Breast cancer

VERY BASIC INTRODUCTION FOR NON MEDICAL STUDENTS

1. Breast Cancer & Awareness Presenter : Saloni Chawla

2. WHAT IS BREAST CANCER ? Breast cancer is a malignant tumor that starts from cells of the breast. A malignant tumor is a group of cancer cells that may grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. The disease occurs almost entirely in women, but men can get it, too . Centre For Medical Physics , Panjab University.

3. Known Risk Factors Women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of getting a disease. Some risk factors (such as drinking alcohol) can be avoided. But most risk factors (such as having a family history of breast cancer) cannot be avoided. Having a risk factor does not mean that a woman will get breast cancer. Many women who have risk factors never develop breast cancer. Centre For Medical Physics , Panjab University.

4. TYPES A tumor is a mass of abnormal tissue. There are two types of breast cancer tumors: Non-Cancerous/ Benign. Cancerous/Malignant. Metastatic cancer is when cancer cells of a malignant tumor spread to other parts of the body, usually through the lymph system and form a secondary tumor Centre For Medical Physics , Panjab University.

5. BREAST ANATOMY Women and men both have breasts, but women have more breast tissue than men. The breasts contain mammary glands. Only the mammary glands in women can make milk to feed a baby. They are divided by an invisible line running up and down and right to left through the nipple . Each of these 4 regions is called a quadrant. Most breast cancers develop in the upper outer quadrant of the breast, closest to the armpit. This is because this area has a lot of glandular tissue. Centre For Medical Physics , Panjab University.

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7. Parts of the breast Structure Each breast lies over a large muscle (called the pectoralis major muscle) on the chest. The breast covers a fairly large area. It goes from just below the collarbone (called the clavicle) to the armpit (called the axilla) and across to the breastbone (called the sternum ). The breast is made up of fat, connective tissue, glands and ducts. Ligaments  are dense bands of connective tissue that support the breast. They run from the skin through the breast and attach to muscles on the chest. Lobules  are the groups of glands that make milk. There are 15–25 lobules in each breast. The glands make milk when they are stimulated by hormones in a woman’s body during pregnancy .(oxytocin) Centre For Medical Physics , Panjab University.

8. Ducts  are tubes that carry milk from the lobules to the nipple . The nipple  is the area at the centre of the areola with an opening to release milk. The nipples contain muscle fibres. When these muscle fibres contract, the nipple becomes erect, or pointed outward . The areola  is the pink or brown, circular area around the nipple on the surface of the breast. It contains small glands that release, or secrete, an oily substance that acts as a lubricant for the nipple and areola. Centre For Medical Physics , Panjab University.

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10. The Lymphatic System of the Breast The breast has many blood vessels and lymph vessels. Lymph vessels are thin tubes similar to blood vessels. They collect and move lymph fluid away from the breast into small bean-shaped masses of lymphatic tissue (called lymph nodes) around the breast. The lymph vessels and lymph nodes are part of the  lymphatic system Lymphatic system is t he group of tissues and organs that produce and store cells that fight infection and diseases., which helps fight infections . Centre For Medical Physics , Panjab University.

11. Lymph Nodes There are several groups of lymph nodes that drain each breast and are found on both sides of the body. The supraclavicular lymph nodes  are above the collarbone. The infraclavicular , or subclavicular , lymph nodes  are below the collarbone. The internal mammary lymph nodes  are inside the chest around the breastbone (called sternum). Centre For Medical Physics , Panjab University.

12. The axillary lymph nodes  are under the arm (called the axilla). There are about 30–50 lymph nodes in the axilla. They are divided into 3 levels based on how close they are to the large muscle of the chest (called the pectoralis major ). When breast cancer spreads, it usually spreads to level I lymph nodes, then to level II and then to level III . Level I, or low axilla , are along the outer border of the muscle under the pectoralis major (called the pectoralis minor) Level II, or mid axilla, are beneath the pectoralis minor. Level III, or high axilla , are along the inner border of the pectoralis minor. Centre For Medical Physics , Panjab University.

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14. Menstruation and Menopause Estrogen and P rogesterone cause changes to the breast tissues each menstrual cycle. In the first part of the menstrual cycle, Estrogen stimulates the milk ducts to make them grow. Progesterone takes over in the second part of a woman’s menstrual cycle. It stimulates the glands in the lobules so they are ready to make milk if a woman becomes pregnant. After menopause, the ovaries don’t make E strogen and progesterone so breasts don’t go through these monthly changes . Centre For Medical Physics , Panjab University.

15. Biomarkers Estrogen receptor (ER) and progesterone receptor (PR).  Cancer cells sometimes use hormones in the body to grow, so it is important to know if this is true for each patient. Breast cancer cells that have ER and/or PR depend on estrogen and/or progesterone to grow. Testing for ER and PR can find out whether treating a cancer with hormonal therapy may work. Centre For Medical Physics , Panjab University.

16. Biomarkers Human epidermal growth factor receptor 2 (HER2).   HER2 is a protein found in all breast cells, but at different amounts. When a breast cell has an abnormally high level of HER2, it can drive breast cancer growth and spread. Testing for HER2 helps doctors know if a cancer can be treated with anti-HER2 treatments. Centre For Medical Physics , Panjab University.

