breast cancer

Breast Cancer and You

What is Cancer

CancerCancer is the abnormal, uncontrollable , continuous replication of cells which will

inevitably lead to the formation of a tumor.

Breast Cancer

Breast cancer

Forms in the tissues of the

breast

Spreads mainly through the

Lymphatic system

1. Chest wall.

2. Pectoral muscles.

3. Lobules (glands that make milk).

4. Nipple surface. 5. Areola.

6. Lactiferous duct tube that carries milk to the nipple

7. Fatty tissue.

8. Skin.

THE NORMAL BREAST

THE LYMPHATIC SYSTEM

Lymphatic System which consists of vessels and

organs plays two vital roles in our lives:

1) The vessels essentially maintain interstitial fluid levels by carrying excess fluids as well as any plasma proteins, back into the CVS.

2) The organs, house critical immune cells such as lymphocytes which carry out our body defense against infection.

THE LYMPHATIC SYSTEM

Most of the lymph vessels of the breast drain into:

Lymph nodes under the arm (auxiliary nodes).

Lymph nodes around the collar bone (supraclavicular and infraclavicular lymph nodes)

Lymph nodes inside the chest near the breast bone (internal mammary lymph nodes)

THE LYMPHATIC SYSTEM

BREAST TUMORS

Malignant

Cancerous

Benign

Not - Cancerous

BENIGN TUMORS

Not cancerous.

Benign breast tumors are abnormal growths, but they do not spread outside of the breast and they are not life threatening.

BENIGN TUMORS

Most lumps are caused by the combination of cysts and fibrosis

Cysts are fluid-filled sacs.

Fibrosis is the formation of scar - like tissue.

These changes can cause breast swelling and pain.

Breast Cancer

Breast cancer is a malignant (cancerous) tumor that starts in the cells of the breast. It is found mostly in women, but men can get breast cancer, too.

Breast Cancer Invasive

Cancerous Malignant Spreads to other

organs (metastasis)

Non - Invasive

Pre – Cancerous Still in its original

position Eventually

develops into invasive breast cancer.

Invasive Breast Cancer

Breast Cancer

The inner lining of milk ducts.

Ductal Carcinoma

The lobules – Milk producing

glands.

Lobular Carcinoma

TYPES OF BREAST CANCER

DuctalCarcinoma

Invasive Ductal Carcinoma

Ductal Carcinoma in situ (DCIS)

InflammatoryBreast Cancer

(IBC)

Lobular

Carcinoma

Invasive Lobular

Carcinoma

Lobular Carcinoma in situ (LCIS)

INFLAMMATORY BREAST CANCER (IBC)

Uncommon (1% to 3% of all breast cancers)

Invasive Brest Cancer.

No lump or tumor.

Mistaken for infection in its early stages.

INFLAMMATORY BREAST CANCER (IBC)

IBC makes the skin of the breast look red and feel warm.

It also may make the skin look thick and pitted and may have an orange peel feel.

The breast may get bigger, hard, tender, or itchy

INFLAMMATORY BREAST CANCER (IBC)

INFLAMMATORY BREAST CANCER (IBC)

DUCTAL CARCINOMA IN SITU (DCIS)

Non – invasive

contained within the milk ducts .

May become invasive (pre – cancer).

DUCTAL CARCINOMA IN SITU (DCIS)

Picture

INVASIVE (OR INFILTRATING) DUCTAL CARCINOMA (IDC)

Most common breast cancer. Accounts for about 8 out of 10 invasive breast

cancers.

Lining of the ducts Grows /invades the breast

tissues

Spreads to lymph nodes

Other organs

INVASIVE (OR INFILTRATING) DUCTAL CARCINOMA (IDC)

LOBULAR CARCINOMA IN SITU (LCIS)

Non – Invasive.

Contained in the lobules and does not spread to the tissues of the breast.

May become malignant .

LOBULAR CARCINOMA IN SITU (LCIS)

picture

INVASIVE (INFILTRATING) LOBULAR CARCINOMA (ILC)

About 1 in 10 Invasive breast cancers are ILC.

