Dr. Subhodh

Breast cancer begins when cells in the breast(s) start to grow out of control. It is understood as being the most common cancer, seen predominantly in females, globally. It is reasonably treatable and often curable.

1. Type: Adenocarcinomas constitute more than 95% of breast cancers with infiltrating ductal carcinoma (IDC) being the most common form of invasive breast cancer.

Frequently occurring breast cancers present as one of the following types mainly

1. Ductal Carcinoma In Situ (DCIS): Is the most common type of non-invasive breast cancer and is confined to the milk ducts of the breast. There is no invasion in the basement membrane. Pure DCIS metastasizes rarely. Non comedo cribrioform carcinoma is the most common DCIS found which, when compared to the comedo type, is mostly non-aggressive.

2. Infiltrating Ductal Carcinoma (IDC): Represents majority (about 3/4th) of the breast cancers, and is known to metastasize commonly to bones, lungs and liver.

3. Lobular Carcinoma In Situ (LCIS): Develops in multiple lobules of the breast (bilaterally). LCIS is less commonly seen, compared to DCIS.

4. Infiltrating Lobular Carcinoma (ILC): Represent about a tenth of all breast cancers and tends to metastasize to other regions of the body.

Less commonly occurring breast cancers such as

5. Inflammatory Breast Cancer: Is relatively uncommon and are caused probably owing to viral infections. The breast is warm, red and swollen.

6. Paget’s disease of the nipple: Is a rare form of breast cancer. It begins in the milk ducts and spreads to the nipple and areola.

7. Medullary Carcinoma

8. Mutinous Carcinoma

9. Tubular Carcinoma

10. Phylloides tumor etc all.

2. Gender: Affects the female populace predominantly. However, a small percentage of breast cancer is attributable to the male populace as well.

3. Etiology: No definite cause is known. However, diet, lifestyle, environment, hormonal/ reproductive factors, personal or family history of breast cancer especially in first degree relatives and also any benign breast disease history etc all are known to increase the risk of breast cancers. Specifically, excessive fatty diet, obesity, type 2 diabetes mellitus, benign breast disease, heredity/ inheritance of mutated breast cancer genes 1 (BRCA1) and 2 (BRCA2), smoking, alcohol intake, infertility, estrogen therapy/ hormone replacement therapy (long term) in post menopausal women, delayed age at first pregnancy, nulliparity (not having child), early menstruation, delayed onset of menopause, lactating mothers not breast feeding, exposure to ionizing radiation, sedentary lifestyle, depression, exposure to MMTV virus etc all can potentially increase the risk for breast cancer.

4. Features: Signs & symptoms, of breast cancer, manifest majorly in the following ways

1. Lump/ nodule in the breast that gets attached to the skin of the breast over time. The lump / nodule could be hard and painless with irregular edges or it could also be soft, rounded, tender and painful.

2. Enlarged lymph nodes in the axilla which are palpable.

3. Swelling of whole or a part of a breast. This is even if there is no distinct lump felt.

4. Retraction or thickening of the nipple(s).

5. Pain in the breast or nipple.

6. Discharge from nipple other than breast milk.

7. Irritation/ scaliness of skin over the breast.

8. Redness of nipples

9. Rarely, red, swollen and tender breast.

5. Screening: Is generally recommended for asymptomatic populations goal of which, as usual, is to be able to detect & diagnose breast cancer at an early stage which is potentially curable. It is mostly radiologic with mammography/ USG being instrumental in raising suspicions for further diagnostics (i.e. biopsy) that help detect breast cancer, if any, early.

6. Diagnosis: A self-examination/ clinical exam of the breast(s)/ axilla that reveals a palpable mass prompts the following diagnostics. Abnormal blood test results may be indicative of malignancy, but a follow up imaging/ biopsy is always the gold standard for accurate diagnosis.

1. Blood: ER/ PR/ HER2/neu, uPA, PAI-1, CA15-3, CA27.29 etc all tumor markers are helpful.
2. Imaging: Mammography/ USG Scan usually, as relevant. Again, CT Scan of abdomen & pelvis and chest, PET CT scan, bone scan etc all help detect metastasis, if any, for cancers in stage III & above.
3. Biopsy: either excisional, incisional, fine needle aspiration (FNA) or core biopsy technique, as contextually appropriate, is frequently employed and a histopathological examination (HPE) thereof clinches the diagnosis and the nature of the disease.

