Healthy Blog

Breast cancer is a malignant tumor that grows in the breast tissue.

Cancer can begin growing in the mammary glands, milk ducts, fatty tissue and connective tissue in the breast.

There are several types of breast cancer:
1. Carcinoma in situ
Carcinoma in situ means cancer that is still in its place, an early cancer that has not spread or infiltrate out of the place of origin.
2. Ductal carcinoma
Ductal carcinoma originating from the cells that line the channel leading to the nipple.
Approximately 90% of breast cancer is ductal carcinoma.
This cancer can occur before or after the menopause.
Sometimes this cancer can be palpated and the mammogram, the cancer appears as small flecks of calcium deposits (mikrokalsifikasi).
This cancer is usually limited to certain areas in the breast and can be surgically removed as a whole.
Approximately 25-35% of patients will suffer from cancer, ductal carcinoma invasive (usually in the same breast).
3. Carcinoma lobuler
Carcinoma lobuler began growing in the mammary gland, usually occurs after menopause.
This cancer can not be touched and not seen on mammogram, but it is usually discovered accidentally in mammography performed for other purposes.
Approximately 25-30% sufferer lobuler carcinoma will eventually invasive cancer (in the same breast or other breast or in both breasts).
4. Invasive cancer
Invasive cancer is cancer that has spread and damage other tissues, can be localized (confined to the breast) or metastatic (spread to other body parts).
Approximately 80% of breast cancers are invasive ductal cancer and 10% are cancer lobuler.
5. Medullary Carcinoma
Cancer is derived from the mammary gland.
6. Carcinoma cristae
Cancer is derived from the mammary gland.

CAUSES
The cause is unknown, but there are some risk factors that cause a woman to be more likely to suffer from breast cancer.
Some risk factors are:
1. Age.
Approximately 60% of breast cancers occur in over 60 years of age. The greatest risk found in women aged over 75 years.
2. Ever had breast cancer.
Women who never had cancer in situ or invasive cancer have the highest risk for breast cancer.
After the affected breast removed, then the risk of breast cancer in a healthy increase of 0.5-1% / year.
3. Family history of breast cancer.
Women who are mothers, sisters or children suffering from cancer, had a 3 times greater risk for breast cancer.
4. Genetic and hormonal factors.
Gene variants have been found 2 that seem to play a role in the occurrence of breast cancer, namely BRCA1 and BRCA2. If a mwanita have one of these genes, then the likelihood of breast cancer is very large.
Other genes that also allegedly involved in the occurrence of breast cancer is p53, BARD1, BRCA3, and Noey2.
This fact suggests that breast cancer is caused by the growth of cells that are genetically damaged.
Hormonal factors are also important because the hormones trigger the growth of cells. High hormone levels during the reproductive years of women, especially if not interrupted by the hormonal changes due to pregnancy, appears to increase the growth opportunities in the cells that have undergone genetic damage and cause cancer.
5. Ever suffered from non-cancerous breast disease.
Breast cancer risk is somewhat higher in women who had suffered from non-cancerous breast disease that causes the increase of milk saluarn structural abnormalities and the occurrence of breast tissue (atypical hyperplasia).
6. Menarche (first menstruation) before age 12 years, menopause after age 55 years, first pregnancy after age 30 years or had never been pregnant.
The earlier menarche, the greater the risk of breast cancer. The risk of breast cancer is 2-4 times greater in women who experience menarche before age 12 years.
Similarly, the first pregnancy or menopause. The slower the menopause and first pregnancy, the greater the risk of breast cancer
7. The use of oral contraceptives or estrogen replacement therapy.
Birth control pills may slightly increase the risk of breast cancer, which depends on the age, duration of usage and other factors. Not yet known how long the effects will continue to exist after pill pill use is stopped.
Estrogen replacement therapy lived for more than 5 years seems also slightly increased risk of breast cancer and the risk is increased if a longer usage.
8. Obesity after menopause.
Obesity as a risk factor for breast cancer is still debated. Some studies mention obesity as a risk factor for breast cancer, possibly because of high levels of estrogen in obese women.
9. The use of alcohol.
Use alkoloh more than 1-2 cups / day can increase the risk of breast cancer.
10. Chemicals.
Some studies have cited the exposure of chemicals that resemble estrogen (contained in pesticides and other industrial products) may increase the risk of breast cancer.
11. DES (diethylstilbestrol).
Women who take DES to prevent miscarriage have a higher risk of breast cancer.
12. Radiation.
Exposure to radiation (especially shines on the chest), in childhood can increase the risk of breast cancer.
13. Other risk factors.
Some studies show that cervical cancer, ovarian and colon cancer and a history of cancer in the family can increase the risk of breast cancer.

