Breast Cancer

Introduction

As old as 1600 BC Emerges from inner lining of milk ducts Or the lobules that supply milk Types:

DCISLCIS

Genetic, Behaviour, Infectious?

Non-Functional BRAC1 & BRAC2 Genes

Age, Menstrual cycle, Drinking alcohol, Late or few Births, Smoking, Hormone replacement therapy & Having dense breast

Pathology

Develops from epithelial cell lining

Invasive, stromal like adenocarcinoma

Mammography for DCIS

Biopsy is used to detect LCIS(non-palpable lesion, multifocal or bilateral)

Paget’s disease(characteristic malignant)

Molecular Basis

BRCA1 and BRCA2 Additional genes

ATM P53 PTEN CDH1

Characteristics Have specific function in body Their abnormal presence causes certain diseases Risk of breast cancer is increased

DiagnosisPhysical examination:

First step in breast cancer diagnosis

Examination of any lump, change in the size or texture of breast and lymph

node in the armpit

Diagnostics mammogram:

X-ray of the breast

Screening mammograms in asymptomatic women

Diagnostic mammograms in women having breast cancer

MRI (magnetic resonance imaging):

Uses radio waves and strong magnets

The pattern observed is translated to image

More expensive still used more as compared to mammogram

Too much sensitive

Ultrasound (sonography): Sound waves are used Echo produced is converted to image

Biopsy: Only way to tell actual presence of breast cancer Effected tissue is taken and pathologically tested

Scintymammography: New method and still under study Radioactive tracer attached to breast cells through veins Detected by special camera

Tomosynthesis (3D mammography): Similar to 2D mammogram More radiation required and 3D image is formed

Two types of tests:

1. Oncotype DX: Helps in depicting the recurrence score Based on this score further treatment is decided Helpful in those who are stage 1 or stage 2 estrogen

positive receptor

2. Mammaprint: Helps in determining the recurrence score in specific

part of body Both estrogen positive and negative can be detected

Prevention

Prophylactic Mastectomy or prophylactic oophorectomy

Tamoxifen and Raloxifene

Aromatase Inhibitors

Treatment

Surgical Methods- Mastectomy, sentinel node biopsy

Brachytherapy

Drug Therapy

Chemotherapeutic Drugs- Cyclophosphamide, Epirubicin,

Flourouracil, Methotrexate, Doxorubicin, Docetaxel

Hormonal Therapy- SERMs, Aromatase Inhibitors

Targeted Therapy- Herceptin, Lapatinib

Biotechnology Applications

To understand the molecular basis, development of

diagnostics and treatment.

Biomarkers

Defining gene and protein patterns

Human Growth Hormone

Biomolecules- Herceptin and Tamoxifen

Molecular Profiling- Real Time PCR & Microarray