Cancer is the abnormal, uncontrollable , continuous

replication of cells which will inevitably lead to the

formation of a tumor.
Forms in the Spreads mainly
tissues of the through the
breast Lymphatic system
THE NORMAL BREAST

1. Chest wall.

2. Pectoral muscles.

3. Lobules (glands that

make milk).

4. Nipple surface.

5. Areola.

6. Lactiferous duct tube

that carries milk to the
nipple

7. Fatty tissue.

8. Skin.
 Lymphatic System which consists of vessels and
organs plays two vital roles in our lives:

1) The vessels essentially maintain interstitial

fluid levels by carrying excess fluids as well as
any plasma proteins, back into the CVS.

2) The organs, house critical immune cells such as

lymphocytes which carry out our body defense
against infection.
Most of the lymph vessels of the breast
drain into:

 Lymph nodes under the arm (auxiliary nodes).

 Lymph nodes around the collar bone
(supraclavicular and infraclavicular lymph
nodes)
 Lymph nodes inside the chest near the breast
bone (internal mammary lymph nodes)
 Malignant  Benign

 Cancerous  Not - Cancerous

 Not cancerous.

 Benign breast tumors are abnormal growths,

but they do not spread outside of the breast
and they are not life threatening.
 Most lumps are caused by the combination of
cysts and fibrosis

 Cysts are fluid-filled sacs.

 Fibrosis is the formation of scar - like tissue.

 These changes can cause breast swelling and

pain.
 Breast cancer is a malignant (cancerous)
tumor that starts in the cells of the breast.
It is found mostly in women, but men
can get breast cancer, too.
 Invasive Non - Invasive

 Cancerous  Pre – Cancerous

 Malignant  Still in its original
 Spreads to other position
organs (metastasis)  Eventually develops
into invasive breast
cancer.
Invasive Breast Cancer
 The inner lining of  The lobules – Milk
milk ducts. producing glands.

 Ductal Carcinoma  Lobular Carcinoma

 Ductal Inflammatory Lobular
Carcinoma Breast Cancer Carcinoma
(IBC)

Invasive Ductal Invasive Lobular

Carcinoma Carcinoma

Ductal Carcinoma Lobular Carcinoma

in situ (DCIS) in situ (LCIS)
 Uncommon (1% to 3% of all breast cancers)

 Invasive Brest Cancer.

 No lump or tumor.

 Mistaken for infection in its early stages.

 IBC makes the skin of the breast look red and
feel warm.

 It also may make the skin look thick and pitted

and may have an orange peel feel.

 The breast may get bigger, hard, tender, or

itchy
 Non – invasive

 contained within the milk ducts .

 May become invasive (pre – cancer).

Picture
 Most common breast cancer.
 Accounts for about 8 out of 10 invasive breast
cancers.

 Lining of the ducts Grows /invades

the breast tissues

Spreads to lymph nodes

Other organs
 Non – Invasive.

 Contained in the lobules and does not spread

to the tissues of the breast.

 May become malignant .

 picture
 About 1 in 10 Invasive breast cancers are ILC.

 Formed in the lobules.

 Grows through the wall of the lobules.

 Spreads
 Risk factors increases your chances of having
breast cancer but does not causes it.

 Breast cancer results from the abnormal,

uncontrollable replication of cells of the breast.
 Risk Factors

Modifiable uncontrollable
factors factors
 Gender

 Age

 Genetic risk factors

 Family history

 Personal history of breast cancer

 Race/ethnic background

 Dense breasts tissue

 Certain benign (not cancer) breast problems

 Menstrual periods

 Breast radiation early in life

 Gender: more prevalent in women.

 One (1) in every 150 cases (MALE).

 Age: The chance of getting breast cancer goes up

as a woman gets older.

 Over 80% of all female breast cancers occur

among women aged 50+ years
 Genetic risk factor:
Women who carry the BRCA1 and BRCA2 genes
have a considerably higher risk of developing
breast cancer.
 Family history:
Breast cancer risk is higher among women
whose close blood relatives have this disease.

