This document discusses the treatment of breast cancer using chemotherapy. It begins with an introduction to breast cancer, its causes, risk factors, signs and symptoms, diagnosis, and general treatment options. It then focuses on chemotherapy as a treatment, describing the different types of chemotherapy drugs used to treat breast cancer like doxorubicin, cyclophosphamide, fluorouracil, and epirubicin. It discusses how these drugs work and their common side effects. The document provides details on chemotherapy regimens and administration methods like intravenous or oral routes. Overall, it provides a comprehensive overview of chemotherapy as a treatment for breast cancer.

2. TREATMENT OF BREAST
CANCER BY CHEMOTHERAPY
SUBMITTED TO:
DR. NADIA NOOR
SUBMITTED BY:
ASIFA KANWAL

3. Treatment of breast cancer by chemotherapy
 Table of content
 introduction
 Breast cancer
 Etiology
 Types of breast cancer
 Risk factors
 CAUSES
 Clinical Manifestations
 Diagnosis
 treatment
 Chemotherapy

4. INTRODUCTION
 Breast cancer is cancer that develops from breast tissue.
 Breast cancer ,the second leading cause of cancer deaths in
women, is the disease women fear most.
 Breast cancer can also occur in men, but it's far less
common.
 In 30s, have a one in 233 chance of developing breast
cancer. By age 85, chance is one in eight.

5.  In the last 30 years, doctors have made great strides in
early diagnosis and treatment of the disease and in reducing
breast cancer deaths.
 80% of breast cancers occur in women older than age 50.
 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).
 Today, radical mastectomy is rarely performed. Instead,
there are more and better treatment options, and many
women are candidates for breast-sparing operations.

6. ETIOLOGY
 The two variables most strongly associated with the
occurrence of breast cancer are gender and age.
 Breast cancer is also caused by a genetic abnormality (a
“mistake” in the genetic material). However, only 5-10% of
cancers are due to an abnormality inherited from your mother
or father. About 90% of breast cancers are due to genetic
abnormalities that happen as a result of the aging process
and the “wear and tear” of life in general.

8. RISK FACTORS
 Gender: female (1% males)
 Race: more common in whites.
 Age: increases as a woman gets older.
 Relative : (mother or sister).
 Menstrual history :early on set late menopause
 Childbirth: first child After the age of 30 or having no children at all.
 Pregnancy and breastfeeding are protective against breast cancer
 First pregnancy at older age

9.  Obesity:
 SMOKING:
 Diet: Fat & Alcohol
 Lack of Physical Activity: Stress
 Radiation Exposure:
 History of cancer: Breast, Uterus, Cervix, Ovary
 Hormones: Estrogens in Hormone replacement therapy &
Birth control pills
 Genetics: Certain conditions that are inheritated 70% have
no risk factors.
 Some risk factors, such as age, sex and family history, can't
be changed

10. Precancerous breast changes (atypical hyperplasia, lobular carcinoma in situ).
Mammographic breast density.
Birth control pills.
CAUSES OF BREAST CANCER
1)In breast cancer, some of the cells in the breast begin growing
abnormally.
2)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.
3)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.
4)In most cases, it isn't clear what causes normal breast cells to become
cancerous.

12. 5)Only 5-10% of breast cancers are inherited.
6)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.
7)Other inherited mutations – including the
ataxiatelangiectasia 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.
8) If one of these genes is present in the family, will have a
50 percent chance of having the gene.

13. 9) Yet most genetic mutations related to breast cancer aren't
inherited.
10) 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.
11) 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.

15. 12)Each of breasts contains 15 to 20 lobes of glandular
tissue, arranged like the petals of a daisy.
13)The lobes are further divided into smaller lobules that
produce milk during pregnancy and breastfeeding.
14)Small ducts conduct the milk to a reservoir that lies just
beneath the nipple.
15)Supporting this network is a deeper layer of connective
tissue called stroma.

