BREAST CANCER

BREAST CANCER

What is cancer?

Cancer is the general name for a group of more than 100 diseases in which cells in a part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because abnormal cells grow out of control. Untreated cancers can cause serious illness and even death.

Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide more quickly until the person becomes an adult. After that, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries.

Cancer cells develop because of damage to DNA. This substance is in every cell and directs all of the cell's activities. Most of the time when DNA becomes damaged, either the cell dies or is able to repair the DNA. In cancer cells, the damaged DNA is not repaired. People can inherit damaged DNA, which accounts for inherited cancers. Many times though, a person’s DNA gets damaged by things in the environment, like, chemicals, viruses, tobacco smoke or too much sunlight.

Cancers can begin in many different parts of the body. But, different types of cancer can act very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That's why people with cancer need treatment that is aimed at their particular kind of cancer.

Because cancer cells keep growing and dividing, they are different from normal cells. Instead of dying, they outlive normal cells and continue to grow and make new abnormal cells.

Cancer usually forms as a tumor (a lump or mass.) Some cancers, like leukemia, do not form tumors. Instead, these cancer cells involve the blood and blood-forming organs, and circulate through other tissues where they grow.

Cancer cells often travel through the bloodstream or through the lymph system to other parts of the body where they begin to grow and replace normal tissue. This spreading process is called metastasis.

Even when cancer has spread to a different part of the body it is still named for the place in the body where it started. For example, breast cancer that has spread to the liver is metastasis breast cancer, not liver cancer. Prostate cancer that has spread to the bone is called metastasis prostate cancer, not bone cancer.

Remember that not all tumors are cancerous. Benign (non-cancerous) tumors do not spread to other parts of the body (metastasize) and are very rarely life-threatening. www.cancer.org.

What is breast cancer?

Breast cancer is the cancer of the breast.

Breast cancer is a common cause of death among women in East Africa. While some women and men with breast cancers are diagnosed and treated with positive outcomes, several others go through the cracks unnoticed and die fearfully and helplessly alone.

Breast cancer, if not caught early, can metastasize and spread to almost any other part of the body such as the lymph nodes, the bones, liver, lungs, and brain resulting in death.

Education to increase awareness of breast cancer risk is the first line of defense against this rather silent killer. Training women to gain skills to perform regular self breast exams known as BSE, once a month, and use of Mammography, once a year, to detect cancers in earlier stages can result in significant improvements in survival rates.

Women who perform regular breast self-exams find 90% of all breast masses. Women can help catch potentially serious changes in the breast early by regularly performing a self-exam (BSE). Every woman should examine her breasts once a month, three to five days after her menstrual period ends. If she has stopped menstruating, she should perform the exam on the same day of each month, such as the first day of the month or a day easy for her to remember, such as birth date. With each exam, she will become familiar with the contours and feel of her breasts, and will be more alert to changes. It is good to start performing breast self exams in your 20's. Women over the age of 30 should perform self breast exams once a month. And women over the age of 40 and older should have a mammography once a year.

Symptoms of breast cancer to look for:

During self examination, women need to feel for lumps as well as to look for the following physical changes: A change in how the breast or nipple feels; a change in how the breast or nipple looks; a change in the size or shape of the breast; a nipple turned inward into the breast; nipple tenderness, nipple discharge, and other physical changes to the breast such as a scaling, redness, or swelling of the breast, areola, or nipple. The breast nipple may have ridges or pitting so that it looks like the skin of an orange. A lump or thickening in or near the breast or in the underarm area may be indicative of disease. Early breast cancer usually does not cause pain. Any woman with these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.

Diagnosis:

Breast cancer can be diagnosed via a diagnostic mammogram, Ultrasound, Magnetic resonance imaging, and Biopsy or via a clinical breast exam performed by a doctor. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer. The lumps will vary in shape and size and the size will determine the stage of the disease, type of treatment and chance of survival rate.

