Breast Disease Atlanta

Types of Breast Cancer

Breast Cancer is one of the most common forms of cancer today. It is frightening…but treatable. It is critical to seek early diagnosis and treatment for any type of cancer and then be prepared for great outcomes with todays’ amazing treatments. Dr. Rudderman is an expert in matters of the breast and as a specially trained reconstructive surgeon, he has been able to guide many, many women through the process and procedures with wonderful, positive results.

The following information gives an overview of the types of breast cancer, diagnostics, treatments and surgical options:

Lobular Carcinoma in Situ (LCIS)

This non-invasive breast cancer starts in the milk ducts. It does not grow through the lobular walls and rarely becomes and an invasive form of cancer. It can be a risk factor for developing invasive cancer in the same or the opposite breast.

Ductal Carcinoma in SITU (DCIS)

Also called intraductal carcinoma this is the most common type of non-invasive breast cancer. With DCIS the cancers cells are inside the ducts but have not spread through the duct walls into adjacent tissue.

DCIS Overview:

  • 1 in 5 new breast cancer cases is diagnosed as DCIS
  • DCIS can be cured, in nearly all cases in the early stage
  • Pathology looks for tumor necrosis in the tissue sample
  • If necrosis is present the tumor may be more aggressive
  • DCIS with necrosis is called – comedocarcinoma
Invasive Ductal Carcinoma (IDC)

Also called Infiltrating Ductal Carcinoma, it starts in the milk duct, is the most common type of breast cancer and is invasive. It grows in the fatty breast tissue and can metastasize, after breaking through the duct wall.

Invasive Lobular Carcinoma (Infiltrating Lobular Carcinoma)

It starts in the milk producing glands and can metastasize to other parts of the body. Invasive lobular carcinoma is often more difficult to detect by mammogram than IDC. About 1 in 10 breast cancers are ILC’s

Breast Cancer Staging

Staging is a process of determining your prognosis & treatment options…based upon the type & extent of the cancer. It may involve blood tests & other tests.

Diagnostic Testing

  1. Blood tests & Biopsies
  2. Mammogram of the opposite breast
  3. Chest X Ray
  4. Breast MRI
  5. Bone Scan
  6. CT Scan (Computerized Tompgraphy)
  7. PET Scan (Positron Emissions Tomography)

Testing is based upon each individual. One or a combination of tests may be needed to determine this. Your Oncologist makes this decision.

Stages of Breast Cancer

STAGE O

Non-invasive, abnormal cells as in DCIS.

STAGE I

An early stage of invasive breast cancer in which Cancer cells are contained in the breast but have spread through the breast tissue.

STAGE II…Involves one of the following:

  • The cancer has spread to the lymph nodes under the arm but the tumor is no more than 2 centimeters across.
  • The tumor is between 2 to 5 centimeters but the cancer has not spread to the underarm nodes.
  • The tumor is between 2 and 5 centimeters and the cancer has spread to the underarm nodes.
  • The tumor is larger than 5 centimeters.
  • The cancer has not spread to the underarm nodes.
STAGE III

Is locally advanced cancer that is broken into 3 sub stages:

111A – Tumor 5+ centimeters has spread and attached to each other or to other structures.

111B – tumor of any size has grown into the chest wall or skin of the breast, the lymph nodes, attached to each other and/or advanced into Inflammatory breast cancer.

111C – Tumor of any size that has spread as follows: into the lymph nodes behind the breast bone and under the arm. Has spread into the lymph nodes above or below the collarbone.

STAGE IV

Cancer that appears after previous treatment and a period of remission. It usually shows up in some other part of the body such as the bones, liver, lungs or brain.

