Reported breast cancer symptoms include:

discharge from the nipple(clear or bloody)
persistent tenderness of the breast
pain in the nipple
swelling or mass in the armpit (lymph nodes)
inverted or scaly nipples
a lump that can be felt, no matter how small
swelling of the breast

Sometimes there are no symptoms of breast cancer when it is in the early stages. If you notice a lump, or are experiencing anything unusual, you must report the symptoms to your doctor as soon as possible. Performing a monthly self breast exam is the one of the best ways to notice any changes in your breasts.

More About Breast Cancer Symptoms

Risk factors

Pathophysiology

Breast cancer is either invasive or noninvasive (often referred to as in situ). There are two types of noninvasive breast cancers: ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). These two types of noninvasive breast cancers do not invade the basement membrane of the breast (see Fig. 1, Anatomy of the Breast). As their names suggest ductal carcinoma in situ cancer cells are found in the lining of the duct whereas lobular carcinoma in situ cancer cells are found in the lobules (see Anatomy section for a detailed description of the ductals and lobules of the breast).

Breast cancer, like other cancers, occurs because of an interaction between the environment and a defective gene. Normal cells divide as many times as needed and stop. They attach to other cells and stay in place in tissues. Cells become cancerous when mutations destroy their ability to stop dividing, to attach to other cells and to stay where they belong. When cells divide, their DNA is normally copied with many mistakes.

Error-correcting proteins fix those mistakes. The mutations known to cause cancer, such as p53, BRCA1 and BRCA2, occur in the error-correcting mechanisms. These mutations are either inherited or acquired after birth. Presumably, they allow the other mutations, which allow uncontrolled division, lack of attachment, and metastasis to distant organs. Normal cells will commit cell suicide (apoptosis) when they are no longer needed. Until then, they are protected from cell suicide by several protein clusters and pathways.

One of the protective pathways is the PI3K/AKT pathway; another is the RAS/MEK/ERK pathway. Sometimes the genes along these protective pathways are mutated in a way that turns them permanently "on", rendering the cell incapable of committing suicide when it is no longer needed. This is one of the steps that causes cancer in combination with other mutations. Normally, the PTEN protein turns off the PI3K/AKT pathway when the cell is ready for cell suicide.

In some breast cancers, the gene for the PTEN protein is mutated, so the PI3K/AKT pathway is stuck in the "on" position, and the cancer cell does not commit suicide.

There are the two types of noninvasive breast cancer described above and there are also two types of invasive breast cancer: infiltrating ductal carcinoma and infiltrating lobular carcinoma.

As their names suggest, infiltrating ductal carcinoma penetrates the wall of the duct and travels to areas outside of it whereas infiltrating lobular carcinoma spreads through the wall of the lobule and also travels to areas outside of it. Infiltrating ductal carcinoma is the most common type of breast cancer, accounting for between 70%-80% of the cases of breast cancer.

Mutations that can lead to breast cancer have been experimentally linked to estrogen exposure.

Failure of immune surveillance, the removal of malignant cells throughout one's life by the immune system.

Abnormal growth factor signaling in the interaction between stromal cells and epithelial cells can facilitate malignant cell growth.In breast adipose tissue, overexpression of leptin leads to increased cell proliferation and cancer.

Breast cancer, like other forms of cancer, is the outcome of multiple environmental and hereditary factors. Some of these factors include:

Lesions to DNA such as genetic mutations. Mutations that can lead to breast cancer have been experimentally linked to estrogen exposure.
Failure of immune surveillance, a theory in which the immune system removes malignant cells throughout one's life.
Abnormal growth factor signaling in the interaction between stromal cells and epithelial cells can facilitate malignant cell growth.
Inherited defects in DNA repair genes, such as ''BRCA1'', ''BRCA2'' and ''TP53''. People in less-developed countries report lower incidence rates than in developed countries.

breast cancer symptoms

Initially, breast cancer may not cause any symptoms. A lump may be too small for you to feel or to cause any unusual changes you can notice on your own. Often, an abnormal area turns up on a screening mammogram (x-ray of the breast), which leads to further testing.

