Mammographic Evaluation on Breast Cancer

Recent preoperative mammographic evaluation (usually within 3 months) is necessary to determine a patient’s eligibility for breast cancer conservation treatment. It should be performed with high quality, dedicated mammographic equipment in a facility certified by the FDA under the Mammographic evaluation prior to biopsy or definitive surgery plays an important role in establishing the appropriateness of breast cancer conservation treatment by defining the extent of a patient’s disease, the presence or absence of multi centricity, and other factors that might influence the treatment decision. It is important for evaluating the contralateral breast. Bilateral mammography is required for palpable lesions as well as nonpalpable lesions that can be identified only radiographically. Nonpalpable masses and microcalcifications comprise an increasing percentage of carcinomas treated with breast conservation.

The breast tumor should be measured in at least two dimensions on the mammographic views or from ultrasonography if it is performed. The size of the tumor should be included in the mammographic report. If the tumor is an indistinct or spiculated mass, approximate dimensions can be given from either the mammogram or the sonogram. The skin of the breast in the area of a mass should be evaluated for thickening that might signify tumor involvement. If the mass is associated with microcalcifications, an assessment of the extent of the calcifications within and outside of the mass should be made, including the dimensions of the area in which calcifications are located. If one or more clusters of microcalcifications are the only markers of the tumor,their location and distribution should be described. For evaluation of masses and microcalcifications, specialized views with positioning adapted to the location of the abnormality may be helpful. Magnification mammography and spot compression is important for characterizing microcalcifications and defining the margins of masses. Ipsilateral multifocality or multicentricity may be present and influence the treatment selection. In every instance, when one abnormality is seen, all areas of each breast should be fully evaluated for the presence of additional disease.

Using magnification mammography and ultrasound, patients with tumors suitable for breast conservation can be selected with a high degree of accuracy. Some studies have suggested that magnetic resonance imaging (MRI) is a useful adjunct to mammography and ultrasound for identifying multifocal and multicentric disease. The use of intravenous contrast material (gadolinium) with MRI allows for the detection of regions of high vascularity in the breast, which include many, but not all, breast cancers. MRI has been found to be more sensitive than mammography as a screening technique in patients at very high risk for breast cancer development. Unfortunately, many benign lesions also exhibit high contrast uptake and so the number of false positive examinations is high. This and the cost, the lack of standardization of technique, and the difficulty in biopsying lesions seen only on MRI have limited the wide-spread use of MRI in the evaluation of these patients. Currently, there are no data on whether treatment changes that occur in response to the additional lesions seen on MRI will affect local recurrence rates or overall patient survival.

History and Physical Examination In Breast Cancer

Because of the potential options for treatment of early stage breast cancer, careful patient selection and a multidisciplinary approach are necessary. Four critical elements in patient selection for breast conservation treatment are:

• History and physical examination.
• Breast imaging.
• Histological assessment of the resected breast specimen.
• Assessment of the patient's needs and expectations.

Much of the information needed to determine a patient’s suitability for breast conservation therapy can be obtained from a detailed history and physical examination. It is important to note that age per se, whether young or old, is not a contraindication to breast conservation. In the elderly, physiologic age and the presence of comorbid conditions should be the primary determinants of local therapy.

The elements of the Breast Cancer Specific History are :

• Family history relatives with breast cancer (age at diagnosis, laterality), ovarian carcinoma
• History of prior therapeutic irradiation involving breast region
• History of collagen vascular disease – type, documentation of diagnosis
• Presence of breast implants – submammary or subpectoral
• Date of last menstrual period/possibility of pregnancy
• Symptoms suggestive of metastasis

The elements of the Breast Physical Exam are :

• Tumor size (measured) and location
• Fixation to skin
• Ratio of breast size to tumor size
• Evidence of multiple primary tumors
• Axillary node status – size, mobility
• Supraclavicular nodes
• Evidence of locally advanced cancer
- skin ulceration, satellitosis
- peau d’orange
- inflammatory carcinoma
- fixed axillary nodes
- lymphedema of the ipsilateral arm

When evaluating the physical examination, it is important to note that skin, nipple, and breast parenchyma retraction are not signs of locally advanced breast cancer and do not represent contraindications to breast conservation.
Labels:breast cancer,physical examination,breast conservation treatment,breast imaging,histological assessment,breast cancer specific history,breast physical exam

What Kinds of Treatment can be Applied in Breast Cancer?

