Breast cancer means a cancerous (causing infiltration and destruction of tissue) growth that originates in breast tissue.

The risk of breast cancer increases with increasing age, mostly among females.

Usually an excess of estrogen stimulates the growth of the tumour.

The causes are:
Positive family history.

• Early menarche Late menopause.
• First child after thirty years of age.
• Excessive body fat.
• Prolonged use of oral contraceptive pills.
• Hormone replacement therapy (HRT) for 10 years or more.
• Oncogenes

The symptoms are:

• A painless lump in the breast Dimpling of the skin in the area of the lump that looks like orange peel.
• Inversion of the nipple.
• A bloodstained nipple discharge.
• Pain in breast. In Paget’s disease: patch of dry, flaky skin on the nipple. A change in the appearance or texture of the breasts.
• Cachexia
• General symptoms: –
• malaise (weariness)
• loss of appetite
• fatigue
• thirt
• fever

A nutritious, low-fat diet with plenty of fruits and vegetables can help reduce the risk of developing breast cancer. A high-fat diet increases the risk because fat triggers estrogen production that can fuel tumor growth.

Give yourself a breast self-exam at least once a month. Look for any changes in breast tissue, such as changes in size, a lump, dimpling or puckering of the breast, or a discharge from the nipple. If you discover a persistent lump in your breast or any changes in breast tissue, it is very important that you see a physician immediately. However, 8 out of 10 lumps are benign, or not cancerous.

You should have a physical every year. If any unusual symptoms or changes in your breasts occur before your scheduled visit, do not hesitate to see the doctor immediately.

Although some studies have shown that factors such as traumatic events and losses can alter immune system functions, these studies have not provided any evidence of a direct cause-and-effect relationship between stress and breast cancer. An area currently being studied is whether or not stress reduction can improve immune response and slow progression in women diagnosed with breast cancer.

The international TNM classification is recognized for staging: T- Extent of primary tumour

• T1 to T3 shows the increase in the extent or size of the tumour.
• N- Involvement of nodes
• N1 to N3 shows the increasing node involvement.
• M- Presence of metastases (distant spread)
• M0 no metastases
• M1 presence of metastases.

The tests conducted are :

• Mammography
• Radiology
• USG
• CT scan
• CT scan
• Lymphangiogram
• Fine Needle
• Aspiration Cytology [FNAC]
• Aspiration
• Biopsy
• Estrogen Sensitivity
• Biochemical screening

TreatmentDepends on: TNM stage Estrogen sensitivity

Includes

• Surgery
• Radiation therapy
• Chemotherapy
• Hormone therapy, or
• Most often, a combination of these.

Management of pain through

• Oral analgesics and localized techniques of pain relief.
• Antibiotics, in case of presence of infection.

Prognosis is good, if early diagnosis is followed by prompt radical cure. Prognosis worsens with increasing stage of the cancer.

The disease can be prevented through regular self-examination of breasts for lump. If there exists a positive family history of breast cancer then regular mammography should be conducted after the age of 30 years.

One needs to know about the complementary therapies that can help in the healing process.

• Relaxation exercises
• Meditation
• Psychological counseling.
• Family and colleagues support.

Terminal care

• Psychological support
• Appropriate nutrition
• Treatment of cough, pruritis and nausea
• Family and friend’s support

Ordinarily, red spots on the skin are not dangerous if they have been there for long time and are not changing in size or color. So I would advise you to take note of any change over the next several months and have it checked by your local doctor in case it changes. About the pain in the breasts, it is not uncommon especially in younger women(<50 years of age) and does not require anything particular done as long as it is stable and a mild pain. But if it is increasing in severity, I would suggest that you ask your doctor to do a physical examination and make sure that you do not have any lumps in your breast(s).

Dr. Sewa S. Legha, MD