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Breast cancer, a common cancer in women, is a disease in which cancer cells are found in the tissues of the breast. Like most cancers, breast cancer is best treated when it is found early. A woman should feel her breasts each month to find any lumps or thick spots in the breasts. Women over the age of 40 should also have a special x-ray called a mammogram, which can find tumors that are too small to feel.

If you have a lump in your breast, your doctor may need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy. Sometimes the biopsy is done by inserting a needle into the breast and drawing out some of the tissue. If the biopsy shows that there is cancer, it is important that certain tests (called estrogen and progesterone receptor tests) be done on the cancer cells.

Estrogen and progesterone receptor tests can tell whether hormones affect how the cancer grows. They can also give information about the chances of the tumor recurring. The results help your doctor decide whether to use hormone therapy to stop the cancer from growing. Tissue from the tumor needs to be taken to the laboratory for estrogen and progesterone tests at the time of biopsy because it may be hard to get enough cancer cells later.

Your chance of recovery (prognosis) and choice of treatment depend on the stage of your cancer (whether it is just in the breast or has spread to other places in the body); the type of breast cancer; certain characteristics of the cancer cells; and your age, menopausal status (whether or not you still have periods), and general state of health.

Stages of Breast Cancer

Once breast cancer has been found, more tests will be done to find out if the cancer has spread from the breast to other parts of the body. This is called staging. Your doctor needs to know the stage of your disease to plan treatment.

About 15-20% of breast cancers are very early cancers. They are sometimes called carcinoma in situ (found only in the duct area). Other terms of this type of breast cancer are intraductal carcinoma or ductal carcinoma in situ and lobular carcinoma in situ. Lobular carcinoma in situ is found on some occasions when a biopsy is done for another lump or abnormality found on the mammogram. It is not cancer. Patients with this condition have a 25% chance of developing breast cancer in either breast in the next 25 years.

Stage I
The cancer is no bigger than 2 centimeters (about 1 inch) and has not spread outside the breast.

Stage II
Any of the following may be true: The cancer is no bigger than 2 centimeters but has spread to the lymph nodes under the arm (the axillary lymph nodes). The cancer is between 2 and 5 centimeters (from 1 to 2 inches). The cancer may or may not have spread to the lymph nodes under the arm. The cancer is bigger than 5 centimeters (larger than 2 inches) but has not spread to the lymph nodes under the arm.

Stage III
Stage III is divided into stages IIIA and IIIB.

Stage IIIA is defined by either of the following:
The cancer is smaller than 5 centimeters and has spread to the lymph nodes under the arm, which have grown into each other or into other structures and are attached to them.
The cancer is bigger than 5 centimeters and has spread to the lymph nodes under the arm.

Stage IIIB is defined by either of the following:
The cancer has spread to tissues near the breast (chest wall, including the ribs and the muscles in the chest).
The cancer has spread to lymph nodes near the collarbone.

Stage IV
The cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.

Inflammatory Breast Cancer

Inflammatory breast cancer is a special class of breast cancer that is rare. The breast looks as if it is inflamed because of its red appearance and warmth. The skin may show signs of ridges and wheals, or it may have a pitted appearance. It tends to spread quickly.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the breast, in the soft tissues of the chest (the chest wall), or in another part of the body.

How Breast Cancer Is Treated

There are treatments for all patients with breast cancer. Four types of treatment are used:

1. Surgery (taking out the cancer in an operation)
2. Radiation therapy (using high-dose x-rays to kill cancer cells)
3. Chemotherapy (using drugs to kill cancer cells)
4. Hormone therapy (using hormones to stop the cells from growing).
Note: Biological therapy (using your body's immune system to fight cancer) and bone marrow transplantation are being tested in clinical trials.

Surgery has a role in the treatment of most patients with breast cancer. It is used to take out the cancer from the breasts. Usually, some of the lymph nodes under the arm are also taken out and looked at under the microscope to see if there are any cancer cells.

A number of different operations are used:

Lumpectomy (sometimes called excisional biopsy) takes out just the lump in the breast. It is usually followed by radiation therapy to the part of the breast that remains. Most doctors also take out some of the lymph nodes under the arm.

Partial or segmental mastectomy takes out the cancer, some of the breast tissue around it, and the lining over the chest muscle. Usually some of the lymph nodes under the arm are taken out. In some cases, radiation therapy follows.

Total or simple mastectomy removes the whole breast. Sometimes lymph nodes under the arm are also taken out.

Modified radical mastectomy takes the breast, some of the lymph nodes under the arm, and the lining over the chest muscles (but leaves the muscles). This is the most common operation of breast cancer.

Treatment of breast cancer depends on the type and stage of your disease, your age and menopausal status, and your overall health.