7. Treatment: Conventional treatment includes surgery, radiotherapy, hormone therapy/ chemotherapy as deems appropriate. Simultaneously, an adjunctive or integrative naturopathic treatment with suitable complementary & alternative medicines (CAM) too can help improve clinical outcomes and facilitate recovery as would be feasible contextually.

8. Prognosis: Preventive measures, earlier diagnosis and right early treatment is key for an effective therapeutic management & better prognosis. Like most other cancers, the chances of cure for an early stage breast cancer are more. The cure/ recovery chances are influenced by the type, grade, stage of cancer, recurrence and the patient’s general health & vitality etc all. Above-mentioned apart, age, menopause status, lymph node status, ER/ PR/ HER-2/ neu status, size & extent of breast cancer etc all also influence the treatment outlook in breast cancer. The five year survival rate is strongly correlated with the stage of breast cancer.

9. Prevention: Rightly said, prevention is always a better choice. Although genetic risks are difficult to modify, still an increased focus on protective factors and avoidance of the risk factors can be of help. An adherence to a Mediterranean diet, maintaining an ideal body weight and an active lifestyle with due emphasis on regular exercising (for at least 30 minutes daily), de-stressing and relaxation is highly recommended for reducing the risks of breast cancer. A healthy eating plate comprises essentially a low fat diet, fibre rich foods including whole grain cereals, green leafy vegetables cooked using healthy vegetable oils, fresh fruits of all colours as seasonally available and healthy proteins/ fats including fresh fish, poultry, beans, nuts etc all. It is advisable to limit milk/ dairy, preferably of low fat content, to 1 to 2 servings max daily. Although alcohol is optional and is not for everyone, the consumption of the same, if any, has to be strictly in moderation, and is best avoided. Smoking is to be avoided as well. Again, red meat, butter, refined grains, sweets, sugary drinks including carbonated beverages and other high calorie foods etc all, if any, are to be taken sparingly or are best avoided too. Limiting dosage/ duration of hormone therapy, if any, especially to counteract post menopausal symptoms and also avoiding exposure to radiation and environmental pollution can help reduce the risks of breast cancer. Apart from the above-mentioned, for high risk cases, a prophylactic oophorectomy, prophylactic radical mastectomy, long term hormone therapy etc all can help reduce the chances/ risks of developing breast cancer significantly. Breastfeeding is known to confer protection against breast cancer risk too.

Ultra sound is commonly known as sonography. It is a process of reproducing ultrasound images of soft tissues of a particular body part and other organs on the computer screen with the help of the echoes of the sound waves produced by the transducer, a high-frequency generating instrument.
Ultra sound is commonly used during the different stages of pregnancy to denote the foetal health, date of delivery, birth defects etc. However, in recent times, the ultra sound has also been associated with the diagnosis of other body parts such as the eyes, heart, gall bladder, liver, ovary, uterus, kidney, uterus, testicles, and ovaries. Ultra sound has also been useful in conducting biopsies for suspecting cancer patients, although not all of the cancers are detected by this imaging process. 3D & 4D ultrasound imaging are useful for looking at a particular body portion with much more precision and in slow motion respectively.

The advantages of ultra sound are:
1. The process of ultrasound imaging is a painless and a fast one. It does not require any insertion of needles or similar objects to denote the problems of the concerned body part.
2. The process is more convenient as compared to other similar imaging processes like MRI, mammogram and x-rays as they can capture images of the soft tissues, blood flow & cysts more clearly than the other processes.
3. The process is free of any harmful effects as there are no chances of exposure to radiation as compared to similar processes such as CT scans or X-rays. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

Breast Cancer - What exactly is it?
‘Breast cancer’ is a term that is used to refer to a malignant tumour, which has developed from cells present in the breast. Generally, all tumours can be divided into two categories i.e. benign and malignant and it is the malignant tumour that is responsible for causing cancer. Breast cancer generally originates in the cells the  milk producing glands of the breast's or the passage, which carries milk from the glands to the lobules. Additionally, breast cancer can also originate in the stromal tissues, including the fibrous and fatty connective breast tissues.

Breast Cancer: Treatment Options
Treatment for breast cancer depends upon two things: the exact type of the cancer and how advanced the cancer is. Treatment options for breast cancer can thus be broadly divided into two categories as Local treatments and Systemic treatments.

