Cancer Education Slides

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Cancer Education Slides

• Breast Cancer

2008
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What is Cancer?

• A group of 100 different diseases
• The uncontrolled, abnormal growth of cells
• Cancer may spread to other parts of the body

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What is Breast Cancer?

• An estimated 184,450 people diagnosed in the
  United States in 2008
• The most common type of cancer in women in the
  United States (excluding cancers of the skin) and
  the second most frequent cause of death from
  cancer in women
• A disease in which normal cells in the breast
  begin to change, grow without control, and no
  longer die
• Cancer that has not spread is called in situ,
  meaning in place
• Cancer that has spread is called invasive or
  infiltrating

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What is the Structure of the Breast?

• The breast is composed mainly of fatty tissue,
  which contains a network of lobes made up of
  tiny, tube-like structures called lobules that
  contain milk glands
• Tiny ducts connect the glands, lobules, and
  lobes, and carry the milk from the lobes to the
  nipple
• Blood and lymph vessels run throughout the breast
• About 90 of all breast cancers start in the
  ducts or lobes of the breast

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What are the Risk Factors for Breast Cancer?

• Age
• Race
• Individual or family history of breast cancer
• A personal history of ovarian cancer
• A genetic predisposition (such as mutations to
  the BRCA1 or BRCA2 genes)
• Estrogen exposure
• Atypical hyperplasia of the breast
• Lobular carcinoma in situ (LCIS)
• Lifestyle factors (obesity, lack of exercise,
  alcohol use)
• Radiation exposure

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Hereditary Breast Cancer

• Small percentage of breast cancers are inherited
• Approximately 80 of hereditary breast cancer is
  caused by mutations in the BRCA1 or BRCA2 genes
• Women who inherit a BRCA mutation have a 50 to
  85 chance of developing breast cancer in their
  lifetime
• Women with especially strong family history may
  consider preventive surgery to remove breast
  tissue and/or chemoprevention
• Several other genetic syndromes can increase
  breast cancer risk
• Genetic counseling and testing is available for
  most syndromes
• For more information, www.cancer.net/genetics

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Breast Cancer and Early Detection

• Early diagnosis means a better chance of
  successful treatment
• Mammography is the best tool doctors have to
  screen for breast cancer and can detect cancers
  too small to be felt
• Recommendations differ many state that women
  obtain a mammogram each year, starting at the age
  of 40
• Magnetic resonance imaging (MRI) may be used for
  very high risk women
• Women are encouraged to discuss screening with
  their doctors

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What are the Symptoms of Breast Cancer?

• New lumps or a thickening in the breast or under
  the arm
• Nipple tenderness, discharge, or physical changes
• Skin irritation or changes, such as puckers,
  dimples, scaliness, or new creases
• Warm, red, swollen breasts with a rash resembling
  the skin of an orange
• Pain in the breast (usually not a symptom of
  breast cancer, but should be reported to a
  doctor)
• No visible or obvious symptoms (asymptomatic)

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How is Breast Cancer Diagnosed?

• Screening and/or diagnostic mammography
• Ultrasound
• MRI scan
• Biopsy is necessary to confirm a diagnosis
• Blood tests are often used to determine if the
  cancer has spread outside the breast
• Additional tests may be used to determine stage

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Breast Cancer Staging

• Staging is a way of describing a cancer, such as
  the size of a tumor and if or where it has spread
• Staging is the most important tool doctors have
  to determine a patients prognosis
• Staging is described by the TNM system the size
  and location of the Tumor, whether cancer has
  spread to nearby lymph Nodes, and whether the
  cancer has Metastasized (spread to other areas of
  the body)
• Some stages are divided into smaller groups that
  help describe the tumor in even more detail
• Treatment depends on the stage of the cancer
• Recurrent cancer is cancer that comes back after
  treatment

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Stage 0 Breast Cancer

• Known as cancer in situ, meaning the cancer has
  not spread past the ducts or lobules of the
  breast (the natural boundaries)
• Also called noninvasive cancer
• Ductal carcinoma in situ (DCIS) is the most
  common in situ breast cancer

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Stage I Breast Cancer

• The tumor is small and has not spread to the
  lymph nodes

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Stage IIa Breast Cancer

• Stage IIa breast cancer describes a smaller tumor
  that has spread to the axillary lymph nodes
  (lymph nodes under the arm), or a medium-sized
  tumor that has not spread to the axillary lymph
  nodes
• Stage IIa may also describe cancer in the
  axillary lymph nodes with no evidence of a tumor
  in the breast

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Stage IIb Breast Cancer

• Stage IIb breast cancer describes a medium-sized
  tumor that has spread to the axillary lymph nodes
• Stage IIb may also describe a larger tumor that
  has not spread to the axillary lymph nodes

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Stage IIIa Breast Cancer

• Stage IIIa breast cancer describes any size tumor
  that has spread to the lymph nodes

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Stage IIIb Breast Cancer

• Stage IIIb breast cancer has spread of the
  breast, or is diagnto the chest wall, or caused
  swelling or ulceration osed as inflammatory
  breast cancer

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Stage IIIc Breast Cancer

• Stage IIIc breast cancer has spread to distant
  lymph nodes but has not spread to distant parts
  of the body

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Stage IV Breast Cancer

• Stage IV breast cancer can be any size and has
  spread to distant sites in the body, usually the
  bones, lungs or liver, or chest wall

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How is Breast Cancer Treated?

