tara powerpoint an in depth look at breast cancers

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An In-Depth Look at Breast

CancerTara Sorg, M.H.A., B.S. R.T.(R) (M) (BD)

[email protected]

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• Identify breast cancers diagnosed among women in the U.S.

• Demonstrate the diagnostic imaging appearance of breast cancers

• Diagnosis, prognosis and treatment of breast cancers

ObjectivesAn In-Depth Look at Breast Cancer

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Breast cancer can be classified in many ways. Microscopic evidence can tell us what type of breast cancer we are dealing with and how aggressive the cancer is.

• Epithelial cells line the organs and tissues of the breast. This is where a majority of BrCA’s develop.

• Adenocarcinoma is a carcinoma that begins in the glandular tissue.• BrCA’s can occur in the cells contained within muscle, fat or connective

tissue.• Cancerous tumors can be a combination of invasive and in situ cancer

(BrCA’s do not always present as a tumor).• BrCA’s can be classified based on proteins of the cancer cells; hormone

receptors or triple-negative.

Classifying Breast Cancer

An In-Depth Look at Breast Cancer

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• A person’s genetic make-up is what directs the body’s proteins within a cell to stay healthy and function correctly. Proteins are influenced by those genes and directs their response to change or treatment.

• Cancer cells from a tissue sample can be tested to see which genes are normal or abnormal. The proteins they make can also be tested.

How genes affect the behavior of breast cancer


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High grade vs low grade cancer (Histology)


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• There may be an element found by researchers from the University of California, helping to explain why some cancers spread faster than others.

• A protein has been identified that seems to act like a switch responsible for regulating the metastasis of cancer from the primary tumor to other areas of the body.

• This protein is used by embryo cells during early development and disappears from the body after birth.

• According to researchers, this protein was only found in people with metastatic cancer.

• It’s believed that regulation of this protein could potentially stop the dangerous progression of this fatal disease.

Our body’s proteins and the affects of BrCA


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“The protein seems to get turned off (after embryonic development), and we’ve only identified a small sub-population of cells that can turn it on,” lead investigator, Dr. Thomas Kipps, Evelyn and Edwin Tasch Chair in Cancer Research at UC San Diego, told FoxNews.com. “By and large, we looked at the brain, lungs, heart, kidney and other organs, and it wasn’t there. Then we looked at a variety of cancers – breast, ovarian, prostate – and it seems to be a common theme to express this embryonic protein.”

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• A woman’s lifetime risk of developing breast cancer is greatly increased if she inherits a harmful mutation in BRCA1 or BRCA2.

• Approx. 12% of women in the general pop. will develop breast cancer sometime during their lives.

• According to the most recent estimates, 55-65% of women who inherit a harmful BRCA1 mutation and around 45% of women who inherit a harmful BRCA2 mutation, will develop breast cancer by age 70.

How much does having a BRCA1 or BRCA2 gene mutation increase a woman’s risk of breast cancer?


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Grading of Breast CancerThe grade of a breast cancer is representative of how “aggressive” the tumor’s potential is.

-For example: A “low-grade” cancer is less aggressive than “high-grade” cancers. Determining the grade is important to healthcare providers as they use this information to guide the patient’s treatment options.-There are different “scoring systems” available for determining the grade. Scoring systems consider three factors:

1. Glandular formation- How well the tumor cells attempt to recreate normal glands2. Nuclear features- “Pleomorphism” or how ugly the tumor cells look3. Mitoses- Rate of cellular division


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Grading Scores


Total Feature Score Tumor Grade Cellular Appearance

3-5 Grade 1 Tumor Well-differentiated (appear normal, growing slowly, non-aggressive)

6-7 Grade 2 Tumor Moderately-differentiated (semi-normal, growing moderately fast)

8-9 Grade 3 Tumor Poorly-differentiated (abnormal, growing quickly, aggressive)

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BIRADS System

The BIRADS system is a tool that is used to assess a patient’s risk of developing breast cancer. This is rated from zero to six, zero being incomplete and in need of further imaging and six being a known malignancy. The BIRADS system takes into account the patient’s breast density and risk factors.


