Biology

BREAST CANCER AND LIFESTYLE MANAGEMENT.

OYEBANJI FLORENCE

BIOLOGY 498 INDEPENDENT STUDY

INSTRUCTOR: DR. ERIC MAY

SPRING 2019

INTRODUCTION

“In 2015, the latest year for which incidence data are available, 242,476 new cases of Female Breast Cancer were reported, and 41,523 women died of Female Breast Cancer in the United States. For every 100,000 women, 125 new Female Breast Cancer cases were reported and 20 died of cancer”. (Group, 2018). The second cause of death the United States is Cancer. Thirty years ago, scientists couldn’t tell the reason why cancer existed. They knew that cancer enkindle from cells that began to proliferate uncontrollably within the body, and they knew that viruses, chemicals, environment hazards, radiation could stimulate change in cell division. But exactly how it happened was a mystery. In the last three decades, however, research has metamorphosed our understanding of cancer. Contributing to this success was the development and application of the techniques of molecular biology, techniques and systems that empowered scientists to test and portray highlights of individual cells in manners impossible a century back.

Today, we know that cancer is a disease of molecules and genes, and we even know many of the molecules and genes involved. In fact, our increasing understanding of these genes makes it possible for the development of exciting and energizing new strategies for avoiding, forestalling, and even avoiding the changes that lead to cancer. For centuries, humans have been worried about the cause of cancer. Cancer was derived from an observation by Hippocrates more than 2,300 years ago that the long, distended veins that radiate out from some breast tumors look like the limbs of a crab. From that observation came the term karkinoma in Greek, and later, cancer in Latin. (health, 2007). With Hooke’s research in the 1600s, and then Virchow in the 1800s, came the understanding that living tissues are composed of cells, and that all cells arise as direct descendants of other cells. Yet, their researches arouse more questions about cancer than it resolved (Cuffari, 2018).

Presently researchers have started to solicit what kinds of normal cells cancer cells arise, how cancer cells differ from their normal counterparts, and what events promote the proliferation of these abnormal cells. And physicians began to ask how cancer could be prevented or cured. One of the most important early observations that people made about cancer was that its incidence varies between different populations. For example, in 1775, an extraordinarily high incidence of scrotal cancer was described among men who worked as chimney sweeps as boys. In the mid-1800s, lung cancer was observed at alarmingly high rates among pitch blende miners in Germany. And by the end of the 19th century, using snuff and cigars was thought by some physicians to be closely associated with cancers of the mouth and throat. Yet each new observation also, ultimately, contributed to scientists’ eventual understanding of the disease. For example, the discovery in 1910 that a defined, submicroscopic agent isolated from a chicken tumor could induce new tumors in healthy chickens showed that a tumor could be traced simply and definitively back to a single cause. Today, scientists know this agent as Roussarcoma virus, one of several viruses that can act as causative factors in the development of cancer (health, 2007).

Likewise, investigations into the association between cancer and tissue damage, particularly that induced by radiation, revealed that while visible damage sometimes occurs, something more subtle happens in cells exposed to cancer-causing agents. One clue to what happens came from the work of Herman Muller, who noticed in 1927 that X-irradiation of fruit flies often resulted in mutant offspring. Might the two known effects of X-rays, promotion of cancer and genetic mutation, be related to one another? And might chemical carcinogens induce cancer through a similar ability to damage genes?

Support for this idea came from the work of Bruce Ames and others who showed in 1975 that com pounds known to be potent carcinogens (cancer-causing agents) generally also were potent mutagens (mutation-inducing agents), and that compounds known to be only weak carcinogens were only weak mutagens. Although scientists know today that many chemicals do not follow this correlation precisely, this initial, dramatic association between mutagenicity and carcinogenicity had widespread influence on the development of a unified view of the origin and development of cancer.

