Breastcancer Edited 100201202904 Phpapp01

7/27/2019 Breastcancer Edited 100201202904 Phpapp01

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INTRODUCTION

Breast cancer, the second-leading cause of cancer

deaths in women, is the disease women fear

most.

Breast cancer can also occur in men, but it's far

less common.

Yet there's more reason for optimism than ever

before.

In the last 30 years, doctors have made great

strides in early diagnosis and treatment of the

disease and in reducing breast cancer deaths.



80% of breast cancers occur in women older than

age 50. In 30s, have a one in 233 chance of

developing breast cancer. By age 85, chance isone in eight.

In 1975, a diagnosis of breast cancer usually

meant radical mastectomy – removal of the entire breast along with underarm lymph nodes and

muscles underneath the breast.

Today, radical mastectomy is rarely performed.Instead, there are more and better treatment

options, and many women are candidates for

breast-sparing operations.



SIGNS AND SYMPTOMSWhen the disease is discovered early, have more

treatment options and a better chance for a cure.Most breast lumps aren't cancerous. Yet the most

common sign of breast cancer for both men and

women is a lump or thickening in the breast. Often,

the lump is painless.

Spontaneous clear or bloody discharge from the

nipple, often associated with a breast lump

Retraction or indentation of the nipple

Change in the size or contours of the breast

Any flattening or indentation of the skin over the

breast



Redness or pitting of the skin over breast, like the skin

of an orange

A number of conditions other than breast cancer cancause the breasts to change in size or feel.

Breast tissue changes naturally during pregnancy and the

menstrual cycle.

Other possible causes of noncancerous (benign) breast

changes include fibrocystic changes, cysts,

fibroadenomas, infection or injury.

If patient haven't yet gone through menopause, maywant to wait through one menstrual cycle before seeing

the doctor.

If the change hasn't gone away after a month, have it

evaluated promptly.



CAUSES

In breast cancer, some of the cells in the breast

begin growing abnormally.

These cells divide more rapidly than healthy cells

do and may spread (metastasize) through the

breast, to lymph nodes or to other parts of the

body.

The most common type of breast cancer begins in

the milk-producing ducts, but cancer may also begin in the lobules or in other breast tissue.

In most cases, it isn't clear what causes normal

breast cells to become cancerous.



Only 5-10% of breast cancers are inherited.

Families that do have genetic defects in one of

two genes, breast cancer gene 1 (BRCA1) or

breast cancer gene 2 (BRCA2), have a much

greater risk of developing both breast and ovariancancer.

Other inherited mutations – including the ataxia-

telangiectasia mutation gene, the cell-cyclecheckpoint kinase 2 (CHEK-2) gene and the p53

tumor suppressor gene – also make it more likely

that will develop breast cancer.



If one of these genes is present in the family, will

have a 50 percent chance of having the gene.

Yet most genetic mutations related to breast cancer aren't inherited.

These acquired mutations may result from radiation

exposure – women treated with chest radiation therapy

for lymphoma in childhood or during adolescence

when breasts are developing have a significantly

higher incidence of breast cancer than do women not

exposed to radiation. Mutations may also develop as a result of exposure to

cancer-causing chemicals, such as the polycyclic

aromatic hydrocarbons found in tobacco and charred

red meats.



Each of breasts contains 15 to 20 lobes of

glandular tissue, arranged like the petals of a

daisy.

The lobes are further divided into smaller lobules

that produce milk during pregnancy and breast-feeding.

Small ducts conduct the milk to a reservoir that

lies just beneath the nipple.

Supporting this network is a deeper layer of

connective tissue called stroma.



RISK FACTORS

Some risk factors, such as age, sex and family

history, can't be changed

Whereas others, including weight, smoking and a

poor diet, are under control.

Age

Personal history of breast cancer.

Family history.

Genetic predisposition.

Radiation exposure.

Excess weight.



Early onset of menstrual cycles.

Late menopause.

First pregnancy at older age.

Race.

Hormone therapy.Birth control pills.

Smoking.

Excessive use of alcohol. Precancerous breast changes (atypical

hyperplasia, lobular carcinoma in situ).

