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الأحد، 19 سبتمبر، 2010

Breast Cancer








What type of breast cancer do I have?


Breast cancer is not a single disease. There are many types of breast cancer, and they may have vastly different implications. Breast cancers range from localized cancers such as ductal carcinoma in situ (DCIS) to invasive cancers that can rapidly spread (****stasize). In the middle of the spectrum are breast cancers, such as colloid carcinomas and papillary carcinomas, which have a much more favorable outlook (prognosis) than the other more typically invasive breast cancers. Sometimes, noninvasive DCIS is found around invasive breast cancers.


What difference does a precise diagnosis make?

The importance of an accurate diagnosis cannot be overstated. It is the precise diagnosis that determines the recommended treatment. Treatment must be specifically tailored to the specific type of breast cancer as well as to the individual patient.



Your doctor should be able to give you a clear de******ion of your type of breast cancer along with the treatment options that are appropriate to your case.



What has been done to exclude cancer in other areas of the same breast or in my other breast?

Unfortunately, there are some patients who may have more than one area of malignancy in the same breast or even an additional malignancy in the other breast. If this does occur, it can greatly change the recommendations for treatment.


Therefore, it is critically important that your doctors carefully investigate beyond the immediate site of the tumor to make certain there are no other areas with possible malignancy.


Sometimes discovering these "secondary" areas requires careful review of your mammograms. It may also require the addition of special views from different angles and specialized examination of your breasts by ultrasound, MRI, or other imaging techniques.



What type of medical team do I need for the most accurate diagnosis?

A well-coordinated team which includes input from the pathologist, surgeon, and radiologist is usually the best way to approach treatment decisions. Advice from the entire team must be available during biopsies and any tumor-clearing surgery to ensure the best chance of a favorable outcome for the patient.


How important is the role of the pathologist reading my slides?

The pathologist evaluating the slides made from fine-needle aspiration biopsies, core biopsies, and tissue slides of the breast must have a great deal of experience and special training. It is important that the pathologist reliably determine the presence or absence of cancer and distinguish cancer from other conditions such as hyperplasia with atypia (an overgrowth with unusual looking but benign cells).


Have my slides been reviewed by more than one pathologist?

A review by more than one pathologist is optimal. There are many subtleties which can be overlooked when reviewing microscope slides. These can lead to both over-reading (making a false-positive diagnosis) and under-reading (making a false-negative diagnosis). When slides are read a second time by another pathologist followed by a discussion of the conclusions, most diagnostic problems are resolved.

There are almost always several pathologists available who can review the pathology of your slides (this is termed a "double reading"). The added safeguard of double reading may not be necessary in most cases of breast cancers but can be a critical factor in some cases.


Can I have my biopsy reviewed by a pathologist at another diagnostic center?

It should always be possible to send slides from your biopsy to a pathologist at another diagnostic center. First of all, there should not be a rush to treatment; breast cancer is almost never an emergency. Developing the best treatment plan depends on a good, thorough pathologic evaluation as well as a complete workup of both breasts, as noted above. You should discuss this with your treatment team or primary-care giver as they can help you arrange for this.


Second, good pathologists are never offended by a request for an outside opinion. They also usually know the names of some of the finest breast pathologists in the country and should be willing to arrange a consultation with one of these doctors.


In most cases of breast cancer, it is not necessary to obtain this in-depth consultation. However, if there are any unusual aspects of your case, it can be important in your decision-making process. The matter of obtaining additional consults may take a week or more



What are the causes of breast cancer?


Breast cancer is the most common cause of cancer in women and the second most common cause of cancer death in women in the U.S. While the majority of new breast cancers are diagnosed as a result of an abnormality seen on a mammogram, a lump, or change in consistency of the breast tissue can also be a warning sign of the disease. Heightened awareness of breast cancer risk in the past decades has led to an increase in the number of women undergoing mammography for screening, leading to detection of cancers in earlier stages and a resultant improvement in survival rates. Still, breast cancer is the most common cause of death in women between 45-55 years of age. Although breast cancer in women is a common form of cancer, male breast cancer does occur and accounts for about 1% of all cancer deaths in men.


Research has yielded much information about the causes of breast cancers, and it is now believed that genetic and/or hormonal factors are the primary risk factors for breast cancer. Staging systems have been developed to allow doctors to characterize the extent to which a particular cancer has spread and to make decisions concerning treatment options. Breast cancer treatment depends upon many factors, including the type of cancer and the extent to which it has spread. Treatment options for breast cancer may involve surgery (removal of the cancer alone or, in some cases, mastectomy), radiation therapy, hormonal therapy, and/or chemotherapy.


With advances in screening, diagnosis, and treatment, the death rate for breast cancer has declined. In fact, about 90% of women newly diagnosed with breast cancer will survive for at least five years. Research is ongoing to develop even more effective screening and treatment programs



Risk factors

When you're told that you have breast cancer, it's natural to wonder what may have caused the disease. But no one knows the exact causes of breast cancer. Doctors seldom know why one woman develops breast cancer and another doesn't.


