Breast Cancer
Introduction As old as 1600 BC Emerges from inner lining of milk ducts Or the lobules that supply milk Types: DCIS LCIS
Genetic, Behaviour, Infectious? Non-Functional BRAC1 & BRAC2 Genes Age, Menstrual cycle, Drinking alcohol, Late or few Births, Smoking, Hormone replacement therapy & Having dense breast
Pathology Develops from epithelial cell lining Invasive, stromal like adenocarcinoma Mammography for DCIS Biopsy is used to detect LCIS(non-palpable lesion, multifocal or bilateral) Paget’s disease(characteristic malignant)
Molecular Basis BRCA1 and BRCA2 Additional genes ATM P53 PTEN CDH1 Characteristics Have specific function in body Their abnormal presence causes certain diseases Risk of breast cancer is increased
Diagnosis Physical examination: First step in breast cancer diagnosis Examination of any lump, change in the size or texture of breast and lymph node in the armpit Diagnostics mammogram: X-ray of the breast Screening mammograms in asymptomatic women Diagnostic mammograms in women having breast cancer MRI (magnetic resonance imaging): Uses radio waves and strong magnets The pattern observed is translated to image More expensive still used more as compared to mammogram Too much sensitive
Ultrasound (sonography): Sound waves are used Echo produced is converted to image Biopsy: Only way to tell actual presence of breast cancer Effected tissue is taken and pathologically tested Scintymammography: New method and still under study Radioactive tracer attached to breast cells through veins Detected by special camera Tomosynthesis (3D mammography): Similar to 2D mammogram More radiation required and 3D image is formed
Two types of tests: 1. Oncotype DX: Helps in depicting the recurrence score Based on this score further treatment is decided Helpful in those who are stage 1 or stage 2 estrogen positive receptor 2. Mammaprint: Helps in determining the recurrence score in specific part of body Both estrogen positive and negative can be detected
Prevention Prophylactic Mastectomy or prophylactic oophorectomy Tamoxifen and Raloxifene Aromatase Inhibitors
Treatment Surgical Methods- Mastectomy, sentinel node biopsy Brachytherapy Drug Therapy Chemotherapeutic Drugs- Cyclophosphamide, Epirubicin, Flourouracil, Methotrexate, Doxorubicin, Docetaxel Hormonal Therapy- SERMs, Aromatase Inhibitors Targeted Therapy- Herceptin, Lapatinib
Biotechnology Applications To understand the molecular basis, development of diagnostics and treatment. Biomarkers Defining gene and protein patterns Human Growth Hormone Biomolecules- Herceptin and Tamoxifen Molecular Profiling- Real Time PCR & Microarray