WHAT IS BREAST?

>is a collection of glands and fatty tissue that lies between the skin and the chest wall > sit on the chest muscles that cover the ribs >is made of 15 to 20 lobes > also contain lymph vessels. These vessels lead to small, round organs called lymph nodes. >The lymph nodes trap bacteria, cancer cells, or other harmful substances.

WHAT IS BREAST CANCER? >Also called the BREAST CARCINOMA
>An uncontrolled growth of breast cells >a malignant tumor that starts from cells of the breast. >happens when cells in the breast begin to grow out of control and can then invade nearby tissues or spread throughout the body. Large collections of this out of control tissue are called tumors. However, some tumors are not really cancer because they cannot spread or threaten someone's life. These are called benign tumors. >Most commonly the cancer in women but it can also happen to men.

• Breast cancer may be one of the oldest known forms of cancer tumors in humans. The oldest description of cancer (although the term cancer was not used) was discovered in Egypt and dates back to approximately 1600 BC. The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were treated by cauterization.The writing says about the disease, "There is no treatment.”. For centuries, physicians described similar cases in their practices, with the same sad conclusion. It wasn't until doctors achieved greater understanding of the circulatory system in the 17th century that they could establish a link between breast cancer and the lymph nodes in the armpit.

EPIDEMIOLOGY

• The French surgeon Jean Louis Petit (1674-1750) and later the Scottish surgeon Benjamin Bell (1749-1806) were the first to remove the lymph nodes, breast tissue, and underlying chest muscle. Their successful work was carried on by William Stewart Halsted who started performing mastectomies in 1882. He became known for his Halsted radical mastectomy, a surgical procedure that remained popular up to the 1970s.

William Stewart Halsted

Breast Cancer Cell
Histopathologic image from ductal cell carcinoma in situ (DCIS) of breast. Hematoxylin-eosin stain. Typical macroscopic (gross) appearance of invasive ductal carcinoma of the breast (pale area at the center).

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carcinoma), the cancer cells are inside the ducts but have not spread through the walls of the ducts into the surrounding breast tissue. >LCIS (also called lobular neoplasia), it begins in the milk-producing glands but does not grow through the wall of the lobules. >Invasive (or Infiltrating) Ductal Carcinoma (IDC) It starts in a milk passage (duct) of the breast, has broken through the wall of the duct, and invaded the fatty tissue of the breast. >Invasive lobular carcinoma starts in the milkproducing glands (lobules).

TYPES OF BREAST CANCER as intraductal Ductal carcinoma in situ (also known

>Inflammatory breast cancer, the affected breast may become larger or firmer, tender, or itchy. >Mixed tumors are those that contain a variety of cell types, such as invasive ductal cancer combined with invasive lobular breast cancer. >Medullary cancer is special type of infiltrating breast cancer has a rather well-defined, distinct boundary between tumor tissue and normal tissue. Metaplastic carcinoma(also known as carcinoma with metaplasia) is a very rare variant of invasive ductal cancer.

LESS COMMON TYPE

>Mucinous carcinoma(Also known as colloid carcinoma), this rare type of invasive breast cancer is formed by mucus-producing cancer cells. >Paget disease of the nipple starts in the breast ducts and spreads to the skin of the nipple and then to the areola, the dark circle around the nipple. >Tubular carcinoma are another special type of invasive ductal breast carcinoma. It was named tubular because of the way the cells look under the microscope. >Papillary carcinoma: The cells of these cancers tend to be arranged in small, finger-like projections when viewed under the microscope.

>Adenoid cystic carcinoma (adenocystic

carcinoma): These cancers are so named because they have both glandular (adenoid) and cylinderlike (cystic) features when viewed under the microscope. >Phyllodes tumor: This very rare breast tumor develops in the stroma (connective tissue) of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Other names for these tumors include phylloides tumor and cystosarcoma phyllodes. These tumors are usually benign but on rare occasions may be malignant.

