The Nurses Prayer

Dear Jesus....Model and inspiration of the nursing profession, I know that when
you ascended into heaven you left the care of the sick/to those of us/whom you
have blessed/with the holy vocation of nursing. Help me to be faithful to the
calling so I can do always the things that you want me to do in the way you want
me to be.
Grant that my voice may be gentle, that my hands may have the softness and
sympathy of your hands, that my presence may bring something of the hope and
consolation, which your presence brought the sufferers of your day. I want to do
all these things dear lord but I know that I am weak. I can do little without your
aid. Please give aid these day and every day of my life so I can always be, what
I know you want me to be...an angel in the sick room.
Amen.
BREAST CANCER AWARENESS
& PREVENTION CAMPAIGN
WHAT DO YOU KNOW ABOUT
BREAST CANCER?

(PRE-TEST)
 TRUE OR FALSE

1. You can get breast cancer even if it doesn’t run in your family.
2. If breast cancer runs in your family, you’re sure to get it.
3. Men can get breast cancer.
4. There’s nothing you can do to lower your breast cancer risk.
5. Older women are more likely to develop breast cancer.
6. Women who drink alcohol increase their risk for breast cancer.
7. Smoking may increase your risk for breast cancer.
8. A woman's chances of developing breast cancer are higher if her mother, a sister, or
daughter have had it.
9. Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to
other parts of the body. (2pts)
10. September is Breast Cancer Awareness Month, an annual campaign to raise awareness
about the impact of breast cancer. (3pts)
 ANSWERS

1. You can get breast cancer even if it doesn’t run in your family.

The Correct Answer is True

Most women diagnosed with breast cancer – more than 85% – have no family history of the
disease. Having a relative with breast cancer does increase your risk. But other factors such
as age, being overweight, alcohol use, and hormone therapy after menopause can also
increase your risk of developing breast cancer.
2. If breast cancer runs in your family, you’re sure to get it.

The Correct Answer is False

Having breast cancer in your family doesn’t guarantee you’ll get it. In fact, most women
who get breast cancer don't have a family history of it. Some breast cancers are related to
gene changes that are inherited from a parent. But many times, cancer runs in families
because family members have similar lifestyle habits – habits you can control and change to
lower your risk of breast cancer. This includes staying at a healthy weight, getting regular
physical activity, and limiting or avoiding alcohol.
Knowing your family history empowers you to tackle the risk factors you can control. It
should also motivate you to get screened regularly so that breast cancer is caught early –
when it’s small, hasn’t spread, and is easier to treat.
3. Men can get breast cancer.

The Correct Answer is True

More than 2,500 men are diagnosed with breast cancer every year. Men should not ignore
breast lumps and should get any breast changes checked. Still, breast cancer is about 100
times more common in women than men, with more than 260,000 women diagnosed in
each year.

4. There’s nothing you can do to lower your breast cancer risk.

The Correct Answer is False

While you can't change certain risk factors - like getting older or having a family history of
breast cancer - you can do a lot to help reduce your breast cancer risk. Exercise more and
eat healthier, especially if you’re overweight or obese. Get to and stay at a heathy weight.
And limit or eliminate alcohol. Being responsible about your health can go a long way.
5. Older women are more likely to develop breast cancer.

The correct answer is True

Breast cancer is more common in women older than age 55. But women of any age can
develop this disease.

6. Women who drink alcohol increase their risk for breast cancer.

The correct answer is True

Studies have clearly linked drinking to an increased risk for breast cancer. Having 1 drink a
day may cause a small increased risk. Having 2 to 3 drinks a day puts a woman at about
20% higher risk than women who drink no alcohol. The more alcohol you drink, the higher
the risk. It's best not to drink alcohol. Women who drink should limit themselves to 1 drink
per day.
7. Smoking may increase your risk for breast cancer.

The correct answer is True

Some studies have shown that long-term heavy smoking can increase breast cancer risk.

8. A woman's chances of developing breast cancer are higher if her mother, a sister, or
daughter have had it.

The correct answer is True

Women who have a mother, sister, or daughter with breast cancer have nearly double the
risk. A family history of ovarian cancer, and maybe pancreatic or prostate cancer, is also
linked to a higher risk.

https://www.urmc.rochester.edu/encyclopedia/content.aspx?
contenttypeid=40&contentid=BreastCancerCancerBrQuiz&CustomAnswers_BreastCancerCancerBrQuiz=q1a
1_c,q2a1_c,q4a2_c,q5a2_c,q6a1_c,q8a2,q9a2,q10a2,q11a2_c,q12a2,q13a2_c,q14a2,q15a2_c
9. Cancer is a disease in which some of the body’s cells grow uncontrollably and spread
to other parts of the body.

The correct answer is True

10. September is Breast Cancer Awareness Month, an annual campaign to raise awareness
about the impact of breast cancer.

The correct answer is False

October is National Breast Cancer Awareness Month.
CONTENTS

I. Introduction
II. Etiology
III.Sign and Symptoms
IV. Pathophysiology
V. Diagnostic Evaluation
VI.Treatment
OBJECTIVES

• To increase public awareness and disseminate knowledge on breast

cancer.
• The goal of this campaign is to raise the public’s “brand awareness”
for breast cancer, its detection, treatment, and the need for reliable,
permanent cure.
• The PINK RIBBON is the most prominent symbol of breast cancer
awareness.
• It is associated with individual generosity, faith in scientific progress,
and an optimistic “can do” attitude.
• It encourages to focus on the emotionally appealing ultimate vision of a
cure for breast cancer, rather than the reality that there is no certain cure
for breast cancer.
• The practice of blindly wearing of displaying a pink ribbon without
making any efforts to cure breast cancer has been described as a kind of
slacktivism.
A woman demonstrating
how to use the thermal
testing machine for breast
cancer during a forum in
Makati City. The
diagnostic tool uses a high
resolution thermal sensing
device and a cloud hosted
analytics solution which
would analyze the thermal
images. (Photo by John
Eric Mendoza)
 MANILA, Philippines — A cancer expert on Tuesday sounded the alarm on the continuous
prevalence of breast cancer in the Philippines, saying the disease is akin to a pandemic.
“When you think about it, COVID has almost come and gone, and yet there is a very very prevalent
pandemic — and that’s breast cancer,” Dr. Norman San Agustin, founder and CEO of Asian Breast
Center made the remark in a breast cancer forum in Makati City.
San Agustin made the remark as he called the continued prevalence of breast cancer cases not only in
the Philippines but elsewhere in the world “staggering.”
“When you look at the statistics, even during the time of COVID, the numbers are staggering. And the
worst of all, in two to three years COVID is almost gone but breast cancer continues to rise and will
continue to do so unless we do something about it,” he said.
Breast cancer remains to be the most common cancer in the Philippines and worldwide.
Data from the World Health Organization revealed that as of 2020, breast cancer is the majority type of
cancer among Filipino women at 31 percent.
The WHO said there were 86,484 cases of cancer in the Philippines, of which, 27,163 are breast
cancers.
Source: https://newsinfo.inquirer.net/1733245/breast-cancer-cases-in-
ph-staggering-health-expert
Thermal imaging

“Nobody needs to die of breast cancer,” Dr. Geetha Manjunath, founder and CEO of India-based
medical startup Niramai, said. “But why are we losing so many women? Late detection.”
Manjunath said thermal imaging could be an effective and cheaper tool to detect breast cancer.
According to Manjunath, the technology she developed uses a high resolution thermal sensing
device and a cloud hosted analytics solution which would analyze the thermal images.
She also noted that the procedure is non-invasive and does not use radiation.
The diagnostic tool will soon be available in select hospitals in the Philippines.

