“Freezing” of Cancer cells in Breast Cancer

“Freezing” of Cancer cells in Breast Cancer

  • Immune cells ‘freeze’ cancer cells
  • As breast cancer cells breakaway, they launch an immune response causing the release of immune cells that “freeze cancer cells.
  • ‘When breakaway cells are forced to remain in the transition state, they don’t grow very well and their ability to form a new tumor is severely compromised.’
  • Survival for those with cancer that is growing but still confined to the breast or nearby lymph nodes have a five-year survival rate of 93 percent, however, this falls to just 22 percent once the tumor has spread.

Breast Cancer is a type of cancer that originates from the breast ducts cells or tubes that carry milk to the nipple or lobules glands cells that make milk.

When breakaway cells are forced to remain in the transition state, they don’t grow very well and their ability to form a new tumor is severely compromised. Investigators hope to mimic this “freezing” to prevent breast cancer spread.
In the US, Breast cancer strikes 266,000 each year and kills 41,000. Breast cancer is the most common form of cancers in women and is second only to lung cancer as the leading cause of cancer deaths among women in the United States. It is estimated that 1 in every 8 U.S. women (12.4%) will develop breast cancer at some point in her life. Breast cancer occurs more frequently in the older woman, but 1 in 4 breast cancers is diagnosed in woman under the age of 50. Less than 5% of all breast cancer diagnosed in women younger than 35. But what causes it and how can it be treated?

According to the research by Dr. Chaffer, from the Garvant Institute of Medical Research is Sidney, said ‘remarkably, by activating the immune response, the primary tumor essentially shuts down its own spreads.

Survival for those with cancer that is growing but still confined to the breast or nearby lymph nodes have a five-year survival rate of 93 percent, however, this falls to just 22 percent once the tumor has spread.

Breast nodule

Immune cells ‘freeze’ cancer cells

One Researcher from Brigham and Women’s Hospital, Dr. Sandra McAllister, who was also involved in the study, added: ‘When breakaway cells are forced to remain in the transition state, they don’t grow very well and their ability to form a new tumor is severely compromised.’

scientists from Harvard, analyzed breast-cancer tumors in humans and mice.

In rodents, they discovered tumors that have not spread away from the breast have the ability to stop ‘breakaway’ cancer cells from traveling to other parts of the body.

This occurs by such tumors triggering an inflammatory response via the immune system, which causes immune cells to be released.

These immune cells find where ‘breakaway’ cancer cells may be settling and trying to create new tumors. The immune cells then ‘freeze’ these cancer cells.

Dr. Chaffer said: ‘When these breakaway cells are settling, before they have established a new tumor, they are particularly vulnerable, because they are in an intermediate state and their identity isn’t very solid.

‘It’s at this point that the immune system can intervene.

After analyzing mice, the researcher then assessed 215 people who had been diagnosed with advanced breast cancer.

They found those who had the same sort of ‘breakaway’ immune cell response were more likely to survive than those without it.

Speaking of future research, Dr. Chaffer said: ‘We want to understand exactly what the tumor is releasing to activate this immune response and how immune cells are targeting the secondary sites.

‘Our goal is to work out how we can mimic this “freezing” of secondary cancers so that one day we might influence all breast cancers to keep their secondary tumors in check.’

Although previous research suggests just 0.02 percent of ‘breakaway’ cells go on to form tumors, Dr. Chaffer claims the scientists have a ‘real opportunity to bring this number down to zero’.

cancer cells

What causes breast cancer?

A cancerous tumor starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiplies ‘out of control’.

Although breast cancer can develop for no apparent reason, there are some risk factors that can increase the chance of developing breast cancer, such as genetics.

What are the symptoms of breast cancer?

According to the American Cancer Society breast cancer symptoms might include:

Lump or mass in your breast
Enlarged lymph nodes in the armpit
Lump in the underarm area
Changes in breast size, shape, skin texture or color
Dimpling or puckering
Nipple pain, changes or discharge other than breast milk
redness, scaliness, or thickening of the nipple or breast skin
Nipple pulling to one side or a change in direction
These symptoms do not always mean you have breast cancer. However, it is important to discuss any symptoms with your doctor, since they may also signal other health problems such as an infection or a cyst. It’s important to get any breast changes checked out promptly by a doctor.

How is breast cancer diagnosed?

If you have any symptoms are noticed any lumps on your breasts, your doctor will examine you and ask you questions about your healthy lifestyle, including smoking and drinking habits and your family history. Your doctor may recommend one or more of the following tests that can be used to find out if you have breast cancer and if he has a spread.

