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Cancer is the abnormal, uncontrollable , continuous
replication of cells which will inevitably lead to the
formation of a ...
Forms in the
tissues of the
breast

Spreads mainly
through the
Lymphatic system
THE NORMAL BREAST
1. Chest wall.

2. Pectoral muscles.
3. Lobules (glands that
make milk).
4. Nipple surface.
5.

Areola.
...
Lymphatic System which consists of vessels and
organs plays two vital roles in our lives:
1)

The vessels essentially main...
Most of the lymph vessels of the breast
drain into:





Lymph nodes under the arm (auxiliary nodes).
Lymph nodes aroun...


Malignant



Benign



Cancerous



Not - Cancerous




Not cancerous.
Benign breast tumors are abnormal growths,
but they do not spread outside of the breast
and they are ...


Most lumps are caused by the combination of
cysts and fibrosis



Cysts are fluid-filled sacs.



Fibrosis is the for...


Breast cancer is a malignant (cancerous)
tumor that starts in the cells of the breast.
It is found mostly in women, but...
Invasive





Cancerous
Malignant
Spreads to other
organs (metastasis)

Non - Invasive






Pre – Cancerous
Still i...
Invasive Breast Cancer




The inner lining of
milk ducts.

Ductal Carcinoma





The lobules – Milk
producing glands.

Lobular Carcinoma
Ductal
Carcinoma

Invasive Ductal
Carcinoma
Ductal Carcinoma
in situ (DCIS)

Inflammatory
Breast Cancer
(IBC)

Lobular
Car...


Uncommon (1% to 3% of all breast cancers)



Invasive Brest Cancer.



No lump or tumor.



Mistaken for infection i...






IBC makes the skin of the breast look red and
feel warm.
It also may make the skin look thick and pitted
and may ...






Non – invasive
contained within the milk ducts .
May become invasive (pre – cancer).
Picture


Most common breast cancer.
Accounts for about 8 out of 10 invasive breast
cancers.



Lining of the ducts



Grows /i...






Non – Invasive.
Contained in the lobules and does not spread
to the tissues of the breast.
May become malignant .


picture


About 1 in 10 Invasive breast cancers are ILC.



Formed in the lobules.



Grows through the wall of the lobules.

...




Risk factors increases your chances of having
breast cancer but does not causes it.
Breast cancer results from the a...
Risk Factors

Modifiable
factors

uncontrollable
factors


Gender



Age



Genetic risk factors



Family history



Personal history of breast cancer


Race/ethnic background



Dense breasts tissue



Certain benign (not cancer) breast problems



Menstrual periods

...


Gender: more prevalent in women.



One (1) in every 150 cases (MALE).





Age: The chance of getting breast cancer...


Genetic risk factor:
Women who carry the BRCA1 and BRCA2 genes
have a considerably higher risk of developing
breast can...




Family history:
Breast cancer risk is higher among women
whose close blood relatives have this disease.

Personal hi...








Race/Ethnic background:
Overall, white women are slightly more likely
to get breast cancer than African-Americ...




Dense breast tissue: Dense breast tissue means
there is more gland tissue and less fatty tissue.

Certain benign (no...




Menstrual period: Women who began having
periods early (before age 12) or who went
through the change of life (menop...








Not having children or having them later in
life.
Certain kinds of birth control
Using hormone therapy after...




Tobacco smoke: Smoking may increase the risk
of breast cancer.
Night work: A few studies have suggested that
women w...


Antiperspirant



Bras



Induced Abortion



Breast implants


Alcohol consumption



Physical exercise



Diet



Postmenopausal hormone therapy



Bodyweight



Breast cancer ...








A lump in a breast.
A pain in the armpits or breast that does not
seem to be related to the woman's menstrual
...


A swelling (lump) in one of the armpits.



An area of thickened tissue in a breast.



One of the nipples has a disc...






The nipple changes in appearance; it may
become sunken or inverted.
The size or the shape of the breast changes.
...
Diagnostic tests and procedures for
breast cancer include:






Breast exam
Mammograms
Breast ultrasound
Breast MRI ...
Clinical Breast
Exam(CBE)

Breast - Self
Exam (BSE)




Women in their 20s and 30s should have a
clinical breast exam every 3 years.
After age 40, women should have a breas...






BSE is an option for women starting in their
20s.
Any changes detected should be reported to a
medical expert.
BS...



An x-ray of the breast.
It uses a very small amount of radiation.


