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= Multifocal Breast cancer =

Multifocal breast cancer is a type of breast cancer which refers to having more than one tumor in a side of breast .It is usually divided to noninvasive and invasive. This is a common disease among female especially women 35-39 years old have a higher risk. This Wikipedia page would like to raise awareness towards breast cancer. This is because cancer has been a disease with high death rate around the globe. Over 508 000 women died because of breast cancer in 2011 .Noninvasive cancer refers to cancer cells are located in milk producing glands in breast while invasive cancer refers to cancer cells are located in breast and are also found in other organs. It is suggested that multifocal breast cancer has higher death rate than unifocal breast cancer.

= 1. Symptoms = Changes in Breast

There are few common signs when having multifocal breast cancer including changing size of breast due to thickening and swelling, changing of texture of breast by distortion and increasing tenderness and abnormal nipples.Breast is lumpy in texture.It is commonly called as nodular or glandular breast tissue.There is also a possibility in having red skin or dry skin. There may not be any signs at early stage which can only be found out by screening regularly.

There are several factors increasing the chance in having multifocal breast cancer.

Age

Aging is one of the factors increasing risk of having multifocal breast cancer.It is suggested that older age would have an increase in risk of having multifocal breast cancer.

Environmental Factors
Some chemicals are carcinogenic and are present in working environment. Several chemicals are endocrine disruptors which affect hormone secretion and increase the chance of having multifocal breast cancer. If women exposed to exogenous estrogenic compounds in long term, the chance of having multifocal breastfeeding cancer. These compounds will highly affect development of breast tissue when these tissues are undifferentiated.

Family History
Family medical history is able to show the possibility of having multifocal breast cancer. If family members had breast or ovarian cancer in the past, there is a higher possibility for other family members to have the same cancer. This is because the mutation of genes such as BRCA1 and BRCA2 can be passed to other generations.

Medicine Intake
Drug diethylstilbestrol is a medicine used to avoid miscarriage to pregnant in the past decays which have increased the risk of having multifocal breast cancer.

Reproductive History
Reproductive history will bring effects to the possibility in having multifocal breast cancer. If a woman give birth at young age, she will have a lower chance in having late-onset breast cancer. However, each pregnancy will increase the chance of having multifocal breast cancer. In developed countries, woman give birth at elder age and the duration of breastfeeding is shorter than the past decays. This leads to an increasing chance in having multifocal breast cancer.

= 2.Diagnosis =

Biopsy
Tumor samples would be extracted by biopsy methods for further checking.There are few biopsy formats which are called fine needle biopsy and core needle biopsy. Fine-needle aspiration is used when tumors surrounding is full of fluid and can be examined. Ultrasound would be used as an assistance for finding location of tumor. Core-needle biopsy is a method to extract small amount of breast tissue. Small amount of marker would be inserted to breast for marking the location of abnormal tissue. This mark would also be used for showing the location of the tumors if surgery is needed after scanning. Core-needle biopsy is divided to ultrasound guided and stereotactic guided. For ultrasound guided, ultrasound equipment is used by doctors to guide the needle while stereotactic guided means using X-ray to guide the needle.

Clinical Breast Exam
Breast would be physically examined by doctors by visual for any abnormal changes of breast.It would be examined on external appearance, shape, size and any lump appear.The axillae would also be examined for checking lymph nodes.

Clinical breast exam would be done before processing Mammogram Clinical breast exam plays an important role in diagnosis in cancer staging.In developed countries which have sophisticated medical system, both Clinical breast exam and breast self-examination together with other scanning process

Mammogram
Mammography is commonly used to examine breast at early stage. This method involved x-ray for screening the breast. Patient’s breast is put on a support plate can a paddle is used to flatten the breast. Patient would be standing in an x-ray machine to allow X-rays to pass through breast tissue to the detector which image can be captured on a photographic film plate or sending electronic signals to computer for a digital image, which is called as mammogram. A mammogram usually consists of the view from top and the two sides of breasts, sometimes with few angles to search for specific location of tumors. Area with denser tissue would have lighter shades, which shades could be connective and glandular tissue or tumors. While less dense tissues such as fat would be in dark shades.Mammography has several limitations. Not all breasts are able to be scanned through x-ray due to dense tissues in breast causing an increase in difficulty in searching and examine tumors. Moreover, mammography has a relatively low accuracy and sensitivity comparing to ultrasound and Magnetic resonance imaging. The risk in using mammography for breast screening is patients would be exposed in a low level of radiation due to the usage of x-ray.

Molecular Breast Imaging

Molecular breast imaging is a screening process which is able to provide image with high resolution by using radioactive tracer to locate tumor in breast. Molecular breast imaging technique is able to sense tumors small than 5mm. It has a high specificity and act as an extra test after mammogram. Molecular Breast imaging is able to investigate unusual images to search for tumors. The risk of this imaging technique is that patients have to expose in a low level of radiation and some patients may have allergy( a rare case).

