Showing posts with label breast. Show all posts
Showing posts with label breast. Show all posts

Friday, February 2, 2018

Woman, why do you allow this to happen to you?


The year 2018 started badly and sadly. I have many “sad” stories to share with you.

Rose is a 49-year-old Indonesian lady. About five years ago she had a swelling in her left breast. She came to a private hospital in Penang and have the lump removed. No further treatment was deemed necessary. The doctor probably thought it was just a fibroadenoma (a common non-cancerous breast lump).

Two years after the surgery, in 2016, the lump grew into a giant fibroadenoma and Rose underwent a mastectomy. Her whole left breast was removed. After surgery in Penang, she was sent home with no further treatment.

In early 2018, Rose started to cough and both her arms and legs are swollen. The lump in her breast grew back again. Rose came back to the same hospital and did a “health screening” test and paid RM 500 for a complied booklet about her health.

Her X-ray report said, “Lung metastasis from ? left breast carcinoma.”

Rose was referred to an oncologist of the hospital. She was told to undergo six cycles of chemotherapy.

Chris: Did you ask the doctor if chemotherapy is going to cure you?

Husband: We never ask.

Rose paid RM 160.00 for this consultation and was given a bottle of cough mixture to bring home!

What can we learn from this pathetic case?
  1. Your health is your responsibility. Many patients think that doctors know best and can fix all their problems. Once they go into the hospital, that’s it — they leave everything to the doctors! If that is your attitude, you will end up like Rose!
Rose found a lump in her breast. She had it removed. Hooray, it was not cancer — that is what everyone likes to hear. Then the lump grew back again — Rose went back to the same doctor and did a mastectomy. Did she ever ask any question — why this and why that? Probably not. The lump did not go away, as it grew bigger, Rose did not bother to consult another doctor — why did she allow the lump to grow so big like in the picture? Because it did not cause any pain, she said! When she started to cough and felt breathless, only then she decided to see the doctor again. She came back to the same hospital to do a “health screening” test. Is that the correct thing to do?
  1. Did Rose get the best of medical treatment? I am not too sure about that. A non-cancer lump became cancerous after two operations — is that a correct diagnosis? Did Rose go to the a “really good” doctor in town?
Remember, not all doctors are the same — in terms of experience, expertise and their empathy towards patients. As I was writing this story, one patient came. He said, The doctor told me there was about 5 liter of fluid in my lung. He tapped out 1 litre. I asked him why he did not remove the remaining 4 litre. He did not answer me. He was arrogant. What do you think of such doctors? Let him treat you again?
  1. Dr. Barry Boyd (in The Cancer Recovery Plan) wrote, “Most doctors don’t bother to counsel their patients after treatment. Once cancer treatment is completed, most patients are left on their own to cope with the rest of their lives. This is what I call falling off the cliff. Patients are left in free fall.”
Is this not what happened to Rose? Cut and cut, but was there any advice as to what to do to prevent or minimize the recurrence of the lump? No — just go home, do and eat what you like! Probably it is just your luck? If more problems crop up come back to us again and we cut you again or chemo you!

A taxi driver at the airport recommended that Rose come and consult us. When Rose came to see us, I thought it was a bit too late. Her health had deteriorated badly. I would try to help the best I can but I know I cannot make the big lump go away. I think it is not the lump that is going to kill her — it is the extensive lung metastasis.

About CA Care (<<Click Here for Homepage)

In obedience to God's will and counting on His mercies and blessings, and driven by the desire to care for one another, we seek to provide help, direction and relief to those who suffer from cancer.
 

Monday, April 3, 2017

Breast cancer

Breast cancer is cancer that starts in the breast tissue.

The breasts

Breasts are made of fat, connective tissue, and gland tissue divided into lobes.

A network of ducts spreads from the lobes towards the nipple.
Diagram showing the lobes and ducts of a breast

Breast size and density

One breast is usually smaller than the other. Your breasts may feel different at different times in the month. It is common for breasts to feel lumpy just before your period. 

Younger women have more glandular tissue than fat in their breasts, making them dense. 

After the menopause the glandular tissue is gradually replaced by fat, which is less dense.

Where it starts

Breast cancer most commonly starts in the cells that line the ducts of the breast.

9 out of 10 of these cancers have no special features when the cells are looked at under the microscope. They are called invasive breast cancer (NST). NST stands for No Special Type. 

Around 1 in 10 breast cancers (10%) are invasive lobular carcinoma. This means that the cancer started in the cells that line the lobules of the breast.

There are other rarer types of breast cancer.

Invasive breast cancer


Invasive breast cancer (no special type) is the most common type of breast cancer. Find out about it and how it is treated.

What invasive breast cancer (NST) is

Invasive breast cancer means that the cancer cells have grown through the lining of the ducts into the surrounding breast tissue. NST stands for No Special Type.

Special type means that when the doctor looks at the cancer cells under a microscope, the cells have particular features. Breast cancers that are classed as special type include lobular breast cancer and some rare types of breast cancer.

Most invasive breast cancers have no special features and so are classed as No Special Type. NST is also sometimes called NOS (not otherwise specified). It used to be called ductal carcinoma.
Diagram showing ductal carcinoma in situ (DCIS)
Remember that if your doctor has told you that you have ductal carcinoma in situ (DCIS), you don't have invasive breast cancer.

Symptoms of invasive breast cancer

Make an appointment to see your doctor if you notice anything different or unusual about the look and feel of your breasts.
The possible symptoms of breast cancer include:
  • a lump or thickening in an area of the breast
  • a change in the size, shape or feel of the breast
  • dimpling of the skin
  • a change in the shape of your nipple, particularly if it turns in, sinks into the breast, or has an irregular shape
  • a blood stained discharge from the nipple
  • a rash on a nipple or surrounding area
  • a swelling or lump in the armpit

Diagnosing invasive breast cancer

You go to a specialist breast clinic. At the breast clinic the doctor or specialist nurse takes your medical history and examines your breasts. They also feel for any swollen (enlarged) lymph nodes under your arms and at the base of your neck.