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1. IDC2. DCIS3. Inflammatory BrCA4. Triple-Negative BrCA5. Paget’s Disease

Identifying the following:


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The most common type of breast cancer among both males and females is invasive ductal carcinoma.Ductal carcinoma refers to cancers that develop within origins of the ducts (tubular structures). Infiltrating (invasive) means the cancer cells have spread beyond the ducts into the surrounding tissue. Approx. 80% of all breast cancers are invasive ductal carcinomas.

IDC- Invasive Ductal Carcinoma

Invasive Ductal Carcinoma (IDC)

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IDC- Signs and Symptoms


• IDC does not always present with symptoms; an abnormal mammogram may find it first

• Palpable lump felt by patient or provider• Swelling of entire breast or single quadrant• Skin irritation, redness, thickening or dimpling• Discharge• Axillary lump• Breast pain

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• 70 y/o patient• Bilateral yearly screening mammogram• Small focal asymmetry in the posterior breast slightly

medial to the plane of the nipple• 1 cm in size• Well-defined abnormality is not seen on MLO view• Focal compression views and ultrasound recommended

IDC Case Study


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IDC Case StudyAn In-Depth Look at Breast Cancer

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IDC Case Study


• Left 3D focal compression views were performed• Images confirmed a subtle mass was present at

12:00• Measures 1.0 x 1.5 x 1.2 cm• Ultrasound was performed to follow focal views• U/S concordant with mammographic findings• BIRADS 5- highly suggestive of malignancy• US guided breast biopsy recommended

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IDC Case StudyAn In-Depth Look at Breast Cancer

Patient underwent U/S guided biopsy. Findings came back as Invasive Ductal Carcinoma. Patient was referred to oncology.

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• Most common type of non-invasive breast cancer• Ductal means that the cancer starts inside the milk ducts, carcinoma refers to

any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs

• In situ means "in its original place" • DCIS is called "non-invasive" because it hasn’t spread beyond the milk duct

into any surrounding breast tissue• DCIS isn’t life-threatening, but having DCIS can increase the risk of developing

an invasive breast cancer later • There’s a greater risk for reoccurrence or developing a new BrCA or for

developing a new breast cancer than a person who has never had breast cancer before

• Most recurrences happen within the 5-10 years after initial diagnosis• The chances of a recurrence are under 30%

DCISAn In-Depth Look at Breast Cancer

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• DCIS generally has no signs or symptoms• Few patients may feel a lump or experience

nipple discharge• According to the National Cancer Institute,

approx. 80% of DCIS cases are found by mammography

DCIS- Signs and Symptoms


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• 71 y/o • Calcifications found on

screening mammogram• Upper outer middle

depth of left breast• Spot magnification views

recommended

DCIS Case StudyAn In-Depth Look at Breast Cancer

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MAG VIEWSDCIS Case StudyAn In-Depth Look at Breast Cancer

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• Magnification views demonstrate a group of pleomorphic microcalcifications in the upper outer middle depth left breast

• Extend anterolateral over 2 cm• Biopsy is recommended• Options include stereotactic core biopsy and surgical

excisional biopsy• Results discussed with the patient

DCIS Case Study


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• Patient underwent stereotactic core biopsy• Specimen positive for DCIS• Patient referred to oncologist and surgeon for

follow-up• Lumpectomy recommended• Clean margins

DCIS FindingsAn In-Depth Look at Breast Cancer

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• Rare and aggressive form of breast cancer• According to the National Cancer Institute, about 1-5% of all breast cancer cases in the

United States are inflammatory breast cancers• Capable of growing and spreading quickly; symptoms worsening within days or hours• Immediate treatment is recommended• Inflammatory breast cancer is either stage III or IV at diagnosis, dependent on

metastasis to surrounding tissue and/or lymph nodes

*The average age at diagnosis for inflammatory breast cancer in the United States is 57 for white women and 52 for African American women; 5 years younger than the average diagnosis ages for other forms of breast cancer. According to the American Cancer Society, inflammatory breast cancer is more common in African American women. A 2008 study found that being overweight makes a person more likely to develop IBC. Like other forms of breast cancer, IBC can also affect men.

