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Breast Cancer Signs, Treatment and ICD10 Codes

What is Breast Cancer?

One kind of cancer that arises from breast tissue is called breast cancer. It is the most prevalent cancer in women and individuals who were assigned female at birth (AFAB), usually affecting those who are older than 50. However, it can also occur in younger women and in men and people assigned male at birth (AMAB).

Signs and Symptoms

Breast cancer frequently manifests as one of the following symptoms:

  • A lump in the breast
  • Change in breast shape
  • Dimpling of the skin
  • Fluid from the nipple
  • A newly inverted nipple
  • Red or scaly patches on the breast
  • Bone pain, swollen lymph nodes, shortness of breath, or yellow skin in cases of distant spread

Risk Factors

Risk factors for developing breast cancer include:

  • Being female
  • Obesity
  • Lack of physical exercise
  • Drinking alcohol
  • Hormone replacement therapy during menopause
  • Ionizing radiation
  • Early age at first menstruation
  • Becoming a parent later in life or never
  • Older age
  • Prior breast cancer
  • Family history of breast cancer
  • Klinefelter syndrome
  • Circadian disruptions related to shift-work and routine late-night eating
  • Exposure to certain chemicals like polychlorinated biphenyls, polycyclic aromatic hydrocarbons, and organic solvents

Treatment

Treatment for breast cancer usually consists of hormonal therapy, targeted therapy, radiation therapy, chemotherapy, and surgery. The cancer’s type, stage, and the patient’s general health all influence the treatment option.

Prognosis

In the US and the UK, there is an approximate 85% five-year survival rate for breast cancer patients. The prognosis varies according to the cancer’s type and stage, the patient’s age, and general health.

Prevention

Preventive measures include maintaining a healthy body composition, avoiding smoking, and eating a healthy diet. Combining these lifestyle changes can make almost a quarter of breast cancer cases worldwide preventable.

Health Disparities

There are significant health disparities in breast cancer diagnosis and treatment, particularly among ethnic minorities. Compared to white women, black women are more likely to be diagnosed with breast cancer at an earlier age and have lower survival rates. Contributing factors to these differences are poverty and restricted access to healthcare.

Special Populations

Men can also get breast cancer, which usually manifests as a breast lump. Treatment for men involves surgery and radiation therapy, with endocrine therapy often being used. Pregnant women with breast cancer require specialized treatment to avoid harming the fetus during chemotherapy and other treatments.

Stages of Breast Cancer

The stages of breast cancer are a way to describe how extensive the cancer is, including the size of the tumor, whether it has spread to lymph nodes, whether it has spread to has extended to remote bodily regions, and what its biomarkers are. The stages are categorized from 0 to IV, with each stage indicating a different level of cancer progression.

Stage 0 (Carcinoma in Situ)

Description: The cancer has not invaded the surrounding tissue and is confined to the milk ducts or lobules.

Characteristics: No evidence of cancer cells invading neighboring normal tissue.

Stage I

Description: The cancer has invaded the surrounding tissue but is still contained in a small area.

Subcategories:

  • Stage IA: Tumor size up to 20 mm, no cancer in lymph nodes.
  • Stage IB: Small clusters of cancer cells in lymph nodes, or no tumor in the breast with small clusters of cancer cells in lymph nodes.

Stage II

Description: The cancer has grown larger and may have spread to lymph nodes.

Subcategories:

  • Stage IIA: Absence of breast tumour, tumour up to 20 mm accompanied by lymph node cancer, or tumour between 20 and 50 mm free of lymph node cancer.
  • Stage IIB: A tumour measuring 20 to 50 mm that has lymph node cancer, or a tumour bigger than 50 mm that does not have lymph node cancer.

Stage III

Description: The cancer has spread further into the breast or the tumor is larger than earlier stages.

