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Breast Cancer.ppt

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Breast Cancer.ppt

  2. 2. INTRODUCTION <ul><li>Breast cancer, the second-leading cause of cancer deaths in women, is the disease women fear most. </li></ul><ul><li>Breast cancer can also occur in men, but it's far less common. </li></ul><ul><li>Yet there's more reason for optimism than ever before. </li></ul><ul><li>In the last 30 years, doctors have made great strides in early diagnosis and treatment of the disease and in reducing breast cancer deaths. </li></ul>
  3. 3. <ul><li>80% of breast cancers occur in women older than age 50. In 30s, have a one in 233 chance of developing breast cancer. By age 85, chance is one in eight. </li></ul><ul><li>In 1975, a diagnosis of breast cancer usually meant radical mastectomy – removal of the entire breast along with underarm lymph nodes and muscles underneath the breast. </li></ul><ul><li>Today, radical mastectomy is rarely performed. Instead, there are more and better treatment options, and many women are candidates for breast-sparing operations. </li></ul>
  4. 4. SIGNS AND SYMPTOMS <ul><li>When the disease is discovered early, have more treatment options and a better chance for a cure. </li></ul><ul><li>Most breast lumps aren't cancerous. Yet the most common sign of breast cancer for both men and women is a lump or thickening in the breast. Often, the lump is painless. </li></ul><ul><li>Spontaneous clear or bloody discharge from the nipple, often associated with a breast lump </li></ul><ul><li>Retraction or indentation of the nipple </li></ul><ul><li>Change in the size or contours of the breast </li></ul><ul><li>Any flattening or indentation of the skin over the breast </li></ul>
  5. 5. <ul><li>Redness or pitting of the skin over breast, like the skin of an orange </li></ul><ul><li>A number of conditions other than breast cancer can cause the breasts to change in size or feel. </li></ul><ul><li>Breast tissue changes naturally during pregnancy and the menstrual cycle. </li></ul><ul><li>Other possible causes of noncancerous (benign) breast changes include fibrocystic changes, cysts, fibroadenomas, infection or injury. </li></ul><ul><li>If patient haven't yet gone through menopause, may want to wait through one menstrual cycle before seeing the doctor. </li></ul><ul><li>If the change hasn't gone away after a month, have it evaluated promptly. </li></ul>
  6. 6. CAUSES <ul><li>In breast cancer, some of the cells in the breast begin growing abnormally. </li></ul><ul><li>These cells divide more rapidly than healthy cells do and may spread (metastasize) through the breast, to lymph nodes or to other parts of the body. </li></ul><ul><li>The most common type of breast cancer begins in the milk-producing ducts, but cancer may also begin in the lobules or in other breast tissue. </li></ul><ul><li>In most cases, it isn't clear what causes normal breast cells to become cancerous. </li></ul>
  7. 8. <ul><li>Only 5-10% of breast cancers are inherited. </li></ul><ul><li>Families that do have genetic defects in one of two genes, breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2), have a much greater risk of developing both breast and ovarian cancer. </li></ul><ul><li>Other inherited mutations – including the ataxia-telangiectasia mutation gene, the cell-cycle checkpoint kinase 2 (CHEK-2) gene and the p53 tumor suppressor gene – also make it more likely that will develop breast cancer. </li></ul>
  8. 9. <ul><li>If one of these genes is present in the family, will have a 50 percent chance of having the gene. </li></ul><ul><li>Yet most genetic mutations related to breast cancer aren't inherited. </li></ul><ul><li>These acquired mutations may result from radiation exposure – women treated with chest radiation therapy for lymphoma in childhood or during adolescence when breasts are developing have a significantly higher incidence of breast cancer than do women not exposed to radiation. </li></ul><ul><li>Mutations may also develop as a result of exposure to cancer-causing chemicals, such as the polycyclic aromatic hydrocarbons found in tobacco and charred red meats. </li></ul>
