Introduction to Breast Cancer: Breast Cancer by Type
When first diagnosed, it is important to remember that breast cancer is not just one type of cancer. No two types are the same and no two women are the same. You cannot compare your diagnosis to someone else's prognosis. Just because two women have the same disease does not mean that their outcome will be the same.
It is vital that you learn as much as you can about your particular cancer. The more you know, the better patient you are because you become a partner in your health care decisions with your doctor. Don't be afraid to ask questions, and don't leave until you are satisfied with the answers you get.
Ductal Cancer In Situ
Ductal Carcinoma In Situ (DCIS) is cancer at its beginning. The cells have mutated and divided and begun to proliferate but they have remained inside the milk duct.
DCIS is sometimes called a pre-cancer. It can often be cured with a mastectomy alone. Some women have DCIS in only one quadrant of the breast, “multi-focal”, and can have a lumpectomy and radiation. Others have it in more than one quadrant, “multi-centric” and then the only choice is mastectomy.
Now that women are getting their mammograms earlier and more regularly, they are getting their cancers diagnosed at the earliest stage possible. The more this happens, the closer we are to saving women from the more advanced invasive or infiltrating cancers. The rate of DCIS has not increased but the number of women who have found their cancer while it was still small has. That is why early detection is so very important.
Lobular Carcinoma In Situ
Lobular Carcinoma In Situ (LCIS) is cancer that is confined to the milk lobule. The cells could sit dormant for a woman’s lifetime, because of this it also referred to as a “neoplasm” or pre- malignancy.
This makes treating it a challenge. Unlike Ductal Cancer In Situ, a diagnosis of LCIS means that you have other treatment choices that range from close watching to prophylactic mastectomy. This is one for you and your physician to thoroughly investigate.
Infiltrating or Invasive Ductal Carcinoma (IDC)
Infiltrating or Invasive Ductal Carcinoma (IDC) makes up the majority of breast cancers being diagnosed. It is a cancer that has broken through the milk duct membrane and grown to become a lump or tumor and is now invading or infiltrating healthy breast tissue.
When a pathologist examines it later, he will be able to measure how fast it grew and how aggressive it was by how many of the cells are dead, (necrosis), how many new cells are created (mitosis) and what role the DNA played in this cycle. From this information you and your doctor can decide on what treatment plan is best for you.
Infiltrating or Invasive Lobular Carcinoma (ILC)
Less than 15% of breast cancers originate in the milk lobule. This means that it occurs in the actual lobules that produce milk. Infiltrating Lobular Carcinoma (ILC) is a lobular cancer that has broken outside of the lobule. ILC has a propensity to occur not only in the opposite breast, but in other quadrants of the same breast.
Invasive lobular is hard to detect because rather than forming a lump it grows in what has been described as sheets or leaves. If you imagine a branch of a tree and the leaves filling out and growing, that is essentially how lobular cancer appears when it is spreading.
Because it is harder to detect that ductal cancer, lobular cancer is often larger when discovered. By its nature, however, lobular is not as aggressive as ductal cancer, so the size does not effect the prognosis as much as a ductal cancer would be found the at same size.
Inflammatory Breast Cancer
Tremendous strides have been made and there has been a dramatic change in the prognosis of IBC.
Inflammatory breast cancer is a very aggressive form of breast cancer. It presents itself with swelling, a feeling of heat inside the skin, a red tinge to the breast area and the breast sometimes swells up too. In some cases dark red or purple stripes may appear across the chest. The skin may pucker inwards like the skin of an orange. At first glance a doctor would view a swollen, hot breast with a rash and declare mastitis, which is a breast infection. Antibiotics are given and nothing helps. Sometimes it may take several visits to the doctor or even a change in doctors before the possibility of IBC is investigated.
Once the diagnosis is made, the key is to act fast. The treatment for IBC is not the same as for regular breast cancer. The protocol has changed to make the treatment of IBC much more successful.
Paget’s Disease
Paget’s disease is sometimes cancerous, but not always. When it is cancer, it is a type of in situ cancer that can begin in the ducts of the nipple. It grows close to the skin or the nipple and then can appear like IBC does with the swelling, heat and the orange peel skin. There may also be an itchy rash and a bloody discharge from the nipple. The nipple will also become inverted.
The type of cancer that lies beneath the skin will determine the treatment. Hormonal therapy will be given if appropriate following surgery, chemotherapy and radiation.
Medullary carcinoma
Medullary cancer is a cancer with the best prognosis of all. It is clearly identifiable and not as aggressive as the other breast cancers. Only a very small percent of women are diagnosed with Medullary cancer. However, women who carry the breast cancer gene mutation, BRCA 1, have a greater chance of developing Medullary cancer.
