Chemotherapy is also used in women whose cancer has already spread to other parts of the body. An example of hormonal therapy is the drug tamoxifen. This drug blocks the effects of estrogen, which can help breast cancer cells survive and grow. Most women with estrogen-sensitive breast cancer benefit from this drug. Aromatase inhibitors block estrogen from being made. In these cases the purpose of radiation is to reduce the chance that the cancer will recur.
The surgeon removes the cancerous area and a surrounding margin of normal tissue. A second incision may be made in order to remove the lymph nodes. Vino Rabi Jan. PiyuPiyu5 Jan. Vishal Jan. JangyaseniBehera Jan. IshaTyagi27 Jan. Show More. Total views. You just clipped your first slide! Breast cancer process india, Breast cancer cost india, Breast cancer, delhi India. Breast cancer information and resources. Apr 13, [14 April ].
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And you can see in this region right here, there's a bit of a thickening of those epithelial structures. Too many cells, that's this area we call hyperplasia.
Over time, these will give way to solid growths. The cells within those solid growths look pretty normal. And you might be able to see that here.
The cells are pretty well organized. They are all lined up. There's just too many of them. That's a benign tumor, an adenoma. Over time, these will give rise to true cancers, carcinomas. And these have the ability to spread locally and throughout the body. In addition, the cells look even more abnormal. They don't look like the cells that gave rise to them.
Now let me give you some more details of the terminology that I've just been using. Hyperplasia is increased cell number. But the architecture of the cells is otherwise normal. They look like normal cells.
If progression occurs, a benign tumor might arise. This is not yet cancer. These tumors are so-called not aggressive. They basically stay where they started. They don't destroy the local tissue. And they don't leave the site. And if they are detected, for example in a colonoscopy, they can be removed.
If they're detected in the lung when they're at this stage, they can be removed surgically and the patient will be fine. However, they can progress into a malignant tumor. And this is where we use the term cancer. Cancer actually refers not to just any tumor, but a malignant tumor. And these, by contrast, are aggressive. The cells are dividing more rapidly.
They're also causing changes within the local tissue such that they're locally destructive to the local tissue. And they have the potential to spread, to get outside of their local area, access the blood vessels, and move to a distant site. And that leads to this final phase of metastasis, which is the tumor growing at a distant site. And that can be one site or it can be many sites. And again, it's the combined effects of the metastatic tumors that tends to kill cancer patients.
Now cancers can arise in virtually all organs, all tissues. Cancer is an umbrella term that actually refers to many different diseases of abnormal growth. The most common tumors in humans affect epithelial tissues, epithelial tissues.
And these epithelial tissues will give rise to a cancer type called carcinomas. Carcinomas are cancers of epithelial tissues. Breast cancer, lung cancer pancreas cancer-- these are all cancers of epithelial tissues. The precursor lesions are called adenomas, in many cases. And these are benign. We can also have cancers of connective tissues, and these are called, collectively, sarcomas, sarcomas. Muscle tumors, myosarcomas.
Fibroblast derived tumors, fibrosarcomas. Cartilage derived tumors, these tumors are rarer in humans, but they occur. And when they occur, they can be quite problematic, as well. And they go through similar stages of progression, as I've been describing for the other tumor types. And we can have tumors of blood cells, leukemias, too many cells in the blood. And I showed you a blood smear of a leukemic patient. The blood smear indicates that there are too many cells circulating.
That contrasts to lymphomas, which is also a blood cell tumor. But here the tumor cells are confined to lymph organs, like the thymus or the spleen or lymph nodes.
So there actually aren't too many cells circulating, but there are too many of these cells in these structures, which likewise can cause problems within those local structures, and surrounding tissues as well.
So some terminology. Cancers affect all tissues, or virtually all tissues. There are probably , different types of cancer when we think about all the different cell types in your body that can undergo these changes and result in one or another type of cancer.
All right. So cancers arise from normal cells. They develop in stages. What causes them to change over time? What gives them the ability to divide inappropriately, to grow abnormally? The answer to this question is that alterations take place in the DNA of the developing cancer cells. And in this respect, cancer is a genetic disease.
And I'm going to use this term in quotes because when we talk about a genetic disease, we tend to talk about inherited diseases. You inherit a disease allele from one of your parents. You develop a disease. In this case, cancer can arise as a consequence of an inherited mutation. We'll talk about that in a subsequent lecture. But what I'm referring to here is genetic alterations that take place within you, within your cells. And this accumulates over time, over decades in some cases, and allows the cells to progress through these various stages.
