A Review on Breast cancer: An Overview

 

V.  N. Dange*, S. J. Shid, Dr. C.S. Magdum, Dr. S.K. Mohite

Rajarambapu College of Pharmacy, Kasegaon Sangli.415404.

 

ABSTRACT:

Each year more than one million women are diagnosed with breast cancer worldwide over half of whom will die from the disease. Breast cancer is the most common cancer and the leading cause of cancer death for women. Extensive breast cancer screening programmes and the development of new treatments have improved the prognosis of breast cancer overall. However the average year survival rate for women with late stage or advanced breast cancer remains low. On average only 35% of women with advanced breast cancer are alive five years after diagnosis. A third of women are diagnosed with breast cancer at a late stage4 when the disease has a poor prognosis. Treatment options for breast cancer vary depending on the stage at which the cancer is diagnosed. Surgery and radiotherapy are commonly used to treat women with early stage breast cancer. Chemotherapy, hormonal and targeted therapies are frequently used to treat patients with more advanced forms of the disease.

 

 

 

 

INTRODUCTION:

Breast Information:

The breast is made up of different tissue, ranging from very fatty tissue to very dense tissue. Within this tissue is a network of lobes, which are made up of tiny, tube-like structures called lobules that contain milk glands. Tiny ducts connect the glands, lobules, and lobes, carrying the milk from the lobes to the nipple, located in the middle of the areola, which is the darker area that surrounds the nipple. Blood and lymph vessels also run throughout the breast; blood nourishes the cells, and the lymph system drains bodily waste products. The lymph vessels connect to lymph nodes, the tiny, bean-shaped organs that help fight infection.^2,3

 

Breast cancer:

Breast cancer is characterised by the uncontrolled growth of abnormal cells in the milk producing glands of the breast or in the passages (ducts) that deliver milk to the nipples.

 

Types of breast cancer :

The type of breast cancer is important in determining the most effective treatment approach. The most common way to classify breast tumours is according to the status of three specific cell surface receptors.  

1. Oestrogen Receptor (ER),

2. Progesterone Receptor (PR)

3. Human Epidermal Growth Factor Receptor (HER)2/ neu receptor.

 

The most common type of breast cancer is known as Hormone Receptor-Positive breast cancer; accounting for around 75% of all breast cancers.⁴ This type of cancer grows in response to the hormones oestrogen and progesterone, and as such is likely to respond to therapies that aim to inhibit the growth effects of hormones.⁵

 

Causes and risk factors :

There are a number of factors that have been shown to increase a woman’s risk of developing breast cancer:

 

Age: The majority of breast cancer cases occur in women over the age of 50.⁸

 

Family history: If a woman has a personal or family history of breast cancer she is at increased risk of developing breast cancer.¹

 

Clinical history: Women who have previously suffered with benign breast cancer are at greater risk of developing breast cancer in the future.¹

 

A late first pregnancy: Women who have a late first pregnancy (after the age of 35) are more likely to develop breast cancer.¹

 

Prolonged hormonal exposure: A long menstrual life or possibly use of hormone replacement therapy after the menopause expose women to an increased risk of developing breast cancer.¹

 

Lifestyle factors: For example, being overweight or obese after the menopause, physical inactivity, a high fat diet and high alcohol consumption can play an important role in the development of breast cancer.¹

 

Symptoms and diagnosis:

 

Fig. no. Signs and symptoms of breast cancer

 

The symptoms of early stage breast cancer can often go undetected. There are 12 common signs of breast cancer, these are summarised below:

1. A hard lump developing in the breast or armpit – typically painless and occurring on one side only.

2. A change in the size or shape of the breast, including indentation, ‘growing’ (particularly prominent) veins or skin erosion.

3. Changes in the skin such as hardening, dimpling, bumps, redness/heat or an orange peel like appearance.

4. Changes in the nipple such as retraction, the secretion of unusual discharge or a rash around the nipple area.

 

Staging :¹¹

In simple terms the stage of a cancer describes the size of the tumour and determines whether it has spread and how far it has spread. The stage is important because it helps cancer specialists to decide on the best treatment option. Adjacent is a simplified description of a staging system for breast cancer.

 

There are three main stages of breast cancer:

Early stage:  which refers to cancer that is confined to the fatty tissue of the breast.

Locally advanced :which has spread to underlying tissue of the chest wall.

