Understanding Breast Cancer
Breast form of fat , connective tissue , and thousands of lobules ( milk -producing glands small ) . When a woman gives birth , mother's milk ( ASI ) will be sent to the nipple through tiny channels while nursing .
The cells in our body normally grow and proliferate on a regular basis . New cells form only when needed . But the process in the body of a cancer patient will be different .
The process will behave strangely so that the growth and proliferation of cells becomes uncontrolled. The abnormal cells can also spread to other parts of the body through the bloodstream. This is called cancer metastasis.
If detected at an early stage, cancer can be treated before it spreads to other parts of the body. The early symptoms of breast cancer is a lump or thickening in the breast tissue. But most lumps are not necessarily signal cancer.
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Breast Cancer Patients in Indonesia
Breast cancer incidence in Indonesia reached about 40 cases per 100,000 population in 2012, according to data on the world health organization (WHO). Compared to our neighboring countries, Malaysia, Indonesia breast cancer affects more women younger age and at a more advanced stage.
Breast cancer does not only attack women but also men rarely.
Any type of Breast Cancer?
Two of the three women who develop breast cancer over 50 years. When you are aware of the symptoms of breast cancer, you are recommended to immediately consulted a doctor. After examination, the doctor will usually refer you to the hospital for further tests to confirm the diagnosis.
Breast cancer is generally divided into two categories, namely non-invasive and invasive. More detailed explanation is as follows:
Invasive breast cancer
The most common form of invasive breast cancers are invasive ductal breast cancer that develops in the cells forming the breast duct. Said invasive means of this cancer can spread beyond the breast. About 80 percent of all cases of invasive breast cancer is a type of this kind.
Another type of noninvasive breast cancer include:
- Invasive lobular breast cancer. The disease develops in the milk-producing glands called lobules.
- Breast cancer inflamed.
- Paget breast cancer.
The types of cancer is also known as secondary or metastatic breast cancer. This species can spread to other parts of the body. Its spread is usually through the lymph nodes (small glands that filter out bacteria from the body) or the bloodstream.
Non-invasive breast cancer
Non-invasive form of cancer is typically discovered through mammography because rarely cause bumps. This type is also often called pre-cancer. The most common type of cancer is ductal carcinoma in situ. This type of breast cancer are benign and are found in the channel (ductal) breast and has not spread.( Read also : lumps-in-breast-not-necessarily-tumor )
Breast Examination and Genetics
The main causes of breast cancer are unknown. Therefore, prevention of breast cancer entirely too difficult to determine. Many factors can increase the risk of cancer, such as age and family medical history.
Breast examination and genetics recommended for women with a chance of developing breast cancer than average. Risk of breast cancer increases with age, women aged 50-70 years are encouraged check-up every three years. Women aged 70 years and above are encouraged to consult and consult a doctor.
Steps to Breast Cancer Treatment
One in nine women will develop breast cancer during their lifetime. Cancers detected at an early stage has a chance to recover through treatment measures. Therefore, it is very important for a woman to perform a routine breast exam.
Breast cancer can be treated with a combination of surgery, chemotherapy, and radiotherapy. Some cases of breast cancer can also be handled through a biological or hormonal therapy. During the period of treatment and recovery, support from others (especially family and close friends) for patients with breast cancer is important.
symptoms of breast cancer
The first indication of breast cancer is generally realized is a lump or thickening in the breast skin, but about 9 out of 10 lumps that appear not caused by cancer.
The first indication of breast cancer that usually realize a lump or thickened skin on the breast. However, about 9 out of 10 lumps that appear not caused by cancer.
There is some indication that you need to consider to be asked directly to the treating doctor. Examples of such symptoms are pain in the breast or armpit that is unrelated to the menstrual cycle.
The emergence of the breast lump or thickened skin and nipple discharge (usually accompanied by blood) also need to be alert. Some other symptoms are changes in the size of one or both breasts, nipple changes shape, and the breast skin to constrict.
You may also experience itching and a rash around your nipple. On the part of your armpit, can also appear lump or swelling. Signs and symptoms of the above need to be alert and try to ask your doctor to make sure the conditions you are experiencing.
Causes of Breast Cancer
The cause of breast cancer is not known with certainty. It is difficult to ensure that every patient has the same cause or not. But there are some factors that can affect the level of risk of breast cancer, among others:
Impact of the Previous Breast Cancer Diagnosis
If you've had breast cancer or changes in the nature of non-invasive cancer cells are contained within the breast duct cells become invasive cancer, you can re-cancer in the same breast or the other breast.
Benign lumps influence Ever Held
Having a benign lump that does not mean you have breast cancer, but certain lump might increase your risk. Small changes in your breast tissue, such as cell growth that is unusual in duct or lobule, may increase your risk for breast cancer.
