Diane wanted so much to compile some basic information about Breast Cancer for her site before her death.  She was in hopes it might be useful to other women.  Unfortunately her health deteriorated rapidly and she never had the time to accomplish this task.  After many weeks of research I have attempted to put together what I think she might have wanted to communicate to other women.  The information provided here and throughout Diane’s Site should not be used for diagnosing or treating Breast Cancer.  If you have or suspect you have Breast Cancer, please consult your health care provider.  My Sincere Thanks ... Diane's brother.

What Is Breast Cancer?

Breast cancer is a malignant tumor that has developed from cells of the breast.  A malignant tumor is a group of cancer cells that may invade surrounding tissues or spread (metastasize) to distant areas of the body.  Breast cancer is the most common malignancy in women and the second leading cause of cancer death (exceeded by lung cancer in 1985).  The incidence of breast cancer is very low in the twenties and gradually increases and plateaus at the age of forty-five and increases dramatically after fifty.  Fifty percent of breast cancer is diagnosed in women over sixty-five indicating the ongoing necessity of yearly screening throughout a woman's life.  The disease occurs almost entirely in women, but men can get it, too.  For every 100 women with breast cancer, 1 male will develop the disease.  The information on this page refers only to Breast Cancer in women.

The Normal Breast Structure

The main parts of the female breast are lobules (milk-producing glands), ducts (milk passages that connect the lobules and the nipple), and stroma (fatty tissue and ligaments surrounding the ducts and lobules, blood vessels, and lymphatic vessels).  Most breast cancers begin in the ducts (ductal), some in the lobules (lobular) and the rest in other tissues.

While a history of breast cancer in the family may lead to increased risk, most breast cancers are diagnosed in women with NO family history. Many breast cancers develop with no symptoms at all. Some tumors may be visible on a mammogram before symptoms develop. It is important for all women to be familiar with the appearance, feel, shape, and texture of their breasts in order to detect changes as soon as they occur. Specifically, a woman should look for the following:

Warm, red, swollen breasts with a rash resembling the skin of an orange.

Skin irritation or changes, such as puckers, dimples, scaliness, or new creases.

New lumps (many women normally have lumpy breasts) or a thickening in the
breast or under the arm.

Nipple tenderness, discharge, or physical changes (such as turned inward nipple or
a persistent sore).

Pain in the breast (usually not a symptom of breast cancer, but should be reported to a doctor).

Women who experience any of these changes should contact a doctor immediately.

Types of Breast Cancers

Carcinoma in Situ
In situ means that the cancer stays confined to ducts or lobules and has not invaded surrounding fatty tissues in the breast or spread to other organs in the body.  In order to diagnose breast cancer in situ, a pathologist will examine a biopsy specimen under the microscope.  There are two types of Breast Carcinoma in Situ:

Ductal Carcinoma in Situ (DCIS)
Also known as intraductal carcinoma.  It is the most common type of noninvasive breast cancer.  Cancer cells inside the ducts do not spread through the walls of the ducts into the fatty tissue of the breast.  Although, by definition, DCIS has not yet invaded the surrounding tissues, the abnormal cells within DCIS may be the forerunners of invasive breast cancer.  Each year, about 1% of women with high-grade DCIS develop invasive breast cancer after lumpectomy.  Thus, DCIS is a potential marker for invasive carcinoma.  Nearly all women diagnosed at this early stage of breast cancer can be cured.  A mammogram is the best way to find DCIS early.  When DCIS is diagnosed, an important distinction that will be considered by the pathologist is whether or not an area of dead or degenerating cancer cells, called tumor necrosis, is present.  If necrosis is present, the tumor is considered more aggressive.  The treatment of DCIS is a topic of great debate.  Experts continue to argue about whether to treat DCIS by some form of breast-conserving surgery, with or without radiation, or by mastectomy.  The term comedocarcinoma is often used to describe DCIS with necrosis.

Lobular Carcinoma in Situ (LCIS)
Also called lobular neoplasian or on-invasive lobular carcinoma usually occurs in women who have not undergone menopause.  LCIS is a multifocal (located in more than one area) disease that typically affects both breasts.  This is in direct contrast to DCIS, which generally is unifocal (confined to one location) or at least limited to one region of the breast.  Because of the multifocal character of LCIS, women with this disease should receive careful examinations of both breasts.  Fortunately, though, most people with LCIS (over 99%) do not develop invasive breast cancer.

