Please enable JavaScript.
Coggle requires JavaScript to display documents.
PBL unit 1 ILO’s - Coggle Diagram
PBL unit 1 ILO’s
Risk factors of breast Cancer
Being female, Women are much more likely than men are to develop breast cancer
Increasing age. Your risk of breast cancer increases as you age
A personal history of breast conditions. If you've had a breast biopsy that found lobular carcinoma in situ (LCIS) or atypical hyperplasia of the breast, you have an increased risk of breast cancer
A personal history of breast cancer. If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
A family history of breast cancer. If your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of people diagnosed with breast cancer have no family history of the disease.
Inherited genes that increase cancer risk. Certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most well-known gene mutations are referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast cancer and other cancers, but they don't make cancer inevitable.
Radiation exposure. If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.
Obesity. Being obese increases your risk of breast cancer.
Beginning your period at a younger age. Beginning your period before age 12 increases your risk of breast cancer.
Beginning menopause at an older age. If you began menopause at an older age, you're more likely to develop breast cancer.
Having your first child at an older age. Women who give birth to their first child after age 30 may have an increased risk of breast cancer.
Having never been pregnant. Women who have never been pregnant have a greater risk of breast cancer than do women who have had one or more pregnancies.
Postmenopausal hormone therapy. Women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications.
Drinking alcohol. Drinking alcohol increases the risk of breast cancer.
Cellular Anatomy
Basic structure and function of DNA
DNA consists of 2 polynucleotide chains or strands, wound around each other such that they resemble a twisted ladder. This structure is referred to as the double helix. The backbone of each of these strands is a repeating pattern of a 5-carbon sugar and a phosphate group. Each sugar is attached to one of the four nitrogen-containing bases: A, T, G, or C.
Proteinsynthesis
What can go wrong + mutations
BRCA1 and BRCA2: The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 or BRCA2 gene. In normal cells, these genes help make proteins that repair damaged DNA. Mutated versions of these genes can lead to abnormal cell growth, which can lead to cancer.
The ATM gene normally helps repair damaged DNA (or helps kill the cell if the damaged can't be fixed). Inheriting 2 abnormal copies of this gene causes the disease ataxia-telangiectasia. Inheriting one abnormal copy of this gene has been linked to a high rate of breast cancer in some families.
The TP53 gene helps stop the growth of cells with damaged DNA. Inherited mutations of this gene cause Li-Fraumeni syndrome. People with this syndrome have an increased risk of breast cancer, as well as some other cancers such as leukemia, brain tumors, and sarcomas (cancers of bones or connective tissue). This mutation is a rare cause of breast cancer
The CHEK2 gene is another gene that normally helps with DNA repair. A CHEK2 mutation increases breast cancer risk.
The PTEN gene normally helps regulate cell growth. Inherited mutations in this gene can cause Cowden syndrome, a rare disorder that puts people at higher risk for both cancer and benign (non-cancer) tumors in the breasts, as well as growths in the digestive tract, thyroid, uterus, and ovaries
Inherited mutations in this gene cause hereditary diffuse gastric cancer, a syndrome in which people develop a rare type of stomach cancer. Women with mutations in this gene also have an increased risk of invasive lobular breast cancer.
Defects in this gene can lead to Peutz-Jeghers syndrome. People affected with this disorder have pigmented spots on their lips and in their mouths, polyps (abnormal growths) in the urinary and digestive tracts, and a higher risk of many types of cancer, including breast cancer.
The PALB2 gene makes a protein that interacts with the protein made by the BRCA2 gene. Mutations in this gene can lead to a higher risk of breast cancer.
Oncogenes
Proto-oncogenes are genes that normally help cells grow. When a proto-oncogene mutates (changes) or there are too many copies of it, it becomes a "bad" gene that can become permanently turned on or activated when it is not supposed to be. When this happens, the cell grows out of control, which can lead to cancer. This bad gene is called an oncogene.