Influence of Genetics and Family Health History
If you have a nuclear family (eg, mother, brother, sister or child) who develop breast or ovarian cancer, your risk for developing breast cancer increases. But breast cancer may also appear more than once in one family by chance.
Generally breast cancer cases are not due to hereditary factors (heredity), but the specific gene mutation known as BRCA1 and BRCA2 can increase the risk of breast cancer and ovarian cancer. This type of cancer may also be derived from parents to children.
Age factor
As people age, the risk of cancer also increases. Breast cancer usually occurs in women aged over 50 years who had experienced menopause. About 80 percent of breast cancer cases occur in women over the age of 50 years.
Risk of Radiation Exposure
Your risk for breast cancer may also increase if frequently exposed to radiation or as a result of certain medical procedures using radiation such as X-rays and CT scans.
Risk Exposure to Estrogen
Risk of breast cancer will be slightly increased as a result of exposure to estrogen levels in the body. Example:
- If you do not have children or gave birth in old age. This will increase the risk of breast cancer due to exposure to estrogen is not hindered by the process of pregnancy.
- If you are having a menstrual period is longer (for example, began menstruating before age 12 or went through menopause after age 55 years).
Effect of Hormone Replacement Therapy
Combination hormone replacement therapy have a slightly higher risk than estrogen hormone replacement therapy. But both can still breast heightens the risk of cancer among 1,000 women who underwent hormone therapy combination for 10 years, it is estimated there will be 19 more cases of breast cancer than women who never received hormone therapy. This risk will also increase as the duration of therapy, but will return to normal after you stop living it.
Effect of Overweight Or Obese
Being overweight after menopause can lead to increased production of estrogen , so the risk of breast cancer increases .
Consumption of Liquor
A study was conducted on 200 women consuming liquor and 200 women not consuming liquor . The results suggest that consuming liquor group members could develop cancer as many as three more . Risk of breast cancer will increase as the large number of liquor consumed .
Breast Cancer Diagnosis
In general, breast cancer is diagnosed through a routine examination or when the sufferer aware of certain symptoms which eventually became the driving force for all physical doctor.examination alone is not enough to confirm a diagnosis of breast cancer.
If you find a lump in your breast, your doctor may recommend some procedures to determine if you have breast cancer or not.
- Mammography. Examination by mammography is generally used to detect the presence of cancer.
- USG. This type of examination is used to determine whether the breast lump containing solid or liquid.
- Biopsy. These checks include process sampling breast cells and tested to determine whether the cells are cancerous. Through this procedure, the biopsy sample will also be examined to determine the cell type of breast cancer, malignancy and reaction to hormones.
When positively diagnosed with cancer, you need some further tests to know the stage and degree of cancer spread. Among them:
- MRI and CT scans .
- Chest X-rays .
- examination of the bones to check whether the cancer has spread to the bone .
- Lymph node biopsy ( stain lymph nodes ) in the armpit . If the cancer has spread , lymph nodes are the first to be infected lymph stains centinel.located vary, so can also be identified by a combination of radioactive isotopes and blue ink .
You are also advised to undergo a reaction that would indicate cancer in certain types of treatment . Among them:
examination of HER2
Cancer is stimulated by a protein , referred to as HER2 (human epidermal growth factor receptor 2 ) , can be treated with drugs that block the effects of HER2 . This type of treatment is called biological therapies or molecules.Examination of hormone receptors
The growth of breast cancer cells may also be triggered by the body's natural hormones, such as estrogen and progesterone. Cancer cell samples to be taken from the breast and tested to see his reaction to estrogen or progesterone. If the hormone attaches to cancer cells, namely the hormone receptors, the cell will be referred to as hormone receptor positive.
Stage Breast Cancer
Stage describes the size of the cancer and the rate of spread. Breast cancer is non-invasive ductal sometimes described as Stage 0. Other Stage describes the development of invasive breast cancer. The doctor will determine the stage of cancer you are diagnosed positive after cancer.
In stage 1
Tumor size less than 2 cm. The tumor does not spread to the lymph nodes in the armpit and no signs of cancer spread to other parts of the body.
In stage 2
Tumor size 2-5 cm or no spread to lymph nodes, or both. There are no signs that the cancer has spread to other parts of the body.
In stage 3
Tumor size 2-5 cm. Tumors may be attached to the skin or tissue around the breast. Lymph nodes in the armpit are infected, but there are no signs that the cancer has spread to other parts of the body.
In stage 4
Tumors of any size and has spread to other parts of the body (metastasis)
Breast Cancer Treatment
There are several factors that a doctor be considered before deciding on the best treatment, the stage and level of cancer progression, overall health condition of the patient and menopause.
Breast cancers detected through routine examination usually is at an early stage. Primary breast cancer (cancer cells originated from the first breast cells and not the result of the spread of cancer cells from other organs) generally can be cured completely if diagnosed and treated early.
