Breast Cancer – Symptoms, Diagnoses and Treatment

By Island Hospital   |   Oct 7, 2021 2:27:55 PM

Breast cancer is cancer that forms in the cells of the breasts. It is the most common cancer in the world with 2.26 million new cases in 2020*. According to the Breast Cancer Foundation of Malaysia, about one in 19 women in the country are at risk of developing breast cancer.

The good news is that breast cancer survival rates have increased, and the number of deaths associated with this disease has steadily declined. This is attributed to factors such as earlier detection, a new personalised approach to treatment and a better understanding of the disease from worldwide research.

Advanced breast treatments are available at Island Hospital in Penang, Malaysia. Our multidisciplinary team of surgeons, medical oncologists and radiation oncologists as well as nurses, and physical assistants is able to formulate a personalised treatment plan based on the pathology and behaviour of breast cancer.

* WHO cancer facts https://www.who.int/news-room/fact-sheets/detail/cancer

Different people may experience different symptoms of breast cancer. Some people may show early symptoms while some do not have any signs or symptoms at all.

However, there are some early warning signs which you can take note of:
• A lump forming in the breast or underarm/armpit area.
• Irritation or dimpling of breast skin.
• Thickening or swelling of part of the breast.
• Nipple area has redness or flaky skin.
• Pulling in of the nipple or pain in the nipple area.
• Nipple discharge other than breast milk, including blood.
• Unusual change in the size or the shape of the breast.
• Pain in any area of the breast.

If you experience any signs or symptoms that feel unusual to you and worries you, you should see your doctor immediately, but, do bear in mind that these symptoms can happen with other conditions that are not cancer.

There is no typical breast.

What is normal for you may not be normal for other women. It is common for women to say that their breasts feel lumpy or uneven.

Other factors that affect the way your breasts look and feel can be your period, childbirth, losing or gaining weight, and taking certain medications. Age is also a factor for breasts change in shape and size.

While many conditions can cause lumps in the breast, cancer may or may not be one of the reasons. Sometimes, breast lumps are caused by other medical conditions. The two most common causes of breast lumps are fibrocystic breast condition and cysts. Fibrocystic condition can make your breast lumpy, tender and sore. But these are noncancerous changes. Cysts are small fluid-filled sacs that can develop in the breast.

There are several kinds of breast cancer. Many of them share symptoms similar to the other.

Ductal carcinoma in situ
This is a precursor of a type of breast cancer that begins in your ducts and is the most common type of breast cancer. This means you have cancer in the cells that line your ducts, but it hasn’t spread into nearby tissue. This type of condition may not show any symptoms, although sometimes it may cause a breast lump or bloody nipple discharge.

Lobular carcinoma in situ
This is not a cancer but a marker for increased risk of breast cancer in the future. It usually has no symptoms and only diagnosed during breast biopsies for other lumps in the breast.

Invasive breast cancer
Breast cancer cells that spread from where it began into the surrounding tissues is referred as invasive or infiltrating. You may notice a lump in your breast or armpit which tends to feel hard and less mobile. It is normally painless. It may or may not be stuck to the underlying skin. You may also notice that one of your breasts look different from the other, and experience swelling or pain in one spot. Your skin may be sore and you may experience a rash or skin that is thick, red or dimpled like an orange.

Metastatic breast cancer
Metastatic breast cancer is advanced breast cancer that spread to other parts of your body, including other organs. Symptoms include, pain in the bones, muscle weakness, headache and nausea, trouble breathing, changes in brain function, belly swelling, loss of appetite which leads to weight loss, yellow skin or eyes (jaundice)

Triple-negative breast cancer
Breast cancer is called triple-negative if it doesn’t have receptors for the hormones estrogen and progesterone and doesn’t make a lot of a protein called HER2. Triple-negative breast cancer tends to grow and spread faster than other types and its tumors make up 10% to 15% of breast cancers. They cause the same symptoms as other common types.

Male breast cancer
About 1% of breast cancers happen in men. As such, men too need to watch out for symptoms such as a lump or thick spot in your breast or armpit. Any changes in the skin of your breast or nipple, such as redness, puckering, scales, or discharge, should not be disregarded.