Biopsy: Small sample of the suspicious area of the breasts is removed for examination under the microscope. These biopsies may be done in one of the following ways:

Fine needle aspiration (FNA): A thin, hollow needle is inserted into the breast. Fluid and cells are removed from the tumor and looked at with a microscope. While this test can help to determine if breast cancer is present, it cannot determine if the cancer is invasive. Additional biopsies may be needed if breast cancer is found.

Core biopsy: A thicker needle is used to remove one or more small cylinder-shaped tissue samples from the tumor.

Stereotactic needle biopsy: This procedure uses a mammogram-directed technique using computerized mammogram breast images which helps to map the exact location of the breast lump x-ray.

stereotactic Bx

Surgical biopsy: An incision (small cut) is made in the breast. Surgeons find the tumor by touch or with a CT (or CAT, computed axial tomography) scan, ultrasound or mammogram. In an excisional biopsy, the entire mass is removed. In an incisional biopsy, part of the tumor is removed

Sentinel Bx

Sentinel lymph node biopsy: Lymph nodes are olive-sized glands that are part of the lymphatic system that circulates lymph fluid throughout the body. The lymphatic system also can carry cancer cells from the tumor site to other areas of the body. In breast cancer, the first nodes to be affected are under the arms. In a sentinel lymph node biopsy, a radioactive blue dye is injected into the area before surgery. The dye shows up in cancerous lymph nodes. The node with the highest amount of blue dye is the “sentinel” node. The surgeon removes all nodes with blue dye. Sentinel node biopsy can spare healthy lymph nodes, which results in fewer side effects such as lymphedema.

Imaging tests:

which may include:

  • Mammograms: A low radiation X-ray called. Mammograms can often detect a breast lump before it can be felt. It also shows small deposits of calcium in the breast. Although most calcium deposits are benign, a cluster of very specks of calcium (called microcalcifications) may be an early sign of cancer
  • Ultrasonography: Using high-frequency sound waves, ultrasonography can often show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer)
  • Magnetic Resonance Imaging (MRI): MRI is used to define the size and extent of cancer within the breast tissue. It is mostly used in women whose dense breast tissue makes it more difficult to find tumors with a mammogram
  • Digital Mammography: Digital mammography is similar to standard mammography and it uses radiographs to image the breast. The advantage of digital mammography is that images are stored digitally and can be enhanced by modifying the brightness or contrast.

Blood tests: Biological protein markers levels are normally ordered, like carcinoembryonic antigen (CEA), CA 27.29, alkaline phosphatase and liver enzymes.  Additional tests are performed to assess the white blood cells, the red blood cells, and the platelets, and tests performed to exclude any problems in the kidneys and the bones.

 

How is breast cancer treated?

The Ideal breast cancer care you can receive should be the most advanced, least invasive treatment with a few with side effects. Planning of the treatment involves an interdisciplinary team of medical professionals. This usually implies a meeting of different specialists, called a multidisciplinary opinion. In this meeting, the planning of treatment will be discussed based on the relevant information summarized above.

The treatment will usually combine intervention methods that:

∙ Effective on cancer locally, such as surgery or radiotherapy

∙ Effective on cancer cells all over the body with systemic therapy such as chemotherapy, hormone therapy and/or HER2-directed therapy.

 

The extent of the treatment will depend on the characteristics of the tumor cells, molecular markets, and on the stage of the cancer, as well as on the age, the menopausal status and the co-morbidity of the patient. It is recommended to ask an oncologist about the expected benefits and risks of every treatment in order to be informed of the consequences of the treatment. For some treatments, several options are available. The choice should be discussed according to the balance between benefits and risks.

Some of the treatment approaches include but are not limited to:

Neoadjuvant therapyis therapy given before surgery or radiotherapy for breast cancer.  Contrary, to adjuvant therapy that he is given after surgery or radiotherapy.  Neoadjuvant chemotherapy for breast cancer is a new multidisciplinary strategy that was introduced with the aim of reducing tumor size before surgery. The main rationale behind this type of treatment is to reduce the tumor size, make an inoperable tumor operable and of course, which is a new tendency allowing more conservative surgery and is now widely used, particularly for large tumors.  One of the advantages seen with neoadjuvant chemotherapy is the opportunity to observe tumors diminished in size or shrink both palpably and on imaging, and having a clinical oncologist can have a rapid assessment of clinical response.  This could help tests the progressive responses in vivo of the tumor to new drugs regimens, which could then could be used as adjuvant therapies. Neoadjuvant chemotherapy can shrink a larger tumor enough so that lumpectomy plus radiation therapy becomes an option to mastectomy

Adjuvant therapy: is a therapy given in addition to surgery. For patients with stage I to III breast cancer, possible adjuvant therapies are radiotherapy, chemotherapy, hormone therapy and targeted therapy. In this setting, radiotherapy is a local treatment whereas chemotherapy, hormone therapy, and targeted therapy can reach cancer cells that may have spread to other parts of the body.

