GROUP ONE

PRESENTATION ON BREAST CANCER

CONTENT
 Introduction
 Risk factors

 Pathophysiology
 Signs and symptoms

 Diagnosis
 Treatment and prevention
INTRODUCTION
 Breast cancer is a type of cancer that
develops from breast tissue. It is the
most common invasive cancer in women an
d the second most common cause of cance
r death in women after lung cancer.
 It affects both men and women but affe
cts women more.
TYPES OF BREAST CANCER

 Ductal Carcinoma In-Situ

The term “in situ” or "in place" refers to a very early form of cance
r that has not spread. Ductal carcinoma in-situ is a type of early br
east cancer inside of the ductal system that has not attacked the nea
rby tissue. This is a very common type of noninvasive cancer.
 Lobular Carcinoma in Situ

This is a very rare non-invasive tumor that most doctors believe will n
ot develop into invasive cancer. Lobular carcinoma in situ is more of
a “marker” or signal that breast cancer may develop. Described as a
n abnormal growth in the number of cells, lobular carcinoma in situ h
as recently been renamed lobular neoplasia. Women who have these “ma
rkers” are at greater risk of developing breast cancer later in life
.
 Infiltrating Ductal Carcinoma

Infiltrating ductal carcinoma is the most common type of breast cancer.

It starts in the milk ducts of your breast and spreads to surrounding
tissues. Infiltrating ductal carcinoma could spread through the lymph
system or bloodstream to other parts of your body.
 TYPES OF BREAST CANCER
 Medullary Carcinoma
Medullary carcinoma accounts for 15% of all breast cancer typ
es. It most frequently occurs in women in their late 40s and
50s, presenting with cells that resemble the medulla (gray ma
tter) of the brain.

 Infiltrating Lobular Carcinoma

Infiltrating lobular carcinoma is the second most common type
of breast cancer after invasive ductal carcinoma. It usually
appears as a subtle thickening in the upper-outer section of
the breast. Infiltrating lobular carcinoma starts in the lobu
les or lobes and has a greater chance of spreading to other p
arts of the body. Usually positive for estrogen and progester
one receptors, these tumors respond well to hormone therapy. 
TYPES CONT’D
 Tubular Carcinoma
Tubular carcinoma cells have a distinctive tub
ular structure when viewed under a microscope.
This type of breast cancer is typically found
in women aged 50 and above. It has an excellen
t 10-year survival rate of 95%. 
  Mucinous Carcinoma
Mucinous carcinoma is a rare type of invasive
breast cancer that rarely spreads to your lymp
h nodes. It is formed when cancer cells inside
your breast produce mucous. This mucous contai
ns cancer cells that are very distinct from no
rmal cells under a microscope. The mucous and
cancer cells combine to form jelly-like tumors
. 
STAGES OF BREAST CANCER
 This involves classifying the cancer by the extent of disea
se. Staging of any cancer is important because it helps the
health care team identify and recommend the best treatment
available.
 STAGE I: tumors are less than 2cm in diameter and confined
to breast.
 STAGE II: tumors are less than 5cm, or tumors are smaller w
ith mobile axillary lymph node involvement.
 Staging III: tumors are greater than 5 cm, or tumors are ac
companied by enlarged axillary lymph nodes fixed to one ano
ther or to adjacent tissues.
 STAGING III b: More advanced lesions with satellite nodules
fixation to the skin or chest wall, ulceration, edema, or w
ith supraclavicular or intraclavicular nodal involvement.
 STAGE IV: all tumors with distant metastases.
RISK FACTORS

 Gender – Women are at far greater risk than men,

with 99% of breast cancers occurring in women.
 Obesity – Fat cells store estrogen, which increa
ses the likelihood of developing breast cancer.
 Age
 Lack of physical exercise
 Genetic factors- Gene mutations of BRCA1 or BRCA2
play a role in 5%-10% of breast cancer cases.
 Hormone use
 Alcoholic Consumptions.
 Exposure to ionizing radiation – Radiation damag
es DNA example prior treatment for Hodgkin’s lym
phoma.
 RISK FACTORS
 Early menarche (before age 12), late menopause (aft
er age 55). A long menstrual history increases the
risk of breast cancer.
 First full-term pregnancy after age 30, null parity
. Prolonged exposure to unopposed estrogen increase
s risk for breast cancer.
 Personal history of breast cancer, colon cancer, en
dometrial cancer, ovarian cancer. Personal history
significantly increases risk of breast cancer, risk
of cancer in other breast, and recurrence.
 Family history of breast cancer in a first-degree r
elative, particularly when premenopausal or bilater
al, increases risk.
RISK FACTORS FOR MEN.
 Predisposing risk factors for breast cancer
in men include hyperestrogenism, a family h
istory of breast cancer, and radiation expo
sure. A thorough examination of the male br
east should be a routine part of a physical
examination. Men in BRCA-positive families
may consider genetic testing. Men with an a
bnormal BRCA gene also have an increased ri
sk of developing prostate cancer.
 PATHOPHYSIOLOGY
 The main components of the breast are lobules (milk-producing g
lands) and ducts (milk passages that connect the lobules and th
e nipple). In general, breast cancer arises from the epithelial
lining of the ducts (ductal carcinoma) or from the epithelium o
f the lobules (lobular carcinoma). Breast cancers may be in sit
u (within the duct) or invasive (arising from the duct and inva
ding through the wall of the duct).
 Metastatic breast cancer is breast cancer that has spread to ot
her organs, with the most common sites being bone, liver, lung,
and brain. Cancer growth rates can range from slow to rapid. Fa
ctors that affect cancer prognosis are tumor size, axillary nod
e involvement (the more nodes involved, the worse the prognosi
s), tumor differentiation, estrogen and progesterone receptor s
tatus, and human epidermal growth factor receptor 2 (HER-2) sta
tus. HER-2 is a protein that helps regulate cell growth. It is
over expressed in about 25% of patients with breast cancer.
SIGNS AND SYMPTOMS
 New lump in the breast or underarm (armpit).
 Thickening or swelling of part of the breast.
 Irritation or dimpling of breast skin.
 Redness or flaky skin in the nipple area or the brea
st.
 Pulling in of the nipple or pain in the nipple area.
 Nipple discharge other than breast milk, including b
lood.
 Any change in the size or the shape of the breast.
 Pain in the breast.
DIAGNOSIS
 Breast examination
 Imaging test
 Biopsy
 Evaluation of tumour markers
TUMOR MARKERS IN BREAST CANCER
 Estrogen and progesterone receptors.
 Human epidermal growth factor receptor