Finally, a simple genetic model, proposed by Alfred Knudson in 1971, provided both a compelling explanation for the origins of retinoblastoma, a rare tumor that occurs early in life, and a convincing way to reconcile the view of cancer as a disease produced by external agents that damage cells with the observation that some cancers run in families. Knudson’s model states that children with sporadic retinoblastoma (children whose parents have no history of the disease) are genetically normal now of conception, but experience two somatic mutations that lead to the development of an eye tumor. Children with familial retinoblastoma (children whose parents have a history of the disease) already carry one mutation at conception and thus must experience only one more mutation to reach the doubly mutated configuration required for a tumor to form. In effect, in familial retinoblastoma, each retinal cell is already primed for tumor development, needing only a second mutational event to trigger the cancerous state. The difference in probabilities between the requirements for one or two mutational events, happening randomly, explains why in sporadic retinoblastoma, the affected children have only one tumor focus, in one eye, while in familial retinoblastoma, and the affected children usually have multiple tumor foci growing in both eyes.

Although it was years before Knudson’s explanation was confirmed, it had great impact on scientists’ understanding of cancer. Retinoblastoma, and by extension, other familial tumors, appeared to be linked to the inheritance of mutated versions of growth-suppressing genes. This idea led to the notion that cells in sporadically arising tumors might also have experienced damage to these critical genes as the cells moved along the path from the normal to the cancerous state.

Before the 20th century, breast cancer was feared and discussed in hushed tones, as if it were shameful. As little could be safely done with primitive surgical techniques, women tended to suffer silently rather than seeking care. When surgery advanced, and long-term survival rates improved, women began raising awareness of the disease and the possibility of successful treatment. The purpose of breast cancer research is to find ways to detect, prevent and treat breast cancer in order to improve the quality of life for patients and survivors.

HISTOLOGY OF CANCER

Cancer is the abnormal division of body cells. According to level of organization, cells are the smallest unit of life and are extremely small that can only to be seen under the microscope. Cells group together to make up tissue and organs of the body. Cells grow, wore out, damage, and Infected. The human body is programmed to replace non-functional cells with functional cells, and this is done through cell replication. The DNA inside a cell is packaged into large number of individual genes, each of which contains a set of instructions telling the cell what to perform, as well as how to grow and divide. After DNA synthesis, proof reading of replicated DNA is done by the DNA polymerase to correct any error that might have occurred during replication. Misplaced base pairs are replaced and any DNA damaged is repaired through chemical reversal, excision repair and double-stranded break repair. With cancer cells, this process is interrupted. The cells divide continuously.

Mutation can also occur during DNA replication. Mutation is the abnormal replacement of bases. Mutation can be missense (change in base pair leads to change in one amino acid for another base pair), nonsense (change in one base pair leads to build up of stop codons), Insertion (change the number of DNA bases in a gene by adding a piece of DNA), Deletion ( removal of a piece of DNA), Duplication (consist of a piece of DNA that is abnormally copies one or more times), and a Frameshift ( addition or loss of DNA bases changes a gene’s reading frame). These mutations can arise as a result of exposure to various sources such as Radiation, Viruses, and Smoking/Tobacco.

Cancer is a group of diseases involve in the abnormal growth of cells and the accumulation of clustered abnormal cells is called Tumor. Growth of cancer cells could be either benign (locally) or malignant (spread or invade to other parts of the body). Cancers continue to grow and spread by direct extension or through a process called metastasis, whereby the malignant cells travel through the lymphatic or blood vessels. There are over 100 types of cancer and the cause of most cancer is lifestyle management. Cancer can affect nearly every part of the body and if not detected or treated at early stages can lead to potential life-threatening conditions. The major types of cancer are carcinoma, sarcoma, lymphoma, leukemia, melanoma, brain and spinal cord cancers.

