BREAST CANCER & TCM. Dr Fatima Manesh (2).pdf

8/16/2019 BREAST CANCER & TCM. Dr Fatima Manesh (2).pdf

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Page | 2 Breast Cancer and TCM by Fatima Manesh

Introduction

I chose the topic "Breast Cancer and Traditional Chinese Medicine (TCM)"

for my thesis because I am a breast cancer survivor. As a result of havinghad cancer, it became clear to me that my thoughts and emotions were the

starting point of my disease. When I first found out that I had cancer, I felt

that my life was over. The discovery of my disease came about just as the

U.S. Economic Recession was gaining speed. There was little work for

many people, housing and investment concerns abounded, stability was at an

all-time low....and then my cancer.

When I surrendered to my cancer treatment, both with Traditional Chinese

Medicine (TCM) and Western Medicine, I recovered. I accepted my disease,

regained my health, and learned that I could still enjoy life and move on. I

started to appreciate each day, happily communicating with my friends andfamily. I never took my recovery for granted.

It is my desire to outline the approaches of both TCM and Western Medicine

in the treatment of breast cancer, and in doing so, make others aware of the

benefits of both.

I hope my experiences with using both types of these treatments, and the

benefits I derived from them, will help other cancer patients to beat the

disease and go on to lead full, healthy, long lives!


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Acknowledgment

This paper is dedicated first and foremost to my beloved husband, Saeed

Mohammadi, and my dear sons, Ehsan, Ali, and Atta.

Many thanks are extended to my professors and the friendly staff at

American Liberty University, especially Doctors Kevin Sultani, Monica

Sultani, Shahbaz, Jahroomy and Kim. Above all, I must thank my

oncologist, Dr. Homayena Sanati, who gave me exemplary care.

Special thanks go to my fellow classmates who shared their time and talentswith me, and to Lili Adibi, who frequently helped and motivated me to

continue this work.

A final thank you to Sharon Girulat, a close family friend, who helped me to

finish.

To all those people around the world who are striving to overcome cancer, I

wish you the best success with your treatment, and a return to good health!


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Dedication to All Cancer Patients

I am a cancer survivor. I am alive for one reason - to share my life and my

knowledge to help others. There are many cancer patients....some will be

survivors, and some not. I do not have the power to know or help them all. I

do have the power to try and meet and help as many as I possibly can, and

that I plan to do!

Whether through my work with acupuncture and my knowledge of

Traditional Chinese Medicine (TCM), or through lectures, visits with

patients, or other methods, I plan to turn cancer victims into cancer

survivors.You may or may not ever know me personally, but I feel that someday I

shall make the world a better, more hopeful place for those patients who

battle cancer.

We all need to ACT to prevent and cure this dreaded disease.

Eat Right

Don't Smoke

Don't Drink

Avoid Toxins

I also strongly believe that my faith in a Higher Power, meditation, positive

attitude, and a heart full of love have done much to help me endure and

improve my life.


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TABLE OF CONTENTS

CHAPTER 1. Pathology Of Cancer

History of Cancer 6

History of Breast Cancer 7

Ancient Egypt and Greece: Breast Cancer as a Systemic Disease 8

William Halstead and the Radical Mastectomy Paradigm 11

The Eighteenth Century: Breast Cancer as a Localized Disease and the Rise of Surgery

12

A New Beginning: Moving Away from the Halstead Mastectomy 13

New Hope for the Twenty-first Century: Changing Public Perception 14

CHAPTER2. What Is Cancer

What Is Cancer?

Normal cells in the body

How cancer starts

How cancer spreads

How cancers differ


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Tumors that are not cancer

How common is cancer?

CHAPTER 3. What Causes Cancer?

What Causes Cancer?

Heredity and Cancer

DNA, genes, and chromosomes

Genes and cancer

When should I worry?

CHAPTER 4. Type Of Cancer

Breast cancer

Colon cancer

Childhood cancers

Cancer Types

CHAPTER 5. Breast Cancer In Western Medicine


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Breast Cancer

What is breast cancer?

The normal breast

The lymph (lymphatic) system of the breast

Benign breast lumps

Fibrocystic changes

Other benign breast lumps

General breast cancer terms

Types of breast cancers

Less common types of breast cancer

Special types of invasive breast carcinoma

What are the risk factors for breast cancer?

Risk factors you cannot change

Family history of breast cancer

Personal history of breast cancer

CHAPTER 6. Breast awareness and self exam


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Mammograms and Self-Exam

What the doctor looks for on your mammogram

Limitations of mammograms

Clinical breast exam

Breast awareness and self exam

How to examine your breasts

Magnetic resonance imaging (MRI)

CHAPTER 7. How is breast cancer treated in western medicine?

General types of treatment

Local versus systemic therapy

Adjuvant and neoadjuvant therapy

Oncoplastic surgery

Breast reconstruction surgery

Radiation therapy

New chemotherapy drugs

Targeted therapies

Drugs that target HER2:


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Anti-angiogenesis drugs:

Other targeted drugs:

Denosumab

Vitamin D


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CHAPTER 8. Breast Cancer Statistics

Breast cancer in the United States

Women

Men

Rates of breast cancer over time

Mammography and rates of early detection over time

Race/ethnicity and breast cancer rates over time

Male breast cancer rates over time

Worldwide variation

Variation within the United States

Race/ethnicity and breast cancer rates

Migration to the U.S. and breast cancer rates

African American women

Ashkenazi Jewish women

Asian American and Pacific Islander women

Primary prevention is the answer

Breast cancer: Europe

Breast Cancer in Europe 2006


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CHAPTER 9. Cancer And Breast Cancer According To Traditional Chinese

Medicine

The Chinese understanding of cancer

Acupuncture

Acupuncture points for cancer

Herbal medicine

The role of the spirit

Diet

Breast Cancer in traditional Chinese medicine

First is the concept of flow and how it relates to health.

The second missing concept is immunity.

Conclusion

CHAPTER 10 . Diagnosis According to Traditional Chinese Medicine (T.C.M.) A

Guide to Oriental Medicine

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1 - Looking Diagnosis

Tongue Diagnosis

2 - Listening Diagnosis

3 - Smelling and tasting Diagnosis

4 - Feeling the pulse (Touching Diagnosis).

Where is the pulse felt?

CHAPTER 11. Chinese Medicine & The Theory of Qi , Blood and the Theory of Yin

Yang

Qi and Blood According to Traditional Chinese Medicine

"Qi is the source of all movement and heat.

Blood is mother to the Qi."


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of metastasis led to perceiving cancer as a systemic illness as well as a localized one, and

more sparing procedures were developed that proved equally effective.

History of Breast Cancer

Breast cancer is an ancient disease, and it has been mentioned in almost every period of

recorded history. Physicians have consistently noted that breast cancer is visible to even

the untrained eye, progressing from a small lump to large tumors. Unlike other fatal

diseases (heart conditions and most other cancers), breast cancer announces itself in a

tangible fashion (Leopold 1999). Yet, despite the visibility of the disease and the powerful

reverberations breast cancer has had, for women specifically and society in general, any

discussion of breast cancer was found only in medical journals before the 1970s.

Historically, the breast carries with it many cultural expectations for women, specifically

their nurturing and sexual obligations. Perhaps it is because the breast holds such cultural

power that the disease was considered by many to be a taboo subject and many of its

sufferers often felt ashamed or embarrassed to openly discuss the disease. This previous

void in literature outside medical journals stands in stark contrast to the extremely visible

presence the disease holds in contemporary culture. Today there is no public forum in

which breast cancer is not discussed (Leopold 1999). Since the success of breast cancer

activism in the 1990s, the symbol of breast cancer--the pink ribbon--is ubiquitous in

American culture, and politicians and healthcare officials are acknowledging the role that

political and cultural assumptions play in finding a cure.

Ancient Egypt and Greece: Breast Cancer as a Systemic Disease

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Ancient Egyptians were the first to note the disease more than 3,500 years ago. Both the

Edwin Smith and George Ebers papyri contain descriptions of conditions that are

consistent with modern descriptions of breast cancer. For example, one nameless ancient

Egyptian surgeon describes “bulging tumors” in the breast and states that “there is no

cure.” In 460 B.C., Hippocrates, the father of Western Medicine, described breast cancer

as a humoral disease. In other words, for Hippocrates, the body consisted of four “humors”

(blood, phlegm, yellow bile, and black bile), which mirrored the building blocks of nature

(air, fire, earth, and water)--and any imbalance of the system of humors caused sickness

or even death. For Hippocrates, cancer was caused by the excess of black bile, or

“melonchole.” This logic made sense to Hippocrates because the appearance of an

untreated breast tumor would be black and hard, eventually erupting through the skin with

black fluids. He named the cancer karkinos, a Greek word for “crab,” because the tumors

seemed to have tentacles, like the legs of a crab. Hippocrates considered surgery dangerous

because those who had the tumor excised “perish quickly; while those who are not excised

lived longer (Olsen 2002).

