Lung & Breast Cancer-1

7/29/2019 Lung & Breast Cancer-1

1/22

Lung Cancer

The principal function of the lungs is to exchange gases between the air we breathe and theblood. Through the lung, carbon dioxide is removed from the bloodstream and oxygen from

inspired air enters the bloodstream. The right lung has three lobes, while the left lung is divided

into two lobes and a small structure called the lingula that is the equivalent of the middle lobe onthe right. The major airways entering the lungs are the bronchi, which arise from the trachea. The

bronchi branch into progressively smaller airways called bronchioles that end in tiny sacs known

as alveoli where gas exchange occurs. The lungs and chest wall are covered with a thin layer oftissue called the pleura.

Lung cancers can arise in any part of the lung, but 90%-95% of cancers of the lung are thought toarise from the epithelial cells, the cells lining the larger and smaller airways (bronchi and

bronchioles); for this reason, lung cancers are sometimes called bronchogenic cancers or

bronchogenic carcinomas. (Carcinoma is another term for cancer.) Cancers also can arise from

the pleura (calledmesotheliomas) or rarely from supporting tissues within the lungs, for

example, the blood vessels

How common is lung cancer?

Lung cancer is the most common cause of death due to cancer in both men and women

throughout the world

Lung cancer is predominantly a disease of the elderly; almost 70% of people diagnosed with

lung cancer are over 65 years of age, while less than 3% of lung cancers occur in people under45 years of age.

What causes lung cancer?

Smoking

The incidence of lung cancer is strongly correlated with cigarette smoking, with about 90% of

lung cancers arising as a result of tobacco use. The risk of lung cancer increases with the number

of cigarettes smoked and the time over which smoking has occurred; doctors refer to this risk in

terms of pack-years of smoking history (the number of packs of cigarettes smoked per daymultiplied by the number of years smoked). For example, a person who has smoked two packs of

cigarettes per day for 10 years has a 20 pack-year smoking history. While the risk of lung cancer

is increased with even a 10-pack-year smoking history, those with 30-pack-year histories or more

are considered to have the greatest risk for the development of lung cancer. Among those whosmoke two or more packs of cigarettes per day, one in seven will die of lung cancer.

Passive smoking

Passive smoking or the inhalation of tobacco smoke by nonsmokers who share living or workingquarters with smokers, also is an established risk factor for the development of lung cancer.

Research has shown that nonsmokers who reside with a smoker have a 24% increase in risk for
http://www.medicinenet.com/script/main/art.asp?articlekey=12308http://www.medicinenet.com/script/main/art.asp?articlekey=12308http://www.medicinenet.com/script/main/art.asp?articlekey=12308http://www.medicinenet.com/script/main/art.asp?articlekey=12308


2/22

developing lung cancer when compared with nonsmokers who do not reside with a smoker. An

estimated 3,000 lung cancer deaths that occur each year in the U.S. are attributable to passivesmoking.

Asbestos fibers

Asbestosfibers are silicate fibers that can persist for a lifetime in lung tissue following exposure

to asbestos. The workplace is a common source of exposure to asbestos fibers, Both lung cancerand mesothelioma (cancer of the pleura of the lung as well as of the lining of the abdominal

cavity called the peritoneum) are associated with exposure to asbestos. Cigarette smoking

drastically increases the chance of developing an asbestos-related lung cancer in workersexposed to asbestos. Asbestos workers who do not smoke have a fivefold greater risk of

developing lung cancer than nonsmokers, but asbestos workers who smoke have a risk that is

fifty- to ninetyfold greater than nonsmokers.

Radon gas

Radon gasis a natural, chemically inert gas that is a natural decay product of uranium. Uranium

decays to form products, including radon, that emit a type of ionizing radiation. Radon gas is a

known cause of lung cancer, with an estimated 12% of lung-cancer deaths attributable to radongas, or about 20,000 lung-cancer-related deaths annually in the U.S., making radon the second

leading cause of lung cancer in the U.S. As with asbestos exposure, concomitant smoking greatlyincreases the risk of lung cancer with radon exposure. Radon gas can travel up through soil and

enter homes through gaps in the foundation, pipes, drains, or other openings. Radon gas isinvisible and odorless, but it can be detected with simple test kits.

Familial predisposition

Recently, the largest genetic study of lung cancer ever conducted, involving over 10,000 peoplefrom 18 countries and led by the International Agency for Research on Cancer (IARC),

identified a small region in the genome (DNA) that contains genes that appear to confer an

increased susceptibility to lung cancer in smokers. The specific genes, located the q arm ofchromosome 15, code for proteins that interact withnicotineand other tobacco toxins (nicotinic

acetylcholine receptor genes).

Lung diseases

The presence of certain diseases of the lung, notablychronic obstructive pulmonary disease

(COPD), is associated with an increased risk (four- to sixfold the risk of a nonsmoker) for thedevelopment of lung cancer even after the effects of concomitant cigarette smoking are excluded.

Prior history of lung cancer

Survivors of lung cancer have a greater risk of developing a second lung cancer than the generalpopulation has of developing a first lung cancer. Survivors of non-small cell lung cancers

(NSCLCs, see below) have an additive risk of 1%-2% per year for developing a second lung
http://www.medicinenet.com/script/main/art.asp?articlekey=12629http://www.medicinenet.com/script/main/art.asp?articlekey=12629http://www.medicinenet.com/script/main/art.asp?articlekey=41532http://www.medicinenet.com/script/main/art.asp?articlekey=41532http://www.medicinenet.com/script/main/art.asp?articlekey=89308http://www.medicinenet.com/script/main/art.asp?articlekey=89308http://www.medicinenet.com/script/main/art.asp?articlekey=89308http://www.medicinenet.com/script/main/art.asp?articlekey=1976http://www.medicinenet.com/script/main/art.asp?articlekey=1976http://www.medicinenet.com/script/main/art.asp?articlekey=1976http://www.medicinenet.com/script/main/art.asp?articlekey=1976http://www.medicinenet.com/script/main/art.asp?articlekey=89308http://www.medicinenet.com/script/main/art.asp?articlekey=41532http://www.medicinenet.com/script/main/art.asp?articlekey=12629


3/22

cancer. In survivors of small cell lung cancers (SCLCs, see below), the risk for development of

second lung cancers approaches 6% per year.

Air pollution

Air pollution from vehicles, industry, and power plants can raise the likelihood of developinglung cancer in exposed individuals. Up to 1% of lung cancer deaths are attributable to breathing

polluted air, and experts believe that prolonged exposure to highly polluted air can carry a riskfor the development of lung cancer similar to that of passive smoking.

How can lung cancer be prevented?

Cessation of smoking and eliminating exposure to tobacco smoke is the most important measure

that can prevent lung cancer. Many products, such asnicotine gum, nicotine sprays, or nicotine

inhalers, may be helpful to people trying to quit smoking. Minimizing exposure to passivesmoking also is an effective preventive measure. Using a home radon test kit can identify and

allow correction of increased radon levels in the home.

What are the types of lung cancer?

Lung cancers, also known as bronchogenic carcinomas, are broadly classified into two types:small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC). This classification is

based upon the microscopic appearance of the tumor cells themselves. These two types of

cancers grow and spread in different ways and may have different treatment options, so adistinction between these two types is important.

NSCLC are the most common lung cancers, accounting for about 80% of all lung cancers.

NSCLC can be divided into three main types that are named based upon the type of cells foundin the tumor:

Adenocarcinomas are the most commonly seen type of NSCLC associated withsmoking, like other lung cancers, this type is observed as well in nonsmokers who

develop lung cancer. Most adenocarcinomas arise in the outer, or peripheral, areas of thelungs.

Bronchioloalveolar carcinoma is a subtype of adenocarcinoma that frequently developsat multiple sites in the lungs and spreads along the preexisting alveolar walls.

Squamous cell carcinomas were formerly more common than adenocarcinomas; atpresent, they account for about 30% of NSCLC. Also known as epidermoid carcinomas,

squamous cell cancers arise most frequently in the central chest area in the bronchi. Large cell carcinomas, sometimes referred to as undifferentiated carcinomas, are the

least common type of NSCLC.

Mixtures of different types of NSCLC are also seen.Other types of cancers can arise in the lung; these types are much less common than NSCLCand SCLC and together comprise only 5%-10% of lung cancers:
http://www.medicinenet.com/script/main/art.asp?articlekey=43951http://www.medicinenet.com/script/main/art.asp?articlekey=43951http://www.medicinenet.com/script/main/art.asp?articlekey=43951http://www.medicinenet.com/script/main/art.asp?articlekey=43951


4/22

Bronchial carcinoids account for up to 5% of lung cancers. These tumors are generallysmall (3 cm-4 cm or less) when diagnosed and occur most commonly in people under 40years of age. Unrelated to cigarette smoking, carcinoid tumors can metastasize, and a

small proportion of these tumors secrete hormone-like substances that may cause specific

symptoms related to the hormone being produced. Carcinoids generally grow and spread

more slowly than bronchogenic cancers, and many are detected early enough to beamenable to surgical resection.