  9. 11. <ul><li>Each of breasts contains 15 to 20 lobes of glandular tissue, arranged like the petals of a daisy. </li></ul><ul><li>The lobes are further divided into smaller lobules that produce milk during pregnancy and breast-feeding. </li></ul><ul><li>Small ducts conduct the milk to a reservoir that lies just beneath the nipple. </li></ul><ul><li>Supporting this network is a deeper layer of connective tissue called stroma. </li></ul>
  10. 12. RISK FACTORS <ul><li>Some risk factors, such as age, sex and family history, can't be changed </li></ul><ul><li>Whereas others, including weight, smoking and a poor diet, are under control. </li></ul><ul><li>Age </li></ul><ul><li>Personal history of breast cancer. </li></ul><ul><li>Family history. </li></ul><ul><li>Genetic predisposition. </li></ul><ul><li>Radiation exposure. </li></ul><ul><li>Excess weight. </li></ul>
  11. 13. <ul><li>Early onset of menstrual cycles. </li></ul><ul><li>Late menopause. </li></ul><ul><li>First pregnancy at older age. </li></ul><ul><li>Race. </li></ul><ul><li>Hormone therapy. </li></ul><ul><li>Birth control pills. </li></ul><ul><li>Smoking. </li></ul><ul><li>Excessive use of alcohol. </li></ul><ul><li>Precancerous breast changes (atypical hyperplasia, lobular carcinoma in situ). </li></ul><ul><li>Mammographic breast density. </li></ul>
  12. 14. WHEN TO SEEK MEDICAL ADVICE <ul><li>Although most breast changes aren't cancerous, it's important to have them evaluated promptly. </li></ul><ul><li>Discover a lump or any of the other warning signs of breast cancer, especially if the changes persist after one menstrual cycle or they change the appearance of the breast. </li></ul><ul><li>If treated for breast cancer, report any new signs or symptoms immediately. </li></ul><ul><li>Possible warning signs include a new lump in the breast or a bone ache or pain that doesn't go away after three weeks. </li></ul>
  13. 15. Screening and diagnosis <ul><li>Screening – looking for evidence of disease before signs or symptoms appear – is the key to finding breast cancer in its early, treatable stages. Depending on age and risk factors, screening may include breast self-examination, examination by nurse or doctor, mammograms (mammography) or other tests. </li></ul><ul><li>Self breast examination is an option beginning at age 20. </li></ul>
  14. 16. Screening
  15. 17. Breast self-exam
  16. 18. Clinical breast exam <ul><li>Mammogram - to check breast tissue </li></ul>Other tests <ul><li>Computer-aided detection (CAD) </li></ul><ul><li>Digital mammography </li></ul><ul><li>Magnetic resonance imaging (MRI) </li></ul><ul><li>Breast ultrasound (ultrasonography) </li></ul>Experimental procedures <ul><li>Ductal lavage </li></ul><ul><li>Molecular breast imaging (MBI) </li></ul>
  17. 19. Mammogram CAD Mammogram Digital mammography Breast Ultrasound
  18. 20. Diagnostic procedures <ul><li>Ultrasound </li></ul><ul><li>Biopsy – Fine-needle aspiration biopsy, core needle biopsy, sterotactic biopsy, wire localization biopsy, surgical biopsy </li></ul><ul><li>Estrogen and progesterone receptor tests </li></ul><ul><li>Staging tests – Stage 0 to IV </li></ul><ul><li>Genetic stage </li></ul>
  19. 21. Breast biopsy
  20. 22. Tamoxifen inhibits estrogen receptor activity AE = antiestrogenic E = estrogenic
  21. 23. TREATMENT <ul><li>In addition to coping with a potentially life-threatening illness – must make complex decisions about treatment. </li></ul><ul><li>Treatments exist for every type and stage of breast cancer. </li></ul><ul><li>Most women will have surgery and an additional (adjuvant) therapy such as radiation, chemotherapy or hormone therapy. </li></ul><ul><li>Experimental treatments are also available at cancer treatment centers. </li></ul>
  22. 24. SURGERY <ul><li>Lumpectomy </li></ul><ul><li>Partial or segmental mastectomy </li></ul><ul><li>Simple mastectomy </li></ul><ul><li>Modified radical mastectomy </li></ul><ul><li>Sentinel lymph node biopsy </li></ul><ul><li>Axillary lymph node dissection </li></ul><ul><li>Radiation therapy </li></ul><ul><li>Chemotherapy </li></ul>
  23. 25. Reconstructive surgery <ul><li>Reconstruction with implants </li></ul><ul><li>Reconstruction with a tissue flap </li></ul><ul><li>Deep inferior epigastric perforator (DIEP) reconstruction </li></ul><ul><li>Reconstruction of the nipple and areola </li></ul>