>Angiosarcoma is a form of cancer that starts from cells that line blood vessels and also occur in the arm of women who develop lymphedema as a result of lymph node surgery or radiation therapy to treat breast cancer. >Male Breast Cancer The male breast has less tissue mass than the female, thus the tumor spreads rapidly and infiltrates the underlying muscle and overlying skin.

PHOTOS OF BREAST CANCER

ETIOLOGY
No one knows the exact causes of breast cancer. Doctors often cannot explain why one woman develops breast cancer and another does not. They do know that bumping, bruising, or touching the breast does not cause cancer. And breast cancer is not contagious. You cannot "catch" it from another person.

RISK FACTORS:
Gender • Early Breast Radiation • Age • Treatment with DES • Genetic Risk Factors • Family History • Personal History of Breast Cancer • Race • Abnormal Breast Biopsy • Mentrual Periods

BREAST CANCER RISK AND LIFESTYLE in • Not Having Children or Having Them Later
Life • Birth control pills • Postmenopausal Hormone Therapy (PHT) • Breast-feeding and Pregnancy • Alcohol • Being Overweight or Obese • Exercise

UNCERTAIN RISK FACTORS
• High Fat Diets • Pollution • Tobacco Smoke • Night Work • underarm antiperspirants • Silicone breast implants

• • • • • • •

SIGNS AND SYMPTOMS

a change in the size or shape of a breast dimpling of the skin of the breast a thickening in the breast tissue a nipple becoming inverted (turned in) a lump or thickening behind the nipple a rash (like eczema) affecting the nipple a bloodstained discharge from the nipple (this is very rare) • a swelling or lump in the armpit.

6 Breast Cancer Symptoms that Most Women Don't Know About
• Breast that is warm to the touch: A breast that always feel warm, sometimes hot to the touch is a symptom of inflammatory breast cancer, a dangerous and rare type od the disease. • Flat or inverted nipple: A nipple that is flat or inverted is also a symptom of breast cancer. This does not include having an inverted nipple since birth. • A breast that is often itchy: If you have itchy breasts or nipples, talk to your doctor. These are both symptoms of breast cancer.

• The skin around the breast is dimpled or looks like an orange peel: Breast and surrounding skin can take on a dimpled appearance, looking like an orange peel. Many women are too embarassed to show a doctor, thinking it is cellulite or from being overweight. This is not the case. • Swollen or breast that does not change with menstrual cycle or size increase: It's normal for a woman's breast to become swollen and tender during a normal menstrual cycle, but when it's constant, it need to be evaluated by a doctor. Women also need to be aware of a sudden breast size increase.

• Breast that is red or blotchy: A breast that is red or blotchy, even having a rash-like appearance should be evaluated by a doctor. It is a symptom of inflammatory breast cancer. Inflammatory breast cancer is a type of cancer that is often undected by a mammogram and self breast exam.

• Physical Examination >visual inspection >palpation • Mammography is an x-ray of the breast that reveals suspicious areas that are denser than normal breast tissue or have abnormal deposits of calcium. • Ultrasonography uses high frequency sound waves that enter the breast and bounce back. • Biopsy >fine needle aspiration >large core breast biopsy >surgical biopsy.

DIAGNOSIS

STAGING
• Carcinoma in situ is very early breast cancer. Cancer has not invaded into the normal breast tissue and is contained in either the breast duct (ductal carcinoma in situ) or the breast lobule (lobular carcinoma in situ). By definition, this type of cancer is not invasive and is not able to travel to the lymph nodes or other parts of the body. • Stage I means the tumor is no larger than two centimeters (cm) (about one inch) and has not spread outside the breast.

• Stage II means the tumor is from two to five cm (roughly two inches) and/or has spread to the lymph nodes under the arm. • Stage III means the cancer is larger than five cm (about two inches) involves the underarm lymph nodes to a greater extent, and/or has spread to other lymph nodes or other tissues near the breast. • Stage IV means the cancer has spread to other organs of the body (metastatic cancer), most often the lungs, bones, and/or liver.