In some cases, however, the first sign of breast cancer is a new lump or mass in the breast that you or your doctor can feel. A lump that is painless, hard, and has uneven edges is more likely to be cancer. But sometimes cancers can be tender, soft, and rounded. So it's important to have anything unusual checked by your doctor.

Reported breast cancer symptoms include:

discharge from the nipple(clear or bloody)
persistent tenderness of the breast
pain in the nipple
swelling or mass in the armpit (lymph nodes)
inverted or scaly nipples
a lump that can be felt, no matter how small
swelling of all or part of the breast
skin irritation or dimpling
breast pain
the nipple turning inward
redness, scaliness, or thickening of the nipple or breast skin
a nipple discharge other than breast milk
a lump in the underarm are

Sometimes there are no symptoms of breast cancer when it is in the early stages. If you notice a lump, or are experiencing anything unusual, you must report the symptoms to your doctor as soon as possible. Performing a monthly self breast exam is the one of the best ways to notice any changes in your breasts.

Breast Cancer Evaluation

The evaluation of breast cancer begins with a medical history and physical examination.

Physical findings of breast cancer in someone with breast cancer may include:

New breast lump
Changes in breast shape or size
Dimpling in the skin of the breast
New lump in the armpit that does not go away
Nipple discharge from one breast
Orange-peel color of the skin overlying the breast
Retracted (pointing inward) nipple or changes in the nipple

For evaluation breast cancer a Testing is required to evaluate breast cancer.

Tests breast cancer that may be used to evaluate breast cancer include:

Breast biopsy
Miraluma breast scan
Bone scan:

To look for cancer that has spread

Breast ultrasound:

May help to identify breast swelling caused by a cyst.

Sentinel node biopsy
Breast tissue hormone status
Mammography:

This is a special x-ray that can reveal close to 90% of all breast cancers

Breast Lump

Breast lamp changes are common. From the time a girl begins to develop breasts and begins menstruating and throughout life, women may experience various kinds of breast pain and other breast changes. Some of these changes normally occur during the menstrual cycle, during pregnancy, and with aging. Breast lumps, tenderness, and other changes may occur.

Most breast lumps and other changes are not cancer.

Your breast is composed of several glands and ducts that lead to the nipple and the surrounding colored area called the areola.

The milk-carrying ducts extend from the nipple into the underlying breast tissue like the spokes of a wheel. Under the areola are lactiferous ducts.

These fill with milk during lactation after a woman has a baby. When a girl reaches puberty, changing levels of hormones cause the ducts to grow and cause fat deposits in the breast tissue to increase.

The glands that produce milk (mammary glands) that are connected to the surface of the breast by the lactiferous ducts may extend to the armpit area (axilla).

There are no muscles in the breasts, but muscles lie under each breast and cover the ribs. These normal structures inside the breasts can sometimes make them feel lumpy. Such lumpiness may be especially noticeable in women who are thin or who have small breasts.

Breast pain is a common breast problem mostly in younger women who are still having their periods, and happens less often in older women. Although pain is a concern, breast pain is rarely the only symptom of breast cancer. Most breast cancers involve a mass or lump.
Breast pain or tenderness may also occur in a teenage boy. The condition, called gynecomastia, is enlargement of the male breast which may occur as a normal part of development, often during puberty.
Lumps within breast tissue are usually found unexpectedly or during a routine monthly breast self-exam. Most lumps are not cancer but represent changes within the breast tissue. As your breasts develop, changes occur. These changes are influenced by normal hormonal variations.
Cyclic mastalgia: About two-thirds of women with breast pain have a problem called cyclic mastalgia. This pain typically is worse before your menstrual cycle and usually is relieved at the time your period begins. The pain may also happen in varying degrees throughout the cycle. Because of its relationship to the menstrual cycle, it is believed to be caused by hormonal changes. This type of breast pain usually happens in younger women, although the condition has been reported in postmenopausal women who take hormone replacement therapy.
Noncyclic mastalgia: Breast pain that is not associated with the menstrual cycle is called noncyclic mastalgia. It occurs less often than the cyclic form. It typically occurs in women older than 40 years and is not related to the menstrual cycle. It is sometimes linked to a fibrous mass (called a fibroadenoma) or a cyst.
Breast infection: The breast is made up of hundreds of tiny milk-producing sacs called alveoli. They are arranged in grapelike clusters throughout the breast. Once breastfeeding begins, milk is produced in the alveoli and secreted into tube-shaped milk ducts that empty through the nipple.
Mastitis is an infection of the tissue of the breast that occurs most frequently during the time of breastfeeding. This infection causes pain, swelling, redness, and increased temperature of the breast. It can occur when bacteria, often from the baby's mouth, enter a milk duct through a crack in the nipple. This causes an infection and painful inflammation of the breast.

