BREAST CANCER

DEFINITIONBreast cancer is a malignant tumor that attacks the breast tissue. Breast tissue is

composed of milk glands, ducts glands, and tissues supporting the breast. Breast cancer cells and causes breast tissue to change shape become abnormal and multiply in an uncontrolled manner

Breast cancer is a group of abnormal cells in the breast that continues to grow in the form of a double. At the end of these cells to form in the breast bejolan. If the cancerous lump was not discarded or controlled, cancer cells can spread (metastasis) to other body parts. Metastases may occur in lymph nodes (lymph) armpit or above the shoulder blade. Besides cancer cells can be lodged in the bones, lungs, liver, skin, and subcutaneous

ETIOLOGIEtiology of breast cancer is not known specifically, but there are risk factors that can

cause breast cancer.Risk factor1. Age

This disease is more common in women aged over 50 years and is rare in women before menopause. Nearly 80% in the early diagnosis of breast cancer cell spread of cases occur in women over the age of 50 years or more, according to the American Cancer Society (ACS)

2. Family HistoryHaving a mother or sister who develop breast cancer or ovarian cancer increases the risk. The risk will be higher when the breast cancer experienced immediate family members (mother, sister, or daughter), especially if the cancer is attacked while they were under the age of 50 years.

3. Tested positive for the BRCA gene mutation associated with 1 or BRCA 2This condition significantly increases the chances of female or male breast cancer. For women who suffer from this gene, have a 80% chance of developing breast cancer, according to the ACS. Recent research has found other genes and gene mutations that may be associated with breast cancer. Several studies have shown nearly 200 mutations in genes that can cause breast cancer.

4. Health History Previous regarding breast conditionsThis includes convicted of breast cancer or affected by proliferative breast disease (PBD). Although known benign condition, PBD also developed into a fairly high risk of breast cancer. And again, after a previous biopsy to remove a benign tumor that turned suspicious, it could also increase slightly the risk of breast cancer

5. Ashkenazi Jewish descentThis population has enough offspring affected by breast cancer.

6. RaceBreast cancer is more common in white women, than other races, such as Latin, Asian, or African-american.

7. Exposed to Radiation In ChestFor patients who were treated for Hodgkin's lymphoma cope with chest radiation before age 30, the chance to develop into breast cancer is also greater than women who did not undergo this treatment.

8. The use hormonesHormone replacement therapy (generally done to deal with the symptoms menapouse) or other exposure to estrogen or progesterone increases the risk in women. Certain

types of breast cancer can develop as a result of the use of these hormones. Risk depends on the length of time the use of hormones. The longer the use, the higher the risk.

9. Breast densityWomen whose fat content in the body a little, dense breasts, it can increase the chances of developing breast cancer. Breasts tend to be more dense with age.

10. Reproductive Health HistoryWomen who give birth to children under age 30 have had a lower risk of developing breast cancer than women who give birth after 30 years or not having children at all.

11. Menstrual historyWomen who first experienced early menstruation (before age 12) or experienced menopause after age 55 are at increased risk of breast cancer is high.

12. By exposure to DES (diethylstilbestrol)Estrogen synthesis have been granted since the 1940s until the early 1970s to pregnant women. Unfortunately, DES is believed to increase the risk of cancer slowly. For many - years, DES can cause vaginal cancer (rare) or cervical cancer. New research shows that girls exposed to DES while in the womb are also at high risk of developing breast cancer.

13. Obesity After MenopauseWeight women who possess jumped significantly more estrogen in the body, because some hormones are made from fat tissue. When the amount of estrogen increased the risk of breast cancer also increases.

14. Moving lazyWomen who are physically inactive, have a high risk of developing breast cancer. This can occur because of lifestyle inactivity can lead to obesity, which is also a risk factor for breast cancer.

15. Alcohol consumptionSeveral studies have concluded that the more alcohol that is consumed women, the risk of breast cancer is greater. Analysis of the study suggest that limiting alcohol intake per day (min 2 cups) so as to reduce risioko breast cancer by 21%. The risk of this happening as a result of alcohol consumption because alcohol can increase the amount of the hormone.

16. SmokeSmoking significantly increases the risk of developing these illnesses, especially for women who have a family history of breast cancer

Breast Carcinoma Histopathological classification (WHO)a. Non-invasive (in situ) Carcinoma

Intraduktus carcinomaIntralobuler carcinoma

b. Invasive CarcinomaInvasive ductal carcinomaInvasive ductal carcinoma with predominant component intraduktusLobuler invasive carcinomaTubular carcinomaMedullary carcinomaPapillary carcinomaMucoid carcinomaAdenoid cystic carcinomaApocrine carcinoma

Squamous cell carcinomac. Paget Carcinoma

Classification according to Smeltzer, 20021. Infiltrating ductal carcinoma, is the most common histological types, constitute 75% of all

breast cancers. This cancer is very clear as hard when palpated. Usually metastasize to the axillary nodes, the prognosis is worse than in other types of cancer.

2. Infiltrating lobular carcinoma, a rare, 5% to 10% of breast cancers. This type is generally multisentris, thereby thickening can occur several sala some areas on one or both breasts.

3. Medullary carcinoma, occupies about 6% of breast cancers and grow in a capsule inside the duct.

4. Cancer occupies 3% of mucinous breast cancer. Mucus-producing, also grew at a slow pace so that this cancer has a better prognosis.

5. The tubular-ductal cancer is rare, about 2% of breast cancers.6. Inflammatory carcinoma cause symptoms tenderness and painful, will be hard and

enlarged breasts, biscuits above and dusky red tumor, often occur edema and retraction of the nipple.

