Breast Cancer Treatment
The breast is composed of lobes and ducts. Each breast has about 15 to 20 lobes. Each lobe contains several smaller sections called lobules. The lobules end in dozens of tiny sacs that can produce milk. The lobes, lobules, and sacs are connected by thin tubes called ducts. Each breast also contains blood vessels and lymphatic vessels. There are groups of lymph nodes located near the breast in the armpit, above the collarbone, and in the chest.
How does breast cancer start?
Breast cancer starts when cells in the breast, such as those lining the ducts and lobules, begin to grow abnormally. These cells can grow uncontrollably and invade surrounding tissues. If cancerous cells continue to grow, they may spread beyond the breast to other parts of the body, which can be life-threatening.Does breast cancer appear suddenly?
Like many types of cancer, breast cancer grows through simple cell division. It starts as a single malignant cell, which then divides into two cells, again into four malignant cells, and so on. Breast cancer must divide 30 times before it can be felt. Even by the twenty-eighth division, it cannot be detected manually.In most cases of breast cancer, each division takes about one to two months. Therefore, by the time a cancerous lump becomes apparent, the cancer may have been present in the body for between two to five years.
What does a breast with breast cancer look like?
The breast may show a lump or change in the breast tissue, a change in the skin texture of the breast making it look dimpled or like an orange peel, and changes in the nipple such as discharge, inversion, alteration in direction, or the presence of sores or peeling skin.Causes of breast cancer in women:
• Personal history of breast cancer.• Personal history of benign (non-cancerous) breast disease.
• Family history of breast cancer in first-degree relatives (mother, daughter, or sister).
• Inherited changes in BRCA1 or BRCA2 genes, or other genes, increase the risk of developing breast cancer. Hereditary breast cancer accounts for about 5% to 10% of all breast cancer cases.
• High breast tissue density due to fibroglandular tissue provides an ideal environment for cancer, and this density also hinders the early detection of cancerous cells.
• Breast tissue exposure to estrogen, which is produced by the body due to:
o Starting menstruation at an early age.
o Older age at the time of the first childbirth or never having given birth.
o Starting menopause at a later age.
• Taking hormones such as estrogen with progestin for menopause symptoms.
• Radiation therapy to the breast or chest.
• Drinking alcohol.
• Obesity.
• Aging is a major risk factor for most cancers.
Stages of breast cancer:
The TNM system is used to describe the size of the primary tumor and the spread of cancer to nearby lymph nodes or other parts of the body.• Tumor (T): Size and location of the tumor.
• Lymph nodes (N): Size and location of the lymph nodes where the cancer has spread.
• Malignant (M): The spread of cancer to other parts of the body.
There are five stages of breast cancer, ranging from zero to four, denoted by the numbers 0, I, II, III, and IV. As the number increases, the extent of cancer spread also increases.
Stage 0: The disease is only present in the ducts or lobules of the breast and has not spread to the surrounding tissue. Therefore, it is the easiest type of breast cancer to treat.
Stage I: Cancer cells are now present in the natural breast tissue. There are two types:
• Stage IA: The tumor in the breast is small and has not spread to the lymph nodes. (T1, N0, M0)
• Stage IB: The cancer is found in the lymph nodes and may also be present in the breast tissue. The tumor size is less than 2 cm.
Stage II: It is classified into two types:
• Stage IIA: may not have a detectable breast tumor, or there may be a tumor that is 2 cm or smaller in size, but cancer cells have spread to at least 1 to 3 nearby lymph nodes. Alternatively, stage IIA may present with a tumor size of 2 to 5 cm in the breast without spreading to the axillary lymph nodes.
• Stage IIB: The tumor size is between 2 and 5 cm and has spread to 1 to 3 lymph nodes under the arm, or the tumor is larger than 5 cm but has not spread to the lymph nodes.
Stage III: It is classified into three types:
• Stage IIIA: The tumor can be of any size and has spread to 4 to 9 lymph nodes, or the growth is larger than 5 cm and has spread to only 1 to 3 lymph nodes.
• Stage IIIB: The tumor can be of any size, and the disease has spread to the chest wall. It may cause breast swelling and can involve up to 9 lymph nodes. Inflammatory breast cancer is classified as stage IIIB.
