Breast Cancer
by Candace Parson
Disability Specialist
There are two main types of cancer that start in the tissues of the breast. Ductal carcinoma starts in the tubes (ducts) that move milk in the breasts. Most breast cancers of this type. Lobular carcinoma (5%) starts in the lobules, or parts of the breast that produce milk. Rarely does cancer start in other areas of the breast such as muscles, fat and blood vessels.
While ductal and lobular are the main types of breast cancer, there are also several rare types of breast cancer. Some of these rare breast cancers are medullary carcinoma (3-5%), inflammatory breast cancer (1-5%), tubular carcinoma (2%), mucinous or colloid carcinoma (1-2%), Paget disease (1%), and metaplastic breast cancer
Metaplastic, medullary, and tubular breast cancers have atypical cell structures. Metaplastic breast cancer consists of cells that are normally not found in the breast such as cells that look like skin cells or cells that make bone. Medullary carcinoma is characterized by cells that resemble the gray matter of the brain. Paget disease starts in the breast ducts and spreads to the skin of the nipple and areola. Inflammatory breast cancer is very aggressive and blocks lymph nodes. Colloid carcinoma has mucous producing cells.
Unfortunately, breast cancer is not limited to women. Men are subject to the same types of breast cancers as women. Infiltrating ductal carcinoma accounts for 80% of all male breast cancers and infiltrating lobular carcinoma accounts for about 2% of all male breast cancers.
Once cancer has been diagnosed, it is important to determine whether the cancer is invasive or noninvasive. Noninvasive (in situ) refers to cancer that has stayed in the place where it originated; that is, cancer cells have not spread to breast tissue around the duct or lobule. Invasive (or infiltrating) breast cancers spread outside the ducts or lobules and invade the surrounding tissues.
Staging is the process of finding out the extent of the cancer in the body. This helps determine the best treatment. The stage is based on the size of the tumor, whether the cancer is invasive or noninvasive, how many lymph nodes are involved, and if the cancer has spread to other parts of the body (metastasis).Tools that aid in staging include chest x-rays, mammograms, bone scans, CT scans, MRI scans, PET scans, ultrasounds, and tissue biopsies.
Stages of breast cancer range over a continuum from 0 to IV. In Stage 0 atypical cells have not spread outside of the ducts or lobules. Ductal carcinoma in situ (DCIS) is in this category. Also in this category is lobular carcinoma in situ (LCIS), which is not considered to be a cancer, but an indicator that a woman has an increased risk of developing breast cancer. Stage I is early stage invasive breast cancer with tumors no larger than two centimeters (about an inch). At this stage cancer cells have invaded but not spread beyond the breast tissue. Stage II includes larger tumors without extensive tumor spread. Stage III is defined as locally advanc cancer. At this stage the cancer is divided into categories according to tumor size, lymph involvement, and site of tumor spread. Stage IV breast cancer is defined as cancer with distant metastasis, i.e. spread to other parts of the body such as the lungs, liver, brain, or bone
Once diagnosed and staged there are a variety of treatment options for breast cancer, which Social Security calls antineoplastic therapy. These include surgery, radiation therapy, chemotherapy, and hormone therapy. Depending on the size of the tumor, breast conserving procedures of a lumpectomy or partial mastectomy may be used to remove only the tumor and a small area of surrounding tissue. Other tumors may require a modified radical mastectomy removing the entire breast and some lymph nodes in the armpit. The radical mastectomy removes the breast and its underlying muscle, and all of the lymph nodes from the armpit.
External and internal radiation therapy is used to shrink the tumor before surgery or kill any possible remaining cells. In internal radiation (brachytherapy) radioactive seeds are placed in or next to the tumor.
Chemotherapy is a form of systemic therapy given before surgery (neoadjuvant) to reduce the size of the tumor. Chemotherapy given after surgery (adjuvant) is given to kill any cancer cells that may have been left behind or may have entered the blood stream. Hormone therapy is another form of systemic therapy, because it blocks the effect of estrogen which is known to promote the growth of many breast cancers. Hormone therapy is most frequently used as adjuvant therapy to reduce the risk of recurrence of breast cancer and to treat breast cancer that has recurred.
Metastasis under the Social Security guidelines for evaluating breast cancer means tumors that have spread from the initial or primary site beyond the regional lymph nodes (distant metastasis). Recurrent cancer is a malignancy that had been in complete remission or was entirely removed surgically and has returned. Breast cancer, except sarcoma, is evaluated under Listing 13.10.
For further information please contact Mary Garrett, Director of Operations and Support Services at (800) 899-3433, you can visit our contact page, or fill out our Free Evaluation.