In small lump in the breast, operative removal of the breast and surrounding tissue may be life saving. If there are indications that not all carcinoma tissue was removed by the surgeon, irradiation with rontgen-rays may improve prognosis. Rontgen-rays have two effects. They will kill rapidly growing cells, for instance the tumors cells but also other rapidly growing cells of the body like intestinal epithelial cells, bone marrow cells and spermatozoa. This asks for very competent administration of these X-rays. The other effect is that the connective tissue in the irradiated region will become very hard and poor in blood vessels. This creates and unfavourable environment for the local growth of tumor.

How is the treatment when metastasis are present ?
The first principle, often forgotten by doctors (but not by patients) is that pain should be treated adequately. When metastasis is localized, local irradiation is often beneficial. A pain producing metastasis in a vertebra can often be irradiated with good results. When metastasis are widespread or generalized, so called systemic treatment should be tried. In tumors of most organs the only possibility is the administration of cytotoxic drugs that will like X-rays kill not only the tumor cells but all rapid growing cells of the body as well. Therefore, the administration of cytostatics is avery spesialized field in medicine and it should be done only by doctors with large experience in the field. Some tumors originate in organs that are normally under influence of hormones. This prostate is such an example and the breast also.

Breast cancer in women in the reproductive age, the tumor may grow more rapidly under the influence of estrogens from the ovarium. For many years, it has been usual to perform bilateral extirpation of the ovaries in patients with severe metastatis disease. This will result in an artificial menopause and it at least 30% of the cases in a prolonged improvement with disappearance of pain.

Tumor nodes and metastases become much smaller and even may disappear. This improvement in general will not last much longer than two years. The ovaries have also been irradiated, but the result is unpredictable. A modern treatment, obviating the need for ovariectomy, is the administration of subtances that block the effect of estrogens, so called anti-estrogens. Tamoxifen is such a substance.

Myths About Chemotherapy

1.The more chemotherapy you receive, the better you'll do.
More is not necessarily better. When it comes to chemotherapy, it's the right combination of drugs that's most important, not going above and beyond the standard dosage. Getting at least the standard dosage is very important, but going above that offers no real advantage.
2.If you don't get sick from chemotherapy, the treatment isn't working.
No. The "no pain, no gain" rumors about chemotherapy are just that—rumors. There is no correlation between the amount that someone suffers from chemotherapy and the benefit it has against the cancer. Everyone responds differently. Some women have very few side effects; some have them daily.
3.Younger women have greater nausea on chemotherapy.
Yes. It's true. The younger you are, the more likely you are to be nauseated. Younger women have a larger nausea-trigger zone in the brain that decreases as you get old.
4.You have to get really nauseated first, so the doctors will know how you respond to the chemotherapy.
No. No one has to get sick. Your first dose of anti-nausea medication will be given along with your chemotherapy, and you'll have oral medication to take home with you to take for the first 48 hours.
5.You will be sicker with each chemotherapy treatment. And you'll be more exhausted as time goes on.
No, and Yes.Your doctor or nurse should be able to adjust your supportive medications to help alleviate your symptoms if you are feeling sick after chemotherapy. Being sick after your first round does not necessarily mean you will be sick or sicker the next time. Fatigue is cumulative, though. You won't start to feel completely energetic again until the entire course of treatment is over.