Risk Factors & BRCA

There are certain things we know about cancer today such as certain risk factors that increase the chance of getting a disease. Aging, previous history of breast cancer, family with other females who have had cancers, certain chromosomes are being studied for linkage to breast cancer and others. BRCA involves genetic testing to determine if a woman (man) is predisposed to breast cancer. It looks like this:

  • BRCA tests determines the risk factor level for developing cancer
  • BRCA testing is based upon gene mutations
  • BRCA1 & BRCA2 gene changes are linked to between 5% & 10% of all ovarian & breast cancers
  • Testing positive for one of these changes says lifetime risk can be as high as 85% for developing breast cancer & up to 60% for Ovarian cancer
  • Personal & family history is factored in heavily as these numbers show a wide range
  • Breast cancer (rare in men) does occur & is related to BRCA e gene changes along with a possibility for prostate cancer
  • Risk of colon & pancreatic cancers (e.g.) may also be higher
  • Genes can be inherited from either the mother’s of father’s side of the family

Risks for Inheriting BRCA1 & BRCA2 Gene Changes

Ashkenazi Jewish Women (ancestors from Eastern Europe)

These women are at risk if one or both of the following is a factor:

  1. Any first degree relative with breast or ovarian cancer…parents, brothers, sisters, children.
  2. Two second degree relatives on the same family side with history of breast or ovarian cancer. Aunts, uncles, nieces, nephews, grandparents.

NON Jewish Women should be tested if 1 or more of these is a factor:

  1. Two first-degree relatives with breast cancer of which 1 was diagnosed before age 50
  2. Three or more first or second-degree relatives (any age) with breast cancer
  3. History of both breast or ovarian cancer in the family
  4. One first degree relative with cancer in both breasts
  5. Two or more relatives with ovarian cancer
  6. One relative with both breast and ovarian cancer
  7. One male relative with breast cancer

Before and after testing… it is important to receive genetic counseling to help you understand the benefits, risks and possible testing outcomes. It is strongly recommended today that women who carry this gene consider prophylactic mastectomy and bilateral breast reconstruction. Dr. Rudderman will counsel you on this matter and refer you as well to a general surgery breast specialist.

Breast Cancer Treatment & Therapies

Dr. Rudderman is one of Atlanta’s surgeons of choice. He is specialized in many complicated problems of the breast & he employs delicate, advanced techniques to achieve the most natural outcomes possible.

Lumpectomy

Procedure to remove the tumor and a small margin surrounding the healthy tissue. Used for removal of smaller tumor that will separate easily from the adjacent tissue.

Mastectomy

A simple mastectomy removes all the breast tissue, lobes, ducts, fatty tissue and skin, nipple and areola.

Radical mastectomy removes all the above and the underlying muscle of the chest wall along with armpit lymph nodes.

Sentinal Node Biopsy

Removal of One Lymph Node…the one near the breast tumor. After it checked and discerned no other nodes are involved…the procedure is completed.

Axillary Lymph Node Dissection

If cancer is found in the sentinal node, additional armpit nodes are removed to check for spread of the cancer and to determine the course of treatment. Chemotherapy or radiation may be deemed necessary from this test result.

Radiation Therapy

Use of high powered energy beams to kill cancer cells administered outside the body or internally with radioactive material (brachytherapy).

Chemotherapy Drugs

Used to destroy cancer cells, to reduce risk of cancer spreading or to shrink tumors (neoadjuvent chemotherapy) before surgery or given post surgery as “adjuvant systematic therapy”.

Hormone Therapy

Called hormone blocking therapy may be used to treat breast cancers that are sensitive to hormones, referred to as estrogen and progesterone receptor positive cancers. These medications include: Tamoxifen, Arimidex, Femara and Aromasin. They work by either blocking estrogen or the enzyme that converts androgens to estrogen. The latter are effective in menopausal women only.

Prophylactic Mastectomy & Reconstructive Surgery

If breast removal is required women face the challenges encompassed with this new situation. Reconstructive surgery is early always chosen to rebuild a breast mound that looks normal and natural. But the question always remains…what about the other breast. Many women opt to have prophylactic mastectomy to remove the fear of more cancer and to restore normalcy to their lives. Many more women opt further to have both breasts reconstructed.

Breast Reconstruction can be done today at the same time as the mastectomy, under the same anesthesia, so you wake up with a new breast mound in place…or it can be done later at a time of your choosing. It is your choice!

  • Dr. Rudderman and his staff made the experience easy and comfortable. They were realistic communicating surgery expectations, expected pain levels and down time from work. Nurses were informative and friendly and wait times minimal. I also liked the fact that Dr. Rudderman does all his own work and doesn't let other less experienced people do parts of the surgery the way other doctors may. I'm only one week out of the surgery, but I am very satisfied with the results so far.

    Susan Parker | Atlanta, GA

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