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  1. The Breasts
  2. Benign Breast Lumps
  3. Breast Cancer
  4. Risk Factors for Breast Cancer
  5. Early Detection
  6. Symptoms
  7. Diagnosis
  8. Orthodox Treatment
  9. Side Effects of Orthodox Treatment

The Breasts

Each breast has 15 to 20 overlapping sections called lobes. Within each lobe are many smaller lobules, which end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are all linked by thin tubes called ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola. Fat fills the spaces around the lobules and ducts. There are no muscles in the breast, but muscles lie under each breast and cover the ribs.
Each breast also contains blood vessels and vessels that carry colorless fluid called lymph. The lymph vessels lead to small bean-shaped organs called lymph nodes. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest. Lymph nodes are also found in many other parts of the body.
         
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Benign Breast Lumps

Any noticeable change, thickening or localized swelling in your breast that was not there before may be a lump. Eighty-five percent of all breast lumps found are benign. Some common benign breast problems that appear as lumps are:

Cystic Disease (fibrocystic breast disease) is the most common cause of breast lumps in women. These lumps or cysts are fluid-filled sacs that enlarge and become tender and painful before the menstrual cycle. This condition is responsible for at least half of all breast biopsies performed. It tends to involve both breasts. These lumps are movable, and if large may feel round and firm. Cystic disease usually disappears after menopause.
Lipomas develop as single, painless lumps. They can vary in size. Lipomas consist of fatty tissue and are commonly found elsewhere in the body.
Fibroadenomas, single solid tumors, appear most often in young women. These breast lumps are firm, rubbery, movable, often oval-shaped, and usually painless.
Papillomas are small, wart-like growths in the lining of a mammary duct near the nipple. These can produce a bloody discharge of the nipple.

There are other, not as common benign breast lumps caused by a variety of breast problems such as sclerosing adenosis, etc.
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Breast Cancer

The most common type of breast cancer begins in the lining of the ducts and is called ductal carcinoma. Another type, called lobular carcinoma, arises in the lobules.
When breast cancer spreads outside the breast, cancer cells are often found in the lymph nodes under the arm (axillary lymph nodes). If the cancer has reached these nodes, it may mean that cancer cells have spread to other parts of the body--other lymph nodes and other organs, such as the bones, liver, or lungs--via the lymphatic system or the bloodstream.
Cancer that spreads is the same disease and has the same name as the original (primary) cancer. When breast cancer spreads, it is called metastatic breast cancer, even though the secondary tumor is in another organ. Doctors sometimes call this "distant" disease.
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Risk Factors for Breast Cancer

The risk of breast cancer increases gradually as a woman gets older. This disease is uncommon in women under the age of 35. All women age 40 and older are at risk for breast cancer. However, most breast cancers occur in women over the age of 50, and the risk is especially high for women over age 60.
Research has shown that the following conditions place a woman at increased risk for breast cancer:

Personal history of breast cancer. Women who have had breast cancer face an increased risk of getting breast cancer again.
Genetic alterations. Changes in certain genes (BRCA1, BRCA2, and others) make women more susceptible to breast cancer.
Family history. A woman's risk for developing breast cancer increases if her mother, sister, daughter, or two or more other close relatives, such as cousins, have a history of breast cancer, especially at a young age.
Certain breast changes. Having a diagnosis of atypical hyperplasia or lobular carcinoma in situ (LCIS) or having had two or more breast biopsies for other benign conditions may increase a woman's risk for developing cancer.
Other factors associated with an increased risk for breast cancer include:
1. Breast density. Women age 45 and older whose mammograms show at least 75 percent dense tissue are at increased risk.
2. Radiation therapy. Women whose breasts were exposed to radiation during their childhood, especially those who were treated with radiation for Hodgkin's disease, are at an increased risk for developing breast cancer throughout their lives.
3. Late childbearing. Women who had their first child after the age of 30 have a greater chance of developing breast cancer than women who had their children at a younger age.

In most cases, doctors cannot explain why a woman develops breast cancer. Studies show that most women who develop breast cancer have none of the risk factors listed above, other than the risk that comes with growing older. Also, most women with known risk factors do not get breast cancer. Scientists are conducting research into the causes of breast cancer to learn more about risk factors and ways of preventing this disease.
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Early Detection

When breast cancer is found and treated early, the chances for survival are better. Women can take an active part in the early detection of breast cancer by having regular screening mammograms and clinical breast exams (breast exams performed by health professionals). Some women also perform breast self-exams.
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Symptoms

Early breast cancer usually does not cause pain. In fact, when breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for:
A lump or thickening in or near the breast or in the underarm area;
A change in the size or shape of the breast;
Nipple discharge or tenderness, or the nipple pulled back (inversion) into the breast; Ridges or pitting of the breast (the skin looks like the skin of an orange; or A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly).
A woman should see her doctor about any symptoms like these. Most often, they are not cancer, but it's important to check with the doctor so that any problems can be diagnosed and treated as early as possible.
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Diagnosis

In addition to checking general signs of health, a woman's doctor may do one or more of the breast exams described on the following page.

