Many factors are involved in cancer, so it’s not always easy to tell why cancer develops, or what causes it—but we know for sure that the following six factors do not play a role in the development of cancer.

Other People: Cancer is not a contagious disease, and it does not pass from one person to another except for in extremely rare circumstances. Certain genes passed by parents, such as BRCA1 and BRCA2, can heighten a person’s risk of developing cancer—keep in mind, however, that this is different from a person inheriting cancer itself.

Certain sexually transmitted diseases can lead to cancer; but again, this is different from cancer being passed from person to person. HPV, for example, causes cervical, vaginal, vulvar, anal, penile, and oropharyngeal cancers. Practicing safe sex is important for avoiding or addressing these diseases if they arise.

Deodorant: A common myth is that by blocking sweat glands in the armpits (particularly in those who shave their underarms), antiperspirants allow toxic compounds to accumulate in the underarm lymph nodes near the breasts, prompting cancer to develop. However, research has found no conclusive evidence to connect deodorant or antiperspirant use and breast cancer.

Tumor Biopsy: One myth suggests that a tumor biopsy, or another surgical procedure, will allow cancer cells to escape and spread within the body. But medical evidence supports the fact that this is unlikely, as most cancer cells that get displaced into the surrounding environment will likely be cleared by immune cells. Research also shows that patients who have biopsy procedures to confirm their respective diagnoses and determine the cancer’s stage had a better outcome and longer survival than patients who did not have a biopsy.

Your Personality: It was once believed that people with certain personality traits were particularly susceptible to cancer, such as neurotic people and introverts. Research has debunked this myth. However, certain traits are associated with behaviors that can raise or lower cancer risk. Highly health-conscious people are unlikely to engage in activities—like smoking, overeating, or basking in the sun too long—associated with cancer. People who pay less attention to diet and exercise may put themselves at higher risk for the disease.

Massages and Lymphoma: One myth suggests that full body massages can spread lymphoma because the therapy stimulates your lymphatic system—tissues and organs (including the thymus, spleen, bone marrow, lymphatics and lymph nodes) that produce white blood cells to fight infections and various diseases. The speculation is that mechanisms of massage can increase blood circulation and lymphatic flow. But there is absolutely no evidence that lymphoma can be spread by massage.

Soy: Research indicates that eating soy products is safe for breast cancer survivors. We looked at data among many breast cancer survivors, both from the United States and from Asia, and what we’re looking to see is what soy intake is safe for breast cancer survivors. And what we found is that even who ate a large amount of soy they actually had either the similar or decreased risk of breast cancer recurrence compared to women who didn’t eat soy.

Many people know that being overweight can increase the chances of developing some serious health problems like heart disease and diabetes. But there’s another health risk from too many pounds that is often overlooked: Cancer. And it’s a risk that shouldn’t be ignored. Obesity will probably overtake smoking as the leading cause of cancer in the future. Some estimate it could happen in the next 20 to 25 years. Unfortunately, most people don’t realize that obesity has a really strong link to cancer.

The cancer-obesity link:

A body mass index (BMI) of 25.0 to 29.9 is considered overweight; 30.0 to 39.9 is considered obese; and 40 and higher is considered severely obese. About 8 percent of all cancers in the U.S. are caused by excess weight, as well as about 7 percent of all cancer deaths.

Being overweight or obese can impact cancer risk in multiple ways. Among them:

Chronic, low-level inflammation is common in people who are obese. This inflammation can, over time, trigger DNA damage that may lead to cancer. One example: Chronic inflammation by gastroesophageal reflux (GERD) or Barrett’s esophagus is a likely cause of esophageal cancer.

Obesity is also linked to increased levels of insulin and insulin-like growth factor-1, and high levels of both may promote the development of colon, kidney, prostate, and endometrial cancer. Fat tissue produces excess estrogen. Elevated levels of this hormone have been tied to a raised risk of several cancers, including breast, endometrial, and ovarian cancers. Fat cells produce hormones that may stimulate or inhibit cell growth, which may boost the chances of developing cancer. This increased likelihood of cancer can impact people of all ages who are overweight or obese. Obesity-related cancers are increasing in younger populations. The risk of colorectal, endometrial, pancreatic, and gallbladder cancers in millennials is about double what it was for Baby Boomers at the same age.

Maintaining a healthy weight is a good goal. But if you are carrying too many pounds, you don’t have to reach your ideal weight to decrease your health risks, including your risk for cancer, even losing 5 to 10 percent of your weight, while it might not seem like enough, has been shown to improve overall health and improve diabetes, blood pressure, and markers of cancer risk.

To help shed pounds, become physically active and eat a diet rich in whole grains, vegetables, fruits, and beans. Limiting fast food, processed food, red meat, and sugary and alcoholic drinks can make a big difference too. If lifestyle and diet changes don’t do the trick, more aggressive treatments including weight loss medications or bariatric surgery may be necessary.

Radiologists use both CT and MRI to detect and monitor cancer. Each imaging method has strengths that make it appropriate for a particular reason. Learn how doctors choose which technique to use.

CT (computed tomography) and MRI (magnetic resonance imaging) are both used to diagnose and stage cancer. Many people do not know the difference between the two methods or why one might be selected over the other. Here, radiologist Richard Do answers some of the questions he gets from his patients about CT and MRI.

MRI also creates detailed pictures of areas inside the body, but it uses radio waves and a powerful magnet to generate the pictures. The person also lies on a table that moves into a doughnut-shaped device, but the doughnut is much thicker. Similarly, these pictures can show the difference between normal and diseased tissue.

With a CT scan, we can create an image of almost the entire body, from the neck to the thighs, in a few seconds. CTs are incredibly useful for diagnosing and staging cancer, checking whether it has come back, and monitoring whether a treatment is working. It’s very effective for surveying the entire body to look for places where the cancer has spread, such as the lungs, liver, or bone. These are called metastases. Most of the time, CT is the first choice to stage cancer.

