Breast cancer
Student: Shoaa Ali Bin-kulib
ID:423200043
Super visor Dr. Samina Hyder Haq
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content
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content :
introduction-----------------------------------------4
Breast cancer classification-----------------------9
Common types of breast cancer ----------------11
Who gets breast cancer---------------------------14
Sign and symptoms-------------------------------16
Screening and testing-----------------------------18
Treatment------------------------------------------22
Complementary and Alternative Medicine----25
Drugs Used in the treatment of breast cancer-27
Reference-------------------------------------------30
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Introduction
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Introduction:
Cancer medical term: malignant neoplasm is a class of
diseases in which a group of cells display uncontrolled growth
(division beyond the normal limits), invasion (intrusion on and
destruction of adjacent tissues), These three malignant
properties of cancers differentiate them from benign tumors
are self-limited, Most cancers form a tumor but some, like
leukemia, do not. The branch of medicine concerned with the
study, diagnosis, treatment, and prevention of cancer is
oncology[1].
Cancer may affect people at all ages, even fetuses, Cancer
causes about 13% of all deaths[1]. According to the American
Cancer Society, 7.6 million people died from cancer in the
world during 2007[2]. Cancers can affect all animals.
Nearly all cancers are caused by abnormalities in the genetic
material of the transformed cells.These abnormalities may be
due to the effects of carcinogens, such as tobacco smoke,
radiation, chemicals, or infectious agents. Other cancerpromoting genetic abnormalities may be randomly acquired
through errors in DNA replication, or are inherited, and thus
present in all cells from birth.
Oncologist-approved information on more than 120 types of
cancer and cancer-related syndromes. The most common types
of cancer are : Bladder Cancer, Breast Cancer, Colon and
Rectal Cancer, Endometrial Cancer, Kidney (Renal Cell)
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cancer , Leukemia, Lung Cancer, Melanoma, Non-Hodgkin
Lymphoma, Pancreatic Cancer, Prostate Cancer, Skin Cancer,
Thyroid Cancer.Cancers are caused by a series of mutations.
Each mutation alters the behavior of the cell somewhat.
Cancer is fundamentally a disease of
regulation of tissue growth. In order for a
normal cell to transform into a cancer
cell, genes which regulate cell growth and
differentiation must be altered.[24] Genetic
changes can occur at many levels, from
gain or loss of entire chromosomes to a
mutation affecting a single DNA
nucleotide. There are two broad
categories of genes which are affected by
these changes. Oncogenes may be normal
genes which are expressed at
inappropriately high levels, or altered
genes which have novel properties. In
either case, expression of these genes
promotes the malignant
Figer(1)
Cancer mechanism[11]
phenotype of cancer cells[11]. Tumor suppressor genes are
genes which inhibit cell division, survival, or other properties
of cancer cells. Tumor suppressor genes are often disabled by
cancer-promoting genetic changes. Typically, changes in
many genes are required to transform a normal cell into a
cancer cell.
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The following table gives the estimated numbers of new cases
and deaths for each common cancer type:
Cancer Type
Estimated New Cases
Estimated Deaths
Bladder
70,980
14,330
Breast (Female - Male)
192,370 - 1,910
40,170 - 440
Colon and Rectal (Combined)
146,970
49,920
Endometrial
42,160
7,780
Kidney (Renal Cell) Cancer
49,096
11,033
Leukemia (All)
44,790
21,870
Lung (Including Bronchus)
219,440
159,390
Melanoma
68,720
8,650
Non-Hodgkin Lymphoma
65,980
19,500
Pancreatic
42,470
35,240
Prostate
192,280
27,360
Skin (Nonmelanoma)
>1,000,000
<1,000
Thyroid
37,200
1,630
Table (1)
Estimated numbers of new cases and deaths for each common cancer type[17].
In this research paper I will discuss breast cancer. Breast
cancer is the most common cancer and the most common
cause of cancer-related deaths in woman world
wide(3).although the incidence seems to be lower in the
developing countries, the more tality is higher(3,4).this is due to
many factors including a lack of screening programs, a lack of
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early detection and diagnosis, and suboptimal treatment. In
Saudi Arabia, only 10% of the female population is under 50
years of age and therefore the majority of our patients are premenopausal. They present with late stage disease and often
with locally advanced breast cancer(LABC).there is
considerable patient and doctor delay, and this, in combination
with the often more aggressive disease seen in the young
patients, means that treatment for cure is not always possible.
This is unfortunately the picture often reported from countries
lacking programs for early detection and breast care
guidelines(5,6).at king Faisal Specialist Hospital & Research
Center[KFSH&RC], [8-10]newly diagnosed breast cancer
patients are seen weekly in the combined breast clinic, most of
them referred from other hospitals after initial management.
KFSH&RC is the major tertiary center in the Middle East,
providing cancer treatment of high international standard.
Every Saudi citizen diagnosed with cancer is entitled to free
treatment in the hospital. The mission statement of the hospital
clearly expresses the responsibility not only to treat cancer
patient but also to prevent and improve primary care of cancer.
Breast cancer management and treatment in countries with
limited resources represent a special challenge (6-8).
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Breast cancer
classification
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Breast cancer classification:
Breast cancers are described along four different classification
schemes, or groups, each based on different criteria and
serving a different purpose:




Pathology - Each tumor is classified by its histological
(microscopic anatomy) appearance and other criteria.
Grade of tumor - The histological grade of a tumor is
determined by a pathologist under a microscope. A welldifferentiated (low grade) tumor resembles normal tissue.
A poorly differentiated (high grade) tumor is composed
of disorganized cells and, therefore, does not look like
normal tissue. Moderately differentiated (intermediate
grade) tumors are somewhere in between.
Protein & gene expression status - Currently, all breast
cancers should be tested for expression, or detectable
effect, of the estrogen receptor (ER), progesterone
receptor (PR) and HER2/neu proteins. These tests are
usually done by immunohistochemistry and are presented
in a pathologist's report. The profile of expression of a
given tumor helps predict its prognosis, or outlook, and
helps an oncologist choose the most appropriate
treatment. More genes and/or proteins may be tested in
the future.
Stage of a tumor - The currently accepted staging scheme
for breast cancer is the TNM classification. This
considers the Tumor itself, whether it has spread to
lymph Nodes, and whether there are any Metastases to
locations other than the breast and lymph nodes.
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breast cancer kind depends on which cells in the breast
turn into cancer. Breast cancer can begin in different parts
of the breast, like the ducts or the lobes[12].
Common
kinds of
breast cancer
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Common kinds of breast
cancer are:

Ductal carcinoma. The most common kind of breast
cancer. It begins in the cells that line the milk ducts in the
breast, also called the lining of the breast ducts.
o Ductal carcinoma in situ (DCIS). The abnormal
cancer cells are only in the lining of the milk ducts,
and have not spread to other tissues in the breast.
o Invasive ductal carcinoma. The abnormal cancer
cells break through the ducts and spread into other
parts of the breast tissue. Invasive cancer cells can
also spread to other parts of the body[14].
Figer(2)
Brest combination
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 Lobular carcinoma. In this kind of breast cancer, the
cancer cells begin in the lobes, or lobules, of the breast.
Lobules are the glands that make milk.
o
Lobular carcinoma in situ (LCIS). The cancer
cells are found only in the breast lobules. Lobular
carcinoma in situ, or LCIS, does not spread to other
tissues very often.
o
Invasive lobular carcinoma. Cancer cells spread
from the lobules to the breast tissues that are close
by. These invasive cancer cells can also spread to
other parts of the body.
Figer(3)
Lobular carcinoma
Uncommon Kinds of Breast
Cancer:
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There are several other less common kinds of breast cancer,
such as Paget's disease or inflammatory breast cancer[14].
Who gets
Breast
Cancer?
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Who gets Breast Cancer?
ncidence increases with age. Breast cancer is rare in those
under the age of 30, but presents in up to 1 in 14 women over
the age of 70.
Lobular carcinoma is the second commonest type of breast
cancer, making up about 10% of all breast cancers.
Also the main risk factors for breast cancer are:

Increasing age

A family history of breast cancer

Proliferative breast disease

Hormonal factors: women who begin menstruation early,
women who have a late menopause, late or few
pregnancies, or who are obese. Some evidence is emerging
that long term oestrogen therapy (for example, long-term
use of the oral contraceptive pill, or hormone replacement
therapy (HRT)) may increase risk, as may a diet which is
high in fat.