17. Prognosis And Survival For Breast Cancer A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with the medical history, the type, stage and characteristics of your cancer, the treatments chosen and the response to treatment can put all of this information together to arrive at a prognosis . Centre For Medical Physics , Panjab University.

18. Newly Diagnosed Breast Cancer The following are prognostic and predictive factors for breast cancer when it is first found and diagnosed. Stage Size of tumor If it has spread to lymph nodes Age at diagnosis HER 2 Status ER/PR Status Centre For Medical Physics , Panjab University.

19. Ductal Carcinoma Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and in situ means "in its original place." DCIS is called "non-invasive" because it hasn’t spread beyond the milk duct into any normal surrounding breast tissue. DCIS isn’t life-threatening, but having DCIS can increase the risk of developing an invasive breast cancer later on . DCIS generally has no signs or symptoms. A small number of people may have a lump in the breast or some discharge coming out of the nipple Centre For Medical Physics , Panjab University.

20. Centre For Medical Physics , Panjab University. Most women received either a lumpectomy (with or without radiation therapy) or a single or double mastectomy.

21. Invasive Ductal C arcinoma Invasive means that the cancer has “invaded” or spread to the surrounding breast tissues . Ductal  means that the cancer began in the milk ducts, which are the “pipes” that carry milk from the milk-producing lobules to the nipple . IDC, sometimes called infiltrating ductal carcinoma, is the most common type of breast cancer. About 80% of all breast cancers are invasive ductal carcinomas. Centre For Medical Physics , Panjab University.

22. Signs And Symptoms Often , an abnormal area turns up on a screening mammogram (X-ray of the breast), which leads to further testing. S welling of all or part of the breast S kin irritation or dimpling B reast pain , nipple pain or the nipple turning inward Redness or thickening of the nipple or breast skin A nipple discharge other than breast milk A lump in the underarm area Centre For Medical Physics , Panjab University.

23. Normal breast with invasive ductal carcinoma (IDC ) Breast profile: A  Ducts B  Lobules C  Dilated section of duct to hold milk D  Nipple E  Fat F  Pectoralis major muscle G  Chest wall/rib cage Enlargement A  Normal duct cell B  Ductal cancer cells breaking through the basement membrane. C  Basement membrane Centre For Medical Physics , Panjab University.

24. Inflammatory Breast Cancer Inflammatory breast cancer develops when cancer cells block the lymph vessels . A tube through which lymph fluid travels in the body  in the skin of the breast. It is called inflammatory because the breast becomes red and swollen. Inflammatory breast cancer develops more often in younger women. Inflammatory breast cancer is rare and aggressive, which means that it grows and spreads quickly. In most cases, it has already spread to the lymph nodes or other organs when it is diagnosed. Centre For Medical Physics , Panjab University.

25. Symptoms A change to the colour of the skin on at least one-third of the breast. The skin becomes very red or purplish in colour. A swollen breast, dimpled or pitted skin that looks like an orange peel . Thickened skin or breast tissue An increase in the size of the breast Changes to the nipple such as a nipple that suddenly starts to point inward. Tenderness or pain in the breast Itching or burning A lump in the armpit (called the axilla), or near the collarbone Centre For Medical Physics , Panjab University.

26. Note The symptoms of inflammatory breast cancer are very similar to the symptoms of infection in the breast tissue (called mastitis), which is more common in breastfeeding women. Doctors may prescribe antibiotics to treat mastitis, but waiting for the antibiotics to work may delay the diagnosis of inflammatory breast cancer. As a result, it is often diagnosed at an advanced stage. Inflammatory breast cancer is considered stage IIIB breast cancer, or locally advanced breast cancer, which means that it has started to grow into surrounding tissues. Centre For Medical Physics , Panjab University.

27. Diagnosis Physical exam Clinical breast exam Diagnostic mammography Biopsy Hormone receptor status testing HER2 status testing Centre For Medical Physics , Panjab University.

28. Treatments Radiation therapy Chemotherapy Targeted therapy Surgery Prognosis and survival Inflammatory breast cancer has a lower survival rate than other types of breast cancer. According to US statistics for 1988–2001, the 5-year relative survival for women with inflammatory breast cancer is 34%. This means that, on average, women diagnosed with inflammatory breast cancer are 34% as likely to live 5 years after their diagnosis as people in the general population. Centre For Medical Physics , Panjab University.

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30. Mastitis Mastitis is an infection in the breast. It most commonly affects women who are breastfeeding, but less often it affects women who are not breastfeeding. A clogged milk duct, not fully draining milk from the breast, or breaks in the skin of the nipple can lead to infection. This causes the body’s white blood cells to release substances to fight the infection, which can lead to swelling and increased blood flow. The infected part of the breast may become swollen, painful, red, and warm to the touch. The woman may also have fever and a headache, or general flu-like symptoms . Centre For Medical Physics , Panjab University.