Myths About Chemotherapy

1.The more chemotherapy you receive, the better you'll do.
More is not necessarily better. When it comes to chemotherapy, it's the right combination of drugs that's most important, not going above and beyond the standard dosage. Getting at least the standard dosage is very important, but going above that offers no real advantage.
2.If you don't get sick from chemotherapy, the treatment isn't working.
No. The "no pain, no gain" rumors about chemotherapy are just that—rumors. There is no correlation between the amount that someone suffers from chemotherapy and the benefit it has against the cancer. Everyone responds differently. Some women have very few side effects; some have them daily.
3.Younger women have greater nausea on chemotherapy.
Yes. It's true. The younger you are, the more likely you are to be nauseated. Younger women have a larger nausea-trigger zone in the brain that decreases as you get old.
4.You have to get really nauseated first, so the doctors will know how you respond to the chemotherapy.
No. No one has to get sick. Your first dose of anti-nausea medication will be given along with your chemotherapy, and you'll have oral medication to take home with you to take for the first 48 hours.
5.You will be sicker with each chemotherapy treatment. And you'll be more exhausted as time goes on.
No, and Yes.Your doctor or nurse should be able to adjust your supportive medications to help alleviate your symptoms if you are feeling sick after chemotherapy. Being sick after your first round does not necessarily mean you will be sick or sicker the next time. Fatigue is cumulative, though. You won't start to feel completely energetic again until the entire course of treatment is over.

The drugs used to treat breast cancer

There are quite a few chemotherapy drugs commonly used for breast cancer. So we can't say what your doctor will recommend. Usually you would have a combination of about 3 chemotherapy drugs together. But in some circumstances, your specialist may suggest one on its own. The drugs are
Cyclophosphamide
Epirubicin
Fluorouracil (5FU)
Methotrexate
Mitomycin
Mitozantrone
Doxorubicin
Docetaxel (Taxotere)
NICE guidance recommends that adjuvant chemotherapy for breast cancer should consist of 4 to 8 cycles of a combination of drugs, including an anthracycline (epirubicin or doxorubicin).

In September 2006 NICE approved the chemotherapy drug docetaxel (Taxotere) after surgery for women with early stage breast cancer who have lymph nodes under the arm that contain cancer cells. NICE say docetaxel can be used in combination with the drugs doxorubicin and cyclophosphamide (the TAC regime). But NICE didn't recommend the chemotherapy drug paclitaxel (Taxol) for women with this stage of breast cancer.

Some of the most common combinations used for breast cancer are
CMF – cyclophosphamide, methotrexate and 5-FU
FEC – epirubicin, cyclophosphamide and 5-FU
E-CMF – epirubicin, followed by CMF
AC – doxorubicin (adriamycin) and cyclophosphamide
MMM – methotrexate, mitozantrone and mitomycin
MM – methotrexate and mitozantrone
In our main chemotherapy section, we have pages on the specific side effects of individual chemo drugs and chemo combinations. The links above take you to the right page for each drug or combination. Or you can go through the alphabetical list yourself in the section on side effects of specific chemo drugs.

Different combinations of drugs have different side effects. For example, with AC or FEC, you are more likely to lose your hair than with CMF.

Breast cancer chemotherapy side effects

Side effects are the unwanted effects of any treatment. Chemotherapy drugs kill cells that are dividing. Cancer cells divide more often than normal cells. But some normal body cells divide quickly and so are also affected by chemo. These include your skin, hair, nails, the lining of your digestive system and your blood cells. Unlike cancer cells, these normal body tissues can recover.

Chemotherapy affects different people in different ways. Some people are more affected by side effects than others. Many people lead normal lives during their treatment and can carry on working.

