The Penncrest

High School Medical Scholars

Club

Breast Cancer

-The older a woman, the more likely she is to get breast cancer

-Young women can get breast cancer, even in their 20s

-White women are more likely to get breast cancer than women of any

other racial or ethnic group

- African American women are more likely to die from breast cancer

than white women

- Out of every one hundred cases of breast cancer, one will occur in a

man.

THINGS YOU PROBABLY DON’T KNOW ABOUT BREAST CANCER

• being a woman

• getting older

• having an inherited mutation in the BRCA1 or BRCA2

breast cancer gene

• lobular carcinoma in situ (LCIS)

• a personal history of breast or ovarian cancer

• a family history of breast, ovarian or prostate cancer

• having high breast density on a mammogram

• having a previous biopsy showing atypical hyperplasia

• starting menopause after age 55

• never having children

• having your first child after age 35

• radiation exposure, frequent X-rays in youth

• high bone density

• being overweight after menopause or gaining weight

as an adult

• postmenopausal hormone use (current or recent use)

of estrogen or estrogen plus progestin

Risk Factors

Symptoms• Breast/ armpit lump

• Bloody/clear nipple discharge

• Breast size/shape change

• Inverted or retracted nipple

• Scaling/flaking of the nipple/ breast skin

• Breast appears to be red

• Armpit swelling

• Nipple pain

• Unusual breast pain

Diagnostics

Detection & DiagnosisBreast cancer can begin in different areas of the breast – the ducts, the lobules, or in some cases, the tissue in between.

Breast cancer is often first suspected when a lump or change in the breast is found or when an abnormal area is seen on a mammogram.

Most of the time, these findings do not turn out to be cancer. However, the only way to know for sure is through follow-up tests.

Over the past 20 years, great progress has been made in the early detection and treatment of breast cancer. As a result, the number of breast cancer survivors continues to rise.

There are over 2.9 million survivors in the United States today (more than any other group of cancer survivors).

Self Exam• This routine exam is quick and easy and can

be done to look for anomalies in front of the mirror and while in the shower.

• The exam can be done as follows: apply light pressure to the surface of the breast and then apply firmer pressure in order to assess deeper tissues. This is done to find lumps or abnormally thick areas of the breast.

• Any discrepancies would require attention from a physician to determine if the lumps are benign or malignant.

Clinical Exam • The clinical exam is essential in detecting and

diagnosing breast cancer.

• After reaching 20 years old, it is recommended that a clinical exam be done every three years to be aware of any changes that may occur that can lead to cancer.

• The physician will ask questions and then begin the exam. The exam will require the patient to be topless as to allow the physician to look and feel for anomalies. The breasts as well as the crucial underarm area will be examined for rashes, lumps, indentations, or discharge. By the end, the physician will determine hether extra steps or further examination is necessary.

Mammogram• This special x-ray is designed to check the

breasts from multiple angles for areas of possible tissue/cyst build up.

• In the image, breast tissue appears white and opaque while fatty tissues are darker and translucent.

• Mammograms are especially helpful in targeting specific lumps and following the progress of suspicious growths.

Ultrasound• Can determine whether something is a cyst

or a mass that may be cancer

• Possible cysts have fluid excreted from them using a needle & a syringe. If clear fluid is removed, no further evaluation is necessary.

• Can be used to find the exact location of a possible or known tumor

MRI• Not a test to determine whether cells/tissues

are benign or malignant (like a biopsy)

• May detect tumors in dense breast tissues

Biopsy • The removal of cells or tissues due to

suspicion

• These cells and/or tissues are examined microscopically

• Only way to determine if a suspicious spot is benign or malignant

Ductal Lavage• A type of screening tool that is used to

detect breast cancer in women of high risk

• Cells are collected from the milk ducts of the breast for analysis

• If caught early, cancer will confine itself to a single duct before moving onto another

Penncrest High School

Types of breast cancer

Ductal Carcinoma in SITU Non-invasive cancer

where abnormal cells are found in the lining of the breast milk duct

It is a very early cancer that is highly treatable

Cancer does not spread unless left undetected or untreated

Invasive Ductal Carcinoma (IDC)

- Abnormal cancer cells begin to form in the milk ducts and will eventually spread to other tissue within the breast.

