Breast cancer is one of the most common pathologies among women above 40 years old. Most frequently, this oncology is diagnosed in females between the age between 55 and 64. The risk factor for developing the disorder are a personal or family history of breast cancer (ductal or lobular), and some genetic mutations raising the possibility of initiating breast cancer (for instance, BRCA1 or BRCA2) (Chalasani, 2021). The major classification is based on histological evidence: the existence or absence of the receptors the cancer is expressing. Breast cancer can produce progesterone (PR+), estrogen (ER +), or human epidermal receptor 2 (HER2+) (Barzaman et al., 2020). If no receptors are expressed on the tumor, it is triple-negative breast cancer (TNBC). The therapeutic approaches will be based on the histological type of the tumor. The latter is subdivided into the following categories: basal-like, basal-like-2, immunomodulatory, mesenchymal, mesenchymal stem-cell-like, and human androgen receptor. The major prognostic moments are tumor size, its grade, and the involvement in the oncological process of axillary lymph nodes.
The major signs and symptoms of breast cancer are the appearances of a new lump in the breast or the axillary area, a change in the structure of the breast tissue (thickening or swelling), any changes in skin color, pain, pulling inside in the nipple area, the changes in the general size or the form of the breast. Any pathological discharge should also be associated with nipple cancer or the ductus. Diagnostic testing involves mammography primarily as a screening method among women above 40 years old that helps predict and diagnose breast cancer as early as possible (U.S. Preventive Services Task Force, 2016). The other not less prospective and trustworthy tests for breast cancer include magnetic resonance imaging (MRI), 3D mammography, and ultrasonography.
A variety of molecular tests allow for distinguishing various types of cancer, such as MammaPrint, Oncotype DS, and others. These tests show a high level of statistically proven trustworthy objective data; however, they are relatively expensive for many countries. The biomarkers circulating in the bloodstream are CEA, TPS, CA 15-3 (Barzaman et al., 2020). One of the other noncirculating prognostic biomarkers is ER which can affect breast cells, making them grow. The number of PR is correlated with ER and could be induced by estrogen. That means the intake of estrogen-containing treatment should be monitored in female patients above 40 years old.
The immune system interactions with the tumor are variable, and normally, the defects and some genetic code “mistakes” are highlighted and eliminated by it (immunosurveillance). Cytotoxic lymphocytes T identify foreign complexes and kill cancer cells. On some occasions, tumor cells can escape from the immune system (for example, dormancy). Several studies showed that during breast cancer, a higher level of myeloid-derived suppressor cells that elevated in breast cancer patients (Barzaman et al., 2020). A lot of patients with myeloid-derived suppressors have metastatic processes.
Traditional therapy for breast cancer includes surgery, chemotherapy, radiation, and hormonal treatment. Patients having an advanced type of breast cancer or metastatic process, unfortunately, have a poor prognosis with 2-4 years of survival. The main aim of the treatment is to eliminate the tumor from the body and prevent its relapse and metastatic processes, which includes resection of the tumor and the axillary lymph nodes. Postoperative radiation is almost always included in the treatment. Chemotherapy and radiation kill the substantial number of immune cells that trigger the immune procedure. The common drugs used for chemotherapy are Adriamycin, Paclitaxel, Docetaxel, etc. (Waks & Winer, 2019). Systemic therapy can be neoadjuvant (preoperative), adjuvant (postoperative), or a combination. For all HR+ tumors, endocrine therapy is also included (Tamoxifen, Letrozole, Anastrozole, etc.).
The information, in this case, informs the practice of the master’s prepared nurse by detailing the specialties of epidemiology, pathogenesis, clinical picture, and treatment modalities of breast cancer. Thorough knowledge of every disorder enhances the comprehension of the disease and simplifies the communication process with the patient. This data can be used by a master’s prepared nurse to set an educational session with the patient during which the importance of screening and the possible solutions on the current occasion can be discussed. Educational sessions can also include the clinical features of breast cancer to prepare females above 40 years old for self-examination and awareness of the possible issue.
The most important information presented in the case was the major signs and symptoms that are relevant to breast cancer, as identifying the pathology in the early stage is essential for modern medicine and the patient’s health. The most challenging data presented in this case was the detailed explanation of the molecular mechanisms of the immune system’s reactions to the tumor cells. However, understanding the interrelations between the molecules can help use the target therapeutic models and schemes. Patient safety can be solved by implementing in his or her schedule screening routines (mammography) once per year. Identifying the early stage of the disorder can prevent complications and worsen the condition of the patient.
Thus, breast cancer is one of the most common oncology disorders among females. It has a complicated chain of immune reactions and various structures identified histologically. According to the size, grade, and lymph node participation, the therapeutic tactic varies. More commonly, the treatment includes resection of the tumor with axillary lymph nodes with adjuvant radiotherapy. If the tissue expresses HR+, endocrinological therapy should be added.
References
Barzaman, K., Karami, J., Zarei, Z., Hosseinzadeh, A., Kazemi, M. H., Moradi-Kalbolandi, S., Safari, E., & Farahmand, L. (2020). Breast cancer: Biology, biomarkers, and treatments. International Immunopharmacology, 84, 106535.
Chalasani, P. (2021). Breast cancer guidelines. Medscape.
U.S. Preventive Services Task Force. (2016). Screening for breast cancer. Web.
Waks, A. G., & Winer, E. P. (2019). Breast Cancer Treatment. JAMA, 321(3), 288.