Infiltrating (or Invasive) Ductal Carcinoma (IDC)
This is the most common breast cancer.  Starting in a milk passage, or duct, of the breast, this cancer breaks through the wall of the duct and invades the breast’s fatty tissue.  Under the microscope, ductal carcinoma looks like a mass with poorly defined edges that have begun to extend into the surrounding tissue.  As the cancer invades the fatty tissue around a duct, it causes the formation of fibrous, scar-like tissue.  Such scar formation may make ductal carcinoma appear larger than it actually is.  Depending upon the location of the tumor, the symptoms of invasive ductal carcinoma may include retraction (drawing inward) of the nipple or nipple discharge and skin changes such as wrinkling or dimpling.  Infiltrating or invasive ductal carcinoma accounts for about 80% of all breast cancers.

Infiltrating (or Invasive) Lobular Carcinoma (ILC)
This type of cancer starts in the milk-producing glands.  Similar to IDC, it also can spread (metastasize) to other parts of the body.  Lobular carcinomas make up approximately 5% to 10% of all invasive breast cancers.  Lobular breast cancer is more difficult to detect by mammography because it may not occur as a distinct lump.  Instead, lobular carcinoma may appear as an irregular thickening in the breast.  A small proportion of women (5%) may develop lobular carcinoma in both breasts.

Inflammatory Breast Cancer
Inflammatory breast cancer is an uncommon type of breast cancer in which breast cancer cells block the lymph vessels in the skin of the breast.  This blockage may cause the breast to become red, swollen, and warm.  The skin of the breast may also appear pink, purple, or bruised, and it may have ridges or appear pitted, like the skin of an orange.  These changes often occur quickly over a period of weeks.  Another possible sign of this type of breast cancer is swollen lymph nodes under the arm, above the collarbone, or in both places.  Often, a tumor cannot be felt, and may not be seen on a mammogram.  The diagnosis of inflammatory breast cancer is based on the results of the biopsy and the doctor’s clinical judgment.  Inflammatory breast cancer generally grows rapidly, and the cancer cells often spread to other parts of the body.  A woman with inflammatory breast cancer usually has local treatment to remove or destroy the cancer in the breast and systemic treatment to control or kill cancer cells that may have spread to other parts of the body.  Local treatment affects only cells in the tumor and the area close to it; systemic treatment affects cells throughout the body.  The local treatment may be surgery and/or radiation therapy to the breast and underarm.  The systemic treatment may be chemotherapy (anticancer drugs), hormonal therapy (drugs that interfere with the effects of the female hormone estrogen), or both.  Systemic treatment is generally given before surgery and/or radiation therapy.  In some cases, local treatment may be followed by additional systemic treatment with hormonal therapy, chemotherapy, or both.  Some women also may have biological therapy (which stimulates the immune system to fight the cancer).

Medullary Carcinoma
This type of invasive breast cancer has a relatively well-defined distinct boundary between tumour tissue and normal breast tissue.  It also has some other special features, including the large size of the cancer cells and the presence of immune system cells at the edges of the tumor.  These tumours represent about 6% of invasive breast cancers.  Unlike the hard lumps characteristic of ductal tumours, medullary cancers often present as soft, well-defined lumps.  They tend not to metastasise to the lymph glands and therefore they are associated with a better prognosis.

Mucinous Carcinoma
This rare type of invasive breast cancer is formed by mucus-producing cancer cells.  These tumours also have a good prognosis because they tend not to spread to lymph nodes.  They are often more common in older women and represent about 2% of all breast cancers.  Colloid carcinoma is another name for this type of breast cancer.

Paget's Disease of the Nipple
Paget's disease of the nipple is a rare form of breast cancer.  This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple and the areola - the dark circle of skin around the nipple.  It usually strikes middle-aged women and may occur in association with an underlying in situ or invasive ductal carcinoma of the breast.  Because the tumor may cause crustiness, oozing, and itching of the areola and nipple, sometimes it is incorrectly diagnosed as eczema or another skin condition.  Yet Paget's disease is distinguished by the fact that it does not involve the surrounding skin and typically is limited to one breast.  Treatment and prognosis of Paget's disease depend on the size of the tumor, and whether it has penetrated surrounding tissues (invasive) or spread to the lymph nodes (metastasized).  A small, noninvasive tumor may require only removal of the lump plus a surrounding area of normal tissue (lumpectomy).  A larger, more aggressive tumor may require more extensive removal of breast tissue (mastectomy).

