Breast Cancer

Breast cancer occurs due to the change and uncontrolled proliferation of one of the cell groups that make up the breast tissue.

Studies show that the incidence of breast cancer has increased significantly in recent years. According to global statistics, the incidence of breast cancer is estimated to be around 40-50 per 100,000. In general, in industrial societies, the probability of a woman developing breast cancer throughout her life is determined to be 1/8.

Although it is thought that not having a family history is a very protective situation, 10-15% of breast cancers are familial, while 85-90% occur in women with no family history.

Despite the increase in the incidence of breast cancer, breast cancer-related death rates are gradually decreasing as a result of advances in diagnosis and treatment.

What Could Be the Symptoms of Breast Cancer?

Since breast cancer is the most common cancer in women, it is especially important to know its findings.
Findings in the breast can be detected during the patient's self-examination or physician examinations, but the ideal is to detect tumors much earlier during screening, before any findings appear.

Findings that may be a sign of breast cancer:

•         Palpable masses or lumps in the breast
•         Asymmetric changes in one breast compared to the other
•         Discharge from the nipple
•         Inward retraction, dimple in an area of the breast
•         Nipple collapse, deformity or long-lasting crusting and flaking
•         Redness, swelling, non-healing wounds on the breast skin
•         Palpable masses and lumps in the armpit and swelling and edema in the same arm
•         Unrelieved pain in the spine and hips, especially

Mass in the breast:

It should not be forgotten that not every lump found on the patient's hand is cancer. They are generally benign masses, but in such a case, a physician's examination and necessary imaging tests are essential to distinguish the nature of this lesion.
Breast masses that are fluid-filled (cystic) or solid (solid) may be present. While breast cysts are considered benign unless proven otherwise, solid lesions may occur due to benign or malignant causes.

Masses that can be described as malignant are generally single lesions that are hard, have an irregular surface, and whose borders cannot be clearly distinguished from the surrounding tissue. Masses may be accompanied by other breast cancer findings (breast deformity, skin changes, etc.).

Asymmetric changes in the breast compared to the other breast:

Enlargement, shrinkage, shrinkage in one breast compared to the other, and changes in the breast contour that are not present on the other side, may be a sign of breast cancer.

Nipple discharge:

Many women may experience discharge, especially from squeezing, at some point in their lives. However, spontaneous discharge, especially bloody discharge from a single breast or a single duct, may be a sign of breast cancer. They definitely need to be investigated.

Inward retraction, dimple in an area of the breast:

Indrawing in one breast and dimples in different positions, which do not occur in the other and usually develop later in one area, may be signs of breast cancer. It needs to be evaluated by a physician.

Some women's nipples are inverted due to their breast structure. Although this situation is considered normal, conditions such as pulling inwards of the tip, which usually affects only one nipple, and non-healing crusting, flaking, and wound formation on the nipple, which develop later and usually concern only one nipple, may be symptoms of breast cancer.

Redness, swelling, non-healing wounds on the breast skin:

Although breast cancer mainly concerns the breast tissue, it can also manifest itself in the form of redness, swelling, and persistent wounds on the breast due to spread to the skin or invasion of the skin's lymph channels by the tumor.

Palpable masses and lumps in the armpit and swelling and edema in the same arm:

Breast cancers usually spread through lymph channels. In breast cancer, swelling and lump formation in the armpit may be observed, which usually accompany breast findings and sometimes without any detectable symptoms in the breast. In more advanced cases, swelling and redness involving the same arm may also accompany this condition. It is essential to conduct detailed investigations.

Non-relieving pain, especially in the spine and hips:

Breast cancer can metastasize to bones, especially in advanced cases. In this case, bone pain may occur severely. Unfortunately, sometimes the tumor in the breast may go unnoticed and only occur while these pains are being investigated.

Types of Breast Cancer

Breast cancers can be divided according to their potential to spread or by histology type.
According to the potential for spread, the basic classification is non-invasive or in situ (does not spread), invasive (has the potential to spread) group.

Ductal carcinoma, which develops in the cells lining the breast ducts that carry milk out of the nipple, is the most common type of breast cancer. It is known that ductal carcinoma is in in situ form if it does not have the ability to spread, and in invasive form if it has the potential to spread.

Cancer that develops in the milk-producing glands (lobules) is called lobular carcinoma. Lobular carcinoma is also divided into two according to its ability to spread. If it does not have the ability to spread, it is in in situ form, and if it has the potential to spread, it is in invasive form.

Invasive Cancers

It indicates that the tumor has penetrated the basic layer on which the cells sit. It is named according to the tissue in which it develops. Invasive ductal carcinoma, which develops in the cells in the walls of the milk ducts, is the most common type of breast cancer. Cancers that develop in the milk-producing glands (lobules) are called lobular carcinoma. If this has the potential to spread, it is called invasive  lobular carcinoma.

Inflammatory breast cancer is a special type of breast cancer that is the worst and most rapidly progressing. Unfortunately, the clinical picture can be confused with inflammatory diseases of the breast. It progresses with widespread redness and hardness without any signs of a mass. In inflammatory diseases of the breast that do not improve despite antibiotic treatment, breast cancer must be considered and a biopsy must be taken.