While the cancer is detected due to physical symptoms that appear might already be on stage more. If detected at an advanced stage and having spread to other parts of the body, the breast cancer can not be cured. The type of treatment that will be recommended were different and the aim to ease the burden for the sufferer.
Type the first breast cancer treatment is usually surgery. Type of operation varies depending on the type of breast cancer that you suffered. The process of surgery is usually followed by chemotherapy, radiation therapy, or biologic treatments for some specific cases. Chemotherapy or hormone therapy can sometimes also be the first treatment step.
If detected at an advanced stage after spread to other parts of the body, breast cancer can not be cured. The type of treatment that will be recommended were different and the aim to ease the burden for the sufferer.
Processes Operations
Surgery for breast cancer is divided into two, namely the operation which only the tumor and a breast lift operation as a whole (mastectomy). Reconstructive plastic surgery can usually be performed immediately after a mastectomy.
To deal with early stage breast cancer, the study showed that the combination of surgical removal of the tumor and radiotherapy have the same level of success with a total mastectomy.
- Lumpectomy (surgical removal of the tumor)
In a lumpectomy, breast forms will be allowed to complete as possible. This surgery is generally recommended for small tumors and involves removal of the tumor along with a bit of the surrounding healthy tissue. Consideration in determining the amount of breast tissue to be removed include the quantity of the tissues around the tumor needs to be removed, the type, size, location of the tumor, and breast size.
- Mastectomy (breast removal)
The process of this operation is the removal of all breast tissue, including the nipple. Patients can undergo mastectomy stains in conjunction with sentinel lymph biopsy if there is no indication of cancer spread to the lymph nodes. Instead, patients are encouraged to undergo the process of removal of lymph nodes in the armpit if the cancer has spread to parts of it.
- Reconstructive plastic surgery
It is a process operation to create a new breast as closely as possible with the other breast. Reconstructive plastic surgery can be done in two ways, namely direct reconstruction surgery simultaneously with mastectomy and reconstructive surgery periodically conducted some time after mastectomy. This new breast making operations can be done using breast implants or tissue from other body parts.Step Chemotherapy
Chemotherapy generally two types, namely chemotherapy after surgery to destroy cancer cells prior to surgery useful and shrink the tumor. Types and combinations of anticancer drugs used will be determined by the physician based on the type of cancer and degree of dissemination.
The side effects of chemotherapy is generally not affect healthy cells. Therefore, prevention or control of most of the side effects will be dealt with other drugs by doctors. Some side effects of chemotherapy include loss of appetite, nausea, vomiting, mouth sores or sore sensation in the mouth, are prone to infections, fatigue, and hair loss.
Chemotherapy can also inhibit the body's production of the hormone estrogen. Patients who have not experienced menopause will menstruate stalled during chemotherapy. This cycle should be back after the treatment is completed. However, early menopause is also likely to occur in women over the age of 40 years because they are approaching the average age of menopause.
If other body parts have been hit by the spread of breast cancer, chemotherapy can not cure cancer. But chemotherapy can shrink tumors, relieve symptoms and prolong life
Step Radiotherapy
Radiotherapy is a treatment process to destroy the remnants of the cancer cells with radiation dose control. This process is usually given about a month after surgery and chemotherapy to condition the body can be recovered first. But not all breast cancer patients need.
Just like chemotherapy, this procedure also has the side effect, namely irritation so that the breast skin sore, red and watery, the color of the breast skin becomes darker, excessive fatigue and lymphedema (excess fluid that appeared on the arm due to blockage of the lymph nodes in the armpit).
Hormone Therapy For Breast Cancer Coping
Especially for breast cancer whose growth is triggered natural estrogen or progesterone (hormone-receptor positive cancers), hormone therapy is used to lower levels of cancer or inhibit the effects of the hormone. This step is also sometimes done before surgery to shrink the tumor to be easily removed, but generally applied after surgery and chemotherapy.
If the condition is not healthy, the patient will not be able to undergo surgery, chemotherapy, or radiotherapy. Therefore, hormone therapy may be an alternative as a single treatment process.
The duration of hormone therapy are commonly recommended is a maximum of five years after surgery. This type of therapy that will be undertaken depending on the age, whether you are menopausal or not, the level of development of cancer, types of hormones that trigger cancer, and other types of treatment undertaken.
Tamoxifen and aromatase inhibitors are two types of drugs that are usually used in hormone therapy. Tamoxifen works to inhibit estrogen that is not committed themselves to the cancer cells.
While the enzyme aromatase inhibitor is recommended for patients who have undergone menopause. Its function is to hinder the performance of aromatase, which are substances that help the production of estrogen in the body after menopause. Examples of these drugs are available in tablet form and is taken daily letrozole, eksemestan, and anastrozole.
