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Breast Cancer

Mastectomy scars: What you should know

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A mastectomy is a surgical procedure that typically results in scarring and is used to treat breast cancer. There are certain kinds of mastectomy that leave more scarring than others.

A surgeon extracts tissue from either or both breasts during a mastectomy, taking out only a section or the breast as a whole. Afterwards, the scarring depends on the place and form of incision that the surgeon makes.

Depending on the amount of breast tissue that needs removal, and whether a person requires reconstruction surgery afterwards, a surgeon may decide on the approach.

It can take months or even years for mastectomy scars to fade, but they never disappear completely. Reconstruction of breasts may enhance their appearance.

We look at various approaches to mastectomy in this article and how these impact scarring. We also clarify how post-mastectomy scars should be treated.

Different paths to incision

The appearance of mastectomy scars will depend on the type of incision.

The appearance of a mastectomy scar will depend on the type of incision and surgical approach.

To start the operation, a surgeon may make an incision in the chest.

The surgeon removes breast tissue, muscles, and lymph nodes. The incision is then closed using stitches.

A scar can form over time. Some mastectomy scars heal in a horizontal line across the chest, a diagonal line, or often in a half moon shape.

The incision type and scar color depend on the position of the breast cancer lesion.

Medical treatments have greatly improved and a number of options are now available. People may ask their surgeon about procedure and its potential outcomes.

Which mastectomy will cause scarring?

The type of mastectomy performed on a patient can determine the degree of scarring.

Partial mastectomy or lumpectomy

It includes extracting the tumor and any underlying breast tissue. Often, the surgeon will also strip the covering of the chest muscles.

A lumpectomy will normally leave a small linear scar on the breast. A surgeon can conceal the scar in the crease of the breast or around the nipple.

A partial mastectomy leaves the majority of the breast intact, and reconstruction is not typically required.

As the size of the breast and amount of tissue removed varies, the size of the breast on the other side can differ.

The resulting breast might also have a divot or depression if it is small and the mass removed is particularly large.

Women who have a lumpectomy typically need radiation therapy.

Skin sparing mastectomy

For women who choose to continue the procedure with immediate breast reconstruction, a surgeon will normally prefer this technique.

Removing the breast, areola, nipple, and one or more lymph nodes requires a skin-sparing mastectomy. The surgeon can, however, preserve the remaining breast tissue.

Saving much of the breast skin enables the surgeon to begin immediate reconstruction from elsewhere in the body with an implant or tissue.

A skin-sparing mastectomy normally leaves the front of the breast with a visible, medium-to-large scar.

Nipple sparing mastectomy

A candidate for a nipple-saving mastectomy may be a person who is due to receive a preventive mastectomy or has early stage breast cancer. Preserving the skin and areola is part of this process.

This strategy would definitely favor women with smaller breasts. A scar on the side or at the base of the breast will result. Placing the incision under the breast in the crease may cover the scar further.

Simple or total mastectomy

A surgical approach that includes extracting the breast, areola, and nipple is this form of mastectomy. Often, if they show cancer symptoms, a surgeon will also remove the lymph nodes as well.

Depending on plans for reconstruction, they can also change the amount of breast skin they extract during the operation.

Usually, an oval shaped incision is made by the surgeon that goes around the nipple and around the width of the breast, leaving a prominent scar around the chest.

Modified radical mastectomy

This approach includes removing all breast tissue plus lymph nodes in the breast and armpit, similar to a simple mastectomy. Mostly, the surgeon leaves the chest wall intact.

A modified radical mastectomy will result in the chest getting a big, noticeable scar.

Follow-up treatments

The aim of a mastectomy or any oncological procedure is to remove just as much tissue as cancer requires to be treated, which will help to minimize any scarring.

The options will be explored by a breast surgeon to oncologist and help a person make the right decision in their case.

A woman will possibly have drainage tubes after surgery and require several weeks to recover.

Some procedures do not usually require a stay in the hospital, such as a lumpectomy. However, larger mastectomies also involve a stay in the hospital.

The duration of the hospital stay and length of recovery time are also determined by the form of mastectomy and reconstruction.

A doctor can prescribe radiation therapy or chemotherapy after a mastectomy to shrink the tumor or kill any remaining cancer cells. These treatments will influence the healing of wounds as well.

For signs of infection, such as warmth, redness, or discharge, a woman should track the wound. A fever may indicate a systemic infection as well.

Breast reconstruction

After a mastectomy, breast reconstruction is an alternative. The appearance of the breast or breasts is recreated by a surgeon, either at the time of the mastectomy or after healing.