Local Treatments
Treatments that target the tumour without having any effect on the rest of the body are called local treatments. The following types of local treatment options are available for treating breast cancer:

1. Surgery: Surgical breast cancer treatment involves removal of the malignant cancerous tumour in an operation. Smaller tumours can be removed using a surgical process referred to as ‘lumpectomy’, wherein the tumour along with a small amount of healthy tissue surrounding the tumour is removed. For larger tumours, removal of the entire breast becomes mandatory, in a surgical process known as ‘mastectomy’. Women who undergo mastectomy can choose to undergo reconstructive plastic surgery for reconstruction of the removed breast(s).
2. Radiation Therapy: This basically involves using radiation to kill cancer cells present in the body. Radiation therapy is a long-drawn process that usually involves a set number of treatments administered over a long period of time. Radiation therapy is also generally the follow-up procedure after a lumpectomy, or more rarely, a mastectomy.

Systemic Treatments
Treatments involving drugs that are administered via either the mouth or direct injection into the bloodstream are called systemic treatments. These include:

1. Chemotherapy: This includes using drugs to destroy the cancer cells present in the body by stopping the cancer cells from growing and dividing. Chemotherapy can be administered using either an IV (intravenous) tube or via pills that can be swallowed.
2. Hormone Therapy: This treatment option is used for treating tumours which have tested positive for progesterone or oestrogen receptors. Blocking hormones that fuel the tumour’s growth is the basis of this therapy.
3. Targeted Therapy: This targets specific proteins and genes which contribute to growth and survival of the cancer cells. Targeted therapy is an extremely focused treatment, and is very effective in blocking the growth and division of cancer cells, as well as minimizing damage to surrounding healthy cells.

Myth: Brain damage is always permanent.

Fact: The brain can repair or compensate for certain losses, and even generate new cells.
People once believed that we were born with a finite number of brain cells, and that was it for life; if you damaged any of them you could never get them back. Similarly, many scientists believed that the brain was unalterable; once it was" broken" it could not be fixed. 

Now, of course, we know that the brain remains plastic throughout life, and can rewire itself in response to learning. It can also generate new brain cells under the right circumstances.

Breast cancer is a type of cancer, which occurs due to the development of cancerous cells in breasts. Women are usually affected by breast cancer and breast cancer is one of the most common forms of cancer after skin cancer. Usually fatal if not diagnosed in its early stage, breast cancer is a very serious medical ailment. Read on more to find all about the different symptoms, causes, preventive measures and treatment of breast cancer.

Symptoms: Breast cancer has few distinct characteristics and if you have a few or all the following symptoms you could be more likely to suffer from breast cancer. 

• The formation of a lump in your breast, which is different from the surrounding tissue and usually more thickened.
• The discharge of bloody fluid  material from the nipples.
• Sudden change of the size, shape and appearance of the breast.
• Certain distinct changes to the skin over the breast for example an indentation in the skin similar to that of a dimple.
• Appearance of an extra nipple which is inverted.
• If the darkened area around the nipples known as the areola is flaking or peeling off. 

Causes: Studies and researches remain inconclusive on what causes breast cancer. Breast cancer occurs due to abnormal division of the cells located in the breast, which over time accumulate and form lumps. They
might spread to other parts of the body. Breast cancer is caused mainly due to a complex interaction of personal genetics, environment and lifestyle choices. Breast cancer can also be caused due to genetics as about 5% to 10% of cases are due to gene mutations which pass onto generations.

Risk factors: There are certain factors, which increase the probability of contracting breast cancer. Increasing age, personal and family history of breast cancer, obesity, radiation exposure, pregnancy at an older age, postmenopausal hormone therapy are some of the factors that increase the chances of breast cancer.

Treatment: Several forms of surgical methods exist to treat breast cancer. Depending on the condition and spread of the disease a suitable surgery is performed. These include mastectomy, lumpectomy, axillary lymph node dissection and removal of both breasts. Other forms of treatment include chemotherapy or the use of high doses of drugs to destroy cancerous cells. Radiation therapy where X-rays are used to destroy the cancer cells is also effective.