In A.D. 200, Galen, Hippocrates successor, also describes cancer as excessive “black bile”

but, unlike Hippocrates, Galen also realized that some tumors were more dangerous than

others. Galen also discusses a wide range of pharmaceutical agents to treat breast cancer,

such as opium, castor oil, licorice, sulpher, and a variety of salves, as well as incantations

to the gods. For humoral physicians, surgery to remove the tumor or entire breast was not

even considered to be an option for a cure since they assumed the cancer would just

reappear near the surgical site or somewhere else in the body. For Galen and physicians

succeeding him over the next 2,000 years, breast cancer was a systemic disease, which

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meant it was a disease of the entire body, not just one localized part. The dark bile was

believed to course throughout the entire body--so even if a tumor were removed, the bile

would still remain in the body, ready to create more tumors.

Until the seventeenth century, physicians assumed that Galen had the final word on breast

cancer and that there was nothing left to discover. However, in 1680, French physician

Francois de la Boe Sylvius began to challenge the humoral theory of cancer by arguing

that cancer did not come from an excess of black bile but from a chemical process that

transformed lymphatic fluids from acidic to acrid. In the 1730s, Paris physician Claude-

Deshais Gendron also rejected the humors theory and insisted that cancer developed when

nerve and glandular tissue mixed with lymph vessels (Olson 1999).

The Eighteenth Century: Breast Cancer as a Localized Disease and the Rise of

Surgery

By 1769, the humoral theory had lost much of its currency. To disprove the humoral

theorists, French physician Jean Astruc took a piece of breast cancer tissue along with a

slice of beef and burned them both in an oven and chewed them. Both tasted the same, and

he concluded the tumor tissue did not contain unusual amounts of bile or acid. With the

humoral theory disproved, physicians began to search for a new origin of breast cancer,

and many argued that its origin was sexual. Physicians knew of Bernardino Ramazzini's

1713 hypotheses that the high frequency of breast cancer in nuns was due to lack of sex;

according to Ramazzini, without regular sexual activity, reproductive organs, including

the breast, started to decay and cancer was the result. Friedrich Hoffman of Prussia posited


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that women who had regular sex but still developed cancer were practicing “vigorous” sex

that could result in lymphatic blockage.

But there were other, nonsexual theories also presented. Giovanni Morgagni blamed

curdled milk. Johanes de Gorter in the 1750s claimed that tumors came from pus-filled

inflammations in the breast that mixed with blood, lodged in the milk gland, and dried into

a tumor. Claude-Nicolas Le Cat from Rouen claimed that depression caused cancer by

constricting the blood vessels and trapping coagulated blood. Lorenz Heister placed

childless women at high risk, while others blamed a sedentary lifestyle which slackened

bodily fluids. Though there was no lack of theories, the cause of breast cancer was still as

mysterious to them as it was to the ancients. But unlike the ancients, eighteenth-century

physicians gradually became more certain that breast cancer was a localized disease. This

had enormous implications, because in contrast to humoral theories which considered

mastectomy a tangential treatment due to the systemic nature of cancer, doctors were

rapidly becoming skeptical of anything but surgery (Olson 1999).

In 1757, Henri Le Dran, a leading French physician, argued that surgery could actually

cure breast cancer as long as the infected axillia lymph nodes were removed. Similarly,

Claude-Nicolas Le Cat argued that the scalpel was the only way to cure cancer. Le Cat

would amputate the breast, cutting out the lymph nodes as well as the pectoralis major

muscle. These physicians were convinced that the presence of a tumor did not necessarily

imply a more serious problem, but was a single-site disease that could be surgically

removed locally before it spread. This theory lasted well into the twentieth century and led

to the creation of the radical mastectomy (Hellman 1993).


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William Halstead and the Radical Mastectomy Paradigm

By the mid-nineteenth century, most physicians held that because cancer was a localized

disease, surgery was the only hope. The development of antiseptic, anesthesia, blood

transfusion, and cellular biology--as well as increased public trust in the medical field--

made radical surgery possible. Gone were the days of pre-anesthesia which necessitated

speed and dexterity with an often resistant patient. Surgeons now had time for deliberate

precision, and William Halstead of New York made radical breast surgery the gold

standard for the next 100 years. Halstead wanted to reduce the recurrences of the disease

which often afflicted patients within a year of their initial surgery and to help even the

most advanced-inflicted patients. Whereas earlier surgeons would remove the breast,

axilla nodes, and pectoralis muscle, that was not enough for Halstead. He knew that cancer

was a cellular disease and worried about his own role in spreading it. He argued that lifting

away the excised breast with surgeon hands probably scattered tumor cells. This led him

to call for a radical mastectomy — removal of the breast, axillary nodes, and both chest

muscles in a single en bloc procedure. He would cut widely around the tumor, removing

all the tissue in one piece.

During the first four decades of the twentieth century, the radical mastectomy dominated

breast cancer treatment. Halstead himself performed hundreds of radical mastectomies and

urged that inflicted women should receive a radical mastectomy before the tumor spread

to regional lymph nodes. While the radical mastectomy may have extended life slightly

and eased the pain of diseased breasts, it was not an unmixed blessing. Some women

avoided the surgery because it would leave them wounded and disfigured for the rest of

their lives. Women had to deal with a deformed chest wall, hollow voids under the collar


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bone and the armpit, chronic pain, and lymphedema or swelling in the arm because the

removed underarm lymph nodes could no longer process circulatory fluids efficiently.

Halstead dismissed these effects as necessary evils; besides, the women’s average age was

“nearly fifty-five years [and t]hey are no longer active members of society” (Olson 1999).

Halstead also gave some thought to shoulder amputation. For Halstead and his followers,

cutting away more and more tissue was the only way to treat breast cancer. Jerome Urban,

the architect of the super-radical mastectomy in 1949, would remove the breast, the

axillary nodes, the chest muscles, and internal mammary nodes in a single procedure, often

on patients who had tumors less than one centimeter large.

Twentieth-Century Surgeries: Oophorectomy, Adrenalectomy, and

Hypophysectomy

In 1895, Scottish surgeon George Beatson discovered that removing the ovaries from one

of his patients shrank her breast tumor. This news spread and soon surgeons were

performing “prophylactic” oophorectomies, which involved removing both ovaries and

performing a radical mastectomy. The operations were debilitating and the results

unpredictable since the surgeons had no way of determining which tumors possessed

estrogen receptors. Because of this, by 1920 most surgeons employed an oopherectomy

only as a last resort. What modern oncologists now know is that some breast tumors have

estrogen receptors that feed on estrogen. Removing the ovaries in some cases starved the

tumor, at least temporarily. The tumor would always regrow because the body

compensated by secreting estrogen-like substances from the adrenal and pituitary glands.

In 1952, approximately the same time as Urban’s super -radical mastectomy, Charles


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Huggins began removing a woman’s adrenal gland (adrenalectomy) in an effort to starve

the tumor of estrogen. Rolf Lefft and Herbert Olivecrona began performing

hypophysectomies, or the removal of the pituitary gland. Side effects included impaired

vision, personality changes, and cognitive difficulties. Even with these extreme surgeries,

the tumors still returned to kill.

A New Beginning: Moving Away from the Halstead Mastectomy

The Halstead mastectomy was based on the premise that breast cancer was a localized

disease that could be treated by surgically removing the diseased part of the body. George

Crile in 1955 began to argue that cancer was not localized but rather is spread throughout

the body. Bernard Fisher also revolutionized cancer treatment by revising metastasis

theory which, like Hippocrates, argued that cancer cells traveled throughout both the

circulatory and lymphatic systems and that surgery could not cure cancer because cancer

cells were floating throughout the body in the circularity system. In 1976, Fisher published

results indicating that simpler breast-conserving surgery followed by radiation or

chemotherapy were just as effective as the radical mastectomy, and usually more so

(Hellman 1993). By advocating a more systemic approach to breast cancer, Fisher and

Crile directly challenged the surgeon’s role as the primary source of breast cancer

treatment. Yet physicians were reluctant to abandon the Halstead mastectomy until the

sexual revolution and modern feminism.

