Breast Cancer

BREAST CANCER SYMPTOMS, STAGES, AND TREATMENT

Breast cancer is the most common type of cancer in women. At Acıbadem, we provide high-quality medical care for diagnosis and treatment with excellent results.

We team up against breast cancer when we provide the best partnership from our patients’ diagnosis to the end of their treatment. With more than 20 years of experience, a team of 50 specialized healthcare professionals, world-class technological advancements, and a multidisciplinary approach, we are here to defeat breast cancer.

What is breast cancer? 

Breast cancer occurs when abnormal cells begin to grow and reproduce out of control. These cells form a tumor mass that can be either benign (noncancerous) or malignant (cancerous). Benign tumors are abnormal growths that do not spread outside of the breast, and they are not dangerous. Breast cancer refers to a malignant tumor that starts in the ducts or lobes of the breast and has the potential to spread to other parts of the body (metastasize). 

What does breast cancer look like? 

The early signs of breast cancer are easier to feel than see. Performing regular self-exams can help women become familiar with the normal look and feel of their breasts and notice any changes quickly. Breast cancer often feels like a lump in the breast. Although many types of breast cancer can cause a lump, not all do. In addition, breast lumps are very common, and most of them are not cancer. Breast cysts, fibroadenomas, and adenosis, for instance, are benign conditions that may produce lumps. Breast cancer tumors feel rigid to the touch. If you detect a lump that is new and feels firm and immobile, you should make an appointment.

Breast cancer causes

The precise causes of breast cancer are still unclear. The main known risks are simply being a woman and getting older. Two-thirds of breast cancer patients are women over 50, and most of the rest are between 39 and 49. Inherited gene mutations cause up to 10% of breast cancer cases. An inherited mutation of the tumor suppressor genes BRCA1 or BRCA2 significantly increases the risk of developing the disease. Additionally, a woman whose mother, sister, or daughter has had breast cancer is two to three times more likely to get it too. Nowadays, people with a family history of breast cancer can do genetic testing and take a risk assessment to make informed decisions about their health. 

Along with the risk factors out of their control, there are some lifestyle choices women can make to improve their chances. Gaining weight increases the risk of breast cancer, especially in menopausal women. Women using birth control pills, on hormone replacement therapy, with no children, or who have their first child after the age of 30 years may also have a higher risk. A sedentary lifestyle and alcohol consumption increase the risk while regular exercise and physical activity decrease the risk of breast cancer.

Can men get breast cancer? 

Breast cancer occurs most often in women, but it can also occur in men. Men account for less than 1% of all detected cases. Male breast cancer forms in the breast tissue, just like in women. Family history, certain genetic disorders, exposure to estrogen or radiation, and obesity and alcohol consumption may contribute to a higher risk of developing breast cancer in a man. It is important to know that men can get breast cancer too. Due to the lack of awareness, men often ignore the early signs of the disease and only consult a doctor at later stages. If detected early, male breast cancer has a similar prognosis and survival rate as female breast cancer.

Early signs of breast cancer

Most women do not have any physical signs of breast cancer at the time of diagnosis. While the tumor is still small, there are usually no alarming signs. This is why regular screening is crucial for early detection.

Breast cancer symptoms

Breast cancer is usually associated with a lump anywhere in the breast or the armpit. However, there are many other warning signs, including:

• Any change in the size, shape, or texture of the breast
• Nipple deformities, such as nipple retraction (turning inward) or inversion
• Skin changes, such as dimpling of the surface, orange peel skin, irritation, or a rash
• A marble-like area under the skin
• Discharge from the nipples that may be clear, yellow, bloody, etc.
• Breast pain that does not go away during the next period

Anything that feels different or unusual should be referred to a doctor because breast cancer symptoms may vary from person to person or depending on the specific type. 

Types of breast cancer 

Breast cancers are not all the same. A tumor can start in different parts of the breast. In nearly 85% of cases, the tumor forms in the epithelium of the ducts that carry milk to the nipple (ductal carcinoma), and up to 15% of cases begin in the glandular tissue of the breast (lobular carcinoma). In rare cases, the tumor forms in other tissues of the breast, but these are usually sarcomas or lymphomas and are not considered breast cancers. 

