Breast Cancer – the bread & butter of OncoPT
When it comes to OncoPT, there’s a few things that are absolutely classic bread and butter of what we do. One of those is breast cancer.
With breast cancer being the most common cancer diagnosis that most of us will see, it’s critical that we truly understand the basics, the foundation behind what breast cancer is and how it really affects our patients.
Despite it being so common, unfortunately many people don’t really understand what it is, how it’s treated, or how it really affects a person both now and potentially for the rest of their life.
If we’re really going to treat breast cancer well, these are the principles we must understand to be a confident and competent OncoPT.
With October coming up quickly (Breast Cancer Awareness Month), now is the time to start planning what kind of community education/outreach initiative you will be doing.
What is breast cancer?
Breast cancer is a cancer that originates in the breast tissue. Pretty simple, right?
But every breast cancer is unique. Even for people who have the same diagnosis on paper, this does not mean that their breast cancers will behave exactly the same.
Most breast cancers are carcinomas which means that they invade the epithelial tissue of the breast. This can include the lobules of the breast & the ducts of the breast.
Ductal carcinoma means that this person has breast cancer is a carcinoma that originated within the ducts of the breast. Some people may have a lobular carcinoma, which means that their cancer originated in the lobules of the breast tissue.
The lobules of the breasts are sacs that actually produce the milk while ducts are tubes that carry the milk to the nipple. But it’s important to note here that the ducts & the lobules are glandular tissue (so epithelial tissue).
The connective tissue of the breast includes the ligaments and the scar tissue that help to support the breast tissue.
Connective tissue tumors are sarcomas. Sarcomas of the breasts are much less common than carcinomas, so most patients you see will likely have a carcinoma of some kind.
One such type of sarcoma that may affect breast tissue is an angiosarcoma of the breast. This cancer originates in the cells that line the lymph vessels are the blood vessels in the breast tissue.
Triple Negative Breast Cancer
Triple negative breast cancer is a type of breast cancer that is negative for progesterone and estrogen receptors on their cells and doesn’t create the protein called HER2.
Inflammatory Breast Cancer
Inflammatory breast cancer comprises roughly 1-5% of all breast cancer diagnoses. Inflammatory breast cancer is actually a type of ductal carcinoma, but the prognosis and the treatment for inflammatory breast cancer are very different.
Inflammatory breast cancer is much more aggressive and is usually at a locally advanced stage at diagnosis.
What causes/contributes to breast cancer/risk factors?
General risk factors of breast cancer include older age, prolonged exposure to estrogen, and a family history of breast cancer.
Additionally, lifestyle factors such as obesity, exercise levels, & alcohol consumption are definitely linked to breast cancer.
While genetic mutations such as the BRCA gene are relatively rare, the risk of a person with a BRCA mutation of developing breast cancer is astronomical.
Other risk factors for breast cancer include previous history of having breast cancer, previous radiation therapy, & being born female.
Breast cancer most commonly affects?
Breast cancer most commonly affects women 55 and older.
BUT, this is a very general statement because as we know there’s a lot of nuances in breast cancer.
For example, triple negative breast cancer tends to be more common in younger women less than 40 years old, black women and those who have a BRCA-1 mutation.
It’s also important to note that about 10% of all breast cancer cases are in males.
What are the signs & symptoms of breast cancer?
Common signs and symptoms of breast cancer include a new lump or mass within the breast.
Other signs and symptoms include:
- Breast swelling
- Peau d’orange skin texture (orange peel skin dimpling appearance)
- Pain or discharge from the nipple or the breast
- Inverted nipple
- Red, dry, flaking or thicker breast skin
- Swollen lymph nodes in the chest and axilla
Signs & Symptoms of Inflammatory Breast Cancer
These patients will most commonly have edema of the breast, redness, warmth, or heaviness in the breast.
Most signs and symptoms of inflammatory breast cancer to develop rapidly as in within 3 to 6 months.
How is breast cancer diagnosed?
Most breast cancers are diagnosed with a biopsy.
Some patients may feel the initial lump or mass in their breast tissue and then go in for a physical exam and imaging. Most patients will then undergo a biopsy to determine if this is cancer & what kind of cancer it is.
How is breast cancer staged/graded/etc.?
Once the biopsy is done, the medical team can determine the type, stage, & grade of breast cancer.
Rembmer: stage is how advanced the cancer is, whereas grade is how undifferentiated the cancer cells are. Both of these are used together to determine a patient’s treatment plan and their prognosis.
Breast cancer is staged with the TNM system:
- T = tumor
- N = lymph node involvement
- M = metastasis
Tumors that are small we’ll have a smaller T number such as T1 or T2, whereas higher numbers will indicate a larger potentially more widespread tumor burden.
Patients with inflammatory breast cancer are typically diagnosed at stage 3 or stage form which means they’ll have a T3 or T4 tumor.
Treatment for breast cancer?
As you’ve probably heard many times in physical therapy, when it comes to treatment for breast cancer, it depends.
Many factors contribute to what treatment a person will undergo for their breast cancer: their diagnosis, stage, grade, age, treatment goals, comorbidities, health status, etc.
While we (the OncoPT) are not making these decisions, it’s critical for us to appreciate how much truly goes in to the treatment planning process for every single patient.
In general, patients with breast cancer will undergo some combination of surgery, chemotherapy, radiation, and hormonal therapy. Not every patient will undergo all of these. Again it really depends on the factors we’ve mentioned previously.
OncoPTs have the opportunity to truly be at the forefront of educating our communities about breast cancer & how it affects patients.
Now is the time to start thinking about how we are going to use our knowledge and our expertise to serve our communities in the very rapidly approaching breast cancer awareness month.
So now I want to hear from you: what did I miss? What else would you include in this episode about breast cancer? Message me on Instagram and let me know.
Until next time, this is Elise with TheOncoPT. And remember you are exactly the physical therapist that your patients with cancer need. So let’s get to work.