History

The oldest description of cancer was discovered in Egypt and dates back to approximately 1600 BC. The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were treated by cauterization

breast cancer was the form of cancer most often described in ancient documents.Because autopsies were rare, cancers of the internal organs were essentially invisible to ancient medicine. Breast cancer, however, could be felt through the skin, and in its advanced state often developed into fungating lesions: the tumor would become necrotic (die from the inside, causing the tumor to appear to break up) and ulcerate through the skin, weeping fetid, dark fluid.

Although breast cancer was known in ancient times, it was uncommon until the 19th century, when improvements in sanitation and control of deadly infectious diseases resulted in dramatic increases in lifespan. Previously, most women had died too young to have developed breast cancer. Additionally, early and frequent childbearing and breastfeeding probably reduced the rate of breast cancer development in those women who did survive to middle age.

Mastectomy for breast cancer was performed at least as early as 548 CE, when it was proposed by the court physician Aetios of Amida to Theodora. It was not until doctors achieved greater understanding of the circulatory system in the 17th century that they could link breast cancer's spread to the lymph nodes in the armpit. The French surgeon Jean Louis Petit (1674–1750) and later the Scottish surgeon Benjamin Bell (1749–1806) were the first to remove the lymph nodes, breast tissue, and underlying chest muscle.

During the 1970s, a new understanding of metastasis led to perceiving cancer as a systemic illness as well as a localized one, and more sparing procedures were developed that proved equally effective. Modern chemotherapy developed after World War II.

Developing countries of breast cancer

The developing countries grow and adopt Western culture they also accumulate more disease that has arisen from Western culture and its habits (fat/alcohol intake, smoking, exposure to oral contraceptives, the changing patterns of childbearing and breastfeeding, low parity).

The developing countries expected numbers of new cases and deaths due to breast cancer in South America for the year 2001 are approximately 70,000 and 30,000, respectively. However, because of a lack of funding and resources, treatment is not always available to those suffering with breast cancer.

For instance, as South America has developed so has the amount of breast cancer.

Breast cancer in less developed countries, such as those in South America, is a major public health issue. It is a leading cause of cancer-related deaths in women in countries such as Argentina, Uruguay, and Brazil.

Society and culture

The society and culture Before the 20th century, breast cancer was feared and discussed in hushed tones, as if it were shameful. As little could be safely done with primitive surgical techniques, women tended to suffer silently rather than seeking care.

When surgery advanced, and long-term survival rates improved, women began raising awareness of the disease and the possibility of successful treatment.

The society and culture In 1952, the first peer-to-peer support group, called "Reach to Recovery", began providing post-mastectomy, in-hospital visits from women who had survived breast cancer.

The breast cancer movement of the 1980s and 1990s developed out of the larger feminist movements and women's health movement of the 20th century.

The society and culture this series of political and educational campaigns, partly inspired by the politically and socially effective AIDS awareness campaigns, resulted in the widespread acceptance of second opinions before surgery, less invasive surgical procedures, support groups, and other advances in patient care

The society and culture "Women's Field Army", run by the American Society for the Control of Cancer (later the American Cancer Society) during the 1930s and 1940s was one of the first organized campaigns.

Psychological aspects

The psychological aspect Not all breast cancer patients experience their illness in the same manner. Factors such as age can have a significant impact on the way a patient copes with a breast cancer diagnosis.

Premenopausal women with estrogen-receptor positive breast cancer must confront the issues of early menopause induced by many of the chemotherapy regimens used to treat their breast cancer, especially those that use hormones to counteract ovarian function.

The psychological aspect one of emotional impact of cancer diagnosis, symptoms, treatment, and related issues can be severe. Most larger hospitals are associated with cancer support groups which provide a supportive environment to help patients cope and gain perspective from cancer survivors. Online cancer support groups are also very beneficial to cancer patients, especially in dealing with uncertainty and body-image problems inherent in cancer treatment.

