Cancer is the abnormal, uncontrollable replication of cells which can lead to tumor formation. Breast cancer forms in the breast tissues and spreads mainly through the lymphatic system. The normal breast contains lobules which produce milk and ducts which carry milk to the nipple. The lymphatic system maintains fluid levels and carries immune cells. Breast cancer is diagnosed through exams, mammograms, ultrasounds, and biopsies. Treatment involves surgery to remove tumors, radiation therapy to kill cancer cells, and chemotherapy using drugs to stop cancer growth.

3. Cancer is the abnormal, uncontrollable , continuous
replication of cells which will inevitably lead to the
formation of a tumor.

5. Forms in the
tissues of the
breast
Spreads mainly
through the
Lymphatic system

6. 1. Chest wall.
2. Pectoral muscles.
3. Lobules (glands that
make milk).
4. Nipple surface.
5. Areola.
6. Lactiferous duct tube
that carries milk to the
nipple
7. Fatty tissue.
8. Skin.
THE NORMAL BREAST

7. Lymphatic System which consists of vessels and
organs plays two vital roles in our lives:
1) The vessels essentially maintain interstitial
fluid levels by carrying excess fluids as well as
any plasma proteins, back into the CVS.
2) The organs, house critical immune cells such as
lymphocytes which carry out our body defense
against infection.

8. Most of the lymph vessels of the breast
drain into:
 Lymph nodes under the arm (auxiliary nodes).
 Lymph nodes around the collar bone
(supraclavicular and infraclavicular lymph
nodes)
 Lymph nodes inside the chest near the breast
bone (internal mammary lymph nodes)

10.  Malignant
 Cancerous
 Benign
 Not - Cancerous

11.  Not cancerous.
 Benign breast tumors are abnormal growths,
but they do not spread outside of the breast
and they are not life threatening.

12.  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
pain.

14.  Breast cancer is a malignant (cancerous)
tumor that starts in the cells of the breast.
It is found mostly in women, but men
can gets breast cancer, too.

15. Invasive
 Cancerous
 Malignant
 Spreads to other
organs (metastasis)
Non - Invasive
 Pre – Cancerous
 Still in its original
position
 Eventually develops
into invasive breast
cancer.

16.  The inner lining of
milk ducts.
 Ductal Carcinoma
 The lobules – Milk
producing glands.
 Lobular Carcinoma

17. Ductal
Carcinoma
Invasive Ductal
Carcinoma
Ductal Carcinoma
in situ (DCIS)
Inflammatory
Breast Cancer
(IBC)
Lobular
Carcinoma
Invasive Lobular
Carcinoma
Lobular Carcinoma
in situ (LCIS)

18.  Uncommon (1% to 3% of all breast cancers)
 Invasive Brest Cancer.
 No lump or tumor.
 Mistaken for infection in its early stages.

19.  IBC makes the skin of the breast look red and
feel warm.
 It also may make the skin look thick and pitted
and may have an orange peel feel.
 The breast may get bigger, hard, tender, or
itchy

20.  Non – invasive
 contained within the milk ducts .
 May become invasive (pre – cancer).

21. Picture

22.  Most common breast cancer.
 Accounts for about 8 out of 10 invasive breast
cancers.
 Lining of the ducts Grows /invades
the breast tissues
Spreads to lymph nodes
Other organs

23.  Non – Invasive.
 Contained in the lobules and does not spread
to the tissues of the breast.
 May become malignant .

24.  picture

25.  About 1 in 10 Invasive breast cancers are ILC.
 Formed in the lobules.
 Grows through the wall of the lobules.
 Spreads

28.  Gender
 Age
 Genetic risk factors
 Family history
 Personal history of breast cancer

29.  Race/ethnic background
 Dense breasts tissue
 Certain benign (not cancer) breast problems
 Menstrual periods
 Breast radiation early in life

30.  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

31.  Genetic risk factor:
Women who carry the BRCA1 and BRCA2 genes
have a considerably higher risk of developing
breast cancer.

32.  Family history:
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

33.  Race/Ethnic background:
 Overall, white women are slightly more likely
to get breast cancer than African-American
women.
 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
breast cancer.

34.  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
cancer.

35.  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
breast cancer.