A few cancer syndromes are caused by inherited mutations of proto-oncogenes that cause the oncogene to be turned on (activated). But most cancer-causing mutations involving oncogenes are acquired
Tumour supressor genes
Tumor suppressor genes are normal genes that slow down cell division, repair DNA mistakes, or tell cells when to die (a process known as apoptosis or programmed cell death). When tumor suppressor genes don't work properly, cells can grow out of control, which can lead to cancer.
An important difference between oncogenes and tumor suppressor genes is that oncogenes result from the activation (turning on) of proto-oncogenes, but tumor suppressor genes cause cancer when they are inactivated (turned off).
Inherited abnormalities of tumor suppressor genes have been found in some family cancer syndromes. They cause certain types of cancer to run in families. But most tumor suppressor gene mutations are acquired, not inherited.
What makes a good doctor
Autonomy
If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected.
An adult patient who… suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment… This right of choice is not limited to decisions which others might regard as sensible. It exists notwithstanding that the reasons for making the choice are rational, irrational, unknown or even non-existent.
Conditions for Autonomy
Two conditions are ordinarily required before a decision can be regarded as autonomous. The individual has to have the relevant internal capacities for self-government and has to be free from external constraints. In a medical context, a decision is ordinarily regarded as autonomous where the individual has the capacity to make the relevant decision, has sufficient information to make the decision and does so voluntarily
Decisions where autonomy is Lacking
Given that there is a strong obligation to respect the decisions of autonomous adults – in relation to medical treatment, the only possible exception is the provision of compulsory treatment under mental health legislation
Consent
Defining Consent
For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.
voluntary – the decision to either consent or not to consent to treatment must be made by the person, and must not be influenced by pressure from medical staff, friends or family
informed – the person must be given all of the information about what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment does not go ahead
capacity – the person must be capable of giving consent, which means they understand the information given to them and can use it to make an informed decision
How consent is given
verbally – for example, a person saying they're happy to have an X-ray
in writing – for example, signing a consent form for surgery
Someone could also give non-verbal consent, as long as they understand the treatment or examination about to take place – for example, holding out an arm for a blood test.
If someone's going to have a major procedure, such as an operation, their consent should be secured well in advance so they have plenty of time to understand the procedure and ask questions.
When Consent is not needed
When they need emergency treatment to save their life, but they're incapacitated (for example, they're unconscious) – the reasons why treatment was necessary should be fully explained once they have recovered
immediately needs an additional emergency procedure during an operation – there has to be a clear medical reason why it would be unsafe to wait to obtain consent
with a severe mental health condition, such as schizophrenia, bipolar disorder or dementia, lacks the capacity to consent to the treatment of their mental health (under the Mental Health Act 1983) – in these cases, treatment for unrelated physical conditions still requires consent, which the patient may be able to provide, despite their mental illness
needs hospital treatment for a severe mental health condition, but self-harmed or attempted suicide while competent and is refusing treatment (under the Mental Health Act 1983) – the person's nearest relative or an approved social worker must make an application for the person to be forcibly kept in hospital, and 2 doctors must assess the person's condition
is a risk to public health as a result of rabies, cholera or tuberculosis (TB)
is severely ill and living in unhygienic conditions (under the National Assistance Act 1948) – a person who's severely ill or infirm and living in unsanitary conditions can be taken to a place of care without their consent
What is a triple assessment
Types of biopsies and how they’re carried out
Image-guided biopsy. Your doctor may use an image-guided biopsy approach when he or she cannot feel a tumor or when the area is deeper inside the body. During this procedure, your doctor guides a needle to the location with the help of an imaging technique. Your doctor can do an image-guided biopsy using a fine needle, core, or vacuum-assisted biopsy (see below). This depends on the amount of tissue needed, possible diagnoses, and other factors. Your doctor will use one of the following types of imaging based on the location and other factors:
Fine needle aspiration biopsy. During this minimally invasive biopsy, the doctor uses a very thin, hollow needle attached to a syringe. He or she collects a small amount of tissue from the suspicious area to examine and test. Your doctor may use this biopsy for a mass that he or she can feel through the skin or with image-guided biopsy
Core needle biopsy. This type of biopsy uses a larger needle to remove a larger tissue sample. It is similar to a fine needle biopsy and is also minimally invasive.
