2. CANCER and BREAST
Cancer is a condition
where body cells grow up
and divide unmanageably;
occupying and destroying
the healthy tissue
(MALIGNANT)
RISK FACTORS:
-Gender
-Age
-Family History
-High hormone levels: HRT, menstrual problems...
-Obesity
-Alcohol
(1)
(2)
(3)
3. TYPES OF BREAST CANCER
NON-INVASIVE
(IN SITU)
INVASIVE OTHERS
LOBULAR DUCTAL
LOBULAR DUCTAL PAGET’S
DISEASE OF
NIPPLE/AREOLA
INFLAMMATORY
RARE
TYPES
MEN
DIAGNOSIS (TRIPLE ASSESSMENT):
-PALPITATION
-RADIOLOGY (ULTRASOUND, MAMMOGRAPHY, MRI)
-FINE-NEEDLE ASPIRATION
Estrogen and progesterone
receptor statuses are also
important for classification and
treatment
(1)
(4)
(10)
4. PATHOLOGY
-p53, BRCA1(chromosome 17), BRCA2(chromosome 13)
mutations in error-correcting proteins
-PI3K/AKT, RAS/MEK/ERK apoptosis prevention pathways
mutation-“on”
MOST COMMON: INVASIVE DUCTAL CARCINOMA (~70% OF CASES)
(1)
(3)
(8)
(8)
(9)
5. STAGE 0 Non-invasive cell malformations
STAGE 1 Tumour ≤2cm, Invasive breast cancer, early stage, invasion limited to breast
STAGE 2 2A -Tumour absent/ Tumour ≤2cm, cancer present in axillary lymph nodes, no
spread to body
-2cm≤ Tumour ≤5cm, no cancer in axillary lymph nodes, no spread to body
2B - 2cm≤ Tumour ≤5cm, cancer present in lymph nodes, no spread to body
-Tumour >5cm, no cancer in axillary lymph nodes, no spread to body
STAGE 3 3A -Tumour absent/ 2cm≤ Tumour ≤5cm/ Tumour >5cm , cancer present in
axillary and may be in lymph nodes near sternum
3B -Any size tumour, cancer present in skin or chest wall, cancer present in
axillary lymph nodes or lymph nodes near sternum
3C -Any size tumour, cancer spread to lymph nodes near clavicle, , cancer
present in axillary lymph nodes or lymph nodes near sternum
STAGE 4 Spread to body (metastasis )
STAGES OF BREAST CANCER
TYPICAL PRESENTATION: MASS IN BREAST, WITHOUT ANY PAIN
(1)
(3)
(5)(6)(7)
6. IMPACT ON INDIVIDUAL AND SOCIETY
INDIVIDUAL
Emotions
Body image
Sexuality
Relationships
Motivation
Activity
Self-esteem
Concentration
Shame
Stigma
DEPRESSION
SOCIETY
Isolation
Psychological
Economic
FAMILY AND FRIENDS
Emotional
Physical
Economic
IMPROVEMENT: INCREASE AWARENESS
(38)
(1)
7. WHY I CHOSE BREAST CANCER?
1)IT IS VERY IMPORTANT
BREAST CANCER UK:
-46,010 women per year DIAGNOSED (UK)
-12,247 of this will DIE (UK)
-1 in 8 women WILL have in lifetime
-Most COMMONLY diagnosed cancer in <35
women(UK)
-In last 10 years, incidence increased by 3.6% (UK)
-In 2008, 1.38 million women diagnosed (WORLDWIDE)
2) EXPERIENCE
3)MY FUTURE PLAN
-Reconstructive Surgery
4) INCREASE AWARENESS
(1)
(11)(20)
(14)
9. CURRENT TREATMENT
CHEMOTHERAPY
Cytotoxic medication
damaging cancer cells
ALKYLATING AGENTS
PLANT ALKALOIDS
ANTIMETABOLITES
ANTITUMOUR
ANTIBIOTICS
TOPOISOMERASE
INHIBITORS
ANTINEOPLASTICS
Can be given for
NEOADJUVANT, ADJUVANT
and PALLIATIVE
management
Depending on treatment,
TRASTUZUMAB may be
additionally used
(1)
(13)
(17)
(23)
(24)
(25)
(10)
10. CURRENT TREATMENT
HORMONAL
(ENDOCRINE)
THERAPY
AROMATASE INHIBITORS
SELECTIVE ESTROGEN
RECEPTOR MODULATORS
ESTROGEN RECEPTOR
DOWNREGULATORS
Blocking action or lowering
concentration of estrogen in
body
Treat hormone-receptor-
positive cancer
TARGETED
THERAPY
HERCEPTIN (TRASTUZUMAB)
TYKERB (LAPATINIB)
AVASTIN (BEVACIZUMAB)
Damage specific
characteristics of cancer
HOLISTIC MEDICINE is also used for symptomatic relief
and eliminating side effects
(1)
(22)
(26)
(32)
(32)