With the decline of the Halstead radical mastectomy and a revised theory of metastasis,

physicians hypothesized about the origins of breast cancer and, during the 1990s,

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breastfeeding was up for debate. Despite this uncertainty, there were still advances. After

an in initial increase in breast cancer rates, the number of deaths plateaued in 1995 and

then started to decline. By 1995, less than 10 percent of breast cancer-inflicted women had

a mastectomy. Improvements in chemotherapy, radiation, hormone treatments

(particularly Tamoxifen), mammography, and surgery helped move breast cancer from an

urgent disease to a chronic condition. Significantly, scientists isolated the genes that cause

breast cancer: BRCA2 and ATM. Today, advances in molecular and genetic sciences are

creating novel therapeutic strategies that give both women and men not only hope but also

more choices about their bodies.

New Hope for the Twenty-first Century: Changing Public Perception

The ultimate cure for breast cancer remains elusive. The disease is so complex, diverse,

and so subtly connected to genetic and environmental variables that finding a cure can

often seem remote if not impossible. While a cure has not yet been found, public

perception surrounding breast cancer has changed dramatically. Once a disease that

women felt ashamed to discuss, breast cancer now has lost much of its stigma, providing

the opportunity for politicians and health care officials to acknowledge that economic and

political considerations bear on the success of breast cancer treatment as much as advances

in medical science.


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CHAPTER2. What Is Cancer

What Is Cancer?

Cancer is the general name for a group of more than 100 diseases. Although there

are many kinds of cancer, all cancers start because abnormal cells grow out of

control. Untreated cancers can cause serious illness and death.

Normal cells in the body

The body is made up of trillions of living cells. Normal body cells grow, divide, and die in

an orderly fashion. During the early years of a person’s life, normal cells divide faster to

allow the person to grow. After the person becomes an adult, most cells divide only to

replace worn-out or dying cells or to repair injuries.

How cancer starts

Cancer starts when cells in a part of the body start to grow out of control. Cancer cell

growth is different from normal cell growth. Instead of dying, cancer cells continue to grow

and form new, abnormal cells. Cancer cells can also invade (grow into) other tissues,

something that normal cells cannot do. Growing out of control and invading other tissues

are what makes a cell a cancer cell.

Cells become cancer cells because of DNA (deoxyribonucleic acid) damage. DNA is in

every cell and it directs all the cell’s actions. In a normal cell, when DNA gets damaged

the cell either repairs the damage or the cell dies. In cancer cells, the damaged DNA is not

repaired, and the cell doesn’t die like it should. Instead, the cell goes on making new cells

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that the body doesn’t need. These new cells all have the same abnormal DNA as the first

cell does.

People can inherit abnormal DNA, but most DNA damage is caused by mistakes that

happen while the normal cell is reproducing or by something in the environment.

Sometimes the cause of the DNA damage may be something obvious like cigarette

smoking or sun exposure. But it’s rare to know exactly what caused any one person’s

cancer.

In most cases, the cancer cells form a tumor. Some cancers, like leukemia, rarely form

tumors. Instead, these cancer cells involve the blood and blood-forming organs and

circulate through other tissues where they grow.

How cancer spreads

Cancer cells often travel to other parts of the body where they begin to grow and form new

tumors. This happens when the cancer cells get into the body’s bloodstream or lymph

vessels. Over time, the tumors replace normal tissue. The process of cancer spreading is

called metastasis.

How cancers differ

No matter where a cancer may spread, it’s always named for the place where it started. For

example, breast cancer that has spread to the liver is called metastatic breast cancer, not

liver cancer. Likewise, prostate cancer that has spread to the bone is called metastatic

prostate cancer, not bone cancer.

Different types of cancer can behave very differently. For instance, lung cancer and skin

cancer are very different diseases. They grow at different rates and respond to different



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treatments. This is why people with cancer need treatment that is aimed at their kind of

cancer.

Tumors that are not cancer

Not all tumors are cancer . Tumors that aren’t cancer are called benign. Benign tumors can

cause problems – they can grow very large and press on healthy organs and tissues. But

they cannot grow into (invade) other tissues. Because they can’t invade, they also can’t

spread to other parts of the body (metastasize). These tumors are almost never life

threatening.

How common is cancer?

Half of all men and one-third of all women in the US will develop cancer during their

lifetimes.

Today, millions of people are living with cancer or have had cancer. The risk of developing

many types of cancer can be reduced by changes in a person’s lifestyle, for example, by

staying away from tobacco, limiting time in the sun, being physically active and healthy

eating.

There are also screening tests that can be done for some types of cancers so they can be

found as early as possible – while they are small and before they have spread. In general,

the earlier a cancer is found and treated, the better the chances are for living for many years.

CHAPTER 3. What Cause Cancer?



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What Causes Cancer?

Cancer is a complex group of diseases with many possible causes. In this section you can

learn more about the known causes of cancer, including genetic factors; lifestyle factors

such as tobacco use, diet, and physical activity; certain types of infections; and

environmental exposures to different types of chemicals and radiation.

Heredity and Cancer

Cancer is such a common disease that it is no surprise that many families have at least a

few members who have had cancer. Sometimes, certain types of cancer seem to run in

some families. This can be caused by a number of factors. Often, family members have

certain risk factors in common, such as smoking, which can cause many types of cancer.

But in some cases the cancer is caused by an abnormal gene that is being passed along from

generation to generation. Although this is often referred to as inherited cancer, what is

inherited is the abnormal gene that can lead to cancer, not the cancer itself. Only about 5%

to 10% of all cancers are inherited. This document focuses on those cancers.

DNA, genes, and chromosomes

Cancer is a disease of abnormal gene function. Genes are pieces of DNA (deoxyribonucleic

acid). They contain the instructions on how to make the proteins the body needs to function,

when to destroy damaged cells, and how to keep the cells in balance. Your genes control

things such as hair color, eye color, and height. They also can affect your chance of getting

certain diseases, such as cancer.

An abnormal change in a gene is called a mutation. The 2 types of mutations are inherited

and acquired (somatic).

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Inherited gene mutations are passed from parent to child through the egg or sperm. These

mutations are in every cell in the body.

Acquired (somatic) mutations are not present in the egg or sperm. These mutations are

acquired at some point in the person's life, and are more common than inherited

mutations. This type of mutation occurs in one cell, and then is passed on to any new

cells that are the offspring of that cell.

Genes are found on long strands of DNA called chromosomes. Humans have 23 pairs of

chromosomes in each cell. We inherit one set of chromosomes from each parent. Each

chromosome can contain hundreds or thousands of genes that are passed from the parents

to the child. Every cell in your body has all of the genes you were born with. Although all

cells have the same genes and chromosomes, different cells (or types of cells) may use

different genes. For example, muscle cells use a different set of genes than skin cells use.

The genes that the cell doesn't need are turned off and not used. The genes that the cell is

using are activated or turned on.

Genes and cancer

Genes seem to have 2 major roles in cancer: Some called oncogenes, can cause cancer;

others known as tumor suppressor genes, stop cancer from developing or growing. More

information about oncogenes and tumor suppressor genes can be found in our

document, Oncogenes, Tumor Suppressor Genes, and Cancer .

Oncogenes are mutated forms of certain normal genes of the cell called proto-

oncogenes. Proto-oncogenes are often genes that normally control what kind of cell it is

and how often it grows and divides. When a proto-oncogene mutates (changes) into an

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oncogene, it turns on or activates when it is not supposed to be. When this occurs, the cell

can grow out of control, leading to cancer.

Tumor suppressor genes are normal genes that slow down cell division, repair DNA

mistakes, or tell cells when to die (a process known as apoptosis or programmed cell

death). When tumor suppressor genes don’t work properly, cells can grow out of control,

which can lead to cancer.

A tumor suppressor gene is like the brake pedal on a car. It normally keeps the cell from

dividing too quickly just as a brake keeps a car from going too fast. When something goes

wrong with the gene, such as a mutation, cell division can get out of control.

An important difference between oncogenes and tumor suppressor genes is that oncogenes

result from the activation (turning on) of proto-oncogenes, but tumor suppressor genes

cause cancer when they are inactivated (turned off).