Formed in the lobules.

Grows through the wall of the lobules.

Spreads

INVASIVE (INFILTRATING) LOBULAR CARCINOMA (ILC)

Factors that contribute to Breast Cancer

RISK FACTORS

Risk factors increases your chances of having breast cancer but does not causes it.

Breast cancer results from the abnormal, uncontrollable replication of cells of the breast.

RISK FACTORS

Risk Factors

Modifiable uncontrollable

factors factors

FACTORS THAT CONTRIBUTES TO BREAST CANCER

Gender

Age

Genetic risk factors

Family history

Personal history of breast cancer

FACTORS THAT CONTRIBUTES TO BREAST CANCER

Race/ethnic background

Dense breasts tissue

Certain benign (not cancer) breast problems

Menstrual periods

Breast radiation early in life

FACTORS THAT CONTRIBUTES TO BREAST CANCER

Gender: more prevalent in women.

One (1) in every 150 cases (MALE).

Age: The chance of getting breast cancer goes up as a woman gets older.

Over 80% of all female breast cancers occur among women aged 50+ years

Genetic risk factor: Women who carry the BRCA1 and BRCA2

genes have a considerably higher risk of developing breast cancer.

Family history: Breast cancer risk is higher among women whose close blood relatives have this

disease.

Personal history of breast cancer: A woman with cancer in one breast has a

greater chance of getting a new cancer in the other breast or in another part of the same

Race/Ethnic background:

Overall, white women are slightly more likely to get breast cancer than African-American women.

African-American women, though, are more likely to die of breast cancer.

Asian, Hispanic, and Native-American women have a lower risk of getting and dying from breast cancer.

Dense breast tissue: Dense breast tissue means there is more gland tissue and less fatty tissue.

Certain benign (not cancer) breast problems:

Women who have certain benign breast changes may have an increased risk of breast cancer.

Menstrual period: Women who began having periods early (before age 12) or who went through the change of life (menopause) after the age of 55 have a slightly increased risk of breast cancer.

Breast radiation early in life: Women who have had radiation treatment to the chest area as a child or young adult have a greatly increased risk of breast cancer.

FACTORS THAT CONTRIBUTES TO BREAST CANCER

Not having children or having them later in life.

Certain kinds of birth control Using hormone therapy after

menopause Not breastfeeding Alcohol Being overweight or obese

FACTORS THAT CONTRIBUTES TO BREAST CANCER

Tobacco smoke: Smoking may increase the risk of breast cancer.

Night work: A few studies have suggested that women who work at night have a higher risk of breast cancer.

FACTORS NOT LINKED TO BREAST CANCER

Antiperspirant

Bras

Induced Abortion

Breast implants

Preventing

Breast Cancer

RISK FACTORS

PREVENTION Alcohol consumption

Physical exercise

Diet

Postmenopausal hormone therapy

Bodyweight

Breast cancer screening

Breastfeeding

Signs and

Symptoms

SIGNS AND SYMPTOMS OF BREAST CANCER

A lump in a breast.

A pain in the armpits or breast that does not seem to be related to the woman's menstrual period.

Pitting or redness of the skin of the breast; like the skin of an orange.

A rash around (or on) one of the nipples.

SIGNS AND SYMPTOMS OF BREAST CANCER

A swelling (lump) in one of the armpits.

An area of thickened tissue in a breast.

One of the nipples has a discharge; sometimes it may contain blood

SIGNS AND SYMPTOMS OF BREAST CANCER

The nipple changes in appearance; it may become sunken or inverted.

The size or the shape of the breast changes.

The nipple-skin or breast-skin may have started to peel, scale or flake.

