Female Breast Cancer
On this page:
Breast cancer is a disease in which malignant (cancer) cells form in the tissues
of the breast.
The breast is made up of lobes and ducts. Each breast has 15 to
20 sections called lobes, which have many smaller sections called lobules.
Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules,
and bulbs are linked by thin tubes called ducts.
Each breast also has blood vessels and lymph vessels. The lymph
vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph
nodes. Lymph nodes are small bean-shaped structures that are found throughout
the body. They filter substances in lymph and help fight infection and disease.
Clusters of lymph nodes are found near the breast in the axilla (under the
arm), above the collarbone, and in the chest.
The most common type of breast cancer is ductal carcinoma, which
begins in the cells of the ducts. Cancer that begins in the lobes or lobules
is called lobular carcinoma and is more often found in both breasts than are
other types of breast cancer. Inflammatory breast cancer is an uncommon type
of breast cancer in which the breast is warm, red, and swollen.
Age and health history can affect the risk of developing breast cancer.
Anything that increases your chance of getting a disease is called
a risk factor. Risk factors for breast cancer include the following:
- Older age.
- Menstruating at an early age.
- Older age at first birth or never having given birth.
- A personal history of breast cancer or benign (noncancer) breast disease.
- A mother or sister with breast cancer.
- Treatment with radiation therapy to the breast/chest.
- Breast tissue that is dense on a mammogram.
- Hormone use (such as estrogen and progesterone).
- Drinking alcoholic beverages.
- Being white.
Breast cancer is sometimes caused by inherited gene mutations (changes).
The genes in cells carry the hereditary information that is received
from a person’s parents. Hereditary breast cancer makes up approximately 5%
to 10% of all breast cancer. Some altered genes related to breast cancer are
more common in certain ethnic groups.
Women who have an altered gene related to breast cancer and who
have had breast cancer in one breast have an increased risk of developing breast
cancer in the other breast. These women also have an increased risk of developing ovarian cancer,
and may have an increased risk of developing other cancers. Men who have an
altered gene related to breast cancer also have an increased risk of developing
this disease.
Tests have been developed that can detect altered genes. These genetic
tests are sometimes done for members of families with a high risk of cancer.
Tests that examine the breasts are used to detect (find) and diagnose breast
cancer.
A doctor should be seen if changes in the breast are noticed.
The following tests and procedures may be used:
- Mammogram: An x-ray of the breast.
- Biopsy: The removal of cells or tissues so they can be viewed under a
microscope to check for signs of cancer. If a lump in the breast is found,
the doctor may need to cut out a small piece of the lump. A pathologist
views the tissue under a microscope to look for cancer cells. Four types
of biopsies are as follows:
- Excisional biopsy: The removal of an entire lump or suspicious tissue.
- Incisional biopsy: The removal of part of a lump or suspicious tissue.
- Core biopsy: The removal of part of a lump or suspicious tissue using
a wide needle.
- Needle biopsy or fine-needle aspiration biopsy: The removal of part
of a lump, suspicious tissue, or fluid, using a thin needle.
- Estrogen and progesterone receptor test: A test to measure the amount
of estrogen and progesterone (hormones) receptors in cancer tissue. If cancer
is found in the breast, tissue from the tumor is examined in the laboratory
to find out whether estrogen and progesterone could affect the way cancer
grows. The test results show whether hormone therapy may stop the cancer
from growing.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend
on the following:
- The stage of the cancer (whether it is in the breast only or has spread
to lymph nodes or other places in the body).
- The type of breast cancer.
- Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
- A woman’s age, general health, and menopausal status (whether a woman
is still having menstrual periods).
- Whether the cancer has just been diagnosed or has recurred (come back).
Return to top 
After breast cancer has been diagnosed, tests are done to find out if cancer
cells have spread within the breast or to other parts of the body.
The process used to find out whether the cancer has spread within
the breast or to other parts of the body is called staging. The information
gathered from the staging process determines the stage of the disease. It is
important to know the stage in order to plan treatment.