Source: https://newsinfo.inquirer.net/1733245/breast-cancer-cases-in-
ph-staggering-health-expert
INTRODUCTION
Discussant: John Harry Marco
 WHY IS BREAST CANCER AWARENESS
IMPORTANT?

• The reason for spreading awareness about breast cancer is that it is the second leading
cause of death among women worldwide. It’s best for women to know the general
signs & and symptoms, know how to check themselves and how often they should be
checked. The earlier it is caught in its tracks, the better with any kind of cancer. This is
why it is important to spread awareness. Educating yourself and those around you can
prevent breast cancer from spreading fast or getting to a worse stage.
 Cancer refers to any one of a large number of diseases characterized by the development of
abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal body
tissue. Cancer cells are abnormal because they divide uncontrollably. A life-threatening characteristic of
these cells is their ability to spread to distant vital organs such as the lungs, liver, brain, and bone.
The majority of patients with breast cancer present with stages III or IV disease, which is
associated with lower survival rates. Some of the factors that account for late presentations include lack
of awareness and information about basic symptoms of cancer as well as poor access to early screening
and treatment.
According to World Health Organization (WHO), “Cancer mortality can be reduced if cases
are detected and treated early,” because there is a higher chance of a cure. Knowledge about cancer,
public awareness programs, and national screening initiatives will increase earlier stages of presentation
for patients. Also, cancer morbidity and mortality can be reduced and controlled by implementation of
evidence-based strategies for cancer prevention, early detection of cancer, and appropriate management.

Source: https://ascopubs.org/doi/full/10.1200/JGO.2016.003509
 The goal of primary breast cancer prevention is to protect women from developing
breast cancer. The goal of secondary breast cancer prevention is to prevent recurrence of breast
cancer.
Primary prevention offers the greatest public health potential and most cost-effective
long-term cancer control program. Breast cancer prevention should be integrated into
comprehensive breast cancer control programs, and complement breast cancer awareness and
early detection efforts. Experts suggest that if maximal benefit was achieved through prevention
programs, up to 50% of breast cancers could be avoided. Breast cancer prevention has three
components: 1) behavior or lifestyle modifications (e.g., diet, exercise, alcohol consumption); 2)
pharmacologic intervention (e.g., tamoxifen) and/or 3) prophylactic surgery (e.g., mastectomy).
Although certain breast cancer risk factors cannot be modified (e.g., aging, age at menarche or
menopause, family history) and other risk factors – such as not having breast fed – are not
necessarily modifiable for all, it is possible to take responsibility at both an individual and a
policy level for some risk factors, such as obesity, harmful use of alcohol and physical inactivity,
which are known to also improve an individual’s general health as well as reduce breast cancer
risk.
 There are currently no studies evaluating the cost effectiveness of breast cancer
prevention efforts; however, as data become available, preventive efforts can be better understood
in terms of long-term cost-effectiveness. Risk assessment is a critical component of cost-effective
prevention programs as it can identify higher-risk patients for targeted prevention activities. Thus,
health professionals must be well-educated in both options - preventive options for breast cancer
which improve the overall health of patients, as well as more targeted interventions for high risk
women, such as surgery to remove breasts and/ or ovaries, that may have unacceptable risks and
side-effects for many women, despite their protective effect against breasts cancer.
 UNDERSTANDING BREAST ANATOMY

What is a breast made of?

• Both men and women have breasts, but women have more breast tissue than men.

The female breast is made of different components, including:

• lobules, which produce breast milk
• ducts, which carry milk to the nipple
• fatty (adipose) tissue and connective (fibrous) tissue, which surround the lobules and
ducts.
All breasts contain fatty and fibrous tissue. Lobules can also be referred to as glandular
tissue. The male breast has ducts but few or no lobes or lobules.
Breast tissue extends from the collarbone to lower ribs,
sternum (breastbone) and armpit.
 WHAT ARE BREAST LOBES AND BREAST DUCTS?

• Each female breast contains 15-20 sections called lobes. Each lobe is made up of many
smaller sacs called lobules (milk glands). It is these lobules that produce milk in
breastfeeding women. The lobes and lobules are connected to the nipple by tubes called
ducts, which carry milk to the nipple. Milk flows through the nipple to the outside during
breastfeeding.
 WHAT ARE LYMPH NODES?

• Lymph nodes (also called lymph glands) are small, rounded structures of about 1 mm to 25
mm that are found throughout the body.
• The lymph nodes form part of the lymphatic system. The lymphatic system is an important
part of the immune system that protects the body from disease and infection. It contains a
network of thin tubes called lymph vessels that are found throughout the body. These lymph
vessels transport a clear fluid called lymph between the lymph nodes. The lymph nodes filter
the lymph to trap or remove substances harmful to the body, such as bacteria or cancer cells.
This helps to protect the body from disease or infection. The lymph then passes back to the
blood.
• The closest lymph nodes to the breast are those in the armpit, which are known as axillary
nodes. The axillary nodes drain lymph from nearby tissues, including the breast. There are also
lymph nodes under the breastbone (internal mammary nodes) and in the neck (supraclavicular
nodes). The number of lymph nodes varies between different people. There are usually about
15-30 lymph nodes in the armpit.

• Because the lymph vessels carry lymph away from the breast, in the case of breast cancer,
cancer cells can enter the lymph vessels and begin to grow in the lymph nodes. The axillary
nodes are often the first place of cancer spread outside the breast. Usually, surgery is used to
remove one or more of the axillary nodes to help check for cancer spread. Cancer found in the
lymph nodes affects the staging and treatment of breast cancer.
Normal Breast Changes Through Life
The female breast will go through various normal changes over the course of a lifetime. Many
of these changes are driven by hormones. They can be related to the menstrual cycle, pregnancy or the
normal aging process. Most breast changes are not cancer, however, if you do notice an unusual breast
change, it is important that you speak with your doctor so that it can be checked as soon as possible.

Normal breast changes throughout life include:

• Breast changes during pregnancy

During pregnancy, the breasts go through different changes in preparation for breastfeeding
after birth. The areola surrounding the nipple will grow larger and become darker. The lobules (milk
glands) of the breast increase in size and number. They also begin to produce milk so a mother can
breastfeed her baby.
• Effect of hormonal changes on breasts
As women develop from pre-puberty through puberty, pregnancy and to
menopause, the breasts will be affected by a variety of fluctuations in hormones.
During puberty, hormones produced by the ovaries (such as oestrogen)
cause growth and development of the breast. After puberty, the hormones
oestrogen and progesterone will change throughout a woman’s monthly
menstrual cycle. This may cause women to have swollen or tender breasts at
different times of the month.
During pregnancy the body will produce additional oestrogen and
progesterone, which trigger further growth and development of the breast to
prepare mothers for breastfeeding. Around the time of menopause
(perimenopause), the ovaries stop producing female hormones including
oestrogen. Without oestrogen, the breast tissue decreases in size. After
menopause (post-menopause), monthly menstrual periods stop.
WHAT IS BREAST CANCER?

• Breast cancer is a type of

cancer that starts in the breast.
It can start in one or both
breasts. Breast cancer originates
in your breast tissue– usually in
the ducts (tubes that carry milk
to the nipple) or lobules (glands
that make milk). It occurs in
both men and women, although
male breast cancer is rare.
• It can also travel to other parts
of your body and form new
tumors. When this happens, it’s
called metastasis.
Anatomy of female breast
• Cancer starts when cells begin to grow out of control.

