BREAST CANCER

DEFINITION
Breast cancer is a malignant tumor that attacks the breast tissue. Breast tissue is
composed of milk glands, ducts glands, and tissues supporting the breast. Breast cancer cells
and causes breast tissue to change shape become abnormal and multiply in an uncontrolled
manner
Breast cancer is a group of abnormal cells in the breast that continues to grow in the
form of a double. At the end of these cells to form in the breast bejolan. If the cancerous lump
was not discarded or controlled, cancer cells can spread (metastasis) to other body parts.
Metastases may occur in lymph nodes (lymph) armpit or above the shoulder blade. Besides
cancer cells can be lodged in the bones, lungs, liver, skin, and subcutaneous
ETIOLOGI
Etiology of breast cancer is not known specifically, but there are risk factors that can
cause breast cancer.
Risk factor
1.
Age
This disease is more common in women aged over 50 years and is rare in women
before menopause. Nearly 80% in the early diagnosis of breast cancer cell spread of
cases occur in women over the age of 50 years or more, according to the American
Cancer Society (ACS)
2.
Family History
Having a mother or sister who develop breast cancer or ovarian cancer increases the
risk. The risk will be higher when the breast cancer experienced immediate family
members (mother, sister, or daughter), especially if the cancer is attacked while they
were under the age of 50 years.
3.
Tested positive for the BRCA gene mutation associated with 1 or BRCA 2
This condition significantly increases the chances of female or male breast cancer. For
women who suffer from this gene, have a 80% chance of developing breast cancer,
according to the ACS. Recent research has found other genes and gene mutations that
may be associated with breast cancer. Several studies have shown nearly 200 mutations
in genes that can cause breast cancer.
4.
Health History Previous regarding breast conditions
This includes convicted of breast cancer or affected by proliferative breast disease
(PBD). Although known benign condition, PBD also developed into a fairly high risk of
breast cancer. And again, after a previous biopsy to remove a benign tumor that turned
suspicious, it could also increase slightly the risk of breast cancer
5.
Ashkenazi Jewish descent
This population has enough offspring affected by breast cancer.
6.
Race
Breast cancer is more common in white women, than other races, such as Latin, Asian,
or African-american.
7.
Exposed to Radiation In Chest
For patients who were treated for Hodgkin's lymphoma cope with chest radiation before
age 30, the chance to develop into breast cancer is also greater than women who did not
undergo this treatment.
8.
The use hormones
Hormone replacement therapy (generally done to deal with the symptoms menapouse)
or other exposure to estrogen or progesterone increases the risk in women. Certain

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types of breast cancer can develop as a result of the use of these hormones. Risk
depends on the length of time the use of hormones. The longer the use, the higher the
risk.
Breast density
Women whose fat content in the body a little, dense breasts, it can increase the chances
of developing breast cancer. Breasts tend to be more dense with age.
Reproductive Health History
Women who give birth to children under age 30 have had a lower risk of developing
breast cancer than women who give birth after 30 years or not having children at all.
Menstrual history
Women who first experienced early menstruation (before age 12) or experienced
menopause after age 55 are at increased risk of breast cancer is high.
By exposure to DES (diethylstilbestrol)
Estrogen synthesis have been granted since the 1940s until the early 1970s to pregnant
women. Unfortunately, DES is believed to increase the risk of cancer slowly. For many
- years, DES can cause vaginal cancer (rare) or cervical cancer. New research shows
that girls exposed to DES while in the womb are also at high risk of developing breast
cancer.
Obesity After Menopause
Weight women who possess jumped significantly more estrogen in the body, because
some hormones are made from fat tissue. When the amount of estrogen increased the
risk of breast cancer also increases.
Moving lazy
Women who are physically inactive, have a high risk of developing breast cancer. This
can occur because of lifestyle inactivity can lead to obesity, which is also a risk factor
for breast cancer.
Alcohol consumption
Several studies have concluded that the more alcohol that is consumed women, the risk
of breast cancer is greater. Analysis of the study suggest that limiting alcohol intake per
day (min 2 cups) so as to reduce risioko breast cancer by 21%. The risk of this
happening as a result of alcohol consumption because alcohol can increase the amount
of the hormone.
Smoke
Smoking significantly increases the risk of developing these illnesses, especially for
women who have a family history of breast cancer