Mammographic breast density.



WHEN TO SEEK MEDICAL ADVICE

Although most breast changes aren't cancerous,

it's important to have them evaluated promptly.

Discover a lump or any of the other warning

signs of breast cancer, especially if the changes

persist after one menstrual cycle or they changethe appearance of the breast.

If treated for breast cancer, report any new signs

or symptoms immediately.

Possible warning signs include a new lump in the

breast or a bone ache or pain that doesn't go away

after three weeks.



Screening and diagnosis

Screening – looking for evidence of disease

before signs or symptoms appear – is the key to

finding breast cancer in its early, treatable stages.

Depending on age and risk factors, screening

may include breast self-examination,examination by nurse or doctor, mammograms

(mammography) or other tests.

Self breast examination is an option beginning atage 20.



Breast self-exam



Clinical breast exam

Mammogram - to check breast tissue

Other tests

Computer-aided detection (CAD)

Digital mammographyMagnetic resonance imaging (MRI)

Breast ultrasound (ultrasonography)

Experimental procedures

Ductal lavage

Molecular breast imaging (MBI)



Mammogram

CAD

Mammogram

Digital

mammography

Breast

Ultrasound



Diagnostic procedures

Ultrasound

Biopsy – Fine-needle aspiration biopsy, core

needle biopsy, sterotactic biopsy, wire

localization biopsy, surgical biopsy

Estrogen and progesterone receptor tests

Staging tests – Stage 0 to IV

Genetic stage



Breast biopsy



Tamoxifen inhibits

estrogen receptor

activity

AE = antiestrogenic

E = estrogenic



TREATMENT

In addition to coping with a potentially life-

threatening illness – must make complex

decisions about treatment.

Treatments exist for every type and stage of

breast cancer.

Most women will have surgery and an additional

(adjuvant) therapy such as radiation,

chemotherapy or hormone therapy.

Experimental treatments are also available at

cancer treatment centers.



SURGERY

Lumpectomy

Partial or segmental mastectomy

Simple mastectomy

Modified radical mastectomy

Sentinel lymph node biopsy

Axillary lymph node dissectionRadiation therapy

Chemotherapy



Reconstructive surgery

Reconstruction with implants

Reconstruction with a tissue flap

Deep inferior epigastric perforator (DIEP)

reconstruction

Reconstruction of the nipple and areola



Hormonal therapy

Selective estrogen receptor modulators (SERMs)

Aromatase inhibitors

Biological therapy

Trastuzumab (Herceptin)

Bevacizumab (Avastin)

Lapatinib (Tykerb)



PREVENTION

Chemoprevention

Tamoxifen (Nolvadex)

Raloxifene (Evista)

Preventive surgery

Prophylactic mastectomy

Prophylactic oophorectomy



LIFE-STYLE FACTORS

Taking aspirin

No / limit alcohol

Maintain a healthy weight

Avoid long-term hormone therapy

Stay physically active

Eat foods high in fiber

Emphasize olive oilAvoid exposure to pesticides



New directions in researchRetinoids - Natural or synthetic forms of vit-A

have the ability to destroy the growth of cancer cells. Effective in premenopausal women and in

those whose tumors aren't estrogen positive.

Flaxseed – High in lignan, a naturally occurringcompound that lowers circulating estrogens in the

body. Decreases estrogen production – acts like

tamoxifen – inhibit the growth of breast cancer tumors. Lignans are also antioxidants with weak

estrogen-like characteristics. These

characteristics may be the mechanism by which

flaxseed works to decrease hot flushes.



COPING SKILLS

Telling others

Maintaining a strong support system

Dealing with intimacy

Self-care taking



Thank you



Breast tenderness is pain or discomfort in the

breasts. It is the most common breast symptomwomen have. It is usually not a sign of breast

cancer.

Most common cause of breast tenderness iscalled fibrocystic breast changes.

These changes are caused by the swelling of very

tiny fluid-filled cysts in fibrous tissue in the breast.

The changes usually happen 7-10 days before the

menstrual period and go away when period ends.