• Treatment depends on stage of cancer
• More than one treatment may be used
• Surgery
• Radiation therapy
• Chemotherapy
• Hormone therapy
• Targeted therapy

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Factors Considered in Treatment Decisions

• The stage and grade (how different cancer cells
  look from healthy cells) of the tumor
• The tumors hormone receptor status (estrogen
  receptor ER, progesterone receptor PR) and
  human epidermal growth factor receptor-2 (HER2)
  status
• Genetic description of the tumor
• The presence of known mutations to breast cancer
  genes
• The womans menopausal status, age, and general
  health

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Cancer Treatment Surgery

• Generally, surgery to remove the tumor with or
  without radiation therapy is initial treatment
• For invasive cancer, lymph nodes are removed and
  evaluated
• More invasive surgery (such as mastectomy) is not
  always better discuss with your doctor
• Breast reconstruction is an option after
  mastectomy

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Cancer Treatment Adjuvant Therapy

• Treatment given in addition to surgery to reduce
  the risk of recurrence
• May include radiation therapy, chemotherapy,
  targeted therapy, and hormone therapy

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Cancer Treatment Radiation Therapy

• The use of high-energy x-rays to destroy cancer
  cells
• Usually used to treat breast cancer after surgery
• External-beam outside the body
• Internal uses implants inside the body
• More precise ways to direct radiation to the
  tumor and shorter treatment courses are being
  studied in clinical trials
• Side effects may include fatigue, swelling, and
  skin changes

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Cancer Treatment Chemotherapy

• Use of drugs to kill cancer cells
• May be given before surgery to shrink a large
  tumor (neoadjuvant chemotherapy) or after surgery
  to reduce the risk of recurrence (adjuvant
  chemotherapy)
• A combination of medications is often used

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Cancer Treatment Hormone Therapy

• Used to lower risk of recurrence for cancers that
  test positive for ER and/or PR
• May be used alone or together with chemotherapy
• Tamoxifen (Nolvadex) is a common hormone therapy
  effective in many premenopausal and
  postmenopausal women raloxifene (Evista) may be
  another option for postmenopausal women
• Aromatase inhibitors are also used alone or
  following tamoxifen use as treatment for
  postmenopausal women, including anastrozole
  (Arimidex), letrozole (Femara), and exemestane
  (Aromasin)
• Different drugs have different side effects
  discuss with your doctor

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Cancer Treatment Targeted Therapy

• Treatment designed to target cancer cells while
  minimizing damage to healthy cells
• Used to stop the action of abnormal proteins that
  cause cells to grow and divide out of control
• Trastuzumab (Herceptin) for women with a
  HER2-positive breast cancer either with or after
  adjuvant chemotherapy lapatinib (Tykerb) for
  advanced or metastatic cancer
• Bevacizumab (Avastin) blocks angiogenesis (the
  formation of new blood vessels) and is used with
  paclitaxel (Taxol) for metastatic or recurrent
  breast cancer.

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The Role of Clinical Trials for the Treatment of
Breast Cancer

• Clinical trials are research studies involving
  people
• They test new treatment and prevention methods to
  determine whether they are safe, effective, and
  better than the standard treatment
• The purpose of a clinical trial is to answer a
  specific medical question in a highly structured,
  controlled process
• Clinical trials can evaluate methods of cancer
  prevention, screening, diagnosis, treatment,
  and/or quality of life

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Clinical Trials Patient Safety

• Informed consent participants should understand
  why they are being offered entry into a clinical
  trial and the potential benefits and risks
  informed consent is an ongoing process
• Participation is always voluntary, and patients
  can leave the trial at any time
• Other safeguards exist to ensure ongoing patient
  safety

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Clinical Trials Phases

• Phase I trials determine the safety and dose of a
  new treatment in a small group of people
• Phase II trials provide more detail about the
  safety of the new treatment and determine how
  well it works for treating a specific type of
  cancer
• Phase III trials take a new treatment that has
  shown promising results when used to treat a
  small number of patients with cancer and compare
  it with the standard treatment for that disease
  phase III trials involve a large number of
  patients

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Clinical Trials Resources

• Coalition of Cancer Cooperative Groups
  (www.CancerTrialsHelp.org)
• CenterWatch (www.centerwatch.com)
• National Cancer Institute (www.cancer.gov/clinical
  _trials)
• EmergingMed (www.emergingmed.com)

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Coping with Side Effects

• Side effects are treatable talk with the doctor
  or nurse
• Fatigue is a common, treatable side effect
• Pain is treatable non-narcotic pain-relievers
  are available
• Antiemetic drugs can reduce or prevent nausea and
  vomiting
• Lymphedema following breast cancer surgery can
  often be managed with help from your doctor
• For more information, visit www.cancer.net/sideeff
  ects

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After Treatment

• Talk with the doctor about developing a follow-up
  care plan
• Important to detect possible recurrence at the
  earliest stage
• Monthly breast self-examinations
• Physical examinations
• Mammograms
• Pelvic examinations
• More information can be found in the ASCO Patient
  Guide Follow-Up Care for Breast Cancer
• Fear of recurrence is common talk with your
  doctor about ways to cope

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Where to Find More InformationCancer.Net Guide
to Breast Cancer(www.cancer.net/breast)

• Overview
• Medical Illustrations
• Risk Factors
• Symptoms
• Diagnosis
• Staging With Illustrations
• Treatment

• Clinical Trials
• Side Effects
• After Treatment
• Current Research
• Questions to Ask the Doctor
• Patient Information Resources

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Cancer.Net (www.cancer.net)

• Comprehensive, oncologist-approved cancer
  information
• Guides to more than 120 types of cancer and
  cancer-related syndromes
• Coping resources
• Survivorship information
• Cancer information in Spanish
• Weekly feature articles
• The latest cancer news
• For patient information resources, please call
  888-651-3038