36.  Antiperspirant
 Bras
 Induced Abortion
 Breast implants

38.  Alcohol consumption
 Physical exercise
 Diet
 Postmenopausal hormone therapy
 Bodyweight
 Breast cancer screening
 Breastfeeding

40.  A lump in a breast.
 A pain in the armpits or breast that does not
seem to be related to the woman's menstrual
period.
 Pitting or redness of the skin of the breast; like
the skin of an orange.
 A rash around (or on) one of the nipples.

41.  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

42.  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.

45. Diagnostic tests and procedures for
breast cancer include:
 Breast exam
 Mammograms
 Breast ultrasound Imaging tests
 Breast MRI scan
 Biopsy

46. Clinical Breast Breast - Self
Exam(CBE) Exam (BSE)

47.  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

48.  BSE is an option for women starting in their
20s.
 Any changes detected should be reported to a
medical expert.
 BSE: Conducted standing or reclining

50.  An x-ray of the breast.
 It uses a very small amount of radiation.
 Mammograms
screening diagnosis
screening mammograms diagnostic mammogram

51.  A technologist will position your breast for the
test.
 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.

53.  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
screen.
 Used to investigate areas of concerns found by
a mammogram.

54.  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
mammogram.

55.  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.

58.  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.

59.  Fine needle aspiration (FNA) biopsy
 Core needle biopsy
 Vacuum-assisted biopsies
 Surgical (open) biopsy
 Lymph node biopsy

60.  Very fine needle is used.
 Extracts fluid from the lump.
 Guided by ultrasound.
 simple but is not 100% accurate.

61.  Needle is larger than in fine needle biopsy.
 Removes more tissues.
 Clearer results.

62.  Done with systems such as ATEC® (Automated
Tissue Excision and Collection)
 Guided by MRI
 First the skin is numbed and a small cut (incision)
is made.
 A hollow probe is put through the cut into the
breast tissue.
 A piece of tissue is sucked out.

64.  Anesthesia is administered.
 Incision is made.
 Part or whole lump is extracted and studies.

65.  Removal of
lymph nodes
 Surgical biopsy
 Removal of
fluids
 Needle biopsy

66. Tissues obtained during biopsy are
examined to determine:
 Malignant or Benign
 Type
 Invasive or Non - invasive
 Size
 Has it metastasized
 Is the lymph nodes affected
 Treatment

67.  Breast cancer grade
 Hormone receptor status
 HER2/neu status

68. 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 faster-
growing cancer.
 The grade helps predict the outcome.

69. 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 ER-
positive, PR positive,
 About 2 out of 3 breast cancers have at least one
of these receptors.

70. HER2/neu status:
 About 1 out of 5 breast cancers have too much of
a protein called HER2/neu.
 Tumors with increased levels of HER2/neu are
called HER2-positive.
 These cancers tend to grow and spread faster
than other breast cancers

71.  Chest x-ray: the lungs.
 Bone scan: the bones.
 CT scan (computed tomography): the chest
and/or abdomen.
 MRI : brain and spinal cord.
 Ultrasound: other parts

72. The TNM staging system
This system takes into account:
 the tumor size and spread (T),
 whether the cancer has spread to lymph nodes
(N) and
 whether it has spread to distant organs (M) for
metastasis

73.  Sage 0 : Non – Invasive breast cancer. Has not spread
to breast tissues.
 Stage l : ≤ 2cm and has not spread to lymph nodes.
 Stage ll
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.

74.  Stage lll
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

76.  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
how far
 Whether or not the cancer cells are sensitive to
hormones
 The patient's overall health
 The age of the patient
 The patient's own preferences

77.  Surgery
 Radiation therapy
 Biological therapy (targeted drug therapy)
 Hormone therapy
 Chemotherapy

78. Surgery for breast cancer:
 Lumpectomy
 Mastectomy
Lymph node surgery:
 Sentinel node biopsy
 Axillary lymph node dissection
Breast reconstruction surgery

79.  Breast-conserving surgery (BCS) or
partial/segmented mastectomy.
 Surgically removing the tumor and a small
margin of healthy tissue around it.
 Followed by radiation therapy

80.  Surgically removing the breast and other
infected components.
Mastectomy
A simple
mastectomy.
A Radical
mastectomy.
Modified radical
mastectomy.

81.  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.

