Breast Cancer Research Paper
Breast cancer starts off in the inner lining of the lobules or milk ducts , which supply them with milk. Breast cancer affects 1 in 8 women during their lives. No identifiable research to explain why some women get breast cancer, although there are numerous risk factors. Risk factors that people cannot change include Age, gene, and Personal factors. A breast cancer that develop from the ducts is called ductal carcinoma, while one that started off in the lobules is known as lobular carcinoma.
Introduction and incidence of breast cancer
Breast cancer is the most common cancer in the world, accounting for around a 1/3 of cancer in females and affecting 1 in 9 women at some point in their lives. Figure 1 below shows the incidence of breast cancer, along with the mortality and clearly shows that, whilst screening is not reducing the number of cases that occur it is having an effect on the proportion of cases that resulting fatality.
The prevalence (the number of people in a population who have been previously diagnosed with the disease) of breast cancer has been indicated to be around 209956 out of a total population of 30919000 in the UK with 1 in 3 living female cancer patients having received a diagnosis of breast cancer. Breast cancer also affects males, with 0.2% of all cancers, and 1% of breast cancers affecting males
Signs and Symptoms of breast cancer
Breast cancer shows no signs when tumour is small and quite treatable. For sighting breast cancer at the beginning stages before any symptoms start to develop, it is essential for women to abide by the recommended screening guidelines. Important symptoms to be noted are the formation of a painless lump, when the cancer grows and starts to be felt. Sometimes, the tumour spreads to under arm lymph nodes and thus, causes a lump or swelling to originate even before it is actually large enough to be felt. The most common signs and symptoms to look for are, pain in the breast, feeling of heaviness of the breast, changes in the shape of the breast, if the skin of the breast region shows signs of swelling, thickening or reddening, discharge from nipples especially if it contains blood, nipple erosion, inversion and tenderness. However, it must be taken into notice that these pains may not always represent the presence of breast cancer. Any abnormality which is persistent in the breast should be assessed by a physician at early stages.
Epidemiology of Cancer
Epidemiology of cancer determines the frequency and distribution of a disease and other health related events in a defined population. Epidemiological studies enable trends to be monitored over time and draws attention to deviations from normal patterns in subpopulations. Examples of epidemiological factors that may affect the occurrence of cancer are age, gender, race and geography.
Although, a global advancement in diagnosis and treatment has been seen, the weight of cancer on the world is still increasing. Through epidemiological studies it has been seen that many cancers can be prevented. It is widely held that 80–90% of human cancers may be attributable to environmental and lifestyle factors such as tobacco, alcohol and dietary habits. Cancer prevention includes primary, secondary and prevention methods. Primary prevention refers to avoiding cancer-causing substances in the environment or dietary elements associated with increased risk; dietary supplementation with putative protective agents. Secondary prevention aims at early detection and removal of benign tumours of oral, cervical and breast cancers. It was estimated that in the year 2000, over 10 million new cases of cancer worldwide occurred (approximately 5.3 million men and 4.7 million women) and over 6 million people died from cancers. The most frequently affected organs are lung, breast, colon, rectum, stomach and liver.
The following terms are frequently used in epidemiology:
Incidence is the proportion in the number of new cases within a specified time.
Prevalence is the total number of cases of a disease that exist at one point in time. When expressed in a defined population.
Mortality refers to the number of deaths from a specific disease over a specified time period.
Morbidity is a general description of the severity of sickness, measured in various ways, including:
- Number of people ill with a disease
- Duration of illness(days, weeks, or years that disease persists)
- Number of work days missed
Understanding epidemiology can help to unravel the aetiology, or cause, of a cancer. In the recent years there has been an increase in the occurrence of cancer. The main factors contributing to this is due to urbanization, life style changes, industrialization, population growth and increased life span. For example: India’s, life expectancy rose steadily. It was 45 years in 1971 and increased to 62 years in 1991. Studies show that an average Indian’s life expectancy will increase to 70 years by 2021. This raise will cause a paradigm shift in the disease pattern from communicable diseases to non-communicable diseases like cancer, diabetes and hypertension.
Burden caused by Cancer
Cancer is considered the secondary death to mankind with nearly 5.5 million cases being observed in the underlying countries. It is estimated that cancer prevalence in India is close to 2.5 million with more than 8,00,000 new cases and 5.50,000 deaths taking place each year. Over 70% cases report for services in diagnostic and treatment during the advanced stages of the disease leading to fewer chances of survival and high mortality rates. The impact of cancer is more than plain numbers. It causes immense emotional trauma during the diagnosis and the treatment of cancer. It is a major financial issue, especially in developing countries like India.
Classification of breast cancer
Ductal carcinoma: it is noninvasive form of the breast which starts with in cell line of breast duct below the nipple and areola. Milk is supplied by the duct
Lobular carcinoma: it starts in lobes or glands that form milk. 8% of the breast cancer accounts to be lobular.
Inflammatory breast cancer: it is the least common form of breast cancer which progress approximately 1% to 3% to diagnose the breast will appear swollen and inflame it cause by inflammation by nets or sheets.
