Breast Cancer: Types, Stats, and Overview

Breast Cancer Overview

• Breast cancer starts when abnormal cells grow uncontrollably in one or both breasts
• These cells can invade nearby tissues and can spread to lymph nodes and other body parts

Types of Breast Cancer

• Ductal cancer affects the milk ducts and is the most common type
• Lobular cancer starts in the lobes of the breast and is often found in both breasts
• Inflammatory cancer makes the breast appear swollen and hot, but occurs very uncommonly

Breast Cancer Statistics

• Breast cancer accounts for 10.4% of all cancer cases among women worldwide
• It is the second most common non-skin cancer (after lung cancer)
• Breast cancer is the fifth leading cause of cancer death
• In 2004, breast cancer caused 519,000 deaths globally, representing 7% of cancer deaths
• Breast cancer is about 100 times more prevalent in women than it is in men
• Breast cancer survival rates are similar for both sexes
• In the Philippines, 26 out of 100 females and 1 out of 105 males may be diagnosed with breast cancer
• Breast cancer has been the leading cancer in Filipino women since the 1980s, and ranks second when considered with lung cancer across both sexes
• Breast cancer incidence peaks around age 30 in women
• In 2004, breast cancer cases surpassed lung cancer by 685 cases across both sexes in the Philippines
• Recently, a rising number of women show signs of bilateral disease at an early age
• Breast cancer survival rates in the Philippines is below 50%
• 70% of breast cancer patients in the Philippines are impoverished
• The Philippines has the highest prevalence of breast cancer in Asia

Factors Contributing to High Breast Cancer Prevalence in the Philippines

• Successful fertility reduction
• Westernised lifestyle
• Limited access to breast health services
• This limited access stems from factors such as:
  • Location of health facilities
  • Limited income
  • High costs of diagnostic tests and hospital care
  • Low education levels
  • Limited breast cancer awareness

Breast Cancer Risk Factors

• Gender: Higher risk for females than males
• Race: More prevalent in Caucasians and Jewish people.
• Age: The 30-60 year age group most commonly affected, but other ages can be affected too
• Family history: Presence of family history, particularly in mothers and sisters, increases risk
• 85% of women with a family history will not develop breast cancer
• Past history: Females with previous breast cancer have an increased risk of developing new breast cancer
• Menstruation: Early menarche and late menopause (increased estrogen exposure) increase risk
• Pregnancy & lactation: Nulliparous females, delayed first pregnancy and absence of breastfeeding are risk factors (increased unopposed estrogen exposure)
• High fat diet and obesity: Local oestrogen synthesis is increased, but risk can be decreased by beta carotene intake
• Strong family oncogenes like HER2/Neu can be present
• 25% of familial breast cancer is attributed to BRCA1 & BRCA2 germline mutations
• 30% of familial breast cancer can be attributed to mutations, but two-thirds remain unexplained
• Hormones:
  • Oestrogen exposure (late menopause, replacement therapy) increases risk
  • Prolactin excess shows some evidence of increasing risk
• Viruses:
  • Bittner milk virus has been linked to breast carcinoma in mice

Breast Cancer Symptoms

• Lump
• Skin dimpling
• Change in skin color and texture
• Change in the appearance of the nipple
• Clear or bloody fluid leaking from the nipple

Precancerous Lesions

• Proliferative changes (atypical hyperplasia) are high risk in patients with fibrocystic disease
• Duct papilloma

Classification of Breast Carcinoma

• Carcinoma of ductal origin (ducts)
• Carcinoma of lobular origin (lobes)
• Each can be invasive or non-invasive

Types of Breast Cancer

• Early classifications divided breast cancers into invasive ductal (ducts) and invasive lobular (lobules)
• Tumours classification can be divided into to 'special' and 'no special' type

Stage Information

• The American Joint Committee on Cancer (AJCC) staging system is a way to group patients based on prognosis
• Therapeutic decisions are formulated based on factors such as:
  • Staging categories
  • Lymph node status
  • Estrogen and progesterone receptor levels in the tumour tissue
  • Menopausal status
  • General patient health

TNM AJCC/UICC 2002 Classification

• T (Primary Tumour) categories:
  • Tx: Primary tumour cannot be assessed
  • T0: No primary tumour
  • Tis: Carcinoma in situ (DCIS/LCIS), Paget's disease of the nipple
  • T1: Tumour is < 2 cm
    • T1a: ≤ 0.5 cm
    • T1b: 0.5-1 cm
    • T1c: > 1 cm
  • T2: Tumour is 2-5 cm
  • T3: Tumour is > 5 cm
  • T4: Tumour of any size that has invaded the chest wall/skin
    • T4a: Invasion of the chest wall
    • T4b: Presence of edema, orange peel skin, satellite nodules
    • T4c: Both T4a and T4b
    • T4d: Carcinomatous mastitis
• N (Lymph Nodes) categories:
  • pN: ≥ 10 examined lymph nodes
  • Nx: Cannot be assessed
  • N0: No lymph node involvement
  • N1: Mobile ipsilateral lymph nodes
  • N2: Fixed ipsilateral lymph nodes
  • N3: Subclavicular, internal mammary, or supraclavicular lymph nodes involved
• M (Distant Metastasis) categories:
  • M0: No distant metastasis
  • M1: Distant metastasis

