Breast cancer is a heterogeneous disease, so there are several different types of breast cancer, although they are generally summarized in two groups: precursor lesions and invasive or infiltrating carcinomas.
In the case of precursor lesions, a distinction must be made between ductal carcinoma in situ or intraductal carcinoma, which can be the preliminary step to developing invasive carcinoma.
It usually has no symptoms, and manifests as minute calcifications on mammography. In situ carcinomas do not cause lymph node involvement or metastasis, and are treated with surgery and radiotherapy, never with chemotherapy.
In the case of invasive carcinomas, invasive non-special invasive carcinoma, formerly called infiltrating ductal carcinoma, stands out as the most frequent variant, representing 7/8 of every ten cases.
It is worth mentioning that any invasive breast carcinoma can be classified into these subtypes:
- Hormonal tumors
- HER2-positive tumors
- Triple-negative tumors
Clinical manifestations of breast cancer
The clinical manifestations of breast cancer vary according to its extent and location in the breast, as well as whether or not there is distant metastasis.
Initially, it was believed that after a period of growth within the mammary gland, the primary tumor invaded the locoregional lymph nodes and then spread through the bloodstream to other organs. However, it is now known that breast cancer can metastasize without prior lymph node involvement.
In its early stage, breast cancer is usually asymptomatic and is usually detected by the presence of changes on mammography or by being able to palpate a tumor in the breast.
Signs and symptoms of breast cancer
The main symptoms and signs of breast cancer at the locoregional level are as follows:
- Appearance of a tumor mass or nodule: this is the most important and frequent finding. It is painless, and although most nodules are benign, they should be evaluated. A hard nodule adherent to the skin may be malignant, while soft, non-growing nodules are usually benign. Among the latter, cysts and fibroadenomas are noteworthy.
- Palpation of an axillary node: this is sometimes the first symptom, even if the breast examination is normal. Caution should be exercised, as it is easy to confuse a benign non-nodal lesion with a lymph node. Rarely, cancer can manifest as an axillary node without the appearance of a tumor at the primary level.
- Nipple discharge or telorrhage: it is essential to know whether it occurs in one or both breasts, as well as the characteristics of the fluid. When the discharge is in only one breast and through only one orifice, breast cancer should be suspected. The study in these cases is a cytology, a sample and a galactography, an x-ray of the ducts of the mammary gland.
- Inversion or retraction of the nipple: although sometimes it may be completely normal, it may be the first sign of breast cancer. If there is nipple eczema, Paget’s disease should be suspected.
- Skin changes: orange peel skin, signs of inflammation or ulceration should alert the patient to the possible existence of a malignant process.
- Pain in the breast: this is defined as the sensation of a pinching or tightness in the breast. It is rare, except in advanced cases.
During its evolution, breast cancer can spread and metastasize to other organs. Metastasis is the evolution of a tumor to a different location.
Treatment of breast cancer
Surgery, radiotherapy, chemotherapy, hormonal treatment and, more recently, molecular targets are the basic pillars against breast cancer. Depending on the characteristics of the tumor and its staging, different procedures are applied.
Localized breast cancer
- Surgery: this is the initial treatment of choice in localized breast cancer. There are two types of surgery, breast-conserving surgery and mastectomy.
The objective in both cases is to completely remove the tumor. Occasionally, when the tumor is not palpable, the surgery can be performed under ultrasound guidance or with marking.
- Chemotherapy: this is an important complementary element in the treatment of breast cancer.
- Hormonal treatment: hormonal therapy is important in those patients with tumors that have hormone receptors, but not in those who do not.
There are several types, and the choice of these varies according to the type of breast cancer as well as the menopausal status of the patient. - Treatment with antibodies: between 15 and 20% of breast tumors can be treated with antibodies. This is in cases where patients present the HER2 receptor. The treatment is generally applied for twelve months and is started during chemotherapy.
- Radiotherapy: it is indicated in the following cases
- After a mastectomy
- For tumors larger than 5 cm in diameter.
- After complementary surgery
- Complementary radiotherapy is usually applied to the remaining breast.
Its duration varies between four and seven weeks, and is applied daily (except on weekends) for a few minutes.
Locally advanced cancer
This group includes breast cancer patients with large breast tumors or with locoregional distant lymph node involvement without metastases.
Preoperative treatment with hormonal treatment or chemotherapy is increasingly used. Patients with HER2 receptor-positive breast tumors should also receive antibody therapy.
After completion, surgery will be performed.
Advanced or metastatic breast cancer
Normally, the intention of treatment in these cases is not curative, but rather to prolong survival while maintaining the patient’s quality of life. Before initiating treatment, the following should be taken into account:
- Location of the metastasis
- Hormone receptor and HER2 receptor status
- Patient symptoms
- Patient preferences
- Disease-free interval
- Menopausal status
Occasionally some metastases may be biopsied to confirm recurrence and determine receptor status.
They excite various processes, among which chemotherapy, antibody treatments and hormone therapy can be highlighted.
In this case, surgery is very limited, being used only in the primary tumor and when there is a solitary metastatic lesion, in which complete remission can be achieved. Radiation therapy is used to treat pain in cases of bone or brain metastases.
For more information on breast cancer and its treatment, consult a specialist in medical oncology.