Saanichton, BC

Dr. Miguel A. Lipka

Breast Cancer

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Breast cancer is the second most common cancer among women, with about 192,000 new cases each year. It remains the leading cause of death of women between age 40 and 55. While known primarily as a woman's disease, men also develop breast cancer. The good news is that survival rates today are higher than ever due to advances in diagnosis and treatment.

Breast cancer begins with abnormal cells developing in breast tissue. It can be confined to the breast or may spread beyond your breast or into other parts of your body. The most common type of breast cancer begins in the ducts designed to carry milk to the nipple. But cancer also may occur in the small sacs that produce milk, called lobules, or in other breast tissue. Breast cancer varies widely and the treatment options are selected to match your individual needs.

Early breast cancer usually doesn't cause pain. In fact, when breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it may cause changes that you should watch for:

  • A lump or thickening in or near the breast or in the underarm area
  • A change in the size or shape of the breast
  • Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast
  • Ridges or pitting of the breast, making the skin look like the skin of an orange
  • A change in the look or feel of the skin of the breast, areola or nipple such as warmth, swelling, redness or scaliness

Breast cancer may occur in several different forms, such as the five types below:

  • Breast Cancer in Situ, DCIS and LCIS -- Many breast cancers detected early, typically by mammography, are classified as breast cancer in situ or noninvasive cancer. These early cell changes may develop into invasive breast cancer. Two types of breast cancer in situ are:

    • DCIS (ductal carcinoma in situ) means that abnormal cells are found only in the lining of a milk duct of the breast. These abnormal cells haven't spread outside the duct. There are several types of DCIS. If not removed, some may change over time and become invasive cancers, while others may not. DCIS is sometimes call intraductal carcinoma.
    • LCIS (lobular carcinoma in situ) means that abnormal cells are found in the lining of a milk lobule. Although LCIS is not considered to be actual breast cancer at this noninvasive stage, it is a warning sign of an increased risk of developing invasive cancer. LCIS sometimes is found in a biopsy for another lump or unusual change detected on a mammogram.
  • Invasive Breast Cancer -- These cancer cells form in the ducts or the milk lobules and spread to the breast tissue around them. Tumors can be found during a breast exam or through screening, such as a mammogram. The size of the tumor, what it looks like under the microscope and whether it has spread to the lymph nodes determines the severity of the cancer, the therapies and the difference treatments will make.

  • Metastatic Breast Cancer -- Metastatic cancer begins in the breast, but spreads outside the breast through the blood or lymph system to other organs. Women usually develop metastatic disease in the months or years following the diagnosis of breast cancer. This cancer most commonly spreads beyond the breast to a patient's bones, lung, liver and brain.

  • Locally Advanced Breast Cancer -- Inflammatory breast cancer is a rare but very serious and aggressive type of breast cancer. The breast may look red and feel warm. A patient may see ridges, welts or hives on the breast or its skin may look wrinkled. It is sometimes misdiagnosed as an infection.

  • Recurrent Breast Cancer -- Recurrent disease means that the cancer has come back or recurred after treatment. It may come back in the breast, in the soft tissues of the chest or chest wall, or in another part of the body.

Breast cancer is usually treated with surgery and then possibly with chemotherapy or radiation, or both. Hormone positive cancers are treated with long term hormone blocking therapy. Treatments are given with increasing aggressiveness according to the prognosis and risk of recurrence.

Stage 1 cancers (and DCIS) have an excellent prognosis and are generally treated with lumpectomy and sometimes radiation.

Stage 2 and 3 cancers with a progressively poorer prognosis and greater risk of recurrence are generally treated with surgery (lumpectomy or mastectomy with or without lymph node removal), chemotherapy, and sometimes radiation (particularly following large cancers, multiple positive nodes or lumpectomy).

Stage 4, metastatic cancer, (i.e. spread to distant sites) has poor prognosis and is managed by various combination of all treatments from surgery, radiation, chemotherapy and targeted therapies. 10 year survival rate is 5% without treatment and 10% with optimal treatment.