Breast Cancer

Breast Cancer Loading image. Please wait...

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter substances in lymph and help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.

The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.

Age and health history can affect the risk of developing breast cancer.
Anything that increases your chance of getting a disease is called a risk factor. Risk factors for breast cancer include:

  • Older age.
  • Menstruating at an early age.
  • Older age at first birth or never having given birth.
  • A personal history of breast cancer or benign (noncancer) breast disease.
  • A mother or sister with breast cancer.
  • Treatment with radiation therapy to the breast/chest.
  • Breast tissue that is dense on a mammogram.
  • Hormone use (such as estrogen and progesterone).
  • Drinking alcoholic beverages.
  • Caucasian race.

Breast cancer is sometimes caused by inherited gene mutations (changes).
The genes in cells carry the hereditary information that is received from a person's parents. Hereditary breast cancer makes up approximately 5% to 10% of all breast cancer. Some altered genes related to breast cancer are more common in certain ethnic groups.

Women who have an altered gene related to breast cancer and who have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast. These women also have an increased risk of developing ovarian cancer, and may have an increased risk of developing other cancers. Men who have an altered gene related to breast cancer also have an increased risk of developing this disease. (For more information, refer to the PDQ summary on Male Breast Cancer.)

Tests have been developed that can detect altered genes. These genetic tests are sometimes done for members of families with a high risk of cancer. (Refer to the PDQ summaries on Screening for BreastCancer, Prevention of Breast Cancer, and Genetics of Breast and Ovarian Cancer for more information.) Loading image. Please wait...

Tests that examine the breasts are used to detect (find) and diagnose breast cancer
A doctor should be seen if changes in the breast are noticed. The following tests and procedures may be used:

  • Mammogram: An x-ray of the breast.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. If a lump in the breast is found, the doctor may need to cut out a small piece of the lump. A pathologist views the tissue under a microscope to look for cancer cells. Four types of biopsies are as follows:
  • Excisional biopsy: The removal of an entire lump or suspicious tissue.
  • Incisional biopsy: The removal of part of a lump or suspicious tissue.
  • Core biopsy: The removal of part of a lump or suspicious tissue using a wide needle.
  • Needle biopsy or fine-needle aspiration biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle.
  • Estrogen and progesterone receptor test: A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If cancer is found in the breast, tissue from the tumor is examined in the laboratory to find out whether estrogen and progesterone could affect the way cancer grows. The test results show whether hormone therapy may stop the cancer from growing.

Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether it is in the breast only or has spread to other places in the body), the type of breast cancer, certain characteristics of the cancer cells, and whether the cancer is found in the other breast. A woman's age, menopausal status (whether a woman is still having menstrual periods), and general health can also affect treatment options and prognosis.Loading image. Please wait...

Stages of Breast Cancer
Key Points for This Section

  • After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.
  • The following stages are used for breast cancer:
  • Stage 0 (carcinoma in situ)
  • Stage I
  • Stage IIA
  • Stage IIB
  • Stage IIIA
  • Stage IIIB
  • Stage IIIC
  • Stage IV

After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.
The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment.

The following stages are used for breast cancer:
Stage 0 (carcinoma in situ)
There are 2 types of breast carcinoma in situ:

  • Ductal carcinoma in situ (DCIS) is a precancerous condition that sometimes becomes an invasive type of breast cancer (cancer that has spread from the duct into surrounding tissues).
  • Lobular carcinoma in situ (LCIS) is not cancer, but rather a marker or indicator that identifies a woman as having an increased risk of developing invasive breast cancer (cancer that has spread into surrounding tissues). It is common for both breasts to be affected.

Stage IIn stage I, the cancer is no larger than 2 centimeters (about 1 inch) and has not spread outside the breast.

Stage IIAIn stage IIA, the cancer is either:

  • no larger than 2 centimeters (about 1 inch) but has spread to the axillary lymph nodes (the lymph nodes under the arm); or
  • between 2 and 5 centimeters (1 to 2 inches) but has not spread to the axillary lymph nodes.Stage IIBIn stage IIB, the cancer is either:
  • between 2 and 5 centimeters (1 to 2 inches) and has spread to the axillary lymph nodes (the lymph nodes under the arm); or
  • larger than 5 centimeters (about 2 inches) but has not spread to the axillary lymph nodes.Stage IIIAIn stage IIIA, the cancer is either:
  • smaller than 5 centimeters (about 2 inches) and has spread to the axillary lymph nodes (the lymph nodes under the arm), and the lymph nodes are attached to each other or to other structures; or
  • larger than 5 centimeters and has spread to the axillary lymph nodes and the lymph nodes may be attached to each other or to other structures.

Stage IIIBIn stage IIIB, the cancer has either:

  • spread to tissues near the breast (the skin or chest wall, including the ribs and muscles in the chest); or
  • spread to lymph nodes within the breast or under the arm.

Stage IIICIn stage IIIC, the cancer may have spread to tissues near the breast (the skin or chest wall, including the ribs and muscles in the chest), but has spread to lymph nodes beneath the collar bone and near the neck.

Stage IVIn stage IV, the cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.

Inflammatory Breast Cancer
In inflammatory breast cancer, the breast looks red and swollen and feels warm. The redness and warmth occur because the cancer cells block the lymph vessels in the skin. The skin of the breast may also show the pitted appearance called peau d'orange (like the skin of an orange).

Recurrent Breast Cancer
Recurrent breast cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the breast, in the chest wall, or in other parts of the body.

Treatment Option OverviewKey Points for This Section
There are different types of treatment for patients with breast cancer.