Facts: -IDC is the most common

cancer making up 70-80% of all breast cancer diagnosis.

-IDC is the breast cancer that affects men.

Triple Negative Breast Cancer

Triple Negative Breast Cancer means the three most common types of receptors known to fuel most breast cancer growth(estrogen, progesterone, and the HER-2/neu gene)are not present in the cancer tumor

Common treatment such as hormone therapy or drugs that target estrogen, progesterone, and HER-2/neu are not effective.

Chemotherapy is viewed as an effective treatment

Breast Cancer During Pregnancy Pregnancy does not cause

breast cancer but you can start to show your symptoms while pregnant.

The most common solution to breast cancer during pregnancy is a lumpectomy or a mastectomy.

Metastatic Breast CancerMetastatic breast

cancer is also classified as Stage 4 cancer. This means that the cancer has spread to other parts of the body. Including the bones, brain, liver, and the lungs

Cells can also break away from

the primary, or main tumor and

spread to other parts of the

body. The cells spread by

traveling through the blood

stream and/or lymphatic

system. This process is called

metastasis.

Growth of Breast Cancer

To grow, malignant breast

tumors need to be fed. They

get nourishment by

developing new blood

vessels in a process called

angiogenesis. The new blood

vessels supply the tumor

with nutrients that promote

growth. As the malignant

breast tumor grows, it can

expand into nearby tissue.

This process is called

invasion.

Growth of Breast Cancer

Stages of Breast CancerCancer Spreads

-Surrounding tissues -Lymph Nodes -BloodTesting

-Lymph Node Biopsies-Chest X-Rays-CT Scans 

-Stages-I-II-III-IV

Stages ctd… grows into surrounding tissues, travels through lymph vessels, or

travel through blood by veins and capillaries. Various tests, such as lymph node biopsies, chest x-rays, and CT

scans, can reveal how advanced the disease state has become. If the tumor is less than two centimeters is or smaller, the disease

is classified as stage I. Stage II tumors are two and five centimeters in size and has

spread to one to three lymph nodes, OR there are no affected lymph nodes but the tumor is greater than five centimeters.

Stage three breast cancer is diagnosed when the cancer is larger than five centimeters has spread to up to nine lymph nodes.

Stage four, most advanced stage of breast cancer, is defined as when the disease state has advanced to involving parts of the body other than the breast

Mastectomy versus lumpectomy (breast conserving surgery) plus radiation and overall survival in early breast cancer

Radiation therapy following mastectomy and overall survival in stage II & III breast cancer

Adjuvant chemotherapy and overall survival

Different adjuvant chemotherapy combinations and overall survival in early breast cancer

Tamoxifen and overall survival in estrogen receptor-positive breast cancer

Aromatase inhibitors and disease-free survival in early breast cancer

Lumpectomy plus radiation therapy in the treatment of ductal carcinoma in situ (DCIS)

High-dose chemotherapy with stem cell transplant for women with metastatic breast cancer and for women with non-metastatic breast cancer at high risk for recurrence

Neoadjuvant (preoperative) hormone therapy for women with estrogen receptor-positive breast cancer

Various Treatment Types

Uses medicine to target and destroy cancerous cells

Affects the whole body because it passes through the bloodstream

Can be used for both early and advanced-stage cancers

Chemotherapy

Tamoxifeno Generic name is Nolvadexo its a SERM

They act on estrogen receptors like agonists and antagonists do• Agonist• attach to a receptor of a cell and promotes action• Antagonist• attaches to the receptor of a cell and blocks the agonistsSERM

effect on receptors varies from tissue so they can inhibit or stimulate estrogen like action in tissues

Tamoxifen…ctd.Is given to breast cancer patients after surgery or chemotherapy and radiation to reduce the risk of it coming back (40% to 50% in postmenopausal women and by 30% to 50% in premenopausal women)

Only effective on hormone receptor positive/early stage breast cancera pill given once a day ( recommended that it should be taken at the same time everyday) and taken for 3-5 years

can shrink the hormone receptor positive breast cancer even before surgery

has other benefits like lowers cholesterol

TamoxifenSIDE EFFECTS

• increased tumor or bone pain

• hot flashes

• nausea

• fatigue

• mood swings

• depression

• headache

• hair thinning

• constipation

• dry skin

• loss of libido

The patient is examined through linear accelerator containing a cat scan, to determine where to target high levels of radiation on the breast cancer cells, using seed or pellets.