Breast reconstruction will still cause scarring, but instead of a flat scar on the chest, it can lead to a more complete look at the breast. The procedure can also decrease a mastectomy’s psychological effects.

By removing tissue from another part of the body, using breast implants or both, a surgeon can accomplish the reconstruction.

Pictures

  • Image warning
  • An info graphic of a mastectomy
  • the-side-view-of-nude-breasts-only-indicating-breast-reconstruction-post-mastectomy-image-credit-national-cancer-institute-2013
  • breast-reconstruction-and-augmentation-with-fat-transfer

What if a woman does not choose reconstruction?

According to BreastCancer.org, an estimated 44 percent of women undergoing mastectomy do not opt to pursue the treatment with breast reconstruction.

Many women choose this course for different medical and personal reasons. Any of these may include:

  • Health concerns that could make later surgeries dangerous
  • The need to more rapidly resume daily operations
  • Concerns about taking tissue or using an implant from other places
  • Cost issues for individuals without insurance

Those that do not want to reconstruct may choose to wear a prosthetic or artificial breast that can be inserted into a bra. An elastic, breast-shaped system that fastens to the body is one alternative.

Women who do not choose one of these choices often refer to their choice as “going flat.”

Reducing scarring without reconstruction

They can consult with their doctor about surgical options if a person chooses against reconstruction, which may make the mastectomy scar and the resulting skin more comfortable.

A surgeon, for example, should ensure that the scar lies as flat against the chest as possible, which can help the chest feel smooth. Otherwise, a person with skin on their chest that bulges could be left by the surgery.

While this bulging is not physically detrimental, many individuals do not like its appearance.

A surgeon may often make what they call an incision of a “Y” or an anchor pattern. Two small incisions are applied to the end of the conventional long incision by this method, which may minimize bulging skin during the procedure.

Mastectomy tattoos

A report by a tattoo artist who collaborated with women to cover their mastectomy wounds with tattoos was published in the Journal of the American Medical Association in 2017.

This is an emerging technique for individuals who chose not to have breast reconstruction, which can be a choice.

Many people even want to have a tattoo artist draw a three-dimensional-looking nipple. Certain tattoo artists specialize in this approach.

Conclusion

An individual option is the choice of reconstructing a breast, covering a mastectomy scar, or living life without wearing a prosthesis. It is necessary for individuals to explore all these options with a surgeon.

If a person thinks that their desires for reconstruction are not valued by a doctor, they should want to get a second opinion.

An individual may also choose to delay any decision until after a mastectomy regarding the reconstruction process.

Sources

  • Allen, D. (2017). Moving the needle on recovery from breast cancer. The healing role of postmastectomy tattoos [Abstract].
    (LINK)
  • Bland, K., M., et al. (2017). The breast: Comprehensive management of benign and malignant diseases, 5th edition. Philadelphia, PA: Elsevier.
    (LINK)
  • Breast reconstruction after mastectomy. (2017).
    (LINK)
  • Breast reconstruction: Options after a skin-sparing mastectomy. (n.d.).
    (LINK)
  • Going flat: Choosing no reconstruction. (2019).
    (LINK)
  • Mastectomy. (n.d.).
    (LINK)
  • Mastectomy. (2017).
    (LINK)
  • What to expect after breast reconstruction surgery. (2017).
    (LINK)
  • Medicalnewstoday – What to know about mastectomy scars (LINK)

Breast Cancer

Breast pain: The most common causes

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Mastalgia, or breast pain, is fairly common. Hormonal fluctuations, an inappropriate bra fit, and infections are also potential causes. In certain situations, transferred pain from other parts of the body, such as the back or neck, is to blame.

Breast pain affects almost two-thirds of women during their reproductive years, and it is one of the most common complaints among people aged 15 to 40.

Although breast pain is not a common sign of breast cancer, it should be discussed with a doctor if it occurs in conjunction with other breast abnormalities such as a lump or discharge.

Continue reading to discover more about some of the causes of breast pain and how to deal with this condition.

Scar tissue

breast Scar tissue

Scar tissue can form as a result of both surgery and radiation therapy for breast cancer. This can lead to:

  • numbness or pain, if the scar tissue develops around nerves
  • an increase in firmness or a rounder appearance of the breast
  • formation of a lump if the scar forms around a surgical stitch

Treatment options include:

  • In physical therapy, if the scar tissue causes pain, stiffness, and pressure
  • Surgical removal of scar tissue, if it is very painful
  • If a person finds scars bothersome, they may opt to use creams and ointments to reduce their appearance.

