Cancer is the abnormal, uncontrollable , continuous
replication of cells which will inevitably lead to the
formation of a tumor.
Forms in the
tissues of the
THE NORMAL BREAST
1. Chest wall.
2. Pectoral muscles.
3. Lobules (glands that
4. Nipple surface.
6. Lactiferous duct tube
that carries milk to the
Lymphatic System which consists of vessels and
organs plays two vital roles in our lives:
The vessels essentially maintain interstitial
fluid levels by carrying excess fluids as well as
any plasma proteins, back into the CVS.
The organs, house critical immune cells such as
lymphocytes which carry out our body defense
Most of the lymph vessels of the breast
Lymph nodes under the arm (auxiliary nodes).
Lymph nodes around the collar bone
(supraclavicular and infraclavicular lymph
Lymph nodes inside the chest near the breast
bone (internal mammary lymph nodes)
Benign breast tumors are abnormal growths,
but they do not spread outside of the breast
and they are not life threatening.
Most lumps are caused by the combination of
cysts and fibrosis
Cysts are fluid-filled sacs.
Fibrosis is the formation of scar - like tissue.
These changes can cause breast swelling and
Breast cancer is a malignant (cancerous)
tumor that starts in the cells of the breast.
It is found mostly in women, but men
can get breast cancer, too.
Spreads to other
Non - Invasive
Pre – Cancerous
Still in its original
into invasive breast
Genetic risk factors
Personal history of breast cancer
Dense breasts tissue
Certain benign (not cancer) breast problems
Breast radiation early in life
Gender: more prevalent in women.
One (1) in every 150 cases (MALE).
Age: The chance of getting breast cancer goes up
as a woman gets older.
Over 80% of all female breast cancers occur
among women aged 50+ years
Genetic risk factor:
Women who carry the BRCA1 and BRCA2 genes
have a considerably higher risk of developing
Breast cancer risk is higher among women
whose close blood relatives have this disease.
Personal history of breast cancer:
A woman with cancer in one breast has a greater
chance of getting a new cancer in the other breast
or in another part of the same
Overall, white women are slightly more likely
to get breast cancer than African-American
African-American women, though, are more
likely to die of breast cancer.
Asian, Hispanic, and Native-American women
have a lower risk of getting and dying from
Dense breast tissue: Dense breast tissue means
there is more gland tissue and less fatty tissue.
Certain benign (not cancer) breast problems:
Women who have certain benign breast
changes may have an increased risk of breast
Menstrual period: Women who began having
periods early (before age 12) or who went
through the change of life (menopause) after
the age of 55 have a slightly increased risk of
Breast radiation early in life: Women who
have had radiation treatment to the chest area
as a child or young adult have a greatly
increased risk of breast cancer.
Not having children or having them later in
Certain kinds of birth control
Using hormone therapy after menopause
Being overweight or obese
Tobacco smoke: Smoking may increase the risk
of breast cancer.
Night work: A few studies have suggested that
women who work at night have a higher risk of
A lump in a breast.
A pain in the armpits or breast that does not
seem to be related to the woman's menstrual
Pitting or redness of the skin of the breast; like
the skin of an orange.
A rash around (or on) one of the nipples.
A swelling (lump) in one of the armpits.
An area of thickened tissue in a breast.
One of the nipples has a discharge; sometimes it
may contain blood
The nipple changes in appearance; it may
become sunken or inverted.
The size or the shape of the breast changes.
The nipple-skin or breast-skin may have
started to peel, scale or flake.
Diagnostic tests and procedures for
breast cancer include:
Breast MRI scan
Breast - Self
Women in their 20s and 30s should have a
clinical breast exam every 3 years.
After age 40, women should have a breast
exam every year
BSE is an option for women starting in their
Any changes detected should be reported to a
BSE: Conducted standing or reclining
An x-ray of the breast.
It uses a very small amount of radiation.
A technologist will position your breast for the
The breast is pressed between 2 plates to flatten
and spread the tissue.
The pressure lasts only a few seconds while the
picture is taken.
The breast and plates are repositioned and then
another picture is taken.
The whole process takes about 20 minutes.
Uses sound waves to outline a part of the body.
The sound wave echoes are picked up by a
computer to create a picture on a computer
Used to investigate areas of concerns found by
Use magnets and radio waves.
Cross-sectional images of the body.
MRI scans can take a long time.
Used if view areas of concern found on a
Patients must lie inside a narrow tube, face
down on a special platform.
The platform has openings for each breast that
allow the image to be taken without pressing
on the breast.
Contrast material may be injected into a vein to
help the MRI show more details.
A biopsy is done when other tests show that
you might have breast cancer.
It confirms if a mass is cancerous or not.
Mass is removed and studied.
Very fine needle is used.
Extracts fluid from the lump.
Guided by ultrasound.
simple but is not 100% accurate.
Needle is larger than in fine needle biopsy.
Removes more tissues.
Done with systems such as ATEC® (Automated
Tissue Excision and Collection)
Guided by MRI
First the skin is numbed and a small cut (incision)
A hollow probe is put through the cut into the
A piece of tissue is sucked out.
Anesthesia is administered.
Incision is made.
Part or whole lump is extracted and studies.
Tissues obtained during biopsy are
examined to determine:
Malignant or Benign
Invasive or Non - invasive
Has it metastasized
Is the lymph nodes affected
Breast cancer grade
Hormone receptor status
Breast cancer grade:
If a biopsy sample is cancer, it is given a grade
from 1 to 3.
A lower grade number means a slower-growing
cancer, while a higher number means a fastergrowing cancer.
The grade helps predict the outcome.
Hormone receptor status:
Hormone receptors are proteins in cells that can
attach to hormones.
Estrogen and progesterone are hormones that fuel
breast cancer growth.
