BREAST CANCER

General Promotion

Breast cancer is a disease that occurs as a result of a tumor caused by the change and uncontrolled proliferation of one of the cell groups that make up the breast tissue.
The cancerous tissue first spreads to its immediate surroundings and then to the lymph nodes close to the breast. In patients who are not diagnosed and treated on time, the cancer spreads to other organs and passes into an incurable stage.

The incidence of breast cancer has increased considerably in recent years. According to statistics on a global scale, the incidence of breast cancer is estimated to be around 40-50 per 100000.

In addition, according to US data, a woman’s lifetime probability of developing breast cancer is expressed as 1/8. Although the incidence increases with advancing age, there are some ways to prevent breast cancer:

Avoiding cancer-causing substances such as cigarettes and alcohol,
Eating healthy and exercising regularly
Taking care to maintain the ideal weight,
Breastfeeding for the first 6 months for mothers who have babies,
Not being a mother too late
Paying attention to the use of hormonal drugs.

Breast Cancer Risk Factors

Be woman,

Being between the ages of 50-70 and in the post-menopausal period,

Having relatives with breast cancer in the family (on the mother or father’s side), (The closer the degree of kinship and the higher the number of relatives with breast cancer, the higher the risk).

Having had breast cancer before,

Early menstruation, late menopause,

to have never given birth,

Having the first birth after the age of 30,

Having given birth but not breastfed the baby,

Taking long-term hormone therapy

Living in a modern city life environment,

Using cigarettes and tobacco products,

Obesity; gaining excess weight, especially after menopause, and consuming foods rich in saturated fats,

Lack of physical activity.

What Are the Types of Breast Cancer?

There are various types of breast cancer. However, they are basically divided into two main groups; first, noninvasive, or in other words in situ (non-invasive) and second, invasive (potentially spreading) group.

Noninvasive Cancers

Cancers that do not spread (in situ) are also divided into two groups as ‘ductal carcinoma in situ’ and ‘lobular carcinoma in situ’. Especially after the 1980s, with the prominence of screening mammography, the incidence of non-invasive (in situ) cancers in all breast biopsies increased from 1.4 percent to 10 percent, and their rate among all breast cancers increased from 5 percent to 15 percent. draws attention.

Classic lobular carcinoma in situ: An important finding that increases the risk of breast cancer 8-10 times in both breasts. In addition to close monitoring, such patients can be given some preventive drugs or surgical interventions such as removing both breast tissues (simple mastectomy) for protective purposes can be performed. With the addition of prosthesis and similar surgical reconstructive procedures with plastic surgery interventions, cosmetically pleasing results can be obtained.
Ductal cancers in situ (ISDC, intraductal cancer): Often, it is not evident on examination. symptom; irregular small-sized calcification finding and/or (pleomorphic microcalcification) detected on mammography are in the form of bloody/transparent single-channel nipple discharge. The ISDC is considered a transition from normal cells to cancer cells that have the potential to spread (invasive). Since it does not form a mass, it is removed by marking with wire or radioactive materials.
If the breast cancer is in a unifocal condition, enough clean tissue is left around it. When radiotherapy (RT) is applied to the remaining breast tissue, the disease shows a good clinical course.

If it is widespread in the breast, all breast tissue needs to be removed (simple mastectomy), and up to 100 percent complete recovery is seen in this case. In pure ISCD, involvement of axillary lymph nodes is rarely encountered in 1-3%. For this reason, patients who will have the entire breast removed; In some types with worse characteristics (high grade etc.), it may be necessary to remove the guard lymph nodes most likely to involve cancer cells in the axillary lymph nodes (sentinel lymph node biopsy).

Invasive Cancers

Ductal carcinoma, which develops in the cells lining the breast ducts that carry milk out of the nipple, is the most common type of breast cancer. This is also differentiated according to its spread: Ductal carcinoma is known to be in situ if it does not spread, and in invasive form if it has the potential to spread.

Cancer that develops from the milk-producing glands (lobules) is called lobular carcinoma. Lobular carcinoma is also divided into two according to its spread. If it does not spread, if it has the potential to spread in situ form, it is in invasive form.