SYMPTOMS
Initial symptoms usually in the form of a lump that feels different from surrounding breast tissue, painless and usually has an irregular periphery.

In the early stages, if pushed by a finger, a lump can be moved easily underneath the skin.
At an advanced stage, the lump usually adheres to the chest wall or the surrounding skin.

In advanced cancer, may form lumps or ulcers on the skin swollen breasts. Sometimes the skin over the lump shrank and looked like an orange peel.

Other symptoms which may be found:
- Lump or mass in armpit
- Changes in breast size or shape
- An abnormal discharge from the nipple (usually bloody or yellow to green, may also be purulent)
- A change in color or texture of the skin on the breast, nipple and areola (dark brown colored area around the nipple)
- Breasts are reddish
- The skin around the nipple scaly
- Putting the milk drawn into or itchy
- Painful swelling of one breast or breasts.

At an advanced stage may develop bone pain, weight loss, swelling of arms or ulcerated skin.

Filtering

Cancer in its early stages rarely cause symptoms, because it is very important to do the filtering.
Several procedures are used for breast cancer screening:
1. Breast Self-Examination
If Breast Self-Examination conducted regularly, a woman will be able to find a lump in the early stages.
Breast Self-examination should be done at the same time every month. For women who still menstruate, the best timing to perform Breast Self Examination is 7-10 days after day 1 of menstruation. For postmenopausal women, Breast Self-examination can be done anytime, but are routinely dilakuka each month (eg every month).
2. Mammography.
On mammography use of low-dose X-ray to find abnormal areas in the breast.
The experts recommend to every woman aged over 40 years to perform routine mammogram every 1-2 years and at the age of 50 years and over mammogarm done once per year.
3.USG breast.
Ultrasound is used to differentiate cysts (fluid-filled sac) with a solid lump.
4.Termografi.
At temperatures termografi used to find abnormalities in the breast.
Breast Self-Examination
1. Standing in front of the mirror, look at the breast. Under normal circumstances, the size of the left and right breast is slightly different. Note the changes in the size differences between left and right breast and nipple changes (for example, are interested in) or discharge from the nipple. Consider whether wrinkled skin on the nipple.
2. Still standing in front of the mirror, both hands placed behind his head and his hands pulled back. With this position it will be easier to find small changes due to cancer. Notice the change in shape and contour of the breast, especially in the lower part of breast.
3. Put both hands on his waist and body leaning slightly toward the mirror, press your shoulders and elbows forward. Notice the change in breast size and contour.
4. Raise your left arm. By using 3 or 4 finger right hand, scan the left breast. Move your fingers in a circle (small circle) around the breast, starting from the outer edge of the breast and then moving inward to the nipple. Press gently, feel any lump or mass under the skin.
Do the same thing on the right breast with his right arm raised and examined it with his left hand.
Note also the region between the two breasts and armpits.
5. Click the nipple gently and see if out of fluid from the nipple.
Do this alternately on the left and right breast.
6. Lying supine with a pillow placed under the left shoulder and left arm is pulled up. Scan the left breast using your right hand fingers. With this position, the breasts will be leveled and facilitate the examination.
Do the same thing on the right breast by placing a pillow under your right shoulder and raised his right arm, and breast searches conducted by the fingers of his left hand.
Inspection no. 4 and 5 will be easier to do when the shower because the hands are wet more easily mobilized and more slippery skin.

DIAGNOSIS
Diagnosis based on symptoms, physical examination and the results of the following:
• Biopsy (sampling of breast tissue for examination under a microscope)
• chest X-ray
• Blood tests to assess liver function and the spread of cancer
• Skening bone (if the tumor is large or discovered enlarged lymph nodes)
• Mammography
• breast ultrasound.