Doctors do know that bumping, bruising, or touching the breast does not cause cancer. And breast cancer is not contagious. You can't catch it from another person.


Doctors also know that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of getting a disease.


Some risk factors (such as drinking alcohol) can be avoided. But most risk factors (such as having a family history of breast cancer) can't be avoided.


Studies have found the following risk factors for breast cancer:

Age:

The chance of getting breast cancer increases as you get older. Most women are over 60 years old when they are diagnosed.



Personal health history:

Having breast cancer in one breast increases your risk of getting cancer in your other breast. Also, having certain types of abnormal breast cells (atypical hyperplasia, lobular carcinoma in situ [LCIS], or ductal carcinoma in situ [DCIS]) increases the risk of invasive breast cancer. These conditions are found with a breast biopsy.



•Family health history:

Your risk of breast cancer is higher if your mother, father, sister, or daughter had breast cancer. The risk is even higher if your family member had breast cancer before age 50. Having other relatives (in either your mother's or father's family) with breast cancer or ovarian cancer may also increase your risk.



•Certain genome changes:

Changes in certain genes, such as BRCA1 or BRCA2, substantially increase the risk of breast cancer. Tests can sometimes show the presence of these rare, specific gene changes in families with many women who have had breast cancer, and health care providers may suggest ways to try to reduce the risk of breast cancer or to improve the detection of this disease in women who have these genetic changes.



Also, researchers have found specific regions on certain chromosomes that are linked to the risk of breast cancer. If a woman has a genetic change in one or more of these regions, the risk of breast cancer may be slightly increased. The risk increases with the number of genetic changes that are found. Although these genetic changes are more common among women than BRCA1 or BRCA2, the risk of breast cancer is far lower.



Radiation therapy to the chest:

Women who had radiation therapy to the chest (including the breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life.



Reproductive and menstrual history:



◦The older a woman is when she has her first child, the greater her chance of breast cancer.



◦Women who never had children are at an increased risk of breast cancer.



◦Women who had their first menstrual period before age 12 are at an increased risk of breast cancer.



◦Women who went through menopause after age 55 are at an increased risk of breast cancer.



◦Women who take menopausal hormone therapy for many years have an increased risk of breast cancer.



•Race: In the United States, breast cancer is diagnosed more often in white women than in African American/black, Hispanic/Latina, Asian/Pacific Islander, or American Indian/Alaska Native women.



•Breast density: Breasts appear on a mammogram (breast x-ray) as having areas of dense and fatty (not dense) tissue. Women whose mammograms show a larger area of dense tissue than the mammograms of women of the same age are at increased risk of breast cancer.



•History of taking DES: DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.) Women who took DES during pregnancy may have a slightly increased risk of breast cancer. The possible effects on their daughters are under study.



•Being overweight or obese after menopause: The chance of getting breast cancer after menopause is higher in women who are overweight or obese.




•Lack of physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer.




•Drinking alcohol: Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer.
Having a risk factor does not mean that a woman will get breast cancer. Most women who have risk factors never develop breast cancer.


Many other possible risk factors have been studied. For example, researchers are studying whether women who have a diet high in fat or who are exposed to certain substances in the environment have an increased risk of breast cancer. Researchers continue to study these and other possible risk facto



Treatment



Women with breast cancer have many treatment options. The treatment that's best for one woman may not be best for another.


The options are surgery, radiation therapy, hormone therapy, chemotherapy, and targeted therapy. You may receive more than one type of treatment. The treatment options are described below.


Surgery and radiation therapy are types of local therapy. They remove or destroy cancer in the breast.


Hormone therapy, chemotherapy, and targeted therapy are types of systemic therapy. The drug enters the bloodstream and destroys or controls cancer throughout the body.


The treatment that's right for you depends mainly on the stage of the cancer, the results of the hormone receptor tests, the result of the HER2/neu test, and your general health.


You may want to talk with your doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option for women at any stage of breast cancer.


Your doctor can describe your treatment choices, the expected results, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects, how to prevent or reduce these effects, and how treatment may change your normal activities.


You may want to know how you will look during and after treatment. You and your health care team can work together to develop a treatment plan that meets your medical and personal needs.


Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat breast cancer include surgeons, medical oncologists, and radiation oncologists. You also may be referred to a plastic surgeon or reconstructive surgeon. Your health care team may also include an oncology nurse and a registered dietitian.


At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns



You may want to ask your doctor these questions before you begin treatment:


•What did the hormone receptor tests show? What did other lab tests show? Would genetic testing be helpful to me or my family?
•Do any lymph nodes show signs of cancer?
•What is the stage of the disease? Has the cancer spread?
•What are my treatment choices? Which do you recommend for me? Why?
•What are the expected benefits of each kind of treatment?
•What can I do to prepare for treatment?
•Will I need to stay in the hospital? If so, for how long?
•What are the risks and possible side effects of each treatment? How can side effects be managed?
•What is the treatment likely to cost? Will my insurance cover it?
•How will treatment affect my normal activities?
•Would a research study (clinical trial) be appropriate for me?
•Can you recommend other doctors who could give me a second opinion about my treatment options?
•How often should I have checkups

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