Pathogenesis and Diagnosis of Breast Cancer

Uncontrolled growth of cells of breasts leads to Breast Cancer. It is commonly known cancer and it is a leading cause of mortality in most of post menopausal women.

Pathogenesis and Diagnosis of Breast CancerBreast cancer awareness, publicity and improvement in breast imaging have positive influence on screening and identification of breast cancer. Many of the risk factors are presented below that includes delayed menopause, obesity, presence of high estradiol concentrations, use of oral contraceptives, protection in planning first birth earlier, high alcohol intake while breastfeeding have protective effect against breast cancer.

Epidemiology:

In Britain, every 1 in 12 females, suffering from breast cancer in between age of 1- 85 years. 18% of all women cancer is “Breast Cancer”, hence common in women due to presence of more glandular tissues in women.

Anatomy:                              

Breast composed mainly of three parts: Connective tissues, lobules and ducts.
Connective tissues include fibrous and fatty tissues (adipose tissues), which covers and bound everything together firmly.
Lobules are the milk producing glands.
Ducts bring milk to the nipples.    
Mostly Lobules and Ducts are the source of Breast cancers.

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Types:

The most common types of Breast cancer includes:
1)Invasive Lobular Carcinoma: Cancerous cells proliferate from the lobules to the nearby breast tissues. It also permeates to the other body parts.

2) Invasive Ductal Carcinoma: Cancerous cells grow into other parts of the tissues of breast, outside the ducts. These cells proliferate and permeate to other body parts.

Other types include:

  1. Infiltrating Lobular Carcinoma
  2. Infiltrating Ductal Carcinoma
  3. Medullary Carcinoma
  4. Mucinous Carcinoma
  5. Tubular Carcinoma
  6. Inflammatory Breast Cancer
  7. Paget’s disease of the breast
  8. Phyllodes Tumor
  9. Triple negative breast cancer

Pathogenesis:

Usually a breast is made up of Stratified epithelium may be Myoepithelial and Epithelial, surrounded by membrane and anchored in the network of blood vessels, connective tissues and lymphatic cells. A neoplastic mutation in the Epithelial and Myoepithelial cells leads to carcinoma of the breast. These neoplastic cells differ from the normal cells of the body in means they spread chronically. The environment and genetic factors are the most common cause of occurrence of breast cancers.

Stages:

Stage 0 It is non-invasive stage which shows that the cancerous and non-cancerous cells both are within limits of that area of the breast.

Stage 1 This stage has 1A and 1B types. 1A depicts no involvement of lymph nodes and the measurement of the tumor is up to 2cm. In 1B type the cancerous cells having measurement greater than 0.2 mm can be seen within the lymph nodes.

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Stage 2 It also has two types 2A and 2B. 2A shows absence of tumor within breast tissues but tumor (having measurement greater than 2cm but smaller than 5cm) can be seen in axillary and sentinel lymph nodes while 2B shows measurement larger than 5cm but no access to axillary lymph nodes.

Stage 3 is further categorized into 3 subtypes 3A, 3B and 3C. The subtype 3A shows absence of tumor in the breast but presence and spreading of tumor in up to 9 axillary and sentinel lymph nodes. 3B subtype scrutinized as inflammatory stage of breast cancer and cause warmness, redness and swelling of the breast’s skin. 3C subtype has involvement of tumor in lymph nodes upward and downward of the clavicle and spreads up to 10 or greater than 10 axillary lymph nodes.

Stage 4 is the foremost and metastases stage which indicates the proliferation of tumor to more organs like liver, lungs, bones etc.

Diagnosis:

Physical Examination of the breast is done to examine the area surrounding armpits, collarbone and neck. Breasts are examined for any lumps, malformations or for other ailments. Lymph nodes are also examined, usually in patients suffering with breast cancer lymph nodes get enlarged.

Self Examination in the breast cancer is very important. This can be done by educating more and more people by the health care providers. So that they become aware of the usual structures of their bodies and if any deformity exists, it can diagnose early.

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Ultrasound Breast Imaging detects the location and size of tumor in the breast either it is fluid filled or with solid. This technique is becoming popular these days for the detection of lumps in the young females.

MRI provides more precise and valid results to females suffering from breast cancer (caused by BRCA 1 & 2 mutation in the genes) and with the lymph adenopathy.

Breast Biopsy To get more accurate and to avoid false negative results biopsy is done with some other techniques concurrently.

Fine Needle Aspiration In this technique, the abnormal cells from the breast are extracted by the help of fine needle. By the help of Ultrasound the exact area of the breast is located from where the abnormal cells extracted. The whole procedure is done after giving local anesthesia.  

Digital Mammography To detect presence of lumps in the dense breast tissues mammography is done. By the help of this technique can detect tumor in the breast early.   

Authors:  Mahnoor Syed*1, Wafa Majeed1, Muhammad Naeem Faisal1, Maria Daud1

1Institute of Pharmacy, Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan

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