What is Breast Cancer ?

Breast cancer is an uncontrolled growth of breast cells. To better understand breast cancer, it helps to understand how any cancer can develop.

Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can “turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.

A tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumors are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumors are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumor to other parts of the body.

The term “breast cancer” refers to a malignant tumor that has developed from cells in the breast. Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast.

Breast Anatomy

Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes, small organs that filter out foreign substances in the body. If cancer cells get into the lymph nodes, they then have a pathway into other parts of the body. The breast cancer’s stage refers to how far the cancer cells have spread beyond the original tumor (see Stages of Breast Cancer table for more information).

Breast cancer is always caused by a genetic abnormality (a “mistake” in the genetic material). However, only 5-10% of cancers are due to an abnormality inherited from your mother or father. About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the “wear and tear” of life in general.

While there are steps every person can take to help the body stay as healthy as possible (such as eating a balanced diet, not smoking, limiting alcohol, and exercising regularly), breast cancer is never anyone's fault. Feeling guilty, or telling yourself that breast cancer happened because of something you or anyone else did, is not productive.

Stages of Breast Cancer

Stage	Definition
Stage 0	Cancer cells remain inside the breast duct, without invasion into normal adjacent breast tissue.
Stage I	Cancer is 2 centimeters or less and is confined to the breast (lymph nodes are clear).
Stage IIA	No tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm) OR the tumor measures 2 centimeters or smaller and has spread to the axillary lymph nodes OR the tumor is larger than 2 but no larger than 5 centimeters and has not spread to the axillary lymph nodes.
Stage IIB	The tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes OR the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.
Stage IIIA	No tumor is found in the breast. Cancer is found in axillary lymph nodes that are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone OR the tumor is any size. Cancer has spread to the axillary lymph nodes, which are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone.
Stage IIIB	The tumor may be any size and has spread to the chest wall and/or skin of the breast AND may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone. Inflammatory breast cancer is considered at least stage IIIB.
Stage IIIC	There may either be no sign of cancer in the breast or a tumor may be any size and may have spread to the chest wall and/or the skin of the breast AND the cancer has spread to lymph nodes either above or below the collarbone AND the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone.
Stage IV	The cancer has spread — or metastasized — to other parts of the body.

Symptoms of Breast Cancer

Initially, breast cancer may not cause any symptoms. A lump may be too small for you to feel or to cause any unusual changes you can notice on your own. Often, an abnormal area turns up on a screening mammogram (x-ray of the breast), which leads to further testing.

In some cases, however, the first sign of breast cancer is a new lump or mass in the breast that you or your doctor can feel. A lump that is painless, hard, and has uneven edges is more likely to be cancer. But sometimes cancers can be tender, soft, and rounded. So it's important to have anything unusual checked by your doctor.

According to the American Cancer Society, any of the following unusual changes in the breast can be a symptom of breast cancer:

• swelling of all or part of the breast
• skin irritation or dimpling
• breast pain
• nipple pain or the nipple turning inward
• redness, scaliness, or thickening of the nipple or breast skin
• a nipple discharge other than breast milk
• a lump in the underarm area

These changes also can be signs of less serious conditions that are not cancerous, such as an infection or a cyst. It’s important to get any breast changes checked out promptly by a doctor.

Stages of Fear after Diagnosis

Most people go through several stages of fear when they are first diagnosed. The stages, and the order in which they happen, are very similar in most people:

• You just can't believe what you've heard and completely deny it.
• You get angry at the doctor who told you and anyone else, such as a lab technician or nurse, who read a result to you.
• You appeal to a higher power and ask over and over, “Why did this happen to me?” or “What did I do to deserve this?”
• You feel resigned, as if there’s nothing you can do to help yourself.
• You accept the truth, hard as it may be, and decide to fight with everything you’ve got in you.

A big part of the fear of breast cancer diagnosis is all the uncertainty and the feeling that you’ve lost control of your life — being swept away on an uncharted journey that you don’t want to take. It’s hard to imagine how anything good could happen on this particular trip.

It turns out that this isn’t necessarily so. While no one wants to be diagnosed with breast cancer, many people in treatment or finished with treatment say that the experience made them stronger and helped them to become closer to their families and friends and learn more about themselves. Being diagnosed is never easy, but once you start the process of getting the best available doctors, the best information, and the best support you can from those who love you, you are in good hands.

10 Ways to Manage Fear after Diagnosis

1. As you begin gathering information to make decisions, get to know the people on your medical team and make every effort to meet them in person. Turn faceless doctors into known resources. These are the people you've hired onto your team to help you. You'll find out who is the best communicator, who can answer which questions, who is available to help you when you need it most.
2. Find a doctor who communicates with you in a way that is comfortable for you, who invites your questions and takes your concerns seriously, who gives you as much or as little information as you feel comfortable with at any given moment.
3. Find out what to expect from tests, procedures, and treatments. Minimize surprises.
4. Make plans with your doctor about how to receive test results in a prompt way. If possible, try to schedule important tests early in the week, so you don't have to wait over a long weekend when lab work may slow down or doctors aren't communicating with each other.
5. Find a mammography center where the radiologist will talk with you about the results before you go home, so you don't have to wait for a letter or a call from your doctor.
6. When you know you're going to have a challenging week (a mammogram coming up or a round of chemotherapy), don't plan to do things that are stressful for you (for example: balance the checkbook, cook dinner for 20, or run a big meeting at work). Use your support systems — friends, movies, yoga, prayer — to help you get through it.
7. If well-meaning people try to tell you stories about others struggling with cancer, stop them right away and say, "I only listen to stories with happy endings!"
8. If you reach a point where difficult emotions are getting in the way of your functioning or taking care of yourself, speak with your doctor about the role of medications that might help ease your anxiety, depression, or sleeping problems.
9. Join a breast-cancer-related group. This can be a support group or online discussion board — a place to share your breast cancer experience openly with people who understand. If you are more action-oriented, look for a breast-cancer-related athletic group, an organization that holds breast cancer education programs, or an advocacy group that lobbies for more research funding or free mammograms. Do whatever makes you feel connected to others in a positive way as a person who is moving beyond breast cancer.
10. Work on ways to feel more positive about your life. Seek out productive, life-enhancing experiences; accept yourself for who you are; and spend time with positive people who affirm who you are and how you've chosen to deal with this disease.