Hereditary Breast Cancer

Breast cancer usually occurs in more than one first-degree relative (mother, sister or daughter), and it usually develops in both breasts (65%). Breast cancer occurs in 70% of women in this group before the age of 45.

Genetic counseling should never be forgotten if more than one family member has breast cancer, if the individuals diagnosed with breast cancer are at a young age, or if individuals develop cancer in both breasts.

Tamoxifen can be used prophylactically to manage the risks of BRCA1 Gene carriers. However, for this drug to be effective, the presence of receptors with appropriate connection points is required, and unfortunately, tumors that develop in this case usually do not contain these receptors. For this reason, there are limitations in terms of its usefulness. In cancers that develop in people carrying the damaged BRCA2 gene, the use of tamoxifen reduces the risk of developing breast cancer and is recommended, since these receptors are generally seen as positive.

Surgical Breast Cancer Treatments

Breast Conserving Surgery

The main goal of treatment is to treat breast cancer without causing organ loss. For this reason, it is now considered the standard treatment of stage I-II breast cancer, but it is important to remain focused on clearing the tumor tissue and saving the patient's life.

During the surgery, the tumorous part is removed with sufficient clean surgical margins. Since breast tissue remains in the patient after breast-conserving surgery, the patient must be informed that the patient must receive radiotherapy for the remaining tissue. This treatment cannot be applied to patients who cannot receive radiotherapy for any reason. Sometimes, if the tumor is proportionally larger than the breast, breast-conserving surgery may not produce the cosmetic result the patient desires.

In women with large breasts, it is possible to remove breast cancer at the same time and reduce both breasts to ideal sizes. With this method, in addition to the surgical treatment of cancer, patients get rid of the problems they experience due to large breasts (breast pain, back pain, shoulder pain, limitation of movement, persistent diaper rash under the breast, spinal curvature, difficulty in radiotherapy, etc.).

Mastectomy

Mastectomy is the complete removal of breast tissue. Today, it is applied to patients with large-scale and/or widely distributed (multi-focus) tumors in the breast, where breast-conserving surgery is not suitable or in cases where the patient does not accept it. It is the classical surgical treatment method of breast cancer. Provides good local control; The risk of tumor recurrence is low.

If breast cancer is hereditary in some patients whose family or first-degree relatives have breast cancer, mastectomy can be performed on the disease-free breast for risk reduction and protection purposes.
In early stage tumors, it can also be performed as a skin-sparing procedure or as a 'nipple-sparing mastectomy' for tumors located far from the nipple.

During surgery in which the nipple is protected, a single dose of radiotherapy (intraoperative radiotherapy) can also be given to the patient's nipple while under anesthesia and on the operating table.

In the presence of genetic mutation, mastectomy option can be applied to reduce the risk. It is possible to achieve good aesthetic results with different reconstruction methods in all breast surgeries.

Armpit Check

The purpose of the procedures performed to determine whether the axillary lymph nodes are tumorous (sentinel lymph node sampling, axillary lymph node dissection) is to accurately stage the disease and guide concomitant treatments and to ensure regional tumor control if lymph involvement is detected.

Whether there is armpit (axillary) lymph node involvement or not is one of the most important parameters regarding how breast cancer will progress (to what extent it threatens the patient's life).

Sentinel Lymph Node Biopsy

Breast cancers tend to spread through lymph channels. Since cancer cells usually go to the axillary lymph nodes first, knowing the status of the axillary lymph nodes is important in diagnosis, treatment and follow-up. For this purpose, a method to evaluate the first (sentinel) lymph node from which the lymphatic flow drains has been developed. This approach is based on the fact that the probability of bypassing this place and metastasizing to other lymph nodes is very low.

Removal of the armpit lymph nodes is necessary for invasive tumors. Since in-situ cancers theoretically do not go to the lymph nodes, there is no need to clean the armpit. In the procedure, a special dye is injected alone or together with a radioactive substance into the area where the tumor is located or under the nipple.

To find the lymph nodes where the lymph channels drain, a direct armpit incision is made and only the stained lymph nodes are removed. During the surgery, they are examined pathologically and if they contain a tumor, the remaining part of the lymph nodes in the armpit is removed. If no tumor cells are seen, the procedure is terminated.

Axillary Lymph Node Dissection

Removal of the armpit lymph nodes is called  axillary lymph node dissection. Studies conducted in recent years have shown that in this procedure, 8-10 lymph nodes must be removed in order to sample the armpit correctly.

With this process, local area control is better achieved. However, the procedure may have its own complications such as swelling in the arm (lymphedema), fluid accumulation in that area (seroma), and temporary limitation of movement. For this reason, some precautions should be taken, such as protecting the patient's hand and arm from injuries and exercises.

Non-Surgical Treatments

Non-surgical treatments include targeted treatment processes with radiotherapy, chemotherapy, hormone therapy or smart drugs.