What is breast cancer?
Breast cancer occurs when cells in the breast grow abnormally and multiply in an uncontrolled way. It can originate in different parts of the breast, most commonly in the milk ducts or the lobules (milk-producing glands). If left untreated, it can spread to the lymph nodes and other organs.
Breast cancer is not a single disease. There are several types, each with different behaviour, treatment requirements, and outcomes. An accurate diagnosis, including biopsy and receptor testing, is essential before any treatment begins.
Types of breast cancer
- Invasive ductal carcinoma (IDC): The most common type. Cancer starts in the milk ducts and invades surrounding breast tissue.
- Invasive lobular carcinoma (ILC): Starts in the lobules. Can be harder to detect on imaging as it does not always form a distinct lump.
- Inflammatory breast cancer: A rare and aggressive form where cancer cells block the lymph vessels in the skin. The breast may appear red, swollen, or feel warm.
- Ductal carcinoma in situ (DCIS): Non-invasive breast cancer confined to the ducts. Considered a pre-cancerous or early form.
- Triple-negative breast cancer: Does not express ER, PR, or HER2 receptors. Often more aggressive, requiring specific treatment approaches.
- HER2-positive breast cancer: Overexpresses the HER2 protein. Responds to targeted therapy alongside surgery.
Stages of breast cancer
Staging describes how far the cancer has spread. Treatment decisions depend heavily on stage.
- Stage 0 (DCIS): Non-invasive cancer cells confined to the duct lining.
- Stage I: Small tumour confined to the breast or only in nearby lymph nodes.
- Stage II: Tumour is larger or has spread to a small number of lymph nodes.
- Stage III: Cancer has spread more extensively to lymph nodes or nearby tissue, but not distant organs.
- Stage IV: Metastatic breast cancer that has spread to other organs (bones, liver, lungs, brain).
Symptoms to watch for
See a doctor promptly if you notice any of these changes in your breast or underarm area.
- A lump or thickening in the breast or armpit that was not there before
- Change in breast size or shape
- Skin changes such as dimpling, puckering, redness, or orange-peel texture
- Nipple turning inward (inversion) when this is new
- Nipple discharge, particularly if blood-stained or from one breast only
- Pain in the breast that is persistent, unexplained, and localised to one spot
- Swelling of the arm or breast (can indicate lymph node involvement)
Most breast lumps are not cancerous. But all new lumps should be assessed by a specialist. Early detection changes outcomes significantly.
How breast cancer is diagnosed
- Clinical examination: Dr. Shruthi examines the breast and underarm area to assess any abnormalities.
- Ultrasound: Often the first imaging step, especially in younger women with denser breast tissue.
- Mammogram: X-ray imaging of the breast. Screening mammograms are recommended for women over 40.
- MRI: Used for high-risk patients or to assess the extent of disease before surgery.
- Biopsy: A small tissue sample is taken from the lump and examined under a microscope. This confirms the diagnosis and determines receptor status (ER, PR, HER2).
Surgical treatment options
Surgery is a central part of breast cancer treatment for most patients. The goal is to remove the cancer with clear margins while preserving as much of the breast as possible.
- Lumpectomy (breast-conserving surgery): removes only the tumour and a small margin of healthy tissue. Followed by radiation therapy.
- Mastectomy: removes the entire breast. May be followed by reconstruction.
- Oncoplastic surgery: combines cancer removal with plastic surgery techniques to achieve better cosmetic outcomes.
- Sentinel lymph node biopsy: samples the first lymph node(s) to receive drainage from the tumour to check if cancer has spread.
- Breast reconstruction: rebuilds the breast after mastectomy using implants or the patient's own tissue.
Dr. Shruthi Neela always explores breast-conserving options first when clinically appropriate. She discusses reconstruction alongside surgery planning so patients can make informed decisions before the operation.