Where MRI really excels is showing certain diseases that a CT scan cannot detect. Some cancers, such as prostate cancer, uterine cancer, and certain liver cancers, are pretty much invisible or very hard to detect on a CT scan. Metastases to the bone and brain also show up better on an MRI.

Because CTs use ionizing radiation, they could damage DNA and may very slightly raise the risk of developing cancer. The Food & Drug Administration estimates that the extra risk of any one person developing a fatal cancer from a typical CT procedure is about 1 in 2,000. MRIs do not use ionizing radiation, so there is no issue of raising cancer risk. But they take much longer to complete than CTs. MRIs require the person to lie still within a closed space for about 20 to 40 minutes. This can affect some people with claustrophobia, and the procedure is noisy, which is why we provide ear protection.

Both CT and MRI commonly require the injection of a contrast dye before or during the procedure. This helps the radiologist see organs and other tissues within the body more clearly.

Our doctors use advanced imaging tests to help detect and diagnose disease, make appropriate treatment recommendations, and monitor your response to therapy.

For CT, I hear anxiety about exposure to radiation, especially if it is being done repeatedly. For example, certain early-stage cancers can be cured. But you might be coming back every few months or every year for a CT scan. The question is: Do we have an alternative? For detecting cancer that has come back throughout the body, a CT scan is preferable to an MRI. As radiologists, we follow a measure called “as low as reasonably achievable.” This means we give enough radiation to create CT images that are of high enough quality that we can make a good clinical decision, but we keep the radiation as low as possible to minimize risk.

For MRI, people who have trouble with claustrophobia or are unable to hold their breath, which may be required for certain abdominal imaging tests, may not be able to tolerate the procedure. Some MRI machines can be configured in ways that may reduce claustrophobia. Medical implants, such as a pacemaker, brain stimulator, or other devices, are another complicating factor. The radio waves used with MRI can heat up devices made of metal. This is potentially a concern for something inside the body. Newer medical devices are usually designed with this in mind, so they are safe inside an MRI.

We usually use CT first for most people, unless a tumor is much better seen on MRI. But we go back and forth as needed. If we see something on a CT scan we’re unsure about, we may recommend an MRI for further evaluation. If someone has several MRIs and is unable to lie still or hold their breath so we can get a good image, we may suggest a CT as an alternative. We’re guided by the principle of whether the benefits of a test outweigh its risks. That’s what medical imaging is about.

Experts say it’s important for women with ovarian and breast cancer to get tested. Yet, less than one-third ovarian cancer patients and less than a quarter breast cancer patients had genetic testing for cancer-associated mutations.

Between 8 and 15 percent of women with breast or ovarian cancer carry cancer-associated mutations that could be used to drive care decisions and influence family members’ healthcare and screening choices.

Testing guidelines for women with ovarian cancer differ from those with breast cancer. All women with epithelial ovarian carcinoma should undergo genetic counseling and be offered testing.

Some of the guidelines for testing people with breast cancer include family history of pancreatic, prostate, ovarian, or other breast cancers.

Genetic testing is important for breast cancer, but for women with ovarian cancer it can have a huge impact on survival. The results of genetic tests help provide information about prognosis, guide treatment, and affect future screening decisions. For family members, genetic testing results can provide an individual with an opportunity to save their own life or provide true relief of the burden of assuming they will get cancer. Eventually, we should be testing people before they ever develop cancer — it could be a great opportunity for prevention.

Cost is no longer an impediment. The tests were much more expensive earlier. People were more likely to find it unaffordable. Now it costs much less, there are more labs and it is possible to test additional genes. Aside from cost there may be other factors keeping women from testing, such as time constraints and fear of the results.

Cancer therapy is increasingly aimed at the fundamental abnormalities within cancer cells – the genes and proteins that normally keep cell division under control, but are damaged or faulty in tumor cells. To understand which genes are abnormal, where they’re located within the genome, and how they affect cell growth, doctors and scientists use a procedure called DNA sequencing.

Sequencing DNA involves determining the precise order of the four chemical building blocks, or “bases,” that make up the DNA molecule. The bases – designated A, C, T, and G for the first letters of their chemical names ­– spell out the genetic code for each cell and each organism. Human cells have about six billion bases in all, arranged in pairs along the entire length of DNA. That figure is roughly equal to six gigabytes of data, or the number of letters in a book with three million pages.

Knowing the sequence of bases – also called nucleotides – helps scientists understand how different segments of DNA function. Some segments contain genes, which are blueprints for proteins produced by the cell. Other segments – more numerous and occupying vastly more space than genes – control whether genes are switched on or off. That is, they determine whether genes are actively being “read” by the cell to produce proteins, or are merely “on file” in the nucleus. Other regions of DNA have no known function and may be holdovers from evolutionary wrong turns and detours.

Since DNA constitutes the “operating manual” of cells, errors in the arrangement of bases can cause a cell to malfunction in a variety of ways. Nowhere is that more evident than in cancer, the disease most associated with wayward genes. The kind of sequencing errors that crop up in cancer cells can take several forms. These include mutations, in which one base is incorrectly swapped for another; copy number alterations, in which a gene or section of gene is repeated over and over or is missing altogether; and translocations, in which a stretch of DNA becomes stranded in the wrong part of the genome.

Not every genetic misspelling or abnormality results in cancer. Many have no discernible effect on a cell’s function. But certain abnormalities are hallmarks of certain kinds of cancer. Doctors know, for example, that many non-small cell lung cancers (NSCLCs) have mutations in the gene EGFR. Targeted drugs are available that counter the effect of some of those mutations. By sequencing tumor cells from patients with NSCLC, therefore, doctors can often identify patients who are likely to benefit from those drugs.

Although the cost of DNA sequencing has dropped dramatically in recent years, it often isn’t feasible or affordable, or even necessary, to sequence all 3 billion base pairs within tumor cells. That’s why much of the sequencing done today is “whole exome sequencing,” which involves reading the bases only in sections of DNA that code for proteins.

DNA sequencing can also be used to identify people who may be at risk for certain types of inherited cancers. Scanning normal cells for mutations in the genes BRCA1 or BRCA2, for example, can indicate whether an individual has an above-average chance of developing cancers associated with those mutations. If so, there are a variety of measures such individuals can take to reduce their risk.