Initially, the cancerous growth is limited to the duct or lobule, which is called in situ or noninvasive breast cancer. Over time, in situ cancers might progress and infiltrate the surrounding tissues, becoming invasive breast cancer. Invasive ductal carcinoma is the most common form, accounting for about 80% of cases, followed by invasive lobular carcinoma, accounting for 10–15%. There are also some rare types of breast cancer, such as Paget’s disease, which affects the nipple; phyllodes tumors, which develop in the breast’s connective tissues; inflammatory breast cancer, which is very aggressive; etc. 

In addition, breast tumors can be named according to their hormone receptor status. About two-thirds of tumors need the female hormones estrogen or progesterone to grow and reproduce. These cancer cells have receptors to catch and use the hormones. They are classified respectively as ER-positive or PR-positive. In these cases, hormone-blocking therapy can stop tumor growth. A tumor that is hormone receptor-negative (HR-negative) is not affected by hormonal therapies. Breast cancers may also be HER2-positive or negative, referring to the levels of a protein called human epidermal growth factor receptor 2. High levels fuel cancer growth, known as HER2-positive breast cancer. When none of the three receptors is detected, it is triple-negative breast cancer. Since each type requires a different treatment, accurate testing is essential for effective treatment. Diagnosing the exact type of breast cancer and how much it has spread within the body determines the treatment strategy and helps doctors to provide the best possible care.

Breast cancer diagnosis

The acquired knowledge of the team and advanced equipment allow for early detection of breast cancer, sometimes years before there would be any visible symptoms. The diagnostic process usually starts with imaging tests. The mammogram, which provides an x-ray of the breast, and the ultrasound, which uses high-frequency sound waves, have long been recognized as the main tools for diagnosing breast cancer. Nowadays, specialized breast centers have various mammography techniques at their disposal. Digital mammography allows images of the breast to be displayed in a digital format on computer screens. Three-dimensional mammography with tomosynthesis provides three-dimensional digital images with low doses of radiation. Four-dimensional breast ultrasonography or automated ultrasound helps practitioners to see clearly, even in dense breast tissue.

If imaging shows anything suspicious, part of the suspicious tissue should be examined by a pathologist under a microscope. This is called a biopsy. Biopsies can be taken in different ways, usually using a needle device with imaging guidance.

In a one-stop clinic, patients can do all the required tests in one visit. At Acıbadem, our experienced physicians have at their disposal the most advanced equipment for the diagnosis of breast cancer, including some devices only available in a few facilities in the world.

Stages of breast cancer 

Breast cancer stages describe the size and spread of cancer throughout the body. It is usually classified on a scale from 0 to IV, where higher numbers indicate a more invasive cancer. Stage 0 is also called noninvasive breast cancer or precancer. It means that there are abnormal cells, but they are limited to the milk ducts or glands and have not invaded surrounding tissues (carcinoma in situ). Stage IV breast cancer, on the other hand, is an advanced condition where the tumor has spread to distant parts of the body, possibly even to organs or bones.

Breast cancer is also graded to provide additional information on how much the cancer cells differ from normal cells and how slowly or quickly the tumor is expected to grow. Low-grade cancer means the abnormal cells are similar to normal cells, and they will probably grow slowly, while high-grade cancer means the opposite.

For patients with a new diagnosis, breast cancer staging and grading, along with hormone-receptor and HER2 status, are essential to help the medical team decide on the best treatment options.

Breast cancer treatment 

Nowadays, breast cancer treatment is highly effective and improving all the time. The treatment process might include surgery, radiotherapy, chemotherapy, hormonal therapy, targeted biological therapy, or immunotherapy.

• Chemotherapy. This treatment uses drugs to destroy fast-growing cells, including cancer cells, throughout the body. Most patients receive chemotherapy after surgery, but it could also be given before the operation to shrink the tumor.
• Hormone therapy. This treatment uses medications to prevent cancer cells from growing by blocking hormones or stopping hormone production. Only hormone receptor-positive breast cancers respond to hormonal therapy. It is usually a long-term treatment, continuing for 5–10 years to prevent the recurrence of cancer.
• Targeted therapy. Biological therapies, driven by advances in genetics and molecular biology, are among the most important recent achievements in cancer treatment. They use medications capable ofidentifying targets that are present in cancerous cells but not in normal cells. Thus, healthy cells are not attacked, and there are fewer side effects than from standard chemotherapy. There are various options for targeted treatment depending on the specific breast cancer type. Cancer cells can be tested to check whether a drug would be effective.
• Immunotherapy. This is an emerging treatment option. Immunotherapy activates the patient’s immune system to fight cancer cells. It may be used for patients with triple-negative breast cancer at an advanced stage.
• Radiotherapy. Radiation is a localized treatment used to kill cancerous cells with high-energy x-rays, electron beams, and radioactive isotopes. Radiotherapy prevents the growth of and kills cancer cells. Patients undergoing radiation therapy at Acıbadem benefit from linear accelerator devices with the latest features for the safest and most effective treatment.