The psychological aspects one the other hand, a recent study conducted by researchers at the College of Public Health of the University of Georgia showed that older women may face a more difficult recovery from breast cancer than their younger counterparts. As the incidence of breast cancer in women over 50 rises and survival rates increase, breast cancer is increasingly becoming a geriatric issue that warrants both further research and the expansion of specialized cancer support services tailored for specific age groups

TreatmentS

Breast cancer treatments have come a long way in the past few generations. Get a general overview of treatment options for today’s breast cancer patients

Breast Cancer Surgery

Surgery is done to remove cancer while it's still in the breast. This article is a brief introduction to breast cancer surgery.

Chemotherapy

Chemotherapy is often used to cut the chances of cancer’s return (recurrence).

Chemotherapy and Breast Cancer: Detailed Information

This article provides in-depth information on breast cancer chemotherapy.

Radiation for Breast Cancer

Radiotherapy is given after surgery to the region of the tumor bed and regional lymph nodes, to destroy microscopic tumor cells that may have escaped surgery. It may also have a beneficial effect on tumor microenvironment.

Radiation can reduce the risk of recurrence by 50-66% (1/2 - 2/3 reduction of risk) when delivered in the correct dose and is considered essential when breast cancer is treated by removing only the lump (Lumpectomy or Wide local excision)

Radiation therapy is another way to help reduce the chance of cancer’s return.

Radiation therapy can be delivered as external beam radiotherapy or as brachytherapy (internal radiotherapy). Conventionally radiotherapy is given after the operation for breast cancer. Radiation can also be given at the time of operation on the breast cancer- intraoperatively.

The largest randomised trial to test this approach was the TAR-GIT-A Trial which found that targeted intraoperative radiotherapy was equally effective at 4-years as the usual several weeks' of whole breast external beam radiotherapy

Hormone Therapy

Hormone therapy may help curb the growth, spread, or recurrence of some types of breast cancer.

Hormone Therapy Drugs for Breast Cancer

Read about tamoxifen, aromatase inhibitors, and other hormonal treatments for breast cancer.

Hormone Therapy for Breast Cancer FAQs

Some (but not all) breast cancers are sensitive to hormones such as estrogen and progestin. Read about hormonal therapy for those types of breast cancer.

Biological Therapy for Breast Cancer

Herceptin is a type of biological therapy for breast cancer. Read about it in this article.

Radiation breast cancer

Radiation breast cancer Radiation can reduce the risk of recurrence by 50-66% (1/2 - 2/3 reduction of risk) when delivered in the correct dose^[ca] and is considered essential when breast cancer is treated by removing only the lump (Lumpectomy or Wide local excision).

Radiotherapy is given after surgery to the region of the tumor bed and regional lymph nodes, to destroy microscopic tumor cells that may have escaped surgery. It may also have a beneficial effect on tumor microenvironment.

Radiation therapy can be delivered as external beam radiotherapy or as brachytherapy (internal radiotherapy). Conventionally radiotherapy is given after the operation for breast cancer. Radiation can also be given at the time of operation on the breast cancer- intraoperatively.

The Radiation therapy largest randomised trial to test this approach was the TAR-GIT-A Trial which found that targeted intraoperative radiotherapy was equally effective at 4-years as the usual several weeks' of whole breast external beam radiotherapy.

Breast cancer Surgery

Surgery is done to remove cancer while it's still in the breast.and

Surgery involves the physical removal of the tumor, typically along with some of the surrounding tissue.

Standard surgeries include:

Mastectomy: Removal of the whole breast.
Quadrantectomy: Removal of one quarter of the breast.
Lumpectomy: Removal of a small part of the breast.

Surgery In other cases, women use breast prostheses to simulate a breast under clothing, or choose a flat chest.

Surgery prosedure If the patient desires, then breast reconstruction surgery, a type of cosmetic surgery, may be performed to create an aesthetic appearance.