Sequencing plays a large role in cancer research as well. Projects such as The Cancer Genome Atlas are sequencing thousands of tumor tissue samples to help uncover which genetic irregularities drive the growth of various types of cancer. Sequencing can also help researchers track how cancers change their genomic stripes over time. By sequencing the DNA in a tumor before and after treatment, for example, researchers hope to learn how cancer adapts to treatment and potentially becomes resistant to it.

An example of this use of sequencing is the study for Prevention of Progression of Blood Cancers. Researchers are collecting tissue samples from people with precursor blood conditions, which develop into hematological cancers such as multiple myeloma and Waldenström macroglobulinemia, as well as other blood disorders. By genetically sequencing the cells in these samples, researchers hope to understand how these disorders evolve and to develop targeted drugs able to stop this progression in its tracks.

New research suggests that women with certain risk factors should begin screenings at age 30, but experts say mammography may not be effective for women in this age group.

A new study suggests mammograms beginning at age 30 may be appropriate for women with certain risk factors, but experts say the screening method may not be effective for this group. A study showed that annual mammography beginning at 30 may benefit women who have dense breasts or a family or personal history of breast cancer.

Mammography is the standard approach used to screen for breast cancer. Women at average risk for breast cancer should get yearly mammograms starting at age 45, then every other year starting at age 55, but some women could choose to have mammograms as early as 40. Recommendations for younger women aren’t as clear, but women at risk for breast cancer require earlier onset or supplemental screening. Recommendations of screening mammography should be personalized on the basis of a woman’s age, breast density, personal history of breast cancer, and family history of breast cancer.

In 2018, the American College of Radiology started to recommend that all women be assessed for breast cancer risk when they reach 30 including a baseline screening mammogram at age 30 to determine breast density.

Though much research has been done on the 40 to 49 age group, it is difficult to study women in the 30 to 39 age range, as most in this age group don’t get mammograms, yet they are at risk for breast cancer. More than 1,000 women under age 40 die every year from breast cancer in the United States. About 4 percent of breast cancers will be diagnosed in women younger than age 40. With over 250,000 new diagnoses of breast cancer each year, that is not an insignificant number.

What the study found: In this latest study, three specific risk factors: a family history (considered a first-degree relative diagnosed with breast cancer, regardless of age), a personal history of breast cancer, or dense breasts were evaluated.

Dense breasts can obscure the underlying mammographic abnormalities, including breast cancers. Having more fibroglandular breast tissue (and less fat) is also itself associated with increased breast cancer risk.

But experts not associated with the study have advised caution when considering mammography at age 30, particularly on the basis of dense breasts.

Dense breasts are common in younger women. Research estimates 74 percent of women ages 40 to 49 have dense breasts compared with just 36 percent of women in their 70s. Most women aged under 40 have dense breast tissue.

Breast density in mammography refers to the amount of parenchymal tissue relative to the amount of fatty tissue in a breast. Parenchymal tissue looks white on mammography — and so are cancerous masses. Cancers can therefore be harder to detect in those with dense breasts. Given most women in their 30s have dense breast tissue, the benefits of mammography for women without a personal history of breast cancer may not outweigh the risks. Screening women in their 30s with dense breasts will likely lead to many false alarms and benign biopsies without much benefit, due to the very low rate of cancer in this age group.

All women with a personal history of breast cancer should be screened annually (unless they have double mastectomy), regardless of age. In addition, women with a risk factor that puts them at very high risk, for example, women with a genetic mutation or prior chest radiation for cancer treatment, should start screening at a younger age.

For other women, even women with a family history or dense breasts, the benefits of screening mammography in the 30s are unlikely to outweigh the harms from screening in this age group.

Other forms of assessment may be helpful for women under 40. By the time a woman is 30, she should meet with her doctor and have a discussion about breast cancer risk to assess whether early or additional breast cancer screening may be indicated. Clinical breast exam by a trained medical professional may begin at age 20 as well.

At this time, no country or organization has guidelines recommending mammography for women under 40, except in the case of having a personal history of breast cancer or other risk factors that would put them at very high risk. In women with a family history of breast cancer, screening is often started 10 years before the youngest relative was diagnosed, but in younger women don’t only rely on mammography. Patients with increased risk due to genetics or the BRCA gene should start screening earlier and use other scans, like an MRI or ultrasound device, in addition to mammography.

It is prudent for women to practice breast self-awareness. Understand how your normal breast tissue feels and the monthly variations, check periodically, and report any changes to your physician.

The bottom line: A recent study suggests mammography beginning at age 30 may be beneficial for women with a personal history of breast cancer, a family history, or dense breasts. But experts say mammography may not be effective for women in this age group, and other assessments would be more beneficial. Women concerned about their risk for breast cancer should consult their doctor.

A breast biopsy is a diagnostic procedure in which a doctor removes a small amount of breast tissue to examine under a microscope. If the tissue sample shows cancer, the physician can have it analyzed further to provide the most accurate diagnosis — a critical first step in getting patients the best treatment possible for their particular type of breast cancer. Pathology is the study of tumour samples to make a diagnosis. All patients must have their cancer diagnosis confirmed for staging, tumor size, margin assessment since these factors can affect treatment options.

A biopsy may be ordered when a mammogram or other breast imaging (such as an ultrasound) reveals an abnormality or you feel a lump in your breast, or when a physician notices something suspicious (such as dimpling or a change in skin texture) during a clinical exam.

There are two basic types of breast biopsy: surgical and needle. A breast biopsy done surgically through an incision in the skin is called a surgical breast biopsy. A breast biopsy done by inserting a needle through the skin is called a breast needle biopsy.

• fine needle aspiration, which uses a thin, hollow needle attached to a syringe, and
• core needle biopsy, which uses a larger needle that removes a small, tube-shaped piece of tissue with a spring-loaded device or a vacuum-assisted device.