  24. 26. Hormonal therapy <ul><li>Selective estrogen receptor modulators (SERMs) </li></ul><ul><li>Aromatase inhibitors </li></ul>Biological therapy <ul><li>Trastuzumab (Herceptin) </li></ul><ul><li>Bevacizumab (Avastin) </li></ul><ul><li>Lapatinib (Tykerb) </li></ul>
  25. 27. PREVENTION <ul><li>Chemoprevention </li></ul><ul><li>Tamoxifen (Nolvadex) </li></ul><ul><li>Raloxifene (Evista) </li></ul><ul><li>Preventive surgery </li></ul><ul><li>Prophylactic mastectomy </li></ul><ul><li>Prophylactic oophorectomy </li></ul>
  26. 28. LIFE-STYLE FACTORS <ul><li>Taking aspirin </li></ul><ul><li>No / limit alcohol </li></ul><ul><li>Maintain a healthy weight </li></ul><ul><li>Avoid long-term hormone therapy </li></ul><ul><li>Stay physically active </li></ul><ul><li>Eat foods high in fiber </li></ul><ul><li>Emphasize olive oil </li></ul><ul><li>Avoid exposure to pesticides </li></ul>
  27. 29. New directions in research <ul><li>Retinoids - Natural or synthetic forms of vit-A have the ability to destroy the growth of cancer cells. Effective in premenopausal women and in those whose tumors aren't estrogen positive. </li></ul><ul><li>Flaxseed – High in lignan, a naturally occurring compound that lowers circulating estrogens in the body. Decreases estrogen production – acts like tamoxifen – inhibit the growth of breast cancer tumors. Lignans are also antioxidants with weak estrogen-like characteristics. These characteristics may be the mechanism by which flaxseed works to decrease hot flushes. </li></ul>
  28. 30. COPING SKILLS <ul><li>Telling others </li></ul><ul><li>Maintaining a strong support system </li></ul><ul><li>Dealing with intimacy </li></ul><ul><li>Self-care taking </li></ul>
  29. 32. Thank you
  30. 33. <ul><li>Breast tenderness is pain or discomfort in the breasts. It is the most common breast symptom women have. It is usually not a sign of breast cancer. </li></ul><ul><li>Most common cause of breast tenderness is called fibrocystic breast changes. </li></ul><ul><li>These changes are caused by the swelling of very tiny fluid-filled cysts in fibrous tissue in the breast. </li></ul><ul><li>The changes usually happen 7-10 days before the menstrual period and go away when period ends. </li></ul>BREAST TENDERNESS
  31. 34. CAUSES <ul><li>Puberty (boys / girls) </li></ul><ul><li>Pregnancy </li></ul><ul><li>Infection of the breast </li></ul><ul><li>Hormone imbalance – too much estrogen </li></ul><ul><li>Birth control pills </li></ul><ul><li>Breast-feeding – when breasts engorged (milk) </li></ul><ul><li>Injury of the breast </li></ul><ul><li>Noncancerous tumor in the breast (fibroma) </li></ul><ul><li>Breast cyst </li></ul><ul><li>Condition called hyperprolactinemia </li></ul><ul><li>Breast cancer, but often cancer does not cause any pain. </li></ul>
  32. 35. DIAGNOSIS <ul><li>Mammogram (a special x-ray of the breasts) </li></ul><ul><li>Ultrasound scan of the breasts (a scan with sound waves) </li></ul><ul><li>Thermography of the breasts (a heat test that outlines the breast in a color pattern) </li></ul><ul><li>Biopsy (removal of a small piece of tissue or fluid from the breast). </li></ul><ul><li>Examination of discharge from a nipple </li></ul><ul><li>Blood test. </li></ul>
  33. 36. TREATMENT <ul><li>Drink fewer or no beverages with caffeine. </li></ul><ul><li>Add vitamins E and A to the diet. </li></ul><ul><li>Reduce salt intake – 1-2 weeks before menstruation. </li></ul><ul><li>Put heat on the breast with a heating pad or warm water bottle. </li></ul><ul><li>Diuretics. </li></ul><ul><li>Surgery is rarely needed. </li></ul>
  34. 37. SELF-CARE <ul><li>Follow the physician’s recommendations for preventing and treating breast tenderness. </li></ul><ul><li>Learn how to examine the breasts after the menstrual period every month. </li></ul>
  35. 38. <ul><li>Nipple discharge is any kind of fluid that comes out of the nipple. </li></ul><ul><li>Nipples contain tiny openings through which fluid can pass. </li></ul><ul><li>Although most nipple discharge is not serious, any discharge should be evaluated. </li></ul><ul><li>The color and consistency of the discharge will help in diagnosis. </li></ul>NIPPLE DISCHARGE
