Breast cancer: Types, Treatment and Outlook

Most of the breast cancers are carcinomas, or cancers that start in cells lining the organs or tissues.

Updated: October 30, 2019

Most of the breast cancers are carcinomas, or cancers that start in cells lining the organs or tissues. In situ breast cancers are more treatable as they do not spread to surrounding tissue.

Invasive breast cancers usually invade the surrounding tissue. Metastatic breast cancer means it has spread to other parts of your body, such as the lungs, bones, liver, or brain. And when the breast cancer returns it is called as recurrent breast cancer.

Types of breast cancer:

Types of breast cancer are:

Ductal carcinoma in situ (DCIS):

This is pre-cancer stage and sometimes called stage 0 breast cancer which starts in a milk duct. As it is the most common type of non-invasive breast cancer, it is highly treatable. In this type of breast cancer, the cells are abnormal but haven't spread to the surrounding tissue. Over time, DCIS may progress to invasive breast cancer.

Invasive ductal carcinoma (IDC):

This is the most common breast cancer, also called "infiltrating ductal carcinoma". IDC starts in a milk duct, breaks through the duct wall, and invades the surrounding breast tissue. It can spread to other parts of the body as well. There are also several subtypes of IDC, which are categorized based on features of the developed tumors.

Invasive lobular carcinoma (ILC):

This type of breast cancer begins in the milk-producing glands, called lobules. This is also known as "infiltrating lobular carcinoma". ILC can spread beyond the lobules into surrounding breast tissue and metastasize to other parts of the body.

Lobular carcinoma in situ (LCIS):

LCIS is also called lobular neoplasia. Like ILC, it starts in the milk-producing lobules. However, it is not breast cancer even though it has carcinoma in its name. It is a collection of abnormal cells. People with LCIS are more likely to develop breast cancer in the future.

Inflammatory breast cancer (IBC):

This is a rare and aggressive type of breast cancer that causes redness and swelling of the breast. The affected breast can feel warm, heavy, and tender. The skin may become hard or ridged like an orange rind. If you experience  these symptoms, see a doctor right away. On average, IBC can occur five years earlier than other types of breast cancer, and it might not show up on a mammogram. African American women are at greater risk for IBC than white women.

Paget disease of the breast or the nipple:

This is a rare form of cancer that affects the skin of the nipple and the darker circle of skin, called the areola which surrounds the nipple. The nipple and areola becomes scaly, red, or itchy and there will be yellow or bloody discharge coming from the nipple. Most people who have this condition also have one or more tumors in the same breast which could be either DCIS or invasive cancer.

Metaplastic breast cancer:

This rare, invasive breast cancer begins in a milk duct and forms large tumors. It can be more difficult to diagnose as it contain a mix of cells that look different than typical breast cancers.

Angiosarcoma of the breast:

This quickly growing cancer is rare which is usually a complication of a prior radiation treatment of the breast.

Subtypes of Breast cancer:

Breast cancers can also be classified by their genetic makeup. Cancer's hormone receptor and HER2 status can help determine the treatment option.
These include:

Hormone receptor positive breast cancer

Some breast cancers are triggered by the hormones estrogen and/or progesterone. But some are not. Therefore, whether your cancer is sensitive to these hormones or not should be known.
Hormone receptor positive breast cancer cells have proteins called hormone receptors that are attached to estrogen and/or progesterone circulating in your body. Hormone receptor positive breast cancer can be treated using hormonal therapies. All invasive breast cancers and DCIS should be tested for hormone status.

HER2-positive breast cancer:

Some breast cancers have higher levels of a protein called human epidermal growth factor receptor 2 (HER2) that promotes cancer growth. Using certain medicines that target HER2 can help kill the cancer.

Triple negative breast cancer:

Estrogen receptor negative, progesterone receptor negative, and HER2 negative are called triple negative breast cancer. Neither hormone therapies nor HER2 drugs can slow down these aggressive cancers. It is more common among Hispanic and African American women, as well as younger women.

