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BREAST CANCER

Breast Cancer

Breast cancer occurs when abnormal cells grow out of control in one or both breasts. They can invade nearby tissues and form a mass called a malignant tumor. The cancer cells can spread (metastasize) to the lymph nodes and other parts of the body.

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Overview and Statistics:

Worldwide, breast cancer comprises 10.4% of all cancer incidences among women, making it the second most common type of non-skin cancer (after lung cancer) and the fifth most common cause of cancer death. In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths). Breast cancer is about 100times more common in women than in men, but survival rates are equal

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26 females out of 100 females and 1 male for every 105 males may be diagnosed with breast cancer in the Philippines. Since the 1980s, breast cancer ranks 1st among the top leading cancers afflicting women in the Philippines and ranks 2nd to lung cancer if both sexes are considered. Its incidence starts to peak at the age of30 in women. (Source: Philippine Cancer Facts & Estimates, PCSI, 2005.) However, it was reported in 2004 that breast cancer cases in the Philippines exceeded lung cancer by 685 cases for both sexes (source: UP-DOH report)

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Recently, more women are presenting with bilateral disease at an early age(30’s-40’s). Generally, the disease is still being diagnosed late in its course hence the survival rate of breast cancer in the Philippines is below 50%. Making the situation more difficult, an estimated seventy percent (70%) of breast cancer patients in the Philippines are indigents.

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Alarmingly, the Philippines has the highest prevalence of breast cancer in Asia.(Source: International Agency for Research on Cancer, 2004). In addition to the successful reduction in fertility and westernization of the Filipino lifestyle, the limited access to breast health contributes significantly to its recorded highest prevalence in Asia. Among the reasons for the limited access to breast health in the Philippines include: location of health facilities, limited income, high prices of diagnostic tests and hospital care, low levels of education, and the lack of breast cancer awareness. 6

Breast Cancer Risk Factors

that cannot be changedAgeFamily/Personal HistoryRaceTreatment with DESRadiationGenetic FactorsMenstrual HistoryReproductive History 7

Breast Cancer Risk Factors

that can be controlledcontrolledObesityExerciseBreastfeeding

Alcohol

HRT

Birth control pills

Not having children 8

Signs and Symptoms

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Most common: lump or thickening in breast. Often painless

Change in color or appearance of areola

Redness or pitting of skin over the breast, like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Staging of Breast Cancer

T= tumor size

N = lymph node involvement

M = metastasis

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Stage 1

Tumor < 2.0 cm in greatest

dimension

No nodal involvement (N0)

No metastases (M0)

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Stage II

Tumor > 2.0 < 5 cm

or

Ipsilateral axillary

lymph node (N1)

No Metastasis (M0)

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Stage III

Tumor > 5 cm (T3)

or ipsilateral axillary lymph nodes fixed to each other or other structures (N2)

involvement of ipsilateral internal mammary nodes (N3)

Inflammatory carcinoma (T4d)

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Stage IV (Metastatic breast cancer)

Any T

Any N

Metastasis (M1)

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Types of breast cancer

In situ Intraductal (DCIS) Intralobular (LCIS)

Invasive Infiltrating ductal carcinoma Tubular carcinoma Medullary carcinoma Mucinous carcinoma

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Diagnosis & Tests

Breast Self Exam

- The breast self-exam is a way that you can check your breasts for changes (such as lumps or thickenings). It includes looking at and feeling your breast. Any unusual changes should be reported to your doctor. When breast cancer is detected in its early stages, your chances for surviving the disease are greatly improved.

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Breast Self Examination

Opportunity for woman to become familiar with her breasts

Monthly exam of the breasts and underarm area

May discover any changes early

Begin at age 20, continue monthly

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When to do BSEmenstruating women- 5 to 7

days after the beginning of their period

Menopausal women -same date each month

Pregnant women – same date each monthTakes about 20 minutesPerform BSE at least once a monthExamine all breast tissue

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Diagnosis & TestsClinical Breast Exam

- A breast exam by a Health professional (such as your doctor, nurse, nurse practitioner, Or physician assistant) is an important part of routine physical checkups. You should have a clinical breast exam at least every three years starting at age 20 and every year starting at age 40. A clinical breast exam may be recommended more frequently if you have a strong family

history of breast cancer.

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Why don’t more women practice BSE?

Fear

Embarrassment

Youth

Lack of knowledge

Too busy, forgetfulness

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Diagnosis & Tests

Mammogram- Mammograms are a good way of identifying

abnormalities in the breast- Used for women over the age of 35

- In younger women the breast tissue is more dense, which makes it difficult to detect any changes on the mammogram.

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Mammography Equipment

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Diagnosis & Tests

Breast Ultrasound

- Breast ultrasound is a procedure that may be used to determine whether a lump is a cyst (sac containing fluid)or a solid mass which could be cancer. If it is found to be a cyst, fluid is typically withdrawn from it using a needle and syringe (a process called aspiration). If clear fluid is removed and the mass completely disappears, no further treatment or evaluation is needed.

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Diagnosis & Tests

OPEN BIOPSY- A biopsy is the only way to tell for sure if

cancer is present.- an incisional biopsy takes a sample of a lump

or abnormal area.- An excisional biopsy takes the entire lump or

area.- This procedure is done either under local

anaesthesia or general anaesthesia24

OTHER INVESTIGATIONS

CHEST X RAY

ABDOMINAL ULTRASOUNDNeedle tests (FNAC)

CT OF THE BRAIN

BONE SCINTIGRAPHY

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Breast Cancer Treatments

• Surgery• Radiation Therapy• Chemotheraphy• Hormone Theraphy• Immunotherapy

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LOCAL TREATMENT

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.

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LOCAL TREATMENT

Total mastectomy: A surgical procedure to

remove the whole breast that contains cancer. This procedure is also called simplemastectomy.

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.

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LOCAL TREATMENT

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 29

SYSTEMATIC TREATMENT

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 over expression. 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. 30

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 31

PREVENTION

6. Check your breasts every month.

7. Try to keep a low fat diet/Your diet can play an important role in breast cancerprevention.

8. Don't forget to get a mammogram

9. Have children earlier in life, if possible

10. Consider breastfeeding instead of formulafeeding.

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PHOTOS OF BREAST CA

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PHOTOS OF BREAST CA

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PHOTOS OF BREAST CA

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PHOTOS OF BREAST CA

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