Question

Identify a person you know who has an immune system disorder or cancer. Review content in your text for potential types of disorders.

Interview the affected person and write a 3-5 page paper identifying your findings including:

• Identify the pathophysiology of the immune system disorder
• Discuss the treatment for the immune system disorder
• Summarize the findings of the interview.
• Use 2-3 evidence-based articles from peer-reviewed journals or scholarly sources to support your findings or identify therapies that may be new or different from what the affected person may be using.

Questions you may want to use to guide your interview:

1. Which immune system disorder do you have?
2. How long have you had this disorder?
3. How has this disorder changed your life (home and work)?
4. Are you able to carry out daily activities independently?
5. What therapies are you using to manage this disorder?
6. What, if any, side effects does the treatment have?
7. What therapies are you using to manage this disorder?
8. What, if any, side effects doe the treatment have?
9. Has this disorder changed your body?
10. Does this disorder have any emotional effects on you?
11. Have alternative therapies, such as Eastern medicine (acupuncture, herbal treatment, yoga) been tried or recommended
12. I need 3 pages please

Answer 1

INTERVIEWER : Which immune system disorder do you have?

INTERVIEWEE : I was diagnosed with early stage-3 breast cancer.

INTERVIEWER : How long have you had this disorder?

INTERVIEWEE : the disease was diagnosed since 2years, but the symptoms started around 6months before the disease was diagnosed.

INTERVIEWER : How has this disorder changed your life (home and work)?

INTERVIEWEE : I lead a disciplined life after treatment. I am conscious of a work-life balance, I eat on time, eat right, and practise yoga regularly. I try to have sound sleep for seven-eight hours. I continue giving my best at the work place.I ate as per a plan. All home-made, freshly prepared food with low amounts of spice and oil. A well-chosen diet of fruits and vegetables was helping build my immune system. I repented for not having taken care of my body for years. I feel my disease, to a great extent, was because of my wrong lifestyle. I placed others and their needs above myself. Every woman should take control of their health and accord it the highest priority.

INTERVIEWER : Are you able to carry out daily activities independently?

INTERVIEWEE :  I hired a part-time cook while trying to attend to other daily chores independently. This added to my self-worth and boosted my confidence. I continued to work for my company remotely. Let the patient decide their daily routine, as each body behaves differently to the treatment.

INTERVIEWER : What therapies are you using to manage this disorder?

INTERVIEWEE : Initially total mastectomy followed by six weeks of radiation therapy and then chemotherapy too

INTERVIEWER : What, if any, side effects does the treatment have?

INTERVIEWEE : I felt very tired and had continual crops of mouth ulcers. From the second week of my chemo I started shedding hair. It came out in bunchesTthe after-effects of chemo are paralysing.

INTERVIEWER : Has this disorder changed your body?

INTERVIEWEE : From the second week of my chemo I started shedding hair. It came out in bunches. I cried a lot. Honestly, this was the worst part of my treatment. It made me conscious of my self-image. I started drawing the curtains of the windows at home so that no one would see me. I tried using a wig but rejected it soon. I would gaze into the mirror for a long time, feeling lost and helpless. But eventually, I realised that I am more than my looks. So don’t fret over the loss of your hair. The hair will definitely grow back.

INTERVIEWER : Does this disorder have any emotional effects on you?

INTERVIEWEE : Utter disbelief, fear and questioning. I had done all the right things, had 3 children before my 30th birthday, breast fed them all, never smoked or drank or used the contraceptive pill. Why me? I cried a lot, feeling lost and helpless.  The mind is incredibly powerful when it comes to healing through positive thinking and by letting go of resentment.

INTERVIEWER : Have alternative therapies, such as Eastern medicine (acupuncture, herbal treatment, yoga) been tried or recommended

INTERVIEWEE : I have not tried any alternative methods of treatment. I believe that alternative methods, if desired, should complement and not substitute conventional methods of treatment. But I practise yoga regularly.

