Nur352 Breast Cancer Assignment Answers

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Mental Health

Introduction to Breast Cancer

Breast cancer is the condition where the cells of the breast tissue tend to grow abnormally. This type of cancer can be manifested in any part of the breast. The three main parts, a breast tissue comprises of includes, lobules, ducts and connective tissues. The lobules are the glands that are responsible for the production of milk. The ducts are the passages that are in the form of tubules. Their main function is to carry the milk to the nipple region. The connective tissue is made up of fibrous as well as fatty tissues. This tissue is responsible for holding the surrounding tissues together with each other. The commonly observed site for development of breast cancer includes, ducts and lobules. The breast cancer can also spread in the surrounding tissues of breast, through the connecting blood vessels to these parts of the body. This is a common mechanism through which the cancer can be metastasized to the other parts of the body as well. The two of the main categories of breast cancer include, invasive ductal carcinoma and non-invasive ductal carcinoma. The non-invasive ductal carcinoma is also commonly known as the in-situ carcinoma, as it is not of metastatic nature (Plitas, 2016). The invasive ductal carcinoma can however, be further segregated into two main categories, including invasive ductal carcinoma and invasive lobular carcinoma.

The development of breast cancer can happen in both males as well as females. Men can get breast cancer too but they are found to have the reported incidences of the occurrence of the same in comparatively lesser rate. Amongst the women breast cancer is the second commonly occurring type of cancer, leading to death. Skin and lung cancer remains the first and the third most commonly occurring types of cancer in women. Studies have reflected that out of every 8 women, every 1 women is bound to have breast cancer. This is usually observed in the later ages of life, like 55 years or older age (DeSantis, 2017). However, in recent trends women aged as young as 25-30 years as well, have been seen to develop breast cancer.

Apart from being the most common type of cancer to cause deaths in women, this cancer can be easily detected. By proper diagnoses and by detecting for the early signs and symptoms this cancer can be easily detected in its early stages. This makes breast cancer as most treatable as well. Localized breast cancer can be managed very well, with a good success rate observed in the patients. There is also a higher rate of longitivety observed in women, who have been detected early and have been managed in their early stages of breast cancer. The spread of this cancer makes

it more extensive and more difficult to be managed. Studies have reflected that with an improved screening 8 out of every 10 women have been not only treated successfully, but have also have found to have a good survival rate post complete demolition of cancer in the body. Survival rate has been found to be as high as up to 10 years, post complete recovery, from the time of initial diagnosis.

Pathophysiology

Breast cancer can be observed to be affecting all races and sexes as well. Cancerous abnormalities in the breast tissue is mainly observed in two types of tissues, namely, ductal epithelium and lobular epithelium. Most of the cancerous cells arise from lobular glands or the milk producing glands. These cells are malignant in nature. However, the normal benign cancer cells are usually observed to be arising from the ductal epithelium. Sarcoma and lymphomas are not typically associated with breast cancer. However, certain types of benign proliferative as well as non-proliferative cancers can be fatal and might also carry a higher chances of the individual developing a malignant breast cancer. Breast cancer is observed to be invading locally and then spreading through the regional lymph nodes to other parts of the body, through the medium of lymphatic drainage (O'Grady, 2018). There cancerous cells can also spread through blood stream in people suffering from the same.

The common metastatic sites for breast cancer that are usually observed in patient population include, lungs, bones, liver, brain or skin. Scalp is also one of the common site of spread of cancerous growth as it is much nearer to the breast site. Even after the initial diagnosis of breast cancer the patient can be having frequent appearance episodes of reoccurrence of the cancerous growth at multiple sites. This is also observed in patients who have been completely recovered by the same. There is also a hormonal link with the development of the breast cancer. Estrogen and progesterone are the nuclear receptors that are present in people affected by breast cancer (Ruiz, 2017). These nuclear hormones are also responsible for promoting DNA replication and cell division, in cases where the appropriate hormone binds to them.