Because it’s important to pinpoint areas of concern and pull tissue from those exact spots, doctors typically use an ultrasound or a mammogram or MRI to guide a breast needle biopsy. A mammogram guided biopsy is also called a stereotactic biopsy. Small metallic markers called “clips” may be placed in the breast at the time of a breast needle biopsy to allow radiologists and surgeons to determine the exact location of the biopsy.

Local anesthesia is given for breast needle biopsies, which makes them tolerable and comfortable for most patients.

The recovery time is typically very short, but may vary depending on the amount of bleeding and/or bruising. A core needle biopsy is more likely to result in bruising than a breast fine needle biopsy. Bruising from a breast biopsy may take several weeks to completely resolve. Your doctor will discuss expected recovery times and what to do to take care of the area that’s been biopsied.

A breast needle biopsy is done with local anesthesia, so it does not require general anesthesia. A surgical breast biopsy may require general anesthesia, but typically won’t require an overnight hospital stay.

If there’s an abnormal finding on your mammogram or breast ultrasound that we need to biopsy, a radiologist will determine the most appropriate type of biopsy, based on how much tissue is needed to get an accurate diagnosis and the question doctors seek to answer with the biopsy.

A biopsy is only recommended if there’s a suspicious finding on a mammogram, ultrasound or MRI, or a concerning clinical finding. If a scan is normal and there are no worrisome symptoms, there’s no need for a biopsy.

If you do need a biopsy, your doctor should discuss which type of biopsy is needed and why. Your doctor can answer any questions you have and explain the procedure and its purpose, as well as its benefits, risks and alternatives.

As with any medical procedure, there are known risks and benefits with a breast needle biopsy. It is possible that patients may have pain, bleeding or infection. So, be aware of these potential complications and discuss them with your doctor before the procedure.

Some patients express concerns about whether a breast needle biopsy might cause cancer to spread. But there’s no evidence of a negative long-term effect from a breast needle biopsy. And the benefits of a breast needle biopsy as opposed to a surgical biopsy or no biopsy at all, outweigh the risks.

Just because you need a breast biopsy doesn’t mean you have cancer. In fact, most breast biopsies turn out to be benign (not cancerous). So don’t worry if it takes several days to receive the results of your breast biopsy.

Breast cancer is the most common type of cancer among women. It often begins in lobules or ducts of the breast tissue; it can spread when the cancer cells get into the blood or lymph system. Every year in the United States, one in 3,000 women will be diagnosed with breast cancer during pregnancy. There is no evidence that breast cancer itself can harm a woman’s baby, so during this challenging time, doctors try to protect the growing fetus while curing or controlling the cancer whenever possible.

If a woman is pregnant and diagnosed with breast cancer, or is diagnosed with breast cancer and becomes pregnant, there can be many factors to consider when deciding on a treatment strategy. These include the size of the tumor, the location of the tumor, if the cancer has spread, how far along the pregnancy is, the patient’s overall health, and the woman’s personal preferences.

In general, surgery is a safe treatment for pregnant women. Decisions about mastectomy or lumpectomy not only depend on tumor features (e.g. size) but also on the timing of pregnancy, because a lumpectomy usually requires radiation therapy afterward, which can negatively affect the baby.

If a woman is late in the pregnancy, radiation can be deferred until after delivery, and if a patient is early in pregnancy and needs chemotherapy, then waiting on radiation is also often reasonable. However, waiting too long may impact the efficacy of the radiation and therefore sometimes a mastectomy will be preferred in that setting to avoid unnecessary delays.

Another standard treatment after breast cancer, chemotherapy, is typically safe in the second and third trimester of pregnancy but not the first. The first trimester is when most of the baby’s organs develop and the risk of miscarriage is highest. Chemotherapy can also lower the mother’s blood cell counts, so it is not recommended close to the peripartum period (soon before or after delivery).

Other adjuvant therapies, such as radiation therapy, hormone therapy, and targeted therapy, must be held off until after delivery.

Some women may be able to breastfeed their child after a lumpectomy and radiation therapy, even though these procedures can reduce milk production and alter breast structure. Women who undergo a single mastectomy can breastfeed with the remaining breast. Double mastectomy patients are unable to breastfeed. Breastfeeding is safe for the mother and the baby if she is not undergoing chemotherapy or taking hormone and targeted therapy drugs. These substances can enter the breast milk and be passed on to the baby.

Breastfeeding after breast cancer treatment does not appear to increase risk of recurrence. In fact, some research suggests that having a history of breastfeeding might lower the risk of the cancer coming back.

A study showed that women who had been treated early for breast cancer and went on to have children did not have a higher risk of their breast cancer recurring than survivors who did not become pregnant. A study is testing whether it’s safe for breast cancer survivors who want to get pregnant to temporarily stop taking hormone-blocking drugs, such as tamoxifen, for hormone-positive breast cancer. These drugs are usually recommended for at least five years after initial treatment to help prevent recurrence.

Although many women are able to get pregnant after breast cancer treatment, certain treatments, such as chemotherapy, might damage the ovaries and cause immediate or delayed reproductive complications, such as infertility. If a patient is diagnosed with breast cancer and foresees getting pregnant in the future, she should talk to her doctor before starting breast cancer treatment and consider pursuing fertility preservation.

Lymphedema is a painful swelling in a limb where lymph nodes have been removed is a common complication of cancer treatment.

The lymphatic system is a network of nodes, vessels, ducts, tissues, and organs that distributes infection-fighting blood cells throughout the body and plays a major role in the immune system. This network acts as the body’s natural sewage system, eliminating dangerous microbes and damaged cells, such as cancer cells. During cancer-related surgeries, such as mastectomies or lumpectomies, doctors may remove the lymph nodes near the tumor to see if the cancer has spread. Removing these vessels makes it harder for fluid in the arms, legs, or other body parts to flow to the chest through which the fluid can get back into the bloodstream. If this fluid builds up, it can lead to swelling and stiffness where the nodes used to be, or lymphedema. Infection can also be a side effect. Radiation therapy following surgery further compromises the lymph network, leaving scarring and inflammation.

