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Overview on Breast Cancer

Overview on Breast Cancer Breast cancer is cancer that originates from the breast tissue. It can affect women of all ages but most commonly affects those above 40. It is potentially fatal but achieving a survival rate is also possible. There are 5 stages of breast cancer (stage 0, 1, 2, 3 and 4). Treatment at stage 0 & 1 can result in survival rates of above 90%.

Symptoms Symptoms and Signs of Breast Cancer See your doctor if you notice any of these signs: A persistent lump or thickening in the breast or axilla that may or may not be painful A change in the size or shape of the breast, such as swollen and thickened skin A change in the colour or appearance of the skin of the breast, such as redness, dimpling or puckering Retracted nipple A persistent rash or scaliness around the nipple Bleeding or any unusual discharge from the nipple

Treatment Options Treatment for Breast Cancer The surgical (lumpectomy or mastectomy) option is often the initial treatment to remove the tumour, without removing the entire breast where possible. If the cancer has spread to the surrounding tissues and lymph nodes, it might be necessary to do a mastectomy. This is usually followed up by chemo- or radiotherapy. These therapies work towards killing off any remaining cancer cells. Another option for some women with early stage breast cancer, is hormone therapy. This may help reduce the chance of recurrence. Lumpectomy A lumpectomy is surgery to remove a small area of breast tissue that is cancerous.This surgery is carried out only in early breast cancer, if the area of tissue to be removed is relatively small. Women who choose a lumpectomy will require radiation therapy to destroy any cancer cells that may remain in the area. Mastectomy A mastectomy is the surgical removal of the entire breast that is done in order to remove a malignant tumour in cases of invasive breast cancer, with or without removing the lymph nodes in the armpit. Sometimes, if more tissue needs to be removed, a lumpectomy may be disfiguring and a mastectomy may be recommended instead. Following a mastectomy, a woman may choose to wear a breast prosthesis or may opt to undergo breast reconstruction, which can be done at the same time as the mastectomy or later. Many women suffer a loss of body image after mastectomy. Hence, options of breast reconstruction can be discussed with the patient. This can be performed using myocutaneous flaps or by the use of saline or silicone implants

moreabtcancers: Mother’s Day – A Time to Raise Pink Compaign

moreabtcancers: Mother’s Day – A Time to Raise Pink Compaign

moreabtcancers: CANCER MICROVESSEL INTERVENTION(CMI)

moreabtcancers: CANCER MICROVESSEL INTERVENTION(CMI)

CANCER MICROVESSEL INTERVENTION(CMI)

Fighting the Cancer

What’s new in cancer treatment:part I

CANCER MICROVESSEL INTERVENTION(CMI)

Cancer treatment is traditionally being treated with the modalities involving surgery, chemotherapy and radiotherapy either done alone or more commonly in combinations. Chemotherapy classically means the delivery of injectable drugs to the patient which has the cancer killing property. When patients are treated with general chemotherapy, chemo medicine will naturally spread throughout the body. Unfortunately, the drug distribution is not limited to only cancerous areas, but healthy areas as well. For this reason, general chemo has such strong side effects, and is not particularly successful as a therapy. Therefore, a new research is being conducted at many centres where transarterial chemo-injection are given instead of systemic chemotherapy. In this procedure a catheter is inserted and chemo medicine are given through the artery that supplies blood to the cancerous area. The advantage is a big increase in drug density inside cancer within a short period of time. The disadvantage is that the high drug density inside cancer is difficult to maintain, because the chemo medicine will eventually spread to the rest of the body along with blood very quickly. However, in this procedure, the side effects are less than the effects associated with systemic chemotherapy. So we are researching whether there is an effective way to keep the chemo medicine staying at the cancer site as long as possible, instead of spreading to the whole body, which may cause many serious side effects.

Cancer Microvessel Intervention (CMI) combines different chemo medicines into a fine grain particle. By using superselective catheterization, this fine grain particle will be distributed inside the artery which supplies the target cancer. These fine grain particles of chemo medicine will stay inside tumor tissue and maintain a high density for a long period of time. CMI is based on the following theory: there are a lot of gaps among the cancer capillary endothelial cells, and tight junctions among the normal capillary endothelial cells. The fine grain chemo particle will go inside the interstitial space of cancer tissue, which causes an increase osmotic stress, selectively constricts the cancer micro-capillary, and then block the blood flow. Therefore, the fine grain particle chemo will stay for a relatively long time inside the tumor. Meanwhile, because of the small size, there will not be embolism (blockage) in the normal capillary. Because it is possible to use so much less chemo medicine, the side effects on the entire body are much less than with systemic chemotherapy.