This is the mechanism of promotion of cancerous cell growth in the body that can be easily transported to various organ sites, by the means of blood stream, lymph nodes or by both. Breast cancer is also observed in patients having a postmenopausal status. They generally are observed to have an estrogen positive status, reflecting that there is a fair chance of the hormone binding with cancer receptor cells and thus, advancing with the development of cancer in the body. Apart from ER receptor there is another cellular receptor that is usually observed in breast cancer patients. This is commonly known as the human epidermal growth receptor or HER2 or HER2neu or ErbB2. This hormone is usually related with poor prognosis of cancer at any given stage. In patients with breast cancer the HER2 receptors are generally seen to be overexpressed and thus reflecting on a cancer positive status (Banin, 2018).

Clinical Manifestation

Usually the breast cancer can be marked by the presence of a lump in the arm pit. However, there are other multiple clinical signs that can be helpful in establishing the presence of breast cancer in the patient. Breast cancer is bound to bring about several changes in the skin tissue around the breast region. In few of the cases a mass can be identified on a mammogram, but these patients might not be having any symptoms on physical examinations. Further diagnostic testing is always required to check for the cancerous or non-cancerous nature. The clinical manifestations can be broadly classified into the following findings:

1. Change in the skin texture- Breast cancer can bring about an inflammation in the skin cells around the best tissue. If and when this swelling progresses, it tends to bring about a change in the skin texture. Some of the commonly observed textural changes include the following:

  • Thickening observed in any of the parts of breast tissue.
  • Skin might be mimic the one being extremely dry or like being sunburned.
  • The skin around the areolar tissue can be observed to be very scaly in nature (Smokovski, 2017).

Along with inflammation, these skin changes can be tagged along with the presence of itching as well. The symptoms might also reflect on a rare breast cancer type known as Paget’s disease. The skin texture is also observed to be changing in rare skin conditions like dermatitis or eczema.

2. Nipple discharge- With a positive status of breast cancer a person might be having a thin or a thick discharge from the nipple. This discharge can be of different color. The most commonly observed color of the discharge include milky white to mild yellow in color. The discharge in rare cases can be of green color or red depicting a presence of bloody discharge. This can be difficult to differentiate with the milking mother, so it is ideal to get oneself checked on a regular basis. Generally the nipple discharges are noncancerous in nature, but it might also be possible to signify cancer in some of the patients. Other underlying reasons for nipple discharge can be attributed to presence of breast infections, side effect of birth control pill, body undergoing certain physiological changes, certain medical conditions, such as thyroid disease.

3. Dimpling- Dimpling of the skin can be due to an inflammatory sign of the breast cancer. It is usually observed in the aggressive stages of breast cancer. Cancer cells can bring about a buildup of lymph fluid in the breast tissue, leading to mimic like pitting edema in the skin. Commonly used terminology for dimpling skins by doctor is “pseudo orange”, as the skin of the breast tissue resembles with the surface of an orange (Santen, 2017).

4. Changes in the lymph nodes- These are responsible for collection of the immune system tissue that is responsible for filtering can capturing the harmful cells. These cells are mainly inclusive of bacteria, virus or any type of cancerous cells. If the cancer cells do not get filtered through the lymph nodes, the first place they might travel to is an underarm lymph nodal region. This will bring about a swelling in the region. This leads in to development of a small and firm swollen lumps that are tender on palpitation. The size of the lymph nodes also tend to change due to any underlying infection of the breast tissue.

5. Pain in the breast or nipple region- Breast cancer can lead to various changes in the breast tissue which are liable to cause pain to a person. This discomfort can also be tagged along with severe discomfort as well as tenderness at particular sites of breast tissue. Generally the nature of the pain is sharp shooting or of a burning sensation (Gadgil, 2017).

6. Inversion of nipple or retraction of the nipple- The changes can be brought about after the cancer has been completely cured. These changes can result in nipple being reversed inwardly or might also look different in terms of its size. Although these changes are often observed during phases of ovulation or during certain phases of menstrual cycle, but should be thoroughly checked for any new advancements.