Although lymphedema symptoms can be prevented and managed in a variety of ways, surgeons are pioneering procedures to restore a healthy lymph system in affected patients. One such procedure, called a vascularized lymph node transfer (VLNT), involves taking lymph nodes from one part of the body, usually from the groin, underarm, or neck and transplanting them to the limb with lymphedema. The blood vessels providing circulation for these lymph nodes are reattached to the blood vessels in the swollen limb. The new nodes can then drain the trapped lymphatic fluid. Several preliminary studies have reported promising outcomes for VLNT in both early and advanced stage lymphedema, but the treatment is still in its exploratory stages.

Breast Cancer treatment involves truly multidisciplinary care. That means that a medical oncologist, radiation oncologist, surgical oncologist and reconstructive surgeon work together as a team to achieve the best possible outcome, unique for each patient’s disease and their needs.

You may have gone through a doctor's clinical examination and mammography indicating that you have breast cancer but a confirmed diagnosis requires a small surgical procedure with either a Fine Needle Aspiration Cytology (FNAC) in which a needle is used to suck out a few cells from the tumour or biopsy in which a small piece of the tumour is excised in an OPD procedure. The cells are then stained and examined under a microscope to diagnose which kind of breast cancer you have. The most common form is infiltrative or invasive ductal carcinoma involving the cells lining the ducts that transport milk from the lobules where it is formed to the nipple. Alternate forms are lobular carcinoma. Infiltration means that the disease has spread beyond the ducts into other parts of the breast tissue.

Additionally, the doctor must investigate whether the disease has spread (metastasised) to other locations. The first site of spread is the lymph nodes on the underarms. Other sites where the disease could spread are lung which must be determined by doing a chest X-ray, liver by doing a pelvic ultrasound, brain by conducting a CT scan and bone which is determined by a bone scan. Depending on how large the tumour is the disease is termed Stage 1 (less than 2.5 cm), Stage 2 (2.5-7cm), Stage 3 (larger than 7 cm) and Stage 4 (spread outside the breast). If the disease has spread to lymph nodes, it is called locally advanced, if it has spread to other sites, it is called metastatic. The treatment for each stage is different, but the aim is complete cure. In the case of metastatic breast cancer however, cure is not possible, but long term control may be. Typical treatment involves surgery, followed by radiation and/or chemotherapy. In case of large tumours, the doctor may prescribe chemotherapy to reduce the size of the tumour followed by surgery.

Like all surgeries, breast cancer surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure. When choosing a surgeon, ensure that s/he has performed a large number of surgeries for breast cancer each year. Also check success rates where possible. Ask if you are eligible for reconstructive surgery. If so, our breast cancer surgeons and reconstructive surgeons could work together to plan procedures that minimize incision and scarring and the best possible cosmetic outcome and symmetry.

Some patients will receive chemotherapy or targeted therapy prior to surgery. The goal of these treatments is shrink the tumor and any involved lymph nodes in order to make the procedure and recovery as easy as possible on the patient. This also allows the treating team to assess how the cancer has responded to treatment, which can be important for some breast cancer subtypes.

The surgeries themselves fall into one of two categories: lumpectomies and mastectomies. Your surgeon will recommend the best option for you based on the size and location of tumors in the breast, the size of the breast itself and the need for radiation treatment.

In a typical lumpectomy surgery, the tumor and a small amount of surrounding normal tissue is removed. Lumpectomies are generally outpatient procedures and have shorter recovery times. These procedures are usually followed by radiation therapy.

In a typical mastectomy surgery, the tumor and the entire breast are removed. There are a number of different types of mastectomies, including procedures that spare the breast’s skin and nipple/areola. Often a mastectomy and breast reconstruction can be performed in the same procedure.

In some cases, both breasts are removed. This can help prevent the development of a new breast cancer. It is typically done for patients who are at high risk for developing breast cancer due to family history or their own genetic profile, such as a BRCA mutation.

In both lumpectomies and mastectomies, surgeons may also remove nearby lymph nodes. These are important parts of the lymphatic system, which helps the body fight disease. Breast cancer can spread through nearby lymph nodes. Doctors will study the ones that are removed to determine if there are cancer cells within the nodes. This information can help determine the risk of the disease spreading to distant organs, as well as the need for chemotherapy and radiation therapy.

Radiation therapy uses powerful beams of energy to kill breast cancer cells remaining after surgery that can’t be seen by the naked eye. Radiation may also be used as a palliative treatment to reduce symptoms caused by cancer spreading to other parts of the body for example bones and improve the patient’s quality of life.

Radiation is given to the breast tissue surrounding the area where the tumor was located, as well as to nearby lymph nodes and the chest wall. After a lumpectomy, patients often receive three to four weeks of daily radiation therapy. In some cases one to two weeks may be appropriate. When the lymph nodes are involved or a mastectomy was needed, patients usually need six weeks of daily radiation therapy. The plan is carefully made keeping in mind the size, location and type of tumour. The area to be radiated is marked with a tattoo so that radiation can be delivered to exactly the same spot at each fraction. The total amount of dose is calculated and a fractional dose is delivered every day.

A newer form of radiation therapy is Proton therapy which delivers high radiation doses directly into the tumor, sparing nearby healthy tissue and vital organs. For many patients, this results in better cancer control with fewer side effects.

Chemotherapy uses powerful drugs to kill cancer cells, control their growth or relieve pain. It can be given either orally or intravenously and can therefore reach any part of the body where cancer cells may be present. It is often given to patients prior to surgery to shrink the tumor and simplify the procedure. Chemotherapy targets fast growing cells and can not distinguish between healthy ones and cancer. As a result, it causes side effects such as sore mouth, darkening of nails, problems of the digestive system, lowered WBC count resulting in infections. But the side effect that breast cancer patients fear the most is loss of hair. You should be reassured that hair will grow back once chemotherapy is completed, just like you had before.

Cancer cells rely on specific molecules (often in the form of proteins) to survive, multiply and spread. Targeted therapies stop or slow the growth of cancer by interfering with, or targeting, these molecules or the genes that produce them. Since only cancer cells produce these proteins, the therapy only affects disease cells and side effects are less.

