Breast Cancer: Symptoms, Types, Stages, Causes & Treatment

Have you noticed any breast cancer symptoms lately? Read our guide to determine if you need immediate medical care or if it is a false alarm!

With a moderately high ratio that only looks to be rising because of lifestyle trends, every Indian citizen should know what breast cancer is.

Therefore, we will discuss the treatment options available for breast cancer and how to prevent the disease. Let's start!

All cancers are uncontrolled multiplication of cells. Furthermore, the unchecked proliferation of cells occurs because of mutation in the genes that control cell growth. For example, the common regions where breast cancer develops are:

• Glands that produce milk
• Ducts that carry milk to the nipple
• Fatty connective tissue

Unfortunately, breast cancer can spread to other parts of the healthy breast, reaching the lymph nodes under the arm. If it enters the lymph nodes, it can then move to other regions of the body.

There are two main categories of breast cancer. These are invasive and non-invasive.

Invasive breast cancer spreads from the breast gland or duct to other parts of the breast or body. Additionally, non-invasive cancers are exclusively centred around the breast gland or the duct. Based on these categories, the various types of breast cancer are:

Non-invasive Breast Cancer Types

There are only 2 types of non-invasive breast cancer. These are:

Ductal Carcinoma in Situ (DCIS)

In this type of breast cancer, cancer is still concentrated in the ducts. However, it may spread to other tissues if left untreated. Cancer has not yet invaded surrounding cells.

Lobular Carcinoma in Situ (LCIS)

In this type of breast cancer, the disease is concentrated or confined to the breasts' milk-producing glands. It may, however, spread to different parts of the breast.

Invasive Breast Cancer Types

There are broadly 8 types of invasive breast cancer. They are:

Angiosarcoma

This extremely rare form of breast cancer occurs when cancer grows in the breasts' blood or lymph cells. 

Inflammatory Breast Cancer

It is a rare yet rapidly growing breast cancer. The breast cancer symptoms include redness, swelling and tenderness in the breast. It is still unclear what causes inflammatory breast cancer. However, it is believed that cancer begins in the lymph vessels of the skin. 

Invasive Ductal Carcinoma (IDC)

80% of invasive breast cancer cases are of this type. IDC starts in the ducts connecting the milk gland to the nipple. It then breaks through the duct wall, consequently invading healthy fatty tissues of the breast.

Invasive Lobular Carcinoma (ILC)

ILC accounts for around 10% of invasive breast cancer cases. This breast cancer typically starts in the milk glands and then spreads to surrounding tissues or other body parts. It also has many subtypes, which are:

• Adenoid Cystic Carcinoma: This type of cancer accounts for 0.1 to 1% of all breast cancers. The lymph node plays an important role in this type of cancer, and there is distant metastasis. Typically this cancer occurs in the salivary glands.
• Low-Grade Adenosquamous Carcinoma: Metaplastic breast cancer is another extremely rare form of breast cancer. However, there can be lesions that are mistaken for cancer. Hence diagnosis will be performed extremely carefully.
• Medullary Carcinoma: Medulla, in this case, refers to the soft structure of the tumour. Therefore, it is described as a carcinoma with medullary features rather than strictly a medullary carcinoma.
• Mucinous Carcinoma: This type of cancer occurs in the mucus. Mucus is a slimy, slippery secretion in the body found commonly in the stomach and the trachea.
• Papillary Carcinoma: Primarily affecting those women who suffer from menopause, this type of cancer has finger-like projections and tumours.
• Tubular Carcinoma: Tubular cancer gets its name from the tube shape of the cancer cell. It is a slow-growing type of cancer.

Male Breast Cancer

Men also have breast tissue, and hence they can get breast cancer. However, it is much rarer in men than it is in women. However, the breast cancer symptoms are the same as those of women.

Metastatic Breast Cancer

Metastatic breast cancer is another name for stage 4 cancer type that has spread to other parts of the body. Therefore, it may reach the bone, liver, or lungs. Since it is an advanced type of cancer, doctors will draw up a speedy treatment plan to combat the breast cancer symptoms.

Paget's Disease of the Nipple

This type of breast cancer grows in the ducts of the nipple. But as the disease persists, it affects the areola, which is the skin surrounding the nipple.

Phyllodes Tumours of the Breast

It is another rare breast cancer type. Growing in the connective tissue of the breast, it may be benign or cancerous.

Triple-Negative Breast Cancer

Triple-negative effects 10-15% of the population with breast cancer. To be diagnosed as a triple-negative, the tumour should have all 3 characteristics:

• Lack of oestrogen receptors that bind to the oestrogen hormone. Oestrogen plays a dominant role in stimulating breast cancer cells to grow.
• There is a lack of progesterone receptors that attach to the cell.
• It shouldn't have HER2 proteins on the surface of the tumour.