Advantages of CMI

There is an example which helps you understand the advantages of CMI.

If a patient weights 60kg and the tumor weights 50g(0.05kg)

General  chemo by vein infusion	If we give 150mg of drug(oxaliplatin) by vein infusion, there is only 0.125mg of this drug inside the tumor, others will inflow to other organs of body.
Cancer Microvessel   Intervention (CMI)	Just 15mg of the same drug by superselective catheterization and intervention. For example, two thirds (10mg) of the drug has been distributed throughout the body via blood circulation; only one third (5mg) of that remains in the targeted tumor tissue. The dose of chemo medicine remaining inside tumor is 40 times greater than with general chemo vein infusion. (5mg=0.125mg X 40)

Mother’s Day – A Time to Raise Pink Compaign

Breakfast in bed, flowers, cards and “coupon” books are just a few meaningful Mother’s Day traditions. Whether you are a mother, future mother, your mother is

no longer here, or just a loving son or daughter – it is a special

holiday for all. On this day we give thanks to our mothers and remember

 those who are no longer with us .

Mothers are caregivers to their children  and sometimes even their

spouses or own parents. They are hardworking and selfless people who rarely 

 stop to take time for themselves. Mothers need to take time for themselves for

 their own mental wellness. We nourish our bodies with food and water every

 day, but our mental health needs to be nourished just as much. By not taking

 time for themselves, their stress levels will increase and cause a loss of

 productivity and performance. Mental Health America, a member agency

of Community Health Charities, suggests the following tips to help mothers

 take a mental break.

• Learn to say no. If you’re overwhelmed at home or at work, be realistic with yourself and do not take on unnecessary work.
• Stop trying to be Superwoman. No one is perfect and you can’t expect it from yourself.
• Visualize. Use your imagination to picture how you would like to manage stressful situations.
• Meditate. Take at least five to ten minutes of quiet reflection. Turn off all thoughts and clear your mind.
• Exercise. Exercising for at least 30 minutes a day is proven to help the body and mind. Even a short walk on your lunch break is better than nothing.
• Share your feelings. Everyone is fighting their own battle – you don’t have to do it alone. Rely on your friends and family to provide support.
• Be flexible. Make a conscience decision to stay calm during stressful situations.

After Mom has had her mental break, she should also be encouraged to get screened for breast, cervical and skin cancer and other diseases

Breast cancer fact sheet

Breast cancer is amongst the most common cancer in women in India. Around one in 10 women will be diagnosed with breast cancer during their lifetime. Although breast cancer can affect all adult women, risk increases with age and the average age of first diagnosis in women is 50 years.

Today, thanks to developments in prevention, detection and treatment of breast cancer, and continuing clinical trials research, more women are surviving breast cancer long term

What is breast cancer?

The human body is made up of cells which divide and grow in an ordered way. Cancer occurs when these cells divide in an uncontrolled manner. Over time these cells form a lump or “tumour”. Tumours are either benign (non-cancerous) or malignant (cancerous). Breast cancer usually appears in the cells which make up breast milk glands and most tumours start in the milk ducts. If found early, and treated promptly, most women can go on to lead long lives.

Breast cancer risk factors:

Being a woman

Simply because you are female, you are at a greater risk of developing breast cancer (99% of breast cancers occur in women).

Most women diagnosed with breast cancer have no additional risk factors.

Your age

As you grow older, your risk increases. About 75% of all new breast cancers are diagnosed in women aged 50 and over, while

25% are in women under the age of 50.

Family history

Most women who develop breast cancer have no family history of the disease. However, a woman’s risk increases if she has close relatives who have had breast cancer – either on her mother’s or father’s side – particularly if they were diagnosed underthe age of 50.

If you have had breast cancer before

A woman who has had breast cancer, compared with women who have never had the disease, is at an increased risk of developing it again – either in the same breast, the other breast, or other sites. Therefore long term follow-up is very important.