In recent years, targeted therapy has become a major weapon in the fight against breast cancer. Breast cancer subtypes that once had poor prognoses are now highly treatable. One type of targeted therapy is endocrine therapy, which is given to patients with hormone receptor-positive breast cancer. This can be given before surgery to shrink the tumor. It is also given after surgery for five to 10 years to prevent recurrence. Patients with the metastatic form of this disease are also given endocrine therapy in order to prevent disease progression.

Patients with HER2-positive breast cancer also receive targeted therapies. These patients may receive a different set of targeted therapy drugs both prior to and after surgery. Since about half of patients with HER2-positive breast cancer also have hormone receptor-positive tumors, they are also given endocrine therapy.

While there are no targeted therapies for triple negative breast cancer, researchers are studying the disease to identify possible drug targets.

Chemotherapy is medicine used to treat cancer. Chemotherapy drugs can be used alone or in combination with other drugs, surgery, or radiation.

Chemotherapy can be used to:

• Kill cancer cells
• Stop cancer from spreading
• Slow the cancer’s growth
• Make the cancer smaller so that surgery can be done or be more effective
• Relieve pain and other symptoms that may be caused by the cancer

It can be administered in a few different ways, including:

• Intravenously (IV) – directly into your blood through a vein
• Intramuscularly (IM) – injected into a muscle
• Subcutaneously (SC) – injected just under the skin
• Topically – applied to the skin
• Orally – taken by mouth (liquid, tablet, or capsule) in clinic or at home

Chemotherapy can be used at different points during cancer treatment. Some patients are only treated with chemotherapy, while others may receive chemotherapy before and/or after surgery to remove a cancerous tumor, or as an adjuvant treatment to another therapy. Some cancers are treated with newer therapies, and do not involve chemotherapy at all.

Patients fear chemotherapy for its widely-known side effects but they should be aware of its effectiveness in treating cancer. These side effects occur because chemotherapy kills fast-growing and fast-dividing cells, which includes cancer cells, but also includes healthy cells that have high rates of growth and division, such as cells of the hair follicle, skin, and those lining the digestive tract.

As a result, the following common side effects may occur:

• Nausea and vomiting
• Loss of appetite
• Diarrhea
• Hair loss
• Mouth sores
• Skin dryness
• Fatigue

People experience side effects with varying levels of severity during their chemotherapy treatment. The following information will help people to manage these side effects very effectively.

Dietary changes can help mitigate digestive issues such as nausea and diarrhea. A nutritionist can be consulted to ensure patients maximize healthy calories and keep hydrated in light of a reduced appetite. Your care team can also recommend medications to alleviate nausea.

Mouth and throat sores can be painful, but good oral health care – including brushing teeth before and after each meal – can help prevent worsening sores or infection. Your cancer care team may prescribe oral rinses, too. Ideally, you should also see a dentist before beginning a chemotherapy regimen so they can identify any conditions in the mouth that need to be taken care of before you begin treatment.

Hair loss in one of the better-known side effects of chemotherapy, but for many people, the drug only causes hair thinning. A new and novel approach to preventing hair loss from some chemotherapy regimens is called scalp cooling, which involves the use of a cool, tight cap that is placed on the head and worn before, during, and after each chemotherapy session. Liquid coolant circulates through the cap, reducing blood flow to cells that produce hair, with the goal of protecting them from the chemotherapy.

To combat fatigue, it is important to keep moving. Aerobic exercises such as walking, swimming, biking, or running, tend to be the most beneficial for cancer patients. Activities such as yoga and stretching, and even resistance training with weights, can be beneficial as well. Always check with your doctor before beginning any new exercise plans.

Researchers are also developing new therapies to reduce the typical side effects of chemotherapy. Targeted therapies differ from standard chemotherapy because they involve drugs which are engineered to attack only cells with a certain molecular target caused by the cancer. Since these drugs can kill cells more specifically, fewer healthy cells die in the process, which can greatly reduce the side effects a patient will endure. Many clinical trials are underway to evaluate these new targeted therapies for the treatment of a number of cancer types.

Many cancer patients experience “chemobrain” – mental clouding or fogginess – during and after chemotherapy treatment. The condition, which can also be worsened by surgery and radiation, can include symptoms like weakened short-term memory, problems finding words, short attention span, and difficulty concentrating and multitasking. Different treatments can affect cognitive function, but there are ways to manage and reduce symptoms.

Regular exercise is helpful for alleviating chemobrain symptoms. Aerobic exercises – walking, running, dancing, or cycling, to name a few – are probably better, but one study did show that resistance and strength training helped as well.

It’s also important to make sure you’re receiving treatment for any depression, anxiety, or sleep problems (including sleep apnea). Make sure you also have had your thyroid, vitamin D and B12 levels checked.

Cognitive treatments including brain games through websites such as lumosity.com and positscience.com, and EEG biofeedback (another form of “brain exercise” that naturally trains your brain waves to be in a less turbulent state), are significantly more effective than medications for treating chemobrain.

It’s actually best to handle the information differently to increase the chance you will remember it. Try to link a visual image with the information you hope to remember. If it’s a name, think of something silly that rhymes with it. If you can, (don’t be embarrassed to say you need to do this) write it down.

A majority of people report cognitive problems during chemo (67 percent of patients in one study), and women may be more at risk than men. Genetic differences (small variations in DNA sequences in genes, called polymorphisms) may also increase risk. These occur in a variety of genes, not just cancer-causing genes.

For most patients, chemobrain improves within 9-12 months after completing chemotherapy, but many people still have symptoms at the six-month mark. A smaller fraction of people (approximately 10-20 percent) may have long-term effects.

For the minority of people who do have long-term effects, they can be noticeable even 10 years after completing treatment. However, these side effects should be stable and not worsening. If they are getting worse 10 or more years later, you should speak with your doctor.

In Alzheimer’s, memory doesn’t respond to cues whereas in chemobrain, cues are helpful. For example, if I asked you to remember “yellow” and asked what it was a few minutes later, a clue such as “it was a color” would be helpful for chemobrain, but not for people with Alzheimer’s.