BREAST CANCER MEDICATION

A recent analysis of a subset of the Nurses' Health Study data indicated that Aspirin may reduce mortality from breast cancer

Hormone blocking therapy: Some breast cancers require estrogen to continue growing. They can be identified by the presence of estrogen receptors (ER+) and progesterone receptors (PR+) on their surface (sometimes referred to together as hormone receptors).

These ER+ cancers can be treated with drugs that either block the receptors, e.g. tamoxifen (Nolvadex), or alternatively block the production of estrogen with an aromatase inhibitor, e.g. anastrozole (Arimidex) or letrozole (Femara). Aromatase inhibitors, however, are only suitable for post-menopausal patients.

There are currently three main groups of medications used for adjuvant breast cancer treatment: hormone blocking therapy, chemotherapy, and monoclonal antibodies

Chemotherapy: Predominately used for stage 2-4 disease, being particularly beneficial in estrogen receptor-negative (ER-) disease. They are given in combinations, usually for 3–6 months. One of the most common treatments is cyclophosphamide plus doxorubicin (Adriamycin), known as AC.

Most chemotherapy medications work by destroying fast-growing and/or fast-replicating cancer cells either by causing DNA damage upon replication or other mechanisms; these drugs also damage fast-growing normal cells where they cause serious side effects.

Damage to the heart muscle is the most dangerous complication of doxorubicin. Sometimes a taxane drug, such as docetaxel, is added, and the regime is then known as CAT; taxane attacks the microtubules in cancer cells.

Another common treatment, which produces equivalent results, is cyclophosphamide, methotrexate, and fluorouracil (CMF). (Chemotherapy can literally refer to any drug, but it is usually used to refer to traditional non-hormone treatments for cancer.)

Monoclonal antibodies: A relatively recent development in HER2+ breast cancer treatment. Approximately 15-20 percent of breast cancers have an amplification of the HER2/neu This receptor is normally stimulated by a growth factor which causes the cell to divide; in the absence of the growth factor, the cell will normally stop growing. Overexpression of this receptor in breast cancer is associated with increased disease recurrence and worse prognosis. Trastuzumab (Herceptin), a monoclonal antibody to HER2, has improved the 5 year disease free survival of stage 1–3 HER2+ breast cancers to about 87% (overall survival 95%). Trastuzumab, however, is expensive, and approx 2% of patients suffer significant heart damage; it is otherwise well tolerated, with far milder side effects than conventional chemotherapy. Other monoclonal antibodies are also undergoing clinical trials. gene or overexpression of its protein product.

breast cancer preventions

Performing regular breast self-exams will allow you to familiarize yourself with your body and alert you when a change in your usual breast tissue is found.
Exercise may decrease breast cancer risk.^[56] Also avoiding alcohol and obesity. Prophylactic bilateral mastectomy may be considered in patients with BRCA1 and BRCA2 mutations. A 2007 report concluded that women can somewhat reduce their risk by maintaining a healthy weight, drinking less alcohol, being physically active and breastfeeding their children.
The American Cancer Society Guidelines for the Early Detection of Cancer recommend yearly mammograms starting at age 40. Also, Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic health exam by a health professional, preferably every three years. After age 40, women should have a breast exam by a health professional every year.
Repeating the breast exam and completing a pain diary for a few consecutive menstrual cycles will also help establish whether your breast pain is cyclic or not.
Sometimes mastitis is unavoidable. Some women are more susceptible than others, especially those who are breastfeeding for the first time.
If you are younger than 40 and in a high-risk category (for example, many women in your family have breast cancer), you should ask your doctor about how early you should have your first mammogram.

Breast cancer Screening

Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.

Scientists are trying to better understand which people are more likely to get certain types of cancer. They also study the things we do and the things around us to see if they cause cancer. This information helps doctors recommend who should be screened for cancer, which screening tests should be used, and how often the tests should be done.

symptoms.

Breast self-exam. A breast self-exam is when you check your own breasts for lumps, changes in size or shape of the breast, or any other changes in the breasts or underarm (armpit).

Mammogram. A mammogram is an X-ray of the breast. Mammograms are the best method to detect breast cancer early when it is easier to treat and before it is big enough to feel or cause symptoms. Having regular mammograms can lower the risk of dying from breast cancer. If you are age 50 to 74 years, be sure to have a screening mammogram every two years. If you are age 40–49 years, talk to your doctor about when and how often you should have a screening mammogram.
Breast self-exam. A breast self-exam is when you check your own breasts for lumps, changes in size or shape of the breast, or any other changes in the breasts or underarm (armpit).
Clinical breast exam. A clinical breast exam is an examination by a doctor or nurse, who uses his or her hands to feel for lumps or other changes.