You have some of the following tests:
  • a mammogram (an x-ray of the breasts)
  • an ultrasound (if you are under 35 you are more likely to have an ultrasound scan instead of a mammogram)
  • a biopsy – a small sample of cells or tissue is taken from your breast and looked at under a microscope

Treatment

To decide on the most appropriate treatment, doctors generally take into account:
  • the type of breast cancer
  • the size of the cancer and whether it has spread (the stage)
  • how abnormal the cells look under the microscope (the grade)
  • whether the cancer cells have receptors for particular hormones
  • whether the cells have receptors for biological therapies
For invasive breast cancer you might have:
  • surgery
  • radiotherapy
  • chemotherapy
  • hormone therapy
  • a combination of these treatments

Follow up

You will have regular check ups once you finish your treatment. Your doctor will examine you and ask about your general health.

This is your chance to ask questions and to tell your doctor if anything is worrying you.

It’s important to remember that you can still contact someone if you are concerned about a symptom and it is a while before your next appointment. Speak to your GP, or contact your consultant or specialist nurse.

How often you have check ups depends on your individual situation.

Guidelines say that everyone who has had treatment for early breast cancer should have a copy of a written care plan.

The care plan has information about tests, and signs and symptoms to look out for. It will also include contact details for specialist staff, such as your breast care nurse.

After your treatment you have regular check ups for at least 5 years. This usually includes yearly mammograms for at least 5 years if you are already part of the national screening programme. Or yearly mammograms until you are able to go for breast screening, at which point they change to every 3 years.

Trials and research

Invasive breast cancer is the most common type of breast cancer. So most breast cancer research will be looking at this type.

Research includes:
  • the causes and prevention of breast cancer
  • screening and diagnosis
  • new treatments
  • ways to improve existing treatments
  • ways to cope with cancer and its treatment

Nearby lymph nodes

There is a network of lymph glands (also called lymph nodes) close to the breast. They are part of the lymphatic system that runs throughout the body. The lymph nodes and lymph vessles have a yellow fluid called lymph that flows through your lymphatic system. It collects waste products and drains into your veins for the waste to be removed. Cancer cells released from the breast tissue can be trapped in the nearby lymph nodes.
Diagram showing the network of lymph nodes in around the breast
Lymph nodes around the breast
The lymph glands in the armpit (axilla) are called the axillary lymph glands. There is also a chain of lymph nodes that runs up the centre of your chest, close to your breast bone. This is called the internal mammary chain.

Who gets it

Around 55,200 people are diagnosed with breast cancer in the UK each year. That is around 150 people a day.

It is more common in women than men. Around 54,800 women are diagnosed each year and around 390 men.

1 in 8 women in the UK develop breast cancer during their lifetime. 1 in 870 men develop it. Most of the women who get breast cancer have had their menopause, but about 2 out of every 10 (20%) are under 50 years old.

Breast cancer risk can be affected by age, family history and lifestyle factors such as obesity and smoking.

How common it is

Breast cancer is the most common cancer in the UK.
15% of all newly diagnosed cancers in the UK are breast cancer.

Symptoms


Find out about the symptoms of breast cancer and when to see your doctor.

These symptoms are more often caused by other medical conditions. But if you have any of them it is important to see your doctor.

Breast lump

A new lump or thickening in your breast or armpit could be a sign of cancer. Many women have breast lumps and 9 out of 10 (90%) of these are not cancer. They are called benign lumps.

It’s important to get any breast lump checked out by your doctor.

Change in size, shape or feel of a breast

Your breast might look bigger or have a different shape than usual. It might feel different. Many healthy women find that their breasts feel lumpy and tender before their period.

Get to know the size, shape and feel of your breasts. See your doctor if you notice any changes or anything that is unusual for you.

Breast pain

Breast pain is very common and it’s not normally due to cancer. You might get pain in one or both breasts for a while, which goes after a time. There might be no obvious reason for this pain, even if you have a lot of tests.

See your doctor if you have breast pain.

Skin changes

Skin changes include puckering, dimpling, a rash, or redness of the skin.

The skin on your breast might look like orange peel. Or the skin might feel a different texture than usual. This can be caused by other things than cancer but get anything that is not normal for you checked out by your doctor.

Change in the position of your nipple

One nipple might turn in or sink into the breast. It might look or feel different to usual.

Fluid leaking from your nipple

Fluid leaking from a nipple in a woman who isn't pregnant or breast feeding can be a sign of cancer. But it can also be caused by other medical conditions.

See your doctor if you have leakage from a nipple and you aren't pregnant or breast feeding.

Inflammatory breast cancer symptoms

A rare type of breast cancer called inflammatory breast cancer can have different symptoms to other types.

Your whole breast might look red and inflamed and feel sore. The breast might feel hard and the skin might look like orange peel.

See your doctor if you have any of these symptoms.

Paget’s disease of the breast

This is a rare skin condition that is sometimes a sign of an underlying breast cancer. The symptoms are a red, scaly rash on the breast. It can be itchy and looks a bit like eczema. It is sometimes mistaken for eczema at first.

See your doctor if you have any changes in the skin of your breast.

When to see your doctor?
 
You should see your doctor if you have:
  • a change in the size, shape or feel of a breast
  • a new lump or thickening in a breast or armpit
  • skin changes such as puckering, dimpling, a rash or redness of the skin
  • fluid leaking from a nipple and you aren't pregnant or breastfeeding
  • changes in the position of a nipple
  • breast pain
Your symptoms are unlikely to be cancer but it is important to get them checked by a doctor.

About breast cancer staging and grades


Find out about the different staging systems for breast cancer and about breast cancer grading.

Staging means how big the cancer is and whether it has spread.

Grading means how abnormal the cancer cells look under the microscope. 

Doctors use the stage and grade of a cancer to help them decide on which treatment you need.

There are different systems used in the UK to stage breast cancer. The most common one is the TNM system. Another is the number staging system.

Your doctor might also talk about early, locally advanced or secondary breast cancer.

TNM stages

The TNM staging system stands for Tumour, Node, Metastasis.
  • T describes the size of the tumour
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body

Number stages

The number staging system divides breast cancers into 4 stages, from 1 to 4.

Early, locally advanced and secondary breast cancer

Early breast cancer means the cancer hasn't spread beyond the breast or the lymph nodes in the armpit on the same side of the body. So, the cancer hasn't spread to any other part of the body. 

