Various types & sub-types of breast cancer, Source of origin, Breast anatomy, Breast biopsy sample analysis, Estrogen positive breast cancer, Progesterone positive breast cancer, HER2 positive breast cancer, Triple negative breast cancer,

1. Cancer Research
TYPES & SUB-TYPES
OF BREAST CANCER

2. TYPES & SUB-TYPES
OF BREAST CANCER
Mr. Shaktiprasad Pradhan
M.Pharm, Ph.D*
Research Professional, UDPS
shakti.pharma16@gmail.com
Utkal University, Bhubaneswar
Odisha, India

3. .
INTRODUCTION
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4. The Breast
The human female breast is an apocrine gland having
remarkable and complex structure.
Most part of a woman's breast consists of fat & connective
tissue, along with less conspicuous parts including milk
ducts, lobes, lobules, arteries and lymph nodes.
Each breast has 15 to 20 lobes (sections) & each lobe is
made up of many lobules (smaller structures) that end in
tiny bulbs that can produce milk.
Lobes, lobules & bulbs are linked by a network of thin
tubes, known as ducts.
Ducts carry milk from the bulbs, where it's produced,
toward the areola (dark area of skin in the center of the
breast). (Cont.)
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5. .
They join together into larger ducts ending at the
nipple, where milk becomes available to a hungry
infant.
The actual milk producing structures are nearly the
same in all women.
Space around the lobules and ducts are filled with
fatty tissue, ligaments and connective tissue.
Breast has no muscle tissue, but muscles do lie
underneath the breasts, separating them from ribs.
Oxygen, nutrients & other life sustaining nourishments
are delivered to breast tissues by the blood in arteries
and capillaries.
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6. Anatomy of a Female Breast
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1.Chest wall 2.Pectoralis muscles 3.Lobules 4.Nipple surface 5.Areola
6.Lactiferous duct tube 7.Fatty tissue 8.Skin.

7. .
BREAST CANCER
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8. Breast Cancer
Breast cancer is a type of cancer that develops from the
breast cells, usually starts in the inner lining of milk ducts
or the lobules that supply them with milk.
It occurs in both males and females but the vast majority
of breast cancer cases occur in females.
It accounts for 16% of all female cancers, 22.9% of invasive
cancers in women & 18.2% of all cancer deaths (both
males & females from breast cancer) globally.
Breast cancer is more common in elderly women & the
rate is much higher in developed countries in compared to
the developing ones.
The different lifestyles and eating habits contributes a lot
for the occurrence of breast cancer.
However breast cancer is the most detectable & most
treatable type of cancer among all human malignancies.8

9. .
ORIGIN SITES OF
BREAST CANCER
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10. Origen Sites of Breast Cancer
The type of tissue where the breast cancer arises
determines how the cancer behaves and what treatments
are most effective. Usually the parts of the breast where
cancer origins, include:
Milk ducts
 Ductal carcinoma is the most common type of breast
cancer.
 Ductal carcinoma can remain within the ducts as a non-
invasive cancer (ductal carcinoma in situ) or it can break
out of the ducts (invasive ductal carcinoma).
Milk producing lobules
 Lobular carcinoma starts in the lobules of the breast,
where breast milk is produced. (Cont.)
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11. .
When it breaks out of the lobules, it's considered
invasive lobular carcinoma.
Connective tissues
Rarely breast cancer can begin in the connective tissue
that's made up of muscles, fat and blood vessels.
Cancer that begins in the connective tissue is called
sarcoma. Examples of sarcomas that can occur in the
breast include phyllodes tumor and angiosarcoma.
The type of tissue where the cancer arises in the
breast determines the type of the breast cancer and
accordingly most effective treatments are preferred.
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12. . Origin Sites of Breast Cancer
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13. .
BREAST BIOPSY
SAMPLE ANALYSIS
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14. Breast Biopsy Sample Analysis
Pathological microscopic examinations of a breast tumor
tissue, from biopsy samples are performed for:
 Unique appearances as
• Some subtypes of breast cancer are named after how
they appear under the microscope including tubular,
mucinous, medullary and papillary.
• The subtype gives suggestion regarding prognosis and
how the breast cancer cells may respond to treatment.
 Cancer grade or Degree of difference between the cancer
cells and normal cells as
• The difference in looking of cancer cells from normal
cells is called cancer's grade.
(Cont.) 14

15. .• Breast cancers are graded on a 1 to 3 scale, with grade 3
cancers being the most different looking and considered
the most aggressive type, so accordingly the treatment is
preferred.
A sample of breast cancer tissue from a biopsy procedure
may be tested for analyzing the genetic makeup of breast
cancer as this might be helpful in the management or
treatment of breast cancer.
 HER2 gene.
• Cancer cells that have too many copies of the HER2 gene
(HER2-positive cancers) produce too much of the growth
promoting protein called HER2.
• Targeted therapy drugs are available to shut down the HER2
protein, thus slowing the growth and killing these cancer
cells. (Cont.) 15

