Breast Cancer: Typing and Staging

Let me begin by saying that I do not support the use of conventional treatments that are detrimental to the immune system.  Cancer patients should seek out a holistic practitioner who can help them determine the root cause of their illness and then address their healing by treating the whole body, not the tumor which is only a symptom of a larger illness.

The signs of breast cancer

Breast cancer can present itself in many ways, sometimes as a steady pain or an occasional throbbing, and can also include some deep tissue and upper back pain.  Breast cancer often appears without the classic lump but by displaying  symptoms such as swelling, irritation, dimpling, nipple discharge, nipple inversion, and/or a thickening and darkening of the skin around the nipple.

Breast cancer occurrence

11.9% of all cancer cases occur in the breast tissue of both males and females and it is the most common cancer in women.  Cancer of the breast claims more than 500,000 lives every year and regular screening and early detection have not decreased the number breast cancer incidence, nor have they improved the survival rates of those who have been diagnosed with the disease.

There are several distinct types and classifications of breast cancer that are based on where the cancer began, how it looks under the microscope, and whether it is still confined to its place of origin.  Breast cancers are further categorized on whether they are fueled by hormones, or by their molecular activity.  Here is an overview of breast cancer classifications that is based on the National Cancer Institute, American Cancer Society, and breastcancer.org, followed by the current treatments that are offered by conventional medicine.

Pre-cancerous or non-cancerous breast conditions

  • Ductal carcinoma in situ or DCIS-  about 60,000 cases per year, or one out of every five cancers that are detected through the use of mammography screenings are classified as Ductal Carcinoma In Situ (or DCIS).  DCIS refers to the abnormal growth of cells that are encapsulated within the milk ducts of the breast.  DCIS  is a calcified lesion that is approximately 1 – 1.5 cm in diameter and appears at white specks on the mammogram due to these mirco-calcifications.  It is considered to be a non-invasive or “stage zero breast cancer,” with some experts arguing for its complete re-classification as a non-cancerous condition.  Those diagnosed with DCIS remain asymptomatic and have no palpable lesions.  Because doctors say that they have no way to tell whether DCIS will develop into an invasive cancer so they generally follow the standard protocols of lumpectomy or mastectomy, followed by radiation, and a prescription for Tamoxifen.  Read more about DCIS
  • Lobular carcinoma in situ- also called lobular neoplasia, are confined to the milk-producing glands of the breast. Only a few women per 100,000 develop LCIS. It is usually invisible on mammograms and only detected during a biopsy done for another reason. LCIS is usually not treated with surgery, but because surgery can raise the risk of later being diagnosed with an invasive cancer, so doctors will often prescribe Tamoxifen.  Read about the health risks related to tamoxifen and finding natural solutions

Tissue of Origin Cancers

  • Invasive ductal carcinoma- begins in the milk duct and accounts for 80% of all breast cancers. Rare subtypes of invasive ductal cancer are named for how the cells look under a microscope such as shape or arrangement. These subtypes generally have a good prognosis, although they may be present with other, more aggressive subtypes.
  • Invasive lobular carcinoma- accounts for around 10% of invasive cancers and begins in the milk-producing lobules. Unlike ductal cancer cells that tend to form a mass that can be felt if it is large enough, lobular cancer cells invade creating a web-like structure making it difficult to be detected by physical examination of the breast or by mammogram.  For this reason, the tumor may be large by the time it causes noticeable symptoms such as pulling of the skin or nipple.
  • Cancers of the Breast Connective Tissue — muscles, fat, or blood vessels. These include Phyllodes tumor, angiosarcoma, and Paget’s Disease which is a rare cancer of the nipple and areola.

Inflammatory breast cancer- accounts for less than 5% of cases and is more common among African American women.  It is a very aggressive cancer which starts in the milk ducts and causes reddening and swelling as early symptoms. Typically, inflammatory tumors are not fueled by estrogen and progesterone, so hormone therapies such as tamoxifen are not prescribed.  Women are most often treated with chemotherapy and surgery.

Hormone status of cancers-  In addition to the classifications above, cancers can be analyzed for their sensitivity to the body’s sex hormones. Estrogen receptor-positive and progesterone receptor-positive tumors are often treated with hormone-blocking medications such as Tamoxifen and aromatase inhibitors.  Read more about the health risks relating to Tamoxifen.

Molecular sub-types 

  • Luminal A- these cancers are hormone-receptor positive, and HER-2 negative — meaning they lack a gene mutation that causes overproduction of the cell-growth receptor HER-2. HER-2 positive cancers are aggressive and are often treated with the drug Herceptin (a hormone therapy).  Herceptin appears to work best in early-stage cancers before the cells have evolved and it becomes harder to treat.  But even in the early-stage cancers, the drug’s effectiveness is generally modest.  In women who test positive for the HER2 protein, Herceptin appears to shrink tumors in roughly one third- and this is a response that typically does not last long.
  • Luminal B -these cancers are positive for estrogen, progesterone, and HER-2 receptors.  They often occur in younger women and have a poorer prognosis than the luminal A cancers.
  • Basal-like cancers/ triple negative breast cancer-  about 15% of breast cancers are found to be triple-negative. This means that the cancerous cells have tested negative for all three hormone receptors, including estrogen (ER-), progesterone (PR-), and HER2 (HER2-).   Having negative test results means that the growth of the tumor is not supported by the estrogen and progesterone, nor by the presence of HER2 receptors. Because of this, triple-negative breast cancers will not respond to the often prescribed hormonal therapies such as tamoxifen, or to therapies that target the HER2 receptors such as Herceptin.Triple negative breast cancers are most likely to occur in pre-menopausal women aged 40 or 50. It is more common in African-American and Hispanic women, and in those who carry the BRCA1 mutation. Triple negative cancers are considered to be aggressive by conventional standards, and are therefore treated very aggressively with surgery, radiation therapy, and/or chemotherapy.  Triple-negative breast cancer is more invasive than other forms of the disease, with tumors that grow more aggressively, spread to other parts of the body faster, and recur more frequently. Women with triple-negative cancer have lower five-year survival rates than other breast cancer patients, with about 34 percent of treated patients experiencing a distant recurrence within 2.6 years following their treatments.  Additionally, current treatment models for triple-negative breast cancer are extremely limited. After completing initial therapies, women often have very few options to prevent recurrence.  Some natural therapies that may help with triple negative cancers