Breast cancers are tested for hormone receptors.
If the tumor has them, it is often called ERpositive, PR positive,
About 2 out of 3 breast cancers have at least one
of these receptors.
About 1 out of 5 breast cancers have too much of
a protein called HER2/neu.
Tumors with increased levels of HER2/neu are
These cancers tend to grow and spread faster
than other breast cancers
Chest x-ray: the lungs.
Bone scan: the bones.
CT scan (computed tomography): the chest
MRI : brain and spinal cord.
Ultrasound: other parts
The TNM staging system
This system takes into account:
the tumor size and spread (T),
whether the cancer has spread to lymph nodes
whether it has spread to distant organs (M) for
Sage 0 : Non – Invasive breast cancer. Has not spread
to breast tissues.
Stage l : ≤ 2cm and has not spread to lymph nodes.
Stage llA: ≤ 2 cm and has spread to lymph nodes or
2-5 cm and has spread to lymph nodes.
Stage llB: 2-5 cm and has spread to lymph nodes or
> 5 cm and has not spread to lymph nodes.
Stage lllA: ≤ 5cm and spread to lymph nodes
forming clumps or >5 cm and spread to lymph
nodes without forming clumps.
Stage lllB: Any size and spread to the skin or
chest wall. Swelling.
Stage lllC: Any size , spread to lymph nodes, skin
and chest wall.
Stage lV: Metastasized
The type of breast cancer
The stage and grade of the breast cancer - how large
the tumor is, whether or not it has spread, and if so
Whether or not the cancer cells are sensitive to
The patient's overall health
The age of the patient
The patient's own preferences
Biological therapy (targeted drug therapy)
Surgery for breast cancer:
Lymph node surgery:
Sentinel node biopsy
Axillary lymph node dissection
Breast reconstruction surgery
Breast-conserving surgery (BCS) or
Surgically removing the tumor and a small
margin of healthy tissue around it.
Followed by radiation therapy
Surgically removing the breast and other
Simple mastectomy : removing the lobules,
ducts, fatty tissue, nipple, areola, and some skin.
Modified radical mastectomy: simple
mastectomy combined with the removal of the
axillary lymph nodes.
Radical mastectomy: a simple mastectomy
combined with removing the lymph nodes and
muscles of the chest wall.
Pain after the surgery and the change in the
shape of the breast.
Wound infection, build-up of blood and buildup of clear fluid in the wound.
If axillary lymph nodes are removed swelling
of the arm and chest may occur
Axillary lymph node dissection: about 10 to 40
lymph nodes are removed.
Usually done at the same time as the mastectomy or
Sentinel lymph node biopsy: is used to determine if
cancer has spread to the lymph nodes under the arm
without removing many of them.
A blue dye/radioactive substance is injected in order
to identify the sentinel lymph nodes which drains
lymph from the tumor.
They are then removed.
Pain, swelling, bleeding, and infection
Swelling in the arm or chest (Lymphedema).
Lymphedema is mostly due to axillary lymph
Surgical procedures aimed at recreating a
breast so that it looks as much as possible like
the other breast.
The surgeon may use a breast implant, or tissue
from another part of the patient's body.
Chemotherapy and hormone therapy.
Radiation therapy is treatment with highenergy rays (such as x-rays) or particles to kill
The patient may require three to five sessions
per week for three to six weeks.
The type of breast cancer will determine the
type of radiation therapy used.
Breast radiation therapy – applied after a
Chest wall radiation therapy – applied after a
Breast boost - a high-dose of radiation therapy
is applied to where the tumor was surgically
Lymph nodes radiation therapy - aimed at the
axilla and surrounding area to destroy cancer
cells that have reached the lymph nodes
radiation to the breast by place radioactive seeds
(pellets) into the breast tissue.
The most common type brachytherapy used to
treat breast cancer is called intracavitary
A device is put into the space left from breastconserving surgery, a source of radiation is then
placed in the device for a short time and then
Swelling and heaviness in the breast.
Sunburn-like changes in the skin and feeling
Damage some of the nerves to the arm. This can
lead to numbness, pain, and weakness in the
shoulder, arm and hand.
Radiation to lymph nodes causes (Lymphedema).
Chemotherapy (chemo) is the use of cancer-killing
Intravenously, given as a shot, or taken as a pill or
They enter the bloodstream and reach most parts of
Damage some normal cells.
Doctors give chemo in cycles.
The time between cycles is most often 2 or 3
For early-stage breast cancer, the total course of
treatment usually lasts for 3 to 6 months.
For advanced breast cancer chemo is often
continued as long as it is working.
The side effects of chemo depend on:
the type of drugs used
the amount given
and the length of treatment.
Short – term side effects
· Hair loss
· Loss of appetite or increased appetite
· Nausea and vomiting
· A higher risk of infection (low WBC count)
· Stopping of menstrual periods
· Easy bruising or bleeding (low platelets)
· Being very tired
Long - term side effects
Menstrual changes: infertility
Nerve damage: pain, burning or tingling and
sensitivity to cold or hot.
Used for breast cancers that are sensitive to
These types of cancer are often referred to as ER
positive (estrogen receptor positive) and PR
positive (progesterone receptor positive)
Estrogen and progesterone promotes cancer
Drugs used to block estrogen
Drugs used to change hormone levels:
Aromatase inhibitors (AIs): stop fat tissue from
making estrogen after menopause
Luteinizing hormone-releasing hormone
(LHRH) analogs: shuts down the ovaries.
Drugs that target HER2
HER2: protein that increase cancer growth.
· Trastuzumab (Herceptin): IV
· Pertuzumab (Perjeta®): IV
· Ado-trastuzumab emtansine (Kadcyla™)
· Lapatinib (Tykerb): pill