Written by:
Anoushka Pinto
Breast cancer is a complex and heterogeneous disease that affects millions of women worldwide. It encompasses various subtypes, each with its unique characteristics and implications for diagnosis and treatment. Understanding the different types of breast cancer, along with the diagnostic tests and treatment options available, is essential for early detection and effective management.
In this article, we will explore the diverse spectrum of breast cancer subtypes and delve into the diagnostic procedures used to identify these cancers. Furthermore, we will discuss the various treatment modalities available and shed light on the associated costs of breast cancer treatment and the factors that may influence them.
1. Ductal Carcinoma In Situ (DCIS)
About
Daignostic tests
Treatment options
Treatment considerations
About
DCIS is a non-invasive breast cancer where abnormal cells are found within the milk duct in the breast, but have not spread outside the duct. It is considered the earliest form of breast cancer and is typically detected during routine mammograms or investigations into breast lumps.
Symptoms: Generally asymptomatic but may include breast lumps or bloody nipple discharge.
Daignostic tests
- Mammography is the primary method for detecting DCIS, revealing calcified clusters or masses.
- Biopsy procedures involve removing tissue samples for analysis by a pathologist.
- MRI and ultrasound can provide detailed images of breast tissue for accurate diagnosis.
Treatment options
- Lumpectomy (breast-conserving surgery) with radiation therapy is a common approach. While lumpectomy preserves breast tissue, it may require radiation therapy.
- Mastectomy (breast removal) may be recommended for extensive or multifocal DCIS. It removes all breast tissue and may be preferred in certain cases.
- Radiation therapy reduces the risk of recurrence after lumpectomy. It removes the affected area with surrounding tissue.
- Immunotherapy also offers hope as a treatment for ductal carcinoma in situ (DCIS) and works by using the body’s own immune system to detect and destroy cancer cells.
- Hormone therapy may be used as an additional treatment to reduce recurrence risk. It blocks hormones that fuel cancer growth, reducing recurrence risk.
- If cancer has spread to nearby lymph nodes, doctors might do a special test called a sentinel lymph node biopsy to see if more treatment is needed.
- If a sentinel lymph node biopsy shows cancer cells in the lymph nodes under the arm, doctors may suggest removing more lymph nodes through a surgery called axillary lymph node dissection to make sure all the cancer is gone.
Treatment considerations
- Decision between lumpectomy and mastectomy based on factors like tumour size and patient preference.
- Success rates of treatment typically involving surgery to remove the tumour are high.
- Participation in clinical trials offers opportunities for exploring new treatment approaches.
2. Invasive Ductal Carcinoma (IDC)
About
Daignostic tests
Treatment options
Treatment considerations
About
IDC is the most common type of breast cancer, accounting for about 80% of all breast cancer diagnoses. It begins in the milk ducts of the breast and then invades nearby tissues in the breast.
Symptoms: Though IDC often shows no early symptoms, warning signs may include breast lumps, swelling, pain, nipple changes, skin abnormalities, or discharge.
Daignostic tests
- Mammography is typically the first step in detecting IDC, creating detailed X-ray images of breast tissue.
- Ultrasound helps distinguish between solid masses and fluid-filled cysts in the breast.
- MRI may provide a more detailed view, especially for high-risk patients or those with dense breasts.
- Biopsy procedures, such as fine needle aspiration or core needle biopsy, analyse tissue samples for cancer cells.
Treatment options
- Lumpectomy preserves breast tissue by removing only the tumour and surrounding healthy tissue.
- Mastectomy may be necessary for more advanced cases, removing the entire breast tissue.
- Chemotherapy uses drugs to shrink tumours before surgery or kill remaining cancer cells after.
- Radiation therapy targets and destroys cancer cells, often used after lumpectomy.
- Targeted therapy specifically targets genetic abnormalities in cancer cells.
- Immunotherapy boosts the body’s immune system to fight cancer cells.
- Hormone therapy blocks hormones that promote tumour growth in hormone receptor-positive cancers.