16. SIGNS AND SYMPTOMS
 When the disease is discovered early, have more treatment options
and a better chance for a cure.
 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.
 Spontaneous clear or bloody discharge from the nipple, often
associated with a breast lump
 Retraction or indentation of the nipple
 Change in the size or contours of the breast Any flattening or
indentation of the skin over the breast

18. Redness or pitting of the skin over breast, like the skin of an orange
A number of conditions other than breast cancer can cause the breasts to
change in size or feel.
Breast tissue changes naturally during pregnancy and the menstrual cycle.
Other possible causes of noncancerous (benign) breast changes include
fibrocystic changes, cysts, fibroadenomas, infection or injury.
If patient haven't yet gone through menopause, may want to wait through
one menstrual cycle before seeing the doctor.
If the change hasn't gone away after a month, have it evaluated promptly.

20. PHATHOPHYSIOLOGY
1) Breast cancer is a malignant tumor that starts in the cells of the breast. Like other cancers,
there are several factors that can raise the risk of getting breast cancer. Damage to the
DNA and genetic mutations can lead to breast cancer have been experimentally linked to
estrogen exposure. Some individuals inherit defects in the DNA and genes like the BRCA1,
BRCA2 and P53 among others. Those with a family history of ovarian or breast cancer
thus are at an increased risk of breast cancer.
2) The immune system normally seeks out cancer cells and cells with damaged DNA and
destroys them. Breast cancer may be a result of failure of such an effective immune defence
and surveillance.
3) These are several signaling systems of growth factors and other mediators that interact
between stromal cells and epithelial cells. Disrupting these may lead to breast cancer as well.

21. WHEN TO SEEK MEDICAL ADVICE
1)Although most breast changes aren't cancerous, it's important to have them
evaluated promptly.
2)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.
3)If treated for breast cancer, report any new signs or symptoms immediately.
4)Possible warning signs include a new lump in the breast or a bone ache or
pain that doesn't go away after three weeks.

22. SCREENING
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.
Self breast examination is an option beginning at age 20.

23. INVITATION OF
WOMEN
SCREENING BY
MEMOGRAPHY
FILM
PROCESSING:READ
AND ANALYZED
RESULT
ABNORMAL
RESULT NORMAL ASSEMENT MAY INCLUDE :
1)Further films
2)Ultrasound
3)Clinical examination
4)Cytology
5)Core biopsy
Open biopsy
Lumpectomy
Mastectomy:
By radiotherapy chemotherapy
Invited three
years later

25. CLINICAL BREAST EXAM:
Mammogram - to check breast tissue
Other tests :
Computer-aided detection (CAD)
Digital mammography
Magnetic resonance imaging (MRI)
Breast ultrasound (ultrasonography)
Experimental procedures :
Ductal lavage
Molecular breast imaging (MBI)

27. Breast ultrasound

28. DIAGNOSIS
Laboratory Tests :
■ Tumor markers such as cancer antigen (CA 27.29) or carcinoembryonic
antigen (CEA) may be elevated.
■ Alkaline phosphatase or liver function tests may be elevated in metastatic
disease.
Other Diagnostic Tests :
■ Mammogram (with or without ultrasound, breast MRI or both).
■ Biopsy for pathology review and determination of tumor estrogen/progesterone
receptor (ER/PR) status and HER2 status.
■ Systemic staging tests may include: chest x-ray, chest CT, bone scan,
abdominal CT or ultrasound or MRI.

30. TREATMENT
The main types of treatment for breast cancer are:
 chemotherapy
 Radiation therapy.
 surgery
 Hormone therapy.
 Targeted therapy.
 Bone-directed therapy

31. CHEMOTHERAPY
Chemotherapy is a treatment using anticancer (also called cytotoxic) drugs
which aims to destroy cancer cells. It is known as a systemic treatment.
Many different types of chemotherapy drugs are used to treat breast cancer.
They can be given in different ways and in different combinations, according to
an individual’s situation.
Chemotherapy can be given in several ways. For breast cancer the drugs are
most commonly given:
• into a vein (intravenously)
• by mouth (orally) as a tablet or capsule.

