Breast cancer types and stages 2023 : Stages 1 to 4 and types and treatment of breast cancer | by Dr lalit b.

        BREAST CARCINOMA

Breast cancer is the most common (30%) of all cancers 

and is the second (next to lung cancer) common cause 

of cancer deaths in women. One out of 8 obstetric-

gynecologic patients is likely to develop breast 

                  Tumor of breast 

carcinoma at sometime during her adult life in USA 

and Western countries.

Obstetricians-gynecologists examine millions of 

patients on a regular basis. As such, they are expected 

to evaluate breast problems with a breast oriented 

history, physical examination, cytology and imaging 

studies for to formulate the management

Screening for Breast Cancer: 

Breast 

carcinomas are generally without any symptoms to 

start with. Screening can detect breast cancer at an 

earlier stage. Ideally screening should 

be performed for all women from 40 years of age. 

Earlier detection improves the survival rate. Five-

year survival is about 85 percent when axillary lymph 

nodes are not involved.

            Types of breast cancer 

Screening and diagnostic methods include:

 1. Breast self examination.

 2. Clinical breast examination (CBE) by a physician

   -  Inspection    -  Palpation.

 3. Breast imaging

™ Screening mammography.

™ Diagnostic mammography.

™ Ultrasonography.

™ Magnetic resonance imaging (MRI).

™ Digital mammography, positron emission

tomography.

4. Breast biopsy

™ Fine needle aspiration biopsy (FNAB).

™ Stereotactic and ultrasound guided core

biopsy.

™ Open biopsy:

      - Excisional biopsy

      - Incisional biopsy.

Breast self examination (BSE)

Breast self examination should be made into a

habit, certainly by the age of 20. The examination

should be made on a monthly basis following the

menses as the breasts become less tender and less

engorged.

The procedures (as described above) are demon-

strated to the patient. Circular method of palpation

is easy to do. Inspection should be done standing in

front of a mirror in a well lit-room. The patient should

palpate her breasts with the opposite hand both in

sitting position and lying supine with a pillow beneath

her back. Axillary and supraclavicular areas are to

be palpated. The nipples should be compressed for

any discharge. She is instructed to contact physician

whenever there is any abnormal finding.

Clinical Breast Examinations (CBE)

Inspection 

Inspection is performed while the patient is

sitting with arms relaxed by her sides. Both the

breasts are observed for contour, symmetry, nipple

positions, and any skin changes. Patient is asked

to press her hands on her hips so as to contract the

pectoralis major muscles. Skin dimpling and nipple

retraction if any, may be obvious with this method.

             Signs of breast cancer 

Palpation 

Entire breast is palpated methodically by quadrant

with the pads of the fingers (most sensitive) both in

upright and in supine positions 

Generally, a malignant mass is felt firm, non-

tender, fixed with ill-defined borders. Entire axilla

and the supraclavicular areas are palpated for any

lymph nodes. Nipple is compressed for any discharge.

         Symptoms of breast cancer 

High risk factors for breast

carcinoma

• Early menarche • Late menopause

• Obesity • Nulliparity

• Late age of first birth (>35 years)

• Never breastfed

• Atypical lobular hyperplasia

• Nipple discharge other than milk

• High dose breast or chest irradiation

• High dietary fat intake • Alcohol consumption

• Estrogen replacement therapy

• Breast carcinoma in first degree relative

(Mother, sister or daughter)

• Carcinoma in the other breast

• Previous cancer of endometrium, ovary, colon

• Inherited mutations of BRCA1 and BRCA 2 genes

Genetic predisposition—is high when there is

mutation of the BRCA 1 (on chromosome 17 q) and/

or BRCA 2 (on chromosome 13 q) genes. BRCA 1 and

BRCA 2 are the tumor suppressor genes. Hereditary

breast cancer is seen in younger women and is often

bilateral. Around 5% of breast cancers are familial.

Breast cancer screening guidelines

(ACOG-2000)

1. Age 20–39

      - BSE monthly 

      - CBE yearly 

2. Age 40-49

        - BSE monthly 

        - CBE yearly 

        - MGY—every 1–2 yrs.

3. Age 50

        - BSE monthly 

        - CBE yearly 

        - MGY yearly

Breast Imaging

1. Mammography (MGY) 

2. Digital mammography (DM) 

3. Ultrasonography

4. MRI

5. PET

6. Fine-needle aspiration cytology (FNAC) 

7. Core Needle Biopsy (CNB)

8. Triple test includes

9. Open biopsy 

            Stages of breast cancer 

Staging of Breast Cancer: 

Breast cancer is

staged clinically according to tumor size, regional

lymph node involvement and distant metastasis

 American Joint Committee on

Cancer Staging (2003) reclassified the nodal status

by number of involved lymph nodes, use of sentinal

lymph node biopsy. Complete staging includes a

thorough history, physical examination, bilateral

mammography, pretreatment chest radiography,

routine blood values, pathology slides with estrogen

receptor, progesterone receptor and HER 2 status

along with breast MRI.

Staging helps to compare the results of trials

throughout the world. This is also helpful to develop

uniform treatment regimens.

For staging of breast cancer readers should consult

any textbook of surgery.

~ Thank you for reading ......