Breast Cancer

and
Strategic Treatment

Presented by:
Komal Padhariya
(T.Y.B.Pharm)
Guided by:
Mrs. Sugandha
C.
 Anatomy of breast
 Breast profile:
A Ducts
B Lobules
C Dilated section of duct to
hold milk
D Nipple
E Fat
F Pectoralis major muscle
G Chest wall/rib cage
 Enlargement:
A Normal duct cells
B Basement membrane
C Lumen (center of duct)
 Interior of breast
 The breast is
composed of glandular
and adipose tissue in
varying proportions.
The glandular tissue
consists of 15–20
lobes containing
numerous lobules,
linked by ductules.
The latter combine to
form the lactiferous
ducts
Blood supply to breast
Anatomy of the breast, showing
lymph nodes
 Each breast also
has blood vessels
and lymph vessels.
Lymph vessels lead
to organs called
lymph nodes.
Lymph node filters
substances in
lymph and helps
fight infection and
 Breast cancer:
 Breast cancer is a disease in which malig
 Age and health history can affect the
risk of developing breast cancer.
 Breast cancer is sometimes caused
by inherited gene mutations
(changes).
 Certain factors affect prognosis
(chance of recovery) and treatment
options.
 TYPES OF BREAST CANCER

BREAST
CANCER

NON INVASIVE & VASCULAR &

NON INVASIVE
INVASIVE LYMPHATIC
CELL GROWTH
DCIS & LCIS INVASION

1. DUCTAL 2. LOBULAR
CARCINOMA CARCINOMA 1. SOLID 2. CRIBIFORM
INSITU INSITU

3. INVASIVE 4. INVASIVE
DUCTAL LOBULAR 3. PAPILLARY 4. COMEDO
CARCINOMA CARCINOMA
 NON INVASIVE & INVASIVE DCIS & LCIS
Lobular Carcinoma Invasive Lobular
Ductal Carcinoma Invasive
in situ (LCIS) Carcinoma
in situ (DCIS) Ductal Carcinoma (IDC)
(ILC)

A normal duct cells A normal duct A normal cells

B ductal cancer A normal lobular cells B lobular
cells cells B ductal cancer cells
C basement B lobular cancer cancer cells breaking
membrane cells breaking through the
D lumen (center of C basement through the basement
duct) membrane basement membrane
membrane C basement
 NON INVASIVE CELL GROWTH
Solid Cribiform Papillary Comedo

A living cancer cells

A cancer cells A cancer cells A cancer cells
B dying cancer cells
B basement B basement membrane B basement
C cell debris
membrane C lumen (center of duct) membrane
(necrosis)
C lumen
D basement
(center of duct)
membrane
 Symptoms of breast
cancer:
 Breast lump
 Lump or mass in the armpit
 A discharge from the nipple area – any bleeding or
weeping
 Hardening of the skin in the nipple area
 Inversion of the nipple – turning inward or at an unusual
angle
 Change in the sensation of the nipple
 Breast pain
 Weight loss
 Bone pain
 Breast enlargement only on one side
 Changes in the areola
 RISK FACTORS OF BREAST CANCER

There are two categories of risk factors for breast cancer-

those we have control over (modifiable) and those we do
not (non-modifiable)

BEYOND YOUR CONTROL

 Gender
 Age
 Genetics
 Race
 Family History
 Late pregnancies

WITHIN YOUR CONTROL

 SMOKING
 ALCOHOL
 Radiation Exposure
 Lifestyle
 Diagnosis of breast
cancer:
 Breast self-exam
 Breast physical exam, done by a
doctor
 Mammography
 Tests that examine the breasts are
used to detect (find) and diagnose
breast cancer.
 Mammogram
 Biopsy
• Excisional biopsy

• Incisional biopsy

• Core biopsy
• Needle biopsy
• Estrogen &
progesterone receptor test
 STAGES OF BREAST CANCER
 Staging is the process physicians use to asses the size and
location of patients cancer
 To stage cancer, cancer are designated the letter T(Tumor
size),N(Palpable nodes) and M(metastatis)
Numerical Stages of Breast Cancer

The stage of a breast cancer describes its size and the extent to which it. has
spread. The staging system ranges from Stage 0 to Stage IV