32. 1) Intravenous chemotherapy :
The most common way involves
inserting a small needle and plastic tube called a
cannula into a vein, either in the back of the hand
or lower arm. The needle is removed and the
plastic tube left in place. The diluted drugs are
then slowly injected into the vein. If a large
volume of fluid is used it can be given as an
infusion (drip) through the cannula over a fixed
period of time.
• The cannula will usually be on the opposite arm
to where you had (or are having) surgery. This is
to avoid the risk of lymphedema.
2) Oral chemotherapy: This is chemotherapy
taken by mouth and it may be given either as
tablets or capsules.

33. 3) Electro chemotherapy :
It is a new treatment and is not widely available. It’s sometimes used
to treat breast cancer that has spread to the skin. Chemotherapy is injected either
directly into the area of skin affected or into the bloodstream. An electric pulse is then
used to help the chemotherapy reach the cancer cells. Once inside the cancer cells, the
chemotherapy destroys them.
SIDE EFFECTS:
• risk of infection from not having enough white blood cells, anaemia (a drop in the
number of red blood cells) and bruising and bleeding
• sickness (nausea) and vomiting
• hair loss or thinning
• sore mouth (mucositis)
• mouth ulcers
• fatigue.

34. Chemotherapy Regimens:
• Doxorubicin 60 mg/m2 IV
USES:
Doxorubicin is a type of chemotherapy drug called an anthracycline. It
slows or stops the growth of cancer cells by blocking an enzyme called topo
isomerize 2. Cancer cells need this enzyme to divide and grow.

35. SIDE EFFECTS:
1) Nausea and vomiting (may be severe)
2) Diarrhea
3) Loss of appetite
4) Missed menstrual periods
5) Darkening of your skin or nails
6) Weakness
7) Tiredness
8) Eye redness
2) Cyclophosphamide 600 mg/m2I IV:
USES:
Cyclophosphamide is a cancer medication that interferes with the growth and
spread of cancer cells in the body. Cyclophosphamide is used to treat several
types of cancer.

36. SIDE EFFECTS:
1) A wound that will not heal
2) Missed menstrual periods,
3) Changes in skin color (darkening), or
4) Changes in nails.

37. • Fluorouracil 500 mg/m2 IV:
USES:
Fluorouracil (5FU) is a chemotherapy drug used to treat different
cancers including breast, bowel, skin, stomach, esophageal (gullet),
and pancreatic cancer.
SIDE EFFECTS:
1) Application site reactions (such as redness, dryness, burning,
erosion [loss of the upper layer of skin], pain, irritation, and swelling),
2) Headache,
3) Common cold
4) Allergy
5) Upper respiratory infection,
6) Muscle soreness,
7) Sinus infection,
8) Sun sensitivity, and.

38. • Epirubicin 100 mg/m2 IV bolus:
USES:
This medication is given by injection into a vein by a health care
professional, as directed by your doctor. Dosage is based on your medical
condition, body size, and response to treatment.

39. SIDE EFFECTS:
1) This medication may cause your urine to turn a reddish color. This is
a normal, harmless effect of the drug that usually stops within 2 days
after each dose and should not be mistaken for blood in your urine.
2) Temporary hair loss is a common side effect. Normal hair growth
should return after treatment has ended.

40. SURGERY
 Surgery aims to remove the breast cancer with a
margin (border) of normal tissue to reduce the risk of
the cancer coming back in the breast (known as
local recurrence) and to try to stop any spread in the
body. The amount of tissue removed depends on
the area of the breast affected and the size of the
cancer in the breast.

41. TYPES OF SURGERY
Breast-conserving SURGERY: :
 This type of surgery is sometimes called partial (or segmental) mastectomy. It is
also sometimes called lumpectomy or quadrantectomy.In this surgery, only the part
of the breast containing the cancer is removed. The goal is to remove the cancer as
well as some surrounding normal tissue.
 side effects: Include pain, temporary swelling, tenderness, and hard scar tissue
that forms in the surgical site. As with all operations, bleeding and infection at the
surgery site are also possible.

