Breast Cancer

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WHAT IS BREAST CANCER?

Breast cancer is a disease in which cells in the breast grow out of control. Breast cancer can begin in different parts of the breast and can spread outside the breast through blood vessels and lymph vessels. When breast cancer spreads to other parts of the body, it is said to have metastasized.

In Malaysia, it is the most common form of cancer affecting women with about one in 19 women in this country. (National Cancer Registry 2007-2011).

Breast cancer happens when the cells in the lobules (milk-producing glands) or the ducts become abnormal and divide overwhelmingly. These abnormal cells begin to attack the surrounding breast tissue and may eventually spread via blood vessels and lymphatic channels to the lymph nodes, lungs, bones, brain and liver.

There are different types of breast cancer. The most common type of breast cancer is:

Ductal carcinoma – (commonest) The cancer cells grow outside the ducts into other parts of the breast tissue.
Lobular carcinoma – Cancer cells spread from the lobules to the breast tissues that are close by.

The most common symptom of breast cancer is a new lump. It is crucial to have any new breast lump or breast changes checked by a doctor experienced in diagnosing breast diseases.

Other possible symptoms of breast cancer include:

Dimpled or Dressed Skin
Visible Lump
Nipple Change
Bloody Discharge
Texture Change
Colour Change

The exact cause of breast cancer is unknown. Women with a family history of the disease have an increased risk of getting breast cancer. Carriers of the BRCA I and BRCA II genes, especially, have at least a 40% to 85% risk of getting breast cancer respectively.

Other risk factors include:

Exposure to radiation
A history of benign breast lumps
Obesity
High-fat diet
Early menarche
Late menopause
A long duration of oral contraceptive pills/hormonal contraception usage

Type of Breast Cancer

There are different types of breast cancer. The most common type of breast cancer is:

Ductal carcinoma – (commonest) The cancer cells grow outside the ducts into other parts of the breast tissue.
Lobular carcinoma – Cancer cells spread from the lobules to the breast tissues that are close by.

Symptoms

The most common symptom of breast cancer is a new lump. It is crucial to have any new breast lump or breast changes checked by a doctor experienced in diagnosing breast diseases.

Other possible symptoms of breast cancer include:

Dimpled or Dressed Skin
Visible Lump
Nipple Change
Bloody Discharge
Texture Change
Colour Change

Factors

Other risk factors include:

Exposure to radiation
A history of benign breast lumps
Obesity
High-fat diet
Early menarche
Late menopause
A long duration of oral contraceptive pills/hormonal contraception usage

BREAST CANCER DIAGNOSIS

Various tests can be used to diagnose breast cancer. If the doctor finds an area of concern on a screening test (a mammogram/ ultrasound scan), or if you have symptoms that could mean breast cancer, you will require more tests to identify for sure if it’s cancer.

Mammogram

A mammogram can detect small lumps that may be missed in a clinical examination. A diagnostic mammogram can help determine if these symptoms are indicative of the presence of cancer. Such signs may include:

A lump
Nipple discharge
Thickening of the skin on the breast

Biopsy

A breast biopsy is a test that extracts tissue or sometimes fluid from the suspicious area. The removed cells are examined under a microscope and tested further to check for the presence of breast cancer. This is needed for confirming breast cancer.

There are three types of biopsies:

Surgical biopsy
Core-needle biopsy
Fine-needle aspiration

Ultrasound

A breast ultrasound is a scan that uses penetrating sound waves to make detailed pictures of the areas inside the breast tissues. It may be more useful in younger patients with dense breast tissue and can be used as in complement with a mammogram.

Magnetic resonance imaging (MRI) of breasts

BREAST CANCER STAGING

Stage	Sites
0	Abnormal cells in an area of the body and may develop into cancer in the future, also known as Carcinoma in situ (CIS).
I	Cancer is relatively small and contained within the breast.
II	Cancer has not spread into surrounding tissues but cancer cells may have spread into lymph nodes close to the tumour.
III	Cancer may have spread to surrounding tissues (skin, muscle) and lymph nodes in the area.
V	Cancer has spread from where it started to another organ. This is also known as secondary or metastatic cancer.

BREAST CANCER TREATMENT

Treatment options for breast cancer are usually discussed with a breast surgeon or an oncologist (cancer specialist). Breast cancer can be treated in a few ways. It depends on the type of breast cancer and how far it has spread. Individuals with breast cancer often get more than one type of treatment.

Among the treatment for breast cancer are:

Immunotherapy

is a form of cancer treatment that uses or helps your immune system to fight cancer. It is a type of biological therapy and this type of treatment uses substances made from living organisms to treat cancer.

Targeted therapy

Drugs for breast cancer work by attaching themselves to proteins such as HER2 protein, either to stop the cancer cells from growing or to attach to the protein on cancer cells to bring the chemotherapy drugs directly to them. Targeted therapy drugs work differently from standard chemotherapy drugs and often have different targeted effects.