The following stages are used for breast cancer:
There are 2 types of breast carcinoma in situ:
- Ductal carcinoma in situ (DCIS) is a noninvasive, precancerous condition
in which abnormal cells are found in the lining of a breast duct. The abnormal
cells have not spread outside the duct to other tissues in the breast. In
some cases, DCIS may become invasive cancer and spread to other tissues,
although it is not known at this time how to predict which lesions will
become invasive.
- Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells
are found in the lobules of the breast. This condition seldom becomes invasive
cancer; however, having lobular carcinoma in situ in one breast increases
the risk of developing breast cancer in either breast.
In stage I, the tumor is 2 centimeters or smaller and has not
spread outside the breast.
In stage IIA:
- no tumor is found in the breast, but cancer is found in the axillary lymph
nodes (the lymph nodes under the arm); or
- the tumor is 2 centimeters or smaller and has spread to the axillary lymph
nodes; or
- the tumor is between 2 and 5 centimeters but has not spread to the axillary
lymph nodes.
In stage IIB, the tumor is either:
- between 2 and 5 centimeters and has spread to the axillary lymph nodes;
or
- larger than 5 centimeters but has not spread to the axillary lymph nodes.
In stage IIIA:
- no tumor is found in the breast, but cancer is found in axillary lymph
nodes that are attached to each other or to other structures; or
- the tumor is 5 centimeters or smaller and has spread to axillary lymph
nodes that are attached to each other or to other structures; or
- the tumor is larger than 5 centimeters and has spread to axillary lymph
nodes that may or may not be attached to each other or to other structures.
In stage IIIB, the cancer may be any size and:
- has spread to tissues near the breast (the skin or chest wall, including
the ribs and muscles in the chest); and
- may have spread to lymph nodes within the breast or under the arm.
In stage IIIC, the cancer:
- has spread to lymph nodes beneath the collarbone and near the neck; and
- may have spread to lymph nodes within the breast or under the arm and
to tissues near the breast.
Stage IIIC breast cancer is divided into operable and inoperable stage
IIIC. In operable stage IIIC, the cancer:
- is found in 10 or more of the lymph nodes under the arm; or
- is found in the lymph nodes beneath the collarbone and near the neck on
the same side of the body as the breast with cancer; or
- is found in lymph nodes within the breast itself and in lymph nodes under
the arm.
In inoperable stage IIIC breast cancer, the cancer has spread
to the lymph nodes above the collarbone and near the neck on the same side
of the body as the breast with cancer.
In stage IV, the cancer has spread to other organs of the body,
most often the bones, lungs, liver, or brain.
Return to top
In inflammatory breast cancer, the breast looks red and swollen
and feels warm. The redness and warmth occur because the cancer cells block
the lymph vessels in the skin. The skin of the breast may also show the pitted
appearance called peau d’orange (like the skin of an orange).
Return to top
Recurrent
breast cancer
is cancer that has recurred (come back) after it has been treated.
The cancer may come back in the breast, in the chest
wall, or in other parts of the body.
Return to top
There are different types of treatment for patients with breast cancer.
Different types of treatment are available for patients with breast cancer.
Some treatments are standard (the currently used treatment), and some are being
tested in clinical trials. Before starting treatment, patients may want to
think about taking part in a clinical trial. A treatment clinical trial is
a research study meant to help improve current treatments or obtain information
on new treatments for patients with cancer. When clinical trials show that
a new treatment is better than the standard treatment, the new treatment may
become the standard treatment.
Clinical trials are taking place in many parts of the country.
Choosing the most appropriate cancer treatment is a decision that ideally involves
the patient, family, and health care team.
Most patients with breast cancer have surgery to remove the cancer
from the breast. Some of the lymph nodes under the arm are usually taken out
and looked at under a microscope to see if they contain cancer cells.
Breast-conserving surgery, an operation to remove the cancer but
not the breast itself, includes the following:
- Lumpectomy: A surgical procedure to remove a tumor (lump) and a small
amount of normal tissue around it.