Others: exposure to radiation; geographical factors.
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Signs and
symptoms
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Signs and symptoms:
The first symptom, or subjective sign,
of breast cancer is typically a lump that
feels different from the surrounding
breast tissue. According to the The
Merck Manual, more than 80% of
breast cancer cases are discovered when
the woman feels a lump[18].
Ther are some other signs according to
the American Cancer Society, unusual
changes in the breast can be a symptom
of breast cancer:







figer(4)
self test for breast cancer
swelling of all or part of the breast
skin irritation or dimpling
breast pain
nipple pain or the nipple turning inward
redness, scaliness, or thickening of the nipple or breast
skin
a nipple discharge other than breast milk
a lump in the underarm area
These changes also can be signs of less serious conditions that
are not cancerous, such as an infection or a cyst. So it’s
important to get any breast changes checked out promptly by a
doctor.
In some cases breast cancer may not cause any symptoms. A
lump may be too small to feel or to cause any unusual changes
.Often, an abnormal area turns up on a screening mammogram
(x-ray of the breast), which leads to further testing.
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Screening and
testing
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Screening and testing:
Most breast-cancer-related tests fall into one or more of the
following categories[18]:



Screening tests: Screening tests (such as yearly
mammograms) are given routinely to people who appear
to be healthy and are not suspected of having breast
cancer. Their purpose is to find breast cancer early,
before any symptoms can develop and the cancer usually
is easier to treat.
Diagnostic tests: Diagnostic tests (such as biopsy) are
given to people who are suspected of having breast
cancer, either because of symptoms they may be
experiencing or a screening test result. These tests are
used to determine whether or not breast cancer is present
and, if so, whether or not it has traveled outside the
breast. Diagnostic tests also are used to gather more
information about the cancer to guide decisions about
treatment.
Monitoring tests: Once breast cancer is diagnosed, many
tests are used during and after treatment to monitor how
well therapies are working. Monitoring tests also may be
used to check for any signs of recurrence
There are many tests of screening, diagnosis, and treatment is
made due to what the patient need in doctor opinion, I will
mention it :




Biopsy
Blood Cell Counts
Blood Chemistries
Blood Marker Tests
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
















Bone Scans
Breast MRI (Magnetic Resonance Imaging)
Breast Physical Exam
Breast Self-Exam (BSE)
CT (CAT) Scans
Chest X-Rays
Digital Tomosynthesis
Ductal Lavage
FISH Test (Fluorescence In Situ Hybridization)
IHC Tests (ImmunoHistoChemistry)
Mammograms
Molecular Breast Imaging
Oncotype DX
PET Scans
SPoT-Light HER2 CISH
Thermography
Ultrasound
Now all over the world people become more educated and
want to have knowledge about any ting they may have. As a
result of this Genetic Testing can be done to learn whether
or not they have an abnormality in what have come to be
known as the “breast cancer genes,” BRCA1 (BReast
CAncer gene one) and BRCA2 (BReast CAncer gene two).
Women who inherit a mutation, or abnormal change, in
either of these genes — from their mothers or their fathers
— have a much higher-than-average risk of developing
breast cancer and ovarian cancer. Men with these mutations
have an increased risk of breast cancer, especially if the
BRCA2 gene is affected, and possibly of prostate cancer.
Many inherited cases of breast cancer have been associated
with these two genes.
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The function of the BRCA genes is to keep breast cells
growing normally and prevent any cancer cell growth. But
when these genes contain the mutations that are passed from
generation to generation, they do not function normally and
breast cancer risk increases. Abnormal BRCA1 and BRCA2
genes may account for up to 10% of all breast cancers, or 1
out of every 10 cases.
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Treatment
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Treatment:
Kinds of Treatment
Breast cancer is treated in several ways. It depends on the kind
of breast cancer and how far it has spread. Treatments include
surgery, chemotherapy, hormonal therapy, biologic therapy,
and radiation. People with breast cancer often get more than
one kind of treatment[15].

Surgery. An operation where
doctors cut out and remove
cancer tissue.

Chemotherapy. Using special
medicines, or drugs to shrink or
kill the cancer. The drugs can be
pills you take or medicines given
through an intravenous (IV)
tube, or, sometimes, both.
Figer(5)
Chemotherapy

Hormonal therapy. Some cancers need certain
hormones to grow. Hormonal treatment is used to block
cancer cells from getting the hormones they need to
grow.