Staging (Determination Stage Cancer)

Cancer staging is important as a guide treatment, follow up and determine prognosis.
Staging of breast cancer (American Joint Committee on Cancer):
- Stage 0: Cancer in situ where the cancer cells are in place in the normal breast tissue
- Stage I: Tumor with a diameter of less than 2 centimeters and has not spread beyond the breast
- Stage IIA: Tumor 2-5 cm in diameter and has not spread to underarm lymph nodes or tumors with diameters less than 2 centimeters but has spread to underarm lymph nodes
- Stage IIB: The tumor with a diameter larger than 5 cm and has not spread to underarm lymph nodes or tumors with diameters of 2-5 cm but has spread to underarm lymph nodes
- Stage IIIA: The tumor with a diameter of less than 5 centimeters and has spread to underarm lymph nodes accompanied by adhesions to one another or to other structures perlengketah; or tumors with diameters more than 5 centimeters and has spread to underarm lymph nodes
- Stage IIIB: The tumor has penetrated outside the breast, ie through the skin into the breast or chest wall or has spread to the lymph nodes in the chest wall and sternum
- Stage IV: Tumor has spread beyond the breast and chest wall, eg to the liver, bones or lungs.

In addition to cancer stage, there are other factors that influence the type of treatment and prognosis:
• Type of cancer cells
• Preview cancer
• Response to hormones cancer
Cancers that have estrogen receptors grow more slowly and more often found in postmenopausal women.
• There was whether or not the gene causes breast cancer.

TREATMENT
Treatment usually begins after a thorough assessment of patient conditions, which is about 1 week or more after the biopsy.
Treatment consists of surgery, radiation therapy, chemotherapy and hormone inhibitors.

Radiation therapy is used to kill cancer cells in the tumor and the surrounding area, including the lymph nodes.
Chemotherapy (a combination of drugs to kill the cells that quickly or pressing berkembanganbiak reproductively) and hormone inhibitor drugs (drugs that affect hormone work which underpins growth of cancer cells) are used to suppress the growth of cancer cells throughout the body.

Treatment for localized breast cancer

For cancer confined to the breast, treatment almost always includes surgery (done immediately after diagnosis) to raise as much as possible of the tumor.
There are several surgical options, the main option is a mastectomy (removal of entire breast) or breast-conserving surgery (only the tumor and surrounding normal tissue).

Breast-conserving surgery
1. Lumpectomy: removal of the tumor and a small amount of surrounding normal tissue
2. Wide excision or partial mastectomy: removal of the tumor and surrounding normal tissue more
3. Kuadrantektomi: appointment of a quarter of the breast.
Appointment of the tumor and some surrounding normal tissue provides the best chance to prevent a recurrence of cancer.
The main advantages of breast-conserving surgery plus radiation therapy is cosmetics.
Usually the side effects of radiation does not cause pain and lasted not long. The skin looks red or blister.

Mastectomy
1. Mastectomy simplex: all breast tissue removed but the muscles under the breast skin is left intact and be left enough to cover the incision. Breast reconstruction is more easily done if the chest muscles and other tissues under the breast is left intact.
This procedure is usually used to treat invasive cancer that had spread out into the ducts, because if breast-conserving surgery, cancer recurrence.
2. Simplex mastectomy plus lymph node dissection or modified radical mastectomy: the breast tissue is removed, leaving the muscles and skin, with removal of underarm lymph nodes.
3. Radical mastectomy: the breast, chest muscles and other tissues removed.
Radiation therapy is performed after surgery, will greatly reduce the risk of cancer recurrence on the chest wall or in the surrounding lymph nodes.

Tumor size and the presence of tumor cells in lymph nodes affect the use of chemotherapy and hormone inhibitors.
Some experts believe that the tumor diameters smaller than 1.3 cm can be fixed with surgery alone. If the tumor diameter larger than 5 cm, usually given chemotherapy after surgery. If the tumor diameter greater than 7.6 cm, chemotherapy is usually given before surgery.

Patients with carcinoma in situ lobuler can remain in a strict supervision and no immediate treatment or bilateral mastectomy (removal of both breasts).
Only 25% carcinoma lobuler develops into an invasive cancer that many patients who choose not to undergo treatment.
If patients choose to undergo treatment, then performed a bilateral mastectomy because the cancer does not always grow at the same breast carcinoma lobuler.
If patients want treatment than mastectomy, and hormone inhibitors are given Tamoxifen.

After undergoing a mastectomy simplex, most patients with ductal carcinoma in situ have never experienced a relapse.
Many patients who undergo lumpectomy, sometimes combined with radiation therapy.

Inflamatoir breast cancer is a very serious cancer, although rare. Looks like the infected breast, palpable warmth, red and swollen.
Treatment consists of chemotherapy and radiation therapy.

