Overview

Symptoms

• A spontaneous clear or bloody discharge from the nipple (areola)
• Any flattening or indentation of the skin over the breast
• A change in the size or shape of the breast
• Changes in the skin of the breast, such as a dimple or skin that looks like an orange peel
• A change in the nipple, such as scaling or an inverted nipple
• A green or bloody fluid that comes from the nipple
• Any change in the color or feel of the skin around the nipple

Diagnosis

• Ultrasound. Uses sound waves to create an image of the breast on a computer screen. By analyzing this image, your doctor may be able to tell whether a lump is a cyst or a solid (cancerous) mass. If the cyst does not disappear completely after the doctor extracts fluid, or if it contains bloody fluid, a biopsy is necessary to determine whether cancer is present.
• Biopsy. A small sample of tissue removed for analysis in the laboratory can provide important information about an unusual breast change and help determine whether surgery is needed and if so, the type of surgery required. The different types of biopsies include:
  • Fine-needle aspiration biopsy. A thin, hollow needle is used to withdraw tissue from the lump in the breast (the procedure is similar to drawing blood). The tissue is then sent to a laboratory for analysis under a microscope.
  • Core needle biopsy. A hollow needle is used to remove tissue samples from the breast lump. Several samples, each about the size of a grain of rice, may be taken and will be sent to a laboratory to be analyzed for the presence of cancer cells. The advantage of a core needle biopsy is that it removes more tissue than the fine-needle aspiration biopsy for analysis of cancer.
  • Stereotactic biopsy. This technique is used to sample and evaluate an area of concern that can be seen on a mammogram but cannot be seen on an ultrasound. A stereotactic biopsy is the same as a core needle biopsy but it uses the patient’s mammogram as a guide. This procedure is usually performed under local anesthesia.
  • Wire localization. This technique may be used when a lump is seen on a mammogram but cannot be evaluated with a stereotactic biopsy. Again, using the patient’s mammogram as a guide, a thin wire is placed inside the breast and the tip of the wire is guided to the breast lump. Wire localization is usually performed right before a surgical biopsy and is a way to help the surgeon understand which breast area should be removed and tested for cancer.
  • Surgical biopsy. This is one of the most accurate methods for determining whether a change observed in the breast is cancerous. During this procedure, the surgeon removes all or part of a breast lump. In general, a small lump will be completely removed (excisional biopsy). If the lump is large, only a sample will be taken (incisional biopsy). This type of biopsy is generally performed on an outpatient basis.

  Malignant cells removed in a biopsy can be tested for the presence of hormone receptors. If the cancer cells have receptors for estrogen or progesterone or for both, (because estrogen or progesterone provide nutrients to the cancer cells), your doctor may recommend treatment with a drug that prevents estrogen from binding to the receptors on the cancer cells.

  Once the initial diagnosis of breast cancer has been made, staging tests determine the size and location of the cancer and whether it has spread to other organs in the body. Staging tests also help the doctor determine which treatment plan is best for the patient. Breast cancer is staged using numbers 0 through IV.

  • Stage 0 cancers are also called noninvasive or in situ (in one place), cancers. Although these cancers do not have the ability to invade normal breast tissue or to spread to other parts of your body, it is important to have them removed at the time of diagnosis because they eventually may become invasive cancers.
  • Stage I to IV cancers are invasive cancers that have the ability to invade normal breast tissue or to spread to other organs in the body (metastatic). A stage I cancer is typically small, well localized and has a high cure rate. The higher the stage number for the breast cancer, the lower the chances of cure for the patient. At a diagnosis of stage IV, the cancer has already spread beyond the breast to other organs in the body, such as bones, lungs or liver. Although it is not possible to cure cancer at this stage, the disease may still respond well to different treatments, which could in some cases shrink the cancer growth, or in other cases, control the growth of the existing cancer for an extended period of time. 
• In addition to the staging tests, genetic tests may also help identify defective genes that are being passed through the family if you have a strong family history of breast or of other cancers. These tests are, however, often inconclusive and should only be done after a thorough evaluation with a genetic counselor. Unless you are at high risk of hereditary breast cancer or of ovarian cancer, genetic testing usually is not recommended.

Determining Treatment Options

Treatments exist for every type and stage of breast cancer. Most women will have surgery and an additional therapy such as radiation, chemotherapy or hormonal therapy. Experimental (investigational) treatments, which have not yet been approved for general use, are also available. At the time of your diagnosis, you should speak with your doctor about these clinical trials to see if one is right for you.

Treatments

There are many treatment options for patients with breast cancer. These include:

• Surgery—radical mastectomy (removal of the breast) is rarely performed. Instead, the majority of women are candidates for removal of the lump (tumor) in the breast (lumpectomy). If you would rather decide on mastectomy for the treatment of your disease, you may also opt for breast reconstruction after the procedure has been performed.
  
