Breast cancerBreast cancer

小组成员：程欢欢 高 帅 蒋陈君 辛 畅 小组成员：程欢欢 高 帅 蒋陈君 辛 畅 杨晓伟 叶德湫 张鹏程 张庆雷杨晓伟 叶德湫 张鹏程 张庆雷

US Mortality, 2002US Mortality, 2002

Source: US Mortality Public Use Data Tape 2002, National Center for Health Statistics, CDCP, 2004.

1.1. Heart DiseasesHeart Diseases 696,947696,947 28.5 28.5

2.2. CancerCancer 557,271 557,271 22.8 22.8

3.3. Cerebrovascular diseasesCerebrovascular diseases 162,672162,672 6.7 6.7

4.4. Chronic lower respiratory diseasesChronic lower respiratory diseases 124,816 5.1124,816 5.1

5.5. Accidents (Unintentional injuries)Accidents (Unintentional injuries) 106,742 106,742 4.4 4.4

6.6. Diabetes mellitusDiabetes mellitus 73,24973,249 3.0 3.0

7.7. Influenza and pneumoniaInfluenza and pneumonia 65,68165,681 2.7 2.7

8.8. Alzheimer diseaseAlzheimer disease 58,86658,866 2.4 2.4

9.9. NephritisNephritis 40,97440,974 1.7 1.7

10.10. SepticemiaSepticemia 33,86533,865 1.4 1.4

Rank Cause of DeathNo.

deaths% of all deaths

Cancer is more violent than the tiger ！！！

What is the cancer What is the cancer process?process?

Cancer begins in cells.Normally, cells grow Cancer begins in cells.Normally, cells grow and divide to form new cells as the body needs and divide to form new cells as the body needs them. When cells grow old, they die, and new them. When cells grow old, they die, and new cells take their place.cells take their place.

Sometimes, this orderly process goes wrong. Sometimes, this orderly process goes wrong. New cells form when the body does not need New cells form when the body does not need them, and old cells do not die when they them, and old cells do not die when they should. These extra cells can form a mass of should. These extra cells can form a mass of tissue called a growth or tumor. Tumors can be tissue called a growth or tumor. Tumors can be benign or malignant.benign or malignant.

Causative agentsCausative agents

Tumour induction

Chemical carcinogens

Virus-induced (HepC, EBV, HPV)

Spontaneous

Immunosuppression

UV and ionizing radiation

Genetic abnormalities (XP)

How do cancer cells How do cancer cells differ from normal?differ from normal?

• Cytoskeletal changeCytoskeletal change

• Cell adhesion/motilityCell adhesion/motility

• Nuclear changesNuclear changes

• Enzyme productionEnzyme production

Cytoskeletal changesCytoskeletal changes

DDistribution and activity of the istribution and activity of the microfilaments and microtubules microfilaments and microtubules change:change:

1.1.change the ways the cell change the ways the cell interacts with neighboring cellsinteracts with neighboring cells

2.2.alter the appearance of the alter the appearance of the cells. cells.

Cell adhesion/motilityCell adhesion/motility

Cell-cell and cell-extracellular matrix Cell-cell and cell-extracellular matrix adhesion reducted:adhesion reducted:

1.1. allows large masses of cells to allows large masses of cells to form.form.

2.2. impact on the ability of the impact on the ability of the cells to move. cells to move.

Nuclear changesNuclear changes

The shape and The shape and organization of organization of

the nuclei the nuclei changed -----changed -----useful in the useful in the diagnosis and diagnosis and staging of staging of tumorstumors

Gene chip

Enzyme productionEnzyme production

Secrete enzymes digest away the Secrete enzymes digest away the barriers to migration and spread of barriers to migration and spread of the tumor cells-----enable them to the tumor cells-----enable them to invade neighboring tissues. invade neighboring tissues.

• In English , the word In English , the word “cancer” means “crab”.“cancer” means “crab”.

the change of the the change of the motality and enzymes motality and enzymes makes cancer cells can makes cancer cells can move up and down in move up and down in human body like the human body like the crabs in the river. crabs in the river.