Even if you were born with healthy genes, some of them can become changed (mutated)

over the course of your life. These mutations are known as sporadic or somatic, meaning

they are not inherited. Sporadic mutations cause most cases of cancer. These mutations

may be caused by things that we are exposed to in our environment, including cigarette

smoke, radiation, hormones, and diet (although in many cases there is no obvious cause).

More gene mutations build up as we get older, leading to a higher risk of cancer.

When someone has inherited an abnormal copy of a gene, their cells already start out with

one mutation. This makes it all the easier (and quicker) for enough mutations to build up

for a cell to become cancer. That is why cancers that are inherited tend to occur earlier in

life than cancers of the same type that are not inherited.

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When should I worry?

When many cases of cancer occur in a family, it is most often due to chance or because

family members have been exposed to a common toxin, such as cigarette smoking. Less

often, these cancers may be caused by an inherited gene mutation. (These are called family

cancer syndromes.) Certain things make it more likely that an abnormal gene is causing

cancers in a family, such as

Many cases of an uncommon or rare type of cancer (like kidney cancer)

Cancers occurring at younger ages than usual (like colon cancer in a 20 year old)

More than one type of cancer in a single person (like a woman with both breast and

ovarian cancer)

Cancers occurring in both of a pair of organs (both eyes, both kidneys, both breasts)

More than one childhood cancer in a set of siblings (like sarcoma in both a brother and a

sister)

Before you decide that cancer runs in your family, first gather some information. For each

case of cancer, look at:

Who is affected? How are we related?

What type of cancer is it? Is it rare?

How old was this relative when they were diagnosed?

Did this person get more than one type of cancer?

Did they smoke or have other known risk factors?


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Cancer in a close relative, like a parent or sibling (brother or sister), is more cause for

concern than cancer in a more distant relative. Even if the cancer was from a gene mutation,

the chance of it passing on to you gets lower with more distant relatives.

It is also important to look at each side of the family separately. Having 2 relatives with

cancer is more concerning if the people are related to each other (meaning that they are

both on the same side of the family). For example, if both relatives are your mother's

brothers it means more than if one was your father's brother and the other was your mother's

brother.

The type of cancer matters, too. More than one case of the same rare cancer is more

worrisome than cases of a more common cancer. And having the same type of cancer in

many relatives is more concerning than if it is several different kinds of cancer. Still, in

some family cancer syndromes, a few types of cancer seem to go together. For example,

breast cancer and ovarian cancer run together in families with hereditary breast and ovarian

cancer syndrome (HBOC). Colon and endometrial cancers tend to go together in a

syndrome called hereditary non-polyposis colorectal cancer (HNPCC), also known as

Lynch syndrome.

The age of the person when the cancer was diagnosed is also important. For example, colon

cancer is rare in people under 30. Having 2 or more cases in close relatives under 30 could

be a sign of an inherited cancer syndrome. On the other hand, prostate cancer is very

common in elderly men, so if both your father and his brother were found to have prostate

cancer when they were in their 80s, it is less likely to be due to an inherited gene change.


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When many relatives have the same type of cancer it is important to notice if the cancer

could be related to smoking. For example, lung cancer is commonly caused by smoking,

so many cases of lung cancer in a family of heavy smokers is more likely to be due to

smoking than to an inherited gene change.

CHAPTER 4. Type of Cancer


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Types of cancer

Cancer Types

Adrenal Cortical Cancer

Advanced Cancer

Anal Cancer

Aplastic Anemia

Bile Duct Cancer

Bladder Cancer

Bone Cancer

Bone Metastasis

Brain/CNS Tumors In Adults

Brain/CNS Tumors In Children

Breast Cancer

Breast Cancer In Men

Cancer in Children

Cancer of Unknown Primary

Castleman Disease

Cervical Cancer

Colon/Rectum Cancer

Endometrial Cancer

Esophagus Cancer

Ewing Family Of Tumors

http://www.cancer.org/cancer/adrenalcorticalcancer/indexhttp://www.cancer.org/cancer/adrenalcorticalcancer/indexhttp://www.cancer.org/cancer/advancedcancer/indexhttp://www.cancer.org/cancer/advancedcancer/indexhttp://www.cancer.org/cancer/analcancer/indexhttp://www.cancer.org/cancer/analcancer/indexhttp://www.cancer.org/cancer/aplasticanemia/indexhttp://www.cancer.org/cancer/aplasticanemia/indexhttp://www.cancer.org/cancer/bileductcancer/indexhttp://www.cancer.org/cancer/bileductcancer/indexhttp://www.cancer.org/cancer/bladdercancer/indexhttp://www.cancer.org/cancer/bladdercancer/indexhttp://www.cancer.org/cancer/bonecancer/indexhttp://www.cancer.org/cancer/bonecancer/indexhttp://www.cancer.org/cancer/bonemetastasis/indexhttp://www.cancer.org/cancer/bonemetastasis/indexhttp://www.cancer.org/cancer/braincnstumorsinadults/indexhttp://www.cancer.org/cancer/braincnstumorsinadults/indexhttp://www.cancer.org/cancer/braincnstumorsinchildren/indexhttp://www.cancer.org/cancer/braincnstumorsinchildren/indexhttp://www.cancer.org/cancer/breastcancer/indexhttp://www.cancer.org/cancer/breastcancer/indexhttp://www.cancer.org/cancer/breastcancerinmen/indexhttp://www.cancer.org/cancer/breastcancerinmen/indexhttp://www.cancer.org/cancer/cancerinchildren/indexhttp://www.cancer.org/cancer/cancerinchildren/indexhttp://www.cancer.org/cancer/cancerofunknownprimary/indexhttp://www.cancer.org/cancer/cancerofunknownprimary/indexhttp://www.cancer.org/cancer/castlemandisease/indexhttp://www.cancer.org/cancer/castlemandisease/indexhttp://www.cancer.org/cancer/cervicalcancer/indexhttp://www.cancer.org/cancer/cervicalcancer/indexhttp://www.cancer.org/cancer/colonandrectumcancer/indexhttp://www.cancer.org/cancer/colonandrectumcancer/indexhttp://www.cancer.org/cancer/endometrialcancer/indexhttp://www.cancer.org/cancer/endometrialcancer/indexhttp://www.cancer.org/cancer/esophaguscancer/indexhttp://www.cancer.org/cancer/esophaguscancer/indexhttp://www.cancer.org/cancer/ewingfamilyoftumors/indexhttp://www.cancer.org/cancer/ewingfamilyoftumors/indexhttp://www.cancer.org/cancer/ewingfamilyoftumors/indexhttp://www.cancer.org/cancer/esophaguscancer/indexhttp://www.cancer.org/cancer/endometrialcancer/indexhttp://www.cancer.org/cancer/colonandrectumcancer/indexhttp://www.cancer.org/cancer/cervicalcancer/indexhttp://www.cancer.org/cancer/castlemandisease/indexhttp://www.cancer.org/cancer/cancerofunknownprimary/indexhttp://www.cancer.org/cancer/cancerinchildren/indexhttp://www.cancer.org/cancer/breastcancerinmen/indexhttp://www.cancer.org/cancer/breastcancer/indexhttp://www.cancer.org/cancer/braincnstumorsinchildren/indexhttp://www.cancer.org/cancer/braincnstumorsinadults/indexhttp://www.cancer.org/cancer/bonemetastasis/indexhttp://www.cancer.org/cancer/bonecancer/indexhttp://www.cancer.org/cancer/bladdercancer/indexhttp://www.cancer.org/cancer/bileductcancer/indexhttp://www.cancer.org/cancer/aplasticanemia/indexhttp://www.cancer.org/cancer/analcancer/indexhttp://www.cancer.org/cancer/advancedcancer/indexhttp://www.cancer.org/cancer/adrenalcorticalcancer/index


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Eye Cancer

Gallbladder Cancer

Gastrointestinal Carcinoid Tumors

Gastrointestinal Stromal Tumor (GIST)

Gestational Trophoblastic Disease

Hodgkin Disease

Kaposi Sarcoma

Kidney Cancer

Laryngeal and Hypopharyngeal Cancer

Leukemia - Acute Lymphocytic (ALL) in Adults

Leukemia - Acute Myeloid (AML)

Leukemia - Chronic Lymphocytic (CLL)

Leukemia - Chronic Myeloid (CML)

Leukemia - Chronic Myelomonocytic (CMML)