 Personal history of breast cancer:

A woman with cancer in one breast has a greater
chance of getting a new cancer in the other breast
or in another part of the same
 Race/Ethnic background:

 Overall, white women are slightly more likely

to get breast cancer than African-American
women.

 African-American women, though, are more

likely to die of breast cancer.

 Asian, Hispanic, and Native-American women

have a lower risk of getting and dying from
breast cancer.
 Dense breast tissue: Dense breast tissue means
there is more gland tissue and less fatty tissue.

 Certain benign (not cancer) breast problems:

Women who have certain benign breast
changes may have an increased risk of breast
cancer.
 Menstrual period: Women who began having
periods early (before age 12) or who went
through the change of life (menopause) after
the age of 55 have a slightly increased risk of
breast cancer.

 Breast radiation early in life: Women who

have had radiation treatment to the chest area
as a child or young adult have a greatly
increased risk of breast cancer.
 Not having children or having them later in
life.
 Certain kinds of birth control
 Using hormone therapy after menopause
 Not breastfeeding
 Alcohol
 Being overweight or obese
 Tobacco smoke: Smoking may increase the risk
of breast cancer.

 Night work: A few studies have suggested that

women who work at night have a higher risk of
breast cancer.
 Antiperspirant

 Bras

 Induced Abortion

 Breast implants
 Alcohol consumption

 Physical exercise

 Diet

 Postmenopausal hormone therapy

 Bodyweight

 Breast cancer screening

 Breastfeeding
 A lump in a breast.

 A pain in the armpits or breast that does not

seem to be related to the woman's menstrual
period.

 Pitting or redness of the skin of the breast; like

the skin of an orange.

 A rash around (or on) one of the nipples.

 A swelling (lump) in one of the armpits.

 An area of thickened tissue in a breast.

 One of the nipples has a discharge; sometimes it

may contain blood
 The nipple changes in appearance; it may
become sunken or inverted.

 The size or the shape of the breast changes.

 The nipple-skin or breast-skin may have

started to peel, scale or flake.
 Diagnostic tests and procedures for
breast cancer include:

 Breast exam
 Mammograms
 Breast ultrasound Imaging tests
 Breast MRI scan
 Biopsy
Clinical Breast Breast - Self
Exam(CBE) Exam (BSE)
 Women in their 20s and 30s should have a
clinical breast exam every 3 years.

 After age 40, women should have a breast

exam every year
 BSE is an option for women starting in their
20s.

 Any changes detected should be reported to a

medical expert.

 BSE: Conducted standing or reclining

 An x-ray of the breast.
 It uses a very small amount of radiation.

 Mammograms

screening diagnosis
screening mammograms diagnostic mammogram
 A technologist will position your breast for the
test.
 The breast is pressed between 2 plates to flatten
and spread the tissue.
 The pressure lasts only a few seconds while the
picture is taken.
 The breast and plates are repositioned and then
 another picture is taken.
 The whole process takes about 20 minutes.
 Uses sound waves to outline a part of the body.

 The sound wave echoes are picked up by a

computer to create a picture on a computer
screen.

 Used to investigate areas of concerns found by

a mammogram.
 Use magnets and radio waves.

 Cross-sectional images of the body.

 MRI scans can take a long time.

 Used if view areas of concern found on a

mammogram.
 Patients must lie inside a narrow tube, face
down on a special platform.

 The platform has openings for each breast that

allow the image to be taken without pressing
on the breast.

 Contrast material may be injected into a vein to

help the MRI show more details.
 A biopsy is done when other tests show that
you might have breast cancer.

 It confirms if a mass is cancerous or not.

 Mass is removed and studied.

 Fine needle aspiration (FNA) biopsy

 Core needle biopsy

 Vacuum-assisted biopsies

 Surgical (open) biopsy

 Lymph node biopsy

 Very fine needle is used.

 Extracts fluid from the lump.

 Guided by ultrasound.

 simple but is not 100% accurate.

 Needle is larger than in fine needle biopsy.

 Removes more tissues.

 Clearer results.
 Done with systems such as ATEC® (Automated
Tissue Excision and Collection)

 Guided by MRI

 First the skin is numbed and a small cut (incision)

is made.

 A hollow probe is put through the cut into the

breast tissue.

