IV.

SCHEMATIC DIAGRAM

Modifiable Risk Factors Non-Modifiable Risk Factors

Obesity Age
Physical Inactivity Age of First Live Birth
Alcohol Consumption Hormonal Factors
Hormone Therapy after Breast Density
Menopause Sex (Female)
Genetics
Family History
Exposure to Ionizing Radiation

DNA Damage

Failure of DNA Repair

Mutations in the
Genome of the Cells
(INITIATION)

Activation of growth- Inactivation of tumor Alterations in genes

promoting oncogenes suppressor genes (BRCA1, that regulate apoptosis
BRCA2, TP53) (P53 gene)

Unregulated cell Decreased

proliferation apoptosis

Affected cells (epithelial

cells) grow and replicate PROMOTION (Proliferation at the mitotic rate of tissue of origin)
out of control

STAGE I
Tumor progression along the
lactiferous ducts

Hard lump or swelling

Malignant neoplasm (Angiogenesis

and Escape from immunity)
STAGE II

Primary tumor grows into Releases "mobility factor" 

surrounding tissue and
interstitial spaces
Tumor crosses
 basement membrane
PROGRESSION
STAGE III
Tumor breaks through
Inflammation
squamous epithelial cells;
migrates along lactiferous Pain
ducts
Invasion to nearby
Tumor spreads through
tissue
body cavities

Extracellular fluid escapes

Malignant cells break through breaks in the skin 
Damage to Suspensory
off from primary tumor
Nipple discharges Ligaments and
cells and spread
Tumor enters and blocks Lactiferous Ducts
through circulation
lymphatic vessels

Swelling under armpit

Cancer cells migrate Fluid dries and forms

Build-up of lymph in the onto skin crust FIbrosis of lactiferous
interstitial space ducts and suspensory
Paget's  disease
ligaments
Skin Dimpling
Retraction
Breast skin unable to Skin Dimpling
stretch due to
suspensonry ligaments
Swelling; dimpling
and retraction
Peau d'orange Release of cytokines

Activation of inflammatory
mediator interleukin 6

Invades nearby tissues Affectation of appetite

(Pectoral muscles, skin; (certain cytokines ↑hepatic hepcidin
STAGE IV spreads through blood to affect centers for production
spine, brain and bone) then hunger in the brain)
continues to distant sites

Reduces transfer of iron to

develop erythroid
precursors in bone marrow
Decrease in food intake
s/s: anorexia and
weight loss Precursor starved for iron

Low RBC production

 Anemia
Frailty
Generalized weakness
Weight loss
Decreased mobility
Hematocrit at least 25%
Hemoglobin at least 9g/dL

Decreased oxygen
carrying capacity of the
blood Decreased blood
flow/oxygen to the brain
Difficulty of breathing
Generalized weakness Dizziness