16. . Other tumor markers.
• This information can be used to interpret the genetic
makeup of tumor cells, so by knowing the tumour
markers the need of aggressive treatments can be
decided.
• For example, women with relatively low risk of breast
cancer (fewer markers) may avoid aggressive treatments.
Genetic information about breast cancer cells are
increasingly used to categorize breast cancers in different
groups, which ultimately helps to choose the most effective
treatment for the specific type of breast cancer.
Group 1 (Luminal A): This group includes tumors that are
ER positive and PR positive, but negative for HER2. Likely
to be benefitted from hormone therapy and
chemotherapy. (Cont.) 16

17. .Group 2 (Luminal B): This group includes tumors that
are ER positive, PR negative and HER2 positive. Likely to
be benefitted from chemotherapy and hormone
therapy and the treatment targeted to HER2.
Group 3 (HER2 positive): This group includes tumors
that are ER negative and PR negative, but HER2
positive. HER2 breast cancers are likely to be benefitted
from chemotherapy and treatment targeted to HER2.
Group 4 (Basal like): This group, which is also called
triple-negative breast cancer, includes tumors that are
ER negative, PR negative and HER2 negative. Basal like
breast cancers are likely to be benefitted from
chemotherapy.
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18. .
TYPES OF
BREAST CANCER
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19. Types of Breast Cancer
Basically breast cancers are of 2 different types as Non-
invasive breast cancer & Invasive breast cancer.
Non-invasive breast cancer: (2 types)
Cancer that are contained within the milk ducts or
lobules in the breast.
They have not grown into or invaded, the normal breast
tissue.
Non-invasive cancers are called carcinoma in situ and
are sometimes referred to as pre cancers.
These are of 2 types as
I. Ductal carcinoma in situ (DCIS)
II. Lobular carcinoma in situ (LCIS) (Cont.)
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20. .
Ductal carcinoma in situ (DCIS)
• DCIS is the most common type of non-invasive breast cancer.
• It starts in the milk ducts of the breast and is non-invasive
because it hasn't spread into any surrounding breast tissue.
• DCIS isn't life threatening, but having DCIS can increase the
risk of developing an invasive breast cancer later in life.
Lobular carcinoma in situ (LCIS)
• LCIS is non-invasive breast cancer that grows in the lobules
(the milk-producing glands at the end of breast ducts).
• It is non-invasive as it has not spread into any surrounding
breast tissue.
• LCIS isn't life threatening, but having LCIS can increase the
risk of developing invasive breast cancer later on in life.
(Cont.) 20

21. 21
Ductal Carcinoma In Situ (DCIS)

22. 22
Lobular Carcinoma In Situ (LCIS)
Breast
A: Ducts, B:Lobules, C: Dilated section of duct to hold milk, D: Nipple, E: Fat, F: Pectoralis major muscle, G: Chest wall
Enlarged Lobule
A: Normal lobular cells, B: Lobular cancer cells, C: Basement membrane.

23. .
Invasive breast cancers: (7 types)
 Breast cancers that have spread outside the ducts or
lobules of the breast into surrounding breast tissue.
 Early breast cancer is the term that refers to cancer that is
contained within the breast and may have spread to
surrounding lymph nodes in the breast or armpit (axilla)
but not anywhere else in the body.
 Type-1, Invasive ductal carcinoma (IDC):
• IDC is the most common type of breast cancer about
80% of all the breast cancers.
• Invasive ductal carcinoma means that the cancer that
began in the milk ducts of the breast has broken
through the lining of the milk duct and spread into the
surrounding breast tissue. (Cont.) 23

24. 24
Invasive ductal carcinoma (IDC)
Breast
A: Ducts, B:Lobules, C: Dilated section of duct to hold milk, D: Nipple, E: Fat, F: Pectoralis major muscle, G: Chest wall
Enlarged Cell
A: Normal duct cells, B: Ductal cancer cells breaking through the basement membrane, C: Basement membrane.

25. .
• Over time invasive ductal breast cancer can spread to
the lymph nodes and potentially to other parts of the
body.
 Type-2, Invasive lobular carcinoma (ILC):
• ILC is the second most common type of breast cancer
after invasive ductal carcinoma.
• Invasive lobular carcinoma means that the cancer that
began in the milk producing lobules of the breast has
broken through the lining of the lobule and spread into
surrounding breast tissue.
• Over time invasive lobular breast cancer can spread to
the lymph nodes and potentially to other parts of the
body.
(Cont.) 25

26. 26
Invasive lobular carcinoma (ILC)
Breast
A: Ducts, B:Lobules, C: Dilated section of duct to hold milk, D: Nipple, E: Fat, F: Pectoralis major muscle, G: Chest wall
Enlarged Lobule
A: Normal lobular cell, B: Lobular cancer cells breaking through the basement membrane, C: Basement membrane

