BREAST CANCER

INTRODUCTION:

Cancers are a group of diseases that cause cells in the body to change and grow out of control. Most types of cancer cells form a lump or mass called a tumor, and are named after the part of the body where the tumor first starts.

A tumor is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic).Tumor is not synonymous with cancer. A tumor can be benign, pre-malignant or malignant, whereas cancer is by definition malignant.

Breast cancer begins in breast tissue, which is made up of glands for milk production, called lobules, and the ducts that connect lobules to the nipple. The remainder of the breast is made up of fatty, connective, and lymphatic tissue. 


CAUSES OF BREAST CANCER:

The exact cause of breast cancer is unknown and there are no fixed causes for breast cancer. Myths in identifying the causes of breast cancer are more prevalent than the real cause. 

Some of the causes that have been collectively associated with breast cancer are:

• Age: The chance of breast cancer depends on age, as the person gets older the chances of it are more.
• Inheritance: Family history of close relative like mother, sister and daughter who has been diagnosed with breast cancer increases the risk factor.
• Early menses or menopause: Early start onset of menses and early menopause are also associated with breast cancer.
• Radioactivity: Exposure to radioactive rays is carcinogenic and increases the chances of breast cancer.
• Hormone Replacement Therapy: Using hormone replacement therapy might also cause it.
• Exposure to harmful chemicals: Working in a chemical factory that uses harmful chemicals like Organochlorines.
• Nullyparity or Late childbearing: Nullyparity or Late childbearing also appear to be a minor risk factor in the development of breast cancer.

SIGNS & SYMPTOMS OF BREAST CANCER:

In early stages, breast cancer usually has no symptoms. As the tumor progresses, you may note the following signs:

• Swelling in the armpit.
• Pain or tenderness in the breast.
• A lump in the breast, is often the first apparent symptom of breast cancer, breast lumps are usually painless, although some may cause a prickly sensation. Lumps are usually visible on a mammogram long before they can be seen or felt.
• A noticeable flattening or indentation on the breast which may indicate a tumor that cannot be seen or felt.
• Any change in the contour, texture or temperature of the breast, reddish, pitted surface like the skin of an orange (called peu de orange) is symptomatic of advanced breast cancer.
• A change in the nipple, such as an indrawn or dimpled look, itching or burning sensation, or ulceration, scaling of the nipple is symptomatic of Paget's disease, a localized cancer.
• Unusual discharge from the nipple that may be clear, bloody or of another color, usually caused by benign conditions but possibly due to cancer.

DIAGNOSIS OF BREAST CANCER:

With the increased number of breast cancer there has also been increase in the diagnostic tool that can help in identifying the onset of the disease. The diagnostic tools have been listed below: 

Mammogram: The first diagnostic tool to identify breast cancer is Mammogram. It is an X-ray of the breast that can show the presence of abnormal growth lumps in the breast area.

Ultra-Sonography: Use of high frequency sound waves often identifies whether the lump is filled with liquid or solid for further investigation.

Aspiration:Fine needle is inserted in the lump to take the tissue or liquid out from the lump and then a biopsy is performed to test for carcinoma.

Surgical Biopsy Surgical biopsy removes a small part of lump by surgery and then the lump is tested for further diagnosis. 


TREATMENT OF BREAST CANCER:

Treatment decisions are made by the patient and her physician, after consideration of the optimal treatment for the stage of cancer, the patient's age and preferences, and the risks and benefits ascribed to each treatment protocol. Most women with breast cancer will have some type of surgery. Surgery is often combined with other treatments such as radiation therapy, chemotherapy, hormone therapy and/or monoclonal antibody therapy.

Surgery

The primary goal of breast cancer surgery is to remove the cancer from the breast and lymph nodes. In a lumpectomy, only cancerous tissue plus a rim of normal tissue is removed. 

Lympectomy is almost always followed by six to seven weeks of radiation therapy. A woman who chooses lumpectomy and radiation will have the same expected long-term survival as if she chose mastectomy.

Simple or total mastectomy includes removal of the entire breast.

Modified radical mastectomy includes removal of the entire breast and lymph nodes under the arm, but does not also include removal of the underlying chest wall muscle, as with a radical mastectomy. 

Radical mastectomy is used infrequently now due to the proven effectiveness of less destructive surgeries.

Both lumpectomy and mastectomy are often accompanied by removal of regional (axillary) lymph nodes to determine if the disease has spread beyond the breast.

Radiation Therapy

Radiation may be used to destroy cancer cells remaining in the breast, chest wall, or underarm area after surgery, or to reduce the size of a tumor before surgery. 

The ability to target radiation therapy accurately has increased dramatically over past decades, which has greatly diminished resulting side effects.

