BREAST CANCER AND NUTRITION
SUMMARY
Breast cancer is the most common malignancy in women. It is the second most common malignancy in cancer-related deaths after lung cancer.
Malnutrition and weight loss are considered to be one of the most valuable causes of death in cancer patients. Cachexia; It is defined as a complex syndrome that occurs with anorexia, weight loss, loss of adipose tissue, muscle tissue and metabolic changes in cancer patients. Determination of nutritional status in cancer patients aims to evaluate the malnutrition status of high-risk patients and to make a comprehensive nutrition program suitable for them. Nutritional supplement should start at the time of diagnosis and should be included in the treatment plan in all disease stages. Nutrition should primarily be oral. Oral nutritional supplement is recommended for patients who cannot take enough nutrients orally. In patients who cannot meet their daily nutritional needs orally, enteral tube feeding should be started as early as possible. Parenteral nutrition should be used only in cases where the gastrointestinal tract is not suitable, such as severe malabsorption, high-output fistula, dysmotility and abdominal pain. Nutrition should be supported with electrolytes, trace elements and vitamins. Because oxidative stress markers increased and antioxidant levels decreased in cancer patients.
Key words: Breast cancer,Cachexia,Nutrition supplementation,Nutrition in cancer patients
INTRODUCTION
The female breast consists of fat, connective tissue and many small mammary glands. Breast cancer often occurs as a mass in the breast tissue, but more than one of the breast masses is not cancerous. Breast cancer is the most common malignancy in women and is the second most common malignancy in cancer-related deaths, after lung cancer. Breast cancer is also rarely seen in men. Breast cancer is seen in 1 in every 100,000 men. It constitutes less than 1% of all breast cancers. Breast cancer is rare before the age of 30 and shows a rapid increase in the reproductive years following this age. This increase continues with a slow slope after menopause. Cancer is more common in women over the age of 40. The most valuable risk factor for the development of breast cancer is advancing age, as well as the family history of breast cancer. Genetically inherited forms constitute 10% of all breast cancers, and it is noteworthy that the incidence of cancer in both breasts is higher in patients in this cluster, at a younger age.
It constitutes 30% of female cancers in the USA and 25-28% of female cancers in Turkey. The risk of developing breast cancer in a woman during her lifetime is 10-12.8% or 1:8-1:10 While the incidence of breast cancer in our country was 37.3/100.000 in 2006, it is claimed that this rate has reached 50/100.000 according to the studies carried out by the Ministry of Health in recent years.
SYMPTOMS AND SCREENING OF BREAST CANCER
Symptoms of breast cancer differ according to the extent of the disease in the body and from individual to individual. Although breast cancer may appear painless at first in many women, it is also mentioned that the following symptoms will be seen.
- Presence of a mass in the chest
- An image of the chest in the form of an orange peel,
- Retraction of the nipple without congenital causes,
- From the chest It is seen that it is valuable to have bloody or bloodless discharge,
- Ulcers, redness and edema on the chest skin,
- Swelling and edema in the lymph nodes and arm, etc.
Although there is not more than one cancer of the palpable masses in the chest, precautions should be taken when a different mass is noticed by women. The aim of early diagnosis is to reduce deaths from cancer, increase the chances of treatment, and prolong survival.
Breast cancer primarily spreads to regional lymph nodes and often involves axillary lymph nodes. Cancer cells that exceed the regional lymph nodes can join the blood circulation and spread to the lungs, pleura, bone, liver, peritoneum, adrenal glands, brain and ovaries, respectively.
Breast Self Examination (BSE), Clinical Breast Examination (CBE), Mammography are common screening techniques used in the diagnosis of breast cancer. While mammography is accepted as a ‘gold standard’, the effect of BSE and CBE on reducing mortality is low. Early diagnosis provides a 30% reduction in breast cancer deaths.
BREAST CANCER STAGES
Cancer disease is graded according to the international TNM system. Accordingly, the spread of the tumor (T), the disease of the lymph nodes (N) and the degree of spread of the disease to other organs (M) are evaluated and the disease is classified as follows.
T0 No Tumor
T1 Tumor up to 2 cm in diameter
T2 Tumor up to 5 cm in diameter
T3 Tumor greater than 5 cm in diameter
T4 Tumor has spread to skin or tissues surrounding the breast
TX Tumor spread cannot be determined
N0 Lymph nodes unaffected
N1 Tumor to axillary lymph nodes reached
N2-3 Tumor has reached axillary lymph nodes and/or great vessels of the thorax; lymph nodes are no longer displaced midway or against the surrounding tissues
NX Lymph node disease cannot be determined
M0 No metastasis to other organs
M1 There is spread to other organs . Ex: to the bones and lungs
MX It is not possible to decide whether to spread to other organs. (12)
TYPES OF BREAST CANCER
Breast cancer cancer cells show different types when viewed under a microscope. In some cases, a single breast tumor may be a combination of these, or it may be a mixture of invasive and in situ cancer. And in some minor forms of breast cancer, it can be seen that the cancer cells do not form a tumor at all.
Ductal carcinoma in situ
Ductal carcinoma in situ (DCIS) is considered as non-invasive or pre-invasive breast cancer. The difference between DCIS and invasive cancer is that it does not spread to the surrounding breast tissue through the canal walls. Because DCIS cannot metastasize outside the breast. DCIS is considered a pre-cancer, and in some cases, invasive cancer can actually go. Almost all of the women diagnosed at this early stage can be treated.
Invasive (infiltrative) ductal carcinoma
This is the most common type of breast cancer. Invasive (or infiltrative) ductal carcinoma (IDC) begins in the breast milk duct, extends beyond the wall of the duct and penetrates into breast adipose tissue. At this point, it can spread (metastasize) to other parts of the body through the lymphatic system and blood.
Invasive (or infiltrative) lobular carcinoma
Invasive lobular carcinoma (LAC) begins in the milk-producing glands (lobules). Like IDC, it can spread to other parts of the body (metastasize). detection is more difficult than invasive ductal carcinoma.
Inflammatory breast cancer
Inflammatory breast cancer (IMC) is the most aggressive form of breast cancer that manifests itself with the involvement of the breast skin. IMT accounts for 1-6% of all breast cancers.
Often there is a single breast swelling or tumor. In inflammatory breast cancer (IMC), the breast skin appears red and the chest feels warm. Also, the breast skin has a thick, pitted appearance similar to an orange peel.
Paget’s disease of the chest
Paget’s disease is a rare disease that occurs together with breast cancer. Paget’s disease begins on the nipple or the area of darker skin surrounding it (areola). It is often seen primarily as a red, scaly rash. It may be itchy.
Phyllodes tumor
This rare type of tumor develops in the chest stroma (connective tissue) rather than ducts or lobules. Uniform phyllodes tumors are treated by removing the tumor along with a margin of usual breast tissue. A malignant phyllodes tumor is treated with a large margin of normal tissue or by mastectomy.
Angiosarcoma
Primary angiosarcoma of the chest is a rare tumor. Angiosarcomas; primary
thoracic angiosarcoma, chronic lymphedema, radiotherapy-mastectomy-related clinically classified into three clusters. Despite early diagnosis and treatment, the prognosis is dire.
