Breast Cancer

Breast Cancer: This disorder ranks second only to lung cancer as the leading cause of cancer death in women ages 35 to 54.  It also occur in men though very rare.  With the advance treatment and care for breast cancer, the 5 year survival rate for localized  breast cancer has improved from 78% in 1940 to 90% today; if the cancer has spread, the rate is 60%.

Cause:  The exact cause of breast cancer in unknown.  Risk factors include a family history of breast cancer, early onset of menses or late onset of menopause, endometrial or ovarian cancer, long menstrual cycles, and first pregnancy after age 35.

Other predisposing factors includes, radiation, estrogen therapy, diet, stress or unusual disturbances in home or work life, hair dyes, and fibrocystic disease of the breast.

Symptoms:

Positive Self Examination

Lump or mass in the breast ( a hard, stony mass is usually malignant)

Change in breast symmetry or size

Change in breast skin such as thickening, dimpling, edema, or ulceration.

Change in nipples, such as itching, burning, erosion, or retraction

Change in temperature - warm, hot, or pink area

Discharge of any kind (produce by breast manipulation such as greenish black, white, creamy, serous, or bloody) - non-lactating woman

Pain (but does not necessary mean breast cancer)

Pathologic bone fractures, hypercalcemia.

Treatment:

Breast cancer treatment are controversial;  therapy should consider the stage of the disease the woman's age, and menopausal status, and the disfiguring effects of the surgery.

Surgery:  Lumpectomy (excision of the tumor)  Irradiation is often combined with this surgery.  Lumpectomy also provides biopsy material to determine tumor cell type. (usually done as an outpatient basis)

In a two stage procedure, the surgeon removes the lump and confirms malignancy.  The surgeon will discuss treatment options with the patients.

In lumpectomy and dissection of the axillary lymph nodes, the tumor and the axillary lymph nodes are removed, leaving the breast intact.

A simple mastectomy removes the breast but not the lymph nodes or pectoral muscles.

Modified radical mastectomy removes the breast and the axillary lymph nodes.

Radical mastectomy removes the breast, pectoralis major and minor muscles, and the axillary lymph nodes.

Postmastectomy, reconstructive surgery can create a breast mound if the patient desires it and if the patients does not show evidence of advanced disease.

Additional surgery to modify hormone production may include oophorectomy, adrenalectomy, and hypophysectomy (with the last of these two procedure the patients must take daily cortisone supplements for the rest of her life.)

Chemotherapy:  Various cytotoxic drug combinations may be used, either as adjuvant therapy (in patients with axillary lymph node involvement but with no evidence of distant metastasis) or as primary therapy (when metastasis has occurred), depending on a number of factors, including the patient's premenopausal or postmenopausal status.

Radiation therapy:  Primary radiation therapy after tumor removal is effective for small tumors in early stages with no evidence of distant metastasis.

Other methods used: Estrogen, progesterone, or androgen therapy.
Anti androgen therapy with aminoglutethimide
Anti estrogen therapy  - Such as Tamoxifen, used in postmenopausal women, most effectively combats estrogen receptor positive tumors.  These newer drug therapies, along with growing evidence that breast cancer is a systemic, not local, disease, has caused a decline in ablative surgery.

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