Triple positive breast cancer:

Cancers that are positive for estrogen receptors, progesterone receptors, and HER2 are called triple positive breast cancer and can be treated with hormone therapies and drugs that target HER2.

Treatment of Breast cancer:

Breast cancer treatment regimens differ widely based on your type of breast cancer, its stage and grade, size, and whether the cancer cells are sensitive to hormones. Your age, overall health risk factors and your own preferences are also taken in to consideration while choosing a treatment option.
Treatments for men and women are similar. Most women undergo surgery for breast cancer and also receive additional treatment such as chemotherapy, hormone therapy or radiation before or after surgery.
There are several options for breast cancer treatment. Consider seeking a second opinion from a breast specialist in a breast center or clinic and also talk to other women who have faced the same decision before taking any treatment plan.
The options for Breast cancer treatment include:

Breast cancer surgery:

Types of surgery that are used to treat breast cancer include:

Lumpectomy or Removing the breast cancer:

Lumpectomy may be referred to as breast conserving surgery or wide local excision, where the surgeon removes the tumor and a small margin of surrounding healthy tissue. It is recommended for removing smaller tumors. People with larger tumors may undergo chemotherapy before surgery to shrink a tumor and make it possible to remove completely with a lumpectomy procedure.

Mastectomy or Removing the entire breast:

Mastectomy is a surgery to remove all of your breast tissue and possibly some of the surrounding tissue. Most mastectomy procedures remove all of the breast tissue which include the lobules, ducts, fatty tissue and some skin, including the nipple and areola. Skin sparing mastectomy and nipple sparing mastectomy are increasingly common surgeries for breast cancer in selected cases in order to improve the appearance of the breast.

Sentinel node biopsy or Removing a limited number of lymph nodes:

Lymph nodes may be removed as part of breast cancer surgery or a separate operation if cancer has spread to your lymph nodes. Your surgeon will discuss with you the role of removing the lymph nodes which has to be removed from your tumor at first. If no cancer is found in those lymph nodes, the chance of finding cancer in any of the remaining lymph nodes is small and there is no need to remove the other nodes.

Axillary lymph node dissection or Removing several lymph nodes:

If cancer is found in the sentinel lymph nodes, your surgeon will discuss with you the role of removing additional lymph nodes in your armpit.

Contralateral prophylactic mastectomy or Removing both breasts:

Some women with cancer in one breast have a very increased risk of cancer in the other breast because of a genetic predisposition or strong family history. In such cases they may choose to have their other healthy breast removed.
Most women with breast cancer in one breast will never develop cancer in the other breast. Discuss your breast cancer risk with your doctor, along with the benefits and risks of this procedure before going for it.
Breast cancer surgery carries a risk of pain, bleeding, infection and arm swelling called lymphedema and the complications of breast cancer surgery depend on the procedures you choose. You may choose to have breast reconstruction after surgery. Your options and preferences can be discussed with your surgeon. Reconstruction with a breast implant such as silicone or water or reconstruction using your own tissue could be the option. These operations can be performed at the time of your mastectomy or later.

Radiation therapy as a treatment option for Breast Cancer:

Radiation therapy uses high energy waves, such as X-rays and protons to kill cancer cells and shrink tumors. It is typically done using a large machine that aims the energy beams at your body called as external beam radiation. But radiation can also be done by placing radioactive material inside your body  called as brachytherapy. It may be recommended for patients who have breast cancer surgery or whose cancer has spread to other parts of the body.
External beam radiation of the whole breast is commonly used after a lumpectomy. But if you have a low risk of cancer recurrence, breast brachytherapy may be an option after a lumpectomy. For larger breast cancers or cancers that have spread to the lymph nodes, radiation therapy to the chest wall after a mastectomy is recommended.
Breast cancer radiation can be given for three days to six weeks, depending on the treatment. Based on your situation, your cancer type and the location of your tumor, a radiation oncologist who uses radiation to treat cancer will determine the best treatment option for you.
Side effects of radiation therapy include fatigue and a red, sunburn like rash where the radiation is aimed. Breast tissue may also appear swollen or more firm. More serious problems such as damage to the heart or lungs may occur which is rare.  Very rarely, second cancers in the treated area can also occur.

