Question

1-Explain in details the causes, signs & symptoms, pathophysiology, diagnosis process and different treatment strategies of Breast Cancer? (with four different references (3 textbook with page numbers and one article)).

Answer 1

Breast cancer

It is transformation of normal breast cell to cancerous ones.

Causes

- cancer cause cells to multiply uncontrollably thus depriving other cells of nutrition

- increasing age causes more risk of breast cancer

- female are more susceptible

- if you have a personal history of some atypical finding in breast cells

- inherited genes may cause breast cancer

- family history of breast cancer

- radiation exposure

- obesity, smoking

- postmenopausal hormone therapy

Signs and symptoms-

- a breast lump or thickening that feels different from surrounding breast tissue during palpation.

- change in shape, size and appearance of breast

- change in shape of nipple

- change in skin over breast like dimpling

- peeling, scaling and crusting of pigmented area of skin surrounding nipple

- reddness of skin of breast which is called pseu de ornange appearance

Pathophysiology-

Normal cells divide and then stop dividing and then are eventually destroyed by program cell death called apoptosis.

Signalling pathway that protect from apoptosis is PI3K/ AKT. This pathway are on during normal cells life and stops during apoptosis. Genes for this pathway are mutated and always remain on during cancerous transformation and thus the cancerous cells are prevented from apoptosis.

P53 (tumour suppression factor) , BRCA genes are mutated and they are often hereditary transfered. This genes in normal protect transformation of normal cell to cancerous . But in Cancer they are mutated and thus tumour supression activity of p53 gene is lost and dna repair property if BRCA is lost. Thus cancerous transformation takes places.

Over presentation of estrogen receptor can also lead to proliferation of breast cell under estrogen action.

Diagnosis-

Most common diagnosis methods are physical examination and mammogram . To find more precise microscopic evidence FNAC ( fine neddle aspiration cytology) is best method. Other methods like biopsy are also used.

They are mostly diagnosed on basis of their atypical histopathological appearance.

On basis of findings grading and staging is done.

Grading - it refers to difference in their appearance from normal cells

Various grades

1- well differentiated- low grade

2- moderately differentiated- intermediate grade

3- poorly differentiated- high grade

Staging- it refers to size , spread of tumour

It is based on tnm system

T- tumour- size of tumour

N- nodes- whether it is spread to regional lymph nodes

M- metastasized- whether it is spread to distant sites

Treatment-

Treatment is often based on grade and stage of cancer.

Mostly surgery followed by chemotherapy and radiotherapy is preferred.

In estrogen receptor positive tumours , estrogen blocking therapy is used.

Sometimes monoclonal antibodies are also used to destroy tumour cells.

Surgery- it is physical removal of tumour and affected tissues from breast. It is of three types

1- mastectomy- removal of whole breast

2 - quadrantectomy- removal of one quater of breast

3- lumpectomy- removal of only affected lump

Hormone therapy- it is prescibed in hormone receptor positive tumours . That is if estrogen receptor are present in tumour. Tamoxifen which block estrogen affects by blocking receptors is used. Anastrozole and letrozole which reduce estrogen production are also used.

Chemotherapy- it is used mainly in stage 2- 4 cancer. Cyclophosphamide, doxorubicin, methotrexate, flurouracil are used drugs.

Radiotherapy- radiation are used to destroy microscopic tumours cells left after surgery. Thus is prevents the recurrence of tumours

Monoclonal antibodies like trastuzumab may be used to destroy tumour cells.