Breast Cancer Treatment

Breast cancer is one of the most common cancers in women in Singapore. The disease causes the cells in the breast to grow at an abnormal rate and although there are different kinds of breast cancer, most of these begin in the ducts or lobules. In progressive stages, cancer cells can spread outside the breast through lymph and blood vessels.

What Causes Breast Cancer?

Breast cancer is caused by the abnormal growth of cells which divides and spread through the lymph nodes to other parts of the breast and body.

Breast cancer usually starts with changes in cells that make up the milk-producing ducts. At other times, it begins in the glandular tissue (lobules) or other breast tissues and the cancer cells spread through the lymph nodes to other tissues.

Some risk factors for breast cancer include:

  • Age
  • Having one or more close relatives with breast cancer
  • Personal history of breast cancer
  • Late menopause after age 55
  • Late childbearing after age 30
  • Excessively drinking alcohol over an extended period of time
  • Being overweight after menopause;
  • Being physically inactive;
  • Drinking alcohol regularly;
  • Long-term use of combined hormone replacement therapy (of more than 5 years)

Risk Factors of Breast Cancer

There are various risk factors that can lead to breast cancer such as genetics and age. Women who are 40 and above are at higher risk of breast cancer. Other risks include:

  • Genetic Mutations: Abnormal genes can be passed on from parents to children and throughout generations. 10% of breast cancer cases are said to be hereditary. Most cases of inherited breast cancers are caused by mutations of the BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two) genes.
  • Reproductive System: Girls who have their first menstruation at age 12 or below, have a higher risk of breast cancer later on. The earlier the breast development occurs, the earlier the breasts become sensitive to the hormonal changes in and around the body as well as to the hormone-disrupting chemicals in modern-day products.
  • Physically Dense Breast: Women with dense breasts are more prone to breast cancer because they have greater amount of fat tissue which hides the tumors at the initial stages.
  • Family History: Genetics play a significant role in the development of breast cancer. A person’s risk is doubled when she has a daughter, mother or sibling who is diagnosed with breast cancer. When two first-degree blood relatives are diagnosed, the person’s risk is increased 5 times.
  • Personal History: Those who are previously diagnosed with breast cancer have a higher chance of getting cancer in the other breast or another part of the same breast.

Signs and Symptoms of Breast Cancer

The primary symptom of breast cancer is a lump or hard mass in the breast tissue. However, different breast cancers have distinctive symptoms and signs, which include Invasive lobular carcinoma (ILC), abnormal thickening of breast and other physical signs.

  • Physical changes in the infected breast such as soreness and swelling
  • Rashes, itching, redness, or other prominent changes
  • An increase in size or change in the shape of the breast(s)
  • Deformation of nipples
  • Abnormal nipple discharge other than breast milk
  • Constant pain in both or one of the breasts
  • Upon pressing, a lump or node can be felt

Breast Cancer Treatment Options

There are various forms of treatments based on the type of cancer and patient’s conditions. Breast cancer patients often go for multiple treatments instead of relying on one or two methods to deal with the complexity of the cancer cells.

Chemotherapy

Chemotherapy uses anti-cancer drugs to prevent the spread of cancer cells and inhibit their growth. It may be used before surgery to shrink tumours smaller or after surgery to decrease the risk of a relapse as part of the overall cancer treatment plan. Side effects include vomiting and nausea, hair loss, loss of appetite and numb toes or fingers.

Hormonal therapy

Late-stage breast cancer will often require other breast cancer treatment options besides mastectomy or breast-conserving surgery to remove tumours in the lymph nodes and to treat a cancer in the breast(s).

Hormones, such as oestrogen, may stimulate the growth of some cancers so hormone therapy aims to reduce this effect as part of breast cancer treatment. Tamoxifen and aromatase inhibitors are prescribed to block the action of oestrogen or to block the enzyme used to produce oestrogen.

However, there may be side effects from this treatment such as mood swings, nausea, joint pain and fatigue.

Radiation therapy

Radiation therapy is one of the most common breast cancer treatment options that makes use of high energy X-rays to kill remaining cancer cells after surgery to remove tumours. However, there may be side effects such as sore breasts, redness, darkening or thickening skin.

Surgical Treatments for Cancer:

There are two kinds of surgeries that can be done to cure breast cancer.

Lumpectomy

This procedure is a form of “breast preservation” or “breast-conserving” surgery, and is technically a partial mastectomy. In this surgery, only the tumor and a small portion of healthy tissues surrounding the tumor are removed. This surgery is recommended for patients with cysts that are not mature yet.

To further eliminate cancer cells that may remain after lumpectomy, most patients go through radiation therapy for around 2 months after the surgery. If chemotherapy is also required, patients are usually advised to undergo chemotherapy before radiation therapy.

Risks of Lumpectomy

  • There is a higher chance of cancer recurrence
  • The breast may become much smaller or deformed after surgery
  • Most of the Lumpectomy patients have to go through 4-5 weeks of radiation after surgery to make sure that the cancer cells are completely killed.

Mastectomy

Mastectomy is the surgical removal of the whole breast to completely take out the breast tissues. In a total mastectomy, no muscle under the breast is removed. The lymph nodes in the armpits are also retained unless they are within the breast tissue. On the other hand, a radical mastectomy includes the removal of underarm lymph nodes and the chest wall muscles.

Nowadays, modern mastectomy provides patients with the option to retain the nipple or preserve the skin in the breast region when removing the breast tissues. These mastectomy options allow for the reconstruction of the breast with a tissue taken from another part of the body or with an implant. Skin-saving and nipple-sparing mastectomy can only be performed when the tissues under the skin or nipple are free from tumor cells.

Risks of Mastectomy

  • Longer recovery process
  • Risk of infection
  • Scar tissue formation and build-up can occur and are sometimes painful

How to Check for Breast Cancer:

It is crucial to regularly check your breasts for abnormal changes such as dimpling of the skin, retracted nipple, abnormal nipple discharge, or a lump. Early detection will enable better outcomes from breast cancer treatment, preventing the cancer from progressing to an advanced stage.

It is advisable to do your breast self-examination (BSE) at least once every month. While standing in front of the mirror, check your breast and surrounding areas of the armpit for any lump, hardened lump or thickened area. Note any changes in the skin or shape of the breast. You can also do the BSE while lying down.

Consult a doctor immediately if you notice any abnormal lumps, dimpling of the skin, or any other changes to your nipples or skin tissue. Your doctor may refer you to a specialist who may do a detailed assessment of your condition. If diagnosed with breast cancer, your specialist will advise you on the next steps and the breast cancer treatment options best suited for you. They will also work with you to come up with a breast cancer treatment plan, while advising you about any side effects.

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