Palpation. The doctor can tell a lot about a lump (its size, its texture, and whether it moves easily) by palpation, carefully feeling the lump and the tissue around it. Benign lumps often feel different from cancerous ones.
Mammography. X-rays of the breast can give the doctor important information about a breast lump. If an area on the mammogram looks suspicious or is not clear, additional mammograms may be needed.
Ultrasonography. Using high-frequency sound waves, ultrasonography can often show whether a lump is solid or filled with fluid. This exam may be used along with mammography.
Fine needle aspiration. A thin needle is used to remove fluid from a breast lump. This procedure may show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer). Clear fluid removed from a cyst may not need to be checked by a lab.
Needle biopsy. Using special techniques, tissue can be removed with a needle from an area that is suspicious on a mammogram but cannot be felt. Tissue removed in a needle biopsy goes to a lab to be checked by a pathologist for cancer cells.
Surgical biopsy. The surgeon cuts out part or all of a lump or suspicious area. A pathologist examines the tissue under a microscope to check for cancer cells.
When cancer is found, the pathologist can tell what kind of cancer it is (whether it began in a duct or a lobule) and whether it is invasive (has invaded nearby tissues in the breast).
Special lab tests of the tissue help the doctor learn more about the cancer. For example, hormone receptor tests (estrogen and progesterone receptor tests) can help predict whether the cancer is sensitive to hormones.

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Orthodox Treatment

The treatment options for each woman depend on the size and location of the tumor in her breast, the results of lab tests (including hormone receptor tests), and the stage (or extent) of the disease.

Methods of Treatment

Methods of treatment for breast cancer are local or systemic. Local treatments are used to remove, destroy, or control the cancer cells in a specific area. Surgery and radiation therapy are local treatments. Systemic treatments are used to destroy or control cancer cells throughout the body. Chemotherapy and hormonal therapy are systemic treatments. A patient may have just one form of treatment or a combination. Different forms of treatment may be given at the same time or one after another.


Surgery is the most common treatment for breast cancer. Several types of surgery may be used. An operation to remove the breast (or as much of the breast as possible) is a mastectomy. Breast reconstruction is often an option at the same time as the mastectomy, or later on. An operation to remove the cancer but not the breast is called breast-sparing surgery or breast-conserving surgery. Lumpectomy and segmental mastectomy (also called partial mastectomy) are types of breast-sparing surgery. They usually are followed by radiation therapy to destroy any cancer cells that may remain in the area.

In lumpectomy, the surgeon removes the breast cancer and some normal tissue around it. Often, some of the lymph nodes under the arm are removed.

In segmental mastectomy, the surgeon removes the cancer and a larger area of normal breast tissue around it. Occasionally, some of the lining over the chest muscles below the tumor is removed as well. Some of the lymph nodes under the arm may also be removed.

In total (simple) mastectomy, the surgeon removes the whole breast. Some of the lymph nodes under the arm may also be removed.

In modified radical mastectomy, the surgeon removes the whole breast, most of the lymph nodes under the arm, and often the lining over the chest muscles. The smaller of the two chest muscles is also taken out to help in removing the lymph nodes.

In radical mastectomy (also called Halsted radical mastectomy), the surgeon removes the breast, the chest muscles, all of the lymph nodes under the arm, and some additional fat and skin. Breast reconstruction (surgery to rebuild a breast's shape) is often an option after mastectomy.

Radiation therapy (also called radiotherapy) is the use of high-energy rays to kill cancer cells and stop them from growing. The rays may come from radioactive material outside the body and be directed at the breast by a machine (external radiation). The radiation can also come from radioactive material placed directly in the breast in thin plastic tubes (implant radiation). Some women receive both kinds of radiation therapy.
Radiation therapy, alone or with chemotherapy or hormone therapy, is sometimes used before surgery to destroy cancer cells and shrink tumors. This approach is most often used in cases in which the breast tumor is large or not easily removed by surgery.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs. The drugs may be given by mouth or by injection. Either way, chemotherapy is a systemic therapy because the drugs enter the bloodstream and travel throughout the body.
Chemotherapy is given in cycles: a treatment period followed by a recovery period, then another treatment, and so on. Most patients have chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. Depending on which drugs are given and the woman's general health, however, she may need to stay in the hospital during her treatment.

