Breast Cancer

Etiology
1. Predisposing risk factors
  1. Hormonal
    1. Increased exposure to endogenous estrogen
      1. First viable pregnancy after 35 years of age Nulliparity and/or absence of breastfeeding Early menarche and/or late menopause Obesity in postmenopausal women
    2. Exogenous estrogen intake
      1. Hormone replacement therapy Hormonal contraception
  2. Individual
    1. Female / Advanced age / European descent / African Americans (triple-negative cancer) / Low-fiber and high-fat diet / Smoking / Alcohol consumption / Positive medical history
2. Hereditary risk factors
  1. Mutations
    1. Tumor suppressor genes
      1. BRCA1 and BRCA2
        Code for a DNA repair protein
        Autosomal-dominant mutation
    2. Oncogenes
      1. RAS
    3. Mutations responsible for receptor overexpression
      1. Estrogen/progesterone receptors
      2. ERBB2 (HER2/neu)
  2. Genetic conditions
    1. Li-Fraumeni syndrome / Peutz-Jeghers syndrome / Klinefelter syndrome
Breast
1. Physiology
  1. Hormones
    1. Estrogen
      1. Breast cells growth and an extensive ductile system.
    2. Progesterone
      1. development of the lobules and alveoli
    3. Prolactin
      1. Lactogenesis
2. Anatomy
  2. Lymphatic drainage
Types
1. Noninvasive carcinomas
  1. Ductal carcinoma in situ (DCIS)
2. Invasive carcinomas
  1. Invasive ductal carcinoma
  2. Invasive lobular carcinoma
Clinical features
1. Early stages
  1. Palpable mass
    1. Typically single, nontender, and firm
    2. Most commonly located in the upper outer quadrant
2. Locally advanced disease
  1. Changes in size and/or shape (asymmetric breasts)
  2. Retractions or dimpling of skin
  3. Peau d'orange
  4. Nipple inversion
  5. Blood-tinged discharge
3. Progressive disease
  1. Ulcerations
  2. Edema of the arm
4. Metastatic spread
  1. Lymphadenopathy
  2. Distant metastases
Benign breast lumps
1. Fibroadenoma
2. Fibrocystic changes
3. Galactocele
4. Cyst
5. Fat necrosis
Diagnostics
1. Radiographic imaging
  1. Breast ultrasound
    1. Differentiate solid lesion from benign cysts
  2. Mammography
    1. Used for early detection of breast abnormalities
2. Biopsy
  1. Fine-needle aspiration (FNA)
  2. Core needle biopsy (CNB)
  3. Surgical biopsy
3. Receptor testing
  1. Immunohistochemistry / Immunoperoxidase
  2. For overexpression of estrogen receptor (ER) or progesterone receptor (PR)
  3. HER2/neu
4. Assessment of lymph node and distant metastases
Treatment
1. Surgical tumor removal
  1. Breast-conserving surgery
  2. Mastectomy
2. Hormone therapy
  1. Tamoxifen / GnRH agonists / Aromatase inhibitors
3. Radiation
4. Chemotherapy
  1. FEC-D: 5-fluorouracil PLUS epirubicin PLUS cyclophosphamide, followed by docetaxel
  2. CMF: cyclophosphamide PLUS methotrexate PLUS fluorouracil
5. Trastuzumab
  1. Causes dilated cardiomyopathy
Epidemiology (in UAE)
Staging
1. TNM
Grading
1. Grade 1: Well-differentiated
2. Grade 2: Moderately differentiated
3. Grade 3: Poorly differentiated
Screening
1. Mammography
2. Self-examination

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Breast Cancer

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	Created by Eman Elkhatib over 2 years ago