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Types of breast cancer

Ductal Carcinoma

Overview:

Ductal Carcinoma occurs when abnormal changes take place in the cells which are found in the lining of a breast duct. Ductal carcinoma can be ‘In Situ’ meaning the abnormal or cancerous cells are contained inside the milk ducts and have not spread to the surrounding tissue.

It can also become ‘invasive’ when the cancerous cells spread beyond the layer of tissue in which it developed and starts growing into surrounding, healthy tissues.

Treatment options:

Breast-conserving surgery is the most common type of breast surgery which involves removing the breast cancer and a small amount of healthy tissue around it.

This treatment can be combined with radiation therapy which is the use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Breast-conserving surgery can also be done without radiation therapy.

The cancer drug, tamoxifen, can also be included in treatment for ductal carcinoma. Tamoxifen is used to prevent breast cancer in women who have had ductal carcinoma in situ (abnormal cells in the ducts of the breast) and in women who are at a high risk of developing breast cancer. It blocks the effects of the hormone oestrogen in the breast.

A total mastectomy with or without tamoxifen is another option that may be considered for ductal carcinoma treatment. A total mastectomy involves removal of the whole breast (usually including the nipple).

Your oncologist will be able to discuss with you the most appropriate and effective treatment.

Lobular Carcinoma

Overview:

Lobular carcinoma occurs when abnormal cells are found in the lobules of the breast. Lobular carcinoma will seldom become invasive cancer. However, having lobular carcinoma in one breast increases the risk of developing cancer in either breast.

Treatment options:

Treatment of lobular carcinoma may include a biopsy, which is the removal of cells or tissues for examination by a pathologist, to diagnose the cancer. This will generally be followed by regular examinations and mammograms to find any changes as early as possible. A mammogram is an x-ray of the breast used to detect irregular cell mass.

The cancer drug, tamoxifen, may also be included in treatment to reduce the risk of developing breast cancer. Tamoxifen works by blocking the effects of the hormone, oestrogen, in the breast. Bilateral prophylactic mastectomy is a treatment choice sometimes used in women who have a high risk of getting breast cancer. It is the surgical removal both breasts in order to reduce the risk of developing breast cancer. Most surgeons believe this is a more aggressive treatment than is needed.

Your oncologist will discuss the best treatment options for you.

Inflammatory breast cancer

Overview:

Inflammatory breast cancer is a rare form of invasive breast cancer in which cancer cells block lymph vessels in the skin of the breast. This type of breast cancer is called “inflammatory” as the breast becomes red and inflamed.

Most inflammatory breast cancers are invasive ductal carcinomas, which mean the cancer develops from cells that line the milk ducts of the breast and then spreads beyond the ducts, blocking the lymphatic vessels in the skin of the breast.

Lymphatic vessels are responsible for the removal of fluid and other waste products in the body’s tissues. This helps to prevent infection. When the lymphatic vessels become blocked, the breast becomes red and swollen, similar to an infection. This is what gives inflammatory breast cancer its name.

Inflammatory breast cancer progresses rapidly, often in a matter of weeks or months. Inflammatory breast cancer is either stage III or IV at diagnosis, depending on whether cancer cells have spread only to nearby lymph nodes or to other tissues as well.

Inflammatory breast cancer symptoms develop quickly. Generally the breast looks red or inflamed or develops a rash, becomes swollen and enlarged and may feel heavy or uncomfortable; it will also feel warm and tender. Sometimes the skin on the breast can appear dimpled or pitted, like an orange peel.

Treatment options:

Treatment for inflammatory breast cancer usually involves a mixture of treatments depending on the size, location and stage of the cancer. This approach to treatment is called a multimodal approach. Studies have found that women with inflammatory breast cancer treated with a multi-modal approach have better responses to therapy and longer survival.

The treatment plan can include chemotherapy, surgery, radiotherapy, hormone therapy and/or targeted treatment.

Chemotherapy, a drug treatment which kills cancer cells, is generally the first treatment option as there’s typically no lump with inflammatory breast cancer.

If surgery is necessary, chemotherapy will be followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection. Radiation therapy will then be provided. Additional therapy (chemotherapy, hormone therapy, or both) may be given.

Paget's disease of the nipple

Overview:

Paget disease of the nipple occurs when abnormal cells are found in the nipple. The cancer usually affects the ducts of the nipple first then spreads to the nipple surface and the areola (the dark circle of skin around the nipple). The nipple and areola often become scaly, red, itchy, and irritated.

It’s common for people with Paget’s disease of the nipple to also have breast cancer somewhere else in the same breast.

The most common symptom of Paget’s disease of the nipple is a change in the nipple and/or areola. The nipple area might become hard, lumpy or crusty. This may look similar to dermatitis or eczema. A nipple biopsy, where cells are removed from the nipple for examination by a pathologist, allows doctors to correctly diagnose.

Treatment options:

Breast-conserving surgery, where only the cancerous part of the breast is removed including removal of the nipple and areola, is a possible treatment option. This treatment will be followed by whole-breast radiation therapy.

This type of treatment is a safe option for people with Paget disease of the nipple who do not have a definite lump in their breast and whose mammograms do not reveal a tumour.

If the patient does have a tumour, depending on the size and location, removal of the whole breast and removal of one or more lymph nodes from the armpit may be needed.

Breast cancer in men

While breast cancer in men is uncommon, it’s not unheard of. Breast cancer in men accounts for around 1% of all breast cancer occurrences.

Breast cancer in men is the same disease as that which affects women. Male breast cancer can be early or advanced at diagnosis.

The most common types of male breast cancer include: invasive ductal carcinoma, Paget’s disease of the nipple, inflammatory breast cancer, infiltrating ductal carcinoma and ductal carcinoma in situ (DCIS).

There are a number of factors that increase a man’s risk of developing breast cancer:

• Like women, a man’s risk of developing breast cancer increases with age
• A known BRCA1 or BRCA2 gene mutation
• A strong family history of breast cancer
• Elevated oestrogen levels
• Past radiotherapy treatment particularly of the chest area.

Treatment options:

Treatment for breast cancer in men involves most of the same options as for women – surgery, chemotherapy, radiotherapy and hormone therapy. However, there are variations as to how these treatments are carried out.

The most common type of surgery for men with breast cancer is a mastectomy, where the whole breast is removed. Breast conserving surgery, where only the part of the breast with the cancer is removed, is generally not suitable due to the lack of breast tissue in men.

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