Leukemia in Children

Liver Cancer

Lung Cancer - Non-Small Cell

Lung Cancer - Small Cell

Lung Carcinoid Tumor

Lymphoma of the Skin

Malignant Mesothelioma

Multiple Myeloma

Myelodysplastic Syndrome

http://www.cancer.org/cancer/eyecancer/indexhttp://www.cancer.org/cancer/eyecancer/indexhttp://www.cancer.org/cancer/gallbladdercancer/indexhttp://www.cancer.org/cancer/gallbladdercancer/indexhttp://www.cancer.org/cancer/gastrointestinalcarcinoidtumor/indexhttp://www.cancer.org/cancer/gastrointestinalcarcinoidtumor/indexhttp://www.cancer.org/cancer/gastrointestinalstromaltumorgist/indexhttp://www.cancer.org/cancer/gastrointestinalstromaltumorgist/indexhttp://www.cancer.org/cancer/gestationaltrophoblasticdisease/indexhttp://www.cancer.org/cancer/gestationaltrophoblasticdisease/indexhttp://www.cancer.org/cancer/hodgkindisease/indexhttp://www.cancer.org/cancer/hodgkindisease/indexhttp://www.cancer.org/cancer/kaposisarcoma/indexhttp://www.cancer.org/cancer/kaposisarcoma/indexhttp://www.cancer.org/cancer/kidneycancer/indexhttp://www.cancer.org/cancer/kidneycancer/indexhttp://www.cancer.org/cancer/laryngealandhypopharyngealcancer/indexhttp://www.cancer.org/cancer/laryngealandhypopharyngealcancer/indexhttp://www.cancer.org/cancer/leukemia-acutelymphocyticallinadults/indexhttp://www.cancer.org/cancer/leukemia-acutelymphocyticallinadults/indexhttp://www.cancer.org/cancer/leukemia-acutemyeloidaml/indexhttp://www.cancer.org/cancer/leukemia-acutemyeloidaml/indexhttp://www.cancer.org/cancer/leukemia-chroniclymphocyticcll/indexhttp://www.cancer.org/cancer/leukemia-chroniclymphocyticcll/indexhttp://www.cancer.org/cancer/leukemia-chronicmyeloidcml/indexhttp://www.cancer.org/cancer/leukemia-chronicmyeloidcml/indexhttp://www.cancer.org/cancer/leukemia-chronicmyelomonocyticcmml/indexhttp://www.cancer.org/cancer/leukemia-chronicmyelomonocyticcmml/indexhttp://www.cancer.org/cancer/leukemiainchildren/indexhttp://www.cancer.org/cancer/leukemiainchildren/indexhttp://www.cancer.org/cancer/livercancer/indexhttp://www.cancer.org/cancer/livercancer/indexhttp://www.cancer.org/cancer/lungcancer-non-smallcell/indexhttp://www.cancer.org/cancer/lungcancer-non-smallcell/indexhttp://www.cancer.org/cancer/lungcancer-smallcell/indexhttp://www.cancer.org/cancer/lungcancer-smallcell/indexhttp://www.cancer.org/cancer/lungcarcinoidtumor/indexhttp://www.cancer.org/cancer/lungcarcinoidtumor/indexhttp://www.cancer.org/cancer/lymphomaoftheskin/indexhttp://www.cancer.org/cancer/lymphomaoftheskin/indexhttp://www.cancer.org/cancer/malignantmesothelioma/indexhttp://www.cancer.org/cancer/malignantmesothelioma/indexhttp://www.cancer.org/cancer/multiplemyeloma/indexhttp://www.cancer.org/cancer/multiplemyeloma/indexhttp://www.cancer.org/cancer/myelodysplasticsyndrome/indexhttp://www.cancer.org/cancer/myelodysplasticsyndrome/indexhttp://www.cancer.org/cancer/myelodysplasticsyndrome/indexhttp://www.cancer.org/cancer/multiplemyeloma/indexhttp://www.cancer.org/cancer/malignantmesothelioma/indexhttp://www.cancer.org/cancer/lymphomaoftheskin/indexhttp://www.cancer.org/cancer/lungcarcinoidtumor/indexhttp://www.cancer.org/cancer/lungcancer-smallcell/indexhttp://www.cancer.org/cancer/lungcancer-non-smallcell/indexhttp://www.cancer.org/cancer/livercancer/indexhttp://www.cancer.org/cancer/leukemiainchildren/indexhttp://www.cancer.org/cancer/leukemia-chronicmyelomonocyticcmml/indexhttp://www.cancer.org/cancer/leukemia-chronicmyeloidcml/indexhttp://www.cancer.org/cancer/leukemia-chroniclymphocyticcll/indexhttp://www.cancer.org/cancer/leukemia-acutemyeloidaml/indexhttp://www.cancer.org/cancer/leukemia-acutelymphocyticallinadults/indexhttp://www.cancer.org/cancer/laryngealandhypopharyngealcancer/indexhttp://www.cancer.org/cancer/kidneycancer/indexhttp://www.cancer.org/cancer/kaposisarcoma/indexhttp://www.cancer.org/cancer/hodgkindisease/indexhttp://www.cancer.org/cancer/gestationaltrophoblasticdisease/indexhttp://www.cancer.org/cancer/gastrointestinalstromaltumorgist/indexhttp://www.cancer.org/cancer/gastrointestinalcarcinoidtumor/indexhttp://www.cancer.org/cancer/gallbladdercancer/indexhttp://www.cancer.org/cancer/eyecancer/index


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Nasal Cavity and Paranasal Sinus Cancer

