November 20, 2018

Breast Cancer

By Dr. Sanjay Gupta, lead physician at the Binaytara Foundation Cancer Center

Breast cancer is the most common cause of death in middle-aged women in western countries.

Aetiological Factors

  • Geographical: More common in western world
  • Age: Rare before the age of 20 years but, thereafter, the incidence steadily rises so that by the age of 90 years
  • Gender: Less than 0.5% of patients with breast cancer are male
  • Genetic: Breast cancer occurs more commonly in women with family history of breast cancer
  • Diet: Breast cancer is associated with diets low in phytoestrogens and alcohol consumption.
  • Endocrine: Common in nulliparous women while breast feeding appears to be protective.

Having child at early stage is protective

In post menopausal women, breast cancer is more common in Obese women

Spread of breast cancer

Local spread: The tumor increases in size and invades  the other portion of breast. It tends to involve the skin and penetrates the pectoral muscle if diagnosed late.

Lymphatic spread: Lymphatic spreads occurs primarily to the axillary and internal mammary lymph nodes. Involvement of supraclavicular nodes and of any contralateral nodes represents advanced disease.

Spread by bloodstream: skeletal metastasis occurs through this route. In order of frequency the lumbar vertebrae, femur, thoracic vertebrae, rib and skull are affected and these deposits are generally osteolytic. Metastasis may also commonly occur in liver, lungs and brain and occasionally to adrenal glands and ovaries.

Clinical presentation

Although any portion of breast may be involved, breast cancer is found most frequently in the upper outer quadrant. Most breast cancer appears as hard lump, which may be associated with indrawing of nipple or overlying skin. As it advances it spreads locally and involves chest wall.

Diagnosis

Diagnosis is based on clinical examination, Imaging ( Mammography, USG, MRI) and Biopsy.

 

Treatment

Chemotherapy

Radiotherapy

Surgery

Hormonal Therapy