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Breast Cancers

What is breast cancer?

Breast cancer is the most common type of cancer in women around the world. It is the second cancer with highest worldwide incidence, following the lung cancer. According to statistics, one of every 8 women is caught by breast cancer in a particular time of the life.
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Cancer cells usually originate from mammary lobules, where the milk is produced, or milk drainage canals in the breast. Breast cancer is most likely in peri-menopausal women, but it may develop at any age. Breast cancer can be seen in men, albeit very rare.  For every 100 women diagnosed with breast cancer, one man is diagnosed.

If one has concerns about symptoms of breast cancer, she/he should take action immediately. More than 90% of early diagnosed breast cancers are successfully treated. You can feel a lump or a solid formation in self-examination of your breast, your physician can palpate a solid formation or a lump in the clinical examination of your breast or an abnormal zone in the breast tissue can be visualized during a mammography test or MRI scan of chest.

Risk Factors of the Breast Cancer

Risk factors of the breast cancer are collected under two main groups; preventable risks and unchangeable risks. Preventable risks are factors that individual can change in her/his life and are as follows: Quit or decrease smoking and consumption of alcohol, have an exercise-friendly lifestyle and eat healthily. Unchangeable risks include age, gender, dense breast tissue, and first period at a younger age or menopause at an older age as well as positive family history.

Stages of the Breast Cancer

As the case for all cancers, early diagnosis is substantially important for the breast cancer. If the condition is early diagnosed, it is mostly not necessary to surgically remove the breast.

According to the widely recognized staging system that determines whether a cancer is local or has spread, the breast cancer has 4 stages, ranging from Stage 1 (local) to Stage 4 (distant organ metastasis). Examinations and tests are ordered to determine the stage, which is used to make the treatment plan.

Stages of Breast Cancer

Stages of Breast Cancer

One or more than one therapeutic option can be used depending on stage of the tumor and characteristics and general health status of the patient: Surgery, radiotherapy, hormone therapy, chemotherapy or targeted therapy.

Diagnostic Methods

Your doctor will order tests in order to understand whether the tumor is local or metastasized to other body regions and to plan a treatment in the light of symptoms.

  • Mammography: this method is based on the principle of assessing the breast tissue using X-rays. Initial mammography is the first mammography that is scanned while patient has no complaint. Mammography is both a screening test and a diagnostic imaging modality. While screening mammography is reserved for person with no complaint, diagnostic mammography enables detailed evaluation of the suspicious lump or the region.
  • Ultrasound: it works based on the principle of back reflection of sound waves. It is used to understand whether the suspected lump or the zone that is visualized on the mammography or palpated by the patient is fluid or solid. The fluid-filled lumps, namely cysts, do not pose a significant threat regarding the cancer. On the contrary, “solid” lumps are breast tumors. Regular follow-up or other advanced methods are required for differential diagnosis of benign or malignant lesions.
  • Galactography: a contrast agent is instilled through the nipple and milk canals are imaged. It is most commonly used for patients who complain of nipple discharge.
  • Fine needle biopsy: A cellular-level specimen is collected with conventional syringe needle and cells are examined under microscope.
  • Thick needle biopsy: A specially manufactured thick needle is used to take a tissue sample.
  • Stereotactic biopsy: Location of the lump is determined with a special device and the specimen is precisely collected from that location.
  • Stereotactic marking: The suspicious zone is visualized with a special device and a thin needle is inserted into this locus.
  • Surgical biopsy: The lump is totally excised at the operating theater and examined under microscope.

Treatment of the Breast Cancer

Hastalığın evresine, hastanın özelliklerine ve genel sağlığına bağlı olarak tedavi seçenekleri bir veya birden fazlasını içerebilir: Cerrahi, radyasyon tedavisi, hormon tedavisi, kemoterapi veya hedefe yönelik tedavi gibi

Conventional treatment methods:

1- Surgical treatment
2 – Radiotherapy
3- Chemotherapy (Medication therapy)
4- Hormone therapy

1- Surgical treatment

It is usually the first frontage in the fight against the cancer. Treatments of most patients start with surgical removal of the cancerous tissue. Sentinel lymph node is biopsied along with axillary lymph node dissection, if required.

Recently, there are several different surgical procedures that are used to treat the breast cancer. These are broadly addressed in two groups; breast-sparing surgery and radical surgery that requires removal of whole breast. Thanks to recent medical novelties, cancerous locus is removed, while the breast is spared and axillary lymph nodes are biopsied, and thus, similar successful outcomes are obtained and patients can be discharged to home in the same day. If it is necessary to remove the whole breast, the breast is reconstructed by plastic surgeons.

2 – Radiotherapy

Radiotherapy is employed to eliminate likelihood of postoperative tumor residues by delivering X-rays (roentgen beams) to breast tissue and axilla.

External beam radiation is the most common method. It is used for postoperative 4 to 6 weeks. Whole breast and sometimes axilla are externally irradiated with the help of a special linear accelerator. Radiation beams are usually delivered for 5 days of week for 4 to 6 weeks.

Side effects of the radiotherapy: tiredness is the most common complaint specified by women who receive radiotherapy. Swelling or feeling of weight in breast may occur. Suntan discoloration in the skin of the targeted area can be observed. Those side effects spontaneously disappear in approximately one year. Novalis TrueBeam STx, the linear accelerator used in our center, reduces the damage in healthy tissues, resulting with minimization of those side effects.

3- Chemotherapy (Medication therapy)

In this method, medications are used to kill cancer cells. After medications are administered by oral or intravenous route, they spread to whole body. Since administration of multiple agents simultaneously creates stronger effect, they are administered in various combinations. Chemotherapy is given in cycles or courses. Four to six cycles are planned. Approximately 3 weeks elapse between two cycles. This results in 3 to 5 months in total to complete a chemotherapy regimen.

For some cases, it is necessary to supplement surgery with chemotherapy.

Even if postoperative work-up shows no residue, chemotherapy can be given for prophylaxis or as a preventive measure. This therapy is referred as adjuvant chemotherapy.

Neoadjuvant chemotherapy is employed to reduce size of Stage 3 tumor or to prepare the patient for the surgery. Another benefit derived from the neoadjuvant chemotherapy is to monitor efficiency of the chemotherapy. Please click for further details about chemotherapy.

4- Hormone therapy

Some breast cancer cells are estrogen-sensitive, which is mediated by hormone receptors of those cells. In other words, estrogen hormone plays a role in enlargement or growth of those cancer cells. Hormone therapy intends preventing occurrence of the cancer by eliminating effects of estrogen in estrogen-sensitive cancers.

 

 

 

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