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Table of Contents General Information About Breast Cancer
Stages of Breast Cancer
Inflammatory Breast Cancer
Recurrent Breast Cancer
Treatment Option Overview
Treatment Options by Stage
Treatment Options for Inflammatory Breast Cancer
Treatment Options for Recurrent Breast Cancer
To Learn More About Breast Cancer
Get More Information From NCI
Changes to This Summary (08/01/2008)
About PDQ
General Information About Breast Cancer
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Breast cancer is a disease in which malignant (cancer) cells
form in the tissues of the breast.
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called
lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that
can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called
ducts. | Enlarge | | | | Anatomy of the breast, showing lymph nodes and lymph vessels. |
Each breast also has blood
vessels and lymph
vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph
vessels lead to organs called lymph
nodes. Lymph nodes are small bean-shaped structures that are
found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the
collarbone, and in the chest.
The most common type of breast cancer is ductal
carcinoma, which begins in the cells of the ducts. Cancer that begins in the
lobes or lobules is called lobular carcinoma and is more often found in both
breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of
breast cancer in which the breast is warm, red, and swollen.
See the PDQ summary on Unusual Cancers of Childhood for information about childhood breast cancer.
Age and health history can affect the risk of developing breast
cancer.
Anything that increases your chance of getting a disease
is called a risk factor. Risk factors for breast cancer include the following:
- Older age.
- Menstruating at an
early age.
- Older age at first birth or never having given birth.
- A personal history of breast cancer or benign (noncancer) breast disease.
- A mother or sister with breast cancer.
- Treatment with radiation therapy to the breast/chest.
- Breast tissue that is dense on a mammogram.
- Taking hormones such as estrogen and progesterone.
- Drinking alcoholic beverages.
- Being white.
Breast cancer is sometimes caused by inherited gene mutations
(changes).
The genes in cells carry
the hereditary information that is
received from a person’s parents. Hereditary breast cancer makes up
approximately 5% to 10% of all breast cancer. Some altered genes related to
breast cancer are more common in certain ethnic groups.
Women who have an altered gene related to breast cancer and who
have had breast cancer in one breast have an increased risk of developing
breast cancer in the other breast. These women also have an increased risk of
developing ovarian cancer, and may
have an increased risk of developing other cancers. Men who have an altered
gene related to breast cancer also have an increased risk of developing this
disease. For more information, see the PDQ summary on Male Breast Cancer Treatment.
Tests have been developed that can detect altered genes. These genetic tests are sometimes done for
members of families with a high risk of cancer. See the following PDQ summaries: for
more information:
Tests that examine the breasts are used to detect (find) and
diagnose breast cancer.
A doctor should be seen if changes in the breast are noticed. The
following tests and procedures may be used:
- Mammogram: An x-ray of the breast.
| Enlarge | | | | Mammography of the right breast. |
- Biopsy: The removal
of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is
found, the doctor may need to remove a small piece of the lump. Four types of
biopsies are as follows:
- Estrogen and progesterone receptor test: A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If cancer is found in the breast, tissue from the tumor is checked in the laboratory to find out whether estrogen and progesterone could affect the way cancer grows. The test results show whether hormone therapy may stop the cancer from growing.
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MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the cancer (the size of the tumor and whether it is in the breast only or has spread to lymph nodes or other places
in the body).
- The type of breast cancer.
- Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
- Whether the cells have high levels of human epidermal growth factor type 2 receptors (HER2/neu).
- How fast the tumor is growing.
- A woman’s age,
general health, and menopausal status (whether a woman
is still having menstrual periods).
- Whether the cancer has just been diagnosed or has recurred (come back).
 Back to Top Stages of Breast Cancer
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After breast cancer has been diagnosed, tests are done to find
out if cancer cells have spread within the breast or to other parts of the
body.
The process used to find out whether the cancer has spread within the breast or to other
parts of the body is called staging.
The information gathered from the staging process determines the stage of the disease. It is
important to know the stage in order to plan treatment.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for breast cancer:
Stage 0 (carcinoma in situ)
There are 2 types of breast carcinoma in situ:
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| Pea, peanut, walnut, and lime show tumor sizes. |
Stage I
In stage I, cancer has formed. The tumor is 2 centimeters or smaller and has not spread outside the breast.
Stage IIA
In stage IIA:
- no tumor is found in the breast, but cancer is found in the axillary lymph nodes (the lymph nodes under the arm);
or
- the tumor is 2 centimeters or smaller and has spread
to the axillary lymph nodes;
or
- the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not
spread to the axillary lymph nodes.
Stage IIB
In stage IIB, the tumor is either:
- larger than 2 centimeters but not larger than 5 centimeters and has spread
to the axillary lymph nodes; or
- larger than 5 centimeters but has not
spread to the axillary lymph nodes.
Stage IIIA
In stage IIIA:
- no tumor is found in the breast. Cancer is found in axillary lymph nodes that are attached to each other or to other structures, or cancer may be found in lymph nodes near the breastbone; or
- the tumor is 2 centimeters or smaller. Cancer has spread
to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or
- the tumor is larger than 2 centimeters but not larger than 5 centimeters. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or
- the tumor is larger than 5 centimeters. Cancer has spread to axillary
lymph nodes that may be attached to each other or to other
structures, or cancer may have spread to lymph nodes near the breastbone.
