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The News on Breast Cancer


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Title: The News on Breast Cancer

The News on Breast Cancer
  • January 2007
  • Presented By Dail Jacob BScN, CONC

  • Somewhere in your life,
  • you will meet someone
  • who is touched by breast cancer.

What is Cancer?
  • Cancer is many diseases, the different types
    correlate with the origin of the cells involved.
  • The human body is made of millions of cells,
    grouped together to form specific tissues and
    organs. The blueprint for cell structure
    function is DNA. Genes inside each cell order
    cells to grow, work, reproduce and die.
  • Cancer cells are cells which have lost their
    original ordered life cycle and characteristics.
    Something environmental or internally commands
    the cells to grow and function differently.
  • The abnormal growth of these cells eventually
    develop into a mass.
  • Cancer cells can metastasize or spread to other
    parts of the body. They do this by direct
    invasion or by traveling through the lymph or
    blood circulation. Two classifications of cancer
    exist solid tumor and hematological cancer.

What is Breast Cancer?
  • Breast cancer is the most common occurring cancer
    in Canadian women.
  • There are different types which can originate in
    different structures. The most common is ductal.
    others lobular, DCIS, invasive, Pagets,
  • Most of the breast involves glandular tissue
  • The staging of the tumor once biopsied and the
    biochemical and morphological characteristics
    determine the stage of disease.

Canadian Statistics
  • In 2006, an estimated 22,200 women will be
    diagnosed with breast cancer and 5,300 will die
    of it.
  • An estimated 160 men will be diagnosed and 45
    will die of it.
  • On average, 429 Canadian women will be diagnosed
    each week.
  • One in 9 women is expected to develop breast
    cancer during her lifetime. One in 27 will die of
  • Since 1993, incidence rates for breast cancer
    have stabilized and death rates have declined
  • The highest rates of breast cancer occur in the
    age bracket of age 50 69.

What Causes Breast Cancer?
  • There is no single cause of breast cancer but
    some factors appear to increase the risk of
    developing it
  • Age
  • Family history of breast cancer especially in a
    mother, sister or daughter diagnosed before
    menopause or if BRCA 1 or BRCA 2 genes are
    present. Heredity accounts for only 10 of all
    breast cancers
  • Family history of uterine, colorectal or ovarian
  • Previous history of breast cancer, or biopsies
    which showed abnormal cells
  • Dense breast tissue

  • Hormone exposure early menstruation, late
    menopause, no pregnancies or a late first
    pregnancy. It appears that the longer your body
    has been exposed to estrogen, the greater the
    risk. Use of Hormone replacement therapy HRT
    for more than 5 years has now also been linked to
    breast cancer. The choice to use HRT must be
    discussed with a doctor balancing the benefits
    with the risk.
  • Obesity this is predominantly related to the
    fact that fat cells store estrogen.
  • Alcohol intake alcohol intake of greater than 2
    drinks daily, has been linked with breast cancer.
  • Environmental factors use of insecticides,
    pesticides, preservatives and hormones in food
    stocks are suspected of causing chromosomal
    changes in the host or altering metabolic and
    hormonal activities in the body.

What Are Signs of Possible Breast Cancer
  • A thickening or a lump felt in the breast or
  • A change in the size or shape of one breast that
    is different from the usual changes noted during
    your menstrual cycle
  • A change in color or texture of the skin or
    underlying tissue of the breast
  • Puckering or dimpling of the breast skin in one
    area as though something is pulling inside
  • Or occasionally a discharge or bleeding from the
  • The most common site of breast tumors in women
    is the upper outer quadrant of the breast. In men
    it is close to the nipple.
  • If these signs are noted, a person should see a
    physician for assessment as soon as possible!
    Many patients out of fear do not seek help.

Most Common Beliefs/Myths About Breast Cancer
  • Only women with a family history get breast
    cancer? T/F
  • By omitting smoking, drinking, alcohol,
    caffeine, and a high fat diet makes your chances
    of getting breast cancer almost zero? T/F
  • Only women in their 50s get breast cancer? T/F
  • If you have lumpy breasts, you are more likely to
    get breast cancer in the future? T/F
  • An injury to the breast can cause breast cancer?
  • Stress has been associated with breast cancer?
  • 7. Breast cancer is associated with wearing an
    under wire bra and use of deodorant? T/F
  • 8. Women who consume soy products, soya sauce
    and oysters have a reduced incidence of breast
    cancer? T/F
  • 9. Microwave oven use is associated with
    increase cancer? T/F
  • 10 Doing a self breast exam can prevent breast
    cancer? T/F
  • 11 Doing a self breast exam in the shower is the
    best way to detect lumps? T/F
  • 12 Small breasted women do not get breast cancer?

