MicroBio 160 1st Edition Lecture 11Outline of Last Lecture I. DNA ReplicationII. What Happens if the Substitution is not Corrected?a. Complements and Substitutions b. Frameshift MutationIII. How else Can Mutations Happen?a. Chemical Mutagensb. RadiationIV. Mutations and Cancera. Tumor Suppressor Genesb. Proto-Oncogenes/ Oncogenesc. DNA Repair GenesV. Multi-hit Theory and Cancer Genes VI. 3 primary familiesOutline of Current Lecture I. Risk Factors II. Anatomy of the BreastIII. SymptomsIV. Detecting Breast Cancer V. Mammogram ImagesVI. CalcificationsVII. Breast DensityVIII. Invasive Diagnostics: BiopsyIX. Non-invasive Breast CancerThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.X. Invasive Breast CancerXI. Estrogen Target TissueXII. Breast MutationsXIII. Human Epidermal Growth Factor Receptor-2 (HER 2)XIV. Cumulative RiskCurrent LectureBreast Cancer—Hormones and Genes:Risk Factors: - Being a female, however, males can also have breast cancer- Getting older— the longer you are exposed to hormones-- the higher your risko Age 20: 1 in 1,681 but Age 70: 1 in 27- Having an inherited mutation (BRCA1 or BRCA2)- A personal or family history of breast or ovarian cancer- Having high breast density on a mammogram- High bone density - Having had hyperplasia or lobular carcinoma in situo Hyperplasia: when the cells have gained enough mutations that they aren’t normal (risk for breast cancer)- Being exposure to large amounts of radiation at a young age - Having more than one drink per day- Having children or having first child after your 35 yearso After having child: first 10 years after having first child (higher risk-- increases the amount of p53)- High levels of blood androgens and estrogens - Postmenopausal hormone use (current or recent use) of estrogen plus progestin- Starting menopause after age 55- Being younger than 12 at the time of your first period - Current or recent use of birth control pillsAnatomy of the Breast:Symptoms: if you do a visual exam, look for these symptomsConsult a doctor as soon as possible if you notice any of these changesDetecting Breast Cancer: Non-invasiveNon-invasiveInvasive The function of the breast is to produce milk when you have a child)Specific way to check for cancer: - Lymph nodes (check if someone is diagnosed to breast cancer)- A persistent lump or thickening in the breast or armpit area- Changes in the color or skin of the breast, areola, or nipple (dimpling, puckering, scaling)- A newly retracted/ inverted (pulled in nipple - Blood or discharge from the nipple- A change in the size or shape of the breast- Should also check under armpit--lymph node can be swollenMammogram images: what they see when looking at a mammogram- 1st: normal breast tissue - 2nd: could be breast cancer (biopsy it—dangerous)- 3rd: bright white spot surrounded by tissue (highly suspicous)Calcifications: - 4th: Small, bright white, smooth- 5: suspicious, classifications tightly clustered together (look like crystals in the breast tissuesBreast density effect on Imaging:- Why is breast density important?o Women with dense breasts have an increased risk of breast cancer We don’t yet know why breast density is related to breast cancero Dense breasts make it difficult to detect breast cancer on a mammogram. Dense breast tissue can look white or light gray on a mammogram and cancer can look white or light gray - As a result, mammograms may not be as effective in women with dense breastsInvasive Diagnostics: Biopsies1.Needle biopsya. Fine needle b. Core needle c. Vacuum assisted breast biopsyAdvantages: - Simple procedure—can be done in an outpatient setting and may use mammographic or ultrasound guidance- Accurate- Quicker than surgical biopsy- Local anesthetic is used to prevent pain- Results available within 48-72 hoursDisadvantages: - Surgical biopsy may still be needed- Doesn’t remove all of the lump- If the needle misses the tumor, the biopsy will show cancer is not present when in fact it is (false negative results) which could delay diagnosis (not common)- Fine needle only: requires cytopathologist to review the results- Fine needle only: cannot fullt distinguish non-invasive from invasive cancer2.Surgical biopsya. ExcisionalAdvantages: - Takes about an hour- More accurate than needle biopsy- Provides more information for treatment plan- May remove entire lump- Might be the only surgery neededDisadvantages: - A surgical procedure - Possible side effects such as infection or blood collection under the skin, scarring and changes in the breast contour - Removing tissue can change the look and feel of the breastNoninvasive Breast Cancer:- When you have caner: lobule—haven’t started to invade the rest of the breast tissueInvasive Breast Cancer:For invasive Breast Cancer, it is still encapsulated: covering around the tumor—hasn’t started to invade any nearby tissue- Ductal in situ: still inside circle—isn’t cancer yet - For patients with LCIS the risk for developing invasive cancer in the same breast is about 18% and 14% inthe other breast after 20 yearsCancer has broken out of the duct and is starting to invade the tissue - Left picture: Invasive Ductal Carcinoma (IDC): This is invasive breast cancer that penetratesthe wall of a duct. It comprises between 70-80% of all breast cancer case- Right picture: Invasive Lobular Carcinoma (ILC): Accounts for 10-15% of all breast cancers Inflammatory Breast Cancer: may have metastasized before you know anything is wrong - What is it?o Most aggressive because it metastasizes so quicklyo Rare o Often no lump formation; cancer is a “sheet”o Affects younger womeno Affects men too- Symptoms:o Sudden increase in size, temperatureo Redness, itchingo Peau d’ orangeo Ridged skino Bruise, swollen lymph nodes Hormones: a chemical messenger from one cell (or group of cells) to another - Function as a signal to the target cells - Actions can include stimulation or inhibition of growth, induction or suppression of apoptosis, activation or inhibition of the immune system, regulating metabolism and preparation for a new activity or phase of life- Hormones are produced by and secreted from endocrine glandsEstrogen Target Tissue:Breast Cancer Mutations: - BRCA1 and BRCA2: part of the DNA repair genes (primary)- BRCA mutations can be passed on by either the mother or the father - HER2 is a
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