Nasopharyngeal Cancer

Neuroblastoma

Non-Hodgkin Lymphoma

Non-Hodgkin Lymphoma In Children

Oral Cavity and Oropharyngeal Cancer

Osteosarcoma

Ovarian Cancer

Pancreatic Cancer

Penile Cancer

Pituitary Tumors

Prostate Cancer

Retinoblastoma

Rhabdomyosarcoma

Salivary Gland Cancer

Sarcoma - Adult Soft Tissue Cancer

Skin Cancer - Basal and Squamous Cell

Skin Cancer - Melanoma

Small Intestine Cancer

Stomach Cancer

Testicular Cancer

Thymus Cancer

Thyroid Cancer

http://www.cancer.org/cancer/nasalcavityandparanasalsinuscancer/indexhttp://www.cancer.org/cancer/nasalcavityandparanasalsinuscancer/indexhttp://www.cancer.org/cancer/nasopharyngealcancer/indexhttp://www.cancer.org/cancer/nasopharyngealcancer/indexhttp://www.cancer.org/cancer/neuroblastoma/indexhttp://www.cancer.org/cancer/neuroblastoma/indexhttp://www.cancer.org/cancer/non-hodgkinlymphoma/indexhttp://www.cancer.org/cancer/non-hodgkinlymphoma/indexhttp://www.cancer.org/cancer/non-hodgkinlymphomainchildren/indexhttp://www.cancer.org/cancer/non-hodgkinlymphomainchildren/indexhttp://www.cancer.org/cancer/oralcavityandoropharyngealcancer/indexhttp://www.cancer.org/cancer/oralcavityandoropharyngealcancer/indexhttp://www.cancer.org/cancer/osteosarcoma/indexhttp://www.cancer.org/cancer/osteosarcoma/indexhttp://www.cancer.org/cancer/ovariancancer/indexhttp://www.cancer.org/cancer/ovariancancer/indexhttp://www.cancer.org/cancer/pancreaticcancer/indexhttp://www.cancer.org/cancer/pancreaticcancer/indexhttp://www.cancer.org/cancer/penilecancer/indexhttp://www.cancer.org/cancer/penilecancer/indexhttp://www.cancer.org/cancer/pituitarytumors/indexhttp://www.cancer.org/cancer/pituitarytumors/indexhttp://www.cancer.org/cancer/prostatecancer/indexhttp://www.cancer.org/cancer/prostatecancer/indexhttp://www.cancer.org/cancer/retinoblastoma/indexhttp://www.cancer.org/cancer/retinoblastoma/indexhttp://www.cancer.org/cancer/rhabdomyosarcoma/indexhttp://www.cancer.org/cancer/rhabdomyosarcoma/indexhttp://www.cancer.org/cancer/salivaryglandcancer/indexhttp://www.cancer.org/cancer/salivaryglandcancer/indexhttp://www.cancer.org/cancer/sarcoma-adultsofttissuecancer/indexhttp://www.cancer.org/cancer/sarcoma-adultsofttissuecancer/indexhttp://www.cancer.org/cancer/skincancer-basalandsquamouscell/indexhttp://www.cancer.org/cancer/skincancer-basalandsquamouscell/indexhttp://www.cancer.org/cancer/skincancer-melanoma/indexhttp://www.cancer.org/cancer/skincancer-melanoma/indexhttp://www.cancer.org/cancer/smallintestinecancer/indexhttp://www.cancer.org/cancer/smallintestinecancer/indexhttp://www.cancer.org/cancer/stomachcancer/indexhttp://www.cancer.org/cancer/stomachcancer/indexhttp://www.cancer.org/cancer/testicularcancer/indexhttp://www.cancer.org/cancer/testicularcancer/indexhttp://www.cancer.org/cancer/thymuscancer/indexhttp://www.cancer.org/cancer/thymuscancer/indexhttp://www.cancer.org/cancer/thyroidcancer/indexhttp://www.cancer.org/cancer/thyroidcancer/indexhttp://www.cancer.org/cancer/thyroidcancer/indexhttp://www.cancer.org/cancer/thymuscancer/indexhttp://www.cancer.org/cancer/testicularcancer/indexhttp://www.cancer.org/cancer/stomachcancer/indexhttp://www.cancer.org/cancer/smallintestinecancer/indexhttp://www.cancer.org/cancer/skincancer-melanoma/indexhttp://www.cancer.org/cancer/skincancer-basalandsquamouscell/indexhttp://www.cancer.org/cancer/sarcoma-adultsofttissuecancer/indexhttp://www.cancer.org/cancer/salivaryglandcancer/indexhttp://www.cancer.org/cancer/rhabdomyosarcoma/indexhttp://www.cancer.org/cancer/retinoblastoma/indexhttp://www.cancer.org/cancer/prostatecancer/indexhttp://www.cancer.org/cancer/pituitarytumors/indexhttp://www.cancer.org/cancer/penilecancer/indexhttp://www.cancer.org/cancer/pancreaticcancer/indexhttp://www.cancer.org/cancer/ovariancancer/indexhttp://www.cancer.org/cancer/osteosarcoma/indexhttp://www.cancer.org/cancer/oralcavityandoropharyngealcancer/indexhttp://www.cancer.org/cancer/non-hodgkinlymphomainchildren/indexhttp://www.cancer.org/cancer/non-hodgkinlymphoma/indexhttp://www.cancer.org/cancer/neuroblastoma/indexhttp://www.cancer.org/cancer/nasopharyngealcancer/indexhttp://www.cancer.org/cancer/nasalcavityandparanasalsinuscancer/index


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Uterine Sarcoma

Vaginal Cancer

Vulvar Cancer

Waldenstrom Macroglobulinemia

Wilms Tumor

http://www.cancer.org/cancer/uterinesarcoma/indexhttp://www.cancer.org/cancer/uterinesarcoma/indexhttp://www.cancer.org/cancer/vaginalcancer/indexhttp://www.cancer.org/cancer/vaginalcancer/indexhttp://www.cancer.org/cancer/vulvarcancer/indexhttp://www.cancer.org/cancer/vulvarcancer/indexhttp://www.cancer.org/cancer/waldenstrommacroglobulinemia/indexhttp://www.cancer.org/cancer/waldenstrommacroglobulinemia/indexhttp://www.cancer.org/cancer/wilmstumor/indexhttp://www.cancer.org/cancer/wilmstumor/indexhttp://www.cancer.org/cancer/wilmstumor/indexhttp://www.cancer.org/cancer/waldenstrommacroglobulinemia/indexhttp://www.cancer.org/cancer/vulvarcancer/indexhttp://www.cancer.org/cancer/vaginalcancer/indexhttp://www.cancer.org/cancer/uterinesarcoma/index


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CHAPTER 5.Breast Cancer in Western Medicine

Breast cancer

Many women are concerned that breast cancer seems to run in their family. A woman who

has a first-degree relative (a mother, sister, or daughter) with breast cancer is about twice

as likely to develop breast cancer as a woman without a family history of this cancer. Still,

most cases of breast cancer, even those in close relatives, are not part of a family cancer

syndrome caused by an inherited gene mutation.

The chance that someone has an inherited form of breast cancer is higher the younger they

are when they get the cancer and the more relatives they have with the disease. Inherited

breast cancer can be caused by several different genes, but the most common

are BRCA1 and BRCA2. Inherited mutations in these genes cause hereditary breast and

ovarian cancer syndrome (HBOC). Along with breast and ovarian cancer, this syndrome

can also lead to male breast cancer, pancreatic cancer, prostate cancer, as well as some

others. This syndrome is more common in women of Ashkenazi Jewish descent than it is

in the general US population.

Women with a strong family history of breast cancer may choose to undergo genetic

counseling to estimate their risk for inherited breast cancer. They then can choose to be

tested to find out if they have a breast cancer gene mutation. If a mutation is present, the

woman has a high risk of developing breast cancer. She may start getting mammograms at

an age younger than 40, have special breast cancer screening tests, or take other measures

to try to reduce her risk of getting breast cancer.

What is breast cancer in western medicine?


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Breast cancer is a malignant tumor that starts in the cells of the breast. A malignant tumor

is a group of cancer cells that can grow into (invade) surrounding tissues or spread

(metastasize) to distant areas of the body. The disease occurs almost entirely in women,

but men can get it, too.

To understand breast cancer, it helps to have some basic knowledge about the normal

structure of the breasts, shown in the diagram below.

The female breast is made up mainly of lobules (milk-producing glands), ducts (tiny tubes

that carry the milk from the lobules to the nipple), and stroma (fatty tissue and connective

tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels).

Most breast cancers begin in the cells that line the ducts (ductal cancers). Some begin in

the cells that line the lobules (lobular cancers), while a small number start in other tissues.

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The lymph (lymphatic) system of the breast

The lymph system is important to understand because it is one way breast cancers can

spread. This system has several parts.

Lymph nodes are small, bean-shaped collections of immune system cells (cells that are

important in fighting infections) that are connected by lymphatic vessels. Lymphatic

vessels are like small veins, except that they carry a clear fluid called lymph (instead of

blood) away from the breast. Lymph contains tissue fluid and waste products, as well as

immune system cells. Breast cancer cells can enter lymphatic vessels and begin to grow in

lymph nodes.

Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary

nodes). Some lymphatic vessels connect to lymph nodes inside the chest (internal

mammary nodes) and those either above or below the collarbone

( supraclavicular or infraclavicular nodes).


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If the cancer cells have spread to lymph nodes, there is a higher chance that the cells could

have also gotten into the bloodstream and spread (metastasized) to other sites in the body.

The more lymph nodes that have breast cancer, the more likely it is that the cancer may be

found in other organs as well. Because of this, finding cancer in one or more lymph nodes

often affects the treatment plan. Still, not all women with cancer cells in their lymph nodes

develop metastases, and some women can have no cancer cells in their lymph nodes and

later develop metastases.

Benign breast lumps

Most breast lumps are not cancerous (benign). Still, some may need to be sampled and

viewed under a microscope to prove they are not cancer.

http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-what-is-breast-cancerhttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-what-is-breast-cancerhttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-what-is-breast-cancerhttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-what-is-breast-cancer


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Fibrocystic changes

Most lumps turn out to be fibrocystic changes. The term fibrocystic refers to fibrosis and

cysts. Fibrosis is the formation of scar-like (fibrous) tissue, and cysts are fluid-filled sacs.

Fibrocystic changes can cause breast swelling and pain. This often happens just before a

woman's menstrual period is about to begin. Her breasts may feel lumpy and, sometimes,

she may notice a clear or slightly cloudy nipple discharge.

Other benign breast lumps

Benign breast tumors such as fibroadenomas or intraductal papillomas are abnormal

growths, but they are not cancerous and do not spread outside the breast to other organs.

They are not life threatening. Still, some benign breast conditions are important because

women with these conditions have a higher risk of developing breast cancer.

General breast cancer terms

Here are some of the key words used to describe breast cancer.

Carcinoma

This is a term used to describe a cancer that begins in the lining layer (epithelial cells) of

organs like the breast. Nearly all breast cancers are carcinomas (either ductal carcinomas

or lobular carcinomas).