27. .
 Type-3, Paget’s disease (PD):
• Paget's disease of the nipple is a rare form of breast cancer
in which cancer cells grow in the nipple or the areola (the
area around the nipple).
• The nipple and areola often become scaly, red, itchy and
irritated.
• Many people with Paget’s disease also have either DCIS or
invasive breast cancer somewhere else in the breast.
• The unusual changes in the nipple and areola are often the
first signs, that breast cancer is present.
 Type-4, Inflammatory breast cancer (IBC):
• IBC is a rare and aggressive form of invasive breast cancer
that affects the blood vessels in the skin and/or lymphatic
vessels of the breast. (Cont.)
• This causes the breast to become red and inflamed. 27

28. .
 Type-5, Phyllodes tumour (PT):
• Phyllodes tumours of the breast are rare, although most
phyllodes tumours are benign (not cancerous) and some
are malignant (cancerous).
• Phyllodes tumours tend to grow quickly, but they rarely
spread outside the breast.
• Phyllodes tumours develop in the breast’s connective
tissue or stroma (the tissue that holds everything
together inside the breast) i.e. outside the ducts and
lobules of the breast.
 Type-6, Locally advanced breast cancer (LABC):
• LABC is an invasive breast cancer that is large or has
spread beyond the breast to other nearby areas such as
the skin, chest wall or muscle and may have extensive
local lymph node involvement. (Cont.)
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29. 29
Type-7, Metastatic breast cancer (MBC):
•Metastatic breast cancer, also known as advanced,
secondary or stage 4 breast cancer.
•This type of breast cancer has spread to more distant
parts of the body such as the bones, liver, lungs or brain.

30. .
SUB-TYPES OF
BREAST CANCER
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31. Sub-types of Breast Cancer
The subtypes of breast cancer are based on the genes, a
cancer expresses.
Hormone receptor positive breast cancer:
 About two-thirds of breast cancers are hormone receptor
positive, which means that they need female hormones
estrogen and/or progesterone to grow and reproduce.
 Estrogen receptor (ER) positive:
• The cells of this type of breast cancer have receptors
that allow them to use the hormone estrogen to grow.
• Treatment with anti-estrogen hormone (endocrine)
therapy can block the growth of these cancer cells.
(Cont.)
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32.  Progesterone receptor (PR) positive:
• This type of breast cancer is sensitive to progesterone,
and the cells have receptors that allow them to use this
hormone to grow.
• Treatment with endocrine therapy blocks the growth of
the cancer cells.
• Most people with hormone positive breast cancer will
be recommended hormone blocking therapy such as
Tamoxifen, Anastrozole or Letrozole.
 Hormone receptor (HR) negative:
• This type of cancer doesn't have hormone receptors, so
it won't be affected by endocrine treatments aimed at
blocking hormones in the body.
(Cont.) 32

33. HER2 positive breast cancer:
• HER2 positive breast cancer cells have too much of the
protein called human epidermal growth factor
receptor-2 on the surface of the cancer cells.
• These excess HER2 receptors promote the growth of
the cancer cells.
• HER2 positive breast cancer may be either hormone
receptor positive or negative and treated with the
drug Herceptin (Trastuzumab), which specifically targets
HER2 positive breast cancer and has been proven to be
a very effective.
• If the breast cancer is also hormone receptor positive,
hormone blocking therapy may be recommended.
(Cont.)
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34. Triple negative breast cancer (TNBC):
• Triple negative breast cancer does not have any of the
three receptors ER, PR, HER2 commonly found on
breast cancer cells (lack estrogen, progesterone and
HER2 receptors).
• Around 15% of diagnosed breast cancers are triple
negative type breast cancer.
• Mainly it affects the younger people with a BRCA1 gene
mutation.
• Chemotherapy is generally recommended, as TNBC
responds better than other types of breast cancer.
• TNBC can be more aggressive & difficult to treat as it
likely to spread and/or recur.
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35. 35
BREAST CANCER
TYPES SUB TYPES
Non-invasive B C
Invasive B C
Lobular Carcinoma In Situ (LCIS)
Ductal Carcinoma In Situ (DCIS)
Invasive Ductal Carcinoma (IDC)
Invasive Lobular Carcinoma (ILC)
Paget’s Disease (PD)
Inflammatory B C (IBC)
Phyllodes Tumour (PT)
Locally Advanced B C (LABC)
Metastatic B C (MBC)
Hormone Receptor
Positive B C
HER 2 Positive B C
Triple Negative B C
Estrogen Receptor Positive
Progesterone Receptor Positive
Hormone Receptor Negative

36. .
REFERENCES
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37. References
World Health Organization, International Agency for
Research on Cancer, 2020.
American Cancer Society: Breast cancer overview. 2020.
Pradhan, Tripathi, Pradhan, Nature an Immunobooster for
Breast Cancer, Book. Partridge India Publication, 2015.
 www.nationalbreastcancer.org/about-breast-cancer/
www.cancer.net/cancer-types/breast-cancer/introduction.
www.cancercenter.com/types/
www.ncbi.nlm.nih.gov/pmc/
www.oncologygypro.esmo.org.
www.bcpp.org/resource/breast-cancer-subtype/
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38. .
Thank You
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