BREAST CANCER:

INTRODUCTION:
 Breast cancer is a malignant tumor that starts in the cells of the breast.
 A malignant tumor is a group of cancer cells that can grow into (invade) surrounding
tissues or spread (metastasize) to distant areas of the body.
 The disease occurs almost entirely in women, but men can get it, too.
 Most commonly from the inner lining of milk ducts or the lobules that supply the ducts
with milk.
 Cancers originating from ducts are known as ductal carcinomas, while those originating
from lobules are known as lobular carcinomas.
 Breast cancer showing an inverted nipple, lump and skin dimpling.(1)

ETIOLOGY:
 Breast cancer is the most common cancer and also the leading cause of cancer mortality
in women worldwide. Approximately 1.38 million new breast cancer cases were
diagnosed in 2008 with almost half of all breast cancer cases and nearly 60% of deaths
occurring in lower income countries. There is a large variation in breast cancer survival
rates around the world, with an estimated 5-year survival of 80% in high income
countries to below 40% for low income countries.
 Low and middle income countries face resource and infrastructure constraints that
challenge the goal of improving breast cancer outcomes by early detection, diagnosis and
treatment. In high income countries like the United States, approximately 232340 women
will be diagnosed and 39620 will die of breast cancer in 2013. For an American woman,
the lifetime risk of developing breast cancer is 12.38% or 1 in 8. The significant decrease
in breast cancer-related mortality in the United States from 1975 to 2000 is attributed to
continued improvement in both screening mammography and treatment. (2)

TERMINOLOGIES:
 Fibrocystic breast changes: term used to describe certain benign changes in the breast,
typically associated with palpable nodularity, lumpiness, swelling, or pain.
 Lymphedema: chronic swelling of an extremity due to interrupted lymphatic circulatin,
typically from an axillary lymph node dissection.
 Mastitis: inflammation or infection of the breast.
 Paget’s disease: from of breast cancer begins in the ductal system and involves the
nipple, areola, and surrounding skin.
  Gynecomastia: overdeveloped breast tissue typically seen in adolescent boys.(3)

ANATOMY OF BREAST:

PATHOPHYIOSOLOGY OF BREAST CANCER:

 Breast cancer, like other cancers, occurs because of an interaction between an
environmental (external) factor and a genetically susceptible host.
 About 90% of breast cancers are due to genetic abnormalities that happen as a result of
the aging process and the “wear and tear” of life in general.
 Breast tissues consist mainly of fatty tissue interspersed with connective tissue. Each
tissue has 15 to 20 sections that are termed as Lobes. Inside each lobe are many smaller
structures called Lobules/Ducts that contain mammary glands.
 Oxygen, nutrients, and other life-sustaining nourishment are delivered to breast tissue by
the blood in the arteries and capillaries.
 Lymph ducts: Drain fluid that carries white blood cells (that fight disease) from the breast
tissues into lymph nodes under the armpit.
 Lymph nodes: Filter harmful bacteria and play a key role in fighting off infection.
 Three Types of Vessels Bacteria Blood Vessels Cell life 2 Lymph Nodes Lymph Vessels
3 Milk Lobules Ducts Nipple1.
 90% of cases are reported with ductal carcinoma. Lobular carcinoma is very rare. If
cancer confines to duct it is benign or in situ but if move beyond duct, termed as
malignant or invasive. Genetic abnormality due to any mutation allows the cells to divide
more rapidly than healthy cells do and may spread through the breast, to the lymph or to
other parts of the body (metastasize) e.g. lungs or liver.
 It has also been observed that breast stromal cells can modulate the growth of normal and
neoplastic breast epithelial cells and can secrete growth factors following stimulation by
endogenous hormones. The adipose tissues contain aromatase enzyme, which produces
estradiol from circulating cholesterol. Because of the higher proportion of these fat cells
in breasts of older women, the levels of estradiol in are much greater than their plasma
levels. This probably accounts for the rising incidence of breast cancer with ageing and
supports the role of steroid hormones in the pathogenesis of breast cancer.(4)
TYPES OF BREAST CANCER:

 There are many types of breast cancer:

1. Ductal carcinoma in situ (DCIS).
2. Invasive Ductal Carcinoma.
3. Inflammatory Breast Cancer.
4. Metastatic Breast Cancer.
5. Angiosarcoma.
6. Lobular carcinoma in situ (LCIS).

1. Ductal carcinoma in situ (DCIS):

 DCIS is a non-invasive cancer where abnormal cells have been found in the lining of
the breast milk duct.
 The atypical cells have not spread outside of the ducts into the surrounding breast
tissue.
  Ductal carcinoma in situ is very early cancer that is highly treatable, but if it’s left
untreated or undetected, it can spread into the surrounding breast tissue.
2. Invasive Ductal Carcinoma (IDC):
 The abnormal cancer cells that began forming in the milk ducts have spread beyond the
ducts into other parts of the breast tissue.
 IDC is the most common type of breast cancer, making up nearly 70- 80% of all breast
cancer diagnoses.
 IDC is also the type of breast cancer that can most commonly affects men.
3. Inflammatory Breast Cancer:
 Inflammatory Breast Cancer is an aggressive and fast growing breast cancer in which
cancer cells infiltrate the skin and lymph vessels of the breast.
 It often produces no distinct tumor or lump that can be felt and isolated within the breast.
 But when the lymph vessels become blocked by the breast cancer cells, symptoms begin
to appear.
4. Metastatic Breast Cancer:
 The cancer has spread to other parts of the body.
 This usually includes the lungs, liver, bones or brain.(5)
5. Lobular carcinoma in situ (LCIS):
 LCIS is an uncommon condition in which abnormal cells form in the milk glands
(lobules) in the breast. LCIS isn't cancer. But being diagnosed with LCIS indicates that
you have an increased risk of developing breast cancer.
 LCIS usually doesn't show up on mammograms. The condition is most often discovered
as a result of a breast biopsy done for another reason, such as a suspicious breast lump or
an abnormal mammogram.
 Women with LCIS have an increased risk of developing invasive breast cancer in either
breast. If you're diagnosed with LCIS, your doctor may recommend increased breast
cancer screening and may ask you to consider medical treatments to reduce your risk of
developing invasive breast cancer.(6)

CAUSES OF BREAST CANCER:

 Doctors know that breast cancer occurs when some breast cells begin to grow
abnormally. These cells divide more rapidly than healthy cells do and continue to
accumulate, forming a lump or mass. Cells may spread (metastasize) through your breast
to your lymph nodes or to other parts of your body.
 Breast cancer most often begins with cells in the milk-producing ducts (invasive ductal
carcinoma). Breast cancer may also begin in the glandular tissue called lobules (invasive
lobular carcinoma) or in other cells or tissue within the breast.
  Researchers have identified hormonal, lifestyle and environmental factors that may
increase your risk of breast cancer. But it's not clear why some people who have no risk
factors develop cancer, yet other people with risk factors never do. It's likely that breast
cancer is caused by a complex interaction of your genetic makeup and your environment.
(7)CC

REFERNCES:

1. https://www.slideshare.net/assr9/breast-cancer-33974196
2. https://www.wjgnet.com/2218-4333/full/v5/i3/283.htm
3. https://www.slideshare.net/syazanimaziana/breast-cancer-13742273
4. https://www.slideshare.net/FarazaJaved/breast-cancer-43048609
5. https://www.slideshare.net/assr9/breast-cancer-33974196
6. https://www.mayoclinic.org/diseases-conditions/lobular-carcinoma-in-situ/symptoms-
causes/syc-20374529
7. https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-
20352470