Hormonal therapy is used to keep cancer cells from getting the hormones they need to grow. This treatment may include the use of drugs that change the way hormones work or surgery to remove the ovaries, which make female hormones. Like chemotherapy, hormonal therapy is a systemic treatment; it can affect cancer cells throughout the body.

Treatment decisions are complex. They are often affected by the judgment of the doctor, by the desires of the patient and, the most important, the stage of the disease. The stage is based on the size of the tumor and whether the cancer has spread.

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Side Effects of Orthodox Treatment

It is hard to limit the effects of cancer treatment so that only cancer cells are removed or destroyed. Because healthy cells and tissues may also be damaged, treatment often causes unwanted side effects.
The side effects of cancer treatment are different for each person, and they may even be different from one treatment to the next.

Surgery
Surgery causes short-term pain and tenderness in the area of the operation, so women may need to talk with their doctor about which method of pain control would be appropriate. Any kind of surgery also carries a risk of infection, poor wound healing, bleeding, or a reaction to the anesthesia used in surgery. Removal of a breast can cause a woman's weight to shift and be out of balance--especially if she has large breasts. This imbalance can cause discomfort in a woman's neck and back. Also, the skin in the breast area may be tight, and the muscles of the arm and shoulder may feel stiff. After a mastectomy, some women have some permanent loss of strength in these muscles.
Because nerves may be injured or cut during surgery, a woman may have numbness and tingling in the chest, underarm, shoulder, and arm. These feelings usually go away within a few weeks or months, but some women may have permanent numbness.
Removing the lymph nodes under the arm slows the flow of lymph. In some women, this fluid builds up in the arm and hand and causes swelling (lymphedema). Women need to protect the arm and hand on the treated side from injury, even long after surgery.
The radiation may cause side effects that involve the heart, lungs, and ribs. One of the common side effects is fatigue, especially in the later weeks of treatment and for sometime afterward. It is also common for the skin in the treated area to become red, dry, tender, and itchy. Toward the end of treatment, the skin may become moist and "weepy." Exposing this area to air as much as possible will help the skin heal. Because bras and some types of clothing may rub the skin and cause irritation, patients may want to wear loose-fitting cotton clothes. These effects of radiation therapy on the skin are temporary, and the area gradually heals once treatment is over. However, there may be a permanent change in the color of the skin.
For most women, the breast will look and feel about the same after radiation therapy. Occasionally, the treated breast may be firmer. Also, it may be larger (due to fluid buildup) or smaller (because of tissue changes) than it was before. For some women, the breast skin is more sensitive after radiation treatment; for others, it is less sensitive.

Chemotherapy
The side effects of chemotherapy depend mainly on the drugs the patient receives. As with other types of treatment, side effects vary from person to person. In general, anticancer drugs affect rapidly dividing cells. These include blood cells, which fight infection, cause the blood to clot, and carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to get infections, bruise or bleed easily, and may have less energy during treatment and for some time afterward. Cells in hair follicles and cells that line the digestive tract also divide rapidly. As a result of chemotherapy, patients may lose their hair and may have other side effects, such as loss of appetite, nausea, vomiting, diarrhea, or mouth sores. There are cases in which the heart is weakened, and second cancers such as leukemia (cancer of the blood cells) have occurred. Also, some anticancer drugs can damage the ovaries. If the ovaries fail to produce hormones, the woman may have symptoms of menopause, such as hot flashes and vaginal dryness. Her periods may become irregular or may stop, and she may not be able to become pregnant. However, some women may still be able to get pregnant during treatment. Because the effects of chemotherapy on an unborn child are not known, it is important for a woman to talk to her doctor about birth control before treatment begins. After treatment, some women regain their ability to become pregnant, but in women over the age of 35 or 40, infertility is likely to be permanent.

Hormonal Therapy
Hormonal therapy can cause a number of side effects. They depend largely on the specific drug or type of treatment, and they vary from patient to patient. Tamoxifen is the most common hormonal treatment. This drug blocks the body's use of estrogen but does not stop estrogen production. Tamoxifen may cause hot flashes, vaginal discharge or irritation, and irregular periods. Any unusual bleeding should be reported to the doctor. Younger women taking tamoxifen may become pregnant more easily and should discuss birth control methods with their doctor.
Serious side effects of tamoxifen are rare, but this drug can cause blood clots in the veins, especially in the legs. In a very small number of women, tamoxifen has caused cancer of the lining of the uterus. The doctor may do a pelvic exam, as well as biopsies or other tests of the lining of the uterus, to monitor for this condition. (This does not apply to women who have had a hysterectomy, surgery to remove the uterus.)
Young women whose ovaries are removed to deprive the cancer cells of estrogen experience menopause immediately. The side effects they have are likely to be more severe than the effects of natural menopause.

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