Types of Breast Cancer & stages

Types of Breast Cancer & stages

Hormone Receptor-Positive Breast Cancer

About 80% of all breast cancers are “ER-positive.” That means the cancer cells grow in response to the hormone estrogen. About 65% of these are also “PR-positive.” They grow in response to another hormone, progesterone.

If your breast cancer has a significant number of receptors for either estrogen or progesterone, it’s considered hormone-receptor positive.

Tumors that are ER/PR-positive are much more likely to respond to hormone therapy than tumors that are ER/PR-negative.

You may have hormone therapy after surgery, chemotherapy, and radiation are finished. These treatments can help prevent a return of the disease by blocking the effects of estrogen. They do this in one of several ways.

  • The medications tamoxifen (Nolvadex) and toremifene (Fareston) are a class of drug called selective ER modulators (SERMs). They help stop cancer from coming back by blocking hormone receptors, preventing hormones from binding to them. It’s sometimes taken for up to 5 years after initial treatment for breast cancer.
  • Elacestrant (Orserdu) and fulvestrant (Faslodex) are selective estrogen receptor degraders (SERDs). These medications work by blocking and damaging estrogen receptors and are sometimes used in the treatment of metastatic breast cancer.
  • A class of medicines called aromatase inhibitors actually stops estrogen production. These include anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara).
  • Luteinizing hormone-releasing hormone (LHRH) agonists shut down the ovaries’ production of estrogen leading to temporary menopause. These medications include goserelin (Zoladex) and leuprolide (Lupron).
  • CDK 4/6 inhibitors abemaciclib (Verzenio), palbociclib (Ibrance) and ribociclib (Kisqali) are sometimes used with aromatase inhibitors or the hormone therapy fulvestrant (Faslodex).
  • Everolimus (Afinitor) is an mTOR inhibitor that improves the success of hormone therapy drugs. It is used for women who have gone through menopause. 
  • Alpelisib (Piqray) is a P13K inhibitor in pill form that can be used with fulvestrant in women with advanced HR+, HER2-negative breast cancer with a PIK3CA gene mutation. 
  • Sacituzumab govitecan (Trodelvy) is a monoclonal antibody with an attached chemotherapy drug. It is used to treat some advanced HR+, HER2-negative breast cancer

HER2-Positive Breast Cancer

In about 20% of breast cancers, the cells make too much of a protein known as HER2.These cancers tend to be aggressive and fast-growing.

For women with HER2-positive breast cancers, the targeted drug trastuzumab (Herceptin) has been shown to dramatically reduce the risk of the cancer coming back. It‘s standard treatment to give this medication along with chemotherapy after surgery to people with breast cancer that’s spread to other areas. It can also be used for early-stage breast cancer. But there is a small but real risk of heart damage and possible lung damage.

There are several other targeted therapies sometimes used in the treatment of HER2-positive breast cancer. These include:

Triple-Negative Breast Cancer

Some breast cancers — between 10% and 20% — are known as “triple negative” because they don’t have estrogen and progesterone receptors and don’t overexpress the HER2 protein. Many breast cancers associated with the gene BRCA1 are triple negative. They are often treated with surgery, chemotherapy, and radiation.

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  • Breast cancer stages

    Breast cancer stages

    What Is Stage 1 Breast Cancer?

    Stage 1 is the earliest stage of invasive breast cancer, meaning the cancer has started spreading from its original location into nearby, healthy breast tissue.

    Stage 1 is divided into two subcategories: Stage 1A and Stage 1B.

    • Stage 1A:
      The tumor is 2 centimeters (cm) or smaller and hasn’t spread outside the breast or to nearby lymph nodes.
    • Stage 1B:
      There may be no visible tumor in the breast, or if there is one, it’s 2 cm or smaller. However, tiny clusters of cancer cells are found in nearby lymph nodes.

    What Is Stage 2 Breast Cancer?

    Stage 2 breast cancer means the cancer is growing, but it’s still confined to the breast or nearby lymph nodes. Like Stage 1, it has two subcategories: Stage 2A and Stage 2B.

