PHCP LEC WEEK 16: MANAGEMENT OF - Early menarche
NEOPLASTIC DISEASE - Null parity
- Late age first birth
BREAST CANCER - Hormone replacement therapy
Genetic
Part of the Breast - mutations of tumor suppresser genes
[BRCA1 and BRCA2])
Radiation Exposure
CLINICAL PRESENTATION
A painless lump is the initial sign of breast
cancer in most women.
The typical malignant mass is:
- Solitary
- Unilateral
- Solid
- Hard
- Irregular
- nonmobile
Most common and deadly malignancy of More advanced cases present with prominent
women globally. skin edema, redness, warmth, and induration.
All breast cancers can be separated into three
METASTATIC BREAST CANCER
major groups defined by the expression of two
Depend on the site of metastases but may
proteins, ER and HER2
include
Breast cancer is a malignancy originating from
- bone pain,
breast tissue.
- Difficulty of breathing
Disease confined to a localized breast lesion is
- abdominal pain or enlargement
referred to as early, primary, localized, or
- jaundice
curable.
- mental status changes
Disease detected clinically or radiologically in
Many women first detect some breast
sites distant from the breast is referred to as
abnormalities themselves, but it is increasingly
advanced or metastatic breast cancer (MBC),
common for breast cancer to be detected
which is usually incurable.
during routine screening mammography in
asymptomatic women.
DIAGNOSIS
Initial workup should include a
- Careful history
- Physical examination of the breast,
- Three-dimensional mammography, and,
possibly, other breast imaging
techniques:
o Ultrasound and magnetic resonance
imaging (MRI).
RISK FACTORS: Breast biopsy is indicated for a mammographic
Age abnormality that suggests malignancy or for a
Gender palpable mass on physical examination.
Endocrine factor:
, STAGING PROGNOSTIC FACTORS
Early Breast Cancer The ability to predict prognosis is used to
- Stage 0: Carcinoma in situ or disease that design treatment recommendations to
has not invaded the basement membrane maximize quantity and quality of life.
- Stage 1: Small primary invasive tumor - Age at diagnosis and ethnicity are patient
without lymph node involvement characteristics that may affect prognosis.
- Stage 2: Involvement of regional lymph - Tumor size and presence and number of
nodes involved axillary lymph nodes are primary
Locally Advanced Breast Cancer factors in assessing the risk for breast
- Stage 3: Usually a large tumor with cancer recurrence and subsequent
extensive nodal involvement in which the metastatic disease.
node or tumor is fixed to the chest wall; - Other disease characteristics that provide
also includes inflammatory breast cancer, prognostic information are histologic
which is rapidly progressive subtype, nuclear or histologic grade,
Advanced or Metastatic Breast Cancer lymphatic and vascular invasion, and
- Stage 4: Metastases in organs distant from proliferation indices.
the primary tumor - Hormone receptors [estrogen (ER) and
progesterone (PR)] are not strong
PATHOLOGIC EVALUATION prognostic markers but are used clinically
Development of malignancy is a multistep to predict response to endocrine therapy.
process involving preinvasive (or noninvasive) - HER2/neu (HER2) overexpression is
and invasive phases. associated with transmission of growth
The goal of treatment for noninvasive signal that control aspects of normal cell
carcinomas is to prevent the development of growth and division.
invasive disease. - Overexpression of HER2 is associated with
Pathologic evaluation of breast lesions increased tumor aggressiveness, rates of
establishes the histologic diagnosis and recurrence, and mortality.
confirms the presence or absence of - Genetic profiling tools provide additional
prognostic factors. prognostic information to aid in treatment
Most breast carcinomas are adenocarcinomas decisions for subgroups of patients with
and are classified as ductal or lobular. otherwise favorable prognostic features.
TREATMENT
Goals of Treatment: Adjuvant therapy for
early and locally advanced breast cancer is
administered with curative intent. Treatment
of MBC is done to improve symptoms and
quality of life, and to prolong survival.
Treatment is rapidly evolving. Specific
information regarding the most promising
interventions can be found only in the primary
literature.
Treatment can cause substantial toxicity,
which differs depending on the individual
agent, administration method, and
combination regimen.
A comprehensive review of toxicities is beyond
the scope of this chapter; consult appropriate
references.