TREATMENTS
• Local treatments are used to remove or destroy the cancer cells in a specific area. Surgery and Radiation therapy are examples of local treatments. • Systemic treatments are used to destroy or control cancer cells all over the body. Chemotherapy and hormonal therapy examples of systemic treatments.

• Surgery Lumpectomy: A surgical procedure to remove a tumor (lump) and a small amount of normal tissue around it. Partial mastectomy: A surgical procedure to remove the part of the breast that contains cancer and some normal tissue around it. This procedure is also called a segmental mastectomy. Total mastectomy: A surgical procedure to remove the whole breast that contains cancer. This procedure is also called a simple mastectomy.

LOCAL TREATMENT

Modified radical mastectomy: A surgical procedure to remove the whole breast that contains cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles. Radical mastectomy: A surgical procedure to remove the breast that contains cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy. • Radiation therapy uses high energy rays (similar to x-rays) to kill cancer cells. It comes from an external source, and it requires patients to come in 5 days a week for up to 6 weeks to a radiation therapy treatment center.

• Chemotherapy is the use of anti-cancer drugs that go throughout the entire body. • Hormonal Therapy: When the pathologist examines your tumor specimen, he or she finds out if the tumor is expressing estrogen and progesterone receptors. • Biologic Therapy: The pathologist also examines your tumor for the presence of HER-2/neu overexpression. HER-2/neu is a receptor that some breast cancers express. A compound called Herceptin (or Trastuzumab) is a substance that blocks this receptor and helps stop the breast cancer from growing.

SYSTEMATIC TREATMENT

ANY VACCINES?
Unlike flu and many other vaccines, most cancer vaccines under development are not intended to be given to healthy people to prevent disease. Rather, they help sick patients bolster their immune system to better fight the cancer *NEUVENGE *TAMOXIFEN

• MINOR COMPLICATIONS: A) Slight swelling of the breast B) The skin becomes darker during the course of radiotherapy C) Most women will have aches or pains from time to time in the treated breast or the muscles surrounding the breast D) patients may develop a rib fracture years following treatment

COMPLICATIONS AFTER TREATMENT

• MORE SERIOUS COMPLICATIONS: A) Very rarely, patients develop a breakdown of the skin, fractures of the sternum (breastbone) or such severe pain in the breast that surgery is needed for treatment. B) Developing arm swelling ("lymphedema") following axillary (armpit) dissection C) Some patients develop "radiation pneumonitis"

LIVING WITH BREAST CANCER
• A woman who has breast cancer surgery or treatment may not feel well for a while. • She may be depressed if she had her breast removed. • She may lose her hair and she may feel sick to her stomach. • She also may worry that the cancer will return and she'll get sick again.

How many cases and deaths are estimated to occur in In 2007, an estimated 178,480 new cases of 2007? diagnosed among invasive breast cancer will be

women, as well as an estimated 62,030 additional cases of in situ breast cancer (Table 2, page 4).5 The expected number of new breast cancers in 2007 is markedly lower than the estimate for 2005 in the previous Breast Cancer Facts & Figures report due to the use of a new, more accurate estimation method and a small decline in the breast cancer

In 2007, approximately 40,460 women are expected to die from breast cancer (Table 2, page 4). Only lung cancer accounts for more cancer deaths in women. In 2007, about 2,030 cases of breast cancer are expected to occur among men, accounting for about 1% of all breast cancers. Approximately 450 men will die from breast cancer.

BREAST CANCER IN THE PHILIPPINES

PREVENTION
1. Pass on that last call for alcohol. 2. Quitters DO prosper - when it comes to smoking. 3. Get physical/Regular aerobic exercise 4. Be aware of your family breast cancer history. 5. Avoid hormone replacement therapy if possible.

6. Check your breasts every month. 7. Try to keep a low fat diet/Your diet can play an important role in breast cancer prevention. 8. Don't forget to get a mammogram - it's not a choice. 9. Have children earlier in life, if possible 10. Consider breastfeeding instead of formula feeding.

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