What Is Breast Cancer?

The breasts are made up of fat, connective tissue, and thousands of lobules ( small milk producing glands ). When a woman gives birth, breast milk will be sent to the nipple through a small channel while feeding. The cells in our body usually grow and multiply regularly. New cells are only formed when needed. But the process in the body of people with cancer will be different.

The process will run unnaturally so that the growth and proliferation of cells become uncontrollable. These abnormal cells can also spread to other parts of the body through the bloodstream. This is called metastatic cancer. If detected at an early stage, the cancer can be treated before it spreads to other parts of the body. Early symptoms of breast cancer is a lump or thickening of the skin tissue of the breast. But most of the lumps do not necessarily indicate cancer.

What Are The Types Of Breast Cancer?
Two of the three women with breast cancer were over 50 years old. When you are aware of the symptoms of breast cancer , you are advised to immediately consult a doctor. After the examination, your doctor usually refer you to the hospital for further examination to confirm the diagnosis .

Breast cancer is generally divided into two categories, namely non-invasive and invasive. More detailed explanations are as follows:

• Invasive breast cancer
  The most common form of invasive breast cancer is invasive ductal breast cancer that develops in breast forming cells. The word invasive means this cancer can spread beyond the breast. About 80 percent of all invasive breast cancer cases are of this type.
  
  Other invasive breast cancer types include:
• Invasive lobular breast cancer. This disease develops in the milk-producing gland called lobules.
• Breast cancer is inflamed.
• Paget's cancer in the breast.
  
  These types of cancers are also known as secondary breast cancer or metastasis. This type can spread to other parts of the body. Its spread is usually through lymph nodes (small glands that filter out bacteria from the body) or bloodstream.
• Non-invasive breast cancer
  Non-invasive forms of cancer are commonly found through mammography because they rarely cause lumps. This type is also often called pre-cancer. The most common type of cancer is ductal carcinoma in situ . This type of breast cancer is benign and is found in the ducts (ducts) of the breast, and has not spread.

Breast and Genetic Examination 
The main cause of breast cancer is unknown. Therefore, full prevention for breast cancer is also difficult to determine. Many factors can increase the risk of cancer, such as age and family health history.

Breast and genetic screening is recommended for women with a higher likelihood of developing breast cancer. The risk of breast cancer increases with age, then women aged 50-70 years are advised to check themselves every three years. Women aged 70 years and over are also advised to consult and consult a doctor.

Steps of Breast Cancer Treatment
One in nine women will develop breast cancer during their lifetime. Cancer that is detected in the early stages has an opportunity to heal through treatment steps . Therefore, it is very important for a woman to perform routine breast examination.

Breast cancer can be treated with a combination of surgery, chemotherapy, and radiotherapy. Some cases of breast cancer can also be treated through biological or hormonal therapy. During the treatment and recovery period, support from others (especially family and close friends) for breast cancer patients is very important.


Symptoms Of Breast Cancer

The first indication of breast cancer that is generally realized is a lump or skin that thickens in the breast, but about 9 out of 10 lumps that appear are not caused by cancer. The first indication of breast cancer that is usually realized is a lump or skin that thickens in the breast. However, about 9 out of 10 lumps that appear are not caused by cancer.

There are some indications you need to take in order to be asked directly to the doctor who handles you. Examples of such symptoms are pain in the breast or armpits that are not related to the menstrual cycle. The appearance of a thickened lump or skin of the breast and discharge from the nipple (usually with blood) also needs to be aware of. Some other symptoms are size changes in one or both breasts, nipple changes, and shrunken breast skin.

You may also experience itching and rashes appear around your nipples. In the armpit you can also appear a lump or swelling. The signs and symptoms of the above you need to be aware and try to ask the doctor to ensure the condition you are experiencing.

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Causes Of Breast Cancer
The cause of breast cancer is not known for certain. It is difficult to ensure that each patient has the same cause or not. But there are several factors that can affect the risk of breast cancer, among others:

Impact of Breast Cancer Diagnosis Previously
If you have had breast cancer or changes in the nature of non-invasive cancer cells contained in the breast channel into invasive cancer cells, you can return to cancer in the same breast or on the other breast.

The Influence of Lumps of Lumps Ever Had
Having a benign lump does not mean you have breast cancer, but certain lumps may increase your risk. Small changes in your breast tissue, such as unusual cell growth in the ducts or lobules, can increase your risk for breast cancer.

The Influence of Genetics and Family Health History
If you have a nuclear family (eg, mother, brother, sister or child) with breast or ovarian cancer, your risk for breast cancer will increase. But breast cancer may also appear more than once in one family by chance.