Other types of dementia usually involve personality changes, motor changes (stiffness, tremors, falls) or hallucinations, which are not typical of chemobrain. However, it can be hard to differentiate chemobrain from age-related forgetfulness when symptoms are mild.

Breast cancer is a malignant tumor that begins and grows in the breast. Malignant tumors can grow and invade nearby tissues or travel to distant organs. This progression is called metastasis. Breast cancer treatment aims to remove these tumors and prevent future tumor growth.

Hormone therapy is one type of breast cancer treatment. Often combined with additional treatments, it’s considered an adjuvant therapy. For metastatic disease, can be used alone or in people who can’t tolerate surgery or chemotherapy. Other treatments include:

• Radiation
• Surgery
• Chemotherapy

In certain breast cancers, the female hormones estrogen and progesterone can stimulate cancer cell growth. Cancers that are hormone receptor-positive grow when hormones attach to the cancer cell receptors. Approximately two-thirds of all breast cancers are hormone receptor-positive, according to the American Cancer Society.

Hormone therapy aims to prevent estrogen from binding to the receptors to slow or prevent cancer growth.

Hormone therapy is only effective for people with hormone receptor-positive tumors. If your breast cancer tumor is hormone receptor-negative, it won’t work for you.

Picking the best type of hormone therapy for you

There are several types of hormone therapy to treat breast cancer, including:

Selective estrogen receptor modulators

Also called SERMs, these drugs prevent breast cancer cells from binding to estrogen. SERMs block the effects of estrogen in breast tissue but not in other tissues within the body. Traditionally these drugs are only used in pre-menopausal women. The most commonly used SERMs include:

• a. Tamoxifen(Soltamox, Nolvadex): This medicine prevents estrogen from binding to cells, so that the cancer can’t grow and divide; people who take tamoxifen for 5-10 years following breast cancer treatment are less likely to have the cancer return, and more likely to live longer than people who don’t, according to the National Cancer Institute.
• b. Toremifene(Fareston): This drug is only approved to treat breast cancer that has spread to other parts of the body, and may not be beneficial for people who’ve had limited success using tamoxifen.
• c. Fulvestrant (Faslodex): This is an injected estrogen receptor-blocking medicine that is commonly used to treat advanced breast cancer, and unlike other SERMs, blocks the effect of estrogen throughout the entire body.
• d. Aromatase inhibitors: Aromatase inhibitors (AIs) prevent the production of estrogen from fat tissue but have no effect on the estrogen produced by the ovaries.

Since AIs can’t stop ovaries from producing estrogen they’re only effective in postmenopausal women. AIs are approved for postmenopausal women with any stage of estrogen-receptor positive breast cancer. Newer research shows that in premenopausal women AI combined with ovarian suppression is more effective than Tamoxifen in preventing breast cancer recurrence after initial treatment. It’s now considered the standard of care.

• i. Common AIs include:
• ii. letrozole (Femara)
• exemestane (Aromasin)
• anastrozole (Arimidex)

For women who haven’t gone through menopause, ovarian ablation may be an option. This can be done medically or surgically. Either method stops estrogen production, which inhibits growth of cancer. Surgical ablation is done by removing the ovaries. Without production of estrogen from the ovaries, you will enter permanent menopause.

Luteinizing hormone-releasing hormones: Drugs called luteinizing hormone-releasing hormones (LHRH) can be used to stop the ovaries from producing estrogen altogether. These drugs include goserelin (Zoladex) and leuprolide (Lupron). This will cause temporary menopause.

Ovarian suppression drugs will induce menopause. Women who choose this option will usually also take an aromatase inhibitor.

Tamoxifen and other SERMs can cause:

• e. Hot flashes
• f. Fatigue
• g. Mood swings
• h. Vaginal dryness
• i. Vaginal discharge

These medicines may also increase your risk for blood clots and endometrial cancer. But these side effects are rare. In some cases, tamoxifen can cause stroke and may increase your risk for a heart attack.

Side effects for AIs include:

• Muscle Pain
• Joint Stiffness
• Joint Pain

Estrogen is important for bone development and strength and AIs limit natural estrogen production. Taking them will increase your risk for osteoporosis and bone fractures.

Outlook: Hormone therapy only can treat people who have hormone receptor-positive tumors. Your treatment will depend on whether you are premenopausal or postmenopausal. Premenopausal women should strongly consider ovarian ablation combined with AI over Tamoxifen alone. But this will cause them to enter menopause prematurely.

Fortunately, hormone therapy is quite successful for most people with hormone positive breast cancer. Long-term survival rates for people who use hormone therapy are higher than for those who don’t.

If you have breast cancer, talk to your doctor or oncologist about whether you will benefit from hormonal therapy. The treatment reduces the risk of breast cancer recurrence in women with hormone receptor positive breast cancer. It can also prolong life and reduce cancer related symptoms in patients with metastatic or late stage hormone positive breast cancer.

There are different options depending on your menopause status. Know your options and weigh the pros and cons of hormonal therapy.

Selective estrogen receptor modulators

• Letrozole (Femara)
• Exemestane (Aromasin)
• Aanastrozole (Arimidex)

Ovarian ablation or suppression

• Luteinizing hormone-releasing hormones
• Goserelin (Zoladex)
• Leuprolide (Lupron

Scientists in the past few years have gained unprecedented control over how to make the human immune system accelerate, and what causes it to slow or stop. This knowledge has spawned new immunotherapy drugs that are delivering dramatic benefits to some patients with advanced cancers.

It has become possible to treat someone who has stage IV metastatic cancer and halt the cancer – and manage it more like a chronic disease using, for example, Checkpoint blockers, drugs that disable the brakes that cancer cells use to fend off an attack on them by immune system T cells.

But beyond the impressive but limited successes of recent immunotherapy advances lies the potential to bring the strategy to more patients and more kinds of cancer. Knowledge of the powerful immune system’s intricate and complex set of controls remains to be discovered.

