Precipitating factors Reproductive history Radiation exposure Alcohol consumption Obesity and dietary fat

Predisposing factors Gender Race/ethnicity Age Family history of cancer or genetics Personal history of cancer Menstrual history/hormonal factors

Chemical carcinogens

Endocrine metabolism Stromal alterations (cell adhesion, extracellular matrix, epithelial polarity) Cell-cell communication Metabolites

Elimination and/or protection

Estrogens synthesis, distribution, metabolism

DNA adducts Oxidative damage Lipid peroxidation Redox imbalance (i.e. prooxidant an antioxidant) Altered transcription?

Estrogen receptor Ligand pathway

Signal transduction Cell proliferation and differentiation

Cumulative genetic alterations

Epigenetic alterations

Alteration and Activations Proto-Oncogenes and/or Inactivation of Tumor Suppressor Genes Alterations cell-signaling pathways Loss of apoptosis

Overgrowth of cells that line the breast ducts (atypical ductal hyperplasia)

The proliferating atypical cells have enlarged, irregular, hyperchromatic nuclei and small nucelei

The cells are mixed with the normal secretory or myoepithelial cells without reaching to a homogenous population of atypical cells

Ductal carcinoma in situ (Stage 0)

Carcinoma breaks the boundary of the milk ducts of the breast

Cancer cells spread into other parts of the breast and become invasive Stage 1A G O O D P R O G N O S I S If treated with - Surgery - radiation therapy -Chemotherapy - hormone therapy -biological therapy - clinical trials Invasive ductal carcinoma (Stage 1) Stage 1B

If not treated/diagnosed Stage 2A Stage 2 Stage 2B

Cancer cells has spread into the axillary lymph nodes G O O D If not treated/diagnosed If treated with - Surgery - radiation therapy -Chemotherapy - hormone therapy -biological therapy - clinical trials P R O G N O S I S

Stage 3A Stage 3B Stage 3C Cancer cells have spread to the axillary nodes and are clumped together or sticking to other structures Stage 3

Spread to the chest wall, breast bone, below the collar bone

If treated with Radiation chemotherapy

F A I R P R O G N O S I S

If not treated/diagnosed

Stage 4

Invasive breast cancer spread s beyond the breast to the lymph nodes and to other organs

Cancer cells metastasize to the spine

Cancer cells stimulate the production of osteoclasts in the spine

BONE BREAKDOWN

Release of growth factors from the bone

Interaction between the breast cancer cells and bone canignite a vicious cycle of increased bone destruction and tumor growth

SPINAL FRACTURE Continuous tumor growth

Increased pressure on the spinal cord is placed

CORD COMPRESSION

Clients injury occurs at T9, T11 and L1

Nerves at the lower extremities affected

HEMIPLEGIA

Bladder distention and Loss of rectal sphincter tone

Stimulation of sensory receptors below the level of the cord injury

Intact peripheral sensory nerves transmit impulses that ascend in the spinothalamic and posterior columns

Sympathetic neurons located in the intermediolateral gray matter of the spinal cord is stimulated

The inhibitory outflow above the injury from cerebral vasomotor centers is increased

Unable to pass below the block of the spinal injury

This large sympathetic outflow causes release of various neurotransmitters

Piloerection, skin pallor and severe vasoconstriction in arterial vasculature

Elevation in blood pressure and vasodilation above the level of injury

Vasodilation of pain-sensitive intracranial vessels lead to headache

Vasomotor brainstem reflexes attempt to lower blood pressure by increasing parasympathetic stimulation to the heart through the vagus nerve BRADYCARDIA

The visceral and peripheral vessels do not dilate because efferent impulses cannot pass through the cord

If treated with Decompression and surgical fixation of the spine Corticosteroids 21-aminosteroid tiriliad Opiate antagonist naloxone Ca channel blockers Glutamate receptor blockers Growth-promoting and growth-inhibiting factors Nutrition, lung function, skin integrity and bladder and bowel management Rehabilitation Elevation of the head of the bed GOOD/FAIR PROGNOSIS

If not treated

Complications: Cerebrovascular accident (CVA) Severe peripheral hypertension Retinal/cerebral hemorrhage Myocardial infarction seizures

DEATH