Breast #Cancer

Breast cancer
Breast cancer (malignant breast neoplasm) is a cancer that starts in the tissues of the breast either from the inner lining of milk ducts (Ductal carcinoma) or the lobules (Lobular carcinoma) that supply the ducts with milk. there is also rare cases that breast cancer starts in other areas of the breast. In 2010, over 250,000 new cases of breast cancer were expected to be diagnosed in women in the U.S. alone and the risk of getting invasive breast cancer during life time of a women is 1/8.

Signs and SymptomBreast cancer is first noticed as a painless lump in the breast or armpit and most often discovered by you or your partner may discover the lump or or your doctor during a routine physical exam.
In early case of cancer, symptoms normally include
1. Lump (mass) in the breast
2. Lump in the armpit (lymph nodes)
3. Nipple discharge (clear or bloody)
4. Inverted or retracted nipple
5. Scaly or pitted skin on nipple persistent tenderness of the breast
6. Unusual breast pain or discomfort
7. Etc.

In advance case of cancer as cancer have spread to distance of the body, symptoms include
1. Bone pain (Secondary tumors in bone)
2. Shortness of breath (Secondary tumors in lung)
3. Unintentional weight loss and drop in appetite (Secondary tumors in liver)
4. Headaches, neurological pain or weakness (Secondary tumors in the nervous system)
5. Etc.

A rare case of breast cancer (Inflammatory Breast Cancer (IBC))
Inflammatory breast cancer (IBC), an aggressive cancer can occur in women of any age, grows in sheets instead of lumps invades nearby skin, leading to whole breast may go suddenly red and feel hot, resembling an inflammation and happening only about 1-6% of all breast cancer cases in the USA. It should be treated very promptly. Symptoms include
1. Rapid swelling (a cup size in a few days) sometimes
2. Associated by skin changes (pink, red, or dark-colored areas)
3. Nipple retraction
4. Persistent itching, skin hot to touch
5. Initially resembles mastitis
6. Breast skin ulcers (later stage of IBC)
7. Etc.

Risk factors
1. Gender
If you are women, your chance of getting breast cancer is 99 % higher due to more breast cells and constant exposure to growth hormones that affect the production of estrogen and progesterone.

2. Aging
Breast cancer increases proportional with age. Researchers found that out of 1/8 invasive breast cancers found in women, 2 out of 3 are women age 55 or older.

3. Heredity
About 5% of woman of breast cancer are caused gene mutation inherited from either the parents.

4. Family factor
Researchers found that if one of your direct family have developed breast or ovary cancer, your risk of getting breast cancer is increased.

5. Pregnancy
The risk of develop breast cancer for women who never get pregnant.

6. Smoking
Researchers found that the risk of women who had smoked cigarettes in their teen years have a high risk of getting breast cancer and women who smoke for 35 years or more have a 59% higher risk of developing breast cancer, compared with those who never smoked

7. BRCA1 and BRCA2
Researchers found that mutation of tumor suppressor gene BRCA1 and BRCA2 are likely to develop breast cancer later in their life.

8. Menstruation
Women who started menstruating at an early age (before age 12) or went through menopause at a later age (after age 55) have a slightly higher risk of breast cancer due to longer lifetime exposed to estrogen and progesterone hormones.

9. Ataxia telangiectasia mutated (ATM)
The alternation of The ATM gene provides instructions for making a protein in controling the rate cells grow and divide and assisting in DNA of cells repair by recognizing damaged or broken DNA strands caused by toxic chemicals or radiation. Inheriting one mutated copy of this gene increase the risk of breast cancer.

10. Tumor protein 53 or P53
P53, a tumor suppressor protein in humans encoded by the TP53 gene can cause Li-Fraumeni syndrome, increasing the risk of developing of breast cancer.

11. Dense breast tissue
Women who have denser breast tissue and more glandular tissue and less fatty tissue, have a higher risk of developing of breast cancer.

12. Previous breast lump that had atypical change
A benign breast lump which showed atypical change called atypical hyperplasia increases the risk of developing breast cancer later in their life.

13. Overweight
Overweight and obese women have a higher risk of developing breast cancer compared to women who maintain a healthy weight in BMI index, especially after menopause.

14. Etc.

Factors that reduce the risk of breast cancer
1. Breast feeding
Researchers found that women who breast feeding their babies slightly lower risk of developing of breast cancer.