Mammograms

screening
screening mammograms

diag...











A technologist will position your breast for the
test.
The breast is pressed between 2 plates to flatten
...






Uses sound waves to outline a part of the body.
The sound wave echoes are picked up by a
computer to create a pic...


Use magnets and radio waves.



Cross-sectional images of the body.



MRI scans can take a long time.



Used if vi...






Patients must lie inside a narrow tube, face
down on a special platform.
The platform has openings for each breas...


A biopsy is done when other tests show that
you might have breast cancer.



It confirms if a mass is cancerous or not...


Fine needle aspiration (FNA) biopsy



Core needle biopsy



Vacuum-assisted biopsies



Surgical (open) biopsy



...


Very fine needle is used.



Extracts fluid from the lump.



Guided by ultrasound.



simple but is not 100% accura...


Needle is larger than in fine needle biopsy.



Removes more tissues.



Clearer results.









Done with systems such as ATEC® (Automated
Tissue Excision and Collection)
Guided by MRI

First the skin is ...


Anesthesia is administered.



Incision is made.



Part or whole lump is extracted and studies.




Removal of
fluids

Needle biopsy





Removal of
lymph nodes

Surgical biopsy
Tissues obtained during biopsy are
examined to determine:









Malignant or Benign
Type
Invasive or Non - invas...


Breast cancer grade



Hormone receptor status



HER2/neu status
Breast cancer grade:






If a biopsy sample is cancer, it is given a grade
from 1 to 3.
A lower grade number means a ...
Hormone receptor status:








Hormone receptors are proteins in cells that can
attach to hormones.
Estrogen and pro...
HER2/neu status:






About 1 out of 5 breast cancers have too much of
a protein called HER2/neu.
Tumors with increase...


Chest x-ray: the lungs.



Bone scan: the bones.



CT scan (computed tomography): the chest
and/or abdomen.



MRI ...
The TNM staging system
This system takes into account:





the tumor size and spread (T),
whether the cancer has sprea...


Sage 0



Stage l



Stage ll



Stage lll



Stage lV


Sage 0 : Non – Invasive breast cancer. Has not spread
to breast tissues.



Stage l : ≤ 2cm and has not spread to lymp...


Stage lll

Stage lllA: ≤ 5cm and spread to lymph nodes
forming clumps or >5 cm and spread to lymph
nodes without formin...






The type of breast cancer

The stage and grade of the breast cancer - how large
the tumor is, whether or not it h...


Surgery



Radiation therapy



Biological therapy (targeted drug therapy)



Hormone therapy



Chemotherapy
Surgery for breast cancer:
 Lumpectomy
 Mastectomy
Lymph node surgery:
 Sentinel node biopsy
 Axillary lymph node diss...






Breast-conserving surgery (BCS) or
partial/segmented mastectomy.
Surgically removing the tumor and a small
margin...


Surgically removing the breast and other
infected components.
Mastectomy

A simple
mastectomy.

Modified radical
mastec...






Simple mastectomy : removing the lobules,
ducts, fatty tissue, nipple, areola, and some skin.
Modified radical ma...






Pain after the surgery and the change in the
shape of the breast.
Wound infection, build-up of blood and buildup ...


Axillary lymph node dissection: about 10 to 40



lymph nodes are removed.
Usually done at the same time as the mastec...
Lymph node
surgery






Pain, swelling, bleeding, and infection
Swelling in the arm or chest (Lymphedema).
Lymphedema is mostly due to ax...




Surgical procedures aimed at recreating a
breast so that it looks as much as possible like
the other breast.
The sur...
Adjuvant therapy:
 After surgery
 Combat metastasis.
 Chemotherapy and hormone therapy.
Neo-adjuvant therapy:
 Before ...






Radiation therapy is treatment with highenergy rays (such as x-rays) or particles to kill
cancer cells.
The patie...






Breast radiation therapy – applied after a
lumpectomy,.
Chest wall radiation therapy – applied after a
mastectomy...


Lymph nodes radiation therapy - aimed at the
axilla and surrounding area to destroy cancer
cells that have reached the ...







Brachytherapy

radiation to the breast by place radioactive seeds
(pellets) into the breast tissue.
The most co...










Swelling and heaviness in the breast.

Sunburn-like changes in the skin and feeling
very tired.
Weakness .
...






Chemotherapy (chemo) is the use of cancer-killing
drugs.
Intravenously, given as a shot, or taken as a pill or
li...


