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1) Mary is concerned about a possible hereditary risk factor in her diagnosis, what can you explain to Mary about "breast cancer genes"

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1) Mary is concerned about a possible hereditary risk factor in her diagnosis, what can you explain to Mary about "breast cancer genes"

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Mutation in BRCA1, BRCA2 genes, risk of developing breast/ovarian cancer is very high with a mutation in either gene, but tends to be higher with BRCA1
Current estimate are that 1% of general population have mutation in either of BRCA genes
10-15% of woman diagnosed with breast cancer have BRCA mutations
In families with 4 or more cases of breast cancer diagnosed before age 60, chance of hereditary breast and ovarian cancer syndrome is approximately 80%
- Lifetime risk of breast cancer 50-85%
-Lifetime risk of ovarian cancer with BRCA1: 25-50%, BRCA2: 15-30%

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1) The physicians say they would need to do a biopsy to determine if the tumor is benign or malignant. What does this mean?

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1) The physicians say they would need to do a biopsy to determine if the tumor is benign or malignant. What does this mean?

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Benign means; Grow slowly,

Well-defined capsule, Not invasive, Well differentiated, Low mitotic index and Do not metastasize. I would like result in watching while

Malignant means grow rapidly, Not encapsulated, invasive, Poorly differentiated, High mitotic index, Can spread distantly (metastasis) intervention would likely be needed.

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2) Mary complains of pain and fatigue. Explain these clinical manifestations

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2) Mary complains of pain and fatigue. Explain these clinical manifestations

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Pain: little or no pain is associated with early stages of cancer, it is influenced by fear, anxiety, sleep loss, fatigue, overall physical deterioration
Fatigue: most frequent symptom, tiredness, weakness, lack of energy, lethargy

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#4 What are 3 main treatment modalities for cancer? what are the links to patho?

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#4 What are 3 main treatment modalities for cancer? what are the links to patho?

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1 - surgery: first resort, for localized cancers
2 - chemo: for metastasis cancers
3 - radiation: for specific cancerous cell targeting

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1. The physicians say they would need to do a biopsy to determine if the tumor is benign or malignant. What does this mean?

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1. The physicians say they would need to do a biopsy to determine if the tumor is benign or malignant. What does this mean?

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Determining whether a tumor is benign or malignant will confirm whether the tumor is cancerous or not, and help in developing a  treatment plan for the patient. In cases where a biopsy reveals the presence of cancer, the biopsy results will include a discussion of the type of cancer, its size, its location, and its margins.
Benign - noncancerous (slow growth, will possibly be monitored over years to assess the tumors possibility for progression to cancer)
Malignant - cancerous (rapid growth)

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7. What does his staging and grading indicate? what is the TNM system?                              

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7. What does his staging and grading indicate? what is the TNM system?                              

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stage I- localized tumor growth; limited to the tissue of origin
grade II- Cells are more abnormal and moderately differentiated.
it is not spreading

*T-primary tumor site
N- lymph node involvement
M-metastatic spread

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2. Why did the physician test for Prostate Specific Antigen (PSA)?

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2. Why did the physician test for Prostate Specific Antigen (PSA)?

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The physician most likely tested for PSA using a blood test to either confirm the presence of prostate cancer (though previously diagnosed with a prostate tumor) or to monitor treatment for prostate cancer. PSA is made by the prostate gland, therefore the blood test will measure the level of PSA in your blood. The higher the level of PSA, the more likely you are to have or to develop cancer.

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3. How does a cancer cell differ from a regular cell?

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3. How does a cancer cell differ from a regular cell?

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Cancer cells:
-Have changes on their surface
-Are able to turn off signals over time which allow them to grow rapidly over time and become invasive
-Not as specialized (distinct)
-Vary in size and shape
-Grow in clusters without a boundary
-Do not interact with other cells
-Remain immature (undifferentiated) and do not mature because of rapid growth
-May not be functional

Normal cells:
-Mature into very distinct cell types with specific functions, size, shape
-Growth with boundary's
-Interact with other cells (i.e. knowing when to stop growing)
-Perform normal function

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3. Mary's B/W demonstrated hypercalcemia. Explain the link  to her cancer.

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3. Mary's B/W demonstrated hypercalcemia. Explain the link  to her cancer.

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Breast cancer is the commonest malignancy associated with hypercalcemia; the detection of hypercalcemia in these patients usually signifies metastatic disease and is associated with a poor prognosis.

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4. How does a regular cell transform into a cancer cell? 

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4. How does a regular cell transform into a cancer cell? 

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Normal cells become cancerous when a series of mutations leads the cell to continue to grow and divide out of control, and, in a way, a cancer cell is a cell that has achieved a sort of immortality.

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5. Besides a mutation, what can influence the development of cancer?

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5. Besides a mutation, what can influence the development of cancer?

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The development of cancer can be influenced by a patients age, weight, exposure to carcinogens, and genetics. These factors can increase the patients risk of developing cancer.

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1. What are Mary's risk factors for breast cancer?

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1. What are Mary's risk factors for breast cancer?

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- Over the age of 60 (62y)
- Family history of breast cancer (mother died at age 54)
- Early menarche (8y)
- Female
- Hormone replacement therapy
- Weight
- North America (environmental exposure, diet, or lifestyle)
- No children

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2. What are the main clinical manifestations of breast cancer?

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2. What are the main clinical manifestations of breast cancer?

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- Lump or mammographic abnormality detected in the breast (most often in upper, outer quadrant)

- Dense with glandular tissue

- Rate of lesion growth varies

- Slow-growing lesions associated with lower mortality rates

- Hard, irregular, poorly delineated, non-mobile, and non-tender
- Small percentage cause nipple discharge

- Usually unilateral and clear or bloody

- Nipple retraction may occur

- Peau d’orange

- Infiltration, induration, dimpling of overlying skin in large cancers

- Breast asymmetry

- Correlation with menstrual cycle

- Recurrence of cancer

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- 8/10 pain in right breast
- swollen right arm
- dry mouth
- difficulty swallowing
- mouth sores
- nausea/vomiting/diarrhea
- low platelets
- low WBC
- low neutrophils
- low Na
- low K
- high creatinine
- low protein
ABGs:
- high pH
- high HCO3
- Reddish orange urine

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#3 TMN and survival rate for classification

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#3 TMN and survival rate for classification

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T - 1 cm, N - no, M - no

Stage 1 or 2: 100-93%