*breastcancer.org

Inflammatory Breast Cancer (IBC)


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• Reddening• Swelling• Skin thickening• Does not present as a lump• Orange-peel appearance• Breast feels “hot”• Flattening or nipple inversion• Lymph node swelling• Aching• Burning sensation

IBC- Signs and SymptomsAn In-Depth Look at Breast Cancer

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• 40 y/o• Baseline exam• Presents with right lump x 4-5 months• Orange-peel appearance x 4-5 months (peau d'orange)• Bilateral mammogram accomplished, including a right

ML• Ultrasound f/u recommended

IBC Case Study


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IBC Case StudyAn In-Depth Look at Breast Cancer

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IBC Case StudyAn In-Depth Look at Breast Cancer

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• Mammogram demonstrates a 5 x 3 cm spiculated mass

• Ultrasound demonstrates a 6 cm abnormality in the 12:00 position

• This area appears to extend to the skin’s surface• Ultrasound core needle biopsy is recommended• No suspicious lymph nodes found

IBC Case Study


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• The three most common types of receptors known to fuel most breast cancer growth–estrogen, progesterone, and the HER-2/neu gene– are not present in the cancer tumor. This means that the breast cancer cells have tested negative for hormone epidermal growth factor receptor 2 (HER-2), estrogen receptors (ER), and progesterone receptors (PR)

• Due to this, common treatments for BrCA such as hormone therapy and drugs that target estrogen, progesterone, and HER-2 are not an option

• Chemo can be used to treat triple negative breast cancer (may respond better to chemo in the earlier stages than many other forms of cancer).

Triple-Negative BrCA


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• TNBC tends to be more aggressive that other BrCA’s. Studies show this type is more likely to metastasize and is also more likely to reoccur than other BrCA’s. Like others, the chance for it to reoccur is at it’s highest the first few years following treatment.

• Five-year survival rates are lower compared to other cancers. Studies show 77% of women with TNBC survived at least 5 years, versus 93% of women with other types of breast cancer.

• Another study of more than 1,600 women published in 2007 found that women with triple-negative breast cancer had a higher risk of death within 5 years of diagnosis, but not after that time period. This study, however, depends on the woman’s stage at diagnosis.

• Tends to be at a higher grade at time of diagnosis when compared to other BrCA’s.

Triple-Negative BrCA Facts and Statistics


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• Luminal cells line the apical surface of the normal breast duct and have secretory properties. Most breast cancers arise from luminal cells. Most cells affiliated with TRBC are described as “basal-like”.

• “Basal-like” means that the cells resemble the basal cells that line the breast ducts. This is a new subtype of breast cancer that researchers have identified using gene analysis technology.

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Paget DiseaseAn In-Depth Look at Breast Cancer

• Rare cancer involving the skin of the nipple and the areola• Most patients with Paget’s have one or more tumors found within

the same breast; DCIS or IBC• Malignant cells called Paget cells are the first sign of this disease• They are most often found in the epidermis (surface) of the skin on

the nipple and areola• Paget cells often have a large, round appearance under a

microscope-May be diagnosed as single or small groups of cells within the epidermis

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• The cause of Paget Disease of the breast is unknown• One theory is that cancer cells from a tumor found inside the breast travel through the milk

ducts to the nipple and areola (this theory goes along with why Paget disease of the breast and tumors inside the same breast are almost always found together)

• A second theory is cells in the nipple or areola abnormally form and divide, turning into cancer on their own; no spread from elsewhere within the breast

Symptoms include:• Itching, tingling, or redness in the nipple and/or areola• Flaking, crusty, or thickened skin on or around the nipple• A flattened nipple• Discharge from the nipple that may be yellowish or bloody• Because the early symptoms of Paget disease of the breast may suggest a benign skin

condition, and because the disease is rare, it may be misdiagnosed at first. People with Paget disease of the breast have often had symptoms for several months before being correctly diagnosed