2. Early age at first full-term pregnancy:
Women who have their first full-term pregnancy at an early age slightly lower the risk of developing breast cancer later in life. Researchers found the women who have a first full-term pregnancy before age 20, the risk of developing breast cancer is about half that of women whose first full-term pregnancy occurs after the age of 30 and only limited to hormone receptor-positive breast cancer.

3. Increasing number of births
The risk of breast cancer declines with the birth of number of children, Researchers found that Women who have given birth to five or more children have half the risk of women who have not given birth and only limited to hormone receptor-positive breast cancer.

4. Preeclampsia
Women who have had pregnancy conditions of high blood pressure and protein in the urine develop after the 20th week may slightly decrease the risk of developing breast cancer. Researchers suggested that certain hormones and proteins associated with preeclampsia may affect the risk of breast cancer.

5. Longer duration of breastfeeding:
Researchers found that Breastfeeding for an extended period of over a year) reduces the risk of developing of breast cancer later in their life in both hormone receptor-positive and hormone receptor-negative breast cancer.

6. Drinking more Coffee
In a new study, published in the journal Breast Cancer Research, women who drink five cups of coffee a day or more can reduce the risk of getting certain types of breast cancer. (How many women can do that without developing nervous tension)

7. Etc.

Diagnosis
1. Clinical Breast Exam (CBE)
The purpose of the clinical breast examination (CBE) is to detect early breast abnormalities or evaluate patient reports of symptoms of breast cancers at an earlier stage for more more effective treatment. In most case, cancer caught in early stage can be cured completely. In U. S. the American Cancer Society (ACS) recommended that women between the age of 20 to 39 should have a CBE once every three years and women 40 and older to get CBE annually.

2. Mammograms
If you have any symptoms is mentioned above, the first test which your doctor order is a mammogram to screen and detect any breast tissue abnormally and any sign of tumor. mammograms can detect between 85 to 90 percent of all abnormalities, including breast cancer, cysts, fibroadenomas, tumors, etc. even before you can feel a lump.

3. Breast Magnetic Resonance Imaging (MRI)
Breast magnetic resonance imaging (MRI) is a medical test that helps physicians diagnose the breast conditions of a patient by using powerful magnetic field, radio frequency pulses to produce detailed pictures of soft tissues and internal structures of the breast. It reveals different details about many breast conditions that cannot be obtained by mammography, ultrasound, etc.

4. Elastography
Elastography, a new technology for imaging breast tissue, is a non-invasive method used to detect or classify the stage of the tumors. In a study comparing ultrasound with breast elastography measurement, researchers found that breast elastography was highly effective in distinguishing benign from malignant breast tumor.
5. Ductal Lavage (Pap smear for the breast)
Ductal lavage also known as Pap smear for the breast, is one of fluid test used in addition to CBE and mammography to detect breast cancer by with drawing fluid which contains breast cells from the breast ducts with the use of a tiny catheter inserted into the nipple.

6. Breast Biopsy
In a breast biopsy, a very small tissue sample is extracted and examined under a microscope for the presence of cancer cells by using a medical instrument (fine needle aspiration cytology (FNAC), Core needle biopsy (CNB) and Stereotactic biopsy) or cutting out by a surgical procedure.

7. Etc.

Factors that influence treatment options
A. Stages of breast cancer
The stages of breast cancer are classified depending to
1. Size of the cancer
2. Invasive or not
3. whether cancer has spread to the lymph nodes
4. whether the cancer has spread to the distance parts or organs of the body.
There are 4 stages of breast cancer in TNM rating (where T is referred for tumor size, N is referred for Lymph Node status, M is referred for invasive or not)
# T: Tumor Size is divided into four classes: T-1 is between 0 - 2 cms, T-2 is between 2 - 5 cms, T-3 is > 5cms, and T-4 is a tumor of any size growing into the chest wall or skin, including inflammatory breast cancer.
#N: No swollen nodes: N-0, some swelling but negative node (not cancerous): N-1a, swelling nodes and positive node (cancerous): N-1b, quite swollen and bunched together: N-2, quite swollen and near the collarbone:N-3.
# M: if no cancer cell is found: M-0, cancer cells found: M-1.