Back, neck, or shoulder sprains

Breast pain might come from the exterior rather than the inside of the breast. Sprains or injuries to the back, neck, or shoulder, for example, might result in pain in the breast.

Cervical root disorders, sometimes known as a pinched nerve, can induce breast pain, according to a 2020 study. A nerve root in the neck is damaged or inflamed in certain illnesses.

Referred pain occurs when people experience pain in a different location than where it originates. The treatment is based on identifying the underlying issue. If a person suffering from breast pain has a pinched nerve, physical therapy or spinal surgery to relieve the pinched nerve may help.

Costochondritis

Inflammation of the costal cartilage, which links the ribs to the breastbone, is known as costochondritis. Sharp chest pain and tenderness can accompany the condition, which can develop gradually or suddenly.

The following variables may aggravate the discomfort:

include:

  • Avoid activities that worsen the pain.
  • applying heat to the area
  • Take one of the following medications:
  • undergoing transcutaneous electrical nerve stimulation (TENS), a procedure that applies an electric current to an area to reduce pain.

Chest wall pain

Pain in the chest wall can be caused by a variety of factors. Even though it is not, this discomfort might sometimes feel like it is coming from the breast.

The pain might range in intensity from a single spot to a large area of the breast. A person may have the following experiences:

  • burning or sharp pain
  • pain that spreads down the arm
  • pain that occurs when someone applies pressure to the chest wall
  • pain that worsens upon movement

Possible causes include:

Treatment will depend on the cause, but it may include pain management and avoiding movements that aggravate the pain until the core cause has been addressed.

Breast cysts

Breast cysts are fluid-filled sacs seen in the breast. They’re noncancerous, soft, and more common in women who aren’t yet menopausal. Some cysts are asymptomatic, while others cause pain and nipple discharge.

Treatment isn’t necessary unless the cysts are particularly large or painful. If therapy is required, the fluid will be drained with a needle.

Breast cancer

When cells in the breast change and multiply uncontrollably, breast cancer develops. Breast pain is not commonly caused by cancer, but it is a cause. Other signs and symptoms could include:

  • a lump in the breast
  • pain in any part of the breast
  • any nipple discharge — bloody, clear, or otherwise
  • dimpling or irritation of breast skin
  • pulling in at the nipple or pain in the nipple
  • flaky, inflamed skin in the nipple area
  • thickening or swelling of part of the breast
  • change in the shape or size of the breast

Rarely, people can develop inflammatory breast cancer, which causes different symptoms. These include:

  • a painful, tender, or itchy breast
  • pink, red, or purple discoloration that covers at least one-third of the breast
  • swelling of the skin, making one breast look larger than the other
  • pitting of the skin, similar to that of orange peel
  • a retracted or inverted nipple

Surgery, chemotherapy, hormone therapy, radiation therapy, and biologic therapy are all options for treating breast cancer. Often, people will get more than one of these treatments.

Hormonal changes

Breasts that are tender or swollen are frequently due to hormonal changes that occur before a period. Tenderness in both breasts is common with this type of breast pain, which can also spread to the armpit.

Cyclic breast pain occurs when breast pain is linked to the menstrual cycle. Premenstrual syndrome (PMS) is a group of symptoms that occur before a period, however cyclic breast discomfort can also occur on its own.

Other PMS symptoms include:

PMS is just transient, and it normally disappears a few days after your period starts. People can address the symptoms in the meanwhile by using over-the-counter (OTC) pain medicines, wearing a comfortable and supportive bra, and applying moderate heat to the area.

Other hormonal changes, such as those that occur during pregnancy or in the early stages of menopause, can also cause breast pain.

Bra fit

Bras that are overly tight or have an underwire that digs into the skin or breast tissue can cause breast pain. If a person has cyclic breast discomfort, they may notice that their regular bras feel too small or uncomfortable at certain periods during their menstrual cycle.

Many major stores provide free bra fittings to help people choose the proper size. If women have soreness before their period, they may want to invest in non-wired, supportive, and comfy bras.

When exercising, supportive bras might also be beneficial. According to a 2021 article, 60–70% of women report decreased breast soreness when they exercise while using a sports bra.

Breast fibrocystic changes

Due to hormonal changes, fibrocystic breast alterations are harmless but potentially painful symptoms that cause the breasts to feel lumpy or have a distinct texture. The most frequent type of noncancerous breast condition is fibrocystic breast disease.

