BREAST CANCER

ULVAN OZAD

STUDENT NUMBER: 090128053

BARTS AND THE LONDONSCHOOL OF MEDICINE AND DENTISTRY

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CANCER and BREASTCancer is a condition where body cells grow up and divide unmanageably;occupying and destroying the healthy tissue (MALIGNANT)

RISK FACTORS:-Gender-Age-Family History-High hormone levels: HRT, menstrual problems...-Obesity-Alcohol

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TYPES OF BREAST CANCER

NON-INVASIVE (IN SITU)

INVASIVE OTHERS

LOBULAR DUCTALLOBULAR DUCTAL PAGET’S

DISEASE OF NIPPLE/AREOLA

INFLAMMATORY

RARE TYPES

MEN

DIAGNOSIS (TRIPLE ASSESSMENT):

- PALPITATION- RADIOLOGY (ULTRASOUND, MAMMOGRAPHY,

MRI)- FINE-NEEDLE ASPIRATION

Estrogen and progesterone receptor statuses are also

important for classification and treatment

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PATHOLOGY-p53, BRCA1(chromosome 17), BRCA2(chromosome 13)

mutations in error-correcting proteins-PI3K/AKT, RAS/MEK/ERK apoptosis prevention pathways

mutation-“on”

MOST COMMON: INVASIVE DUCTAL CARCINOMA (~70% OF CASES)(1)

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STAGE 0 Non-invasive cell malformations

STAGE 1 Tumour ≤2cm, Invasive breast cancer, early stage, invasion limited to breast

STAGE 2 2A -Tumour absent/ Tumour ≤2cm, cancer present in axillary lymph nodes, no spread to body -2cm≤ Tumour ≤5cm, no cancer in axillary lymph nodes, no spread to body2B - 2cm≤ Tumour ≤5cm, cancer present in lymph nodes, no spread to body -Tumour >5cm, no cancer in axillary lymph nodes, no spread to body

STAGE 3 3A -Tumour absent/ 2cm≤ Tumour ≤5cm/ Tumour >5cm , cancer present in axillary and may be in lymph nodes near sternum3B -Any size tumour, cancer present in skin or chest wall, cancer present in axillary lymph nodes or lymph nodes near sternum 3C -Any size tumour, cancer spread to lymph nodes near clavicle, , cancer present in axillary lymph nodes or lymph nodes near sternum

STAGE 4 Spread to body (metastasis )

STAGES OF BREAST CANCER

TYPICAL PRESENTATION: MASS IN BREAST, WITHOUT ANY PAIN(1)

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IMPACT ON INDIVIDUAL AND SOCIETY

INDIVIDUALEmotions

Body imageSexuality

RelationshipsMotivation

ActivitySelf-esteem

ConcentrationShameStigma

DEPRESSION

SOCIETY

IsolationPsychological

Economic

FAMILY AND FRIENDS

EmotionalPhysical

Economic

IMPROVEMENT: INCREASE AWARENESS

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WHY I CHOSE BREAST CANCER?1)IT IS VERY IMPORTANTBREAST CANCER UK: - 46,010 women per year DIAGNOSED (UK) - 12,247 of this will DIE (UK) - 1 in 8 women WILL have in lifetime- Most COMMONLY diagnosed cancer in <35

women(UK)- In last 10 years, incidence increased by 3.6% (UK)- In 2008, 1.38 million women diagnosed

(WORLDWIDE)

2) EXPERIENCE

3)MY FUTURE PLAN-Reconstructive Surgery

4) INCREASE AWARENESS (1)

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CURRENT TREATMENT

SURGERY

LUMPECTOMY

MASTECTOMY

LYMPH NODE DISSECTION

RADIATION THERAPY

EXTERNAL

INTERNAL

Direct removal of tumour

Radiation destroying cancer cells

THERMAL THERAPY can be used together with

radiotherapy

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CURRENT TREATMENT

CHEMOTHERAPY

Cytotoxic medication damaging cancer cells

ALKYLATING AGENTS

PLANT ALKALOIDS

ANTIMETABOLITES

ANTITUMOUR ANTIBIOTICS

TOPOISOMERASE INHIBITORS

ANTINEOPLASTICS

Can be given for NEOADJUVANT, ADJUVANT

and PALLIATIVE management

Depending on treatment, TRASTUZUMAB may be

additionally used

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CURRENT TREATMENT

HORMONAL (ENDOCRINE)

THERAPY

AROMATASE INHIBITORS

SELECTIVE ESTROGEN RECEPTOR MODULATORS

ESTROGEN RECEPTOR DOWNREGULATORS

Blocking action or lowering concentration of estrogen in

body

Treat hormone-receptor-positive cancer

TARGETED THERAPY

HERCEPTIN (TRASTUZUMAB)

TYKERB (LAPATINIB)

