DOWN SYNDROME!

Dear All, since we are doing down syndrome for next week, it is of the utmost importance that we prepare before we come for PCL... dam formal right.. AHHAHA...

JUST READ THIS LA! (: ITS REALLY GOOD!

DOWN SYNDROME WEBSITES -
http://www.ndss.org/
http://www.yourgenesyourhealth.org/ds/whatisit.htm
http://www.nlm.nih.gov/medlineplus/downsyndrome.html
http://www.nichd.nih.gov/publications/pubs/downsyndrome.cfm#ADiagnosis

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

Ways to prevent breast cancer

There is no sure way to prevent breast cancer. But there are things all women can do that might reduce their risk and help increase the odds that if cancer does occur, it is found at an early, more treatable stage.

a. Lowering your risk:

Risk can be lowered by changing those risk factors that can be changed.

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

ü Weight gain in midlife, independent of BMI, has been shown to significantly increase breast cancer risk. Additionally, and elevated BMI has been conclusively shown to increase the risk of post-menopausal breast cancer.

2. Minimize or avoid alcohol.

ü Alcohol use is the most well established dietary risk factor for breast cancer.

ü The Harvard Nurses' Health study, along with several others, has shown consuming more than one alcoholic beverage a day can increase breast cancer risk by as much as 20-25 percent.

3. Consume as many fruits and vegetables as possible.

ü Eat seven or more servings of all cruciferous vegetables (broccoli, cabbage, brussels sprouts, cauliflower) ; dark leafy greens (collards, kale, spinach) ; carrots and tomatoes daily. The superstar fruits include citrus, berries and cherries.

ü Note: it is best to eat cruciferous vegetables raw or lightly cooked, as some of the phytochemicals believed to offer protection against breast cancer are destroyed by heat.

4. Exercise regularly the rest of your life.

ü Many studies have shown that regular exercise provides powerful protection against breast cancer.

5. Do your fats right!

ü Minimize consumption of omega-6 fats (sunflower, safflower, corn and cottonseed oils), saturated fats and trans fats.

ü Maximize your intake of omega-3 fats, especially from oily fish (salmon, tuna, mackerel, sardines, lake trout and herring).

ü Consume monounsaturated oils (canola, olive oil, nuts/seeds, avocados) as your primary fat source, as these foods have potential anticancer properties.

6. Do your carbs right!

ü Minimize consumption of the high glycemic index, white flour, white rice, white potatoes, sugar and products containing them.

ü These foods trigger hormonal changes that promote cellular growth in breast tissue.

ü Replace these carbs with whole grains and beans/legumes. Beans/legumes because of their high fiber and lignan content are especially special.

7. Consume whole food soy products regularly

ü Only consume organic, non-GMO (genetically modified) soy. Epidemiologic studies have shown a positive association between soy consumption and reduced breast cancer risk.

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

ü Do not take prescription estrogens unless medically indicated.

ü Also avoid estrogen-like compounds found in environmental pollutants, such as pesticides and industrial chemicals.

ü Buy organic produce if you can afford it; otherwise, thoroughly wash all non-organic produce.

ü Minimize exposure to residual hormones found in non-organic dairy products, meat and poultry.

9. Take your supplements daily.

.

10. Maintain a positive mental outlook.

ü Engage in self-nurturing behaviors regularly. Develop rich, warm and mutually beneficial relationships with family and friends. Get adequate sleep (7-8 hours per night). The mind-body associations with breast cancer are significant.

b. Finding breast cancer early:

Other than lifestyle changes, the most important action a woman can take is to follow early detection guidelines.

Reference:

http://womenshealth.about.com/od/cancerprevention/a/10stepsprevbcan.htm
http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_breast_cancer_be_prevented_5.asp