Breast Cancer: Types, Symptoms, Diagnosis, and Treatment

Breast cancer is a disease that can manifest in various forms and affect individuals differently. This blog post aims to provide an understanding of the types of breast cancer, the symptoms, diagnostic methods, screening practices, and treatment options available.

Types of Breast Cancer

Breast cancer is generally classified into two main types: Ductal Infiltrating and Lobular Infiltrating. The classification is based on whether the cancer originates from the epithelial cells of the lobules or the ducts.

1. Ductal Infiltrating: This type of cancer extends beyond the epithelium, affecting nearby and sometimes distant structures. A subgroup within this type is called Infiltrating Ductal Carcinoma Not Otherwise Specified (NAS), known for its extreme aggressiveness and malignancy.
2. Lobular Infiltrating: This type is further divided into five varieties: classic, solid, tubulo-alveolar, and mixed. The solid and tubulo-alveolar forms generally have a better prognosis than the other three.

Other less common types of breast cancer include:

• Paget's Carcinoma: This variant originates from the epithelial cells of the nipple, which appears red, retracted, and sometimes bleeding. This tumor is often associated with infiltrating ductal carcinoma, most frequently of the NAS type.
• Inflammatory Carcinoma: This type is characterized by a rapidly growing thickening, often painful, with the overlying skin appearing hot, red, and swollen. It metastasizes very quickly and early, especially to the lymphatic system.
• Juvenile Carcinoma: This is a very rare type of breast cancer, but it generally has a fairly favorable prognosis.

Symptoms of Breast Cancer

The symptoms of breast cancer depend on the type of tumor, its size, its spread, and the patient's age.

In the early stages, the symptoms may include the presence of a single mass, generally less than 5 centimeters in diameter, with an extremely variable volume. The mass may have a hard, fibrous consistency with poorly defined margins. Other early symptoms may include moderate erosions or swellings, serous or bloody secretions from the nipple, wrinkling of the overlying skin, and an increase in volume of the axillary lymph nodes on the same side as the diseased breast.

In advanced stages, the symptoms may include the presence of a mass of considerable volume, greater than 5 centimeters, fixed, non-mobile, compared to the underlying planes. Other symptoms may include edema (swelling) of the breast, which is also red, painful, with swelling adhering to the skin (orange peel skin) and its infiltration or ulceration, sometimes skin nodules, axillary lymph nodes increased in volume and fixed to the underlying planes, nipple retraction, and sometimes edema of the arm on the same side as the tumor.

Diagnosis of Breast Cancer

The diagnosis of breast cancer involves a combination of patient history, physical examination, and several diagnostic tests. The doctor will question the patient to find out the existence of a possible risk factor, especially for breast cancer in the family. The doctor will then move on to inspection and palpation to evaluate any asymmetries in the shape or volume of one breast compared to the other.

Diagnostic tests may include:

• Mammography: This is an essential tool for planning any diagnostic procedure and also therapy. It can highlight a tumor before the mass becomes palpable and recognizes approximately 70% of lesions smaller than 1 centimeter.

• Cytological Examination by Needle Aspiration: This involves aspirating material from the lesion with a thin needle, under the guidance of the ultrasound. The material is then analyzed under the microscope to see what type of cells form it.

• Biopsy: If the cytological test has not resolved the doubt about the diagnosis, a biopsy may be carried out. This involves removing a small piece of tumor lesion, which will be further analyzed under the microscope.

• Ultrasound: This is mainly used to differentiate cysts from solid lesions and as a guide for performing fine needle aspiration.

• Ductogalactography: This involves injecting a colored radioactive substance into the breast ducts with a needle. If there is a mass, on X-rays you will see a defect in the filling of the same ducts with the dye.

Screening for Breast Cancer

Breast self-examination is a crucial aspect of early detection of breast cancer. A woman should carry out self-examination every month starting from the age of 20, preferably in the week in which she has just finished menstruating.

Mammography is another essential screening tool. The first mammogram should be performed at age 40, and from there every 12 months. For patients at risk due to family history or otherwise, it should start at 30, and then always once a year.

Treatment of Breast Cancer

The treatment of breast cancer often involves a combination of surgery, radiotherapy, and hormonal treatments. For many years, total mastectomy (removal of the entire breast) has represented the therapy for Ductal Carcinoma In Situ (DCIS). However, today, conservative surgery (removal of only a piece of the breast) is also an option.

Radiotherapy is used after surgery to reduce the number of local recurrences in patients who have not undergone total mastectomy.

Hormonal treatments with a drug called tamoxifen have also been seen to be effective in reducing the risk of local recurrence and contralateral breast cancer. It is an anti-estrogen compound, which means it prevents estrogen from causing tumor cells to proliferate.