According to the World Health Organization (WHO), breast cancer is the most prevalent cancer globally. By the end of 2020, about 7.8 million women alive had been diagnosed with different types of breast cancer over the past five years. It occurs in 40.3 per 100,000 women in Kenya, making it the most prevalent cancer among Kenyan women. Globally, about 1% of breast cancer incidences occur in men. While in countries like the United States, many of the cases are detected before stage IV. In sub-Saharan Africa, most of the cases are diagnosed in stages III and IV.
Breast cancers occur in the lining cells of ducts, lobules, or the tissue in between. Carcinoma is the most common type of breast cancer and cancer generally. Some cancers are referred to as “in situ” because they are in the place of origin. Cancer is regarded as invasive once it has spread from its area of origin to surrounding tissues, and some eventually spread to other organs.
1. Ductal Carcinoma In Situ (DCIS)
Ductal Carcinoma In Situ is a non-invasive type of breast cancer whose origin is inside milk ducts. The abnormal cells are found in the lining of the milk duct. It’s not regarded as invasive because it exists only in the milk duct and hasn’t yet spread to the surrounding breast tissue. However, having ductal carcinoma in situ increases the chances of getting invasive breast cancer than someone who has never had breast cancer.
If detected early, it’s highly treatable, but if left undetected and untreated, it can spread into the surrounding tissue in the breast.
Typically, ductal carcinoma in situ doesn’t have any signs, but it’s possible to notice:
- Bloody nipple discharge
- Lump in the breast
Treating ductal carcinoma in situ often includes a lumpectomy to remove the mass and a bit of healthy breast tissue surrounding the lump combined with radiation. Sometimes patients may prefer a mastectomy. Unfortunately, people who’ve had ductal carcinoma in situ are at a higher risk of having another type of breast cancer occur or cancer in another organ.
2. Invasive Ductal Carcinoma (IDC)
Invasive ductal carcinoma is also known as infiltrative ductal carcinoma. It’s cancer that has spread from the milk ducts into the surrounding breast tissue or other body organs. Invasive ductal carcinoma makes up almost 80% of all breast cancer cases, making it the most common type of breast cancer. It’s also the most common type of breast cancer in men.
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Although you may not notice the signs of invasive ductal carcinoma immediately, these are some of the symptoms:
- The appearance of a rash or redness on the breast
- A lump or swelling in the breast
- Dimpling around the nipple
- Nipple discharge
- Lumps in the underarm
- Thickening of breast skin
Treating invasive ductal carcinoma may include a lumpectomy, mastectomy, radiation, chemotherapy, hormonal therapy, and either a sentinel node biopsy or axillary node biopsy performed on the lymph nodes in the underarm.
3. Lobular Carcinoma In Situ
Lobular carcinoma in situ is a type of cancer that occurs when abnormal cells start growing in the breast’s lobules (glandular tissue). The cancer is called In Situ because the abnormal cells have not yet spread outside the milk glands. It is one of the most highly treatable cancers. Early treatment often prevents it from spreading to surrounding tissue. However, having lobular carcinoma in situ in one breast increases the chances of it occurring in the other breast.
In most cases, you’ll not see any signs of lobular carcinoma in situ, but in some rare cases, one could notice a lump. Typically, doctors discover lobular carcinoma in situ incidentally while looking into another breast issue and is confirmed through a biopsy.
Once a doctor discovers a patient has lobular carcinoma in situ, they might first opt to monitor it closely. However, suppose the biopsy determines that the patient has pleomorphic lobular carcinoma in situ (PLCIS). In that case, the doctor will recommend an immediate lumpectomy or mastectomy because pleomorphic lobular in situ, unlike other classic lobular carcinomas in situ, poses a greater risk of developing invasive breast cancer.
4. Invasive Lobular Carcinoma (ILC)
Invasive lobular cancer is the name given to cancer that starts in milk-producing glands of the breast and has spread to surrounding tissue and through the lymphatic nodes to other parts of the body.
Unfortunately, it’s not easy to detect invasive lobular carcinoma as you may not experience any symptoms. However, as it grows, one can notice some symptoms such as:
- Dimpling or thickening of the breast skin or part of the breast.
- Breast swelling or appearing fuller.
- Sudden nipple inversion.
Unlike other types of breast cancer, invasive lobular carcinoma has fewer chances of presenting itself as a distinct breast lump. The treatment of invasive lobular carcinoma includes a lumpectomy or mastectomy combined with chemotherapy and/or radiation.
5. Inflammatory Breast Cancer (IBC)
Inflammatory breast cancer is a type of breast cancer that invades the skin and lymph vessels of the breast and is usually very aggressive and grows fast. Similar to invasive lobular carcinoma, inflammatory breast cancer does not present a distinct lump. With inflammatory breast cancer, the breast skin looks purple or red, the breast swells, there’s either thickening or dimpling on the breast skin, and the breast looks like an orange peel. The cancer cells block the lymph vessels in the skin, which causes the breast to look inflamed.
Inflammatory breast cancer is sometimes confused with mastitis, but if symptoms persist after medication, you should have the doctor check for inflammatory breast cancer. Inflammatory breast cancer requires urgent treatment as it’s primarily diagnosed in stage III and is very aggressive. Most times, inflammatory breast cancer is discovered while having already spread to other organs in the body. It’s one of the most challenging types of breast cancer to treat, and the outcomes generally are worse.
6. Triple Negative Breast Cancer
Typically cancer cells have three kinds of receptors that are essential in fuelling their growth: oestrogen, progesterone, and human epidermal growth factor (HER2), which is a protein. The absence of the three receptors gives this type of cancer the name triple-negative cancer. This type of breast cancer doesn’t respond to treatments like hormone therapy making it challenging to treat. Triple negative breast cancer has higher chances of spreading and recurring than other forms of cancer.
The symptoms of triple-negative breast cancer include:
- A change in the shape, size, or appearance of one or both breasts
- Discharge from the nipples
- Lumps on a breast
- Irritation, warmth, itchiness, or pain in the breast
- Nipple turns inward
- Dimpling of the skin
While the causes of cancer are often unknown, the presence of BRCA1 gene mutation is highly associated with triple-negative breast cancer. The treatment of triple-negative breast cancer involves chemotherapy.
7. Metastatic Breast Cancer
This is breast cancer that has spread to other parts of the body such as the liver, lungs, bones, or brain. Metastatic breast cancer is a stage 4 cancer. The cancer cells originate from the breast but travel to other body parts, forming other tumours in those regions. If a metastatic tumour travels to a bone and forms a new tumour there, it’s still regarded as breast cancer, not bone cancer. The cancer spreads through blood or the lymphatic system.
Diagnosis of Breast Cancer
A diagnosis of the different types of breast cancer is made using a combination of tests, including:
- Breast ultrasound
- Diagnostic mammogram
Once imaging is done, it’s followed by a biopsy done by removing tissue from the affected breast area to determine the presence and the type of cancer.
Being a woman and growing older are the main factors influencing the risk of developing breast cancer. However, several other factors increase the chances of developing breast cancer, including:
How To Know If You’re At Risk Of Developing Breast Cancer
Early detection of breast cancer increases the chances of better outcomes, so regular self-examination and doctor checkups are essential.
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Photo by National Cancer Institute on Unsplash