4 Steps to Diagnosis
  • Self Breast Exam
  • Clinical Exam
  • Mammography
  • Biopsy if indicated

Staging of Disease
  • Stage 1
  • The tumor is no more than 2 centimeters
    (cm) across (T1)     
  • The lymph nodes in the armpit are not
  • The cancer has not spread
  • Stage 2 Divided into 2 groups
  • Stage 2A means
  • The tumor is less than 2 cm, the lymph nodes
    under the arm contain cancer but are not stuck to
    each other and the cancer has not spread or   
  • The tumor is less than 5 cm, there are no cancer
    cells in the lymph nodes in the armpit and the
    cancer has not spread or   
  • Although no tumor is seen in the breast, the
    lymph nodes under the arm contain cancer but are
    not stuck together, and there is no sign of
    spread to other parts of the body
  • Stage 2B means
  • The tumor is less than 5 cm and the lymph nodes
    under the arm contain cancer but are not stuck to
    each other, and the cancer has not spread or   
  • The tumor is bigger than 5 cm across, there are
    no cancer cells in the lymph nodes in the armpit
    and the cancer has not spread

  • Stage 3 Stage 3 breast cancer is divided into
    3 groupsStage 3A means
  • Although no tumor is seen in the breast, the
    lymph nodes under the arm contain cancer and are
    stuck together, but there is no sign of cancer
    spread or   
  • The tumor is 5 cm or less, the lymph nodes in
    the armpit contain cancer and are stuck to each
    other, but the cancer has not spread
    elsewhere or   
  • The tumor is more than 5 cm, the lymph nodes in
    the armpit contain cancer and may be stuck
    together, but there is no further spread
  • Stage 3B means
  • The tumor is fixed to the skin or chest wall, the
    lymph nodes may or may not contain cancer, but
    there is no further spread
  • Stage 3C means
  • The tumor can be any size and has spread to lymph
    nodes in the armpit and under the breast bone, or
    to nodes above or below the collarbone, but there
    is no further spread
  • Stage 4
  • The tumor can be any size     
  • The lymph nodes may or may not contain cancer
  • The cancer has spread or metastasized to other
    parts of the body such as the lungs, liver or
  • If you only have cancer spread to the lymph
    nodes in your armpit, you do not have stage 4
    breast cancer.  Stage 4 only applies to cancer
    spread to other body organs.
  • The most common sites of distal metastasis
    include bone, lung, liver brain.

  • Goals
  • Cure
  • Control
  • Palliation
  • A metastatic work up is often done before a
    surgical procedure is done. If the patient has
    distant metastasis, surgery may not be the first
    approach to management.

Treatment of Breast Cancer
  • Surgery
  • Chemotherapy
  • Radiotherapy
  • Hormonal Therapy

  • Complete or radical mastectomies are rarely done
    now. Some indications for still performing this
    procedure include multiple sites of tumor in the
    breast, inflammatory breast cancer or tumors
    which are large gt 5 cm or involving the skin,
    pregnancy where radiotherapy is contraindicated,
    previous radiotherapy, local recurrence of
    disease, lupus or scleroderma, severe cardiac or
    lung disease.
  • The most common procedure is a partial
  • Sentinel Node biopsy.
  • Reconstruction
  • Axillary Node Dissection, risk of lymphedema.

  • Indication Systemic control of disease.
  • Recommend starting chemotherapy 4 6 weeks after
  • Choice of which chemotherapy is guided by
    practice guidelines based on the type of breast
    cancer, the stage of disease, the characteristics
    of the tumor seen by the pathologist and goals of
  • Can be given prior to surgery neoadjuvant. This
    is indicated for a large breast tumor or with
    inflammatory breast cancer.
  • Many types of medications. Chemotherapy
    medications are usually given in combination to
    have a synergistic effect upon cancer cell
    destruction or prevention of cell duplication and
  • Gene therapy.
  • Side effects of chemotherapy.

  • Radiotherapy
  • Indication local control of disease.
  • External beam or brachytherapy.
  • Usually started 1 month after chemotherapy.
  • Indications for boost therapy young patients
    with DCIS or patients identified to be at high
    risk for local recurrence.
  • Side effects of radiotherapy.
  • Hormone therapy

Breast Cancer Recurrence
  • In Canada, 14 women with breast cancer will
    eventually have a recurrence.
  • For a subgroup of patients who are HER2 positive,
    the risk of recurrence was reduced with the
    upfront use of the drug Herceptin. This news in
    2004 changed the front line practice for this
    subgroup of patients. Approx. 25 of all breast
    cancer patients are HER2 positive. HER2 positive
    patients generally have a poorer prognosis
    therefore this outcome is great news.
  • 3 types of recurrence take place
  • Local
  • Regional
  • Distant
  • Some of the prognostic indicators or indications
    that a patient may eventually reoccur include
    lymph node involvement ER/PR status Grade of
    the tumor clear margins tumor size oncogene
    expressions in the cells.