31. Treatment Mastitis is treated with antibiotics. In some cases, a breast abscess (a collection of pus) may form. Abscesses are treated by draining the pus, either by surgery or by using a needle (often guided by ultrasound), and then antibiotics.  NOTE : Inflammatory breast cancer has symptoms that are a lot like mastitis and can be mistaken for an infection. If you’ve been diagnosed with mastitis and antibiotic treatment doesn’t help within a week or so, you might need a skin biopsy  to be sure it’s not cancer. Inflammatory breast cancer can spread quickly, so don’t put off going back to the doctor if you still have symptoms after antibiotic treatment. Centre For Medical Physics , Panjab University.

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33. How does mastitis affect your risk for breast cancer? Having mastitis does not raise your risk of developing breast cancer . Centre For Medical Physics , Panjab University.

34. Gynecomastia ( E nlarged Breasts in Males ) It is a common disorder of the endocrine system in which there is a non-cancerous increase in the size of male breast tissue.  Most adolescent boys, up to 70%,have some breast development during puberty . New born and adolescent males often experience temporary gynecomastia due to the influence of maternal hormones and hormonal changes during puberty, respectively Gynecomastia may be seen in individuals with  Klinefelter Syndrome or certain cancers, with disorders involving the E ndocrine system or metabolic dysfunction, with the use of certain medications, or in older males due to a natural decline in  testosterone production Centre For Medical Physics , Panjab University.

35. Disturbances in the endocrine system that lead to an increase in the ratio of estrogens/androgens are thought to be responsible for the development of gynecomastia . This may occur even if the levels of estrogens and androgens are both appropriate but the ratio is altered . Centre For Medical Physics , Panjab University.

36. Physiological Many new born infants of both sexes show breast development at birth or in the first weeks of life . During pregnancy, the  placenta converts the androgen hormones DHEA and DHEA sulfate  to the estrogenic hormones  estrone and estradiol, respectively A fter these estrogens are produced by the placenta, they are transferred into the  baby's circulation thereby leading to temporary gynecomastia in the baby .  In some infants neonatal milk (also known as witch's milk ) can be secreted . The temporary gynecomastia seen in new born babies usually resolves after two or three weeks . Gynecomastia in adolescents usually starts between the ages of ten and twelve and commonly goes away after eighteen months . Centre For Medical Physics , Panjab University.

37. Physiological and Non P hysiological Gynecomastia in adolescents usually starts between the ages of ten and twelve and commonly goes away after eighteen months .  Increased fatty tissue in these men leads to increased conversion of androgenic hormones such as testosterone to estrogens . When the human body is deprived of adequate nutrition , testosterone levels drop while the adrenal glands continue to produce estrogens thereby causing a hormonal imbalance. Approximately 10–25% of cases are estimated to result from the use of medications . This is known as non-physiologic gynecomastia. Centre For Medical Physics , Panjab University.

38. Medications Anti-androgens used to treat prostate enlargement, prostate cancer and some other conditions. Examples include flutamide , finasteride ( Proscar , Propecia ) and spironolactone ( Aldactone ). Anabolic steroids and androgens. AIDS medication Anti-anxiety medications, such as diazepam Antibiotics Centre For Medical Physics , Panjab University.

39. Street Drugs and Alcohol Substances that can cause gynecomastia include: Alcohol Amphetamines Marijuana Heroin Methadone Centre For Medical Physics , Panjab University.

40. Gynecomastia Centre For Medical Physics , Panjab University.

41. NOTE Klinefelter syndrome  ( KS ) also known as  47,XXY  or  XXY , is the set of symptoms that result from two or more X chromosomes in males .  The primary feature is  sterility . Often symptoms may be subtle and many people do not realize they are affected. Sometimes symptoms are more prominent and may include weaker muscles, greater height, poor coordination, less body hair, smaller genitals, breast growth, and less interest in sex. Centre For Medical Physics , Panjab University.

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43. MYTHS AND FACTS Myth : Most breast cancers run in families. Fact : Only 5% to 10% of breast cancers are thought to be hereditary, which means they are caused by abnormal genes passed from parent to child. The other 90% are largely due lifestyle and environmental factors . Myth : There is nothing you can do to lower your risk of developing breast cancer. Fact:90% of breast cancers are largely due to lifestyle and environmental factors. To keep your risk as low as it can be, maintain a healthy weight, exercise regularly, and limit the amount of alcohol you drink. Centre For Medical Physics , Panjab University.

44. Myth : Regular mammograms prevent breast cancer. Fact : Mammograms don’t prevent breast cancer, but they can save lives by finding breast cancer as early as possible, when it’s most treatable. Myth : Antiperspirants cause breast cancer. Fact : There is no scientific evidence to support the claim that antiperspirants cause breast cancer, either because of toxin build up or aluminium exposure. Centre For Medical Physics , Panjab University.

45. NGO’s in INDIA Centre For Medical Physics , Panjab University.

46. Bibliography CANADIAN CANCER SOCIETY AMERICAN CANCER SOCIETY www.breastcancer.org https:// en.wikipedia.org/wiki/Gynecomastia www.cancer.org Centre For Medical Physics , Panjab University.