Inflammatory breast cancer is characterized by the blockage of lymphatic vessels in the skin of the breast by cancer cells, resulting in a red and swollen appearance. The skin may also appear dimpled or puckered, resembling the skin of an orange, and the nipple may be inverted (turned inward).
• Stage IIIC: The tumor may be of any size and has spread to 10 or more lymph nodes.
Stage IV (metastatic): The tumor can be of any size, and the cancer has spread to other organs and tissues, such as the bones, lungs, brain, liver, distant lymph nodes, or the chest wall. This represents the most advanced and serious stage of breast cancer.
What are the symptoms of breast cancer?
The first signs of breast cancer are often the appearance of a lump in the breast or under the armpit. Therefore, these are among the most important early symptoms of breast cancer.1- Symptoms of breast cancer in women:
These signs and others may be caused by breast cancer or other conditions. Consult the specialists at Warith International Cancer Institute (WICI) in Iraq if there are symptoms of breast cancer, which are as follows:• A lump in the breast or under the arm.
• Changes in the size or shape of the breast.
• The appearance of a dimple or wrinkle in the skin of the breast.
• The nipple turns inward into the breast.
• Discharge from the nipple that is not breast milk, especially if it is blood-stained.
• Scaly, red, or swollen skin on the breast, nipple, or areola.
• Dimples in the breast resembling the skin of an orange.
2- Symptoms of metastatic breast cancer:
Metastatic breast cancer, classified as stage IV breast cancer, is a form of advanced breast cancer where cancer cells have spread beyond the breast. Therefore, it is the most serious type of breast cancer. The symptoms of metastatic breast cancer depend on where the cancer has spread. Common organs and symptoms include the following:• Symptoms of breast cancer metastasis to the bones: This can include severe new pain in the bones that gradually becomes constant. Bone metastases can also cause fractures.
• Symptoms of breast cancer metastasis to the brain: Signs can include headaches, nausea, facial numbness, and changes in speech, vision, or balance.
• Symptoms of breast cancer metastases to the liver: Liver metastases rarely produce symptoms. When they occur, symptoms can include pain in the right side of the abdomen, weakness, poor appetite, and yellowing of the eyes and skin.
• Symptoms of breast cancer metastases to the lungs: Signs of lung metastases include chest pain, shortness of breath, and persistent coughing.
3- Breast cancer pain:
Many may wonder what breast cancer pain feels like. Although malignant breast cancer symptoms do not typically include pain in the breast or nipple, some cases may involve pain if the tumor grows large enough to be felt like a hard mass in the breast tissue.What are the symptoms of benign breast tumors?
Some benign breast changes may cause signs or symptoms (such as breast lumps, pain, or nipple discharge), while others may be found on a mammogram. Either way, it can be difficult to distinguish them from malignant breast cancer, so other scans or tests are necessary to confirm the diagnosis.How to detect breast cancer:
• Clinical breast exam: Examination of both breasts and under the armpits for lumps or any other unusual findings.• Genetic testing or BRCA testing: Genetic testing is one of the key assessments for breast cancer, as it reveals the likelihood of developing breast cancer in the future.
• Mammography: X-ray imaging of the breast, where the breast is compressed between two plates. X-rays are used to capture images of breast tissue. A mammogram does not cause cancer but helps to detect the disease.
• Ultrasound: An imaging procedure that relies on high-energy sound waves (ultrasound) bouncing off tissues or internal organs, creating echoes.
• Magnetic Resonance Imaging (MRI): A procedure that uses magnets, radio waves, and a computer to create a series of detailed images of both breasts. A contrast dye may be injected into a vein to enhance the visibility of breast tissue.
• Blood sample test: A procedure in which certain substances released into the blood by organs and tissues in the body are measured. Abnormal levels can indicate disease.
• Biopsy: Removal of cells or tissue so that a pathologist can examine them under a microscope for signs of cancer. If a lump is found in the breast, a biopsy may be performed.
Types of breast cancer:
Decisions regarding the best treatment are based on the results of certain tests that determine the type of breast cancer. These tests include:• Estrogen and progesterone receptor testing: A test to measure the amount of estrogen and progesterone receptors in cancerous tissue. If estrogen and progesterone receptors are higher than normal, the cancer is called estrogen and/or progesterone receptor-positive. This type of breast cancer may grow faster. The test results indicate whether hormone therapy to block estrogen and progesterone may help stop the cancer's growth.
