By : asem shadid

435032467

Pbl 2 – pod 2

1. Describe the normal anatomy of the breast in female ?2. Describe the breast cancer and its different type ,stages and

grading ?3. List the tumor marker of breast cancer ?4. Clinical significance of progesterone and estrogen in breast

cancer ?5. How the breast cancer spread in different sites ?6. Define the paraneoplastic syndrome ?

Objectives :

• Describe the normal anatomy of the breast

in female ?

• Anatomy of the Breasts• The lobes, lobules, and bulbs are all linked by thin tubes called ducts.

• Each lobe has many smaller lobules, which end in dozens of tiny bulbs that can produce milk.

• The nipples contain no fat, hair or sweat glands.

• There are many smooth muscle fibres in tissues of the breast, which are specially arranged to help the nipple to become erect when stimulated

• The structures associated with the mammary gland are:

• Nipple – where mammary ducts open to surface• Areola – reddish brown skin around nipple; contains large sebaceous glands• Lobes – make up glandular tissue of the mammary gland• Lobules - grape-like secretory structures of the lobes; sometimes called alveoli• Lactiferous ducts – formed by converging ducts from several lobules; 15-20/ nipple• Lactiferous sinus – expanded chamber formed by the enlargement of the lactiferous duct near nipple• Suspensory ligaments - extend inward from the skin of the breast to the pectoral tissue in order to

support the weight of the breast

• Describe the breast cancer

• and its different type ,stages and

grading ?

• Breast cancer is a malignant (cancer) tumor that starts in the cells of the breast. It is found mostly in women, but men can get breast cancer, too.

• How many women get breast cancer?• The American Cancer Society’s estimates for breast cancer in women in the United• States for 2015 are: About 231,840 new cases of invasive breast cancer

1. Chest wall2. Pectoralis muscles3. Lobules4. Nipple5. Areola6. Milk duct7. Fatty tissue8. Skin

normalnormal

Types of breast cancers : .Ductal carcinoma in situ (DCIS)DCIS means that abnormal cells start in the cells lining the ducts without growing(invading) into the tissue of the breast. DCIS is also sometimes called a non-invasive breast cancer.

Invasive (or infiltrating) ductal carcinoma (IDC)This is the most common breast cancer. It starts in the cells lining a duct, and grow into (invade) the tissue of theBreast. Then spared .

Invasive (infiltrating) lobular carcinoma (ILC)This cancer starts in the cells lining the milk glands (the lobules). The cells grow throughthe wall of the lobules and then can spread to nearby lymph nodes or other parts of the body.

Inflammatory breast cancer (IBC)

This is a rare type of invasive breast cancer. Often, there is no single lump or tumor.IBC makes the skin of the breast look red and feel warm. It also may make theskin look thick and pitted,

Types of breast cancers

• Staging and grading of breast cancer in women • The stage of a cancer describes its size and if it has spread from

where it started.

• TNM staging• T: size or direct extent of the primary tumor

• N: degree of spread to regional lymph nodes

•  M refers to metastases, or whether the cancer has spread to other body parts.• Some of the stages are further divided into sub stages using the letters A, B, and

C.• Stage 1 or 2 breast cancer is often called early breast cancer.

• As a rule, the lower the number, the less the cancer has spread.

• And within a stage, an earlier letter means a lower (and often better) stage.

Staging

There are two kinds of stage 0 breast cancer:Ductal carcinoma in situ (DCIS): Abnormal cells are in the lining of a milk duct and have not spread outside the duct.Lobular carcinoma in situ (LCIS): Abnormal cells are in the lining of a lobule.

• To find out the grade of a tumour, the biopsy sample is examined under a microscope. A grade is given based on how the cancer cells look and behave compared with normal cells. This can give an idea of how quickly the cancer may be growing. There are three grades.

• grading

• Grade 1 or low-grade

• The cancer cells look similar to normal cells (are well differentiated) and usually grow slowly. The cancer cells are less likely to spread.