a. Stage 1T-1 tumor and clear lymph nodes with no evidence of spreading (M-0), or T-1N-0M-0.
b. Stage 2
Stage 2 is the combination of combination of T-1, T-2, or T-3 tumor, N-0. N-1a and N-1b but no spreading (M-0)
c. Stage 3
Stage 3 is the combination of all T or N but no spreading (M-0)
d. Stage 4
Stage 4 is the combination of T, N-1a, N-1b, N-2, N-3 and M-1

B. Hormone receptors sites and HER2 (Human Epidermal growth factor Receptor 2)
1. Hormone receptors
A hormone receptor is a receptor protein on the surface of a cell with the function of binding to a specific hormone in its interior. Estrogen receptors are that bind estrogen hormone and progesterone receptors are cells with the same.
Estrogen and progesterone receptor status tests
They are the tests to determine whether the tumor's growth is influenced by the hormones estrogen and/or progesterone by taking a sample of breast cancer tissue obtained during a biopsy.
a. Cancer with hormones sensitive is always slower growing
b. Reponses well to hormones suppression treatment
c. If there is negative found in both tests (ER- and PgR-), hormone suppression treatments are not required (tuomor is not driven by hormones). Further testings are required to determine the best options.
d.
# ER-0, PgR-0 is no estrogen and progesterone receptor found
#Er-1+, PgR-2+ small numbers of estrogen and progesterone receptors found accordingly
#ER-2+, PgR-2+ a medium numbers of estrogen and progesterone receptors found accordingly
# ER-3+, PgR-3+ large numbers of estrogen and progesterone receptors found accordingly.

2. Testing HER2 (human epidermal growth factor receptor 2)
About 30% of breast cancers are caused by over expression of its protein product or HER2.
If your cancer is no driven by either hormones estrogen or progesterone, you doctor my order the testing of HER2. HER2, a gene with function of signaling the growth and differentiation of cells. and a healthy breast has only 2 copies of the HER2 gene.
A test of HER 2 positive can be treat by the amplification of other genes and the use of the drug Herceptin, in combination with other chemotherapy drugs, otherwise your cancer is not caused by gene HER2.
a. IHC test
IHC is the most commonly used test ordered by your doctor to determine the number of HER2 receptor protein on the surface of the cancer cells done by a special staining process performed on fresh or frozen breast cancer tissue removed during biopsy.
*HER2-0 or HER2-1+ is considered HER2 negative
*HER2-2+ or HER2-3+ is considered HER2 positive.

b. FISH test (Fluorescence in situ hybridization test)
If the IHC test can not clearing provide results of the HER2 positive or negative then FISH will be required. FISH is considered more accurate to determine whether the cells have extra copies of the HER2 gene by vitalizing gene HER2 in breast cancer tissues removed during biopsy. HER2-positive or negative)


The main types of invasive and non invasive breast cancer
1. Invasive breast cancer
Invasive breast cancers grow by alternation of the DNA of the breast cells and either have a tendency to spread to the lymph nodes then to distant parts of the body or already do so. Most breast cancers are invasive.
Common types of invasive breast cancers include:
a. Infiltrating/Invasive Ductal Carcinoma (IDC)
This is the most common type of breast cancer accounted for about three-quarter of all breast cancer, originated in the milk ducts, then spread out to nearby breast tissue including Inflammatory breast cancer (IBC), Medullary carcinoma, Metaplastic breast cancer, Paget's disease of the nipple, Tubular carcinoma, etc.

b. Infiltrating/Invasive Lobular Carcinoma (ILC)
Lobular breast cancer is another common types of invasive breast cancers, originated in the glands or lobes, that has broken through the wall of the lobule and begun to invade the tissues of the breast. Infiltrating Lobular Carcinoma accounted for about ten percent of all breast cancer.

2. Non invasive breast cancer
Non invasive breast cancer is also known as carcinoma in situ of which breast cancer cells stay within the milk ducts or lobules in the breast.
a. Ductal carcinoma in situ (DCIS)
DCIS is one the most common type of non-invasive breast cancer as it has tendency not to beyond the milk duct into surrounding breast tissue and treated differently than other types of invasive cancer. DCIS isn’t life-threatening, but it increases the risk of developing an invasive breast cancer in the future of the patient life.

b. Lobular Carcinoma In Situ (LCIS)
LCIS, is another types of invasive breast cancer, originated from the abnormal cells growth in the breast lobules, but not spread to the surrounding breast tissues. Researchers found that 25 percent of patients who have LCIS will develop breast cancer at some point in the future.