Staging Breast Cancer

Lymph Node Metastasis
Stage Tumor Size
Involvement (Spread)

I Less than 2 cm No No
II Between 2-5 cm No or in same side of breast No
III More than 5 cm Yes, on same side of breast No
IV Not applicable Not applicable Yes
 Stage Definition
Stage 0 Cancer cells remain inside the breast duct,
without invasion into normal adjacent breast
tissue

Stage I Cancer is 2 centimeters or less and is confined

to the breast (lymph nodes are clear)

Stage II The tumor is over 2 centimeters but no larger

than 5 centimeters
Or
There is spread to the lymph nodes under the
arm
Stage III (includes Also called locally advanced cancer. The tumor
substages IIIA & is more than 5 centimeters across
IIIB) Or
The cancer is extensive in the underarm lymph
nodes
Or
It has spread to other lymph nodes or tissues
Stage IV near the breast
The cancer has spread—or metastasized—to
other parts of the body.
 Additional staging
information:
 Early stage:
Stage 0
Stage I
Stage II
 Later stage:
Stage II if there are many lymph nodes
involved
Stage III (IIIA, IIIB)
 Advanced stage:
Stage IV
 Strategic treatment of
breast cancer:
 Four types of standard treatment are
used:
Surgery
Radiation therapy
Chemotherapy
Hormone therapy
 New types of treatment
Sentinel lymph node biopsy followed by
surgery
High-dose chemotherapy with stem cell
transplant
Monoclonal antibodies as adjuvant therapy
 Surgery
 Breast-conserving surgery
 Lumpectomy
 Partial mastectomy

Breast-conserving surgery. Dotted

lines show area containing the
tumor that is removed and some
of the lymph nodes that may be
removed.
 Other types of surgery
include the following:
 Total mastectomy:
Total mastectomy. Dotted
line shows entire breast is
removed. Some lymph
nodes under the arm may
also be removed.
 Modified radical mastectomy
:
Modified radical
mastectomy. Dotted line
shows entire breast and
some lymph nodes are
removed. Part of the chest
wall muscle may also be
removed.
 Radical mastectomy:
 
Radiation therapy
Woman in position for radiation treatment, from the front. Middle radiation
beam is shown.
A Bright yellow: breast being treated
B Light yellow: beam in air, not touching woman
C Opening of the linear accelerator
D Arm holder supports woman's right arm

 Woman in position for radiation treatment, from the side. Side radiation
treatment beam is shown
A Bright yellow: breast being treated
B Light yellow: beam in air, not touching woman
C Opening of the linear accelerator
D Arm holder

 Cross-sectional view of a woman receiving radiation to the breast area

A Middle radiation beam
B Side radiation beam
C Bright yellow: place where radiation is given to the breast
D Rib cage/chest wal
lE Heart
F Lungs
G Backbone
H Sternum/breast bone
 Chemotherapy
 Systemic chemotherapy
 Regional chemotherapy
 Classes of Drugs:
 Alkylators
 Antimetabolites
 Antibiotics
 Antimiotic agents
 Antimicrotubule
Chemotherapy combinations
for non-metastatic breast
cancer:
 AC ± T – Adriamycin (chemical name:
doxorubicin) with cyclophosphamide (brand
name: Cytoxan), with or without Taxol (chemical
name: paclitaxel) or Taxotere (chemical name:
docetaxol)
 CMF – cyclophosphamide, methotrexate, and
fluorouracil ("5-FU" or 5-fluorouracil)
 CAF – cyclophosphamide, Adriamycin, and
fluorouracil ("5-FU" or 5-fluorouracil)
 CEF – cyclophosphamide, Epirubicin (similar to
Adriamycin), and fluorouracil ("5-FU" or 5-
fluorouracil)
 FAC – fluorouracil ("5-FU" or 5-fluorouracil),
Adriamycin, and cyclophosphamide.
 Hormone therapy
 Role of estrogen

 Selective estrogen-
receptor modulator
(SERM)
eg.Tamoxifen, Raloxifene,
Toremifene
 Aromatase inhibitors
• Arimidex
• Aromasin
• Femara