Local recurrence means cancer that has come back in the area of the breast after treatment.

Locally advanced breast cancer means the cancer hasn't spread to another part of the body but might be:
  • bigger than 5 cm across
  • growing into the skin or muscle of the chest
  • present in the lymph nodes in the armpit, and the nodes are stuck to each other or to other structures
Secondary breast cancer is also called metastatic breast cancer or stage 4 breast cancer. It means that the cancer has spread to other parts of the body, such as the liver or bones.

Grading

Grade means what the cancer cells look like under the microscope.

Breast cancers can be:
  • low grade – grade 1 (slow growing)
  • intermediate grade – grade 2
  • high grade – grade 3 (faster growing)
Low grade cancers tend to grow more slowly than high grade. High grade cancers are more likely to come back after they have first been treated. But the grade can only give a guide to how any individual cancer will behave and individual cancers may behave differently.

TNM staging

Find out about tumour, node and metastasis (TNM) staging for breast cancer.

Your scans and tests give some information about the stage of your cancer. But your doctor might not be able to tell you the exact stage until you have surgery.

The TNM staging system is the most common way that doctors stage breast cancer. TNM stands for Tumour, Node, Metastasis.
Doctors may also use a number staging system.

The TNM system

Here is a slightly simplified description of the TNM staging system for breast cancer.

Tumour (T)

Tumour describes the size of the tumour (area of cancer). This is a simplified description of the T stage.
TX means that the tumour size can't be assessed.
Tis means ductal carcinoma in situ (DCIS).
 
T1 means that the tumour is 2 centimetres (cm) across or less.
Diagram showing a stage T1 breast cancer
T1 is further divided into 4 groups:
  • T1mi means the tumour is 0.1cm across or less
  • T1a means the tumour is more than 0.1 cm but not more than 0.5 cm
  • T1b means the tumour is more than 0.5 cm but not more than 1 cm
  • T1c means the tumour is more than 1 cm but not more than 2 cm
T2 means that the tumour is more than 2 centimetres but no more than 5 centimetres across.
Diagram showing a stage T2 breast cancer
T3 means the tumour is bigger than 5 centimetres across.
Diagram showing stage T3 breast cancer
T4 is divided into 4 groups:
  • T4a means the tumour has spread into the chest wall (the structures surrounding and protecting the lungs)
  • T4b means the tumour has spread into the skin and the breast might be swollen
  • T4c means the tumour has spread to both the skin and the chest wall
  • T4d means inflammatory carcinoma – this is a cancer in which the overlying skin is red, swollen and painful
T4.jpg

Node (N)

Node (N) describes whether your cancer has spread to the lymph nodes.
NX means that the lymph nodes can't be assessed (for example, if they were previously removed).
N0 means there are no cancer cells in any nearby nodes.
Isolated tumour cells (ITCs) are small clusters of cancer cells less than 0.2 mm across, or a single tumour cell, or a cluster of fewer than 200 cells in one area of a lymph node. Lymph nodes containing only isolated tumour cells are not counted as positive lymph nodes.

N1

N1 means cancer cells are in the lymph nodes in the armpit but the nodes are not stuck to surrounding tissues.
pN1mi means one or more lymph nodes contain areas of cancer cells called micrometastases that are larger than 0.2mm. Or the nodes contain more than 200 cancer cells but are less than 2mm.
pN1a means that cancer cells have spread (metastasised) into 1 to 3 lymph nodes and at least one is larger than 2mm.
pN1b means there are cancer cells in the lymph nodes behind the breast bone (internal mammary nodes) found with a sentinel node biopsy but the areas are too small to feel.
pN1c means there are cancer cells in 1 to 3 lymph nodes in the armpit and in the lymph nodes behind the breast bone, but they are too small to feel.

N2

N2 is divided into 2 groups:
N2a means there are cancer cells in the lymph nodes in the armpit, which are stuck to each other and to other structures.
N2b means there are cancer cells in the lymph nodes behind the breast bone (the internal mammary nodes), which have been seen on a scan or felt by the doctor. There is no evidence of cancer in lymph nodes in the armpit.

N3

N3 is divided into 3 groups:
N3a means there are cancer cells in lymph nodes below the collarbone.
N3b means there are cancer cells in lymph nodes in the armpit and behind the breast bone.
N3c means there are cancer cells in lymph nodes above the collarbone.
N3.jpg

Metastasis (M)

Metastasis (M) describes whether the cancer has spread to a different part of the body.
M0 means that there is no sign that the cancer has spread.
cMo(i+) means there is no sign of the cancer on physical examination, scans or x-rays. But cancer cells are present in blood, bone marrow, or lymph nodes far away from the breast cancer – the cells are found by laboratory tests
M1 means the cancer has spread to another part of the body.
M stages breast.jpg

Treatment

The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:
  • your type of cancer (the type of cells the cancer started in)
  • where the cancer is 
  • other health conditions that you have
The stage of the cancer and these other factors can also give an idea of your outlook (prognosis).
Other factors that may influence treatment are:
  • the grade of your cancer cells
  • whether you have had your menopause
  • whether your cancer cells have receptors for particular cancer drugs
Your doctor will take many different factors into account when deciding which treatment is best for you.
Treatment may include:
  • surgery
  • radiotherapy
  • chemotherapy
  • hormone therapy
  • biological treatments
  • a combination of these treatments

Stage 2

Find out what stage 2 breast cancer means and about treatment options.

Stage 2 breast cancer means that the cancer is either in the breast or in the nearby lymph nodes or both. 

It is an early stage breast cancer.

Stage 2 breast cancer has two groups.