BREAST CANCER

Breast cancer is the most common invasive cancer in women and the second leading cause of cancer death in women after lung cancer. Breast cancer is the most frequent malignancy in women worldwide and is curable in ~70–80% of patients with early-stage, non-metastatic disease. Advanced breast cancer with distant organ metastases is considered incurable with currently available therapies. On the molecular level, breast cancer is a heterogeneous disease; molecular features include activation of human epidermal growth factor receptor 2 (HER2, encoded by ERBB2), activation of hormone receptors (oestrogen receptor and progesterone receptor) and/or BRCA mutations. Treatment strategies differ according to molecular subtype. Management of breast cancer is multidisciplinary; it includes locoregional (surgery and radiation therapy) and systemic therapy approaches. Systemic therapies include endocrine therapy for hormone receptor-positive disease, chemotherapy, anti-HER2 therapy for HER2-positive disease, bone stabilizing agents, poly(ADP-ribose) polymerase inhibitors for BRCA mutation carriers and, quite recently, immunotherapy. Future therapeutic concepts in breast cancer aim at individualization of therapy as well as at treatment de-escalation and escalation based on tumour biology and early therapy response. Next to further treatment innovations, equal worldwide access to therapeutic advances remains the global challenge in breast cancer care for the future.

SYMPTOMS

The first symptoms of breast cancer usually appear as an area of thickened tissue in the breast or a lump in the breast or an armpit.

Other symptoms include:

• pain in the armpits or breast that does not change with the monthly cycle
• pitting or redness of the skin of the breast, similar to the surface of an orange
• a rash around or on one of the nipples
• discharge from a nipple, possibly containing blood
• a sunken or inverted nipple
• a change in the size or shape of the breast
• peeling, flaking, or scaling of the skin on the breast or nipple

Most breast lumps are not cancerous. However, women should visit a doctor for an examination if they notice a lump on the breast.

STAGES

A doctor stages cancer according to the size of the tumor and whether it has spread to lymph nodes or other parts of the body.

There are different ways of staging breast cancer. One way is from stage 0–4, with subdivided categories at each numbered stage. Descriptions of the four main stages are listed below, though the specific substage of a cancer may also depend on other specific characteristics of the tumor, such as HER2 receptor status.

• Stage 0: Known as ductal carcinoma in situ (DCIS), the cells are limited to within the ducts and have not invaded surrounding tissues.
• Stage 1: At this stage, the tumor measures up to 2 centimeters (cm) across. It has not affected any lymph nodes, or there are small groups of cancer cells in the lymph nodes.
• Stage 2: The tumor is 2 cm across, and it has started to spread to nearby nodes, or is 2–5 cm across and has not spread to the lymph nodes.
• Stage 3: The tumor is up to 5 cm across, and it has spread to several lymph nodes or the tumor is larger than 5 cm and has spread to a few lymph nodes.
• Stage 4: The cancer has spread to distant organs, most often the bones, liver, brain, or lungs.

BREAST CANCER AND PATHOPHYSIOLOGY

Breast cancer is a malignant tumor that starts in the cells of the breast. Like other cancers, there are several factors that can raise the risk of getting breast cancer. Damage to the DNA and genetic mutations can lead to breast cancer have been experimentally linked to estrogen exposure. Some individuals inherit defects in the DNA and genes like the BRCA1, BRCA2 and P53 among others. Those with a family history of ovarian or breast cancer thus are at an increased risk of breast cancer.

The immune system normally seeks out cancer cells and cells with damaged DNA and destroys them. Breast cancer may be a result of failure of such an effective immune defence and surveillance.

These are several signalling systems of growth factors and other mediators that interact between stromal cells and epithelial cells. Disrupting these may lead to breast cancer as well.