Genetics

Researchers have found that changes or mutations to two specific genes (BRCA1 and BRCA2) substantially increase a woman’s risk. These changes can be detected by genetic screening and doctors can suggest treatments to delay or prevent breast cancer

from developing. Recently, new genes associated with breast cancer have been discovered.

Oestrogen

The female hormone, oestrogen, also has a role. Women who began menstruation early or women who have a late menopause may be at a slightly increased risk. Women who have no children and those who have their first child after age 30 may also be at

a slightly higher risk. Long term Hormone Replacement Therapy (HRT) increases risk.

Lifestyle

If you eat a diet high in sugars and fats and low in fresh fruit and vegetables, if you are overweight, or if you drink too much alcohol, you may be putting yourself at greater risk of developing breast cancer.

Being sedentary

Research shows that women who are physically active and maintain a healthy body weight have a lower risk of breast cancer

Breast Changes It is important to be aware of the normal look and feel of your breasts and to report any persistent breast changes promptly. The earlier breast cancer is detected, the better the chance of long term cure. If you experience any of these symptoms, particularly if they persist for several weeks, see your doctor as soon as possible: A new lump or lumpiness, especially if it is only in one breast. A change in breast size or shape. A change to the nipple, such as crusting, ulcer, redness or inversion. Nipple discharge. A change in the skin of the breast such as redness or dimpling. An unusual pain that doesn’t go away.

It is recommended that woman at average risk for breast cancer receive clinical breast exams at least every three years from age 20 to 39 and then every year beginning at age 40.  Also beginning at age 40, a woman should receive a mammogram every year.  Women at higher risk may need to get screened earlier and more frequently than recommended above. If you know you have a higher risk, talk with your healthcare practitioner about the best early detection plan. This could mean starting mammograms when you are younger, having extra screening tests or having more frequent exams. There are charts called Risk Assessment Tools that a healthcare practitioner can use to determine if you are at higher risk.

Women should also perform a monthly breast self-exam to look for any changes in their breasts and see a doctor right away if they notice any swelling or lumps, skin irritation, nipple pain or the nipple turning inward, redness or scaliness of the nipple, or any discharge that is not breast milk. If breast changes occur, it is best to be certain that it is not cancer.

On this day we should remember cancer when diagnose early is curable. After all, wouldn’t "a world without breast cancer" be the best Mother’s Day gift of all?

General awareness about cancers

Why and when to see your Doctor


Knowing how your body normally looks and feels can help you spot early any changes that could be caused by a cancer. Having any of the following symptoms doesn’t necessarily mean you have cancer, but it’s sensible to get them checked out by your GP.
• A lump anywhere on your body.
• Changes on your skin or to an existing mole (such as itching, bleeding, or a change in shape or colour).
• A cough or hoarseness that lasts for more than three weeks.
• A change in bowel habit that lasts for more than six weeks.
• Any abnormal bleeding from your vagina or back passage, in your urine or when being sick (vomiting).
• Unexplained, significant weight loss (5kg over a couple of months).
• Coughing up blood.

Some cancers have very specific symptoms, but not all cancers will have symptoms in the early stages. Some cancers are diagnosed by accident, while someone is being investigated or treated for another condition.
Cancer can’t be diagnosed based on symptoms alone. Investigations, such as x-rays, scans and biopsies, are nearly always needed to make a diagnosis.