Subcategories:

  • Stage IIIA: Cancer in four to nine lymph nodes, or a tumor larger than 50 mm with cancer in one to three lymph nodes.
  • Stage IIIB: A large tumor with cancer in one to three lymph nodes, or a tumor that has spread to the skin or chest wall.
  • Stage IIIC: Cancer in ten or more lymph nodes, or lymph nodes near the collarbone, or a tumor of any size with cancer in lymph nodes.

Stage IV

Description: The cancer has spread to distant parts of the body beyond the breast.

Characteristics: Cancer has metastasized to bones as well as organs like the liver, brain, and lungs.

Each stage is further defined by the T-N-M system, which includes:

  • T: Tumor size
  • N: Lymph node involvement
  • M: Metastasis, or the spread of disease to distant body parts

Understanding the stage of breast cancer helps doctors determine the best course of treatment and predict the patient’s prognosis.

Metaplastic breast cancer

Metaplastic breast cancer (MBC) is a rare and aggressive type of breast cancer that accounts for less than 1% of all breast cancers. It is characterized by the differentiation of tumor cells into squamous, mesenchymal, or neuroectodermal components, making it highly heterogeneous.

Clinical Characteristics

Age of Diagnosis: Sixty years old is the median diagnosis age.

Stage at Diagnosis: About 60% of patients are diagnosed with stage II cancer, and 22% with stage III cancer.

Histology: The most common histologic subtypes are squamous (29%) and spindle cell (21%).

Triple-Negativity: About two-thirds of patients have triple-negative breast cancer (TNBC).

Lymphovascular Invasion: Twenty-five percent of patients have lymphovascular invasion.

Distant Metastases: The most common distant metastases are to the lung (22%) and bone (13%).

Treatment and Survival

Surgery: 60% of patients undergo mastectomy.

Chemotherapy: 51% receive anthracycline-based chemotherapy, and 26% receive non-anthracycline chemotherapy.

Radiation: 58% of patients receive radiation therapy.

Endocrine Therapy: Endocrine treatment is given to 19% of patients.

Overall Survival (OS): The two-year OS rate is 79%, and the five-year OS rate is 69%.

Progression-Free Survival (PFS): The PFS rate is 72% for the first two years and 61% for the fifth.

Prognostic Factors: Stage III cancer, poor functional status, and distant metastases to the brain and lung are significant predictors of decreased OS.

Prognosis

Known for its aggressive nature, metastatic breast cancer typically has a poorer prognosis than non-metastatic breast cancer. Distinct poor prognostic factors include the stage of MBC, reduced performance status, and metastasis to the brain and lung.

Breast Cancer ICD10 Codes

The most relevant ICD-10 codes for breast cancer are:

  • C50 – Malignant neoplasm of breast
  • 0 – Nipple and areola malignant neoplasm
  • 1 – Breast cancerous tumor of the central region
  • 2 – Upper-inner quadrant breast malignant neoplasm
  • 3 – Lower-inner quadrant breast malignant neoplasm
  • 4 – Upper-outer quadrant breast malignant neoplasm
  • 5 – Lower-outer quadrant breast malignant neoplasm
  • 6 – Breast axillary tail malignant neoplasm
  • 8 – Breast cancerous neoplasm overlapping sites
  • 9 – Breast cancerous neoplasm of unknown site

These codes specify the location and characteristics of the breast cancer neoplasm. For example, C50.211 defines a malignant neoplasm of the upper-inner quadrant of the right female breast.

For visits for screening mammography for malignant neoplasm of the breast, the ICD-10 code Z12.31 is exclusively utilised. In this way, screening histories can be tracked and patients who might require more frequent screenings can be identified.

Other relevant codes include:

  • 0 – Positive status for estrogen receptor [ER+]
  • 1 – Negative status for estrogen receptor [ER-]
  • 0 – Consultation for radiation therapy for antineoplastic
  • 1 – Consultation for immunotherapy and antineoplastic chemotherapy

These codes help document the breast cancer type, screening, and treatment. The ICD-10 coding system provides a standardized way for healthcare professionals worldwide to record breast cancer diagnoses, procedures, and encounters.

