16979543
A 36 year old woman
with breast lump
- Physiology of breast
- Tanner Stages
- Estrogen
- involves in ductal development.
- Development of the stromal tissues of the breast.
- Deposition of fat in the breast.
- involves in ductal development.
- Progesterone
- Responsible for lobular development and differentiation of epithelium
- enlargement of alveolar cells
which become secretory in
nature
- enlargement of alveolar cells
which become secretory in
nature
- Responsible for lobular development and differentiation of epithelium
- Prolactin
- is the most important hormone
for lactogenesis in late pregnancy
and postpartum period
- Lactation
- Mammogenesis
- Process of growth and development of mammary gland
- Process of growth and development of mammary gland
- lactogenesis
- Initiation of milk secretion
- Initiation of milk secretion
- galactopoiesis
- Maintenance of milk secretion.
- Maintenance of milk secretion.
- Milk let-down
reflex
- oxytocin
- contraction of myoepithelial cells
- contraction of myoepithelial cells
- oxytocin
- Mammogenesis
- Lactation
- is the most important hormone
for lactogenesis in late pregnancy
and postpartum period
- Tanner Stages
- Went for routine health check
- mammogram performed
- lesions identified
- History was taken
- Family history of breast cancer
- Risk factor of breast cancer
- Female gender
- Advancing Age
- Ethnicity
- White women
- White women
- Radiation to Chest or Face Before Age 30
- Overweight and obese women
- first child after age 30
- Hormone Replacement Therapy)
- Alcohol \ smoking
- Early period and late menopause
- Female gender
- Risk factor of breast cancer
- Family history of breast cancer
- Physcial
examination was
performed
- Breast examination
- No palpable breast mass
- Wide local excision of breast lump performed
- Releaved infiltrating ductal breast carcinoma
- Breast carcinoma
- Epidemiology
- Genetic Mutations
- Screening ?
- DNA Microarrays Technology
- hybridization between two DNA
strands, the property of
complementary nucleic acid
sequences to specifically pair with
each other by forming hydrogen
bonds between complementary
nucleotide base pairs.
- hybridization between two DNA
strands, the property of
complementary nucleic acid
sequences to specifically pair with
each other by forming hydrogen
bonds between complementary
nucleotide base pairs.
- DNA Microarrays Technology
- Staging and grading
- Investigations
- Mammogram
- MRI
- Screening high-risk women
- Gathering more information about an area of suspicion
- Monitoring treatment
- Screening high-risk women
- Ultrasound
- Usually after mammogram
- Detect abnormality type
- Before mammogram to
evaluate lump
- Usually after mammogram
- Biopsy
- Fine needle aspiration biopsy
- Core needle biopsy
- Vacuum-assisted breast biopsy (guided)
- Surgical Biopsy
- Fine needle aspiration biopsy
- Blood tests
- Tumor markers
- Useful in
- Detecting the recurrence
- Monitoring the response to the treatment
- Detecting the recurrence
- Serum Tumor Markers
- Cancer antigen 15-3 (CA 15-3)
- Cancer antigen 27.29 (CA 27.29)
- Carcinoembryonic antigen (CEA)
- Cancer antigen 15-3 (CA 15-3)
- Tissue Tumor Markers
- Estrogen and Progesterone Receptors
- Human Epidermal Growth Factor Receptor 2 (HER2)
- Estrogen and Progesterone Receptors
- Useful in
- Tumor markers
- Mammogram
- Management
- Local
- Surgery
- Pre-op preparation
- Discontinuation of Aspirin.
- CXR
- Echocardiogram
- Discontinuation of Aspirin.
- Management of post-op pain
- Short-acting anesthetic bupivacaine.
- Psychoeducation
- Short-acting anesthetic bupivacaine.
- Breast
Reconstruction
- Implant reconstruction
- Associated with Anaplastic Large Cell Lymphom
- Associated with Anaplastic Large Cell Lymphom
- Autologous or
"flap"
reconstruction
- Indications
- previous
radiotherapy, radical
mastectomy with
removal of the chest
muscle and having a
tight mastectomy
scar
- previous
radiotherapy, radical
mastectomy with
removal of the chest
muscle and having a
tight mastectomy
scar
- Indications
- Tissue expansion
- Implant reconstruction
- Lumpectomy
- Indications
- small, early stage breast cancers.
- small, early stage breast cancers.
- Contraindications
- Previous radiation\
Multiple masses\ Large
tumor\ Diffuse malignant
microcalcifications
- Previous radiation\
Multiple masses\ Large
tumor\ Diffuse malignant
microcalcifications
- Advantages
- preserve the appearance\
less invasive surgery\
short recovery time
- preserve the appearance\
less invasive surgery\
short recovery time
- Disadvantages
- Radiotherapy is needed
after the surgery\ local
recurrence\ additional
surgeries may be needed
- Radiotherapy is needed
after the surgery\ local
recurrence\ additional
surgeries may be needed
- Indications
- Mastectomy
- subtypes
- Radical mastectomy\
Modified radical
mastectomy\ Simple
mastectomy\ Skin-sparing
mastectomy
- Radical mastectomy\
Modified radical
mastectomy\ Simple
mastectomy\ Skin-sparing
mastectomy
- extensive, long recovery time and
additional surgeries to reconstruct the
breast are needed.