Most cases of breast cancer are not due to heredity, but certain gene mutations known as BRCA1 and BRCA2 can increase the risk of breast cancer and ovarian cancer . This type of cancer may also be passed on to the child's parents.

Age factor
As we get older, the risk of cancer will also increase. Breast cancer generally occurs in women aged over 50 years who have experienced menopause . Approximately 80 percent of cases of breast cancer occur in women aged over 50 years.

Risk of Radiation Exposure
Your risk for breast cancer can also increase if exposed to frequent radiation or due to certain medical procedures that use radiation such as x-ray and CT scan.

Estrogen Exposure Risk
The risk of breast cancer will increase slightly due to levels of exposure to estrogen in the body. Example:

• If you have no offspring or birth in the elderly. This will increase the risk of breast cancer because exposure to estrogen is not hindered by the process of pregnancy.
• If you have a longer menstrual period (for example, start menstruating before age 12 years or having menopause after age 55 years).

Effect of Hormone Replacement Therapy
Combined hormone replacement therapy has a slightly higher risk of estrogen replacement therapy. But both can still increase the risk of breast cancer. Among the 1,000 women who undergo combination hormone therapy for 10 years, it is estimated there will be 19 cases of breast cancer more than women who never received hormone therapy. This risk will also increase with the duration of therapy, but will return to normal once you stop living it.

The Effect of Excess Weight Or Obesity
Being overweight after menopause can lead to increased estrogen production so the risk of breast cancer will increase.

Consumption of Liquor
A study has been conducted on 200 women who consume liquor and 200 non-alcoholic women. The results suggest that members of the alcoholic beverage group could have as many as three more cancers. The risk of breast cancer will increase with the amount of liquor consumed.


Breast Cancer Diagnosis

In general, breast cancer is diagnosed through a routine examination or when the sufferer is aware of certain symptoms that eventually become a driver to the doctor. Physical examination alone is not sufficient to confirm the diagnosis of breast cancer.

If you find a lump in your breast, your doctor will recommend some procedures to determine whether you have breast cancer or not.

• Mammography . Mammography examination is commonly used to detect the presence of cancer.
• Ultrasound . This type of examination is used to ascertain whether the lump in the breast is solid or fluid-filled.
• Biopsy . This examination includes the process of sampling breast cells and test it to determine whether the cells are cancerous. Through this procedure, biopsy samples will also be investigated to determine the type of breast cells affected by cancer, its malignancy and its reaction to hormones.

When diagnosed with cancer, you need a number of further tests to determine the stage and extent of cancer spread. Among them:

• MRI and CT scan .
• Chest x-rays.
• Examination of bone to check whether the cancer has spread to the bone.
• Biopsy of lymph nodes (lymph glands) in the armpit. If cancer spreads, the first lymph nodes to be infected are lymph nodes sentinel.Location varies so it needs to be identified with a combination of radioactive isotopes and blue ink.

You are also advised to undergo an examination that will show a cancer reaction to certain types of treatment. Among them:

• HER2 checkProtein-induced cancers, called HER2 ( human epidermal growth factor receptor 2 ), can be treated with drugs that block the HER2 effect. This type of treatment is called biological or molecular therapy.
• Examination of hormone receptorsGrowth of breast cancer cells may also be triggered by the body's natural hormones, such as estrogen and progesterone . The cancer cell sample will be taken from the breast and tested to see its reaction to estrogen or progesterone. If the hormone attaches to the cancer cell, which is at the hormone receptor, the cell will be referred to as a positive hormone receptor.

Breast Cancer Stage
The stadium describes the size of the cancer and its extent. Non-invasive ductal breast cancer is sometimes described as Stage 0. Other stages explain the development of invasive breast cancer. The doctor will determine the stage of cancer after you have been diagnosed with cancer.

• In stage 1
  Tumor size less than 2 cm. The tumor does not spread to the lymph nodes in the armpits and there are no signs of spread of cancer to other parts of the body.
• In stage 2
  Tumor size 2-5 cm or no spread to lymph nodes, or both. There are no signs that the cancer has spread to other parts of the body.
• In stage 3
  Tumor size 2-5 cm. The tumor may be attached to the skin or tissue around the breast. The lymph nodes in the armpit are infected, but there are no signs that the cancer has spread to other parts of the body.
• In stage 4
  Tumors of all sizes and have spread to other parts of the body (metastasis).

Breast Cancer Treatment

There are several factors that become a doctor's consideration before deciding on the best treatment, namely the stage and the rate of cancer development, the overall health condition of the patient and the menopause .

Breast cancer that is detected through routine examination is usually at an early stage. Primary breast cancer (the first cancer cell begins with breast cells and not the spread of cancer cells from other organs) can generally heal totally if diagnosed and treated early.