Stage 2A

Stage 2A means one of the following
  • there is no tumour or a tumour 2 centimetres (cm) or smaller in the breast and cancer cells are found in 1 to 3 lymph nodes in the armpit or in the lymph nodes near the breastbone
Diagram-1-of-2-showing-stage-2A-breast-cancer.png
  • the tumour is larger than 2cm but not larger than 5cm and there is no cancer in the lymph nodes
Diagram 2 of 2 showing stage 2A breast cancer

Stage 2B

Stage 2B means one of the following
  • the tumour is larger than 2cm but not larger than 5cm and small areas of cancer cells are in the lymph nodes
Diagram 1 of 3 showing stage 2B breast cancer
  • the tumour is larger than 2cm but not larger than 5cm and the cancer has spread to 1 to 3 lymph nodes in the armpit or to the lymph nodes near the breastbone
Diagram 2 of 3 showing stage 2B bowel cancer
  • the tumour is larger than 5cm and has not spread to the lymph nodes
Diagram 3 of 3 showing stage 2B breast cancer

TNM stages

The TNM staging system stands for Tumour, Node, Metastasis.
  • T describes the size of the tumour
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body
In the TNM staging system stage 2A breast cancer is the same as:
  • T0 N1 M0
  • T1 N1 M0
  • T2 N0 M0
Stage 2B is the same as:
  • T2 N1 M0
  • T3 N0 M0

Treatment

The usual treatment is surgery to remove the cancer. Your doctor will also check the lymph nodes close to the breast to see if they contain cancer cells. You either have a test called a sentinel lymph node biopsy (SLNB) or surgery to remove some of the lymph nodes under the arm.

Your surgeon might remove just the cancerous area with a border of normal breast tissue (a wide local excision or lumpectomy). After this you usually have several weeks of radiotherapy to the rest of the breast.

Or you might have the whole breast removed (mastectomy) and then a new breast made (breast reconstruction). You don't usually need radiotherapy to the breast after this kind of surgery. But you might have radiotherapy to the lymph nodes under your arm if they contain cancer cells. Or you might have surgery to remove the lymph nodes.

Your surgeon might suggest that you have breast reconstruction at the same time as surgery to remove the cancer. But if you need to have radiotherapy after the surgery your surgeon is likely to suggest that you wait to have the reconstruction until after the radiotherapy has finished.
You usually have other treatments too.

You might have chemotherapy or hormone therapy before surgery. These treatments can shrink a cancer down and make it possible to have a lumpectomy instead of mastectomy for some women. 

If your cancer cells have receptors for hormone therapy drugs you are likely to have hormone therapy for at least 5 years. 
You might have chemotherapy after your surgery if the cancer was large, high grade, had spread into several lymph nodes or didn't have hormone receptors.
You have a biological therapy called trastuzumab (Herceptin) as well as chemotherapy if your cancer cells have particular proteins called HER2 receptors. You usually have this treatment for a year.

Stage 3

Find out what stage 3 breast cancer is and about treatment options.
Stage 3 means that the cancer has spread from the breast to lymph nodes close to the breast or to the skin of the breast or to the chest wall.
It is also called locally advanced breast cancer.
Stage 3 breast cancer is divided into 3 groups.

Stage 3A

Stage 3A means one of the following:
  • no tumour is seen in the breast or the tumour may be any size and cancer is found in 4 to 9 lymph glands under the arm or in the lymph glands near the breastbone
Diagram 1 of 3 showing stage 3A breast cancer
  • the tumour is larger than 5cm and small clusters of breast cancer cells are in the lymph nodes
Diagram 2 of 3 showing stage 3A breast cancer
  • the tumour is more than 5cm and has spread into up to 3 lymph nodes in the armpit or to the lymph nodes near the breastbone
Diagram 3 of 3 showing stage 3A breast cancer

Stage 3B

Stage 3B means the tumour has spread to the skin of the breast or the chest wall (the structures surrounding and protecting the lungs, such as the ribs, muscles, skin or connective tissues). It has made the skin break down (an ulcer) or caused swelling.
Diagram 1 of 2 showing stage 3B breast cancer
  • the cancer may have spread to up to 9 lymph nodes in the armpit or to the lymph nodes near the breastbone.
Diagram 2 of 2 showing stage 3B breast cancer
Cancer that has spread to the skin of the breast may also be inflammatory breast cancer.

Stage 3C

Stage 3C means the tumour can be any size, or there may be no tumour, but there is cancer in the skin of the breast causing swelling or an ulcer and it has spread to the chest wall. It has also spread to:
  • 10 or more lymph nodes in the armpit
Diagram 1 of 3 showing stage 3C breast cancer
  • lymph nodes above or below the collar bone
Diagram 2 of 3 showing stage 3C breast cancer
  • lymph nodes in the armpit and near the breastbone
Diagram 3 of 3 showing stage 3C breast cancer
For treatment, doctors divide stage 3C breast cancer into cancers that can be operated on (operable breast cancers) and those that can't (inoperable cancer).

TNM stages

The TNM staging system stands for Tumour, Node, Metastasis.
  • T describes the size of the tumour
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body
In the TNM staging system stage 3A breast cancer is the same as:
  • T0 N2 M0
  • T1 N2 M0
  • T2 N2 M0
  • T3 N1 M0
  • T3 N2 M0
Stage 3B is the same as:
  • T4 N0 M0
  • T4 N1 M0
  • T4 N2 M0
Stage 3C is the same as:
  • Any T N3 M0

Treatment

You might have drug treatments such as chemotherapy or biological therapy as a first treatment. This is followed by surgery and then more drug treatments. 

Or you might have surgery as a first treatment followed by chemotherapy or other drug treatments.

Drug treatment before surgery

You might have chemotherapy as a first treatment to shrink the cancer down.
If your cancer cells have particular proteins called HER2 receptors you might also have a biological therapy drug called trastuzumab (Herceptin).
These treatments might shrink the tumor enough to allow your surgeon to remove just the area of cancer. If the cancer doesn’t shrink enough, you need to have the whole breast removed (a mastectomy).
Your surgeon will also remove lymph nodes under the arm to check for cancer cells. 
You usually have radiotherapy to the breast after surgery. 
If you have a new breast shape made (breast reconstruction) you usually have it after the radiotherapy has finished. 
You might also have hormone therapy if your cancer cells have hormone receptors. Or you might have more chemotherapy.

