Breast cancer
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Breast Cancer. An Individualized Disease Cindy Stinson PhD, APRN, CNS,RN-BC. Types of Breast Cancer. Estrogen Positive/ Progesterone Positive Breast Cancer Triple Negative Breast Cancer Herceptin Positive Breast Cancer Inflammatory Breast Cancer Phyllodus Tumor.

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Breast Cancer

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Breast cancer

Breast Cancer

An Individualized Disease

Cindy Stinson PhD, APRN, CNS,RN-BC


Types of breast cancer

Types of Breast Cancer

  • Estrogen Positive/ Progesterone Positive Breast Cancer

  • Triple Negative Breast Cancer

  • Herceptin Positive Breast Cancer

  • Inflammatory Breast Cancer

  • Phyllodus Tumor


Estrogen progesterone positive

Estrogen/Progesterone Positive

  • Receptors are proteins on the outside surfaces of cells that can attach to certain substances, such as hormones, that circulate in the blood.

  • Normal breast cells and some breast cancer cells have receptors that attach to estrogen and progesterone. These 2 hormones often fuel the growth of breast cancer cells.


Estrogen progesterone positive1

Estrogen/Progesterone Positive

  • About 75% of all breast cancers are “ER positive.” They grow in response to the hormone estrogen. About 65% of these are also “PR positive.” They grow in response to another hormone, progesterone.

  • Women with hormone receptor-positive cancers tend to have a better prognosis and are much more likely to respond to hormone therapy than women with cancers without these receptors.


Breast cancer

Targeted Drugs Breast Cancer- Drugs Approved for Breast Cancer- (http://www.cancer.gov/cancertopics/druginfo/breastcancer)

  • Estrogen is produced by the ovaries and other tissues of the body, using a substance called aromatase.

  • Aromatose Inhibitors (AIs) do not block estrogen production by the ovaries, but they can block other tissues from making this hormone.

  • Used mostly in women who have reached menopause, when the ovaries are no longer producing estrogen.


Breast cancer

Targeted Drugs Breast Cancer- Drugs Approved for Breast Cancer- (http://www.cancer.gov/cancertopics/druginfo/breastcancer)

  • Tamoxifen (Nolvadex®) helps to prevent the growth of estrogen-sensitive breast tumors, but it works differently from AIs.

  • Tamoxifen blocks a tumor's ability to use estrogen.

  • Currently, three AIs are approved by the U.S. Food and Drug Administration: Arimidex®, (Aromasin®), and Femara®.

  • Currently clinical trials underway for a vaccine to either prevent or slow down growth


Triple negative breast cancer

Triple-Negative Breast Cancer

  • “Triple negative” (10-17% breast cancers) because they lack estrogen and progesterone receptors and do not overexpress the HER2 protein. The majority of breast cancers associated with the breast cancer gene known as BRCA1 are triple negative.

  • These cancers generally respond well to adjuvant chemotherapy. Overall, however, they have a poorer prognosis than other types of breast cancer. So far, no targeted therapies like tamoxifen or Herceptin have been developed to help prevent recurrence in women with triple-negative breast cancer.


Triple negative breast cancer1

Triple-Negative Breast Cancer

  • In a recent genetic study, researchers found that one in five African American women with breast cancer have an inherited (passed down in the family) mutation (change) in at least one of the 18 genes that are linked with a higher risk of breast cancer.

  • Compared to the general population, African American women are more likely to be diagnosed with breast cancer at a younger age, die from the disease, and have triple-negative breast cancer.

  • Triple negative breast cancer is more likely to affect younger people, African Americans, Hispanics, and/or those with a BRCA1 gene mutation.

  • Researchers have suspected that these differences are due to inherited genes linked to breast cancer, but this is the first study to look at all known breast cancer gene mutations, not just BRCA genes.