TREATMENT

Surgery:

Breast-conserving surgery (BSC): also known as lumpectomy or wide local excision, BSC involves resection of the tumour along with a margin of tissue while conserving the cosmetic appearance of the breast. Most breast surgeries are of this type because (i) most tumours are locally invasive and (ii) large primary tumours can be reduced in size by neoadjuvant chemotherapy prior to conservative surgery.

Mastectomy: surgical removal of entire breast, including the fascia over the pectoralis muscles. Surgeons may preserve some skin and the nipple/areola for reconstruction. The indication for mastectomy is multicentric invasive carcinoma, inflammatory carcinoma, or extensive intraductal carcinomas.
Axillary lymph node dissection: removal of the lymph nodes draining the breast tissue for lymph node micrometastasis. This is done at the same time as BSC or mastectomy. However, recent evidence suggests that axillary lymph node biopsy is unnecessary regardless of whether the sentinel lymph node biopsy is negative or positive because there is no mortality benefit.

Adjuvant therapy:

cytotoxic chemotherapy, endocrine therapy, or radiation therapy may be used postsurgery to prevent relapse.

Radiation therapy
Either whole or partial breast irradiation may be used (see Carcinogenesis chapter for mechanism of radiation therapy). Adjuvant radiation therapy is applied post-BCS or post-mastectomy to prevent recurrence. Since most recurrence of early-stage breast cancer occurs locally, partial irradiation at the tumour site has similar mortality benefits as whole breast irradiation. However, new evidence suggests an increased risk of local and axillary recurrence with partial irradiation.
Radiation of metastatic disease (e.g. bone or brain metastases) is also used.

Endocrine therapy

Breast cancer is a hormone-sensitive cancer. Most breast cancer cells are ER-positive, and thus will respond to reduction of circulating estrogens. HR-negative breast cancers will not respond to endocrine therapy.
Mainly used as (i) adjuvant therapy for early-stage hormone-sensitive breast cancer or as (ii) first line therapy for metastatic hormone-sensitive breast cancer.
Cancer Care Ontario recommends 5 years of adjuvant endocrine therapy for early-stage breast cancer in postmenopausal women.
Antiestrogens (e.g. tamoxifen): Competitively binds ER and inhibits estrogen binding.

Aromatase inhibitors:

Aromatase, also known as estrogen synthase, is an enzyme responsible for estrogen synthesis. There are two types: steroidal (type I) and non-steroidal (type II). The steroidal type (e.g. exemestane) is an androgen analogue that binds permanently with the aromatase enzyme, leading to long-term and specific inhibition of the enzyme. The non-steroidal type (e.g. anastrozole and letrozole) originates from an anti-epileptic drug that reversibly binds and inhibits the cytochrome P450 unit in aromatase. Because the non-steroidal type has a good molecular fit with the substrate-binding site, it is more potent than the steroidal type. Both types have good efficacy and high specificity for the aromatase enzyme.

Ovarian ablation:

induction of artificial menopause by ovariectomy significantly reduces breast cancer risk. Adrenalectomy eliminates a source of androgens in females, which is the precursor to aromatase-derived estrogens. However, these surgical approaches are irreversible and cause major side effects, so they are less often used.
Ovarian suppression: LHRH (GnRH) agonist (e.g. goserelin and leuprorelin) can be used to reversibly suppress LH/FSH release and thus estrogen release.

Chemotherapy

Cytotoxic drugs, such as cyclophosphamide, methotrexate, doxorubicin, and paclitaxel, are used in hormone receptor-negative or HER2-positive breast cancers. They can either be given presurgery as neoadjuvant to shrink the tumour or postsurgery as adjuvant to prevent relapse.

ARTICLES FOR RERERENCE

Perou, C. M. et al. Molecular portraits of human breast tumours. Nature 406, 747–752 (2000).
Cardoso, F. et al. European Breast Cancer Conference manifesto on breast centres/units. Eur. J. Cancer 72, 244–250 (2017).
Bray, F. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 68, 394–424 (2018).