Breast cancer classification

Breast cancer classification divides breast cancer into several categories according to multiple different schemes, each based on different criteria and serving a different purpose. A typical description usually considers each of these aspects in turn: the histolopathological type, the grade of the tumor, the stage of the tumor, and the expression of proteins and genes.

The American Joint Committee on Cancer (AJCC) staging system provides a strategy for grouping patients with respect to prognosis. Therapeutic decisions are formulated in part according to staging categories but primarily according to lymph node status, estrogen- and progesterone-receptor levels in the tumor tissue, menopausal status, and the general health of the patient.

Classification of breast cancer is usually, but not always, primarily based on the histological appearance of tissue in the tumor. A variant from this approach, defined on the basis of physical exam findings, is that inflammatory breast cancer (IBC), a form of ductal carcinoma or malignant cancer in the ducts, is distinguished from other carcinomas by the inflamed appearance of the affected breast, which correlates with increased cancer aggressivity.

The practical purpose of classification is to describe each individual instance of breast cancer in a way that helps select which treatment approach is anticipated to have the best chance for a good outcome, with increased efficacy and low toxicity. Treatment algorithms rely on breast cancer classification to define specific subgroups that are each treated according to the best evidence available. Classification aspects must be carefully tested and validated, such that confounding effects are minimized, making them either true prognostic factors, which estimate disease outcomes such as disease-free or overall survival in the absence of therapy, or true predictive factors, which estimate the liklihood of response or lack of response to a specific treatment.

Stage Information

The American Joint Committee on Cancer (AJCC) staging system provides a strategy for grouping patients with respect to prognosis. Therapeutic decisions are formulated in part according to staging categories but primarily according to lymph node status, estrogen- and progesterone-receptor levels in the tumor tissue, menopausal status, and the general health of the patient.

The AJCC has designated staging by TNM classification.

Primary tumor (T):

TX: Primary tumor cannot be assessed T0: No evidence of primary tumor Tis: Carcinoma in situ; intraductal carcinoma, lobular carcinoma in situ, or

Paget's disease of the nipple with no associated tumor. Note: Paget's disease associated with a tumor is classified according to the size of the tumor.

T1: Tumor 2.0 cm or less in greatest dimension

T1mic: Microinvasion 0.1 cm or less in greatest dimension T1a: Tumor more than 0.1 but not more than 0.5 cm in greatest dimension T1b: Tumor more than 0.5 cm but not more than 1.0 cm in greatest dimension T1c: Tumor more than 1.0 cm but not more than 2.0 cm in greatest dimension

T2: Tumor more than 2.0 cm but not more than 5.0 cm in greatest dimension T3: Tumor more than 5.0 cm in greatest dimension T4: Tumor of any size with direct extension to (a) chest wall or (b) skin,

only as described below. Note: Chest wall includes ribs, intercostal muscles, and serratus anterior muscle but not pectoral muscle.

T4a: Extension to chest wall T4b: Edema (including peau d'orange) or ulceration of the skin of the

breast or satellite skin nodules confined to the same breast

T4c: Both of the above (T4a and T4b)
T4d: Inflammatory carcinoma*

*Note: Inflammatory carcinoma is a clinicopathologic entity characterized

by diffuse brawny induration of the skin of the breast with an erysipeloid edge, usually without an underlying palpable mass.¹ Radiologically there may be a detectable mass and characteristic thickening of the skin over the breast. This clinical presentation is due to tumor embolization of dermal lymphatics with engorgement of superficial capillaries.