Carcinoma cancer are cancers or malignancies that starts in the epithelia cells found at stratum lucidum of the epidermis of the skin for thin skin and stratum corneum of the epidermis of the skin for thick skin which are the cells that make up the skin, and the tissue that line the surfaces of internal organs and structures such as the reproductive system, digestive system, pericardium, and abdominal cavity. Sarcoma cancers are cancers that begin in the bones and in the connective tissue. Connective tissue sarcoma forms in the tissue that connect, support, and surround other body structures. This includes muscle, fat, blood vessels, nerves, tendons and the lining of the joints. There are different types of sarcoma which depend on the type, location of the sarcoma. But they are grouped into two main types: bone sarcomas and soft tissue sarcoma. Bone sarcoma according to the name is the sarcoma that starts from the bone cells (osteocytes). Most sarcomas are often treated by having surgery to remove the tumor. Lymphoma cancer starts from the lymphatic system that is responsible to fight infections that affect the body. The lymph node which is part of the lymphatic system is found throughout the body system so it can start anywhere in the body. Some of the lymphatic system white blood cells (lymphocytes) start to divide abnormally and don’t die as they usually do. These cells start to divide before they become fully grown and they can’t fight infection. The abnormal lymphocytes start to collect in the lymph nodes or other places such as the bone-marrow, thymus, or spleen. There are two main types of lymphoma: Non-Hodgkin and Hodgkin. Non-Hodgkin and Hodgkin lymphoma involve different types of lymphocyte cells. Every type of lymphoma grows at a different rate and responds differently to treatment. Lymphoma is very treatable, and the outlook can vary depending on the type of lymphoma and its stage.

Leukemia is a condition in which the bone marrow makes too many white blood cells. The blood cells are not fully formed and so they don’t work properly. The abnormal cells build up in the blood. These leukemia cells can’t fight infection the way normal white blood cells do. And because there are so many of them, they start to affect the way major organs work. Eventually, there aren’t enough red blood cells to supply oxygen, enough platelets to clot the blood, or enough normal white blood cells to fight infection. There are two main types: acute or chronic. The acute leukemia happens when most of the abnormal blood cells stay immature and can’t carry out normal functions and chronic leukemia happens when there are some immature cells, but others are normal and can function normally. That means it gets bad, but more slowly. Melanoma is a cancer that begins in the melanocytes. Other names for this cancer include malignant melanoma and cutaneous melanoma. Most melanoma cells still make melanin, so melanoma tumors are usually brown or black. But some melanomas do not make melanin and can appear pink, tan, or even white. Melanomas can develop anywhere on the skin, but they are more likely to start on the trunk (chest and back) in men and on the legs in women. The neck and face are other common sites. Melanomas can also form in other parts of your body such as the eyes, mouth, genitals, and anal area, but these are much less common than melanoma of the skin. Having darkly pigmented skin lowers your risk of melanoma at these more common sites, but anyone can get melanoma on the palms of the hands, soles of the feet, and under the nails. Melanomas in these areas make up a much larger portion of melanomas in African Americans than in whites.

Cancer can start in the cells of the brain or spinal cord is called Brain and Spinal Cord Cancers. The brain controls the body by sending electrical messages along nerve fibers. The fibers run out of the brain and join to make the spinal cord, which also takes messages from the body to the brain. The brain and spinal cord form the central nervous system. The brain is made up of billions of nerve cells called neurons. It also contains special connective tissue cells called glial cells that support the nerve cells. The most common type of brain tumor develops from glial cells and is called glioma. Some tumors that start in the brain or spinal cord are non-cancerous (benign) and grow very slowly. Others are cancerous and are more likely to grow and spread.

