Transcript Breast Cancer

Chapter 5
Neoplasia
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Cell Growth
• Growth categories
– Labile
– Stable
– Permanent
• Growth regulators
– Proto-oncogenes
– Tumor suppressor genes
– Apoptosis regulating genes
– DNA repair genes
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Neoplastic Growth
Malignant
Benign
• Slow growth
• Expands into tissues,
usually encapsulated
• Cells are well
differentiated.
• Do not metastasize
• Variable growth rate,
depends on the level of
cell differentiation
• Invades surrounding
tissues by infiltration,
not encapsulated
• Undifferentiated cells
may not resemble cells
of origin.
• Metastasizes to distant
tissues
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Neoplastic Growth (cont.)
Benign
Malignant
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Carcinogenesis
• Defined
• Most common targets for genetic damage
– Proto-oncogenes
– Tumor suppressor genes
– DNA repair genes
– Apoptosis regulating genes
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Carcinogenesis (cont.)
• Etiology of genetic damage (carcinogenic agents)
– Inherited traits/influences
– Chemicals
– Environmental insults/agents
– Viral infections
– Immune system defects
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Local Growth and Distant Metastasis
• Local growth
– Carcinoma in situ
– Local spread
• Mechanical pressure, enzymes, lack of adhesion
• Metastasis
– Lymph system
– Blood system
– Seeding
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Diagnosis
• Symptoms
• Screening
– Physical exams (visual/palpation)
– Radiographs (mammography)
– Pap smear
– Oral screening devices (brush biopsy and others)
• Laboratory
• Biopsy
– Excisional/incisional
– Aspiration
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Diagnosis (cont.)
• Benign
– Well differentiated
– No extension into or fixation to surrounding tissues
– No metastasis
• Malignant
– Variable levels of differentiation (anaplasia)
• Atypical cells
– Extend into and are fixed to surrounding tissues
– Lymph node and distant metastasis
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Anaplastic Changes
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Tumor Grading and Staging
• Cancer grading
– Level of differentiation
• Systems
– UICC—TMN
– AJCC—TNM/anatomic stage/prognostic groups
• Molecular diagnosis
• Molecular profiling
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Systemic Effects
• Paraneoplastic syndromes
– Fever
– Anorexia
– Endocrine imbalances
– Anemia
– Thrombocytosis
– Hypercoagulability
– Neurologic problems
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Cancer Therapies
• Surgery
• Radiation therapy
• Chemotherapy
• Hormone/antihormone therapy
• Immunotherapy
• Targeted therapy
• Complementary and alternative therapies
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Side Effects of Therapy
Mucositis
• Mucositis
• Anemia
• Leukopenia
• Xerostomia
• Others
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Prevention
• Stop the use of tobacco products.
• Proper nutrition
• Eat a variety of fruits and vegetables every day.
• Reduce the amount of refined grains and sugars
consumed.
• Reduce the amount of high-fat red meat consumed.
• Maintain a healthy weight throughout life.
• Stay physically active.
• Limit alcohol consumption.
• Limit sun exposure, use sunscreen or other protection.
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Oral Metastatic Cancers
• Metastatic cancer from any primary cancer site
– Breast, lung, prostate, renal cell, and colorectal
cancers most likely
• Mandible more commonly affected than maxilla
• May be the first sign of cancer in 30% of cases
• Usually presents as poorly defined radiolucent defects
– May cause pathologic jaw fractures
– Paresthesia of associated soft tissues is common.
• Be suspicious of this type of lesion in patients with a
history of cancer
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Oral Metastatic Cancers (cont.)
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Skin Cancers
• Basal cell
• Squamous cell
• Melanoma
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Basal Cell Carcinoma
• Etiology—UV light, genetic factors
• Epidemiology—most common form of skin cancer
(approximately 80%)
• Pathogenesis—UV exposure causes accumulation of
genetic defects over time; lesion exhibits slow growth.
• Characteristics—most found in head and neck area,
appears nodular with depressed center and rolled pearly
borders often with capillaries seen throughout the border
area
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Basal Cell Carcinoma (cont.)
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Squamous Cell Carcinoma
• Etiology—UV light, burned areas, genetics, EBV, and HPV
• Epidemiology—second most common skin cancer
(approximately 20%)
• Pathogenesis—begins in keratinocytes of outer dermis,
has a prolonged in situ stage, may metastasize in @2%
of cases
• Characteristics—painless, nonhealing, rough, red scaly
papule that eventually becomes ulcerated and crusted as
it enlarges
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Squamous Cell Carcinoma (cont.)
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Breast Cancer
• Epidemiology—almost 300,000 women and 2,000+ men
will be diagnosed with breast cancer in 2011.
• Most occur in upper outer quadrant of the breast and
around the nipple.
• Local lymph node involvement usually begins in axial
nodes; may extend to nodes around the clavicle and
sternum.
• Common metastatic sites include lungs, kidneys, liver,
adrenal glands, ovaries, bones of the spine, ribs, pelvis,
and skull, including the maxilla and the mandible.
• 70 to 80% are estrogen receptor positive.
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Risk Factors Associated with Breast Cancer
Box 5.8
RISK FACTORS ASSOCIATED WITH BREAST CANCER
Factor
Details
Age
The risk of breast cancer increases with age
Race
More whites are affected than blacks, but more blacks die from the disease
Previous history of breast
cancer
There is a 3 to 4 times greater risk of breast cancer in the opposite breast after having cancer diagnosed in one breast
Previous history of other
hormone-associated cancers
Ovarian and endometrial cancer are examples of other hormone-associated cancers that increase the risk of having
breast cancer
Family history of breast cancer
Breast cancer in one primary relative (mother, sister) increases risk; two or more relatives with breast cancer increases
that risk even more
Genetic predisposition
Some5–10% of breast cancers are known to be associated with the BRCA 1 and 2 genes
Estrogen and progesterone
exposure
Early menstruation, late menopause, and the use of hormone replacement therapy increase a woman’s overall exposure
to estrogen, women who had their first pregnancy after age 35 or those who never had a full term pregnancy
Lifestyle factors
Obesity, lack of physical activity, and more than 1 or 2 alcoholic drinks per day have all been associated with an
increased risk of breast cancer
Radiation
High doses of ionizing radiation such as radiation therapy for other cancers that place the breast in the radiation beam
increase the risk for breast cancer in that breast. The use of tanning beds and x-rays may also increase risk
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Prostate Cancer
• Risk factors—age over 65 and African American descent
• Approximately 250,000 cases in 2011, second leading
cause of death in men
• Early detection
– PSA
– Physical examination
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Lung Cancer
• Leading cause of death in both men and women
• Tobacco smoke is the #1 risk factor.
• Symptoms are usually ignored until the disease has
progressed to an advanced stage.
• Small cell carcinoma may present with Cushing
syndrome–like symptoms.
• All stages combined 1 year survival rate 43%
• Diagnosed in early stage 5-year survival rate 53%
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Colorectal Cancer
• Risk factors: increasing age (90% over 50), family
history, IBD, smoking, inactivity, obesity, type 2 diabetes,
etc.
• Associated with colorectal polyps and disorders such as
FAP and Peutz-Jeghers
• Suggest a referral if the patient presents with melanotic
macules and other signs of GI problems
• 5-year survival rate if caught early is 90%.
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