What is breast cancer ?What is breast cancer ?

Definition of breast cancerDefinition of breast cancer: : Cancer that forms in tissues of the Cancer that forms in tissues of the breast, usually the ducts (tubes that breast, usually the ducts (tubes that carry milk to the nipple) and lobules carry milk to the nipple) and lobules (glands that make milk). It occurs in (glands that make milk). It occurs in both men and women, although male both men and women, although male breast cancer is rare. breast cancer is rare.

Prevalence of cancer in UKPrevalence of cancer in UK

What are the symptoms of breast What are the symptoms of breast cancer?cancer?

• A lump or a thickening in the breast or A lump or a thickening in the breast or in the armpitin the armpit

• A change in size or shape of the A change in size or shape of the mature breastmature breast

• Fluid (not milk) leaking from the Fluid (not milk) leaking from the nipplenipple

• Change in size or shape of the nippleChange in size or shape of the nipple

• Unusual pain in the breast or in the Unusual pain in the breast or in the armpitarmpit

What are risk factors for breast What are risk factors for breast cancer?cancer?

• AgeAge

• Personal history of breast cancerPersonal history of breast cancer

• Family historyFamily history

• Certain breast changesCertain breast changes

• Gene changesGene changes

• Reproductive and menstrual historyReproductive and menstrual history

• RaceRace

The classification of breast The classification of breast cancercancer

• Ductal Carcinoma in-situ Ductal Carcinoma in-situ

• Infiltrating Ductal Infiltrating Ductal

• Medullary Carcinoma Medullary Carcinoma

• Infiltrating Lobular Infiltrating Lobular

• Tubular Carcinoma Tubular Carcinoma

• Mucinous Carcinoma Mucinous Carcinoma

• Inflammatory Breast CancerInflammatory Breast Cancer

Relative Survival (%) during Three Time PeriodsRelative Survival (%) during Three Time Periods

*5-year relative survival rates based on follow up of patients through 2001.

Source: SEER Program (1975-2001), NCI 2004.

 

 

 

Site 1974-1976 1983-1985 1995-2000

All sitesAll sites 5050 5353 6464

Breast (female)Breast (female) 7575 7878 8888

Colon Colon 5050 5858 6363

LeukemiaLeukemia 3434 4141 4646

Lung and bronchusLung and bronchus 1313 1414 1515

Melanoma of the skinMelanoma of the skin 8080 8585 9191

Non-Hodgkin lymphomaNon-Hodgkin lymphoma 4747 5454 5959

OvaryOvary 3737 4141 44 44

PancreasPancreas 33 33 44

ProstateProstate 6767 7575 9999

RectumRectum 4949 5555 6464

Urinary bladderUrinary bladder 7373 7878 8282

Treatment methodsTreatment methods • Surgery Surgery

• ChemotherapyChemotherapy

• Radiotherapy Radiotherapy

• Hormone therapyHormone therapy

• immunotherapyimmunotherapy

Surgery Surgery

• Breast-sparing surgeryBreast-sparing surgery: An operation : An operation to remove the cancer but not the to remove the cancer but not the breast is breast-sparing surgery. breast is breast-sparing surgery.

• MastectomyMastectomy: An operation to remove : An operation to remove the breast (or as much of the breast the breast (or as much of the breast tissue as possible) is a mastectomy. tissue as possible) is a mastectomy. In most cases, the surgeon also In most cases, the surgeon also removes lymph nodes under the armremoves lymph nodes under the arm

乳腺癌手术乳腺癌手术

Chemotherapy Chemotherapy

To decrease a patient's risk of recurrenceTo decrease a patient's risk of recurrence

Use anticancer drugs :Use anticancer drugs :

1.a combination of drugs1.a combination of drugs

---AC (doxorubicin and cycolphosphamide---AC (doxorubicin and cycolphosphamide 环磷环磷酰胺酰胺 ) ) ---CMF (cyclophosphamide, methotrexate ---CMF (cyclophosphamide, methotrexate 甲甲氨蝶呤 氨蝶呤 and fluorouraciland fluorouracil 氟尿嘧啶 氟尿嘧啶 ) )

2.be given as a pill or by injection into a vein .2.be given as a pill or by injection into a vein .