HISTOLOGY OF BREAST CANCER

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer deaths in women worldwide, accounting for 23% of total cancer cases and 14% of all cancer related mortalities. (JM Hall, 1990) (JM Hall, 1990) Currently, the lifetime risk of developing breast cancer for women is 1/8. However, >40% of the affected patients are currently >65 of age and remarkably, this group accounts for almost 60% of the total deaths from breast cancer. Interestingly, before 49 years of age the estimated risk of developing breast cancer is 1/53 however, this rises to 1/43 for 50–59 years old and rises again to 1/23 for 60–69. Significantly, for women aged >70 this risk is the highest with a 1/15 chance of developing breast cancer. In 2008, breast cancer caused 458,503 deaths worldwide (13.7% of cancer deaths in women and 6.0% of all cancer deaths for men and women together (McGuire, Malone, & McLaughlin, 2015) .The incidence of breast cancer varies greatly around the world: it is lowest in less-developed countries and greatest in the more-developed countries. Because of its visibility, breast cancer was the form of cancer most often described in ancient documents. Breast cancer, however, could be felt through the skin, and in its advanced state often developed into fungating lesions: a skin lesion that is fungus-like in appearance and growth rate.

The oldest discovered evidence of breast cancer is from Egypt and dates back 4200 years, to the Sixth Dynasty. The study of a woman’s remains from the necropolis of Qubbet el-Hawa showed the typical destructive damage due to metastatic spread. The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were treated by cauterization. The writing says about the disease, “There is no treatment.” For centuries, physicians described similar cases in their practices, with the same conclusion. Ancient medicine, from the time of the Greeks through the 17th century, was based on humoralism, and thus believed that breast cancer was generally caused by imbalances in the fundamental fluids that controlled the body, especially an excess of black bile. Alternatively, it was considered a divine punishment. Because ancient medicine believed that the cause was systemic, rather than local, and because surgery carried a high mortality rate, the preferred treatments tended to be pharmacological rather than surgical. Herbal and mineral preparations, especially involving the poison arsenic, were relatively common.

Mastectomy for breast cancer was performed at least as early as AD 548, when it was proposed by the court physician Aetios of Amida to Theodora (Olson, 2002).It was not until doctors achieved greater understanding of the circulatory system in the 17th century that they could link breast cancer’s spread to the lymph nodes in the armpit. The French surgeon Jean Louis Petit (1674–1750) performed total mastectomies which included removing the axillary lymph nodes, as he recognized that this reduced recurrence. Petit’s work was built on by another French surgeon, Bernard Peyrilhe (1737–1804), who additionally removed the pectoral muscle underlying the breast, as he judged that this greatly improved the prognosis. The Scottish surgeon Benjamin Bell (1749–1806) advocated removal of the entire breast, even when only a portion was affected. Their successful work was carried on by William Stewart Halsted who started performing radical mastectomies in 1882, helped greatly by advances in general surgical technology, such as aseptic technique and anesthesia. The Halsted radical mastectomy often involved removing both breasts, associated lymph nodes, and the underlying chest muscles. This often led to long-term pain and disability but was necessary in order to prevent the cancer from recurring. Before the advent of the Halsted radical mastectomy, 20-year survival rates were only 10%; Halsted’s surgery raised that rate to 50%. Extending Halsted’s work, Jerome Urban promoted super radical mastectomies, taking even more tissue, until 1963, when the ten-year survival rates proved equal to the less-damaging radical mastectomy.

STAGES OF BREAST CANCER

The stage of a breast cancer is determined by the cancer’s characteristics, such as how large it is and whether it has hormone receptors. Breast cancer stage is usually expressed as a number on a scale of 0 through IV. Stage 0 describing non-invasive cancers that remain within their original location and stage IV describing invasive cancers that have spread outside the breast to other parts of the body. The breast cancer staging system, called the TNM system, is overseen by the American Joint Committee on Cancer (AJCC). The AJCC is a group of cancer experts who oversee how cancer is classified and communicated. (Ganesh N. Sharma, 2010)This is to ensure that all doctors and treatment facilities are describing cancer in a uniform way so that the treatment results of all people can be compared and understood. In the past, stage number was calculated based on just three clinical characteristics, T, N, and M. The size of the cancer tumor and whether it has grown into nearby tissue (T) whether cancer is in the lymph nodes (N) whether the cancer has spread to other parts of the body beyond the breast (M). In 2018, the AJCC updated the breast cancer staging guidelines to add other cancer characteristics to the T, N, M system to determine a cancer’s stage. Tumor grade: a measurement of how much the cancer cells look like normal cells. Estrogen- and progesterone-receptor status: do the cancer cells have receptors for the hormones estrogen and progesterone? HER2 status: are the cancer cells making too much of the HER2 protein? Oncotype DX score, if the cancer is estrogen-receptor-positive, HER2-negative, and there is no cancer in the lymph nodes. Stage 0 is used to describe non-invasive breast cancers, such as DCIS (ductal carcinoma in situ). In stage 0, there is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started or getting through to or invading neighboring normal tissue. The tumor is confirmed usually to a milk duct or milk-producing gland and has not invaded surrounding breast tissue.