Cancers of supporting lung tissue such as smooth muscle, blood vessels, or cells involvedin the immune response can rarely occur in the lung.

What are lung cancer symptoms and signs?

Symptoms of lung cancer are varied depending upon where and how widespread the tumor is.

Warning signs of lung cancer are not always present or easy to identify. A person with lung

cancer may have the following kinds of symptoms:

No symptoms: In up to 25% of people who get lung cancer, the cancer is first discoveredon a routinechest X-rayorCT scanas a solitary small mass sometimes called a coinlesion, since on a two-dimensional X-ray or CT scan, the round tumor looks like a coin.These patients with small, single masses often report no symptoms at the time the cancer

is discovered.

Symptoms related to the cancer: The growth of the cancer and invasion of lung tissuesand surrounding tissue may interfere with breathing, leading to symptoms such as cough,

shortness of breath, wheezing,chest pain, and coughing up blood (hemoptysis). If the

cancer has invaded nerves, for example, it may causeshoulder painthat travels down the

outside of the arm (called Pancoast's syndrome) orparalysisof the vocal cords leading tohoarseness. Invasion of the esophagus may lead to difficulty swallowing (dysphagia). If a

large airway is obstructed, collapse of a portion of the lung may occur and causeinfections (abscesses,pneumonia) in the obstructed area.

Symptoms related to metastasis: Lung cancer that has spread to the bones may produceexcruciating pain at the sites of bone involvement. Cancer that has spread to the brain

may cause a number of neurologic symptoms that may includeblurred vision,headaches,seizures, or symptoms ofstrokesuch asweaknessor loss of sensation in parts of the

body.

Paraneoplastic symptoms: Lung cancers frequently are accompanied by symptoms thatresult from production of hormone-like substances by the tumor cells. Theseparaneoplastic syndromes occur most commonly with SCLC but may be seen with any

tumor type. A common paraneoplastic syndrome associated with SCLC is the production

of a hormone called adrenocorticotrophic hormone (ACTH) by the cancer cells, leadingto oversecretion of the hormone cortisol by the adrenal glands (Cushing's syndrome). Themost frequent paraneoplastic syndrome seen with NSCLC is the production of a

substance similar to parathyroid hormone, resulting in elevated levels of calcium in the

bloodstream.

Nonspecific symptoms: Nonspecific symptoms seen with many cancers, including lungcancers, includeweight loss, weakness, andfatigue. Psychological symptoms such as

depressionand mood changes are also common.
http://www.medicinenet.com/script/main/art.asp?articlekey=336http://www.medicinenet.com/script/main/art.asp?articlekey=336http://www.medicinenet.com/script/main/art.asp?articlekey=336http://www.medicinenet.com/script/main/art.asp?articlekey=315http://www.medicinenet.com/script/main/art.asp?articlekey=315http://www.medicinenet.com/script/main/art.asp?articlekey=315http://www.medicinenet.com/script/main/art.asp?articlekey=34434http://www.medicinenet.com/script/main/art.asp?articlekey=34434http://www.medicinenet.com/script/main/art.asp?articlekey=87510http://www.medicinenet.com/script/main/art.asp?articlekey=87510http://www.medicinenet.com/script/main/art.asp?articlekey=87510http://www.medicinenet.com/script/main/art.asp?articlekey=3700http://www.medicinenet.com/script/main/art.asp?articlekey=3700http://www.medicinenet.com/script/main/art.asp?articlekey=3700http://www.medicinenet.com/script/main/art.asp?articlekey=24738http://www.medicinenet.com/script/main/art.asp?articlekey=24738http://www.medicinenet.com/script/main/art.asp?articlekey=24738http://www.medicinenet.com/script/main/art.asp?articlekey=109388http://www.medicinenet.com/script/main/art.asp?articlekey=109388http://www.medicinenet.com/script/main/art.asp?articlekey=109388http://www.medicinenet.com/script/main/art.asp?articlekey=2051http://www.medicinenet.com/script/main/art.asp?articlekey=2051http://www.medicinenet.com/script/main/art.asp?articlekey=6078http://www.medicinenet.com/script/main/art.asp?articlekey=6078http://www.medicinenet.com/script/main/art.asp?articlekey=6078http://www.medicinenet.com/script/main/art.asp?articlekey=450http://www.medicinenet.com/script/main/art.asp?articlekey=450http://www.medicinenet.com/script/main/art.asp?articlekey=450http://www.medicinenet.com/script/main/art.asp?articlekey=99346http://www.medicinenet.com/script/main/art.asp?articlekey=99346http://www.medicinenet.com/script/main/art.asp?articlekey=99346http://www.medicinenet.com/script/main/art.asp?articlekey=20628http://www.medicinenet.com/script/main/art.asp?articlekey=20628http://www.medicinenet.com/script/main/art.asp?articlekey=20628http://www.medicinenet.com/script/main/art.asp?articlekey=489http://www.medicinenet.com/script/main/art.asp?articlekey=489http://www.medicinenet.com/script/main/art.asp?articlekey=489http://www.medicinenet.com/script/main/art.asp?articlekey=64119http://www.medicinenet.com/script/main/art.asp?articlekey=64119http://www.medicinenet.com/script/main/art.asp?articlekey=64119http://www.medicinenet.com/script/main/art.asp?articlekey=334http://www.medicinenet.com/script/main/art.asp?articlekey=334http://www.medicinenet.com/script/main/art.asp?articlekey=334http://www.medicinenet.com/script/main/art.asp?articlekey=18262http://www.medicinenet.com/script/main/art.asp?articlekey=18262http://www.medicinenet.com/script/main/art.asp?articlekey=18262http://www.medicinenet.com/script/main/art.asp?articlekey=120806http://www.medicinenet.com/script/main/art.asp?articlekey=120806http://www.medicinenet.com/script/main/art.asp?articlekey=120806http://www.medicinenet.com/script/main/art.asp?articlekey=342http://www.medicinenet.com/script/main/art.asp?articlekey=342http://www.medicinenet.com/script/main/art.asp?articlekey=342http://www.medicinenet.com/script/main/art.asp?articlekey=120806http://www.medicinenet.com/script/main/art.asp?articlekey=18262http://www.medicinenet.com/script/main/art.asp?articlekey=334http://www.medicinenet.com/script/main/art.asp?articlekey=64119http://www.medicinenet.com/script/main/art.asp?articlekey=489http://www.medicinenet.com/script/main/art.asp?articlekey=20628http://www.medicinenet.com/script/main/art.asp?articlekey=99346http://www.medicinenet.com/script/main/art.asp?articlekey=450http://www.medicinenet.com/script/main/art.asp?articlekey=6078http://www.medicinenet.com/script/main/art.asp?articlekey=2051http://www.medicinenet.com/script/main/art.asp?articlekey=109388http://www.medicinenet.com/script/main/art.asp?articlekey=24738http://www.medicinenet.com/script/main/art.asp?articlekey=3700http://www.medicinenet.com/script/main/art.asp?articlekey=87510http://www.medicinenet.com/script/main/art.asp?articlekey=34434http://www.medicinenet.com/script/main/art.asp?articlekey=315http://www.medicinenet.com/script/main/art.asp?articlekey=336


5/22

How is lung cancer diagnosed?

Doctors use a wide range of diagnostic procedures and tests to diagnose lung cancer. Theseinclude the following:

The history and physical examination may reveal the presence of symptoms or signsthat are suspicious for lung cancer. In addition to asking about symptoms and risk factorsfor cancer development such as smoking, doctors may detect signs of breathingdifficulties, airway obstruction, or infections in the lungs.Cyanosis, a bluish color of the

skin and the mucous membranes due to insufficient oxygen in the blood, suggests

compromised function due to chronic disease of the lung. Likewise, changes in the tissue

of the nail beds, known as clubbing, also may indicate chronic lung disease.

Thechest X-rayis the most common first diagnostic step when any new symptoms oflung cancer are present. The chest X-ray procedure often involves a view from the back

to the front of the chest as well as a view from the side. Like any X-ray procedure, chest

X-rays expose the patient briefly to a small amount of radiation. Chest X-rays may reveal

suspicious areas in the lungs but are unable to determine if these areas are cancerous. Inparticular, calcified nodules in the lungs or benign tumors called hamartomas may be

identified on a chest X-ray and mimic lung cancer.

CT (computerized tomography, computerized axial tomography, or CAT) scansmay be performed on the chest, abdomen, and/or brain to examine for both metastatic and

lung tumors. A CT scan exposes the patient to a minimal amount of radiation. The mostcommon side effect is an adverse reaction to intravenous contrast material that may have

been given prior to the procedure. This may result initching, arash, orhivesthatgenerally disappear rather quickly. Severeanaphylactic reactions(life-threatening

allergic reactions with breathing difficulties) to contrast material are rare. CT scans of theabdomen may identify metastatic cancer in the liver or adrenal glands, and CT scans of

the head may be ordered to reveal the presence and extent of metastatic cancer in thebrain.