Regional lymph nodes (N):

NX: Regional lymph nodes cannot be assessed (e.g., previously removed) N0: No regional lymph node metastasis N1: Metastasis to movable ipsilateral axillary lymph node(s) N2: Metastasis to ipsilateral axillary lymph node(s) fixed to each other or

to other structures

N3: Metastasis to ipsilateral internal mammary lymph node(s)

Pathologic classification (pN):

pNX: Regional lymph nodes cannot be assessed (not removed for pathologic

study or previously removed)

pN0: No regional lymph node metastasis
pN1: Metastasis to movable ipsilateral axillary lymph node(s)

pN1a: Only micrometastasis (none larger than 0.2 cm) pN1b: Metastasis to lymph node(s), any larger than 0.2 cm

pN1bi: Metastasis in 1 to 3 lymph nodes, any more than 0.2 cm and all

less than 2.0 cm in greatest dimension

pN1bii: Metastasis to 4 or more lymph nodes, any more than 0.2 cm and

all less than 2.0 cm in greatest dimension

pN1biii: Extension of tumor beyond the capsule of a lymph node

metastasis less than 2.0 cm in greatest dimension

pN1biv: Metastasis to a lymph node 2.0 cm or more in greatest dimension

pN2: Metastasis to ipsilateral axillary lymph node(s) fixed to each other

or to other structures

pN3: Metastasis to ipsilateral internal mammary lymph node(s)

Distant metastasis (M):

MX: Presence of distant metastasis cannot be assessed M0: No distant metastasis M1: Distant metastasis present (includes metastasis to ipsilateral

supraclavicular lymph nodes)

AJCC stage groupings

Stage 0 ;

Tis, N0, M0

Stage I ;

T1,* N0, M0

*T1 includes T1mic

Stage IIA ;

T0, N1, M0 T1,* N1,** M0 T2, N0, M0 *T1 includes T1mic **The prognosis of patients with pN1a disease is similar to that of patients

with pN0 disease.

Stage IIB ;

T2, N1, M0 T3, N0, M0

Stage IIIA ;

T0, N2, M0 T1,* N2, M0 T2, N2, M0 T3, N1, M0 T3, N2, M0 *T1 includes T1mic

Stage IIIB ;

T4, Any N, M0 Any T, N3, M0

Stage IV ;

Any T, Any N, M1

Stage Information for Breast Cancer

References

Breast. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 347-76.
Singletary SE, Allred C, Ashley P, et al.: Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol 20 (17): 3628-36, 2002. [PUBMED Abstract]
Woodward WA, Strom EA, Tucker SL, et al.: Changes in the 2003 American Joint Committee on Cancer staging for breast cancer dramatically affect stage-specific survival. J Clin Oncol 21 (17): 3244-8, 2003. [PUBMED Abstract]

Developing countries of breast cancer

The developing countries grow and adopt Western culture they also accumulate more disease that has arisen from Western culture and its habits (fat/alcohol intake, smoking, exposure to oral contraceptives, the changing patterns of childbearing and breastfeeding, low parity).

The developing countries expected numbers of new cases and deaths due to breast cancer in South America for the year 2001 are approximately 70,000 and 30,000, respectively. However, because of a lack of funding and resources, treatment is not always available to those suffering with breast cancer.

For instance, as South America has developed so has the amount of breast cancer.

Breast cancer in less developed countries, such as those in South America, is a major public health issue. It is a leading cause of cancer-related deaths in women in countries such as Argentina, Uruguay, and Brazil.

PROGNOSIS

Prognosis is important for treatment decisions because patients with a good prognosis are usually offered less invasive treatments, such as lumpectomy and radiation or hormone therapy, while patients with poor prognosis are usually offered more aggressive treatment, such as more extensive mastectomy and one or more chemotherapy drugs.

A prognosis is a prediction of outcome and the probability of progression-free survival (PFS) or disease-free survival (DFS). These predictions are based on experience with breast cancer patients with similar classification.

Younger women tend to have a poorer prognosis than post-menopausal women due to several factors. Their breasts are active with their cycles, they may be nursing infants, and may be unaware of changes in their breasts. Therefore, younger women are usually at a more advanced stage when diagnosed. There may also be biologic factors contributing to a higher risk of disease recurrence for younger women with breast cancer.

A prognosis is an estimate, as patients with the same classification will survive a different amount of time, and classifications are not always precise. Survival is usually calculated as an average number of months (or years) that 50% of patients survive, or the percentage of patients that are alive after 1, 5, 15, and 20 years.