While the cancer is detected due to physical symptoms that appear may already be in a more advanced stage. If detected at an advanced stage and after spreading to other parts of the body, then breast cancer can not be cured. The type of treatment to be recommended is also different and aims to ease the burden for the sufferer.

The first type of breast cancer treatment is usually surgery. The type of surgery varies depending on the type of breast cancer you are suffering from. The surgical process is usually followed up with chemotherapy, radiotherapy, or biological treatments for certain cases. Chemotherapy or hormone therapy can sometimes be the first treatment step.

If detected at an advanced stage after spreading to other parts of the body, breast cancer can not be cured. The type of treatment to be recommended is also different and aims to ease the burden for the sufferer.

Operating processes
Surgery for breast cancer is divided into two, ie surgery that only removes the tumor and surgery that raises the breast thoroughly (mastectomy). Plastic surgery reconstruction can usually be done immediately after a mastectomy.

To deal with early-stage breast cancer, studies have shown that surgical combination of tumor removal and radiotherapy have the same success rate as total mastectomy.

• Lumpectomy ( surgical removal of the tumor)In lumpectomy, the shape of the breast will be left as completely as possible. This surgery is generally recommended for small tumors and includes removal of the tumor along with a bit of healthy tissue around it. Considerations in determining the amount of breast tissue to be removed include the quantity of tissue around the tumor that needs to be removed, the type, size, location of the tumor, and the size of the breast.
• Mastectomy (removal of the breast)This surgical process is the removal of the entire breast tissue, including the nipple. Patients may undergo a mastectomy along with sentinel lymph node biopsy if there is no indication of cancer spread in the lymph nodes. Conversely, patients are advised to undergo the process of removal of lymph nodes in the armpits if the cancer has spread to that part.
• Plastic surgery reconstructionThis is the operation process to make the new breasts as closely as possible with the other breasts. Reconstructive plastic surgery can be done in two ways, namely direct reconstruction surgery along with a mastectomy, and periodic reconstruction surgery done some time after mastectomy. This new breast-making operation can be performed by using breast implants or tissues from other body parts.

Step Chemotherapy
Chemotherapy is generally there are two types, namely chemotherapy after surgery to destroy cancer cells and before a useful operation shrink tumors. The types and combinations of anticancer drugs used will be determined by the physician based on the type of cancer and its extent.

The side effects of chemotherapy will generally affect healthy cells. Therefore, the prevention or control of some side effects will be treated with other medicines by the doctor. Some of the side effects of chemotherapy include loss of appetite, nausea , vomiting, mouth ulcers or painful sensation in the mouth, susceptible to infection, fatigue, and hair loss .

Chemotherapy can also inhibit the production of the body's hormone estrogen . Patients who have not experienced menopause will experience menstruation that stops during chemotherapy. This cycle should return after treatment is completed. However, early menopause may also occur in women over the age of 40 as they approach the average age of menopause.

If other body parts already affected by the spread of breast cancer, chemotherapy will not be able to cure cancer. But chemotherapy can shrink tumors, relieve symptoms, and prolong life.

Step Radiotherapy
Radiotherapy is a therapeutic process to destroy the remnants of cancer cells with controlled doses of radiation. This process is usually given about a month after surgery and chemotherapy to condition the body can recover first. But not all breast cancer patients need it.

Just like chemotherapy, this procedure also has side effects, namely irritation so that the breast skin is sore, red, and watery, the skin color of the breast becomes darker, excessive fatigue and lymphedema (excess fluid that arises in the arm due to blockage of lymph nodes in the armpits).

Hormone Therapy To Overcome Breast Cancer
Especially for breast cancer whose growth is triggered by estrogen or natural progesterone (hormone-positive hormone receptor), hormone therapy is used to lower the level of cancer or inhibit the effects of these hormones. This step is also sometimes performed before surgery to shrink the tumor to be easily removed, but is generally applied after surgery and chemotherapy.

If the condition is not healthy, the patient will not be able to undergo surgery, chemotherapy, or radiotherapy. Therefore, hormone therapy can be an alternative as a single treatment process.

The duration of hormone therapy that is generally recommended is a maximum of five years after surgery. The type of therapy that will be lived depends on the age, whether you have menopause or not, the level of cancer development, the type of hormone that triggers cancer, and other types of treatment that is lived.

Tamoxifen and aromatase enzyme inhibitors are two types of drugs commonly used in hormone therapy. Tamoxifen serves to inhibit estrogen from binding to cancer cells.

While the inhibitor of aromatase enzyme is recommended for patients who have experienced menopause. Its function is to inhibit the performance of aromatase, a substance that helps estrogen production in the body after menopause. Examples of these drugs in the form of tablets that are available and taken every day are letrozol, eksemestan, and anastrozol.