• HER2/neu testing: A laboratory test to measure the number of HER2/neu genes present and the amount of HER2/neu protein produced in a tissue sample. If there is a higher-than-normal amount of either, the cancer is called HER2/neu positive or HER2 positive. This type of breast cancer tends to grow and spread more aggressively. The cancer can be treated with drugs that target the HER2/neu protein.
• Multigene panel testing: Tests that examine tissue samples to assess the activity of multiple genes simultaneously. These tests may help predict whether the cancer will spread to other parts of the body or recur.
Based on these tests, breast cancer types are categorized as follows:
• Hormone receptor-positive or hormone receptor-negative.
• HER2-positive or HER2-negative.
• Triple-negative (estrogen receptor-negative, progesterone receptor-negative, and HER2-negative).
This information helps the medical team at the leading breast cancer treatment Institute in Iraq to determine the most effective treatments for breast cancer.
Breast cancer survival rate:
Certain factors affect breast cancer survival rates and treatment options, including:• Stage of cancer (tumor size and whether it is confined to the breast or has spread to the lymph nodes or other parts of the body).
• Type of breast cancer.
• Levels of estrogen and progesterone receptors in the tumor tissue.
• Levels of HER2/neu receptor in the tumor tissue.
• Whether the tumor tissue is triple-negative (cells that lack estrogen receptors, progesterone receptors, and high levels of HER2/neu).
• Rate of tumor growth.
• Likelihood of the tumor recurring and returning.
• The woman's age, overall health, and menopausal status.
• Whether the breast cancer is a first diagnosis or a recurrence.
Screenings to determine the extent of cancer cell spread within and beyond the breast:
• Sentinel lymph node biopsy: The sentinel lymph node is the first lymph node in a group that receives lymphatic drainage from the primary tumor. It is the first lymph node to which cancer is likely to spread from the primary tumor. After the sentinel lymph node is removed during surgery, a pathologist examines the tissue under a microscope for cancer cells. If no cancer cells are found, it may not be necessary to remove additional lymph nodes.• Chest X-ray: An imaging procedure used to examine the organs and bones within the chest.
• Computed Tomography (CT scan): A procedure that provides a series of detailed images of the breast, taken from different angles.
• Bone scan: A procedure used to check for rapidly dividing cells, such as cancer cells, in the bones by injecting a small amount of radioactive material into a vein. The radioactive substance travels through the bloodstream and accumulates in cancerous bones, where it is detected by a scanner.
• PET scan: A procedure used to locate cancer cells in the body. A small amount of radioactive glucose is injected into a vein. The PET scanner rotates around the body and captures images of where the glucose is used. Cancer cells appear brighter in the scan because they are more active and consume more glucose than normal cells.
Methods for treating breast cancer in Iraq:
The team at Warith International Cancer Institute (WICI), the leading cancer treatment Institute in Iraq, works to care for breast cancer patients by developing a personalized treatment plan for each case, which may include more than one type of treatment. Several factors are considered, such as the stage and grade of the cancer, the presence of specific biomarkers, overall health, and patient preferences. The treatment plan also ensures that the patient is educated about breast cancer, treatment goals, available options, potential side effects, and the expected duration of treatment.1- Surgical treatment for breast cancer:
Most breast cancer patients undergo surgery to remove the cancer. Surgery is a key method for treating stage I breast cancer, and the types of surgery include:• Partial mastectomy or breast-conserving surgery is a procedure that involves removing the cancer and some of the surrounding healthy tissue, but not the entire breast. Some of the lymph nodes under the arm may be removed, and part of the chest wall lining may also be removed if the cancer is close to it.
• A total mastectomy is a surgical procedure to remove the entire breast affected by cancer. Some of the lymph nodes under the arm may also be removed.
• The modified radical mastectomy involves the complete removal of the breast affected by cancer. This may include the removal of the nipple, areola, and skin over the breast, along with most of the lymph nodes located under the arm.
Chemotherapy can be given before tumor removal surgery to shrink the tumor and reduce the amount of tissue that needs to be removed during the surgery.
After the doctor removes all visible cancer during the surgery, some patients may receive radiation therapy, chemotherapy, targeted therapy, or hormone therapy after the surgery to kill any remaining cancer cells.