The following are examples of symptoms:

  • breasts that feel firmer or thicker than usual
  • tenderness
  • lumps or cysts
  • sensitive nipples
  • itchiness

Before a period, the symptoms may become more severe, but they normally subside following menopause.

The following procedures may be used to treat or manage fibrocystic breasts:

  • taking OTC pain medication, such as acetaminophen (Tylenol) or ibuprofen (Advil)
  • applying cool or warm compresses when the breasts are more painful
  • avoiding a large intake of salt, caffeine, or fat in the diet
  • starting or stopping birth control pills

If you think your fibrocystic breast changes are linked to a new contraceptive, talk to your doctor before changing your dose.

Mastitis

Mastitis is the medical word for breast inflammation or swelling. Infection is the most common cause. Although the condition most commonly affects breastfeeding mothers, it can also afflict non-breastfeeding people.

Mastitis can cause the following symptoms:

  • swelling, pain, and warmth in part of the breast
  • fever
  • headaches
  • general flu-like symptoms

Antibiotics are used to treat infections. Breastfeeding mothers must empty their breasts of milk as well. If an abscess is present, the pus will be surgically removed or removed with a needle.

Medications

Some drugs have been linked to the onset of breast pain. These are some of them:

  • Bigitalis preparations, such as digoxin (Digox), which treat congestive heart failure and abnormal heart rhythm
  • chlorpromazine (Thorazine), a medication for mental health disorders
  • certain potassium-sparing diuretics, such as eplerenone (Inspra) or spironolactone (Aldactone)
  • oxymetholone (Anadrol), which treats low red blood cell count
  • methyldopa (Aldomet), which is a treatment for high blood pressure

People who are experiencing breast pain should consult a doctor to see if any of their prescriptions are the source of their symptoms.

Cyclic vs. noncyclic pain

There are certain fundamental differences between cyclic pain and noncyclic pain, which is linked to the menstrual cycle. The table below contrasts and compares the two forms of pain:

Cyclic painNoncyclic pain
varies with hormones in the menstrual cycledoes not vary with the menstrual cycle
common among females in their 20s, 30s, and 40smore common after menopause
generally affects both breasts equallytends to affect one or more localized areas of one breast
may occur alongside tenderness, swelling, or lumpinesspain often feels sharp and burning

Hormones may not be the main cause of cyclic pain, especially if one breast hurts more than the other.

Keeping a symptom diary can help you figure out if your pain is cyclic. Alternatively, to discover if there is a trend, people can utilize applications that track menstruation and its associated symptoms.

It can be beneficial to provide a numerical value to the pain severity every day during one or more menstrual cycles in a symptom diary. It’s possible that the pain is cyclic if it happens or gets worse at the same time every cycle. During a doctor’s visit, people might discuss this information with them.

Managing breast pain

Mastalgia pain can be alleviated in a variety of people. These are some of them:

  • wearing a supportive bra that fits well
  • taking OTC pain medications
  • limiting the intake of chocolate, coffee, tea, and soft drinks
  • applying hot or cold compresses to the breasts
  • getting regular exercise
  • engaging in relaxation methods to reduce stressanxiety, and tension

Before attempting self-care practices, consult with a healthcare professional to ensure that they are acceptable. Medical intervention may be required in some cases.

Conclusion

Breast pain, also known as mastalgia, can be caused by a variety of factors. It’s possible that this ailment is cyclic or noncyclic. If the discomfort is cyclic, it is caused by the menstrual cycle’s fluctuating hormones.

PMS, fibrocystic breast changes, traumas and sprains, and inflammation around the ribs can all cause noncyclic breast pain. This symptom is sometimes caused by cysts or infections.

Despite the condition that breast cancer is rarely the cause of breast discomfort, anyone experiencing this symptom should see a doctor to rule it out.