Chemotherapy as a treatment option for Breast Cancer:

Chemotherapy uses drugs to destroy fast growing cells, such as cancer cells. If there is a high risk of returning or spreading cancer to another part of your body, chemotherapy may be recommended after surgery to decrease the chance of recurrence.
In women with larger breast tumors, chemotherapy is given before surgery. This is done in order to shrink the tumor to a size that makes it easier to remove with surgery. Chemotherapy may be recommended for women whose cancer has already spread to other parts of the body to control the cancer and decrease any symptoms caused by the cancer.
Side effects of chemotherapy depends on the drugs that are used for the treatment. Common side effects include hair loss, nausea, vomiting, fatigue and an increased risk of developing an infection. Rare side effects can include premature menopause, infertility (if premenopausal), damage to the heart and kidneys, nerve damage, and, very rarely, blood cell cancer.

Hormone therapy as a treatment option for Breast Cancer:

Hormone therapy is often used to treat breast cancers that are sensitive to hormones such as estrogen receptor positive (ER positive) and progesterone receptor positive (PR positive) cancers.
Hormone therapy can be used before or after surgery or other treatments to decrease the chance of recurrence. It may be used to shrink and control the cancer if the cancer has already spread by blocking the hormones.
Treatments that can be used in hormone therapy include:

  • Medications that block hormones from attaching to cancer cells such as selective estrogen receptor modulators
  • Medications that stop the production of estrogen after menopause such as aromatase inhibitors
  • Surgery or medications to stop hormone production in the ovaries

Side effects of hormone therapy depend on your specific treatment, but may include hot flashes, night sweats and vaginal dryness. More serious side effects include a risk of bone thinning or osteoporosis and blood clots.

Targeted therapy drugs as a treatment option for Breast Cancer:

Targeted drug treatments is use to treat specific abnormalities within cancer cells. As an example, a protein called human epidermal growth factor receptor 2 (HER2) which is overproduce by some breast cancer cells will be targeted. The protein helps breast cancer cells grow and survive. By targeting cells that make too much HER2, the drugs can kills cancer cells while sparing healthy cells.
Targeted therapy drugs that focus on other abnormalities within cancer cells are also available. Before using this therapy, your cancer cells may be tested to see whether you might get benefit from this therapy drugs. Some medications are used after surgery to reduce the risk of recurrence. Others are used in cases of advanced breast cancer to slow down the growth of the tumor and prevent spreading.

Palliative care as a treatment option for Breast Cancer:

Palliative care is specialized medical care in which the palliative care specialists work with you, your family and your other doctors to provide an extra layer of support to focuses on providing relief from pain and other symptoms of a serious illness. It complements your ongoing care. Palliative care can be used with other aggressive treatments, such as surgery, chemotherapy or radiation therapy.
People with cancer may feel better and live longer, when palliative care is used along with all of the other appropriate treatments.
Palliative care is provided by a team of doctors, nurses and other specially trained professionals and the aim is to improve the quality of life for people with cancer and their families.

Outlook for Breast Cancer:

Treatment outcomes may depend on the stage of cancer, response to treatment for a patient, and other risk factors.
Usually, stage 0 and 1 breast cancers are highly treatable. The five year survival rate for women diagnosed with breast cancer in these early stages is close to 100%. At stages 2 and 3, some 93% and 72% of women, respectively, can expect to live at least five years after being diagnosed with breast cancer. Stage 4 or metastatic breast cancer is difficult to treat. The five year survival rate in this case is about 22%.
For men with breast cancer, the five year survival rates are similar which is 100% for stages 0 and 1, 91% for stage 2, 72% for stage 3, and 20% for stage 4.
These statistics are just averages and they don't reflect an individual patient's experience.

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