11. CURRENT TREATMENT - HOW EFFECTIVE?
CANCER RESEARCH UK - MORTALITY
-2008: 12.000 WOMEN, 70 MEN DIED IN UK
89.000 WOMEN DIED IN EUROPEAN UNION
458.000 WOMEN DIED IN THE WORLD
-1.300 DEATHS PER YEAR- WOMEN UNDER 50
-IN UK, 2nd MOST COMMON COUSE OF WOMEN
DEATH (31% OF ALL CASES)
CANCER RESEARCH UK – SURVIVAL
-INCREASE IN 10 YEARS SURVIVAL
RATE FOR 32% IN 25 YEARS
(1)
(15)
(15)
(16)
(16)
12. WHY NEW TREATMENT?
SIDE EFFECTS OF CURRENT TREATMENT
-CHEMOTHERAPY: HAIR CHANGES, ANAEMIA, INFECTION, MEMORY LOSS, BRUISING,
BLEEDING, DIARRHOEA, NEUROPATHY, MOUTH SORENESS, FERTILITY PROBLEMS, NAIL
CHANGES, NAUSEA, VOMITING, DEPRESSION...
-RADIOTHERAPY: JOINT PAIN, SKIN PROBLEMS, FATIGUE, HEART PROBLEMS, BONE LOSS...
-SURGERY: LYMPHADEMA, COSMETIC PROBLEMS, PSYCHOLOGICAL PROBLEMS,
DEPRESSION, NERVE DAMAGE, SORENESS...
-HORMONE THERAPY: WEIGHT GAIN, HOT FLUSHES, IMPOTENCE, NIGHT SWEATS,
MUSCLE LOSS, FATIGUE, LOSS OF SEX DRIVE...
-TARGETED THERAPY: WEAKNESS, PAIN, THERMAL FEELINGS, DIORRHEA, VOMITING,
NAUSEA...
WE WANT:
-MINIMUM SIDE EFFECTS
-MINIMUM COST
-MINIMUM TREATMENT DURATION
-MAXIMUM SURVIVAL RATE
-MAXIMUM PATIENT HAPPINESS
-MAXIMUM LIFE QUALITY
(12)
(1)
(18)
(19)(21)
13. IMPROVE SURGERY (SENTINEL
NODE MAPPING)
NEW AND FUTURE TREATMENTS
UNDER RESEARCH
(1)
ONCOLYTIC VIRAL THERAPY
INTERVENTIONAL RADIOLOGY
GENE THERAPY
VACCINES
BREAST CANCER RESISTANCE
GENE USAGE
PRECISE DIAGNOSIS
(33)
(33)
(33)
(33)
(34)
(33)
(33)
CRYOTHERAPY
NEW HORMONAL (ENDOCRINE)
THERAPIES (35)
TURNING CANCER INTO A
CHRONIC DISEASE
ANTI-VEGF THERAPY
NEW CYTOTOXIC CHEMOTHERAPY
FORMULATIONS (36)
(36)
NOVEL MICROTUBULE
TARGETING AGENTS (36)
(38)
14. IMPACT OF INTRODUCTION AND
SUCCESS OF NEW TREATMENT
(1)
INTRODUCTION
INCREASED DIAGNOSIS
NEW HOPES
PSYCHOLOGICAL IMPROVEMENT
RESEARCH IMPROVEMENT
INCREASED SHORT TERM COSTS
SUCCESS
INCREASED SURVIVAL
DECREASED MORTALITY
DECREASED SECONDARY DISEASES
IMPROVED PSYCHOLOGY
DECREASED LONG TERM COSTS
DECREASED HOSPITALIZATION
INCREASED SATISFACTION
BETTER COSMETIC APPEARANCE
FURTHER RESEARCH
IMPROVED LIFE QUALITY
IMPROVED LIFESPAN
INDIVIDUAL FAMILY SOCIETY
15. SUMMARY
(1)
-CANCER OF BREAST TISSUE
-STAGE 0: PREMALIGNANT, STAGES 1-3: GOOD PROGNOSIS, STAGE 4: METASTASIS
-DISEASE HAS BIG IMPACT ON INDIVIDUAL, FAMILY AND SOCIETY
-DIAGNOSIS RATES INCREASING, STILL VERY HIGH MORTALITY RATES
-VARIOUS TREATMENT METHODS PRESENT, TREATMENT HAS IMPROVED IN THE LAST
30 YEARS
-TREATMENT HAS SIDE EFFECTS AND IS STILL NOT ENOUGH SO NEW TREATMENTS ARE
NEEDED
-NEW DIAGNOSTIC AND SURGICAL METHODS, PHARMACEUTICAL DRUGS AND GENE
TREATMENTS ARE UNDER RESEARCH
-SUCCESSFUL IMPLEMENTATION OF NEW TREATMENTS WILL IMPROVE THE IMPACT OF
CANCER ON INDIVIDUAL, FAMILIES AND SOCIETY
(39)
16. REFERENCES
• (1): Breast Cancer awareness, Photo Bucket, last accessed: 08February 2011, http://media.photobucket.com/image/breast_cancer%20ribbon/vicky_fxz/breast_cancer_ribbon.gif?o=123
• (2): Breast Anatomy Picture, Family Practice Notebook, Last accessed: 08 February 2011, http://www.fpnotebook.com/_media/GynBreastAnatomyGeneral.jpg