2- Radiation therapy for breast cancer:
Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or prevent them from growing. There are two types of radiation therapy:• External beam radiation therapy uses a machine to direct radiation toward the area of the body affected by cancer.
• Internal radiation therapy uses a sealed radioactive material in needles, wires, or catheters that are placed directly inside or near the cancer.
3- Chemotherapy for breast cancer:
Chemotherapy for breast cancer uses medications to stop the growth of cancer cells, either by killing the cells or preventing them from dividing. The staff at Warith International Institute, the best cancer treatment hospital in Iraq, determines the types of chemotherapy for breast cancer. Chemotherapy for breast cancer is usually administered intravenously or taken orally. When given this way, the medications enter the bloodstream to reach cancer cells.4- Hormonal therapy for breast cancer:
Some hormones can promote the growth of certain types of cancer. Therefore, hormonal therapy slows or stops the growth of hormone-sensitive tumors by either preventing the body from producing hormones or by interfering with the effects of hormones on breast cancer cells.5- Biological therapy or targeted therapy for breast cancer:
Targeted therapy uses drugs or other substances to identify and attack specific cancer cells. Within the best cancer treatment institution in Iraq, biomarker tests are conducted to help predict how well certain targeted therapy drugs will work. Several types of targeted therapy are used to treat breast cancer, including the following:• Laboratory-produced immune system proteins are used to treat cancer. These antibodies can bind to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies can kill cancer cells, inhibit their growth, or prevent them from spreading.
• Inhibitors that block signals necessary for tumor growth. These inhibitors can be used alongside other cancer-fighting drugs as an adjunct treatment.
• Inhibitors that block proteins responsible for the growth of cancer cells. These inhibitors can be administered alongside hormonal therapy to treat hormone receptor-positive breast cancer.
• Inhibitors that prevent cancer cells from growing and block the formation of new blood vessels needed for tumor growth. These inhibitors are used to treat HER2-negative breast cancer that is hormone receptor-positive.
• Inhibitors that prevent DNA repair and may cause cancer cell death. These inhibitors treat HER2-negative breast cancer with mutations in the BRCA1 or BRCA2 genes.
6- Immunotherapy for breast cancer:
Immunotherapy helps the patient's immune system fight breast cancer. Doctors at Warith International Cancer Institute may suggest biomarker tests to help predict the response to certain immunotherapy drugs.Breast cancer treatment side effects:
Some breast cancer treatments may cause side effects that persist or appear months or years after the treatment has ended.The side effects of breast radiation therapy are not common, but they may include:
• Pneumonitis after breast radiation therapy, especially when chemotherapy is administered simultaneously.• Lymphedema in the arm is a temporary swelling caused by the accumulation of lymph fluid.
• An increased risk of developing breast cancer in the other breast for women under 45 years old who have received radiation therapy to the chest wall after a mastectomy.
The late effects of chemotherapy depend on the medications used, but they may include:
• Cardiac arrest.• Blood clots.
• Early menopause.
• Second cancer, such as leukemia.
Symptoms of biological therapy for breast cancer:
• Heart problems, such as heart failure.Side effects of hormonal therapy for breast cancer:
The side effects of hormonal therapy that either inhibit the production of estrogen or block hormones from affecting cancer cells can range from joint and bone pain, and hot flashes, to feelings of fatigue and weakness.Breast cancer treatment without chemotherapy:
Some women with breast cancer may not need chemotherapy, especially if the breast tumor has not spread to other parts of the body. In these cases, surgery and other treatments, such as radiation therapy or hormone therapy, may be sufficient to remove all cancerous cells.How long does breast cancer treatment take?
Breast cancer treatment can take between 3 to 12 months to complete, followed by follow-up periods determined by the best breast cancer specialists in Iraq.Some tests performed to diagnose or stage the cancer may be repeated to assess the effectiveness of the treatment. Decisions about the stages of breast cancer treatment, including whether to continue, change, or stop the treatment, may be based on the results of these tests.