  36. 39. <ul><li>A clear, straw-colored discharge sometimes develops in early pregnancy. </li></ul><ul><li>A whitish or greenish discharge occurring in nonpregnant women is galactorrhea – cause – birth control pills, hormone imbalance, pituitary tumor, or cyst under the areola. </li></ul><ul><li>Pus discharge indicates a breast infection. </li></ul>
  37. 40. DIAGNOSIS <ul><li>No menstrual periods </li></ul><ul><li>Headaches </li></ul><ul><li>Visual problems. </li></ul><ul><li>Lab tests of the discharge </li></ul><ul><li>Blood tests </li></ul><ul><li>Mammogram (x-ray of the breasts) </li></ul><ul><li>Ultrasound scan of the breasts </li></ul><ul><li>CT scan of the brain. </li></ul>
  38. 41. TREATMENT <ul><li>Surgery </li></ul><ul><li>Radiation therapy </li></ul><ul><li>Chemotherapy. </li></ul>
  39. 43. <ul><li>Galactorrhea is a milklike discharge of fluid from the breast nipples. </li></ul><ul><li>Usually the discharge is from both breasts rather than just one. </li></ul><ul><li>A discharge like this is called galactorrhea unless pregnant or breast-feeding. </li></ul><ul><li>Galactorrhea usually occurs when the body produces too much prolactin. Prolactin is a hormone produced by the pituitary gland. Normally, prolactin helps a woman make milk when she has a baby. </li></ul>GALACTORRHEA
  40. 44. ETIOLOGY <ul><li>Birth control pills and other medicines </li></ul><ul><li>Underactive thyroid gland </li></ul><ul><li>Problems with the pituitary gland </li></ul><ul><li>Some brain diseases, such as meningitis </li></ul><ul><li>Cyst under the darkened area around the nipple (galactocele) </li></ul><ul><li>Shingles caused by the chickenpox virus in the chest wall </li></ul><ul><li>Surgery on the chest </li></ul><ul><li>Other medical problems – kidney failure, liver disease, sarcoidosis, or Cushing's disease. </li></ul>
  41. 45. DIAGNOSIS <ul><li>Medical history – stopped having menstrual periods, having trouble getting pregnant, or having headaches or vision problems. OTC medicines if any. Sample of the discharge may be tested in the lab. </li></ul><ul><li>Blood tests </li></ul><ul><li>Mammogram (x-ray of the breasts) </li></ul><ul><li>Ultrasound scan of the breasts </li></ul><ul><li>CT scan of the brain to look at the pituitary gland. </li></ul>
  42. 46. TREATMENT <ul><li>If a galactocele is causing the galactorrhea, the cyst will be removed. </li></ul><ul><li>If the discharge is caused by drugs, it will clear up when stop taking the drugs. However, stopping drugs is not always necessary. </li></ul><ul><li>If the galactorrhea is caused by a pituitary gland tumor, needs surgery, radiation, or drug treatments. Can treat with bromocriptine (stops production of prolactin). </li></ul>
  43. 47. How long will the effects last? <ul><li>Once the cause of the discharge is diagnosed and treated, she should no longer have the discharge. However, if pituitary tumor is present, may need long-term treatment with bromocriptine or radiation because the tumor could come back. </li></ul>SELF-CARE <ul><li>Follow-up tests. </li></ul><ul><li>Take drugs as prescribed. </li></ul><ul><li>If the galactorrhea is mild and a cause cannot be found, breast binders can help stop the discharge by preventing stimulation of the nipples. </li></ul>
  44. 48. <ul><li>Paget's disease is a slowly growing cancer of the nipple. It is a rare form of breast cancer. It mainly affects women and very rarely men. </li></ul><ul><li>When abnormal cells grow uncontrollably, they are called tumors. It is not known why they occur. In Paget's disease, the tumor starts in the milk ducts of the nipple. </li></ul>PAGET'S DISEASE OF THE NIPPLE
  45. 49. SYMPTOMS <ul><li>Symptoms seem harmless. It is often thought to be a skin inflammation or infection, which can delay its diagnosis and treatment. </li></ul><ul><li>Redness, oozing, and crusting of the nipple and the circular, dark area around the nipple (areola), which causes itching and burning. </li></ul><ul><li>Sore on the nipple that will not heal. </li></ul><ul><li>Usually only 1 nipple is affected. Sometimes no changes in the skin can be seen. May have a lump in the breast, which may or may not be able to feel. </li></ul>