Breast Carcinoma Histopathological classification (WHO)

a. Non-invasive (in situ) Carcinoma
Intraduktus carcinoma
Intralobuler carcinoma
b. Invasive Carcinoma
Invasive ductal carcinoma
Invasive ductal carcinoma with predominant component intraduktus
Lobuler invasive carcinoma
Tubular carcinoma
Medullary carcinoma
Papillary carcinoma
Mucoid carcinoma
Adenoid cystic carcinoma
Apocrine carcinoma

Squamous cell carcinoma

c. Paget Carcinoma
Classification according to Smeltzer, 2002
1. Infiltrating ductal carcinoma, is the most common histological types, constitute 75% of all
breast cancers. This cancer is very clear as hard when palpated. Usually metastasize to the
axillary nodes, the prognosis is worse than in other types of cancer.
2. Infiltrating lobular carcinoma, a rare, 5% to 10% of breast cancers. This type is generally
multisentris, thereby thickening can occur several sala some areas on one or both breasts.
3. Medullary carcinoma, occupies about 6% of breast cancers and grow in a capsule inside
the duct.
4. Cancer occupies 3% of mucinous breast cancer. Mucus-producing, also grew at a slow
pace so that this cancer has a better prognosis.
5. The tubular-ductal cancer is rare, about 2% of breast cancers.
6. Inflammatory carcinoma cause symptoms tenderness and painful, will be hard and
enlarged breasts, biscuits above and dusky red tumor, often occur edema and retraction of
the nipple.
7. Breast carcinoma in situ
Pathophysiology
Breast cancer is a disease that occurs when genetic damage occurs in DNA from breast
epithelial cells. There are many types of breast cancer. Genetic alterations found in the
epithelial cells, spreading into the duct or lobular tissue. The rate of growth of cancer depends
on the effects of estrogen and progesterone. Cancer can be invasive (infiltration) and
noninvasive (in situ). Or infiltration of invasive breast cancer can progress to the wall of the
duct and surrounding tissue, so far that many cancers are invasive ductal carcinomas occur.
Ductal carcinomas derived from the lactiferous ducts and shaped like tentacles that invade the
surrounding breast structure. The tumor is usually unilateral, can not be described, solid, nonmobile, and nontender. Lobular carcinoma is derived from breast lobe. Usually bilateral and
not palpable. Nipple carcinoma (Paget's disease) is derived from the nipple. It usually occurs
with invasive ductal carcinoma. Bleeding, bloody, and hardening nipples (Lowdermilk et al
2000).
Breast cancer can invade surrounding tissue so as to have tentacles. Invasive growth
pattern can produce irregular tumor can terapa palpation. At the time of developing tumors,
fibrosis occurs around and shorten the Cooper's ligaments. When Cooper's ligaments shorten,
resulting in peau d'orange (orange peel) skin changes and edema associated with breast
cancer. If breast cancer attacks the lymphatic duct, tumors may develop in the lymph nodes,
spleen axila usually attack nodes. Tumors can damage the skin layers, causing ulceration.
Metastases caused by breast cancer and blood occupies lympa system, led to the development
of tumors in bone, lung, brain, and liver (Lowdermilk et al, 2000, Swart 2011)
Stages of Breast Cancer
- Phase I
Consisting of tumors less than 2 cm, not the lymph nodes, and no detectable metastases
- Phase II
Consists of a tumor larger than 2 cm but less than 5 cm, with no fixed lymph node
negative or positive, and no detectable metastases
- Phase III
Consists of a tumor larger than 5 cm with lymph node positive fixed in clavicular area,
and no evidence of metastasis