Acıbadem Breast Cancer Center and our expert team provide a full range of breast cancer treatments under one roof, including some state-of-the-art options only available in a handful of clinics around the world:

• Surgery. This is usually the first step in treatment, especially for early-stage breast cancer. It aims to remove the cancerous tissues as completely as possible. When the entire breast tissue is removed, this is called a mastectomy. Mastectomies were frequently performed in the past. Today, mastectomies are used in advanced breast cancer cases or when there are multiple tumors within a breast. At Acıbadem, the first choice is always breast-conserving surgery, called a lumpectomy. This comprises the excision of the tumor with about 1–2 cm of normal tissue surrounding it, after which oncoplastic techniques are used to restore the breast and ensure good cosmetic results. Even when a mastectomy is required, our surgeons use new methods, such as nipple-sparing or skin-sparing mastectomies. As in a standard mastectomy, all the breast tissue is excised, but the nipple–areola complex is preserved for breast reconstruction. 

• Robot-assisted surgery. The robotic system Da Vinci can be used for mastectomies without any incisions on the breast, providing a high level of accuracy in treatment. The entire breast tissue is removed through a small incision in the armpit. This is followed by the placement of prosthetics through the same incision. Robotic breast cancer surgery ensures good cosmetic results, since there are no cuts on the breast, and the incision in the armpit is easy to conceal.
• Single-dose radiotherapy. For certain breast cancer patients, radiotherapy can be completed in a single session during surgery before the incision is closed. High-dose radiation is given only to a precise region, in the tumor bed itself, protecting the healthy tissue nearby. Intraoperative radiation therapy with a robotic device can be used in three ways: in postmenopausal patients with hormone-sensitive small tumors as a single dose following breast-conserving surgery, in premenopausal patients with hormone-sensitive small tumors as boost radiation, and in patients who have a nipple-sparing mastectomy to reduce the risk of recurrence.
• Immediate breast reconstruction. For many patients it is possible to restore the breast tissue during the same operation in which it is removed, using breast prosthetics or the patient’s own tissues.The latest reconstructive techniques are used at Acıbadem to restore the natural look of breasts affected by breast cancer.

Breast cancer survival rate 

Survival rates represent the percentage of breast cancer patients who survive for a certain length of time after being diagnosed. Usually, five-year survival is considered, since recurrence is less likely after this period. 

Medical developments in diagnosing and treating cancer have led to increased survival rates. Nowadays, breast cancer treatment is highly effective, with survival rates of 90% or higher, according to World Health Organization (WHO) data. However, survival rates depend on the type, stage, and specific characteristics of the cancer and the expertise of the medical team performing the treatment.

Breast cancer statistics 

The lifetime risk of developing breast cancer for a woman is about 12%. According to WHO data, half of breast cancer cases develop in women who have no identifiable risk factors other than sex and age (over 40 years).

Why choose Acıbadem for breast cancer treatment in Turkey?

The increasing variety of treatment options requires an integrated approach, with a care team of experienced specialists in different areas, to take into account every patient’s specific needs. 

At Acıbadem Breast Cancer Center, we have been serving patients from around the world for 30 years. We use a multidisciplinary approach for all patients, with experts in general surgery, medical oncology, radiation oncology, cosmetic and plastic surgery, radiology, pathology, and genetics, all specializing in breast cancer treatment. We are highly successful in diagnosing and treating breast cancer, thanks to our multidisciplinary approach, high-tech infrastructure, and world-class teams of specialists. 

We are proud to host the first and only higher education board-certified breast cancer institute in Turkey, the Acıbadem Senology Research Institute. This is a center of science contributing to global knowledge of breast cancer through research and experience.