THE ORIGIN…THE ORIGIN…• Malignant tumor developed from cells in the

breast.

• Usually either begins in the cells of the lobules, or the ducts.

• Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes etc.

TYPESTYPES OF BREAST OF BREAST CANCER…CANCER…Most common types based on its origin-• DUCTAL CARCINOMA: or DCIS, starts in the

cells which line the breast's ducts that supply milk to the nipple.

Between 85% and 90% of all breast cancers are Ductal.

• LOBULAR CARCINOMA: or LCIS, begins in the lobes, or glands which produce milk in the breast.

About 8% of breast cancers are lobular.

ANATOMY OF THE BREAST

Second most common types-• INVASIVE (INFILTRATING) FORM:- Has the potential to spread out of the original tumor site - invade other healthy parts of breast and body. - This rare form of breast cancer is named for its appearance

• NON-INVASIVE FORM: Also called In-situ.- It has not yet invaded other healthy tissues.- Can turn invasive, if left untreated.- Eg: DCIS, LCIS

• INFLAMMATORY FORM: -least common, aggressive - takes the form of sheets or nests.-Can start in soft tissues of the breast, just under the skin, or it can appear in the skin. ( Paget’s disease)

- Breast Cancers – sensitive to Estrogen- causes tumors to grow.- Such cells have Estrogen receptors on their surface. – Estrogen receptor positive- ER positive cancer.

• HER2-positive cancer : Over expression of HER2 gene causes this.- More aggressive and higher risk of recurring.

THE STAGES…THE STAGES…• Stage 0: Cancer cells remain inside the breast

duct, no invasion into normal adjacent breast tissue.

• Stage I: Cancer -2 cm or less - confined to the breast (lymph nodes are clear).

• Stage IIA: No tumor in the breast - cancer cells in axillary lymph nodes OR  tumor - <2 cm -has spread to axillary lymph nodes OR 

tumor - >2cm but <5 cm -has not spread to axillary lymph nodes.

• Stage IIB: tumor >2cm but <5 cm - has spread to axillary lymph nodes OR 

tumor >5 cm - has not spread to the axillary lymph nodes.

• Stage IIIA: No tumor in breast - Cancer in axillary lymph nodes (near the breastbone or closely stuck)OR 

Any size tumor - Cancer has spread to axillary lymph nodes (near the breastbone or closely stuck)

• Stage IIIB: Any size tumor - has spread to chest wall and/or skin of the breast -to axillary lymph nodes (clustered and close by)

• Stage IIIC: May be no cancer in breast or Any size tumor - has spread to chest wall and/or skin of breast - lymph nodes above/below collarbone and breastbone.

• Stage IV: cancer has spread — or metastasized — to other parts of the body.

SYMPTOMS...SYMPTOMS...No symptoms in early stages – hence, regular breast

exams.• Breast lump or in armpit – hard, no pain- self

examination.• Redness, dimpling or puckering of breast.• Bloody, clear or yellow, green- pus like secretions.Advanced symptoms-• Bone pain.• Breast pain/discomfort.• Skin ulcers.• Swelling of arm next to affected breast.• Rapid weight loss.

MAMMOGRAPHY OF BREASTS SHOWING BREAST CANCER

THE GENETICS THE GENETICS BEHIND…BEHIND…

BRCA1 and BRCA2 genes-• Help repair cell damage- normal growth of

breasts.• Abnormal BRCA1 and BRCA2 genes - account for

up to 10% of all breast cancers.• Not necessary that abnormal BRCA genes only

cause breast cancer.• Mutations, especially, SNPs - linked to higher

breast cancer risk in women with an abnormal BRCA1 gene as well as women who didn't inherit an abnormal breast cancer gene.

• Mutated BRCA1 and 2 genes affect both the breasts more often.

• Such women – ovarian, colon, pancreatic, and thyroid cancers, melanoma.

In men,• Men with mutated BRCA2 gene -higher risk

for breast cancer - about 80 times greater than average.

• Men with mutated BRCA1 gene - slightly higher risk of prostate cancer.

• Men with abnormal BRCA2 gene -7 times more likely to develop prostate cancer.

• Other cancer risks - cancer of the skin or digestive tract, - slightly higher in men with abnormal BRCA1 or BRCA2 genes.

Other genes-Changes in other genes - associated with breast

cancer - much less common – rarer mutations.• ATM: helps repair damaged DNA. - abnormal copies - causes Ataxia-telangiectasia

- a rare disease that affects brain development. - Inheriting abnormal ATM gene - linked to an

increased rate of breast cancer - abnormal gene stops cells from repairing damaged DNA.

• p53 : Tumor suppressor. - causes Li-Fraumeni syndrome – cancers at

young age. - Such people - higher-than-average-risk of

breast cancer, leukemia, brain tumors, and sarcomas

• CHEK2: Tumor suppressor. - Abnormal CHEK2 gene also causes Li-Fraumeni

syndrome and can double breast cancer risk.• PTEN: helps regulate cell growth. - Abnormal PTEN gene causes Cowden syndrome

- higher risk of both benign (not cancer) and cancerous breast tumors, growths in the digestive tract, thyroid, uterus, and ovaries.

• CDH1: makes a protein that helps cells adhesion to form tissue- E-Cadherin.

- Abnormal CDH1 gene - rare type of stomach cancer at an early age.

- Women with an abnormal CDH1 gene - increased risk of invasive lobular breast cancer.

CAUSES/RISK CAUSES/RISK FACTORS..FACTORS..• Family history of breast cancer (20-30%

patients with history).• Genetic abnormality- BRCA1 and BRCA2,

p53, HER2 etc.• Early menarch or late menopause.• Age and gender- Women 100 times more

prone to than men.• Late conception.• DES administration during pregnancy.• HRT for several years.• Radiation exposure at young age.

TREATMENT….TREATMENT….• Surgery: Lumpectomy, Quadrantectomy, Mastectomy,

Sentinel node Biopsy, (Mammography)• Radiation Therapy and Hyperthermia• Chemotherapy: Taxol, 5-FU, Cyclophosphamide,

Adriamycin• Hormonal Therapy: SERMs (Tamoxifen), Aromatase

inhibitors (Aromasin) etc.• Targeted Biologic therapies : Anti cancer drugs-

Herceptin, Avastin etc.

• Cope with side effects.• Various combinations of the above therapies are

employed to cure Breast cancer depending on its stage.

PREVENTION… PREVENTION… • Administer Tamoxifen- for women >35 years

old• Consider prophylactic mastectomy for

previously affected women, or those with strong family history.

• Lifestyle changes.• Limit or stop alcohol consumption.• Support groups can help create awareness.

STRIVESTRIVESURVIVESURVIVEINSPIRE…INSPIRE…

THANK YOUTHANK YOU