A technique called a low-dose helical CT scan (or spiral CT scan) is sometimes used inscreening for lung cancers. This procedure requires a special type of CT scanner and has

been shown to be an effective tool for the identification of small lung cancers in smokers

and former smokers. However, it has not yet been proven whether the use of thistechnique actually saves lives or lowers the risk of death from lung cancer. The

heightened sensitivity of this method is actually one of the sources of its drawbacks, since

lung nodules requiring further evaluation will be seen in approximately 20% of peoplewith this technique. Of the nodules identified by low-dose helical screening CTs, 90% are

not cancerous but require up to two years of costly and often uncomfortable follow-up

and testing. Trials are underway to further determine the utility of spiral CT scans inscreening for lung cancer.

Magnetic resonance imaging(MRI) scans may be appropriate when precise detail abouta tumor's location is required. The MRI technique uses magnetism, radio waves, and a

computer to produce images of body structures. As with CT scanning, the patient is

placed on a moveable bed which is inserted into the MRI scanner. There are no knownside effects of MRI scanning, and there is no exposure to radiation. The image and

resolution produced by MRI is quite detailed and can detect tiny changes of structures
http://www.medicinenet.com/script/main/art.asp?articlekey=10671http://www.medicinenet.com/script/main/art.asp?articlekey=10671http://www.medicinenet.com/script/main/art.asp?articlekey=10671http://www.medicinenet.com/script/main/art.asp?articlekey=336http://www.medicinenet.com/script/main/art.asp?articlekey=336http://www.medicinenet.com/script/main/art.asp?articlekey=336http://www.medicinenet.com/script/main/art.asp?articlekey=15781http://www.medicinenet.com/script/main/art.asp?articlekey=15781http://www.medicinenet.com/script/main/art.asp?articlekey=15781http://www.medicinenet.com/script/main/art.asp?articlekey=1992http://www.medicinenet.com/script/main/art.asp?articlekey=1992http://www.medicinenet.com/script/main/art.asp?articlekey=1992http://www.medicinenet.com/script/main/art.asp?articlekey=511http://www.medicinenet.com/script/main/art.asp?articlekey=511http://www.medicinenet.com/script/main/art.asp?articlekey=511http://www.medicinenet.com/script/main/art.asp?articlekey=12953http://www.medicinenet.com/script/main/art.asp?articlekey=12953http://www.medicinenet.com/script/main/art.asp?articlekey=12953http://www.medicinenet.com/script/main/art.asp?articlekey=421http://www.medicinenet.com/script/main/art.asp?articlekey=421http://www.medicinenet.com/script/main/art.asp?articlekey=421http://www.medicinenet.com/script/main/art.asp?articlekey=12953http://www.medicinenet.com/script/main/art.asp?articlekey=511http://www.medicinenet.com/script/main/art.asp?articlekey=1992http://www.medicinenet.com/script/main/art.asp?articlekey=15781http://www.medicinenet.com/script/main/art.asp?articlekey=336http://www.medicinenet.com/script/main/art.asp?articlekey=10671


6/22

within the body. People with heart pacemakers, metal implants, artificial heart valves,

and other surgically implanted structures cannot be scanned with an MRI because of therisk that the magnet may move the metal parts of these structures.

Positron emission tomography(PET) scanning is a specialized imaging technique thatuses short-lived radioactive drugs to produce three-dimensional colored images of those

substances in the tissues within the body. While CT scans and MRI scans look atanatomical structures, PET scans measure metabolic activity and the function of tissues.

PET scans can determine whether a tumor tissue is actively growing and can aid in

determining the type of cells within a particular tumor. In PET scanning, the patientreceives a short half-lived radioactive drug, receiving approximately the amount of

radiation exposure as two chest X-rays. The drug accumulates in certain tissues more

than others, depending on the drug that is injected. The drug discharges particles knownas positrons from whatever tissues take them up. As the positrons encounter electrons

within the body, a reaction producing gamma rays occurs. A scanner records these

gamma rays and maps the area where the radioactive drug has accumulated. For example,

combiningglucose(a common energy source in the body) with a radioactive substance

will show where glucose is rapidly being used, for example, in a growing tumor. PETscanning may also be integrated with CT scanning in a technique known as PET-CT

scanning. Integrated PET-CT has been shown to improve the accuracy of staging (seebelow) over PET scanning alone.

Bone scans are used to create images of bones on a computer screen or on film. Doctorsmay order a bone scan to determine whether a lung cancer has metastasized to the bones.

In a bone scan, a small amount of radioactive material is injected into the bloodstreamand collects in the bones, especially in abnormal areas such as those involved by

metastatic tumors. The radioactive material is detected by a scanner, and the image of the

bones is recorded on a special film for permanent viewing.

Sputum cytology: The diagnosis of lung cancer always requires confirmation ofmalignant cells by a pathologist, even when symptoms and X-ray studies are suspicious

for lung cancer. The simplest method to establish the diagnosis is the examination of

sputum under a microscope. If a tumor is centrally located and has invaded the airways,this procedure, known as a sputum cytology examination, may allow visualization of

tumor cells for diagnosis. This is the most risk-free and inexpensive tissue diagnostic

procedure, but its value is limited since tumor cells will not always be present in sputumeven if a cancer is present. Also, noncancerous cells may occasionally undergo changes

in reaction to inflammation or injury that makes them look like cancer cells.

Bronchoscopy: Examination of the airways by bronchoscopy (visualizing the airwaysthrough a thin, fiberoptic probe inserted through the nose or mouth) may reveal areas of

tumor that can be sampled (biopsied) for diagnosis by a pathologist. A tumor in the

central areas of the lung or arising from the larger airways is accessible to sampling using

this technique. Bronchoscopy may be performed using a rigid or a flexible fiberopticbronchoscope and can be performed in a same-day outpatient bronchoscopy suite, an

operating room, or on a hospital ward. The procedure can be uncomfortable, and it

requires sedation or anesthesia. While bronchoscopy is relatively safe, it must be carried

out by a lung specialist (pulmonologist or surgeon) experienced in the procedure. When atumor is visualized and adequately sampled, an accurate cancer diagnosis usually is

possible. Some patients may cough up dark-brown blood for one to two days after the
http://www.medicinenet.com/script/main/art.asp?articlekey=11912http://www.medicinenet.com/script/main/art.asp?articlekey=11912http://www.medicinenet.com/script/main/art.asp?articlekey=17467http://www.medicinenet.com/script/main/art.asp?articlekey=17467http://www.medicinenet.com/script/main/art.asp?articlekey=17467http://www.medicinenet.com/script/main/art.asp?articlekey=12547http://www.medicinenet.com/script/main/art.asp?articlekey=12547http://www.medicinenet.com/script/main/art.asp?articlekey=12547http://www.medicinenet.com/script/main/art.asp?articlekey=17467http://www.medicinenet.com/script/main/art.asp?articlekey=11912


7/22

procedure. More serious but rare complications include a greater amount of bleeding,

decreased levels of oxygen in the blood, and heart arrhythmias as well as complicationsfrom sedative medications and anesthesia.

Needle biopsy:Fine needle aspiration(FNA) through the skin, most commonlyperformed with radiological imaging for guidance, may be useful in retrieving cells for

diagnosis from tumor nodules in the lungs. Needle biopsies are particularly useful whenthe lung tumor is peripherally located in the lung and not accessible to sampling by

bronchoscopy. A small amount of local anesthetic is given prior to insertion of a thin

needle through the chest wall into the abnormal area in the lung. Cells are suctioned intothe syringe and are examined under the microscope for tumor cells. This procedure is

generally accurate when the tissue from the affected area is adequately sampled, but in

some cases, adjacent or uninvolved areas of the lung may be mistakenly sampled. Asmall risk (3%-5%) of an air leak from the lungs (called apneumothorax, which can

easily be treated) accompanies the procedure.

Thoracentesis: Sometimes lung cancers involve the lining tissue of the lungs (pleura)and lead to an accumulation of fluid in the space between the lungs and chest wall (called

apleural effusion). Aspiration of a sample of this fluid with a thin needle (thoracentesis)may reveal the cancer cells and establish the diagnosis. As with the needle biopsy, a

small risk of a pneumothorax is associated with this procedure.

Major surgical procedures: If none of the aforementioned methods yields a diagnosis,surgical methods must be employed to obtain tumor tissue for diagnosis. These can

include mediastinoscopy (examining the chest cavity between the lungs through a

surgically inserted probe with biopsy of tumor masses or lymph nodes that may containmetastases) or thoracotomy (surgical opening of the chest wall for removal or biopsy of a

tumor). With a thoracotomy, it is rare to be able to completely remove a lung cancer, and

both mediastinoscopy and thoracotomy carry the risks of major surgical procedures(complications such as bleeding, infection, and risks from anesthesia and medications).

These procedures are performed in an operating room, and the patient must be

hospitalized.

Blood tests: While routine blood tests alone cannot diagnose lung cancer, they mayreveal biochemical or metabolic abnormalities in the body that accompany cancer. For

example, elevated levels of calcium or of the enzyme alkaline phosphatase may

accompany cancer that is metastatic to the bones. Likewise, elevated levels of certainenzymes normally present within liver cells, includingaspartate aminotransferase(AST

or SGOT) andalanine aminotransferase(ALT or SGPT), signal liver damage, possibly

through the presence of tumor metastatic to the liver. One current focus of research in thearea of lung cancer is the development of a blood test to aid in the diagnosis of lung

cancer. Researchers have preliminary data that has identified specific proteins, or

biomarkers, that are in the blood and may signal that lung cancer is present in someone

with a suspicious area seen on a chest X-ray or other imaging study.