Vacuum-assisted biopsy. This type of biopsy uses a suction device to collect a tissue sample through a specially designed needle. Your doctor can collect multiple or large samples from the same biopsy site with this method. A vacuum-assisted biopsy can sometimes be image guided.
Excisional biopsy. During an excisional biopsy, your doctor removes the entire suspicious area. This is commonly used for suspicious changes on the skin. Doctors also sometimes use it for a small, easily removable lump under the skin. However, fine needle aspiration or core needle biopsy are more common for lumps that cannot be seen or felt through the skin.
Shave biopsy. For this type of biopsy, the doctor uses a sharp tool to remove tissue from the skin surface.
Punch biopsy. During a punch biopsy, the doctor inserts a sharp, circular tool into the skin. He or she then takes a sample from below the skin surface.
Endoscopic biopsy. An endoscope is a thin, lighted, flexible tube with a camera. Doctors use this tool to view the inside of the body, including the bladder, abdomen, joints, or gastrointestinal (GI) tract. They insert endoscopes through the mouth or a tiny surgical incision. The attached camera helps the doctor see any abnormal areas. Doctors also use them to take tiny samples of the tissue using forceps. The forceps are also a part of the endoscope
Laparoscopic biopsy. This type of biopsy is used for the abdomen. Similar to an endoscopic biopsy, the doctor inserts a thin tube with a video camera called a laparoscope into the abdomen through a tiny incision. The camera helps the doctor see any abnormal areas. Then doctors can insert a small needle and take a tissue sample.
Bone marrow aspiration and biopsy. These two procedures are similar. Doctors often do them at the same time to examine the bone marrow. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy removes a small amount of solid tissue using a needle. Doctors use these procedures to find out if a person has a blood disorder or blood cancer. Blood cancers include leukemia, lymphoma, or multiple myeloma.
Liquid biopsy. This minimally invasive procedure can test a blood sample for cancer. During a liquid biopsy, a health care professional collects a routine sample of blood and analyzes it in a specific way. Compared to a tissue biopsy, a liquid biopsy has less risks to patients, and doctors can easily perform it multiple times. It may also allow doctors to check the progress of a tumor and see how well a treatment is working. This type of biopsy is still new, and more research is being done to learn about its uses.
Breast Examination Steps and Stages
Introduction
Introduce yourself to the patient
Wash your hands
Explain to the patient what the examination Involves, check if the patient understands the steps of the examination
Position the patient at 45 degrees
Ensure a chaperone is present during the examination if the patient has requested
Ask the patient to remove their clothing to expose their chest, from above their waist
Provide a blanket for the patient to cover themselves when not required to expose the breasts
Inspection
Inspect the patient from the end of the bed, Check for any obvious masses, scars or asymmetry
Ask the patient to place their hands by their sides, comparing both breasts
Check for any obvious scars or masses present, and note the size and position of any observed
Look for any skin changes or ulceration, Erythema, Puckering, or Peau d'orange(Orange peel looking skin)
Look for any nipple changes, Nipple discharge or inversion
Ask the patient to place both hands on their hips and repeat this inspection, this will accentuate and asymmetry
Inspect the Axiilae for any obvious masses
Ask the patient to place both hands behind their head and repeat this inspection, this will accentuate any asymmetry
Palpation
Ask the patient to place both hands behind their head
Examine each quadrant of the breast in turn, including the axillary tail (also termed the “Tail of Spence”)
Using a flat hand, press the breast against the underlying chest wall, rolling the underlying tissue
If you palpate any lumps, note their position, size, shape, consistency, overlying skin changes, and mobility, Examine their fixity to pectoralis muscles by asking the patient to push against your hand with their hand outstretched
Examine both axilla in turn
When examining the left axilla, hold the patients left arm with your left hand and examine the axilla with your right hand
When examining the right axilla, hold the patients right arm with your right hand and examine the axilla with your left hand
Palpate for any lymphadenopathy, 5 sets of axillary lymph nodes are present: apical, anterior, central, posterior, and medial
To fully examine a breast, you should also remember to assess for potential metastasis
Palpate the spine for tenderness
Palpate the abdomen for hepatomegaly
Percuss and auscultate the lungs for lung masses
Final Completion
To finish the examination, stand back from the patient and state to the examiner that to complete your examination, you would like to follow up your examination with:
Mammography and / or ultrasound, if necessary
Biopsy (core needle or fine needle aspirate), if necessary
Role of breast cancer awareness in population health
Prevention
maintain a healthy weight
exercise regularly
do not drink alcohol
Studies have shown women who breastfeed are statistically less likely to develop breast cancer than those who do not.