Generally, the prognosis for patients with medullary carcinoma is better than for women with other types of invasive ductal or lobular carcinoma.
Phyllodes
A phyllodes tumor can be found in the breast tissue that surrounds the ducts and lobules. Most often they are not cancerous. However, if they are, they do not respond to the traditional therapy that is effective on ductal or lobular cancers. The treatment consists of surgery, either by lumpectomy
Breast tissue is found in both men and women, therefore, breast cancer can occur in men. If a man finds a lump in his breast, it is essential he seek immediate evaluation. Where a woman can have many benign breast lumps such as cysts, etc., they are very rare in men. Therefore, anything out of the ordinary warrants a closer examination.
The most benign condition that is found in men is called gynecomastia. This can be caused by medication, hormonal disorders and exposure to the female hormone estrogen. Men produce small amounts of estrogen, just as women produce small amounts of testosterone. When there is an over abundance in either, side effects occur. In women, overgrowth of testosterone can cause a loss of menstruation, unwanted hair growth and sometimes infertility. In men, estrogen can cause gynecomastia or a benign growth of their breast tissue, often under the nipple.
What increases your risk?
The BRCA Gene mutation
Genetics can also lead to breast disorders in men. Men who carry the BRCA gene are of greater risk of breast cancer than men whose family do not carry the gene mutation. Another rare, genetic condition called Klinefelter syndrome can cause gynecomastia and possibly breast cancer
Family History
1 out of 5 men have a first or second generation relative with breast cancer, both male and female. Men who have breast cancer can pass the risk on to their daughters as well. Women should not only look to their mothers and aunts when assessing family history, because they can inherit it from their fathers and their fathers can inherit it from their own mothers or fathers.
Age.
Men are usually over the age of 60 when diagnosed with breast cancer.
Previous cancers that required chest irradiation.
If a man had another cancer and received radiation to the chest area, there is an increased risk of him developing breast cancer. Some men treated for spinal conditions as children, when radiation guidelines were not as strict, are also at risk. For example, many women who were treated for scoliosis as children and received many Xrays to evaluate their condition, later went on to develop breast cancer.
Alcohol Abuse and Liver Damage
Men who are heavy drinkers whose alcohol consumption adversely effects their liver functioning or even damages the liver, increase their estrogen level and this leads to an increased risk of breast cancer.
Obesity
Fat contains estrogen cells. Male hormones are converted to estrogen in fat cells. This leads to an increased risk of breast cancer.
Other diseases
Treatment for prostrate cancer sometimes includes hormonal treatment including estrogen. That raises a man’s risk for breast cancer. If a man had the mumps as an adult or had to have his testicles removed because of testicular cancer, his estrogen level will be higher, which could potentially effect his breast tissue.
Occupational Hazards
Men who worked in heavy metals, petroleum based manufacturing, may have effected their hormone levels. This is not completely understood, but studies are being conducted to see if there is a connection between these occupations and an increase in estrogen, leading to an increased risk in breast cancer.
How is it found?
Breast cancer in men is found the same way in men as it is in women. The only difference is awareness. A woman is geared to look for a lump and act on it. A man may not think there is anything to a lump on his breast. The sooner men become aware of this risk, the better the long term outcome will be for their prognosis, because their cancers will be found early, when they are the most treatable.
If a man feels his breast has enlarged, or finds an abnormal swelling, fast action is vital. Because it can spread to his lymph nodes faster than a woman’s can, because there is less breast tissue to contain the cancer cells.
Men can get mammograms, ultra-sounds and MRIs to evaluate their breasts. If a man has a genetic predisposition to breast cancer, prophylactic screening is recommended to find any cancer that may be too small to be felt. Being tested for the familial genetic mutation, BRCA, can also guide screening timelines.
Treatment
Right now, there is no difference between the treatment of male breast cancer and female breast cancer. This includes, surgery, radiation, chemotherapy, and hormonal treatment.
THERE NEEDS TO BE MORE RESEARCH INTO THE TREATMENT OF MALE BREAST CANCER. It does not matter that there is a small population of men with breast cancer. They deserve to have the best treatment options tailored for the unique disease in their bodies. These men are often diagnosed late stage, when their options are fewer. Early detection is the best defense. The only way a man can get early detection is if he knows his risks. The Male Breast Cancer Awareness Campaign seeks to do this.
What to look for:
A change in breast size
Painless lump or thick tissue
Change in the appearance of skin covering the breast: Dimpling, puckering, orange peel looking
Redness or inflammation of the skin or nipple
Discharge from the nipple, clear or cloudy, any discharge at all
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