Treatment:

Once the doctor makes the official diagnosis of breast cancer, he decides, with the patient’s input, on the best way to treat the disease. Some women with breast cancer need treatment right away. Breast cancer treatment depends upon many factors, including the type of cancer and the extent to which it has spread. Treatment options for breast cancer may involve surgery (removal of the cancer alone or, in some cases, mastectomy), radiation therapy, hormonal therapy, and/or chemotherapy.

Overview of some treatment methods

Women with breast cancer have many treatment options. These include surgery, radiation therapy, chemotherapy, hormone therapy, and biological therapy. Many women receive more than one type of treatment.

The choice of treatment depends mainly on the stage of the disease. The doctor works together with the patient to develop a treatment plan that reflects her

medical needs and personal values. The patient should be well informed in order to be in charge of her health.

Local therapy: Surgery and radiation therapy are local treatments. They remove or destroy cancer in the breast. When breast cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.

Systemic therapy: Chemotherapy, hormone therapy, and biological therapy are systemic treatments. They enter the bloodstream and destroy or control cancer throughout the body. Some women with breast cancer have systemic therapy to shrink the tumor before surgery or radiation. Others have systemic therapy after surgery and/or radiation to prevent the cancer from coming back. Systemic treatments also are used for cancer that has spread.

Side effects are common and depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next.

Surgery is the most common treatment for breast cancer. Breast-sparing surgery involves an operation to remove the cancer but not the breast. Sometimes an excision biopsy serves as a lumpectomy because the surgeon removes the whole lump.

Most women receive radiation therapy to the breast in addition to the breast-sparing surgery to destroy cancer cells that may remain in the breast.

Mastectomy: An operation to remove the whole breast, total mastectomy or as much of the breast tissue as possible is called mastectomy. In most cases, the surgeon also removes lymph nodes under the arm. Some women have radiation therapy after surgery.

In modified radical mastectomy, the surgeon removes the whole breast, and most or all of the lymph nodes under the arm. Often, the lining over the chest muscles is removed. A small chest muscle also may be taken out to make it easier to remove the lymph nodes.

Radiation therapy: (Radiotherapy) uses high-energy rays to kill cancer cells. Most women receive radiation therapy after breast-sparing surgery. Some women receive radiation therapy after a mastectomy. Treatment depends on the size of the tumor and other factors. The radiation destroys breast cancer cells that may remain in the area.

Some women have radiation therapy before surgery to destroy cancer cells and shrink the tumor. Doctors use this approach when the tumor is large or may be hard to remove. Some women also have chemotherapy or hormone therapy before surgery.

Radiotherapy is either External coming from a large machine outside the body or Internal (implant radiation) where by thin plastic tubes (implants) that hold a radioactive substance are put directly in the breast. The implants stay in place for several days. A woman stays in the hospital while she has implants. Doctors remove the implants before she goes home.

Side effects include redness of the skin in the treated area treated. The skin may also be dry, tender, and itchy. The breast may feel heavy and tight. These problems will go away over time. Patients are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

Chemotherapy uses anticancer drugs to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs. The drugs may be given as a pill or by injection into a vein (IV). Either way, the drugs enter the bloodstream and travel throughout the body.

Chemotherapy can be administered in an in-patient, outpatient, at home or a combination of these. There are usually some side effects and the doctor will suggest ways to control many of the side effects. Other side effects include increased susceptibility to infections, bruising or bleeding, extreme fatigue, mouth sores, poor appetite, and hair loss. The doctor can suggest ways to control many of these side effects.

Support: There is always Shock and stress after a cancer diagnosis that can make it hard on the patient. It often helps to build a supportive network to make the journey more bearable. At any stage of disease, supportive care should be available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. Patients may also have to deal with different specialists that include surgical oncologist, medical oncologists, radiation oncologists, a plastic surgeon, and a counselor.

With advances in screening, diagnosis, and treatment, the death rate from breast cancer can be reduced and survivors can enjoy a better quality of life. The most important thing to Remember: Early Detection and Intervention as the first defense against breast cancer.

Credit goes to the numerous cancer organizations whose links provide evidence-based information

Compiled by Philippa Kibugu-Decuir

Founder/President Breast Cancer Initiative East Africa Inc. (BCIEA Inc.)