Treatment considerations
- Treatment plans depend on tumour size, location, patient health, and personal preferences.
- Chemotherapy, radiation therapy, targeted therapy, and immunotherapy may be used alone or in combination.
- Hormone therapy and anti-hormone therapy are effective for hormone receptor-positive cancers.
- Participation in clinical trials offers opportunities for exploring new treatment approaches.
3. Invasive Lobular Carcinoma (ILC)
About
Daignostic tests
Treatment options
Treatment considerations
About
ILC starts in the milk-producing glands (lobules) of the breast and can spread to the lymph nodes and other body parts.. It accounts for about 10-15% of invasive breast cancers.
Symptoms: Symptoms may include breast thickening, swelling, changes in skin texture, or inverted nipples.
Daignostic tests
- Mammograms and ultrasounds aid in detecting the cancer, although it’s less likely to show on mammograms.
- MRI may be used for clearer imaging and to assess cancer extent.
- Biopsies are performed to collect tissue samples for laboratory analysis. They may involve:
- Fine-Needle Aspiration (FNA): A tiny needle extracts cell samples from the lump.
- Core Biopsy: A larger needle collects tissue samples from the lump.
- Surgical Biopsy: During surgery, tissue samples are taken for analysis.
Treatment options
- Lumpectomy removes cancer and surrounding tissue, preserving most breast tissue.
- Mastectomy removes all breast tissue, varying in extent based on individual circumstances.
- Sentinel lymph node biopsy determines lymph node involvement, guiding further treatment.
- Axillary lymph node dissection may be needed if cancer spreads to lymph nodes.
- Hormone therapy targets hormone-sensitive tumours to prevent recurrence or control spread. Administered before or after surgery, it blocks hormone receptors or reduces hormone production.
- Radiation therapy uses high-energy beams to kill cancer cells, often recommended after lumpectomy or mastectomy. It targets specific areas to minimise side effects.
- Chemotherapy is administered to kill cancer cells, usually after surgery or to shrink large tumours before surgery. It may involve multiple drugs, given orally or intravenously.
- Targeted therapy is recommended for HER2-positive ILC, where drugs target HER2 protein to inhibit cancer cell growth and spread.
Treatment considerations
- Additional tests may determine the cancer stage, ranging from 0 to IV.
- Treatment plans are tailored based on the aggressiveness of the cancer, its stage, overall health, and patient preferences.
- Choice between lumpectomy and mastectomy depends on factors such as tumour size, location, and patient preference.
- Clinical trials can offer opportunities to explore new treatments or combinations, potentially improving outcomes or reducing side effects.
4. Triple-Negative Breast Cancer (TNBC)
About
Daignostic tests
Treatment options
Treatment considerations
About
Triple-negative breast cancer (TNBC) is a type of breast cancer that doesn’t respond to hormones like oestrogen and progesterone, nor to a protein called HER2. These hormones and proteins can fuel the growth of some breast cancers, but TNBC doesn’t have them. TNBC can grow and spread more quickly than other breast cancers, and it’s more likely to come back after treatment. It’s called “triple-negative” because it lacks three specific characteristics found in other breast cancers.
Symptoms: TNBC exhibits symptoms similar to other breast cancers:
- New lump or mass
- Breast swelling or pain
- Skin changes like dimpling or redness
- Nipple changes such as retraction or discharge
- Swollen lymph nodes
Daignostic tests
- Mammogram detects abnormalities in breast tissue.
- Biopsy extracts tissue for analysis, determining TNBC characteristics.
- Additional tests like MRI, ultrasound, CT, or PET scans may be performed for staging.
Treatment options
- Chemotherapy is usually the primary treatment, as TNBC lacks hormone receptors. It is administered before or after surgery to kill rapidly dividing cancer cells.
- Immunotherapy uses drugs to activate the immune system to identify and destroy cancer cells.Pembrolizumab is a common immunotherapy drug for TNBC.
- Lumpectomy removes the tumour along with a margin of healthy tissue, while preserving as much breast tissue as possible.
