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September 4, 2024
One of the predominant cancers that women around the world suffer from is breast cancer. Malaysia is no exception. According to a study conducted by the University Putra Malaysia, 13.6% of women in Malaysia are diagnosed with breast cancer before the age of 40 while the figure remains only 5% for the same group in the USA.
In our previous article, A Basic Understanding Breast Cancer: Types, Stages & More, we have covered certain aspects of breast cancer including what is it, staging, risk factors and others. Continuing with the subject, let’s get a comprehensive understanding of breast cancer diagnosis, treatment and other aspects associated with it in this article.
Most often, breast cancer diagnosis begins with an exam and a discussion of your symptoms. The doctor may conduct certain imaging tests to examine the breast tissue for anything that is not typical. A sample tissue can be removed from the breast to test whether cancerous cells are present or not.
To begin with, your doctor will conduct a breast exam, where they will look at the breast to find anything unusual such as changes in the skin or the nipple. Then the doctor will feel the breasts for lumps. Not only the breast, but the doctor will also feel along the collarbones and around the armpits to look for lumps.
Your doctor may use different tests to screen the area of concern such as:
An X-ray of the breast tissue, a mammogram is the most commonly used test to screen for breast cancer. Initially, your doctor may conduct a screening mammogram to screen the entire breast, and once they find anything specifically concerning, they may conduct another one to look more closely. This detailed mammogram is known as a diagnostic mammogram. Both breasts are looked at closely during this test.
A breast ultrasound is used to gain more information about a breast lump. Ultrasounds use sound waves to make pictures of the structures inside our bodies. A breast ultrasound is particularly useful in identifying the specific nature of a lump, for example, whether it is filled with fluid or if it is a solid mass. A breast ultrasound helps your doctor to decide what tests need to be conducted next.
A breast MRI is conducted to gain a clearer picture of the breast. A magnetic field and radio waves are used in MRI machines to create pictures of the inside of the body. Sometimes, an MRI is used to look more closely at the affected breast, but usually, both breasts are checked to identify all issues. Before an MRI, a dye is usually injected into the patient’s body so that the tissues can reflect in a better way in the images.
A biopsy is a common procedure used to test for cancerous cells. During this procedure, a healthcare professional removes a tissue sample from the breast for lab testing. The process is invasive and involves guiding needles to the precise location using imaging techniques like ultrasound, X-rays, or other methods. Once the sample is collected, it is sent to the lab where tests can detect cancerous cells and provide information about the cancer’s type, growth rate, and hormone receptors on the cells. This detailed information helps your doctor determine the most appropriate treatment plan.
Treatment for breast cancer can be divided into two categories:
These kinds of treatments are done with the intention to treat the tumour but not affect the rest of the body. Two kinds of treatments are done in this regard:
Breast cancer surgery is one of the most commonly used surgery options. Different types of breast surgery are done for various reasons. For example:
Primary, two main types of surgery are done to treat breast cancer:
A surgery to remove the cancer and the normal tissue surrounding it. During this procedure, only part of the breast containing the cancer is removed. The amount that’s removed is based on the size of the tumour and how much the cancer has spread. This surgery is also known as partial mastectomy, segmental mastectomy, quadrantectomy or lumpectomy.
An entire breast, all of the breast tissue and sometimes other nearby tissues are removed through this surgery. Mastectomies can be of several types. In some women, both breasts are removed, which is known as a double mastectomy.
High-energy rays are used to destroy cancer cells during radiation therapy. Radiation therapy is often used in addition to other treatments of breast cancer. Whether radiation therapy will be used depends on the stage of the breast cancer and other factors. It can be used after a breast-conserving surgery to lower the chances of the cancer coming back in the same breast or nearby lymph nodes. It may also be used after mastectomy, especially if the lump is larger than 5 cm, if cancer cells are found in several lymph nodes or if the cancer is spread to other parts of the body.
Two main types of radiation therapy are used:
This is the most common type of radiation therapy used for treating breast cancer. Radiation is provided through a machine outside the body focussing on the area affected by cancer.
Also known as internal radiation, this is another way to administer radiation therapy. In this kind of radiation, a device containing radioactive pellets or seeds is placed in the breast tissue for a short time in the area where the cancer is, for removing the cancer. Brachytherapy can be used for women who have had breast-conserving surgery for accelerated treatment. However, the decision to use brachytherapy solely lies with your doctor.
