The Pathophysiology of Breast Cancer

Knowing the pathophysiology of breast cancer is important. Breast cancer is a very popular disease in women and is also apparent in men. As a nurse it's important to know what causes breast cancer, the signs and symptoms of this cancer, different treatment options and risk factors. It's also important to know preventative measures in order for the nurse to educate the patient on what to do in order to prevent this disease. It is also important to know the morbidity and mortality of this disease. The nurse should make it her goal in order to decrease this number by teaching good preventative measures. Breast cancers are derived from the epithelial cells that line the terminal duct lobular unit, which forms part of the milk duct. Breast cancer cells remain in the basement membrane and are known as in situ or non invasive. Invasive breast cancer is when when the cancer cells spread outside of the basement membrane of the ducts and lobules, moving their way into the surrounding tissues (McCready 2004)

Over 41,000 women in the Uk are diagnosed with breast cancer every year (McCready 2004.) The morbidity of the disease is breast cancer is the second leading cause of cancer deaths in women, with an estimated 39,600 deaths in 2002. (Ridner 2002) The etiology of breast cancer is unknown. There 11 different types of normal cell tissues after a study of 3,157 human breast tumors each of the tumors were similar to 1 of the 11 normal cell types. This means that each breast cancer cell is different and each one isn't an exact copy of the normal breast tissue. Since there isn't a clear understand of the origin of breast cancer there has yet to come to a conscious answer of how many types of breast cancer there are. (Santagata, S., Thakkar, A., Ergonul, A., Wang, B., Woo, T., Hu, R., Harrell,C., McNamara,G., Schwede,M., Culhane,A., Kindelberger,D., Rodig,S., Richardson,A., Schnitt, S., Tamimi, R.M., Ince, T. A. 2014)

Some risk factors that that can’t be changed for breast cancer are being a white woman who is in the post menopausal age group which is roughly 45 and older. Another risk is if a woman started to have periods before the age of 11 and have menopause before the age 45. These patients are twice more likely to get breast cancer because they are exposed to the hormone earlier. Also the age the patient had her first child matters as well if the patient has the first child at 35 is at higher risk than a women who has a child at 20. The reason why that this is a huge risk factor is because having these at these particular times exposes the female body to more hormones than they are normally exposed to during that time. Also it is estimated that 35 percent of women in the UK that gets the cancer develop a second disease. The reproductive history play a big factor. For example 5-10 percent of women in western countries get cancer genetically and chance increases if the person had breast cancer before the age of 50. (McCready 2004).

If someone doesnt have children at all or have children and don't breastfeed it could also make the prone to having breast cancer. Breastfeeding is known for having protective mechanism against breast cancer but some believe this is just due to having children and not specifically breastfeeding. Using oral contraceptives or hormone treatment put people at risk as well. If someone is to take oral contraceptives before the age of 20 than people who start at an older age. There is less of a risk with hormone replacement pills and after the first to four years of use the risk isn't there anymore The pathophysiology of breast cancer isn't determined fully yet but there are some theories about what could manifest it.Breast cancer could be caused by the BRCA1 or BRCA2. This genetic mutation makes patients more likely to get breast cancer. (McCready 2004)

Once the cells start to grow rapidly it depends on which type of breast cancer tumor the patient has that could affect the growth of the tumor. The tutor would have specific biomarkers: hormone receptor, HER2 positive or triple negative. Her2 -positive tumors tend to grow very fast and are normally more aggressive whereas the other types grow at a slower pace (Mahon, palmieri 2009). Which is why there's different treatment option for different people. If the cancer isn't detected early the tumor could continue to grow and spread and eventually reach other places in the body. It could reach the bone. This is caused by the interaction between the cancer and bone cells. Osteoclast and osteoblast would normally assist each other when it comes to the bone but when breast cancer is present it causes the osteoclast to become overactive. Osteoclast is what breaks down our bones so if it is overactive it will cause out bone to be broken and become more brittle faster than it could be prepared. It could spread to the liver. This could cause discomfort and pain in the live and lead to jaundice. It could spread to the lungs, depending on the size of the tumor would affect if the patient is systematic or not. It could spread to the brain but this is more common in people who were presented with a cancer that was HER 2- positive ( Beaumont 2011).

When patients are in the subclinical stage most tumors are detectable by mammogram because they are very small. If the patient performs regular self breast exams they would be able to realize when they are in the prodromal phase since the patients regularly knows what the patients normal breast feels like a small bump would give them a sense of something isn't right. For a patient that doesn't normally do self breast exams or when, when the tumor is fairly large is when they realize that they are in the clinical stage. This is because they sometimes will physically be able to see the tumor because of how large it has gotten. This is due to not knowing what the patient's own breasts feel like on a regular basis so those small little lumps don't mean anything cause the patient wouldnt know if its normal or abnormal. The prognosis of the disease depends on the side of the tumor and how far it has spread. It also could be based off the type of tumor it is. Normally when the tumor is in the ducts it would be considered stage one. As the cancer cells start to grow and start to spread then the stage starts to increase as well. The signs and symptoms of breast cancer could are as follows Breast cancer could cause pitting of the nipples or of the skin. The pitting is due to inflation in the underlying tissue of the breast caused by nucleotide-binding domain leucine-rich repeat proteins (Wei,Qi, Li, Tan, Ren, Wang (2017).