AVASTIN (BEVACIZUMAB)

Damage specific characteristics of cancer

HOLISTIC MEDICINE is also used for symptomatic relief and eliminating side effects

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CURRENT TREATMENT - HOW EFFECTIVE?CANCER RESEARCH UK - MORTALITY

-2008: 12.000 WOMEN, 70 MEN DIED IN UK 89.000 WOMEN DIED IN EUROPEAN UNION 458.000 WOMEN DIED IN THE WORLD

-1.300 DEATHS PER YEAR- WOMEN UNDER 50

-IN UK, 2nd MOST COMMON COUSE OF WOMEN DEATH (31% OF ALL CASES)

CANCER RESEARCH UK – SURVIVAL

-INCREASE IN 10 YEARS SURVIVAL RATE FOR 32% IN 25 YEARS

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WHY NEW TREATMENT?SIDE EFFECTS OF CURRENT TREATMENT

-CHEMOTHERAPY: HAIR CHANGES, ANAEMIA, INFECTION, MEMORY LOSS, BRUISING, BLEEDING, DIARRHOEA, NEUROPATHY, MOUTH SORENESS, FERTILITY PROBLEMS, NAIL CHANGES, NAUSEA, VOMITING, DEPRESSION...

-RADIOTHERAPY: JOINT PAIN, SKIN PROBLEMS, FATIGUE, HEART PROBLEMS, BONE LOSS...

-SURGERY: LYMPHADEMA, COSMETIC PROBLEMS, PSYCHOLOGICAL PROBLEMS, DEPRESSION, NERVE DAMAGE, SORENESS...

-HORMONE THERAPY: WEIGHT GAIN, HOT FLUSHES, IMPOTENCE, NIGHT SWEATS, MUSCLE LOSS, FATIGUE, LOSS OF SEX DRIVE...

-TARGETED THERAPY: WEAKNESS, PAIN, THERMAL FEELINGS, DIORRHEA, VOMITING, NAUSEA...

WE WANT:- MINIMUM SIDE EFFECTS- MINIMUM COST- MINIMUM TREATMENT DURATION

-MAXIMUM SURVIVAL RATE-MAXIMUM PATIENT HAPPINESS-MAXIMUM LIFE QUALITY

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IMPROVE SURGERY (SENTINEL NODE MAPPING)

NEW AND FUTURE TREATMENTS UNDER RESEARCH

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ONCOLYTIC VIRAL THERAPY

INTERVENTIONAL RADIOLOGY

GENE THERAPY

VACCINES

BREAST CANCER RESISTANCE GENE USAGE

PRECISE DIAGNOSIS

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CRYOTHERAPY

NEW HORMONAL (ENDOCRINE) THERAPIES (35)

TURNING CANCER INTO A CHRONIC DISEASE

ANTI-VEGF THERAPY

NEW CYTOTOXIC CHEMOTHERAPY FORMULATIONS (36)

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NOVEL MICROTUBULE TARGETING AGENTS (36)

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IMPACT OF INTRODUCTION AND SUCCESS OF NEW TREATMENT

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INTRODUCTIONINCREASED DIAGNOSIS

NEW HOPESPSYCHOLOGICAL IMPROVEMENT

RESEARCH IMPROVEMENTINCREASED SHORT TERM COSTS

SUCCESSINCREASED SURVIVAL

DECREASED MORTALITYDECREASED SECONDARY DISEASES

IMPROVED PSYCHOLOGYDECREASED LONG TERM COSTSDECREASED HOSPITALIZATION

INCREASED SATISFACTIONBETTER COSMETIC APPEARANCE

FURTHER RESEARCHIMPROVED LIFE QUALITY

IMPROVED LIFESPAN

INDIVIDUAL FAMILY SOCIETY

SUMMARY

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-CANCER OF BREAST TISSUE

-STAGE 0: PREMALIGNANT, STAGES 1-3: GOOD PROGNOSIS, STAGE 4: METASTASIS

- DISEASE HAS BIG IMPACT ON INDIVIDUAL, FAMILY AND SOCIETY

- DIAGNOSIS RATES INCREASING, STILL VERY HIGH MORTALITY RATES

- VARIOUS TREATMENT METHODS PRESENT, TREATMENT HAS IMPROVED IN THE LAST 30 YEARS

- TREATMENT HAS SIDE EFFECTS AND IS STILL NOT ENOUGH SO NEW TREATMENTS ARE NEEDED

- NEW DIAGNOSTIC AND SURGICAL METHODS, PHARMACEUTICAL DRUGS AND GENE TREATMENTS ARE UNDER RESEARCH

- SUCCESSFUL IMPLEMENTATION OF NEW TREATMENTS WILL IMPROVE THE IMPACT OF CANCER ON INDIVIDUAL, FAMILIES AND SOCIETY

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