Brca mutation

BRCA Mutation

  • BRCA 1 mutation: A gene on chromosome 17 that normally helps to suppress cell growth. A person who inherits a mutated BRCA1 gene has a higher risk of getting breast, ovarian, or prostate cancer.BRCA 2 mutation: A gene on chromosome 13 that normally helps to suppress cell growth. A person who inherits a mutated BRCA2 gene has a higher risk of getting breast, ovarian, or prostate cancer.


Herceptin positive breast cancer

Herceptin Positive Breast Cancer

  • About 1 of 4 breast cancers (25%) have too much of a growth-promoting protein called HER2/neu (often just shortened to HER2).

  • Referred to as "HER2-positive."


Herceptin positive breast cancer1

Herceptin Positive Breast Cancer

  • Women with HER2-positive breast cancers, have too many copies of the HER2/neu gene (known as gene amplification), resulting in greater than normal amounts of the HER2/neu protein (known as overexpression of HER2/neu).

  • These cancers tend to grow and spread more aggressively than other breast cancers.

  • Herceptin is a targeted drug for women who are HER 2 positive


Inflammatory breast cancer american joint committee on cancer case definition for ibc

Inflammatory Breast Cancer-(American Joint Committee on Cancer Case Definition for IBC)

  • This uncommon type of invasive breast cancer accounts for about 1% to 3% of all breast cancers.

  • Designated Stage IIIB or IV at diagnosis

  • Composite entity characterized clinically by diffuse edema (peaud'orange) and erythema (redness) of the breast, over the majority of the breast and often without an underlying mass.

  • The clinical appearance is due to pathologic plugging of the dermal lymphatics of the breast, but pathologic involvement of the dermal lymphatics alone does not confirm the diagnosis.


Inflammatory breast cancer

Inflammatory Breast Cancer

  • Rare

  • Aggressive

  • Unknown etiology and generally poor outcome

  • Even with multimodality therapy, median overall survival among women with IBC is less than 4 years

  • First described in 1814


Inflammatory breast cancer1

Inflammatory Breast Cancer

  • Cases among women with IBC compared to all breast cases were more likely to have positive axillary lymph nodes, high tumor grade, and negative hormone receptors.

  • ER negative tumors comprised 22.5% of all breast cancer cases (47,251 of 209,718) compared to 45.6% of IBC cases (1,654 of 3,631)

  • IBC is increasing by 4.35% each year


Epidemiology http www ncbi nlm nih gov pmc articles pmc2852616

Epidemiology (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852616/)

  • Incidence rates were significantly higher among Black women (3.1 per 100,000 woman-years) than among White women (2.2 per 100,000 woman-years) (1988-2000)

  • Among women with IBC, median ages varied by racial group, ranging from 49.5 years for American Indian/Alaskan Natives to 54 years for Black and Asian Pacific Islanders (API) and to 58 years for Whites.

  • For women overall, median age was 57 years for IBC and 61.9 years for all breast cancer cases combined


Epidemiolgy

Epidemiolgy

  • Many research reports have noted that IBC is associated with pregnancy and/or lactation. Whereas other series suggest that IBC is no more common for pregnancy-related tumors than for other breast cancer types.

  • A surprising portion of young women with IBC had their first symptoms during pregnancy or lactation. The misconception is that these young women are at lower risk for breast cancer and the fact that IBC is the most aggressive form of breast cancer may result in metastases already present when the diagnosis is made. (http://www.ibcresearch.org/)

  • The highest BMI (BMI > 26.65 kg/m2) was associated with an increased risk for IBC compared to non-IBC, irrespective of menopausal status, age at menarche, family history of breast cancer, gravidity, smoking status, or alcohol use. (IBC patients treated at the University of Texas' M.D. Anderson Cancer Clinic during the years 1985 to 1996 were pair-matched with n = 143 non-IBC breast cancer and n = 134 non-breast cancer patients, according to date of diagnosis and race).