What Is Cancer?
Chances are that you or someone you know has been affected by cancer. Here is some
information to help you better understand what cancer is.
You are made up of trillions of cells that over your lifetime normally grow and divide as
needed. When cells are abnormal or get old, they usually die. Cancer starts when something goes
wrong in this process and your cells keep making new cells and the old or abnormal ones don't die
when they should. As the cancer cells grow out of control, they can crowd out normal cells. This
makes it hard for your body to work the way it should.
For many people, cancer can be treated successfully. In fact, more people than ever
before lead full lives after cancer treatment.
Cancer is more than just one disease
There are many types of cancer. Cancer can develop anywhere in the body and is named
for the part of the body where it started. For instance, breast cancer that starts in the breast is still
called breast cancer even if it spreads (metastasizes) to other parts of the body.

There are two main categories of cancer:

1. Hematologic (blood) cancers are cancers of the blood cells, including leukemia, lymphoma,
and multiple myeloma.
2. Solid tumor cancers are cancers of any of the other body organs or tissues. The most common
solid tumors are breast, prostate, lung, and colorectal cancers.
These cancers are alike in some ways, but can be different in the ways they grow, spread,
and respond to treatment. Some cancers grow and spread fast. Others grow more slowly. Some are
more likely to spread to other parts of the body. Others tend to stay where they started. Some types
of cancer are best treated with surgery; others respond better to drugs such as chemotherapy. Often
2 or more treatments are used to get the best results.
WHAT IS A TUMOR?

A tumor is a lump or growth. Some lumps are cancer, but many are not.

• Lumps that are not cancer are called benign

• Lumps that are cancer are called malignant

What makes cancer different is that it can spread to other parts of the body while
benign tumors do not. Cancer cells can break away from the site where the cancer started.
These cells can travel to other parts of the body and end up in the lymph nodes or other
body organs causing problems with normal functions.
 DIFFERENCE OF TUMOR AND CANCER

Tumors, abnormal growth of tissue, are clusters of cells that are

capable of growing and dividing uncontrollably; their growth is not
regulated. Oncology is the study of cancer and tumors. The term "cancer" is
used when a tumor is malignant, which is to say it has the potential to cause
harm, including death.
WHAT CAUSES CANCER?

Cancer cells develop because of multiple changes in their genes. These changes can
have many possible causes. Lifestyle habits, genes you get from your parents, and being
exposed to cancer-causing agents in the environment can all play a role. Many times, there
is no obvious cause.
The following includes the most-studied known or suspected risk factors for
cancer. Although some of these risk factors can be avoided, others—such as growing older
—cannot. Limiting your exposure to avoidable risk factors may lower your risk of
developing certain cancers.
• Age, Alcohol, Cancer-Causing Substances, Chronic Inflammation, Diet, Hormones,
Immunosuppression, Infectious Agents, Obesity, Radiation, Sunlight, Tobacco
WHAT IS THE CANCER STAGE?

• When a cancer is found, tests are done to see how big the cancer is and whether it has
spread from where it started. This is called the cancer's stage.
• A lower stage (such as a stage 1 or 2) means that the cancer has not spread very much. A
higher number (such as a stage 3 or 4) means it has spread more. Stage 4 is the highest
stage. The stage of the cancer is very important in choosing the best treatment for a
person.
HOW DOES CANCER SPREAD?

• Cancer can spread from where it started (the primary site) to other parts of the
body.

• When cancer cells break away from a tumor, they can travel to other areas of
the body through either the bloodstream or the lymph system. Cancer cells
that travel through the bloodstream may to reach distant organs. If they travel
through the lymph system, the cancer cells may end up in lymph nodes.
Either way, most of the escaped cancer cells die or are killed before they can
start growing somewhere else. But one or two might settle in a new area,
begin to grow, and form new tumors. This spread of cancer to a new part of
the body is called metastasis.
HOW DOES CANCER SPREAD?

• Cells that make up a metastasis are the same type of cells as in the primary
cancer. They are not a new type of cancer. For instance, breast cancer cells
that spread to the lungs are still breast cancer and NOT lung cancer. And
colon cancer cells that spread to the liver are still colon cancer.

• In order for cancer cells to spread to new parts of the body, they have to go
through several changes. They first have to become able to break away from
the original tumor and then attach to the outside wall of a lymph vessel or
blood vessel. Then they must move through the vessel wall to flow with the
blood or lymph to a new organ or lymph node.
 WHAT ARE THE DIFFERENT TYPES OF BREAST
CANCER?

Breast cancer can be categorized by whether it is non-invasive or invasive:

• Non-invasive breast cancer (in situ)

Ductal carcinoma in situ (DCIS) is a pre-malignant lesion – it is not yet cancer, but
can progress to become an invasive form of breast cancer. In this type of cancer, the cancer
cells are in the ducts of the breast but have not spread into the healthy breast tissue.
Lobular neoplasia (previously called lobular carcinoma in situ) is when there are changes in
the cells lining the lobules, which indicate that there is an increased risk of developing
breast cancer in the future. Lobular neoplasia is not actually breast cancer, and although
women with lobular neoplasia will have regular check-ups, most will not develop breast
cancer.

Note: In situ literally stands for “in place of”, “at the original site of”, “in the
natural position of” or “in the undisturbed shape or orientation of”
• Invasive breast cancer
Invasive breast cancer is the name given to a cancer that has spread outside the
ducts (invasive ductal breast cancer) or lobules (invasive lobular breast cancer). These can
be further classified by their histology; for example, tubular, mucinous, medullary and
papillary breast tumors are rarer subtypes of breast cancer.
Breast cancer is also categorized by how advanced the disease is:

Early breast cancer

Breast cancer is described as early if the tumor has not spread beyond the breast or axillary
lymph nodes (also known as Stage 0 IIA breast cancer). These cancers are usually operable and the
primary treatment is often surgery to remove the cancer, although many patients also have preoperative
neoadjuvant systemic therapy.

Locally-advanced breast cancer

Breast cancer is locally-advanced if it has spread from the breast to nearby tissue or lymph
nodes (Stage IIB III). In the vast majority of patients, treatment for locally-advanced breast cancer starts
with systemic therapies. Depending on how far the cancer has spread, locally-advanced tumors may be
either operable or inoperable (in which case surgery may still be performed if the tumor shrinks after
systemic treatment).
Metastatic breast cancer
Breast cancer is described as metastatic when it has spread to other parts of the body, such as
the bones, liver or lungs (also called Stage IV). Tumors at distant sites are called metastases. Metastatic
breast cancer is not curable but is treatable.

Advanced breast cancer

Advanced breast cancer is a term used to describe both locally-advanced inoperable breast
cancer and metastatic breast cancer.
ETIOLOGY
Discussant: John Paul Nuyda
CAUSES

• The actual cause of breast cancer is not known, but there are some factors that increase the
risk of developing breast cancer.
• Doctors know that breast cancer occurs when some breast cells begin to grow abnormally.
These cells divide more rapidly than healthy cells do and continue to accumulate, forming a
lump or mass. Cells may spread (metastasize) through your breast to your lymph nodes or to
other parts of your body.
• Breast cancer most often begins with cells in the milk-producing ducts (invasive ductal
carcinoma). Breast cancer may also begin in the glandular tissue called lobules (invasive
lobular carcinoma) or in other cells or tissue within the breast.
• Researchers have identified hormonal, lifestyle and environmental factors that may increase
your risk of breast cancer. But it's not clear why some people who have no risk factors
develop cancer, yet other people with risk factors never do. It's likely that breast cancer is
caused by a complex interaction of your genetic makeup and your environment.
INHERITED BREAST CANCER

• Doctors estimate that about 5 to 10 percent of breast cancers are linked to gene mutations
passed through generations of a family.
• A number of inherited mutated genes that can increase the likelihood of breast cancer have
been identified. The most well-known are breast cancer gene 1 (BRCA1) and breast cancer
gene 2 (BRCA2), both of which significantly increase the risk of both breast and ovarian
cancer.
• If you have a strong family history of breast cancer or other cancers, your doctor may
recommend a blood test to help identify specific mutations in BRCA or other genes that are
being passed through your family.
• Consider asking your doctor for a referral to a genetic counselor, who can review your
family health history. A genetic counselor can also discuss the benefits, risks and limitations
of genetic testing to assist you with shared decision-making.
RISK FACTORS

A breast cancer risk factor is anything that makes it more likely you'll get breast cancer. But
having one or even several breast cancer risk factors doesn't necessarily mean you'll develop
breast cancer. Many women who develop breast cancer have no known risk factors other than
simply being women.

