The Penncrest High School Medical Scholars Club. -The older a woman, the more likely she is to get...
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Transcript of The Penncrest High School Medical Scholars Club. -The older a woman, the more likely she is to get...
The Penncrest
High School Medical Scholars
Club
Breast Cancer
-The older a woman, the more likely she is to get breast cancer
-Young women can get breast cancer, even in their 20s
-White women are more likely to get breast cancer than women of any
other racial or ethnic group
- African American women are more likely to die from breast cancer
than white women
- Out of every one hundred cases of breast cancer, one will occur in a
man.
THINGS YOU PROBABLY DON’T KNOW ABOUT BREAST CANCER
• being a woman
• getting older
• having an inherited mutation in the BRCA1 or BRCA2
breast cancer gene
• lobular carcinoma in situ (LCIS)
• a personal history of breast or ovarian cancer
• a family history of breast, ovarian or prostate cancer
• having high breast density on a mammogram
• having a previous biopsy showing atypical hyperplasia
• starting menopause after age 55
• never having children
• having your first child after age 35
• radiation exposure, frequent X-rays in youth
• high bone density
• being overweight after menopause or gaining weight
as an adult
• postmenopausal hormone use (current or recent use)
of estrogen or estrogen plus progestin
Risk Factors
Symptoms• Breast/ armpit lump
• Bloody/clear nipple discharge
• Breast size/shape change
• Inverted or retracted nipple
• Scaling/flaking of the nipple/ breast skin
• Breast appears to be red
• Armpit swelling
• Nipple pain
• Unusual breast pain
Diagnostics
Detection & DiagnosisBreast cancer can begin in different areas of the breast – the ducts, the lobules, or in some cases, the tissue in between.
Breast cancer is often first suspected when a lump or change in the breast is found or when an abnormal area is seen on a mammogram.
Most of the time, these findings do not turn out to be cancer. However, the only way to know for sure is through follow-up tests.
Over the past 20 years, great progress has been made in the early detection and treatment of breast cancer. As a result, the number of breast cancer survivors continues to rise.
There are over 2.9 million survivors in the United States today (more than any other group of cancer survivors).
Self Exam• This routine exam is quick and easy and can
be done to look for anomalies in front of the mirror and while in the shower.
• The exam can be done as follows: apply light pressure to the surface of the breast and then apply firmer pressure in order to assess deeper tissues. This is done to find lumps or abnormally thick areas of the breast.
• Any discrepancies would require attention from a physician to determine if the lumps are benign or malignant.
Clinical Exam • The clinical exam is essential in detecting and
diagnosing breast cancer.
• After reaching 20 years old, it is recommended that a clinical exam be done every three years to be aware of any changes that may occur that can lead to cancer.
• The physician will ask questions and then begin the exam. The exam will require the patient to be topless as to allow the physician to look and feel for anomalies. The breasts as well as the crucial underarm area will be examined for rashes, lumps, indentations, or discharge. By the end, the physician will determine hether extra steps or further examination is necessary.
Mammogram• This special x-ray is designed to check the
breasts from multiple angles for areas of possible tissue/cyst build up.
• In the image, breast tissue appears white and opaque while fatty tissues are darker and translucent.
• Mammograms are especially helpful in targeting specific lumps and following the progress of suspicious growths.
Ultrasound• Can determine whether something is a cyst
or a mass that may be cancer
• Possible cysts have fluid excreted from them using a needle & a syringe. If clear fluid is removed, no further evaluation is necessary.
• Can be used to find the exact location of a possible or known tumor
MRI• Not a test to determine whether cells/tissues
are benign or malignant (like a biopsy)
• May detect tumors in dense breast tissues
Biopsy • The removal of cells or tissues due to
suspicion
• These cells and/or tissues are examined microscopically
• Only way to determine if a suspicious spot is benign or malignant
Ductal Lavage• A type of screening tool that is used to
detect breast cancer in women of high risk
• Cells are collected from the milk ducts of the breast for analysis
• If caught early, cancer will confine itself to a single duct before moving onto another
Penncrest High School
Types of breast cancer
Ductal Carcinoma in SITU Non-invasive cancer
where abnormal cells are found in the lining of the breast milk duct
It is a very early cancer that is highly treatable
Cancer does not spread unless left undetected or untreated
Invasive Ductal Carcinoma (IDC)
- Abnormal cancer cells begin to form in the milk ducts and will eventually spread to other tissue within the breast.