Paget’s disease of the breast
Paget’s disease often happens along with ductal carcinoma. It affects the skin of your nipple and areola which may be scaly, and red. You may also experience bloody or yellow discharge from the nipple that looks flat or inverted. You may also feel burning or itching in your breasts.

Inflammatory breast cancer (IBC)
Inflammatory breast cancer is a rare type of breast cancer that causes symptoms similar to an infection. The breast feels warm, swollen, and red with skin that is dimpled, leathery, or ridged. You may also notice that your nipple turns inward and experience unusual nipple discharge.

Breast cancer is sometimes found after symptoms appear, but many women with breast cancer do not experience any symptoms. This is why regular breast cancer screening is so important.

Imaging Tests to Find Breast Cancer
Different tests can be used to look for and diagnose breast cancer. They include Mammograms, Breast Ultrasound or Breast MRI. Should your doctor find an area of concern on a screening test (a mammogram), or if you have symptoms that point towards breast cancer, you will need more tests to know for sure.

Biopsy
A biopsy is done when mammograms, other imaging tests, or a physical exam shows a breast change that may be cancer. A biopsy is done to know for sure if it’s cancer.

At Island Hospital, our multidisciplinary team specialising in different areas of cancer treatment – such as surgery and medical oncology will work together with radiologists and pathologists to determine a patient’s overall treatment plan that combines different types of treatments.

For breast cancer, the biology and behaviour of the cancer affects the treatment plan. While some tumours may be smaller, but they may grow quickly. Others may be larger but grow slowly. Treatment is very personalised and it depends on several factors, such as the stage of the tumour and its subtype, hormone receptor status (ER, PR), HER2 status, nodal status, genomic markers, patient’s age, general health, menopausal status, and patient preferences.

Although there are some standard breast cancer treatment regimens, women do have choices. It is best to discuss your options with your doctor or surgeon. You might get chemotherapy, hormone therapy, or targeted therapy along with surgery or radiation. You will have to consider all the risks and benefits of each treatment option and how they will affect your lifestyle.

Surgery
This may be an option for many, that is to take out the tumour. The operation is called lumpectomy and it removes only the part of your breast that has cancer. It’s sometimes called breast-conserving surgery.

In a mastectomy though, surgeons remove the whole breast.

Chemotherapy
Chemotherapy uses medications to kill cancer cells. You take the medicines as pills or through an IV drip. Chemotherapy can be given after surgery to kill any cancer cells that may still be present in different parts of the body. Doctors sometimes prescribe it before surgery to shrink the tumour to allow operations to be carried out. Chemotherapy works well against cancer, but it also can harm or kill healthy cells. However, as there are more healthy cells in the body than cancer cells, our body is able to regenerate new healthy cells and recover from each cycle of chemotherapy.

Radiation therapy
Radiation therapy uses high-energy waves to kill cancer cells. It is used when the breast is not completely removed (breast conservation surgery). This is also used to control cancers that are too large to be removed.

Targeted therapy
Targeted therapy triggers your body’s immune system to help destroy cancer cells. The medicines used target breast cancer cells that have high levels of a protein called HER2. T-DM1, or ado-trastuzumab emtansine (Kadcyla). It is a medicine that combines Herceptin and the chemotherapy medicine emtansine to target HER2-positive cancer cells..

Hormone therapy
Hormone therapy uses drugs to prevent hormones circulating in the body, especially estrogen, from fuelling the growth of breast cancer cells. Some types of this therapy work by stopping the ovaries from making hormones, either through surgery or medication.

Immunotherapy
Immunotherapy uses your own immune system to target cancer. The drugs atezolizumab (Tecentriq) and sacituzumab govitecan-hziy (Trodelvy) have been approved to treat triple-negative breast cancer that has spread.

Most breast cancer treatments have side effects which may go away when the therapy stops. Some may show up later. Common side effects include nausea, fatigue, weight gain or loss, arm swelling, mouth sores, hair loss, skin or nail changes, hot flushes, trouble getting pregnant, trouble sleeping and thinking clearly and depression.

Dr. Saw Min Hong

Specialty
Cancer/Haemato-Oncology
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Dr. Eric Soh Boon Swee

Specialty
Obstetrics and Gynaecology (O&G)
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Dr. Jayanthi Karen

Specialty
Obstetrics and Gynaecology (O&G)
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Dr. Cheah Soon Keat

Specialty
Cancer/Clinical Oncology
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