Factors that are associated with an increased risk of breast cancer include:
• Being female - Women are much more likely than men are to develop breast cancer.
• Increasing age - Your risk of breast cancer increases as you age.
• A personal history of breast conditions - If you've had a breast biopsy that found lobular
carcinoma in situ (LCIS) or atypical hyperplasia of the breast, you have an increased risk of
breast cancer.
• A personal history of breast cancer - If you've had breast cancer in one breast, you have an
increased risk of developing cancer in the other breast.
• A family history of breast cancer - If your mother, sister or daughter was diagnosed with
breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the
majority of people diagnosed with breast cancer have no family history of the disease.
• Inherited genes that increase cancer risk - Certain gene mutations that increase the risk of
breast cancer can be passed from parents to children. The most well-known gene mutations
are referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast
cancer and other cancers, but they don't make cancer inevitable.
• Radiation exposure - If you received radiation treatments to your chest as a child or young
adult, your risk of breast cancer is increased.
• Obesity - Being obese increases your risk of breast cancer.
• Beginning your period at a younger age - Beginning your period before age 12 increases
your risk of breast cancer.
• Beginning menopause at an older age - If you began menopause at an older age, you're more
likely to develop breast cancer.
• Having your first child at an older age - Women who give birth to their first child after age
30 may have an increased risk of breast cancer.
• Having never been pregnant - Women who have never been pregnant have a greater risk of
breast cancer than do women who have had one or more pregnancies.
• Postmenopausal hormone therapy - Women who take hormone therapy medications that
combine estrogen and progesterone to treat the signs and symptoms of menopause have an
increased risk of breast cancer. The risk of breast cancer decreases when women stop taking
these medications.
• Drinking alcohol - Drinking alcohol increases the risk of breast cancer.
FACTORS NOT LINKED TO BREAST CANCER

• Antiperspirant
• Bras
• Induced Abortion
• Breast Implants
SIGNS AND SYMPTOMS
Discussant: Vhie Ann D. Ermino
 SIGNS VS. SYMPTOMS

• Sign is an objective, observable phenomenon that can be identified by another person.

• Symptom is a subjective experience that cannot be identified by anyone else.
A visual guide to early signs and symptoms of breast cancer
 EARLY WARNING SIGNS AND SYMPTOMS OF
BREAST CANCER

A painless lump in the breast is usually the first sign of breast cancer,
though you may not feel it yourself. Instead, many lumps are detected by a
routine screening mammogram. In fact, at the time of diagnosis, most
women don’t have any apparent signs of breast cancer. When the tumor is
small in the early stages of breast cancer, it’s rarely noticeable to the touch or
the naked eye. That’s why mammograms play an important role.
Symptoms of breast tumors vary from person to person. Some common, early warning signs
of breast cancer include:

• Skin changes, such as swelling, redness, or other visible differences in one or both breasts
• An increase in size or change in shape of the breast(s)
• Changes in the appearance of one or both nipples
• Nipple discharge other than breast milk
• General pain in/on any part of the breast
• Lumps or nodes felt on or inside of the breast
 EARLY WARNING SIGNS OF
INVASIVE BREAST CANCER

Symptoms more specific to invasive breast cancer are:

• Irritated or itchy breasts

• Change in breast color
• Increase in breast size or shape (over a short period of time)
• Changes in touch (may feel hard, tender or warm)
• Peeling or flaking of the nipple skin
• A breast lump or thickening
• Redness or pitting of the breast skin (like the skin of an orange)
• It's important to remember that other, benign conditions may have caused these changes.
For example, changes to the skin texture on the breast may be caused by a skin condition
like eczema, and swollen lymph nodes may be caused by an infection in the breast or
another, unrelated illness. Seeing a doctor for an evaluation will help you determine
whether something you notice is cause for concern.
 NON-INVASIVE BREAST CANCER SYMPTOMS

• Non-invasive breast cancer is sometimes called stage 0 cancer. It is an early stage of breast cancer,
meaning the tumor is often very small. Given that the primary symptom of breast cancer is an
abnormal lump in the breast and non-invasive breast cancer usually comes with a tumor that’s so
small it’s only detectable by a mammogram, non-invasive breast cancer is unlikely to cause
noticeable physical symptoms.
Ductal carcinoma in situ symptoms
Ductal carcinoma in situ (DCIS) does not cause any symptoms. Rarely, a woman may feel a
lump in the breast or have nipple discharge. However, most cases of DCIS are detected with a
mammogram.

Lobular carcinoma in situ symptoms

Lobular carcinoma in situ (LCIS) does not cause symptoms and cannot be seen with a
mammogram. This condition is usually found when a doctor is doing a breast biopsy for another reason,
such as to investigate an unrelated breast lump. If a person has LCIS, the breast cells will appear
abnormal under a microscope.
 INVASIVE BREAST CANCER SYMPTOMS

• Most breast cancers start in the ducts, or the tubes that carry milk to the nipple, or in the
lobules, the little clusters of sacs where breast milk is made. Invasive breast cancer refers
to breast cancer that spreads from the original site to other areas of the breast, the lymph
nodes or elsewhere in the body. In these cancers that form in the ducts or lobules, invasive
ductal carcinoma (IDC) or invasive lobular carcinoma (ILC), the cancer spreads from the
ducts or lobules to other tissue. Depending on the stage, you may notice symptoms.
INVASIVE BREAST CANCER

Distant (A) and closer (B)

lateral view of the left breast
in a woman with invasive
ductal left breast carcinoma
Invasive breast cancer symptoms may include:

• A lump or mass in the breast

• Swelling of all or part of the breast, even if no lump is felt
• Skin irritation or dimpling
• Breast or nipple pain
• Nipple retraction (turning inward)
• The nipple or breast skin appears red, scaly, or thickened
• Nipple discharge
• A lump or swelling in the underarm lymph nodes
 INFLAMMATORY BREAST CANCER SYMPTOMS

Unlike other breast cancers, inflammatory breast cancer (IBC) rarely causes breast lumps and
may not appear on a mammogram. Inflammatory breast cancer symptoms include:

• Red, swollen, itchy breast that is tender to the touch

• The surface of the breast may take on a ridged or pitted appearance, similar to an orange peel (often
called peau d’orange)
• Heaviness, burning, or aching in one breast
• One breast is visibly larger than the other
• Inverted nipple (facing inward)
• No mass is felt with a breast self-exam
• Swollen lymph nodes under the arm and/or above the collarbone
• Symptoms unresolved after a course of antibiotics
 INFLAMMATORY BREAST CANCER

Classic clinical features of inflammatory breast cancer. (A) Erythema, edema (B)
Enlargement of the breast.
• Unlike other breast cancers, inflammatory breast cancer usually does not
cause a distinct lump in the breast. Therefore, a breast self-exam, clinical
breast exam, or even a mammogram may not detect inflammatory breast
cancer. Ultrasounds may also miss inflammatory breast cancer. However, the
changes to the surface of the breast caused by inflammatory breast cancer
can be seen with the naked eye.