Adenocarcinoma

An adenocarcinoma is a type of carcinoma that starts in glandular tissue (tissue that makes

and secretes a substance). The ducts and lobules of the breast are glandular tissue (they

make breast milk), so cancers starting in these areas are often called adenocarcinomas.

http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-what-is-breast-cancerhttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-what-is-breast-cancerhttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-what-is-breast-cancerhttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-what-is-breast-cancerhttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-what-is-breast-cancerhttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-what-is-breast-cancerhttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-what-is-breast-cancerhttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-what-is-breast-cancer


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Carcinoma in situ

This term is used for an early stage of cancer, when it is confined to the layer of cells where

it began. In breast cancer, in situ means that the cancer cells remain confined to ducts

(ductal carcinoma in situ). The cells have not grown into (invaded ) deeper tissues in the

breast or spread to other organs in the body. Carcinoma in situ of the breast is sometimes

referred to as non-invasive or pre-invasive breast cancer because it may develop into an

invasive breast cancer if left untreated.

When cancer cells are confined to the lobules it is called lobular carcinoma in situ. This is

not actually a true cancer or pre-cancer.

Invasive (infiltrating) carcinoma

An invasive cancer is one that has already grown beyond the layer of cells where it started

(as opposed to carcinoma in situ). Most breast cancers are invasive carcinomas — either

invasive ductal carcinoma or invasive lobular carcinoma.

Sarcoma

Sarcomas are cancers that start in connective tissues such as muscle tissue, fat tissue, or

blood vessels. Sarcomas of the breast are rare.

Types of breast cancers

There are several types of breast cancer, but some of them are quite rare. In some cases a

single breast tumor can be a combination of these types or be a mixture of invasive and in

situ cancer.


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Ductal carcinoma in situ

Ductal carcinoma in situ (DCIS; also known as intraductal carcinoma) is the most common

type of non-invasive breast cancer. DCIS means that the cancer cells are inside the ducts

but have not spread through the walls of the ducts into the surrounding breast tissue.

About 1 in 5 new breast cancer cases will be DCIS. Nearly all women diagnosed at this

early stage of breast cancer can be cured. A mammogram is often the best way to find DCIS

early.

When DCIS is diagnosed, the pathologist (a doctor specializing in diagnosing disease from

tissue samples) will look for areas of dead or dying cancer cells, called tumor necrosis,

within the tissue sample. If necrosis is present, the tumor is likely to be more aggressive.

The term comedocarcinoma is often used to describe DCIS with necrosis.

Invasive (or infiltrating) ductal carcinoma

This is the most common type of breast cancer. Invasive (or infiltrating) ductal carcinoma

(IDC) starts in a milk passage (duct) of the breast, breaks through the wall of the duct, and

grows into the fatty tissue of the breast. At this point, it may be able to spread (metastasize)

to other parts of the body through the lymphatic system and bloodstream. About 8 of 10

invasive breast cancers are infiltrating ductal carcinomas.

Invasive (or infiltrating) lobular carcinoma

Invasive lobular carcinoma (ILC) starts in the milk-producing glands (lobules). Like IDC,

it can spread (metastasize) to other parts of the body. About 1 in 10 invasive breast cancers

is an ILC. Invasive lobular carcinoma may be harder to detect by a mammogram than

invasive ductal carcinoma.


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Paget disease of the nipple: This type of breast cancer starts in the breast ducts and spreads

to the skin of the nipple and then to the areola, the dark circle around the nipple. It is rare,

accounting for only about 1% of all cases of breast cancer. The skin of the nipple and areola

often appears crusted, scaly, and red, with areas of bleeding or oozing. The woman may

notice burning or itching.

Phyllodes tumor: This very rare breast tumor develops in the stroma (connective tissue)

of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Other names

for these tumors include phylloides tumor and cystosarcoma phyllodes. These tumors are

usually benign but on rare occasions may be malignant.

Benign phyllodes tumors are treated by removing the tumor along with a margin of normal

breast tissue. A malignant phyllodes tumor is treated by removing it along with a wider

margin of normal tissue, or by mastectomy. Surgery is often all that is needed, but these

cancers may not respond as well to the other treatments used for more common breast

cancers. When a malignant phyllodes tumor has spread, it can be treated with the

chemotherapy given for soft-tissue sarcomas.

Angiosarcoma: This is a form of cancer that starts in cells that line blood vessels or lymph

vessels. It rarely occurs in the breasts. When it does, it usually develops as a complication

of previous radiation treatments. This is an extremely rare complication of breast radiation

therapy that can develop about 5 to 10 years after radiation. Angiosarcoma can also occur

in the arms of women who develop lymphedema as a result of lymph node surgery or

radiation therapy to treat breast cancer.

What are the risk factors for breast cancer?


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A risk factor is anything that affects your chance of getting a disease, such as cancer.

Different cancers have different risk factors. For example, exposing skin to strong sunlight

is a risk factor for skin cancer. Smoking is a risk factor for cancers of the lung, mouth,

larynx (voice box), bladder, kidney, and several other organs.

But risk factors don't tell us everything. Having a risk factor, or even several, does not

mean that you will get the disease. Most women who have one or more breast cancer risk

factors never develop the disease, while many women with breast cancer have no apparent

risk factors (other than being a woman and growing older). Even when a woman with risk

factors develops breast cancer, it is hard to know just how much these factors may have

contributed to her cancer.

There are different kinds of risk factors. Some factors, like a person's age or race, can't be

changed. Others are linked to cancer-causing factors in the environment. Still others are

related personal behaviors, such as smoking, drinking, and diet. Some factors influence

risk more than others, and your risk for breast cancer can change over time, due to factors

such as aging or lifestyle.

Risk factors you cannot change

Gender

Simply being a woman is the main risk factor for developing breast cancer. Men can

develop breast cancer, but this disease is about 100 times more common among women

than men. This is likely because men have less of the female hormones estrogen and

progesterone, which can promote breast cancer cell growth

http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-risk-factorshttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-risk-factorshttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-risk-factorshttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-risk-factorshttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-risk-factorshttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-risk-factorshttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-risk-factorshttp://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-risk-factors


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Aging

Your risk of developing breast cancer increases as you get older. About 1 out of 8 invasive

breast cancers are found in women younger than 45, while about 2 of 3 invasive breast

cancers are found in women age 55 or older.

Genetic risk factors

About 5% to 10% of breast cancer cases are thought to be hereditary, resulting directly

from gene defects (called mutations) inherited from a parent.

BRCA1 and BRCA2 : The most common cause of hereditary breast cancer is an inherited

mutation in the BRCA1 and BRCA2genes. In normal cells, these genes help prevent cancer

by making proteins that keep the cells from growing abnormally. If you have inherited a

mutated copy of either gene from a parent, you have a high risk of developing breast cancer

during your lifetime. The risk may be as high as 80% for members of some families

with BRCA mutations. These cancers tend to occur in younger women and more often

affect both breasts than cancers in women who are not born with one of these gene

mutations. Women with these inherited mutations also have an increased risk for

developing other cancers, particularly ovarian cancer.

In the United States BRCA mutations are found most often in Jewish women of Ashkenazi

(Eastern Europe) origin, but they can occur in any racial or ethnic group.

Changes in other genes: Other gene mutations can also lead to inherited breast cancers.

These gene mutations are much rarer and often do not increase the risk of breast cancer as

much as the BRCA genes. They are not frequent causes of inherited breast cancer.


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were still developing. Radiation treatment after age 40 does not seem to increase breast

cancer risk.

Diethylstilbestrol exposure

From the 1940s through the 1960s some pregnant women were given the drug

diethylstilbestrol (DES) because it was thought to lower their chances of miscarriage

(losing the baby). These women have a slightly increased risk of developing breast cancer.

Women whose mothers took DES during pregnancy may also have a slightly higher risk

of breast cancer.

Lif estyle-related factors and breast cancer r isk

Having children

Women who have had no children or who had their first child after age 30 have a slightly

higher breast cancer risk. Having many pregnancies and becoming pregnant at a young age

reduce breast cancer risk. Pregnancy reduces a woman's total number of lifetime menstrual

cycles, which may be the reason for this effect.

Recent oral contraceptive use

Studies have found that women using oral contraceptives (birth control pills) have a slightly

greater risk of breast cancer than women who have never used them. This risk seems to go

back to normal over time once the pills are stopped. Women who stopped using oral

contraceptives more than 10 years ago do not appear to have any increased breast cancer

risk. When thinking about using oral contraceptives, women should discuss their other risk

factors for breast cancer with their health care team.


