Breast Cancer

1. Breast Cancer The Penncrest High School Medical Scholars Club

2. 5 Things You probably don’t Know About 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 breastcancer, one will occur in a man.

3. Symptoms • Breast Cancer is often Asymptomatic • Breast orarmpit lump • Bloody or clear nipple discharge • Breast size or shape change • Inverted or retracted nipple • Scaling or flaking of the nipple/ breast skin • Breast appears to be red • Unusual breast pain or nipple pain

4. Risk Factors • Menstruating at an early age. • Family history of breast, ovarian or prostate cancer • High breast density on a mammogram • 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 • Overweight after menopause or gaining weight as an adult • Postmenopausal hormone Replacement Therapy

5. Prevention 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

6. Diagnosis

7. Detection Breast 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).

8. 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. • 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.

9. 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. • 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 whether extra steps or further examination is necessary.

10. 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.

11. 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

12. MRI • Not a test to determine whether cells/tissues are benign or malignant (like a biopsy) • May detect tumors in dense breast tissues

13. 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

14. 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

15. Types of Breast Cancer

16. 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

17. 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.

18. 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

19. 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.

20. Metastatic Breast Cancer Metastatic 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

21. Tumor Growth Angiogenesis: 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.

22. Tumor Metastasis Metastasis: 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.

23. Breast Cancer Staging

24. Stages of Breast Cancer Staging describes the severity of a person’s cancer based on the extent of the original tumor and whether or not cancer has spread in the body. Staging is important for several reasons: Staging helps the doctor plan the appropriate treatment. The stage can be used to estimate the person’s prognosis. Knowing the stage is important in identifying clinical that may be suitable for a particular patient. Staging helps health care providers and researchers exchange information about patients; it also gives them a common terminology for evaluating the results of clinical trials and comparing the results of different trials.

25. Stages of Breast Cancer Various tests, such as lymph node biopsies, chest x-rays, and CT scans, can reveal how advanced the disease state has become. Stages I Tumor is less than two centimeters or smaller II Tumors are between two and five centimeters in diameter and have spread to one to three lymph nodes, OR there are no affected lymph nodes but the tumor is greater than five centimeters III Tumors larger than five centimeters has spread to up to nine lymph nodes. IV The 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 and grows into surrounding tissues, travels through lymph vessels, or travel through blood by veins and capillaries

26. Breast Cancer Treatments

27. Treatments Breast Cancer treatment includes all of the following alone and or in conjunction with one another Chemotherapy Radiation Hormonal Therapy Surgery Targeted Therapies

28. Chemotherapy • 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

29. Chemotherapy for Breast Cancer • Chemotherapy drugs are usually given in 2-4 week cycles, but some may be used on a weekly basis. • Single agent (one drug at a time) may be an option in treating breast cancer that has already spread to other areas. • Although responses to combination chemotherapy are higher, toxicity is also greater as compared to single agent chemotherapy.

30. Chemotherapy for Breast Cancer • The most common chemotherapy drugs used to treat breast cancer include : • Anthracyclines: Andriamycin, Ellence, and Doxil • Taxanes: Taxoter, Taxol, and protein-bound Abraxane • Cytoxan • Xelodaand5 Flourouracil(5 FU) • Navelbine • Gemzar • Herceptin: For use in breast cancers have the HER-2 gene • Other drugs may include Ixempra, Halaven, methotrexate (Rheumatrex, Trexall), Tykerb,and others.

31. Radiation • 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. • There are two types of radiation • External 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.

32. Radiation Side Effects • Radiation causes irritation, redness, and or dryness to the treated area. • Another side effect is fatigue, especially after couple weeks after the the treatment

33. Hormonal Therapy • Hormonal therapy is using medicine to block of hormones to prevent cancer cells from spreading. • Two most common hormone therapies • SERMs (Selective Estrogen Receptor Modulators) • Targets estrogen hormones at the breast cancer cells • 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 • NOT effective on hormone receptive breast cancers

34. Tamoxifen The most commonly used- Generic name is Nolvadex Its a SERM – Selective Estrogen Response Modulator Act on estrogen receptors as both agonists and antagonists • Agonist -attach to a receptor of a cell and promotes action • Antagonist -attaches to the receptor of a cell and blocks the agonists • SERM - effect on receptors varies from tissue so they can inhibit or stimulate estrogen like action in tissues

35. Tamoxifen Given to breast cancer patients after surgery or chemotherapy and radiation to reduce the risk of it coming back Only effective on hormone receptor positive/early stage breast cancer a pill given once a day and taken for 3-5 years Shrinks the hormone receptor positive breast cancer even before surgery

36. Hormonal Therapies Side Effects This type of therapy can causes hot flashes; vaginal discharge, dryness and irritation; irregular periods; decreased sex drive; and mood changes and increased tumor or bone pain • Aromatase inhibitors may also cause joint and muscle pain, as well as an increased risk of bone thinning.

37. Surgery • There are four types of surgery that a patient can under go • Lumpectomy • Removal of only tumor and possible surrounding tissue • Also known as breast-conserving surgery • Partial or segmental mastectomy or quadrantectomy • Removes more breast tissue than Lumpectomy • Radiation is given off after surgery • Total Mastectomy • Removal of the entire breast but no lymph nodes are removed • This 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

38. Targeted Therapies • Treatment that targets specific characteristics of cancer cells • Less likely to harm normal cells than chemotherapy • Should not be used by pregnant women • 5 known target therapies used by doctors • Herceptin, Tykerb, Avastin, Perjeta, and Afinitor

39. The Future of Breast Cancer Treatment: Genetic Targeting

40. Genetically Targeted Therapies • A Recently developedPowerful Diagnostic Tool • Treatment that targets genetically identified cancer cells • Less likely to harm normal cells than chemotherapy • Increased accuracy of treatment

41. Study #1 • 39-year-old female • Acute myeloid leukemia (AML) • Standard diagnostictest • Stem cell transplant • Diagnostic dilemma • Genomesequence test • Indicated Chemotherapy with ATRA • 6 weeks, $40,000

42. Study #2 • Female • Breast cancer-age 37 • Ovarian cancer-age 39 • Ovarian tumor returned-age 42 • Genome sequencing allowed for precautions to be recommended and takenfor family

43. 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, University of Alabama in Birmingham • As technology is enhanced, cost and time will decrease • More than 300 cancer patients and their tumors

44. The Future of Breast Cancer Treatment: Gene Therapy

45. What Exactly is Gene Therapy? • Gene Therapy is a way to correct flawed or faulty genes that are responsible for disease development.

46. How does it work? • A gene may be inserted to replace a defective gene • An abnormal gene may be swapped for a normal one • The abnormal gene could be repaired • The regulation of a gene can be altered

47. How does it Work? The sequel • Find a vector • Possible vectors: genetically altered viruses, direct introduction, artificial lipid spheres, chemical linking, and a 47th chromosome

48. What genes cause breast cancer? • Breast Cancer 1 (BRCA-1) • Breast Cancer 2 (BRCA-2) • Protein 53 (P53) • Protein 65 (P65) • Ataxia Telangiectasia Mutated (ATM)

49. Success Story? • At the University of Texas Anderson Cancer Center they found that gene therapy used on a particularly brutal form of breast cancer caused the cancer to wither, lowered the chance for recurrence and augmented the effectiveness of some forms of chemotherapy

50. Problems with Gene Therapy • It takes time and repeated tries • Immune system defense • Viral vectors gone bad • Multigene disorders • Cost