• Symptoms of inflammatory breast cancer can develop rapidly, and the

disease can progress quickly. Any sudden changes in the texture or
appearance of the breast should be reported to your doctor immediately.
• For women who are pregnant or breast-feeding, redness, swelling, itchiness
and soreness are often signs of a breast infection such as mastitis, which is
treatable with antibiotics. If you are not pregnant or nursing and you develop
these symptoms, your doctor should test for inflammatory breast cancer.

• Because of the aggressive nature of IBC, CTCA knows it’s critical to detect
and diagnose the disease quickly, develop a comprehensive treatment plan
and provide integrative care services that help improve patients’ treatment
outcomes and reduce their side effects.
 METASTATIC BREAST CANCER SYMPTOMS

Metastatic breast cancer symptoms depend on the part of the body to which the cancer has
spread and its stage. Sometimes, metastatic disease may not cause any symptoms.

• If the breast or chest wall is affected, symptoms may include pain, nipple discharge, or a
lump or thickening in the breast or underarm.
• If the bones are affected, symptoms may include pain, fractures, constipation or decreased
alertness due to high calcium levels.
• If tumors form in the lungs, symptoms may include shortness of breath or difficulty
breathing, coughing, chest wall pain or extreme fatigue.
 METASTATIC BREAST CANCER SYMPTOMS

• If the liver is affected, symptoms may include nausea, extreme fatigue,

increased abdominal girth, swelling of the feet and hands due to fluid
collection and yellowing or itchy skin.

• If breast cancer spreads to the brain or spinal cord and forms tumors,
symptoms may include pain, confusion, memory loss, headache, blurred or
double vision, difficulty with speech, difficulty with movement or seizures.
 PAPILLARY CARCINOMA SYMPTOMS

Although papillary carcinoma may not be present, a routine mammogram may detect its
development. For those who do experience symptoms related to this type of cancer, the
following may be common:

• Mass: Papillary carcinoma is most often detected as a cyst or lump of about 2 cm to 3 cm

in size that may be felt with the hand during a breast self-exam.
• Nipple discharge: About 50 percent of papillary carcinomas occur beneath the nipple,
resulting in bloody nipple discharge.
 SYMPTOMS OF ANGIOSARCOMA OF THE BREAST

• Another rare form of breast cancer, angiosarcoma forms inside the lymph and blood
vessels. Only a biopsy may definitively diagnose this type of cancer. Angiosarcoma can
cause changes to the skin of your breast, such as the development of purple-colored nodules
that resemble a bruise.
• These nodules, if bumped or scratched, may bleed. Over time, these discolored areas may
expand, making your skin appear swollen in that area. You may or may not have breast
lumps with angiosarcoma. If you also have lymphedema, which is swelling caused by a
buildup of lymphatic fluid, angiosarcoma may occur in the affected arm. Cancer treatment
sometimes damages the lymph vessels, which may lead to lymphedema.
ANGIOSARCOMA OF THE BREAST
 PHYLLODES TUMOR SYMPTOMS

Most phyllodes tumors are benign, but one in four is considered cancerous,
according to the ACS (American Cancer Society). This rare type of cancer is found in the
connective tissues of the breast. Most patients don’t experience pain, although they may
have a lump. Phyllodes tumors may grow fast but, fortunately, they don’t typically spread to
other areas of the body. Because these tumors may grow quickly, causing the skin to stretch,
they need to be surgically removed. If a tumor is cancerous, your care team may recommend
that you undergo a mastectomy to prevent it from growing back, especially if the tumor
wasn’t completely removed during the initial surgery.
PHYLLODES TUMOR
 MALE BREAST CANCER SYMPTOMS

Male breast cancer symptoms can be similar to those experienced by women and may
include:

• Lumps in the breast, usually painless

• Thickening of the breast
• Changes to the nipple or breast skin, such as dimpling, puckering or redness
• Discharge of fluid from the nipples
MALE BREAST CANCER
PATHOPHYSIOLOGY
Discussants:
Christine Mae A. Agao & Carmela Joy L. Abril
 HOW DOES CANCER SPREAD BEYOND THE
BREAST?

Breast cancer can invade through nearby tissue, or spread through the body via the
lymphatic system and blood.
 Tissue: the cancer spreads from the original site and grows into nearby areas (often
referred to as “invasive”).
 Lymphatic system: breast cancer cells break away from the original site and can enter
nearby lymph tubes (vessels), grow in nearby lymph nodes or travel through lymph
vessels to other parts of the body.
 Blood: breast cancer cells break away from the original site and can enter and travel
through nearby blood vessels to other parts of the body.
Metastatic breast cancer may affect almost any organ in the body—most commonly, lungs,
liver, bone, brain, and skin.
 WHERE IS THE FIRST PLACE BREAST CANCER
SPREADS?

• The first place that breast cancer commonly spreads to outside the breast
are the lymph nodes in the armpit (axillary nodes). Surgery is usually
needed to remove one or more lymph nodes to help check for breast cancer
spread. This operation to remove lymph nodes in the armpit is known as
axillary surgery.

• Breast cancer found in the lymph nodes will impact the breast cancer’s
staging, and the treatment plan will often be affected as well.
• If cancer is found in the lymph nodes, there is a higher chance that cells
have travelled through the lymphatic system and bloodstream to spread
(metastasise) to other parts of the body. In this instance, treatment with
systemic therapies, such as chemotherapy, is likely to be recommended.

• If cancer is found in a large number of axillary nodes, radiotherapy may

also be recommended to kill any breast cancer cells that remain in the
armpit but cannot be removed by surgery.

Note: Sometimes, removing lymph nodes can make it hard for

your lymphatic system to drain properly. If this happens,
lymphatic fluid can build up in the area where the lymph nodes
were removed. This extra fluid causes swelling called
lymphedema.
 NORMAL PHYSIOLOGY OF THE HUMAN BREAST

• Prior to sexual maturity, male and female breasts are structurally and functionally similar;
they are both comprised of small immature nipples, fatty and fibrous tissue and several
duct-like arrangements beneath the areola.

• When puberty is underway in males and females, this is where the major structural
development occurs. Male breasts remain unchanged due to the lack of high levels of
estrogen and progesterone. Females, on the other hand, have significant changes occur
due to an assortment of hormones (estrogen, growth hormone, insulin-like growth factor-
1, progesterone, and prolactin) that cause the female breast to develop into a lactating
system.
• The mature female breast’s foundational unit is the lobe (each breast contains 15-20) a system
of ducts which is comprised of and supported by Cooper ligaments. Each lobe is made up of
20-40 lobules (glands that produce milk). The lobules contain alveolar cells, which are
complicated spaces lined with epithelial cells that secrete milk and sub-epithelial cells that
contract, passing milk into the arrangement of ducts that leads to the nipple.
• The lobes and lobules are enclosed and separated by muscle strands and adipose connective
tissue which varies in amount depending on weight, genetics, endocrine factors and
contributes to the diversity of breast size and shape.
• During the reproductive years, breast tissue undergoes cyclic changes in response to hormonal
changes of the menstrual cycle. After menopause, adipose deposits and connective tissue
increases, glandular breast tissue becomes involuted, and breasts are reduced in size and form.
Due to elevated aromatase (decreases circulating estrogen) there can be an increase in white
adipose tissue inflammation.
• The function of the female breast is primarily to provide a source of nourishment for the
newborn; however, breasts are also a source of pleasurable sexual sensation and in Western
cultures have become a sexual symbol.
 PATHOPHYSIOLOGY OF BREAST CANCER