स्तन वसा, संयोजी ऊतक, और लोब में विभाजित ग्रंथि ऊतक से बना होता है। स्तन कैंसर तब शुरू होता है जब स्तन में कोशिकाएं नियंत्रण से बाहर निकलने लगती हैं। नलिकाएं का एक नेटवर्क लोब से निपल तक फैलता है। एक स्तन आमतौर पर दूसरे से छोटा होता है। महीने में अलग-अलग समय पर आपके स्तन अलग-अलग महसूस कर सकते हैं स्तनों के लिए आपकी अवधि के ठीक पहले लंपट महसूस करना आम बात है। आपके स्तन महीने में अलग-अलग समय पर अलग-अलग महसूस हो सकते हैं। स्तनों का आपकी अवधि के ठीक पहले लंपट महसूस होना आम बात है। 
स्तन कैंसर सामान्यतः कोशिकाओं जो स्तन के नलिकाएं होती हैं, में शुरू होता है। स्तन कैंसर तब शुरू होता है जब स्तन में कोशिकाएं नियंत्रण से बाहर बढ़ने लगती हैं। कोशिकाओं का यह उत्परिवर्तन एक ट्यूमर को जन्म देता है, जिसे एक गांठ के रूप में महसूस किया जा सकता है। अगर अनुपचारित छोड़ दिया जाता है, तो घातक कोशिका अंततः शरीर के अन्य भागों में फैल सकती हैं, एक प्रक्रिया जिसे मेटास्टैसिस कहा जाता है। 
स्तन कैंसर के लक्षण
स्तन में एक गांठ आमतौर पर स्तन कैंसर से जुड़ा है, लेकिन अधिकतर समय, स्तन में गांठ कैंसर नहीं होता। किशोरावस्था में हार्मोनल परिवर्तन से लेकर क्षतिग्रस्त वसा ऊतक तक, महिलाओं में शुरुआती 20 से लेकर शुरुआती 50 की उम्र तक सभी स्तन गांठों में से 90 प्रतिशत से ज्यादा गैर-कर्कश (सौम्य) हैं। 
स्तम्भों में लंप्स स्तन संक्रमण, फाइब्रोकाइसटिक स्तन रोग (ढेलेदार स्तन), फाइब्रोएडीनोमा (गैर-कन्सेसर ट्यूमर), वसा-परिगलन (क्षतिग्रस्त ऊतक) जैसे कई अन्य कारणों के कारण हो सकते हैं।
यद्यपि अधिकांश स्तन गांठ कम गंभीर स्थितियों के कारण होते हैं, नए, पीड़ारहित गांठें फिर भी स्तन कैंसर का सबसे आम लक्षण हैं। एक महिला अपने स्तन में बदलाव देख सकती है, और मामूली असामान्य दर्द जो दूर जाता प्रतीत नहीं होता। इन परिवर्तनों के लिए देखें:

1. स्तन या निपल का अलग महसूस होना:
- निपल कोमलता, या स्तन या अंडरआर्म क्षेत्र में या उसके पास एक गांठ या मोटा होना।
- त्वचा की बनावट में परिवर्तन या स्तन की त्वचा में छिद्रों का इज़ाफ़ा
- स्तन में एक गांठ

2. दिखने में बदलाव:
- स्तन के माप या आकार में कोई भी अस्पष्टीकृत परिवर्तन
- स्तन पर कहीं भी गढ़ा
- स्तन की अस्पष्ट सूजन (खासकर अगर यह केवल एक तरफ है)
- स्तन का अस्पष्ट संकुचन (खासकर अगर यह केवल एक तरफ है)
- निप्पल जो थोड़ा सा आवक हो जाता है, या उलटा हो गया है

3. निपल निर्वहन:
किसी भी प्रकार के निप्पल निर्वहन, विशेष रूप से साफ़ निर्वहन या खूनी निर्वहन स्तन कैंसर का संकेत हो सकता है। एक दूधिया निर्वहन जब महिला स्तनपान नहीं कर रही है, हालांकि स्तन कैंसर से जुड़ा नहीं है, लेकिन एक डॉक्टर द्वारा जांच कराया जाना चाहिए।
इन लक्षणों में से एक या अधिक होने का मतलब यह नहीं है कि आपको स्तन कैंसर है। यदि आप इन संकेत और लक्षणों में से किसी का अनुभव करते हैं, तो एक पूर्ण मूल्यांकन के लिए अपने चिकित्सक को देखें।