• (3): Davidson’s Principles and Practice of Medicine, Colledge et al, pages 274-275,21st edition,2010, Churchill Livingstone-Elsevier
• (4): Types of Breast Cancer, CancerHelpUK, Last accessed: 08February 2011, http://www.cancerhelp.org.uk/type/breast-cancer/about/types/
• (5): Breast Cancer Treatment, National Cancer Institute, Last accessed: 08February 2011, http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient/page2
• (6): Breast Cancer, MedicineNet.com, Last accessed: 08February 2011, http://www.medicinenet.com/breast_cancer/page11.htm
• (7): Number stages of breast cancer, Cancer research UK, Last accessed: 08February 2011, http://www.cancerhelp.org.uk/type/breast-cancer/treatment/number-stages-of-breast-cancer
• (8): Breast Cancer, Wikipedia, Last accessed: 08February 2011, http://en.wikipedia.org/wiki/Breast_cancer#Pathophysiology
• (9): Invasive ductal carcinoma of breast, atlas of pathology, Last accessed: 08February 2011, http://www.pathologyatlas.ro/invasive-ductal-carcinoma-breast-pathology.php
• (10): Kumar and Clark, Clinical Medicine, pages 487-489, 7th edition, 2009, Saunders-Elsevier
• (11): Breast Cancer Statistics, Breast Cancer UK, Last accessed: 08February 2011, http://www.breastcanceruk.org.uk/statistics/
• (12): Radiotherapy, NHS Choices, Last accessed, 08 February 2011, http://www.nhs.uk/Conditions/Radiotherapy/Pages/Introduction.aspx
• (13): Cgemotherapy information, Chemocare.com, Last accessed: 08 February 2011, http://www.chemocare.com/whatis/types_of_chemotherapy.asp
• (14): Boobies, bleach and breast cancer, Last accessed: 08 February 2011, http://ahealthykitchen.com/wp-content/uploads/2010/12/breast-cancer.gif
• (15):Mortality, Breast cancer UK, Last accessed: 08February 2011, http://info.cancerresearchuk.org/cancerstats/types/breast/mortality/
• (16): Survival, Breast Cancer UK, Last accessed: 08February 2011, http://info.cancerresearchuk.org/cancerstats/types/breast/survival/
• (17): Chemotherapy definition, NHS Choices, Last accessed: 08 February 2011, http://www.nhs.uk/Conditions/Chemotherapy/Pages/Definition.aspx
• (18): Chemotherapy side effects, NHS Choices, Last accessed: 08 February 2011, http://www.nhs.uk/Conditions/Chemotherapy/Pages/Side-effects.aspx
• (19): Side effects of breast cancer treatment, Cancer compass, Last accessed: 08 February 2011, http://www.cancercompass.com/learn/cancer-information/breast-cancer/side-effects
• (20): Breast cancer statistics, cancer research ch UK, Last accessed: 08 February 2011, http://info.cancerresearchuk.org/cancerstats/types/breast/
• (21): Treatment side effects, BreastCancer.org, Last accessed: 08 February 2011, http://www.breastcancer.org/treatment/side_effects/
• (22):Breast cancer patients taking Herceptin during chemotherapy fare better, Little about, Last accessed: 08 February 2011, http://www.littleabout.com/Health/breast-cancer-patients-herceptin-
chemotherapy-fare/49778/#
• (23): The chemo room, Southerner’s journal, Last accessed: 08 February 2011, http://southernersjournal.com/?tag=breast-cancer-ports
• (24):Science News, Science Daily, Last accessed: 08 February 2011, http://www.sciencedaily.com/releases/2005/05/050513102615.htm