43. 2) Mastectomy
Mastectomy is surgery to remove the entire breast. All of the breast
tissue is removed, sometimes along with other nearby tissues.
a)Simple mastectomy: Also called total mastectomy, the surgeon
removes the entire breast, including the nipple, but does not
remove underarm lymph nodes or muscle tissue from beneath the
breast.
b) Skin-sparing mastectomy: In this procedure, most of the skin
over the breast (other than the nipple and areola) is left intact. This
approach is only used when immediate breast reconstruction is
planned.
c) Modified radical mastectomy: This procedure is a simple
mastectomy and removal of axillary (underarm) lymph nodes.

44. Radical mastectomy: In this
extensive operation, the surgeon
removes the entire breast, axillary
lymph nodes, and the pectoral (chest
wall) muscles under the breast.
side effects:
1)wound infection,
2)hematoma (buildup of blood in the
wound),
3) seroma (buildup of clear fluid in the
wound).

45. 3) Lymph node surgery:
a) Axillary lymph node dissection (ALND): In this
procedure, anywhere from about 10 to 40 lymph
nodes are removed from the area under the arm
(axilla) and checked for cancer spread.
b) Sentinel lymph node biopsy (SLNB): Removes the
first lymph node(s) to which a tumor is likely to spread
(these are called the sentinel nodes). Removing many
lymph nodes increases the risk of lymphedema , to
lower this risk, doctors may use a sentinel lymph node
biopsy (SLNB). side effects: As with any operation, pain,
swelling, bleeding, and infection are possible.

46. HORMONE THERAPY
1)Hormone therapy is another form of systemic therapy. It is most often used
as an adjuvant therapy to reduce the risk of the cancer coming back after
surgery, but it can be used as neoadjuvant treatment, as well. It is also used
to treat cancer that has come back after treatment or has spread.
2)A woman's ovaries are the main source of the hormone estrogen until
menopause.
3)Estrogen promotes the growth of cancers that are hormone receptor-
positive

47. Hormonal therapy medicines treat hormonereceptor-positive
breast cancers in two ways:
1) By lowering the amount of the hormone estrogen in the body.
2) By blocking the action of estrogen on breast cancer cells.
• Hormonal therapy medicines are NOT effective against hormone-
receptor-negative breast cancers.
Drugs that block estrogen :
1) Tamoxifen:
Tamoxifen blocks estrogen receptors in breast cancer
cells.it is called a selective estrogen receptor modulator or SERM.
• This drug is taken by mouth, most often as a pill.
• The most common side effects of these drugs include fatigue, hot
flashes, vaginal dryness or discharge, and mood swings.

48. 2) Toremifene (Fareston®):
Toremifene is a drug similar to tamoxifen. It is also a SERM and has
similar side effects.
3) Fulvestrant (Faslodex®):
Fulvestrant is a drug that first blocks the estrogen
receptor and then also eliminates it temporarily. It is not a SERM – it acts like
an anti-estrogen throughout the body.
Treatments to lower estrogen levels :
1) Aromatase inhibitors:
(A letrozole (Femara), anastrozole (Arimidex), and
exemestane (Aroma sin). They work by blocking an enzyme (aromatase) in fat
tissue that is responsible for making small amounts of estrogen in post-
menopausal women. They cannot stop the ovaries from making estrogen, aIso
are taken daily as pills.

49. 1) low blood levels of calcium and phosphate .
2)ONJ
3) does not seem to affect the kidneys, so it is safe to take if patient have
kidney problems.
Denosumab can also be used to strengthen bones in breast cancer patients
with weak bones who are being treated with aromatase inhibitors. When it is
used for this purpose, it is given less often (usually every 6 months).
SIDE EFFECTS