Phyllodes Tumor
This very rare type of breast tumor develops in the stroma (connective tissue) of the breast, in contrast to carcinomas, which develop in the ducts or lobules.  Phyllodes (also spelled phylloides) tumors are usually benign but on rare occasions may be malignant.  Benign phyllodes tumors are treated by removing the mass and a narrow margin of normal breast tissue.  A malignant phyllodes tumor is treated by removing it along with a wider margin of normal tissue, or by mastectomy.  These cancers do not respond to hormonal therapy and are not so likely to respond to chemotherapy or radiation therapy.  In the past, both benign and malignant phyllodes tumors were referred to as cystosarcoma phyllodes.

Tubular Carcinoma
Tubular Carcinomas are a special type of invasive breast carcinoma.  These rare tumours are often small and in recent years more have been detected by breast screening.  These tumours have a very good overall prognosis in the range of 80% at 5 years.  They make up for only 3% of all invasive breast cancers.  They have a better prognosis than invasive ductal or lobular carcinomas.

What is the Prognosis for Breast Cancer?

Most women who are treated for early breast cancer go on to lie healthy, active lives. You may have more choices of treatment if your breast cancer is found early.

Treatments have changed over time. Today, many women who are diagnosed with breast cancer do not have to lose a breast. Because there are improved ways to treat breast cancer, it is more important than ever for you to learn all you can. Working with your team of medical specialists, you can play a key role in choosing the treatment that is best for you.

Once your doctor has determined your specific type and stage of breast cancer, you can begin to plan for your treatment and recovery. Your chance of recovery will depend on many factors, including:

The type and stage of your cancer (what kind of cancer; the size of the tumor; and whether it is only in your breast, or has spread to any lymph nodes or to other parts of your body).

How fast the cancer is growing. Special tests on the tissue can measure how fast the cancer cells are dividing and how different they are compared to normal breast cells.

How much the breast cancer cells depend on female hormones (estrogen and progesterone) for growth which can be measured by hormone receptor tests. Patients whose tumors are found to be dependent on hormones (described as estrogen-positive or progesterone positive) can be treated hormonal therapy to prevent further growth or recurrence of breast cancer.

Your age and menopausal status (whether or not you still have monthly periods)

Your general state of health

Stage 0
Stage 0 is sometimes called noninvasive carcinoma or carcinoma in situ.  Lobular carcinoma in situ (LCIS) refers to abnormal cells in the lining of a lobule.  These abnormal cells seldom become invasive cancer.  Nevertheless, their presence is an indication that a woman has an increased possibility of developing breast cancer.  This risk of cancer is increased for both breasts.

Stage I and II
Stage I and stage II are early stages of breast cancer in which the cancer has spread beyond the lobe or duct and infiltrated nearby tissue.  Stage I means that the tumor is no more than about an inch across and cancer cells have not spread beyond the breast.  Stage II means one of the following: the tumor in the breast is less than 1 inch across and the cancer has spread to the lymph nodes under the arm; or the tumor is between 1 and 2 inches (with or without spread to the lymph nodes under the arm); or the tumor is larger than 2 inches but has not spread to the lymph nodes under the arm.

Stage III 
Stage III is also called locally advanced cancer.  In this stage, the tumor in the breast is large (more than 2 inches across) and the cancer has spread to the underarm lymph nodes; or the cancer is widespread in the underarm lymph nodes; or the cancer has spread to lymph nodes near the breastbone or to other tissues near the breast.

Stage IV
Stage IV is metastatic cancer.  The cancer has spread further than the breast and underarm lymph nodes to other parts of the body.

In 2003, about 1,334,100 new cancer cases are expected to be diagnosed,
and 556,500 Americans are expected to die from their disease – more
than 1,500 people a day.  Cancer is the second leading cause of death in
the U.S., exceeded only by heart disease.  A summary of the nation's top
four cancers is provided below.

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