Breast cancer prevention:
1- Reproductive history helps reduce exposure to estrogen hormone:
A woman's reproductive history affects the length of time breast tissue is exposed to estrogen. Early onset of menstruation, late onset of menopause, having a late age at first childbirth, and never giving birth have been associated with increased estrogen exposure and a higher risk of breast cancer. Reproductive factors such as early pregnancy and breastfeeding reduce the duration that breast tissue is exposed to estrogen, which may help in preventing breast cancer.2- Preventive mastectomy:
Some women who are at high risk of developing breast cancer may choose to undergo a mastectomy to reduce their risk. After the surgery, these women have a significantly lower risk of developing breast cancer and most feel much less anxious about the risk of breast cancer. Some women with breast cancer may choose to remove a healthy breast at the same time as the cancerous breast is removed. This is called contralateral prophylactic mastectomy. The best cancer treatment institution in Iraq ensures that a cancer risk assessment is conducted and provides counseling on various ways to prevent breast cancer before any decision is made regarding surgery.3- Oophorectomy:
The ovaries produce most of the estrogen in the body. Treatments that stop or reduce the amount of estrogen produced by the ovaries include surgery to remove the ovaries, radiation therapy, or taking certain medications. These methods decrease the amount of estrogen in the body and reduce the risk of breast cancer.4- Exercising regularly:
Women who engage in physical exercise have a lower risk of developing breast cancer.Early detection of breast cancer:
Early screening for breast cancer is the best way to protect yourself from the disease. Warith International Cancer Institute (WICI) is the best places for early breast cancer detection in Iraq, offering free screening campaigns funded by the Imam Hussain Holy Shrine. While early detection does not prevent cancer, it can help identify it earlier when treatment is easier and less invasive.1- Breast self-examination: It is important to perform regular self-checks to detect any changes immediately. Be sure to examine all areas of the breasts, including the armpits and the collarbone. Perform the examination once a month, about a week after the menstrual period, and start doing this at age twenty.
2- Clinical breast examination: Female physicians at the Warith International Cancer Institute (WICI) examine both breasts and the lymph nodes in the armpits. This examination is recommended every 3 years between the ages of 20 and 30, and annually after age 40. The best cancer hospital in Iraq offers free breast cancer screening.
3- Breast mammography: A mammogram is a very precise device that can detect abnormalities and calcifications, no matter how small, which can be indicators of early-stage cancer. It is performed after age 40 and for women with a history of cancer, regardless of their age. Global reports confirm that mammography and breastfeeding do not conflict with the goals of screening and diagnosis, as it is safe during pregnancy and breastfeeding.
4- Ultrasound examination: This test is applied to women from age 20 up to 40.
The choice of the appropriate device depends on age and other factors. In any case, early detection is the most important step, as the cure rate for breast cancer in its early stages is 99%.
Is breast cancer fatal?
If left untreated, breast cancer can spread throughout the body and become fatal. Therefore, untreated breast cancer carries a higher risk of death compared to cases that receive treatment. It is important to undergo breast cancer treatment at the best cancer treatment institution in Iraq, which values the importance of psychological support for patients.Other conditions that may affect the breast:
The difference between fibrocystic breasts and breast cancer:
Many breast lumps are benign (non-cancerous) changes in breast tissue, known as fibrocystic breast changes. These are a natural result for many women due to hormonal fluctuations or severe breast inflammation. They are more common in women of reproductive age but can affect women of any age.Benign intramammary lymph nodes (IMLN):
Lymph nodes are an important component of the immune system, helping to combat infections and housing white blood cells that play a crucial role in immune defense. However, lymph nodes in the breast may sometimes become inflamed. Symptoms of benign intramammary lymph nodes in the breast include pain in the lymph nodes and swelling of them.Breast cancer in men:
Breast cancer is rare in men, but it can occur. Risk factors for breast cancer in men include advanced age, genetic mutations, family history of breast cancer, treatment with radiation therapy, hormone therapy, certain conditions and diseases associated with the testicles and liver, and obesity.Symptoms of breast cancer in men:
• A lump or swelling in the breast.• Redness or peeling of the skin on the breast.
• Irritation or dimpling of the breast skin.
• Discharge from the nipple.
• Nipple retraction or pain in the nipple area.
It is advisable to consult the best cancer specialists at Warith International Cancer Institute (WICI) in Karbala if you experience similar symptoms or changes in the breast. The appropriate treatment for breast cancer in men depends on the size and spread of the tumor and may include surgery, chemotherapy, radiation therapy, hormone therapy, and targeted therapy, like the treatments for breast cancer in women.