Before surgery:
neoadjuvant chemo



After surgery:
adjuvant chemo







Doctors give chemo in cycles.
The time between cycles is most often 2 or 3
weeks.
For early-stage breast cancer...
The side effects of chemo depend on:
 the type of drugs used
 the amount given
 and the length of treatment.
Short – term side effects








· Hair loss
· Loss of appetite or increased appetite
· Nausea and vomiting
· A hi...
Long - term side effects






Menstrual changes: infertility
Nerve damage: pain, burning or tingling and
sensitivity t...






Used for breast cancers that are sensitive to
hormones.
These types of cancer are often referred to as ER
positiv...
Drugs used to block estrogen




Tamoxifen
Toremifene (Fareston®)
Fulvestran
Drugs used to change hormone levels:




Aromatase inhibitors (AIs): stop fat tissue from
making estrogen after menopaus...
Drugs that target HER2
HER2: protein that increase cancer growth.





· Trastuzumab (Herceptin): IV
· Pertuzumab (Per...









· Mouth sores
· Diarrhea
· Nausea
· Fatigue
· Feeling weak or tired
· Low blood counts
· Shortness of bre...
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What is breast cancer
types of breast cancer
risk factors associated with breast cancer
prevention
signs and symptoms
diagnosis
treatment

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Breast Cancer

  1. 1. Cancer is the abnormal, uncontrollable , continuous replication of cells which will inevitably lead to the formation of a tumor.
  2. 2. Forms in the tissues of the breast Spreads mainly through the Lymphatic system
  3. 3. THE NORMAL BREAST 1. Chest wall. 2. Pectoral muscles. 3. Lobules (glands that make milk). 4. Nipple surface. 5. Areola. 6. Lactiferous duct tube that carries milk to the nipple 7. Fatty tissue. 8. Skin.
  4. 4. Lymphatic System which consists of vessels and organs plays two vital roles in our lives: 1) The vessels essentially maintain interstitial fluid levels by carrying excess fluids as well as any plasma proteins, back into the CVS. 2) The organs, house critical immune cells such as lymphocytes which carry out our body defense against infection.
  5. 5. Most of the lymph vessels of the breast drain into:    Lymph nodes under the arm (auxiliary nodes). Lymph nodes around the collar bone (supraclavicular and infraclavicular lymph nodes) Lymph nodes inside the chest near the breast bone (internal mammary lymph nodes)
  6. 6.  Malignant  Benign  Cancerous  Not - Cancerous
  7. 7.   Not cancerous. Benign breast tumors are abnormal growths, but they do not spread outside of the breast and they are not life threatening.
  8. 8.  Most lumps are caused by the combination of cysts and fibrosis  Cysts are fluid-filled sacs.  Fibrosis is the formation of scar - like tissue.  These changes can cause breast swelling and pain.
  9. 9.  Breast cancer is a malignant (cancerous) tumor that starts in the cells of the breast. It is found mostly in women, but men can get breast cancer, too.
  10. 10. Invasive    Cancerous Malignant Spreads to other organs (metastasis) Non - Invasive    Pre – Cancerous Still in its original position Eventually develops into invasive breast cancer.
  11. 11. Invasive Breast Cancer
  12. 12.   The inner lining of milk ducts. Ductal Carcinoma   The lobules – Milk producing glands. Lobular Carcinoma
  13. 13. Ductal Carcinoma Invasive Ductal Carcinoma Ductal Carcinoma in situ (DCIS) Inflammatory Breast Cancer (IBC) Lobular Carcinoma Invasive Lobular Carcinoma Lobular Carcinoma in situ (LCIS)
  14. 14.  Uncommon (1% to 3% of all breast cancers)  Invasive Brest Cancer.  No lump or tumor.  Mistaken for infection in its early stages.
  15. 15.    IBC makes the skin of the breast look red and feel warm. It also may make the skin look thick and pitted and may have an orange peel feel. The breast may get bigger, hard, tender, or itchy
  16. 16.    Non – invasive contained within the milk ducts . May become invasive (pre – cancer).
  17. 17. Picture
  18. 18.  Most common breast cancer. Accounts for about 8 out of 10 invasive breast cancers.  Lining of the ducts  Grows /invades the breast tissues Spreads to lymph nodes Other organs
  19. 19.    Non – Invasive. Contained in the lobules and does not spread to the tissues of the breast. May become malignant .
  20. 20.  picture
  21. 21.  About 1 in 10 Invasive breast cancers are ILC.  Formed in the lobules.  Grows through the wall of the lobules.  Spreads
  22. 22.   Risk factors increases your chances of having breast cancer but does not causes it. Breast cancer results from the abnormal, uncontrollable replication of cells of the breast.
