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Stage II Breast Cancer indicates that the cancer is growing, and it may still be contained in the breast or is growing and extending to nearby lymph nodes. Stage II breast cancer is further categorised into two sub-stages; Stage IIA and Stage IIB. The differing factors that deviate the two stages are, firstly the size of the tumor, and secondly the distance and development of the lymph nodes. In Stage IIA, the tumor is small, approximately 0 - 2 cm, and has not yet spread to or is in the initial period of spreading to the lymph nodes. In Stage IIB, the tumor has grown and is larger than what it was in Stage IIA, about 2 – 5 cm. In this stage, the cancer could either not yet be growing in the lymph nodes, or, has spread and is present in the lymph nodes.

Breast Cancer is the most frequently diagnosed cancer and leading cause of death in females worldwide. Moreover, one in eight women in the USA, and one in eleven women in Australia, will develop invasive breast cancer throughout their life.

Risk Factors
Research has demonstrated that the risk for breast cancer is a result of a combination of factors. There are two types of risks when it comes to Breast Cancer, there are risks that you cannot change such as; age and family history. Then, there are risks factors that you can change such a bad diet. However, these risk factors will not affect all individuals the same way and not all these risk factors have the same effect. One individual may have a few of the risk factors and be diagnosed with breast cancer while the other individual may have many risk factors and not be diagnosed with it.

Risk Factors that are unchangeable:


 * Being a woman
 * Age
 * Family history
 * Genetics
 * Having dense breasts
 * Personal history of breast cancer
 * Menstrual history
 * Breastfeeding history
 * Radiation to face or chest before the age of 30Diagram showing the network of lymph nodes in and around the breast CRUK 315.svg

Risk factors that can be changed:


 * Being overweight or obese
 * Smoking cigarettes
 * Drinking alcohol
 * Reproductive history
 * Hormone intake
 * Unhealthy diet
 * Diethylystillbestrol (DES) exposure
 * Low Vitamin D levels
 * Being physically inactive

Signs and Symptoms
The most commonly known sign of breast cancer is the physical lump present in the breast muscle. The size of this lump, mass of the tumour and growth of the lymph nodes are the major factors which distinguishes between Stages I and II of Breast Cancer. Stage II Breast Cancer tumors are much larger in comparison to Stage I, because the cancer cells have become more aggressive and grown. This means the physical lump in the breast is more visible. Additionally, in Stage II, the cancer has grown and spread to the lymph nodes. In stage II, it is evident that the axillary lymph nodes are significantly larger. The severity of Breast Cancer can be distinguished by several factors, including:


 * Size of the tumour.
 * Growth rate of the tumour.
 * Location of the tumour in the breast.

Other physical symptoms of Stage II Breast Cancer include:


 * Breast or nipple pain.
 * Redness of the breasts.
 * Nipple discharge.
 * Breast dimpling.
 * Skin discolouration around the breasts.
 * Swelling of the breasts.



Investigation and Diagnosis
There are several procedures that assist doctors in determining the different ways to diagnose breast cancer as well as determining the severity of each case. The diagnosis is always a procedure that goes through three stages otherwise known as triple assessments. This involves:


 * Clinical examination
 * Histopathology
 * Imaging.

Clinical Examination:
The first clinical examination involves a breast exam. This test is done by a doctor, checking both of the breasts and lymph nodes by feeling for any abnormalities or lumps in the area.

Histopathology:
Histopathology

Imaging:
The second way to diagnose is a breast ultrasound. An ultrasound works by observing the sound waves to view images deep within the body, as well as viewing the breast tissues and structures. This type of procedure identifies whether a fluid-filled cyst lump or a solid mass lump is present in the breast.

Another procedure is a mammogram. This test is an X-ray of breast tissue that can detect changes too small to be identified during the breast exam. This test is commonly used to check for breast cancer in women who don’t appear to show any of the signs and symptoms of breast cancer. If an abnormality is identified by the mammogram, a diagnostic mammogram is used to further evaluate the case.

Management and Treatment
The management and treatment of breast cancer is dependent on the staging, extent and spread of the cancer cells. In most cases of Stage II Breast Cancer, drug therapy is an essential part of treatment.

This can include chemotherapy radiation, Hormone Replacement Therapy (HRT), or targeted therapy drugs, such as HER2 for positive patients. Doctors and practitioners will determine which drugs should be used based on what will work best to suppress the tumour and the hormone receptor status.

Another common treatment used for Stage II Breast Cancer is surgical procedures. Surgical procedures are beneficial in removing the entire cancer from the breast and axillary nodes, some surgeries include a mastectomy, or a Breast-Conserving Surgery (BCS). A mastectomy works by removing the entire breast tissue in the breast containing the cancer, and thus completely removing the cancer. The BCS, also known as a lumpectomy or a partial mastectomy refers to an operation which will only remove the cancer from the breast tissue, without having to perform a mastectomy. Furthermore, in Stage II Breast Cancer, if the cancer cells have potentially spread to the lymph nodes, invasive tests can be performed to investigate further. These tests involve either a Sentinel Lymph-Node Biopsy (SLNB), or an Axillary Lymph-Node Dissection (ALND).

Outcome and Prognosis
It is difficult to determine the prognosis of a patient as treatments and survival rates are constantly changing, hence affecting the accuracy of the estimation that can be given. Additionally, each individual is different and it is challenging to generalise a prognosis. However, an estimation can be made based on the large groups of people being diagnosed over the years with breast cancer. In order to determine the prognosis, there are factors that need be considered such as the grade and the stage of the cancer as well as the hormone receptor (HRT) status.

There are computer programs that doctors use online to estimate prognosis. It is estimated by collecting data about the individuals case and their breast cancer alongside data from various research studies. The data is then demonstrated by viewing the estimated survival rates after the diagnosis as well as the survival benefits from each treatments. Another way to estimate the prognosis is the Nottingham Prognostic Index (NPI). This is a scoring system to improve patient outcome for breast cancer, it weighs several factors such as size, grade and stage of the cancer to categorise the prognosis. The categories are excellent, good, moderate or poor. In each of the categories there is an estimation of the survival rates (5-10 years) of individuals after diagnosis.