What is staging of lung cancer?

NSCLC are assigned a stage from I to IV in order of severity:
http://www.medicinenet.com/script/main/art.asp?articlekey=3463http://www.medicinenet.com/script/main/art.asp?articlekey=3463http://www.medicinenet.com/script/main/art.asp?articlekey=3463http://www.medicinenet.com/script/main/art.asp?articlekey=1978http://www.medicinenet.com/script/main/art.asp?articlekey=1978http://www.medicinenet.com/script/main/art.asp?articlekey=1978http://www.medicinenet.com/script/main/art.asp?articlekey=5768http://www.medicinenet.com/script/main/art.asp?articlekey=5768http://www.medicinenet.com/script/main/art.asp?articlekey=114975http://www.medicinenet.com/script/main/art.asp?articlekey=114975http://www.medicinenet.com/script/main/art.asp?articlekey=114975http://www.medicinenet.com/script/main/art.asp?articlekey=6610http://www.medicinenet.com/script/main/art.asp?articlekey=6610http://www.medicinenet.com/script/main/art.asp?articlekey=6610http://www.medicinenet.com/script/main/art.asp?articlekey=6583http://www.medicinenet.com/script/main/art.asp?articlekey=6583http://www.medicinenet.com/script/main/art.asp?articlekey=6583http://www.medicinenet.com/script/main/art.asp?articlekey=6583http://www.medicinenet.com/script/main/art.asp?articlekey=6610http://www.medicinenet.com/script/main/art.asp?articlekey=114975http://www.medicinenet.com/script/main/art.asp?articlekey=5768http://www.medicinenet.com/script/main/art.asp?articlekey=1978http://www.medicinenet.com/script/main/art.asp?articlekey=3463


8/22

In stage I, the cancer is confined to the lung. In stages II and III, the cancer is confined to the chest (with larger and more invasive

tumors classified as stage III).

Stage IV cancer has spread from the chest to other parts of the body.

SCLC are staged using a two-tiered system:

Limited-stage (LS) SCLC refers to cancer that is confined to its area of origin in thechest.

In extensive-stage (ES) SCLC, the cancer has spread beyond the chest to other parts ofthe body.

What is the treatment for lung cancer?

Treatment for lung cancer can involve surgical removal of the cancer,chemotherapy, orradiationtherapy, as well as combinations of these treatments.

As with other cancers, therapy may be prescribed that is intended to be curative (removal or

eradication of a cancer) or palliative (measures that are unable to cure a cancer but can reduce

pain and suffering). More than one type of therapy may be prescribed. In such cases, the therapythat is added to enhance the effects of the primary therapy is referred to as adjuvant therapy. An

example of adjuvant therapy is chemotherapy or radiotherapy administered after surgical

removal of a tumor in an attempt to kill any tumor cells that remain following surgery.

Surgery: Surgical removal of the tumor is generally performed for limited-stage (stage I or

sometimes stage II). The surgical procedure chosen depends upon the size and location of the

tumor. Surgeons must open the chest wall and may perform a wedge resection of the lung

(removal of a portion of one lobe), a lobectomy (removal of one lobe), or a pneumonectomy(removal of an entire lung). Sometimes lymph nodes in the region of the lungs also are removed

(lymphadenectomy). Following the surgical procedure, patients may experience difficultybreathing, shortness of breath, pain, and weakness. The risks of surgery include complications

due to bleeding, infection, and complications of general anesthesia.

Radiation: Radiation therapy may be employed as a treatment for both NSCLC and SCLC.

Radiation therapy uses high-energy X-rays or other types of radiation to kill dividing cancer

cells. Radiation therapy may be given as curative therapy, palliative therapy (using lower dosesof radiation than with curative therapy), or as adjuvant therapy in combination with surgery or

chemotherapy. The radiation is either delivered externally, by using a machine that directs

radiation toward the cancer, or internally through placement of radioactive substances in sealedcontainers within the area of the body where the tumor is localized.Brachytherapyis a term usedto describe the use of a small pellet of radioactive material placed directly into the cancer or into

the airway next to the cancer. This is usually done through a bronchoscope.

Radiation therapy does not carry the risks of major surgery, but it can have unpleasant side

effects, including fatigue and lack of energy. A reduced white blood cell count (rendering a

person more susceptible to infection) and low blood platelet levels (making blood clotting more
http://www.medicinenet.com/script/main/art.asp?articlekey=7778http://www.medicinenet.com/script/main/art.asp?articlekey=7778http://www.medicinenet.com/script/main/art.asp?articlekey=7778http://www.medicinenet.com/script/main/art.asp?articlekey=7782http://www.medicinenet.com/script/main/art.asp?articlekey=7782http://www.medicinenet.com/script/main/art.asp?articlekey=7782http://www.medicinenet.com/script/main/art.asp?articlekey=7782http://www.medicinenet.com/script/main/art.asp?articlekey=42306http://www.medicinenet.com/script/main/art.asp?articlekey=42306http://www.medicinenet.com/script/main/art.asp?articlekey=42306http://www.medicinenet.com/script/main/art.asp?articlekey=42306http://www.medicinenet.com/script/main/art.asp?articlekey=7782http://www.medicinenet.com/script/main/art.asp?articlekey=7782http://www.medicinenet.com/script/main/art.asp?articlekey=7778


9/22

difficult and resulting in excessive bleeding) also can occur with radiation therapy. If the

digestive organs are in the field exposed to radiation, patients may experiencenausea, vomiting,ordiarrhea. Radiation therapy can irritate the skin in the area that is treated, but this irritation

generally improves with time after treatment has ended.

Chemotherapy: Both NSCLC and SCLC may be treated with chemotherapy. Chemotherapymay be given alone, as an adjuvant to surgical therapy, or in combination with radiotherapy.

While a number of chemotherapeutic drugs have been developed, the class of drugs known as theplatinum-based drugs have been the most effective in treatment of lung cancers.

Chemotherapy is the treatment of choice for most SCLC, since these tumors are generallywidespread in the body when they are diagnosed. Only half of people who have SCLC survive

for four months without chemotherapy. With chemotherapy, their survival time is increased up to

four- to fivefold. Chemotherapy alone is not particularly effective in treating NSCLC, but when

NSCLC has metastasized, it can prolong survival in many cases.

Chemotherapy may be given as pills, as an intravenous infusion, or as a combination of the two.Chemotherapy treatments usually are given in an outpatient setting. A combination of drugs is

given in a series of treatments, called cycles, over a period of weeks to months, with breaks in

between cycles. Unfortunately, the drugs used in chemotherapy also kill normally dividing cells

in the body, resulting in unpleasant side effects. Damage to blood cells can result in increasedsusceptibility to infections and difficulties with blood clotting (bleeding or bruising easily).

Other side effects include fatigue, weight loss,hair loss,nausea,vomiting, diarrhea, andmouth

sores. The side effects of chemotherapy vary according to the dosage and combination of drugsused and may also vary from individual to individual. Medications have been developed that can

treat or prevent many of the side effects of chemotherapy. The side effects generally disappear

during the recovery phase of the treatment or after its completion.

Prophylactic brain radiation: SCLC often spreads to the brain. Sometimes people with SCLC

that is responding well to treatment are treated with radiation therapy to the head to treat very

early spread to the brain (called micrometastasis) that is not yet detectable with CT or MRI scansand has not yet produced symptoms. Brain radiation therapy can cause short-term memory

problems, fatigue, nausea, and other side effects.

Treatment of recurrence: Lung cancer that has returned following treatment with surgery,

chemotherapy, and/or radiation therapy is referred to as recurrent or relapsed. If a recurrentcancer is confined to one site in the lung, it may be treated with surgery. Recurrent tumors

generally do not respond to the chemotherapeutic drugs that were previously administered. Since

platinum-based drugs are generally used in initial chemotherapy of lung cancers, these agents are

not useful in most cases of recurrence. A type of chemotherapy referred to as second-linechemotherapy is used to treat recurrent cancers that have previously been treated with

chemotherapy, and a number of second-line chemotherapeutic regimens have been proven

effective at prolonging survival. People with recurrent lung cancer who are well enough to

tolerate therapy also are good candidates for experimental therapies (see below), includingclinical trials.
http://www.medicinenet.com/script/main/art.asp?articlekey=41943http://www.medicinenet.com/script/main/art.asp?articlekey=41943http://www.medicinenet.com/script/main/art.asp?articlekey=41943http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=10560http://www.medicinenet.com/script/main/art.asp?articlekey=10560http://www.medicinenet.com/script/main/art.asp?articlekey=10560http://www.medicinenet.com/script/main/art.asp?articlekey=24732http://www.medicinenet.com/script/main/art.asp?articlekey=24732http://www.medicinenet.com/script/main/art.asp?articlekey=24732http://www.medicinenet.com/script/main/art.asp?articlekey=101642http://www.medicinenet.com/script/main/art.asp?articlekey=101642http://www.medicinenet.com/script/main/art.asp?articlekey=101642http://www.medicinenet.com/script/main/art.asp?articlekey=99669http://www.medicinenet.com/script/main/art.asp?articlekey=99669http://www.medicinenet.com/script/main/art.asp?articlekey=99669http://www.medicinenet.com/script/main/art.asp?articlekey=99669http://www.medicinenet.com/script/main/art.asp?articlekey=99669http://www.medicinenet.com/script/main/art.asp?articlekey=99669http://www.medicinenet.com/script/main/art.asp?articlekey=101642http://www.medicinenet.com/script/main/art.asp?articlekey=24732http://www.medicinenet.com/script/main/art.asp?articlekey=10560http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=41943


10/22

Targeted therapy: The drugs erlotinib (Tarceva) and gefitinib (Iressa) are so-called targeted

drugs, which may be used in certain patients with NSCLC who are no longer responding tochemotherapy. Targeted therapy drugs more specifically target cancer cells, resulting in less

damage to normal cells than general chemotherapeutic agents. Erlotinib and gefitinib target a

protein called the epidermal growth factor receptor (EGFR) that is important in promoting the

division of cells. This protein is found at abnormally high levels on the surface of some types ofcancer cells, including many cases of non-small cell lung cancer.