  • Four types of standard treatment are used:
    - Surgery
    - Radiation therapy
    - Chemotherapy
    - Hormone therapy

  • Other types of treatment are being tested in clinical trials. These include the following:
    - Sentinel lymph node biopsy followed by surgery
    - High-dose chemotherapy with bone marrow transplantation or peripheral blood stem cell transplantation

There are different types of treatment for patients with breast cancer.
Different types of treatment are available for patients with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Four types of standard treatment are used:
Surgery
Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following:

  • Lumpectomy: A surgical procedure to remove a tumor (lump) and a small amount of normal tissue around it.
  • Partial mastectomy: A surgical procedure to remove the part of the breast that contains cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.

Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy. This procedure is called lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done through a separate incision.

Other types of surgery include the following:

  • Total mastectomy: A surgical procedure to remove the whole breast that contains cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
  • Modified radical mastectomy: A surgical procedure to remove the whole breast that contains cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
  • Radical mastectomy: A surgical procedure to remove the breast that contains cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.

Even if the doctor removes all of the cancer that can be seen at the time of surgery, the patient may be given radiation therapy, chemotherapy, or hormone therapy after surgery to try to kill any cancer cells that may be left. Treatment given after surgery to increase the chances of a cure is called adjuvant therapy.

If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast's shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at a future time. The reconstructed breast may be made with the patient's own (nonbreast) tissue or by using implants filled with saline or silicone gel. The Food and Drug Administration (FDA) has decided that breast implants filled with silicone gel may be used only in clinical trials. Before the decision to get an implant is made, patients can call the FDA's Center for Devices and Radiologic Health at 1-888-INFO-FDA (1-888-463-6332) for more information.

Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.

Hormone therapy with tamoxifen is often given to patients with early stages of breast cancer and those with metastatic breast cancer (cancer that has spread to other parts of the body). Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase the chance of developing endometrial cancer. Women taking tamoxifen should have a pelvic examination every year to look for any signs of cancer. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.

Other types of treatment are being tested in clinical trials. These include the following:
Sentinel lymph node biopsy followed by surgery
Sentinel lymph node biopsy is the removal of the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed for biopsy. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the surgeon removes the tumor (breast-conserving surgery or mastectomy).

High-dose chemotherapy with bone marrow transplantation or peripheral blood stem cell transplantation
This is a method of giving very high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the bone marrow or blood of the patient or a donor and are frozen for storage. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. Over a short time, these reinfused stem cells grow into (and restore) the body's blood cells.

Studies have shown that high-dose chemotherapy followed by bone marrow transplantation or peripheral blood stem cell transplantation does not work better than standard chemotherapy in the treatment of breast cancer. Doctors have decided that, for now, high-dose chemotherapy should only be tested in clinical trials. Before taking part in such a trial, women should talk with their doctors about the serious side effects, including death, that may be caused by high-dose chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Treatment Options by Stage
Ductal Carcinoma In Situ (DCIS)
Treatment of ductal carcinoma in situ (DCIS) may include the following:

  • Breast-conserving surgery with or without radiation therapy or hormone therapy.
  • Total mastectomy with or without hormone therapy.
  • Clinical trials testing breast-conserving surgery and hormone therapy with or without radiation.

Lobular Carcinoma In Situ (LCIS)
Treatment of lobular carcinoma in situ (LCIS) may include the following:

  • Biopsy to diagnose the LCIS followed by regular examinations and regular mammograms to find any changes as early as possible. This is referred to as observation.
  • Tamoxifen to reduce the risk of developing breast cancer.
  • Bilateral prophylactic mastectomy. This treatment choice is sometimes used in women who have a high risk of getting breast cancer. Most surgeons believe that this is a more aggressive treatment than is needed.
  • Clinical trials testing cancer prevention drugs.

Stage I, Stage II, and Stage IIIA Breast Cancer
Treatment of stage I, stage II, and stage IIIA breast cancer that is confined to the breast and lymph nodes under the arm may include the following:

  • Breast-conserving surgery to remove only the cancer and some surrounding breast tissue, followed by lymph node dissection and radiation therapy.
  • Modified radical mastectomy with or without breast reconstruction surgery.
  • A clinical trial evaluating sentinel lymph node biopsy followed by surgery.

Adjuvant therapy (treatment given after surgery to increase the chances of a cure) may include the following:

  • Radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy.
  • Systemic chemotherapy with or without hormone therapy.
  • Hormone therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Stage IIIB, Stage IIIC, Stage IV, and Metastatic Breast Cancer
Treatment of stage IIIB and advanced stage IIIC breast cancer (early stage IIIC breast cancer is treated as Stage I, stage II, and stage IIIA breast cancer ) may include the following:

  • Systemic chemotherapy.
  • Systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy. Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.
  • Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Treatment of stage IV or metastatic breast cancer may include the following:

  • Hormone therapy and/or chemotherapy with or without trastuzumab (Herceptin).
  • Radiation therapy and/or surgery for relief of pain and other symptoms.
  • Clinical trials testing new chemotherapy and/or hormone therapy. Clinical trials are also studying new combinations of trastuzumab (Herceptin) with anticancer drugs.
  • Clinical trials testing other approaches, including high-dose chemotherapy with bone marrow transplantation or peripheral blood stem cell transplantation.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Treatment Options for Inflammatory Breast Cancer
Treatment of inflammatory breast cancer may include the following:

  • Systemic chemotherapy
  • Systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy. Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.
  • Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Treatment Options for Recurrent Breast Cancer
Treatment of recurrent breast cancer (cancer that has come back after treatment) in the breast or chest wall may include the following:

  • Surgery (radical or modified radical mastectomy), radiation therapy, or both.
  • Systemic chemotherapy or hormone therapy.

Changes to This Summary (10/09/2003)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.



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