Stages of Breast Malignant Tumours

• Stage 0 (Ductal carcinoma in situ, DCIS): Almost always curable
• Invasive breast cancers are classified into these stages:
  • Stage 1: Tumour < 2 cm, no lymph node involvement elsewhere in the body
  • Stage 2: Tumour between 2-5 cm, axillary lymph nodes may be affected, no distant spread
  • Stage 3: Tumour > 5 cm, can be attached to surrounding structures, lymph nodes usually affected
  • Stage 4: Tumour of any size, lymph nodes usually affected, spread to other parts of the body (metastatic)

Mammograms

• Mammograms are effective in early breast cancer detection
• Yearly mammograms recommended for women over 40 by the American Cancer Society (ACS)
• Women over 20 should have mammograms every 2-5 years depending on their risk

Monthly Self-Exams

• Monthly self-exams are a good tool for early breast cancer detection
• Breast self-exams enable you to check breasts for any changes such as lumps/thickenings, and involves looking at and feeling your breasts

Clinical Breast Exams

• Breast exams done by a health professional are important
• Recommended every 3 years from age 20, and every year from age 40
• Clinical breast exams may be recommended more often with a strong family history of breast cancer

Thermography

• Thermography: A newer way to detect breast cancer
• Creates a thermal image of the breast tissue
• Can detect cancer before traditional mammograms

Breast Biopsy

• Used to determine if a trouble spot is cancerous or benign
• Breast biopsy removes cells or tissue from a suspicious mass that is examined under a microscope
• Biopsies may be performed when an abnormal breast change is found
• Method recommended depends on:
  • Size of breast lump or abnormal area
  • Location in the breast
  • Number of lumps or abnormal areas
  • Presence of suspicious calcifications
  • Other medical problems
  • Personal preferences

Image-Guided Needle Biopsy

• Minimally invasive alternative to surgery
• A radiologist usually performs this type of biopsy

Ductal Lavage

• Used for breast cancer detection by collecting cells from the milk ducts and identify precancerous cells called atypical cells
• Typically performed on women with multiple risk factors, to detect the risk of cancer before it starts
• Works on the premise that most breast cancers develop in milk duct cells and that it usually begins in one duct.

Stages of Breast Cancer

• Stage 0: Non-invasive in that is can be often referred to as a ‘non-evasive circoma’ with abnormal cells indicating increased risk of cancer, double mastectomy or tamoxifen could be helpful
• Stage I: Tumour is less than 1 cm across, and has not spread into the surrounding areas.
• Stage II: Cancer is anywhere from 1-2 cm across, and has spread into the surrounding areas including the lymph nodes to manage further spread
• Stage III: Cancer is more than 2 cm across, and has spread to the lymph nodes, associated with inflammatory breast cancer.
• Stage IV: The cancer has spread past the breast and lymph nodes, and needs immediate treatment of chemotherapy and hormonal therapy

Breast Cancer Treatments

• Remission: Being in remission is associated with a high risk of reoccurrence within 5 years, even after the last know cancer has been killed
• Radiation one of the most widely used, especially to a targeted area
• Works by killing all the cells in the effected area
• Can be administered externally or internally
• External radiation is delivered over a 5-7 weeks and 5 times a week, most common
• Internal radiation is delivered directly into the site where the tumor was, giving and extra boost to the end of treatment

Radiation Top 10 Notes

• Kills all cancer cells after surgery
• Unlike what it is commonly thought, radiation therapy does not make you radioactive
• Process is painless and treatments can take up to 5-7 weeks, radiation may become more painful over time
• Treatments can take over an hour, and hair will not fall out from just radiation
• Treatments can take an hour, and your hair will not fall out, unless you are also taking chemotherapy
• Your skin in the area may become red and easily irritated, or you may feel tired even after it has been concluded
• Reduces the chances of the cancer reoccurring
• Chemotherapy: Affects the whole body, administered prior to surgery. Reducing the size of the tumor
• Leukocytes (white blood cells) that is also your immune system), making you more susceptible to every day bugs
• Includes nausea and, losing all your hair
• Administered through an IV; or is available in pill, and liquid form

Chemotherapy for Breast Cancer

• Introduces the cancer to the immune system, taking a more proactive approach, but is only effective in certain types of cancer
• Comes with general side effects, fever, chills, muscle aches, and nausea; but in rare cases (5%) heart trauma occurs which can lead to strokes, and even congestive heart failure