Surgery as a first treatment

You usually have the whole breast removed (a mastectomy). Your surgeon will also remove some of the lymph nodes under the arm to check them for cancer cells. 
After the surgery you have radiotherapy to the breast.
You might then have surgery to create a new breast shape (breast reconstruction). 
You might have treatment with chemotherapy for a few months. 
If your cancer cells have receptors for a protein called HER2 you might have a biological therapy drug called trastuzumab (Herceptin) as well as chemotherapy. You have this for a year.
If your cancer cells have hormone receptors you might then have hormone therapy for at least 5 years.

Inflammatory breast cancer

Some stage 3 cancers are a type called inflammatory breast cancers. The treatment is slightly different than for other stage 3 breast cancers. 

Stage 4

Find out what stage 4 breast cancer means and about treatment options.

Stage 4 breast cancer means that the cancer has spread to other parts of the body.

It is also called advanced cancer, secondary breast cancer or metastatic breast cancer.

In stage 4 breast cancer:
  • the tumour can be any size
  • the lymph nodes may or may not contain cancer cells
  • the cancer has spread (metastasised) to other parts of the body such as the bones, lungs, liver or brain
M stages breast.jpg

TNM stages

The TNM staging system stands for Tumour, Node, Metastasis.
  • T describes the size of the tumour
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body
In the TNM staging system stage 4 breast cancer is the same as:
  • Any T Any N M1

Treatment

Your specialist will take a number of different factors into account when deciding which treatment is best for you, including:
  • which part of your body the cancer has spread to
  • the treatment you have already had
  • your general health
  • whether you have had your menopause
  • whether the cancer is growing slowly or more quickly
  • whether the cancer cells have receptors for particular types of drug treatment
Secondary breast cancer may respond to several types of treatment. Doctors try to start with treatment that has as few side effects as possible.

Remember that treatment can often keep secondary breast cancer under control for many months or years.

Types of treatment

Hormone therapy is a common treatment for secondary breast cancer. It can often shrink and control the cancer wherever it is in the body. It works well if the cancer cells have particular proteins called hormone receptors.
If one hormone therapy stops working so well, another might then help.
Your specialist might suggest chemotherapy if your cancer doesn't have hormone receptors or has spread to the liver or lungs.
You might have treatment with a biological therapy such as the monoclonal antibody trastuzumab (Herceptin). Herceptin targets and blocks a protein that stimulates breast cancer cells to grow and multiply. It only works if your breast cancer cells make too much of a protein called HER2.
You might have radiotherapy if the cancer has spread to:
  • the bones
  • the brain
  • the skin near the breast or on the mastectomy scar
Your doctor or nurse can prescribe medicines to control symptoms that the cancer causes. The symptoms will depend on where the cancer has spread to but may include a cough, constipation, sickness, or high blood calcium levels for example.

Making decisions about treatment

More information about advanced cancer

 

Friday, December 23, 2016

Water And Cancer Prevention

Water And Cancer Prevention
Chiu-Nan Lai, Ph.D.

The incidence of cancer has accelerated in the 21st century. Cases of young people contacting cancer are increasing. These are generally malignant cases, so that metastasis has set in by the time cancer is diagnosed. The body's blueprint of health and diseases are influenced by the nine months spent in the womb, as well as environmental factors experienced later on in life. To understand why young people develop cancer, it is necessary to identify whether the fetus in the womb had contact with contaminants, whether there were nutritional deficiencies, and whether the baby consumed its mother's milk within 12 hours of birth. A baby's lifelong immune system, digestive ability, and enzyme formation in the stomach are dependent on the special nutrients and antibodies found in the milk that it first suckles.

A dentist, whose parents died from cancer, conducted intensive research on the causes of cancer. His research spanning thirty years showed that all the cancer patients he examined did not drink their mother's milk within twelve hours of birth. Of course, this finding does not mean that all people who did not drink their mother's milk would get cancer, but it does indicate that the likelihood of contacting cancer is higher. Perhaps, this may be the reason why the incidence of cancer in America is so alarmingly high-only 4% of U.S. mothers breastfeed their children.

This dentist discovered that, among other external environmental factors, lack of water among cell structures is a common feature among cancer patients. If the patient's cells can rehydrate, he/she can easily recover. However, does it mean that drinking more water will enable the body's cells to absorb more water? This is not necessarily the case: if the water is polluted, or if the water inside the body is acidic, the body's cells will automatically block the absorption of such water to prevent the entry of toxins. Such toxins can come from outside the body, or they could be uric acid that the metabolic system cannot discharge from the body. Chronic lack of water can lead to aging and other diseases.

The book "Messages from Water" documents how the crystalline structure of water can change through contamination. Microwave radiation can harm the crystalline structure of water. Water inside the cells is a form of liquid crystal, and changes in its liquid crystalline structure influence the functions exhibited by genes from the cell nucleus, as well as whether cells divide and grow (or stop growing). If the crystalline structure of cells is somehow disturbed, these cells may continue to divide and grow, leading to the development of cancer. Many years ago, I conducted laboratory experiments which showed that when potassium was added to a cancer cell cultures, these cancer cells changed to normal cells. After the potassium enters the cells, the liquid crystalline structure and genetic structure of the cells change and lose their "cancer" characteristic.

The key point to preventing and curing cancer is to recover the cleanliness of water inside the body, and to nourish the body's cells with the necessary minerals. Eating clean food, drinking clean water, and breathing clean air are important aspects. In today's environment, it is also important to avoid sources of radiation (e.g., mobile phones, computers, televisions, and microwave ovens) that disrupts the water's crystalline structure. This may be a coincidence, but the young people I heard who got cancer are also those who frequently use mobile phones or who live with people who do so. One day, we may treat the use of mobile phones the same way we treat cigarette smoking - second hand smoke and second hand radiation are both harmful.

We can also understand the importance of water through a person's energy or qi. Qi belongs to the water element, and lack of water will weaken the body's qi and lead to illnesses (including cancer).

Many years ago, Dr. Yoshitaka Ohno, a Japanese doctor, started to search for a cure to chronic diseases such as cancer, Alzheimer, multiple sclerosis, hypertension, asthma, and diabetes. His research indicated that water is a major causal factor. To verify his theory, he searched for different sources of water. While conducting his research in Japan, he found a rare magnetic mountain with a source of naturally-magnetized water that can effectively treat chronic diseases. A renowned local doctor successfully treated many kinds of modern chronic diseases using this water. In the past, Russia, China, Japan, and the U.S.A. had reports of the healing properties of magnetized water.

