Transcript Breast Cancer

Breast Cancer
Dr. Gehan Mohamed
Introduction
Most common female cancer.
 The incidence of breast cancer htiw sesaercni
age .80 %of cases occur in post-menopausal
nemow .
 Cancer breast most commonly affect upper
outer quadrant .
 Male breast cancer less common (1%) and
usually the patient presented with metastasis
within pectoralis muscle.
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Cancer breast most commonly
affect upper outer quadrant
Risk Factors for Breast Cancer
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1- Female
2- Aging:After the age of 30 years.
3-Menstrual history :early onset, late menopause
4- Past history of Relative affection (mother or sister)
5-Exogenous Estrogen: Either in the form of Hormonal replacement
therapy(HRT) in postmenopausal women or used as Oral
Contraceptives.
6-Radiation exposure.
7-Obesity
8-Diet: Fat,Alcohol
9- BRCA1gene ,BRCA2 gene have role in familial breast Cancer,
ovarian cancer
10-Precancerous breast leisons: e.g Atpyical Hyperplasia
Genetic mutations
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1- BRCA-1 gene,BRCA-2 gene
mutation specially in the familial type.
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2- Gene which code for HER2 (HER2/neu)
receptors =human epithelial growth factor
receptor:
Normal breast cells have HER2 receptors, which help
them grow ,involved in multiplication, survival, and
differentiation of cells.
- In about 20 to 30% of breast cancers, cancer cells
have too many HER2 receptors. Such cancers tend
to be very fast growing.
Types of breast cancer
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1- breast carcinoma : arise from epithelial
lining of breast ducts and glands
2- Breast sarcoma : arise from stromal
cells ,blood vessels,fat inside breast
e.g angiosarcoma .
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Breast carcinoma
Types of Breast carcinoma
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A- Ductal carcinoma
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ductal carcinoma in situ (DCIS)
Invasive ductal carcinoma
a- ductal carcinoma not otherwise specified (NOS)
b-Mucinous
c-Tubular
d- Medullary
e-Inflammatory carcinoma
f-Paget’s disease
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B- Lobular carcinoma
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Lobular carcinoma insitu (LCIS)
Invasive
Normal breast lobules
Ductal Carcinoma in situ
(DCIS)
Ductal
cancer
cells
Normal
ductal
cell
Illustration © Mary K. Bryson
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Illustration © Mary K. Bryson
Range of
Ductal Carcinoma in situ
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Invasive Ductal Carcinoma
(IDC – 80% of breast cancer)
Ductal cancer cells
breaking through
the wall
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Illustration © Mary K. Bryson
The cancer has spread to the
surrounding tissues
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Cancer Can also Invade Lymph
or Blood Vessels
Cancer cells
invade
lymph duct
Cancer cells
invade
blood vessel
Illustration © Mary K. Bryson
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Invasive Lobular Carcinoma
(ILC)
Lobular cancer
cells breaking
through the wall
Illustration © Mary K. Bryson
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Lobular carcinoma
Mucinous carcinoma of the breast: show malignant
cells swimming in lakes of bluish mucin
Invasive lobular carcinoma of
the breast.
Presentation
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1- Breast Signs and Symptoms
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2- Abnormal mammogram
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3- Axillary lympadenopathy
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4- Metastatic disease
Breast Cancer—Signs and
Symptoms
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Initial sign is single, hard, painless nodule
 Mass
is freely movable in early stage
Advanced signs
a-Fixed nodule
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b- Retraction of nipple or discharge from it .
c- Dimpling ,or puckering of skin
d-Change in breast contour
 Biopsy confirms diagnosis of malignancy
Breast Signs and Symptoms
Most common:
lump or
thickening in
breast. Often
painless
Discharge
or
bleeding
Redness or pitting
of skin over the
breast, like the
skin of an orange
Change in size
or contours of
breast
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Change in color
or appearance
of areola
cancer breast showing Skin puckering (Peaud orange)
due to infiltration of skin lymphatics leading to their
obstruction and accumlation of fluid under skin
.
Screening Mammography
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Mammography routine screening tool
 Detect lesions before they become palpable or if they
are deep in the breast tissue
Recommendations
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Biannually or annually in 40-49 y/o
Annually in >50 y/o
mammography
Breast Calcifications
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Calcifications show up as
white spots on a mammogram
Round well-defined, larger
calcifications (left column)
are more likely benign
Tight cluster of tiny,
irregularly shaped
calcifications (right column)
may indicate cancer
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Calcification Features
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Lymphatic drainage of the breast
Staging of Breast Cancer
The American Joint Committee on
Cancer (AJCC) has designated staging
by TNM
 T= tumor size
 N = lymph node involvement
 M = metastasis
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Staging
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Tumor
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Node
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Tis: in situ
T1: <2cm
T2: 2-5cm
T3: >5cm
T4: invasion of skin or chest wall
N1: 1-3 axillary nodes or internal mamary nodes
N2: 4-9 axillary nodes or palpable int mam node
Metastasis
Treatment of Ductal carcinoma
Treatment of DCIS:
 Lumpectomy and radiation
 Radiation decreases local recurrence by 50%
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or Simple Mastectomy
Treatment of advanced cases : Radical Mastectomy.
so must remove hormone stimulation
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Premenopausal women: ovaries removed
Postmenopausal women: hormone-blocking agent
Types of surgery for cancer
breast
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Special types of breast cancers
Inflammatory carcinoma: there is signs and
symptoms of inflammation (as
redness,hotness,pain,swelling )due to Carcinoma
invading lymphatic ducts but no actual
inflammation.
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Paget's disease is a slowly growing
cancer of the nipple. In Paget's disease,
the tumor starts in the milk ducts of the
nipple.
It may be in situ carcinoma, or invasive.
SYMPTOMS
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Symptoms:
Redness, oozing, and
crusting of the nipple and the circular,
dark area around the nipple (areola),
which causes itching and burning.
erosion on the nipple that will not heal.
These manifestations can be mistaken as
skin inflammation or infection, which can
delay diagnosis and treatment of paget
disease.
Paget disease: show erosion and
ulceration of the nipple
Paget disease: the malignant ductal
cells present in the epidermis
Differential diagnosis for
breast lump
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Malignant lump
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Breast abscess
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Fibrocystic changes: Lumpiness, thickening and swelling,
often associated with a woman’s period
Fibroadenomas: A solid, round, rubbery lump that moves
under skin when touched, occuring most in young women
Infections: The breast will likely be red, warm, tender and
lumpy
Trauma: a blow to the breast or a bruise can cause a lump
(traumatic fat necrosis)
Case 1
A 41-year-old woman presented with a
mass in her left breast.
 Physical examination:
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 Revealed
a mass, in the left breast.
 A single palpable axillary lymph node was
also found.
 Mammography confirmed the presence of a
mass 2.5 cm in diameter.
Mammography
Mass
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The patient underwent a modified radical
mastectomy to remove the mass including
axillary lymph node dissection.
Cross-section of breast revealing the mass
Retracted nipple
Fat
Mass
Normal breast tissue
Diagnosis:
Malignant tumor of the breast =
(ductal Carcinoma of the
breast)