• Most breast cancer occurs in women older than 50 years. The major risk factors for breast
cancer are classified as reproductive, such as nulliparity and pregnancy-associated breast
cancer; familial, such as inherited gene syndromes; and environmental and lifestyle, such
as hormonal factors and radiation exposure. Some examples of known carcinogenic
agents with sufficient evidence in humans that contribute to the development of breast
cancer are alcoholic beverages, diethylstilbestrol, estrogen-progestogen contraceptives,
estrogen-progestogen menopausal therapy, X-radiation and γ-radiation. Other important
factors are delayed involution of the mammary gland and increased breast density.
• Overall, lifetime risk of breast cancer is reduced in parous women compared to nulliparous
women, but pregnancy must occur at a young age. The influence of pregnancy on the risk
of cancer also depends on family history, lactation postpartum, and overall parity. Breast
gland involution after pregnancy and lactation uses some of the same tissue remodeling
pathways activated during wound healing. The presence of macrophages in the involuting
mammary gland contributes to carcinogenesis. Most breast cancers are adenocarcinomas
and first arise from the ductal/lobular epithelium as carcinoma in situ.
• Carcinoma in situ is an early-stage, noninvasive, proliferation of epithelial cells that is
confined to the ducts and lobules, by the basement membrane. About 84% of all in situ
disease is ductal carcinoma in situ (DCIS); the remainder is mostly lobular carcinoma in
situ (LCIS) disease.
• Ductal carcinoma in situ (DCIS) refers to a heterogenous group of proliferative lesions
limited to ducts and lobules without invasion to the basement membrane. DCIS occurs
predominantly in women but can also occur in men. DCIS has a wide spectrum of risk for
invasive cancers. Preinvasive lesions do not invariably progress to invasive malignancy.
• Lobular carcinoma in situ (LCIS)
originates from the terminal duct-
lobular unit. Unlike DCIS, LCIS
has a uniform appearance; thus,
the lobular structure is preserved.
The cells grow in non-cohesive
clusters, typically because of a
loss of the tumor-suppressive
adhesion protein E-cadherin. Also,
unlike DCIS, LCIS is found as an
incidental lesion from a biopsy
and not mammography, is more
likely to be present bilaterally.
• Breast cancer is a heterogeneous disease with diverse, molecular, genetic,
phenotypic, and pathologic changes. Tumor heterogeneity results from the
genetic, epigenetic, and microenvironmental influences (selective pressure)
that tumor cells undergo during cancer progression. Cellular
subpopulations from different sections of the same tumor vary in many
ways including growth rate, immunogenicity, ability to metastasize, and
drug response, demonstrating significant heterogeneity. The biological
attributes of a tumor as a whole are strongly influenced by its
subpopulation of cells with cellular populations communicating through
paracrine or contact-dependent signaling (juxtacrine) from ligands and
mediated from components of the microenvironment such as blood vessels,
immune cells, and fibroblasts.
 HORMONE RECEPTORS

• Estrogen and progesterone receptors, present in some breast cancers, are nuclear hormone
receptors that promote DNA replication and cell division when the appropriate hormones
bind to them. Thus, drugs that block these receptors may be useful in treating tumors with
the receptors. About two thirds of postmenopausal patients with cancer have an estrogen
receptor–positive (ER+) tumor. Incidence of ER+ tumors is lower among premenopausal
patients.

• Another cellular receptor is human epidermal growth factor receptor 2 (HER2; also called
HER2/neu or ErbB2); its presence correlates with a poorer prognosis at any given stage of
cancer. In about 20% of patients with breast cancer, HER2 receptors are overexpressed.
Drugs that block these receptors are part of standard treatment for these patients.
 BREAST CANCER GENES

• BRCA1 and BRCA2 gene mutations increase the risk of developing breast cancer to 70% .
Prophylactic bilateral mastectomy reduces the risk of breast cancer by 90% and should be
offered to women with a BRCA mutation. Other genetic mutations that increase the risk of
developing breast cancer include mutations in CHEK2, PALB2, ATM, RAD51C, RAD51D,
BARD1, and TP53, which are usually included in panel genetic testing.

Note: The genes most commonly affected in hereditary breast

and ovarian cancer are the breast cancer 1 (BRCA1) and breast
cancer 2 (BRCA2) genes. About 3% of breast cancers (about
7,500 women per year) and 10% of ovarian cancers (about
2,000 women per year) result from inherited mutations in the
BRCA1 and BRCA2 genes.
 Histological special types of
breast cancer preferentially oestrogen
receptor positive.

(A) Tubular carcinoma,

(B) cribriform carcinoma,
(C) classic invasive lobular carcinoma,
(D) pleomorphic invasive lobular
carcinoma,
(E) mucinous carcinoma,
(F) neuroendocrine carcinoma,
(G) micropapillary carcinoma,
(H) papillary carcinoma,
(I) low grade invasive ductal carcinoma
with osteoclast-like giant cells.

(Weigelt, Geyer, & Reis-Filho, 2010)

 Histological special types of
breast cancer preferentially oestrogen
receptor negative.

(A) Adenoid cystic carcinoma,

(B) secretory carcinoma,
(C) acinic-cell carcinoma,
(D) apocrine carcinoma,
(E) medullary carcinoma,
(F) metaplastic carcinoma with
heterologous elements,
(G) metaplastic carcinoma with
squamous metaplasia,
(H) metaplastic spindle cell carcinoma,
(I) metaplastic matrix-producing
carcinoma.

(Weigelt, Geyer, & Reis-Filho, 2010)

• Gene expression profiling studies have identified major subtypes classified as luminal A,
luminal B, HER2+, basal-like, Claudin-low, and normal breast. These subtypes have
different prognoses and responses to therapy. Tumors can be stratified with gene expression
profiles such as Oncotype Dx, Prosigna, and MammaPrint on the basis of genetic profiles.
This information helps personalize breast cancer treatment and determine which women
need aggressive systemic treatment for high-risk cancers versus close surveillance for
indolent tumors.

Many models of breast carcinogenesis have been suggested and the expanding themes
include:
1) gene addiction,
2) phenotype plasticity,
3) cancer stem cells,
4) hormonal outcomes affecting cell turnover of mammary epithelium, stem cells,
extracellular matrix, and immune function.
• Cancer gene addiction includes oncogene addiction, whereby these driver genes play key
roles in breast cancer development and progression. In non-oncogene addiction, these
genes may not initiate cancer but play roles in cancer development and progression.
Examples of key driver genes include HER2 and MYC, and examples of tumor-suppressor
genes include TP53, BRCA1, and BRCA2. Once a founding tumor clone is established,
genomic instability may assist through the establishment of other subclones and contribute
to both tumor progression and therapy resistance.

