer has a good chance of recovery after treatment. Mixed tumors - Tumors that are composed of different types of cancer cells, such as invasive ductal and lobular, are referred to as mixed tumors. Mucinous (colloid) carcinoma - Quite rare, this type of breast cancer produces mucous but has a good prognosis after treatment. Sarcomas of the breast - Sarcomas are cancers that form in connective tissue. Most breast cancers are carcinomas, which form in epithelial tissue. Angiosarcoma - This rare type of breast cancer starts in cells that line the blood vessels within your breast or underarm area. It can occur due to radiation treatments and is apt to grow and spread quickly. Phyllodes tumor (cystosarcoma phyllodes) - Named for its leaf-shaped growth pattern, these tumors are often harmless. If they are cancerous, surgery is required, but a Phyllodes tumor will not benefit from chemo or radiation treatments. Non Invasive Breast Cancer Cancers stay within the milk ducts or lobules in the breast. They do not grow into or invade normal tissues within or beyond the breast. Non-invasive cancers are sometimes called carcinoma in situ (in the same place) or pre-cancers. Subtypes:

Ductal carcinoma in situ (DCIS)- is the most common type of non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and in situ means "in its original place." DCIS is called "non-invasive" because it hasnt spread beyond the milk duct into any normal surrounding breast tissue. DCIS isnt life-threatening, but having DCIS can increase the risk of developing an invasive breast cancer later on. Lobular carcinoma in situ (LCIS)- is an area (or areas) of abnormal cell growth that increases a persons risk of developing invasive breast cancer later on in life. Lobular means that the abnormal cells start growing in the lobules, the milk-producing glands at the end of breast ducts. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs such as breast tissue. In situ or in its original place means that the abnormal growth remains inside the lobule and does not spread to surrounding tissues. People diagnosed with LCIS tend to have more than one lobule affected. Despite the fact that its name includes the term carcinoma, LCIS is not a true breast cancer. Rather, LCIS is an indication that a person is at higher-than-average risk for getting breast cancer at some point in the future. For this reason, some experts prefer the term lobular neoplasia instead of lobular carcinoma. A neoplasia is a collection of abnormal cells. Risk Factors that can also be the Cause Primary risk factors: Gender Age Personal history Family History 99% occurs in female risk increases after 50 years old 15% of women develop the disease in the opposite breast. woman who have first degree relative with breast cancer have 2x 3x increased risk. (genetics: BRCA1, BRCA2)

Secondary risk factors: Giving birth to the first child after 30 Prolonged hormonal stimulation early menarche (<12 y/o) late menopause (>50 y/o) Atypical hyperplasia on previous breast biopsy Excessive exposure to ionizing radiation History of endometrial, ovarian, or colon cancer Lifestyle

Clinical Manifestations B-leeding R-everted nipple E-levation or lump A-ssymetry of the breast S-kin dimpling T-enderness Early breast cancer has no symptoms. It is usually not painful. Most breast cancer is discovered before symptoms are present, either by finding an abnormality on mammography or feeling abreast lump.

Medications Hormonal therapy may be given because breast cancers (especially those that have ample estrogen or progesterone receptors) are frequently sensitive to changes in hormones. Hormonal therapy may be given to prevent recurrence of a tumor or for treatment of existing disease. In some cases, it is beneficial to suppress a woman's natural hormones with drugs; in others, it is beneficial to add hormones. In premenopausal women, ovarian ablation (removal of the hormonal effects of the ovary) may be useful. This can be accomplished with medications that block the ovaries' ability to produce estrogens or by surgically removing the ovaries, or less commonly with radiation.

Until recently, tamoxifen (Nolvadex), an antiestrogen (a drug that blocks the effect of estrogen), has been the most commonly prescribed hormone treatment. It is used both for breast cancer prevention and for treatment. Fulvestrant (Faslodex) is another drug that acts via the estrogen receptor, but instead of blocking it, this drug eliminates it. It can be effective if the breast cancer is no longer responding to tamoxifen. Fulvestrant is only given to women who are already in menopause and is approved for use in women with advanced breast cancer. Toremifene (Fareston) is another anti-estrogen drug closely related to tamoxifen. Aromatase inhibitors, which block the effect of a key hormone affecting the tumor, may be more effective than tamoxifen in the adjuvant setting. The drugsanastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara) have a different set of side effects and risks than tamoxifen. Aromatase inhibitors are rapidly moving into first-line hormonal therapy regimens. In addition, they are frequently used after two or more years of tamoxifen therapy. Megace (megestrol acetate) is a drug similar to progesterone which may also be used as hormonal therapy. Targeted therapy is a type of treatment that has been developed to directly work against some of the cellular changes that have been identified in breast cancers. Examples of targeted therapies include monoclonal antibodies against cancer cell-specific proteins. Monoclonal antibodies are antibodies against proteins in or around a cancer cell. Antibodies recognize an "invader" -- in this case, a cancer cell -- and attack it. Trastuzumab (Herceptin) is an antibody against the HER-2 protein, a protein responsible for cancer cell growth in many women with breast cancer (about 15%-25% of breast cancers). Adding treatment with trastuzumab to chemotherapy given after surgery has been shown to lower the recurrence rate and death rate in women with HER2/neu-positive early breast cancers. Using trastuzumab along with chemotherapy has become standard adjuvant treatment for these women. Lapatinib (Tykerb) is another drug that targets the HER2/neu protein and may be given combined with chemotherapy. It is used in women with HER2-positive breast cancer that is no longer helped by chemotherapy and trastuzumab. Another monoclonal antibody, Bevacizumab (Avastin) has been shown to have activity in the treatment of breast cancer and is used in combination with chemotherapy. This drug targets the ability of cancer cells to form new blood vessels. However, the U.S. FDA revoked its approval of this drug in November 2011, noting that those taking Avastin faced potentially life-threatening side effects without proof that the drug provided benefits in slowing tumor growth or improving longevity or quality of life. Side Effects loss of hair nausea and vomiting loss of appetite fatigue low blood cell counts