Hormone therapy: This therapy consists of one or possibly a combination of two of the following treatments:

∙ A drug called tamoxifen which counteracts the action of estrogens on the breast and is active in both premenopausal and in postmenopausal patients

∙ A drug from the aromatase inhibitor family like anastrozole, exemestane or letrozole which inhibit the production of estrogens in post-menopausal women

∙ A drug from the gonadotropin-releasing hormone analogs family that lower the level of estrogens in pre-menopausal women

∙ Ovariectomy – the removal of the ovaries in premenopausal women The choice of hormone therapy is based on the menopausal status of the patient.

 

Chemotherapy:

Chemotherapy for early-stage breast cancer consists of combining two or three anti-cancer drugs, which are given according to a precise protocol. For breast cancer, the treatment is generally given for 4 to 8 cycles, a cycle being a time period of 2 to 4 weeks with a precise dosage, duration, and sequence of drugs including a resting period before a new cycle is started. It is not clear which combination of drugs is best, but it is recommended that it contains doxorubicin or epirubicin, which are anti-cancer drugs from the anthracycline family. Assessment of heart function is important before therapy with anthracyclines. However, regimens without any anthracycline have been shown to be as effective, for instance, the combination of docetaxel and cyclophosphamide. Treatments are often named with acronyms using the initial letter of each drug name (e.g. FEC, stands for the combination of Fluorouracil, Epirubicin, and Cyclophosphamide). For frail or elderly patients the CMF (Cyclophosphamide, Methotrexate, and Fluorouracil) regimen may still be appropriate. Another option, especially for women in whom tumor cells have spread to the lymph nodes, is to combine an anthracycline (doxorubicin* or epirubicin) with a taxane drug (paclitaxel), preferably given in sequence rather than in combined fashion.

Targeted TherapyTargeted therapies for breast cancer are drug treatments that help the body’s immune system fight cancer. Herceptin® is a type of biologic therapy that targets cells that produce too much of a protein called HER2. This protein is present in some breast cancer patients. Herceptin binds to the cells, shutting off HER2 production.

HER2-directed therapy is used for HER2 positive breast cancers. Trastuzumab is a drug effective in patients with HER2 positive tumors, regardless of the size of the tumor and of its hormonal status. In the studies performed to evaluate its efficacy as an adjuvant therapy, trastuzumab was always given in combination with chemotherapy. It is not clear, whether the adjuvant use of trastuzumab without chemotherapy has a positive effect. The standard recommended the duration of adjuvant treatment with trastuzumab is 1 year. Results from studies comparing this standard duration to shorter or to longer durations are pending. Trastuzumab can be given together with paclitaxel or carboplatin but should not be given together with doxorubicin* or epirubicin. The latter two drugs and trastuzumab are both toxic to the heart. Trastuzumab cannot be given to patients whose heart function is abnormal. If there is doubt about the heart function, it should be assessed before trastuzumab treatment.

SurgeryLike all surgeries, breast cancer surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure.

Surgery is the most common treatment for breast cancer. Procedures may include:

Mastectomy: This surgery removes one or both breasts. The entire breast is removed, along with any affected lymph nodes. In about 80% of mastectomies, breast reconstruction or implant surgery is done during the same procedure, after the breast is removed.

Breast-sparing surgery is an attempt to save as much healthy breast tissue as possible. These procedures are best for treating early stage (I and II) breast cancer. Breast-sparing techniques include:

Lumpectomy: The tumor and a small margin of healthy breast tissue are removed.

Partial mastectomy: The breast cancer tumor is removed, along with a margin of healthy breast tissue. The lining of the chest muscles and any affected lymph nodes under the arm are removed also.

Breasts reconstruction: Using either breast implants or tissue from your abdomen or other parts of your body, the surgeon can recreate a breast either during the cancer surgery (immediate reconstruction) or after surgery (delayed reconstruction). Learn more about our guide to breast reconstruction.

Radiation Therapy: Radiation Therapy uses high-energy beams to destroy cancer cells. New radiation therapy techniques and remarkable skill allow doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells. Radiation therapy treatments available are Intensity-modulated radiation therapy (IMRT and Accelerated partial breast irradiation an internal (APBI)

 

The information in this document does not replace a medical consultation. It is for personal guidance use only. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of the disease.

Sources:

American Cancer Society

The National Cancer Institute

National Comprehensive Cancer Network

American Academy of Gastroenterology

National Institute of Health

MD Anderson Cancer Center

Memorial Sloan Kettering Cancer Center

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