Other attempts at targeted therapy include drugs known as antiangiogenesis drugs, which block

the development of new blood vessels within a cancer. Without adequate blood vessels to supply

oxygen-carrying blood, the cancer cells will die. The antiangiogenic drug bevacizumab (Avastin)has also been found to prolong survival in advanced lung cancer when it is added to the standard

chemotherapy regimen. Bevacizumab is given intravenously every two to three weeks. However,

since this drug may cause bleeding, it is not appropriate for use in patients who are coughing up

blood, if the lung cancer has spread to the brain, or in people who are receiving anticoagulationtherapy ("blood thinner" medications). Bevacizumab also is not used in cases of squamous cell

cancer because it leads to bleeding from this type of lung cancer.

Cetuximab is an antibody that binds to the epidermal growth factor receptor (EGFR).. In patients

with NSCLC whose tumors have been shown to express the EGFR by immunohistochemical

analysis, the addition of cetuximab may be considered for some patients.

Photodynamic therapy(PDT): One newer therapy used for different types and stages of lung

cancer (as well as some other cancers) is photodynamic therapy. In photodynamic treatment, aphotosynthesizing agent (such as a porphyrin, a naturally occurring substance in the body) is

injected into the bloodstream a few hours prior to surgery. During this time, the agent is taken up

in rapidly growing cells such as cancer cells. A procedure then follows in which the physician

applies a certain wavelength of light through a handheld wand directly to the site of the cancerand surrounding tissues. The energy from the light activates the photosensitizing agent, causing

the production of a toxin that destroys the tumor cells. PDT has the advantages that it can

precisely target the location of the cancer, is less invasive than surgery, and can be repeated atthe same site if necessary. The drawbacks of PDT are that it is only useful in treating cancers that

can be reached with a light source and is not suitable for treatment of extensive cancers. The U.S.

Food and Drug Administration (FDA) has approved the photosensitizing agent called porfimersodium (Photofrin) for use in PDT to treat or relieve the symptoms of esophageal cancer and

non-small cell lung cancer. Further research is ongoing to determine the effectiveness of PDT in

other types of lung cancer.

Radiofrequency ablation(RFA): Radiofrequency ablation is being studied as an alternative to

surgery, particularly in cases of early stage lung cancer. In this type of treatment, a needle is

inserted through the skin into the cancer, usually under guidance by CT scanning.Radiofrequency (electrical) energy is then transmitted to the tip of the needle where it produces

heat in the tissues, killing the cancerous tissue and closing small blood vessels that supply the

cancer. RFA usually is not painful and has been approved by the U.S. Food and Drug

Administration for the treatment of certain cancers, including lung cancers. Studies have shownthat this treatment can prolong survival similarly to surgery when used to treat early stages of
http://www.medicinenet.com/script/main/art.asp?articlekey=89980http://www.medicinenet.com/script/main/art.asp?articlekey=89980http://www.medicinenet.com/script/main/art.asp?articlekey=19038http://www.medicinenet.com/script/main/art.asp?articlekey=19038http://www.medicinenet.com/script/main/art.asp?articlekey=19038http://www.medicinenet.com/script/main/art.asp?articlekey=89980


11/22

lung cancer but without the risks of major surgery and the prolonged recovery time associated

with major surgical procedures.

Experimental therapies: Since no therapy is currently available that is absolutely effective in

treating lung cancer, patients may be offered a number of new therapies that are still in the

experimental stage, meaning that doctors do not yet have enough information to decide whetherthese therapies should become accepted forms of treatment for lung cancer. New drugs or new

combinations of drugs are tested in so-called clinical trials, which are studies that evaluate theeffectiveness of new medications in comparison with those treatments already in widespread use.

Experimental treatments known as immunotherapies are being studied that involve the use of

vaccine-related therapies or other therapies that attempt to utilize the body's immune system tofight cancer cells.

What is the prognosis (outcome) of lung cancer?

The prognosis of lung cancer is dependent upon where the cancer is located, the size of the

cancer, the presence of symptoms, the type of lung cancer, and the overall health status of thepatient.

SCLC has the most aggressive growth of all lung cancers, with a median survival time of only

two to four months after diagnosis when untreated. (That is, by two to four months, half of allpatients have died.) However, SCLC is also the type of lung cancer most responsive to radiation

therapy and chemotherapy. Because SCLC spreads rapidly and is usually disseminated at the

time of diagnosis, methods such as surgical removal or localized radiation therapy are lesseffective in treating this type of lung cancer. When chemotherapy is used alone or in

combination with other methods, survival time can be prolonged four- to fivefold; however, of

all patients with SCLC, only 5%-10% are still alive five years after diagnosis. Most of those who

survive have limited-stage SCLC.

In non-small cell lung cancer (NSCLC), the most important prognostic factor is the stage (extent

of spread) of the tumor at the time of diagnosis. Results of standard treatment are generally poorin all but the most smallest of cancers that can be surgically removed. However, in stage I

cancers that can be completely removed surgically, five-year survival approaches 75%.

Radiation therapy can produce a cure in a small minority of patients with NSCLC and leads torelief of symptoms in most patients. In advanced-stage disease, chemotherapy offers modest

improvements in survival although rates of overall survival are poor.

The overall prognosis for lung cancer is poor when compared with some other cancers. Survival

rates for lung cancer are generally lower than those for most cancers, with an overall five-yearsurvival rate for lung cancer of about 16% compared to 65% forcolon cancer, 89% forbreast

cancer, and over 99% for prostate cancer.

NEOPLASM INVOLVING THE BREAST

What is breast cancer?

Collections of cells that are growing abnormally or without control
http://www.medicinenet.com/script/main/art.asp?articlekey=326http://www.medicinenet.com/script/main/art.asp?articlekey=326http://www.medicinenet.com/script/main/art.asp?articlekey=326http://www.medicinenet.com/script/main/art.asp?articlekey=298http://www.medicinenet.com/script/main/art.asp?articlekey=298http://www.medicinenet.com/script/main/art.asp?articlekey=298http://www.medicinenet.com/script/main/art.asp?articlekey=298http://www.medicinenet.com/script/main/art.asp?articlekey=298http://www.medicinenet.com/script/main/art.asp?articlekey=298http://www.medicinenet.com/script/main/art.asp?articlekey=326


12/22

lump or thickening in the breast or underarm change in size or shape of the breast nipple discharge or nipple turning inward redness or scaling of the skin or nipple ridges or pitting of the breast ski

What is the breast?

The breast is a collection of glands and fatty tissue that lies between the skin and the chest wall.

The glands inside the breast produce milk after a woman has a baby. Each gland is also called a

lobule, and many lobules make up a lobe. There are 15 to 20 lobes in each breast. The milk getsto the nipple from the glands by way of tubes called ducts. The glands and ducts get bigger when

a breast is filled with milk, but the tissue that is most responsible for the size and shape the breast

is the fatty tissue. There are also blood vessels and lymph vessels in the breast. Lymph is a clear

liquid waste product that gets drained out of the breast into lymph nodes. Lymph nodes are

small, pea-sized pieces of tissue that filter and clean the lymph. Most lymph nodes that drain thebreast are under the arm in what is called the axilla.


Collections of cells that are growing abnormally or without control are called tumors. Tumors

that do not have the ability to spread throughout the body may be referred to as benign and arenot thought of as cancerous. Tumors that have the ability to grow into other tissues or spread to

distant parts of the body are referred to as malignant. Malignant tumors within the breast arecalled breast cancer. Theoretically, any of the types of tissue in the breast can form a cancer,

cancer cells are most likely to develop from either the ducts or the glands. These tumors may be

referred to as invasive ductal carcinoma (cancer cells developing from ducts), or invasivelobular carcinoma (cancer cells developing from lobes).

