gynecology and obstetrics
Breast Cancer
Pathophysiology of Breast Cancer
Breast cancer invades locally and spreads through the regional lymph nodes, bloodstream, or both. Metastatic breast cancer may affect almost any organ in the body—most commonly, lungs, liver, bone, brain, and skin. Most skin metastases occur near the site of breast surgery; scalp metastases are uncommon. Some breast cancers may recur sooner than others; recurrence can often be predicted based on tumor markers. For example, metastatic breast cancer may occur within 3 years in patients who are negative for tumor markers or occur > 10 years after initial diagnosis and treatment in patients who have anestrogen-receptor positive tumor. Estrogenandprogesteronereceptors are nuclear hormone receptors that promote DNA replication and cell division when the appropriate hormones bind to them. Thus, medications that block these receptors are useful in treating and preventing tumors with the receptors. For tumors in which HER2 receptors are overexpressed, medications that block these receptors are part of standard treatment. HER2 overexpressing tumors respond well to these medications because HER2 is a significant driver of cancer cell progression. gene mutations increase the risk of developing breast cancer to 70% ( Pathophysiology references ). Prophylactic bilateral mastectomy reduces the risk of breast cancer by 90% and should be offered to women with a 1.Kuchenbaecker KB, Hopper JL, Barnes DR, et al: Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers.JAMA317 (23):2402–2416, 2017. doi: 10.1001/jama.2017.7112 2.Breast Cancer Association Consortium; Dorling L, Carvalho S, Allen J, et al: Breast cancer risk genes — Association analysis in more than 113,000 women.N Engl J Med4;384 (5):428–439, 2021. doi: 10.1056/NEJMoa1913948 