Tamoxifen

• It is an effective tool to help eliminate the cancer, which many cancers love the estrogen already in our body.
• Works by blocking the estrogen receptors in the cancer preventing it from getting the estrogen it feeds on shrinking or eliminating the cancer completely.
• Reduces the likelihood of high risk patients get cancer, but also comes with general side effects, nausea, vomiting, blurred vision, and even swelling in your lips

Alternative Medicine

• There are certain medicines that can help to reduce or eliminate breast cancer, Vitamin A, Betacarotine, Vitamin C, and Vitamin E all increase the effect of chemotherapy or CO-Q10 reduces the toxicity of chemotherapy or Vitamin D, and Cholecalciferol helps inhibits growth in cancer, and finally Melitonin to block estrogen receptors

Bone Marrow Transplants

• They are one of the newest options for cancer, particularly when high doses of radiation and chemotherapy is received
• Replaces what was destroyed by the treatments/chemotherapy
• Caution must be used to test it/trials or breast cancer

Hormone Therapy for Breast Cancer

• Hormone therapy works by changing the way hormones stimulate cancer growth, by preventing blocking hormones on cancer cells
• If there are estrogen and progesterone receptors, hormone therapy may be need
• It is most commonly used for hormonal therapies, progestins and antiestrogens could be relevant.

Neoadjuvant Therapy

• Neoadjuvant therapy: Treatment given before the primary treatment for a condition or disease. Chemotherapy, radiation therapy, and hormone therapy are involved before surgery
• Commonly given to reduce the size of the surgical area for an optimal cosmetic result, or following surgeries as well for needed treatment as well

Masectomy

• A mastectomy is the surgical removal of the breast, usually as a treatment plan for it
• Is used for the process of Modified radical mastectomy to remove all the breast tissue and all of the lymph nodes, and may involve total mastectomy and axillary clearance.
• Radical mastectomy: For removes all the breast tissue, lymph nodes, and muscles if cancer has invaded the pectoralis muscles

Surgical Complications following Masectomy

• Local pain, wound infection, and bleeding
• Numbness or tingling of the shoulder following damage
• Radiotherapy can be done to destroy cancer cells and improve the results

Breast Conservation Surgery

• Brest conserving surgery or lumpectomy: Removal of a breast lump or some tissue in the area that is sent to a lab for examination is typically done
• Reserved for cases where there is early stage cancer and small compared to the rest of breast
• Used for invase cancer and involves a lymph node procedure

Prostate Cancer

Facts About Prostate Cancer

• One of the most common caners in men
• Prostate cancer can be detected early through a digital rectal exam (DRE).
• 10 men out of 100,000 will suffer from prostate cancer.

Risk Factors for Prostate Cancer

• Genetics: Gene alterations on chromosome 1, 17, and the X chromosome.
• Prostate cancer is found most often in men over age 50.
• High fat die that leads to increased risks
• Clinical Signs and Symptoms
• Symptoms of urinary obstructions
• Unintended weight loss and/or loss of appetite
• Weight loss, weakness
• Oliguria

###Stages of Prostate Cancer

• Prostate Cancer Stage I Cancer is found in the prostate only.
• Prostate Cancer Stage II The tumor limited to grows inside the prostate but hasn’t extended beyond it.
• Prostate Cancer Stage III Cancer has spread outside the prostate, but only barely and nearby tissues
• Prostate Cancer Stage IV Cancer has spread outside to other tissues like the bones, liver, or lungs.

###Diagnostic Exam

• PSA can be found in those with prostate cancer
• Biopsy
• Transrectal Biopsy. through the rectum and into the prostate.
• Radionuclide Scan - Bone

Complications

• Sexual dysfunction ###Medical Managements
• Stage I Treatment: Implant radiation therapy/
• Stage II Treatment
• Stage III Treatment ###Hormonal Therapy
• Hormone therapy is also called androgen deprivation therapy
• The goal is to reduce the testotterone levels which is produced in the testies
• Orchiectomy which removes the testies, where more than 90% of the androgens, mostly testosterone,

###Side effects of hormone therapy

• reduced or absent libido (sexual desire)
• decreased mental acuity (sharpness)
• weight gain
• Increased risk of hypertension (high blood pressure)
• Brachytherapy

Preoperative anxiety management

• preoperative routines

POSTOPERATIVE care

• Maintaining fluid balance

Surgery Care

• 1. Pull up with esophagogastric anastomosis

Tips for a healthy Prostate

• Eat a balanced diet.
• Get some form of exercise.

Esophageal Cancer

• Well described at the beginning of the 19th century

Clinical presentation

• A complaint of dysphagia in an adult should always prompt an endoscopy
• Weight loss that occurs 50% within cancer patients

Etiology

• Is thought to be related to exposure of the esophageal mucosa to: noxious or toxic stimuli Is a contraindication

The etiology

• Chronic ingestion of: hot liquids or foods is a contributing factor

Diagnostic

Performing esophagogastroduodenoscopy allows: direct visualization

Treatment

Esophageal resection : part of the treatment