SIGNS OF BREAST CANCER

SYMPTOMS AND SIGNS

Diagnosis

METHODS OF DIAGNOSIS

Diagnostic tests and procedures for breast cancer include:

Breast exam Mammograms Breast ultrasound Imaging

tests Breast MRI scan Biopsy

BREAST EXAMS

Clinical Breast Breast - Self

Exam(CBE) Exam (BSE)

CLINICAL BREAST EXAMS

Women in their 20s and 30s should have a clinical breast exam every 3 years.

After age 40, women should have a breast exam every year

BREAST - SELF EXAM

BSE is an option for women starting in their 20s.

Any changes detected should be reported to a medical expert.

BSE: Conducted standing or reclining

BREAST IMAGING TECHNIQUES

MAMMOGRAMS

An x-ray of the breast. It uses a very small amount of radiation.

Mammograms

screening diagnosis

screening mammograms diagnostic mammogram

MAMMOGRAMS A technologist will position your breast for

the test. The breast is pressed between 2 plates to

flatten and spread the tissue. The pressure lasts only a few seconds

while the picture is taken. The breast and plates are repositioned and

then another picture is taken. The whole process takes about 20 minutes.

BREAST ULTRASOUND

Uses sound waves to outline a part of the body.

The sound wave echoes are picked up by a computer to create a picture on a computer screen.

Used to investigate areas of concerns found by a mammogram.

BREAST ULTRASOUND

MRI (Magnetic Resonance Imaging)

Use magnets and radio waves.

Cross-sectional images of the body.

MRI scans can take a long time.

Used if view areas of concern found on a mammogram.

BREAST MRI

Patients must lie inside a narrow tube, face down on a special platform.

The platform has openings for each breast that allow the image to be taken without pressing on the breast.

Contrast material may be injected into a vein to help the MRI show more details.

BIOPSY

A biopsy is done when other tests show that you might have breast cancer.

It confirms if a mass is cancerous or not.

Mass is removed and studied.

TYPES OF BREAST BIOPSY

Fine needle aspiration (FNA) biopsy

Core needle biopsy

Vacuum-assisted biopsies

Surgical (open) biopsy

Lymph node biopsy

FINE NEEDLE ASPIRATION (FNA) BIOPSY

Very fine needle is used.

Extracts fluid from the lump.

Guided by ultrasound.

simple but is not 100% accurate.

CORE NEEDLE BIOPSY

Needle is larger than in fine needle biopsy.

Removes more tissues.

Clearer results.

VACUUM-ASSISTED BIOPSIES:

Done with systems such as ATEC® (Automated Tissue Excision and Collection)

Guided by MRI

First the skin is numbed and a small cut (incision) is made.

A hollow probe is put through the cut into the breast tissue.

A piece of tissue is sucked out.

SURGICAL (OPEN) BIOPSY

Anesthesia is administered.

Incision is made.

Part or whole lump is extracted and studies.

LYMPH NODE BIOPSY

Removal of lymph nodes

Surgical biopsy

Removal of fluids

Needle biopsy

EXAMINATION OF BREAST TISSUES

Tissues obtained during biopsy are examined to determine:

Malignant or Benign Type Invasive or Non - invasive Size Has it metastasized Is the lymph nodes affected Treatment

FACTORS CONSIDERED DURING AN EXAMINATION

Breast cancer grade

Hormone receptor status

HER2/neu status

Breast cancer grade:

If a biopsy sample is cancer, it is given a grade from 1 to 3.

A lower grade number means a slower-

growing cancer, while a higher number means a

faster-growing cancer.

The grade helps predict the outcome.

Hormone receptor status:

Hormone receptors are proteins in cells that can attach to hormones.

Estrogen and progesterone are hormones that fuel breast cancer growth.

Breast cancers are tested for hormone receptors. If the tumor has them, it is often called ER-positive, PR positive,

About 2 out of 3 breast cancers have at least one of these receptors.

HER2/neu status:

About 1 out of 5 breast cancers have too much of a protein called HER2/neu.

Tumors with increased levels of HER2/neu are called HER2-positive.

These cancers tend to grow and spread faster than other breast cancers

TESTS TO FIND WHETHER THE CANCER HAS SPREAD

Chest x-ray: the lungs.

