At Women’s Healthcare of Morgantown, one of our main priorities is to educate women about breast cancer. In 2017, during Breast Cancer Awareness Month, we discussed in our blog:
- What is breast cancer
- Who is at risk
- How it can be detected
- Who needs to self-check
- How to do a self-check examination
- The importance of breast cancer screening
This year, 2018, we would like to further the discussion about breast cancer types, tumor grades, stages and treatment options.
- Carcinomas: Tumors that start in the epithelial cells that line organs and tissues throughout the body.
- In Situ: The breast cancer may not have spread to other breast tissue areas.
- Invasive: The breast cancer has spread into surrounding breast tissue areas.
- “Well-Differentiated” Tumor: If the tumor and tissue are close to the normal cells and tissue.
- “Undifferentiated” Tumor: Tumors that grow or spread at a slower rate and have abnormal cells and lack tissue structure.
A tumor is graded based on how abnormal the tumor cell and tissue look. This can be an indicator for how rapidly the tumor will grow and spread. There are four grades of tumors.
- GX:This is an undetermined grade.
- G1: Low grade tumor that is well differentiated.
- G2: Intermediate grade tumor that is moderately differentiated.
- G3: High grade tumor, but poorly differentiated.
- G4: High grade tumor, but undifferentiated.
A tumor grade can help develop a patient’s treatment plan and determine which stage of cancer they may be in.
STAGES OF BREAST CANCER
A patient’s breast cancer stage is determined by seven characteristics:
- Tubule Formation: The size of the tissue and if it has grown.
- Nuclear Grade: Is the cancer in the lymph nodes?
- Mitotic Rate: Has the cancer spread to other parts of the body?
- Tumor Grade: This is a measurement of how much the cancer cells look like normal cells.
- Estrogen and Progesterone Receptor Status: Are there estrogen or progesterone receptors in the cancer cells?
- Human Epidermal Growth Factor Receptor 2 (HER2) Status: HER2 plays a role in the development of cancer.
- Oncotype DX Score: a genomic test to determine how the cancer will behave or respond to treatment.
Stage one of breast cancer is an invasive breast cancer, and it is divided into two categories:
- Category one is when a tumor measures up to two centimeters but has not spread outside of the breast and has not invaded the lymph node.
- Category two is when there is no tumor in the breast; however, smaller groups of cancer cells that are larger than 0.2 millimeters, but smaller than two millimeters, are in the lymph nodes OR there is a tumor in the breast, and there are small groups of cancer cells in the lymph nodes.
Stage II, like stage I, is also broken up into categories:
- Category one is when there is no tumor in the breast but is found in one to three lymph nodes under the arm or near the breast bone. Or, if the tumor is between two to five centimeters, has not spread to the lymph nodes, is HER2 negative and is hormone receptor positive, it can be diagnosed as Stage II, Category One.
- Category two is when the tumor is larger than two centimeters but smaller than five centimeters, is found in the breast, and groups of cancer cells larger than 0.2 millimeters, but smaller than two millimeters, are found in the lymph nodes. Or, if the tumor has spread to one to three lymph nodes under the arm or near the breast bone. Or, if the tumor is larger than five centimeters but hasn’t spread to the lymph nodes under the arm or near the breast bone.
In stage III, there are three categories:
- Category one describes when there is no tumor in the breast, but cancer is found in four to nine lymph nodes near the breastbone, which can be found during a physical exam or imaging tests. Or, the tumor is larger than five centimeters, and small groups of cells larger than 0.2 centimeters, but not larger than two millimeters, are found in the lymph nodes. Or, the tumor is larger than five centimeters, or cancer, which can be found during a sentinel lymph node biopsy, has spread to one to three lymph nodes or near the breast bone.
- Category two describes the tumor as any size and has spread to the chest wall, skin of the breast and has caused swelling, may have spread to nine lymph nodes under the arm or near the breast bone.
- Category three describes if there is no sign of cancer in the breast, but if there is a tumor, it may be any size and may have spread to the chest wall or skin. The cancer has spread to ten or more lymph nodes under the arm or above or below the collarbone or breast bone.
Inflammatory breast cancer is considered stage three, category two, and can give patient’s reddening on the breast skin, warm or swollen breasts, and the cancer cells have spread to the lymph nodes.
Stage IV is an invasive type of breast cancer that has spread to other body areas such as the lungs, distant lymph nodes, skin, bones, liver and brain.
During this time, a patient may hear that their cancer is metastatic. Learn more about stage IV in our more in-depth blog here.
TYPES OF BREAST CANCER AND TREATMENT OPTIONS
As we mentioned in our last blog, breast cancer can start in different parts of the breast, but they all start when cells in the breast start to grow out of control, forming a tumor.