Phase IV
Consisting of tumors and in various sizes with normal lymph nodes or ksnkerosa, and the
presence of distant metastases (Smeltzer, 2002)

Supporting investigation
Early detection is done to prevent the development of breast cancer. Kecilk breast tumors
more easily treated if detected and the prognosis is better. Mendetaksi remedy examination of
breast cancer, among others: (Breast Health UK, 2010, Swart 2011).
a. Breast self-examination
Breast self-examination and clinical breast examination is inexpensive and non-invasive
procedure for breast examination. If found abnormal indications, ie lump or thickening in
the breast tissue, pain in one breast or armpit. One breast to be larger or lower, or the
nipples are interested in changing positions, skin changes (contract), swelling under the
armpit ayau collarbone, rash on or around the skin. If there are signs must be done three
studies, the clinical breast examination, mammography or ultrasonography, and biopsy
b. Mammography
Mammography uses low-dose x-rays to make detailed images of the breast.
Mammography can detect breast cancer at an early stage, can show lesions that can not be
detected by clinical breast examination. There are 2 two types of mammography, screening
and diagnostics. Breast screening is done in women without symptoms such as a lump in
the breast or nipple discharge is found no breast self-examination or abnormality is found
during screening mammography. Women with breast implants or a history of breast cancer
using mammography diagnostics.
c. MRI
MRI is used for some cases, namely: cases of breast cancer with mammography result is
negative, to determine the size of the tumor in invasive lobular cancer, breast cancer for
monitoring response to therapy preoreratif, there is discordance between the assessment of
the initial assessment of the lump in the breast.
d. Digital infrared
e. Positron Emission Tomography Scanning
PET scanning is used to identify lymph node metastases nonaxilary for advanced breast
cancer and inflammatory breast cancer before starting a non-adjuvant therapy.
f. Genetic tests
The primary cause of inherited breast cancer is a mutation of the BRCA1 or BRCA2
genes, which is a risk factor for the development of other diseases. However, these genes
are very rare in the population of women with breast cancer. This test has been done in the
United States.
Stage Breast Cancer:
1. Stage I: tumor less than 2 cm, no affected lymph nodes (LN) or widespread deployment.
2. Stage IIa: tumor less than 5 cm, without LN involvement, no distant spread. Tumors less
than 2 cm with LN involvement
3. Stage IIb: tumor less than 5 cm, with the involvement of LN. Tumors larger than 5 cm
without LN involvement
4. Stage IIIa: tumor larger than 5 cm, with the involvement of LN. all tumors with LN
exposed, no distant spread
5. Stage IIIb: tumors with direct spread to the chest wall or skin tumors by edema of the
hands or supraclavicular LN involvement.
6. Stage IV: all tumors with distant metastases. (Setio W, 2000, hal : 285)

surgery
1. Partial mastectomy (local tumor excision and radiation). Ranging from lumpectomy to segmental
removal (removal of an extensive network with exposed skin).
2. The total mastectomy with low axial dissection of the entire breast, lymph nodes dilateral
otocpectoralis all minor.
3. The modified radical mastectomy
The whole breast, all or most of the network of axial
1) radical mastectomy
The entire breast, pectoralis major and minor muscles beneath it: the entire axial.
2) extended radical mastectomy
Just as radical mastectomy plus internal mammary lymph nodes.
Non surgery
1. Radiation
In the breast and regional lymph nodes that can not be resected in advanced cancer; on bone
metastases, axillary lymph node metastases.
2. Chemotherapy
Adjuvant systemic after mastectomy; palliative in advanced disease.
3. Hormone therapy and endocrine
Cancer that has spread, taking estrogen, androgen, antiestrogen, coferektomi adrenalectomy
hypophysectomy.
(Smeltzer at all, 2002, page: 1596-1600)