Women’s Independent Press

Information obtained from the National Breast Cancer Foundation
www.nationalbreastcancer.org

What is Ductal Carcinoma In Situ?
Ductal carcinoma in citu (DCIS) is a non-invasive cancer where abnormal cells have been found in the lining of the breast milk duct. The atypical cells have not spread outside of the ducts into the surrounding breast tissue. Ductal carcinoma in situ is very early cancer that is highly treatable, but if it’s left untreated or undetected, it can spread into the surrounding breast tissue.
What does the term, “in situ” mean? The earliest stages of cancers are called “carcinoma in situ.” Carcinoma means “cancer” and in situ means “in the original place.”

What is invasive ductal carcinoma?
The abnormal cancer cells that began forming in the milk ducts have spread beyond the ducts into other parts of the breast tissue. Invasive cancer cells can also spread to other parts of the body. It is also sometimes called infiltrative ductal carcinoma.
IDC is the most common type of breast cancer, making up nearly 70- 80% of all breast cancer diagnoses.IDC is also the type of breast cancer that can most commonly affects men.

What is Triple Negative Breast Cancer?
A diagnosis of triple negative breast cancer means that the three most common types of receptors known to fuel most breast cancer growth–estrogen, progesterone, and the HER-2/neu gene– are not present in the cancer tumor. This means that the breast cancer cells have tested negative for hormone epidermal growth factor receptor 2 (HER-2), estrogen receptors (ER), and progesterone receptors (PR). Since the tumor cells lack the necessary receptors, common treatments like hormone therapy and drugs that target estrogen, progesterone, and HER-2 are ineffective. Using chemotherapy to treat triple negative breast cancer is still an effective option. In fact, triple negative breast cancer may respond even better to chemotherapy in the earlier stages than many other forms of cancer.

What is Inflammatory Breast Cancer (IBC)?
Inflammatory breast cancer is an an aggressive and fast growing breast cancer in which cancer cells infiltrate the skin and lymph vessels of the breast. It often produces no distinct tumor or lump that can be felt and isolated within the breast. But when the lymph vessels become blocked by the breast cancer cells, symptoms begin to appear.

What is Metastatic Breast Cancer?
Metastatic breast cancer is also classified as Stage 4 breast cancer. The cancer has spread to other parts of the body. This usually includes the lungs, liver, bones or brain.
How does cancer spread, or metastasize?
The spread of cancer usually happens through one or more of the following steps:
Cancer cells invade nearby healthy cells. When the healthy cell is taken over, it too can replicate more abnormal cells.
Cancer cells penetrate into the circulatory or lymph system. Cancer cells travel through the walls of nearby lymph vessels or blood vessels.
Migration through circulation. Cancer cells are carried by the lymph system and the bloodstream to other parts of the body.
Cancer cells lodge in capillaries. Cancer cells stop moving as they are lodged in capillaries at a distant location and divide and migrate into the surrounding tissue.
New small tumors grow. Cancer cells form small tumors at the new location (called micrometastases.)

Can a woman get breast cancer during pregnancy?
It is possible to be diagnosed with breast cancer during pregnancy, although it is rare and the breast cancer is not caused by the pregnancy. Women who are diagnosed with breast cancer during pregnancy have tremendous additional strain due to concern for the safety of the unborn child. It can be a traumatic and extremely difficult situation, but there is still hope for both mother and child, thanks to the many treatment options available.
If you are pregnant and have been diagnosed, be sure to communicate carefully with your obstetric care team as well as your oncology team, and it never hurts to verify that they have open communication with each other. Your medical team will take extra care in designing the treatment plan that best controls the breast cancer while protecting your unborn child.

Although by far, the most common breast cancer type is ductal carcinoma in situ (DCIS), there are other types that are less commonly seen.

Medullary Carcinoma
Medullary carcinoma accounts for 3-5% of all breast cancer types. The tumor usually shows up on a mammogram, but does not always feel like a lump. At times, it feels like a spongy change of breast tissue.

Tubular Carcinoma
Making up about 2% of all breast cancer diagnosis, tubular carcinoma cells have a distinctive tubular structure when viewed under a microscope. It is usually found through a mammogram and is a collection of cells that can feel like a spongy area of breast tissue rather than a lump. Typically this type of breast cancer is found in women aged 50 and above and usually responds well to hormone therapy.

Mucinous Carcinoma (Colloid)
Mucinous carcinoma represents approximately 1% to 2% of all breast cancers. The main differentiating features are mucus production and cells that are poorly defined. It also has a favorable prognosis in most cases.

Paget Disease of the Breast or Nipple
This condition (also known as mammary Paget disease) is a rare type of cancer affecting the skin of the nipple and often the areola, which is the darker circle of skin around the nipple. Most people with Paget disease evident on the nipple also have one or more tumors inside the same breast; generally either ductal carcinoma in situ or invasive breast cancer (1–3). Paget disease is frequently misdiagnosed at first because the first noticeable symptoms can easily be confused with more common skin conditions affecting the nipple. Like all breast cancers, the prognosis for Paget disease depends on a variety of factors, including the presence or absence of invasive cancer and whether or not it has spread to nearby lymph nodes.

Symptoms and Signs

Every person should know the symptoms and signs of breast cancer, and any time an abnormality is discovered, it should be investigated by a healthcare professional.
Most people who have breast cancer symptoms and signs will initially notice only one or two, and the presence of these symptoms and signs do not automatically mean that you have breast cancer.
By performing monthly breast self-exams, you will be able to more easily identify any changes in your breast. Be sure to talk to your healthcare professional if you notice anything unusual.

A change in how the breast or nipple feels
Nipple tenderness or a lump or thickening in or near the breast or underarm area
A change in the skin texture or an enlargement of pores in the skin of the breast (some describe this as similar to an orange peel’s texture)
A lump in the breast (It’s important to remember that all lumps should be investigated by a healthcare professional, but not all lumps are cancerous.)

A change in the breast or nipple appearance
Any unexplained change in the size or shape of the breast
Dimpling anywhere on the breast
Unexplained swelling of the breast (especially if on one side only)
Unexplained shrinkage of the breast (especially if on one side only)
Recent asymmetry of the breasts (Although it is common for women to have one breast that is slightly larger than the other, if the onset of asymmetry is recent, it should be checked.)
Nipple that is turned slightly inward or inverted
Skin of the breast, areola, or nipple that becomes scaly, red, or swollen or may have ridges or pitting resembling the skin of an orange.

Any nipple discharge—particularly clear discharge or bloody discharge
It is also important to note that a milky discharge that is present when a woman is not breastfeeding should be checked by her doctor, although it is not linked with breast cancer.
If I have some symptoms, is it likely to be cancer?
Most often, these symptoms are not due to cancer, but any breast cancer symptom you notice should be investigated as soon as it is discovered. If you have any of these symptoms, you should tell your healthcare provider so that the problem can be diagnosed and treated.
If I have no symptoms, should I assume I do not have cancer?
Although there’s no need to worry, regular screenings are always important. Your doctor can check for breast cancer before you have any noticeable symptoms. During your office visit, your doctor will ask about your personal and family medical history and perform a physical examination. In addition, your doctor may order one or more imaging tests, such as a mammogram.