BREAST CANCER

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style="text-align: center;">BREAST CANCER 

INTRODUCTION : 

                                 Breast cancer is the most common cancer diagnosed in women. It is the second most common cause of death from cancer among women in the world. Anatomically, the breast has milk-producing glands in front of the chest wall. They lie on the pectoralis major muscle, and there are ligaments support the breast and attach it to the chest wall. 15 to 20 lobes circularly arranged to form the breast. The fat that covers the lobes determines the breast size and shape. Each lobe is formed by lobules containing the glands responsible for milk production in response to hormone stimulation. Breast cancer always evolves silently. Most of the patients discover their disease during their routine screening. Others may present with an accidentally discovered breast lump, change of breast shape or size, or nipple discharge. Physical examination, imaging, especially mammography, and tissue biopsy must be done to diagnose breast cancer. The survival rate improves with early diagnosis.

Etiology: 

               AGE 
               GENDER 
               DIET ISSUE 
               OBESITY 
               RISK FACTOR 

Anatomy of the female breast. The nipple and areola are shown on the outside of the breast. The lymph nodes, lobes, lobules, ducts, and other parts of the inside of the breast are also shown.

Symptoms: 
                 Lump in breast tissue 
                                                 Dimpling of tissue
                                                 Patch on skin 
                                                Swollen lymph node 
                                               

Pathophysiology:
                             Breast cancer develops due to DNA damage and genetic mutations that can be influenced by exposure to estrogen. Sometimes there will be an inheritance of DNA defects or pro-cancerous genes like BRCA1 and BRCA2. Thus the family history of ovarian or breast cancer increases the risk for breast cancer development. In a normal individual, the immune system attacks cells with abnormal DNA or abnormal growth. This fails in those with breast cancer disease leading to tumor growth and spread.

About 90% of breast cancer are due to the genetic abnormalities that happen as a result of aging process and "wear" and "tear" of life 

Diagnostic Parameters: 

 Mammogram:
                            A mammogram is special type of X-Rays taken to look for abnormal growth or changes in breast tissues 

Breast Ultrasound:
                                                 An ultrasound can distinguish between a solid mass which may be cancer, and a fluid-filled cyst,  Which usually not a cancer. 

MRI: 

              MRI may be used to find out how much the disease has grown throughout the breast tissue 

Biopsy: 

              Removal of cell from suspicious mass to see if it is cancer or not 

Positron Emission Tomography: 
                                                                                   PET may also be used for to find out whether the cancer has spread to organs. 

Treatment / Management: 

The 2 basic principles of treatment are to reduce the chance of local recurrence and the risk of metastatic spread. Surgery with or without radiotherapy achieves local control of cancer. When there is a risk for metastatic relapse, systemic therapy is indicated in the form of hormonal therapy, chemotherapy, targeted therapy, or any combination of these. In locally advanced disease, systemic therapy is used as a palliative therapy with a small or no role for surgery.

Differential Diagnosis:

• Breast abscess
• Fat necrosis
• Fibro adenoma                                   

Surgical Oncology: 

 Mastectomy: Removal of the whole tissue.

Lumpectomy: Removal of a small part of the tissue.

A quadrantectomy involves removing the entire segment of the breast that contains the tumor. The last 2 procedures are usually combined with axillary clearance through a separate incision. Axillary procedures may include sentinel lymph node biopsy, sampling, partial (II), or complete (III) axillary lymph node dissection. Lumpectomy is the removal of a benign mass without excision of the normal breast tissue.

Radiation Oncology: 

Radiotherapy is given after surgery to the region of the tumor bed and regional lymph nodes, to destroy microscopic tumor cells that may have escaped surgery.

Medical Oncology: 

There are currently  main groups of medications used for adjuvant breast cancer treatment after surgery.

Hormone Blocking Therapy: Some breast cancers require estrogen to continue growing. These ER+ cancers can be treated with drugs that either block the receptors, e.g. Tamoxifen, or alternatively block the production of estrogen with an Aromatase inhibitor, e.g. Anastrozole or Letrozole. The use of tamoxifen is recommended for 10 years.

Chemotherapy: Chemotherapy is predominantly used for cases of breast cancer estrogen receptor-negative (ER-) disease. The chemotherapy medications are administered in combinations, usually for periods of 3-6 months.

One of the most common regimens, known as "AC". combines Adriamycin (Doxorubicin)+ Cyclophosphamide. Another common treatment is Cyclophosphamide+ Methotrexate+ Fluorouracil (or "CMF").

Prognosis:

The prognosis of early breast cancer is quietly good. Stage 0 and stage I both have a 100% 5-year survival rate. The 5-year survival rate of stage II and stage III breast cancer is about 93% and 72%, respectively. When the disease spreads systemically, its prognosis worsens dramatically. Only 22% of stage IV breast cancer patients will survive their next 5 years.

Complications:

Complications can arise from the treatment, whether chemotherapy, radiation, hormonal therapy, or surgery.

Surgical complications include:

• Infection
• Pain
• Bleeding

• Cosmetic issues

• Chemotherapy complications include:

• • Nausea/vomiting and diarrhea
  • Hair loss
  • Memory loss ("chemo brain")
  • Vaginal dryness
  • Menopausal symptoms/fertility issues
  • Neuropathy

  Complications accompanying hormonal therapy include:

  • Hot flashes
  • Vaginal discharge dryness
  • Fatigue
  • Nausea

  Radiation can result in the following complications:

  • Pain and skin changes
  • Fatigue
  • Nausea
  • Hair loss
  • Heart and lung issues (long-term)