2 (HER2)
 CA 27.29

 CA 15-3
 ESTROGEN AND PROGESTERONE RECCEPTORS

 These receptors fuel cancer growth when bo

unded to estrogen and progesterone
 Sample take for this receptors are cancer
cells obtained from biopsy or surgery
 Cells are classified as either Hormone rec
eptor Negative or Hormone receptor positiv
e
 Drugs are available for the treatment of H
ormone receptor positive cancer cells
 TESTS FOR ESTROGEN AND PROGESTERON RECEPT
ORS
 The receptors are tested for using immu
nohistochemistry technique(IHC)
 Where special markers are used to label
the receptors and viewed under the micr
oscope
 If the test shows at least 1% of cells
have receptors, it is said to be ER+ th
ey are estrogen receptors, and PR+ if t
hey are progesterone receptors
HORMONE RECEPTOR POSITIVE AND NEGATIVE CANCER CELLS

 Hormone receptor positive cancer cells

are more common in women after menopaus
e
 HR+ cells grow slower compared to HR- c
ells.
 HR- cells cannot be treated with hormon
e therapy drugs.
 HR- cells are more common in women who
haven’t reached menopause.
TREATMENT
 Treatment is done with drugs in two way
s
 Administer drugs that reduce estrogen o
r progesterone levels in the body
 Administer estrogen/progesterone recep
tor blockers
HUMAN EPIDERMAL GROWTH FACTOR RECEPTOR 2(HER2)

 It is responsible for the normal growth

, division and development of the norma
l cells
 It replicates uncontrollably during can
cer and cause increased growth in breas
t cells (this happens in about 25% of c
ases)
 HER2 positive breast cancer cells grow
faster than HER2 negative cancer cells
TREATMENT FOR HER2 POSITIVE CANCERS

 Transtuzumab (Herpcetin): this drug blocks HER2 receptors tha

t receive chemical signals thus preventing the cells from gro
wing.
 TDM-1/Ado-trantuzumab emtansine (Kadcula): this is a combinat
ion of Hepcertin and chemotherapy drug emtansine. Hepcertin b
inds to emtansine and transports it to the targeted HER2 cell
s.
 Nertinib (Nerlynx): this drug blocks and prevent cancer cells
from receiving growth signals
 Pertuzumab (Perjata): also blocks cancer cells from receiving
signals
 Lapatinib (Tykerb): this drug block certain proteins that can
cause the uncontrolled replication of cancer cells
 CANCER ANTIGEN 27.29

 Another marker for breast cancer patient is

the CA27.29
 It is a monoclonal antibody
 They it is either a glycoprotein or mucus co
ntaining protein which are present on the su
rface of epithelial cells
 It can be shed into the blood stream
 Blood levels are normally less than 40U/ml
 Levels above 100U/ml shows there is a cancer
LIMITATIONS
 Levels may remain elevated 3 months aft
er therapy
 Other cause of elevation:
a. Lung cancer
b. Liver cancer
c. Prostate cancer
 CANCER ANTIGEN 15-3

 CA 15-3 is used to monitor breast cancer

patients.
 Elevated levels are seen in <10% of patie
nts with early diagnosis and in about 70%
of patients with advanced disease
 CA15-3 can also be elevated in other canc
ers and some non cancerous conditions suc
h as benign breast condition and hepatiti
s
 LIMITATIONS
 Not all breast cancers cause increased
level of CA15-3 and not all increased l
evels mean there is a cancer.
 It is a normal product of breast tissue
TRIPLE-NEGATIVE BREAST CANCER
 The triple receptor-negative breast cancer
(TNBC) subtype is characterized by the lac
k of expression of both hormone receptors
as well as lack of over-expression and/or
lack of gene amplification of human epider
mal growth factor receptor 2 (HER2).
 TNBC has a worse prognosis and tends to re
lapse early compared with other subtypes o
f breast cancer.
RISK FACTORS OF TNBC
 Young age at breast cancer diagnosis,
 Young age at menarche,
 High parity,
 Lack of breast feeding,
 high body mass index and African Americ
an ethnicity.
 REFERENCES
 Saunders, Christobel; Jassal, Sunil (200
9). Breast cancer (1. ed.). Oxford: Oxfo
rd University Press.
 Beckett G. & Walker .S. (2010). Clinical
Biochemistry. New York; Wiley.
 "Breast Cancer". NCI. Archived from the
original on 25 June 2014. Retrieved 29 J
une 2014.