Breast Cancer Pathophysiology

Cancer Pathophysiology
There are trillions of cells in the body. These cells have a tightly regulated cell cycle
that controls their growth, maturity, division and death. During childhood normal
cells divide faster to allow the person to grow. Once adulthood is reached the cells
divide to replace worn-out cells and to repair injuries. This cell division and growth is
controlled by the cellular blue print or DNA and genes that lie within the cells
nucleus.

Cancer begins when cells in a part of the body start to grow out of control. All types
of cancer, irrespective of their origin, occur due to this disturbed growth of cells that
leads to formation of tumours and lesions. In addition, the cancer cells possess
some rogue like properties:

They have longer life spans and instead of dying continue to grow and form new,
abnormal cells
Cancer cells can also invade other tissues. This is something that normal cells
cannot do. This property is called metastasis.
Cancer cells grow into tumors that are supplied by a new network of blood vessels.
This is called angiogenesis and is unique in maintaining the blood supply and supply
of nutrients to the cancer cells.
What makes a normal cell turn cancerous?
A normal cell can become a cancer cell if it undergoes damage to the DNA. Since it
is the DNA that regulates the cells cycle of growth and death and any changes or
damage to DNA affects the cell.

For most cells if the DNA is damaged the cell either repairs the damage or the cell
dies. In cancer cells, the damaged DNA is not repaired and the damage is
propagated to newer abnormal cells that are born of the defective cell.

Damaged DNA by mutation can also be inherited from parents or relatives. DNA
damage can also occur due to exposure to toxins like cigarette smoking, alcohol etc.

Breast Cancer Pathophysiology

Breast cancer is a malignant tumor that starts in the cells of the breast. Like other
cancers, there are several factors that can raise the risk of getting breast cancer.
Damage to the DNA and genetic mutations can lead to breast cancer have been
experimentally linked to estrogen exposure. Some individuals inherit defects in the
DNA and genes like the BRCA1, BRCA2 and P53 among others. Those with a family
history of ovarian or breast cancer thus are at an increased risk of breast cancer.

The immune system normally seeks out cancer cells and cells with damaged DNA
and destroys them. Breast cancer may be a result of failure of such an effective
immune defence and surveillance.

These are several signalling systems of growth factors and other mediators that
interact between stromal cells and epithelial cells. Disrupting these may lead to
breast cancer as well.

PATHOPHYSIOLOGY AND TYPES OF BREAST CANCER

There are four different types of breast cancer. They are described below.

Breast cancer is either invasive or noninvasive (often referred to as in situ). There

are two types of noninvasive breast cancers: ductal carcinoma in situ (DCIS) and
lobular carcinoma in situ (LCIS). These two types of noninvasive breast cancers do
not invade the basement membrane of the breast (see Fig. 1, Anatomy of the
Breast). As their names suggest ductal carcinoma in situ cancer cells are found in
the lining of the duct whereas lobular carcinoma in situ cancer cells are found in the
lobules (see Anatomy section for a detailed description of the ductals and lobules of
the breast).

There are the two types of noninvasive breast cancer described above and there
are also two types of invasive breast cancer: infiltrating ductal carcinoma and
infiltrating lobular carcinoma. As their names suggest, infiltrating ductal carcinoma
penetrates the wall of the duct and travels to areas outside of it whereas infiltrating
lobular carcinoma spreads through the wall of the lobule and also travels to areas
outside of it. Infiltrating ductal carcinoma is the most common type of breast
cancer, accounting for between 70%-80% of the cases of breast cancer.

Each of the four types of breast cancer has four stages that relate to the severity of
the cancer. The following describes the types and stages of breast cancer.

Stage 0noninvasive carcinomas (LCIS or DCIS). Cancer cells have not invaded the
surrounding breast tissue.

Stage Ithe tumor is no more than 2 cm in size and cancer cells have not spread
beyond the breast.

Stage IIeither the tumor has spread to the lymph nodes under the arms but the
tumor is less than 2 cm
in size, or the tumor has not spread to the lymph nodes under the arms but is
greater than 5 cm in size, or the tumor is between 2 and 5 cm and may or may not
have spread to the nodes.

Stage IIIthe tumor is greater than 5 cm in size and has spread to the lymph nodes
under the arms.

Stage IVthe cancer has spread to other parts of the body (metastatic cancer).

Female Breast

Fibrocystic breast disease

Alternative names Return to top

Female Breast

Fibrocystic breast disease

Alternative names Return to top

Mammary dysplasia; Benign breast disease

Definition Return to top

Fibrocystic breast disease is described as common, benign (non-cancerous) changes

in the tissues of the breast. The term "disease" in this case is misleading, and many
providers prefer the term "change."

