Symptoms, Diagnosis, and Treatment Methods of Breast Cancer

Breast cancer is the most common cancer among women and the leading cause of cancer-related deaths. It accounts for 24% of all female cancers and 15.5% of cancer deaths. It is reported that 1 in 8 women will be diagnosed with breast cancer at some point in their lives. Rarely, breast cancer is also seen in men, with 1 man diagnosed for every 100 women. The incidence of breast cancer has been found to increase every year.

Cancer occurs when the body's cells uncontrollably and continuously multiply. Breast cancer develops due to the uncontrolled proliferation of cells located in the milk ducts of breast tissue, which are responsible for milk production. Worldwide, 80% of breast cancer cases seen in 1 in 8 women are due to the uncontrolled proliferation of cells in the milk ducts, while the remaining 20% develop in the breast lobules, defined as invasive lobular carcinoma. In addition to these, there are different types of breast cancer, such as medullary, mucinous, and tubular. In the presence of breast cancer, cancer cells multiply over time to form a mass. This process, which occurs more slowly compared to other types of cancer, can lead to cancer cells spreading to lymph nodes and then to different regions of the body via the bloodstream.

Symptoms of breast cancer include discharge from the nipple, deformation, swelling in the breast and armpit area, and/or the presence of a mass. Treatment methods for breast cancer vary depending on the stage at which the cancer is diagnosed. The earlier breast cancer is diagnosed, the higher the chance of successful treatment. Therefore, after the age of 20, every woman should perform a breast self-exam in the first week after her menstrual period ends to assess her risk of breast cancer. Individuals aged 40 to 69 are advised to undergo mammography once a year for breast cancer screening.

What is Breast Cancer?

Breast tissue consists of lobes, fatty tissue, ligaments, spaces (sinuses), glands, and milk ducts. Breast cancer, which occurs due to the uncontrolled proliferation of cells in breast tissue, is one of the leading causes of death after cardiovascular diseases. Although breast cancer is rarely seen in men, it is the most commonly diagnosed cancer in women. Like all types of cancer, breast cancer involves certain mutations in the DNA of healthy cells. As a result, these cells begin to proliferate uncontrollably. Cancerous cells divide and multiply much faster than healthy cells and have a longer lifespan. Therefore, over time, cancerous cells lead to accumulations. The accumulation of cells that results in mass formation is defined as a tumor.

In breast cancer, this situation often develops due to the rapid proliferation of cells in the milk ducts or glands within the breast tissue. The cancer cells that begin to multiply in these areas form a mass known as a tumor. Tumors in breast cancer can be benign (non-cancerous) or malignant (cancerous). These tumors, which can be classified as either cancerous or non-cancerous, have different effects on the body. The proliferation of cells that leads to malignant tumors is usually quite slow in the early stages and does not cause symptoms. Consequently, a person often does not notice this condition in its early stages. This leads to the cancer spreading primarily to the lymph nodes and then to various parts of the body through the circulatory system, known as metastasis. Breast cancer typically occurs between the ages of 50 and 70 and is more frequently seen in individuals with a family history of breast cancer. Therefore, breast cancer screening is extremely important. All women over 40, even if they do not exhibit breast cancer symptoms, are advised to undergo regular mammograms.

Breast cancer is the most common cancer among women and the second leading cause of cancer-related deaths after lung cancer. It accounts for 24% of all female cancers and 14% of cancer deaths. It is reported that one in every eight women will develop breast cancer at some point in their lives. Rarely, breast cancer is also seen in men. One male is diagnosed with breast cancer for every 100 women. The frequency of breast cancer has been found to increase each year. The increasing prevalence of breast cancer, its treatability in early stages, and the possibility of early diagnosis in today's conditions underscore the importance of breast cancer.

What Are the Symptoms of Breast Cancer?

