Breast cancer has a very long history, first reported more than 3500 years ago, ancient Egyptian skeletons show some signs of breast cancer. In the first century, doctors experimented the surgical incisions to destroy tumors. They also thought that breast cancer was linked with the end of menstruation in women. Today, breast cancer, a remarkable global health concern, is the second most prevalent forms of cancer-related morbidity and mortality among women worldwide.
The exact cause of most breast cancers is unknown. Researchers have found things that increase the risk of breast cancer, but it is not clear that why some women who do not have any related factors get cancer, yet others with risk factors never do. Advances in medical science have studied the way for early diagnosis and innovative treatment options, leading to improved survival rates and quality of life for patients. This comprehensive overview of breast cancer will discuss the various treatments and diagnostic methods, within latest approaches and techniques in this field.
Understanding Breast Cancer
Before diving into specific treatments and diagnostic tools, it is vital to understand breast cancer. This malignancy begins when cancer cells in the breast start to grow uncontrollably. Breast cancer can occur in various locations within the breast, including the ducts (ductal cancer) and lobules (lobular cancer). There are several types of breast cancer, such as invasive ductal carcinoma, invasive lobular carcinoma, triple-negative breast cancer, and HER2-positive breast cancer, each with distinct characteristics and treatment approaches.
Patients with small tumor sizes have a significantly higher survival rate and a high reduced probability of the breast cancer. Many technologies are developed for early detection of primary tumors, as well as recurrent and metastases disease, for effective breast cancer management. As an instant, theragnostic emerged as a new paradigm for cancer treatment, it has the potential to provide patient care by personalized therapy.
Diagnosis typically begins with risk assessment, clinical examinations, and imaging studies. As a medical imaging modality, ultrasound has a key role in breast cancer detection, and lymph-node diagnosis for many years. A multidisciplinary approach is often required, utilizing the expertise of oncologists, radiologists, pathologists, and surgeons to create an individualized treatment plan.
Diagnostic Methods for Breast Cancer
Early diagnosis of breast cancer increases the chances of successful outcomes. Several diagnostic methods are employed to detect breast cancer, assess its stage, and determine an appropriate treatment plan:
Clinical Breast Examination (CBE)
This physical examination performs a healthcare professional examining of the breasts for any abnormalities in the skin or nipple, changes in breast shape or size, swelling, or lumps. Although this examination is mostly part of routine health check-ups of breast cancer, but it is not sufficient on its own for diagnosis.
Mammography
Mammography is a specialized radiologic test that uses X-rays to recognize the internal structures of the breast tissue. This is the most common imaging technique for breast cancer and can detect tumors that are too small to feel during a physical examination. Screening mammograms are recommended for women by the age of 40 and above, or for those with a family history of breast cancer.
There are two types of mammograms; screening mammograms (performed on women who have no symptoms of breast cancer), and diagnostic mammogram (is used when there are symptoms or abnormalities detected in a screening mammogram). Mammography can identify breast cancer at early stages, before symptoms appear, makes it a critical tool in reducing death rates.
Breast Ultrasound
Ultrasound used to evaluate findings from a mammogram. This technique uses sound waves to make images of structures of the breast tissue, characterizes the solid mass or fluid-filled cyst, and determines whether a biopsy is needed.
Breast MRI
Magnetic Resonance Imaging (MRI) offers more-detailed view of breast tissue by using radio waves to create images of the inside of the body. It can be particularly useful for women with a high risk of breast cancer or with dense breast tissue. MRI also might be used to look for cancer cells in the other breast, and often used alongside mammography and ultrasound for more accurate assessment. Before breast MRI, patients usually receive an injection of dye, which helps the tissue show up better in the images.
Biopsy
A biopsy, a definitive method for diagnosing breast cancer, involves the extraction of breast tissue. The results of biopsy determine the presence of cancer, the type and grade of cancer, that are crucial for planning treatment. It is then examined microscopically to admit the presence of cancer cells. There are several types of biopsies:
-Fine Needle Aspiration (FNA): FNA is a thin needle used to remove fluid from a lump or a small sample of tissue.
-Core Needle Biopsy: A larger needle removes a core of tissue from the suspicious area for examination.
-Surgical Biopsy: Involves the surgical removal of a portion of the tissue or the whole lump for analysis.
Genetic Testing
For women with family history of breast cancer, genetic testing can identify mutations in the BRCA1 and BRCA2 genes may be recommended. Identifying these mutations advised to assess risk and undergo genetic testing. The results and guides might influence screening strategies and treatment options.
Hormone Testing
This is an essential information for guiding treatment decision. Hormone receptor testing performs on the tumor tissue to determine whether the cancer cells have receptors for estrogen (ER) or progesterone (PR). May the positive hormone receptor cancers respond to hormone therapies.
Treatment Approaches Once diagnosed, breast cancer treatment typically depends on modalities tailored to the cancer type, stage, hormone status, and the patient’s overall health and preferences. The main treatment plans include surgery, radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, involving a professional healthcare team.
Surgery
Surgery is often the primary and fundamental component of breast cancer treatment. Depending on the type of cancer, it can be curative especially in early-stage cases. several surgical options exist:
-Lumpectomy: A breast-conserving surgery that removes the tumor and a small margin of some surrounding healthy tissue. Lumpectomy reduces the risk of recurrence and typically followed by radiation therapy.
