Breast cancer

Symptoms of Breast Cancer May Include the Following: 

• Painless lump in the breast
• Persistent itch and rash around the nipple
• Bleeding or unusual discharge from the nipple
• Skin over the breast is swollen and thickened
• Skin over the breast is dimpled or puckered
• Nipple becomes pulled in or retracted

Guidelines on Breast Screening for normal risk women without symptoms:

Patients with family history and other risk factors may require a different screening schedule – do consult your doctor.

How is Breast Cancer Diagnosed?

• Clinical Examination – Especially if there is a lump or nipple discharge, or an unusual breast change is detected.
• Mammogram – This is special x-ray imaging that can detect abnormal masses in the breast such as calcium deposits, cysts and tumours.
• Ultrasound Scan – Used to examine abnormalities found the mammogram. An ultrasound scan can distinguish between a solid mass, which may be a cancer, or a fluid-filled cyst which is usually not cancer.
• Magnetic Resonance Imaging (MRI) – A MRI scan can better assess areas of concern in the breast. This is particularly useful for younger women because this group tends to have higher breast tissue density, reducing the effectiveness of conventional imaging tests such as the mammogram and ultrasound in detecting breast cancer.

What is a biopsy?

To confirm breast cancer, a biopsy will have to be performed in which cells are removed and examined under a microscope.

Common biopsy techniques:

• Fine Needle Aspiration (FNA)
• Core Needle or Tru-cut Biopsy
• Excision Biopsy

What is Breast Cancer Assessed?

Stages / Extent of Spread

*Individual patients may have a different experience depending on the specific characteristics of their breast cancer, and which therapies can be used to target their cancer.

These characteristics of breast cancer can impact the chances of relapse and affect the patient’s survival rate.

Tumour Grade Histologic Grade

This refers to how much the tumour cells resemble normal cells when viewed under the microscope, rated from 1 to 3. Grade 3 tumours contain very abnormal and rapidly growing cancer cells. The higher the histologic grade, the greater the chance of breast cancer relapsing.

Lymph Nodes

The number of lymph nodes that is in the armpit, on the same side of the affected breast, is an important indicator. A higher number of positive nodes will often result in a worse outcome and warrants more aggressive treatments.

Tumour Size

In general, the larger the size of the tumour, the greater the chance of breast cancer recurrence.

Oestrogen/Progesterone Receptors

Close to 2/3 of all breast cancers contain significant levels of oestrogen and/or progesterone receptors. They are referred to as oestrogen receptor positive (ER+) tumours. ER+ tumours tend to grow less aggressively and may respond favourably to treatment with hormones.

HER2

HER2 is a protein found on the surface of certain cancer cells. A tumour is described as HER2-positive if tests show an excess of the HER2 protein on its cells. Tumours that are HER2-positive tend to grow more quickly than other types of breast cancer. 20-25% of all breast cancers have HER2-positive tumours.

Knowing if a cancer is HER2-positive can affect the choice of treatment because women with such tumours can benefit from HER2-targeted therapies. These include drugs such as trastuzumab (Herceptin®), pertuzumab (Perjeta®) or TDM-1 (Kadcyla®).

How is Breast Cancer Treated?

The treatment of breast cancer and the chances of recovery depend on whether the cancer is only in the breast or has spread to other places in the body. More factors that can determine the treatment options and prognosis include the type of cancer, specific characteristics of the cancer cells, whether the cancer is found in the other breast, the patient’s age, menopausal status (whether the patient still has menstrual periods) and the patient’s general health.

Surgery

Surgery can be a direct way to remove cancer from the body. Forms of surgery include:

1. Breast-conserving surgery

• Lumpectomy or wide local excision – Removal of the cancer and a small amount of surrounding tissue
• Quadrantectomy – Removal of the quarter of the breast where the cancer is found

2. Mastectomy – Removal of the whole breast

During the breast surgery, some of the lymph nodes under the armpit may also be removed for examination.

Radiation therapy

Radiation therapy uses high-energy rays to target and kill cancer cells. It is used to kill cancer cells remaining in or around the breast, lowering the chances of the cancer returning in the breast.

Radiation therapy can be vital after a breast-conserving surgery like lumpectomy, since much of the breast tissue is left intact.

Most women who have a mastectomy do not need radiation therapy. However it can be used to treat the chest wall and the lymph nodes in the armpit if the risk of recurrence is high.

Systemic Therapy

• Chemotherapy
• Hormonal Therapy
• Targeted therapy, e.g. Trastuzumab (Herceptin®) or pertuzumab (Perjeta®)

Rehabilitation

Physical rehabilitation includes:

• Shoulder exercises after the surgery
• Arm care, which can help avoid the onset of lymphoedema
• Balanced nutrition and lifestyle adaptation to enhance recovery

Mental rehabilitation involves:

• Close support from your spouse, family and friends, as well as support groups
• Reassurance through a better understanding of the chances of survival
• Regular reviews with the doctor