 The only estrogen-

receptor down regulator
(ERD)
Eg. Faslodex

 Ovarian shutdown and

removal
 Side effects
 Side Effects Common to All
Treatments:
 Mood swings
 Depression
 Weight gain
 Hot flashes
 Vaginal dryness
 Bloating
 Early start of menopause (may be
reversed)
 "Flare reaction" or burning pain in bones
(metastatic cancer only)
 New types of treatment are
being tested in clinical trials.
 Sentinellymph node biopsy
followed by surgery
•High-dose chemotherapy with stem
cell transplant

•Monoclonal antibodies as adjuvant

therapy
•Herceptin (chemical name: trastuzumab) is a very
effective treatment against HER2-positive breast
cancer in women with stage II, III, and IV disease
(medium to large cancers or cancers with lymph
nodes involved or metastatic disease.
 HOW HERCEPTIN WORKS ?
1. BLOCKING OF THE
TUMOR CELL GROWTH

2.SIGNALING OF
THE IMMUNE
SYSTEM

3. WORKING WITH
CHEMOTHERAPY
MECHANISM OF ACTION
 Two tests are used to figure out if the
cancer is likely to respond to Herceptin

 FISH (Fluorescence In Situ Hybridization)

 IHC (ImmunoHistoChemistry)

4. FISH (Fluorescence In Situ Hybridization)

 Tests shows how many copies of HER 2 gene are in
tumor cells
 Gives scores of either “positive” or “negative”
 If tumor “FISH positive” it will probably respond well to
herceptin

HER 2 amplification by single

color FISH (red signals)
2. IHC (Immuno Histo Chemistry)

• Test used to see if a tumor has too much of the HER 2 receptor protein
on the surface of the cancer cells
• Gives a score of 0 to 3+ that indicates the amount of HER 2 receptor
protein in the tumors
• If the tumor scores 0 to 1+ called “HER 2 negative”.
• If the tumor scores 2+ or 3+ called “HER 2 positive”
• Women with IHC positive respond favourably to herceptin
• Drug is not considered effective for tumors with IHC scores of 0and 1+

HER 2 overexpression (3+)

shown by IHC
 DOSAGE
 The dose is calculated by the weight of the
patient

 4mg/kg on the first day then 2mg/kg once a

week .

 Convert patient weight in to kg – 2.2

pounds=1kg .
patients weight in pounds/2.2 = patient
weight in kg

 Insert patient weight in kg in to dosage

equation using
either 4 or 2 mg/kg as multiplier

FORMULA :

patient weight in kg x = ml of
Herceptin reconstituted
solution
 ADMINISTRATION
 Given intravenously
 Given once a week or once every
three weeks
 4mg/kg loading dose administered
over a 90 min infusion
 2 mg/kg maintaince dose
administered as a 30 min infusion
 DO NOT ADMINISTER as IV PUSH OR
BOLUS
 Herceptin should not mixed or
diluted with other drugs
 SIDE EFFECTS OF HERCEPTIN
EARLY EFFECTS
 Fever and sweating
 Chills
 Skin flushing – redness
 Discomfort in the throat
 Difficulty in breathing
ONGOING EFFECTS
 Weakness , tiredness
 Headache
 Sore eyes
 Joint pain
 Diarrhea
LATE SIDE EFFECTS
 Heart problems
 Allergic like reactions
 Lung reactions
 HERCEPTIN AND CHEMOTHERAPY
 Herceptin is often given in combination with
other cancer drugs.
 Some of the chemotherapy drugs that has
been given with Herceptin includes
 Taxol
 Navelbine
 Xeloda
 Paraplatin
 Chemotherapy drugs are given intravenously
on the same weekly schedule as Herceptin
 Studies revealed that , women with metastatic
disease got better results when they took
Herceptin with chemotherapy drugs
 CONCLUSION:
 A survey says that every one in 875
women and every one in 10,000 men
suffer from breast cancer worldwide. In
many cases it is found as small tumor
while in some the cancer spreads which
could be fatal.
 Early detection can help us to avoid
serious damages caused by proliferation.
This can be possible by self examination
and with the help of the physician.
The treatments for curing breast
cancer are very expensive so
spending

“5 minutes for self examination

OR 5 weeks in hospital”
The choice is yours!!!
THANK YOU