The condition is so commonly found in breasts, it is believed to be a variation of

normal. Other related terms include "mammary dysplasia," "benign breast disease,"
and "diffuse cystic mastopathy."

Causes, incidence, and risk factors Return to top

The cause is not completely understood, but the changes are believed to be
associated with ovarian hormones since the condition usually subsides with
menopause, and may vary in consistency during the menstrual cycle.

The incidence of it is estimated to be over 60% of all women. It is common in

women between the ages of 30 and 50, and rare in postmenopausal women. The
incidence is lower in women taking birth control pills. The risk factors may include
family history and diet (such as excessive dietary fat, and caffeine intake), although
these are controversial.

Symptoms Return to top

A dense, irregular and bumpy "cobblestone" consistency in the breast tissue

Usually more marked in the outer upper quadrants
Breast discomfort that is persistent, or that occurs off and on (intermittent)
Breast(s) feel full
Dull, heavy pain and tenderness
Premenstrual tenderness and swelling
Breast discomfort improves after each menstrual period
Nipple sensation changes, itching
Note: Symptoms may range from mild to severe. Symptoms typically peak just
before each menstrual period, and improve immediately after the menstrual period.

Signs and tests Return to top

Physical examination reveals the presence of mobile (non-anchored) breast

"masses." These masses are usually rounded, with smooth borders, and either
rubbery or slightly changeable in shape. Dense tissue may make the breast
examination more difficult to interpret.

Mammography may be difficult to interpret due to dense tissue.

A biopsy of the breast may be necessary to rule out other disorders.
Aspiration of the breast with a fine needle can often diagnose and treat larger cysts.
Treatment Return to top

Self care may include restricting dietary fat to approximately 25% of the total daily
calorie intake, and eliminating caffeine.

Performing a breast self-examination monthly, and wearing a well-fitting bra to

provide good breast support are important.

The effectiveness of Vitamin E, Vitamin B-6, and herbal preparations, such as

evening primrose oil are somewhat controversial. Discuss their use with your health
care provider.

Oral contraceptives may be prescribed because they often decrease the symptoms.
A synthetic androgen may be prescribed by a doctor in severe cases, when the
potential benefit is thought to outweigh the potential adverse effects.

Expectations (prognosis) Return to top

If dietary changes decrease the symptoms, and are maintained, the benefit most
likely will persist. A combination of treatment and use of medications may be
necessary to obtain relief for severe cases.

Complications Return to top

Because fibrocystic changes may make breast examination and mammography

more difficult to interpret, early cancerous lesions may occasionally be overlooked.

Calling your health care provider Return to top

Call your health care provider if you feel a new, unusual, or "dominant" lump during
a breast self-examination.

Call for an appointment with your health care provider if you are a woman, aged 20
or older, who has never been taught, or does not currently know how, to perform
breast self-examination. Also call if you are a woman, aged 40 or older, who has not
had a screening mammogram.

Prevention Return to top

Reduction of dietary fat and caffeine if you have fibrocystic breast changes has
been suggested, although recent studies have questioned the role of caffeine and
fat in fibrocystic disease.

Update Date: 5/15/2006

Mammary dysplasia; Benign breast disease

Definition Return to top

Fibrocystic breast disease is described as common, benign (non-cancerous) changes

in the tissues of the breast. The term "disease" in this case is misleading, and many
providers prefer the term "change."

The condition is so commonly found in breasts, it is believed to be a variation of

normal. Other related terms include "mammary dysplasia," "benign breast disease,"
and "diffuse cystic mastopathy."

Causes, incidence, and risk factors Return to top

The cause is not completely understood, but the changes are believed to be
associated with ovarian hormones since the condition usually subsides with
menopause, and may vary in consistency during the menstrual cycle.

The incidence of it is estimated to be over 60% of all women. It is common in

women between the ages of 30 and 50, and rare in postmenopausal women. The
incidence is lower in women taking birth control pills. The risk factors may include
family history and diet (such as excessive dietary fat, and caffeine intake), although
these are controversial.

Symptoms Return to top

A dense, irregular and bumpy "cobblestone" consistency in the breast tissue

Usually more marked in the outer upper quadrants
Breast discomfort that is persistent, or that occurs off and on (intermittent)
Breast(s) feel full
Dull, heavy pain and tenderness
Premenstrual tenderness and swelling
Breast discomfort improves after each menstrual period
Nipple sensation changes, itching
Note: Symptoms may range from mild to severe. Symptoms typically peak just
before each menstrual period, and improve immediately after the menstrual period.

