Variance in relation to a cancer or a cancer marker: breast cancer
- Discuss biological variance or other sources of variance in relation to a cancer or a cancer marker relevant to your practice.
- Provides a comprehensive analysis and synthesis of pathophysiology relevant details, facts and concepts.
- Presents a highly structured argument, using information from a variety of peer-reviewed sources and/or relevant medical guidelines (six APA new references).
- Proficiently critiquing of information presented (Critical thinking and writing).
- Proficiently discusses conflicting pieces of information to produce an evidence-based conclusion.
- Proficiently applies evidence-based research and/or pathophysiology to work environment and/or to a health-related setting. Variance in relation to a cancer or a cancer marker: breast cancer
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Differences and Divergence of Biomarkers in Breast Cancer: Significance in Pathophysiology and Treatment Decisions in the Clinical Setting
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Introduction
Breast cancer is one of the leading causes of death in women worldwide. It is not caused by a single identifiable aspect but an amalgamation of environmental and genetic or inherited factors (Kabel, 2017). It is, therefore “multifactorial” in etiology (Hammer & McPhee, 2014). It is also not homogeneous and has several subtypes (Huether & McCance, 2017). Its diagnosis and treatment plans are dependent on biomolecules known as tumor markers (Hirata et al., 2014; Ballinger et al., 2017; Kabel, 2017).
Biological Divergence with Regard to Breast Cancer Biomarkers
Cancer biomarkers are biological molecules that are given out by the body’s cells in response to the presence of cancer, or by the cancerous cells themselves (Kabel, 2017). The tumor biomarkers are very important not only in the diagnosis of breast cancer, but also in the choice of chemotherapeutic options and decision making about treatment. Therefore, besides aiding treatment decisions, they are also used to assess the response to chemotherapeutic treatment. Tumor biomarkers are also significant in assessing chemotherapy toxicity and evaluating for metastasis. Tumor markers are tested from serum, biopsies, or urine. Elevated values will point to the possibility of an ongoing neoplastic process (Ballinger et al., 2017; Kabel, 2017). Variance in relation to a cancer or a cancer marker: breast cancer
Breast cancer is present in four main sub-types namely basal-like, luminal A, luminal B, and HER2 (human epidermal growth factor receptor 2) positive breast cancers (Huether & McCance, 2017). There is a plethora of breast cancer tumor biomarkers used to identify and diagnose all of these disparate sub-types of the neoplasia. Most tumor biomarkers are protein in nature, but whole genes and deoxyribonucleic acid (DNA) have also been identified as cancer markers (Hirata et al., 2014). According to Masuda (2014), the ribonucleic acid (RNA) transcriptional biomarker GATA3 is found in over 90% of all breast cancer cases. 97% of cases are also positive for CK7 (cytokeratin 7). The markers CD10 and p63 assist in differentiating between invasive and non-invasive forms of breast cancer; while the biomolecule Ki67 is an important survival predictor (has prognostic significance) as per studies (Masuda, 2014). Other breast cancer biomarkers include the biomolecules CA 27-29, CA 15-3, CA 27.29, P53, cyclin E, HER-2, and carcinoembryonic antigen (CEA), amongst others (Kabel, 2017). It is important to note, however, that HER-2 exists as both a breast cancer gene biomarker and protein tumor biomarker. The American Society of Clinical Oncology (ASCO) states that breast cancer markers of clinical significance include CA 15-3, CEA, CA 27.29, HER2, and plasminogen activator inhibitor 1 (PAI-1) amongst others (Kabel, 2017). The marker HER2 is specifically associated with poor outcomes and poor overall survival rates (Hirata et al., 2014). At the same time, inheritance of mutated BRCA1 and BRCA2 genes denotes a high likelihood of developing breast cancer 8 out of 10 times (Hammer & McPhee, 2014). Concentrating on the most fulminant and aggressive inflammatory breast cancer (IBC), Tiffany and Cristofanilli (2014) on their part present the markers EZH2, EGFR, CXCR4 & CCR7 (chemokines), and P53 (tumor suppressor) as the most significant. They also include the RNA molecules MiR-21, miR-10b, and miR-19a in the group.
Pathophysiologic Underpinnings
Estrogen and progesterone are significant through their mediators estrogen receptor (ER) and progesterone receptor (PR). Abnormal changes in cell molecular behavior begin the cell proliferation process through interaction from genetic triggers like mutated BRCA 1 & 2 genes and favourable environmental factors like diet and physical inactivity. The HER2 gene and protein together with the biomolecule marker MYC then drive the malignant cellular changes throughout the malignancy. One clinical significance therefore is that chemical substances that inhibit the action of estrogen or block the pathway of estrogen receptor (ER) are effective in the treatment of breast cancer (Hammer & McPhee, 2014; Huether & McCance, 2017). This is one pathophysiologic application that is important in the practical healthcare setting. Variance in relation to a cancer or a cancer marker: breast cancer
Conclusion
Breast cancer is significant in that it is a leading cause of mortality among women. More significant, however, is the fact that there are many disparate biological markers that can be used to both identify and tailor and assess treatment of the same. The same biomolecular markers are intricately involved in the pathophysiology of the condition. Breast cancer markers are an area that is still rich with opportunities for research.
References
Ballinger, T.J., Kassem, N., Shen, F., Jiang, G., Smith, M.L., Railey, E. … & Schneider, B.P. (2017). Discerning the clinical relevance of biomarkers in early stage breast cancer. Breast Cancer Research and Treatment, 164(1). Doi: 10.1007/s10549-017-4238-0
Hammer, D.G., & McPhee, S.J. (Eds). (2014). Pathophysiology of disease: An introduction to clinical medicine, 7th ed. New York, NY: McGraw-Hill Education.
Hirata, B.K.B., Oda, J.M.M., Guembarovski, R.L., Ariza, C.B., Coral de Oliveira, C.E., & Watanabe, M.A.E. (2014). Molecular markers for breast cancer: Prediction on tumor behavior. Disease Markers, 2014, 1-12. Doi: 10.1155/2014/513158
Huether, S.E. & McCance, K.L. (2017). Understanding pathophysiology, 6th ed. St. Louis, MO: Elsevier, Inc.
Kabel, A.M. (2017). Tumor markers of breast cancer: New prospectives. Journal of Oncological Sciences, 3(1), 1-7. Doi: 10.1016/j.jons.2017.01.001
Masuda, S. (2014). Pathological examination of breast cancer biomarkers: current status in Japan. Breast Cancer, 23(4). DOI 10.1007/s12282-014-0566-7
Tiffany, A. & Cristofanilli, M. (2014). Biomarkers and therapeutic targets in inflammatory breast cancer (IBC). Current Breast Cancer Reports, 6, 245-250. Doi: 10.1007/s12609-014-0166-8
Variance in relation to a cancer or a cancer marker: breast cancer