Prognostic factors are reflected in the classification scheme for breast cancer including lymph nodes and other parts of the body), grade, recurrence of the disease, and the age and health of the patient.

complication of breast cancer

Complications related to breast of cancer usually develop as side effects of treatment methods. For example, side effects may occur with any chemotherapy drug. Depending on slight differences in regimens, in the drugs themselves, and in the individuals involved, some may experience side effects and others not from the same chemo protocol.

Complications of breast cancer include:

Destruction of the breast
Destruction of the chest wall surrounding the breast
Mastitis
Nipple discharge
Chest pain
Radiation therapy side effects
Chemotherapy side effect

A. Non surgery complication

Non surgery complication including :

Additional complications occur when the cancer spreads to other parts of the body, called metastasis. The most common sites include the lungs, liver and bones.

Complications of metastasis include:

Pneumonia
Collapsed lung
Respiratory failure
Liver failure
Bone fractures:

Hip fracture
Wrist fracture

B. Surgery complication

Mastectomy, lumpectomy, and axillary node dissection are fairly safe surgeries. But every surgery has the risk of complications.

Patients should contact their doctor immediately if they see any signs of:

Infection, including redness and swelling of the incision with pus or foul-smelling drainage, perhaps with fever. Antibiotics can be used to treat post-surgical infections.
Lymphedema, the swelling of the arm and/or hand on the side of the surgery due to the removal of the lymph nodes under the arm. Lymphedema often goes away on its own, but sometimes requires treatment. Treatment is usually provided by physical or occupational therapists and includes:
- Manually draining the fluid.
- Caring for the skin.
- Exercising the arm.
- Wearing compression bandages to keep the swelling from recurring.
Seroma, which is accumulation of fluid in the location of the surgery. While most of the time the fluid is absorbed by the body, the area can be drained using a needle if it does not go away.
Other complications may include stiffness of the shoulder and possible numbness or altered sensation in the upper arm or armpit. Before breast cancer surgery, your doctor should provide you with information about recovery and follow-up care. Print out these Questions to Ask to take to your appointment so you can better understand your care.

C. Chemotherapy
The digestive tract and the hair are often involved in a side effect because, like cancer cells, their cells rapidly divide and thus are somewhat damaged as the cancer cells are killed off. Because nausea and vomiting are such common and prominent side effects of chemotherapy, doctors often will prescribe additional medications to help with such problems. In addition to these visible side effects, low blood counts, which can cause fatigue, easier bruising, or infection, are common because the dividing cells of the bone marrow are also prone to damage by chemotherapy agents.
In rare instances, chemotherapy can cause heart damage or trigger another cancer such as leukemia. However, the more common long-term complications created by breast cancer and its prevalent treatment method are more gender-specific. Chemotherapy in premenopausal women may damage ovaries so that they stop producing hormones, which may give rise to menopausal symptoms such as vaginal dryness and hot flashes. Periods may stop or become very irregular, making pregnancy virtually impossible. Women who do go into menopause early will also face a higher risk for bone-thinning osteoporosis.
While impossible to predict side effects, the experience of a large majority of women who have undergone chemotherapy is that the side effects subside after treatment is finished. Nonetheless, a woman’s state of mind may make her side effects feel perhaps more intense than they physically are. For some, the short-term cognitive issues of concentration and memory loss, known as “chemo-brain, chemo-fog, or chemo-memory,” add to the challenge.
Depression, fear, sadness, or feelings of isolation also may serve to make completion of chemotherapy a difficult time for many women; adjusting back to a “normal” life, while thoughts of a relapse crop up in the not-so-distant background, can be daunting. Talk therapy with a professional, or regular contact with a family member or friend, during this period is highly advisable.

D. Radiation therapy and hormon therapy
Other treatments, particularly radiation and hormone therapies, can also result in rare, more serious side effects. Side effects of radiation therapy can come on slowly. Over time, common side effects that seemed wholly manageable at first can become debilitating, while more serious—if rarer—complications such as inflamed lung tissue, heart damage, or secondary cancers can emerge.
A possible long-term effect of the lowered estrogen that comes from hormone therapy is a significantly greater risk for osteoporosis. Accordingly, your doctor may monitor your bone mineral density while you're taking the medication. Lower estrogen levels also may lead to vaginal dryness and irritation.