  23. 23. Risk Factors Modifiable factors uncontrollable factors
  24. 24.  Gender  Age  Genetic risk factors  Family history  Personal history of breast cancer
  25. 25.  Race/ethnic background  Dense breasts tissue  Certain benign (not cancer) breast problems  Menstrual periods  Breast radiation early in life
  26. 26.  Gender: more prevalent in women.  One (1) in every 150 cases (MALE).   Age: The chance of getting breast cancer goes up as a woman gets older. Over 80% of all female breast cancers occur among women aged 50+ years
  27. 27.  Genetic risk factor: Women who carry the BRCA1 and BRCA2 genes have a considerably higher risk of developing breast cancer.
  28. 28.   Family history: Breast cancer risk is higher among women whose close blood relatives have this disease. Personal history of breast cancer: A woman with cancer in one breast has a greater chance of getting a new cancer in the other breast or in another part of the same
  29. 29.     Race/Ethnic background: Overall, white women are slightly more likely to get breast cancer than African-American women. African-American women, though, are more likely to die of breast cancer. Asian, Hispanic, and Native-American women have a lower risk of getting and dying from breast cancer.
  30. 30.   Dense breast tissue: Dense breast tissue means there is more gland tissue and less fatty tissue. Certain benign (not cancer) breast problems: Women who have certain benign breast changes may have an increased risk of breast cancer.
  31. 31.   Menstrual period: Women who began having periods early (before age 12) or who went through the change of life (menopause) after the age of 55 have a slightly increased risk of breast cancer. Breast radiation early in life: Women who have had radiation treatment to the chest area as a child or young adult have a greatly increased risk of breast cancer.
  32. 32.       Not having children or having them later in life. Certain kinds of birth control Using hormone therapy after menopause Not breastfeeding Alcohol Being overweight or obese
  33. 33.   Tobacco smoke: Smoking may increase the risk of breast cancer. Night work: A few studies have suggested that women who work at night have a higher risk of breast cancer.
  34. 34.  Antiperspirant  Bras  Induced Abortion  Breast implants
  35. 35.  Alcohol consumption  Physical exercise  Diet  Postmenopausal hormone therapy  Bodyweight  Breast cancer screening  Breastfeeding
  36. 36.     A lump in a breast. A pain in the armpits or breast that does not seem to be related to the woman's menstrual period. Pitting or redness of the skin of the breast; like the skin of an orange. A rash around (or on) one of the nipples.
  37. 37.  A swelling (lump) in one of the armpits.  An area of thickened tissue in a breast.  One of the nipples has a discharge; sometimes it may contain blood
  38. 38.    The nipple changes in appearance; it may become sunken or inverted. The size or the shape of the breast changes. The nipple-skin or breast-skin may have started to peel, scale or flake.
  39. 39. Diagnostic tests and procedures for breast cancer include:      Breast exam Mammograms Breast ultrasound Breast MRI scan Biopsy Imaging tests
  40. 40. Clinical Breast Exam(CBE) Breast - Self Exam (BSE)
  41. 41.   Women in their 20s and 30s should have a clinical breast exam every 3 years. After age 40, women should have a breast exam every year
  42. 42.    BSE is an option for women starting in their 20s. Any changes detected should be reported to a medical expert. BSE: Conducted standing or reclining
  43. 43.   An x-ray of the breast. It uses a very small amount of radiation.  Mammograms screening screening mammograms diagnosis diagnostic mammogram
  44. 44.       A technologist will position your breast for the test. The breast is pressed between 2 plates to flatten and spread the tissue. The pressure lasts only a few seconds while the picture is taken. The breast and plates are repositioned and then another picture is taken. The whole process takes about 20 minutes.
  45. 45.    Uses sound waves to outline a part of the body. The sound wave echoes are picked up by a computer to create a picture on a computer screen. Used to investigate areas of concerns found by a mammogram.
  46. 46.  Use magnets and radio waves.  Cross-sectional images of the body.  MRI scans can take a long time.  Used if view areas of concern found on a mammogram.