Stage I describes invasive breast cancer (cancer cells are breaking through to or invading normal surrounding breast tissue) Stage I is divided into subcategories known as IA and IB. Stage IA describes invasive breast cancer in which the tumor measures up to 2 centimeters (cm) and the cancer has not spread outside the breast and no lymph nodes are involved. stage IB describes invasive breast cancer in which there is no tumor in the breast; instead, small groups of cancer cells larger than 0.2 millimeter (mm) but not larger than 2 mm are found in the lymph nodes. There is a tumor in the breast that is no larger than 2 cm, and there are small groups of cancer cells larger than 0.2 mm but not larger than 2 mm in the lymph nodes. Still, if the cancer is estrogen-receptor-positive or progesterone-receptor-positive, it is likely to be classified as stage IA. Microscopic invasion is possible in stage I breast cancer. In microscopic invasion, the cancer cells have just started to invade the tissue outside the lining of the duct or lobule, but the invading cancer cells can’t measure more than 1 mm. Stage II is divided into subcategories known as IIA and IIB. Stage IIA describes invasive breast cancer in which no tumor can be found in the breast, but cancer (larger than 2 millimeters [mm]) is found in 1 to 3 axillary lymph nodes (the lymph nodes under the arm) or in the lymph nodes near the breast bone (found during a sentinel node biopsy) or the tumor measures 2 centimeters (cm) or smaller and has spread to the axillary lymph nodes or the tumor is larger than 2 cm but not larger than 5 cm and has not spread to the axillary lymph nodes. stage IIB describes invasive breast cancer in which the tumor is larger than 2 cm but no larger than 5 centimeters; small groups of breast cancer cells larger than 0.2 mm but not larger than 2 mm, and are found in the lymph nodes or the tumor is larger than 2 cm but no larger than 5 cm; cancer has spread to 1 to 3 axillary lymph nodes or to lymph nodes near the breastbone (found during a sentinel node biopsy) or the tumor is larger than 5 cm but has not spread to the axillary lymph nodes.

Stage III is divided into subcategories known as IIIA, IIIB, and IIIC. stage IIIA describes invasive breast cancer ,in which either, no tumor is found in the breast or the tumor may be any size; cancer is found in 4 to 9 axillary lymph nodes or in the lymph nodes near the breastbone (found during imaging tests or a physical exam) or the tumor is larger than 5 centimeters (cm); small groups of breast cancer cells (larger than 0.2 millimeter [mm] but not larger than 2 mm) are found in the lymph nodes or the tumor is larger than 5 cm; cancer has spread to 1 to 3 axillary lymph nodes or to the lymph nodes near the breastbone (found during a sentinel lymph node biopsy). stage IIIB describes invasive breast cancer in which the tumor may be any size and has spread to the chest wall and/or skin of the breast. It could be swelling or an ulcer and may have spread to up to 9 axillary lymph nodes or may have spread to lymph nodes near the breastbone. stage IIIC describes invasive breast cancer in which: there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast and the cancer has spread to 10 or more axillary lymph nodes, or the cancer has spread to lymph nodes above or below the collarbone, or the cancer has spread to axillary lymph nodes or to lymph nodes near the breastbone. Stage IV describes invasive breast cancer that has spread beyond the breast and nearby lymph nodes to other organs of the body, such as the lungs, distant lymph nodes, skin, bones, liver, or brain.

