Friday, July 23, 1999

Pathophysogy week 2b

Not Me!

All cells have a outer plasma membrane that separate the cell's contents from the extracellular fluid. It provides a physical barrier that separates the inside of the cell from its surrounding environment. It regulates with the environment such as nutrients, waste, and release of secretions. It contains a variety of receptors that helps the cell recognize specific molecules. It provides the cell a stable structure. Cytoplasm consists of material inside the cell from the plasma membrane to the nucleus. Cytoplasm contains all the ingredients for cellular metabolism such as proteins, glucose, electrolytes, and many more depending on the cell's function. The nucleus contains the DNA and enzymes essential for controlling cellular activities. Differentiation is a specialized process that occurs as an embryo. Each cell has all its genetic information intact; however, as the embryo grows, the body dictates what cells need to be produced such as neurons, muscle cells; every cell has their own specialized function and are organized in collections called tissues. Every cell has its own cell cycle and production (mitosis) and the DNA has control over growth and production. If the DNA is altered in the parent cell, the daughter cells contain the same altered cells. All cells need an adequate blood supply, oxygen and nutrition in order to prosper. Hormones stimulates cell growth and reproduction or it may be inhibited by nearby cells. Altered DNA can either mutate in other structures and functions, or cause the cell to die. (Gould, B. E.., pg 96-97, 2011)
The difference between a cancer cell and a normal cell is its growth patterns. Unlike a normal cell, when its time is up, it dies. Cancer cells continue to grow and prosper into mutated cells. Cancer cells can also invade other cells which normal cells cannot. Some cancer cells become neoplasm (tumor). Benign tumors consist of differentiated cells, mitosis is fairly normal, growth is slow, can expand in a mass, most times it is encapsulated and it usually remains localized. Malignant tumors vary in size and are undifferentiated, has an increased mitosis and atypical, has a rapid growth, capable of infiltrating tissues, has no capsule, capable of metastasizing, and become life threating. (Gould, B. E.. , pg 97- 98, 2011)(BreastCancerOverview, pdf, 2011)
Mary is a 35 y.o. Female, 5 foot 3 inches tall, 110 pounds, who has been on oral birth control pills for 5 years, She does regular breast self exams. Her aunt on her mother's side is the only other family member known to have breast cancer. Mary found a lump in her right breast while doing a self exam. She immediately made an appointment with her physician. Other the next few days, she had a physical examination and a mammogram. The mammogram showed a growth and a biopsy was recommended. The biopsy showed cancer and surgery was scheduled.
In Mary's situation, two obvious risk factors were noted, in family history on her mother's side, her aunt had breast cancer. Secondly, Mary was on birth control pills for 5 years and according to the cancer society, 3+ more years on birth control pills can increases the cancer risk for those women; however, if a women stopped taking birth control pills and it has been over 10 years since taking the birth cintrol pills, the risk goes down. Other statistics that were not enclosed in the story are the following: Women who have early menstrual periods before age 12 and went through menopause after 55 have a slight increase of breast cancer due to longer exposure to hormones estrogen and progesterone. The same could be said for women who do not breast feed vs. breast feed their children, there is a decrease risk due to decrease hormonal effects from cessation of the menstrual cycle while breast feeding . Lack of exercise can increase the risk of breast cancer because exercise lowers the hormonal levels, alters metabolism and boosts the immune system. Lastly, woman with dense breast tissue contains more gland tissue and less fatty tissue causing potential problems in mammogram interpretations . (, 2012)

During surgery, a few surrounding lymph nodes were sent to the lab and since some showed cancer cells, a mastectomy was done. Per Mary's wishes, a mastectomy was done on the healthy left breast. After surgery, the breast tissues of both breasts was examined. The lab test found the following: on her right breast, invasive ductal carcinoma; stage 2; Estrogen receptor positive. On her left breast; ductal carcinoma in situ; also ER positive.
Mary's left breast did not show any lumps in her mammogram or on her physical, she still requested if a mastectomy was done on a right, that it would be also be done on her left. Like Mary, other women also choose to have a bilateral (both) mastectomy, especially if one breast contains cancer and the other is healthy in order to decrease their risk for future cancer in the unaffected side. (, 2012)
Per cancer society, the term 'in situ' is used in “early stages of cancer, when it is still confined to the layer of cells where it began”. This preinvasive stage cancer may be present for months or years.
In Mary's case, she elected to have both (bilateral) mastectomy for preventive care. Even with women who option for the bilateral mastectomy, some breast tissue still remains and the risk is greatly decreased; however, cancer can regenerate in the breast tissue that remains. Mary had a biopsy prior to her surgery, I am sure the method of treatment was discussed thoroughly between her and her doctor prior to surgery due to the results of the biopsy. From the biopsy lab test, breast cancer grade are given from one to three. Lower number means slowing growing cancer, and higher number means faster growing cancer. This is also used as a prognosis. Staging of cancer indicates how wide spread the cancer is by the time it is found. It portrays if the cancer is invasive or non-invasive, it also indicates the size of the tumor and if lymph nodes are involved and whether it has metastasize. (Gould, B. E.., pg 99, 2011) (, 2012) (, 2012)
Post-op lab results showed that Mary had stage II, invasive ductal (cells lining the milk ducts ) carcinoma with estrogen receptor (ER) positive. This type of cancer had spread out side the duct into the surrounding tissue with no lobe invasion. In order to grow, this type of cancer depends on the hormone estrogen. The lab result on her left breast showed ductal carcinoma in situ (DCIS) with positive ER. This type of cancer is a noninvasive cancer, but if not removed, it could develop into an invasive cancer. It also means that this cancer was only found in the breast ducts and has not spread past the layer of tissue where they began. This type of cancer also relies on the hormone estrogen in order to grow. According to Mary's post-op lab results her left breast cancer would be a stage 0. (, 2012) (, 2012)
For Mary, treatment was tailored to her individual cancer. Bilateral mastectomy was performed to removed the cancer that is visible. The next step taken was to lower the risk of recurrence and get rid of any remaining unseen cancer cells that have been left behind (adjuvant therapy). Radiation and hormonal therapy where chosen for her treatment. Radiation therapy is the use of high energy x-rays to kill cancer cells. A radiation regimen consist of a specific number of treatment over a set period of time. Mary was also prescribed tamoxifen for her hormonal therapy. Her type of cancer fuels its growth by the estrogen hormone. Tamoxifen is a drug that blocks estrogen from binding to the cancer cell. It is effective in lowering the risk of recurrence to the breast that had cancer and risk of future recurrence. Tamoxifen can be classified as an antiestrogen or selective estrogen receptor modulators. (Gould, B. E.., pp. 99, 107-110, 11, 2011) (, 2012) (medcinenet, 2012)


Gould, B. E.. (2011) Chapter 5
(pp. 101-102), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.
Gould, B. E.. (2011) Chapter 5
(pp. 96-97), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.
Gould, B. E.. (2011) Chapter 5
(pp. 99), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.
Gould, B. E.. (2011) Chapter 5
(pp. 107-108), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.

Gould, B. E.. (2011) Chapter 5
(pp. 111), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.

Anonymous. (2011). Breast Cancer Risk Factors
Retrieved January 15, 2011, from website
Anonymous. (2011). Tamoxifen
Retrieved January 15, 2011, from NIH website
Anonymous. (2011). Tamoxifen
Retrieved January 15, 2012, from website
Anonymous. (2011). Breast cancer treatment by stage
Retrieved January 15, 2012, from website

No comments :