Paget’s disease: this type of breast cancer appears as skin rashes over nipple. It shows science of itchy, these signs of itching under the skin. This will indicate small ductal carcinoma in suit (disc)
Breast cancer stages
Stage 0: this can be use to explain abnormal invasive of breast, it can be use in DCIS. These are diagnosed in which abnormal cells lining to the breast duct, the abnormal cell surrounding breast tissue or progress outside the duct. DCIS can progress to invasive breast cancer if it is left untreated
Stage 1: it’s an early type of invasive breast cancer in which cancer cell penetrate breast tissue from the starting point of cancer the size of tumor is not more than 2 cm
Stage 2: in this cancer progress to the lymph node the size of the tumor is between 2 and 5 cm, it does not progress to the lymph node it’s around 5 cm.
Stage 3: it consist of two type stage’s
Stage 3A: in this type of cancer the tumor size is large than 2 centimetres and smaller than 5cm and it spread under arm of the lymph nodes.
Stage 3B: cancer progress to tissue surrounding breast along with skin chest wall, ribs, and lymph nodes, in the wall of the cheats.
Stage 4: it is a distant metastatic cancer. This type of cancer is spread whole part of the body, like bones, liver etc.
Treatment of Breast Cancer
Now a day’s who r suffering from breast cancer have many types of treatment and therapy are available, some of treatment are
Among this all therapy’s most common therapy is radiation therapy in which we can destroy the cancer cells in breast Systemic therapy are hormonal therapy and targeted therapy in this the blood enters and destroy the control system of the body Stage of cancer mainly depends on
The treatment which is treated most commonly in breast cancer is surgery these are two types they are:
Breast- sparing surgery
Breast-sparing surgery: the target of breast sparing surgery is to specifically remove tissue’s surrounding the tumor which may involve removal of the lump or quarter of breast.
Mastectomy: in women’s suffering from mastectomy will remove the whole breast if needed will have suitable treatment in case of lump enlargement in small breast or a lump situated middle of the breast. There are various type of mastectomy are differentiate
Either it remove the breast tissue these breast tissue includes skin and nipple
The other type is radical mastectomy which removes the muscle of the chest wall
Radio therapy is use for the radiations like x-rays; it can destroy the cancer cells were it is treated and the effects go to the normal cells by radiation. These are two types they are
External radio therapy
Internal radio therapy
External radio therapy: these are use in high energies of x-rays like irradiation and cobalt.
These can be destroyed the cancer cell to stop growing or die when the DNA is damage.
Internal radio therapy: in this to treat the cancer by using radioactive metals, in this two types of radioactive therapy are there 1) radioactive implement 2) radioactive liquids,
Side effects mainly depends which
Hormone therapy is based on use of naturally produced chemicals as a treatment approach. Two harmones that are estrogen and progesterone manages various activities inside the body. Hormone therapy focus on shrinkage of cancer area .if further surgery is required then harmone therapy is used before it as it decreases the task of removing whole breast during surgery. Harmone therapy works only in the presence of oestrogen receptors. Tamoxifen and aromatase inhibitor lies in this category. Tamoxifen is known to be an estrogen antagonidst because its structure resembles alot with synthetic oestrogen. Being structurely similar to estrogen it act by binding to oestrogen receptor and leads to formation of non productive complex so oestrogen receptor count decreases and growth promotion effect of oestrogen get suppressed. Side effect of tamoxifen includes hot flashes, vomiting, and skin rashes.
Chemo therapy and their assessment
Medications for treatment of breast cancer belong to four categories. First category is of ant metabolites which inhibits action of metabolite as these compounds are similar in structurally to metabolites. Medications belonging to this category are 5 fluorouracil and methothrexate. Second categories of medication are antibiotics like doxorubicin and epirubicin. Third categories of medications are inhibitors of microtubule formation like paclitaxel which belong to taxol group. Forth category of medication is alkylating agents like cyclophosphamide. All these medicatins act differently. Alkylating agents like cyclophosphamide gets activated in liver by cyt p450 enzyme and leads to alkylation of DNA. Antibiotic like doxorubicin acts by intracting with molecular oxygen leading to formation of superoxide and hydrogen peroxide which ultimately leads to single step breakdown of DNA. Taxol group act by binding reversibly to beta tubulin and leads to over stabalization of beta tubulin which is non functionalthis result in cell death of infected cells. All treatment possesses a number of side effects. Cyclophosphamide causes bone marrow depression. Paclitaxel causes neutropenia that is decrease in number of neutrophils. Methothrexate shows renal damage, hepatic function alteration and pulmonary toxicity. Fluoro uracil shows bone marrow depression as major toxicity.
All these medication possess lot of side effect so research work need to be done at a faster pace to obtain a treatment with good therapeutic effect and least side effects.
Target therapy has emerged as a new approach now days. It involves use of drug that stabilizes breast cancer as targeted therapy can block action of certain undesired proteins like HER2 that promote growth of breast cancer cells.
Trastuzumab: it is provided intravenously that is through vein. It can be used as mono therapy or in combination with chemotherapy. Side effects related to first treatment include fever, chills, weakness, nausea, vomiting, diarrhoea, headaches, difficulty in breathing, and rashes.
After first treatment side effects become less severe as tolerance develops. Trastuzumab can lead to heart problem, and serious breathing problems. Doctor need to check status of heart and lungs both before and in between of treatment.
Lapatinib: it is orally available medication which is given in combination with chemotherapy Side effects of this are nausea, vomiting, diarrhoea, tiredness, mouth sores, and rashes. It can also lead red, painful hands and feet.
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