Research shows that naturally-magnetized water can accelerate cellular absorption of water, supplement minerals in the body, protect cells, maintain normal blood circulation and PH levels, discharge pollutants in the cellular structure and fluids, as well as control free radical formation. People who have consumed naturally-magnetized water find an increase in bowel movement frequency and that their faeces have unusual smells. It is also possible that the more we drink this water, the thirstier we become. This is because normal water typically cannot be absorbed by the cellular membranes, and the body's cells have been deprived of water for a long time. Discharge of mercury is also accelerated six hours after amalgam in the teeth has been removed. People with chronic diseases generally see positive effects of drinking this water within two to four weeks. Magnetized water is also helpful in protecting friendly bacteria in the body, discharging harmful bacteria and toxins from the body, and preventing infection. This water is called Nariwa.
Over 70% of our body is made of water. In this polluted environment, water that can help our cells begin to absorb the water they need is indeed a treasure, regardless of whether the water comes from organic vegetables or magnetized water.

In preventing and treating cancer and modern chronic diseases, it is important to consider the effect of the environment. Water is one such important factor. Of course, to fully recover our health and happiness, it is important to be with nature as much as possible, and learn how to discharge negative emotions. Finally, it is necessary to develop and cultivate our spirituality.

Note:

For more information, please contact Lapis Lazuli Light (Singapore).

Friday, December 16, 2016

Chapter 1 THERE HAS TO BE AN ALTERNATIVE

Chapter 1

 THERE HAS TO BE AN ALTERNATIVE

  Thirty years ago, diseases such as colon cancer, prostate cancer, and diverticular disease were virtually unknown. Today, they are almost a certainty if you live long enough.1*  Consider: 

What We Pay for Health Care 

  Never in the history of the world has any other country come close to having as many doctors as we do in the United States: approximately 700,000 according to the US Census.

   And never in the entire history of the world has any other country come close to spending as much as we do on health care: a conservative 1 trillion dollars a year. That means that what we spend on health care is more than the entire Gross National Product of all but six countries in the world today[2**] . 

[1* Sources for statistics are endless, and, depending on what source is used, actual numbers may vary. But regardless of how the numbers may vary, two things remain constant: the steadily increasing trend of major diseases (such as heart disease, cancer, diabetes, and infectious diseases) and the exponentially rising costs associated with those diseases.]

[ 2** Figures for the amount spent on health care in the United States range from $1-1.4 trillion per year. But even at the lower $1 trillion figure, that's still more than the GNP of 124 out of the world's 130 countries.]

What Value Have We Received.... 

We lead the developed world in deaths from 
>Heart disease 

>Prostate cancer. 

>Breast cancer 

>Colorectal cancer 

>Diabetes 

The American Cancer Society now says that one in every 2.5 individuals will develop some form of invasive cancer during their lifetime—and half of them will die from it. 

  Cancer is the leading cause of death by disease in children under the age of 10. 

  And even though we spend $100 billion dollars a year on cancer treatment and research, the overall survival rate for cancer patients is no better than it was 50 or 100 years ago. 

And It's Getting Worse 

Immune Diseases; Obesity; Premature Aging; Heart Disease; Joint Pain; Breathing Difficulties; Hemorrhoids; High Cholesterol; PMS; Chronic Fatigue; Constipation; Malnutrition.

And It's Getting Worse

  The incidence of diabetes in the United States has doubled in just the last 5 years! 

  Fifty years ago, diverticular disease (herniations of the colon) were virtually unknown (afflicting less than 10% of the American population). Today, according to the Merck Manual, 100% of all Americans will have many—if they live long enough. 

  Thirty years ago, colorectal cancer was virtually unknown. Today, it is the single most prevalent cancer among men and women combined. 

  The number of Americans who suffer from Asthma, according to the Centers for Disease Control, has risen by an astounding 75% in just the last 20 years. 

  Breast cancer rates are up 30% in just the last 15 years.

And on . . . and on . . . and on

And now it's official: In the Feb. 9, 1994 issue of the Journal of the American Medical Association, the “War on Cancer” was declared a failure. “In all age groups, cancer incidence is increasing . . . Few new, effective treatments have been devised for the most common cancers.”

And the Most Shocking Fact of All

The April 15, 1998 Journal of the American Medical Association reported that there are more than 2,000,000 drug “reactions” annually in the United States, and that more than 100,000 of those reactions are fatal. This makes prescription drugs the 4th leading
cause of death in America. But the reality is actually much much worse.

  These numbers only count drugs that are prescribed correctly and at the right dose.

  Not included are patients who are given the wrong drugs, or who are given those drugs at the wrong dosage or in the wrong combination.

  And these numbers do not include the patients who have fatal reactions to the
drugs, but whose death is mistakenly attributed to other causes

  Nor do these numbers include the patients whose cause of death is deliberately obscured
to protect the physicians and hospitals involved

- Add in these numbers and you find that deaths from adverse reactions to drugs may number as high as 700,000 a year. (Actually, the FDA estimates that only 1% of all adverse reactions are reported [1*]which, if true, would make 700,000 an incredibly
conservative estimate.) And finally, combine that 700,000 with the number of people who die from misdiagnosis, inappropriate treatment, secondary infections received in hospitals, or just plain physician error,[2**]and the startling fact you're left with is that
modern medicine, despite all the great things it may have accomplished, is arguably the single leading cause of death in the United States.

Understand, this is not an attack on medical doctors—the vast majority of whom are extremely competent, highly dedicated, and often even heroic. Nevertheless, it is important to realize that when it comes to the major diseases of our time, the modern medical paradigm of searching for "magic bullets" and managing symptoms with drugs has failed miserably.

There Has to Be an Alternative!

There is a network of elite herbalists, holistic healers, and renegade medical doctors throughout the world, performing miracles on a daily basis. The network is not only elite, it is also extremely difficult to penetrate because it is technically illegal to diagnose or treat people for major diseases unless you use the FDA approved modalities such as Cutting, Burning, and Poisoning (surgery, radiation, and chemo). Thousands of people throughout the world have come to these "miracle doctors" terminally ill, and thousands have left perfectly healthy. And now the secrets of these miracle doctors are revealed in this book.