• (25):High-Dose Chemo Doesn't Help Breast Cancer, Alice Park, TIME, Last accessed: 08 February 2011, http://www.time.com/time/health/article/0,8599,1694334,00.html
• (26:) Hormone therapy: go natural, Media health issue, Last accessed: 08 February 2011, http://www.mediaren.net/hormone-therapy-go-natural/index.html
• (27): Surgical procedures for breast cancer, Empowher, 2009 Nucleus Medical Art, Inc.,Last accessed: 08 February 2011, http://www.empowher.com/media/reference/surgical-procedures-breast-
cancer
• (28): Breast cancer, Breast services, Mr. R Vashisht 2001, Last accessed: 08 February 2011, http://www.vashishtsurgicalservices.co.uk/breast_cancer/patient_info/breast_mastectomy.htm
• (29): Lymph node surgery for breast cancer staging, healthwise, incorporated, revolution health, Last accessed: 08 February 2011, http://www.revolutionhealth.com/articles/lymph-node-surgery-
for-breast-cancer-staging/tj4752
• (30): how radiotherapy is performed, Angela Tylor, Health vital points, last accessed: 08 February 2011, http://www.allvitalpoints.com/how-radiotherapy-is-performed/
• (31):About breast cancer radiotherapy, Cancer help UK, Last accessed: 08 February 2011, http://www.cancerhelp.org.uk/type/breast-cancer/treatment/radiotherapy/about-breast-cancer-
radiotherapy
• (32): Treatment&Side effects, Breastcancer.org, Last accessed: 08 February 2011, http://www.breastcancer.org/treatment/
• (33): Future Treatments for Breast Cancer, Audrey Robinson, Ezine Articles, Last accessed: 08 February 2011, http://ezinearticles.com/?Future-Treatments-for-Breast-Cancer&id=5105631
• (34): The future of surgery in the treatment of breast cancer , Wood, the Breast, Volume 12 Issue 6, 8th International Conference on Primary Therapy of Early Breast Cancer, St Gallen, Switzerland ,
2003, Last accessed: 08 February 2011, http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WC2-49PYMC3-
2&_user=125872&_coverDate=12%2F31%2F2003&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1634241481&_rerunOrigin=google&_acct=C000
010240&_version=1&_urlVersion=0&_userid=125872&md5=fc4c9e0a3bd6c4b13c6ad6f4b91fd4bd&searchtype=a
• (35): Recent advances in endocrine therapy of breast cancer, Howell and Dowset, Volume 315, Nomber, 7112, BMJ, 1997, Last accessed: 08 February 2010,
http://www.bmj.com/content/315/7112/863.full
• (36): The future of breast cancer treatment, Dickler, Johns Hopkins advanced studies in medicine, Volume 7 –No.16, 2007, Last accessed: 08 February 2011,
www.jhasim.com/files/articlefiles/pdf/ASM_7_16p517-522.pdf
• (37): Eve Marie Sanchez, Closed doors, open windows, Last accessed: 08 February 2011, http://closeddoorsopenwindows.wordpress.com/
• (38): Breast cancer prevention, All natural prevention, Goad, Last accessed: 08 February 2011, http://www.allnaturalprevention.com/pages/Breast-Cancer-Prevention.htm
• (39): Breast cancer symptoms and causes, Last accessed: 08 February 2011, http://beckiebennet.typepad.com/blog/2011/01/breast-cancer-symptoms-and-causes.html#tp
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