Breast Cancer
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Breast Cancer
The leading cancer among Indian women, often detected late due to lack of awareness and screening.
Types of Breast Cancer
Type
Description
Ductal Carcinoma In Situ (DCIS)
Non-invasive; confined to milk ducts
Invasive Ductal Carcinoma (IDC)
Most common (70–80%); starts in ducts, invades surrounding tissue
Invasive Lobular Carcinoma (ILC)
Starts in lobules; ~10–15% of invasive cases
Triple-Negative Breast Cancer
Triple-Negative Breast Cancer Lacks ER, PR, and HER2; more aggressive
HER2-Positive Breast Cancer
Overexpresses HER2 protein; responsive to targeted therapy
Inflammatory Breast Cancer
Inflammatory Breast Cancer Rare, aggressive; causes redness and swelling of breast
Male Breast Cancer
Rare (~1% of all breast cancers)
Risk Factors
Non-Modifiable
Modifiable
Increasing age
Obesity
Female sex
Alcohol consumption
Family history/genetic mutations (BRCA1/2)
Lack of physical activity
Early menarche / late menopause
Hormone replacement therapy
Dense breast tissue
Nulliparity or late first pregnancy
Personal history of breast or ovarian cancer
Radiation exposure to chest (e.g., lymphoma RT)
Diagnosis
- Clinical exam
- Imaging: Mammogram, Ultrasound, MRI breast, Whole body PET CT
- Biopsy: Core needle or excisional biopsy
- Pathology: Determines type, grade, hormone receptor (ER/PR) and HER2 status
Staging
- TNM System (Tumor size, Node involvement, Metastasis)
- Stages 0–IV, with higher stages indicating more advanced disease
Treatment Options
Modality
Details
Surgery
Lumpectomy (breast-conserving) or mastectomy + axillary staging
Radiation Therapy
Post-lumpectomy or high-risk post-mastectomy; reduces recurrence risk
Chemotherapy
Chemotherapy Neoadjuvant (before surgery) or adjuvant (after); especially in high-grade, node+ or triple-negative cancers
Hormonal Therapy
For ER/PR-positive cancers (e.g., tamoxifen, aromatase inhibitors)
Targeted Therapy
For HER2+ cancers (e.g., trastuzumab, pertuzumab)
Immunotherapy
Used in selected triple-negative cancers (e.g., with PD-L1 expression)
Prognosis Factors
- Stage at diagnosis
- Tumor grade
- Hormone receptor and HER2 status
- Lymph node involvement
- Response to treatment
Radiation Therapy in Breast Cancer
- Purpose: Used to eliminate residual microscopic disease, reduce the risk of local recurrence, and improve overall survival, especially after breast-conserving surgery or in high-risk post-mastectomy patients.
When is Radiation Used?
Clinical Situation
Indication for Radiation
Breast-Conserving Surgery (BCS)
Always indicated (whole breast irradiation ± boost)
Post-Mastectomy
If high-risk features: T3/T4 tumor, positive margins, >3 nodes
Positive Axillary Lymph Nodes
Chest wall + regional nodal irradiation
Reconstruction Present
Radiation may still be given based on risk factors
Types of Radiation Therapy
Type
Description
Whole Breast Irradiation (WBI)
Standard after lumpectomy; treats entire breast
Tumor Bed Boost
Extra dose to the site of tumor (common in younger patients)
Chest Wall Irradiation
Used post-mastectomy in high-risk cases
Regional Nodal RT
Targets axillary, supraclavicular, ± internal mammary nodes
Partial Breast Irradiation (PBI)
For selected early-stage cases; shorter treatment
Dose and Duration
Regimen
Dose & Duration
Conventional Fractionation
50 Gy in 25 fractions over 5 weeks
Hypofractionation (Standard)
40 Gy in 15 fractions over 3 weeks (common globally)
Ultrahypofractionation
26 Gy in 5 fractions over 1 week (selected early-stage)
Boost (if given)
Additional 10–16 Gy to tumor bed
Side Effects
Acute
Chronic
Skin redness, fatigue, breast swelling
Fibrosis, lymphedema, cosmetic changes, rare heart/lung toxicity
Special Considerations
- Left-sided breast cancer: Use deep inspiration breath-hold (DIBH) to reduce heart dose.
- IMRT or VMAT: May be used for complex anatomy or bilateral breast irradiation.
- Post-reconstruction: Careful planning needed to reduce implant complications.