There are many types of breast cancer, with Ductal Carcinoma in Situ (DCIS), Invasive Ductal Carcinoma (IDC) and Invasive Lobular Carcinoma (ILC) being the most common.
Ductal Carcinoma in Situ (DCIS)
According to the American Cancer Society, 60,000 DCIS cases are diagnosed in the United States each year.
DCIS is a non-invasive, non-life threatening type of breast cancer that begins in the milk ducts. While it is not life-threatening, people who have DCIS have a 30 percent increased risk of developing an invasive breast cancer or recurrent DCIS within five to ten years of their initial DCIS diagnosis.
Unfortunately, there are not a lot of symptoms tied to DCIS. And, according to the National Cancer Institute, 80 percent of DCIS diagnosis are made because of a mammography.
DCIS can be diagnosed from a physical exam, mammogram or biopsy:
- Physical exam: During a physical exam, your physician may be able to feel a small lump in the breast, although noticeable lumps are rare with this type of cancer.
- Mammography: If a lump can not be felt during a physical exam, your physician will order a mammogram, which will detect white specks (microcalcifications) or a shadow.
- Biopsy: If your physician reads your mammography as unusual, they will order a biopsy. Because DCIS is a non-invasive, non-life threatening cancer, surgery is rarely needed. You physician will order:
- Fine needle aspiration biopsy: a hollow needle is inserted inside the breast.
- Core needle biopsy: a large needle is needed to remove larger samples.
- Incisional biopsy: if one of the above biopsy options can remove the cells or tissue, an incisional biopsy will be ordered, in which a small amount of tissue is removed to be examined.
- Excisional biopsy: in rare cases, an excisional biopsy is ordered to remove all of the suspicious lump.
It’s important to note, DCIS can be diagnosed by a biopsy; however, surgery will be needed to confirm if all of the cancer cells or tissues have been removed.
Treatment for DCIS can include, but is not limited to:
- Lumpectomy and then radiational therapy: This is one of the most common treatments for DCIS. This type of treatment is used to save most of the breast.
- Mastectomy: The removal of the entire breast can be recommended.
- Hormonal Therapy after surgery: The above treatments can block the amount of estrogen being produced in the body.
Invasive Ductal Carcinoma (IDC)
IDC is the most common type of breast cancer, with 80 percent of breast cancer diagnosis being this. There are five subtypes of IDC including:
- IDC Type: Tubular Carcinoma of the Breast
- IDC Type: Medullary Carcinoma of the Breast
- IDC Type: Mucinous Carcinoma of the Breast
- IDC Type: Papillary Carcinoma of the Breast
- IDC Type: Cribriform Carcinoma of the Breast
According to the American Cancer Society, 180,000 women in the United States find out they have invasive breast cancer each year. IDC is more common in older women.
Common symptoms of ICD include swelling in the breast, dimpling, breast and nipple pain, nipple discharge and a lump under the arm. Like DCIS, ICD can be diagnosed through a physical exam, mammogram or biopsy, but it can also be diagnosed through an ultrasound or breast MRI.
- Ultrasound: An ultrasound will bounce sound waves off of the breast, which can pick up images of the tissue.
- Breast Magnetic Resonance Imaging (MRI): The MRI will use magnetic fields, radio waves and a computer to take pictures of the tissue inside the affected area.
Treatment can include a lumpectomy, mastectomy, radiation therapy and hormonal therapy.
Invasive Lobular Carcinoma (ILC)
ILC, the second most common breast cancer, is an invasive type of cancer. This type of cancer begins in the breast milk ducts but continues to spread to other areas of the body.
Symptoms of ILC can resemble symptoms of ICD. Other symptoms could include a change of texture on the skin and the nipple turning inward.
Treatments for ILC can include a lumpectomy, mastectomy, sentinel lymph node dissection, axillary lymph node dissection, radiation therapy and hormonal therapy.
Other Forms of Breast Cancer
There are other, rare forms of breast cancer including Paget’s Disease of the Nipple and Phyllodes Tumors of the Breast.
WOMEN’S HEALTHCARE OF MORGANTOWN | BREAST CANCER
Breast Cancer Awareness Month is an annual international health campaign organized by major breast cancer charities to increase awareness and raise funds for prevention, diagnosis, treatment, research and cure.
At Women’s Healthcare of Morgantown, it is our duty to provide complete, compassionate healthcare for all women at all stages of their lives, and this includes educating them on breast cancer.
You can help us by encouraging your daughters, sisters, mothers and friends to perform regular self-checks and schedule yearly mammograms, depending on their age.
To learn more about performing self-checks, click here.