-Mastectomy: This is meant for removing one or both breasts, either partially or completely. Mastectomy might be recommended for invasive cancer cases, larger or multiple tumors, or as a preventative measure when there are high-risk patients.
-Sentinel Lymph Node Biopsy: This procedure removes the first few lymph nodes to which cancer cells are likely to spread are examined and removed, allowing pathologists to assess cancer spread.
-Axillary Lymph Node Dissection: More extensive lymph node removal can be crucial if cancer cells in sentinel nodes are present.
Radiation Therapy
Radiation therapy uses high-energy rays to attack and kill cancer cells or shrink tumors. It is commonly uses after surgery for eliminating any remaining cancer cells in the breast, chest wall, or nearby lymph nodes, and it also can be used after mastectomy whether there is a high risk of recurrence.
There are two types of radiation therapy:
-External Beam Radiation: Targeting the breast area from outside the body.
-Brachytherapy: Includes placing radioactive sources directly in or near the tumor area.
Chemotherapy
Chemotherapy employs drugs such as doxorubicin, cyclophosphamide, and paclitaxel to kill cancer cells or inhibit their growth. It may be administered before surgery (neoadjuvant chemotherapy) to shrink tumors or after surgery (adjuvant chemotherapy) to reduce the risk of recurrence by eliminating any remaining cancer cells. Chemotherapy is often prescribed for patients with aggressive or advanced cancers or for those with a high chance of recurrence.
Hormonal Therapy
Hormonal therapy is effective for hormone receptor-positive breast cancers, and can be used for several years after initial treatment, which rely on blocking the effects of hormones like estrogen or progesterone for growth levels in the body.
Common hormonal therapies are:
-Tamoxifen: Blocks estrogen receptors in breast tissue, and mostly used in premenopausal women
-Aromatase Inhibitors: By using the drugs (such as anastrozole, letrozole, and exemestane) lower estrogen levels by inhibiting the aromatase enzyme. This is primarily used in postmenopausal women.
Targeted Therapy
Targeted therapies focus on specific characteristics of cancer cells, such as HER2 status that attack cancer cells overexpressing the HER2 protein or CDK4/6 inhibitors used for hormone receptor-positive breast cancers to inhibit cell division.
Emerging Treatments and Clinical Trials
Continuously the breast cancer treatment is evolving with ongoing research and clinical trials. One of the decent emerging treatments is immunotherapy which helps the immune system recognize and fight cancer. For example, pembrolizumab (Keytruda) has shown promise for certain triple-negative breast cancers.
Immunotherapy may use in combination with chemotherapy. Patients with breast cancer may consider participation in clinical trials and improving treatment options to access advancing medical knowledge and innovative treatments that are not available yet. They also should discuss the essential need of participating in clinical trials with their medical team or expert doctor.
Quality of Life and Survivorship
Throughout the treatment journey of breast cancer, paying attention to the quality of life is paramount. Physical, emotional, and psychological support plays a key role in dealing with the challenges of diagnosis procedures. Many resources and support services are available, involving counseling, support groups, and rehabilitation programs.
-Post-Treatment Care: Follow-up care is necessary for monitoring potential recurrence and managing any long-term side effects of treatment. Survivorship care plans should be discussed to maintain health and well-being in women.
-Lifestyle Modifications: Lifestyle changes, including a balanced diet, regular exercise, and avoiding tobacco and excessive alcohol, can positively impact recovery and reduce the risk of recurrence. Moreover, patients are encouraged to engage in supportive communities for emotional and psychological well-being.
Cancer diagnostic probe (CDP)
If a problem is shown in your breast, such as lumps, or if an area of the breast looks abnormal on a screening mammogram, doctors may get a diagnostic mammogram. This is a more detailed X-ray of the breast, and was developed to detect involved breast cavity side margins. Cancer diagnostic probe scoring ability in intra-operative margin detection was verified on non-neoadjuvant breast cancer patients. The CDP device is composed of three main parts; a disposable sensor, a wireless electrical head probe, and a main control computer system. Hospital Tech is a provider of breast cancer detection devices, among others
Gamma Probes
A gamma probe is an instrument used to detect radiation in patients. It is designed principally for use in surgery. The doctor may use this exam to investigate a breast abnormality found with mammography, the most common screening test for breast cancer. This is commonly used primarily for Sentinel Node Biopsy (sentinel lymph node mapping), and parathyroid surgeries. Proper use of a gamma probe allows the surgeon to make a smaller incision and have greater confidence that exploration was successful.
Conclusion
Breast cancer is a complex disease requiring a multifaceted approach to diagnosis and treatment, which have evolved significantly over the years, leading to improved outcomes and survival rates. Early detection methods through regular screening and awareness of symptoms are vital for successful treatment. With advances in medical technology and innovative therapeutic options has remarkably improved. Understanding the various diagnostic tools, such as CDP and Gamma probe devices, and treatment modalities, offers hope for effective management.
Continuous research into new treatment options and new diagnostic methods alongside supportive care strategies further enhances the fight against breast cancer, paving increasingly the way for a survivorship where is for all affected individuals in the future. Patients must be encouraged to engage in open discussions with their medical and healthcare providers about their diagnosis, treatment options, and any clinical trials that may be available. In the future, with ongoing advancements in breast cancer research and treatment, there is optimism for the fight against this disease.
Sources:
https://yeditepehastaneleri.com/
https://pubmed.ncbi.nlm.nih.gov/