A lump or tumor could be palpable through the skin. The tumor is caused by a cluster of overgrown cells in a specific area that if not spotted early could spread to other parts of the breast, lymph nodes and body, (McCready 2004) The diagnostic exam for breast cancer would be a mammogram, which causes two plates to squeeze the breast tissue and if there is a lump it produces a scan which would show a white dot on the breast. After a dot is noticed on the mammogram a biopsy is then taken in order to see if the lump is benign or cancerous. When a biopsy i taken it is used along side either a mammography or an ultrasound. This is so the needle could be guided correctly into the lump. A fine needle biopsy is used for cytology and a core biopsy is used for histology. A clinical breast exam should also be done regularly. This is done by feeling the breast for any abnormalities. (McCready 2004). Breast cancer could be treated by surgery,radiotherapy, chemotherapy and hormone therapy. There's two types of surgery options. There's breast conversion and mastectomy. Breast conversion is when they would localize the tumor and take out the tumor along with a one centimeter magin around it. A mastectomy is when the entire breast tissue is removed along with some underlying tissue. After a mastectomy most patients would be able to receive some breast reconstruction

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Another option for treatment is radiotherapy. Radiotherapy would be offered to patient if they have a risk of recurrence. A patient who received a lumpectomy would receive radiation in order to prevent the recurrence since breast tissue is still present. When a patient goes for radiation they would receive treatments daily for three to five weeks. Another option would be chemotherapy. It is suggested that patients that have breast cancer receive some type of chemotherapy in order to have a better chance of survival. This is suggested because after surgery and radiotherapy some patients had micrometastatic present and the chemotherapy would get rid of them. Another type of treatment is hormone therapy. This is because most breast cancer hold onto oestrogen receptors and in the patient this will have control over the cancer cells. Tamoxifen is an anti-oestrogen drug that binds to the oestrogen receptors on breast cancer cells. This is beneficial to patients who have positive oestrogen cancer cells. This is most beneficial when a 20 mg dose is taken for five years. ( 2004)

There are many different complications when it comes to breast cancer. For example some things include like swelling and tenderness of the breast. There also a lot of psychological effects that happen as well. These include fear, sadness and feelings of isolation ( 2004). This can happen when the patient has a hard time trying to go back to the life they have and thoughts of relapse can really haunt them. Another example is that after 20-30 percent off women go through body imaging and sexuality issues after a mastectomy ( 2004). Also 30 percent of women that have breast cancer end up developing an anxiety state or a depressive illness, that is 3-4 times more than the rest of population. Also there can sense of loss to a couple of things. For example a loss of health, choice, control and uncertainty of the future ( 2004). These reasons are why a nurse should be aware of the possible problems that may occur and be ready to engaged accordingly. Another complication is that Im conclusion metastatic breast cancer is a huge issue and it needs to be careful assessed by the nurse and full medical team. It also very important for the nurse to educate the patient on any type of preventative measures so the disease would occur. Making sure to check up on the patient after the medications and going through all those procedures is very important so they don't end up with many psychological issues.

References

Beaumont, T., & Leadbeater, M. (2011). Treatment and care of patients with metastatic breast cancer. Nursing Standard, 25(40), 49–60. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=104646930&site=ehost-live ( Beaumont 2011) Ridner SH. (2002). Breast cancer lymphedema: pathophysiology and risk reduction guidelines. Oncology Nursing Forum, 29(9), 1285–1293. https://doi.org/10.1188/02.ONF.1285-1293 (Ridner 2002) Wei, Y., Huang, H., Qiu, Z., Li, H., Tan, J., Ren, G., & Wang, X. (2017). NLRP1 Overexpression Is Correlated with the Tumorigenesis and Proliferation of Human Breast Tumor. BioMed Research International, 2017, 1–9. https://doi.org/10.1155/2017/4938473 (Wei,Qi, Li, Tan, Ren, Wang (2017) McCready T. (2004). Continuing professional development. Management of patients with breast cancer. Primary Health Care, 14(6), 41–50. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=106655456&site=ehost-live (McCready 2004) Mahon SM, & Palmieri FM. (2009). Metastatic breast cancer: the individualization of therapy. Clinical Journal of Oncology Nursing, 13, 19–28. https://doi.org/10.1188/09.CJON.S1.19-28 (Mahon, palmieri 2009) Santagata, S., Thakkar, A., Ergonul, A., Wang, B., Woo, T., Hu, R., Harrell,C., McNamara,G., Schwede,M., Culhane,A., Kindelberger,D., Rodig,S., Richardson,A., Schnitt, S., Tamimi, R.M., Ince, T. A. (2014). Taxonomy of breast cancer based on normal cell phenotype predicts outcome. Journal of Clinical Investigation, 124(2), 859–870. https://doi.org/10.1172/JCI70941 (Santagata, S., Thakkar, A., Ergonul, A., Wang, B., Woo, T., Hu, R., Harrell,C., McNamara,G., Schwede,M., Culhane,A., Kindelberger,D., Rodig,S., Richardson,A., Schnitt, S., Tamimi, R.M., Ince, T. A. 2014)

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