Sometimes, precancerous cells may be found within breast tissue, and are referred to as ductal

carcinoma in-situ (DCIS) or lobular carcinoma in-situ (LCIS). DCIS and LCIS are diseases in

which cancerous cells are present within breast tissue, but are not able to spread or invade othertissues. DCIS represents about 20% of all breast cancers. Because DCIS cells may become

capable of invading breast tissue, treatment for DCIS is usually recommended. In contrast,

treatment is usually not needed for LCIS.

Am I at risk for breast cancer?

Breast cancer is the most common malignancy affecting women in North America and Europe.Close to 200,000 cases of breast cancer were diagnosed in the United States in 2001. Breast

cancer is the second leading cause of cancer death in American women behind lung cancer. The

lifetime risk of any particular woman getting breast cancer is about 1 in 8 although the lifetimerisk of dying from breast cancer is much lower at 1 in 28. Men are also at risk for development

of breast cancer, although this risk is much lower than it is for women.


13/22

The most important risk factor for development of breast cancer is increasing age. As any

woman ages, her risk of breast cancer increases. Risk is also affected by the age when a womanbegins menstruating (younger age may increase risk), and her age at her first pregnancy(older

age may increase risk). Use of exogenous estrogens, sometimes in the form of hormone

replacement treatment (HRT) may increase breast cancer risk, but use of oral contraceptives

most likely does not increase risk. Family history is very important in determining breast cancerrisk. Any woman with a family history of breast cancer will be at increased risk for developing

breast cancer herself. Furthermore, known genetic mutations that increase risk of breast cancer

are present in some families; these include mutations in the genes BRCA1 and BRCA2. Between3% to 10% of breast cancers may be related to changes in one of the BRCA genes. Women can

inherit these mutations from their parents.. Genetic testing for mutations should be considered

for any woman with a strong family history of breast cancer, especially breast cancers in familymembers less than 50 years, or strong family history of prostate or ovarian cancer. If a woman is

found to carry either mutation, she has a 50% chance of getting breast cancer before she is 70.

Family members may elect to get tested to see if they carry the mutation as well. If a woman

does have the mutation, she may choose to undergo more rigorous screening or even undergo

preventive (prophylactic) mastectomies to decrease her chances of contracting cancer. Thedecision to undergo genetic testing is a highly personal one that should be discussed with a

doctor who is trained in counseling patients about genetic testing. For more information ongenetic testing, seeLet the Patient Beware: Implications of Genetic Breast-Cancer Testing,

Psychological Issues in Genetic Testing for Breast Cancer, andTo Test or Not to Test? Genetic

Counseling Is the Key.

Some factors associated with breast cancer risk can be controlled by a woman herself. Use of

hormone replacement therapy (HRT), drinking more than 5 alcoholic drinks/ week, being

overweight, and being inactive may all contribute to breast cancer risk. These are calledmodifiable risk factors.It is important to remember that even someone without any risk factors

can still get breast cancer. Proper screening and early detection are our best weapons in reducing

the mortality associated with this disease. For further information about breast cancer riskfactors, seeBreast Cancer Risk Assessment Tool,andRisk Factors and Breast Cancer

How can I prevent breast cancer?

The most important risk factors for the development of breast cancer, such as age and family

history, cannot be controlled by the individual. Some risk factors may be in a womans control;

however. These include things like avoiding long-term hormone replacement therapy, havingchildren before age 30, breastfeeding, avoiding weight gain through exercise and proper diet, and

limiting alcohol consumption to 1 drink a day or less. For women already at very high risk due to

family history, risk of developing breast cancer can be reduced by about 50% by taking a drugcalled Tamoxifen for five years. Tamoxifen has some common side effects (like hot flashes andvaginal discharge), which are not serious and some uncommon side effects (like blood clots,

pulmonary embolus, stroke, and uterine cancer) which are life threatening. Tamoxifen isn't

widely used for prevention, but may be useful in some cases. Use of Tamoxifen for prophylacticreasons should be considered carefully by an individual and her doctor, as its use is very

individualized. For more information on breast cancer prevention, seeRisk and Prevention.
http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=34&id=1718http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=34&id=1718http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=34&id=1718http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=34&id=1718http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=1727http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=1727http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=1727http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=1727http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=34&id=7242http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=34&id=7242http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=34&id=7242http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=34&id=1719http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=34&id=1719http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=34&id=1719http://www.oncolink.org/types/subsection.cfm?c=3&s=5&ss=34http://www.oncolink.org/types/subsection.cfm?c=3&s=5&ss=34http://www.oncolink.org/types/subsection.cfm?c=3&s=5&ss=34http://www.oncolink.org/types/subsection.cfm?c=3&s=5&ss=34http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=34&id=1719http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=34&id=7242http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=1727http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=1727http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=34&id=1718http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=34&id=1718


14/22

What screening tests are available?

The earlier that a breast cancer is detected, the more likely it is that treatment can be curable. Forthis reason, wescreen for breast cancerusing mammograms, clinical breast exams, and breast

self-exams. Screening mammograms are simply x-rays of the breasts. Each breast is placed

between two plates for a few seconds while the x-rays are taken. If something appears abnormal,or better views are needed, magnified views or specially angled films are taken during the

mammogram. Mammograms often detect tumors before they can be felt and they can also

identify tiny specks of calcium that could be an early sign of cancer. Regular screeningmammograms can decrease the mortality of breast cancer by 30%. The majority of breast

cancers are associated with abnormal mammographic findings. Woman should get a yearly

mammogram starting at age 40 (although some groups recommend starting at 50), and womenwith a genetic mutation that increases their risk or a strong family history may want to begin

even earlier. Many centers are now making use of digital mammograms, which may be more

sensitive than conventional mammography.

Between the ages of 20 and 39, every woman should have a clinical breast exam every 3 years;and after age 40 every woman should have a clinical breast exam done each year. A clinical

breast exam is an exam done by a health professional to feel for lumps and look for changes inthe size or shape of the breasts. During the clinical breast exam, you can learn how to do a breast

self-exam. Every woman should do a self breast exam once a month, about a week after her

period ends. About 15% of tumors are felt but cannot be seen by regular mammographicscreening.

In certain populations of women, MRI screening may be recommended. The American Cancer

Society now recommends yearly breast MRI for breast cancer screening for women who carry aknown BRCA 1 or 2 mutation, those with a very strong family history of breast or ovarian

cancer, and those who have had prior radiation treatment to the chest (for example, radiation aspart of treatment for Hodgkins Lymphoma). Other populations of women who may or may notbenefit from MRI screening are those who have already had breast cancer, those with known

lobular carcinoma in-situ (LCIS), and those with very dense breast which may be difficult to

visualize on mammograms. Decisions regarding how to screen for breast cancer (withmammograms, MRI, or both) should be made between an individual and her physician, based on

her individual breast cancer risk profile.

Other screening modalities that are currently being studied include, ductal lavage, ultrasound,

optical tomography, and PET scan. For more information on these experimental techniques, see

Advanced Breast Imaging,Penn Leads International Study on Breast Cancer Detection, and

Komen Foundation Focuses Attention on the Need for Improved Breast Imaging and EarlyDetection Technologies: OncoLink Talks with President and CEO Susan Braun and Director of

Grants Anice Thigpen, PhD

What are the signs of breast cancer?
http://www.oncolink.org/types/subsection.cfm?c=3&s=5&ss=35http://www.oncolink.org/types/subsection.cfm?c=3&s=5&ss=35http://www.oncolink.org/types/subsection.cfm?c=3&s=5&ss=35http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=7331http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=7331http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=1726http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=1726http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=1726http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=12http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=12http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=12http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=12http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=12http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=12http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=12http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=1726http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=35&id=7331http://www.oncolink.org/types/subsection.cfm?c=3&s=5&ss=35


15/22

Unfortunately, the early stages of breast cancer may not have any symptoms. This is why it is

important to follow screening recommendations. As a tumor grows in size, it can produce avariety of symptoms including:

lump or thickening in the breast or underarm

change in size or shape of the breast nipple discharge or nipple turning inward redness or scaling of the skin or nipple ridges or pitting of the breast skin

These symptoms do not always signify the presence of breast cancer, but they should always be

evaluated immediately by a healthcare professional.

How is breast cancer diagnosed and staged?

Once a patient has symptoms suggestive of a breast cancer or an abnormal screening

mammogram, she will usually be referred for a diagnostic mammogram. A diagnosticmammogram is another set of x-rays with additional angles and close-up views. Often, and

ultrasound will be performed during the same session. An ultrasound uses high-frequency sound

waves to outline the suspicious areas of the breast. It is painless and can often distinguish

between benign and malignant lesions.

Depending on the results of the mammograms and/or ultrasounds, your doctors may recommendthat you get a biopsy. A biopsy is the only way to know for sure if you have cancer, because it

allows your doctors to get cells that can be examined under a microscope. There are different

types of biopsies; they differ on how much tissue is removed. Some biopsies use a very fine

needle, while others use thicker needles or even require a small surgical procedure to remove

more tissue. Your team of doctors will decide which type of biopsy you need depending on yourparticular breast mass.

