The different types of breast cancer
BY Lisa Mayoh freelance
We break down seven different forms of breast cancer and how to detect them.
Breast cancer is not a one-type affects-all condition. There are multiple forms of breast cancer that develop in different parts of the breast, at different stages. Here we look at seven forms of the disease, and how to spot the early warning signs.
Breast cancer diagnosis
Breast cancer predominantly affects women aged between 50 and 70, although younger women can also develop the disease. Cancer Council Australia Chief Executive Officer Ian Olver advises its important women are familiar with how their breasts feel and report any prolonged changes to their doctor. "The best way of diagnosing breast cancer is through a mammogram, which detects changes before symptoms occur," Prof Olver said. Currently, in Australia, free mammograms are offered to all women from as early as 40.
Ductal carcinoma in situ (DCIS)
This is the most common non-invasive breast cancer, occurring when abnormal cells are contained inside the breast's milk ducts. Cancer Australia CEO Helen Zorbas said about 1200 cases of DCIS were diagnosed each year, mostly in women aged 50 to 59. "Most women are not aware of any symptoms at the time of diagnosis, with most cases found following routine screening with mammograms" Dr Zorbas said. "If DCIS is not treated it may develop into invasive breast cancer, which can spread outside the ducts into the breast tissue and then possibly to other parts of the body."
Treatment: Usually involves surgery – either breast-conserving surgery like a lumpectomy, or a full mastectomy. For some women, the surgical biopsy to diagnose and therefore remove, DCIS is the only surgery needed. Radiotherapy is usually recommended after breast conserving surgery.
Lobular carcinoma in situ (LCIS)
This is the name for abnormal cells that are contained in the lobules of the breast. The cause is unknown, and Dr Zorbas said LCIS cannot usually be felt as a breast lump, with most cases detected when a woman has a biopsy for another reason. "LCIS is not an invasive breast cancer and does not need to be treated if there are no other abnormal changes to the breast," Dr Zorbas said. "However, it increases the risk of developing breast cancer so it's important that she has regular check-ups."
Treatment: Not often required. However, a doctor will advise careful observation to watch for any signs of invasive breast cancer. Other strategies reduce the risk of breast cancer in the future, such as medications or surgery, may be recommended.
Paget's disease of the nipple
This is a rare form of invasive breast cancer that affects the nipple and areola that affects around two in every 100 cases of breast cancer. "The main sign of Paget's disease of the nipple is a change in the nipple or areola – it might become hard, lumpy or crusty, looking like dermatitis or eczema," Dr Zorbas explained. "There may be an ulcer, feel itchy or sore or may be a discharge or bleeding from the nipple."
Treatment: Surgery is the most common treatment however the specific treatment often depends on the characteristics of the underlying breast cancer. A modified radical mastectomy may be recommended when invasive cancer or extensive DCIS has been diagnosed. In cases where underlying breast cancer is not invasive, the surgeon may perform a simple mastectomy to remove only the breast. Additional treatments include radiation and hormone therapies.
Inflammatory breast cancer
This is a rare and aggressive form of invasive breast cancer that affects the blood vessels in the skin of the breast, causing it to become red and inflamed. Each year, around one to two per cent of the 13,000 women diagnosed with breast cancer will be diagnosed with this particular form. "Unlike other breast cancers that form a lump, inflammatory breast cancer spreads along and blocks the lymphatic vessels in the skin of the breast," Dr Zorbas sais. "Signs can develop quickly and may include a rash, the breast becoming swollen or uncomfortable, with skin appearing dimpled."
Treatment: Usually consists of chemotherapy, targeted therapy, surgery, radiation therapy, and hormonal therapy. Chemotherapy is generally the first treatment to control or kill cancer cells. After chemotherapy, patients with IBC may undergo surgery and radiation therapy to the chest wall.
Early breast cancer
As Dr Zorbas says, early breast cancer is contained in the breast, which may also spread to lymph nodes in the breast or armpit. Early breast cancer can be treated successfully, and most women aren't at risk of the cancer recurring after treatment. "Treatment for early breast cancer may involve breast surgery, radiotherapy, chemotherapy, hormonal therapies or targeted therapies," Dr Zorbas said.
Treatment: Breast conserving surgery followed by radiotherapy is as effective as a mastectomy for most women with early breast cancer. However, Dr Zorbas said that breast conserving surgery such as a lumpectomy left a greater chance that the cancer could return. "This is called local recurrence and doesn't increase the chance of the cancer spreading to other parts of the body," Dr Zorbas said. "Checking for local recurrence is one of the reasons why follow-up tests are important after treatment for breast cancer." Chemotherapy can also lower the risk of breast cancer coming back or spreading to other parts of the body.
Locally advanced breast cancer
This is an invasive form of breast cancer that may have spread to lymph nodes in the armpit, or to other tissues such as the skin, muscle or ribs. About 10 to 20 per cent of all breast cancer diagnosed in Australia each year is locally advanced breast cancer. Dr Zorbas said signs may include dimpled skin, ulcers on the breast, a lump in the breast that feels attached to the chest wall or a large red, swollen breast.
Treatment: For localised breast cancer, the most extensive surgical option is to remove the breast and lymph nodes under the arm. Another option is to remove the lump and a small section of the breast, followed by radiotherapy treatment.
Secondary breast cancer
This is an invasive breast cancer that has spread to other parts of the body. Also known as advanced breast cancer, Dr Zorbas said many women diagnosed with secondary breast cancer have been diagnosed with breast cancer before. "The cancer cells spread to other parts of the body in blood vessels or lymphatic vessels and form a new cancer deposit," she said. The most common places that breast cancer spreads to are the bones, liver, lung and brain.
Treatment: Radiotherapy can be used to treat different parts of the body that are affected by secondary breast cancer. Chemotherapy can also stop the cancer from growing or spreading, relieve symptoms and improve quality of life. "For women with secondary breast cancer, hormonal therapies can slow or stop the growth of secondary breast cancers and can relieve symptoms," Dr Zorbas said.
Plus, don't miss our exclusive PINK Magazine for iPad. We've partnered up with National Breast Cancer Foundation to bring you an interactive digital magazine packed with inspiring stories, health tips and much, much more. Download the free app on the App Store or view online at bodyandsoul.com.au/pinkmagazine.
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