A Journey with Breast Cancer Essay

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A Journey with Breast Cancer



A Journey with Breast Cancer

What is Cancer?
The body is made up of many types of cells. Normally, cells grow and divide to produce
more cells only when the body needs them. This is an orderly process which keeps the body
healthy. Sometimes cells keep dividing when new cells are not needed. They may form a
mass of extra tissue called a growth or tumor. Benign tumors are not a threat to life but
malignant tumors are cancer. Cells in these tumors can invade and damage nearby tissues
and organs. The fear is that cancer cells can break away from a malignant tumor and enter
the bloodstream or lymphatic system. That is how breast cancer spreads and forms other
tumors in the body. The spread of cancer is called metastisis. (Dollinger, Rosenbaum and
Cable, 1991).

Understanding the breasts
Each breast has 15 to 20 overlapping sections called lobes. There are many smaller
lobules, which end in dozens of tiny bulbs that can produce milk. The lobes, lobules and
bulbs are all linked by thin tubes called ducts. These ducts lead to the nipple in the
center of a dark area of skin called the areola. Fat fills the spaces around the lobules
and ducts. The breast does not have muscles tissue but muscles lie under each breast and
cover the ribs. Each breast contains blood vessels and vessels that contain lymph. The
lymph vessels lead to small bean shaped organs called lymph nodes. Clusters of lymph
nodes are found near the breast under the arm, above the collarbone and in the chest. They
are also found in other parts of the body. (Dollinger, Rosenbaum and Cable, 1991).

Types of breast cancer
According to Dollinger, Rosenbaum and Cable (1991), the most common type of breast cancer
begins in the lining of the ducts It is called ductal carcinoma. Lobular carcinoma arises
in the lobules. They explain that when breast cancer spreads outside of the breast, cancer
cells are often found in the lymph nodes under the arm. If it reaches these nodes it may
mean that cancer cells have spread to other parts of the body, other lymph nodes or other
organs. It may have spread to the bones, liver or lungs.

When cancer spreads, it is called metastatic breast cancer. The median duration of
survival for women with metastatic disease is two to three years. Malignant cells are
transported via the lymphatic system. Distant metastasis occurs when the cancerous tumor
cells break away from the primary tumor and spread to other sites in the body. (McEvilly
and Hassey, 1998).

Risk factors for breast cancer
According to the National Cancer Institute (1999), research has shown that the following
conditions place a woman at increased risk for breast cancer:

Personal history of breast cancer - Women who have had breast cancer face an
increased risk of getting breast cancer again.

Genetic alterations - Changes in certain genes (BRCA1, BRCA2, and others) make
women more susceptible to breast cancer. In families in which many women have
had the disease, gene testing can show whether a woman has specific
genetic changes known to increase the susceptibility to breast cancer.

Family history- A woman's risk for developing breast cancer increases if her mother,
sister, daughter or two or more other close relatives, such as cousins, have
a history of breast cancer, especially at a young age.

Certain breast changes - Having a diagnosis of atypical hyerplasia or lobular
carcinoma in situ (LCIS) or having had two or more breast biopsies
for benign conditions may increase a woman's risk for
developing cancer.

Breast density - Women age 45 and older whose mammograms show at least 75
per cent dense tissue are at increased risk. Dense breasts contain many glands
and ligaments, which makes breast tumors difficult to see and the
dense tissue itself is associated with developing breast cancer.

Radiation therapy - Women whose breasts were exposed to radiation during their
childhood, especially those who were treated with radiation for Hodgkin's
disease, are at an increased risk.

Late childbearing - Women who had their first child after the age of 30 have a greater
chance of developing breast cancer than women who had their children at a
younger age. Early menstruation - Women who started menstruating at an early
age (before age 12), experienced menopause late (after age 55), never
had children, or took hormone replacement therapy or birth
control pills for long periods of time. Each of these factors increases
the amount of time a woman's body is exposed to estrogen. The longer this
exposure, the more likely she is to develop breast cancer.

In most cases, doctors cannot explain why a woman develops breast cancer. Studies show
that most women who develop breast cancer have none of the risk factors listed above.
Also, women with known risk factors may never develop breast cancer (Dollinger, Rosenbaum
and Cable, 1991).

Early detection
When breast cancer is found and treated early, the chances for survival are better. Women
can take an active part in the early detection by having regular mammograms and breast
exams. Self examination is also very important. Mammograms can often detect cancer
before it is felt. It can also show calcium deposits which may be an early sign of
cancer. There are some limitations because a mammogram may miss some cancers or may find
things that turn out not to be cancer at all. Detecting a tumor early does not guarantee
that a woman's life will be saved. Some fast growing cancers may have already spread to
other parts of the body before being detected. (Dollinger, Rosenbaum and Cable, 1991).
The National Cancer Institute recommends that women in their forties and older have
mammograms on a regular basis, every one to two years.

