Breast Cancer

The breast is made of glands, ducts, fat, and supporting tissue. Cancer begins when a cell in that tissue acquires changes that let it divide when it should stop. A tumour can stay inside the duct, which is called in situ disease, or it can invade the surrounding breast. Invasive cancer can also reach lymph nodes under the arm or, later, organs such as bone, liver, lung, or brain. Those patterns are why two people with breast cancer can still need completely different care.

Pathology usually tests the cancer for estrogen receptor, progesterone receptor, and HER2. Hormone-receptor-positive cancers may be treated with medicines that block estrogen or lower its effect. HER2-positive cancers overproduce a growth signal and may be treated with drugs aimed at that signal, often with chemotherapy. Triple-negative breast cancer lacks all three of those markers. It is often treated with chemotherapy, and immunotherapy is considered in selected cases. A positive receptor does not mean every related drug is suitable, and a negative receptor means that particular family of drugs is unlikely to help.

Most people with breast cancer have no single cause that can be named. Age is the strongest common risk. The chance rises through midlife and later. A previous breast cancer, certain benign but high-risk biopsy findings, and dense breast tissue also matter. Inherited changes in genes such as BRCA1 and BRCA2 raise risk substantially, but most breast cancers are not caused by a known inherited mutation. A family history in a close relative is a reason to ask whether genetic counselling is useful. It is not, by itself, a diagnosis.

Hormonal factors can add risk: early periods, late menopause, a later first pregnancy, and long use of combined menopausal hormone therapy. After menopause, extra body fat can raise estrogen. Alcohol adds risk. Chest radiation given years earlier should be mentioned in clinic. None of these factors means cancer is inevitable, and their absence does not make a new lump safe to ignore.

The symptom that brings many people to a doctor is a new lump in the breast or armpit. Other changes deserve the same attention: a change in size or shape, skin dimpling or puckering, redness, a nipple that newly turns inward, or discharge from the nipple, especially if it is bloody or happens without squeezing. Pain can occur, but pain alone is a poor guide. Many painful breast changes are not cancer, and some cancers cause no pain at all.

Not every lump is cancer. Cysts and hormonal thickening are common. Examination, imaging, and sometimes a biopsy are how they are sorted out. If you already feel a change, do not wait for the next screening date.

A mammogram is a low-dose X-ray of the breast. It can show a cancer before it is large enough to feel. Ultrasound is often added, especially when the breasts are dense or when a lump needs to be distinguished from a fluid-filled cyst. MRI is used in selected higher-risk people and to map some cancers before surgery. It is not the first test for everyone. Screening age and interval depend on national guidance, personal risk, and what is practical. This page cannot tell you the right schedule for your situation.

If imaging is abnormal, a biopsy is the test that confirms cancer. A needle takes a small sample, which a pathologist examines under a microscope. Receptor tests are done on that tissue. A scan that looks suspicious is not the same as a cancer diagnosis. Blood tests and tumour markers do not diagnose breast cancer on their own. Genetic testing of the person, as opposed to the tumour, is considered when family history, age at diagnosis, or the cancer type makes an inherited risk plausible. It is a separate decision from treating the cancer that is already there.

Stage describes how large the cancer is in the breast, whether lymph nodes are involved, and whether it has spread to distant organs. Early-stage disease is often treated with curative intent. Locally advanced disease may need medicines before surgery so that an operation becomes safer or more effective. Metastatic, or stage IV, disease means the cancer has spread beyond the breast and nearby nodes. Treatment then usually aims to control the cancer and protect quality of life for as long as possible. Cure is not the honest goal in most metastatic cases, and that should be said clearly.

If the risk of spread is meaningful, a CT scan, bone scan, or PET-CT may be discussed. Not everyone needs whole-body imaging. Extra scans without a reason can find harmless findings that delay care. The final stage is often known only after surgery and the full pathology report.

Surgery removes the cancer in the breast, either as a lumpectomy that conserves the breast or as a mastectomy. A surgeon leads that decision, which also depends on tumour size, number of areas involved, and the person’s preference. Radiation is commonly advised after breast-conserving surgery and in selected cases after mastectomy. A radiation oncologist plans that part. Medical oncology covers the medicines that travel through the bloodstream and can treat cells that scans cannot yet see.

Chemotherapy may be given before surgery, called neoadjuvant treatment, or after surgery, called adjuvant treatment. It is also used for metastatic disease. The drugs, the number of cycles, and whether hair loss or low blood counts are likely depend on the regimen. Hormone therapy is a tablet or, in some premenopausal women, an injection, and it often continues for several years when receptors are positive. HER2-directed antibodies or tablets are added when HER2 is positive. Immunotherapy is not routine for every breast cancer. It is considered mainly in defined triple-negative situations. Bone-strengthening medicines are sometimes added when cancer has spread to bone, or to protect bone during long hormone therapy.

A small hormone-positive cancer may need surgery and hormone tablets without chemotherapy. A larger triple-negative cancer may start with chemotherapy. Previous treatment, other illnesses, and goals of care all change the advice. A newer drug is not automatically a better drug.

Side effects follow the regimen, not the word chemotherapy in general. Some people work through treatment with changes to the schedule. Others need time away around infusion days. Nausea is usually reduced with modern anti-sickness medicines, but fatigue, low white cells, neuropathy, and hair loss still occur with particular drugs. Hormone therapy can cause hot flushes, joint aches, and, over years, thinning of bone. HER2 drugs need heart monitoring in many regimens. Any fever during chemotherapy should be reported the same day. People who may want a pregnancy later should ask about fertility before treatment starts.

A visit about breast cancer is used to read the records you already have, explain them in plain language, and outline options that may apply. Bring the biopsy or pathology report, scan CDs or reports, blood tests, and a list of treatment already given, including dates and drug names if you have them. A family member can come with you. The visit is not an emergency assessment, and it does not confirm a plan until the records have been reviewed.

Dr. Nishith Vaddeboina is a medical oncologist. Appointments published on this website are at American Oncology Institute, Nallagandla, Hyderabad. The biography also lists consultant work at Renova Century Hospitals. Confirm the hospital when you book. Plans are discussed against recognised guidance, including NCCN, ESMO, and ASCO, and then adjusted to the person in the room. Nothing on this page replaces that conversation.

Ask a doctor about a new lump, nipple discharge, skin redness, or a change in breast shape. Screening advice depends on age and risk. During treatment, fever, chest pain, sudden breathlessness, or bleeding need urgent care rather than a website. This page cannot tell you whether a symptom is cancer.