General signs and symptoms
The following are the most common signs and symptoms of cancer.
Lumps
You should see your doctor if you notice a lump or swelling anywhere on your body.
Coughing and breathlessness If you have a cough or feel breathless for more than three weeks, you should see your GP. Tell them if you have any blood in your sputum (phlegm) when you cough.
Change in bowel habit
Blood in your stools (bowel motions) can be a symptom of bowel cancer. The blood is usually dark but can be bright red in colour.
You may notice a change in your normal bowel pattern, such as diarrhoea or constipation, for no obvious reason. Some people may have alternating episodes of diarrhoea and constipation. You may have a feeling of not having emptied your bowel properly after a bowel motion. Some people have pain in the tummy (abdomen) or back passage.
If any changes in bowel habit last for more than six weeks, you should check them out with your GP.
Abnormal bleeding
Unexplained bleeding should always be checked out by your GP.
Any unexplained bleeding is a sign that something might be wrong and should always be checked out.
• Bleeding between periods or after sex may be caused by cancer of the womb orcervix. Women who have any vaginal bleeding after they have had their menopause should always see their GP.
• Blood in your urine may be caused by bladder or kidney cancer.
• Coughing up blood in your sputum (phlegm) can sometimes be a sign of lung cancer.
• Vomiting blood can be a sign of stomach cancer, although it can also be due to a stomach ulcer.
• Bruising and nosebleeds are rarely signs of cancer, but can in some cases be caused by leukaemia. However, people with leukaemia usually have other symptoms too.
Unexplained weight loss
If you’ve lost a lot of weight over a short period of time (a couple of months or less) that can’t be explained by changes in your diet, increased exercise or stress, it’s important to tell your GP.
Suspicious moles or skin changes
Malignant melanoma is a type of skin cancer that often starts with a change in the appearance of normal skin. This can look like an abnormal new mole. Fewer than one third of melanomas develop in existing moles. Any of the following changes should always be checked out.
• Asymmetry - Melanomas are likely to be irregular or asymmetrical. Ordinary moles are usually symmetrical (both halves look the same).
• Border - Melanomas are more likely to have an irregular border with jagged edges. Ordinary moles usually have a well-defined, regular border.
• Colour - Moles tend to be one shade of brown. Melanomas often have more than one colour.
• Diameter (width) - Melanomas are usually more than 7mm in diameter. Moles are normally no bigger than the blunt end of a pencil (about 6mm across).
• Evolving (changing) - Look for changes in the size, shape or colour of a mole.

It’s important to see your GP if you have any unusual marks on the skin that last for more than a few weeks, or if you have a mole that shows any of the above signs.
Hoarseness
A hoarse voice may be a sign of cancer of the larynx. Hoarseness can occasionally be a symptom of other cancers, such as thyroid cancer, cancer of the oesophagus or lung cancer. If hoarseness continues for longer than two weeks, you should tell your GP.
Pain
People often think that pain is a symptom of cancer, but many people with cancer have no pain in the early stages. Some people with cancer will never have pain.

Lung cancer symptoms
Lung cancer is common in both men and women. Smoking cigarettes is known to be the cause of most lung cancers.
The symptoms of lung cancer may include any of the following:
• continued coughing for three weeks or longer, or a change in a long-standing cough
• a chest infection that doesn’t get better
• increasing breathlessness and wheezing
• coughing up blood in your sputum (phlegm)
• a hoarse voice
• a dull ache or a sharp pain when you cough or take a deep breath
• loss of appetite or loss of weight
• difficulty swallowing
• excessive tiredness (fatigue) and lethargy.
It’s important to have any of these symptoms checked by your GP as early as possible.


Large bowel cancer symptoms
The large bowel is made up of the colon and the rectum, and is part of the digestive system. Most cancers of the large bowel develop in the colon.
The following can all be symptoms of large bowel cancer:
• dark or bright red blood in or on your stools
• a change in your normal bowel habit, such as diarrhoea or constipation, for no obvious reason that lasts for longer than six weeks
• unexplained weight loss
• pain in the tummy (abdomen) or back passage
• a feeling of not having emptied your bowel properly after a bowel motion
• general discomfort, such as gas, bloating or cramps, in the tummy (abdomen).
Sometimes tiredness (fatigue) is a symptom of a bowel cancer. This can happen if the cancer has been bleeding, which means that the number of red blood cells in your body is reduced (anaemia). Anaemia may also make you feel breathless.
Sometimes a cancer can cause a blockage (obstruction) in the bowel. The symptoms of this are being sick (vomiting), constipation, pain in the abdomen or a bloated feeling.
Although these symptoms can be caused by conditions other than large bowel cancer, it’s important to get them checked by your doctor.


Prostate cancer symptoms
The prostate is a small gland found only in men. It‘s about the size of a walnut and surrounds the first part of the tube (urethra) that carries urine from the bladder to the penis.
Many men with early prostate cancer are unlikely to have any symptoms, as these only occur when the cancer is large enough to put pressure on the urethra.
In men over the age of 50, the prostate gland often gets larger due to a noncancerous condition known as benign prostatic hyperplasia or benign prostatic hypertrophy (BPH). The symptoms of both benign enlargement of the prostate gland and a malignant tumour (cancer) are similar and can include any of the following:
• difficulty in starting to pass urine
• a poor or weak flow of urine
• urgently needing to pass water
• passing urine more frequently than usual, especially at night
• blood in the urine, although this is uncommon.
If you have any of these symptoms, you should discuss them with your GP.