Remember , not all chemotherapy drugs cause the same side effects and some people have very few side effects.
Chemotherapy has some general side effects. The drugs kill cancer cells because they divide quickly. Your blood cells also divide rapidly, so chemotherapy can lower the number of healthy white blood cells, red blood cells and platelets you have.
Here are some of the more serious potential side effects that you will want to be aware of and discuss carefully with your oncologist:
· Chemotherapy can lead to bone loss. Women past menopause do not produce enough hormones to maintain strong bones. Over time, thinning bones may develop into osteoporosis and increase your risk of serious fractures. If you are still pre-menopausal when you begin chemotherapy, your ovaries may stop making hormones, putting your bones at risk. The combination CMF is more likely to stop the ovaries from making hormones compared to treatment that contains Adriamycin.
· The taxanes Taxol and Abraxane can cause more discomfort in the hands and feet from nerve damage than Taxotere. This can be temporary or permanent. Your doctor may refer to this as neuropathy. Lowering the dosage of Abraxane improves the neuropathy in most women.
· Taxotere has also been found to irritate tear ducts and cause excess tearing. If it persists and bothers you, it can usually be treated by inserting tiny silicone tubes into the "pipes" that drain the tears.
· Adriamycin can have a toxic effect on the heart; your doctor will work to minimize this risk by carefully keeping your total drug dosage within a safe range. Read an article about other chemotherapy drugs that may have greater benefits for women with early-stage cancer.
· In very rare cases, cyclophosphamide (brand name: Cytoxan) may cause a treatment-induced leukemia (cancer of the blood cells).
Tiredness or fatigue is now the most common side effect for people having chemotherapy. Other side effects of chemotherapy can also include :
Feeling sick (nausea) and being sick
Hair loss or thinning
Sore mouth
Diarrhoea
Changes to your periods (menstrual cycle)
Sore eyes - they may feel as if they have grit in them. Let your doctor know, as eyedrops can help.
Even some 'over the counter' medicines, herbal medicines or complementary therapies may be harmful to take with chemotherapy.
Sometimes chemotherapy causes long term side effects. You will probably feel tired for some time after your treatment has finished. If you had not had your menopause before you had breast cancer, you need to know that chemotherapy can affect your ability to get pregnant. If you are still having periods, they may stop when you have chemotherapy. Your periods may start again 6 months to a year after your treatment finishes. You can also ask your doctor or nurse if you can meet other patients who've had chemo for breast cancer.

Chemotherapy in Breast Cancer.

Chemotherapy means treatment with drugs. , in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer. Chemotherapy is a systemic therapy this means it affects the whole body by going through the bloodstream. The purpose of chemotherapy and other systemic treatments is to get rid of any cancer cells for example breast cancer that may have spread from where the cancer started to another part of the body.
Chemotherapy is much easier to tolerate today than even a few years ago. And for many women it's an important "insurance policy" against cancer recurrence. It's also important to remember that organs in which the cells do not divide rapidly, such as the liver and kidneys, are rarely affected by chemotherapy. And doctors and nurses will keep close track of side effects and can treat most of them to improve the way you feel.
Chemotherapy is effective against cancer cells because the drugs love to interfere with rapidly dividing cells. The side effects of chemotherapy come about because cancer cells aren't the only rapidly dividing cells in your body. The cells in your blood, mouth, intestinal tract, nose, nails, vagina, and hair are also undergoing constant, rapid division. This means that the chemotherapy is going to affect them, too.
But in cancer treatment it means 'cytotoxic chemotherapy' – drugs that kill cancer cells. Chemotherapy uses these cytotoxic drugs to destroy cancer cells. The drugs work by disrupting the growth of cancer cells. As they circulate in the blood, they can reach them wherever they are in your body.

The drugs can't tell the difference between cancer cells and normal cells. They just kill cells that are actively growing and dividing into new cells. Cancer cells do this much more often than normal cells, so they are more likely to be killed by the treatment. Cancer cells are not as good at repairing themselves as normal cells. Normal cells can often repair any damage caused by chemotherapy. Over time, cancer cells become more resistant to chemotherapy treatments. Recently, scientists have identified small pumps on the surface of cancer cells that actively move chemotherapy from inside the cell to the outside.