Sources:

  • https://www.karger.com/Article/FullText/505364
  • https://www.cdc.gov/cancer/breast/index.htm
  • https://about-cancer.cancerresearchuk.org/about-cancer/breast-cancer/symptoms
  • https://www.stanfordchildrens.org/en/topic/default?id=breast-conditions-90-P01589
  • https://www.nationalbreastcancer.org/cyst-in-breast
  • https://www.breastcancer.org/symptoms/benign/cysts
  • https://www.nationalbreastcancer.org/breast-pain/
  • https://www.medicalnewstoday.com/articles/311833
  • https://www.nhs.uk/conditions/breast-pain/
  • https://www.nhs.uk/conditions/costochondritis/
  • https://www.breastcancer.org/symptoms/benign/fibrocystic-changes
  • https://www.ncbi.nlm.nih.gov/books/NBK562196/
  • https://www.ncbi.nlm.nih.gov/books/NBK551609/
  • https://www.breastcancer.org/symptoms/benign/mastalgia
  • https://www.cancer.org/cancer/breast-cancer/non-cancerous-breast-conditions/mastitis.html
  • https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome
  • https://www.breastcancer.org/treatment/side_effects/scar_tissue
  • https://www.ncbi.nlm.nih.gov/books/NBK562195/

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Breast Cancer

Stage 4 breast cancer: What you need to know

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Gender and sex exist on a spectrum. This article will use the terms “male,” “female,” or both to refer to the sex assigned at birth. To learn more, visit here.

When cancer spreads to distant organs, tissue, or lymph nodes, it is classified as stage 4 breast cancer. Stage 4 breast cancer is often known as advanced cancer, secondary breast cancer, or metastatic breast cancer by healthcare experts.

Symptoms differ depending on where the cancer has spread. Treatment for stage 4 breast cancer attempts to keep the cancer under control, reduce symptoms, and provide the best possible quality of life for the patient.

This article goes through the signs and symptoms of stage 4 breast cancer, as well as the outlook and treatment choices.

Stage 4 breast cancer

Stage 4 breast cancer

Stage 4 breast cancer develops when cancerous cells migrate beyond the breast and nearby lymph nodes to other parts of the body.

Breast cancer most usually spreads to the lungs, liver, and bones, according to the American Cancer Society (ACS). It can potentially spread to other organs like as lymph nodes, skin, and the brain.

Stage 4 breast cancer can be diagnosed as either a new case (de novo) or a recurrence of a previous case (recurrence).

Rates of survival

The Surveillance, Epidemiology, and End Results (SEER) Program database is used by the American Cancer Society to track 5-year relative survival rates.

A relative survival rate estimates how long a person with a certain ailment will survive after obtaining a diagnosis in comparison to those who do not have the condition.

If the 5-year relative survival rate is 70%, it signifies that a person with the ailment has a 70% chance of living for 5 years as someone who does not have the condition.

According to the American Cancer Society, the 5-year relative survival rate for stage 4 breast cancer is 28% for women and 22% for men.

The type of breast cancer a person has can also affect the 5-year relative survival rate. For example, the 5-year survival rate for a person with triple-negative breast cancer is 12%, and it is 19% for those with inflammatory breast cancer.

According to the American Cancer Society, survival statistics are dependent on a number of criteria but do not account for every facet of a person’s health and well-being.

The following are some aspects that survival rates do not consider:

  • the person’s age and overall health
  • the size of the tumor
  • the cancer’s response to treatment
  • the cancer’s HER2 status
  • the presence of hormone receptors on cancer cells
  • new treatment options that improve the long-term outlook

As a result, it’s essential to keep in mind that these figures are estimations. A person might inquire about how their disease is going to effect them from a healthcare practitioner.

Is it treatable?

Experts consider stage 4 breast cancer to be incurable, according to a 2016 report. Treatments, on the other hand, can assist to relieve symptoms, decrease the tumor, and extend survival time.

A person with stage 4 breast cancer should consult with a specialist to discover the best therapy choices for them.

Symptoms

The specific symptoms that a person may encounter depend on where the cancer is located.

The following are some examples of potential symptoms:

  • bone pain
  • issues with balance
  • weight loss
  • weakness anywhere throughout the body
  • a constant dry cough
  • confusion
  • loss of appetite
  • seizures
  • severe headaches
  • issues with vision
  • a constant state of nausea

Spread to bones

When breast cancer spreads to the bones, it can cause:

  • new and noticeable pain that comes and goes to begin with but becomes constant over time
  • fractures, which cause sudden and severe pain
  • back or neck pain
  • weakness and numbness
  • difficulty urinating
  • difficulty passing bowel movements
  • fatigue
  • nausea
  • weakness
  • loss of appetite
  • dehydration

Spread to brain

Symptoms related to cancer that spread to the brain include:

  • headaches
  • memory problems
  • seizures
  • changes in personality and mood
  • stroke
  • slurred speech
  • blurred vision
  • dizziness
  • issues with balance

Spread to liver

When breast cancer spreads to the liver, it can cause symptoms such as:

  • fatigue
  • weakness
  • swelling in the legs
  • weight loss
  • lack of appetite
  • jaundice
  • abdominal pain

Spread to lungs

If breast cancer spreads to the lungs, a person may experience:

  • shortness of breath
  • a persistent cough
  • wheezing
  • coughing up blood and mucus
  • pain in the lung

Treatment 

Stage 4 breast cancer cannot be cured with treatment. The treatment’s goal is to:

  • slow down and control the growth of the cancer
  • relieve any symptoms
  • increase life expectancy and quality of life

Researchers are continually exploring for new ways to treat stage 4 breast cancer.