The disease progresses slowly in its initial stages. Therefore, breast cancer may not present symptoms during its early phase. Some commonly observed symptoms of breast cancer include:

• Pain in the breast tissue
• Enlargement of the breast
• Shape differences between the two breasts
• Increased pain during menstrual periods that was not previously experienced
• Thickening or irritation of the skin on the breast
• Painless swelling or mass in the breast or underarm
• Structural changes such as depression or color change in the nipple
• Redness or sores on the nipple
• Peeling or rash on the nipple
• Pink or red discharge from the nipple
• Weakness
• Fatigue
• Weight loss

The symptoms of breast cancer in men are similar to those in women. Symptoms in men often lead to discharge from the nipple or redness around the nipple. Additionally, symptoms such as painless swelling in breast tissue, indentation, retraction, or bulging at the nipple may also occur. While these symptoms do not always indicate cancer, they often prompt women to consult a doctor. During these consultations, early detection can be achieved.

Stages of Breast Cancer

Breast cancer symptoms can vary at each stage. When breast cancer symptoms are visually examined, differences in skin texture can be observed among the stages. Breast cancer consists of five main stages and three sub-stages:

• Stage 0: Ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). This stage indicates the formation of cancer. It has not spread to surrounding tissues and is limited to the area where it started.
• Stage 1: This is the initial stage of invasive breast cancer. In stage 1, the tumor is less than 2 cm in size and cancer cells have not spread to areas outside the breast (such as lymph nodes).
• Stage 2: In stage 2A, there is no tumor in the breast, but cancer is present in the underarm lymph nodes; or the tumor is 2 cm or smaller and has spread to the underarm lymph nodes; or the tumor is larger than 2 cm but smaller than 5 cm and has not spread to the underarm lymph nodes. In stage 2B, the tumor is larger than 2 cm but smaller than 5 cm and has spread to the underarm lymph nodes; or it is larger than 5 cm but has not spread to the underarm lymph nodes.
• Stage 3A: There is no tumor in the breast, but there is cancer in the underarm lymph nodes that are adhered to each other or to surrounding tissues; or the tumor is 5 cm or smaller and has spread to surrounding tissues or adhered underarm lymph nodes; or the tumor is larger than 5 cm and has spread to the underarm lymph nodes (which may be adhered to each other or surrounding tissues).
• Stage 3B: The tumor can be of any size and has spread to nearby tissues (skin, chest wall, ribs, or chest wall muscles) and may have spread to lymph nodes inside the breast or lymph nodes under the arm.
• Stage 3C: Cancer has spread to lymph nodes under the collarbone and along the neck and may have spread to lymph nodes under the arm and inside the breast.
• Stage 4: This is distant metastatic cancer. The cancer has spread to other areas of the body. The goal of treatment in this stage is to extend the patient’s lifespan and maintain a high quality of life.

Stage 3C can be classified into operable and inoperable categories.

In operable stage 3C breast cancer:

• There is involvement in 10 or more lymph nodes under the arm, or
• There is spread to lymph nodes under the collarbone on the same side as the tumor, and to neighboring neck lymph nodes, or
• There is spread in lymph nodes inside the breast and lymph nodes under the arm.

In inoperable stage 3C breast cancer:

• Cancer has spread to lymph nodes above the collarbone and there is involvement in lymph nodes in the neighboring neck area on the same side as the tumor.

Causes of Breast Cancer

Breast cancer occurs due to genetic and environmental factors. A family history of breast cancer increases an individual's risk of developing the disease. Other risk factors that can be considered causes of breast cancer include:

• Exposure to radiation
• Following a diet low in fruits and vegetables
• Starting menstruation at an early age
• Using hormones for a long time after menopause
• Having low fat tissue in the breast
• Never having breastfed
• Using birth control pills for a long time
• Adopting a sedentary lifestyle
• Older age
• Obesity

How Does Breast Cancer Develop?