[1* A study by a group of French doctors actually makes that 1% estimate seem wildly optimistic. The study found that only about 1 out of every 24,000 adverse reactions is actually reported by doctors to the appropriate monitoring agency.]

[2** Just one example of how high these numbers actually are: On the ABC News Nightline program, the Harvard School of Public Health stated that approximately 1.3 million people a year suffer some kind of inury because of hospital treatment, and 180,000 of those people die.] 

  In the following pages, I will share with you those things that I have learned in my 30+ years of working with, studying with, and sharing with these remarkable healers. By the time you have
finished, you will have learned everything you need to know (in precise detail) to optimize your own health (and the health of those you know and love) and to live a long and happy life.

   1. In the next chapter, I will outline the principles of The Baseline of Health. If you read no other chapter in this book, the heart of everything I have to say is located here.

   2. The rest of the chapters in the book address all of the different body systems you need to concern yourself with in order to optimize your health—and give you step-by-step pointers on how to accomplish just that.

   3. In conclusion, I will provide you with very specific product and useage recommendations.

  Note: Keep in mind that good health really comes down to "playing the odds."

  For example, if you smoke cigarettes, there's no guarantee that you're going to get sick and die. (We've all heard stories of the man who smoked and drank like a fiend for 80 years, only to be shot to death by a jealous husband when the smoker was discovered
in bed with the other man's 20-year-old wife.) On the other hand, there's no question that your odds of having emphysema or lung cancer or of having parts of your mouth, lips, and tongue surgically removed increase dramatically if you smoke. It's all a question of odds.

  Well, in the same way, if you follow the program laid down in this book, your odds of having good health and long life are significantly increased—not guaranteed, but significantly increased. Oh yes, and you're going to feel a whole lot better, have more energy, vitality, sexuality, youthfulness, and radiance in the process.


Good Health And Long Life


Sunday, November 27, 2016

Over-diagnosis & Mammography

Over-diagnosis & Mammography 


Radiology Today (click for magazine cover)

June 2012

Overdiagnosis & Mammography 
By Kathy Hardy
Radiology Today
Vol. 13 No. 6 P. 24

A study finds over-diagnosis with increased screening, but there’s no way to determine which tumors do not need to be treated.

As radiologists, oncologists, patients, and advocates continue to wrestle with when mammography screening should begin, a new study suggests that with more views of breast tissue comes more potential overdiagnosis of breast cancer. The study, published in the Annals of Internal Medicine, concludes that mammography screening entails a substantial amount of overdiagnosis, which could lead women to undergo unnecessary and potentially harmful treatments.

Some believe the research casts more doubt on screening mammography, a modality still dealing with an identity crisis in the wake of the US Preventive Services Task Force’s 2009 recommendations suggesting that women at normal risk of breast cancer can reasonably delay mammography screening until they reach the age of 50. However many people in the breast imaging field still recommend mammograms for women at normal risk begin at age 40. The split creates a decision for referring physicians and patients regarding when to start breast cancer screening. Many breast radiologists contend that the idea of overdiagnosis and potentially unnecessary treatment of nonfatal cancer adds to the dilemma for doctors.

“This new epidemiological study tries to show that if we weren’t screening so much, we wouldn’t find as many unimportant tumors,” says Robin B. Shermis, MD, MPH, medical director of Ohio’s Toledo Hospital Breast Care Center. “This study deals in a theoretical world. In practicality, we can’t always tell which tumors have a potential aggressive biology when they are first detected. At initial detection, there is no way to identify whether or not a tumor is life threatening or will become life threatening.”

In blunter words, if you can’t differentiate between the tumors that will progress and kill a woman and the ones that will never harm her, how do you decide which tumors to treat? Breast radiologists assert that it’s too early to discuss what to do when mammography uncovers a tumor that fulfills the laboratory criteria of cancer but, if left alone, would never cause the patient any harm. They contend that, since science cannot accurately predict which tumors are harmless and which are more aggressive, it’s necessary to treat any tumor that's found as if it's deadly. That means surgical removal and sometimes radiation or chemotherapy.

“That’s exactly the problem,” says Rulla M. Tamimi, ScD, an associate professor of medicine at Harvard Medical School and a coauthor of the study. “Through imaging and pathology, we’re unable to determine the difference between fatal and nonfatal cancers. It’s important to have studies like this to get the debate going. Women should know about overdiagnosis.”

Finding Too Much?
The objective of the report, “Overdiagnosis of Invasive Breast Cancer Due to Mammography Screening: Results From the Norwegian Screening Program,” was to estimate the percentage of overdiagnosis of breast cancer attributable to mammography screening. This was done with a comparison of invasive breast cancer incidence with and without screening.

Tamimi says the data from Norway provided a unique opportunity to review data collected during the county-by-county introduction of a breast cancer screening program for women aged 50 to 69 that took place from 1996 to 2005. Researchers analyzed approximately 40,000 breast cancers, comparing cases found in counties where screenings were offered against counties where screenings were not yet offered. The study’s authors found that instances of invasive breast cancer increased 18% to 25% among participants who received screening mammography. They also found that between 1,169 and 1,948 of those women were overdiagnosed and received unnecessary treatments.

“In any screening program, there will be risks and benefits,” Tamimi says. “One of those risks is detecting cancers that, if left alone, will not cause mortality in the population of people screened.”

Carol H. Lee, MD, FACR, attending radiologist at Memorial Sloan-Kettering Cancer Center in New York and chair of the ACR’s Breast Imaging Commission Communications Committee, notes that the Norwegian study findings agree with those of the US Preventive Services Task Force recommendations, which suggested that there is a risk of overdiagnosis based on the number of women screened. However, she’s not suggesting that this means cancers found in breast tissue should be left alone.

“Saying [there is overdiagnosis], I know that screening with mammography saves lives,” Lee says. “The emphasis on overdiagnosis is too great.”

Lee contends that screening mammography shouldn’t decrease just because it may find cancers that are not deadly. “Does it make sense to stop finding cancers because some of them will not go on to be fatal?” she asks. Lee also challenges the use of the term “overdiagnosis,” saying instead that nonlethal breast cancer may be overtreated, not overdiagnosed.