Stage IIIB
In stage IIIB, the tumor may be any size and cancer:
- has spread to the chest wall and/or the skin of the breast; and
- may have spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
Cancer that has spread to the skin of the breast is inflammatory breast cancer. See the section on Inflammatory Breast Cancer for more information.
Stage IIIC
In stage IIIC, there may be no sign of cancer in the breast or the tumor may be any size and may have spread to the chest wall and/or the skin of the breast. Also, cancer:
Cancer that has spread to the skin of the breast is inflammatory breast cancer. See the section on Inflammatory Breast Cancer for more information.
Stage IIIC breast cancer is divided into operable and inoperable stage IIIC.
In operable stage IIIC, the cancer:
- is found in ten or more axillary lymph nodes; or
- is found in lymph nodes below the collarbone; or
- is found in axillary lymph nodes and in lymph nodes near the breastbone.
In inoperable stage IIIC breast cancer, the cancer has spread to the lymph nodes above the collarbone.
Stage IV
In stage IV, the cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.
Back to Top Inflammatory Breast Cancer
In inflammatory breast
cancer, cancer has spread to the skin of the breast and the breast looks red and swollen and feels warm. The
redness and warmth occur because the cancer cells block the lymph vessels in the skin. The skin of the breast
may also show the pitted appearance called peau
d’orange (like the skin of an orange). There may not be any lumps in the breast that can be felt. Inflammatory breast cancer may be stage IIIB, stage IIIC, or stage IV.
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| Inflammatory breast cancer of the left breast showing peau d’orange and inverted nipple. |
Back to Top Recurrent Breast Cancer
Recurrent breast
cancer is cancer that has recurred
(come back) after it has been treated. The cancer may come back in
the breast, in the chest wall, or
in other parts of the body.
Back to Top Treatment Option Overview
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There are different types of treatment for patients with breast
cancer.
Different types of treatment are available for patients with breast
cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A
treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Four types of standard treatment are used:
Surgery
Most patients with breast cancer have surgery to remove the cancer from the breast. Some
of the lymph nodes under the arm
are usually taken out and looked at under a microscope to see if they contain
cancer cells.
Breast-conserving
surgery, an operation to remove the cancer but not the breast
itself, includes the following:
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| Breast-conserving surgery. Dotted lines show the area containing the tumor that is removed and some of the lymph nodes that may be removed. |
Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy. This procedure is called lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done through a separate incision.
Other types of surgery include the following:
- Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
| Enlarge | | | | Total (simple) mastectomy. The dotted line shows where the entire breast is removed. Some lymph nodes under the arm may also be removed. |
- Modified radical
mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under
the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
| Enlarge | | | | Modified radical mastectomy. The dotted line shows where the entire breast and some lymph nodes are removed. Part of the chest wall muscle may also be removed. |
- Radical
mastectomy: Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.
Even if the doctor removes all the cancer that can be seen at
the time of the surgery, some patients may be given radiation therapy, chemotherapy, or hormone therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to
increase the chances of a cure, is called adjuvant
therapy.
If a patient is going to have a mastectomy, breast reconstruction (surgery to
rebuild a breast’s shape after a mastectomy) may be considered. Breast
reconstruction may be done at the time of the mastectomy or at a future time.
The reconstructed breast may be made with the patient’s own (nonbreast) tissue
or by using implants filled with saline or silicone gel. Before the decision to get an implant is
made, patients can call the Food and Drug Administration's (FDA) Center for Devices and Radiologic Health at
1-888-INFO-FDA (1-888-463-6332) or visit the FDA's Web site for more information on breast implants.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working. The hormone estrogen, which makes some breast cancers grow, is made mainly by the ovaries. Treatment to stop the ovaries from making estrogen is called ovarian ablation.
Hormone therapy with tamoxifen is often given to patients with early
stages of breast cancer and those
with metastatic breast cancer (cancer
that has spread to other parts of the body). Hormone therapy with tamoxifen or
estrogens can act on cells all over the body and may increase the chance of
developing endometrial cancer.
Women taking tamoxifen should have a pelvic exam every year to look for any
signs of cancer. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.
Hormone therapy with an aromatase inhibitor is given to some postmenopausal women who have hormone-dependent breast cancer. Hormone-dependent breast cancer needs the hormone estrogen to grow. Aromatase inhibitors decrease the body's estrogen by blocking an enzyme called aromatase from turning androgen into estrogen.
For the treatment of early stage breast cancer, certain aromatase inhibitors may be used as adjuvant therapy instead of tamoxifen or after 2 or more years of tamoxifen. For the treatment of metastatic breast cancer, aromatase inhibitors are being tested in clinical trials to compare them to hormone therapy with tamoxifen.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in
clinical trials. It may not mention every new treatment being studied.
Information about clinical trials is available from the
NCI Web site.
Sentinel lymph node biopsy followed by surgery
Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the surgeon removes the tumor (breast-conserving surgery or mastectomy).
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