Neoplasm

Individual Case Study: Neoplasm

November 11th 2016

Introduction

        The case study is about Ann, a 37 year old mother of two, who has been diagnosed with breast cancer and has been through treatment. The first learning objective is to understand the pathophysiology of breast cancer.  The second learning objective is to understand how Ann is perhaps susceptible to cancer by examining the modifiable and non-modifiable risk factors of breast cancer. Afterwards, the third learning objective is to study the signs and symptoms of breast cancer. The fourth and fifth learning objective are to understand the diagnostic procedures that are involved in breast cancer and the treatment plan that are involved for breast cancer.

Learning Objective 1: What is the pathophysiology of breast cancer?

Explain the definition of Cancer

The Canadian Breast Cancer Foundation, defines cancer as a collection of heterogenous diseases, which can be invasive or non invasive. Moreover, cancer affects the body in a microscopic level, at the cell. This mutation at the cell results in abnormal cell growth. Abnormal cell growth can occur inside any cell in the body and alter regulatory function of that cell.  When individuals grow, their tissues and cells are repaired and replaced; this process eliminated old and damaged cells. The entire action of cell multiplication and division is strictly regulated by the DNA sequence. In Neoplasia, the extreme cell division is not regulated by the same mechanism.

Usually, cell growth stops when it has reached the optimal requirement for the body. In addition, the older cells do not die, they continue to divide and become new neoplastic cells. Eventually these cells bundle together and turn into tumors or neoplasms. Therefore, neoplasms is defined by a growth of abnormal cells which can be benign, premalignant or malignant.

The classification of Neoplasia

When abnormal growth cannot metastasize to neighboring tissues or organs it is called benign. This is not cancerous; it is not considered a serious condition however it has the potential to become cancerous.  Premalignant neoplasm is classified when a growth of abnormal cell is not cancerous however it has the possibility of developing into a cancerous tumor.  Premalignant neoplasm is dangerous due to the fact that mutations that occurs to the cells can be transferred to new developing cells, which would increasing the possibility of those cells becoming cancerous. Premalignant neoplasia should be frequently screened to prevent the possibility of it progressing to cancer cells. Neoplasia is classfied as cancerous, the abnormal cell growth which is able to attack other tissues of the body.  The mutated cells can even enter the lymph cells and affect the blood vessels and cause more damage; therefore it is important to screen and diagnose quickly. If not caught early, the cells are able to grow and form a tumor.  

What is the pathophysiology and classification of breast cancer?

The cancerous cells in breast usually originates in the milk carrying ducts also known as ductal cancers and it also originates in the glands producing milk which are called lobular cancers. Both of these types of cancers can remain where they are or they can invade neighboring tissues and organs. Often when the cancerous cells invade, they do so through the lymph nodes. The lymphatic system contains several lymph vessels which reach the axillary lymph nodes and the mammary lymph nodes of the breasts. A tumor occurs when there is a protein mutation; proteins are essential for cellular function. When an individual has malignant neoplasia, the abnormal protein leads to unregulated protein functions. This occurs due to the fact that the normal sequence of protein synthesis is hindered.  This can lead to increase in some proteins and decrease in others. In breast cancer, proteins can cause a proliferative effect on the cells and decrease the function of proteins that cause an inhibitory influence on cells that divide. p53, BRCA 1 and BRCA 2 are being unproduced compared to Cyclin D and HER2 which are being overproduced. When a cell's balance is being disturbed, for example, DNA damage, being deprived of nutrients and so on, the P53 protein is responsible for maintaining the cells survival. P53 is responsible for DNA repair and synthesis, disposing of damaged cells and maintaining energy metabolism. This prevents the cells from proliferating and leads to a decrease risk of breast cancer. However if an individual has a decrease amount of p53, the cell has a reduced capacity and cannot maintain its viability easily.  This allows the developing cells to become neoplastic cells. Moreover, BRCA1 and BRCA2 are also responsible for regulating the functioning of the cell. both of these genes are involved in DNA repair and they respond to DNA damage.  Therefore, when there are mutations that occur in the BRCA cells, it can increase the risk of developing breast cancer. Moreover, Cyclin D is also responsible for the regulatory functions of the cells. Cyclin D is a protein that is activated when there is a growth factor is present. When Cyclin D is overexpressed, it leads to a formation of cancer forming cells.

What is the pathogenesis of malignant neoplasia?

The progression of cancer, and carcinogenesis includes numerous events.  The initiation step is the most significant step when it comes to carcinogenesis. This occurs very quickly. This procedure usually takes place in the DNA of the cells. The cells in the DNA are destroyed by the carcinogen.  The cells are now initiated and activated and they are able to remain in that state for a long period of time. However, the cells continue to grow at a slow, steady pace. After the initiation step, the next step is the promotion of tumors which is activated by promoting agents. Promoting cells are considered carcinogenic however they can cause replication of the previous initiated cells which can lead to tumor formation  (Radic et al. 35).

Learning Objective 2: What are the causes and risk factors of breast cancer?

I. What are the non-modifiable risk factors?

There are several non-modifiable risk factors however only a few are pertinent. in Ann's case.   Ann's non-modifiable risk factors for breast cancer include being a woman, aging, having a family history of breast cancer and having a personal history of breast cancer. Being a woman is an immense risk factor; this is due to the fact that women have hormones such as estrogen and progesterone which promote growth of breast tissue cells ("Center"). Moreover, simply aging is considered a risk factor; this is due to the fact that as women age, there are more opportunities for genetic mutations to occur throughout the body. As the body ages it is not capable of repairing the genetic damage as efficiently.  Furthermore, Ann has a personal history of breast cancer which further increases her chances of developing the disease again. This is due to the fact that primary breast cancer tissue can develop in the same breast or the opposite breast. The final risk factor that increases Ann's probability of breast cancer is the fact that her mom was also diagnosed with breast cancer ("Center"). Approximately 5 to 10 percent of breast cancer is believed to be genetic; it is caused by a mutation that is inherited by the children.  The most inherited cases of breast cancer are due to two specific genes: BRCA1 and BRCA2 (Breast cancer gene 1 & 2) ("Center"). The mechanism through which BRCA1 and BRCA2 act has been discovered. PTEN is considered one of the most important tumor suppressor gene; the researchers discovered that when the PTEN had been split in two, BRCA1 and BRCA2 genes would repair the damage thereby aiding the PTEN gene in preventing tumors. However, a mutation in the BRCA1 and BRCA2 prevents this error from being corrected (Minami et al 1).