7. Redness- The skin color of the breast tissue also tends to change in color. The skin tissue can seem to be discolored or bruised in appearance. This skin color change should not be neglected, especially in cases where the patient has not been subjected to any recent trauma. Generally in breast cancer the skin color tends to persist and it does not fades as the infection progresses.

8. Swelling- Breast cancer can lead to the swelling of entire breast area. The assessment of presence of any lump in the body might not be visible after the swelling covers up for majority of the breast tissue. Sometimes, due to unusual breast size, the person might be able to differentiate between the normal breast tissue for having a presence or absence of swelling. Generally with the presence of swelling, the skin might also feel tight so it can be sign to get oneself checked thoroughly.

Diagnostic Testing

There are a series of tests that can be used to detect the possible presence of breast cancer in the patient. This although resurfaces up on first term basis, when the person might come for a physical examination to the physician. These diagnostic tests are very useful in establishing a set diagnosis for the presence, the type of cancer or can also be helpful in the screening for stages of the breast cancer. The diagnostic test mainly include two types of test category, namely, imaging tests and biopsy.

The imaging tests can be useful in getting an inside picture of how body is being impacted by the disease manifestation. The imaging tests are inclusive of the following type:

  • Diagnostic mammography- It is similar to the screening mammography, but it is helpful in taking more pictures of the breast tissue. This is the diagnostic choice in cases where the patient might be having a nipple discharge of might be having a presence of lump in the breast tissue. Diagnostic mammography can be helpful in detecting for any suspicious presence of the same (Henriksen, 2019).
  • Ultrasound- It mainly uses sound waves to create the images of inside of the breast tissue. It is helpful in differentiating between a solid mass or a fluid filled cyst that may or may not be of cancerous origin (Gutierrez, 2019).
  • MRI- Magnetic resonance imaging is useful in producing for detailed images of the breast tissue. It makes use of a dye that is injected in the patient’s body. The dye illuminates the body parts that are present with the cancerous growth cells and thus, the images of the same can be easily captured. This also helps in identifying for the extent of spread of the disease in the breast tissue. This is very useful in risk prevention, especially by making detection in early stages of cancer spread (Vogel, 2017).

Biopsy in the other hand is usually done by removing a small amount of tissue from the breast region and taking that sample for evaluation. This sample is usually examined under a microscope for detecting the presence of growth of cancerous cells. There are multiple types by which this sample can be taken for biopsy. Some of the common form of biopsy include:

  • Fine needle aspiration- This method makes use of a small needle to take out the sample in small amount.
  • Core needle biopsy- This method is used to take out larger sample as compared to fine needle biopsy. This also requires to give the patient a local nerve block in the region from where sample is to be taken to be analyzed.
  • Surgical biopsy- The method is used to remove a larger chunk of muscle mass and usually considered a surgical procedure. It is although not a recommended approach for diagnosing cancer, but it helps in taking a larger sample to be evaluated for the presence and extent of cancer in the body (Heil, 2018).
  • Image guided biopsy- Needle is guided with the help of an ultrasound or an MRI imaging technique. This method also involves placing a small metal clip in the breast region form where the sample is generally withdrawn. Common choices of image guided biopsy includes, fine needle, core needle or vacuum-assisted biopsy. It is also governed by the size of the sample to be taken (Balasubramanian, 2018).
  • Sentinel lymph node biopsy- This method is a way to diagnose the presence of the cancerous cells in the nearby tissues. Sentinel lymph nodes are the closest lymph nodes to the breast tissue, therefore, they are an optimal choice to withdraw sample from, for early detection and prevention of breast cancer.

Associated Complications

A. Surgical Complications-

1. Short-term complication- These can be inclusive of the following:

  • Infection- The person is at a high risk of developing infection post-surgery. This infection can manifest through the incision site in the patient.
  • Post-op complications associated with anesthesia- This can be in the form of development of productive cough, drowsiness, respiratory depression and so on.
  • Seroma- This is mainly characterized by fluid accumulation in the area from where the breast tissue is removed. This can be due to ineffective drainage in the surgical area (Jagsi, 2016).
  • Hematoma- This can be caused due to blood accumulation at the surgical site, generally developed post-surgery.

