Breast cancer: types, stages, treatment and getting a second opinion

What is breast cancer?

Breast cancer starts when cells in the breast begin to grow in an uncontrolled way. Most breast cancers begin in the milk ducts or in the milk-producing lobules. If the abnormal cells stay inside the duct, doctors speak of a non-invasive or "in situ" cancer; if they grow through the duct wall into the surrounding tissue, the cancer is called invasive and may spread to the lymph nodes under the arm and, less often, to other organs.

Breast cancer mainly affects women, particularly after the age of 50, but younger women and men can also develop it. Many changes in the breast are not cancer at all – benign lumps, cysts and hormonal changes are far more common, as explained on our page about benign breast lumps. Any new lump or change should nevertheless be checked by a doctor promptly; the early warning signs are described in our guide to breast cancer symptoms.

Types of breast cancer

Pathologists classify breast cancer by where it starts and by the biological features of the cells. These details guide the treatment plan.

• Ductal carcinoma in situ (DCIS): abnormal cells confined to the ducts. It is non-invasive and is often found on a screening mammogram.
• Invasive ductal carcinoma (also called invasive breast cancer of no special type): the most common form.
• Invasive lobular carcinoma: begins in the lobules and can be harder to feel or see on a mammogram.
• Inflammatory breast cancer: a rare, fast-growing type that makes the breast red, swollen and warm, often without a distinct lump.
• Paget’s disease of the nipple: a rare form that appears as a scaly, itchy or crusted nipple.

Receptor status

The tumour is also tested for hormone receptors (oestrogen and progesterone, "ER" and "PR") and for the HER2 protein. Cancers can be hormone receptor-positive, HER2-positive, or "triple negative" when none of these three are present. This profile strongly influences which medicines will work best, and it is one of the first things a second-opinion team will look at in your pathology report.

Breast cancer stages

Staging describes how large the tumour is and how far it has spread. Doctors usually use the TNM system (tumour size, lymph nodes, metastasis), combined with the grade and receptor status.

• Stage 0: non-invasive cancer such as DCIS.
• Stage 1 and 2: early breast cancer – a smaller tumour, with or without a limited number of affected lymph nodes.
• Stage 3: locally advanced cancer – a larger tumour or more extensive lymph node involvement.
• Stage 4: metastatic cancer that has spread to other parts of the body, such as bones, liver or lungs. It is treated to control the disease and protect quality of life, often for many years.

Staging uses imaging (mammography, ultrasound, sometimes MRI, CT or bone scans) and the biopsy result. The tumour grade (1 to 3) describes how quickly the cells appear to be growing. Your oncology team will explain exactly what your stage means for you; general figures never replace that individual discussion.

Breast cancer treatment options

Treatment is planned by a multidisciplinary team – breast surgeon, medical oncologist, radiation oncologist, radiologist, pathologist and, when needed, a plastic surgeon. Most patients receive a combination of treatments, and the order depends on the type and stage.

Surgery

Breast-conserving surgery (lumpectomy or wide local excision) removes the tumour with a margin of healthy tissue; a mastectomy removes the whole breast. The lymph nodes are checked with a sentinel node biopsy or, in some cases, an axillary clearance.

Chemotherapy

Medicines that destroy cancer cells throughout the body. They may be given before surgery (neoadjuvant) to shrink the tumour, or after surgery (adjuvant) to lower the risk of recurrence.

Radiotherapy

Usually recommended after breast-conserving surgery and sometimes after mastectomy, to treat any remaining cancer cells in the breast area.

Hormone (endocrine) therapy

For hormone receptor-positive cancers, tablets such as tamoxifen or aromatase inhibitors are often taken for several years.

Targeted therapy and immunotherapy

HER2-positive cancers are treated with HER2-targeted medicines; other targeted drugs and immunotherapy are used for selected cancers according to current international guidelines.

Reconstruction and life after treatment

Many women who need a mastectomy can have breast reconstruction, either at the same operation or later. After breast-conserving surgery, a reduction or lift on the other side can restore symmetry; see our page on breast asymmetry. Follow-up visits and regular imaging continue for years, and if you have implants it is useful to read about mammography with implants.

Fatigue, worries about body image and changes in intimacy are common after treatment. Specialist nurses, support groups and psychological support are an important part of recovery, wherever you are treated. Gentle exercise, a balanced diet and not smoking support general health during and after treatment.

Treatment and a second opinion in Istanbul

Some patients from the UK, Ireland and elsewhere look abroad because of waiting times, or simply want a second opinion on a proposed plan. A second opinion does not replace your local team: it is a review of your scans, biopsy report and treatment plan by another experienced team, and it can either confirm the plan or raise useful questions to take back home.

At New City Clinic’s oncology service in Istanbul, medical oncologists, breast surgeons and plastic surgeons work together in Ministry of Health-accredited hospitals. You can read more in the article Breast cancer in Turkey: second opinion and reconstruction on newcityclinic.com.

Please do not delay diagnosis or treatment while you look for options. If you have a new symptom, see your GP or local breast clinic first; a second opinion is most useful once you have a biopsy result and imaging.

How New City Clinic can help

Send your reports, imaging and pathology results via WhatsApp or the contact form. A medical coordinator will arrange a free online review, explain the options in plain English and, if you decide to come to Istanbul, organise appointments at our accredited partner hospitals, interpreters, transfers and accommodation. Your local doctors remain part of your care, and we can share a written summary with them.