MicroBio 160 1st Edition Lecture 11 Outline of Last Lecture I DNA Replication II What Happens if the Substitution is not Corrected a Complements and Substitutions b Frameshift Mutation III How else Can Mutations Happen a Chemical Mutagens b Radiation IV Mutations and Cancer a Tumor Suppressor Genes b Proto Oncogenes Oncogenes c DNA Repair Genes V Multi hit Theory and Cancer Genes VI 3 primary families Outline of Current Lecture I Risk Factors II Anatomy of the Breast III Symptoms IV Detecting Breast Cancer V Mammogram Images VI Calcifications VII Breast Density VIII Invasive Diagnostics Biopsy IX Non invasive Breast Cancer These 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 Cancer XI Estrogen Target Tissue XII Breast Mutations XIII Human Epidermal Growth Factor Receptor 2 HER 2 XIV Cumulative Risk Current Lecture Breast 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 risk o 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 situ o 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 years o 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 pills Anatomy of the Breast 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 Symptoms if you do a visual exam look for these symptoms 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 Consult a doctor as soon as possible if you notice any of these changes Detecting Breast Cancer Non invasive Non invasive Invasive Should also check under armpit lymph node can be swollen Mammogram 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 tissues Breast 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 cancer o 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 breasts Invasive Diagnostics Biopsies 1 Needle biopsy a Fine needle b Core needle c Vacuum assisted breast biopsy Advantages 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 hours Disadvantages 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 cancer 2 Surgical biopsy a Excisional Advantages Takes about an hour More accurate than needle biopsy Provides more information for treatment plan May remove entire lump Might be the only surgery needed Disadvantages 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 breast Noninvasive 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 in the other breast after 20 years When you have caner lobule haven t started to invade the rest of the breast tissue Invasive Breast Cancer Cancer 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 penetrates the 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 quickly o Rare o Often no lump formation cancer is a sheet o Affects younger women o Affects men too Symptoms o Sudden increase in size temperature o Redness itching o Peau d orange o Ridged skin o 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 glands Estrogen Target Tissue Estrogen receptor inside the cell Fat like substances so they can cross the membrane outside of the cell They just have to worry about finding the receptor ion the inside high estrogen concentration proliferate increase Breast Cancer Mutations error rate more BRCA1 and BRCA2 part of the DNA repair genes primary BRCA mutations can be passed on by either the mother or the father
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