Cancer is a disease that occurs when the accumulation of mutations in critical genes – those that control cell growth and division or repair damaged DNA – allows cells to grow and divide uncontrollably to form a tumor. The purpose of cell divisions was to replace damaged and old cells or to allow growth to occur in an organism. When tumor develops, the function of the normal cell will be affected. As the cancer cells take all the nutrients and oxygen that needed from the normal cell, in order to survive. And because tumor or the cancer cells does not have any specific function as normal cell, it can harm the organism’s body from functioning normally and eventually lead to death (National Cancer Institute, 2015; Cooper, 2000). There are many different types of cancer (colon cancer, stomach cancer, lung cancer, etc.). Breast cancer is one of the most common diagnosed cancer among the females and a slight possibility for the males. The most common form of breast cancer is ductal cancer, where the cancer begins in the cells lining of the milk ducts. Tumor that are cancerous can invade surrounding tissue and spread it to other parts of the body. Thus, when the cancer spreads, other parts of the body such as, bones, liver, lungs or even brain may appear cancerous cells as well. The spreading of tumors is also known as metastatic cancers (Leis, 1980).
The progression of breast cancer is an important information for healthcare team, because knowing the stages of the breast cancer is in, can help the medical team to find the best way to contain and destroy the cancerous cells in the breast. The determination for the stages of the breast cancer is being done through the TNM system, which stands for (American Cancer Society, 2018; Cadiz, Gormaz & Burotto, 2018):
T= Tumor size
N= Lymph node status (the number and location)
M= Metastases (spreading of cancer to other part of body)
The progression of breast cancer consists of four stages. The stages are being determined according to the factors such as: the size of tumor within the breast; the number of lymph nodes affected; the nearest lymph nodes that are found under the arm (axillary area) and the signs indicating if the breast cancer has spread to other organs within the body, also known as metastasized (American Cancer Society, 2018; Cadiz, Gormaz & Burotto, 2018). In the stage 0 breast cancer, there are two main type of cancers: ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). A DCIS cancer is an early cancer that is non-invasive and highly treatable. But, if it’s left untreated, it might spread to other cells around it. In most DCIS cancer, abnormal cells are found to be in the lining of the breast milk duct. As for LCIS at stage 0, it is also non-invasive, and it grows abnormal cells in the lobules. However, LCIS can indicate a woman to have an increased risk of developing breast cancer. Next, in the first stage of breast cancer, the cancer cells are evident. But, it is still contained in the area where the first abnormal cells in stage 0 began to develop. Stage1 breast cancer are highly treatable as it is detected in early stage. Stage1 of breast cancer can be divided in to 2 parts: Stage 1A and Stage 1B. The main difference of these two parts is the size of the tumor and the lymph nodes of evident of cancer. In stage 1A breast cancer, the tumor is smaller it has not yet spread to the lymph nodes. However, in Stage 1B breast cancer, lymph nodes have evidence of cancer with small cluster of cells between the approximate size of 0.2mm to 2.0mm. Despite of that, there are no actual tumor being found in the breast in both stages and the tumor is smaller than the approximate 2cm (Cadiz, Gormaz & Burotto, 2018; National Breast Cancer Foundation, Inc., 2018; Benson, 2003).
In stage 2 breast cancer, the cancer stats to grow but within the breast or has only spread to the nearby lymph nodes. In this stage, it can be divided into two groups: stage 2A and stage 2B. The difference between these two stages is determined by the size of the tumor and the evident of cancer that spread to the lymph node. In the stage 2A, there are no cancerous cells associated with the actual tumor. Also, there are either none or less than four axillary lymph nodes that consist of cancerous cells. Also, the tumor in stage 2A is less about 2-5cm. As for the breast cancer in stage 2B, the tumor can range between the 2-5 cm with less than four axillary lymph nodes that contains cancerous cells, or has not spread to any axillary lymph nodes. Treatments for stage 2 breast cancer patients are more aggressive. However, stage 2 breast cancer usually responds well to treatment (American Cancer Society, 2018; Cadiz, Gormaz & Burotto, 2018; National Breast Cancer Foundation, Inc., 2018; Benson, 2003).