2. Long term complications- These can be inclusive of the following:

  • Frozen shoulder- The patients following breast cancer surgery tend to have restricted movement in the affected side shoulder. This can be manifested due to pain and restriction caused due to post-surgical scaring of the tissue.
  • Lymphedema- This is caused by restricted flow in the lymph nodes. Generally surgical intervention involves removal of lymph nodes and thus, there is a marked circulation deficit brought about by the absence of lymph nodes. Thus, lymphedema can be observed in such patients after surgical interventions.

B. Chemotherapy Related Complications-

This can be inclusive of the following:

  • Infection- Generally it is observed in the form of febrile neutropenia. Post- chemotherapy the white blood cells count tends to deplete drastically and thus, it can bring about an infection in the body.
  • Peripheral neuropathy- This is manifested by a sensation of pins and needles in the extremities. This can also be observed along with a sense of numbness in hands and feet.
  • Chemo brain- Post receiving chemotherapy the patient might experience a short-term memory loss. They also might have difficulty with multitasking and may suffer from severe attention deficit. The situation is medical termed as the person being in a state of chemo brain (Bear, 2017).
  • Infertility- Periods in women generally tend to cease after receiving chemotherapy. The infertility is a guarantee in especially older women who are at a verge of developing menopause.

C. Complications from Hormone Therapy-

This can be inclusive of the following-

  • Blood clots- Patient might experience the presence of blood clots in lower extremities after getting hormonal therapy.
  • Drug interaction- Some of the common drugs have been observed to counter interact with tamoxifen. These have been noted as adverse signs of drug interaction in individuals who are either currently taking hormone therapy or have taken it before (Wang, 2016).

D. Complications from Radiation Therapy-

This can be inclusive of the following:

  • Infection- Patients can be observed to develop blisters as well as redness after getting radiation therapy. There are also a higher risk of developing infection from post reconstructive surgery.
  • Fibrosis- Radiation therapy tends to bring a change in the texture of the breast tissue leading it to get fibrosis. This can also be observed in terms of capsular contractures as well.
  • Heart disease- Radiation therapy can be damage the structure surrounding heart or heart itself. This can lead to patients developing any combination of heart-related sides effects form radiation. Thus, leading to the development of heart disease in the patient (Brownlee, 2018).

E. Psychological complications- People ongoing cancer treatment are generally kept away from family members due to chances of spread of the radiations. There is a higher rate of depression as well as suicidal ideation observed in these individuals. Extreme fatigue associated with cancer can be stressful for the patient to cope up with the cancer management making it a challenging process (Pouy, 2018).

References for Breast Cancer

F. Banin-Hirata, B. K., de Oliveira, C. E., Losi-Guembarovski, R., Ozawa, P. M., Vitiello, G. A., de Almeida, F. C., ... & Watanabe, M. A. (2018). The prognostic value of regulatory T cells infiltration in HER2-enriched breast cancer microenvironment. International reviews of immunology, 37(3), 144-150.

G. DeSantis, C. E., Ma, J., Goding Sauer, A., Newman, L. A., & Jemal, A. (2017). Breast cancer statistics, 2017, racial disparity in mortality by state. CA: A Cancer Journal for Clinicians, 67(6), 439-448.

H. Gadgil, A., Sauvaget, C., Roy, N., Muwonge, R., Kantharia, S., Chakrabarty, A., ... & Sankaranarayanan, R. (2017). Cancer early detection program based on awareness and clinical breast examination: Interim results from an urban community in Mumbai, India. The Breast, 31, 85-89.

I. Heil, J., Richter, H., Golatta, M., & Sinn, H. P. (2018). Vacuum-Assisted Biopsy to Diagnose a Pathological Complete Response in Breast Cancer Patients After Neoadjuvant Systemic Therapy. Annals of surgery, 268(6), 60-61.