  46. 50. DIAGNOSIS <ul><li>Sample of discharge from the nipple may be examined under a microscope. </li></ul><ul><li>Biopsy – to remove the sample of breast tissue to test for cancer. </li></ul><ul><li>Mammogram of both breasts to look for cancer in other parts of the breasts. </li></ul><ul><li>Ultrasound scan or MRI - both of these tests create pictures of the breasts. </li></ul>
  47. 51. TREATMENT <ul><li>If the cancer is only in the nipple and not any other part of the breast: </li></ul><ul><li>Radiation treatments </li></ul><ul><li>Surgery to remove just the nipple and surrounding tissue. </li></ul><ul><li>If a mass is found deep in the breast: </li></ul><ul><li>Surgery to remove all or part of the breast </li></ul><ul><li>Chemotherapy. </li></ul>
  48. 52. How long will the effects last? <ul><li>Without treatment, the cancerous sore will remain on the nipple and may spread deeper into the breast. </li></ul>PREVENTION <ul><li>Check monthly for any lumps, sores, or oozing from the breasts and report any breast changes to the physician right away. </li></ul>
  49. 53. <ul><li>Breast-feeding should be a comfortable and enjoyable experience. </li></ul><ul><li>Sore nipples are a common problem among breast-feeding mothers. </li></ul><ul><li>Often mothers quit nursing their babies early because of sore nipples, but this doesn't have to happen. </li></ul><ul><li>Sore nipples usually can be prevented or treated. </li></ul>SORE NIPPLES
  50. 54. Nipple protectors <ul><li>Mild nipple discomfort at the beginning of feedings during the first few days of breast-feeding usually needs no treatment. </li></ul><ul><li>Nipple pain that is severe or lasts throughout a single or for more than a week is not normal and should be evaluated by doctor or a lactation consultant. </li></ul><ul><li>Protects sore nipples during breast-feeding </li></ul><ul><li>Shaped to allow skin contact with baby </li></ul><ul><li>Made with odorless, tasteless, ultra-fine silicone </li></ul>
  51. 55. CAUSES <ul><li>Position of the baby's mouth on the breast. </li></ul><ul><li>Size and shape of the nipples and the baby's mouth can affect how the baby latches on the breast. </li></ul><ul><li>Also, infant's sucking habits can cause nipple discomfort. </li></ul><ul><li>Other possible causes of nipple pain are an infection of the nipples (yeast or bacterial), breast infection or improper nipple skin care. </li></ul>
  52. 56. PROBLEMS CAUSED <ul><li>If baby is not latching on to the breast correctly, he may not be getting enough milk. </li></ul><ul><li>Also, nipple pain may cause to put off nursings or not let the baby suck long enough when he nurses. </li></ul><ul><li>Sucking is important because this is what triggers the milk to begin to flow (let-down reflex). </li></ul><ul><li>Nipple pain can cause a drop in the milk supply. </li></ul><ul><li>As a result, baby may not gain weight well. </li></ul><ul><li>Sore nipples and low milk supply problems often go hand-in-hand. </li></ul>
  53. 57. TREATMENT <ul><li>Make sure the baby is positioned correctly to nurse </li></ul><ul><li>Begin a feeding on the less sore nipple to trigger the let-down reflex and start milk flowing </li></ul><ul><li>Frequent shorter feedings are better than less frequent lengthy feedings </li></ul><ul><li>Keep the nipples dry </li></ul><ul><li>If any cracks or other breaks in the skin, keep the nipples covered with a soothing ointment </li></ul><ul><li>Use a pump to express the milk if the pain is so severe that cannot nurse the baby </li></ul><ul><li>Watch for signs of a breast infection </li></ul>
  54. 58. WHEN TO SEEK MEDICAL ADVICE <ul><li>Immediate – following symptoms additional to sore nipples: chills, fever, headache, flu-like symptoms, or pain or redness in the breast. </li></ul><ul><li>OB/GYN – Nipples sting or burn and have shooting pains in the breast, especially after nursing. Nipple pain keeps from nursing long enough to trigger let-down reflex. </li></ul><ul><li>Pediatrician – baby unsatisfied after most nursings. Baby may not be satisfied because milk supply is low or baby is not emptying breasts. Nipples – yeast infection, see white patches in the baby's mouth, or baby has had a diaper rash for 3 or more days. </li></ul>
  55. 59. Thank you