82.  Pain after the surgery and the change in the
shape of the breast.
 Wound infection, build-up of blood and build-
up of clear fluid in the wound.
 If axillary lymph nodes are removed swelling
of the arm and chest may occur
(Lymphedema).

83.  Axillary lymph node dissection: about 10 to 40
lymph nodes are removed.
 Usually done at the same time as the mastectomy or
breast-conserving surgery.
 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.

84.  Pain, swelling, bleeding, and infection
 Swelling in the arm or chest (Lymphedema).
 Lymphedema is mostly due to axillary lymph
node biopsy.

85.  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.

86. Adjuvant therapy:
 After surgery
 Combat metastasis.
 Chemotherapy and hormone therapy.
Neo-adjuvant therapy:
 Before surgery
 Reduce tumors
 Radiation therapy

87.  Radiation therapy is treatment with high-
energy rays (such as x-rays) or particles to kill
cancer cells.
 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.

88.  Breast radiation therapy – applied after a
lumpectomy,.
 Chest wall radiation therapy – applied after a
mastectomy
 Lymph nodes radiation therapy - aimed at the
axilla and surrounding area to destroy cancer
cells that have reached the lymph nodes

89.  Swelling and heaviness in the breast.
 Sunburn-like changes in the skin and feeling
very tired.
 Weakness .
 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).

90.  Chemotherapy (chemo) is the use of cancer-
killing drugs.
 Intravenously, given as a shot, or taken as a pill
or liquid.
 They enter the bloodstream and reach most parts
of the body.

91.  Before surgery:
neoadjuvant chemo
 After surgery:
adjuvant chemo

92.  Doctors give chemo in cycles.
 The time between cycles is most often 2 or 3
weeks.
 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.

93. The side effects of chemo depend on:
 the type of drugs used
 the amount given
 and the length of treatment.

94. 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

95. Long - term side effects
 Menstrual changes: infertility
 Nerve damage: pain, burning or tingling and
sensitivity to cold or hot.
 Heart damage

96.  Used for breast cancers that are sensitive to
hormones.
 These types of cancer are often referred to as ER
positive (estrogen receptor positive) and PR
positive (progesterone receptor positive)
cancers.
 Estrogen and progesterone promotes cancer
growth.

97.  Tomoxifen :it blocks the actions of estrogen , a
female hormone. Taking tamoxifen may
increase your risk of uterine cancer, stroke, or a
blood clot in the lung, which can be fatal.
 Toremifene (Fareston®):it is used in
postmenopausal women to treat breast
cancer that has spread to other parts of the
body (metastatic breast cancer). It is usually
used to treat cancer that needs estrogen, a
female hormone, in order to grow (estrogen
receptor positive). Toremifene is a nonsteroidal
antiestrogen that blocks the effects of estrogens
in the breast tissue, thereby slowing or
stopping the growth of cancer.

98.  Side effects of Toremifene : Azole
antifungals ( itraconazole, ketoconazole,
voriconazole), mitomycin C, nefazodone, protease
inhibitors ( boceprevir , ritonavir ), or
telithromycin because they may increase the risk of
toremifene's side effects
 Carbamazepine, dexamethasone, hydantoins (eg,
phenytoin), phenobarbital, rifamycins (eg,
rifabutin, rifampin), or St. John's wort because the
effectiveness of toremifene may be decreased
 Anticoagulants ( warfarin) or hydantoins because
actions and side effects of these medicines may be
increased.

99.  Fulvestrant : it is an estrogen receptor
antagonist. It works by blocking estrogen from
tumors that need estrogen to grow.
 Side effects : Back, bone, joint, muscle, or pelvic pain;
constipation; cough; dizziness; headache; hot flushes;
loss of appetite; mild pain at the injection site; mild sore
throat; mild stomach pain; mild pain in the hands or
feet; nausea; tiredness; vomiting; weakness.

100. 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.

101. Drugs that target HER2
HER2: protein that increase cancer growth.
 · Trastuzumab (Herceptin): IV
 · Pertuzumab (Perjeta®): IV
 · Ado-trastuzumab emtansine (Kadcyla™)
 · Lapatinib (Tykerb): pill

102.  · Mouth sores
 · Diarrhea
 · Nausea
 · Fatigue
 · Feeling weak or tired
 · Low blood counts
 · Shortness of breath
 · Cough

103. Thank you