J. Henriksen, E. L., Carlsen, J. F., Vejborg, I. M., Nielsen, M. B., & Lauridsen, C. A. (2019). The efficacy of using computer-aided detection (CAD) for detection of breast cancer in mammography screening: a systematic review. Acta Radiologica, 60(1), 13-18.

K. Inchanalkar, S., Deshpande, N. U., Kasherwal, V., Jayakannan, M., & Balasubramanian, N. (2018). Polymer nanovesicle-mediated delivery of MLN8237 preferentially inhibits Aurora kinase a to target RalA and anchorage-independent growth in breast cancer cells. Molecular pharmaceutics, 15(8), 3046-3059.

L. Jagsi, R., Jiang, J., Momoh, A. O., Alderman, A., Giordano, S. H., Buchholz, T. A., ... & Smith, B. D. (2016). Complications after mastectomy and immediate breast reconstruction for breast cancer: a claims-based analysis. Annals of surgery, 263(2), 219.

M. Michael, J., Crook, J., Morton, D., Batchelar, D., Hilts, M., & Fenster, A. (2017). Reply to: Who Should Bear the Cost of Convenience? A Cost-effectiveness Analysis Comparing External Beam and Brachytherapy Radiotherapy Techniques for Early Stage Breast Cancer. Clinical oncology (Royal College of Radiologists (Great Britain)), 29(6), 392.

N. O'Grady, S., & Morgan, M. P. (2018). Microcalcifications in breast cancer: From pathophysiology to diagnosis and prognosis. Biochimica et Biophysica Acta (BBA)-Reviews on Cancer, 1869(2), 310-320.

O. Picon‐Ruiz, M., Morata‐Tarifa, C., Valle‐Goffin, J. J., Friedman, E. R., & Slingerland, J. M. (2017). Obesity and adverse breast cancer risk and outcome: Mechanistic insights and strategies for intervention. CA: a cancer journal for clinicians, 67(5), 378-397.

P. Plitas, G., Konopacki, C., Wu, K., Bos, P. D., Morrow, M., Putintseva, E. V., ... & Rudensky, A. Y. (2016). Regulatory T cells exhibit distinct features in human breast cancer. Immunity, 45(5), 1122-1134.

Q. Pouy, S., Peikani, F. A., Nourmohammadi, H., Sanei, P., Tarjoman, A., & Borji, M. (2018). Investigating the effect of mindfulness-based training on psychological status and quality of life in patients with breast cancer. Asian Pacific journal of cancer prevention: APJCP, 19(7), 1993.

R. Prat, A., Pascual, T., De Angelis, C., Gutierrez, C., Llombart-Cussac, A., Wang, T., ... & Wolff, A. C. (2020). HER2-enriched subtype and ERBB2 expression in HER2-positive breast cancer treated with dual HER2 blockade. JNCI: Journal of the National Cancer Institute, 112(1), 46-54.

S. Santen, R. J., Stuenkel, C. A., Davis, S. R., Pinkerton, J. V., Gompel, A., & Lumsden, M. A. (2017). Managing menopausal symptoms and associated clinical issues in breast cancer survivors. The Journal of Clinical Endocrinology & Metabolism, 102(10), 3647-3661.

T. Smokovski, I., Risteski, M., Polivka, J., Zubor, P., Konieczka, K., Costigliola, V., & Golubnitschaja, O. (2017). Postmenopausal breast cancer: European challenge and innovative concepts. EPMA Journal, 8(2), 159-169.

U. Tang, Y., Wang, Y., Kiani, M. F., & Wang, B. (2016). Classification, treatment strategy, and associated drug resistance in breast cancer. Clinical breast cancer, 16(5), 335-343.

V. Vogel, W. V., Nestle, U., & Valli, M. C. (2017). PET/MRI in breast cancer. Clinical and Translational Imaging, 5(1), 71-78.

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