Symptoms
Early breast cancer does not cause pain as a rule. In fact, when breast cancer first
develops, there may be no symptoms at all. According to Dollinger, Rosenbaum and Cable,
1991), as cancer grows it can cause many changes that women should watch for:

A lump or thickening in or near the breast or in the underarm area;
A change in the size or shape of the breast;
Nipple discharge or tenderness, or the nipple pulled back into the breast;
Ridges or pitting of the breast (looks the skin of an orange);
A change in the way the skin of the breast, areola or nipple looks or feels.
Diagnosis
The physician is able to tell a lot about a lump by its size, texture and whether is moves
easily. He/she does this by feeling the lump and the tissues around it. Apparently, benign
tumors have a different feel. The physician finds out a lot of information by reading
the mammogram. Ultrasonography is also used to tell whether a lump is solid or fluid
filled. The following procedures may be performed to make a diagnosis according to
Dollinger, Rosenbaum and Cable, (1991):

Fine needle aspiration. A thin needle is used to remove fluid from a lump. If it is fluid
filled it is not cancer. If it is solid it may or may not be cancer.

Needle biopsy. Tissue can be removed with a needle from an area that is suspicious on a
mammogram and cannot be felt.

Surgical biopsy. The surgeon cuts out part or all of a lump or suspicious area.
When cancer is found
The pathologist can tell what kind of cancer it is, if it is invasive, whether the cancer
is sensitive to hormones, if it grows slowly or rapidly. The patient will be referred to
an oncologist who specializes in the treatment of cancer. Generally, treatment will begin
within a few weeks after diagnosis. This is the time to get a second opinion, prepare self
and loved ones.

Treatment
There are more treatment options and hope for survival than ever before. The options
depend on the size and location of the tumor, the results of lab test and hormone receptor
tests, and the stage of the disease. The women's age, menopausal status, general health
and size of her breasts are considered. This is the time to learn all that is possible
about the disease, the treatment choices and to take an active part in decisions about
medical care and options.

There are many resources where a patient can learn about breast cancer. Calling the
National Cancer Institute's Cancer Information Service a 1-800-4-CANCER is a great way to
gather the most current up to date treatment information, including information about
current clinical trials. A cancer specialist can provide answers to questions about
breast cancer treatment. They can also make referrals to other resources. There is so
much to learn about breast cancer and its treatment. As I described in my personal
journey, this is a very difficult time to remember all of the information heard and
understand all of the answers at once. I suggest keeping a journal to refer to when things
seem a lot clearer.


Planning treatment
Methods of treatment are local or systemic. Local treatments are used to remove, destroy,
or control the cancer cells in a specific area. Surgery and radiation therapy are local
treatments. Systemic treatments are used to destroy or control cancer cells throughout the
body. Chemotherapy and hormonal therapy are systemic treatments. A patient may have one
form of treatment or both (McEvilly and Hassey, 1998).

Surgery is the most common treatment for breast cancer. An operation to remove the breast
or as much of the breast as possible, is a mastectomy. Breast reconstruction is often an
option at the same time as the mastectomy, or later on. An operation to remove the cancer
but not the breast is called breast sparing surgery. They usually are followed by
radiation therapy to destroy any cancer cells that may remain in the area. In most cases,
the lymph nodes under the arm are removed to help determine whether cancer cells have
entered the lymphatic system (Dollinger, Rosenbaum and Cable, 1991).

In lumpectomy, the breast cancer and surrounding tissue is removed. Some of the lymph nodes under the arm are removed.
In segmental mastectomy, the surgeon removes the cancer and a larger area of normal breast
tissue around it. Occasionally, some of the lining over the chest muscles below the tumor
is removed as well. Some of the lymph nodes under the arm may also be removed. (Dollinger,
Rosenbaum and Cable, 1991).

In total (simple) mastectomy, the whole breast is removed with some of the lymph nodes.
In modified radical mastectomy, the whole breast is removed, the lymph nodes under arm and
often the lining over the chest muscles. The smaller of the two chest muscles is also
taken out to help in removing the lymph nodes (Dollinger, Rosenbaum and Cable, 1991)..

In radical mastectomy, also called Halsted radical mastectomy, the breast is removed, the
chest muscles, all of the lymph nodes under the arm and some additional fat and skin.
This operation was considered standard procedure for many, many years. Thank goodness, it
is only used rarely these days and only in cases where the cancer has spread to the chest
muscles. (Dollinger, Rosenbaum and Cable, 1991).

Breast reconstruction is surgery to rebuild a breast's shape. This option should be
discussed with a plastic surgeon prior to having a mastectomy (Fraker and Edwards, 1998).

Radiation therapy is the use of high energy rays to kill cancer cells and stop them from
growing . These rays can come from radioactive material outside the body and be directed
at the breast by a machine. It can also come from radioactive material placed directly in
the breast in thin plastic tubes. Some women receive both kinds (McEvilly and Hassey,
1998).

Chemotherapy is the use of drugs to kill cancer cells. It is usually in a combination of
drugs. They may be given orally or by injection. Either way, it is a systemic therapy
because the drugs enter the blood stream and travel throughout the body.

Treatment Choices
Treatment choices depend on a number of factors. These include age, menopausal status,
general health, the size, location, stage of the tumor, lymph node involvement and size of
the breast. Certain features of the tumor cells, such as whether or not they depend on
hormones to grow are considered. But, the most important consideration is the stage of the
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