  47. 47.    Patients must lie inside a narrow tube, face down on a special platform. The platform has openings for each breast that allow the image to be taken without pressing on the breast. Contrast material may be injected into a vein to help the MRI show more details.
  48. 48.  A biopsy is done when other tests show that you might have breast cancer.  It confirms if a mass is cancerous or not.  Mass is removed and studied.
  49. 49.  Fine needle aspiration (FNA) biopsy  Core needle biopsy  Vacuum-assisted biopsies  Surgical (open) biopsy  Lymph node biopsy
  50. 50.  Very fine needle is used.  Extracts fluid from the lump.  Guided by ultrasound.  simple but is not 100% accurate.
  51. 51.  Needle is larger than in fine needle biopsy.  Removes more tissues.  Clearer results.
  52. 52.      Done with systems such as ATEC® (Automated Tissue Excision and Collection) Guided by MRI First the skin is numbed and a small cut (incision) is made. A hollow probe is put through the cut into the breast tissue. A piece of tissue is sucked out.
  53. 53.  Anesthesia is administered.  Incision is made.  Part or whole lump is extracted and studies.
  54. 54.   Removal of fluids Needle biopsy   Removal of lymph nodes Surgical biopsy
  55. 55. Tissues obtained during biopsy are examined to determine:        Malignant or Benign Type Invasive or Non - invasive Size Has it metastasized Is the lymph nodes affected Treatment
  56. 56.  Breast cancer grade  Hormone receptor status  HER2/neu status
  57. 57. Breast cancer grade:    If a biopsy sample is cancer, it is given a grade from 1 to 3. A lower grade number means a slower-growing cancer, while a higher number means a fastergrowing cancer. The grade helps predict the outcome.
  58. 58. Hormone receptor status:     Hormone receptors are proteins in cells that can attach to hormones. Estrogen and progesterone are hormones that fuel breast cancer growth. Breast cancers are tested for hormone receptors. If the tumor has them, it is often called ERpositive, PR positive, About 2 out of 3 breast cancers have at least one of these receptors.
  59. 59. HER2/neu status:    About 1 out of 5 breast cancers have too much of a protein called HER2/neu. Tumors with increased levels of HER2/neu are called HER2-positive. These cancers tend to grow and spread faster than other breast cancers
  60. 60.  Chest x-ray: the lungs.  Bone scan: the bones.  CT scan (computed tomography): the chest and/or abdomen.  MRI : brain and spinal cord.  Ultrasound: other parts
  61. 61. The TNM staging system This system takes into account:    the tumor size and spread (T), whether the cancer has spread to lymph nodes (N) and whether it has spread to distant organs (M) for metastasis
  62. 62.  Sage 0  Stage l  Stage ll  Stage lll  Stage lV
  63. 63.  Sage 0 : Non – Invasive breast cancer. Has not spread to breast tissues.  Stage l : ≤ 2cm and has not spread to lymph nodes.  Stage ll Stage llA: ≤ 2 cm and has spread to lymph nodes or 2-5 cm and has spread to lymph nodes. Stage llB: 2-5 cm and has spread to lymph nodes or > 5 cm and has not spread to lymph nodes.
  64. 64.  Stage lll Stage lllA: ≤ 5cm and spread to lymph nodes forming clumps or >5 cm and spread to lymph nodes without forming clumps. Stage lllB: Any size and spread to the skin or chest wall. Swelling. Stage lllC: Any size , spread to lymph nodes, skin and chest wall.  Stage lV: Metastasized
  65. 65.    The type of breast cancer The stage and grade of the breast cancer - how large the tumor is, whether or not it has spread, and if so how far Whether or not the cancer cells are sensitive to hormones  The patient's overall health  The age of the patient  The patient's own preferences
  66. 66.  Surgery  Radiation therapy  Biological therapy (targeted drug therapy)  Hormone therapy  Chemotherapy
  67. 67. Surgery for breast cancer:  Lumpectomy  Mastectomy Lymph node surgery:  Sentinel node biopsy  Axillary lymph node dissection Breast reconstruction surgery
  68. 68.    Breast-conserving surgery (BCS) or partial/segmented mastectomy. Surgically removing the tumor and a small margin of healthy tissue around it. Followed by radiation therapy
  69. 69.  Surgically removing the breast and other infected components. Mastectomy A simple mastectomy. Modified radical mastectomy. A Radical mastectomy.
  70. 70.    Simple mastectomy : removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. Modified radical mastectomy: simple mastectomy combined with the removal of the axillary lymph nodes. Radical mastectomy: a simple mastectomy combined with removing the lymph nodes and muscles of the chest wall.