7. Breast carcinoma in situ

PathophysiologyBreast cancer is a disease that occurs when genetic damage occurs in DNA from breast

epithelial cells. There are many types of breast cancer. Genetic alterations found in the epithelial cells, spreading into the duct or lobular tissue. The rate of growth of cancer depends on the effects of estrogen and progesterone. Cancer can be invasive (infiltration) and noninvasive (in situ). Or infiltration of invasive breast cancer can progress to the wall of the duct and surrounding tissue, so far that many cancers are invasive ductal carcinomas occur. Ductal carcinomas derived from the lactiferous ducts and shaped like tentacles that invade the surrounding breast structure. The tumor is usually unilateral, can not be described, solid, non-mobile, and nontender. Lobular carcinoma is derived from breast lobe. Usually bilateral and not palpable. Nipple carcinoma (Paget's disease) is derived from the nipple. It usually occurs with invasive ductal carcinoma. Bleeding, bloody, and hardening nipples (Lowdermilk et al 2000).

Breast cancer can invade surrounding tissue so as to have tentacles. Invasive growth pattern can produce irregular tumor can terapa palpation. At the time of developing tumors, fibrosis occurs around and shorten the Cooper's ligaments. When Cooper's ligaments shorten, resulting in peau d'orange (orange peel) skin changes and edema associated with breast cancer. If breast cancer attacks the lymphatic duct, tumors may develop in the lymph nodes, spleen axila usually attack nodes. Tumors can damage the skin layers, causing ulceration. Metastases caused by breast cancer and blood occupies lympa system, led to the development of tumors in bone, lung, brain, and liver (Lowdermilk et al, 2000, Swart 2011)

Stages of Breast Cancer- Phase I

Consisting of tumors less than 2 cm, not the lymph nodes, and no detectable metastases- Phase II

Consists of a tumor larger than 2 cm but less than 5 cm, with no fixed lymph node negative or positive, and no detectable metastases

- Phase IIIConsists of a tumor larger than 5 cm with lymph node positive fixed in clavicular area, and no evidence of metastasis

- Phase IVConsisting of tumors and in various sizes with normal lymph nodes or ksnkerosa, and the presence of distant metastases (Smeltzer, 2002)

Supporting investigationEarly detection is done to prevent the development of breast cancer. Kecilk breast tumors more easily treated if detected and the prognosis is better. Mendetaksi remedy examination of breast cancer, among others: (Breast Health UK, 2010, Swart 2011).a. Breast self-examination

Breast self-examination and clinical breast examination is inexpensive and non-invasive procedure for breast examination. If found abnormal indications, ie lump or thickening in the breast tissue, pain in one breast or armpit. One breast to be larger or lower, or the nipples are interested in changing positions, skin changes (contract), swelling under the armpit ayau collarbone, rash on or around the skin. If there are signs must be done three studies, the clinical breast examination, mammography or ultrasonography, and biopsy

b. MammographyMammography uses low-dose x-rays to make detailed images of the breast. Mammography can detect breast cancer at an early stage, can show lesions that can not be detected by clinical breast examination. There are 2 two types of mammography, screening and diagnostics. Breast screening is done in women without symptoms such as a lump in the breast or nipple discharge is found no breast self-examination or abnormality is found during screening mammography. Women with breast implants or a history of breast cancer using mammography diagnostics.

c. MRIMRI is used for some cases, namely: cases of breast cancer with mammography result is negative, to determine the size of the tumor in invasive lobular cancer, breast cancer for monitoring response to therapy preoreratif, there is discordance between the assessment of the initial assessment of the lump in the breast.

d. Digital infrarede. Positron Emission Tomography Scanning

PET scanning is used to identify lymph node metastases nonaxilary for advanced breast cancer and inflammatory breast cancer before starting a non-adjuvant therapy.

f. Genetic testsThe primary cause of inherited breast cancer is a mutation of the BRCA1 or BRCA2 genes, which is a risk factor for the development of other diseases. However, these genes are very rare in the population of women with breast cancer. This test has been done in the United States.

Stage Breast Cancer:1. Stage I: tumor less than 2 cm, no affected lymph nodes (LN) or widespread deployment.2. Stage IIa: tumor less than 5 cm, without LN involvement, no distant spread. Tumors less than 2 cm with LN involvement3. Stage IIb: tumor less than 5 cm, with the involvement of LN. Tumors larger than 5 cm without LN involvement4. Stage IIIa: tumor larger than 5 cm, with the involvement of LN. all tumors with LN exposed, no distant spread5. Stage IIIb: tumors with direct spread to the chest wall or skin tumors by edema of the hands or supraclavicular LN involvement.6. Stage IV: all tumors with distant metastases. (Setio W, 2000, hal : 285)

surgery1. Partial mastectomy (local tumor excision and radiation). Ranging from lumpectomy to segmental removal (removal of an extensive network with exposed skin).2. The total mastectomy with low axial dissection of the entire breast, lymph nodes dilateral otocpectoralis all minor.3. The modified radical mastectomyThe whole breast, all or most of the network of axial1) radical mastectomyThe entire breast, pectoralis major and minor muscles beneath it: the entire axial.2) extended radical mastectomyJust as radical mastectomy plus internal mammary lymph nodes.

Non surgery1. RadiationIn the breast and regional lymph nodes that can not be resected in advanced cancer; on bone metastases, axillary lymph node metastases.2. ChemotherapyAdjuvant systemic after mastectomy; palliative in advanced disease.3. Hormone therapy and endocrineCancer that has spread, taking estrogen, androgen, antiestrogen, coferektomi adrenalectomy hypophysectomy.(Smeltzer at all, 2002, page: 1596-1600)