CAUSES AND TYPES OF BREAST CANCER

As explained in the previous paragraphs, Changes or mutations in DNA can cause normal breast cells to become cancer. Certain DNA changes are passed on from parents (inherited) and can greatly increase your risk for breast cancer. BRCA1 and BRCA2 are human genes that produce tumor suppressor proteins. These proteins help repair damaged DNA and, therefore, play a role in ensuring the stability of each cell’s genetic material. When either of these genes is mutated, or altered, such that its protein product is not made or does not function correctly, DNA damage may not be repaired properly. As a result, cells are more likely to develop additional genetic alterations that can lead to cancer. Specific inherited mutations in BRCA1 and BRCA2 most notably increase the risk of female breast and ovarian cancers, but they have also been associated with increased risks of several additional types of cancer. People who have inherited mutations in BRCA1 and BRCA2 tend to develop breast and ovarian cancers at younger ages than people who do not have these mutations. Other lifestyle-related risk factors, such as nutritional choices, lack of exercise can increase your chance of developing breast cancer, but it’s not yet known exactly low some of these risk factors cause normal cells to become cancer. Hormones seem to play a role in many cases of breast cancer, but just how this happens is not fully understood. The breast is composed of two main types of tissues i.e., glandular tissues and stromal (supporting) tissues. Glandular tissues house the milk-producing glands (lobules) and the ducts (the milk passages) while stromal tissues include fatty and fibrous connective tissues of the breast. The breast is also made up of lymphatic tissue-immune system tissue that removes cellular fluids and waste. Breast cancer can begin in different areas of the breast the ducts, the lobules, or in some cases, the tissue in between. Moreover, breast cancer can affect both genders. Both male and females have underlying breast tissue whose development depend on hormones. The reason while men have flat breast tissue is because breast hormones in males are hardly stimulated. However, some men tend to grow breast because of abnormal release of hormones that enhance breast growth. Breast growth could result from age, hormonal drugs which increase estrogen levels, Klinefelter syndrome, radiation, or family history of breast cancer.

Most cancer types are named after the first place where the symptom initially develops. Some types of breast cancer include Ductal carcinoma in situ (DCIS) which is a non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts. Invasive ductal carcinoma (IDC), sometimes called infiltrating ductal carcinoma, is the most common type of breast cancer which refers to cancer that has broken through the wall of the milk duct and begun to invade the tissues of the breast. Over time, invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body. Medullary carcinoma of the breast is a rare subtype of invasive ductal carcinoma. It is called “medullary” carcinoma because the tumor is a soft, fleshy mass that resembles a part of the brain called the medulla. According to breast cancer organization, medullary carcinoma can occur at any age, but it usually affects women in their late 40s and early 50s. Mucinous carcinoma of the breast is the cancer in which the tumor is made up of abnormal cells that float in pools of mucin, a key ingredient in the slimy, slippery substance known as mucus. Normally, mucus lines most of the inner surface of our bodies, such as our digestive tract, lungs, liver, and other vital organs. Many types of cancer cells including most breast cancer cells produce some mucus. In mucinous carcinoma, however, mucin becomes part of the tumor and surrounds the breast cancer cells. Under a microscope, it looks like the cancer cells are scattered throughout pools of mucus. Research suggests that only about 2-3% of invasive breast cancers are pure mucinous carcinomas meaning that this is the only type of cancer present within the tumor. About 5% of invasive breast cancers appear to have a mucinous component within them, with other types of cancer cells present as well. Mucinous carcinoma is extremely rare in men. Although mucinous carcinoma can be diagnosed at any age, it tends to affect women after they’ve gone through menopause. Some studies have found that the average age at diagnosis is in the 60s or early 70s.