Biological therapy. This treatment works with your
body's immune system to help it fight cancer or to control
side effects from other cancer treatments. Side effects are
how your body reacts to drugs or other treatments.
Biological therapy is different from chemotherapy, which
attacks cancer cells directly.
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
Radiation. The use of highenergy rays (similar to X-rays)
to kill the cancer cells. The
rays are aimed at the part of the
body where the cancer is
located.
Figer(6)
Radiation therapy
It is common for doctors from different specialties to work together in
treating breast cancer. Surgeons are doctors that perform operations.
Medical oncologists are doctors that treat cancers with medicines.
Radiation oncologists are doctors that treat cancers with radiation.
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Complementary
and Alternative
Medicine
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Complementary and
Alternative Medicine:
Complementary medicine is a group of medicines and practices that
may be used in addition to the standard treatments for cancer.
Alternative medicine means practices or medicines that are used
instead of the usual, or standard, ways of treating cancer. Examples of
complementary and alternative medicine are meditation, yoga, and
dietary supplements like vitamins and herbs.
Complementary and alternative medicine does not treat breast cancer,
but may help lessen the side effects of the cancer treatments or of the
cancer symptoms. It is important to note that many forms of
complementary and alternative medicines have not been scientifically
tested and may not be safe.
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Drugs/Produc
ts Used in the
Treatment of
This Disease
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Drugs/Products Used in the
Treatment of This Disease:

Abraxane:(Nanoparticle, albumin-bound paclitaxel)

Methotrexate Injection BP:(Methotrexate)

Arimidex:(Anastrozole)

Aromasin:(Exemestane)

Avastin:(Bevacizumab)

Endoxan:(Cyclophosphamide)

Femara:(Letrozole)

Gemzar:(Gemcitabine hydrochloride)

Haldol Decanoate:(Haloperidol decanoate)

Herceptin:(Trastuzumab)

Megace:(Megestrol acetate)

Onkotrone:(Mitozantrone hydrochloride)

Pamisol:(Disodium pamidronate)

Provera:(Medroxyprogesterone acetate)
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
Tamoxifen-BC:(Tamoxifen citrate)

Taxotere:(Docetaxel)

Tykerb:(Lapatinib Ditosylate)

Xeloda:(Capecitabine)

Zoladex 3.6mg and 10.8 mg Implant:(Goserelin acetate)

Zometa:(Zoledronic acid)[19]
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References
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References:
Books and research papers:
1. Croce CM (January 2008). "Oncogenes and cancer". The
New England journal of medicine 358
2. Knudson AG (November 2001). "Two genetic hits (more
or less) to cancer". Nature reviews. Cancer 1 (2): 157–62
3. Lipworth L, Tarone RE, McLaughlin JK: The
epidemiology of renal cell carcinoma. Journal of Urology
176(6 pt 1):2353-2358, 2006.
4. American Cancer Society: Cancer Facts and Figures
2009. Atlanta, Ga: American Cancer Society, 2009.
5. Parkin DM, PisaniP, Ferlay J. Global cancer statistics.
CA. Cancer J.clin 1999.
6. Greenlee RT , Murray T , Bolen S, et al.cancer
statistics.2000.CA. Cancer J.clin 2000.
7. Hisham AN,yip CH.spectrum of cancer in Malaysian
women.over-view. World J.surg.2003.
8. Chopra R.Management of locally advanced breast cancer
in india. Paper presented at the global summit consensus
conference,2002.
9. Anderson Bo,BraunS, Carison RW,over view brest health
care guidelines for countries with limited resource.
10.
VargasHI, Anderson Bo,chopra R, diagnosis of
breast cancer in countries with limited resource 2003.
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Web sites:
11.www.en.wikipedia.org/wiki/Cancer
12.www.en.wikipedia.org/wiki/Breast_cancer
13.www.cancer.net/patient/Cancer+Types
14.www.cdc.gov/cancer/breast/basic_info/
15.www.mayoclinic.com/health/breast-cancer/
16.www.virtualmedicalcentre.com/diseases.asp
17. www.cancer.gov/cancertopics/commoncancers
18. www.breastcancer.org/symptoms/testing/types/
19. www.ncbi.nlm.nih.gov/pubmed/11522269
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