• Phenotypic plasticity is exemplified by a distinctive phenotype called epithelial-to-

mesenchymal transition (EMT). EMT is involved in the generation of tissues and organs
during embryogenesis, is essential for driving tissue plasticity during development, and is
hijacked during cancer progression. The EMT-associated programming is involved in many
cancer cell characteristics, including suppression of cell death or apoptosis and senescence.
It is reactivated during wound healing and is resistant to chemotherapy and radiation
therapy.
• Remodeling or reprogramming of the breast during post-pregnancy involution is
important because it involves inflammatory and “wound healing-like” tissue
reactions known as reactive stroma or inflammatory stroma.
• The reactive stroma releases various signals and interleukins that affect nearby
carcinoma cells, inducing these cells to activate their previously silent EMT
programs. The activation is typically reversible (i.e., plasticity), and those EMT
programs may revert through mesenchymal-epithelial (MET) to the previous
phenotypic state before the induction of the EMT program.
• Reactive stroma increases the risk for tumor invasion and may facilitate the
transition of carcinoma in situ to invasive carcinoma. Activation of an EMT
program during cancer development often requires signaling between cancer cells
and neighboring stromal cells. In advanced primary carcinomas, cancer cells
recruit a variety of cell types into the surrounding stroma. Overall, increasing
evidence suggests that interactions of cancer cells with adjacent tumor-associated
stromal cells induce malignant phenotypes.
• Using a mouse model of tumor heterogeneity, investigators demonstrated different clones
within the heterogeneous population had distinct properties, such as the ability to dominate
the primary tumor, or to contribute to metastatic populations, or to enter the lymphatic or
vascular systems via vascular mimicry.
• Invasion by primary tumor cells typically involves the collective migration of large
cohesive groups into adjacent tissue rather than the scattering of individual
carcinoma cells. However, still unknown are the precise events occurring at the
invasive stage. Dormant carcinoma cells called minimal residual disease (MRD)
appear to perpetuate carcinogenesis and form the precursors of eventual metastatic
relapse and, sometimes, rapid cancer recurrence. Dormant cells have exited the cell
cycle and are not proliferating. Thus current treatments that preferentially kill
proliferating cells render dormant cells intrinsically more resistant and may remain
after initial chemotherapy, radiotherapy, and surgery.
• Emerging evidence supports three main prerequisites that must be met for
metastatic colonization to succeed: the capacity to seed and maintain a population
of tumor-initiating stem cells; the ability to create adaptive, organ-specific
colonization programs; and the development of a supportive microenvironmental
niche. Metastases may also occur early in the process of neoplastic transformation.
• Extracellular matrix (ECM) changes in breast cancer progression and metastasis. The primary
components of the ECM in normal mammary gland are significantly changed in breast cancer. A
desmoplastic reaction is associated with breast cancer development, due to the increased
production of fibrous ECM by activated fibroblasts and cancer cells. The increased collagen
deposition and crosslinking by lysyl oxidase (LOX) enzymes, together with the increased
production of fibronectin and other ECM components, stiffens the ECM, which in turn promotes
tumor aggressiveness.
• The basement membrane surrounding the mammary gland epithelium is broken down by ECM
remodeling enzymes like MMPs, heparanase and others. Matricellular proteins that promote
cancer cell fitness such as tenascin C, periostin, osteopontin, SPARC and thrombospondin-1 are
also upregulated. Breast cancer cells from the primary tumor, that include cells with the ability to
establish metastatic colonies, enter the blood circulation, disseminate and can reach distant sites.
While the vast majority of disseminated cancer cells are eliminated or undergo dormancy due to
the adverse environment, few cancer cells are able to resist the selective pressure and establish a
metastatic colony. These cells may rely on signals from the ECM such as type I collagen (collagen
I), crosslinked by LOX. Tenascin C (TNC) and periostin (POSTN), which are crucial ECM
proteins of the metastatic niche, promote stem/progenitor pathways and metastatic fitness in
disseminated breast cancer cells.
• The first clinical manifestation of breast cancer is usually a small, painless lump in the
breast. Other manifestations include palpable lymph nodes in the axillae, dimpling of the
skin, nipple and skin retraction, nipple discharge, ulcerations, reddened skin, and bone pain
associated with bony metastases.

• Treatment is based on the extent or stage of the cancer and includes surgery, radiation,
chemotherapy, hormone therapy, and biologic therapy.
DIAGNOSTIC EVALUATION
Discussant: Vanessa June L. Bermas
DIAGNOSING BREAST CANCER

Tests and procedures used to diagnose breast cancer include:

• Breast exam. Your doctor will check both of your breasts and lymph nodes in your armpit,
feeling for any lumps or other abnormalities.
• Mammogram. A mammogram is an X-ray of the breast. Mammograms are commonly
used to screen for breast cancer. If an abnormality is detected on a screening
mammogram, your doctor may recommend a diagnostic mammogram to further evaluate
that abnormality.
• Breast ultrasound. Ultrasound uses sound waves to produce images of structures deep
within the body. Ultrasound may be used to determine whether a new breast lump is a
solid mass or a fluid-filled cyst.
• Removing a sample of breast cells for testing (biopsy). A biopsy is the only definitive
way to make a diagnosis of breast cancer. During a biopsy, your doctor uses a
specialized needle device guided by X-ray or another imaging test to extract a core of
tissue from the suspicious area. Often, a small metal marker is left at the site within your
breast so the area can be easily identified on future imaging tests.
• Biopsy samples are sent to a laboratory for analysis where experts determine whether
the cells are cancerous. A biopsy sample is also analyzed to determine the type of cells
involved in the breast cancer, the aggressiveness (grade) of the cancer, and whether the
cancer cells have hormone receptors or other receptors that may influence your
treatment options.
• Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio
waves to create pictures of the interior of your breast. Before a breast MRI, you receive
an injection of dye. Unlike other types of imaging tests, an MRI doesn't use radiation to
create the images.
Core needle biopsy A core needle biopsy uses a long, hollow tube to obtain a sample of
tissue. Here, a biopsy of a suspicious breast lump is being done.
The sample is sent to a lab for testing and evaluation by doctors,
called pathologists. They specialize in analyzing blood and body
tissue.

Breast MRI
Staging Breast Cancer
Once your doctor has diagnosed your breast cancer, he or she works to establish
the extent (stage) of your cancer. Your cancer's stage helps determine your prognosis and
the best treatment options.
Complete information about your cancer's stage may not be available until after
you undergo breast cancer surgery.

Tests and procedures used to stage breast cancer may include:

• Blood tests, such as a complete blood count
• Mammogram of the other breast to look for signs of cancer
• Breast MRI
• Bone scan
• Computerized tomography (CT) scan
• Positron emission tomography (PET) scan
• Not all women will need all of these tests and procedures. Your doctor selects the
appropriate tests based on your specific circumstances and taking into account
new symptoms you may be experiencing.

• Breast cancer stages range from 0 to IV with 0 indicating cancer that is

noninvasive or contained within the milk ducts. Stage IV breast cancer, also
called metastatic breast cancer, indicates cancer that has spread to other areas of
the body.

• Breast cancer staging also takes into account your cancer's grade; the presence of
tumor markers, such as receptors for estrogen, progesterone and HER2; and
proliferation factors.
TREATMENT
Discussant: Micaela Alyza R. Rea
Breast cancer treatment can be highly effective, achieving survival
probabilities of 90% or higher, particularly when the disease is identified
early. (WHO)

The treatments for breast cancer are:

• Surgery
• Chemotherapy
• Hormonal therapy
• Biological therapy
• Radiation therapy
 WHAT IS A BREAST CANCER SURGERY?

• If you have localized breast cancer, your healthcare team will almost always recommend
surgery to remove it. Surgery is considered the primary treatment for breast cancer when
it's technically possible to remove the affected tissue. (It's not an effective treatment for
metastatic breast cancer — when the cancer has already spread to other parts of your
body.)
• Sometimes breast cancer surgery removes an individual tumor from your breast
(lumpectomy), and other times it may be necessary to remove your entire breast
(mastectomy) to remove the cancer. Breast surgery for cancer is primarily a treatment, but
it can also be diagnostic and even cosmetic. Sometimes surgery is exploratory to look for
signs of cancer spreading. Sometimes it involves reconstructing your breast after a
mastectomy.
 WHAT IS A BREAST CANCER SURGERY?