- Partial mastectomy: A surgical procedure to remove the part of the breast
that contains cancer and some normal tissue around it. This procedure is
also called a segmental mastectomy.
Patients who are treated with breast-conserving surgery may also
have some of the lymph nodes under the arm removed for biopsy. This procedure
is called lymph node dissection. It may be done at the same time as the breast-conserving
surgery or after. Lymph node dissection is done through a separate incision.
- Total mastectomy: A surgical procedure to remove the whole breast that
contains cancer. This procedure is also called a simple mastectomy. Some
of the lymph nodes under the arm may be removed for biopsy at the same time
as the breast surgery or after. This is done through a separate incision.
- Modified radical mastectomy: A surgical procedure to remove the whole
breast that contains cancer, many of the lymph nodes under the arm, the
lining over the chest muscles, and sometimes, part of the chest wall muscles.
- Radical mastectomy: A surgical procedure to remove the breast that contains
cancer, chest wall muscles under the breast, and all of the lymph nodes
under the arm. This procedure is sometimes called a Halsted radical mastectomy.
Even if the doctor removes all of the cancer that can be seen
at the time of surgery, the patient may be given radiation therapy, chemotherapy,
or hormone therapy after surgery to try to kill any cancer cells that may be
left. Treatment given after surgery to increase the chances of a cure is called adjuvant
therapy.
If a patient is going to have a mastectomy, breast reconstruction (surgery
to rebuild a breast’s shape after a mastectomy) may be considered. Breast reconstruction
may be done at the time of the mastectomy or at a future time. The reconstructed
breast may be made with the patient’s own (nonbreast) tissue or by using implants
filled with saline or silicone gel. The Food and Drug Administration (FDA)
has decided that breast implants filled with silicone gel may be used only
in clinical trials.
Radiation therapy is a cancer treatment that uses high-energy x-rays or
other types of radiation to kill cancer cells. There are two types of radiation
therapy. External radiation therapy uses a machine outside the body to send
radiation toward the cancer. Internal radiation therapy uses a radioactive substance
sealed in needles, seeds, wires, or catheters that are placed directly into
or near the cancer. The way the radiation therapy is given depends on the type
and stage of the cancer being treated.
Chemotherapy is a cancer treatment that uses drugs to stop the
growth of cancer cells, either by killing the cells or by stopping the cells
from dividing. When chemotherapy is taken by mouth or injected into a vein
or muscle, the drugs enter the bloodstream and can reach cancer cells throughout
the body (systemic chemotherapy). When chemotherapy is placed directly into
the spinal column, an organ, or a body cavity such as the abdomen, the drugs
mainly affect cancer cells in those areas (regional chemotherapy). The way
the chemotherapy is given depends on the type and stage of the cancer being
treated.
Hormone therapy is a cancer treatment that removes hormones or
blocks their action and stops cancer cells from growing. Hormones are substances
produced by glands in the body and circulated in the bloodstream. The presence
of some hormones can cause certain cancers to grow. If tests show that the
cancer cells have places where hormones can attach (receptors), drugs, surgery,
or radiation therapy are used to reduce the production of hormones or block
them from working.
Hormone therapy with tamoxifen is often given to patients with
early stages of breast cancer and those with metastatic breast cancer (cancer
that has spread to other parts of the body). Hormone therapy with tamoxifen
or estrogens can act on cells all over the body and may increase the chance
of developing endometrial cancer. Women taking tamoxifen should have a pelvic examination
every year to look for any signs of cancer. Any vaginal bleeding, other than menstrual bleeding,
should be reported to a doctor as soon as possible.
Sentinel lymph node biopsy is the removal of the sentinel lymph
node (the first lymph node the cancer is likely to spread to from the tumor)
during surgery. A radioactive substance and/or blue dye is injected near the
tumor. The substance or dye flows through the lymph ducts to the lymph nodes.
The first lymph node to receive the substance or dye is removed for biopsy.
A pathologist views the tissue under a microscope to look for cancer cells.
If cancer cells are not found, it may not be necessary to remove more lymph
nodes. After the sentinel lymph node biopsy, the surgeon removes the tumor
(breast-conserving surgery or mastectomy).