Advanced or metastatic : where the tumour has spread to other parts of the body.  

 

Approximately one third of breast cancer cases are diagnosed after the cancer has spread beyond the primary tumour site (metastasised).⁴

 

Treatment of  Breast cancer :

Treatment options vary depending on the stage of the cancer – its size, position, whether it has spread to other parts of the body and the physical health of the patient. ^6,7

1.    Surgery : This is the main treatment option for patients whose breast cancer has not spread to other parts of the body and is also an option for more advanced stages of the disease. The types of breast cancer surgery differ in the amount of tissue that is removed with the tumour; this depends on the tumour’s characteristics, whether it has spread, and the patient’s personal feelings.

 Some of the most common types of surgery include:

     i.        Breast conserving therapy or ‘Lumpectomy’ which involves the removal of the cancerous area, the surrounding tissue and in some cases the lymph node, whist aiming to maintain a normal breast appearance after surgery.

    ii.        ‘Partial Mastectomy’ or ‘Quadrantectomy’; this is where a larger portion of tissue is removed (compared with Lumpectomy).

  iii.        ‘Total Mastectomy’, which is performed in an attempt to further cancer prevention. This surgery involves the removal of the entire breast, without the removal of lymph nodes.⁹

 

2. Radiotherapy: Therapy with radiation is often used in addition to surgery and chemotherapy to reduce the chances of the cancer recurring. It can be given after surgery (known as adjuvant treatment) or in conjunction with chemotherapy prior to surgery (neoadjuvant therapy) to shrink the tumour. Radiotherapy can also be used without surgery in patients with advanced metastatic breast cancer to help alleviate symptoms.

 

3. Chemotherapy: Chemotherapy may be given prior to surgery (neo-adjuvant) with the aim of reducing tumour size and the need for extensive surgery, or after surgery (adjuvant) to reduce the chances of the cancer coming back. When the cancer has spread to other parts of the body (metastatic), chemotherapy may be used to reduce symptoms, improve quality of life and extend survival. Chemotherapy drugs can be given intravenously (directly into the blood), or orally in a tablet. Chemotherapy is typically associated with adverse side effects such as fatigue, nausea and diarrhea; this is because of its toxic nature and non-specific mode of action, which means that all cells are attacked (even healthy cells).¹⁰

 

4. Hormonal therapy: Medicines that block or inhibit the actions of the hormones oestrogen and progesterone are often used in the treatment of patients with Hormone Receptor-Positive breast cancer.

 

5. Targeted therapy: Targeted therapies (also called biological therapies) are a relatively new approach to cancer treatment and target specific biological processes that are often essential to tumour growth. Targeted therapy can include use of monoclonal antibodies, vaccines and gene therapies. Targeted therapies precisely target cancer-specific processes, making them effective and less toxic to non-cancerous, healthy cells.

 

CONCLUSION:

Breast cancer is characterised by the uncontrolled growth of abnormal cells in the milk producing glands of the breast or in the passages (ducts) that deliver milk to the nipples. Breast cancer is the most common cancer and the leading cause of cancer death for women. The type of breast cancer is important in determining the most effective treatment approach. Current treatments for breast cancer include surgery, radiotherapy, chemotherapy, hormonal and targeted therapies. These therapies may be used alone or in combination depending on the stage of the disease.

 

REFERENCES:

1      Garcia M et al. Global Cancer Facts & Figures. Atlanta, GA: American Cancer Society, 2007

2      WHO Cancer factsheet N°297 updated February 2009

3      American Cancer Society, National cancer database (5 Year BC Prognosis) 2009-2010.

4      National Cancer  Institutes. SEER Stat Fact Sheets.

5      WebMD, Breast Cancer Health Centre

6      Harries M et al. Endocr Relat Cancer 2002;9:75-85

7      Cancer Help.org. Triple Negative Breast Cancer.

8.     Breast cancer treatment, the breast cancerInfo.com. 2010.

9.     Surgical oncology. UT health science center. 2009. Sep 24, 2010.

10.  Wells B G. 5th ed. New Delhi: Tata McGraw hill publishing company limited; 2004. Breast Cancer, Pharmacotherapy Hand Book

11. Stages of breast cancer, Breast cancer.org. 2010.

 

 

 

Received on 13.12.2016       Accepted on 12.01. 2017    

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