Bone scan: the bones.

CT scan (computed tomography): the chest and/or abdomen.

MRI : brain and spinal cord.

Ultrasound: other parts

STAGING OF BREAST CANCER

The TNM staging system

This system takes into account:

the tumor size and spread (T), whether the cancer has spread to lymph

nodes (N) and whether it has spread to distant organs

(M) for metastasis

STAGING OF BREAST CANCER

Sage 0

Stage l

Stage ll

Stage lll

Stage lV

STAGING OF BREAST CANCER

Sage 0 : Non – Invasive breast cancer. Has not spread to breast tissues.

Stage l : ≤ 2cm and has not spread to lymph nodes.

Stage ll

Stage llA: ≤ 2 cm and has spread to lymph nodes or

2-5 cm and has spread to lymph nodes.Stage llB: 2-5 cm and has spread to lymph nodes

or> 5 cm and has not spread to lymph nodes.

STAGING OF BREAST CANCER

Stage lll

Stage lllA: ≤ 5cm and spread to lymph nodes forming clumps or >5 cm and spread to lymph nodes without forming clumps.

Stage lllB: Any size and spread to the skin or chest wall. Swelling.

Stage lllC: Any size , spread to lymph nodes, skin and chest wall.

Stage lV: Metastasized

SURVIVAL RATES

Treatment

THE TREATMENT OF BREAST CANCERS WILL DEPEND ON VARIOUS FACTORS

The type of breast cancer

The stage and grade of the breast cancer - how large the tumor is, whether or not it has spread, and if so how far

Whether or not the cancer cells are sensitive to hormones

The patient's overall health

The age of the patient

The patient's own preferences

THE MAIN BREAST CANCER TREATMENT OPTIONS MAY INCLUDE:

Surgery

Radiation therapy

Biological therapy (targeted drug

therapy)

Hormone therapy

Chemotherapy

SURGERY Surgery for breast cancer: Lumpectomy Mastectomy

Lymph node surgery: Sentinel node biopsy Axillary lymph node dissection

Breast reconstruction surgery

LUMPECTOMY

Breast-conserving surgery (BCS) or partial/segmented mastectomy.

Surgically removing the tumor and a small margin of healthy tissue around it.

Followed by radiation therapy

MASTECTOMY

Surgically removing the breast and other infected components.

Mastectomy

A simple mastectomy.

A Radical mastectomy.

Modified radical mastectomy.

MASTECTOMY

Simple mastectomy : removing the lobules, ducts, fatty tissue, nipple, areola, and some skin.

Modified radical mastectomy: simple mastectomy combined with the removal of the axillary lymph nodes.

Radical mastectomy: a simple mastectomy combined with removing the lymph nodes and muscles of the chest wall.

SIDE EFFECTS OF BREAST SURGERY

Pain after the surgery and the change in the shape of the breast.

Wound infection, build-up of blood and build-up of clear fluid in the wound.

If axillary lymph nodes are removed swelling of the arm and chest may occur

(Lymphedema).

LYMPH NODE SURGERY

Axillary lymph node dissection: about 10 to 40 lymph nodes are removed.

Usually done at the same time as the mastectomy or breast-conserving surgery.

Sentinel lymph node biopsy: is used to determine if cancer has spread to the lymph nodes under the arm without removing many of them.

A blue dye/radioactive substance is injected in order to identify the sentinel lymph nodes which drains lymph from the tumor.

They are then removed.

Lymph node surgery

SIDE EFFECTS OF LYMPH NODE SURGERY

Pain, swelling, bleeding, and infection

Swelling in the arm or chest (Lymphedema).

Lymphedema is mostly due to axillary lymph node biopsy.

RECONSTRUCTIVE OR BREAST IMPLANT SURGERY

Surgical procedures aimed at recreating a

breast so that it looks as much as possible like the other breast.

The surgeon may use a breast implant, or tissue from another part of the patient's body.

