Medicine for Africa - Medical Information Service

ANCER - BREAST

Definition:
 
The female breast is the location of a multitude of benign and malignant tumorous lesions throughout a woman's life. The word 'tumor' means any kind of abnormal tissue growth, be it a cyst or a hard tissue mass.

A mass designated as tumor does not specify whether it is benign or malignant. Benign tumors are differentiated from malignant ones by determining the kind of cells of which the tumor consists.

'Normal' tissue cells that just increase in amount or size due to an external stimulation are 'benign tumors', while a tumor that consists of abnormally developed cells with a growth pattern of its own, is called a 'malignant tumor' or cancer.

Women with an increased risk of developing breast cancer are those who have a close relative (mother, sister, aunt, cousin) previously diagnosed with a malignant breast tumor. In this case, close medical supervision is indicated. Late start of the menstrual period, as well as late menopause and no child-bearing can all cause breast cancer. Extreme overweight (obesity) and long-term ingestion of estrogen-containing medications (e.g. certain contraceptive pills) can also lead to breast cancer, especially after the menopause. Your private physician will best be able to determine the risk factors that are of significance in your specific case.

Various types of breast cancer have also been associated with high-risk subtypes of the Human Papilloma Virus (HPV), as has recently been reported by an increasing number of scientific researchers from all over the world.  The DNA of high-risk HPV types had been identified as early as 1992 by the author of this article, and reported in 1993 at the biennial congress of the International Association of Breast Cancer Research.  Recent technological advances in identifying viral DNA in tissue samples and human secretions now support these early findings by other researchers.
 

Symptoms:
 
A newly discovered knot, changes in skin color or smoothness (into an 'orange-peel' like consistency), hardening of the skin or tissue of the breast or secretions from the breast nipple are all symptoms that have to be evaluated by a physician as soon as possible. While none of those signs is diagnostic for a malignant tumor, there is a high probability of a cancerous growth associated with them.
 

Diagnosis:
 
Part of every thorough physical examination is the palpation of the breasts by the examining physician. A newly discovered knot requires immediate evaluation. The first step is a mammography, which can, at times, provide a preliminary diagnosis. This test is usually followed by a needle biopsy, which is performed with a thick caliber needle under x-ray supervision to assure that the area in question is biopsied. The tissue is then examined under a microscope by a pathologist and diagnosed according to the tumor's histology (cell structure), as either a benign or a malignant tumor. If it is a benign tumor, a complete excision of the lesion is usually satisfactory. A malignant tumor needs to be excised, along with enough 'healthy' tissue around the primary lesion, in order to assure that all or most cancer cells have been removed. Depending on the size and kind of breast cancer, a partial mastectomy (lumpectomy) might be sufficient; in more aggressive cancers or larger size cancers, a complete mastectomy may be necessary. In addition, groups of local lymph nodes, usually the first site of the spread of cancerous cells, are removed and the entire tissue, i.e. the breast tissue and the lymph nodes, is once again thoroughly examined by the pathologist. Cell shape and structure (histology), their growth pattern (mitosis activity), their similarity or dissimilarity to normal cells (differentiation), and their capability of invading surrounding tissue or local lymph nodes are all part of the final diagnosis the pathologist assigns to the tumor. There are many different kinds of cancers, such as ductal carcinoma in situ, infiltrating ductal carcinoma, infiltrating lobular carcinoma, etc. Aaccording to its histology, size and potential of metastasizing, each cancer harbors a different prognosis -- that is, the chance of responding to treatment varies widely between different types of cancer and even within the same type of cancer. The physician reviews all the information before deciding on the appropriate course of treatment for each tumor
 

Treatment:
 
Treatment consists primarily of surgery in order to remove all of the tumor tissue that can be identified. Additional treatment may consist of certain medications such as estrogen-containing drugs (tamoxifen) in hormone responsive cancers, or chemotherapy which is usually a multi-drug regimen. A combination therapy is often indicated, which calls for radiation in addition to medication, to assure that any small remaining cell aggregates which cannot yet be identified will be destroyed as well.
 

Prevention:
 
The most important 'preventive' treatment can be performed by you. You should conduct, at regular intervals, a 'self-examination' of your breasts. You should stand or sit in front of a mirror, and then palpate each breast with the fingers of the opposite hand in order to discover small nodules at the earliest possible time, or to detect whether a previously diagnosed nodule increased in size. Changes in size could be an important clue to the development of an uncontrollable growth pattern. More than 50% of malignant breast tumors arise in the upper outer quadrant of the breast. Also, by lifting both arms simultaneously above your head, you should note whether both breasts move up to the same degree. If they do not, it could be caused by scarring which may be secondary to an old infection, a small perforated cyst or a cell growth of benign or malignant origins. This, as well as any newly discovered knot or a growing nodule should immediately be evaluated by a physician. An annual mammography can detect early tumorous growths, often before they can be felt. Regularly performed mammographies are being paid for by your health insurance and should be coordinated and supervised by your physician for long-term health coverage. The diagnosis of a malignant breast cancer is for every affected woman one of the most devastating nightmares. However, after the first shock has subsided, it can be helpful to ask for a clear answer as to which type of tumor it is, and what the prognosis is for this specific type. Every cancer is an individual growth and many cancers, especially when diagnosed early, have sometimes a very good response rate to treatment. The diagnosis of breast cancer is nowadays not anymore equal to an immediate 'death sentence'. The most important 'preventive' treatment can be performed by you by conducting a self-examination from time to time and by going for an annual mammography. At the earliest signs of something 'abnormal' you should visit your physician without delay.

                                                   
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