Breast Cancer

Breast Cancer

Dr. Gehan Mohamed

Introduction

Most common female cancer.

The incidence of breast cancer increases withage. 80% of cases occur in post-menopausalwomen .

Cancer breast most commonly affect upperouter quadrant .

Male breast cancer less common (1%) andusually the patient presented with metastasiswithin pectoralis muscle.

Cancer breast most commonlyaffect upper outer quadrant

Risk Factors for Breast Cancer

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 replacementtherapy(HRT) in postmenopausal women or used as OralContraceptives.

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

1- BRCA-1 gene,BRCA-2 genemutation specially in the familial type.

2- Gene which code for HER2 (HER2/neu)receptors =human epithelial growth factorreceptor:

Normal breast cells have HER2 receptors, which helpthem grow ,involved in multiplication, survival, anddifferentiation of cells.

- In about 20 to 30% of breast cancers, cancer cellshave too many HER2 receptors. Such cancers tendto be very fast growing.

Types of breast cancer

1- breast carcinoma : arise from epitheliallining of breast ducts and glands

2- Breast sarcoma : arise from stromalcells ,blood vessels,fat inside breast

e.g angiosarcoma .

Breast carcinoma

Types of Breast carcinoma

A- Ductal carcinoma

 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

B- Lobular carcinoma

Lobular carcinoma insitu (LCIS)

Invasive

Normal breast lobules

Ductal Carcinoma in situ(DCIS)

$G:\Teaching\COP6731\CAD\Breast Diagrams\ductal_carcinoma[2][1].jpg$

Illustration © Mary K. Bryson

Ductalcancercells

Normalductalcell

Range ofDuctal Carcinoma in situ

$G:\Teaching\COP6731\CAD\Breast Diagrams\dcis_range[1].jpg$

Illustration © Mary K. Bryson

Invasive Ductal Carcinoma(IDC – 80% of breast cancer)

$G:\Teaching\COP6731\CAD\Breast Diagrams\invasive_ductal_carcinoma[2][1].jpg$

The cancer has spread to thesurrounding tissues

Illustration © Mary K. Bryson

Ductal cancer cellsbreaking throughthe wall

Cancer Can also Invade Lymphor Blood Vessels

Illustration © Mary K. Bryson

Cancer cellsinvadelymph duct

Cancer cellsinvadeblood vessel

Invasive Lobular Carcinoma(ILC)

$G:\Teaching\COP6731\CAD\Breast Diagrams\invasive_lobular_carcinoma[2][1].jpg$

Illustration © Mary K. Bryson

Lobular cancercells breakingthrough the wall

Lobular carcinoma

Mucinous carcinoma of the breast: show malignantcells swimming in lakes of bluish mucin

Invasive lobular carcinoma ofthe breast.

Presentation

1- Breast Signs and Symptoms

 2- Abnormal mammogram

3- Axillary lympadenopathy

4- Metastatic disease

Breast Cancer—Signs andSymptoms

Initial sign is single, hard, painless nodule

Mass is freely movable in early stage

Advanced signs

a-Fixed nodule

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 orthickening inbreast. Oftenpainless

Change in coloror appearanceof areola

Redness or pittingof skin over thebreast, like theskin of an orange

Redness or pittingof skin over thebreast, like theskin of an orange

Dischargeorbleeding

Change in sizeor contours ofbreast

Change in sizeor contours ofbreast

cancer breast showing Skin puckering (Peaud orange)due to infiltration of skin lymphatics leading to theirobstruction and accumlation of fluid under skin.

Screening Mammography

Mammography routine screening tool

Detect lesions before they become palpable or if theyare deep in the breast tissue

Recommendations

Biannually or annually in 40-49 y/o

Annually in >50 y/o

mammography

Breast Calcifications

Calcifications show up aswhite spots on a mammogram

Round well-defined, largercalcifications (left column)are more likely benign

Tight cluster of tiny,irregularly shapedcalcifications (right column)may indicate cancer

$G:\Teaching\COP6731\CAD\Breast Diagrams\ans7_breastcalcifications[1].jpg$

Calcification Features

$G:\Teaching\COP6731\CAD\Breast Diagrams\ans7_breastcalcifications[1].jpg$

Lymphatic drainage of the breast

Staging of Breast Cancer

The American Joint Committee onCancer (AJCC) has designated stagingby TNM

T= tumor size

N = lymph node involvement

M = metastasis

Staging

Tumor

Tis: in situ

T1: <2cm

T2: 2-5cm

T3: >5cm

T4: invasion of skin or chest wall

Node

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%

 or Simple Mastectomy

Treatment of advanced cases : Radical Mastectomy.

so must remove hormone stimulation

Premenopausal women: ovaries removed

Postmenopausal women: hormone-blocking agent

Types of surgery for cancerbreast

Special types of breast cancers

Inflammatory carcinoma: there is signs andsymptoms of inflammation (asredness,hotness,pain,swelling )due to Carcinomainvading lymphatic ducts but no actualinflammation.