Breast Surgery

A surgery in which only the part of the breast containing the cancer is removed. The treatment involves the removal of cancer as well as some surrounding normal tissue

Lumpectomy – Lumpectomy is an extraction of a breast lump with an encompassing edge of normal breast tissue. Lumpectomy is recommended to remove smaller tumors.
Mastectomy – A surgery in which the entire breast is removed, including all of the breast tissue and sometimes other nearby tissues. (Breast Reconstructive surgeries can be done by a plastic surgeon to create a breast shape using an artificial implant, a flap of tissue from another place on your body, or both.)
Sentinel Node Biopsy – A procedure involving the removal of sentinel lymph nodes, which are the first to be drained by the tumour. These lymph nodes will be removed and analysed in a lab. If these nodes are free of cancer, the cancer is unlikely to have spread and other nodes do not need to be removed.
Axillary Lymph Node Dissection – If cancer is present in the sentinel lymph nodes, then the removal of additional lymph nodes will need to be done. Axillary Lymph Node Dissection can be done at the same time as the surgery for your breast cancer.

Chemotherapy

Is a treatment option that involves the use of drugs given by injection or, occasionally, orally to prevent the cancer cells’ ability from dividing and reproduce. Chemotherapy treats cancer by penetrating the tissues and organs via the bloodstream. Chemotherapy drugs are toxic to the cancer cells but they may also cause some side effects to the normal tissues. Chemotherapy is useful to shrink down the tumour when the breast tumour is too large for upfront surgery, a term we call “neoadjuvant chemotherapy”, until the tumour is small enough for optimal surgical resection. Moreover, chemotherapy can be used when cancer has spread to other parts of the body. Chemotherapy can be used in combination with other treatments such as radiotherapy and immunotherapy.

Type of chemo drugs:

Alkylating agent is a type of chemo drug that is capable of damaging the DNA of a cancer cell to ensure that the cell doesn’t make more copies of them.
Topoisomerase inhibitor is a compound that can block the human enzymes that contribute to the growth of cancer cells.
Antitumor antibiotic is an anticancer drug that is capable of slowing down or stop the growth of cancer cells.
Antimetabolites is a chemo drug that is capable of interfering with more than one enzyme that’s necessary for the growth of DNA inside the cancer cell.
Mitotic inhibitor is a type of chemo drug that is capable of stopping the body from producing the protein which contributes to cancer cell growth.
Corticosteroids is man-made steroids used to help reduce the side effects of chemotherapy.

At Beacon Hospital, we understand that chemotherapy treatment can be a major financial burden for the financially-challenged patients. Hence, we have introduced the Beacon Chemotherapy Welfare Fund for breast cancer patients.

Radiotherapy

Radiotherapy is often combined with breast surgery, to enhance treatment. It uses high doses of radiation to kill cancer cells. This is a localized form of treatment and is mandatory after conservative surgical treatment. It is given after a lumpectomy or mastectomy if the breast tumour is locally extensive. Radiotherapy reduces the risk of local recurrence.

The main type of radiotherapy used to treat breast cancer is called External Beam Radiation Therapy (EBRT), which is usually delivered by a machine called a linear accelerator that focuses high-energy X-rays from the outside of the body to the tumour. External Beam Radiation Therapy is the most common procedure after surgery, regardless of whether a lumpectomy or a mastectomy is selected during treatment.

Halcyon Radiotherapy System

Halcyon Radiotherapy System at Beacon Hospital enables:

Fast and precise X-ray dose delivered to each tumour with high accuracy over a minimum number of treatment sessions
Reduces unwanted radiation dose, thus, minimising side effects

At Beacon Hospital’s Cancer Centre, treatment may comprise a number of healthcare professionals depending on the type of treatment. We adopt a multidisciplinary approach which includes a clinical oncologist, medical oncologist, radiologist, neurologist, neurosurgeon, cancer nurses, as well as other allied health professionals such as dietitian and physiotherapists.

TrueBeam 2.7 Radiosurgery/Radiotherapy System

TrueBeam 2.7 Radiosurgery/Radiotherapy System at Beacon Hospital offers:

HyperArc™ High-Definition Radiotherapy and Radiosurgery

HyperArc™ high-definition Radiotherapy system represents a significant step forward for high quality Linac-based Radiosurgery, with an easy delivery of non-coplanar Stereotactic Radiosurgery (SRS) treatments. HyperArc™ could irradiate multiple tumours at the same time without repositioning the patient, which provides better management of patient motions while saving time for the patient and the clinical team. HyperArc™ ensures the planners achieve extremely compact dose distributions consistently and efficiently while maintaining patient safety.

BREAST CANCER PROGNOSIS

Breast cancer is potentially curable if detected early. Clinical or self-examination combined with screening mammography can detect the disease early. With appropriate treatment, cure rates are encouraging. Even in the palliative setting, many drugs and treatments can improve survival and provide a better quality of life.