Systemic therapies are those which can be administered at any part of the body. The primary types of Systemic Treatments used are:
Anti-cancer drugs are used in chemotherapy to treat cancer. The drugs can be given through the mouth or your vein. The drugs travel through the bloodstream to reach cancer cells in most parts of the body. Chemo can be given directly into the spine if cancer spreads into the spinal fluid which surrounds the spinal cord and brain.
Chemotherapy can be used before or after surgery depending on the patient’s condition. It can also be given when cancer is diagnosed or after the initial treatments. For women suffering from metastatic breast cancer (advanced breast cancer), chemotherapy is often used as the main treatment.
Chemotherapy has certain side effects, depending on the dose and the type of the drug given. The most common side effects include hair loss, mouth sores, nail changes, loss of appetite, weight changes, nausea, vomiting, diarrhoea, fatigue, hot flashes and sometimes nerve damage.
Certain types of breast cancers are affected by hormones such as oestrogen and progesterone. Receptors (proteins) on the breast cancer cells attach to oestrogen and progesterone, which helps them to grow. Hormone or endocrine therapy are treatments that stop these hormones from attaching to these receptors.
Hormone therapy is effective for cancer that is hormone receptor-positive. Hormone therapy can reach cancer cells almost anywhere in the body, not only in the breast. This therapy is not useful for hormone receptor-negative cancers (tumours that do not have hormone receptors).
Breast cancer treatment drugs are used to target proteins that help the cancer cells to grow, spread and live longer. Targeted drug therapy destroys cancer cells or slows down their growth. These drugs enter the bloodstream to reach almost any part of the body.
Some targeted therapy drugs work in more than one way to control cancer cells. Sometimes they are also considered as immunotherapy as they boost the immune system. Targeted drug therapy is not free from side effects. The most common side effects are fatigue and low blood count. The less common side effects include hair loss, diarrhoea, vomiting, mouth sores and others. Sometimes targeted drugs work even when chemo drugs don’t. Some drugs also help other types of treatments to work.
Immunotherapy uses medicines to boost a person’s immune system to identify and destroy cancer cells. Immunotherapy works on specific proteins present in the immune system to enhance the immune response.
Immunotherapy too can have certain side effects such as swelling, pain, soreness, itchiness, redness and rash. You may also get flu-like symptoms in immunotherapy. Some immunotherapy is also used as targeted therapy as it can work in more than one way to control cancer.
Now that we have a clearer understanding of the types of treatments used for breast cancer, let’s look at which treatment works best for each stage of breast cancer. The stage of breast cancer is an important deciding factor for using treatment options. The more the breast cancer has spread, the more treatment a patient needs.
This is the most premature form of breast cancer where the cancer is limited to the inside of the milk duct and has not spread to nearby tissues. This kind of tumour is known as ductal carcinoma in situ (DCIS).
The most commonly used treatment for stage 0 cancer is breast conservative surgery (BCS) and mastectomy. Through the BCS, the doctor removes the tumour and a small amount of normal breast tissue around it. Lymph nodes are not removed for this stage.
If the DCIS is very large or there are several DCIS areas in the breast or the DCIS could not be removed completely through BCS, then a simple mastectomy may be needed. If the DCIS is hormone receptor-positive then your doctor may decide to opt for hormone therapy after a breast surgery.
The most common treatment path taken for treating breast cancer stage I, II and III is surgery which is often followed by radiation therapy. Sometimes systemic drug therapy is also administered. The treatment path depends on the extent to which the cancer has spread. Your personal preference is also taken into consideration while deciding your treatment path.
Apart from surgery and radiation therapy, the other commonly used treatment options during stages 1 to 3 are chemotherapy, hormone therapy, targeted drugs, immunotherapy or a combination of these. The type of treatment that will work best depends on the tumour’s hormone receptor status, HER2 status and other factors.
Stage IV or advanced stage breast cancer is when cancer has spread beyond the breast, to nearby lymph nodes or other parts of the body.
Systematic drug therapies are the main treatment path for patients with stage IV breast cancer. Hormone therapy, chemotherapy, immunotherapy targeted drugs or a combination of these are normally used. Surgery and radiation therapy may be useful in certain situations.
The treatment is aimed at shrinking tumours and improving symptoms for patients to help them live longer. Unfortunately, metastatic cancer is considered incurable.
Dealing with a breast cancer diagnosis can be difficult. However, it is important to remember that proper treatment can improve prognosis to a great extent.
Early detection is key to improving treatment outcomes. Pay attention to your body so that you notice the signals at the right time.
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