Depending to your diagnosis, your breast cancer is ranked in stage and grade by your oncologist and radiologist and treatment will be suggested or given accordingly.

Phytoestrogen and breast cancer
Since there is controversy of phytoestrogen protects against or induces breast cancer, we would like you to read this research from The American Journal of Clinical Nutrition 2oo4

Prevention and after treatments
A. With Foods
1. Food with high amount of beta carotene
All yellow orange vegetables contains high amount of beta carotene, a precursor of vitamin A which can be stored in the liver. Researchers found that eating foods high in beta- carotene lowers the risk of breast cancer.

2. Food with high amount of Indole -3-carbinol
Cruciferous vegetables, such as broccoli, cauliflower, cabbage, turnips, brussel sprout, etc. contains high amount of indole -3-carbinol which inhibits the breast cancer promoting estrogens such as the 16-hydroxy- estradiol and 16-hydroxy-estrone.

3. Nuts and seeds
Most but and seeds contain high amount of linoleic acid which found to prevents and reduces the risk of breast cancer in some studies.

4. Foods contain high amount lycopene
Lycopene is a bright red carotene and carotenoid but no vitamin A activity pigment and phytochemical found in tomatoes and other red fruits and vegetables, such as red carrots, watermelons and papayas. Reseachers found that lycopene inhibits tumors cells. Eat cooked tomatoes reduces the risk of breast and prostate cancer.

5. Foods with high resveratrol
Drinking no more than 150 mg of red wine or eating red grape helps to reduce the risk of breast cancer due to high amount of resveratrol. Researchers found that resveratrol has the ability to prevent the estrogen process that leads to cancer by blocking the formation of the estrogen DNA abducts.

6. Food with high amount of Omega 3 fatty acid
Cold water fish such as salmon, tuna, etc and nuts and seeds such as walnut, pumpkin seeds, flaxseeds contain high amount of Omega 3 fatty acid. Researchers found that omega-3 fatty acids not only combat breast cancer but also prevent the breast cancer from spreading to other issue or organs.

7. Food with high amount of anthocyanins
Cherries contain high amount of anthocyanins. In some studies, found that cherries inhibit colon cancer and breast cancer cells.

8. Food with amount of limonoids
Researcher found that the peel and white membrane of oranges, lemon, tangerine contain high amount of limonoid, a chemical compound showed inhibition of breast cancer in test tubes. Eat whole fruit oranges and tangerines.

9. Eating whole grains
Study showed that women who ate one serving a day of a cereal high in wheat bran reduces the risk of breast cancer by increasing intake of high levels of vitamin and mineral and reducing in take of artificial ingredients added in refine grain which promotes estrogen.

10. Avoid trans and saturated fat
Diet high in trans and saturated fats increase the production of bad estrogen that induces the risk of breast cancer.

11. Polyphenol Epigallocatechin-3 Gallate (EGCG)
Green tea contains high amount of EGCG, a compound has been known to inhibit breast cancer cells. A new study has elucidated the molecular mechanisms by which (-)-Epigallocatechin-3-gallate (EGCG), a compound found in green tea, exerts anti-cancer effects in tamoxifen-resistant breast cancer cells.

12. Top your olive oil instead of high heat
Oil becomes trans fat in high heat increases the risk of breast cancer as mentioned above.

13. Diallyl trisulfide
Garlic and onion contain sunstance diallyl trisulfide that can suppress breast cancer cell invasion and metastasis.

14. Isoflavinoids
Soy caontains high amount of isoflavonoid which can block the more powerful estrogens from stimulating estrogen sensitive cancer cells by occupying the estrogen receptors in breast cells.

15. Lignan
Lignan also known as mammalian lignan in flaxseed is a chemical structural similarity to the natural estrogen, 17-Beta-estradiol which has a weak estrogenic or antiestrogenic properties to inhibit breast cancer cells.

16. Etc. Please read 100+ Healthy Foods Classification

B. With Antioxidants
Antioxidants reduce the risk of oxidation causes of tissues damage and mutation of DNA of cells which can cause breast cancer and recurrence of breast cancer by scavenging or stopping them before causing damage to the normal cells.
You can read more details of above at this link Antioxidants, Free Radicals, Cancers, Diseases

1. Lycopene
Lycopene found abundant in cooked tomatoes as a powerful antioxidants counterbalances the detrimental oxygen free radicals before they can damage cellular structures in the breast as well as other types of cancer.