Support Services for Cancer Patients
  • Look Good/Feel Better
  • Support Groups
  • Educational Sessions
  • Psychosocial support psychologist, pastoral
    care, social worker the nursing team
  • Rehab Nutrition Exercise Programs
  • Lymphedema Management
  • Music Therapy, Art Therapy , Massage Therapy
  • Resource Room with library, wigs prosthesis
  • Volunteers

The Future
  • Overall survivorship of patients with breast
    cancer has increased. We look at it as a chronic
    illness, though some patients will die of this
  • Many options of treatment and the research is
    focusing on more targeted therapies with fewer
    side effects.
  • We have excellent medication and support services
    to help patients, and reduce the side effects of
  • A national Cancer Control Strategy has been
    established. Many provinces also have set up
    comprehensive programs to oversee the approach to
    diagnosis, management and outcomes.
  • Canadians are becoming more health conscience and
    aware of environmental risks and concerns.
  • Development of programs to achieve healing and
    wholeness after the cancer experience

Testimonial of Personal Experience with Audrey
  • Gastric Cancer

Gastrointestinal Cancers
  • Esophageal 1,200 1,400 new cases
  • Gastric 2,800 3,200 new cases
  • Colorectal 17,000 new cases. 3rd most common in
    incidence death.

Stomach Gastric Cancer
  • Stomach cancer starts in the cells of the
    stomach. The stomach is a muscular sac and is
    lined with glandular cells that produce acid and
    special proteins called enzymes which help to
    digest food.
  • The most common type of gastric cancer is
    adenocarcinoma 85, which starts in the
    glandular cells in the lining of the stomach.
  • There are 2 less common types
  • Gastric lymphoma involves the lymph system
  • Leiomyosarcoma involves the muscle
  • Worldwide accounts for 3 of all cancers. Areas
    where there is a higher incidence include Japan,
    South America, Eastern Europe the Middle East.
  • In Canada the areas of highest incidence include
    the Maritimes, Quebec and Manitoba.

Etiology of Gastric Cancer
  • No single cause
  • Factors associated with increased risk include
  • Age gt 50 age 50 59 highest incidence
  • Gender 2X greater in men
  • Diet higher incidence with salted or cured,
    pickled or BBQ foods. There is a higher incidence
    with low intake of fruits vegetables low in
    Vit. A or C.
  • Smoking / ETOH
  • Workplace exposure to asbestos, nickel, coal
    dust, gold mining, silica, chromium, oil mist or
    diesel emissions and rubber timber processing
  • Lower production of stomach acid than normal
  • Helicobacter pylori bacteria
  • H/O pernicious anemia Vit B12 deficiency
  • H/O GERD gastro esophageal reflux disease
  • Contaminated water source , lack of refrigeration
  • Genetic small group Type A blood, nonpolyposis
    colon ca, Li Fraumeni syndrome.

Signs Symptoms of Gastric Cancer
  • Unfortunately, tumors in the stomach can grow for
    a long time before someone is aware of a problem.
    The symptom are often vague at first and resemble
    other gastric ailments such as ulcer disease.
  • Indigestion / heartburn
  • Bloating / fullness after meals
  • Loss of appetite
  • Nausea
  • Abdominal discomfort, especially after eating
  • Pain in upper back or upper chest
  • Vomiting blood / Blood in stool
  • Difficulty swallowing
  • Change of bowel habit
  • In the advance stages anemia, weight loss,
    Nausea vomiting, pain, jaundice malnutrition.

Diagnosis of Gastric Cancer
  • There is no routine screening for this disease.
  • Report symptoms to family physician, clinical
  • Blood work
  • Gastroscopy biopsy.
  • UGI Series
  • Stool test for occult blood
  • Metastatic work-up, as stage of disease will help
    determine the approach to treatment. CT scan,
    ultrasound, MRI, PET scan.

Treatment of Gastric Cancer
  • The best scenario for cure is if the patient is
    able to have surgical removal of the gastric
    tumor. Generally this involves a partial or total
    gastrectomy and resection of the nodes and
    adjacent tissues involved. In North America, only
    10 20 of patients are diagnosed in the early
  • Approximately 80 of patients have metastasis at
    the time of confirmed diagnosis.
  • Other treatments include
  • Chemotherapy
  • Radiotherapy external beam or by brachytherapy
  • Chemoradiation combined either before surgery or
  • Endoscopic laser surgery and insertion of stents
    to treat obstructions.
  • Biologic therapies available in clinical trials
    involves a treatment that uses the patients
    immune system to fight cancer These substances
    made in the body or in a lab, are used to boost,
    direct or restore the bodys natural defenses.

Patient Care Concerns
  • Post operative complications
  • Anastomotic leak
  • Dumping syndrome
  • Nutritional challenges
  • Symptom control related to disease treatment
  • Pain control
  • Nausea possible vomiting
  • Mucositis or esophagitis
  • Fatigue weakness
  • Myelosuppression, particularly anemia
  • Performance status ability to maintain
    functional status
  • Recurrence of disease

  • Questions ?

Resource Sites
  • Canadian Cancer Society
  • National Cancer Institute of Canada
  • National Cancer Institute/ US National Institute
    of Health
  • ASCO American Society of Clinical Oncology
  • National Surgical Adjuvant Breast Bowel Project
  • ASCO People Living With Cancer
  • Cancer Care Ontario http//
  • B.C. Cancer Agency