If you’re caring for someone who’s been diagnosed with breast cancer, it’s helpful for you to get grounded in the basics of the disease. Breast cancer usually starts with a cancerous, or malignant, tumor located in the breast tissue. Most breast cancers are located in the area around the nipple. For women, breast cancer is the most common cancer and the second leading cause of cancer deaths, following only lung cancer. Although men can get breast cancer, it’s rare (only one half of 1 percent of all breast cancers are in men).

Most breast cancers are found when a woman feels a lump or hard area within her breast or when a suspicious area turns up on a mammogram. Not all tumors are malignant; doctors determine whether one is by taking a biopsy of the tumor tissue. Then they can examine whether cells are growing in the out-of-control fashion that indicates cancer.

The majority of breast tumors are described as being either lobular or ductal. These terms refer to the location of the tumor: whether it’s located in a lobule, or milk-producing gland, or in a duct, one of the tubes connecting the lobules with the nipple.

In situ and invasive breast cancer

One of the first things doctors try to establish is whether a breast tumor is contained within its original location or has spread to surrounding tissue. To determine this, doctors use two terms:

• In situ. This means the malignant cells are contained within the original area — that is, within the duct or lobule. Women with very early-stage breast cancer will be told they have ductal carcinoma in situ or lobular carcinoma in situ. These are also sometimes called stage 0 because they aren’t invasive.
• Invasive (or infiltrating). This means the cancerous cells have broken through the wall of the duct or lobule and are expanding into other areas. The most common type of breast cancer is invasive (or infiltrating) ductal carcinoma (IDC), which means cancer that started within a milk duct has now spread into the fatty tissue of the breast. Eight in ten of all breast cancers are IDC. Invasive lobular carcinoma, or ILC, is much less common, accounting for only one in ten invasive breast tumors.

The rarest type: Inflammatory breast cancer

Inflammatory breast cancer, a form of invasive breast cancer, accounts for only 1 to 3 percent of all breast cancers. This type of cancer doesn’t start with a lump or tumor. Instead, it begins by blocking lymph vessels in the skin. Women with inflammatory breast cancer may notice their breasts are red, swollen, and painful, and the skin may have a thick, pitted appearance that’s often described as resembling orange peel. Unfortunately, inflammatory breast cancer is often mistaken for mastitis, or infection of the milk ducts around the nipple.

The lymphatic system carries fluid that fights infection, and the lymph nodes and vessels near the breast and under the arm are one of the first places breast cancer typically spreads. Once in the lymph nodes and vessels, cancerous cells can be carried to other areas of the body.

Doctors biopsy lymph nodes to assess if breast cancer has spread. You’ll hear the term lymph node involvement as a marker for whether a cancer is contained within the breast or is metastatic, which means it’s spreading to other areas. The term sentinel node refers to the lymph node that doctors determine is the first node into which a tumor might drain; this node is usually biopsied.

Breast cancer tests for diagnosis and staging

Once a mammogram, ultrasound, or MRI locates a potential tumor, the doctor may order additional tests to see if the cancer has spread:

• Blood tests can assess kidney and liver function and may also reveal tumor markers, although these are not very reliable for breast cancer.
• A biopsy of the tumor will be used to assess certain characteristics that can tell the doctor how aggressive the cancer is. Typically, lymph nodes are biopsied as well.
• Chest X-rays can show if the cancer has spread to the lungs.
• Bone scans can reveal whether there’s cancer in the bones.
• CT scans are used to look at the chest and abdomen to see if the cancer has spread to other organs.
• Sometimes PET scans are used to check for cancer in the lymph nodes or to scan the whole body for cancer.
• The doctor may ask for an MRI if she’s concerned about whether cancer has spread to the brain.
• The doctor will ask about the patient’s family history and may recommend a new test called Oncotype DX, which is used to predict the likelihood of breast cancer recurrence. It can be a useful tool for women with early-stage cancer who are trying to decide whether chemotherapy is necessary.<br type=”_moz” />

How breast cancer is diagnosed and staged

Oncologists use a complex system of letters and numerals to determine the status or stage of breast cancer. Knowing these numbers is very important, because it will help the patient understand the prognosis. If your friend or relative wants you to accompany her to doctor visits, you can help her understand what you both hear there. You’ll also want to know as much as possible in order to research and understand treatment options and explore clinical trials.

The letter T is used to designate the tumor size and spread, the word N indicates whether there’s cancer present in the lymph nodes, and the letter M stands for metastasis. So T2, N0 (zero), M0 means a 2-centimeter tumor that has not spread to the lymph nodes or any other areas.