NEOPLASTIC DISEASE - Null parity
- Late age first birth
BREAST CANCER - Hormone replacement therapy
Genetic
Part of the Breast - mutations of tumor suppresser genes
[BRCA1 and BRCA2])
Radiation Exposure
CLINICAL PRESENTATION
A painless lump is the initial sign of breast
cancer in most women.
The typical malignant mass is:
- Solitary
- Unilateral
- Solid
- Hard
- Irregular
- nonmobile
Most common and deadly malignancy of More advanced cases present with prominent
women globally. skin edema, redness, warmth, and induration.
All breast cancers can be separated into three
METASTATIC BREAST CANCER
major groups defined by the expression of two
Depend on the site of metastases but may
proteins, ER and HER2
include
Breast cancer is a malignancy originating from
- bone pain,
breast tissue.
- Difficulty of breathing
Disease confined to a localized breast lesion is
- abdominal pain or enlargement
referred to as early, primary, localized, or
- jaundice
curable.
- mental status changes
Disease detected clinically or radiologically in
Many women first detect some breast
sites distant from the breast is referred to as
abnormalities themselves, but it is increasingly
advanced or metastatic breast cancer (MBC),
common for breast cancer to be detected
which is usually incurable.
during routine screening mammography in
asymptomatic women.
DIAGNOSIS
Initial workup should include a
- Careful history
- Physical examination of the breast,
- Three-dimensional mammography, and,
possibly, other breast imaging
techniques:
o Ultrasound and magnetic resonance
imaging (MRI).
RISK FACTORS: Breast biopsy is indicated for a mammographic
Age abnormality that suggests malignancy or for a
Gender palpable mass on physical examination.
Endocrine factor:
, STAGING PROGNOSTIC FACTORS
Early Breast Cancer The ability to predict prognosis is used to
- Stage 0: Carcinoma in situ or disease that design treatment recommendations to
has not invaded the basement membrane maximize quantity and quality of life.
- Stage 1: Small primary invasive tumor - Age at diagnosis and ethnicity are patient
without lymph node involvement characteristics that may affect prognosis.
- Stage 2: Involvement of regional lymph - Tumor size and presence and number of
nodes involved axillary lymph nodes are primary
Locally Advanced Breast Cancer factors in assessing the risk for breast
- Stage 3: Usually a large tumor with cancer recurrence and subsequent
extensive nodal involvement in which the metastatic disease.
node or tumor is fixed to the chest wall; - Other disease characteristics that provide
also includes inflammatory breast cancer, prognostic information are histologic
which is rapidly progressive subtype, nuclear or histologic grade,
Advanced or Metastatic Breast Cancer lymphatic and vascular invasion, and
- Stage 4: Metastases in organs distant from proliferation indices.
the primary tumor - Hormone receptors [estrogen (ER) and
progesterone (PR)] are not strong
PATHOLOGIC EVALUATION prognostic markers but are used clinically
Development of malignancy is a multistep to predict response to endocrine therapy.
process involving preinvasive (or noninvasive) - HER2/neu (HER2) overexpression is
and invasive phases. associated with transmission of growth
The goal of treatment for noninvasive signal that control aspects of normal cell
carcinomas is to prevent the development of growth and division.
invasive disease. - Overexpression of HER2 is associated with
Pathologic evaluation of breast lesions increased tumor aggressiveness, rates of
establishes the histologic diagnosis and recurrence, and mortality.
confirms the presence or absence of - Genetic profiling tools provide additional
prognostic factors. prognostic information to aid in treatment
Most breast carcinomas are adenocarcinomas decisions for subgroups of patients with
and are classified as ductal or lobular. otherwise favorable prognostic features.
TREATMENT
Goals of Treatment: Adjuvant therapy for
early and locally advanced breast cancer is
administered with curative intent. Treatment
of MBC is done to improve symptoms and
quality of life, and to prolong survival.
Treatment is rapidly evolving. Specific
information regarding the most promising
interventions can be found only in the primary
literature.
Treatment can cause substantial toxicity,
which differs depending on the individual
agent, administration method, and
combination regimen.
A comprehensive review of toxicities is beyond
the scope of this chapter; consult appropriate
references.