Facts: -IDC is the most common
cancer making up 70-80% of all breast cancer diagnosis.
-IDC is the breast cancer that affects men.
Triple Negative Breast Cancer
Triple Negative Breast Cancer means the three most common types of receptors known to fuel most breast cancer growth(estrogen, progesterone, and the HER-2/neu gene)are not present in the cancer tumor
Common treatment such as hormone therapy or drugs that target estrogen, progesterone, and HER-2/neu are not effective.
Chemotherapy is viewed as an effective treatment
Breast Cancer During Pregnancy Pregnancy does not cause
breast cancer but you can start to show your symptoms while pregnant.
The most common solution to breast cancer during pregnancy is a lumpectomy or a mastectomy.
Metastatic Breast CancerMetastatic breast
cancer is also classified as Stage 4 cancer. This means that the cancer has spread to other parts of the body. Including the bones, brain, liver, and the lungs
Cells can also break away from
the primary, or main tumor and
spread to other parts of the
body. The cells spread by
traveling through the blood
stream and/or lymphatic
system. This process is called
metastasis.
Growth of Breast Cancer
To grow, malignant breast
tumors need to be fed. They
get nourishment by
developing new blood
vessels in a process called
angiogenesis. The new blood
vessels supply the tumor
with nutrients that promote
growth. As the malignant
breast tumor grows, it can
expand into nearby tissue.
This process is called
invasion.
Growth of Breast Cancer
Stages of Breast CancerCancer Spreads
-Surrounding tissues -Lymph Nodes -BloodTesting
-Lymph Node Biopsies-Chest X-Rays-CT Scans
-Stages-I-II-III-IV
Stages ctd… grows into surrounding tissues, travels through lymph vessels, or
travel through blood by veins and capillaries. Various tests, such as lymph node biopsies, chest x-rays, and CT
scans, can reveal how advanced the disease state has become. If the tumor is less than two centimeters is or smaller, the disease
is classified as stage I. Stage II tumors are two and five centimeters in size and has
spread to one to three lymph nodes, OR there are no affected lymph nodes but the tumor is greater than five centimeters.
Stage three breast cancer is diagnosed when the cancer is larger than five centimeters has spread to up to nine lymph nodes.
Stage four, most advanced stage of breast cancer, is defined as when the disease state has advanced to involving parts of the body other than the breast
Mastectomy versus lumpectomy (breast conserving surgery) plus radiation and overall survival in early breast cancer
Radiation therapy following mastectomy and overall survival in stage II & III breast cancer
Adjuvant chemotherapy and overall survival
Different adjuvant chemotherapy combinations and overall survival in early breast cancer
Tamoxifen and overall survival in estrogen receptor-positive breast cancer
Aromatase inhibitors and disease-free survival in early breast cancer
Lumpectomy plus radiation therapy in the treatment of ductal carcinoma in situ (DCIS)
High-dose chemotherapy with stem cell transplant for women with metastatic breast cancer and for women with non-metastatic breast cancer at high risk for recurrence
Neoadjuvant (preoperative) hormone therapy for women with estrogen receptor-positive breast cancer
Various Treatment Types
Uses medicine to target and destroy cancerous cells
Affects the whole body because it passes through the bloodstream
Can be used for both early and advanced-stage cancers
Chemotherapy
Tamoxifeno Generic name is Nolvadexo its a SERM
They act on estrogen receptors like agonists and antagonists do• Agonist• attach to a receptor of a cell and promotes action• Antagonist• attaches to the receptor of a cell and blocks the agonistsSERM
effect on receptors varies from tissue so they can inhibit or stimulate estrogen like action in tissues
Tamoxifen…ctd.Is given to breast cancer patients after surgery or chemotherapy and radiation to reduce the risk of it coming back (40% to 50% in postmenopausal women and by 30% to 50% in premenopausal women)
Only effective on hormone receptor positive/early stage breast cancera pill given once a day ( recommended that it should be taken at the same time everyday) and taken for 3-5 years
can shrink the hormone receptor positive breast cancer even before surgery
has other benefits like lowers cholesterol
TamoxifenSIDE EFFECTS
• increased tumor or bone pain
• hot flashes
• nausea
• fatigue
• mood swings
• depression
• headache
• hair thinning
• constipation
• dry skin
• loss of libido
The patient is examined through linear accelerator containing a cat scan, to determine where to target high levels of radiation on the breast cancer cells, using seed or pellets.