= 3.Management =

Tamoxifen
Tamoxifen is used as treatment for breast cancers at early stage as it is suggested that Tamoxifen treatment would rise the chance of survival. The function of Tamoxifen is to restrict the secretion of oestrogen, a female sex hormone for regulation female reproductive system. It is also commonly consumed as a prevention of breast cancer. Pateints with abnormal CYP2D6 enzyme are not recommanded to consume.

Lumpectomy

Lumpectomy is used for removing Tumors  formed in breast together with healthy breast tissue surrounding the Tumors.

Radiation therapy is often applied after lumpectomy to reduce the chance of reformation of tumors in affected area.

There is a possibility of recurrence if tumor after surgery.

Radio Therapy

Radiotherapy treatment refers to using radiation to damage DNA sequence in cancer cells This therapy is used to remove remaining cancer cells in cell wall. Radio Therapy is commonly performed with chemotherapy to ensure all cancer cells and tumors are removed. If a patient is recommended to use radio therapy, the patient will be asked to meet a radiation oncologist for treatment. Radiotherapy is usually performed daily. There are side effects after treatment including changes in skin color and texture, extreme tiredness and losing appetite.

Chemotherapy
Chemotherapy is commonly act as extra treatment for other cancer treatment such as radiotherapy. Medical oncologist will first discuss with patient to examine the feasibility of using chemotherapy to cure Multifocal Breast Cancer. Medical oncologist will first perform molecular test to patients to examine the possibility of killing cancer cells and not recurring. Molecular test includes Oncotype DX and Prosigna. The information collected is also used to make decision in choosing cancer treatments.The principle of chemotherapy is killing cancer cells and some abnormal cells. This treatment can be in drug form or injecting chemicals to vein. Chemotherapy will bring side effects to patients.

Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy
Cytoreductive surgery is to remove tumors found in patients’ breasts. Patients need to spend around 2 weeks in hospital for surgery and recovery. It has less pain and side effects comparing to other treatments although it still has a possibility to bring side effects to patients. There are side effects of having nausea, diarrhea and increasing blood clots. Hyperthermic Intraperitoneal Chemotherapy is commonly done together. Drugs solution are heated to maintain its effectiveness for a longer period of time and reduce the duration that drugs affecting healthy breast tissues.After surgery, it is recommended to revisit doctors and specialists after four to six weeks for a check up.

Side effects
Treatments would lead to side effects in short term and long term to patients.

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Lymphoedema ====== Lymphoeda is a side effect after breast cancer treatment. It forms swell due to increase in body fluid in tissue an usually occur in arms, hands and fingers. Lymphiedema would cause tightness and dry skin, stiffed arm and swelling. Swelling in chest is due to healing of breast tissue after treatments and would disappear after some time. Swelling may cause tighten of clothing.

The reason of lymphoedema is due to the destruction in lymphatic system. Lymph nodes may be removed during surgery and would not be able to be replaced. Lumph nodes are extracted to test for any cancer cell present. Lymph nodes in lymphatic system are used to filter cancer cells and bacteria. The decreased number of lymph nodes reduce the ability to drain body fluid and fluid are accumulated in breast tissues which would cause swells. To reduce the risk of having such problem patients are suggested to have physical exercise and maintaining healthy weight.

==== Bone health(Osteoporosis) ==== Breast cancer treatment would affect the bone health of patient. Cancer treatment may lead to osteoporosis. Osteoporosis means the bone strength and density is lower than normal level due to thinner bone structure and lead to fragile bones. During cancer treatment the oestrogen level would decrease which oestrogen is used as a protection of bones. The reduction of oestrogen level is due to intake of tamoxifen and chemotherapy.

= 4.Prevention =

Tamoxifen
Tamoxifen is a medicine which is used for preventing breast cancer.It is an antioestrogen which means Tamoxifen will inhibit the secretion of oestrogen in body. It is found to be an effective way to cure breast cancer.

Such therapy can also be used in a long duration as it reduce the chance of having breast cancer and other cardiovascular diseases by reducing the oestrogen level.

Raloxifene
Raloxifene is a medicine which is able to stop estrogen affecting breast by acting as inhibitors of estrogen production. Raloxifene brings benefit to bone density and reduce the chance of having breast cancer. However, there is a risk of increasing chance in having blood clot. Raloxifene is not suggested to be applied in young women for preventing multifocal breast cancer and are mostly used in women which menstruation stopped.

Breastfeeding
Breastfeeding for over half year would provide benefit to children and reduce the risk of having multifocal breast cancer of non-smoking mothers.

Breastfeeding leads to changes in hormone levels and delayed the menstruation cycle in women body.

Aromatase inhibitors
It is suggested that tamoxifen may not be suitable to women as the side effect in consuming tamoxifen in long term will increase the risk of hyperplasia and stroke. Therefore, Aromatase inhibitor is introduced as selective aromatase inhibition is considered to be more cost effective. The intake of these inhibitors will not bring effect to P450 enzymes which is important to generate cortisol and aldosterone, which are hormones that ar important to women body.