Bladder cancer symptoms
The bladder is a hollow, muscular, balloon-like organ that collects and stores urine. The most common symptoms of bladder cancer are:
• Blood in the urine - This usually happens suddenly and may come and go. It’s not usually painful. Sometimes the blood in your urine can’t be seen and is picked up by a urine test.
• Bladder changes - You may have a burning feeling when you pass urine, or need to pass urine more often or urgently than usual. These are all symptoms of bladder irritation and are more likely to be due to an infection than cancer. Your GP may want to investigate further if you have repeated infections.
If you have any worrying symptoms, getting them checked out with your GP is the best way to find out the cause.


Breast cancer symptoms
Breast cancer mainly affects women, but in rare cases can affect men too. In most cases, the first symptom of breast cancer is a painless lump. You should visit your doctor straight away if you notice a lump or other changes in your breast(s). Although most breast lumps are not cancerous (benign), they still need to be checked carefully to rule out the possibility of cancer.
Other, less common signs of breast cancer may include:
• a change in the size or shape of a breast
• dimpling of the skin on the breast
• a thickening in the breast tissue
• a nipple becoming inverted (turned in)
• a lump or thickening behind the nipple
• a rash (like eczema) affecting the nipple
• a swelling or lump in the armpit
• blood in discharge from the nipple.
Pain in the breast is not usually a symptom of breast cancer, but it can occur.


Ovarian cancer symptoms
Symptoms of ovarian cancer can be quite vague and may not occur until the cancer is at a late stage. When symptoms occur, they can include any of the following:
• loss of appetite
• feeling sick (nausea)
• excessive gas (wind)
• a bloated, full feeling
• unexplained weight gain
• swelling in the abdomen – this may be due to a build up of fluid (ascites), which can also cause shortness of breath
• pain in the lower abdomen
• changes in bowel or bladder habits, such as constipation, diarrhoea or needing to pass urine more often than usual
• lower back pain
• pain during sex
• abnormal vaginal bleeding.
If you have any of the above symptoms, it’s important to have them checked by your doctor.


Screening
Screening is a way of testing healthy people, either to see if a cancer can be found early or to detect changes that may develop into cancer at a later date.
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References
This section has been complied using information from a number of reliable sources including;
• Cancer Research UK. http://info.cancerresearchuk.org/
cancerstats/incidence/commoncancers/ (accessed August 2011).
• Clinical Guidelines CG027: Referral for Suspected Cancer. June 2005. National Institute for Health and Clinical Excellence (NICE).
• Clinical Guideline 121. Lung cancer: The diagnosis and treatment of lung cancer. April 2011. National Insitute for Health and Clinical Excellence.
• Tobias & Hochhauser. Cancer and its Management (6th edition). 2005. Wiley-Blackwell, Oxford.



How is cancer treated?


There are several different types of cancer treatment.

• Surgery
• Radiotherapy
• Chemotherapy
• Hormonal therapy
• Biological therapy
Some are used to treat cancer in a particular (local) area of the body. These are called local treatments. They include surgery and radiotherapy. Other treatments can treat cancer in more than one part of the body at a time. These are called systemic treatments. Chemotherapy, hormonal therapy and biological therapy generally work in this way.
The main types of treatment for cancer are described here. It’s quite common for a combination of treatments to be used.


Surgery
An operation to remove the tumour is the main treatment for many types of cancer.
Surgery is most likely to be used if the cancer is only in one area of the body and has not spread. It can sometimes be used to remove a cancer that has spread to another area of the body, but this is less common.


Radiotherapy
Radiotherapy uses high energy x-rays to destroy cancer cells. The radiation is targeted at the area affected by cancer so that it does as little harm as possible to normal cells. One of the most common side effects is tiredness. Other side effects depend on the part of the body being treated.


