MicroBio 160 1st Edition Lecture 12 Outline of Last 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 X Invasive Breast Cancer XI Estrogen Target Tissue XII Breast Mutations XIII Human Epidermal Growth Factor Receptor 2 HER 2 XIV Cumulative Risk Outline of Current Lecture I Breast Cancer Staging II Sentinel Lymph Node Biopsy III Sentinel Lymph Node Detection IV Surgery for Breast Cancer V Radiation Therapy vs Brachytherapy VI Hormone Therapy VII Tamoxifen the first SERM VIII Raloxifene an alternative SERM IX How your body makes Estrogen after Menopause Current Lecture 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 Breast Cancer Stage and Survival 5 10 year survival rates Staging Breast Cancer TNM Stage Tumor Size Axillary Lymph nodes Metastasis Noninvasive O Tiny cluster of cancer cells in a breast duct in situ no invasive cancer seen No spread None Invasive I Up to 2cm No spread None Invasive II a Smaller than 2cm b Between 2 and 5cm c Larger than 5cm a Has spread to axillary lymph nodes b May or may not have spread to the axillary lymph nodes c No spread Invasive III a Any size b Larger than 5cm c Any size but cells have spread to skin or chest wall d Any size a Has spread to the axillary None lymph nodes so that the nodes become attached to each other b Has spread to the axillary lymph nodes c May or may not have spread to the axillary lymph nodes d Has spread to the lymph nodes along breastbone or above or below collarbone Metastatic IV Any size May or may not have spread to the axillary lymph nodes None Has spread to other organs of the body Sentinel Lymph Node Biopsy Lymph Node Status Chances of Surviving 5 Years Chances of Surviving 10 years Chances Surviving Years without Recurrence No career in any node Better than 90 Better than 80 Better than 70 Cancer in one to three nodes About 60 to 70 About 40 to 50 About 25 to 40 Cancer in four or more nodes About 40 to 50 About 25 to 40 About 15 to 35 Injecting dye into tumor to identify sentinel nodes In your lymphatic system there are one way valves when you inject it will spread out from the tumor Whatever is the first one moving out from the radius of the tumor anyone after that are the secondary lymph nodes Sentinel Lymph Node Detection Before going to the operating room the surgeon injects a small dose of low level radioactive tracer called technetium 99 into the breast in the region of the patient s tumor Technetium 99 contains less radiation than a standard x ray CT scan or bone scan and is a relatively safe substance Half life is less than 6 hours o A blue dye is also injected to help virtually track the location of the sentinel node during surgery the surgeon then uses a hand held counter to detect the radioactive tracer and locate the sentinel node Surgery for Breast Cancer Lumpectomy You take out the lump and some of the surrounding tissue when a pathologist looks at the tissue they want to have clean margins free of cancer Wide excision Quadrectomy Mastectomy They go all the way up to the armpit and remove the entire breasts o Simple Mastectomy o Radical Mastectomy Very invasive Removes the breast tissue in the shoulder Radiation Therapy vs Brachytherapy Mammosite RTS Inside the breast inside the cavity where the tumor used to be they plant a balloon that balloon has a catheter the balloon will remain in place for the duration of the radiation treatments Radioactive material placed in body in the area near cancer cells internal radiation therapy implant radiation or brachytherapy o Benefits radiation dose targets lumpectomy cavity minimizes normal tissue exposure Hormone Therapy Why is hormone receptor status important in breast cancer treatment 75 of breast cancers are estrogen receptor positive ER positive or ER 65 of ER breast cancers are also progesterone receptor positive PR positive or PR Approximately 25 of breast cancer patients have tumors that are HER2 We can block HER2 receptors with Herceptin We can block estrogen receptors with SERMs Tamoxifen the first SERM 1992 NCI study involving 13 000 healthy women at high risk for breast cancer based on their family or medical history Half were given tamoxifen while other half were given a placebo After 5 years group receiving tamoxifen had a lower rate of breast cancer Both shared same risk of getting breast cancer however Tamoxifen reduces risk Increases uterine cancer risk and blood clot risk Raloxifene an alternative SERM Raloxifene is another anti estrogen SERM medication Approved by the FDA in 1997 for preventing osteoporosis in postmenopausal women Reduces risk of breast cancer without stimulation of uterine cell division exhibited by Tamoxifen Women taking Raloxifene had 36 fewer uterine cancers and 29 fewer blood clots than women taking Tamoxifen How your body makes Estrogen after Menopause if you are post menopausal most of your estrogen is produced in two steps 1 Your adrenal gland two small glands that sit on top of your kidneys make a hormone called androgen androgens are mostly male hormone but women have them too 2 Then a special protein found in muscle and fat cells throughout your body makes an enzyme called aromatase which changes androgen into estrogen
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