Next, in Stage 3 breast cancer, it can be divided into 3 groups which are stage 3A, 3B and 3C. But in all stages, the tumor is greater than 5cm and the cancer has extended from the breast to other nearby lymph nodes and muscles, but not to the distant organs. This stage is considered to be a critical situation. In stage 3A the cancer may spread to 10 or more axillary lymph nodes, with one area (at least) of cancer spread is greater than 2mm. Or, the cancer has spread to the lymph nodes under the infraclavicular nodes, with at least one area of cancer that has spread greater than 2mm. As for stage 3B, cancer has invaded the chest wall or breast skin with the symptoms of swelling, inflammation or ulcers. And it may be found in at least one axillary lymph nodes, with the condition of having at least one area of cancer spread greater than 2mm, and has enlarged the internal mammary lymph nodes. Or, cancer has spread to 4 or more axillary lymph nodes with the same condition of having at least one area of cancer spread greater than 2mm, and tiny amounts of cancer cells are found in the internal mammary lymph nodes on the sentinel lymph node biopsy. In the stage 3C, there may not have any actual tumor or a tumor of any size is found Moreover, in this stage, cancer has extended to the lymph nodes above the collarbone, or supraclavicular nodes, with at least one area of cancer spread more than 2mm. Or, the cancer has invaded the chest wall or breast skin and 10 or more lymph nodes under arm. Treatments for stage 3C breast cancer can be divided into operable and inoperable. When the stage 3C breast cancerous inoperable, it means that a simple surgery is not enough to get rid of all the cancerous cells in the breast. As an alternate treatment method, the cancerous cells are being shrunk as much as possible before the surgery is considered. As a general treatment for stage 3 breast cancer, the treatment options vary widely from mastectomy for local treatment to chemotherapy or a systemic treatment. However, the choice of the treatment depends greatly on each individuals breast cancer’s type and condition. Lastly, in stage 4 breast cancer, the cancer cells have undergone metastasis, meaning that the cancerous cells have spread far away from the breast into other distant part of the body, such as the brain, kidney, liver and more. Stage 4 breast cancer are often considered incurable (American Cancer Society, 2018; Cadiz, Gormaz & Burotto, 2018; National Breast Cancer Foundation, Inc., 2018; Benson, 2003).
There are several ways for detection of breast cancer. First, screening mammography, taking an x-ray picture of each breast and analyzed by a radiographer for evidence of tumors. As for clinical examination, it is a clinical breast examination which involves a thorough physical examination of the whole breast area, including both breasts, nipples, armpits and collarbone (Baines, 2000). Next, breast cancer can be detected by Magnetic Resonance Imaging (MRI); where it produces a three-dimensional detailed inside image of the body using magnetic fields instead of radiation. MRI is suitable for Women that are under 50 years old and are at a high risk of having breast cancer, with the help from the Medicare. This is because MRI does not emit any damaging ionizing radiation that is found in x-ray and CT imaging. However, for pregnant women that are in their first trimester, they should not get an MRI as that’s is the period where the baby’s organs are developing. Also, people with metal inside their body should not get the test as well as MRI employs strong magnetic field that can extends beyond the machine and exerts powerful forces onto magnetizable objects (National Institute of Biomedical Imaging and Bioengineering, 2018; Lehman & Smith, 2009).
Furthermore, Ultrasound can also be used as detection for breast cancer. An ultrasound usually uses high-frequency sound waves to outline a part of the body to check for abnormalities in the breast. Breast lump that is filled with fluid (a cyst) or any solid lump and abnormalities in the breast, usually are the abnormalities. Usually ultrasound is used to complement mammography. When the mammogram shows an abnormal result of the breast, ultrasound is being done. For patients that are under 30, it is usually recommended to do ultrasound before mammography to check for breast lump. This is because mammograms are difficult to determine any abnormalities in the breast of a young women as their breast tend to be denser and filled with many milk glands (Madjar, 2010). Lastly, an individual can detect for breast cancer by going through a biopsy, which is the removal of a small sample of tissue from the breast or lymph nodes. Then it is being analyzed by a pathologist under a microscope. In certain cases, doctors use ultrasound to guide biopsy to suspicious areas in the breast. After the examination, the result from the analysis will help diagnose both the presence of breast cancer and its type (Osanai et al., 2000).
There are several treatments that could be done for breast cancer patient, according to the cancer’s stage and grade and the general health of the patient. For female, having experienced menopause or not is needed to be noted for choosing the right treatment as well. The first type of treatment for breast cancer is usually surgery. There are 2 main types of breast cancer surgery: breast-conserving surgery and mastectomy. Breast-conserving surgery is a way to remove the cancerous tumor from the breast. Furthermore, in a breast-conserving surgery, the amount of breast tissue that is removed will depend on, the severity of the breast cancer; the size and location of the tumor in the breast, the amount of surrounding tissue that needed to be removed and the size of the breast. Usually, the surgeon will remove an area of healthy breast tissue during the surgery in order to test if there are any traces of cancer in the healthy cells. If there are no cancer present in the healthy part of tissue, then there will be a lower chance for the cancer to return.
As for mastectomy, the whole breast is being removed in the surgery. And usually, after having a mastectomy, women can have a reconstructive surgery at the same time as a mastectomy (immediate reconstruction) or be carried out later (delayed reconstruction) to recreate a bulge to replace the breast that was removed (Sun et al., 2017).
After a surgery, usually a further treatment and therapies is being done. There are several types of therapies and treatments such as: radiotherapy, chemotherapy, hormone or biological treatments; depending on the type of stages and grade of breast cancer has. Radiation therapy (also known as radiotherapy), is a highly targeted and effective way to destroy cancer cells that remained in the breast using controlled doses of radiation after surgery or chemotherapy. Also, there are different type of radiotherapy being given, which are: breast radiotherapy, which is usually done after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue; chest wall radiotherapy, which is applied after a mastectomy to the chest wall; radiotherapy to the lymph nodes; where radiotherapy is aimed at the armpit (axilla) and the surrounding area to kill any cancer that may be present in the lymph nodes; breast boost, a boost of high-dose radiotherapy is being offered in the area cancer was remove. However, there are some side effect of radiotherapy. For example, irritation and darkening of the skin on your breast, which may lead to sore, red, weep skin; feeling fatigue and lymphedema, where fluids are accumulated due to the blockage of the lymph nodes under the arm (Janssen et al., 2018; National Health Service, 2016).