Inflammatory breast cancer2

Inflammatory Breast Cancer

  • Blood type A has been associated more generally with increased cancer risk

  • IBC can occur in men, but usually at an older age than in women


Diagnosis

Diagnosis

  • Based primarily on the results of a doctor's or nurse’s examination.

  • Biopsy, ultrasound, and mammogram are used to confirm the diagnosis.

  • Skin thickening often shows up on a mammogram.

  • Dermatologists need to know about symptoms because patients may be referred to their office.


Clinical presentation

Clinical Presentation

  • Sudden increase in breast cancer

  • Little or no response to antibiotic treatment- sometimes mistaken for Mastitis.

  • The possible diagnosis of IBC should be considered more strongly when a woman who is not pregnant or breast-feeding comes in with these symptoms. Breast infection is less common in women who are not pregnant or breast-feeding, and even rarer in women after menopause. When infection occurs it is usually associated with fever or other signs of infection.


Clinical presentation1

Clinical Presentation

  • Symptoms may include heaviness, burning, aching, increase in breast size, tenderness, or a nipple that is inverted (facing inward). These symptoms usually develop quickly—over a period of weeks or months.

  • Swollen lymph nodes may also be present under the arm, above the collarbone, or in both places.

  • It is important to note that these symptoms may also be signs of other conditions such as infection, injury, or other types of cancer.


Phyllodes tumor

Phyllodes Tumor

  • A very rare type of breast tumor, which can be benign or malignant.

  • This type of tumor is called a "sarcoma," because it occurs in the connective tissue (stroma) of the breast, rather than in epithelial tissue (lining of ducts and lobes).

  • Phyllodes tumors take their name from the Greek word phullon (leaf) because of their leaf-shaped growth pattern.

  • Feels like a firm, smooth-sided, bumpy (not spiky) lump in the breast tissue.


Risk factors

Risk Factors

  • More common in women who have benign breast lumps called fibroadenomas.

  • However, most women who have fibroadenomas do not develop phyllodestumours.


Phyllodes tumor1

Phyllodes Tumor

  • Breast skin over the tumor may become reddish and warm to the touch.

  • This type of breast tumor grows very fast — so much so that the lump can become bigger in a couple of weeks.

  • Most women who are diagnosed with Phyllodes tumor are usually premenopausal.

  • In very rare cases, adolescent girls may be diagnosed with this type of breast tumor.

  • This type of breast tumor is not usually found near microcalcifications.


Phollodus tumor

Phollodus Tumor

  • Cells from a needle biopsy can be tested in the lab but seldom give a clear diagnosis, because the cells can resemble carcinomas and fibroadenomas.

  • An open surgical biopsy, which results in a slice of tissue, will provide a better sample of cells and will result in a proper diagnosis for a Phyllodes tumor.

  • Most breast cancers are classified as stages 1 to 4, but that is not the case with Phyllodes tumor. After a surgical biopsy, the pathologist will study the cells under a microscope.


Phyllodes tumor2

Phyllodes Tumor

  • Two characteristics are considered: the speed at which the cells are dividing and the number of irregularly shaped cells in the tissue sample.

  • Depending on how the cells meet these criteria, the tumor is classed as benign (harmless), borderline or malignant (cancerous).

  • Most Phyllodes tumors turn out to be benign.

  • Prognosis after treatment, is very good for a benign Phyllodes tumor.

  • There is a low chance of recurrence for a Phyllodes tumor, if you are 45 or older.


Phyllodes tumor3

Phyllodes Tumor

  • For patients with a diagnosis of borderline or malignant tumors, prognosis will vary.

  • Borderline tumors have the potential to become cancerous, and even after surgery, if some cells remain (although in rare cases) they will metastasize.

  • Malignant tumors can recur even two years after treatment and may spread to lungs, bones, liver and chest wall.

  • In a few cases, lymph nodes were involved as well.

  • Surgery to remove a Phyllodes tumor is the standard treatment. This type of tumor does not respond well to radiation, chemotherapy or hormonal therapies


Breast cancer

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