Once the tissue is removed, a doctor known as a pathologist will review the specimen. The

pathologist can tell if is the cells are cancerous or not, If the tumor does represent cancer, the

pathologist will characterize it by what type of tissue it arose from, how abnormal it looks(known as the grade), whether or not it is invading surrounding tissues, and whether or not the

entire lump was removed during surgery. The pathologist will also test the cancer cells for the

presence of estrogen and progesterone receptors as well as a receptor known as HER-2/neu. Thepresence of estrogen and progesterone receptors is important because cancers that have those

receptors can be treated with hormonal therapies. HER-2/neu expression may also help predict

outcome. There are also some therapies directed specifically at tumors dependent on the presence

of HER-2/nue. SeeUnderstanding Your Pathology Reportfor more information.

In order to guide treatment and offer some insight into prognosis, breast cancer is staged into five

different groups. This staging is done in a limited fashion before surgery taking into account thesize of the tumor on mammogram and any evidence of spread to other organs that is picked up

with other imaging modalities; and it is done definitively after a surgical procedure that removes
http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=838&id=9588http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=838&id=9588http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=838&id=9588http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=838&id=9588


16/22

lymph nodes and allows a pathologist to examine them for signs of cancer. The staging system is

somewhat complex, but here is a simplified version of it:

Stage 0 (called carcinoma in situ)

Lobular carcinoma in situ (LCIS) refers to abnormal cells lining a gland in the breast. This is arisk factor for the future development of cancer, but this is not felt to represent a cancer itself.

Ductal carcinoma in situ (DCIS) refers to abnormal cells lining a duct. Women with DCIS have

an increased risk of getting invasive breast cancer in that breast. Treatment options are similar topatients with Stage I breast cancers.

Stage I : early stage breast cancer where the tumor is less that 2 cm, and hasn't spread beyondthe breast

Stage II : early stage breast cancer in which the tumor is either less than 2 cm across and has

spread to the lymph nodes under the arm; or the tumor is between 2 and 5 cm (with or withoutspread to the lymph nodes under the arm); or the tumor is greater than 5 cm and hasn't spread

outside the breast

Stage III : locally advanced breast cancer in which the tumor is greater than 5 cm across and has

spread to the lymph nodes under the arm; or the cancer is extensive in the underarm lymphnodes; or the cancer has spread to lymph nodes near the breastbone or to other tissues near the

breast

Stage IV : metastatic breast cancer in which the cancer has spread outside the breast to other

organs in the body

Depending on the stage of your cancer, your doctor may want additional tests to see if you have

metastatic disease. If you have a stage III cancer, you will probably get a chest x-ray, CT scan

and bone scan to look for metastases. Each patient is an individual and your doctors will decidewhat is necessary to adequately stage your cancer.

What are the treatments for breast cancer?

Surgery

Almost all women with breast cancer will have some type of surgery in the course of their

treatment. The purpose of surgery is to remove as much of the cancer as possible, and there aremany different ways that the surgery can be carried out. Some women will be candidates forwhat is called breast conservation therapy (BCT). In BCT, surgeons perform a lumpectomy

which means they remove the tumor with a little bit of breast tissue around it, but do not remove

the entire breast. BCT always needs to be combined with radiation therapy to make it an optionfor treating breast cancer. At the time of the surgery, the surgeon may also dissect the lymph

nodes under the arm so the pathologist can review them for signs of cancer. Some patients will

have a sentinel lymph node biopsy procedure first to determine if a formal lymph node dissection


17/22

is required. Sometimes, the surgeon will remove a larger part (but not the whole breast), and this

is called a segmental or partial mastectomy. This needs to be combined with radiation therapy aswell. In early stage cancers (like stage I and II), BCT (limited surgery with radiation) is as

effective as removal of the entire breast via mastectomy. The advantage of BCT is that the

patient will not need a reconstruction or prosthesis, but will be able to keep her breast. Some

patients with early-stage cancer prefer to have mastectomy, and this is an appropriate option aswell..

More advanced breast cancers are usually treated with a modified radical mastectomy. Modified

radical mastectomy refers to removal of the entire breast, as well as and dissection of the lymph

nodes under the arm. Sometimes, patients who have modified radical mastectomy will requireradiation treatment afterwards to decrease the risk of the cancer coming back.

Some patients with DCIS will be candidates for BCT, while others will require modified radical

mastectomy because of the size or distribution of DCIS cells. Most patients with DCIS who havea lumpectomy are treated with radiation therapy to prevent the local recurrence of DCIS

(although some of these DCIS patients may be candidates for close observation after surgery).Patients with DCIS that have a mastectomy do not need to have the lymph nodes removed fromunder the arm.

Your surgeon can discuss your options and the pros and cons of your needed surgical procedures.Many women who have modified radical mastectomies choose to undergo a reconstruction. A

patient who desires reconstruction should try to meet with a plastic surgeon before her

mastectomy to discuss reconstruction options. For more information on breast reconstruction, seeBreast Reconstructive Surgery Options.

Chemotherapy

Even when tumors are removed by surgery, microscopic cancer cells can spread to distant sitesin the body. In order to decrease a patient's risk of recurrence, many breast cancer patients are

offered chemotherapy.Chemotherapyis the use of anti-cancer drugs that go throughout the

entire body to eliminate cancer cells that have broken off from the breast tumor and spread.Many factors go into determining whether an individual patient should have chemotherapy.

Generally, patients with higher stage disease need chemotherapy; however, chemotherapy can be

beneficial even for patients with early-stage disease. Individual factors such as age, overall

health, and biologic properties of a womans breast tumor may go into decisions regardingwhether or not she should have chemotherapy. There are many different chemotherapy drugs,

and they are usually given in combinations for 3 to 6 months after you receive your surgery.

Depending on the type of chemotherapy regimen you receive, you may get medication every 2 to

4 weeks. Most chemotherapies used for breast cancer are given through a vein, so need to begiven in an oncology clinic. Drugs that are commonly used in breast cancer treatment include

adriamycin (doxorubicin), cyclophosphamide, and taxanes. There are advantages and

disadvantages to each of the different regimens that your medical oncologist will discuss withyou. Based on your own health, your personal values and wishes, and side effects you may wish

to avoid, you can work with your doctors to come up with the best regimen for your lifestyle.
http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=36&id=7016http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=36&id=7016http://www.oncolink.org/treatment/treatment.cfm?c=2http://www.oncolink.org/treatment/treatment.cfm?c=2http://www.oncolink.org/treatment/treatment.cfm?c=2http://www.oncolink.org/treatment/treatment.cfm?c=2http://www.oncolink.org/types/article.cfm?c=3&s=5&ss=36&id=7016


18/22

Generally, chemotherapy is given after surgery for early-stage breast cancer. Sometimes,

chemotherapy may be given before surgery to shrink large tumors and allow surgery to be moreeffective. For patients with stage IV disease, chemotherapy may be given without surgery, and a

variety of different agents may be tried until a response is achieved.

Radiotherapy

Breast cancer is often treated withradiation therapy. Radiation therapy refers to use of high

energy x-rays to kill cancer cells. Patients having radiation usually need to come to a radiation

therapy treatment center 5 days a week for up to 6 weeks to receive treatment. The treatmenttakes just a few minutes, and it is painless. Radiation therapy is used in all patients who receivebreast conservation therapy (BCT). It is also recommended for patients after a mastectomy who

have had large tumors, lymph node involvement, or close/positive margins after the surgery.

Radiation is important in reducing the risk of local recurrence and is often offered in moreadvanced cases to kill tumor cells that may be living in lymph nodes. Your radiation oncologist

can answer questions about the utility, process, and side effects of radiation therapy in your

particular case.

Some newer techniques for radiation therapy are being used in certain centers. These are ways to

reduce the treatment time needed for radiotherapy, and usually take 1 3 weeks instead of 6weeks, and are called accelerated partial breast irradiation (APBI). These techniques may require

a patient to have a radioactive implant placed inside the breast. These techniques are

experimental, and are only indicated for early-stage breast cancer patients.

Hormonal Therapy

When the pathologist examines a tumor specimen, he or she may determine that the tumor is

expressing estrogen and/ or progesterone receptors. Patients whose tumors express estrogenreceptors are candidates for therapy with estrogen blocking drugs. Estrogen-blocking drugs

include Tamoxifen and a family of drugs called aromatase inhibitors. These drugs are delivered

in pill form for 5 - 10 years after breast cancer surgery. These drugs have been shown todrastically reduce your risk of recurrence if your tumor expresses estrogen receptors. They may

be accompanied by side effects, however. When taking Tamoxifen, patients may experience

weight gain, hot flashes and vaginal discharge.. Taking Tamoxifen may also increase risk of

serious medical issues, such as blood clots, stroke, and uterine cancer. Patients taking aromataseinhibitors may experience bone or joint pain, and are at increased risk for thinning of the bones

(osteopenia or osteoporosis). Patients taking aromatase inhibitors should have yearly bone

density testing, and may require treatment for bone thinning.