As for chemotherapy, this treatment uses anti-cancer (cytotoxic) medicine to weaken and destroy cancer cells in the body, including cells at the original cancer site and the area where cancer cells may have spread to another part of the body. This treatment is usually used after surgery to destroy the remaining cancer cells that weren’t removed, and this process is known as adjuvant chemotherapy. Or, it can be given before surgery to shrink the cancer in result of lesser tissue to be removed, and this process is known as “neoadjuvant” chemotherapy. Moreover, chemotherapy can be used to treat advanced-stage breast cancer to destroy the cancer cells as much as possible. There are several types of medications that are used for chemotherapy; mostly, a combination of two or more medicines will be used as chemotherapy treatment for breast cancer. The choice and combination of the medication depended on the type and severity of breast cancer of the patient had (Hussain et al., 2005; Hassan et al., 2010). Through chemotherapy medication, the production of oestrogen in the body can be stopped; which helps to stop the growth of some breast cancer. There can be some side effect of having chemotherapy treatment. Side effect such as: nausea and vomiting, loss of appetite, fatigue, hair loss and more. However, most of the side effect can be prevented with medicines that is prescribed by the doctor. Usually, after finishing the course of chemotherapy, an individual’s ovaries will start producing oestrogen again, or it can be otherwise. This is because some women that’s are over 40 years may enter an early menopause (Hussain et al., 2005; Hassan et al., 2010).
There are some breast cancers that are stimulated to grow by the hormones (oestrogen or progesterone); this cancer is known as hormone receptor-positive breast cancer. By using hormonal therapy treatment, it can help to treat any stages of this type of breast cancer, through lowering the amount of the hormone estrogen in the body and by stopping the action of estrogen on breast cancer cells. Because that most of the estrogen in the female bodies are made by the ovaries; so, by lowering hormone and preventing the action of estrogen, it can prevent the hormone-receptor-positive breast cancer from recurring after surgery. Also, hormonal therapy medicines can help to shrink or slow the growth of advanced-stage or metastatic hormone-receptor-positive breast cancer. Which help to remove the tumor easier. There are several types of hormonal therapy medicines, including aromatase inhibitors, selective estrogen receptor modulators, and estrogen receptor down regulators. For aromatase inhibitors, it is often being given to the postmenopausal women, where aromatase inhibitors block the enzyme aromatase which help to reduce the amount of estrogen in body. As for selective estrogen receptor modulators (SERMs) it is used to block the estrogen from attaching to the breast cell. It can be used to treat women both before and after menopause. There are three types of SERMs: Tamoxifen, Evista and Fareston, which appear in the form of pills. Lastly, Estrogen Receptor Downregulators (ERDs) functions similarly as SERMs (tamoxifen), where the ERDs attach to the estrogen receptors in breast cells, and prevent the estrogen from attaching to the breast cells. This can help to reduce the number of estrogen receptors and change the shape of breast cell estrogen receptors. ERDs that is used to treat hormone-receptor-positive breast cancer is call Faslodex (Abdulkareem & Zurmi, 2012; Jones & Buzdar, 2004)
Furthermore, biological therapy, or targeted therapy, can also be used to treat breast cancer. Targeted therapies are treatments that target the specific characteristic of a cancer cells, such as a protein call – human epidermal growth factor receptor (HER2) which stimulated the breast cancer cells to grow; and cancer that is caused by this protein is call HER2-positive. Targeted therapy, can treat the cancer cell by stopping the effects of HER2 and help the immune system to fight against cancer cells. Trastuzumab is the main type of targeted therapy also known as monoclonal antibody. It is usually help to treat metastatic breast cancer, where the trastuzumab antibody targets and destroys cancer cells that are HER2-positive. It is usually being given to patient in a hospital through drip. Sometimes, It can be given as an a subcutaneous injections as well, where it is injected under the skin. However, there are some side effect of trastuzumab, some might fell fatigue, have diarrhea or aches and pains; or an initial allergic reaction due to the medication, which could lead to nausea, wheezing, chills and fever. Also, pregnant women are not recommended to get targeted therapies as it might be safe for the pregnancy (Masoud & Pagès, 2017; Higgins & Baselga, 2011).
In conclusion, according to the national breast cancer foundation (2018), breast cancer has been gradually increase especially among the women. Thus, it is important for us as individuals to take care of our own health in order to prevent the risk of having breast cancer. There are many causes an increase in risk of having breast cancer, but the one thing we can do as individuals to prevent breast cancer from happening to us is by changing the lifestyle habit. For instance, limit drinking alcohol and stop smoking; avoid exposure to radiation and environmental pollution; be physically active and more. Also, it is important for us to have an annual check for our own body health, in order to diagnosed and get treatment early if there are any sign of cancer.