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especially in countries such as the United States, where breast-feeding for this long is

uncommon.

One explanation for this possible effect may be that breast-feeding reduces a woman's total

number of lifetime menstrual cycles (similar to starting menstrual periods at a later age or

going through early menopause).

Alcohol

The use of alcohol is clearly linked to an increased risk of developing breast cancer. The

risk increases with the amount of alcohol consumed. Compared with non-drinkers, women

who consume 1 alcoholic drink a day have a very small increase in risk. Those who have

2 to 5 drinks daily have about 1½ times the risk of women who drink no alcohol. Excessive

alcohol use is also known to increase the risk of developing several other types of cancer.

Being overweight or obese

Being overweight or obese has been found to increase breast cancer risk, especially for

women after menopause. Before menopause your ovaries produce most of your estrogen,

and fat tissue produces a small amount of estrogen. After menopause (when the ovaries

stop making estrogen), most of a woman's estrogen comes from fat tissue. Having more fat

tissue after menopause can increase your chance of getting breast cancer by raising

estrogen levels. Also, women who are overweight tend to have higher blood insulin levels.

Higher insulin levels have also been linked to some cancers, including breast cancer.

But the connection between weight and breast cancer risk is complex. For example, the

risk appears to be increased for women who gained weight as an adult but may not be

increased among those who have been overweight since childhood. Also, excess fat in the


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waist area may affect risk more than the same amount of fat in the hips and thighs.

Researchers believe that fat cells in various parts of the body have subtle differences that

may explain this.

Physical activity

Evidence is growing that physical activity in the form of exercise reduces breast cancer

risk. The main question is how much exercise is needed. In one study from the Women's

Health Initiative (WHI) as little as 1.25 to 2.5 hours per week of brisk walking reduced a

woman's risk by 18%. Walking 10 hours a week reduced the risk a little more.

Factors with uncertain, contr oversial , or unproven effect on breast cancer r isk

Diet and vitamin intake

Many studies have looked for a link between what women eat and breast cancer risk, but

so far the results have been conflicting. Some studies have indicated that diet may play a

role, while others found no evidence that diet influences breast cancer risk. Studies have

looked at the amount of fat in the diet, intake of fruits and vegetables, and intake of meat.

No clear link to breast cancer risk was found.

Studies have also looked at vitamin levels, again with inconsistent results. Some studies

actually found an increased risk of breast cancer in women with higher levels of certain

nutrients. So far, no study has shown that taking vitamins reduces breast cancer risk. This

is not to say that there is no point in eating a healthy diet. A diet low in fat, low in red meat

and processed meat, and high in fruits and vegetables may have other health benefits.


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Breast implants

Several studies have found that breast implants do not increase breast cancer risk, although

silicone breast implants can cause scar tissue to form in the breast. Implants make it harder

to see breast tissue on standard mammograms, but additional x-ray pictures called implant

displacement views can be used to examine the breast tissue more completely.

Chemicals in the environment

A great deal of research has been reported and more is being done to understand possible

environmental influences on breast cancer risk.

Of special interest are compounds in the environment that studies in lab animals have found

to have estrogen-like properties. These could in theory affect breast cancer risk. For

example, substances found in some plastics, certain cosmetics and personal care products,

pesticides (such as DDE), and PCBs (polychlorinated biphenyls) seem to have such

properties.

Tobacco smoke

For a long time, studies found no link between cigarette smoking and breast cancer. In

recent years though, some studies have found that smoking may increase the risk of breast

cancer. The increased risk seems to affect certain groups, such as women who started

smoking when they were young. In 2009, the International Agency for Research on Cancer

concluded that there is limited evidence that tobacco smoking causes breast cancer.

An active focus of research is whether secondhand smoke increases the risk of breast

cancer. Both mainstream and secondhand smoke contain chemicals that, in high


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concentrations, cause breast cancer in rodents. Chemicals in tobacco smoke reach breast

tissue and are found in breast milk.

The evidence on secondhand smoke and breast cancer risk in human studies is

controversial, at least in part because smokers have not been shown to be at increased risk.

One possible explanation for this is that tobacco smoke may have different effects on breast

cancer risk in smokers and in those who are just exposed to smoke.

Night work

Several studies have suggested that women who work at night — for example, nurses on a

night shift — may have an increased risk of developing breast cancer. This is a fairly recent

finding, and more studies are looking at this issue. Some researchers think the effect may

be due to changes in levels of melatonin, a hormone whose production is affected by the

body's exposure to light, but other hormones are also being studied.


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CHAPTER 6. Mammograms and Self-Exam

Mammograms and Self-Exam

A mammogram is an x-ray of the breast. A diagnostic mammogram is used to diagnose

breast disease in women who have breast symptoms or an abnormal result on a screening

mammogram. Screening mammograms are used to look for breast disease in women who

are asymptomatic; that is, they appear to have no breast problems. Screening mammograms

usually take 2 views (x-ray pictures taken from different angles) of each breast. For some

patients, such as women with breast implants, more pictures may be needed to include as

much breast tissue as possible. Women who are breast-feeding can still get mammograms,

but these are probably not quite as accurate because the breast tissue tends to be dense.

What the doctor looks for on your mammogram

The doctor reading the mammogram will look for several types of changes:

Calcifications are tiny mineral deposits within the breast tissue, which look like small white

spots on the films. They may or may not be caused by cancer. There are 2 types of

calcifications:


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Macrocalcifications are coarse (larger) calcium deposits that are most likely changes in

the breasts caused by aging of the breast arteries, old injuries, or inflammation. These

deposits are related to non-cancerous conditions and do not require a biopsy.

Macrocalcifications are found in about half the women over 50, and in about 1 of 10

women under 50.

Microcalcifications are tiny specks of calcium in the breast. They may appear alone or in

clusters. Microcalcifications seen on a mammogram are of more concern, but still usually

do not mean that cancer is present. The shape and layout of microcalcifications help the

radiologist judge how likely it is that cancer is present. If the calcifications look

suspicious for cancer, a biopsy will be done.

A mass, which may occur with or without calcifications, is another important change seen

on a mammogram. Masses can be many things, including cysts (non-cancerous, fluid-filled

sacs) and non-cancerous solid tumors (such as fibroadenomas), but they could also be

cancer.

Cysts can be simple fluid-filled sacs (known as simple cysts) or can be partially solid

(known as complex cysts). Simple cysts are benign and don’t need to be biopsied. Any

other type of mass (such as a complex cyst or a solid tumor) might need to be biopsied to

be sure it isn’t cancer.

A cyst and a tumor can feel alike on a physical exam. They can also look the same on a

mammogram. To confirm that a mass is really a cyst, a breast ultrasound is often done.

Another option is to remove (aspirate) the fluid from the cyst with a thin, hollow needle.

If a mass is not a simple cyst (that is, if it is at least partly solid), then you may need to

have more imaging tests. Some masses can be watched with periodic mammograms,


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while others may need a biopsy. The size, shape, and margins (edges) of the mass help

the radiologist determine if cancer is present.

Limitations of mammograms

A mammogram cannot prove that an abnormal area is cancer. To confirm whether cancer

is present, a small amount of tissue must be removed and looked at under a microscope.

This procedure, called a biopsy.

Clinical breast exam

A clinical breast exam (CBE) is an exam of your breasts by a health care professional, such

as a doctor, nurse practitioner, nurse, or doctor's assistant. For this exam, you undress from

the waist up. The health care professional will first look at your breasts for abnormalities

in size or shape, or changes in the skin of the breasts or nipple. Then, using the pads of the

fingers, the examiner will gently feel (palpate) your breasts.

Special attention will be given to the shape and texture of the breasts, location of any lumps,

and whether such lumps are attached to the skin or to deeper tissues. The area under both

arms will also be examined.

The CBE is a good time for women who don't know how to examine their breasts to learn

the proper technique from their health care professionals. Ask your doctor or nurse to teach

you and watch your technique.

Breast awareness and self exam

Beginning in their 20s, women should be told about the benefits and limitations of breast

self-exam (BSE). Women should know how their breasts normally look and feel and report


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any new breast changes to a health professional as soon as they are found. Finding a breast

change does not necessari

BREAST CANCER & TCM. Dr Fatima Manesh (2).pdf

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