 A piece of tissue is sucked out.

 Anesthesia is administered.

 Incision is made.

 Part or whole lump is extracted and studies.

 Removal of  Removal of
fluids lymph nodes

 Needle biopsy  Surgical biopsy

 Tissues obtained during biopsy are
examined to determine:

 Malignant or Benign
 Type
 Invasive or Non - invasive
 Size
 Has it metastasized
 Is the lymph nodes affected
 Treatment
 Breast cancer grade

 Hormone receptor status

 HER2/neu status
 Breast cancer grade:

 If a biopsy sample is cancer, it is given a grade

from 1 to 3.

 A lower grade number means a slower-growing

cancer, while a higher number means a faster-
growing cancer.

 The grade helps predict the outcome.

 Hormone receptor status:

 Hormone receptors are proteins in cells that can

attach to hormones.

 Estrogen and progesterone are hormones that fuel

breast cancer growth.

 Breast cancers are tested for hormone receptors.

If the tumor has them, it is often called ER-
positive, PR positive,

 About 2 out of 3 breast cancers have at least one

of these receptors.
 HER2/neu status:

 About 1 out of 5 breast cancers have too much of

a protein called HER2/neu.

 Tumors with increased levels of HER2/neu are

called HER2-positive.

 These cancers tend to grow and spread faster

than other breast cancers
 Chest x-ray: the lungs.

 Bone scan: the bones.

 CT scan (computed tomography): the chest

and/or abdomen.

 MRI : brain and spinal cord.

 Ultrasound: other parts

 The TNM staging system

This system takes into account:

 the tumor size and spread (T),

 whether the cancer has spread to lymph nodes
(N) and
 whether it has spread to distant organs (M) for
metastasis
 Sage 0

 Stage l

 Stage ll

 Stage lll

 Stage lV
 Sage 0 : Non – Invasive breast cancer. Has not spread
to breast tissues.

 Stage l : ≤ 2cm and has not spread to lymph nodes.

 Stage ll
Stage llA: ≤ 2 cm and has spread to lymph nodes or
2-5 cm and has spread to lymph nodes.
Stage llB: 2-5 cm and has spread to lymph nodes or
> 5 cm and has not spread to lymph nodes.
 Stage lll

Stage lllA: ≤ 5cm and spread to lymph nodes

forming clumps or >5 cm and spread to lymph
nodes without forming clumps.
Stage lllB: Any size and spread to the skin or
chest wall. Swelling.
Stage lllC: Any size , spread to lymph nodes, skin
and chest wall.

 Stage lV: Metastasized

 The type of breast cancer
 The stage and grade of the breast cancer - how large
the tumor is, whether or not it has spread, and if so
how far
 Whether or not the cancer cells are sensitive to
hormones
 The patient's overall health
 The age of the patient
 The patient's own preferences
 Surgery
 Radiation therapy

 Biological therapy (targeted drug therapy)

 Hormone therapy

 Chemotherapy
Surgery for breast cancer:
 Lumpectomy

 Mastectomy

Lymph node surgery:

 Sentinel node biopsy

 Axillary lymph node dissection

Breast reconstruction surgery

 Breast-conserving surgery (BCS) or
partial/segmented mastectomy.

 Surgically removing the tumor and a small

margin of healthy tissue around it.

 Followed by radiation therapy

 Surgically removing the breast and other
infected components.

Mastectomy

A simple Modified radical A Radical

mastectomy. mastectomy. mastectomy.
 Simple mastectomy : removing the lobules,
ducts, fatty tissue, nipple, areola, and some skin.

 Modified radical mastectomy: simple

mastectomy combined with the removal of the
axillary lymph nodes.

 Radical mastectomy: a simple mastectomy

combined with removing the lymph nodes and
muscles of the chest wall.
 Pain after the surgery and the change in the
shape of the breast.

 Wound infection, build-up of blood and build-

up of clear fluid in the wound.

 If axillary lymph nodes are removed swelling

of the arm and chest may occur
(Lymphedema).
 Axillary lymph node dissection: about 10 to 40
lymph nodes are removed.
 Usually done at the same time as the mastectomy or
breast-conserving surgery.