- Mastectomy removes the entire breast tissue, including the lobules, ducts, fatty tissue, skin, nipple, and areola. It is considered when lumpectomy is not feasible or for patients opting for complete breast removal.
- Sentinel lymph node biopsy or axillary lymph node dissection may be performed to examine lymph node status.
- In targeted therapy, PARP (Poly ADP Ribose Polymerase) inhibitors may be used in combination with chemotherapy or immunotherapy to prevent cancer cells from repairing themselves, leading to cell death.
- Radiation therapy is administered post-surgery to reduce recurrence risk.
Treatment considerations
- Individualised treatment plans based on cancer stage, patient health, and preferences.
- TNBC requires systemic therapy (treatments that are administered throughout the entire body) due to its tendency to spread early.
- Regular monitoring and awareness of potential side effects are crucial during treatment.
- Participation in clinical trials provides chances to explore new treatments or combinations, potentially enhancing results or eliminating adverse effects.
5. HER2-Positive Breast Cancer
About
Daignostic tests
Treatment options
Treatment considerations
About
HER2-positive breast cancer overexpressed a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells. This type of breast cancer may be more aggressive but can be targeted with HER2-targeted therapies.
Symptoms:HER2-positive breast cancer often doesn’t present noticeable symptoms in its early stages. However, when symptoms do occur, they may include:
- Changes in breast size, shape, or contour.
- Presence of a mass or lump, sometimes as small as a pea.
- Lump or thickening in or near the breast or underarm, persisting throughout the menstrual cycle.
- Changes in skin appearance on the breast or nipple, such as dimpling, puckering, or inflammation.
- Development of a marble-like hardened area under the skin.
- Discharge from the nipple, which may be blood-stained or clear fluid.
Daignostic tests
- Breast biopsies are essential for diagnosing all types of breast cancers. Pathologists then examine the breast tissue cells for the presence of HER2 proteins using two main laboratory tests:
- Immunohistochemistry (IHC): This test detects HER2 proteins in breast cancer cells using immunostaining.
- Fluorescence in situ hybridization (FISH): Used to confirm IHC test results, FISH identifies extra copies of the HER2 gene.
- Based on the results, HER2-positive breast cancer is diagnosed if high levels of HER2 proteins or HER2 genes are present.
Treatment options
- Targeted therapy utilises monoclonal antibody therapy, tyrosine kinase inhibitor therapy, and antibody-drug conjugates (ADCs) to specifically target cancer cells.
- Chemotherapy is administered either before surgery to shrink tumours or after surgery to prevent recurrence.
Treatment considerations
- Treatment plans are tailored based on factors such as cancer stage and HER2 status.
- Roche Pharma offers a clinical trial for Indian patients with HER2-positive breast cancer, focusing on unresectable locally advanced or metastatic cases.
6. Inflammatory Breast Cancer (IBC)
About
Diagnostic tests
Treatment options
Treatment considerations
About
Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer that differs from other types. IBC tends to spread quickly and may not form a well-defined tumour. Instead, cancer cells block the lymph vessels in the breast, leading to the characteristic redness and swelling. Because of its aggressive nature, early detection and prompt treatment are crucial for better outcomes.
Symptoms: Inflammatory breast cancer (IBC) manifests with distinctive symptoms, including:
- Rapid changes in the appearance of one breast over several weeks.
- Thickening, heaviness, or swelling of one breast.
- Alterations in skin color, resulting in a red, purple, pink, or bruised appearance.
- Unusual warmth in the affected breast.
- Dimpling or ridges resembling an orange peel on the skin.
- Tenderness, pain, or aching in the breast.
- Enlarged lymph nodes under the arm, above, or below the collarbone.
- Flattened or inverted nipple on the affected breast.
- For a diagnosis of inflammatory breast cancer, these symptoms must persist for less than six months.
Diagnostic tests
- Mammogram detects differences in breast skin thickness or density.
- Breast ultrasound uses sound waves to visualise internal breast changes, aiding in detection.