Chemotherapy
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.
There are more than 50 different chemotherapy drugs. Sometimes treatment is with just one chemotherapy drug but often two or more drugs are given together. This is known as combination chemotherapy. The type of chemotherapy treatment you are given depends on the type of cancer you have.
Chemotherapy can cause various side effects depending on which drug (or combination of drugs) is used. However, there are many ways of preventing or reducing the side effects of chemotherapy.


Hormonal therapy
Hormones are natural substances made by the body that control the growth and activity of certain cells. Some cancers depend on particular hormones in order to grow. Hormonal therapies reduce the levels of these hormones in the body or block the hormones from reaching cancer cells. This shrinks the cancer and stops it growing.


Biological therapy
Biological therapies work in various ways to destroy cancer cells. They can:
• stimulate the body’s defences (immune system) to attack the cancer
• attach to particular types of cells (including cancer cells) in the body so that they die
• interfere with a cancer’s ability to grow
• stop a tumour from making its own blood supply so it can’t get the oxygen and nutrients it needs.
Some biological therapies will do just one of these things while others may use two or more of these methods to attack the cancer.
Biological therapies can be given different names according to how they work. Some of the main types of biological therapies used to treat cancer are monoclonal antibodies,cancer growth inhibitors and angiogenesis inhibitors. Research is trying to discover whether other types of biological therapy such as vaccines and gene therapy can be used to treat cancer. This type of research is in the very early stages.
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Sentinal lymph node biopsy

The sentinel lymph node is the hypothetical first lymph node or group of nodes reached by cancer cell from a primary tumor.
The spread of some forms of cancer usually follows an orderly progression, spreading first to regional lymph nodes, then the next echelon of lymph nodes, and so on. In layperson language, some cancers spread in a predictable fashion from where the cancer started. In these cases, if the cancer spreads it will spread first to lymph nodes (lymph glands) close to the tumor before it spreads to other parts of the body. The concept of sentinel lymph node surgery is to see if the cancer has spread to the very first lymph node (called the "sentinel lymph node"). If the sentinel lymph node does not contain cancer, then there is a high likelihood that the cancer has not spread to any other area of the body.
Procedure
To perform a sentinel lymph node biopsy, the physician performs a lymphoscintigraphy, wherein a low-activity radioactive substance is injected near the tumor. The injected substance, Filtered Sulfur Colloid, is tagged with the radionuclide Technetium-99m. A gentle massage of the injection sites spreads the sulphur colloid, relieving the pain and speeding up the lymph uptake. Scintigraphic imaging is usually started within 5 minutes of injection and the node appears from 5 min to 1 hour. This is usually done several hours before the actual biopsy. About 15 minutes before the biopsy the physician injects a blue dye in the same manner. Then, during the biopsy, the physician visually inspects the lymph nodes for staining and uses a Gamma Probe to assess which lymph nodes have taken up the radionuclide. One or several nodes may take up the dye and radioactive tracer, and these nodes are designated the sentinel lymph nodes. The surgeon then removes these lymph nodes and sends them to a pathologist for rapid examination under a microscope to look for the presence of cancer.
A frozen section procedure is commonly employed (which takes less than 20 minutes), so if neoplasia is detected in the lymph node a further lymph node dissection may be performed. With malignant melanoma, many pathologists eschew frozen sections for more accurate "permanent" specimen preparation due to the increased instances of false-negative with melanocytic staining.
Advantages
There are various advantages to the sentinel node procedure. First and foremost, it decreases unnecessary lymph node dissections where this is not necessary, thereby reducing the risk of lymphedema, a common complication of this procedure. Increased attention on the node(s) identified to most likely contain metastasis is also more likely to detect micro-metastasis and result in staging and treatment changes. The main uses are in breast cancer andmalignant melanoma surgery, although it has been used in other tumor types (colon cancer) with a degree of success.
Disadvantages
However, the technique is not without drawbacks, particularly when used for melanoma patients. This technique only has therapeutic value in patients with positive nodes. Failure to detect cancer cells in the sentinel node can lead to a false negative result - there may still be cancerous cells in the lymph node basin. In addition, there is no compelling evidence that patients who have a full lymph node dissection as a result of a positive sentinel lymph node result have improved survival compared to those who do not have a full dissection until later in their disease, when the lymph nodes can be felt by a physician. Such patients may be having an unnecessary full dissection, with the attendant risk of lymphedema.

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