High-dose chemotherapy with bone marrow transplantation or peripheral
blood stem cell transplantation is a method of giving high doses of chemotherapy
and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature
blood cells) are removed from the blood or bone marrow of the patient or a
donor and are frozen and stored. After the chemotherapy is completed, the stored
stem cells are thawed and given back to the patient through an infusion. These
reinfused stem cells grow into (and restore) the body’s blood cells.
Studies have shown that high-dose chemotherapy followed by bone
marrow transplantation or peripheral blood stem cell transplantation does not
work better than standard chemotherapy in the treatment of breast cancer. Doctors
have decided that, for now, high-dose chemotherapy should be tested only in
clinical trials. Before taking part in such a trial, women should talk with
their doctors about the serious side effects, including death, that may be
caused by high-dose chemotherapy.
Return to top
Treatment of ductal carcinoma in situ (DCIS) may include the following:
- Breast-conserving surgery with or without radiation therapy or hormone
therapy.
- Total mastectomy with or without hormone therapy.
- Clinical trials testing breast-conserving surgery and hormone therapy
with or without radiation therapy.
Treatment of lobular carcinoma in situ (LCIS) may include the
following:
- Biopsy to diagnose the LCIS followed by regular examinations and regular
mammograms to find any changes as early as possible. This is referred to
as observation.
- Tamoxifen to reduce the risk of developing breast cancer.
- Bilateral prophylactic mastectomy. This treatment choice is sometimes
used in women who have a high risk of getting breast cancer. Most surgeons
believe that this is a more aggressive treatment than is needed.
- Clinical trials testing cancer prevention drugs.
Treatment of stage I, stage II, stage IIIA , and operable stage
IIIC breast cancer may include the following:
- Breast-conserving surgery to remove only the cancer and some surrounding
breast tissue, followed by lymph node dissection and radiation therapy.
- Modified radical mastectomy with or without breast reconstruction surgery.
- A clinical trial evaluating sentinel lymph node biopsy followed by surgery.
Adjuvant therapy (treatment given after surgery to increase the
chances of a cure) may include the following:
- Radiation therapy to the lymph nodes near the breast and to the chest
wall after a modified radical mastectomy.
- Systemic chemotherapy with or without hormone therapy.
- Hormone therapy.
Treatment of stage IIIB and inoperable stage IIIC
breast cancer may include the following:
- Systemic chemotherapy.
- Systemic chemotherapy followed by surgery (breast-conserving surgery or
total mastectomy), with lymph node dissection followed by radiation therapy.
Additional systemic therapy (chemotherapy, hormone therapy, or both) may
be given.
- Clinical trials testing new anticancer drugs, new drug combinations, and
new ways of giving treatment.
Treatment of stage IV or metastatic breast cancer
may include the following:
- Hormone therapy and/or chemotherapy with or without trastuzumab (Herceptin).
- Radiation therapy and/or surgery for relief of pain and other symptoms.
- Clinical trials testing new chemotherapy and/or hormone therapy. Clinical
trials are also studying new combinations of trastuzumab (Herceptin) with
anticancer drugs.
- Clinical trials testing other approaches, including high-dose chemotherapy
with bone marrow transplantation or peripheral blood stem cell transplantation.
Return to top
Treatment of inflammatory breast cancer may include the following:
- Systemic chemotherapy.
- Systemic chemotherapy followed by surgery (breast-conserving surgery or
total mastectomy), with lymph node dissection followed by radiation therapy.
Additional systemic therapy (chemotherapy, hormone therapy, or both) may
be given.
- Clinical trials testing new anticancer drugs, new drug combinations, and
new ways of giving treatment.
Return to top
Treatment of recurrent breast cancer (cancer that has come back
after treatment) in the breast or chest wall may include the following:
- Surgery (radical or modified radical mastectomy), radiation
therapy, or both.
- Systemic chemotherapy or hormone therapy.
Return to top
Abnormal Vaginal Bleeding