- MRI produces detailed breast and body structure images using strong magnetic fields and radio waves.
- PET imaging combined with CT scans, assists in detecting cancer spread to lymph nodes and other areas.
- Biopsy confirms cancer diagnosis by examining tissue samples.
Treatment options
- Given orally or intravenously, chemotherapy reduces tumour size before surgery, enhancing surgical outcomes. It may also be administered post-surgery to prevent recurrence.
- Mastectomy, (removal of the affected breast) and axillary lymph node dissection (removal of nearby lymph nodes) are standard procedures, as less aggressive surgeries are ineffective due to IBC’s rapid spread.
- Radiation therapy targets residual cancer cells post-surgery, reducing the risk of recurrence.
- Targeted therapy utilises medicines to attack specific chemicals in cancer cells, offering a targeted approach to treatment.
- Hormone therapy is effective for oestrogen receptor-positive (ER+) and progesterone receptor-positive (PR+) cancers, reducing the risk of recurrence post-surgery.
- Immunotherapy enhances the body’s immune system to identify and destroy cancer cells, particularly beneficial for triple-negative cancers that lack HER2 or hormone receptors.
- Palliative Care offers supportive care to alleviate symptoms and improve quality of life during cancer treatment.
Treatment considerations
Clinical trials provide opportunities to explore new treatments, potentially improving outcomes and reducing side effects.
7. Lobular Carcinoma In Situ (LCIS)
About
Diagnostic tests
Treatment options
Treatment considerations
About
Lobular Carcinoma In Situ (LCIS) is a condition where abnormal cells are found in the milk-producing glands (lobules) of the breast. It’s not cancer itself, but having LCIS means you have a higher risk of developing breast cancer later on.
Symptoms: LCIS typically does not manifest any noticeable symptoms and is often discovered incidentally during routine screenings or diagnostic tests for other breast concerns. However, if you notice any changes in your breasts, such as lumps, skin abnormalities, or nipple discharge, it’s essential to consult your doctor promptly.
Diagnostic tests
- LCIS is usually detected through breast biopsies performed to investigate other breast abnormalities found during screenings or examinations. Common biopsy methods include:
- Core needle biopsy: A thin, hollow needle is used to extract tissue samples for examination.
- Surgical biopsy: Surgical removal of suspicious cells for detailed analysis.
- The tissue samples collected during these biopsies are sent to a laboratory for thorough examination by pathologists to confirm the presence of LCIS.
Treatment options
Treatment for LCIS involves various factors, including personal preferences and the extent of the condition. The primary treatment approaches include:
- Regular monitoring through clinical exams and mammograms to detect any signs of cancer development.
- Medications, such as selective estrogen receptor modulators (SERMs) or aromatase inhibitors, may be prescribed to reduce the risk of breast cancer development.
Surgical options include lumpectomy or mastectomy, depending on the extent of LCIS and individual risk factors.
Treatment considerations
When determining the most suitable treatment plan, your doctor considers factors such as the type of LCIS, extent of breast tissue involvement, family history of cancer, and personal preferences.
8. Angiosarcoma of The Breast
About
Diagnostic tests
Treatment options
Treatment considerations
About
Angiosarcoma is an exceedingly rare type of cancer, accounting for only 0.1% to 0.2% of all breast cancer cases. It originates in the blood or lymphatic vessels within the breast and sometimes extends to the skin of the arms. Angiosarcoma can spread rapidly and metastasize throughout the body.
Radiation-Induced Angiosarcoma of the Breast (RIAS) is a secondary type associated with past radiation therapy for breast cancer. It typically emerges six to ten years post-radiation.
Symptoms:This cancer manifests in two primary forms, each with distinct symptoms:
- Primary Angiosarcoma: Occurs in individuals with no prior history of breast cancer. Symptoms may include thickened skin in the breast area, breast lump, and rash or bruised appearance on the breast or arm skin
- Secondary Angiosarcoma: Develops in individuals previously treated for breast cancer. It is often associated with past radiation therapy or lymphedema. Symptoms may include swelling in the breast or arm, painful breast lump, rash or bruised appearance on the breast or arm skin
Diagnostic tests
- Primary angiosarcoma usually necessitates a breast biopsy, while secondary angiosarcoma often involves a skin punch biopsy.
