Breast cancer

US Mortality, 2002
Rank
1. 2. 3.

Cause of Death
Heart Diseases Cancer Cerebrovascular diseases

No. deaths
696,947 557,271 162,672

% of all deaths
28.5 22.8 6.7

4.
5. 6. 7. 8. 9. 10.

Chronic lower respiratory diseases

Accidents (Unintentional injuries) Diabetes mellitus Influenza and pneumonia Alzheimer disease Nephritis Septicemia

124,816
106,742 73,249 65,681 58,866 40,974 33,865

5.1
4.4 3.0 2.7 2.4 1.7 1.4

Source: US Mortality Public Use Data Tape 2002, National Center for Health Statistics, CDCP, 2004.

Cancer is more violent than the tiger

What is the cancer process?

Cancer begins in cells.Normally, cells grow and
divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes, this orderly process goes wrong. New

cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor. Tumors can be benign or malignant.

Causative agents
Spontaneous
UV and ionizing radiation

Chemical carcinogens

Tumour induction
Virus-induced (HepC, EBV, HPV) Genetic abnormalities (XP)

Immunosuppression

How do cancer cells differ from normal?

Cytoskeletal change
Cell adhesion/motility Nuclear changes Enzyme production

Cytoskeletal changes
microfilaments and microtubules change: 1.change the ways the cell interacts with neighboring cells 2.alter the appearance of the cells.
Distribution and activity of the

Cell adhesion/motility
Cell-cell and cell-extracellular matrix adhesion reducted: 1. allows large masses of cells to form. 2. impact on the ability of the cells to move.

Nuclear changes
The shape and organization of the nuclei changed -----useful in the diagnosis and staging of tumors
Gene chip

Enzyme production
Secrete enzymes digest away the barriers to migration and spread of the tumor cells-----enable them to invade neighboring tissues.

 In English , the word

cancer means crab. the change of the motality and enzymes makes cancer cells can move up and down in human body like the crabs in the river.

What is breast cancer ?

Definition of breast cancer: Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

Prevalence of cancer in UK

What are the symptoms of breast cancer?

A lump or a thickening in the breast or in

the armpit A change in size or shape of the mature breast Fluid (not milk) leaking from the nipple Change in size or shape of the nipple Unusual pain in the breast or in the armpit

What are risk factors for breast cancer?

Age Personal history of breast cancer Family history Certain breast changes Gene changes Reproductive and menstrual history Race

The classification of breast cancer

Ductal Carcinoma in-situ Infiltrating Ductal Medullary Carcinoma Infiltrating Lobular Tubular Carcinoma Mucinous Carcinoma Inflammatory Breast Cancer

Relative Survival (%) during Three Time Periods

Site
All sites
Breast (female) Colon Leukemia Lung and bronchus Melanoma of the skin Non-Hodgkin lymphoma Ovary Pancreas Prostate

1974-1976
50
75 50 34 13 80 47 37 3 67

1983-1985
53
78 58 41 14 85 54 41 3 75

1995-2000
64
88 63 46 15 91 59 44 4 99

Rectum
Urinary bladder

49
73

55
78

64
82

*5-year relative survival rates based on follow up of patients through 2001. Source: SEER Program (1975-2001), NCI 2004.

 Surgery

Treatment methods

Chemotherapy Radiotherapy Hormone therapy immunotherapy

Surgery
Breast-sparing surgery: An operation to remove the cancer but not the breast is breast-sparing surgery. Mastectomy: An operation to remove the breast (or as much of the breast tissue as possible) is a mastectomy. In most cases, the surgeon also removes lymph nodes under the arm

Chemotherapy

To decrease a patient's risk of recurrence Use anticancer drugs : 1.a combination of drugs ---AC (doxorubicin and cycolphosphamide) ---CMF (cyclophosphamide, methotrexate and fluorouracil ) 2.be given as a pill or by injection into a vein .

Radiotherapy
Radiation therapy uses high energy rays (similar to x-rays) to kill cancer cells. However , the rays can also kill normal cells besides the cancer cells . So this therapy may cause severe side effects .

-60

Hormone therapy
1. Breast tumors need hormones to grow----
estrogens, progesterone, prolactin, growth hormone, androgen, thyroxin etc. 2.Hormone therapy keeps cancer cells from getting or using the hormones they need. It is directed mainly to correct the estrogenous impact on the breast 3.Antiestrogens tamoxifen toremifen , aromatase.

Immunotherapy
Nonspecific immunoregulatory substances : BCG LMS Nonspecific immunotheropy Cytokin : IFN IL-2 vaccine

immunotheropy

Specific immunotheropy

Monoclonal antibody

Trastuzumab (Herceptin)

Bevacizumab (Avastin)

Immunotherapy-----vaccine
A HER2/neu peptide (a small part of the protein
made by the HER2/neu gene), used as the antigen in a vaccine, has been shown to cause an increased immune response against the HER2/neu receptor on cancer cells. Other specific antigen vaccines have also shown promise. These vaccines are almost always used after primary therapy (lumpectomy and radiation therapy, or mastectomy) and sometimes together with hormonal therapy or chemotherapy, to try to prevent the cancer from coming back.

Immunotherapy-----MAb
The MAb trastuzumab (Herceptin ) is used in women with breast cancer whose cancer cells have too many copies of the HER2/neu gene. These genes make extra receptors for growth-stimulating factors on the cells, which results in a more aggressive form of breast cancer. Trastuzumab attaches to the receptors, blocking the access of the growth factors to the cancer cells and slowing their growth.

Immunotherapy-----MAb
Bevacizumab (Avastin)|, a monoclonal antibody that slows blood vessel growth in tumors, has been shown to be helpful when used along with chemotherapy in some women with advanced breast cancer.