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BREAST CANCER

Breast cancer (malignant breast neoplasm) is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas. Breast cancer is a disease of humans and other mammals; while the overwhelming majority of cases in humans are women, men can also develop breast cancer. Cancer cells are abnormal cells. Cancer cells grow and divide more quickly than healthy cells. Some cancer cells may form growths called tumors. All tumors increase in size, but some tumors grow quickly, others slowly. Cancer cells can spread to other parts of the body through the blood and lymph systems. This is called metastasis. Breast cancer is when cancer starts in the breast. Breast cancer can be found by mammogram, by a woman feeling a lump or by a doctors exam. To find breast cancer, it is important to: Do monthly self breast exams. Have a yearly exam by your doctor if you are over 40. These are done less often for younger women. Have a mammogram each year after age 40. Prognosis and survival rate varies greatly depending on cancer type and staging. With best treatment and dependent on staging, 5-year relative survival varies from 98% to 23%, with an overall survival rate of 85%. Worldwide, breast cancer comprises 22.9% of all cancers (excluding non-melanoma skin cancers) in women.[7] In 2008, breast cancer caused 458,503 deaths worldwide (13.7% of cancer deaths in women). Breast cancer is more than 100 times more common in women than breast cancer in men, although males tend to have poorer outcomes due to delays in diagnosis. The first noticeable symptom of breast cancer is typically a lump that feels different from the rest of the breast tissue. More than 80% of breast cancer cases are discovered when the woman feels a lump. The earliest breast cancers are detected by a mammogram. Lumps found in lymph nodes located in the armpits can also indicate breast cancer. Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. Pain ("mastodynia") is an unreliable tool in determining the presence or absence of breast cancer, but may be indicative of other breast health issues.

Inflammatory breast cancer is a particular type of breast cancer which can pose a substantial diagnostic challenge. Symptoms may resemble a breast inflammation and may include itching, pain, swelling, nipple inversion, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as peau d'orange; the absence of a discernible lump delays detection dangerously. Another reported symptom complex of breast cancer is Paget's disease of the breast. This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. As Paget's advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget's also have a lump in the breast. In rare cases, what initially appears as a fibroadenoma (hard movable lump) could in fact be aphyllodes tumor. Phyllodes tumors are formed within the stroma (connective tissue) of the breast and contain glandular as well as stromal tissue. Phyllodes tumors are not staged in the usual sense; they are classified on the basis of their appearance under the microscope as benign, borderline, or malignant. Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain.]Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are called nonspecific, meaning they could be manifestations of many other illnesses. Most symptoms of breast disorders, including most lumps, do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. Nevertheless, the appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age. Breast Tissue - A womans breasts may feel more firm and lumpy before menopause. A woman has less estrogen after menopause, so the breasts feel much softer and less lumpy. The firm, lumpy tissue can hide a small lump making it hard to feel. By checking your breasts each month, you become familiar with your breast tissue and notice changes. Small lumps can also be found by a mammogram or by a doctor during your exam. Some lumps are so Tests - If a lump is found, a mammogram or ultrasound will be done. A biopsy is often done to check if the lump is cancer and if so, what type. A biopsy is a procedure to remove tiny pieces of tissue. The samples are then checked by a doctor. If the biopsy finds cancer, more tests may be done to see if the cancer has spread to other parts of your body.
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Types of Treatment The size, stage, rate of growth, and other characteristics of the tumor determine the kinds of treatment. Treatment may include surgery, drugs (hormonal therapy and chemotherapy), radiation and/or immunotherapy. Surgical removal of the tumor provides the single largest benefit, with surgery alone being capable of producing a cure in many cases. To somewhat increase the likelihood of long-term disease-free survival, several chemotherapy regimens are commonly given in addition to surgery. Most forms of chemotherapy kill cells that are dividing rapidly anywhere in the body, and as a result cause temporary hair loss and digestive disturbances. Radiation may be added to kill any cancer cells in the breast that were missed by the surgery, which usually extends survival somewhat, although radiation exposure to the heart may cause heart failure in the future. Some breast cancers are sensitive to hormones such as estrogen and/or progesterone, which makes it possible to treat them by blocking the effects of these hormones Based on your biopsy results and the type of cancer, you and your doctor will decide the best treatment for your breast cancer. Here are the treatments that may be done: Surgery - Surgery is done to remove as much of the cancer as possible. Either the whole breast is removed, called mastectomy, or a part of the breast is removed, called lumpectomy. With either surgery, lymph nodes under the arm are checked for cancer. You and your doctor may also talk about reconstruction surgery. This surgery is done to create the look of a normal breast. You may still need to have more treatment. Having a mastectomy or lumpectomy does not guarantee that the breast cancer is gone from the entire body. Small cancer cells that are too small to detect may remain in the body. Surgery involves the physical removal of the tumor, typically along with some of the surrounding, apparently healthy tissue. Standard surgeries include:

Mastectomy: Removal of the whole breast. Quadrantectomy: Removal of one quarter of the breast. Lumpectomy: Removal of a small part of the breast.

If the patient desires, then breast reconstruction surgery, a type of cosmetic surgery, may be performed to create an aesthetic appearance. In other cases, women use breast prostheses to simulate a breast under clothing, or choose a flat chest.

PREVENTION
Exercise may decrease breast cancer risk. Also avoiding alcohol and obesity. Prophylactic bilateral mastectomy may be considered in patients with BRCA1 and BRCA2 mutations. A 2007 report concluded that women can somewhat reduce their risk by maintaining a healthy weight, drinking less alcohol, being physically active and breastfeeding their children.
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TREATMENT
Breast cancer is usually treated with surgery and then possibly with chemotherapy or radiation, or both. A multidisciplinary approach is preferable. 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.[61] HER2+ cancers should be treated with the trastuzumab (Herceptin) regime.[62] Chemotherapy is uncommon for other types of stage 1 cancers. 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 (plus trastuzumab for HER2+ cancers) 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

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