A large part of breast tissue is composed of fatty tissue. During the breastfeeding period, the milk glands and milk ducts grow. This is the main reason breast tissue varies from person to person. Breast cancer arises from the differentiation of the cells that make up the milk ducts and milk glands within the breast tissue. When these cells, which are present in every healthy woman, multiply uncontrollably, breast cancer develops. Cancerous cells continue to proliferate over time, leading to the formation of a mass. If left untreated, cancer cells can spread throughout the body.

Diagnosis and Treatment of Breast Cancer

Breast cancer is one of the diseases that require awareness. This is due to the fact that the disease often shows no symptoms in its early stages. After the age of 20, every woman should perform a self-examination of her breasts at least once a month. If any differences are noticed in the breast tissue or if a painless lump is felt in the breast, the individual should quickly consult a doctor. After the age of 40, it is crucial for all women to have a mammogram at least once a year for early detection. When a person consults a doctor with a suspicion of breast cancer, the doctor will first listen to the patient's history and perform a physical examination. If deemed necessary, the doctor may request a mammogram, ultrasound, PET scan, MRI, or biopsy. The treatment for breast cancer is determined based on the stage of the cancer and the patient's current health condition. Although preserving breast tissue is the priority in treatment, in necessary cases, a mastectomy may be performed to completely remove the breast tissue. After surgical intervention, radiotherapy and chemotherapy may be required.

Do not neglect to have regular mammograms for early detection of breast cancer.

What are the diseases associated with breast cancer?

Paget's Disease
Paget's disease is a rare condition that occurs alongside breast cancer, seen in 1 or 2 cases out of every 100 breast cancers. It typically begins at the nipple or in the surrounding darker skin area (areola). It usually presents first as a red, scaly rash and can be itchy. It may closely resemble other skin diseases such as psoriasis or eczema, which can lead to confusion. To make a diagnosis, a sample of the affected skin tissue from the nipple is taken (biopsy) and examined under a microscope. If the results indicate Paget's disease, a mammogram is planned. Paget's disease is often a sign of breast cancer or ductal carcinoma in situ (DCIS). Approximately half of the women with Paget's disease have a lump behind the nipple. Nine out of ten cases are invasive breast cancer.

Inflammatory Breast Cancer
This is a less common type of breast cancer, accounting for only 1-4 out of every 100 breast cancer diagnoses. It is called inflammatory because the breast tissue becomes inflamed. Cancer cells block the smallest lymphatic vessels in the breast. As the lymph vessels are obstructed, the breast swells, becomes red, hardens, or tightens, and pain and warmth can be felt upon touch. Pain may not always be present. Other symptoms include thickening, bulging, or dimpling of the breast tissue, and sometimes a lump can form in the breast. The nipple may also be inverted (pulling in) or have discharge.

The symptoms of inflammatory breast cancer can appear quite suddenly and are often confused with a breast infection (mastitis).

The Breast Cancer Treatment Process and Aftercare

Nutrition: Maintaining an ideal weight and balanced nutrition are at the top of the list of considerations for breast cancer prevention. Research has shown that nutrition has a 30-40% impact on cancer treatment. The American Cancer Research Association states that maintaining an ideal weight is the most critical factor in cancer. Patients who have been diagnosed and treated for breast cancer who gain weight are at increased risk of recurrence.

Fat Intake: For individuals consuming excessive fat after menopause, reducing fat intake can decrease the risk of breast cancer. A diet rich in Omega-3 can reduce cancer risk.

Alcohol Consumption: Alcohol consumption decreases the folate levels in the blood. Folate is a substance that reduces cancer risk and can be found in dark green vegetables, orange juice, artichokes, and beets. Alcohol intake should not exceed one glass per day.

Exercise: The primary goal of exercising during and after breast cancer treatment is to facilitate a return to normal life as quickly as possible. The benefits of exercise include:

• Improving mobility in joints and muscles
• Increasing cardiovascular and lung capacity
• Regulating blood pressure
• Enhancing lymphatic fluid circulation to prevent lymphedema in the arm
• Preventing post-surgical shoulder movement restrictions (frozen shoulder)
• Helping the individual feel better by alleviating fatigue and weakness.