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Breast cancer is the most common cancer among women worldwide. The estimated incidence of new breast cancer in women aged 40-44 is 63.3 per 100,000. The incidence of breast cancer increases with age, and its incidence is highest after menopause. In 2008, 458,503 women worldwide died of breast cancer. Since the early 1990s, breast cancer deaths have decreased in developed countries, but mortality from this disease is increasing in developing countries.
Patients with a family history may undergo genetic testing. The most common mutations associated with breast cancer are BRCA1 and BRCA2 mutations. Individuals with this mutation are more likely to develop breast cancer. If there are obvious lumps or areas that cause suspicion; Examine the size of the lumps and their relationship to the skin and pectoral muscles. Generally, irregular, painless, and firm masses are good for tumors. Other signs and symptoms; Swelling in part of the breast, skin irritation, abnormal asymmetry, pain, and inverted nipple, nipple or breast skin redness or scaling or discharge. In some cases, the first symptom of breast cancer is adenopathy, usually found in the armpit lymph nodes.
Oncotype-DX test, which is a genetic test in breast tumor samples, has been used in recent years as a guide for some patients who are candidates to receive hormonotherapy with estrogen/progesterone receptor-positive tumors, who cannot be decided to receive chemotherapy. The Oncotype-DX test is a test that determines the recurrence risk by detecting a recurrence score by investigating the presence of 21 genes that play a role in cancer recurrence.
Mammography can detect microcalcifications that may be associated with malignant tumors. It is also used as a screening test. Image: Normal breast (left) and breast with invasive tumors (right) Ultrasonography Breast ultrasound is widely used in the diagnosis of breast cancer to evaluate specific abnormalities detected on mammography. Ultrasonography can help distinguish cysts from solid masses, benign and malignant tumors. -MRI, -CT, -PET
Vivid: A clear diagnosis requires a biopsy.
Fine needle aspiration (FNA): The FNA technique is most likely used to differentiate benign cysts in tumors.
Core biopsy: As the tissue structure can be examined under the microscope, the core biopsy quickly replaced FNA and became the first choice in breast cancer treatment.
Histology Lymphatic / Vascular Invasion
As cancer spreads to the lymph nodes and the number of cancerous nodules increases, the prognosis worsens. The following methods are often used to assess the condition of the lymph nodes:
Hormone receptor (ER / PR) status If there are more estrogen receptors (ER) and progesterone receptors (PR) in the cell than normal, cancer will grow faster in the presence of these hormones. Test results show whether treatments that block estrogen and progesterone can stop cancer growth.
Human epidermal growth factor receptor 2 (HER2) status
If there are higher than normal levels of the HER2 protein on the cell surface, cancer can grow faster and is more likely to spread to other parts of the body.
Breast cancer without breast cancer (or very low expression levels of ER, PR, or HER2 receptors) is considered triple-negative breast cancer. These tumors are associated with poor prognosis.
The most widely used system for staging breast cancer is the TNM staging system. These stages provide prognostic indicators and guide treatment decisions. Non-invasive breast cancer (ductal carcinoma or lobular carcinoma in situ) is defined as stage 0 disease. The cancer is still limited to the ducts or lobules of origin and has not yet metastasized. Early breast cancer refers to locally or locally invasive cancer (stage I, stage II, and certain stage IIIA tumors) that can be surgically removed. Locally advanced disease describes locally spread cancers (stage IIIB, IIIC, and certain stage IIIA tumors) that do not spread to adjacent tissues (such as adjacent lymph nodes, skin, or chest wall) that cannot be surgically removed. Metastatic breast cancer refers only to stage IV disease. Cancer cells spread to distant parts of the body through the lymphatic system or blood circulation.
The patient's treatment decision; It determines the stage and size of the tumor, the likelihood and degree of metastasis, HER2 positive, the patient's physical condition (WHO, Karnowski Scale), the patient's age, preferences, and psychological status. Breast cancer treatment options: local surgery Radiation therapy Systematic Hormone Therapy Chemotherapy Biological therapy Supportive therapy