There are two types of radiationExternal Radiation: Delivers high doses of

radiation to breast cancer cells from a machine outside the body.

Internal Radiation: Delivers high doses of radiation from implants placed directly into or near a breast tumor.

Radiation

Radiation causes irritation, redness, and or dryness to the treated area.

Another side effect is fatigue, especially after couple weeks after the the treatment

Radiation Side Effects

Hormonal therapy is using medicine to block of hormones to prevent cancer cells from spreading.

Two most common hormone therapiesSERMs (Selective Estrogen Receptor Modulators)

Targets estrogen hormones at the breast cancer cells to prevent the growth of the cells

Tamoxifen is a commonly-used hormone therapy used to prevent breast cancer recurrence.

Hormone therapy is also used for post-menopausal women at high risk for developing breast cancer.

Aromatase Inhibitors These drugs stop the reproduction of estrogen

hormones by binding to the enzyme which produces of estrogen

Then cancer cells starve from the lack of estrogenNOT effective on hormone receptive breast cancers

Hormonal Therapy

This type of therapy can causes hot flashes; vaginal discharge, dryness and irritation; irregular periods; decreased sex drive; and mood changes.

Aromatase inhibitors may also cause joint and muscle pain, as well as an increased risk of bone thinning.

Hormonal Therapies Side Effects

There are four types of surgery that a patient can under go Lumpectomy

Removal of only tumor and possible surrounding tissueAlso known as breast-conserving surgery

Partial or segmental mastectomy or quadrantectomyRemoves more breast tissue than LumpectomyRadiation is given off after surgery

Total MastectomyRemoval of the entire breast but no lymph nodes are

removedThis process is usually used for treat in-situ, microinavasive,

or stage IA breast cancers. Radical mastectomy

All breast tissue is removed, and lymph nodes are also sampled Many people need breast reconstruction immediately or delayed

after the surgery

Surgery

Treatment that targets specific characteristics of cancer cells

Less likely to harm normal cells than chemotherapy

Should not be used by pregnant women5 known target therapies used by doctors

Herceptin, Tykerb, Avastin, Perjeta, and Afinitor

Targeted Therapies

Powerful Diagnostic Tool--Decoding Genomes• Recently developed

• Sequence of patients' genome of the cancer cells

• Increased accuracy of treatment

• Beneficial to the patients and their families

Study #1• 39-year-old female

o Acute myeloid leukemia (AML)

• Standard diagnos testo Stem cell transplanto Diagnostic dilemma

• Genoma sequence testo Chemotherapy with ATRA

• 6 weeks, $40,000

Study #2• Female

o Breast cancer-age 37o Ovarian cancer-age 39o Ovarian tumor returned-age 42

• Genome sequencing allowed precautions take for family

Progress for the Future• "These cases of personalized genomic

medicine are just some of the first examples of what will likely be commonplace in the near future." - Boris Pasche, MD, PhD, of the University of Alabama in Birmingham

• As technology is enhanced, cost and time will decrease

• More than 300 cancer patients and their tumors

There are steps you can take that may reduce

your risk. These include:

maintaining a healthy weight

exercise

limiting alcohol intake

avoid postmenopausal hormones,

For women at risk of estrogen-receptor

positive breast cancer.

taking tamoxifen or raloxifene may

reduce the risk

PREVENTION & RISK FACTORS

Gene Therapy

October 2012 marks the 28th anniversary of Breast Cancer Awareness Month, a time to not only reflect on those who have lost their battle to the disease, but also to encourage its prevention.

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