There are two types of radiationExternal Radiation: Delivers high doses of
radiation to breast cancer cells from a machine outside the body.
Internal Radiation: Delivers high doses of radiation from implants placed directly into or near a breast tumor.
Radiation
Radiation causes irritation, redness, and or dryness to the treated area.
Another side effect is fatigue, especially after couple weeks after the the treatment
Radiation Side Effects
Hormonal therapy is using medicine to block of hormones to prevent cancer cells from spreading.
Two most common hormone therapiesSERMs (Selective Estrogen Receptor Modulators)
Targets estrogen hormones at the breast cancer cells to prevent the growth of the cells
Tamoxifen is a commonly-used hormone therapy used to prevent breast cancer recurrence.
Hormone therapy is also used for post-menopausal women at high risk for developing breast cancer.
Aromatase Inhibitors These drugs stop the reproduction of estrogen
hormones by binding to the enzyme which produces of estrogen
Then cancer cells starve from the lack of estrogenNOT effective on hormone receptive breast cancers
Hormonal Therapy
This type of therapy can causes hot flashes; vaginal discharge, dryness and irritation; irregular periods; decreased sex drive; and mood changes.
Aromatase inhibitors may also cause joint and muscle pain, as well as an increased risk of bone thinning.
Hormonal Therapies Side Effects
There are four types of surgery that a patient can under go Lumpectomy
Removal of only tumor and possible surrounding tissueAlso known as breast-conserving surgery
Partial or segmental mastectomy or quadrantectomyRemoves more breast tissue than LumpectomyRadiation is given off after surgery
Total MastectomyRemoval of the entire breast but no lymph nodes are
removedThis process is usually used for treat in-situ, microinavasive,
or stage IA breast cancers. Radical mastectomy
All breast tissue is removed, and lymph nodes are also sampled Many people need breast reconstruction immediately or delayed
after the surgery
Surgery
Treatment that targets specific characteristics of cancer cells
Less likely to harm normal cells than chemotherapy
Should not be used by pregnant women5 known target therapies used by doctors
Herceptin, Tykerb, Avastin, Perjeta, and Afinitor
Targeted Therapies
Powerful Diagnostic Tool--Decoding Genomes• Recently developed
• Sequence of patients' genome of the cancer cells
• Increased accuracy of treatment
• Beneficial to the patients and their families
Study #1• 39-year-old female
o Acute myeloid leukemia (AML)
• Standard diagnos testo Stem cell transplanto Diagnostic dilemma
• Genoma sequence testo Chemotherapy with ATRA
• 6 weeks, $40,000
Study #2• Female
o Breast cancer-age 37o Ovarian cancer-age 39o Ovarian tumor returned-age 42
• Genome sequencing allowed precautions take for family
Progress for the Future• "These cases of personalized genomic
medicine are just some of the first examples of what will likely be commonplace in the near future." - Boris Pasche, MD, PhD, of the University of Alabama in Birmingham
• As technology is enhanced, cost and time will decrease
• More than 300 cancer patients and their tumors
There are steps you can take that may reduce
your risk. These include:
maintaining a healthy weight
exercise
limiting alcohol intake
avoid postmenopausal hormones,
For women at risk of estrogen-receptor
positive breast cancer.
taking tamoxifen or raloxifene may
reduce the risk
PREVENTION & RISK FACTORS
Gene Therapy
October 2012 marks the 28th anniversary of Breast Cancer Awareness Month, a time to not only reflect on those who have lost their battle to the disease, but also to encourage its prevention.
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