CAUSES Puberty (boys / girls)

Pregnancy

Infection of the breast

Hormone imbalance – too much estrogen

Birth control pills Breast-feeding – when breasts engorged (milk)

Injury of the breast

Noncancerous tumor in the breast (fibroma) Breast cyst

Condition called hyperprolactinemia

Breast cancer, but often cancer does not cause any pain.



DIAGNOSIS

Mammogram (a special x-ray of the breasts)

Ultrasound scan of the breasts (a scan with sound

waves)

Thermography of the breasts (a heat test that

outlines the breast in a color pattern)

Biopsy (removal of a small piece of tissue or

fluid from the breast).

Examination of discharge from a nipple

Blood test.



TREATMENT

Drink fewer or no beverages with caffeine.

Add vitamins E and A to the diet.

Reduce salt intake – 1-2 weeks before

menstruation.

Put heat on the breast with a heating pad or warm

water bottle.

Diuretics.

Surgery is rarely needed.



SELF-CARE

Follow the physician’s recommendations for

preventing and treating breast tenderness.

Learn how to examine the breasts after the

menstrual period every month.



Nipple discharge is any kind of fluid that comes

out of the nipple.

Nipples contain tiny openings through which

fluid can pass.

Although most nipple discharge is not serious,

any discharge should be evaluated.

The color and consistency of the discharge will

help in diagnosis.



A clear, straw-colored discharge sometimes

develops in early pregnancy.

A whitish or greenish discharge occurring in

nonpregnant women is galactorrhea – cause –

birth control pills, hormone imbalance, pituitarytumor, or cyst under the areola.

Pus discharge indicates a breast infection.



DIAGNOSIS

No menstrual periods

Headaches

Visual problems.

Lab tests of the discharge

Blood tests

Mammogram (x-ray of the breasts)

Ultrasound scan of the breastsCT scan of the brain.



TREATMENT

Surgery

Radiation therapy

Chemotherapy.



Galactorrhea is a milklike discharge of fluid from

the breast nipples.

Usually the discharge is from both breasts rather

than just one.

A discharge like this is called galactorrhea unless

pregnant or breast-feeding.

Galactorrhea usually occurs when the body

produces too much prolactin. Prolactin is ahormone produced by the pituitary gland.

Normally, prolactin helps a woman make milk

when she has a baby.

ETIOLOGY



ETIOLOGYBirth control pills and other medicines

Underactive thyroid gland Problems with the pituitary gland

Some brain diseases, such as meningitis

Cyst under the darkened area around the nipple(galactocele)

Shingles caused by the chickenpox virus in the

chest wall

Surgery on the chest

Other medical problems – kidney failure, liver

disease, sarcoidosis, or Cushing's disease.

DIAGNOSIS



DIAGNOSIS

Medical history – stopped having menstrual

periods, having trouble getting pregnant, or having headaches or vision problems. OTC

medicines if any. Sample of the discharge may be

tested in the lab.Blood tests

Mammogram (x-ray of the breasts)

Ultrasound scan of the breasts

CT scan of the brain to look at the pituitary

gland.

TREATMENT



TREATMENT

If a galactocele is causing the galactorrhea, the

cyst will be removed.

If the discharge is caused by drugs, it will clear

up when stop taking the drugs. However,

stopping drugs is not always necessary.

If the galactorrhea is caused by a pituitary gland

tumor, needs surgery, radiation, or drug

treatments. Can treat with bromocriptine (stops production of prolactin).

H l ill th ff t l t?



How long will the effects last?

Once the cause of the discharge is diagnosed and

treated, she should no longer have the discharge.However, if pituitary tumor is present, may need

long-term treatment with bromocriptine or

radiation because the tumor could come back.SELF-CARE

Follow-up tests.

Take drugs as prescribed.

If the galactorrhea is mild and a cause cannot be

found, breast binders can help stop the discharge

by preventing stimulation of the nipples.



Paget's disease is a slowly growing cancer of the

nipple. It is a rare form of breast cancer. It mainly

affects women and very rarely men.

When abnormal cells grow uncontrollably, they

are called tumors. It is not known why they

occur. In Paget's disease, the tumor starts in the

milk ducts of the nipple.

