Justine is a 28-year-old woman, who recently married her partner of 6 years, Blake, and they are wanting to start a family. Justine decides to visit her GP to discuss stopping her oral contraceptives and whether it is a good idea to take vitamins prior to conception. The GP performs a number of exams and checks, including measuring Justine's blood pressure, HBA1c level, screening for STis, a Pap smear, and breast examination.During the examination, the GP notices a lump in Justine's left breast and therefore refers her for further testing, including an ultrasound examination and a mammogram. Unfortunately for Justine, these tests detect a circular lump with 2 cm in diameter in her left breast. Upon receiving the results, the doctor refers Justine to an oncologist. As part of the referral, the GP takes notes on Justine's reproductive history including the following points:Justine had her first period when she was 10.She started oral contraceptives at the age of 14 to help regulate her period and lessen her period pain.She has not been pregnant.She has no known family history of breast cancer.Justine has a nervous 3-week wait to see the oncologist, and when she finally has her appointment, the oncologist sends her for a new ultrasound scan to see if there are any changes. Justine's oncologist informs her that the abnormal growth has considerably increased in size and is now more than 5 cm in diameter. The oncologist advises Justine to undergo surgery, and after discussing Justine's interest in starting a family and breastfeeding, it is decided that she will have a unilateral mastectomy. During surgery, changes in nearby lymph nodes are noted, and therefore it is decided that three lymph nodes that are closest to the left breast are also removed. Both the excised part of the breast tissue and all three lymph nodes are sent for histology, with the following results noted: Invasive lobular carcinoma with marked anaplasiaMetastatic breast cancer cells are present in the first two lymph nodes, but the third was spared The cancer cells express both ostrogen and progesterone receptors A whole-body PET-scan is also performed, which indicates the presence of tumour cells in Justine's thoracic vertebrae and in her left lung.When the histology and PET results become available, the oncologist discusses the treatment options with Justine.
In her second ultrasound, the oncologist noticed signs of angiogenesis. Define angiogenesis and explain its significance in Justine's case of breast cancer.