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What is Breast Cancer

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Cancer is a disease in which cells become abnormal and form more cells in an uncontrolled way. With breast cancer, the cancer begins in the tissues that make up the breasts. The cancerous cells may form a mass of tissue called a malignant tumor. The cells of a malignant tumor may spread to other parts of the body and threaten life. (Benign [buh-NYN] tumors are abnormal growths that are not cancer. The cells of a benign tumor do not spread to other parts of the body and do not threaten life.)

The most common types of breast cancer are:

Lobular carcinoma (LAH-byuh-luhr KAR-sih-NOH-muh) — Cancer that begins in the glands of the breast that make milk. These milk-making glands are called lobules. About 1 in 10 breast cancers are this type.
Ductal carcinoma — Cancer that begins in the milk ducts of the breast. Milk ducts are thin tubes that carry milk from the lobules to the nipple. About 8 in 10 breast cancers are this type.
In addition, there are two types of breast tumors that are not cancer but increase the risk of breast cancer:

Ductal carcinoma in situ (DCIS) — DCIS is a condition in which abnormal cells are found in the lining of breast ducts. These cells have not spread outside the duct to the surrounding breast tissue. But some cases of DCIS become breast cancer over time. So DCIS is sometimes called Stage 0 breast cancer. Since it's not possible to know which cases of DCIS will become breast cancer, it's important to get treatment for DCIS. Women with DCIS often are treated with breast-sparing surgery and radiation therapy. Radiation therapy lowers the chance that DCIS will come back or develop into breast cancer. If a large area of DCIS is found or it is found in more than one location, some women will choose to have a mastectomy. Underarm lymph nodes usually are not removed in the treatment of DCIS. The drug tamoxifen, which stops the growth of breast tumors that depend on estrogen, is also sometimes used in the treatment of DCIS. Tamoxifen may decrease the risk of a breast cancer developing in the same breast after treatment or in the opposite breast.

Lobular carcinoma in situ (LCIS) — LCIS is a condition in which abnormal cells are found in breast lobules. In contrast with DCIS, there is no evidence that the abnormal cells will become cancerous. However, having LCIS means that a woman has an increased risk of developing breast cancer in either breast. Despite this increased risk, most women with LCIS will never get breast cancer. Most women with LCIS are followed closely with regular checkups and mammograms. Some women choose to take tamoxifen to decrease their risk of developing breast cancer. Rarely, women with LCIS choose to have both breasts removed as a preventive measure, but most doctors think this approach is inappropriate.

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What does "early-stage" breast cancer mean?

Breast cancer is categorized as Stage I, II (A or B), III (A, B, or C), or IV. The stage is based on the size of the tumor and whether the cancer has spread. Stages I, IIA, IIB, and IIIA are considered "early-stage" breast cancer and refer to cancers that may have spread to nearby lymph nodes but not to distant parts of the body.

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How is early-stage breast cancer treated?


Treatment of early-stage breast cancer often involves more than one approach. Surgery is usually the first step. Most women with early-stage breast cancer have a choice between 2 surgical treatments:

Breast-sparing surgery, followed by radiation therapy — Breast-sparing surgery, also called breast-conserving surgery, includes lumpectomy (luhm-PEK-tuh-mee) and partial (or segmented) mastectomy (ma-STEK-tuh-mee). With lumpectomy, the tumor and some surrounding normal tissue are removed. With partial mastectomy, a portion of the breast containing the tumor is removed. Women who have breast-sparing surgery usually have lymph nodes under the arm removed. This may occur during the breast-sparing surgery or at a later time. Breast-sparing surgery keeps the breast intact — looking a lot like it did before surgery.
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Mastectomy — With simple (total) mastectomy, the surgeon removes the whole breast that has cancer and possibly some of the lymph nodes under the arm. With modified radical mastectomy, the whole breast, plus many of the lymph nodes under the arm, the lining over the chest muscles, and, sometimes, part of the chest wall muscles are removed.
The goal of both surgeries is to remove all of the cancer from the breast. The doctor will also want to find out if the cancer has spread to nearby lymph nodes. With axillary lymph node dissection (ALND), some or all of the lymph nodes under your arm are removed. With sentinel lymph node (SLN) biopsy, a substance is injected near the tumor that allows the doctor to see which lymph node the substance flows to first. This is the sentinel lymph node. It is the first lymph node the cancer is likely to spread to. The sentinel lymph node is removed and looked at under a microscope. If cancer is not found, the other lymph nodes may be left in place. If cancer is found, more lymph nodes may be removed.

The lymph node status, along with test results, helps the doctor know what other treatments, called adjuvant (AY-juh-vuhnt) therapy, might also be prudent. The goal of adjuvant therapy after surgery is to kill any cancer cells that might be elsewhere in the body and to keep cancer from recurring.

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How do I decide which surgery is right for me?

The choice may not be an easy one to make. You should consider the medical opinions of the team of doctors involved in your care. Your doctors will consider many factors, including your overall health, in making recommendations and can explain the risks and benefits of each approach. Speaking with several doctors might also help you in your decision-making. For instance, a plastic surgeon can explain how different reconstruction methods might affect the look and feel of your breast. A radiation oncologist might help put the risk of recurrence in perspective. And of course, your feelings matter too. Ample discussion with doctors and loved ones will help you to sort through all these factors and come to a decision you can be content with.

The following sections provide a more in-depth look at breast-sparing surgery and mastectomy. This information might help a woman make a choice about surgical treatment.