Systemic Therapy

Systemic therapy includes chemotherapy and hormone therapy. Adjuvant systemic therapy is used after all visible cancer has been surgically removed in order to kill any undetected tumor cells that may have migrated to other parts of the body.

Tumor size, histology, and the presence of cancer in axillary nodes are considered in the decision whether to use adjuvant systemic therapy.

Systemic therapy is also used in treating women with advanced breast cancer. In such conditions, removal of most of the cancer by surgery is not possible, and therefore systemic therapies become the main treatment modality. 

Chemotherapy

Research has established that combinations of several drugs are more effective than just one drug alone, If the disease has become resistant to the first-line therapies, which include specific combinations of cyclophosphamide, methotrexate, fluorouracil, doxorubicin, epirubicin, and paclitaxel, about 20% to 30% of patient's will respond to second-line drugs. 

Chemotherapy medications for breast cancer include:

• Paclitaxel
• Doxorubicin
• Paraplatin
• Cyclophosphamide
• Epirubicin
• Gemcitabine
• Vincristine

In many cases, chemotherapy medicines are given in combination which means you get two or three different medicines at the same time. These combinations are known as chemotherapy regimens. In early stage breast cancer, standard chemotherapy regimens lower the risk of the cancer coming back. In advanced breast cancer, chemotherapy regimens make the cancer shrink or disappear in about 30-60% of people treated. The Standard chemotherapy regimens include:

• Doxorubicin and Docetaxel
• Doxorubicin and Cyclophosphamide, with or without Paclitexel or Docetaxel
• Cyclophosphamide, Methotrexate, and 5- fluorouracil
• Cyclophosphamide, Epirubicin, and 5-fluorouracil
• 5-fluorouracil, Doxorubicin, and Cyclophosphamide
• Cyclophosphamide,Doxorubicin,and5-fluorouracil
• Docetaxel, Doxorubicin and Cyclophosphamide.

Side Effects of Chemotherapy:

Chemotherapy destroys cancer cells because the medicines target rapidly dividing cells. But normal cells in your blood, mouth, intestinal tract, nose, nails, vagina, and hair also divide rapidly. So chemotherapy affects them, too.

The healthy cells in your body can repair the damage that result from chemotherapy. But cancer cells can't repair themselves very well.

The side effects you may have from chemotherapy depend on the regimen you're on, the amount of medicine you're getting, the length of treatment, and your general health. The side effects you have may be different from someone else who is on the same regimen.

While your body is recovering from chemotherapy, other medicines can help ease many of the side effects you may have. It's important to tell your doctor and oncology nurse about any side effects you're having. If medicines aren't controlling the side effects, your doctor or nurse can help you find something that works. 

Hormone Therapy:

Estrogen, a hormone produced by the ovaries, promotes growth of some breast cancers. Women whose breast cancers test positive for estrogen or progesterone receptors can be given hormone therapy to block the effects of estrogens on the growth of breast cancer cells. Tamoxifen, the most commonly used antiestrogen drug, has been shown to provide a 26% annual reduction in recurrence and a 14% annual reduction in deaths. Hormone therapy is effective in both postmenopausal and premenopausal patient's whose cancers are positive for steroid hormone receptors. 


 BREAST CANCER:

Active Ingrediant	Form	Strength	Pack Type	Packing Style
Cyclophosphamide	Injection	200mg/15ml, 500mg/30ml, 1g/50ml	Vial	15ml, 30ml, 50ml
Cyclophosphamide	Tablets	50mg	Blister, Container	10's, 100's
Docetaxel	Injection	40mg/ml	Vial	0.5ml, 2ml
Doxorubicin Hydrochloride	Injection	10 mg/5ml, 50mg/25ml	Vial	5ml, 25ml
Epirubicin Hydrochloride	Injection	10mg, 50mg	Vial	10mg, 50mg
Gemcitabine Hydrochloride	Injection	200mg, 1g	Vial	10ml, 20ml Vial
Methotrexate	Injection	25mg/ml	Vial	2ml
Methotrexate	Tablet	2.5mg	Blister	10's
Paclitaxel	Injection	30 mg/5ml, 100 mg/16. 7 ml, 260 mg/43.4 ml	Vial	5ml, 20ml, 50ml
Tamoxifen	Tablet	10mg, 20mg	Vial	10's
fluorouracil	Injection	50mg/ml	Vial & Ampoule	5ml, 10ml
Liposomal Doxorubicin Hydrochloride	Injection	10mg, 50mg	Vial	10ml
Vinblastine Sulphate	Injection	1mg/ml	Vial	10ml
Vincristine Sulphate	Injection	1mg/ml	Vial	1ml