A 36 yr old woman with Breast lump

Anatomy of breast
1. epithelial part
  1. milk production
2. connective tissue part
  1. cooopers ligament
3. blood supply
  1. internal mammary artery
  2. acromiothoracic artery & intercostal arteries
  3. lateral thoracic artery
4. lymphatic drainge
  1. lateral axillary node
  2. pectoral nodes
  3. subscapular nodes
  4. central axillary nodes
  5. infraclavicular nodes
  6. parasternal nodes
  7. supraclavicular nodes
  8. apical axillary
  9. ant./post. axillary
physiology of breast
1. estrogen
  1. development of stromal tissue of breast
  2. involved in ductal development
  3. deposition of fat in breast
2. progesterone
  1. responsible for lobular development & differentiation of epithelium
    1. enlargement of alveolar cells which become secretory in nature
3. prolactin
  1. most imp hormone for lactogenesis in late pregnancy and postpartum period
    1. lactation
      1. mammogenesis
        process of growth & development of mammary gland
      2. lactogenesis
        initiation of milk secretion
      3. galactopoiesis
        maintenance of milk secretion
      4. milk -let down reflex
        oxytocin
        contraction of myoepithelial cells
went for a routine health check
1. mammogram performed
  1. lesions identified
    1. history was taken
      1. family history of breast cancer
        risk factor for breast cancer
        advancing age
        female gender
        ethnicity
        white women
        hormone replacement therapy
        first child after age 30
        overweight and obese women
        alcohol/smoking
        early period and late menopause
    2. physical exam done
      1. breast examination
        no nipple discharge
        no axillary lymphadenopathy
        no palpable breast mass
        wide local excision of breast lump performed
        revealed infiltrating ductal breast carcinoma
        Breast carcinoma
        management
        systemic
        chemotherapy
        cyclophosphamide
        doxorubicin
        methotrextate
        hormonal therapy
        ER positive
        PR positive
        targeted therapy
        HER-2 targeted therapies
        local
        surgery
        lumpectomy
        advatage: preserve appearance and less invasive
        disadvenatge: radical therpay may be needed after and chances of local reoccurance
        contrainfications"
        previous radiation/multiple masses/large tumors
        mastectomy
        subtypes
        modified radical mastectomy/radical mastectomy/simple mastectomy/skin sparingmastectomy
        indications
        previous radiation/multiple masses/large tumor/ diffsue malignant carcionma
        breast reconstruction
        tissue expansion
        flap reconstruction
        indications
        previous radiotheraphy, radical mastectomy, tight mastectomy scar
        implant reconstruction
        Follow up
        measure level of blood tumor markers
        pelvic exam
        doctor visits
        imaging tests
        mammograma
        prognosis
        average 5 year survival rate ior people with breast cancer is 90%
        average 10 year survival for breast cancer is 85%
        if spread to regional lymph nodes 5 year survival is 83%
        if cancer spreads to distant parts of body 5 year survival rate is 27%
        classification
        ductal
        ductal carcinoma in situ
        malignant proliferation of cells in duct
        no invasion to basement membrane
        it doesnt produce mass, detected as calcification
        paget disease
        DIC that extends up tp duct and invade skin of nipple
        nipple ulceration and erythema
        invasive ductal carcinoma
        present as mass
        has 4 subtypes
        tubular
        good progosis
        tumor lacks myoepithelial cells
        medullary
        hih grade cells. lymphomas and plasma cells
        good prognosis
        mucinous
        tubules in mucus pools
        good prognosis
        inflammatory
        poor prognosis, in old woman, in dermal lympahtics, inflammed swollen breasts
        tubular
        lobular carcinoma in situ
        multifocal & bilateral
        no invasion, masses or calcifications
        discovered by accident
        malignant proliferation of cell in lobule
        invasive lobular carcinoma
        single file pattern
        signet cell morphology
        no duct formation
        lacks f-cadherin
        investigations
        blood tests
        tumor markers
        tissue tumor markers
        estrogen and progesterone receptors
        human epidernal growth factor
        serum tumor markers
        CEA
        CA 27.29
        CA 15-3
        biopsy
        fine needle aspiration
        core needle biopsy
        surgical biopsy
        mammogram
        MRI
        gather more information about area of suspicion
        screen high risk women
        moniter treatment
        ultrasound
        usuualy after mamogram
        detect abnormality type
        before mammogram to evaluate lump
        molecular classification
        Luminal A
        ER+
        luminal B
        ER+ HER2+
        her2 +ve
        HER2-
        basal like
        PR-. ER- HER2-
  2. screening guidelines
    1. 75+
      1. every other year while life expectancy is 10+
    2. 50-74
      1. every other year starting at 55
    3. 40s
      1. 45+ every year
  3. disadventages
    1. false negative results
    2. overdiagnosis and overtreatment
    3. false positive results
  4. types of mammograms
    1. screening mammography
    2. diagnostic mammography

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A 36 yr old woman with Breast lump

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