Two main questions are-

First, why do some patients with tumors– like melanoma, lung, bladder and kidney – not respond to immunotherapy? Why is it only 20 or 30 or 40 percent? Why don’t all of them respond? Second, why do some cancers not respond at all, like pancreatic, prostate, ovarian, and breast cancer, glioblastoma, and colon cancer other than patients with Lynch syndrome?”

Despite those unanswered questions, the science behind immunotherapy is far more advanced than it was even a decade ago. For nearly 100 years, since the idea first emerged, efforts to harness the immune defenses as a cancer treatment met with many failures and limited success – even though the immune system, which evolved mainly to combat infectious viruses and bacteria, is capable of eliminating body cells that have become cancerous.

Early strategies focused on stimulating the immune response with vaccines or removing T cells from a patient, “educating” them in the laboratory, and returning them to the body to seek out and destroy cancer cells. But except in a few instances, these measures didn’t spark an effective immune reaction.

Real progress started when it was recognized that the best way to activate the immune system was not by stepping on the gas pedal – but by removing the brakes. Scientists learned that cancer cells evade the immune forces by activating molecular “checkpoints” that both conceal the identity of the cancer cells and switch off the immune response. These natural checkpoints are crucial to health – without them, people would be much more vulnerable to misguided attacks on normal tissue, as in autoimmune diseases like lupus. The role of one of those checkpoints on cancer cells, PDL-1, was identified in 2000 when it was discovered that it partnered with another molecule on T cells, PD-1, to stave off attack by immune T cells. Another checkpoint, CTLA-4, also switches off the immune response. The T cells get exhausted, and go into a state where the tumor is masked from the immune system, or the tumor secretes substances that create a highly immunosuppressive microenvironment around the tumor which prevents killer T cells from invading the tumor, is composed of many kinds of suppressor cells including macrophages, dendritic cells, endothelial cells, and others. Research has identified key molecular signaling pathways in the tumor microenvironment that are hijacked by cancer cells as protection. Currently researchers are exploring strategies for “reprogramming” the environment to boost the immune response against tumors.

The discoveries of checkpoints that allow cancer to escape immune attack rapidly led to the development of “checkpoint blockade” antibody drugs that free T cells to attack and kill cancer cells. A groundbreaking clinical trial showed that ipilimumab (Yervoy), which blocks CTLA-4, could slow advanced melanoma in a significant number of patients and prolong their survival. Several other antibody drugs that block the PD-1/PD-L1 interaction have now been approved, including pembrolizumab (Keytruda), nivolumab (Opdivo), and atezolizumab (Tecentriq). These drugs have found a place in treating non-small cell lung cancer, kidney cancer, bladder cancer, head and neck cancer, and Hodgkin lymphoma, and are being tested in other forms of cancer.

While many other checkpoint blockers are in company pipelines or clinical trials, researchers are exploiting the power of the immune system in other ways.

One approach that has gotten a lot of attention because of some early dramatic successes is CAR T cells. The patient’s T cells are removed and genetically modified in the laboratory to produce special receptors on their surface that recognize a specific protein on tumor cells. Then billions of the CAR T cells are infused into the patient to seek out and destroy the cancer. In some patients with very advanced blood cancers this strategy has had remarkable success, but it also can produce severe side effects that need to be closely managed.

Cancer vaccines continue to intrigue immunologists. Even though there are effective vaccines against the human papilloma virus (HPV), which causes cervical cancer, and some head and neck and anal cancers, only a minority of people at risk have undergone vaccination

Researchers are discovering effective vaccines for non-viral cancers, but the field is still in its infancy. Such vaccines would provoke the immune system to react against proteins displayed on the surface of cancer cells. Ultimately the solution may be a combination therapy, just as it was for HIV/AIDS. The key to turning HIV from a lethal disease to a chronic disease was realizing you have to attack it with several drugs at the same time.

The potential of immuno-oncology is just beginning to be realized. Uncovering more will take both a much more detailed understanding of how the immune response is controlled and the tools or treatments to manipulate it for clinical benefit.

Leukemia is the most common childhood cancer, accounting for 31 percent of cancers in children younger than 15, and 25 percent of those younger than 20. Most young patients develop leukemia because of a mutation, or DNA change that occurs randomly in a blood cell only, and is not inherited from a parent. On the other hand, there are some syndromes caused by mutations in the “germline” that are present in every cell of the body that can be inherited from a parent, creating a predisposition to a variety of cancers. These cancers may include leukemia and other blood disorders.

It has been estimated that at least 10 percent of pediatric cancer patients – not just those with blood disorders – have a germline mutation in a known cancer predisposition gene. If a leukemia-predisposing syndrome is diagnosed in a parent, then in some cases it might be appropriate to consider genetic testing of a child that might lead to close surveillance to watch for any signs or symptoms of a blood abnormality.

Examples of genetic syndromes that can raise the risk of leukemia in a pediatric patient include: Down syndrome, or trisomy 21. Children with Down syndrome have a significantly higher risk of developing acute lymphocytic leukemia (ALL) or acute myeloid leukemia (AML) than other children. Down syndrome has also been linked with transient myeloproliferative disorder – a leukemia-like condition within the first month of life that often resolves on its own without treatment.

Li-Fraumeni syndrome. Caused by a mutation in the TP53 tumor suppressor gene, this condition creates an elevated risk of cancers in both childhood and adulthood, including several kinds of solid tumors and leukemia. Other genetic disorders that can carry an increased risk of leukemia include neurofibromatosis 1 and Noonan syndrome, inherited bone marrow failure disorders such as Fanconi anemia and Schwachman-Diamond syndrome, and inherited immune disorders such as ataxia-telangiectasia, Wiskott-Aldrich syndrome, and Bloom syndrome. Genetic testing in a child to detect an inherited leukemia predisposition syndrome would be considered especially when there is thought to be benefit from early detection and surveillance — which, for example, could prompt earlier intervention. In the setting of many bone marrow failure syndromes, for example, one could screen for a myelodysplastic syndrome before it evolves into AML.