For breast cancer treatment, you may have chemotherapy.There are a number of strategies in the administration of chemotherapeutic drugs for cancer treatments like breast cancer.
Combined modality chemotherapy is the use of drugs with other cancer treatments, such as radiation therapy or surgery. Combination chemotherapy is a similar practice that involves treating a patient with a number of different drugs simultaneously. The biggest advantage is minimising the chances of resistance developing to any one agent.
In neoadjuvant chemotherapy (preoperative treatment) initial chemotherapy is designed to shrink the primary tumour, thereby rendering local therapy (surgery or radiotherapy) less destructive or more effective.
Adjuvant chemotherapy (postoperative treatment) can be used when there is little evidence of cancer present, but there is risk of recurrence. Palliative chemotherapy is given without curative intent, but simply to decrease tumor load and increase life expectancy. All chemotherapy regimens require that the patient be capable of undergoing the treatment.

Breast Cancer,the Most Common Malignant Tumor in Women

Almost one-fourth of all cancers in women are located in the breast,causing about 20 percents of all cancer deaths in females. Most of these deaths occur between the age of 50 and 60, although the disease may actually develop years earlier. There are many population differences in cancer incidence around the world, for instance, women in the U. S. Are five times more likely to die from breast cancer than are women in Japan.

Without treatment, about 20 percents of patients with breast cancer will live five years from the onset of symptoms. If the disease is diagnosed in its early stages, treatment will be more succesful and may enable the patient to live a normal life span. Much can now be done to control pain for those whose cancers are in succesfully managed. Early detection is the primary weapon.

Breast cancer like cancer elsewhere in the body,is an uncontrolled growth of cells,little pieces of the growth may separate from the tumor and travel through the vessels of the lymphatic system to nearby lymph nodes,where the travelling cancer cells come to rest and form a secondary growth. It may also spread by way of the blood stream. These processes of spread throughout the body are called metastases.

The cause of breast cancer has not been established; an hereditary predisposition may exist. Studies conducted over the past several years have suggested the possibility that breast cancer may be associated with the improper functioning of glands which have to do with secondary sexual characreristics,pregnancy,and lactation. Although there are occasionally sharp changes in the breasts of women who are taking contraceptive pills, there is no evidence that the pill causes breast cancer.

In general, women considered to be in the high-risk group are; those with family history of mammary cancer,those who began menstruating early in life and who have continued their cycles for more than 30 years, and those who have had no pregnancies, or only one or two.

BREAST CANCER

The breasts are modified skin glands, and are referred to as the mammary glands. In women, however,they are active,functioning parts of the body throughout much of life.

The size and shape of the breasts in different individuals varies from round to conical. The consistency is usually firm and elastic,but varies a great deal, depending upon the presence and amount of fatty tissue. Rarely are the two breasts equal in size, the left is usually larger.

Even in the normal healthy body of man,cells regularly die but are replaced by new cells. When however,cells of the body start to divide and multiply without any purpose,this leads to the formation of a tumor. In human pathology, many kinds of tumors are possible. There are different classifications of tumors. The most important classifications is whether a tumor is dangerous or not for the life of the individual. In case it is dangerous, the tumor is called malignant.In this classification, the other group of tumors is in principle not dangerous for the human body. This group is called benign tumors. It should be noted however that there are malignant tumors of all grades of malignancy, some are even relatively benign.

Malignant tumors may originate from epithelium (skin, colon,etc). They are called carcinoma. When they take their origin in cells of connective tissue, they are called sarcoma. When they originate in lymph glands, they are called lymphoma. All malignant tumors together are called cancer. One of the most feared carcinomas is carcinoma of the breast in woman called breast cancer.

Every year, more than 200,000 women are diagnosed with breast cancer in the United States. Breast cancer ranks second as the leading cause of cancer deaths in American women. Until recently breast cancer topped the list of leading causes of cancer deaths in women, but lately lung cancer has claimed the top position. If skin cancer is excluded, breast cancer is the commonest cancer among American women.

Breast cancer begins in the breast and spreads first to the lymph nodes of the armpit (axilla). In certain cases of malignant lumps, lumpectomy followed by radiation therapy is as effective as a radical mastectomy. Typically, lumpectomy does not require a breast replacement (prosthesis).