The case that cancer develops through the acquisition of mutations in genes has been building for about a century. We've been suspecting that cancer was a genetic disease for a very long time. And now we know it's true because we've seen the alterations in the genes of cancer cells. And we'll come to those specific alterations in subsequent lectures. But I want to give you the background that led us there.
The first and the oldest was the observation going back almost years that cancer cells have abnormal number and structure of chromosomes. As you know, your cells have 46 chromosomes, 23 pairs. And most of your cells look like the cells on the left, where there's a pair of chromosome 1, 2, 3, and so forth. These chromosomes are painted with a specific chromosome specific paint so we can distinguish which one is which, and this is a so-called normal karyotype.
Cancer cells can look like this. And you can see that they're different in many respects from normal cells. A, there's way too many chromosomes. This is a condition we call aneuploidy. Aneuploidy, as opposed to being diploid, the cells are aneuploid, an abnormal number of chromosomes. Moreover, you can see in some of the highlighted areas that the chromosome structure is abnormal.
We have this chromosome here, which has a little bit of the pale blue chromosome-- which may be chromosome 4, I can't read it-- and a little bit of this pink chromosome, which is one of these guys here. A translocation has taken place so that the structure of the chromosome is abnormal.
So we have aneuploidy, defects in chromosome number, but also defects in chromosome structure, like translocations. Chemotherapy may be given prior to surgical management. The decision to give neoadjuvant therapy is guided by the MDT with patient input. It may be used to reduce tumour size pre-operatively. It is also used in patients with inflammatory breast cancer. A cohort of patients will be considered for adjuvant chemotherapy.
These tend to be regimens containing a taxane and an anthracycline. It is a monoclonal antibody that targets HER2 receptors. It may cause significant cardiac-based adverse effects and cardiac function should be assessed prior to and during use. It may harm a developing foetus and pregnancy must be avoided during and seven months post-treatment. Endocrine therapies are typically used as an adjunct to other treatments to reduce risk of recurrence. In women or those with ovaries, treatment choice depends on ovarian function.
There are two main options:. Endocrine therapy tends to be commenced after any adjuvant chemotherapy. A standard course lasts 5-years. Extended therapy beyond 5-years may be considered - the benefits and risks should be discussed with the patient. At times neo-adjuvant endocrine therapy may be given. This tends to be in the context of a clinical trial. Use is guided by the MDT and patient wishes:. In advanced metastatic breast cancer, treatment aims to prolong survival and improve quality of life.
Endocrine treatment with tamoxifen or anastrozole see above and targeted therapy with Herceptin may be used where receptor status is positive. A number of chemotherapy regimens are available, and the side-effects must be weighed and explained in the context of the potential for improved survival.
Medications such as denosumab and bisphosphonates may be used to prevent lytic bone lesions and reduce bone pain and fracture. The prognosis is dependent on stage and grade of disease, tumour characteristics and patient co-morbidities.
Survival is best in those aged , this is thought to be due to screening and tumour characteristics. Have comments about these notes? Leave us feedback. We'd love to hear your feedback on our Breast cancer notes. Pulsenotes uses cookies. By continuing to browse and use this application, you are agreeing to our use of cookies.
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Breast surgery Breast cancer Notes. Introduction Breast cancer is the most common malignancy affecting women in the UK. Epidemiology There are around 55, cases of breast cancer in the UK each year. Risk factors A number of risk factors are associated with an increased risk of breast cancer. Female gender Age Family history Personal history of breast cancer Genetic predispositions e. BRCA 1, BRCA 2 Early menarche and late menopause Nulliparity Increased age of first pregnancy Multiparity risk increased in period after birth, then protective later in life Combined oral contraceptive still debated, effect likely minimal if present Hormone replacement therapy White ethnicity Exposure to radiation.
BRCA There are a number of hereditary syndromes that may predispose to breast cancer. Here we will focus on the breast cancer type 1 and 2 susceptibility genes BRCA 1 and 2 : BRCA 1 : Caused by a mutation on chromosome 17 that predisposes patients to breast cancer amongst other malignancies.
BRCA 2 : Caused by a mutation on chromosome 13 that predisposes patients to breast cancer amongst other malignancies. Pathology The majority of breast malignancies are carcinomas, these are divided into either ductal or lobular.
Molecular subtypes Invasive breast cancer can be categorised into one of four molecular subtypes based upon gene expression receptor status of oestrogen receptors and progesterone receptors, HER2 and Ki Screening The NHS runs a screening programme to detect breast cancer. Around a quarter with an abnormal result will subsequently be found to have breast cancer. Unclear: results or imaging unclear or inadequate.
Further investigations required. Clinical features Breast cancer often presents with a breast or axillary lump.
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