“If a tumor meets the histologic criteria for being malignant, we treat them all as if they’re life threatening,” Lee says. “That’s the trade-off. We can’t tell whether it is life threatening.”

Treat What You Find
Looking at the study’s parameters, radiologist Stamatia Destounis, MD, managing partner of Elizabeth Wende Breast Care in Rochester, New York, questions the validity of the data, noting that “if you want to prove something invalid you can look at the data any way you want.” In particular, she points to the time span used to gather data for this study.

“With mammography, you need to study a program for more than nine years,” she says. “Imaging to detect breast cancer involves identification of subtle findings on mammography over time and long-term follow-up after breast cancer diagnosis to identify long-term benefits. We need more information on the women within the study and the control group over longer periods of time to identify a benefit.”

In her work with the ACR, Lee spends a great deal of time discussing the benefits of breast cancer screening. With the publicity that surrounds studies like this and the task force recommendations, she says referring physicians and women are unsure of what steps they should take when it comes to mammography.

“Another benefit of screening mammography relates to treatment options,” Lee says. “If you have a mammogram, there’s a chance that it will pick up a cancer that will never be life threatening, but you’ll still undergo surgery and possibly chemotherapy and/or radiation. However, there is also a chance that your life will be saved and treatment for the cancer will be less invasive because it is caught sooner. Which would you prefer? Different women will have different reactions.”

One of Lee’s arguments against studies like this and the task force recommendations is that with an epidemiological study you’re dealing with mathematical modeling rather than with actual practice. Shermis agrees that epidemiology has its place when studying breast cancer from a public health perspective. However, while the studies may provide insight to cost factors associated with unnecessary medical procedures and the stress associated with screening mammography follow-ups, they don’t address the human aspect of detecting the disease in women.

“Yes, there’s anxiety associated with any follow-up related to screening mammography findings, but that’s minimal compared to knowing you have a tumor and not treating it,” Shermis says. “An option would never be to leave a cancer alone. In addition, there’s much less stress involved and it’s much less expensive to treat a cancer when it’s small than after it has grown large.”

Confusing Referrers and Patients
Shermis and others believe these study results simply add to the already confusing amount of information disseminated in the past several years regarding screening mammography guidelines.

“This is just more misleading info,” Shermis says. “Women and referring physicians are confused enough. We were just starting to see a bounce back in screening mammography from the backlash that resulted when the task force findings were issued. Now, this study compounds the confusion.”

Identifying cancer is not a perfect science, Shermis notes. However, it is the job of breast imagers, oncologists, and surgeons to follow the proper steps required to make the best educated decision possible when it comes to breast cancer detection and ultimately a course of treatment.

“Nothing’s perfect,” he says, “but when you have the right people involved, it’s a relatively smooth process. Until we can identify cancers, we need to treat tumors that we find. Breast cancer screening has been profoundly successful in saving lives. As long as you have good standards for how to work up cancers and you follow them, you will have success.”

Radiologists, surgeons, and oncologists “all recognize that this tumor may not do anything,” Shermis adds. “None of us could look at a cancer and say we didn’t have to treat it. However, we’ve seen tiny cancers metastasize and large cancers do nothing. We’re not in a position to guess whether or not a tumor could lead to cancer.”

“The continuing dilemma for breast imagers is that we try to be as evidence-based as possible,” Lee says. “We’re not resting on our laurels. Clinical trials done with a half-million women over more than 20 years show us that mammography is still the gold standard for breast cancer screening. We need to stop picking apart the basic finding that mammography saves lives.”

Identifying Dangerous Tumors
Rather than a continued focus on the ethicality of breast cancer screening, Lee suggests that researchers look to finding a way to sort out which cancers have the potential to be lethal and which are safe to leave alone. Tamimi believes that’s where data from the Norwegian study can actually be used to help the evolution of breast screening guidelines. Pointing out instances of overdiagnosis and overtreatment of tumors found in the breast can help researchers determine where to focus next in the process of developing accurate breast cancer detection methods. Advancements in imaging technology and the use of ultrasound and MRI in scanning breast tissue continue to help locate tumors but, in many cases, also increase the incidence of false-positives. But there are other areas where further research could help identify what the technology is finding.

“They need to look at tumor characteristics and tumor markers and learn more about which traits are less aggressive,” Tamimi says.

“Many women aren’t even aware that overdiagnosis exists in breast cancer screening,” she adds. “The discussion started with prostate cancer, but more should be said regarding overdiagnosis in breast cancer. Women are being told they have a cancer, which comes with its own stress, and then they have to deal with treatment. They should really have a clear picture of whether or not what was found in their breasts is good or bad before making those decisions.”

For the immediate future, however, Tamimi understands how these findings can create confusion for women over time. “It’s disappointing to people to hear that screening mammography isn’t the tool that it’s been presented as,” Tamimi says. “Dialogue about overdiagnosis is important to get out there so that research and developments don’t stay stagnant.”

Tamimi says the Norwegian study serves as a starting point for more effective communication between physicians and patients regarding over-diagnosis, which she contends goes hand in hand with misdiagnosis.

Lee points out that while this study brings up the issue of too much screening and the potential for overdiagnosis that might come with that, at the same time state and federal governments are debating the legislation of mandatory breast density notification. Texas, Connecticut, and Virginia passed laws within the last two years that require radiologists to notify patients if they have dense breast tissue following routine screening mammography; other states, as well as the federal government, are considering similar measures this year. There is the belief that legislating dense breast notification could lead to more screening with ultrasound, MRI, and other imaging modalities, which could lead to more false-positives.

“On the one hand we’re saying there are too many false-positives and too much screening,” Lee says. “On the other hand, there is the breast density notification issue that will likely lead to more screening. As breast imagers we’re caught between two imperatives: screen less vs. screen more.”

While Lee recognizes that mammography is not perfect, it is the only screening tool that has been shown to decrease mortality from breast cancer. “The bottom line is that screening mammography saves lives,” she says.

— Kathy Hardy is a freelance writer based in Phoenixville, Pennsylvania. She is a frequent contributor to Radiology Today.