Breast cancer

Definition and symptoms

Breast cancer is an uncontrolled growth of mammary cells resulting from anomalous changes in the genes that regulate the growth of cells and keep them healthy.  

Its commonest symptoms are the presence of a “tumorous” lump in the breast that is generally detected from a self-examination or mammographic screening.  Other common symptoms include: lump in the armpit, changes in the size and shape of the breast and in the skin - such as inflammation of the breast, irritation of the skin known as “orange peel”-, local pain, nipple inversion and discharge.

It should be noted that benign breast conditions can also present the same symptoms, which is why it is essential for anyone with such symptoms to see their GP or gynaecologist so breast cancer can be ruled out.

(Image and histological) diagnosis

Suspected cases of breast cancer require both a mammography and an ultrasound to be carried out; the latter enables the physician to determine whether the tissue affected is dense or cystic. Core needle tissue biopsies are crucial for confirming or ruling out breast-cancer diagnoses and for providing the information necessary for classifying the type of breast cancer found.

Once breast cancer has been confirmed, an extension study needs to be carried out in most cases, involving a bone scintigraphy and a thoracic-abdominal scan (CAT) - to rule out any metastasis in organs such as the bones, lungs or liver.

(Biology and stage) classification

Breast cancers are divided up into ductal and lobular carcinomas, with the former being the most common (80%) and originating from the milk ducts. 

Breast cancers are classed according to their biological behaviour, various subtypes depending on the expression or absence of hormonal receptors as well as the HER2 protein: luminal (80%, positive hormonal receptors), HER2 (20%, HER2 positive) and triple negative (20%, not expressed in either the hormonal receptors or HER2).

They are also classed according to TNM classification (T- size of the tumour), N (the status of the armpit’s lymph nodes) and M (Metastasis) by using the results of pathological anatomy.

Treatment

Treatment for early-stage breast cancer, that is, where it is localised in the breast and not in the lymph nodes and has not metastasised in any organ, includes several procedures:  surgery, radiotherapy, chemotherapy, biological treatment and hormonal treatment. The above treatment depends on the behaviour of the tumour, that is, on the tumour's biology and on the spread of the disease (TNM Classification).  Where there is any doubt over the benefits of chemotherapy, the recommendation is for genome platforms to be carried out such as the Oncotype DX – which evaluates 21 genes in the tumour by providing a score of 0-100 that states the benefits of chemotherapy in that case

Prevention 

Lifestyles that help to prevent breast cancer include:

• a healthy diet (rich in fruit and greens)
• carrying out regular physical exercise
• keeping to a suitable weight
• not smoking
• limiting the consumption of alcohol and having appropriate levels of Vitamin D