Breast cancer is cancer of the tissue payudara.Ini is the most common type of cancer suffered by women. Men also can develop breast cancer, although less likely than 1 in 1000. The most common treatment is surgery and if necessary followed by chemotherapy and radiation.
Cancer is a condition where cells have lost control and the normal mechanism, so that the growth of abnormal, rapid and uncontrolled.
In addition, breast cancer (mammary carcinoma) is defined as a disease of malignant neoplasm derived from the parenchyma. This disease by the World Health Organization (WHO) included in the International Classification of Diseases (ICD)
Cancer cells formed from normal cells in a complex process called transformation, which consists of initiation and promotion stages.
At the initiation stage there is a change in the genetic material of cells that provoke the cells become malignant. Changes in the genetic material of these cells is caused by an agent called carcinogens, which can include chemicals, viruses, radiation (radiation) or sunlight. But not all cells have the same sensitivity to a carcinogen. Genetic abnormalities in cells or other materials, called a promoter, causing the cells more susceptible to a carcinogen. Even physical disorder menahunpun can make cells more sensitive to experience a malignancy.
Progesterone, a hormone that induces side-branching ductal breast glands and lobualveologenesis in breast epithelial cells, is expected to act as an activator trajectory tumorigenesis in breast cells induced by carcinogens. Progestin will induce the transcription of cell cycle regulator cyclin D1 for a secreted form of epithelial cells. Secretion can be improved about 5 to 7-fold with stimulation of estrogen, therefore estrogen is the hormone progesterone activates the expression of perceiving the epithelial cells. In addition, calcitonin secretion of progesterone also induces luminal cells and gland morphogenesis.
In the promotion phase, a cell that has undergone initiation will become malignant. Cells that have not passed the stage of initiation will not be affected by the promotion. Because it takes several factors for the occurrence of malignancies (a combination of cells that are sensitive and a carcinogen).
Usually a painless lump in the breast. The first bump is small, the longer it will be even greater, then attached to the skin or cause a change in the breast skin or nipple.
Skin or nipple had become interested in (retraction), pink or brownish to be edema until the skin looks like orange peel (peau d'orange), shrink, or arising ulcers (ulcers) in the breast. Ulcers that the longer the greater and deeper so that it can destroy the entire breast, often fetid, and bleed easily. Other characteristics include:
Bleeding on the nipple.
Pain or pain in general only emerged when the tumor is already large, has raised ulcers, or if it appears metastases to the bones.
Then comes the enlarged lymph nodes in the armpit, swelling (edema) in the arm, and the spread of cancer throughout the body (Handoyo, 1990).
Advanced breast cancer is very easily recognizable by knowing operbilitas Heagensen the following criteria:
There are extensive edema of the breast skin (over 1/3 wide breast skin);
presence of satellite nodules on the skin of the breast;
karsinimatosa types of mastitis breast cancer;
There are models parasternal;
There supraclavicular nodes;
presence of distant metastases;
and there are two of the signs of locally advanced, namely skin ulceration, skin edema, skin fixed to the wall of the thoracic, axillary lymph nodes than 2.5 cm in diameter, and axillary lymph nodes attached to each other.
Nipple discharge is a discharge from the nipple spontaneously and not normal. The discharge is normal if it occurs in women who are pregnant, breastfeeding and contraceptive pill users. A woman had to be alert when on the bloody nipple discharge, watery fluid with red or brown, out on his own without having to massage the nipples, continues, only in one breast (unilateral), and liquids other than breast milk.
According Moningkey and Kodim, the specific causes of breast cancer are still unknown, but there are many factors that are expected to have an influence on the occurrence of breast cancer include:
Reproductive factors: reproductive characteristics associated with risk of breast cancer is nulliparity, menarche at a young age, menopause at an older age, and first pregnancy at older ages. The main risk of breast cancer is increasing age. It is estimated, the period between the occurrence of the first period with the age at first pregnancy is a window of initiation of breast cancer development. Anatomically and functionally, the breasts will undergo atrophy with age. Less than 25% of breast cancers occur in the period before the onset of menopause it is estimated that tumors occur long before clinical changes.
The use of hormones: estrogen hormone associated with breast cancer. Reports from the Harvard School of Public Health states that there is a significant increase in breast cancer in users of estrogen replacement therapy. A meta-analysis states that although there is the risk of breast cancer in oral contraceptive users, women who use these drugs for a long time have a higher risk for breast cancer before menopause. Cells that are sensitive to hormonal stimulation may undergo changes benign or become malignant degeneration.
Fibrocystic disease: In women with adenosis, fibroadenoma, and fibrosis, there is no increased risk of breast cancer. At hiperplasis and papilloma, slightly increased risk of 1.5 to 2 times. Whereas in atypical hyperplasia, the risk increases up to 5 times.