Paget Disease- Origin and Symptoms


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• 67 y/o• Saw her dermatologist for changes of her left nipple• Mammogram showed sub-areola density and changes

from prior imaging• Breast MRI recommended• MRI showing an asymmetric linear type enhancement at

the base of the left nipple• Beyond this point, no morphologic or kinetic feature of

malignancy bilaterally is noted

Paget Disease Case Study


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Paget Disease Case StudyAn In-Depth Look at Breast Cancer

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• Biopsy of left nipple is recommended• Incidental finding seen in the right axilla; U/S

recommended • U/S biopsy recommended for right abnormal

appearing lymph node• Results conclude there is no evidence of non-

Hodgkin’s lymphoma or metastatic disease• Paget’s diagnosed following surgical consult for left

nipple

Paget Disease Case Study


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ConclusionAn In-Depth Look at Breast Cancer

• According to the American Cancer Society (ACS), second to skin cancer, breast cancer is the most-commonly diagnosed cancer in women in the United States.

• Breast cancer is cancer that begins with the malignant cells forming in the breast.

• A malignant tumor or cellular make-up is a group of cancer cells that can grow into nearby tissues or spread (metastasize) to other areas of the body.

• There are several lifestyle-related, environmental, and hormonal factors may increase your risk of developing breast cancer.

• However, many women who develop the disease have no known risk factors.• Certain traits are known to increase the risk of breast cancer, such as obesity,

personal or family history of breast cancer, and genetic mutations such as BRCA1 and BRCA2 gene mutations.

• Breast cancer is most likely caused by a complex interaction of your genetic makeup, your behavior, and your environment.

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ReferencesBREASTCANCER.ORG (2015). HER2 status. Retrieved November 16, 2015 from http://www.breastcancer.org/symptoms/diagnosis/her2

BREASTCANCER.ORG (2015). Signs and symptoms of IDC. Retrieved October 27, 2015 from http://www.breastcancer.org/symptoms/types/idc/symptoms

Grush, Loren (2013). Stopping cancer’s spread: New protein found to control deadly cancer metastasis. Retrieved December 23, 2015 from http://www.foxnews.com/health/2013/06/15/stopping-cancer-spread-researchers-identify-protein-that-regulates-cancer.html

NATIONALBREASTCANCER.ORG (2015). Triple negative breast cancer. Retrieved October 28, 2015 from http://www.nationalbreastcancer.org/triple-negative-breast-cancer

National Cancer Institute (2015). BRCA1 and BRCA2: Cancer Risk and Genetic Testing. Retrieved December 23, 2015 from http://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#q2

National Cancer Institute (2015). Inflammatory breast cancer. Retrieved October 27, 2015 from http://www.cancer.gov/types/breast/ibc-fact-sheet

http://www.breastcancer.org/symptoms/diagnosis/her2

http://www.breastcancer.org/symptoms/types/idc/symptoms

http://www.breastcancer.org/symptoms/types/idc/symptoms

http://www.foxnews.com/health/2013/06/15/stopping-cancer-spread-researchers-identify-protein-that-regulates-cancer.html



http://www.nationalbreastcancer.org/triple-negative-breast-cancer

http://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#q2

http://www.cancer.gov/types/breast/ibc-fact-sheet

http://www.cancer.gov/types/breast/ibc-fact-sheet

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National Cancer Institute (2015). Paget disease of the breast. Retrieved November 13, 2015 from http://www.cancer.gov/types/breast/paget-breast-fact-sheet

NATIONALBREASTCANCER.ORG (2015). Triple negative breast cancer. Retrieved October 28, 2015 from http://www.nationalbreastcancer.org/triple-negative-breast-cancer

ZenBio (2015). Human mammary cells. Retrieved October 28, 2015 fromhttp://www.zen-bio.com/products/cells/human-mammary-cells.php

References Cont’d

http://www.cancer.gov/types/breast/paget-breast-fact-sheet

http://www.cancer.gov/types/breast/paget-breast-fact-sheet

http://www.nationalbreastcancer.org/triple-negative-breast-cancer

http://www.zen-bio.com/products/cells/human-mammary-cells.php

http://www.zen-bio.com/products/cells/human-mammary-cells.php

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