FAQ’s

1: What type of collagen cause breast cancer?

The type IV collagen family is the one that is most important in the development of breast cancer. Specifically, several collagen types exhibit heightened expression in breast cancer tissues, including:

  • COL10A1: This particular collagen type is linked to a poor prognosis and is highly expressed in breast cancer.
  • COL11A1: It is also highly expressed in breast cancer and is linked to aggressive behavior and radiotherapy resistance.
  • COL1A1: This collagen type is overexpressed in breast cancer and contributes to the aggressive characteristics of breast cancer cells.
  • COL22A1: Although its expression is relatively low compared to other collagens, it is significantly different between tumor samples and paired normal tissue samples.
  • COL3A1: This collagen type is also overexpressed in breast cancer and is associated with poor prognosis.

On the other hand, some collagens exhibit low expression in breast cancer, including:

  • COL6A6: It is under expressed in breast cancer and is inversely associated with pathological stage, tumor stage, and lymph node metastasis.
  • COL4A3: This collagen type is also under expressed in breast cancer and is positively associated with a favorable prognosis.
  • COL17A1: Its higher expression levels are correlated with a favorable prognosis in breast cancer.

These collagens play significant roles in breast cancer progression, influencing crucial cellular processes such as proliferation, metastasis, apoptosis, and drug resistance.

2: Can dogs get breast cancer?

Yes, dogs can develop breast cancer, also known as mammary tumors. Mammary tumors are the most common form of cancer in female dogs, and they can be benign or malignant. The risk factors for developing mammary tumors in dogs include:

  • Size: Larger dogs are more likely to develop mammary tumors.
  • Breed: Certain breeds, such as Yorkshire Terriers, Poodles, and Maltese, are more prone to developing mammary tumors.
  • Housing: Dogs living outdoors or on farms are at a higher risk of developing mammary tumors.
  • Body Score: Overweight dogs are more likely to develop mammary tumors.
  • Reproductive Status: Spaying a female dog before her first heat cycle significantly reduces the risk of developing mammary tumors.

Symptoms of breast cancer in dogs include:

  • Bloody discharge or pus from the nipple
  • Multiple bumps
  • Painful or swollen breasts
  • Singular lumps
  • Ulceration
  • Yellow discharge or pus from the nipple
  • Systemic symptoms such as breathing difficulties, coughing, lameness, lethargy, loss of appetite, weakness, weight loss, and enlarged lymph nodes.

Diagnosis typically involves a fine needle biopsy of the tumor and lymph nodes, as well as imaging tests such as X-rays and ultrasound. Treatment usually involves surgery to remove the cancerous cells, and the earlier the tumor is removed, the better the prognosis.

3: How often is breast asymmetry cancer?

Breast asymmetry, whether physical or detected through mammograms, is not typically a direct indicator of breast cancer. However, there are some studies that suggest a correlation between breast asymmetry and breast cancer risk.

  • Physical Breast Asymmetry

Physical breast asymmetry, which is a visible difference in breast size or shape, is not usually a risk factor for breast cancer. While it can cause concern, further testing and lab results typically reveal no presence of breast cancer or underlying conditions that need treatment. Some women who have disparities in breast size and form may decide to have breast asymmetry surgery.

  • Mammographic Breast Asymmetry

Mammographic breast asymmetry, which is a difference in breast density as seen on a mammogram, is also not a direct indicator of breast cancer. If an asymmetry is detected, additional imaging tests are usually performed to rule out any potential breast cancer.

  • Statistical Correlation

Studies have found a positive correlation between breast asymmetry ratio over 20% and breast cancer risk. For example, one study showed that the breast volume asymmetry ratio over 20% was significantly higher in women with breast cancer compared to healthy women. The odds ratio (OR) for this correlation was 2.18, indicating that the chance of having breast cancer was about 2.18 times higher in women with asymmetry ratios over 20% compared to those with symmetry.

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