• Grade 2 or moderate- or intermediate-grade

• The cancer cells look more abnormal and grow slightly faster than grade 1 cells.

• Grade 3 or high-grade

• The cancer cells look very different from normal cells (are poorly differentiated) and may grow quicker than grade 1 or 2 cells.

• Clinical significance of progesterone and estrogen in breast

cancer ?

Estrogen receptors (ER) and progesterone receptors (PR; also called PgR) may be found in breast cancer cells. Cancer cells with these receptors depend on estrogen and related hormones, such as progesterone, to grow.

• If breast cancer cells have estrogen receptors, the cancer is called ER-positive breast cancer.• If breast cancer cells have progesterone receptors, the cancer is called PR-positive breast

cancer.• If the cells do not have either of these two receptors, the cancer is called ER/PR-negative.

All patients with invasive breast cancer or a breast cancer recurrence should have their tumors tested for estrogen and progesterone receptors.

Why ? Learning whether a tumor has estrogen and/or progesterone receptors helps doctors determine a patient's risk of recurrence (return of the cancer after treatment) and whether the cancer can be treated with hormone therapy.

Hormone therapy blocks the tumor from using estrogen and/or progesterone only for cancers that are ER and/or PR positive, slowing or stopping tumor growth.

Estrogen receptors (ER) and progesterone receptors (PR )

• Testing the tumor for both estrogen and progesterone receptors is a standard part of a breast cancer diagnosis. Because the results are used to guide treatment .

• The most common method currently used called immunohistochemistry or IHC.

• IHC testing can detect receptors in cancer cells from a sample of tissue.

• Sometimes, a breast cancer is positive for estrogen receptors, but negative for progesterone receptors. Because current hormone therapies are designed to treat ER+ cancers,and these cases are treated the same as breast cancers that are positive for both hormone receptors.

How do hormone therapies work? Hormone therapies can stop tumor growth by preventing the cancer cells from getting the estrogen they need to grow. They can do this in different ways.the drug tamoxifen, attach to hormone receptors inside the cancer cells and block estrogen from attaching to the receptors. the drug aromatase inhibitors, lower the level of estrogen in the body so the cancer cells cannot get the estrogen they need.

How the breast cancer spread in different sites ?

Metastatic Breast Cancer• What is Metastatic Breast Cancer?• Metastatic breast cancer is also classified as Stage 4 breast cancer. The cancer has

spread to other parts of the body. • This usually includes the lungs, liver, bones or brain.

Where in the body does breast cancer usually spread?The most common sites for breast cancer to spread  (and methods for localized treatment) are:

Lymph nodes Under the arm (or axilla, called axillary nodes) .

Bones – the ribs, spine, pelvis and long bones of the arms and legs are the most common metastatic sites , but breast cancer can spread to many parts of the skeleton.

• Roughly 70% of all patients living with advanced breast cancer have bone metastases. Very often bone metastases can be successfully managed for a long time.

Bone marrow - cancer cells in the bone marrow are often present with metastatic breast cancer, especially when there are bone metastases.

Brain - Although any kind of metastatic breast cancer can spread to the brain, certain kinds are more likely to do so.• Brain metastasis is observed in 10% of breast cancer patients with metastatic

properties.

• The most common sites of metastasis includes the axillary lymph nodes, bone, lungs, liver and brain.

Muscle, fatty tissue and skin – usually in the area near where the initial tumor was, for example the muscles of the chest wall .

Liver – because the blood supply is filtered by the liver, this is a very common site for breast cancer to spread.

Where in the body does breast cancer usually spread? Also

Paraneoplastic syndrome

Paraneoplastic syndrome

A syndrome is a set of medical signs and symptoms that are correlated with each other and, often, with a specific disease.

A paraneoplastic syndrome is a syndrome that is the consequence of cancer in the body but not due to the local presence of cancer cells.

are mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by an immune response to the tumor.

most commonly present with cancers of the lung, breast, ovaries or lymphatic system

• By : asem shadid• 435032467

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