Hormone receptors

  • ER+: About 80% of breast cancers are estrogen-receptor positive.
  • ER+/PR+: About 65% of estrogen-receptor-positive breast cancers are also progesterone-receptor-positive. This means that the cells have receptors for both hormones  that may be supporting the growth of the breast cancer.
  • ER+/PR-: About 13% of breast cancers are estrogen-receptor-positive and progesterone-receptor-negative. This means that estrogen, but not progesterone, may be supporting the growth and spread of the cancer cells.
  • ER-/PR+: About 2% of breast cancers are estrogen-receptor-negative and progesterone-receptor-positive. This means that the hormone progesterone may be supporting the growth of this cancer. Only a small number of breast cancers test negative for estrogen receptors but positive for progesterone receptors.
  • ER-/PR-: If the breast cancer cells do not have receptors for either hormone, the cancer is considered estrogen-receptor-negative and progesterone-receptor-negative (or “hormone-receptor-negative”). About 25% of breast cancers fit into this category.

stages of breast cancer

The Four Stages of Cancer

1. Stage 0: This is used to describe cancer in situ, which means “in place.” Cancers at this stage are identified according to the location where they initially emerged and multiplied. However, the resulting tumor has not yet spread to the nearby tissues and can be removed with surgical means. The prognosis for Stage 0 cancers is very high.

2. Stage 1: At this stage, the cancer cells have gained the ability to pass through the “basement membrane,” which is the thin, fibrous boundary of the tissue in which the cancer began and then start to invade the neighboring tissues.  This cancer has not yet spread into the lymphatic system and so it is referred to as an “early stage” cancer.  Surgical removal as well as complementary and alternative treatment options are a consideration at this time, as well as making changes to the diet, lifestyle, and personal habits in order to fight this cancer and prevent its return.

3. Stage 2 and 3: Once a cancer cell has invaded, a common next step is for one of its daughter cells to invade through a lymph vessel (which is similar to a blood vessel and carries the clear fluid called lymph).  It is here that the cancerous cell might get caught in a lymph node where it might provoke an immune response against it (which will result in its destruction). If that doesn’t happen, it will divide and form into a lump in one or more lymph nodes. This stage is often referred to as regional spread. That is, the cancer has spread within the general region in which it first began but not to other parts of the body.   Stage 2 and 3 cancers are a more serious concern, but the cancer has not yet spread to the other organs of the body.  Boosting your immune system is crucial at this level.  Complementary and alternative treatment options should be given top priority at this time, as well as making permanent changes to the diet, lifestyle, and personal habits in order to fight this cancer and prevent its return.

4. Stage 4: In the previous example, the cells that formed the lump in the lymph nodes have now spread further through the lymph vessels and have also entered the blood stream.  Once in the blood stream, the cancer cells can go just about anywhere in the body to form new colonies and spread further into the other organs of the body. Stage 4 is referred to as a “distant spread cancer”, advanced cancer, or metastatic cancer. This type of cancer is much more difficult to treat. Boosting your immune system is now of critical importance.  Complementary and alternative treatment options should be given top priority at this time, as well as making permanent changes to the diet, lifestyle, and personal habits in order to fight this cancer from all fronts  and have a better chance at achieving long-term survival.

Genetic Testing

MammaPrint- Can help identify which patients may safely forego chemotherapy. This is done by testing a panel of 70 genes within the tumor to assess if the tumor is aggressive and the chances of it recurring. The use of MammaPrint reduced chemotherapy prescriptions by 46% among the more than 3,300 patients in the trial categorized as having a high risk of breast cancer recurrence based on common clinical and pathological criteria.  “If we can select those patients that don’t need chemotherapy, unneeded treatment can be avoided and we will be one step closer to making sure treatment for breast cancer is tailored to the individual,” said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City.

MammaPrint testing will be particularly valuable for young women with breast cancer, said Dr. Victor Vogel, director of Breast Medical Oncology/Research for the Geisinger Health System in Pennsylvania, since they are more likely to receive chemotherapy in standard breast cancer care, even though it can destroy their fertility and leave them open to long-term health problems, Vogel said.  “In my training, if you had a young woman with breast cancer, she got chemotherapy,” Vogel said. “But now we can be selective, and we know there’s a very large number of young women with small hormone-responsive tumors who do not need chemotherapy.”  This test is covered by Medicare and by most insurance companies.  Find out more with this link.   

 

 

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