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Breast Cancer in Young Adults

Jessica Young and Rico Dence
Breast Cancer is common in the young adult cancer (AYA) community. Up Cancer is working to educate the community in learning the symptoms of Breast Cancer and understand the different types of Breast Cancer.  
Breast cancer is formed by cells that create a tumor on the breast. This can be found by x-ray or felt as a lump. This tumor becomes cancer if it is able to invade or spread to other areas of the body.

There are five stages of breast cancer with subcategories. A great factor that enhances the stages is if the breast cancer cells have entered the lymph system and size of the tumor.

The lymph system has lymph vessels that contain a fluid, called lymph, that has tissue by-products, waste material, and immune system cells. The lymph vessels take this fluid away from the breast and these cancer cells can be carried through these vessels to lymph nodes. There is a high chance that the cancer cells spread to other areas of the body once cancer cells spread to the lymph nodes, including organs.

It does not mean that all patients develop metastasis once cancer cells enter the lymph nodes. Patients can develop metastasis with no cancer cells in the lymph nodes.

Stage I Breast Cancer is when the cells are invading surrounding breast tissue and is subcategorized by IA and IB.

Stage I IA is invasive breast cancer that has a tumor 2 centimeters, the cancer has not spread outside the breast, and lymph nodes are not involved. The cancer is most likely IA if it is estrogen-receptor-positive or progesterone-receptor-positive.

Stage I IB is when there are small groups of cancer cells in the breast instead of a single tumor. These cells are larger than 0.2 millimeters but smaller than 2 millimeters and are found in lymph nodes. Or a tumor is in the breast that is smaller than 2 centimeters and small groups of cancer cells that are larger than 0.2 mm but smaller than 2 mm in the lymph nodes.

Stage II is divided like stage I, into Stage IIA and Stage IIB.

Stage IIA is when cancer, larger than 2 mm, is found in 1 to 3 areas of the lymph system. These lymph nodes are found under the arm or near the breast bone. No tumor is found in the breast in this stage. It is also Stage IIA when the tumor is 2 centimeters or smaller and spread to the axillary lymph nodes or the tumor is larger than 2 centimeters but smaller than 5 centimeters and did not spread to the axillary lymph nodes.

Stage IIB is diagnosed when the tumor is larger than 2 centimeters but smaller than 5 centimeters and small groups of cancer cells, larger than .02 mm but smaller than 2 mm, are found in the lymph nodes. Is also when a tumor is larger than 2 centimeters but smaller than 5 centimeters and spread to 1 to 3 axillary or breast bone lymph nodes or when the tumor is larger than 5 centimeters and has not entered the lymph system.

Stage III is subcategorized into IIA, IIB, and IIIC.

Stage IIIA is when there is no tumor found in the breast or a tumor of any size is found and additionally is found in 4 to 9 areas of the lymph system. Also is the tumor is larger than 5 centimeters and small groups of cancer cells are found in the lymph system or 1 to 3 areas of the axillary lymph nodes.

Stage IIIB involves the tumor being any size and has spread to the chest wall or skin of the breast. This will cause swelling or and ulcer and potentially spread up to 9 axillary lymph nodes or to lymph nodes by the breast bone.

Stage IIIC can involve no sign of cancer in the breast of have a tumor of any size that could be on the chest or skin of the breast wall. The cancer had spread to 10 or more axillary lymph nodes or to lymph nodes around the collarbone or by the breast bone.

Stage IV, also called “de novo” when at first diagnosis, is when the breast cancer has spread further to organs such as the brain, lungs, bones, liver, skin, or distant lymph nodes. Doctors may also use the terms “advanced” or “metastatic” to describe Stage IV breast cancer. This can also be a recurrence from past breast cancer that has spread through the body.

There are multiple types of breast cancer, one being Triple-Negative Breast Cancer. This is a more aggressive breast cancer as there are fewer medicines that target the cancer. Studies shown that this cancer is more likely to recur after treatment and also spread to other areas of the body. The cancer cells in this cancer is less likely to resemble healthy breast cancer cells. Additionally, these cells can be “Basal-Like” meaning they can resemble nasal cells that line the breast ducts. Basal-Like cancers are also more aggressive and more likely to be triple-negative.

There are special proteins that are found around and inside the cell called cell receptors. These protein receptors receive messages from the bloodstream and then relay this message to the cells.

Along with the protein receptors, there are hormone receptors that are on the surface and inside healthy breast cells. Estrogen and progesterone will attach to the hormone receptors to provide information on how to grow and function. Not all breast cancers have these receptors as two of three will test positive for one or both.

Lastly, breast cells have HER2 protein that promote cell growth. About 20% of breast cancer create too much HER2 protein which cause the cells to grow and divide quickly.

This cancer does not respond to hormonal therapy medicines or treatment for HER2 protein receptors due to it testing negative for estrogen, progesterone, and HER2 protein receptors. The negative results show that the cancer is not stimulated by these proteins. Triple-Negative Breast Cancer is about 10-20% of breast cancers. Doctors still hope to find medications that can treat this cancer.