Signs and tests Return to top

Physical examination reveals the presence of mobile (non-anchored) breast

"masses." These masses are usually rounded, with smooth borders, and either
rubbery or slightly changeable in shape. Dense tissue may make the breast
examination more difficult to interpret.

Mammography may be difficult to interpret due to dense tissue.

A biopsy of the breast may be necessary to rule out other disorders.
Aspiration of the breast with a fine needle can often diagnose and treat larger cysts.
Treatment Return to top

Self care may include restricting dietary fat to approximately 25% of the total daily
calorie intake, and eliminating caffeine.

Performing a breast self-examination monthly, and wearing a well-fitting bra to

provide good breast support are important.

The effectiveness of Vitamin E, Vitamin B-6, and herbal preparations, such as

evening primrose oil are somewhat controversial. Discuss their use with your health
care provider.

Oral contraceptives may be prescribed because they often decrease the symptoms.
A synthetic androgen may be prescribed by a doctor in severe cases, when the
potential benefit is thought to outweigh the potential adverse effects.

Expectations (prognosis) Return to top

If dietary changes decrease the symptoms, and are maintained, the benefit most
likely will persist. A combination of treatment and use of medications may be
necessary to obtain relief for severe cases.

Complications Return to top

Because fibrocystic changes may make breast examination and mammography

more difficult to interpret, early cancerous lesions may occasionally be overlooked.

Calling your health care provider Return to top

Call your health care provider if you feel a new, unusual, or "dominant" lump during
a breast self-examination.

Call for an appointment with your health care provider if you are a woman, aged 20
or older, who has never been taught, or does not currently know how, to perform
breast self-examination. Also call if you are a woman, aged 40 or older, who has not
had a screening mammogram.

Prevention Return to top

Reduction of dietary fat and caffeine if you have fibrocystic breast changes has
been suggested, although recent studies have questioned the role of caffeine and
fat in fibrocystic disease.

Update Date: 5/15/2006

Fibrocystic breast disease

Alternative names Return to top

Mammary dysplasia; Benign breast disease

Definition Return to top

Fibrocystic breast disease is described as common, benign (non-cancerous) changes

in the tissues of the breast. The term "disease" in this case is misleading, and many
providers prefer the term "change."

The condition is so commonly found in breasts, it is believed to be a variation of

normal. Other related terms include "mammary dysplasia," "benign breast disease,"
and "diffuse cystic mastopathy."

Causes, incidence, and risk factors Return to top

The cause is not completely understood, but the changes are believed to be
associated with ovarian hormones since the condition usually subsides with
menopause, and may vary in consistency during the menstrual cycle.

The incidence of it is estimated to be over 60% of all women. It is common in

women between the ages of 30 and 50, and rare in postmenopausal women. The
incidence is lower in women taking birth control pills. The risk factors may include
family history and diet (such as excessive dietary fat, and caffeine intake), although
these are controversial.

Symptoms Return to top

A dense, irregular and bumpy "cobblestone" consistency in the breast tissue

Usually more marked in the outer upper quadrants
Breast discomfort that is persistent, or that occurs off and on (intermittent)
Breast(s) feel full
Dull, heavy pain and tenderness
Premenstrual tenderness and swelling
Breast discomfort improves after each menstrual period
Nipple sensation changes, itching
Note: Symptoms may range from mild to severe. Symptoms typically peak just
before each menstrual period, and improve immediately after the menstrual period.

Signs and tests Return to top

Physical examination reveals the presence of mobile (non-anchored) breast

"masses." These masses are usually rounded, with smooth borders, and either
rubbery or slightly changeable in shape. Dense tissue may make the breast
examination more difficult to interpret.

Mammography may be difficult to interpret due to dense tissue.

A biopsy of the breast may be necessary to rule out other disorders.
Aspiration of the breast with a fine needle can often diagnose and treat larger cysts.
Treatment Return to top

Self care may include restricting dietary fat to approximately 25% of the total daily
calorie intake, and eliminating caffeine.

Performing a breast self-examination monthly, and wearing a well-fitting bra to

provide good breast support are important.

The effectiveness of Vitamin E, Vitamin B-6, and herbal preparations, such as

evening primrose oil are somewhat controversial. Discuss their use with your health
care provider.

Oral contraceptives may be prescribed because they often decrease the symptoms.
A synthetic androgen may be prescribed by a doctor in severe cases, when the
potential benefit is thought to outweigh the potential adverse effects.

