Summary

Summary:

1) Pathophysiology of breast cancer

Breast cancer means uncontrolled growth of breast cells (which forms tumours), as a result of mutations/abnormal changes in the genes responsible for regulating the growth of cells and keeping them healthy.

The two broad categories of genes affected by genetic changes:

a) Oncogenes (expression of these genes promote the malignant phenotype of cancer cells)

b) Tumour suppressor genes (BRCA 1 and BRCA- involved in the repair of damaged DNA, play a role in maintaining the stability of the human genome )

Common form of breast cancer :
-Ductal Carsinoma In Situ (DCIS)
Ductal epithelial cells undergo malignant transformation and proliferate intraluminally.

-Lobular Carsinoma In Situ (LCIS)
↑ in the no. of cells within the lobules

-Infiltrating Ductal Carsinoma (invasive)
Tendency to metastasize via lymphatics

-Infiltratiltrating Lobular Carsinoma (invasive)
Begins in lobules , able to metastasize (lymph nodes)

Less common form of breast cancer :
-Tubular Carcinoma
Forms distinct boundary between tumor tissue and normal tissue.

-Mucinous Carcinoma
Mucus-producing cancer cells

-Medullary Carcinoma
Poorly differentiate tumor

-Inflammatory breast cancer
Inflamed breast

-Paget’s disease of the nipple
Nipple changes, No lump is felt

-Phylloides tumor
Develop in the connective tissues of the breast.
Treated by surgical remove.

2) Risk factors of breast cancer

- General risk factors:

a) Gender

b) Aging

c) Genetic risk factors

d) Family history of breast cancer

e) Race and ethnicity

f) Personal history of breast cancer

g) Dense breast tissue

h) Certain benign breast conditions

i) Menstrual periods

j) Previous chest radiation

- Lifestyle related factors:

a) Not having children, or having them later in life

b) Recent oral contraceptive use

c) Using post-menopausal hormone therapy

d) Not breast-feeding

e) Alcohol

f) Being overweight or obese

g) Lack of physical activity

Ways to prevent breast cancer

1. Maintain a healthy body weight (BMI less than 25) throughout your life.

2. Minimize or avoid alcohol.

3. Consume as many fruits and vegetables as possible.

4. Exercise regularly the rest of your life.

5. Do your fats right!

6. Do your carbs right!

7. Consume whole food soy products regularly

8. Minimize exposure to pharmacologic estrogens and xeno-estrogens.

9. Take your supplements daily.

10. Maintain a positive mental outlook.

11. Follow early detection guidelines.

3) Genetics of breast cancer

Main Genes related to Breast Cancer:
1) BReast CAncer gene 1 (BRCA1)
>Provides instruction in repairing damaged DNA.
>Regulate activities of other genes
>Involve in embryonic development
>Regulate cell division
>Mutation
*Unable to help repair damaged DNA
*Unable to fix mutation

2) BReast CAncer gene 2 (BRCA2)
>Provides instruction in repairing damaged DNA.
>Maintaining the stability of a cell’s genetic information
>Regulate cytokinesis

4) Management and Investigation

Screening:

a) Screening Test (ST)- for healthy people

Clinical breast examination, screening mammogram, breast self examination

b) Diagnostic Test (DT)- for people suspected of breast cancer

Clinical breast exam, diagnostic mammograms, ultrasound, MRI, biopsy, hormone receptor test

Staging:

Stage 0 – carcinoma in situ (abnormal cells remain in the tissue where they first formed)

Stage 1 – early stage of invasive breast cancer (<>

Stage 2 – size of tumours, spread to lymph nodes under the arm?

<2cm>
2-5cm No
2-5cm Yes
>5cm No

Stage 3 - locally advanced cancer (spread from where it started to nearby tissue or lymph nodes)

3A - < / > 5 cm across, spread to underarm lymph nodes, and those behind of breastbone

3B – grown into chest wall / skin of the breast, spread to underarm lymph nodes and those behind of breastbone, inflammatory.

3C – any size, spread to lymph nodes behind breastbone and under the arm, above or below the collarbone.

Stage 4 – distant metastatic cancer

Treatment:

1) Breast sparing surgery (remove lump only)

2) Mastectomy

Simple - removal of whole breast, some lymph nodes under arm removed removed

Radical - removal of whole breast + most/all lymph nodes under arm, lining over the chest muscles is often removed.

3) Radiation Therapy

4) Chemotherapy – anticancer drugs used to kill cancer cells

5) Hormone Therapy – lower the amount of hormone in body OR block action of estrogen on body

6) Targeted Therapy – helps immune system fight cancer

Care after Treatment:

1) Breast reconstruction - using implants (saline or silicon or both), or either the stomach or back muscles

2) External Prostheses – made of silicon gel

3) Follow up treatment – regular checkups for emotional wellbeing and support, mammograms, clinical exam