SYMPTOMS



SYMPTOMS

Symptoms seem harmless. It is often thought to

be a skin inflammation or infection, which candelay its diagnosis and treatment.

Redness, oozing, and crusting of the nipple and

the circular, dark area around the nipple (areola),which causes itching and burning.

Sore on the nipple that will not heal.

Usually only 1 nipple is affected. Sometimes nochanges in the skin can be seen. May have a

lump in the breast, which may or may not be able

to feel.

DIAGNOSIS



DIAGNOSIS

Sample of discharge from the nipple may be

examined under a microscope.

Biopsy – to remove the sample of breast tissue to

test for cancer.

Mammogram of both breasts to look for cancer in

other parts of the breasts.

Ultrasound scan or MRI - both of these tests

create pictures of the breasts.

TREATMENT



TREATMENT

If the cancer is only in the nipple and not any other

part of the breast:

Radiation treatments

Surgery to remove just the nipple and

surrounding tissue.

If a mass is found deep in the breast:

Surgery to remove all or part of the breast

Chemotherapy.

H l ill th ff t l t?



How long will the effects last?

Without treatment, the cancerous sore will

remain on the nipple and may spread deeper intothe breast.

PREVENTIONCheck monthly for any lumps, sores, or oozing

from the breasts and report any breast changes to

the physician right away.



Breast-feeding should be a comfortable and

enjoyable experience.

Sore nipples are a common problem among

breast-feeding mothers.

Often mothers quit nursing their babies early

because of sore nipples, but this doesn't have to

happen.

Sore nipples usually can be prevented or treated.

Mild i l di f t t th b i i f



Nipple protectors

Mild nipple discomfort at the beginning of

feedings during the first few days of breast-

feeding usually needs no treatment. Nipple pain that is severe or lasts throughout a

single or for more than a week is not normal and

should be evaluated by doctor or a lactation

consultant.

• Protects sore nipples

during breast-feeding

• Shaped to allow skincontact with baby

• Made with odorless,

tasteless, ultra-fine

silicone

CAUSES



CAUSES

Position of the baby's mouth on the breast.

Size and shape of the nipples and the baby's

mouth can affect how the baby latches on the

breast.

Also, infant's sucking habits can cause nipplediscomfort.

Other possible causes of nipple pain are an

infection of the nipples (yeast or bacterial), breastinfection or improper nipple skin care.

PROBLEMS CAUSED



PROBLEMS CAUSED

If baby is not latching on to the breast correctly,

he may not be getting enough milk.Also, nipple pain may cause to put off nursings

or not let the baby suck long enough when he

nurses. Sucking is important because this is what triggers

the milk to begin to flow (let-down reflex).

Nipple pain can cause a drop in the milk supply.As a result, baby may not gain weight well.

Sore nipples and low milk supply problems often

go hand-in-hand.

TREATMENT



TREATMENT

Make sure the baby is positioned correctly to nurse

Begin a feeding on the less sore nipple to trigger the let-down reflex and start milk flowing

Frequent shorter feedings are better than less

frequent lengthy feedingsKeep the nipples dry

If any cracks or other breaks in the skin, keep the

nipples covered with a soothing ointmentUse a pump to express the milk if the pain is so

severe that cannot nurse the baby

Watch for signs of a breast infection

WHEN TO SEEK MEDICAL ADVICE



WHEN TO SEEK MEDICAL ADVICE Immediate – following symptoms additional to sore

nipples: chills, fever, headache, flu-like symptoms,or pain or redness in the breast.

OB/GYN – Nipples sting or burn and have shooting

pains in the breast, especially after nursing. Nipple pain keeps from nursing long enough to trigger let-

down reflex.

Pediatrician – baby unsatisfied after most nursings.

Baby may not be satisfied because milk supply islow or baby is not emptying breasts. Nipples – yeast

infection, see white patches in the baby's mouth, or

baby has had a diaper rash for 3 or more days.

Breastcancer Edited 100201202904 Phpapp01

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Transcript of Breastcancer Edited 100201202904 Phpapp01