Symptoms

What Are the Symptoms of Breast Cancer?
It takes a long time for a cancerous cell in the breast to form a tumor and for a specialist to understand it during the examination or to be evident in the radiological examination. Women are usually at least 1 cm. they can detect a mass that has reached its size, thanks to the manual control method.

Today, most of the symptoms of breast cancer are found by the person himself. Cancerous masses are relatively hard, have irregular edges, appear rough, and cannot be moved easily within the breast tissue.

Symptoms of Breast Cancer are;

A palpable hardness or mass in the breast,
Asymmetry that has recently emerged between the two breasts,
Inward retraction of the nipple or breast skin,
Breast redness, wound, eczema, crusting, cracking,
Orange peel-like appearance on the breast skin,
Change in shape or direction of the nipple,
Unusual swelling or increase in size of the breast,
Pain of a different character than can be found in the breast during menstrual periods,
discharge from the nipple; especially in pink, red,
Stiffness, swelling, or mass in the armpit.

*If the cancer has metastasized (spread) to distant organs, these spreads are rarely the first sign of breast cancer. The most common areas where breast cancer spreads are the hip and spine bones, as well as the lungs and liver.

Breast Cancer Stages

As with all other cancers, defining the stage of breast cancer, that is, determining the stage of the cancer, is necessary for planning the treatment. The stages of breast cancer are as follows:

Stage 0 (carcinoma in situ)
Cancer cells did not gain the potential to spread and remained completely limited in the breast.

Stage I
Cancer cells have gained the potential to spread, but are smaller than 2 cm and completely confined to the breast.

Stage IIA
There is no tumor in the breast, but cancer has spread to the armpit lymph nodes. Or a) Tumor 2 cm. or smaller and has spread to the axillary lymph nodes, or b) The tumor is larger than 2 cm but smaller than 5 cm and has not spread to the axillary lymph nodes.

Stage IIB
The tumor is larger than 2 cm but smaller than 5 cm and has spread to the axillary lymph nodes, or the tumor is larger than 5 cm but has not spread to the axillary lymph nodes.

Stage IIIA
a) There is no tumor in the breast, or

b) The tumor in the breast is 2 cm or less, or

c) Tumor greater than 2 cm but less than 5 cm, or

d) It is greater than 5 cm. In addition, the cancer may either involve the axillary lymph nodes attached to each other or have spread to the lymph nodes near the rib cage.

Stage IIIB
The tumor may be of any size and the cancer may have spread to the chest wall and/or the skin of the breast and have spread to the axillary lymph nodes that are attached together or to the lymph nodes near the rib cage.

Stage IIIC
The breast may not be a sign of cancer, or the tumor may be any size and may have spread to the chest wall and/or breast skin. In addition, the cancer may have spread to lymph nodes above or below the collarbone, or to lymph nodes under the armpit or to lymph nodes near the rib cage.

Stage IIIC breast cancer is being studied in operable and inoperable stages:

There is 10 or more lymph node involvement in operable stage breast cancer. The involved lymph nodes are either under the collarbone or in the armpits and near the sternum.

In the inoperable stage, the cancer has spread to the lymph nodes above the collarbone.

Stage IV
Cancer cells have spread to distant organs in the body (bone, liver, lung, brain).

Determining the stage of the disease in breast cancer also plays an important role in planning the treatment to be applied. The treatment plan created by determining the stage of the disease increases the success rate.

Diagnostic Methods

Your doctor will first perform a physical examination after listening to your and your family’s medical history. Then, with imaging methods such as mammography or breast ultrasound, ductoscopy (examination of milk ducts by entering very thin fiberoptic systems through the mouth of the canal at the nipple), ductography (or galactography, imaging by giving contrast material from the nipple), magnetic resonance imaging (MR). may require such tests.
Considering the importance of early diagnosis in breast cancer and the possibility of screening, it can be said that the following measures are of great importance:

Self Examination
70 percent of breast cancers are found when patients examine or examine their own breasts. That’s why women after the age of 20; Once a month, in the post-menstrual period, they should observe their own breasts, preferably in front of the mirror, and feel their breasts and armpits with their hands. If they notice any changes, they should consult a doctor as soon as possible.