Tamoxifen and aromatase enzyme inhibitors may cause some similar side effects, including headache , nausea, vomiting and heat sensation, sweating, and hot flushes. However, tamoxifen has a special side effect, which can cause changes in menstrual cycle in breast cancer patients.

Step Ablation Or Ovarian Suppression
Ovarian ablation or suppression will stop the ovarian performance to produce estrogen.

Ablation itself can be done with surgery or radiotherapy. Ovarian ablation will permanently stop ovarian performance and trigger early menopause.

Ovarian suppression uses a luteinising hormone-releasing hormone (aLHRH) agonist called goserelin . Use of this drug will stop menstruation for a while. Menstruation will return to normal after the use process is complete. For people aged close to the age of menopause or about 45 years, their periods may stop permanently even if goserelin is over.

Goserelin injections are given once a month. Side effects of this drug resemble the menopause such as emotional feeling, difficulty sleeping and the sensation of heat accompanied by heart palpitations.

Biological Therapy With Trastuzumab
Growth of some types of breast cancer triggered by the HER2 protein (human epidermal growth factor receptor 2) is called HER2 positive. In addition to stopping the HER2 effect , biological therapy also helps the immune system to fight cancer cells. If your HER2 protein level is high and you are able to undergo biological therapy, trastuzumab may be recommended by your doctor to you after chemotherapy.

Antibodies serve to destroy harmful cells such as viruses and bacteria. These proteins are produced naturally by the immune system. Trastuzumab is a type of biological therapy known as monoclonal antibody. This drug will inhibit HER2 so that cancer cells will die.

This therapy is not suitable for patients with heart disease such as angina , hypertension , or heart valve disease . If it is required to use trastuzumab, patients should undergo regular cardiac examination. Other side effects of trastuzumab are nausea, headache, diarrhea, shortness of breath, chills, fever , and pain.


Breast Cancer Prevention

Total prevention for breast cancer is difficult to know because the cause of this cancer is not known with certainty. But there are several steps we can take to lower the risk of breast cancer.

The main step is to apply a healthy lifestyle. For example reducing the consumption of fatty foods, maintaining a healthy and ideal weight, regular exercise, and limit alcohol consumption. These ways can not only reduce the risk of breast cancer, but also prevent other diseases.

In addition to lifestyle, the study also showed that women who had breastfed had a lower risk of developing breast cancer. This may be because their ovulation periods become irregular while breastfeeding so that estrogen levels remain stable.

Clinically Facing Breast Cancer
There are some treatments to decrease the risk for women with higher than average breast cancer risk. The two main types of handling will be described in more detail below.

• Handling with medicinesTwo types of drugs available for women at high risk for breast cancer are tamoxifen and raloxifene. Menopausal women can use both drugs, while women who are not yet menopausal are only encouraged to use tamoxifen. If you have had or have a risk of having blood clots or cervical cancer , these drugs may also be unsuitable.
  
  For those of you who want to have children, doctors will usually advise to stop taking tamoxifen at least two months before trying to conceive because this drug will affect the development of the fetus. Tamoxifen can also increase the risk of blood clots, so you should stop taking it at six weeks before surgery.
• MastectomyIn addition to treating breast cancer, mastectomy is also used to reduce the risk of breast cancer in women at high risk due to hereditary history. This surgery can reduce the risk of breast cancer by 90%, but still have the risk of complications.
  
  Breast removal may also significantly decrease patient confidence. In addition to plastic surgery, concurrent breast reconstruction or after mastectomy, you also have another alternative, a fake breast that can be used inside the bra.

Breast Cancer Examination

The way that is commonly abbreviated BSE is one of the preventive measures of breast cancer. Deaths from breast cancer can be prevented by examination. If breast cancer is detected at an early stage, your chances for a full recovery will be higher. Chances are you need a mastectomy or chemotherapy will also decrease. Mammography is the most commonly recommended type of examination for all women to detect breast cancer. Although breast cancer is less common in women over the age of 70, they can still undergo a mammogram once in 3-5 years. If you are a woman between 50 and 70 years of age, you should have a mammogram once every three years. Likewise with women under the age of 50, they are advised to do regular checkups once every three years.

Especially for women at high risk of breast cancer, for example because there is a nuclear family with breast or ovarian cancer, they should undergo an annual MRI scan or mammography before reaching the age of 50 years. MRI examination is sometimes an option because the results are more accurate to detect cancer in dense breasts. Another alternative to detect breast cancer is through genetic screening. You may choose to undergo a genetic examination by a blood test to look for mutations of BRCA1 , BRCA2 , and TP53 . Having one of these genes can increase the risk of breast cancer.

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