Wow! Those 3 months went fast! It has been 3 months since my last blog.
Just writing that statement sends me back to my Catholic childhood.
‘Forgive me Father for I have sinned. It has been 3 months since my last confession.’ 😊
Writing a blog is a little like confession, in that you have to open up a little more and expose some inner workings of your heart and soul. But unlike confession, writing these breast cancer blogs opens up opportunities to help and inform others.
In ‘Show Us Your Tits – Baring All and Beating Breast Cancer’ I explain and describe my experience after being diagnosed with ductal carcinoma in the form of an estrogen positive breast cancer. This is the most commonly diagnosed origin, and type of breast cancer.
You could think of it as the Toyota HiLux of breast cancer!
When we dig deeper into breast cancer, the disease is not ONE but ELEVEN different diseases, all under the diagnostic umbrella of breast cancer (as this is the tissue that the cancer has grown in.)
Let’s start with the locations in the breast, where cancer can begin.
Ductal
Most commonly, breast cancer begins in the milk ducts. These are the tubes that lead from the milk producing lobules to the nipple. If the cancer is found whilst still inside the parameters of the duct, it is called DCIS - Ductal carcinoma in Situ and is often referred to as ‘pre-cancer’ or ‘Stage 0’. This means it has not spread into surrounding breast tissue, but if left untreated, it can develop into an invasive cancer. DCIS cannot be felt and is usually picked up by a mammogram or perhaps an ultrasound.
Invasive Ductal Carcinoma (IDC) is cancer that has spread from the duct into surrounding breast tissue. Abnormal cells have grown in the duct and they have invaded breast tissue beyond the duct walls. This is when a ‘tumour’ starts to grow.
IDC is the type of cancer I was diagnosed with (at Stage 2 – because it was already 3cm in length) and it makes up about 80% of all breast cancer cases. You could call it, the common garden variety of breast cancer.
Lobular
The second most common location for breast cancer to begin growing is in a breast lobule. These are the milk glands of the breast. As the lobules are situated further back in the breast, this type of breast cancer can be harder to detect and most definitely, more difficult to feel as a lump. Lobular cancers make up about 10% of breast cancers.
Other locations
Much rarer, are Paget’s Disease (cancer of the nipple and/or areola) and Inflammatory Breast Cancer – which is highly aggressive – where cancer cells block the lymph vessels in the skin of the breast. These two sites account for the remaining 10% of locations within the breast, where cancer begins to grow.
TYPES OF BREAST CANCER
Within these locations, cancerous tumours can grow in different ways, fed by different substances in your body.
Hormone Positive Breast Cancers
Most breast cancers are fed by estrogen and/or progesterone. These cancerous tumours have receptors that collect hormones and use them to multiply their nasty, mutated cells.
When we talk about how aggressive a breast cancer might be, these ones are usually mid-range.
My breast cancer had receptors for estrogen, so we call this an E+ breast cancer. You can also get E+/P+ (receptors that use both estrogen and progesterone), or only P+ (progesterone receptors only). The good news about these varieties is that you can take medication for 5-10 years post cancer diagnosis, that blocks the growth effects of estrogen and progesterone on breast cancer cells.
These three different types of hormone positive breast cancer make up around 66% of cases.
Triple Positive +++
Triple Positive Breast Cancer is a variety that has receptors for both estrogen AND progesterone, but also for the protein HER2 (Human Epidermal Growth Factor 2). You can also get cancers that are only receptive to HER2 alone.
HER2 involvement causes these cancers to grow faster and therefore, be more aggressive. About 20% of breast cancers are HER2 positive.
Advancements in drug treatment with anti-HER2 medicines over recent decades, have dramatically increased survival rates for women with triple positive breast cancer.
Triple Negative - - -
This is one of the most aggressive types of breast cancer. It is also harder to treat and is more likely to come back. It does not have receptors for estrogen or progesterone, so hormone blocking medications will not have an impact on the tumour’s growth. Triple negative tumours also do not have the receptors for HER2 protein, so there will be no response to those targeted drugs either.
Triple negative breast cancers represent 10-15% of breast cancers overall.
So, we have four different locations and six different types (depending on tumour receptors)
It’s pretty complicated huh?
Yep!
Being diagnosed with one of these diseases makes most women’s heads spin. What type of breast cancer? What location? How aggressive is it? How long has it been there? Has it spread to lymph nodes? Will I be cured? Will I need a mastectomy? Chemo?
It is a very daunting time, with new words and phrases coming at you hard and fast. Often women have to choose a surgeon and specialist, and then decide on treatment options pretty soon out of the diagnosis gate.
So please keep vigilant about your breast health.
We know that the earlier breast cancer is diagnosed, the better the outcome. Make sure you are doing regular monthly checks.
Any of the following unusual changes in the breast, can be the first sign of breast cancer:
- swelling of all or part of the breast
- skin irritation
- skin dimpling, sometimes looking like an orange peel
- breast or nipple pain
- an indentation or fold in the breast
- nipple discharge
- redness, scaliness, or thickening of the nipple or breast skin
- a lump or swelling, on or around the breast including the underarm area.
If you are 40+ keep up-to-date with regular, screening mammograms.
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