The medical team then combines this information into a stage. There are four stages of invasive breast cancer, and some stages are broken down still further:

Stage 1

The tumor is smaller than 2 centimeters and no lymph nodes are involved.

Stage IIA

There are three possibilities at this stage:

• The tumor measures less than 2 centimeters but has spread to the axillary lymph nodes.
• No tumor is found in the breast itself, but cancer cells are found in the lymph nodes under the arm.
• The tumor is between 2 and 5 centimeters across but there’s no lymph node involvement.

Stage IIB

There are two possibilities at this stage:

• The tumor is 2 to 5 centimeters across and has spread to the axillary lymph nodes.
• The tumor is bigger than 5 centimeters but hasn’t spread to the lymph nodes.

Stage IIIA

There are two possibilities at this stage:

• The tumor has spread to the axillary lymph nodes and the nodes are clumped together or sticking to other structures.
• No tumor is found in the breast, but cancer is in the lymph nodes, which are clumping together or sticking to other structures, or it is present in lymph nodes near the breastbone.

Stage IIIB

There are two possibilities at this stage:

• A tumor of any size has spread to the chest wall or skin of the breast; it also may have spread to axillary lymph nodes or those near the breastbone.
• All inflammatory breast cancer, which is considered Stage IIIB or higher when diagnosed.

Stage IV

The cancer has spread to other organs of the body, usually the lungs, brain, or liver; or the bones. Sometimes the doctor will say the cancer is metastatic at presentation, which means it had already spread to other parts of the body before the original tumor was discovered.

Oncologists and other cancer specialists look at whether breast cancer cells have certain characteristics that can predict aggressive growth. Pathology results from the biopsy will determine:

• Whether the cancer has receptors for the hormones estrogen and progesterone. You’ll hear the doctor use the terms ER-positive or ER-negative, which means the tumor tested positive or negative for an abundance of estrogen receptors.
• The amount of a protein called HER-2 produced by cancer cells. A HER-2 positive tumor is considered to be more aggressive, but it also means your family member can take Herceptin, a new drug that treats HER-2 positive tumors with excellent success.

Information about hormonal receptor status and HER-2 status can help the doctor recommend an individualized treatment plan that will offer the best chance of curing or controlling the cancer.

Once the medical team has assembled all the information possible to determine staging, it will offer a prognosis. This can be a tricky business, as there are many variables that affect a woman’s health and response to breast cancer treatment.

Sometimes doctors will discuss prognosis in terms of statistical “cure rates,” “recurrence rates,” or “survival rates.” This can sound very impersonal, but it’s the medical profession’s way of offering its best guess in terms of what you can expect.

One measure commonly used is the 5-year survival rate, which means the percentage of those who live at least five years after being diagnosed. Keep in mind that many of these patients live considerably longer than five more years, but they may be tracked for only five years.

Another term is 5-year relative survival rate, which takes into account the fact that some patients with cancer will die from other causes. Many organizations are adopting this number, as it’s considered more accurate.

Assuming you’re invited to your family member’s doctor visits, pay close attention when her doctor gives her this information, and ask as many questions as you need to in order to understand the information. A person who’s still reeling from a cancer diagnosis may have trouble taking in what she hears.

For example, the doctor may tell her that among all people with breast cancer, five-year relative survival is 100 percent for stage I, 86 percent for stage II, 57 percent for stage III, and 20 percent for stage IV. But these are very general numbers — her doctor can use information about tumor characteristics and general health to offer her a better sense of her own breast cancer and put these statistics in perspective.

Resources:

• What Is Breast Cancer
• Lymph Nodes And Cancer Spread

Vitamin D & Colorectal Cancer Survival

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“A critical weekly review of important new research findings for health-conscious readers…”

By, Robert A. Wascher, MD, FACS

Updated: 09/20/2009

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The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.

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VITAMIN D & COLORECTAL CANCER SURVIVAL

Vitamin D is increasingly being looked at as a cancer prevention nutrient, as multiple prior clinical research studies have linked higher blood levels of this hormone-like vitamin, and calcium (which is regulated by Vitamin D), with a decreased risk of colon and rectal cancer, as well as other cancers.

Less well understood is the role of Vitamin D as a survival factor in patients who have already been diagnosed with colorectal cancer. Now, a newly updated clinical research study from Harvard University, just published in the British Journal of Cancer, suggests that higher Vitamin D levels in colorectal cancer survivors may be associated with a significantly greater likelihood of surviving the third most common cause of cancer death in the United States.