Currently, the most common treatments that doctors may recommend include:

Stage 4 breast cancer may take both a physical and emotional toll on a person. An important part of treatment is helping the person cope with the emotions and stress connected with the diagnosis.

Palliative care may also be an option. This sort of care gives an extra layer of assistance to people with serious diseases and their families. It helps treat physical and mental problems and can optimize the person’s quality of life while they live with advanced cancer.

Some potential approaches for mental health care include:

  • reaching out to family and friends
  • talking with a social worker
  • having regular meetings with a psychologist or psychiatrist
  • joining support groups

BreastCancer.org recommends obtaining professional and experienced counselors and workers wherever feasible. However, it also indicates that people who are having problems paying may wish to seek therapy through a psychologist training program or clinic.

Chance of remission and recurrence

When cancer goes into remission, tests that seek for cancer cannot detect it. A doctor may refer to this pathological complete response.

Treatment may also produce partial remission. This suggests that therapy has destroyed a portion of the cancer but that testing can still discover the cancer.

Stage 4 breast cancer will not go away completely. However, Breastcancer.org states that therapy can help manage the cancer for years. It states that the cancer might be aggressive at times and go into remission at other times.

Because stage 4 breast cancer is not treatable, it will not vanish and then resurface.

Conclusion

Having stage 4 breast cancer indicates that cancer cells from the breast tissue have spread to distant areas of the body.

Signs and symptoms might vary dependent on where the cancer has progressed to. However, they may include bone discomfort, unexplained weight loss, lack of appetite, and severe headaches, among others.

Stage 4 breast cancer is not currently treatable. However, certain treatment methods can delay the spread of the cancer, reduce the symptoms, and prolong survival.

Sources

  • https://www.breastcancer.org/symptoms/types/recur_metast/metastic/bone
  • https://www.breastcancer.org/symptoms/types/recur_metast/metastic/brain
  • https://www.cancer.org/cancer/breast-cancer.html
  • https://www.medicalnewstoday.com/articles/stage-4-breast-cancer
  • https://www.breastcancer.org/symptoms/types/recur_metast/metastic/liver
  • https://www.breastcancer.org/symptoms/types/recur_metast/metastic/lung
  • https://www.breastcancer.org/symptoms/types/recur_metast/living_metast/mental-healthcare
  • https://www.breastcancer.org/symptoms/types/recur_metast
  • https://www.breastcancer.org/symptoms/types/recurrent
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844269/

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Breast Cancer

What to know about HER2-negative breast cancer

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HER2-negative breast cancer suggests that the cancerous cells do not have high amounts of the protein HER2. There are a variety of therapy options for this form of breast cancer, but the prognosis varies.

Understanding an HR-positive or HER2-negative

Human epidermal growth factor receptor 2 is abbreviated as “HER2.” It could be referring to the HER2 gene or the protein that the gene produces.

HER2 receptors are proteins found on the surface of breast cells. They normally aid in the regulation of healthy breast tissue growth and repair.

When the HER2 gene malfunctions and starts generating too many copies of itself, HER2 proteins on the surface of breast cells are overproduced. This can lead to cancer that is HER2-positive.

This page offers an overview of HER2-negative breast tumors, which are cancers that develop for reasons other than a defective HER2 gene.

We detail the treatment choices for various forms of HER2-negative cancers, as well as the prognosis and survival rates.

Diagnosis

A doctor will need to ascertain the type of breast cancer a person has in order to make a diagnosis. This entails extracting a small amount of breast tissue for testing during surgery or a biopsy.

Testing indicates which genes and proteins are involved in the progression of cancer. This aids in determining the best therapy alternatives.

Types

The presence or lack of hormone receptors on the surface of cancer cells is used to differentiate HER2-negative breast cancer into two types in most studies:

  • hormone receptor-positive (HR-positive) breast cancer
  • triple-negative breast cancer

Hormones such as estrogen and progesterone have a function in the development of healthy breast tissue. Individual protein receptors on the surface of breast cells exist for each hormone. Hormones are taken up by the receptors, which tell the cells to expand.

