Kristin Fernandez, MD, breast cancer specialist, consults a breast cancer patient.
Under normal circumstances, cells that wear out replace themselves with an exact replica. When a group of mildly incorrect cells grows slowly and stays contained, it forms a benign (non dangerous) tumor.
However, when the damaged cells are growing quickly and out of control, they form a malignant tumor cancer. Breast cancer begins in the cells of the lobules, which are milk-producing glands or in the milk ducts, which carry milk from the lobules to the nipple.
Though breast lumps occur for a number of reasons (and 85 percent are non-cancerous), if you find one, please make an appointment to meet with one of our physicians. He or she will follow this process to determine how best to care for you:
- Diagnosis: Our doctors will carefully image and biopsy the breast to get the most accurate diagnosis possible.
- Treatment: If a cancer diagnosis is confirmed, your doctors will work with you to create an individualized treatment plan. Breast cancer treatments typically include surgery and and systemic therapy, like chemotherapy, endocrine therapy, or targeted biologic treatments. Radiation therapy is part of the treatment after lumpectomy. Some women may be eligible to participate in clinical trials.
- Recovery: After the treatments are finished, your MedStar Health team will help you with the recovery process, from reconstructive surgery to follow-up care
Learn More About the Types of Breast Cancer We Treat:
- Breast Cancer During Pregnancy
- Breast Cancer in Men
- HER2/Neu Positive Breast Cancer
- Inflammatory Breast Cancer
- Locally Advanced Breast Cancer
- Paget’s Disease of the Nipple
- Triple Negative Breast Cancer
- Ductal Carcinoma In Situ (DCIS)
- Metastatic Breast Cancer
During pregnancy, your breasts can change dramatically—they may become lumpier and/or larger or firmer. Pay attention to how your body changes, what feels normal, and immediately tell your doctor if you discover a suspicious lump.
Pregnancy does not affect your ability to survive breast cancer and does not increase your chances of experiencing cancer again later. You are also just as likely to respond to treatment while pregnant as you would be if you were not pregnant. And, breast cancer cannot spread to your baby.
Our experts at MedStar Health are experienced in managing a cancer diagnosis and the care of pregnant women who are dealing with the emotional impact of their diagnosis. We understand the difficult decision-making process for a woman who is pregnant and facing a breast cancer diagnosis. We will educate you about your various treatment strategies and consider the health and safety of both you and your baby as paramount.
Diagnostic methods and their limitations for pregnant women
- Digital mammogram: If you have a mammogram during pregnancy, we will cover your abdomen with a shield, to make it as safe as possible for your baby. Every situation is different, and your doctor will discuss your options with you taking into account the age of the fetus, as well as other significant factors. The ability to interpret the results may be limited because of the lactational (caused by milk) changes occurring in your breasts.
- Ultrasound: Ultrasound is safe for pregnant women, and can help distinguish between a non-cancerous fluid-filled cyst and a solid lump. It is the gold standard for imaging pregnant women with breast lumps. However, it may not be able to distinguish between cancerous and non-cancerous solid lumps.
- MRI: Although used in non-pregnant women with breast cancer, we do not recommend it for pregnant women because it requires a dye, called gadolinium, the effect of which on your baby is not known.
- Biopsy: A biopsy, which removes some of the affected tissue for further investigation under a microscope, is safe for pregnant women, as well as for women who are breastfeeding.
In rare cases (about one in 1,000 men, compared to one in eight women), men can develop this disease.
The following symptoms can appear in men:
- Changes in the nipple
- A lump in the area around the nipple
- Dimpled skin on the breast
Risk factors for men include:
- Klinefelter's syndrome, which is a genetic disorder that often causes elevated estrogen levels
- Having a close relative or relatives with breast cancer or the BRCA-2 genetic mutation
- Advanced age
- Chronic liver problems
This disease in men can be challenging to identify because it is rare and unexpected. It can also spread to the chest wall, so it is important to consult with your doctor if you detect any suspicious lumps or changes in the breast area.
To confirm a diagnosis, your doctor may also use a digital mammogram and/or ultrasound to better understand the appearance of the inside of your breast and a minimally invasive breast biopsy to examine some tissue from your breast under a microscope.
At MedStar Health, the primary treatment for male breast cancer is a mastectomy, and may include chemotherapy, radiation, and endocrine therapy.
The cells in breast tissue contain a gene called human epidermal growth receptor 2 (HER2/neu) that controls how cells grow, divide, and repair themselves. The right amount of HER2/neu helps breast cells grow normally. When breast cells contain too many copies of this gene (about one out of four cases), too many proteins (receptors) are produced that promote cancer cell growth. Cancer that develops from an abundance of these proteins is considered HER2/neu positive.
HER2 positive cancers are aggressive, can spread easily, but respond well to treatment that specifically targets HER2/neu genes. The following tests determine the level of HER2/neu genes in your cancer cells:
- Immunohistochemistry (IHC) test
- Fluorescence In Situ Hybridization (FISH) test
If you test positive for HER2/neu, your MedStar Health doctor may recommend a targeted biologic therapy, Herceptin. Biologic therapies are drugs that can change the behavior of the cells in your breast. In fact, the research on these drugs was first performed at MedStar Georgetown University Hospital.