Obesity: There is a positive relationship between body weight and body shape with breast cancer in postmenopausal women. Variations on the incidence of this cancer in Western countries and not the West as well as the frequency changes after migration indicates that there is the influence of diet on the occurrence of this malignancy.
Consumption of fat: fat consumption is estimated as a risk factor for breast cancer. Willet et al. conducted a prospective study for 8 years about fat and fiber intake in relation to breast cancer risk in women aged 34 to 59 years.
Radiation: Exposure to ionizing radiation during or after puberty increases the risk of breast cancer. Of the few studies conducted concluded that the cancer risk of radiation is linearly related to dose and exposure time of the age.
Family history and genetic factors: Family history is an important component in the history of the patient to be implemented screening for breast cancer. There is an increased risk of malignancy in women with breast cancer families. In the genetic studies found that breast cancer is associated with a particular gene. If there BRCA 1, which is a susceptibility gene for breast cancer, the probability for the case of breast cancer by 60% at age 50 and by 85% at the age of 70 years. The age factor is very influential -> about 60% of breast cancers occur in the age of 60 years. The greatest risk of age 75 years
Peyudara cancer can occur due to some genetic factors inherited from parent to child. Genetic factors referred to is the presence of mutations in several genes that play an important role in the formation of breast cancer genes in question are some of the genes are oncogenes and tumor suppressing genes that nature.
Pensupresi tumor genes that play an important role in the formation of breast cancer include BRCA1 and BRCA2 genes.
There are several breast cancer treatment whose application depends a lot on clinical stage of disease (Tjindarbumi, 1994), namely:
Mastectomy is the surgical removal of the breast. There are 3 types of mastectomy (Hirshaut & Pressman, 1992):
Modified Radical Mastectomy, the surgical removal of the entire breast, the breast tissue in the sternum, collarbone and ribs, and lump around the armpit.
Total (Simple) Mastectomy, the surgical removal of the entire breast, but not the nodes in the armpit.
Radical Mastectomy, the surgical removal of part of the breast. Typically called a lumpectomy, the removal is only in tissues that contain cancer cells, not the whole breast. This operation is always followed by administration of radiotherapy. Lumpectomy is usually recommended in patients with large tumors less than 2 cm and located at the edge of the breast.
Irradiation / radiation is the process of irradiating the affected area of cancer using X-rays and gamma rays are aimed at killing any remaining cancer cells in the breast after surgery (Denton, 1996). The effect of this treatment the body becomes weak, decreased appetite, color of skin around the breast to black, as well as hemoglobin and leukocytes tended to decline as a result of radiation.
Chemotherapy is the administration of anti-cancer drugs or cytokines in the form of a pill or capsule or liquid through the infusion aimed at killing cancer cells through mechanisms of chemotaxis. Not only in breast cancer cells, but also in the whole body (Denton, 1996). The effects of chemotherapy is that patients experience nausea and vomiting and hair loss due to the influence of drugs given during chemotherapy.
Primary prevention of breast cancer is one form of health promotion as is done in the "healthy" through efforts to avoid exposure to various risk factors and implementing a healthy lifestyle. Pencagahan primer can also be an examination of BSE (breast self-examination) are conducted regularly so that it can reduce the risk factors for breast cancer.
Secondary prevention is done on individuals who are at risk for breast cancer. Every woman is normal and have a normal menstrual cycle is a population at risk of breast cancer. Secondary prevention by early detection. Some early detection methods had been developed. Screening through mammography has a claimed accuracy of 90% of all breast cancer patients, but the exposure is constantly on mammography in healthy women is one risk factor for breast cancer. Therefore, screening with mammography can still be carried out by a number of considerations, among others:
Women who have reached the age of 40 years are encouraged to cancer risk assessement survey.
In women with risk factors received Reference for mammography done every year.
Normal woman gets Reference mammography every two years until they reach the age of 50 years.
Foster and Constanta found that breast cancer death by less in women who did breast self examination (Breast Self-Examination) than those who did not. Although the sensitivity of BSE to detect breast cancer is only 26%, when combined with the sensitivity of mammography is early detection to 75%
Tertiary prevention is usually directed at individuals who have positive breast cancer. Proper treatment of breast cancer patients according to the stage will be able to reduce kecatatan and prolong survival. Tertiary prevention is essential to improve the quality of life of patients and prevent complications of the disease and continue treatment. Measures of treatment may include surgery although no effect on the survival of patients. If the cancer has metastasized far, chemotherapy with sitostatika action. At a certain stage, treatment is given only a symptomatic and encouraged to seek alternative treatment of breast cancer with herbal remedies.