When a cancer is HR-positive, the cells proliferate and multiply by using estrogen, progesterone, or both. When a malignancy is classified as triple-negative, it lacks these hormone receptors.

As we’ll see below, there are several subtypes of these cancers:

Luminal (HR-positive) breast cancers

Breast cancers that grow in the inner, or luminal, cells are known as Luminal Breast Cancers. The mammary ducts are lined by these cells.

HR-positive Luminal cancers are those that involve at least one type of hormone receptor.

Luminal A (LA) and Luminal B (LB) are the two kinds of luminal breast cancer (LB).

The main difference between the two types is that LA cells have a lower concentration of a protein known as Ki-67. This protein regulates the rate at which tumor cells develop. As a result, LA malignancies grow more slowly than LB cancers and have a better prognosis.

Luminal A breast cancer

According to certain research, LA breast cancer accounts for 30–45 percent of all breast cancers.

The following are some of the characteristics of LA cancer:

  • cells that are HER2-negative
  • cells that test positive for estrogen receptors
  • lower levels of Ki-67
  • low-grade tumors

Luminal B breast cancer

According to some estimates, LB breast cancer accounts for 10–20 percent of all breast cancers.

HER2-negative or HER2-positive LB cancers exist. It is also characterized by the following characteristics:

  • cells that test positive for estrogen receptors
  • higher levels of Ki-67
  • higher-grade tumors
  • larger tumors
  • a higher chance of spreading to a lymph node

Triple-negative breast cancer

Approximately 10–15% of all breast cancers are triple-negative. Triple-negative breast cancer tests negative for three receptors:

  • HER2
  • estrogen
  • progesterone

Triple-negative breast cancer is more common in:

  • people who have a mutation in the BRCA1 gene
  • Black people
  • people below the age of 50
  • premenopausal people

General treatments

Several factors influence the type of treatment a person receives, including:

  • the stage of cancer
  • whether and where the cancer has spread
  • whether there are hormone receptors in the cells
  • genetic mutations
  • symptoms
  • previous treatments
  • overall health

Surgery, chemotherapy, radiation therapy, bisphosphonates, or a combination of these treatments may be required for those with HER2-negative breast cancer.

Surgery

Most people with breast cancer have surgery to remove the tumor. There are two main types of surgery:

Breast-conserving surgery: This involves the removal of the tumor and some of the surrounding healthy breast tissue.

Mastectomy: This involves the total removal of the affected breast.

Chemotherapy

Chemotherapy medications work by limiting cancer cells’ capacity to divide and develop.

For triple-negative breast cancers, chemotherapy is more common than for luminal breast cancers. Both forms, however, may require chemotherapy, especially if the tumor is larger than 1 centimeter (cm) ,

Radiation therapy

High-intensity X-rays are used to kill cancer cells in this treatment.

Bisphosphonates

Some people may be prescribed bisphosphonates by their doctors to help prevent breast cancer from spreading to their bones.

Bisphosphonate medications include zoledronic acid and sodium clodronate, to name a few.

Specific treatments

Some luminal breast cancer treatments will not be appropriate for triple-negative breast cancer, and vice versa.

Specific treatment methods for both categories are listed in the sections below:

Options for luminal (HR-positive) breast cancer

Hormone therapy is given to the majority of people who have luminal or other forms of HR-positive breast cancer. This is referred to as endocrine therapy by others.

Because it is HR-negative, triple-negative breast cancer does not respond to hormone therapy.

Anti-estrogen therapy

Anti-estrogen therapy works by inhibiting estrogen from binding to breast cancer cells’ estrogen receptors.

Anti-estrogen therapy is divided into four categories:

  • selective estrogen-receptor response modulators, such as tamoxifen
  • aromatase inhibitors
  • estrogen-receptor downregulators, such as fulvestrant (Faslodex)
  • luteinizing hormone releasing agents, including goserelin (Zoladex) and leuprolide (Lupron), prevent the ovaries from producing estrogen

The type of anti-estrogen therapy a person receives depends on various factors, including:

  • the stage of the breast cancer
  • whether the person has any other medical conditions
  • whether the person has been through menopause

A person usually continues hormone therapy for at least 5 years.

Other hormone therapies

HR-positive breast cancer may not respond to the therapy listed above in some circumstances. As a result, for more advanced cancer, a doctor may consider one of the hormone therapy listed below:

  • progestin medications, such as megestrol (Megace)
  • an anabolic steroid, such as fluoxymesterone (Halotestin)

Targeted therapies

Targeted therapies target specific genetic alterations that contribute to the growth and spread of cancer. These medications are frequently used in conjunction with hormone therapy.