Expectations (prognosis) Return to top

If dietary changes decrease the symptoms, and are maintained, the benefit most
likely will persist. A combination of treatment and use of medications may be
necessary to obtain relief for severe cases.

Complications Return to top

Because fibrocystic changes may make breast examination and mammography

more difficult to interpret, early cancerous lesions may occasionally be overlooked.

Calling your health care provider Return to top

Call your health care provider if you feel a new, unusual, or "dominant" lump during
a breast self-examination.

Call for an appointment with your health care provider if you are a woman, aged 20
or older, who has never been taught, or does not currently know how, to perform
breast self-examination. Also call if you are a woman, aged 40 or older, who has not
had a screening mammogram.

Prevention Return to top

Reduction of dietary fat and caffeine if you have fibrocystic breast changes has
been suggested, although recent studies have questioned the role of caffeine and
fat in fibrocystic disease.

Update Date: 5/15/2006

Female Breast

Fibrocystic breast disease

Alternative names Return to top

Mammary dysplasia; Benign breast disease

Definition Return to top

Fibrocystic breast disease is described as common, benign (non-cancerous) changes

in the tissues of the breast. The term "disease" in this case is misleading, and many
providers prefer the term "change."

The condition is so commonly found in breasts, it is believed to be a variation of

normal. Other related terms include "mammary dysplasia," "benign breast disease,"
and "diffuse cystic mastopathy."

Causes, incidence, and risk factors Return to top

The cause is not completely understood, but the changes are believed to be
associated with ovarian hormones since the condition usually subsides with
menopause, and may vary in consistency during the menstrual cycle.

The incidence of it is estimated to be over 60% of all women. It is common in

women between the ages of 30 and 50, and rare in postmenopausal women. The
incidence is lower in women taking birth control pills. The risk factors may include
family history and diet (such as excessive dietary fat, and caffeine intake), although
these are controversial.

Symptoms Return to top

A dense, irregular and bumpy "cobblestone" consistency in the breast tissue

Usually more marked in the outer upper quadrants
Breast discomfort that is persistent, or that occurs off and on (intermittent)
Breast(s) feel full
Dull, heavy pain and tenderness
Premenstrual tenderness and swelling

Breast discomfort improves after each menstrual period

Nipple sensation changes, itching
Note: Symptoms may range from mild to severe. Symptoms typically peak just
before each menstrual period, and improve immediately after the menstrual period.

Signs and tests Return to top

Physical examination reveals the presence of mobile (non-anchored) breast

"masses." These masses are usually rounded, with smooth borders, and either
rubbery or slightly changeable in shape. Dense tissue may make the breast
examination more difficult to interpret.

Mammography may be difficult to interpret due to dense tissue.

A biopsy of the breast may be necessary to rule out other disorders.
Aspiration of the breast with a fine needle can often diagnose and treat larger cysts.
Treatment Return to top

Self care may include restricting dietary fat to approximately 25% of the total daily
calorie intake, and eliminating caffeine.

Performing a breast self-examination monthly, and wearing a well-fitting bra to

provide good breast support are important.

The effectiveness of Vitamin E, Vitamin B-6, and herbal preparations, such as

evening primrose oil are somewhat controversial. Discuss their use with your health
care provider.

Oral contraceptives may be prescribed because they often decrease the symptoms.
A synthetic androgen may be prescribed by a doctor in severe cases, when the
potential benefit is thought to outweigh the potential adverse effects.

Expectations (prognosis) Return to top

If dietary changes decrease the symptoms, and are maintained, the benefit most
likely will persist. A combination of treatment and use of medications may be
necessary to obtain relief for severe cases.

Complications Return to top

Because fibrocystic changes may make breast examination and mammography

more difficult to interpret, early cancerous lesions may occasionally be overlooked.

Calling your health care provider Return to top

Call your health care provider if you feel a new, unusual, or "dominant" lump during
a breast self-examination.

Call for an appointment with your health care provider if you are a woman, aged 20
or older, who has never been taught, or does not currently know how, to perform
breast self-examination. Also call if you are a woman, aged 40 or older, who has not
had a screening mammogram.

Prevention Return to top

Reduction of dietary fat and caffeine if you have fibrocystic breast changes has
been suggested, although recent studies have questioned the role of caffeine and
fat in fibrocystic disease.

Update Date: 5/15/2006

Unfortunately, I can not copy pictures. However if you go to the Internet and put in
Fibrocystic breast disease" you will be able to see a schmatic of the breast disease.