  71. 71.    Pain after the surgery and the change in the shape of the breast. Wound infection, build-up of blood and buildup of clear fluid in the wound. If axillary lymph nodes are removed swelling of the arm and chest may occur (Lymphedema).
  72. 72.  Axillary lymph node dissection: about 10 to 40  lymph nodes are removed. Usually done at the same time as the mastectomy or breast-conserving surgery.  Sentinel lymph node biopsy: is used to determine if   cancer has spread to the lymph nodes under the arm without removing many of them. A blue dye/radioactive substance is injected in order to identify the sentinel lymph nodes which drains lymph from the tumor. They are then removed.
  73. 73. Lymph node surgery
  74. 74.    Pain, swelling, bleeding, and infection Swelling in the arm or chest (Lymphedema). Lymphedema is mostly due to axillary lymph node biopsy.
  75. 75.   Surgical procedures aimed at recreating a breast so that it looks as much as possible like the other breast. The surgeon may use a breast implant, or tissue from another part of the patient's body.
  76. 76. Adjuvant therapy:  After surgery  Combat metastasis.  Chemotherapy and hormone therapy. Neo-adjuvant therapy:  Before surgery  Reduce tumors  Radiation therapy
  77. 77.    Radiation therapy is treatment with highenergy rays (such as x-rays) or particles to kill cancer cells. The patient may require three to five sessions per week for three to six weeks. The type of breast cancer will determine the type of radiation therapy used.
  78. 78.    Breast radiation therapy – applied after a lumpectomy,. Chest wall radiation therapy – applied after a mastectomy Breast boost - a high-dose of radiation therapy is applied to where the tumor was surgically removed.
  79. 79.  Lymph nodes radiation therapy - aimed at the axilla and surrounding area to destroy cancer cells that have reached the lymph nodes
  80. 80.     Brachytherapy radiation to the breast by place radioactive seeds (pellets) into the breast tissue. The most common type brachytherapy used to treat breast cancer is called intracavitary brachytherapy. A device is put into the space left from breastconserving surgery, a source of radiation is then placed in the device for a short time and then removed.
  81. 81.      Swelling and heaviness in the breast. Sunburn-like changes in the skin and feeling very tired. Weakness . Damage some of the nerves to the arm. This can lead to numbness, pain, and weakness in the shoulder, arm and hand. Radiation to lymph nodes causes (Lymphedema).
  82. 82.    Chemotherapy (chemo) is the use of cancer-killing drugs. Intravenously, given as a shot, or taken as a pill or liquid. They enter the bloodstream and reach most parts of the body.  Combats metastasis.  Damage some normal cells.
  83. 83.  Before surgery: neoadjuvant chemo  After surgery: adjuvant chemo
  84. 84.     Doctors give chemo in cycles. The time between cycles is most often 2 or 3 weeks. For early-stage breast cancer, the total course of treatment usually lasts for 3 to 6 months. For advanced breast cancer chemo is often continued as long as it is working.
  85. 85. The side effects of chemo depend on:  the type of drugs used  the amount given  and the length of treatment.
  86. 86. Short – term side effects        · Hair loss · Loss of appetite or increased appetite · Nausea and vomiting · A higher risk of infection (low WBC count) · Stopping of menstrual periods · Easy bruising or bleeding (low platelets) · Being very tired
  87. 87. Long - term side effects    Menstrual changes: infertility Nerve damage: pain, burning or tingling and sensitivity to cold or hot. Heart damage
  88. 88.    Used for breast cancers that are sensitive to hormones. These types of cancer are often referred to as ER positive (estrogen receptor positive) and PR positive (progesterone receptor positive) cancers. Estrogen and progesterone promotes cancer growth.
  89. 89. Drugs used to block estrogen    Tamoxifen Toremifene (Fareston®) Fulvestran
  90. 90. Drugs used to change hormone levels:   Aromatase inhibitors (AIs): stop fat tissue from making estrogen after menopause Luteinizing hormone-releasing hormone (LHRH) analogs: shuts down the ovaries.
  91. 91. Drugs that target HER2 HER2: protein that increase cancer growth.     · Trastuzumab (Herceptin): IV · Pertuzumab (Perjeta®): IV · Ado-trastuzumab emtansine (Kadcyla™) · Lapatinib (Tykerb): pill
  92. 92.         · Mouth sores · Diarrhea · Nausea · Fatigue · Feeling weak or tired · Low blood counts · Shortness of breath · Cough
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