The authors of this clinical research study analyzed volunteers within the massive Nurses’ Health Study. A total of 1,107 volunteers were diagnosed with colon or rectal cancer, between 1986 and 2004, after joining this long-term prospective public health study. Using a previously validated scoring system that accurately predicts Vitamin D levels in the blood, the researchers assessed the survival rates of these colorectal cancer patients as a function of their Vitamin D scores. (It is important to note that Vitamin D scores were calculated prior to the diagnosis of colorectal cancer in these patient volunteers.) The results were rather profound.

The Vitamin D scores for these 1,017 colorectal cancer patients were broken up into a five different ranges, and the patients with the highest Vitamin D scores were then compared with those in the lowest “quintile” with respect to cancer-related mortality and overall mortality. This analysis revealed that patients with the highest Vitamin D scores were 50 percent less likely to die of colorectal cancer during the course of this study, and 38 percent less likely to die from all causes, when compared to the patients with the lowest Vitamin D scores.

While the exact mechanisms whereby Vitamin D and calcium may decrease the risk of colorectal cancer, and the risk of death following a diagnosis of colorectal cancer, are still being studied, there is already intriguing data showing that Vitamin D supplementation can “up-regulate” the activity of genes in both premalignant and malignant colon and rectal tumors that, in turn, increase the death rate of the abnormal cells that make up such tumors (through a pathway known as apoptosis).

While no nutrient or medication has been shown to prevent all colorectal cancers, or to cure all colon and rectal cancers once they develop, there is an increasing amount of high-quality clinical data suggesting that higher levels of Vitamin D in the blood are associated with a decreased risk of both premalignant and malignant colon and rectal tumors. Now, based upon this new study’s results, it appears that higher Vitamin D levels may also be associated with improved survival following the diagnosis of colorectal cancer as well. The impact of Vitamin D levels on colorectal cancer survival also mirror similar findings that I have recently reported on with respect to breast cancer (Breast Cancer Recurrence, Death & Vitamin D).

Look for a much more detailed discussion of the role of Vitamin D, and other dietary and nutritional factors, in cancer prevention in my forthcoming book, “A Cancer Prevention Guide for the Human Race.”

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Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

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Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California

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http://doctorwascher.com

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Copyright 2007 - 2009 Robert A. Wascher, MD, FACS All rights reserved

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Would you like a method for checking your progress at overcoming the cancer? You prepare the sample at home THE HEALING REGIMEN

The regimen I recommend for ALL cancer patients comes at the cancer from six different “directions.” Six different theories about how to deal with cancer cells. All of these six forms of treatment are gentle (no dangerous, too-rapid “die off”), non-toxic and they all work together. They are, in fact, synergistic. They help each other.

They address the four characteristics of every cancer. These four conditions must be corrected before anyone can get over cancer: 1) A weak immune system; 2) A lack of oxygen to the cells; 3) Excessive toxins; and 4) Acidity. Conventional cancer treatment (chemotherapy, radiation and surgery) makes all of these conditions worse. In fact, it is responsible for almost all the deaths attributed to “cancer.” That’s right. The “treatment” causes the deaths — not the cancer.

Why? The conventional cancer treatments are approaching the cancer tumor (or its existence in your blood, lymph system or bone marrow) as if it were the “enemy.” Kill the cancer cells at all costs! Those costs may be your heart, your liver, your kidneys — or your life. Why do they do these things? There are literally 350 other effective ways to treat cancer. All of them are non-toxic and harmless to your other organs. Why doesn’t your cancer doctor tell you about these options? Can you spell M-O-N-E-Y? The average cancer patient (like you) generates $1.3 million in revenue for the cancer “industry.” Do you think they want you to be healed by something that costs pennies a day? MY CRUSADE

To get to this regimen, I have studied cancer treatment every day for the last ten years — since 1998, when I first realized all the information that was available even then on the Internet. I’ve sifted through hundreds of “alternative” cancer “cures.” I’ve talked to thousands of cancer survivors, cancer doctors, nutritionists, nurses, cancer experts of all kinds. I’ve read everything I could get my hands on. I am on a mission — a crusade, if you will — to help as many people as possible avoid my former wife’s fate. [See "About Me" on the left of this screen.]

JUST A LIMITED TIME COMMITMENT

Now, you or your loved one can benefit from my experience. All I suggest is that you give this regimen six to eight weeks while postponing other treatment. I’m not asking for you to commit your life — just six to eight weeks. I’ve found that within just a few days, 90% or more of the cancer patients who do this feel so much better that they continue with this regimen for life.

You see, I know it’s not too difficult because I do it every day myself for prevention. I am 76 years old and in perfect health.

ADDITIONAL COACHING

Obviously, if this regimen doesn’t work to reverse your cancer or that of your loved one, there are literally hundreds of other options to try. You can use the “Coaching” option on this web site to get me by telephone to help you isolate the best ones for you.

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