Do you know how to recognize the symptoms of breast cancer

As the name implies, breast cancer is a type of cancer that occurs in the breast. It starts when cancer cells begin to grow out of control.

Breast cancer cells will usually form a tumor that can be seen on an x-ray or felt as a lump. Breast cancer occurs almost entirely in women, but men also have the possibility of developing this type of cancer.

1. Epidemiology in Indonesia

Second only to oral cancer

An average of 10 out of 100,000 women in Indonesia suffer from breast cancer

Mammary carcinoma is rare before the age of 25 years and unusual before the age of 30 years, but the incidence increases rapidly after the age of 30 years with an average medium age of 60 years. (Source: Data from the Indonesian Ministry of Health in 2010).

2. Clinical Symptoms

Hard lump in the breast (painless, small to large, adherent to the skin)

Nipple changes (retraction, pain, discharge/blood)

Changes in breast skin: wrinkling, orange peel-like irritation

Small lumps

Sores on the breast that are difficult to heal

Breast feels hot, red & swollen

Itching in the area around the nipple

Fixed hard lump (sticky)

If the lump is cancerous, it usually starts in just 1 breast
3. Diagnosis

Anamnesis

           Location of the lump, when it started, speed of growth, concomitant symptoms such as the presence or absence of pain, type and amount of nipple discharge, changes in the shape and size of the breast, association with menstruation, changes in the skin, and nipple retraction.

           skin, and nipple retraction.

           Risk factors that need to be known include: family history of breast cancer and/or ovarian cancer, obstetric and gynecological history, hormonal therapy, previous history of surgery/aspiration of lumps in the breast.

Physical Examination

Inspection

          Patient sitting upright, hands raised straight up à Breast shape, skin color, dimpling, papillary retraction, orange peel.
Palpation

          Lie down with a thin pillow on the back; Palpate the lump (number, size, shape, boundary, mobile/no, pain/-), gently massage the nipple with fluid/blood).

          Sitting: Axillary, supraclavicular KGB feeling

          SADARI (Breast Self Check) examination

      c. Supporting examination

Mammography: Shows abnormalities in the breast in the smallest form, namely microcalcifications. Accuracy up to 90%.

Mammary ultrasound: Can estimate the possibility of cysts, benign tumors, or the possibility of mammary carcinoma.

MRI: Can determine the spread of carcinoma especially lobular carcinoma or determine the response to neoadjuvant chemotherapy.

Biopsy: Taking tissue samples from the tumor which will be continued to cytological examination (anatomical pathology). Can determine the direction of malignancy more accurately.

       d. Management

          Stage I, II, II early (operable stage): curative nature of treatment

          Stage I, II treatment: radical mastectomy or modified radical mastectomy with or without radiation and adjuvant cytostatics. 

          Stage IIIA: simple mastectomy with radiation and adjuvant cytostatics

          Stage IIIB and IV: nature of treatment: palliative

          Operative measures can be partial or complete removal depending on the results of the history, physical examination, support and biopsy results that have been carried out.

          Radiotherapy or chemotherapy can be done once the tumor type is known.

          Advanced / widespread breast cancer, the nature of palliative therapy. Primary therapy in the form of systemic therapy (chemotherapy and hormonal therapy).

          Toxoregional therapy (radiation and surgery) if needed.