Tamoxifen and aromatase inhibitors can cause some side effects that are similar, such as headache, nausea, vomiting and a sensation of heat, sweating, and palpitations (hot flushes). However, tamoxifen has a special side effect, which can cause changes in the menstrual cycle in patients with breast cancer.
Step Ovarian Ablation or Suppression
Ovarian ablation or suppression would stop the performance of the ovaries to produce estrogen .
Ablation itself could do with surgery or radiotherapy . Ovarian ablation performance of the ovaries will stop permanently and trigger early menopause .
Ovarian suppression using agonists luteinising hormone - releasing hormone ( aLHRH ) called goserelin . The use of this drug will stop menstruating for a while . Menstruation will return to normal after the adoption process is completed . For patients aged approaching menopause or about 45 years , they may stop menstruating permanently despite the use of goserelin has been completed .
Goserelin injections given once a month. The side effects of these drugs resemble the menopause such as emotional feelings , difficulty sleeping , and a sensation of heat accompanied by heart palpitations.
Biological Therapy With Trastuzumab
The growth of most types of breast cancer that is triggered by the protein HER2 (human epidermal growth factor receptor 2) is called HER2 positive. In addition to stopping the effects of HER2, biological therapy also helps the immune system to fight cancer cells. If you are a high level of HER2 protein and you are capable of undergoing biologic therapy, trastuzumab may be recommended by doctors for you after chemotherapy.
Antibody function destroy harmful cells such as viruses and bacteria. This protein is produced naturally by the immune system. Trastuzumab is a type of biological therapy known as a monoclonal antibody. This drug will inhibit HER2 so that the cancer cells will die.
This therapy is not suitable for patients with heart disease such as angina, hypertension, or heart valve disease. If it is required to use trastuzumab, patients must undergo regular cardiac examinations. Other side effects of trastuzumab are nausea, headache, diarrhea, shortness of breath, chills, fever, and pain.
Breast Cancer Prevention
Prevention in total for breast cancer difficult to know because the cause of cancer is not known with certainty. But there are some steps you can take to reduce the risk of breast cancer.
The main step is to adopt a healthy lifestyle. For example, reducing the consumption of fatty foods, maintaining a healthy weight and ideal, regular exercise, and limiting alcohol consumption. These methods not only can reduce the risk of breast cancer, but also prevent many other diseases.
In addition to lifestyle, the study also showed that women who breastfeed have a lower risk for breast cancer. This may occur because ovulation they become routine during breastfeeding so that estrogen levels remain stable.
Facing the Breast Cancer Clinical
There are some treatments for decreasing the risk for women with breast cancer risk is higher than average. Two main types of treatment are described in more detail below.
Treatment with drugs
Two types of medications are available to women at high risk of developing breast cancer is tamoxifen and raloxifene. Women who had experienced menopause can use both of these drugs, while premenopausal women is only recommended for use tamoxifen. If you had or have a risk of blood clots or uterine cancer, both these drugs may be unsuitable.
For those of you who want to have children, your doctor may recommend to stop taking tamoxifen at least two months before trying to conceive because this drug will affect fetal development. Tamoxifen may also increase the risk of blood clots, so you should stop taking the six weeks prior to surgery.
mastectomy
In addition to dealing with breast cancer, a mastectomy is also used to reduce the risk of breast cancer in women at high risk due to the history of descent. This operation can reduce breast cancer risk by 90%, but remains at risk of complications.
Removal of the breast also may reduce the confidence of patients significantly. In addition to plastic surgery, breast reconstruction after mastectomy performed simultaneously or, you also have other alternatives, namely fake breasts that can be used in the bra.Breast Cancer Screening
Since 2007, Yappika volunteers (Foundation Strengthening Participation, Community Partnership Initiative and Indonesia) is calling and teaching women to perform breast self-examination. How is commonly abbreviated as BSE is one of the measures of prevention of breast cancer.
Breast cancer deaths can be prevented through the inspection. If breast cancer is detected at an early stage, your chances of a full recovery will be higher. Chances are you need a mastectomy or chemotherapy will also decrease.
Mammography is the most frequent type of examination is recommended for all women to detect breast cancer. Although breast cancer is less common in women over the age of 70, they can still mammogram once in 3-5 years. If you are a woman between the ages of 50-70 years old, you should undergo mammography examination once every three years. Likewise with women aged under 50 years, they are advised to conduct a routine inspection once every three years.
Especially for women at high risk of developing breast cancer, for example, because there is a nuclear family with breast cancer or ovarian cancer, they should undergo annual MRI scans or mammograms before the age of 50 years. MRI examination is sometimes an option because the results are more accurate for detecting cancer in dense breasts.
Another alternative is to detect breast cancer through genetic screening. You can choose to undergo genetic tests through a blood test to look for variations in BRCA1, BRCA2, and TP53. Having one of these genes can increase the risk of breast cancer.
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