Step One
The examination starts in front of the mirror first. By placing the hands on the waist, it is first checked whether the breasts are symmetrical. A visible mass in the breasts is investigated, and it is checked whether there is any depression or color change in the breast skin.

Second step
The same examinations are repeated by raising the hands.

Third Step
Then, the examination is done while lying down. Examination starts with the right breast first. A small pillow is placed under the right shoulder-back for a more comfortable examination. The right hand is placed behind the head.

Step Four

The examination is carried out with 2-3 fingertips of the left hand. Starting around the nipple and pressing lightly on the breast tissue, it is checked whether there is any sensitivity or mass with clockwise circular movements. After examining the entire breast, the armpit is examined. The left breast and armpit are evaluated similarly.

Medical Examination

Even if she has no complaints about her breasts, every woman should be examined by a general surgeon for clinical breast examination every 3 years between the ages of 20-40 and once a year after the age of 40.

Imaging methods: Breast imaging aims to detect breast cancer at the earliest possible stage. In parallel with technological developments and especially the widespread use of screening mammography, there is a significant increase in breast cancer cases that can be detected by imaging methods even though it is not palpable.

Early Diagnosis and Prevention in Breast Cancer

Breast cancer is the most common type of cancer in women, and it knocks on the door of approximately one in eight women at some point in their life. However, the probability of curing breast cancer detected at an early stage is close to 100 percent.
After the age of 20, every woman should self-examine once a month, see a doctor once a year, and some imaging tests are of great importance in early diagnosis. Breast self-examination is performed on any day of the month in postmenopausal women.

The clinical examination is performed once a year by a doctor specialized in breast after the age of 40. If the person has a family history of breast cancer, it can also be performed under the age of 40. Mammography is applied after the age of 40, and it can be recommended at an earlier age according to family history.

Breast cancer can also be seen in men, so all men, especially men with risk factors, should observe the changes in their breasts. With screening methods, early diagnosis of breast cancer can be made easily and women can be completely cured of this disease.

Treatment Methods

The chance of success in the treatment of breast cancer is directly related to how early the cancer is caught. When detected at an early stage, the 5-year survival rate can reach 96 percent.
Surgery is the most important part of breast cancer treatment. The aim of breast cancer surgery is to remove the entire tumor from the body. Treatment methods other than surgery are aimed at preventing the tumor from recurring (recurrence) or spreading to other organs. There are basically 3 types of surgery:

-Mastectomy
It is called the removal of the entire breast along with the tumor. In the same session or in the late period (1-2 years later) to the patient; New breasts can be made with silicone prostheses or their own tissues.

-Skin Conserving Mastectomy
It is a preferred method in cases where the entire breast tissue needs to be removed but the breast skin can be preserved. Instead of the removed tissue, a silicone prosthesis is placed inside the skin to provide a cosmetic appearance. It is especially preferred for risk-reducing breast cancer surgeries (prophylactic mastectomy).

-Breast Conservation Surgery
A surgical method in which only the tumor is removed along with some normal breast tissue around it. This surgery has two purposes: First, the cosmetic appearance of the breast is not deteriorated by leaving the breast in place; secondly, to ensure that the patient is affected at the lowest level, both physically and psychologically. After breast cancer surgery, radiotherapy can be applied for 5-7 weeks.

In the last 20 years, there have been great changes in the surgical treatment of early-stage breast cancer. As a result of studies involving thousands of patients and with a follow-up period of more than twenty years, it has been revealed that the survival rates obtained with breast-conserving surgery are equivalent to mastectomy (removal of the entire breast) in eligible patients.

Today, in breast cancer surgeries, it is not necessary to remove the entire breast, except for some medical necessity. The breast is an organ that has an important place in women’s sexual identity and body perception.

With these breast cancer surgical methods called partial mastectomy, lampectomy, quadrantectomy, women avoid losing their breasts unnecessarily.

However, in some patients, it may be necessary to remove the entire breast. In this case, surgery can be performed for breast repair and surgeons can create a breast that is very similar to the natural breast.