Attacks the lymphatic channels in the skin of your breast, causing redness, swelling, and sensations of warmth. Other symptoms may include:
- Pink, purple, or bruised breast skin that does not improve
- Grooved, dimpled or uneven breast skin
- Breast heaviness
- Inverted or flattened nipples
- Swollen lymph nodes under the arm, or above the collarbone
IBC is rare, affecting only about 1-5% of women, but it is fast growing and aggressive—it has already spread to skin and may spread to other areas Therefore, a qualified breast surgeon should examine you if you experience any of the above symptoms.
Our specialists at MedStar Health have the experience to diagnose IBC and move swiftly to the immediate treatment options this type of breast cancer requires.
If your doctor describes your cancer as locally advanced, that means your cancer cells may have spread into large portions of your breast or to lymph nodes under your arm, behind your breastbone, or around your collarbone. Your tumor may also have grown into your chest wall or into the skin of your breast.
- Lump(s) in the breast
- Skin changes
- Underarm lymph node swelling
- Nipple changes
One of MedStar Health’s experienced care experts will perform a clinical breast exam to manually check your breasts for abnormalities.
To confirm a diagnosis, your doctor may also use a digital mammogram and/or breast ultrasound to better understand the appearance of the inside of your breast, and a minimally invasive breast biopsy to examine some tissue from your affected breast under a microscope.
Treatment usually begins with a regimen of neoadjuvant chemotherapy (chemotherapy that is given before surgery) or endocrine therapy that can help shrink the tumor, followed by surgery. Continuing treatment may include radiation and biologic targeted therapy.
Paget's disease of the nipple is a rare type of breast cancer that is present in the skin of the nipple and areola and often in the tissue itself. Symptoms include:
- Redness and irritation of the skin around the nipple and areola
- Crusting and flaking of the skin around the nipple area
- Tingling, itching, or burning in the nipple area
- Change in the general appearance of the nipple
While Paget's disease is a rare form of cancer, experienced care specialists at MedStar Health have the expertise and training to treat it. Our experts will diagnose this condition with a biopsy of the skin in the affected area. The breast is also imaged and biopsied as needed. Common treatment options for Paget's disease of the nipple include surgery and radiation.
This type of cancer is identified by the absence of hormone and protein receptors. By looking at the receptor status, our physicians at MedStar Health can determine how aggressive the cancer may be and whether it may respond to certain drugs. Some contain one to three of the following proteins (receptors), which therapies target to control cancerous cell growth:
- Human epidermal growth receptor 2 (HER2/neu)
Some tumors do not contain any of these three receptors; they are called triple negative breast cancer and are more challenging to treat because they do not respond to targeted treatments. (Triple negative tumors can also be more aggressive, and tend to recur more often than other types of breast cancer.) Fortunately, triple negative types can often respond well to chemotherapy.
Ductal carcinoma in situ, or DCIS, is a pre-cancer — a generally symptom-less condition that can lead to invasive cancer. Doctors do not yet have a way to predict which patients will develop the more intense disease, though, so most patients get treatment.
Also called intraductal carcinoma, DCIS is considered stage 0 and is non-invasive, confined to the milk ducts. That means that unless it undergoes further changes and becomes cancerous, it will not push through the duct walls into surrounding tissue and will not spread outside the breast.
About 1 in 5 breast cancer-related diagnoses are DCIS, but almost all cases are curable. Our specialists have extensive experience diagnosing and successfully treating the condition.
Metastatic breast cancer has spread (metastasized) to other organs and is also called stage IV cancer. Metastatic breast cancer most often appears in the bones, lungs, liver or brain.
We provide a complete range of care and support for metastatic breast cancer: physical, emotional and psychological. While there is no cure for the disease, our doctors have the experience and the full array of treatment options needed to relieve pain and prolong your life, focusing on providing the best quality of life possible.
Metastatic breast cancer might not cause symptoms, but some patients experience:
- Shortness of breath
- Weight loss
- Bone pain
While some of our patients have metastatic breast cancer when they are first diagnosed, most have already been treated for the disease in its earlier stages. Unfortunately, even with top treatment, breast cancer can return months and even years later. If metastatic breast cancer is suspected, our doctors will perform blood and imaging tests and possibly biopsy to diagnosis and appropriately treat the cancer.
Even if cancer is found elsewhere in your body, it is still treated based on where it started —in this case, the breast. Treatment for metastatic breast cancer depends on the cancer’s characteristics, such as its appearance under a microscope and whether it has receptors for the hormones estrogen or progesterone, the spread, symptoms, and past breast cancer treatments.
Treatments for metastatic breast cancer include:
- Hormone therapy
- Targeted therapy
- Certain patients may be eligible to participate in clinical trials of therapies under investigation.
For a physician referral, please call 1-877-715-HOPE.
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The Harry and Jeanette Weinberg Cancer Institute
9103 Franklin Square Drive
Baltimore, MD 21237
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Baltimore, MD 21239
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Johnston Professional Bldg
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12 MedStar Blvd.
Bel Air, MD 21015