It is called triple-negative because oestrogen, progesterone and HER2 proteins should not be present in the tumour. Further, triple-negative breast cancer is hard to treat as it does not respond to hormonal therapy.

In all these cases, the breast cancer symptoms may vary, and the reader is requested to read individually on all these subtypes.

Depending on the spread of cancer cells and the tumour size, this condition is classified into 5 stages of breast cancer.

For a doctor to classify cancer into any of the five stages, they will need to answer the following questions:

• Is the cancer invasive or non-invasive?
• How large is the tumour?
• Are the lymph nodes compromised or involved?
• Has cancer spread to other nearby breast tissues or organs?

Therefore, the stages of breast cancer are:

Stage 0

DCIS (ductal carcinoma in situ) is commonly referred to as stage 0. It is the beginning stage of the disease where breast cancer cells have not spread further than the milk ducts.

Stage 1

Stage 1 of breast cancer is divided into two types. These are:

• Stage 1A: In this stage, the primary tumour is of a size less than 2 cm in width. Moreover, the lymph nodes are not affected.
• Stage 1B: In this stage, the tumour may be smaller than 2 cm or not present. However,  cancer cells are present in the nearby lymph nodes.

Stage 2

Breast cancer stage 2 is also divided into two types. These are shown below:

• Stage 2A: In this stage, the breast cancer tumour is smaller than 2 cm. However, it may have spread to 1 or 3 nearby lymph nodes. Moreover, the tumour length may also be between 2 and 5 cm. Further, it has not spread to any lymph nodes. Therefore, in both cases, it is classified as stage 2A.
• Stage 2B: If the breast cancer tumour is between 2 and 5 cm and has spread to 1 or 3 underarm lymph nodes, it is known as stage 2B cancer. Moreover, there can be other classifications. For example, the tumour can also be larger than 5 cm, but lymph nodes are surprisingly clear of cancer.

Stage 3

Stage 3 has 3 further sub categorisations. They are as shown below: 

• Stage 3A: In this sub-stage, the primary tumour can be of any size. Moreover, breast cancer has spread from 4 armpit lymph nodes to 9 armpit lymph nodes.  Further, the internal mammary lymph nodes may be enlarged.
• Stage 3B: This stage is quite an advanced stage where the tumour has cut into the chest wall or skin. Breast cancer may have affected up to 9 lymph nodes.
• Stage 3C: Breast cancer cells are found in 10 or more armpit or collarbone lymph nodes. It may even be found in the internal mammary nodes.

Stage 4

The worst-case scenario is stage 4 cancer, where the primary tumour may be of any size. However, the distinguishing factor is that cancer should have spread to distant parts of the body. Further, it may have also spread to near and distant lymph nodes.

It should be noted that the signs and symptoms of breast cancer vary based on the type of breast cancer. The unfortunate part of breast cancer is that it shows little to no symptoms at the earliest stages.

Therefore, women and men must go for regular check-ups to detect the disease at its earliest. Medical help is greatly beneficial and life-saving if cancer has been diagnosed early. Further, the feeling of lumps on the breast may not give accurate results, so a mammogram is advised.

However, the most common breast cancer symptoms are:

• A recently developed lump or thickening that feels different from the surrounding tissue.
• Bloody discharge from the nipple
• Swelling in all parts or some parts of the breast
• Changes in the appearance of the skin on the breast, such as pitting
• Inversion of nipple
• Lumps or swelling in the armpit
• Nipple discharge from the breast that is not milk
• Pain in the breast region
• Peeling, flaking or scale formation on the skin around the breast.
• Red and pitted skin over the breast region
• Unexplained change in size or shape of the breast (not due to puberty or pregnancy)

These are the most significant breast cancer symptoms. However, to check the signs for other types of breast cancer, the reader will need to search specifically for those symptoms.

There are 2 primary causes of breast cancer. First, breast cancer can be caused by the way other cancers are caused due to abnormal cell growth or genetic history.

Abnormal Growth of Cells in Gland and Duct Cells

The chief cause of breast cancer is the abnormal growth of cells in the glands or the milk ducts. Moreover, once these cancer cells enter the lymph nodes, they may spread to other parts of the body.

Genetic History

It is supposed that 5-10% of breast cancers have hereditary causes. There are a couple of genetic mutations that are responsible for breast cancer. Moreover, breast cancer gene 1(BRCA1) and breast cancer gene 2 (BRCA2) increase the risk for breast or ovarian cancer.

In such cases, a doctor may recommend a visit to a genetic counsellor.

Apart from these, what are the causes of breast cancer?

Unfortunately, even though the environment, lifestyle and hormonal changes are potential causes, there is insufficient proof that they are breast cancer-causing factors.