Treatments for HR-positive, HER2-negative metastatic breast cancer target and block CDK4/6, a protein thought to drive tumor growth, according to specialists.

CDK4/6 inhibitors include the following:

  • abemaciclib (Verzenio)
  • palbociclib (Ibrance)
  • ribociclib (Kisqali)

Targeted therapy is paired with a gonadotropin-releasing hormone analog or ovarian suppression in men and women who have not yet reached menopause.

Triple-negative breast cancer treatment options

The following therapies may be used instead of or in addition to the more general cancer treatments listed above for some persons with triple-negative breast cancer:

Immunotherapy

Immunotherapy medications like atezolizumab (Tecentriq) and pembrolizumab (Keytruda) assist the immune system in attacking cancer cells.

Cancer cells can hide from the immune system thanks to proteins like the PD-L1 protein. Tecentriq inhibits the development of PD-L1, a protein that the immune system uses to recognize and kill cancer cells.

Therapy that is specific to the patient

In triple-negative breast cancer, doctors also use targeted medicines to treat specific genetic abnormalities. For those who have already had two treatments, the medication sacituzumab govitecan-hziy (Trodelvy) was approved in 2020. It’s an antibody drug conjugate, which means it binds to cancer cells and kills them.

Inhibitors of PARP

Triple-negative breast cancer is caused by a mutation in the BRCA1 or BRCA2 genes in certain patients. PARP inhibitors may be beneficial to these folks.

Poly ADP-ribose polymerase is the acronym for poly ADP-ribose polymerase. It’s a DNA-repair enzyme that works in both healthy and malignant cells.

PARP inhibitors prevent the PARP enzyme from working properly. Cancers with a BRCA1 or BRCA2 gene mutation have a tougher time surviving DNA damage as a result of this. Olaparib (Lynparza) and talazoparib are two examples (Talzenna).

Outlook

The percentage of people who are alive after a given amount of time after being diagnosed with cancer is referred to as the cancer survival rate.

The survival rate for breast cancer is determined by a variety of factors, including the tumour’s grade and stage.

Under a microscope, the grade indicates how aberrant the malignant cells appear. Cells that appear abnormal proliferate and spread more quickly.

The cancer’s stage refers to how big it is and how far it has spread. This is normally measured on a scale of 0 to 4 by doctors.

Cancers at stage 0 are ones that are still in the early stages of development and have not spread to neighboring cells. Cancers in stage 4 are the most advanced and have the worst prognosis.

Cancer survival rates are also influenced by the following factors:

  • whether the cancer is HR-positive or HR-negative
  • the person’s age at diagnosis
  • the person’s overall health

Cancer-specific survival rates

Survival statistics for several forms of breast cancer are included in a 2019 overview of breast cancer therapy.

HR-positive cancers, such as luminal cancers, had a greater survival rate than triple-negative breast cancers, according to the findings.

Stage 1 cancer survival rates

Stage 1 HR-positive breast cancer has a 5-year survival rate of roughly 99 percent.

Furthermore, because LA breast cancer has lower Ki-67 levels than LB breast cancer, it grows more slowly. As a result, clinicians are more likely to discover LA cancer at an earlier stage, giving patients a somewhat better prognosis.

Stage 1 triple-negative breast cancer has an 85 percent 5-year survival rate. These cancers have a faster growth rate and respond to fewer treatments.

Metastatic cancer survival rates

Breast cancers can spread to other parts of the body, which is known as metastasis. The prognosis for metastatic cancer is substantially worse.

Following a diagnosis of metastatic cancer, people with HR-positive breast cancer usually live for another 4–5 years. Following the same diagnosis, people with triple-negative breast cancer may live an extra year.

It’s crucial to keep in mind that survival statistics are estimations based on the outcomes of people who have had cancers that are similar to yours.

However, cancer survival rates are influenced by a variety of complex circumstances. These variables will differ from one person to the next.

Summary

HR-positive breast cancer and triple-negative breast cancer are the two main kinds of HER2-negative breast cancer. Treatments for various cancers differ in some ways.

Breast cancers that are HR-positive have a better prognosis than cancers that are triple-negative.

People can use survival rates to estimate how successful their treatment will be. People should, however, speak with their doctor for further information regarding their specific treatment plan and prognosis.

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