• The type of surgery that your healthcare team recommends for you will
depend on many individual factors, including the type of cancer you have,
how advanced it is, your general health and your personal preferences.
Depending on your condition, surgery may be only a piece of your overall
treatment plan, or it may be the only treatment you need.
 WHAT ARE THE DIFFERENT TYPES OF
SURGERIES FOR BREAST CANCER?

The two types of surgery used to treat breast cancer are mastectomy and
lumpectomy. Additional surgeries for breast cancer may include lymph node
dissection (lymphadenectomy) and breast reconstruction surgery.

1. Mastectomy
Mastectomy, or breast removal surgery, is the most common surgery
for breast cancer. That’s because mastectomy treats both late-stage and
early-stage breast cancers. In addition, some people with a high risk of
developing breast cancer in the future choose prophylactic mastectomy as a
preventative measure.
Types of mastectomy procedures include:

• Total mastectomy: Removal of your entire breast, sparing your chest muscle beneath.
• Double mastectomy: Removal of both breasts. This may be necessary if the cancer has
already spread to both breasts, or it may be a preventative measure.
• Skin-sparing or nipple-sparing mastectomy: Removal of all your breast tissue, but sparing
your skin and, if possible, your nipple, to use to reconstruct your breast.
• Modified radical mastectomy: Removal of your breast tissue and your underarm lymph
nodes. Lymph nodes are often the first place that breast cancer spreads to.
• Radical mastectomy: Removal of your breasts, underarm lymph nodes and chest muscles.
This is a rare surgery, only necessary when breast cancer has infiltrated your chest muscles.
Sample of total mastectomy

Source: https://healthjade.net/mastectomy/
2. Lumpectomy
Lumpectomy, also called breast-conserving surgery, removes only part of your
breast tissue. This is an alternative option for treating earlier-stage breast cancer. When the
tumor is relatively small and hasn’t spread yet, you can have surgery just to remove the
“lump” — the tumor itself. Lumpectomy also removes a margin of the surrounding tissue,
just to make sure there aren’t any stray cancer cells left in your breast.
The benefit of lumpectomy is that it allows you to keep most of your breast. But to
prevent breast cancer from returning, your healthcare provider will most likely recommend
radiation therapy after the surgery. Having a total mastectomy instead is often a way of
avoiding radiation therapy. But for people who have the option, lumpectomy with radiation
therapy has been shown to be equally effective to total mastectomy in treating early-stage
breast cancer.
Source: https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/breast-conserving-surgery-lumpectomy.html
Types of lumpectomy procedures include:

• Excisional biopsy: This is a procedure to remove a tumor for biopsy. Analyzing the tumor
in a lab can help determine if the tumor is cancerous (malignant).
• Wide local excision: Surgery to remove a cancerous tumor and a margin of tissue around it.
The marginal tissue will be tested afterward to make sure it’s cancer-free.
• Quadrantectomy: A segmental mastectomy that removes about a quarter of your breast,
including your duct-lobular system. Recommended when the tumor shows ductal spread.
• Re-excision lumpectomy: A procedure that follows the original excision of the tumor and
the margin of tissue around it. When the marginal tissue tests positive for cancer cells, your
surgeon will reopen the surgical site to remove an additional margin of tissue until the
tissue comes back cancer-free.
Lymph node dissection
Your lymph system is often the first place cancer spreads, and cancer in your lymph
nodes is a warning sign that it may be spreading beyond your breast. To find out, your
surgeon may remove and analyze one or several of the lymph nodes under your arm next to
your affected breast. This is where breast cancer cells would be most likely to drain.

Lymph node procedures include:

• Sentinel lymph node biopsy: This is an investigative procedure to find out if cancer has
spread to your lymph system. The sentinel lymph node is a good indicator because it's the
first node that filters fluid draining away from the affected breast. Your surgeon will often
perform a sentinel node biopsy during the operation to remove the original tumor from your
breast — and sometimes before. They'll remove the sentinel node and analyze it for cancer
cells.
Source:
https://www.cancer.gov/news-events/cancer-currents-blog/2017/b
Reconstructive breast surgery
If you're having some or all of your breast or breasts removed to treat breast cancer,
you may be interested in reconstructive surgery to restore your breast shape. Surgeons can
often rebuild the breast with plastic surgery techniques immediately following your
lumpectomy or mastectomy. They can also perform a separate surgery at a later time, such as
after you've finished radiation therapy or chemotherapy treatment and your tissues have had
time to recover.
Regardless of whether you have immediate or delayed reconstruction surgery, you
may need an additional follow-up surgery to perfect your results. Follow-up surgeries may
adjust the size balance between your breasts, for example, or add a reconstructed nipple.
Breast reconstruction can use a mix of different methods and can happen in stages. You and
your surgeon will determine the right methods and timing based on your condition and
preferences.
Breast reconstruction methods include:

• Implant reconstruction: A breast implant replaces the tissue that was removed from your
breast to restore its shape and volume. The implant is a silicone shell that’s filled with either
saline or silicone gel. The surgeon places it over or under your muscle and covers it with
your skin — either your original breast skin or a skin graft from another part of your body.
• Autologous or “flap” reconstruction: This method takes tissue from another part of your
body to reconstruct your breast. Skin, fat and sometimes muscle from areas such as your
belly or buttocks tend to better resemble breast tissue in look and feel. Sometimes surgeons
use a combination of flap and implant reconstruction for more realistic results.
• Nipple reconstruction: If you had a nipple-sparing mastectomy or lumpectomy, your
surgeon preserved your nipple to use in the reconstruction of your breast. If they weren’t
able to preserve your original nipple, they can construct a new one from a skin graft taken
from another part of your body. This may be done in a follow-up surgery after breast
reconstruction.
SAMPLES OF UNTREATED BREAST CANCER

Figure 1: Patient presenting with

locally advanced (Human Epidermal
Growth factor Receptor 2) HER2
positive breast cancer after two years
of self medication with vegan diet
Figure 2:

This is a case of a 40-

year-old patient with
breast sarcoma. She lives
in a remote area where
access to medical care is
difficult.
Due to negligence and
lack of awareness, she
consulted her doctor very
late.

Source: https://medizzy.com/feed/4336988
 Figure 3:

A neglected case of
advanced breast
cancer. Need more
awareness and
screening program.

Source: https://dzrsurg.wordpress.com/2014/07/22/a-neglected-case-of-
advanced-breast-cancer-need-more-awareness-and-screening-program/
EARLY DETECTION
SAVES LIVES!
THANK
YOU for
listening!
SOURCES

• https://my.clevelandclinic.org/health/diseases/3986-breast-cancer
• https://www.cancer.org/cancer/breast-cancer/about/what-is-breast-cancer.html
• https://www.cancer.gov/about-cancer/causes-prevention/risk
• https://oncologynurse-ce.com/breast-cancer-pathophysiology/
• https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470
• https://www.cancercenter.com/cancer-types/breast-cancer/symptoms
• https://www.healthline.com/health/breast-cancer-dimpling#pictures
• https://u.osu.edu/breastcancercasestudy2019/pathophysiology-description/
• https://www.brisbanebulkbillingdoctor.com.au/news/whats-the-difference-between-signs-and-
symptoms/
SOURCES

• https://www.dana-farber.org/ductal-carcinoma-in-situ-program/
• https://my.clevelandclinic.org/health/treatments/8338-breast-cancer-surgery#:~:text=The
%20two%20types%20of%20surgery,lymphadenectomy)%20and%20breast%20reconstruction
%20surgery.
 Prepared by Group 1

CARMELA JOY ABRIL

VANESSA JUNE L. BERMAS
VHIE ANN D. ERMINO
MICAELA ALYZA R. REA
CHRISTINE MAE A. AGAO
JOHN HARRY L. MARCO
JOHN PAUL NUYDA