Moreover, women, age, personal or family history of breast cancer are some of the risk factors. Other risk factors include:

• Periods starting sooner than 12 years
• Getting menopause at an older age
• Obesity
• Having children after 30
• Alcohol
• Having never been pregnant

These are some of the risk factors and probable causes of breast cancer.

A breast cancer diagnosis has to be done early for a higher chance of survival. Usually, women are advised to undergo routine check-ups to catch breast cancer at its earliest. Then, a doctor will prescribe any of the following tests, with imaging and biopsy being the most likely.

Physical Examination

During the physical examination, a doctor will feel the breasts or under the arms for lumps, thickening or swelling. The test involves a person having to sit or stand with arms outstretched above her or at the side. This test, however, cannot be conclusive, so the patient may have to undergo imaging tests or a biopsy.

Biopsy

A biopsy involves taking out some part of the tissue and sending it to check for the presence of cancerous cells. From the biopsy, the following can be understood:

• Which type of cancer has formed?
• Is breast cancer sensitive to hormones?

Hence, a biopsy is a pretty conclusive test.

Imaging Tests

There are plenty of imaging tests that a doctor can prescribe for a patient. These are:

Mammogram

An initial test for breast cancer is a mammogram. A mammogram is like an X-ray. However, the test may sometimes show lumps that are not present. However, a doctor will follow up on any suspicious results with further tests such as a biopsy.

MRI 

Magnetic Resonance Imaging will take different images of the breast and combine them. This test may be taken as a follow-up to an ultrasound or mammogram.

Ultrasound

The ultrasound will differentiate between the fluid in a cyst and solid mass using sound waves. Hence the ultrasound is a pretty conclusive test as well.

So, how to Diagnose Breast Cancer?

A combination of physical examination, biopsy, and imaging tests may be used to diagnose breast cancer conclusively.

A doctor will decide on the course of the breast cancer treatment based on:

• Cancer stage
• Type
• Sensitivity to hormones
• Age
• Health
• Preference of the patient

These are the 5 main treatments for breast cancer:

Biological Treatment

Drugs can be used for the treatment of certain types of cancer. These drugs are Herceptin, Tykerb, Avastin, etc.

Chemotherapy

If there is a likelihood that the cancer cells may spread or the disease may recur, doctors prescribe cytotoxic chemotherapy. Moreover, doctors may also prescribe chemotherapy either before or after the surgery as they see fit.

Hormone-Blocking Treatment

Some breast cancers are highly dependent on hormones to grow. For example, the ER (oestrogen receptor) and PR (progesterone receptor) positive cancers are treated in this manner. Doctors will prescribe this course of action to those whose cancer responds to hormones. Examples of some hormone-blocking medications are:

• Aromatase inhibitors
• Goserelin
• Ovarian ablation or suppression
• Tamoxifen

This treatment may affect fertility.

Radiation Therapy

After one month after therapy, a doctor may prescribe radiation therapy. This treatment method will target the remaining tumor cells and destroy them.

Surgery

Surgery for breast cancer may involve removing lumps or both breasts altogether. Removal of lumps is called lumpectomy, and removing parts of the breast or the full breast is called mastectomy. There are 3 different types of mastectomy. They are:

• Sentinel node biopsy
• Axillary lymph node dissection
• Reconstruction

All these forms of treatment have their corresponding risks, so discuss with your doctor before choosing a course of action.

There are several breast cancer prevention methods. However, they are not foolproof methods. Therefore, they are guidelines to help reduce a person's risk of breast cancer.

• Every woman should regularly undergo mammograms and check-ups to diagnose breast cancer in its early stages. Then, a doctor should be able to advise on the best course of action. A person may also try a breast examination by themselves.
• Drink alcohol in moderation and follow a healthy lifestyle by exercising every day.
• If a person is taking hormonal therapy after menopause, they may need to consult with a doctor.
• Diet is another factor that can contribute to a decrease in the likelihood of breast cancer. A Mediterranean diet can help to reduce the risk of breast cancer.
• Preventive medication for those who are at high risk for breast cancer is also an option. Doctors, however, will reserve this treatment only for those who are at very high risk.
• If a person is at high risk for breast cancer, they may also undergo breast and ovary removal surgery.

Out of these options, the sixth way is the most effective breast cancer prevention technique.

In conclusion, any breast cancer symptoms may be false alarms. All lumps are not cancerous. All swellings and thickenings or discharges do not relate to breast cancer. Therefore, visit a doctor at the earliest and complete a check-up. Further, proceed for a treatment option only after assessing all risks.

While breast cancer symptoms may be worrying, there is a high chance of survival. It is a very common form of cancer that, if detected early, can be completely cured. Therefore, there is little to worry about!

However, do get regular check-ups and mammograms to detect the disease at its earliest stage.