- Mammogram detects tumours, cancer, or cysts and assesses cancer extent in the breast.
- Breast MRI produces detailed breast tissue images to detect tumours and evaluate cancer spread.
- PET Scan identifies cancer presence and spread throughout the body.
- Noninvasive imaging like ultrasounds detect breast tumours and abnormal blood flow.
Treatment options
- Lumpectomy or mastectomy may be recommended based on tumour size and location.
- Some patients receive chemotherapy post-surgery to address residual cancer.
- Additional radiation treatments post-surgery might be prescribed as part of the treatment plan.
Treatment considerations
Clinical trials provide opportunities to explore new treatments, potentially improving outcomes and reducing side effects.
9. Paget's Disease of The Breast
About
Diagnostic tests
Treatment options
About
Paget’s disease of the breast is a rare type of breast cancer that originates in the nipple and can spread to the surrounding dark skin (areola). This condition is most commonly diagnosed in individuals over the age of 50 and is often associated with underlying ductal breast cancer, either in situ (localised) or invasive. Typically, Paget’s disease of the breast involves not just the nipple but also the surrounding skin.
Symptoms:
- Flaky or scaly skin on the nipple
- Crusty, oozing, or hardened skin resembling eczema on the nipple or areola
- Itching
- Redness
- A tingling or burning sensation
- Straw-colored or bloody nipple discharge
- A flattened or inverted nipple
- A lump in the breast
- Thickening of the skin on the breast
These symptoms typically manifest in one breast only and often progress from the nipple to involve the areola and other areas of the breast over time. Early diagnosis can be challenging as the signs may come and go, sometimes appearing to improve with topical treatments.
Diagnostic tests
- Breast examination is typically the first step in detecting any signs or symptoms of Paget’s disease of the breast. It is a non-invasive procedure to check for any lumps, changes in texture, or abnormalities in the nipples or areolas.
- Mammography may reveal changes in the nipple or surrounding tissue, such as thickening, irregularities, or calcifications.
- Ultrasound can provide detailed images of the nipple and surrounding tissue, helping to identify any abnormalities characteristic of Paget’s disease.
- Breast MRI can help detect Paget’s disease of the breast by visualizing changes in the nipple and surrounding tissue with high precision.
- A biopsy may be performed on the affected nipple or surrounding skin to confirm the presence of cancerous cells. There are different types of breast biopsies, including core needle biopsy and surgical biopsy, depending on the location and size of the suspicious area.
Treatment options
- Mastectomy, which involves removing the breast tissue, nipple, areola, and surrounding skin.
- Lumpectomy, also known as breast-conserving surgery, removes the cancer and a small margin of healthy tissue.
- Sentinel lymph node biopsy to assess lymph node involvement.
- Adjuvant therapy, such as chemotherapy, radiation therapy, or hormone therapy, may be recommended post-surgery to prevent cancer recurrence.
Diagnostic and Treatment Costs:
Source: Lybrate, Practo, Dr Jay Anam, Ganesh Diagnostic, Wellness Destination India, Onco.com, DNA Labs India, Metropolis Healthcare
Breast cancer remains a significant health concern globally, impacting the lives of countless individuals and families. However, advancements in medical science have led to remarkable progress in the detection and treatment of this disease. By understanding the various types of breast cancer, undergoing regular screenings, and seeking timely medical intervention, individuals can enhance their chances of early detection and successful treatment.
Moreover, it is crucial to recognize the financial implications associated with breast cancer treatment. From diagnostic tests to therapeutic interventions, the costs can vary significantly depending on factors such as the stage of the disease, the chosen treatment modalities, and insurance coverage. By addressing these financial challenges and exploring available resources and support services, individuals can navigate the journey of breast cancer treatment with greater strength and confidence.
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