The breast or breast is made up of fat, connective and glandular tissue. Each breast has between 10 and 20 sections known as lobes, which in turn are divided into smaller sections, the lobules. The lobules contain the milk-producing glands in lactation. Through the ducts the milk reaches the nipple.
The lobules and ducts are found in the stroma, a fatty tissue in which the blood and lymph vessels, which go to the lymph nodes, are also located. These nodes are responsible for protection against bacteria, tumor cells and other harmful substances.
According to the Spanish Society of Medical Oncology (SEOM), breast cancer appears when the glandular epithelial cells reproduce uncontrollably and very quickly. These cancer cells can travel through the blood and lymphatic vessels and reach other parts of the body, where they can attach to organs and metastasize.
Breast cancer can appear in both men and women. However, more than 99 percent of diagnoses occur in women.
As with other cancers, such as osteosarcoma or brain tumors, the cause or causes that cause breast cancer are not known. However, specialists have identified risk factors that predispose to developing the disease:
Age: It is the main risk factor. As a woman gets older, she is more likely to get breast cancer.
Genetics: Women with a family history of breast cancer are at higher risk. This increases if the relative is the mother, sister or daughter.
Reproductive factors: Agents that increase exposure to endogenous estrogens, such as the early onset of the first period, late menopause, or the use of hormone replacement therapy after menopause increase the risk of breast cancer. Not having given birth is also never related to this cancer.
Previous breast cancer: Those patients who have had invasive breast cancer have a higher risk of contralateral breast cancer.
Breast density: If it is high, it is also related to this cancer.
Ionizing radiation: Exposure to this type of radiation, especially during puberty, increases the possibility of having breast cancer.
The most frequent manifestation that helps detect cancer is the appearance of a lump (palpable nodule) that generally does not cause pain. Other common symptoms are changes in the skin of the breast or retraction of the nipple.
Self- exams and mammograms are the most useful tools to find suspicious lumps in the breasts. In general, the mammography technique facilitates the detection of small lumps, difficult to predict by palpation of the chest. This type of test should be repeated annually starting at age 50, or at age 45 if a person has a family history of first-degree breast cancer.
Not all lumps that appear in the breasts are a symptom of cancer. In fact, nine out of ten lumps are benign. These noncancerous lumps can be fibrosis or tumors of the connective and glandular tissue, or cysts or fluid-filled bags.
Benign breast tumors (fibro adenomas) are not life threatening and are usually easy to treat. The specific tumors of the breast are:
Ductal carcinoma in situ is located in the breast ducts or ducts through which the milk reaches the nipple. If not treated it can cause metastasis. That is why it is very important to detect its presence in time, to avoid progression to cancer.
This detection can only be done through specific tests, such as a mammogram, since carcinoma in situ does not usually produce any symptoms. Invasive carcinoma is the most common of breast cancers, accounting for approximately 80 percent of all cancers.
Lobular or lobular carcinoma
Lobular carcinoma, also known as invasive lobular neoplasia, follows the same filtration process as invasive ductal carcinoma into adipose tissue, but from the lobules.
Inflammatory breast cancer
It is a fairly aggressive cancer that grows fast. It is called inflammatory because cancer cells block the lymphatic vessels and this manifests itself in the skin, which takes on a thick, hollow appearance, similar to that of an orange peel.
Other rare types of breast cancer are mucinous or colloid, in which cancer cells produce some mucus, and medullary, an infiltrating tumor, but with a better prognosis than other invasive cancers.
It spreads through the skin of the nipple and areola. In this type of cancer, the skin of the nipple and areola has a reddish, scaly appearance, with occasional blood loss. Paget’s disease may be associated with carcinoma in situ or infiltrating.
The process of diagnosing breast cancer begins when there is suspicion from a physical examination or a routine mammogram. From that moment on, the specialist can carry out a series of tests that confirm the cancer:
Mammograms: X-ray images that detect abnormal areas of the breast. These tests are not 100% reliable and can offer suspicious images that are not ultimately malignant or fail to detect a malignant tumor.
Ultrasonography: Allows to distinguish cystic (fluid filled) lesions from solid lesions. This technique usually completes mammography.
Nuclear Magnetic Resonance (NMR): It is a radiological exploration that uses the action of an electromagnetic field to obtain images. MRI is used as a complementary test to the previous two or to analyze the brain or spinal cord.
If after carrying out these tests the suspicion continues, the next step that the specialist will take will be the confirmation of the cancer by performing a biopsy.
As they explain from SEOM, the definitive diagnosis of cancer is established by the pathological anatomy specialist when observing the malignant cells obtained in the biopsy under the microscope.
From these cells, you will be able to define the tumor, evaluate the prognosis and possible treatments. The factors it evaluates are:
Tumor size: The larger the tumor, the greater the risk of its recurrence.
Histological type: Depends on the cells from which the tumor is derived. Ductal carcinoma is the most frequent (80 percent of cases), followed by lobular carcinoma.
Histological grade: Provides information on the maturation (growth) of tumor cells. The most differentiated are the most mature, grade I and least aggressive; the least differentiated are grade III.
Lymph node involvement: The prognosis of the disease is established by the number of nodes that have been affected. The greater the number of nodes, the greater the risk of relapse.
From SEOM they insist that when operating breast cancer it is important to study the lymph nodes in the armpit (the first place where the tumor spreads). One option to evaluate the nodes is the sentinel node technique that allows most axillary nodes to be preserved.
Hormonal receptors: The specialist will analyze if the tumor cells are in the hormones estrogens and progesterone.
HER-2: This is receptor 2 for human epidermal growth factor, a protein that participates in the growth of cells. HER-2 is present in normal cells and in most tumors. However, in 15-20 percent of breast tumors it is found in high concentrations, making the tumor more aggressive.