Solid Tumor Malignancies

Breast Cancer

Risk factors: Non-modifiable

• Gender: Increased prevalence in women

• Age: Increasing age (>40)

• Personal or family history:

  • Genetic/familial predisposition: $BRCA1$ or $BRCA2$ mutation

  • First-degree relative with breast or ovarian cancer

• Endogenous estrogen exposure:

  • Early menarche (<12 years old)

  • Late menopause (>55 years old)

Risk factors: Modifiable

• Hormonal exposure:

  • Late initial pregnancy (>30 years old)

  • Nulliparity (not having any children)

  • Post-menopausal hormone replacement therapy

  • Oral contraceptive use (controversial)

• Obesity and Body Mass Index (BMI)

• Physical inactivity / sedentary lifestyle

Signs and Symptoms

• Asymptomatic: Often detected with routine mammography screening

• Localized symptoms:

  • Painless palpable lump

  • Breast discharge

  • Breast redness or warmth

  • Palpable local-regional lymph node involvement

• Metastatic disease: Symptoms consistent with specific organ involvement:

  • Right upper quadrant pain or discomfort (liver metastasis)

  • Shortness of breath (lung metastasis)

Clinical Considerations

• Metastatic Breast Cancer vs. Primary Liver Cancer:

  • Identification: Differentiated based on tissue biopsy.

  • Importance: Prognosis and treatment protocols differ significantly depending on the original cancer source.

Screening Recommendations

• Average/Standard Risk (Gender and Age):

  • Mammogram: Age $45-54$ once annually.

Diagnostic Workup

• History and physical examination

• Mammography

• Biopsy/Pathology:

  • HER2/neu Tumor Marker: Biopsy sample determines drug treatment selection; present in $20\text{-}30\%$ of breast cancer cases.

  • Hormone Tumor Markers:

    • ER/PR (Estrogen/Progesterone Receptors): Sample helps select drug treatment; present in $60\text{-}70\%$ of breast cancer cases.

Prostate Cancer

Hormone Regulation of the Prostate

• Normal growth of the prostate depends on the presence of androgens ($DHT$).

• Regulation is mediated through biochemical interactions between the hypothalamus, pituitary gland, adrenal gland, and testes:

  • LHRH (Luteinizing hormone-releasing hormone) released from the hypothalamus stimulates the release of LH (Luteinizing hormone) and FSH (Follicle-stimulating hormone) from the anterior pituitary gland.

  • These hormones promote testosterone production in the testes, which regulates prostate growth.

• The $DHT$-receptor complex regulates androgen activity at the cellular level.

Risk Factors for Prostate Cancer

• Non-modifiable:

  • Age: >50

  • Race: African American > Caucasians > Asians

  • Genetic predisposition: Family history with a $1^{\text{st}}$ degree relative

  • Note: Benign Prostatic Hyperplasia ($BPH$) can complicate diagnosis but is not a direct risk factor.

• Modifiable:

  • Diet: Association between high fat/high red meat intake and increased risk.

Signs and Symptoms

• Early stage: Usually asymptomatic.

• Localized disease: Urinary urgency, frequency, dysuria, weak urinary flow, hematuria (blood in urine), erectile dysfunction.

• Advanced/Metastatic disease:

  • Symptoms consistent with specific organ involvement.

  • Bone pain and fractures (bone metastasis).

Screening and Detection

• Digital Rectal Exam (DRE): Assessing for hard vs. rubbery texture.

• Prostate-Specific Antigen (PSA):

  • PSA is produced by secretory cells; levels are obtained via blood test.

  • Levels vary with age, $BPH$, and prostate size.

  • Used for early detection and monitoring response to therapy.

  • Recommendation: Combined $PSA + DRE$.

Screening Recommendations

• General Population: Men $50$ and older should discuss $PSA$ screening with their healthcare provider to evaluate risks and benefits.

• High Risk: Men (African American or those with a first-degree relative with prostate cancer) should discuss screening beginning at age $45$.

Diagnostic Workup

• History and physical examination.

• Biopsy and pathology.

• Prostate-Specific Antigen ($PSA$) blood test.