2. Vitamin A
Vitamin A plays an important role as an antioxidant as it scavenges free radicals by preventing them to become cancerous. including breast tissues but vitamin A have had mixed results in treating cancer according to W. Byers, Ph.D., a professor of oncology and cell biology at Georgetown's Lombardi Comprehensive Cancer Center as vitamin A may cause some breast cancer cells to form blood vessels brings up the rather disturbing notion that treatment with these drugs may actually stimulate tumor growth,..."

3. Vitamin C
As an antioxidant and water soluble vitamin, vitamin C can be easily carry in blood and operate in much of the part of body. By restoring vitamin E, vitamin A and E helps to fight against forming of free radicals by scavenging in inhibiting any cause of oxidation.

4 Vitamin E
It beside is important in protecting muscle weakness, repair damage tissues, lower blood pressure and inducing blood clotting in healing wound, etc, it also is one of powerful antioxidant, by moving into the fatty medium to prevent lipid peroxidation, resulting in lessening the risk of chain reactions by curtailing them before they can starts.

5. Coenzyme Q10
Coenzyme Q10 enhances energy production by promoting the process of the production of ATP then serving as fuel for the cells and acts an antioxidant to prevent the generation of free radicals during this process, thus reducing the risk of breast cancer and other types of cancers.

g. Etc.

C. With Herbs
1. Keladi TikusKeladi Tikus is also known as Rodent Tuber, a genus of Typhonium in Araceae family native to Eeast Asian. The herb has been used in traditional herbal
medicine in treating cancer, including leukemia. Researcher Sheen Lai Choo from Malaysia Science Research Center found that compound Fitol in keladi tikus expresses apoptosis property by activating PPARy to causes cancer cells die by suicide (Apaptosis).

2. Eruca sativa
Eruca sativa is also known as Arugula herba genus of Eruca, belongs to the family Brassicaceae, native to Europe and western Asia and It is a type of cruciferous vegetable like broccoli, cauliflower and cabbage. Study showed that Eruca sativa promotes apoptosis, suppresses cell cycle progression and inhibits angiogenesis of human breast cancer cells.

3. Anethum graveolens (Dill) seeds
Anethum graveolens is also known as dill, a genus Anethum, belongs to the family Apiaceae. Monoterpenes, the substance of essential oil activates the secretion of glutathione-S-transferase is an anti carcinogens and carcinogens neutralizing agent.

4. Trifolium pratense
Trifolium pratense is best known as Red clover, a genus Trifolium, belongs to the family Fabaceae, native to Europe, Western Asia and northwest Africa. Researcher found that genistein inhibits of cancer cell growth, promotes apoptosis

5. Actaea racemosa
Actaea racemosa is also known as black cohosh, a genus Actaea, belongs to the family Ranunculaceae, native to eastern North America. researchers found that black cohosh can block cell growth, Rebbeck and colleagues note. The herb contaons high amount of antioxidanta, and has been shown to have anti-estrogen effects. Taking black cohosh may reduce the risk of breast cancer by more than 50 per cent, suggested by an epidemiological study from the United States.

6. Punica granatum essential oil
Punica granatum is also known as pomegranate, a genus Punica, belongs to family Lythraceae, native to native to the Iranian Plateau and the Himalayas in north Pakistan and Northern India. Researcher from the Technion-Israel Institute of Technology found that pomegranate essential oil triggers apoptosis, a self-destruct mechanism in breast cancer cells.

7. Etc.

D. Chinese Herbs
1. Ban Zhi Lian
Ban Zhi Lian is also known as scutellaria. The bitter and cool herb has been used in TCM as diuretic and to treat tumors and cancer as it clears heat, expels toxins, eliminates stagnation, stops bleeding and calms pain by enhancing the functions of lung, liver, spleen, stomach and large intestine channels. In vitro study, essential oil extract of 200mg/ml of the herb possesses the effect of inhibiting the tissues of rectum cancer or colon cancer.
In lab tests of animals and breast-cancer cells, BZL101 caused apoptosis or cell death, researchers found.