 Sentinel lymph node biopsy: is used to determine if

cancer has spread to the lymph nodes under the arm
without removing many of them.
 A blue dye/radioactive substance is injected in order
to identify the sentinel lymph nodes which drains
lymph from the tumor.
 They are then removed.
Lymph node
surgery
 Pain, swelling, bleeding, and infection

 Swelling in the arm or chest (Lymphedema).

 Lymphedema is mostly due to axillary lymph

node biopsy.
 Surgical procedures aimed at recreating a
breast so that it looks as much as possible like
the other breast.

 The surgeon may use a breast implant, or tissue

from another part of the patient's body.
Adjuvant therapy:
 After surgery

 Combat metastasis.

 Chemotherapy and hormone therapy.

Neo-adjuvant therapy:
 Before surgery

 Reduce tumors

 Radiation therapy
 Radiation therapy is treatment with high-
energy rays (such as x-rays) or particles to kill
cancer cells.
 The patient may require three to five sessions
per week for three to six weeks.

 The type of breast cancer will determine the

type of radiation therapy used.
 Breast radiation therapy – applied after a
lumpectomy,.

 Chest wall radiation therapy – applied after a

mastectomy

 Breast boost - a high-dose of radiation therapy

is applied to where the tumor was surgically
removed.
 Lymph nodes radiation therapy - aimed at the
axilla and surrounding area to destroy cancer
cells that have reached the lymph nodes
 Brachytherapy

 radiation to the breast by place radioactive seeds

(pellets) into the breast tissue.

 The most common type brachytherapy used to

treat breast cancer is called intracavitary
brachytherapy.
 A device is put into the space left from breast-
conserving surgery, a source of radiation is then
placed in the device for a short time and then
removed.
 Swelling and heaviness in the breast.

 Sunburn-like changes in the skin and feeling

very tired.

 Weakness .

 Damage some of the nerves to the arm. This can

lead to numbness, pain, and weakness in the
shoulder, arm and hand.

 Radiation to lymph nodes causes (Lymphedema).

 Chemotherapy (chemo) is the use of cancer-killing
drugs.

 Intravenously, given as a shot, or taken as a pill or

liquid.

 They enter the bloodstream and reach most parts of

the body.

 Combats metastasis.

 Damage some normal cells.

 Before surgery:  After surgery:
neoadjuvant chemo adjuvant chemo
 Doctors give chemo in cycles.
 The time between cycles is most often 2 or 3
weeks.

 For early-stage breast cancer, the total course of

treatment usually lasts for 3 to 6 months.
 For advanced breast cancer chemo is often
continued as long as it is working.
The side effects of chemo depend on:
 the type of drugs used

 the amount given

 and the length of treatment.

Short – term side effects

 · Hair loss
 · Loss of appetite or increased appetite
 · Nausea and vomiting
 · A higher risk of infection (low WBC count)
 · Stopping of menstrual periods
 · Easy bruising or bleeding (low platelets)
 · Being very tired
Long - term side effects

 Menstrual changes: infertility

 Nerve damage: pain, burning or tingling and

sensitivity to cold or hot.

 Heart damage
 Used for breast cancers that are sensitive to
hormones.

 These types of cancer are often referred to as ER

positive (estrogen receptor positive) and PR
positive (progesterone receptor positive)
cancers.

 Estrogen and progesterone promotes cancer

growth.
Drugs used to block estrogen

 Tamoxifen
 Toremifene (Fareston®)
 Fulvestran
Drugs used to change hormone levels:

 Aromatase inhibitors (AIs): stop fat tissue from

making estrogen after menopause

 Luteinizing hormone-releasing hormone

(LHRH) analogs: shuts down the ovaries.
Drugs that target HER2

HER2: protein that increase cancer growth.

 · Trastuzumab (Herceptin): IV
 · Pertuzumab (Perjeta®): IV
 · Ado-trastuzumab emtansine (Kadcyla™)
 · Lapatinib (Tykerb): pill
 · Mouth sores
 · Diarrhea
 · Nausea
 · Fatigue
 · Feeling weak or tired
 · Low blood counts
 · Shortness of breath
 · Cough