- less likely to need radiation
- Indications
- Previous radiation\ Multiple
masses\ Large tumor\ Diffuse
malignant microcalcifications
- Previous radiation\ Multiple
masses\ Large tumor\ Diffuse
malignant microcalcifications
- subtypes
- Surgery to remove lymph nodes
- Sentinel lymph node biopsy
- Axillary lymph node dissection
- Sentinel lymph node biopsy
- Pre-op preparation
- Radiation Therapy
- Surgery
- Systemic
- Chemotherapy
- Cyclophosphamide\ Doxorubicin\
Epirubicin\ Methotrexate\
Fluorouracil\ Paclitaxel\ Docetaxel
- Cyclophosphamide\ Doxorubicin\
Epirubicin\ Methotrexate\
Fluorouracil\ Paclitaxel\ Docetaxel
- Hormonal therapy
- ER (estrogen)-positive or
PR (progesterone)-positive
breast cancer.
- ER (estrogen)-positive or
PR (progesterone)-positive
breast cancer.
- Targeted therapy
- HER2-targeted therapies
- HER2-targeted therapies
- Chemotherapy
- Local
- Follow up
- Doctor visits
- Mammograms
- Pelvic exams
- imaging
tests
- x-ray, CT scan,
PET scan, MRI
scan, bone scan
- x-ray, CT scan,
PET scan, MRI
scan, bone scan
- measure levels of
blood tumor
markers
- Doctor visits
- Prognosis
- The average
5-year survival
rate for people
with breast
cancer is 90%. The
average 10-year
survival rate is
83%.
- spread to the
regional lymph
nodes, the
5-year survival
rate is 85%
- spread to a
distant part of
the body, the
5-year survival
rate is 27%
- spread to a
distant part of
the body, the
5-year survival
rate is 27%
- spread to the
regional lymph
nodes, the
5-year survival
rate is 85%
- The average
5-year survival
rate for people
with breast
cancer is 90%. The
average 10-year
survival rate is
83%.
- Classification
- Ductal
- Ductal carcinoma in situ
- Releaved infiltrating ductal breast carcinoma
- Malignant proliferation of the cell in ducts.
- No invasion to the basement membrane
- It doesn’t produce a mass
- Detected as calcification
- Paget disease
- DCIS that extends
up the ducts to
involve the skin of
the nipple
- Nipple
ulceration and
erythema
- Nipple
ulceration and
erythema
- DCIS that extends
up the ducts to
involve the skin of
the nipple
- Releaved infiltrating ductal breast carcinoma
- Invasive Ductal carcinoma
- Duct-like structure + desmoplastic stroma
- Present as a mass
- has four
subtypes
- Tubular
- Tubule lacks myoepithelial
cells
- Good prognosis
- Tubule lacks myoepithelial
cells
- Medullary
- High-grade cells + lymphocytes and plasma
cells
- Good prognosis
- increase with BRCA 1
- High-grade cells + lymphocytes and plasma
cells
- Mucinous
- Tubule in mucus
pools
- Good prognosis
- older women
- Tubule in mucus
pools
- Inflammatory
- In dermal
lymphatics
- Inflamed swollen breast
- Poor
prognosis
- In dermal
lymphatics
- Tubular
- Duct-like structure + desmoplastic stroma
- Ductal carcinoma in situ
- Tubular
- Lobular carcinoma in situ
- Malignant proliferation
of the cell in lobule.
- No invasion
- No mass or
calcification
- incidentally
discovered
- incidentally
discovered
- Dyscohesive cells
- Multifocal
and bilateral
- Malignant proliferation
of the cell in lobule.
- Invasive Lobular carcinoma
- Single file pattern
- Signet cell morphology.
- No duct formation
- lacks E-cadherin
- lacks E-cadherin
- Single file pattern
- Lobular carcinoma in situ
- Ductal
- Molecular classification
- Luminal A
- ER+
- ER+
- Luminal B
- ER+ , HER2+
- ER+ , HER2+
- Her2 +ve
- ER-
- ER-
- Basal like
- ER-,PR-,HER2-
- ER-,PR-,HER2-
- Luminal A
- Epidemiology
- Breast carcinoma
- Releaved infiltrating ductal breast carcinoma
- Wide local excision of breast lump performed
- No nipple changes
- No axillary lymphadenoapthy
- No palpable breast mass
- Breast examination
- History was taken
- Types of mammogram
- Screening mammography
- Diagnostic mammography
- Screening mammography
- Disadvantages
- False-positive results
- False-negative results
- Overdiagnosis and overtreatment
- False-positive results
- screening guidelines
- lesions identified
- mammogram performed
- Anatomy of breast
- Lymphnodes
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