Invasive lobular carcinoma (ILC), sometimes called infiltrating lobular carcinoma, is the second most common type of breast cancer after invasive ductal carcinoma. It’s cancer that has broken through the wall of the lobule and begun to invade the tissues of the breast. Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer. Inflammatory breast cancer usually starts with the reddening and swelling of the breast instead of a distinct lump just as the name implies. IBC tends to grow and spread quickly, with symptoms worsening within days or even hours. According to the National Cancer Institute, Paget’s disease of the nipple accounts for less than 5% of all breast cancer cases in the United States. Paget’s disease of the nipple is a rare form of breast cancer in which cancer cells collect in or around the nipple.

Diagnosis of Breast Cancer

Most breast cancers start with lumps thereafter; further metastasis takes place. The classic symptom for breast cancer is a lump found in the breast or armpit. Doing monthly breast self-exam (BSE) is a great way to be familiar with the breasts’ texture, cyclical changes, size, and skin condition. The general alerting features of breast cancer are such as swelling or lump (mass) in the breast, swelling in the armpit (lymph nodes), nipple discharge (clear or bloody), pain in the nipple, inverted (retracted) nipple, scaly or pitted skin on nipple, persistent tenderness of the breast, and unusual breast pain or discomfort. In Advanced stage (Metastatic) of disease underarm lymph nodes are present with other symptoms such as bone pain (bone metastases), shortness of breath (lung metastases), drop in appetite (liver metastases), unintentional weight loss (liver metastases), headaches, neurological pain or weakness. Most types of breast types are diagnosed through microscopic examination or biopsy. While, some other types of breast cancer require other tests. Clinical breast examination (CBE) seeks to detect breast abnormalities or evaluate patient reports of symptoms to find palpable breast cancers at an earlier stage of progression. It can be diagnosed through physical examination, mammography, or fine needle aspiration cytology. Treatment options for earlier‐stage cancers are generally more numerous, include fewer toxic alternatives, and are usually more effective than treatments for later‐stage cancers. DCIS generally has no signs or symptoms, but a small number of people may have a lump in the breast or some discharge coming out of the nipple. According to the National Cancer Institute, about 80% of DCIS cases are found by mammography. As mammography screening has its limitation in diagnosis in breast carcinoma, minimally invasive procedures offer a better option. According to the American Cancer Society, any of the following unusual changes in the breast can be a first sign of breast cancer, including invasive ductal carcinoma: swelling of all or part of the breast, skin irritation or dimpling, breast pain, nipple pain or the nipple turning inward, redness, scariness, or thickening of the nipple or breast skin, nipple discharge other than breast milk, a lump in the underarm area.

LIFESTYLE MANAGEMENT

Breast cancer is commonly treated by various combinations of surgery, radiation therapy, chemotherapy, and home therapy. Prognosis and selection of therapy may be influenced by the following clinical and pathology features based on conventional histology and immunohistochemistry. Some of which include menopausal status of the patient, stage of the disease, grade of the primary tumor, estrogen receptor (ER) and progesterone receptor (PR) status of the tumor, human epidermal growth factor type 2 receptor (HER2/neu) overexpression and/or amplification. A recent review of the effect of lifestyle factors on breast cancer mortality concluded that physical activity has the most robust effect of all lifestyle factors on reducing breast cancer recurrence; Lowered endogenous hormone levels, reduction of inflammation and reversal of insulin resistance have all been hypothesized to mediate the effects of exercise. (Lahart IM, 2015). Preclinical research suggests that excess dietary intake of lipids and carbohydrates can influence metabolic and hormonal processes (e.g., by increasing endogenous estrogen levels) that affect the development of breast cancer metastasis. So, by reducing excess intake of lipids and carbohydrates can limit occurrences. Recent observational studies have shown that women with breast cancer who have a substantial smoking history have increased breast cancer mortality compared with those who never smoked. So, limiting smoking habit could reduce the recurrence of breast cancer.

CONCLUSION.

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