RadiotherapyRadiotherapy

Radiation therapy uses high energy Radiation therapy uses high energy rays (similar to x-rays) to kill cancer rays (similar to x-rays) to kill cancer cells. However , the rays can also kill cells. However , the rays can also kill normal cells besides the cancer normal cells besides the cancer cells . So this therapy may cause cells . So this therapy may cause severe side effects .severe side effects .

钴钴 -60-60 放疗机放疗机

Hormone therapyHormone therapy

• 1. Breast tumors need hormones to grow----- 1. Breast tumors need hormones to grow----- estrogens, progesterone, prolactin, growth estrogens, progesterone, prolactin, growth hormone, androgen, thyroxin etc. hormone, androgen, thyroxin etc.

• 2.Hormone therapy keeps cancer cells 2.Hormone therapy keeps cancer cells from getting or using the hormones from getting or using the hormones theythey

need. It is directed mainly to correct the need. It is directed mainly to correct the estrogenous impact on the breast estrogenous impact on the breast

• 3.Antiestrogens – tamoxifen3.Antiestrogens – tamoxifen 他莫昔芬 他莫昔芬 toremifentoremifen 托瑞米芬 托瑞米芬 , aromatase, aromatase 芳香化酶芳香化酶 . .

immunotheropy

Nonspecific immunotheropy

Specific immunotheropy

ImmunotherapyImmunotherapy

Nonspecific immunoregulatory substances : BCG LMS

Cytokin : IFN IL-2

Monoclonal antibody

vaccine

Trastuzumab (Herceptin)Trastuzumab (Herceptin) Bevacizumab (Avastin)Bevacizumab (Avastin)

Immunotherapy-----Immunotherapy-----vaccinevaccine • A HER2/neu peptide (a small part of the protein A HER2/neu peptide (a small part of the protein

made by the HER2/neu gene), used as the made by the HER2/neu gene), used as the antigen in a vaccine, has been shown to cause an antigen in a vaccine, has been shown to cause an increased immune response against the increased immune response against the HER2/neu receptor on cancer cells.HER2/neu receptor on cancer cells.

• Other specific antigen vaccines have also shown Other specific antigen vaccines have also shown promise. These vaccines are almost always used promise. These vaccines are almost always used after primary therapy (lumpectomy and radiation after primary therapy (lumpectomy and radiation therapy, or mastectomy) and sometimes together therapy, or mastectomy) and sometimes together with hormonal therapy or chemotherapy, to try to with hormonal therapy or chemotherapy, to try to prevent the cancer from coming back. prevent the cancer from coming back.

Immunotherapy-----MAbImmunotherapy-----MAb

The MAb trastuzumabThe MAb trastuzumab 曲妥珠单抗 曲妥珠单抗 (Herceptin(Herceptin 赫赛汀 赫赛汀 ) is used in women with ) is used in women with breast cancer whose cancer cells have too breast cancer whose cancer cells have too many copies of the HER2/neu gene. These many copies of the HER2/neu gene. These genes make extra receptors for growth-genes make extra receptors for growth-stimulating factors on the cells, which stimulating factors on the cells, which results in a more aggressive form of breast results in a more aggressive form of breast cancer. Trastuzumab attaches to the cancer. Trastuzumab attaches to the receptors, blocking the access of the growth receptors, blocking the access of the growth factors to the cancer cells and slowing their factors to the cancer cells and slowing their growth. growth.

Immunotherapy-----MAbImmunotherapy-----MAb

Bevacizumab (Avastin)Bevacizumab (Avastin) 贝伐单抗贝伐单抗 || 阿瓦阿瓦斯汀斯汀 , a monoclonal antibody that , a monoclonal antibody that slows blood vessel growth in tumors, slows blood vessel growth in tumors, has been shown to be helpful when has been shown to be helpful when used along with chemotherapy in used along with chemotherapy in some women with advanced breast some women with advanced breast cancer. cancer.