Breast Reconstruction

Breast reconstruction can be used for silicone implants or copy or tissue taken from other body parts.
Reconstruction can be done simultaneously with the mastectomy or can be done at a later date.

Lately, the use of silicon has questionable security. Silicon sometimes seeps out of his pocket so that the implant becomes hard, causing pain and shape change. In addition, silicon laliran sometimes get into the blood.

Chemotherapy & Drugs Inhibiting Hormone

Chemotherapy and hormone inhibitors are often given immediately after surgery and continued for several months or years.
This treatment is delaying the return of cancer and prolong patient life expectancy.
Providing some type of chemotherapy is more effective than chemotherapy alone. But without surgery or penyinara, these drugs can not cure breast cancer.

Side effects from chemotherapy can include nausea, fatigue, vomiting, sores in the mouth that causes pain or temporary hair loss.
At this time vomiting is relatively rare because of the drug ondansetron. Without ondansetron, patients would be vomiting as much as 1-6 times during 1-3 days after chemotherapy. Weight and duration of vomiting varies, depending on the type of chemotherapy used and patient.
For several months, the patient also becomes more susceptible to infection and bleeding.
But ultimately these side effects will disappear.

Tamoxifen is a drug blocks a hormone that can be given as therapy continued after surgery.
Chemically related to tamoxifen esrogen and has some similar effects with terapisulih hormones (such as reducing the risk of osteoporosis and heart disease and increased risk of uterine cancer). But Tamoxifen does not reduce hot flashes or vaginal dryness due to menopause change.

Treatment of breast cancer that has spread

Breast cancer can spread to different parts of the body. Parts of the body most frequently attacked are the lungs, liver, bone, lymph nodes, brain and skin.
Cancer appears on these body parts in time for years or even decades after the cancer is diagnosed and treated.

Breast cancer that has spread but does not show symptoms usually will not benefit from treatment. As a result of treatment is often delayed until symptoms (eg pain) or cancer began to deteriorate.
If patients feel pain, given the drug inhibiting hormone or chemotherapy to suppress the growth of cancer cells throughout the body.
But if cancer is found only in bone, then do radiation therapy. Radiation therapy is the most effective treatment for bone cancer and cancer that had spread to the brain.

Hormone inhibitors more often given to:
- A cancer that is supported by estrogen
- Patients who showed no signs of cancer for more than 2 years after diagnosis – cancer patients are not too threatening.
The drug is most effective when given to patients aged 40 years and still menstruate and produce large amounts of estrogen or to patients who undergo menopause 5 years ago.

Tamoxifen has few side effects the drug of first choice sehngga.
Moreover, to stop the formation of estrogen can be done surgery to remove the ovaries (ovaries) or radiation therapy to destroy the ovaries.

If the cancer begins to spread again for months or years after drug inhibiting hormone, the hormone inhibitor used in the other.
Aminoglutetimid is a hormone inhibitor used to treat pain from cancer in bone. Hydrocortisone (a steroid hormone) are usually given at the same time, because aminoglutetimid hydrocortisone suppress the formation of naturally by the body.

The most effective chemotherapy is cyclophosphamide, doxorubicin, paclitaxel, dosetaxel, vinorelbin and mitomycin C. These drugs are often used in addition to inhibiting hormone drug administration.

Antibiotics

Clinical stage of breast cancer is the best indicator for determining the prognosis of this disease.
Figures 5-year survival in patients with breast cancer who have undergone appropriate treatment approaches:
- 95% for stage 0
- 88% for stage I
- 66% for stage II
- 36% for stage III
- 7% for stage IV.

PREVENTION
Many risk factors can not be controlled.
Some diet experts and oncologists believe that changes in diet and lifestyle in general can reduce the incidence of cancer.

Endeavored to make early diagnosis of breast cancer easier to treat and can disembhan if still at an early stage.
BSE, clinical breast examination and mammography as a screening procedure is 3 tools to detect cancer early.

Recent research has mentioned 2 kinds of drugs shown to decrease the risk of breast cancer, ie tamoxifen and raloksifen. Both are anti-estrogens in the breast tissue.
Tamoxifen has been widely used to prevent relapse in patients who had undergone treatment for breast cancer.
This medicine may be used in women who have a very high risk.

Preventive mastectomy is surgery to remove one or both breasts and an option to prevent breast cancer in women who have a very high risk (for example, one woman who had her breasts removed because of cancer, women who have a family history of breast cancer and women who have p53 gene, BRCA1 atauk BRCA 2).