  Breast cancer surgeries include the following:
  • Lumpectomy. This surgery saves as much of the breast tissue as possible by removing only the suspicious lump and a surrounding area of normal tissue. Many women diagnosed with breast cancer undergo a lumpectomy instead of a mastectomy. If a tumor is very large and located deep within the breast, or if the patient has already had radiation treatment, two or more widely separated areas of cancer in the same breast, a tissue disease that makes him/her sensitive to radiation treatment, or a breast cancer of inflammatory nature, lumpectomy may not be an option. If the patient has a large tumor but still wants to consider lumpectomy, chemotherapy given before the lumpectomy surgery may help to reduce the size of the large tumor and make the patient eligible for the surgery.
  • Partial or segmental mastectomy. This surgery saves as much of the breast tissue as possible by removing the suspicious lump as well as some of the breast tissue around the tumor and the lining of the chest muscles beneath it.
  • Simple mastectomy. In this procedure, the surgeon removes all of the breast tissue—the lobules, ducts, fatty tissue and skin, including the nipple.
  • Modified radical mastectomy. In this procedure, the surgeon removes the entire breast, including the overlying skin, and some underarm lymph nodes (axillary lymph node dissection), but leaves the chest muscles intact.
  • Sentinel lymph node biopsy. Because breast cancer typically first spreads to the lymph nodes under the arm, all women diagnosed with breast cancer should have these nodes examined. Rather than remove as many lymph nodes as possible through invasive surgery, surgeons now focus on finding the “sentinel” nodes, that is the first nodes that receive the drainage from breast cancer and therefore the first place to which cancer cells from the breast will travel. If a sentinel node is removed, examined and found to be normal, the chance of finding cancer in any of the remaining nodes is small and no other nodes need to be removed, thus sparing the patient from the need for a more extensive surgical procedure and greatly decreasing the risk of post-surgical complications.
  • Axillary lymph node dissection. If the sentinel lymph node does show the presence of cancer cells, the surgeon will remove additional lymph nodes in the patient’s armpit (axilla). The removal of these lymph nodes does increase the risk of serious arm swelling (also called lymphedema), but new surgical techniques have made this complication less likely. 
• Chemotherapy—uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
  
  The size of the breast cancer, the characteristics of the cancer cells, and the extent of spread of the cancer into the body help determine the need for a patient to receive chemotherapy. If it is determined that a cancer has a high chance of returning or of spreading to other parts of the body, the doctor may recommend that you receive chemotherapy after the initial surgery to decrease the chance that the cancer will return. If it is identified at the time of diagnosis that the cancer has already spread to other parts of the body, chemotherapy may be recommended to try to control the growth of the cancer and decrease any symptoms you may experience that are caused by the cancer.
• Radiation therapy—uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
  
  In general, radiation is the standard of care following a lumpectomy for both invasive and noninvasive breast cancers. Oncologists are also likely to recommend radiation following a mastectomy for a large tumor, for inflammatory breast cancer, for cancer that has invaded the chest wall, or for cancer that has spread to more than four lymph nodes in the patient’s armpit.
  
  Radiation is usually started three to four weeks after surgery has occurred. If a doctor also recommends chemotherapy as part of the breast cancer treatment options, the chemotherapy drugs are usually administered before the patient receives radiation treatment. Radiation treatment may be delivered according to different schedules and is often delivered five days a week for five to six consecutive weeks. These treatments are painless, similar to getting an x-ray, and take about 30 minutes. The effects of the radiation treatment are cumulative, however, and you may become tired toward the end of the overall 5-6 weeks treatment. Your breast may also become tender and appear sunburned.
• Hormone therapy (or hormone blocking therapy)—is often used to treat women whose cancers are sensitive to hormones (also called estrogen and progesterone receptor positive cancers). This treatment can be used to decrease the chance of your cancer returning. If, at the time of diagnosis, it is identified that the cancer has already spread to other organs in your body, hormone therapy may control the growth of that cancer.
  
  Two classes of medications are used in hormone therapy: selective estrogen receptor modulators (SERMs) and aromatase inhibitors. 
• SERMs—act by blocking estrogen present in the body from attaching to the estrogen receptor on the cancer cells, which in return will slow the growth of the cancer.
• Aromatase inhibitors—block the conversion of a hormonal substance (androstenedione) into estrogen. As a result, estrogen production is stopped in cells other than the ovaries. Fat cells, the adrenal gland and other normal cells make small amounts of estrogen. Preventing estrogen from attaching to the estrogen receptor on the cancer cells will slow the growth of the cancer. These drugs are only effective in postmenopausal women.
• Biological therapy—uses man-made versions of substances normally made by the immune system.

Biogen Idec Investigational Treatments

• Clinical trials—using investigational treatments may be discussed as a possible treatment option for some patients, depending on the specific requirements of the different trials and the patient’s cancer stage and disease status. Click here to learn more about clinical trials. About Clinical Trials

Currently, Biogen Idec is conducting clinical trials in this disease.
For more information, click here.

To contact Biogen, click here.

Breast Cancer Resources

http://www.breastcancer.org/
http://www.cancer.gov/cancertopics/types/breast
http://www.centerwatch.com/patient/studies/cat29.html

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