Biologic Therapy

The pathologist also examines your tumor for the presence of HER-2/neu overexpression. HER-

2/neu is a receptor that some breast cancers express. A compound called Herceptin (orTrastuzumab) is a substance that blocks this receptor and helps stop the breast cancer from

growing. Patients with tumors that express HER-2/neu may benefit from Herceptin, and this

should be discussed with a medical oncologist when the treatment plan is decided upon.
http://www.oncolink.org/treatment/treatment.cfm?c=5http://www.oncolink.org/treatment/treatment.cfm?c=5http://www.oncolink.org/treatment/treatment.cfm?c=5http://www.oncolink.org/treatment/treatment.cfm?c=5


19/22

Follow-up testing

Once a patient has been treated for breast cancer, she needs to be closely followed for arecurrence. At first, you will have follow-up visits every 3-4 months. The longer you are free of

disease, the less often you will have to go for checkups. After 5 years, you could see your doctor

once a year. You should have a mammogram of the treated and untreated breasts every year.Because having had breast cancer is a risk factor for getting it again, having your mammograms

done every year is extremely important. If you are taking Tamoxifen, it is important that you get

a pelvic exam each year and report any abnormal vaginal bleeding to your doctor.

Clinical trials are extremely important in furthering our knowledge of this disease. It is though

clinical trials that we know what we do today, and many exciting new therapies are currentlybeing tested. Talk to your doctor about participating in clinical trials in your area.

Breast Cancer - Topic Overview

ByKathe Gallagher, MSW

This topic is for people who have been diagnosed with breast cancer for the first time. If you arelooking for information on breast cancer that has spread or come back after treatment, see the

topicBreast Cancer, Metastatic or Recurrent.


Breast canceroccurs when abnormal cells grow out of control in one or both breasts. They caninvade nearby tissues and form a mass, called a malignant tumor. The cancer cells can spread(metastasize) to thelymph nodesand other parts of the body.

Breast cancer is many womens worst fear. But experts have made great progress in treatingcancer. If it is found early, breast cancer can often be cured, and it is not always necessary to

remove the breast.

What causes breast cancer?

Doctors do not know exactly what causes breast cancer. But some things are known to increase

the chance that you will get it. These are called risk factors. The main risk factors for breastcancer include:1

Aging. Breast cancer is much more common in older women than in younger women. Yourbreast cancer risk increases as you age.

2

Family history of breast cancer. You have a higher risk if a close family member, especially yourmother or sister, has had breast cancer.
http://health.yahoo.com/article/healthwise--tv3614-creditshttp://health.yahoo.com/article/healthwise--tv3614-creditshttp://health.yahoo.com/article/healthwise--tv3614-creditshttp://health.yahoo.com/breastcancer-overview/breast-cancer-metastatic-or-recurrent/healthwise--tv7120.htmlhttp://health.yahoo.com/breastcancer-overview/breast-cancer-metastatic-or-recurrent/healthwise--tv7120.htmlhttp://health.yahoo.com/breastcancer-overview/breast-cancer-metastatic-or-recurrent/healthwise--tv7120.htmlhttp://health.yahoo.com/breastcancer-overview/breast-cancer/healthwise--tp13155.htmlhttp://health.yahoo.com/breastcancer-overview/breast-cancer/healthwise--tp13155.htmlhttp://health.yahoo.com/breastcancer-overview/lymph-nodes/healthwise--stl158216.htmlhttp://health.yahoo.com/breastcancer-overview/lymph-nodes/healthwise--stl158216.htmlhttp://health.yahoo.com/breastcancer-overview/lymph-nodes/healthwise--stl158216.htmlhttp://health.yahoo.com/breastcancer-overview/1/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/1/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/1/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/2/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/2/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/2/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/family-history-of-breast-cancer/healthwise--zm6339.htmlhttp://health.yahoo.com/breastcancer-overview/family-history-of-breast-cancer/healthwise--zm6339.htmlhttp://www.healthwise.org/http://health.yahoo.com/breastcancer-overview/family-history-of-breast-cancer/healthwise--zm6339.htmlhttp://health.yahoo.com/breastcancer-overview/2/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/1/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/lymph-nodes/healthwise--stl158216.htmlhttp://health.yahoo.com/breastcancer-overview/breast-cancer/healthwise--tp13155.htmlhttp://health.yahoo.com/breastcancer-overview/breast-cancer-metastatic-or-recurrent/healthwise--tv7120.htmlhttp://health.yahoo.com/article/healthwise--tv3614-credits


20/22

Female hormones. Usinghormone therapyafter menopause raises your risk. This includesestrogen-progestin and estrogen-testosterone.

1, 3Using estrogen by itself may slightly raise

breast cancer risk.1

And your risk is slightly higher if you started your period before age 12 or

startedmenopauseafter age 55. The years when you have a menstrual cycle are your high-

estrogen years. Experts think that the longer you have higher estrogen, the more risk you have

for breast cancer.4

Gene changes. Women who inherit certaingenescalled BRCA1 and BRCA2 are more likely tohave breast cancer.

Some other things are known to increase your risk, such as having extra body fat, being inactive,

or drinking alcohol (these lead to higher levels of estrogen in the body).4, 5

But many women who have risk factors do not get breast cancer. And many women who get

breast cancer do not have any known risk factors.

What are the symptoms?

Breast cancer can cause:

A change in the way the breast feels. The most common symptom is a painless lump orthickening in the breast or underarm.

A change in the way the breast looks. The skin on the breast may dimple or look like an orangepeel. There may be a change in the size or shape of the breast.

A change in the nipple. It may turn in. The skin around it may look scaly. A clear or bloody fluid that comes out of the nipple.

See your doctor right away if you notice any of these changes.

Many people think that only women get breast cancer. But about 1 in every 100 cases of breastcancer occurs in men. So any man who has a breast lump should be checked.

6, 7

How is breast cancer diagnosed?

During a regular physical exam, your doctor can check your breasts to look for lumps or

changes. Depending on your age and risk factors, the doctor may advise you to have amammogram, which is an X-ray of the breast. A mammogram can often find a lump that is too

small to be felt. Sometimes a woman finds a lump during a breast self-exam.

If you or your doctor finds a lump or other change, the doctor will want to take a sample of the

cells in your breast. This is called abiopsy. Sometimes the doctor will put a needle into the lumpto take out some fluid or tissue (needle biopsy). In other cases, a surgeon may take out the whole

lump through a small cut in your breast. The results of the biopsy help your doctor know if youhave cancer and what type of cancer it is.

You may have other tests to find out the stage of the cancer. The stage is a way for doctors todescribe how far the cancer has spread. Your treatment choices will be based partly on the type

and stage of the cancer.
http://health.yahoo.com/breastcancer-overview/hormone-therapy/healthwise--sth149520.htmlhttp://health.yahoo.com/breastcancer-overview/hormone-therapy/healthwise--sth149520.htmlhttp://health.yahoo.com/breastcancer-overview/hormone-therapy/healthwise--sth149520.htmlhttp://health.yahoo.com/breastcancer-overview/1/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/1/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/3/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/3/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/3/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/1/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/1/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/1/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/1/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/menopause/healthwise--stm159386.htmlhttp://health.yahoo.com/breastcancer-overview/menopause/healthwise--stm159386.htmlhttp://health.yahoo.com/breastcancer-overview/menopause/healthwise--stm159386.htmlhttp://health.yahoo.com/breastcancer-overview/4/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/4/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/4/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/genes/healthwise--stg124306.htmlhttp://health.yahoo.com/breastcancer-overview/genes/healthwise--stg124306.htmlhttp://health.yahoo.com/breastcancer-overview/genes/healthwise--stg124306.htmlhttp://health.yahoo.com/breastcancer-overview/4/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/4/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/5/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/5/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/5/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/6/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/6/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/7/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/7/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/7/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/mammogram/healthwise--stm159424.htmlhttp://health.yahoo.com/breastcancer-overview/mammogram/healthwise--stm159424.htmlhttp://health.yahoo.com/breastcancer-overview/biopsy/healthwise--stb117050.htmlhttp://health.yahoo.com/breastcancer-overview/biopsy/healthwise--stb117050.htmlhttp://health.yahoo.com/breastcancer-overview/biopsy/healthwise--stb117050.htmlhttp://health.yahoo.com/breastcancer-overview/biopsy/healthwise--stb117050.htmlhttp://health.yahoo.com/breastcancer-overview/mammogram/healthwise--stm159424.htmlhttp://health.yahoo.com/breastcancer-overview/7/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/6/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/5/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/4/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/genes/healthwise--stg124306.htmlhttp://health.yahoo.com/breastcancer-overview/4/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/menopause/healthwise--stm159386.htmlhttp://health.yahoo.com/breastcancer-overview/1/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/3/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/1/healthwise--tv3614-bib.htmlhttp://health.yahoo.com/breastcancer-overview/hormone-therapy/healthwise--sth149520.html


21/22

How is it treated?

Most people who have breast cancer have surgery to remove the cancer. The surgeon may also

take out some or all of thelymph nodesunder your arm to find out if the cancer has spread tothis area. After surgery, you may haveradiation therapyto destroy cancer cells. You may also

getchemotherapyor hormone therapy. These are powerful medicines that travel through yourbody to kill cancer cells. You

Documents

Lung & Breast Cancer-1