2. Qing Hao
Qing Hao is also known as Worm Wood. The bitter and cold herb has been used in TCM as anti malaria agent and to trealupus, schistosomiasis as it disperses cold and dampness, expels wind and calms pain by enhancing the functions of kidney, liver and gallbladder channels.
Researchers found that qing hao elevates the calcium ions of leukemia white cells, triggering apoptosis, a self-destruct mechanism in cancer cells. A University of Washington study showed that qing hao selectively kills several cancer cell lines in the test tube.

3. Huang Lian
Huang Lian is also known as Figwortflower. The bitter and cool herb has been used in TCM to treat indigestion, diabetes, inflammation of intestine, diarrhea caused by bacterial infection, high fever, restlessness and insomnia, etc. as it clears heat, dries dampness, disperses fire and expels toxins by enhancing the functions of heart, large intestine, liver, and stomach channels.
Researchers at Memorial Sloan Kettering Cancer Center (MSKCC) found that huang lian extract has been shown to induce apoptosis and to arrest cell growth by up-regulating Interferon beta and tumor necrosis factor-alpha genes in breast cancer cells.

4. Yun Zhi
Yun Zhi is also known as Turkey Tail Mushroom. The sweet, bland and cold herb has been used in TCM as an antibiotic, anti-viral, and anti-tumor agent and to treat hepatitis B, tumors in the digestive system, respiratory system and in the cervix uteri as it clear heat and dampness, transforming phlegm and expels toxin by enhancing the functions of liver, spleen, lung channels.
Researchers found that Yun Zhi significantly improves survival rates and lifespan for gastric, esophageal, colorectal, breast and lung cancers.
5. Bai Hua She She Cao
Bai Hua She She Cao is also known as spreading hedyotis, The bitter, sweet and cold herb has been used in TCM as anti-bacteria, anti-inflammation, anti-tumor, anti-virus agent and to treat snakebite and enhances immune system as it clears heat, drains dampness, expels toxins and resolves abscesses by enhancing the functions of liver, stomach, large intestine channels.
The Sanjiv Kumar YADAV, Shao Chin LEE(Yong Loo Lin School of Medicine, National University of Singapore researcher results showed that the ethanol extract from Bai Hua She She Cao effectively evokes cancer cell apoptosis, possibly through burst-mediated caspase activation.

f. Etc.

Treatments
A. Types of treatments

Most invasive cancers are treated with combination of the below types of treatment
1. Surgery
Most patients with invasive or non invasive breast cancer are required surgery to remove the cancer from the breast. While non invasive cancer patients are not needed further treatment, invasive cancer patients usual needed to have some of the lymph nodes removed and examined under a microscope by pathologist to see if they contain cancer cells.
1.1. Breast-conserving surgery
The operation only removes the breast cancer cells but conserves the other healthy breast cells. It only works well with patients with small size of tumors.
a. Lumpectomy:
Operation used to remove the breast cancer cells and some the tissue around the breast.
b. Partial mastectomy
Normally, partial mastectomy required 2 incisions in the surgery. One incision for removing the breast cancer cells and tissue around it, the others is for removal for lymph nodes tissues for examination.
1. 2. Mastectomy
a. Total mastectomy
The complete removal of the breast that has cancer and some lymph node tissues are taken as the same time in the operation.
b. Modified radical mastectomy: The surgery not only to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, but sometimes, also parts of the chest wall muscles as well.This types of operation may only perform with patient with advance stage of breast cancer.
c. Radical mastectomy:
Beside removing the breast that has cancer, radical mastectomy also remove the chest wall muscles under the breast, and all of the lymph nodes under the arm.

1.3. Side effect
a. Soreness, tenderness, and pain at the incision site.
b. Nerve damage
c. Lymphedema
d. Shift in weight
e. Tightness in skin
f. Poor wound healing, bleeding, or
g. reaction to the anesthesia

2. Radiation therapy
2.1 By using high-energy x-rays or other types of radiation, radiation therapy kills breast cancer cells and keep them from growing or regrowing. Depending to stage or grade of the breast cancer of the patient, there are two types of radiation therapy.
a. External radiation
By using a machine outside the body to send direct high-energy x-rays or other types of radiation toward the cancer.
b. Internal radiation
Internal radiation
By placing a radioactive substance direct into or near the cancer by a medical intrument with the aim to kill nearby cancer cells.

2.2 Side effects
a. Fatigue
b. Chest pain
c. Heart problem
d. Short of breath
e. Skin discoloration or pinkness, irritation.
f. Etc.

