Breast Cancer
Breast CancerFaraza JavedM.Phil PharmacologyBreast CancerBreast
cancer is second only to lung cancer as a cause of cancer deaths in
women.
Cancer that has not spread is called in situ, meaning in place.
Cancer that has spread is called invasive or infiltrating.
PathophysiologyBreast cancer, like othercancers, occurs because
of an interaction between an environmental (external) factor and a
genetically susceptible host. About 90% of breast cancers are due
to genetic abnormalities that happen as a result of the aging
process and the wear and tear of life in general. The etiology of
breast cancer is still poorly understood with known cancer risk
factors explaining only a small proportion of cases.
Breast tissues consist mainly of fatty tissue interspersed with
connective tissue. Each tissue has 15 to 20 sections that are
termed as Lobes. Inside each lobe are many smaller structures
called Lobules/Ducts that contain mammary glands.
Oxygen, nutrients, and other life-sustaining nourishment are
delivered to breast tissue by the blood in the arteries and
capillaries.
Lymph ducts: Drain fluid that carries white blood cells (that
fight disease) from the breast tissues into lymph nodes under the
armpit.
Lymph nodes: Filter harmful bacteria and play a key role in
fighting off infection.
Three Types of Vessels
BacteriaNourishmentBloodVessels
Cell life2Waste
productsLymphNodesLymphVessels3MilkLobulesDuctsNipple1690% of cases
are reported with ductal carcinoma. Lobular carcinoma is very rare.
If cancer confines to duct it is benign or in situ but if move
beyond duct, termed as malignant or invasive.Genetic abnormality
due to any mutation allows the cells to divide more rapidly than
healthy cells do and may spread through the breast, to the lymph or
to other parts of the body (metastasize) e.g. lungs or liver.
It has also been observed that breast stromal cells can modulate
the growth of normal and neoplastic breast epithelial cells and can
secrete growth factors following stimulation by endogenous
hormones. The adipose tissues contain aromatase enzyme, which
produces oestradiol from circulating cholesterol. Because of the
higher proportion of these fat cells in breasts of older women, the
levels of oestradiol in are much greater than their plasma
levels.This probably accounts for the rising incidence of breast
cancer with ageing and supports the role of steroid hormones in the
pathogenesis of breast cancer.
Risk FactorsObesity AgeAlcohol ConsumptionHormone Replacement
TherapyIonizing RadiationHaving Children late or not at allHistory
of CancerGenetics (BRCA1, BRCA2, HER-2)
SymptomsLump in the breast tissueDimpling of skinSkin
irritationRed Scaly Patch on SkinSwollen Lymph NodesConstant Pain
in breast and armpit area
Diagnostic ParametersMammogram: A mammogram is a special type of
X-ray taken to look for abnormal growths or changes in breast
tissue.
Breast Ultrasound: An ultrasound can distinguish between a solid
mass, which may be cancer, and a fluid-filled cyst, which is
usually not cancer.
MRI: MRI may be used to find out how much the disease has grown
throughout the breast the tissue.
Biopsy: Removal of cells from a suspicious mass to see if its
cancer or not.
Positron Emission Tomography: PET may also be used to find out
whether the cancer has spread to organs.
Molecular Testing of Tumor: The standard tests to further
evaluate the cancer include estrogen receptor (ER), HER-2 tests.
The presence of these receptors helps determine the type of
treatment that is most likely to lower the risk of recurrence.
Generally, hormonal therapy works well for ER-positive cancers,
also called hormone receptor-positive cancers. If a persons tumor
does not have ER, the tumor is categorized as negative tumor
type.This type of cancer usually grows and spreads more quickly
than hormone receptor-positive disease.
TreatmentTheAmerican Joint Committee on Cancer(AJCC) and
theInternational Union against Cancer(UICC) recommendTNM staging.
Their TNM system, which they now develop jointly, classifies cancer
by several factors,Tfortumor,Nfornodes,Mformetastasis and helpful
to some extent in treatment approaches.Tdescribes the size of the
original (primary)tumorand whether it has invaded nearby
tissue,Ndescribes nearby (regional)lymphnodesthat are
involved,Mdescribes distantmetastasis(spread of cancer from one
part of the body to another).
The management of breast cancer depends on various factors,
including thestageof the cancer and the age of the patient. Breast
cancer is usually treated withsurgery, which may be followed by
chemotherapy or radiation therapy, or both. A multidisciplinary
approach is preferable.Hormone receptor-positive cancers are often
treated with hormone-blocking therapy over courses of several
years. Monoclonal antibodies, or other immune-modulating
treatments, may be administered in certain cases of metastatic and
other advanced stages of breast cancer.
1. SurgeryMastectomy: Removal of the whole tissue.
Lumpectomy: Removal of a small part of the tissue.
2. MedicationThere are currently three main groups of
medications used for adjuvant breast cancer treatment after
surgery.
Hormone Blocking Therapy: Some breast cancers require estrogen
to continue growing. These ER+ cancers can be treated with drugs
that either block the receptors, e.g.Tamoxifen, or alternatively
block the production of estrogen with anAromatase inhibitor,
e.g.Anastrozole orLetrozole. The use of tamoxifen is recommended
for 10 years.
Chemotherapy: Chemotherapy is predominantly used for cases of
breast cancer estrogen receptor-negative (ER-) disease. The
chemotherapy medications are administered in combinations, usually
for periods of 36 months.One of the most common regimens, known as
"AC", combinesAdriamycin(Doxorubicin)+ Cyclophosphamide. Another
common treatment is Cyclophosphamide+ Methotrexate+ Fluorouracil(or
"CMF").
Targeted Therapy:
Monoclonal Antibodies: Trastuzumab, a monoclonal antibody to
HER2 which is only effective in patients with HER2
amplification/overexpression.Bevacizumab (Avastin): Blocks
angiogenesis (the formation of new blood vessels) and is under
evaluation in clinical trials.Lapatinib: Tyrosine Kinase Inhibitor
only used to treat HER2 positive metastatic breast cancer.
3. RadiotherapyRadiotherapyis given after surgery to the region
of the tumor bed and regional lymph nodes, to destroy microscopic
tumor cells that may have escaped surgery.
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You can be a victim of cancer or a survivor of cancer. Its a
mindset.
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