    • Stage 2A:
      • No tumor is found in the breast, but cancer has spread to up to 3 lymph nodes near the breast or underarm.
      • Or the tumor is 2 cm or smaller and has spread to the lymph nodes.
      • Or the tumor is between 2 and 5 cm but hasn’t spread to the lymph nodes.
    • Stage 2B:
      • The tumor is between 2 and 5 cm and has spread to up to 3 lymph nodes near the breast or underarm.
      • Or the tumor is larger than 5 cm but hasn’t spread to the lymph nodes.

    What Is Stage 3 Breast Cancer?

    Stage 3 breast cancer is considered more advanced. It means the cancer has spread more extensively within the breast and nearby lymph nodes but not to distant parts of the body. It’s broken down into Stage 3A, 3B, and 3C.

    • Stage 3A:
      • No tumor is found in the breast, or it can be any size.
      • Cancer has spread to 4–9 lymph nodes under the arm or near the breastbone.
      • In some cases, the tumor is larger than 5 cm and has spread to 1–3 lymph nodes.
    • Stage 3B:
      • The tumor may be any size.
      • It has spread to the chest wall and/or the skin of the breast (which may cause swelling or ulceration).
      • It may also involve up to 9 lymph nodes under the arm or near the collarbone.
    • Stage 3C:
      • The tumor may be any size.
      • Cancer has spread to the chest wall and/or the skin, and to 10 or more lymph nodes, or to nodes near the collarbone or breastbone.

    What Is Stage 4 Breast Cancer?

    Stage 4 breast cancer, also known as metastatic breast cancer, means the cancer has spread far beyond the breast and nearby lymph nodes to other parts of the body.

    Common areas where breast cancer spreads include:

    • Bones
    • Lungs
    • Liver
    • Brain

    According to a 2017 study, bone metastasis was the most common (seen in about 65% of cases), followed by the lungs (31%), liver (26%), and brain (9%). About one-third of patients had cancer spread to multiple organs.

    Symptoms of stage 4 breast cancer

    depend on where the cancer has spread, but general signs may include:

    • Constant fatigue
    • Weakness
    • Unexplained weight loss
    • Pain in the area where cancer has spread (e.g., bones or joints)
  • A Guide to Breast Cancer

    Understanding Breast Cancer

    Breast cancer happens when cells in the breast begin to grow abnormally. These cells can multiply quickly, forming a lump or mass. Early signs may include a noticeable lump, changes in skin color or texture, or other unusual changes in the breast.

    Most breast cancers start in either the milk-producing glands (lobules) or the ducts that carry milk to the nipple. However, cancer can also develop in the fatty or connective tissue within the breast.

    As the cancer grows, it may spread into nearby healthy tissue and reach the lymph nodes under the arms. Once it enters the lymphatic system, it can travel to other parts of the body.

    While breast cancer is much more common in women, men can also develop it — though it’s rare, since men have a small amount of breast tissue too.

    Common Signs and Symptoms

    In the early stages, breast cancer may not cause any obvious symptoms. Sometimes, a tumor is too small to feel but may still show up on a mammogram.

    When symptoms do appear, the most common one is a new lump in the breast. Keep in mind, though, that not all lumps are cancerous.

    Here are some signs to watch for:

    • A new lump or thickened area in the breast or underarm
    • Breast pain that doesn’t go away
    • Swelling in part or all of the breast
    • Skin changes, such as redness, dimpling, or a pitted appearance (like an orange peel)
    • Nipple discharge that isn’t breast milk, especially if it’s bloody
    • Peeling, flaking, or scaling of the nipple or breast skin
    • An inverted nipple or changes in its appearance
    • A sudden change in breast size or shape

    It’s important to remember that many of these symptoms can be caused by non-cancerous conditions, such as cysts or infections. Still, if you notice any unusual changes in your breasts, it’s a good idea to see a doctor for evaluation and possible testing.