3. Chemotherapy
3.1. Chemotherapy is most used to treat breast cancer patience with advance stage or grade, as it has spread to a distant parts of the body by using drugs taken by mouth or injected into a vein or muscle of the patient to stop the growth of or to kill cancer cells.
3.2. Side effects
a. Nausea
b. Vomiting
c. Hair loss
d. Fatigue
e. Anemia
f. Mouth sores taste and smell changes
g. Infection
h. Etc.

4. Hormone therapy
4.1. If the breast cancer is due to hormone related actions, hormone therapy is most effective to blocks their action and stops cancer cells from growing. Tamoxifen is often given to patients with early stages of invasive breast cancer by suppressing the production of estrogen for over period of 5 years.

4.2. Side effects
a. Headache
b. Nausea
c. Breast pain
d. Constipation or diarrhea Nausea
e. Loss of or decrease in appetite
f. Tenderness in the breasts
g. Trouble sleeping
h. Etc.

5. Biological therapy
a. By enhancing the body's own immune or hormonal system to kill cancer cells, while leaving healthy cells relatively intact with the use of antibodies to attack cancer cells or block their activities or interrupting the hormonal or chemical pathways of the cancers with certain drugs composed of small molecules .
b. Side effects
b.1. Allergic reactions,
b. 2. Difficulty breathing, swelling,
b. 3. Nausea,
b.4. Fever or chills, and
b. 5. Dizziness and fatigue
b.6. Etc.

6. Target therapy
6.1. Target therapy is a treatment used to treat breast cancer caused by specific cells by killing them but without harming normal cells.
Trastuzumab (Herceptin) is a drug that used effectively to treat breast cancer caused by growth factor protein HER2, while lapatinib inhibits the HER2 protein and other proteins effects inside tumor cells.

6.2. Side effects
a. Shortness of breath
b. Leg swelling
c. Severe fatigue
d. Weakness
e. Nausea
f. Vomiting
g. Cough
h. Diarrhea
i. Headache
j. Etc.

The main objective of all treatments is to remove all the primary cancerous and non cancerous tumors but leave the breast as undisturbed as possible and prevent the cancerous tumors from reoccurring.

Male breast Cancer
Although it is rare, it can happen, approximate 1% of breast cancer patients are male. It is most common in older men, but can occur at any age. Symptoms are a similar to those of femal breast cancer. Therefore, if you notice any usual symptoms of your breast, please see your doctor imediately, because early diagnosis have a good chance to be cured. Treatments are also similar to those of above, depending to the grade and stage of the tumors. (We will come back with a article of male breast cancer later).

Breast reconstruction
Breast reconstruction after mastectomy for patient with breast cancer are always discussed before the surgery. Although, the reconstruction of breast is no longer giving back the natural breast but most women are graceful. There are many ways for breast reconstruction and general anesthesia is required in all stages. No matter what types of breast reconstruction you choose. Before mastectomy, your breast reconstruction and breast removal surgeons will provide you with all information, made sure you understand, discuss and ask, if you have any question before going into operation room.
1. Implant
1.1. If you chose to have breast reconstruction after surgery with implant, you may be advised to have implanted done after the would of the surgery area is completely heal. In this type of treatment, the surgeon will remove enough skin over your breast during the mastectomy to be able to close the skin flaps for the reconstruction breast and placed a expander is a pouch made out of silicone, it will be slowly filled until it reach the right size, before the permanent breast implant is placed.
This type of breast reconstruction is done over stages and general anesthesia is necessary.
1.2. Side effects
a. leaking
b. Scar may become permanent
c. Shifting
d. Infection
e. Uneven breasts
f. Etc.

2. Breast reconstruction with natural tissue
If you chose to have breast reconstruction with natural tissue and later after surgery
2.1. Trectus abdominous muscle flap
Using skin, fat, and muscle in your lower belly, from one hip to the other, by tunneling this tissue under the skin of your abdomen up to the breast area with the blood vessels cut and reattached to blood vessels under your arm then made to the size and shape that match your other breast.

2.2 The latissimus muscle flap

Using skin, fat, and muscle of your upper back, on the side of your breast that was removed by tunnelling this tissue under your skin to the breast area with blood vessels will remain connected to the area where the tissue was taken off then made to the size and shape that match your other breast.

2.3. Side effects
a. Loss of sensation
b. Scar
c. Uneven breast size
d. Etc.
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