Mastectomy, by removing as much breast tissue as possible, a mastectomy can reduce your risk of breast cancer by up to 90%.
Medicine
tamoxifen – for women who either have or have not been through the menopause
anastrozole – for women who have been through the menopause
raloxifene – for women who have been through the menopause
Side effects can include
sweating
feeling sick
tiredness
Hot flushes
Leg cramps
There's also a small risk of more serious problems, such as weakened bones (osteoporosis), blood clots or womb cancer.
These medicines are usually taken once a day for 5 years. They can reduce your risk of breast cancer while you're taking them and possibly for several years afterwards.
Issues caused by the internet
As many illnesses present with the same initial symptoms an anxious patient who may dig too deep into the internet for a quick diagnosis may find themselves self diagnosing very serious and life threatening illnesses such as cancer when the actual diagnosis may be much simpler and easily treatable. This means that an already anxious patient may become even more anxious and scared and make very big decisions while waiting for a doctor’s confirmation as they could seen that there is a very short life expectancy with the illness they read about
Malignant vs Benign
What is a fibroadenoma (how it differs to breast cancer and how it is treated)
Non surgical Management
If your doctor is reasonably certain that your breast lump is a fibroadenoma — based on the results of the clinical breast exam, imaging test and biopsy — you might not need surgery.
Surgery can distort the shape and texture of the breast
Fibroadenomas sometimes shrink or disappear on their own
The breast has multiple fibroadenomas that appear to be stable — no changes in size on an ultrasound compared to an earlier ultrasound
If you choose not to have surgery, it's important to monitor the fibroadenoma with follow-up visits to your doctor for breast ultrasounds to detect changes in the appearance or size of the lump. If you later become worried about the fibroadenoma, you can reconsider surgery to remove it.
Surgery
Your doctor might recommend surgery to remove the fibroadenoma if one of your tests — the clinical breast exam, an imaging test or a biopsy — is abnormal or if the fibroadenoma is extremely large, gets bigger or causes symptoms
Lumpectomy or excisional biopsy. In this procedure, a surgeon removes breast tissue and sends it to a lab to check for cancer.
Cryoablation. Your doctor inserts a thin, wand-like device (cryoprobe) through your skin to the fibroadenoma. A gas is used to freeze and destroy the tissue.
After a fibroadenoma is removed, it's possible for one or more new fibroadenomas to develop. New breast lumps need to be assessed with a mammogram, ultrasound and possibly biopsy — to determine if the lump is a fibroadenoma or might become cancerous.
Fibroadenomas are among the most common noncancerous (benign) breast lumps in young women.
A fibroadenoma might feel firm, smooth, rubbery or hard and has a well-defined shape. Usually painless, it might feel like a marble in your breast, moving easily under your skin when examined. Fibroadenomas vary in size, and they can enlarge or shrink on their own.
Types of Fibroadenomas
Complex fibroadenomas. These can contain changes, such as an overgrowth of cells (hyperplasia) that can grow rapidly. A pathologist makes the diagnosis of a complex fibroadenoma after reviewing the tissue from a biopsy.
Juvenile fibroadenomas. This is the most common type of breast lump found in girls and adolescents between the ages of 10 and 18. These fibroadenomas can grow large, but most shrink over time, and some disappear.
Giant fibroadenomas. These can grow to larger than 2 inches (5 centimeters). They might need to be removed because they can press on or replace other breast tissue.
Phyllodes tumor. Although usually benign, some phyllodes tumors can become cancerous (malignant). Doctors usually recommend that these be removed.