ADJUVANT AND NEOADJUVANT THERAPY

Adjuvant therapy: After surgery Combat metastasis. Chemotherapy and hormone therapy.

Neo-adjuvant therapy: Before surgery Reduce tumors Radiation therapy

RADIATION THERAPY FOR BREAST CANCER

Radiation therapy is treatment with high-energy rays (such as x-rays) or particles to kill cancer cells.

The patient may require three to five sessions per week for three to six weeks.

The type of breast cancer will determine the type of radiation therapy used.

TYPES OF RADIATION THERAPHY

Breast radiation therapy – applied after a lumpectomy,.

Chest wall radiation therapy – applied after a mastectomy

Breast boost - a high-dose of radiation therapy is applied to where the tumor was surgically removed.

TYPES OF RADIATION THERAPHY

Lymph nodes radiation therapy - aimed at the axilla and surrounding area to destroy cancer cells that have reached the lymph nodes

TYPES OF RADIATION THERAPHY

Brachytherapy

radiation to the breast by place radioactive seeds (pellets) into the breast tissue.

The most common type brachytherapy used to treat breast cancer is called intracavitary brachytherapy.

A device is put into the space left from breast-conserving surgery, a source of radiation is then placed in the device for a short time and then removed.

SIDE EFFECTS OF RADIATION THERAPHY

Swelling and heaviness in the breast.

Sunburn-like changes in the skin and feeling very tired.

Weakness .

Damage some of the nerves to the arm. This can lead to numbness, pain, and weakness in the shoulder, arm and hand.

Radiation to lymph nodes causes (Lymphedema).

CHEMOTHERAPY Chemotherapy (chemo) is the use of cancer-

killing drugs.

Intravenously, given as a shot, or taken as a pill or liquid.

They enter the bloodstream and reach most parts of the body.

Combats metastasis.

Damage some normal cells.

WHEN IS CHEMO ADMINISTERED?

Before surgery: neoadjuvant chemo

After surgery: adjuvant chemo

HOW IS CHEMO GIVEN?

Doctors give chemo in cycles. The time between cycles is most often 2

or 3 weeks.

For early-stage breast cancer, the total course of treatment usually lasts for 3 to 6 months.

For advanced breast cancer chemo is often continued as long as it is working.

SIDE EFFECTS

The side effects of chemo depend on: the type of drugs used the amount given and the length of treatment.

SIDE EFFECTS

Short – term side effects

· Hair loss · Loss of appetite or increased appetite · Nausea and vomiting · A higher risk of infection (low WBC

count) · Stopping of menstrual periods · Easy bruising or bleeding (low platelets) · Being very tired

SIDE EFFECTS

Long - term side effects

Menstrual changes: infertility

Nerve damage: pain, burning or tingling and sensitivity to cold or hot.

Heart damage

HORMONE THERAPY FOR BREAST CANCER

Used for breast cancers that are sensitive to hormones.

These types of cancer are often referred to as ER positive (estrogen receptor positive) and PR positive (progesterone receptor positive) cancers.

Estrogen and progesterone promotes cancer growth.

HORMONE THERAPY FOR BREAST CANCER

Drugs used to block estrogen

Tamoxifen Toremifene (Fareston®) Fulvestran

HORMONE THERAPY FOR BREAST CANCER

Drugs used to change hormone levels:

Aromatase inhibitors (AIs): stop fat tissue from making estrogen after menopause

Luteinizing hormone-releasing hormone (LHRH) analogs: shuts down the ovaries.

TARGETED THERAPY FOR BREAST CANCER

Drugs that target HER2

HER2: protein that increase cancer growth.

· Trastuzumab (Herceptin): IV · Pertuzumab (Perjeta®): IV · Ado-trastuzumab emtansine (Kadcyla™) · Lapatinib (Tykerb): pill

SIDE EFFECTS

· Mouth sores · Diarrhea · Nausea · Fatigue · Feeling weak or tired · Low blood counts · Shortness of breath · Cough

The End